Care Crisis Research Articles

Establishment of the Community Mental Health Centres in Uganda Communities: Challenges and Prospects

The establishment of Community Mental Health Centres has been a vital prospect in the area of mental health care. Community mental health centres attempt to shift emphasis away from hospitalization and introduce new remedies to mental health problems. The flow chart method was used in this opinion paper for clarity. Usually, community mental health centres provide short-term treatments, outpatient care, and special crisis intervention or emergency services. There are challenges and prospects the Ministry of Health and other health care providers need to address to find a lasting solution for the establishment and continued existence of these centres in Uganda. The employment of healthcare professionals that will guarantee quality assurance and effective healthcare delivery in these centres is very necessary. The challenges of professional discrimination also need to be effectively addressed in order to have an enduring therapeutic milieu for mentally challenged patients. Recommendations were made that the Ugandan government through her Ministry of Health should establish and provide community health centres and halfway homes for the emergency and effective treatments of mentally challenged individuals.

Establishing evidence to inform culturally competent mental health services: A mixed methods study protocol.

COVID-19 has exacerbated the significant and longstanding mental health inequalities for ethnic minorities, who were less likely to access mental health support in primary care but more likely to end up in crisis care compared to the majority ethnic group. Services were poorly offered and accessed to respond to the increased mental health challenges. To 1) establish evidence on which changes to mental health services provided in response to COVID-19 are beneficial for ethnic minorities who experience mental health difficulties in the North of England, and 2) to inform what and how culturally competent mental health services should be routinely provided. A mixed methods approach comprising 1) a rapid review to map services and models of care designed or adjusted for mental health during the pandemic, 2) an observational study of retrospective routine data to assess changes to mental health services and associated outcomes, 3) qualitative interviews to understand experiences of seeking care and factors associated with high-quality service provision, and 4) a Delphi study to establish consensus on key features of culturally competent services. From the selected areas in the North of England, adults from ethnic minorities who experience mental health difficulties will be identified from the primary, community and secondary care services and local ethnic minority communities. This study will identify ways to tackle health inequalities and contribute to mental health service recovery post pandemic by providing practice recommendations on equitable and effective services to ensure culturally competent and high-quality care. A list of services and features on what and how mental health services will be provided. Working with study collaborators and public and patient involvement partners, the study findings will be widely disseminated through presentations, conferences and publications and will inform the subsequent funding application for intervention development and evaluation.

Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities.

The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration's (SAMHSA's) best practices guidelines. Secondary data from SAMHSA's Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities' organizational characteristics associated with adopting BHCC best practices. Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.

Treatment of adjustment disorders in mental health crisis care: a reflective case study

Clinical decision-making is an integral part of the nursing process, as well as a study requirement at Master's level for the advanced professional practice pathway. This article uses Gibbs' reflective cycle as a framework to explore a clinical decision made in practice. Through presentation of a case study of a patient with an adjustment disorder, the authors explore the process of prescribing appropriate treatment in the context of an uncertain evidence base. The authors will examine decision-making and communication theories and consider any biases, as well as ethical, organisational and professional factors that may influence the decision-making process. The individual and organisational steps needed to embed robust decision-making into practice will be discussed.

Crisis of care and crisis of democracy.

Resumen: Este artículo discute el significado político de la crisis de los cuidados en su relación con la crisis de la democracia. Desde las éticas del cuidado y la teoría crítica se caracteriza, en primer lugar, a los cuidados como un tipo específico de práctica social y política. En segundo lugar, se examinan los problemas éticos y políticos derivados de una organización social de los cuidados según principios de mercado. Se concluye abordando la pregunta por una solución democrática a la actual crisis de los cuidados.

Mental Health: Potential Bipartisan Oasis in a Partisan Congress

Mental Health: Potential Bipartisan Oasis in a Partisan Congress

The impact of the COVID-19 pandemic on primary care physicians and nurses in Nova Scotia: a qualitative exploratory study.

