Conventional Mental Health Services Research Articles

Organizational Change in Complex Systems: Organizational and Leadership Factors in the Introduction of Open Dialogue to Mental Health Care Services

Conventional mental health services are frequently criticized for failing to support people and communities in their care. Open Dialogue is a non-conventional humanistic approach to mental health care, which has been implemented in many different settings globally. At two Australian public health care services, implementation of the approach led to positive client outcomes and sustained organizational and clinical change. The aim of the study was to identify and explore the organizational, management, leadership and cultural factors that contributed to sustained implementation in these complex systems. We conducted nine individual semi-structured interviews of health care leaders and managers from the two sites. Transcriptions of the interviews were analyzed thematically. Leaders facilitated a gradual development of clinical and organizational legitimacy for the non-standardized Open Dialogue approach by holding the anxiety and frustration of practitioners and parts of the administration, cultivating cultural change and adaptation and by continually removing organizational obstacles.

Spirituality and relational health among Black Americans

AbstractBlack Americans may be less likely to seek conventional mental health services, often preferring to seek assistance within their social support networks, including spiritual and religious communities. Research related to relational health as a marker of spirituality among Black Americans is limited, especially in counseling literature. Relational health and spirituality preserve wellness particularly among Black Americans. Thus, we have illuminated new pathways for exploring Black American well‐being. A multiple regression analysis of 233 adult participants (68 men and 165 women), who identified as Black American or African American (n = 221) or Bi‐/Multi‐racial (n = 12), indicated a significant relationship between spirituality and relational health. The mentor and community subscales on the Relational Health Indices (RHI) made a significant contribution to the model, indicating that quality relationships impact levels of spirituality. Religious affiliation moderated the relationship between relational health domains and spirituality.

Re-imagining mental health services for American Indian communities: Centering Indigenous perspectives.

The Indigenous peoples of North America are heirs to the shattering legacy of European colonization. These brutal histories of land dispossession, military conquest, forced settlement, religious repression, and coercive assimilation have robbed American Indian communities of their economies, lifeways, and sources of meaning and significance in the world. The predictable consequence has been an epidemic of "mental health" problems such as demoralization, substance abuse, violence, and suicide within these communities. One apparent solution would seem to be the initiation or expansion of mental health services to better reach American Indian clients. And yet, conventional mental health services such as counseling and psychotherapy depend on assumptions and aspirations that may not fit well with American Indian cultural sensibilities. For example, counseling practices draw on the presumed value for clients of introspective and expressive "self talk," whereasIndigenous community norms may emphasize communicative caution outside of interactions with intimate kin, leading to marked reticence rather than candid disclosure. Moreover, given community sensitivities to salient histories of colonization, such differences have the potential to further alienate American Indian community members from the very services and providers designated to help them. In this article, I review a postcolonial predicament that bedevils American Indian community mental health services and trace a program of research that has sought to harness American Indian cultural and spiritual traditions for reimagining helping services in a manner that truly centers Indigenous perspectives.

Willingness to Use Mental Health Services for Depression Among African Immigrants and White Canadian-Born People in the Province of Quebec, Canada.

Studies suggest that non-Caucasian immigrants to Canada are less likely than Canadian-born people to use mental health services. To meet the mental health needs of ethnocultural minorities, insights into their help-seeking attitudes are of great concern. This study examined the willingness of African immigrants and White Canadian-born to seek care for depression from conventional mental health services. African immigrants (N = 262) and White Canadian-born people (N = 250) living in Montreal, Canada, indicated their willingness to use mental health services under different conditions varying as a function of four factors: the severity of symptoms, the waiting time for first consultation, the type of care offered in the mental health service, and whether informal sources of help were available. Seven qualitatively different positions were identified: Never Consult (18% of the African immigrants and 1% of the White Canadian-born people); Hesitant (18% of the African immigrants and 7% of the White Canadian-born people); Depends on Waiting Time (16% of the African immigrants); Depends on Waiting Time and Symptoms (22% of the African immigrants); Depends on Symptoms (36% of the White Canadian-born people and 6% of the African immigrants); Willing to consult (33% of the White Canadian-born people and 2% of the African immigrants); Certain to Consult (9% of the White Canadian-born people and 4% of the African immigrants), while 14% of participants in each group did not express any position. African immigrants were more likely to underuse mental health services, compared with White Canadian-born people. The above diversity of positions strongly suggests that the design and implementation of interventions to reduce disparities in African immigrants' use of mental health care must not be "one size fits all" but must be tailored to address these immigrants' differing attitudes and needs.

What are the barriers to, and enablers of, working with people with lived experience of mental illness amongst community and voluntary sector organisations? A qualitative study.