The COVID-19 pandemic has brought immense disruption worldwide, dramatically altering the ways we live, work and learn on a day-to-day basis; however, few studies have investigated this from the perspective of primary care providers. In this study, we sought to explore the experiences of primary care providers in the province of Nova Scotia, with the intention of understanding the impact of the COVID-19 pandemic on primary care providers' ability to provide care, their information pathways, and the personal and professional impact of the pandemic. We conducted an exploratory qualitative research study involving semistructured interviews conducted via Zoom videoconferencing or telephone with primary care providers (physicians, nurse practitioners and family practice nurses) who self-identified as working in primary health care in Nova Scotia from June 2020 to April 2021. We performed a thematic analysis involving coding and classifying data according to themes. Emergent themes were then interpreted by seeking commonalties, divergence, relationships and overarching patterns in the data. Twenty-four primary care providers were interviewed. Subsequent analysis identified 4 interrelated themes within the data: disruption to work-life balance, disruptions to "non-COVID-19" patient care, impact of provincial and centralized policies, and filtering and processing an influx of information. Our findings showed that managing a crisis of this magnitude requires coordination and new ways of working, balancing professional and personal life, and adapting to already implemented changes (i.e., virtual care). A specific primary care pandemic response plan is essential to mitigate the impact of future health care crises.

The Evolving Ukrainian Refugee Health Care Crisis - A Platform for the True Meaning of the Physician's and Health Care Professional's Healing Work

The Evolving Ukrainian Refugee Health Care Crisis - A Platform for the True Meaning of the Physician's and Health Care Professional's Healing Work

The suicides in the Russian Federation: review of national studies

The epidemiological data of suicide rate, protective and risk factors is required to evaluate suicide losses, to develop appropriate interventions and to determine their effectiveness. Despite stable decreasing trend in suicide rates over the past three decades, the burden of suicides is determined by loss of young working-age population. In the post-Soviet Russia, fluctuations in suicide mortality indicators are associated with complicated periods of social economic transformations and radical changes of public policy. The risk factors also include economically depressive territories of residence, unemployment, psychoactive substance abuse, childhood and adolescence, family ill-being, incarceration, particular professional groups, physical illnesses, etc. The review established researchers' aspirations for topics improving understanding of suicide risk factors in population of Russia and needs of vulnerable groups. Such works are to result in better strategies of suicide prevention and development of new crisis care technologies. They identify problems in program implementation and provide important stimulus for determining global priorities in research and development areas.

COVID-19 Pandemic and the Crisis of Care: Wellness Discourses, Neoliberal Self-Care, and (Dis)Infodemic

The COVID-19 pandemic resulted in an influx of misinformation surrounding the virus and its origins. This paper examines the negative consequences of neoliberal self-care discourses related to COVID-19 that contributed to the disinfodemic, focusing on the wellness industry. Some health gurus and wellness instructors promoted lifestyle adjustments and self-care to prevent contracting the virus and sometimes blamed COVID-19 patients for contracting it. These claims contributed to vaccine hesitancy and pseudo-scientific beliefs. The misinformation was attractive partly because it promised individual control and independence from mainstream (scientific) advice. These discourses existed before the pandemic but were amplified within the wellness community after the COVID-19 pandemic. The paper concludes by exploring the feminist notions of care and solidarity as a counter to the neoliberal notion of self-care.

Representing Life and Death in Care Institutions: Between Invisible Victims and Suffering Old Women

The article examines the representation and (in)visibility of ageing people in German care institutions during the Covid-19 pandemic. Within the framework of a qualitative content-analytical and discourse-analytical study of 185 articles, including 108 images from German newspapers, the authors trace the patterns behind the representation of ageing people. In so doing, they argue that in the media discourse ageing people are often represented without agency and in a strongly homogenised way as “others.” By emphasising pre-existing conditions and vulnerability, older and disabled people appear naturally at risk. The article also problematises the mere counting of life and death in care institutions, which contributes to a naturalisation and symbolic annihilation of the death of ageing people. Furthermore, the authors identify the notion of the suffering old woman as a key figure in pandemic media discourse, performing a critical function. She embodies an appeal to society to show sympathy and solidarity and to act reasonably with respect to the pandemic measures yet contains no elements of discursive agency or personal characteristics beyond that. Additionally, the suffering old woman reinforces traditional patterns of patriarchal representation. The authors conclude that the pandemic has placed the German care crisis in settings of institutionalised geriatric care into the media spotlight. However, the comprehensive inclusion of ageing people has been absent. Emphasising one’s own ability and thus adapting to the midlife years seems to be the only way to precarious inclusion for ageing people in the discourse.

The community mental health team fidelity scale: A measure of program fidelity of social networks interventions for severe mental illness.

To develop, pilot, and implement a program fidelity measure for community mental health services providing OD and 'treatment as usual' (TAU) or standard NHS crisis and community care. Measure structure, content, and scoring were developed and refined through an iterative process of discussion between the research team and OD experts. Measure was piloted in the 6 OD and 6 TAU services participating in a large-scale research program. Initial data suggests that the Community Mental Health Team Fidelity Scale (COM-FIDE) is a potentially reliable and feasible measure of the fidelity of community mental health services and specific OD components of such services.

Negotiating Care Work: Gendered Network Structures of Pandemic Care Discourses on Twitter in Germany

Precarious conditions of care work are contested and deeply gendered issues all over the globe. The Covid-19 pandemic both intensifies the (national) care crises and makes care work more visible as a public issue. In this article, we ask for the opportunities, structural conditions, and limitations of voice and visibility in emerging publics beyond established media organizations. Applying the concept of performative publics and using social network analysis, we reconstruct and compare the constitution of publics around the two German language Twitter hashtags 0#systemrelevant and #CoronaEltern. In a comparative design, we ask which actor groups and what kind of genders gain visibility, and in which speaker positions women, men, and non-binary people appear. The comparison of the two case studies reveals rather different network structures and asks for more nuanced, issue-based “medium data” analyses in the linkage of gender media studies and computational methods. Whereas the public discourse on professional paid care work resembles gendered power structures, the public discourse on privatized, unpaid care work shows shifted patterns concerning female visibility. These findings are discussed critically as gendered discourse spaces of professional and privatized care work stay rather separated and thus risk reproducing traditional private/public boundaries. Furthermore, findings emphasize the importance of “invisible” relational work which keeps hashtags running. Ratios of paying attention from women to men and vice versa are unequally distributed. Females either invest more communicative effort than males or receive less attention for the equal amount of reaching out to others.

Review: Crisis responses for children and young people - a systematic review of effectiveness, experiences and service organisation (CAMH-Crisis).

In England, one in six children aged 5-19 has a probable diagnosable mental health disorder. This is a major public health problem, with multiple agencies adopting varying approaches to care delivery for children and young people (CYP) in crisis. To examine the organisation of crisis services across education, health, social care and voluntary sectors; the experiences and perceptions of CYP, families and staff; the effectiveness of current approaches to care and the goals of crisis intervention. A systematic review of all relevant English language evidence regarding the provision and receipt of crisis support for CYP aged 5-25 (PROSPERO-CRD42019160134). Seventeen databases were searched from 1995 to 2021 and relevant UK-only grey literature was identified. Critical appraisal was conducted using appropriate design specific appraisal tools. A narrative approach to synthesis was conducted. In total, 138 reports (48 reports covering 42 primary research studies; 36 reports covering 39 descriptive accounts of the organisation services and 54 UK-only grey literature reports) were included. The evidence suggests that crisis services were organised as follows: triage/assessment-only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, four themes were identified: (a) barriers and facilitators to seeking and accessing appropriate support; (b) what children and young people want from crisis services; (c) children's, young people's and families' experiences of crisis services; and (d) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of crisis services were identified. Despite a lack of high-quality international studies, findings suggest that support prior to reaching crisis point is important. From this work, various aspects of crisis care have been identified that can be incorporated into existing services across education, health, social care and the voluntary sector.

Spanish residents’ experiences of care during the first wave of the COVID-19 syndemic: a photo-elicitation study

ABSTRACT Purpose The main aim of this research was to explore experiences of care during the lockdown of the first wave of COVID-19 syndemic in Spain Methods This is a qualitative and explorative study using self-photo-elicitation as a data collection method. Fifteen participants (Twelve women and three men) shared 25 photographs and one video between the June 18 and August, 2020. Participants’ photographs and texts were collected online. Data were analysed based on Thematic Analysis. Results Three emerging categories were constructed: 1) the deconstruction of care: self-care and collective care 2) the crisis of care and gendered care, 2) beyond anthropocentrism: animalism and ecology. Findings indicate the need to understand “care” in terms of social reproduction, including self-care, care towards other humans and non-human animals, and collective care. Also, the need to care for planetary health and to be in contact with nature as a form of self-care and social care. Conclusions Care in a period of social and health crisis puts human relationships and also non-human life at the centre. Care requires adopting taking an ecological one-health perspective.