There is increasing emphasis on psychological and social approaches to managing and treating mental illness, including a growing evidence base on the effectiveness of community-based social interventions including arts and heritage activities, library programmes, volunteering schemes, nature-based activities and community groups. However, there is a gap in understanding of what the barriers to, and enablers of, working with individuals with mental illness might be for the community and voluntary sector. A qualitative approach was used involving focus groups with non-profit organisations delivering social activities within communities across the United Kingdom. Behaviour Change Theory, the COM-B model and the Theoretical Domains Framework, were employed as the theoretical framework, to develop interventions to address the barriers raised. Representatives of the organisations reported being motivated by the mental health needs of others, and by seeing the benefits of participation. Further motivations included expanding inclusion, and economic motivation to ensure sustainability. Strengths identified included offering innovative, responsive services that were distinct from conventional mental health services. Running these services demanded new and potentially challenging skills, such as understanding statutory responsibilities, and being able to train and support staff. Further challenges included maintaining boundaries between their roles as community organisations and clients' mental health needs and avoiding burn-out. Ability to deliver this work was enhanced by support of peer organisations and opportunities to share practice. However, funding was often short term, and complex to obtain, which could destabilise organisations' sustainability. Lack of transparency around the process, differences in language between the community and health sectors, and confusion around commissioning pathways undermined the potential opportunity offered by social prescribing policy. Interventions to address these barriers were identified, including long term funding to support core costs, training on engaging with the commissioning process, around mental health support and safeguarding, and developing mentoring schemes and local co-operatives of organisations for developing partnerships with the health sector.

Money matters: participants’ purchasing experiences in a budget authority model of self-directed care

ABSTRACTSelf-directed care (SDC) is a service delivery model in which individuals diagnosed with a severe and persistent mental illness (SPMI) direct their behavioral healthcare by managing an individual budget and purchasing the goods and services they deem most helpful in meeting their needs and supporting their recovery. Participants may purchase conventional mental health services as well as alternative goods (e.g., books, clothing) and services (e.g., fitness classes) to support their recovery. Several quantitative studies have examined the types of purchases commonly made by SDC participants. This qualitative study builds on this research by reporting findings from interviews with 18 SDC participants on the factors that influence their purchasing decisions, the benefits derived from SDC purchases, and perceived barriers experienced in making desired purchases. Findings reveal the extent to which money matters in mental health recovery and suggest that individualized budgeting and purchasing contribute to SDC participants’ mental wellness and stability, enhance their control over service choices, and, most notably, provide some material relief in ongoing struggles with chronic poverty. Findings also highlight the importance of flexible spending guidelines and streamlined approval processes; overly proscriptive policies may undermine participants’ self-determination. Additional implications for SDC practice, policy, and research are discussed.

American Indian women cancer survivors’ perceptions and experiences with conventional and non-conventional mental health care for depressive symptoms

ABSTRACT Background: Despite cancer and depression being disproportionately high for American Indian and Alaska Native (AI/AN) women, such cancer survivors’ help-seeking practices and perceptions related to depression are absent in extant research. A broader context of historical oppression has set the stage for unequal health outcomes and access to quality services. The purpose of this article was to explore AI women cancer survivors’ experiences with conventional mental health services and informal and tribally-based assistance, as well as barriers related to mental health service utilization. Methods: A qualitative descriptive study methodology, with qualitative content analysis, was used to examine the experiences of AI women cancer survivors as they related to help-seeking experiences for depressive symptoms. The sample included 43 AI women cancer survivors (n = 14 breast cancer, n = 14 cervical cancer, and n = 15 colon and other types of cancer survivors). Results: Since receiving a cancer diagnosis, 26 (62%) participants indicated they had feelings of depression. Some participants (n = 13) described mixed perceptions of the mental health service system. Generally, participants viewed families and informal support systems as primary forms of assistance, whereas conventional services were reported as a supplementary or ‘as needed’ forms of support, particularly when the informal support system was lacking. Participants received help in the forms of psychotropic medications and psychotherapy, as well as help from family and AI-specific healing modalities (e.g. sweat lodges and healing ceremonies). Stigma and confidentiality concerns were primary barriers to utilizing conventional services as described by 12 (29%) participants. Discussion: Participants’ help primarily came from family and tribally-based entities, with conventional mental health care being more salient when informal supports were lacking. The mixed perceptions espoused by participants may be related to a broader context of historical oppression; family and social support and tribally-based services may be protective factors for cancer survivors with depression.

New technologies in suicide prevention

IntroductionThe use of new technologies is beginning to be embraced by volunteers and professionals, from crisis lines, suicide prevention centers, mental health centers, researchers and politicians.ObjectivesNew technologies have entered the field of suicide prevention with high expectations for the future, despite a relatively slow start. Internet, smartphones, apps, social networks and self-help computer programs have a strong potential to achieve, sustain and help people at risk of suicide, their families, teachers, health professionals and for the survivors.AimsTo provide comprehensive overview on the role of new technologies in suicide prevention.MethodsGiven the relatively early and underdeveloped state of this area of inquiry, the author viewed his task as gathering and critically appraising the available research relevant to the topic, with the aim of formulating a hypothesis to be tested with further research.ResultsNew cheaper services will soon be available to effectively reach and assist the most vulnerable people and prevent suicides. The potential to help vulnerable people who do not use conventional mental health services and people in regions with inadequate psychiatric facilities represents an attractive target with favourable perspectives for suicide prevention Smartphone, apps, websites, avatar coach, and virtual suicidal subjects are important for both delivering help as well as to educate mental health professionals as in the case of role playing.ConclusionsShadows and lights are emerging through the use of new technologies. If more people can be reached there are however concern for improper use of social network and pro-suicide websites.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Depression/Bipolar Peer Support Groups: Perceptions of Group Members about Effectiveness and Differences from Other Mental Health Services

Peer support services remain poorly understood by many mental health service providers. In this study we explored the views of people who use peer led support groups. We asked how adding peer support groups changed, balanced, or augmented the use of conventional mental health services. Participants were 43 adults attending 4 peer led support groups for depression/bipolar disorder. Data consisted of observations of all 43 participants interacting in their group, in-depth interviews of 20 participants, and results from 2 standardized questionnaires to ballpark the level of symptom severity relative to other groups. Through constant comparative analysis, 12 categories emerged. The most salient features of our findings consisted of the shared perception that groups promoted recovery and augmented conventional services. Members felt acceptance due to their shared diagnoses. Groups provided an experience of community in which recovery skills could be practiced, practical advice received, and hope and empowerment encouraged. Groups appeared to provide participants with important support and healing unavailable from psychotherapy and psychiatry. Peer support groups appeared to be an important addition and sometimes an adequate substitute for psychotherapy and/or psychiatry. Further research is indicated and quantitative students should build on the insights of qualitative studies in developing their protocols.

Telemental Health Care, an Effective Alternative to Conventional Mental Care: a Systematic Review.

Background and Objectives:Due to the high costs of conventional mental health care, there has been a rise in the application of web-based technologies in recent years, i.e., telemental health care. We conducted this systematic review in 2017, using high quality research articles on the applications, technologies, advantages and challenges associated with telemental health care published since year 2000.Methods:We used a combination of relevant key words to search four major databases, such as “Web of Sciences, Embase, PubMed and Science Direct”. From among 156 articles, which had been published since 2000, twenty five articles met all of the inclusion criteria and were selected for the final review. The information extracted from these articles were used to construct Tables 1 and 2. Also, the materials derived from 55 credible articles were used as further support and complementary facts to substantiate the information presented in the Discussion section.Results:The findings revealed that telemental health care is an extended domain supportive of conventional mental health services. Currently, telemental health care has multiple capabilities and technologies for providing effective interventions to patients with various mental illnesses. It provides clinicians with a wide variety of innovative choices and strategies for mental interventions, in addition to significant future potentials.Conclusions:Telemental health care can provide effective and adaptable solutions to the care of mental illnesses universally. While being comparable to in-person services, telemental health care is particularly advantageous and inexpensive through the use of current technologies and adaptable designs, especially in isolated communities.

Services for people at high risk improve outcomes in patients with first episode psychosis.

ObjectiveAbout one‐third of patients referred to services for people at high risk for psychosis may have already developed a first episode of psychosis (FEP). We compared clinical outcomes in FEP patients who presented to either high risk or conventional mental health services.MethodRetrospective study comparing duration of hospital admission, referral‐to‐diagnosis time, need for compulsory hospital admission and frequency of admission in patients with FEP who initially presented to a high‐risk service (n = 164) to patients with FEP who initially presented to conventional mental health services (n = 2779). Regression models were performed, controlling for several confounders.Results FEP patients who had presented to a high‐risk service spent 17 fewer days in hospital [95% CI: −33.7 to (−0.3)], had a shorter referral‐to‐diagnosis time [B coefficient −74.5 days, 95% CI: −101.9 to −(47.1)], a lower frequency of admission [IRR: 0.49 (95% CI: 0.39–0.61)] and a lower likelihood of compulsory admission [OR: 0.52 (95% CI: 0.34–0.81)] in the 24 months following referral, as compared to FEP patients who were first diagnosed at conventional services.ConclusionServices for people at high risk for psychosis are associated with better clinical outcomes in patients who are already psychotic.