Biden Urges Bipartisan Effort on Mental Health

Back to table of contents Previous article Next article Government & LegalFull AccessBiden Urges Bipartisan Effort on Mental HealthKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:9 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.68AbstractPresident Joe Biden outlined numerous priorities related to mental health and substance use disorder care during his State of the Union address. He emphasized the importance of working across the aisle to support patients in need.iStock/drnadigIn his State of the Union address, President Joe Biden pointed to numerous health policies, including improving mental health and addressing the opioid epidemic, that represent opportunities for members of both parties to work together.APA applauded the inclusion of mental health in Biden’s address in a news release. “While the nation faces the opioid epidemic, an ongoing crisis in youth mental health, and barriers to access, mental health is truly an issue where bipartisan progress can and must be made,” APA’s statement reads.During his address, Biden spoke about his four-part Unity Agenda, which focuses on tackling the mental health crisis, especially among youth; addressing the epidemic of opioid and other drug overdoses; ending cancer; and supporting veterans.“Despite the division within American politics today, leaders on both sides of the aisle can agree that many of our citizens are struggling with mental health challenges, often without support,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “Congress’s recent spending bill represented a huge victory for psychiatry and the patients we serve. We must continue that momentum and provide much-needed support, especially to our youth, those with substance use disorders, and our health care workforce.” Biden outlined specific actions his administration will take in his Unity Agenda, including the following:Supporting the health care workforce: This year, the Centers for Disease Control and Prevention (CDC) will launch a new campaign to provide mental health and resiliency resources for health care organizations on how to support their workforces. In his Unity Agenda, Biden acknowledged that health workers experienced high levels of burnout, anxiety, and depression even before the onset of the COVID-19 pandemic. “Studies have shown that burnout [has] reached crisis levels, affecting up to 54 percent of nurses and physicians,” Biden’s Unity Agenda Fact Sheet states. Strengthening parity enforcement: Though the Mental Health Parity and Addiction Equity Act was passed in 2008, many health plans are still not in compliance with the federal law. The administration will propose new rules this spring to ensure insurers are not imposing inequitable barriers to care and that mental health professionals are being paid on par with other health professionals.Investing in crisis services and 988: The 988 Lifeline launched in the summer of 2022, and while it has increased access to crisis counseling for all Americans, experts emphasize that more work is needed to improve the country’s mental health crisis system. In the coming year, the Department of Health and Human Services (HHS) will improve the Lifeline’s capacity by investing in the crisis care workforce, scaling mobile crisis services, and developing guidance on best practices in crisis response.Expanding access to telehealth services: According to the Unity Agenda, HHS will triple resources dedicated to promoting interstate license reciprocity for delivering mental health services across state lines. The Department of Defense (DOD) will also expand the BRAVE program, a virtual behavioral health center providing services 24/7 to service members and their families located on federal installations across the globe.Recruiting a more diverse mental health workforce: HHS will increase funding to expand the Minority Fellowship Program and recruit mental health professionals from Historically Black Colleges and Universities.Fighting the opioid epidemic: The administration will expand access to proven treatments, including buprenorphine, for opioid use disorder; launch a national campaign to educate young people on the dangers of fentanyl and how naloxone saves lives; and ensure every jail and prison across the country can provide treatment for substance use disorders.Supporting veterans and their families and reducing veteran suicide: The Department of Veterans Affairs (VA) will create new resources to improve suicide risk identification and increase counseling on the safe storage of firearms and lethal medications. ■ResourcesThe APA statement on the State of the Union addressFACT SHEET: In State of the Union, President Biden to Outline Vision to Advance Progress on Unity Agenda in Year AheadRemarks of President Joe Biden – State of the Union Address as Prepared for DeliveryCongress Passes Spending Bill With Several APA PrioritiesAfter 988’s Launch, Experts Emphasize More Work Needed ISSUES NewArchived

Using Rapid-Cycle Change to Improve COVID-19 Vaccination Strategy in Primary Care.