A Gathering of Native American Healers: Exploring the Interface of Indigenous Tradition and Professional Practice.

This article reports insights from a 4-day Gathering of Native American Healers at the University of Michigan in October of 2010. This event convened 18 traditional healers, clinically trained service providers, and cross-cultural mental health researchers for a structured group dialogue to advance professional knowledge about the integration of Indigenous healing practices and conventional mental health treatments in community-based mental health services for Native Americans. Our thematic analysis of transcripts from five Roundtable sessions afforded several key insights and understandings pertaining to the integration of Indigenous healing and conventional mental health services. First, with reference to traditional healing, the importance of a rampant relationality, various personal qualities, Indigenous spirituality, and maintenance of traditional life and culture were accentuated by Roundtable participants. Second, for traditional healers to practice effectively, Roundtable participants posited that these individuals must maintain personal wellness, cultivate profound knowledge of healing practices, recognize the intrinsic healing potential within all human beings, and work for the community rather than themselves. In speaking to the possibilities and challenges of collaboration between Indigenous and conventional biomedical therapeutic approaches, Roundtable participants recommended the implementation of cultural programming, the observance of mutuality and respect, the importance of clear and honest communication, and the need for awareness of cultural differences as unique challenges that must be collaboratively overcome.

Peer support among persons with severe mental illnesses: A review of evidence and experience

Peer support is largely considered to represent a recent advance in community mental health, introduced in the 1990s as part of the mental health service user movement. Actually, peer support has its roots in the moral treatment era inaugurated by Pussin and Pinel in France at the end of the 18th century, and has re-emerged at different times throughout the history of psychiatry. In its more recent form, peer support is rapidly expanding in a number of countries and, as a result, has become the focus of considerable research. Thus far, there is evidence that peer staff providing conventional mental health services can be effective in engaging people into care, reducing the use of emergency rooms and hospitals, and reducing substance use among persons with co-occurring substance use disorders. When providing peer support that involves positive self-disclosure, role modeling, and conditional regard, peer staff have also been found to increase participants' sense of hope, control, and ability to effect changes in their lives; increase their self-care, sense of community belonging, and satisfaction with various life domains; and decrease participants' level of depression and psychosis.

Stakeholder's perceptions of help-seeking behaviour among people with mental health problems in Uganda

IntroductionMental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are known to compromise the outcome of the care.AimTo examine the help-seeking behaviours of individuals with mental health problems, and the factors that may influence such behaviours in Uganda.MethodSixty-two interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach.ResultsThe findings revealed that in some Ugandan communities, help is mostly sought from traditional healers initially, whereas western form of care is usually considered as a last resort. The factors found to influence help-seeking behaviour within the community include: beliefs about the causes of mental illness, the nature of service delivery, accessibility and cost, stigma.ConclusionIncreasing the uptake of mental health services requires dedicating more human and financial resources to conventional mental health services. Better understanding of socio-cultural factors that may influence accessibility, engagement and collaboration with traditional healers and conventional practitioners is also urgently required.

Age-related patterns in mental health-related complementary and alternative medicine utilization in Canada

The aim of this study was to examine whether age-related differences in rates of use of complementary and alternative medicine (CAM) specifically for mental health problems parallel well-known age-related differences in use of conventional mental health services and medications. A sample of middle-aged (45-64 years; n = 10,762), younger-old (65-74; n = 4,113) and older-old adults (75 years and older; n = 3,623) was drawn from the 2001-2002 Canadian Community Health Survey (CCHS), Cycle 1.2, Mental Health and Wellbeing. Age-related utilization rates of conventional and complementary mental health services and medications/products were calculated. Logistic regression analyses were used to examine the strength of association between age group and utilization of services and medications or products in the context of other important sociodemographic and clinical characteristics. When considered in the context of other sociodemographic and clinical characteristics, older age was positively associated with mental health-related utilization of alternative health products. Older age was not significantly associated with mental health-related consultations with CAM providers. Overall, age-related patterns in mental health-related use of CAM did not directly correspond to age-related patterns in conventional mental health care utilization, suggesting different sets of predictors involved in seeking each type of care.

Limitations in the routine use of telepsychiatry

Telepsychiatry is well established in many countries, but there is still little information about its use in routine health care. We reviewed the literature for information on the use of telepsychiatry in mental health services. From 1033 publications identified in the literature search and through references from a separate project, 16 studies or descriptions of the routine use of telepsychiatry services were selected for further review. Eleven of these articles dealt primarily with videoconferencing and five with telephone- based services. Clinical use of videoconferencing in the programmes described by the reviewed papers was modest, with an average of 16 consultations per month. Three of the telephone-based services had large numbers of clients. The papers we reviewed gave limited consideration to the healthcare systems in which telepsychiatry was provided and to the use of conventional mental health services. Telepsychiatry appears to still be a niche technology in many health systems. A lack of champions for the technology and reimbursement problems may contribute to the limited use of this area of telemedicine.

Understanding Immigrants' Reluctance to Use Mental Health Services: A Qualitative Study from Montreal

Studies suggest that non-European immigrants to Canada tend to under use mental health services, compared with Canadian-born people. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse. This paper explores the reasons for underuse of conventional mental health services in a community sample of immigrants with identified emotional and somatic symptoms. Fifteen West Indian immigrants in Montreal with somatic symptoms and (or) emotional distress, not currently using mental health services, participated in a face-to-face in-depth interview exploring health care use. Interviews were analyzed thematically to discern common factors explaining reluctance to use services. Across participants' narratives, we identified 3 significant factors explaining their reluctance to use mental health services. First, there was a perceived overwillingness of doctors to rely on pharmaceutical medications as interventions. Second, participants perceived a dismissive attitude and lack of time from physicians in previous encounters that deterred their use of current health service. Third, many participants reported a belief in the curative power of nonmedical interventions, most notably God and to a lesser extent, traditional folk medicine. The above factors may highlight important areas for intervention to reduce disparities in immigrant use of mental health care. We present our framework as a model, grounded in empirical data, that further research can explore.

Help-Seeking Behaviours of Individuals with Mood Disorders

This study had the following objectives: 1) to estimate the 12-month prevalence of conventional and unconventional mental health service use by individuals with major depressive disorder (MDD) or mania in the past year, and 2) to identify factors associated with the use of conventional mental health services by individuals with MDD or mania in the past year. We examined data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Respondents with MDD (n = 1563) or manic episodes (n = 393) in the past 12 months were included in this analysis. An estimated 63.9% of respondents with MDD and 59.0% of those with manic episodes reported having used some type of help in the past 12 months; 52.9% of those with MDD and 49.0% of those with manic episodes used conventional mental health services. Approximately 21% of respondents with either MDD or manic episodes used natural health products specifically for emotional, mental health, and drug or alcohol use problems. Respondents who reported comorbid anxiety disorders and long-term medical conditions were more likely to have used conventional mental health services. Relative to previous Canadian literature, our analysis suggests that the frequency of conventional mental health service use among persons with MDD has not increased significantly in the past decade. Further, the rate of conventional mental health service use by persons with manic episodes is unexpectedly low. These findings may reflect the lack of national initiatives targeting mood disorders in Canada. They have important implications for planning future education, promotion, and research efforts.

Substance use and psychiatric comorbidity

Over the past 20 years there has been an increasing awareness of the co-occurrence of psychiatric and substance use disorders (SUDs) in the general population. Comorbidity has become a mainstream problem for clinicians working in the fields of general adult psychiatry, child and adolescent mental health services, forensic psychiatry, primary care and the general hospital, as well as those working in the addictions. This increasing visibility is the result of a number of factors, including: • deinstitutionalization • an increase in the availability and use of alcohol and illicit drugs, particularly among young people (see also pages 58-61) • an increase in the prevalence of multiple substance use • the organization and accessibility of treatment services • homelessness. Alcohol and nicotine are the most common drugs implicated. The pattern and type of illicit and other drug use has varied over time and geographical location, reflecting cultural trends. Individuals with psychiatric comorbidity make heavy demands on conventional mental health and addiction treatment services. This contribution discusses the epidemiology, aetiology and clinical characteristics of comorbid substance use and psychiatric disorders, and briefly reviews the services that are needed to address the needs of this challenging group.

An Innovative Project for Young People in Care Who have been Sexually Abused

Summary Professional awareness of child mental health problems and sexual abuse has increased greatly over the past 20 years, and this is especially true for young people under the care of social services. The current paper provides an overview of the research literature on needs and service provision in this area. It goes on to describe an innovative interagency project in Dorset which offers flexible, fast track intervention packages to looked after young people with a profile indicating sexual abuse, who have been reluctant to engage with conventional child and adolescent mental health services. The paper includes preliminary results from an evaluation of this project and discusses the implication for future service provision. Mental health needs and provision A number of studies have indicated that the provision of mental health services for young people in local authority care is inconsistent with the need for such provision. One studyof adolescents who had been in care for an average of three years reported