During the COVID-19 pandemic, misinformation and distrust exacerbated disparities in vaccination rates by race and ethnicity throughout the United States. Primary care, public health systems, and community health centers have shifted their vaccination outreach strategies toward these disparate, unvaccinated populations. To support primary care, we developed the SAVE Sprint model for implementing rapid-cycle change to improve vaccination rates by overcoming community outreach barriers and workforce limitations. Participants were recruited for the 10-week SAVE Sprint program through partnerships with the National Association of Community Health Centers (NACHC) and the Resilient American Communities (RAC) Initiative. The majority of the participants were from community health centers. Data were evaluated during the program through progress reports and surveys, and interviews conducted three months post-intervention were recorded, coded, and analyzed. The SAVE Sprint model of rapid-cycle change exceeded participants' expectations and led to improvements in patient education and vaccination among their vulnerable populations. Participants reported building new skills and identifying strategies for targeting specific populations during a public health emergency. However, participants reported that planning for rapid-pace change and trust-building with community partners prior to a health care crisis is preferable and would make navigating an emergency easier.

German general practitioners’ experiences during the COVID-19 pandemic and how it affected their patient care: A qualitative study

Background General practitioners (GPs) play a significant role in providing medical care to patients affected by the coronavirus disease 2019 (COVID-19). Little is known about the impact of the pandemic on patient care from the perspective of GPs. Objectives To gain insight into GPs’ experiences of the COVID-19 pandemic and its impact on patient care in Germany. Methods From August to December 2020, qualitative, semi-structured telephone interviews were conducted with 22 GPs from four randomly selected federal states in Germany. We analysed the data according to Kuckartz’s method of content analysis. Results Five themes emerged: changes in healthcare system, practice routines, patient care, personal life, and improving health crisis preparedness. Communication with authorities and following rapidly changing guidelines were the biggest challenges during the pandemic. Teamwork and collegial exchange in the practice were seen as important sources of support to overcome these barriers. Participants stated that they managed to secure care but expressed concerns about how social distancing might affect the doctor-patient relationship. In their professional and private lives, GPs perceived themselves as role models with a high responsibility for the health of others. Consistent guidance by health authorities and reliable information were raised as necessary for managing patient care in the pandemic. Conclusion Findings show that patient care was successful but GPs’ adaptation to unprecedented conditions was limited by poor communication and collaboration with health authorities. Therefore, providing adequate support services by policymakers is essential to strengthen primary care in future health crises.

Fulfilling the Goals of 988 Through Crisis Stabilization Care.

Recent implementation of the nationwide 988 Suicide and Crisis Lifeline has expanded telephone-based mental health crisis services and created a unified framework for crisis care in the United States. However, the infrastructure for the final step of the crisis continuum-an appropriate mental health service for persons in crisis to receive the care they need-is fragmented, unevenly distributed, underfunded, and understudied. Given the few options for individuals in crisis, most often inpatient psychiatric hospitals are the default option. In this Open Forum, the authors describe the scope of the problem and propose how clinicians, policy makers, and researchers can improve the availability of evidence-based disposition options for individuals in crisis.

Digital footprints as a new translational approach for mental health care: a commentary

There is a crisis in mental health care, with more people suffering from psychiatric disorders than resources that are available for treatment, even though spending is substantial. Millions who suffer from addiction, psychosis, depression and suicidality are either untreated or inadequately treated and organized psychiatry is unable to reach them. Possibly as reflection of under-treatment of psychiatric disorders, the rates of suicide have risen: from 1999 through 2014, the age-adjusted suicide rate in the US increased 24%, from 10.5 to 13.0 per 100,000. Assessment of psychiatric symptoms in ongoing outpatient settings is costly, inadequate and unable to detect clinical changes over time. One’s digital phenotype is assessed through footprints left over as result of our interface with technology, including automated assessments of quantity and quality of social media activity, patterns and speed of device usage, and physiological data that is automatically collected, such as location, quantity and type of movement, heart rate, and sleep patterns. The use of digital footprints has been advocated for large-scale data collection that can facilitate psychiatric research in naturalistic settings. We highlight recent papers in Discover Mental Health addressing digital approaches to mental health and we also advance here the concept that digital footprints are ready for clinical use. However, before that happens there needs to be discussion on the appropriate boundaries between care that is driven by signals from digital footprints and the rights to privacy and self-determination.