Decision-making In Mental Health Research Articles

Building an implementation strategy for community-based rehabilitation for mental health in Colombia.

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies. The aim of this study was to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia. This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data. A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies. CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts. http://links.lww.com/IJEBH/A210.

Analysis and mapping the research landscape on patient-centred care in the context of chronic disease management.

Patient-centred care has emerged as a transformative approach in managing chronic diseases, aiming to actively involve patients in their healthcare decisions. This study was conducted to analyse and map the research landscape on patient-centred care in the context of chronic disease management. This study used Scopus to retrieve the relevant articles. The analysis focused on the growth pattern, highly cited articles, randomised clinical trials, patients and providers perspectives, facilitators and barriers, frequent author keywords, emerging topics, and prolific countries and journals in the field. In total, 926 research articles met the inclusion criteria. There was a notable increase in the number of publications over time. Cancer had the highest number of articles (n = 379, 40.9%), followed by diabetes mellitus, and mental health and psychiatric conditions. Studies on patient-centred care in diabetic patients received the highest number of citations. The results identified 52 randomised controlled trials that covered four major themes: patient-centred care for diabetes management, shared decision-making in mental health and primary care, shared decision-making in cancer care, and economic evaluation and cost-effectiveness. The study identified 51 studies that examined the impact of tools such as computer-based systems, decision aids, smartphone apps, and online tools to improve patient-centred outcomes. A map of author keywords showed that renal dialysis, HIV, and atrial fibrillation were the most recent topics in the field. Researchers from the United States contributed to more than half of the retrieved publications. The top active journals included "Patient Education and Counselling" and "Health Expectations". This study provides valuable insights into the research landscape of patient-centred care within the context of chronic diseases. The current study provided a comprehensive overview of the research landscape on patient-centred care, which can empower patients by raising their awareness about clinical experiences and outcomes.

Static and dynamic predictors of forensic mental health decision-making.

In Canada, individuals found not criminally responsible on account of mental disorder (NCR) fall under the supervision of a jurisdictional review board (RB) per the Criminal Code. Limited research has examined whether RB decisions balance the needs of public safety with social reintegration as intended by federal legislation. To fill this gap, the present study determined whether forensic decisional outcomes in one provincial RB system accounted for information relevant to violence risk. Study instruments included the Level of Service/Case Management Inventory (LS/CMI), Historical Clinical Risk Management-20 Version 3, and the Revised Violence Risk Appraisal Guide. A retrospective longitudinal design was employed to examine an NCR cohort (N = 109) that entered the RB system between 2005 and 2010 and their respective RB hearings (N = 327) until 2015. Results indicated that risk-relevant information was supplied to the RB by forensic professionals; however, key criminogenic risk and need factors as defined by the LS/CMI were absent in clinical reports. RB decisions were still strongly predicted by empirically supported risk factors linked to violent recidivism. Higher release likelihoods corresponded to a proportionally greater reliance on dynamic risk factors to enact dispositions. Forensic risk instruments are central aspects of correctional rehabilitation, and the results demonstrated their relevance to forensic tribunals. It is recommended that information from a forensic risk instrument be routinely delivered to RBs to support evidence-based decision-making. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Formation of a stakeholder group of women with a lived experience of Post-partum Psychoses (PP) - Experience from a perinatal psychiatry service in India.

Our paper describes the process of creating a stakeholder group for service development and research in Postpartum Psychosis (PP) at a Perinatal Psychiatry Service in India. We involved women who have recovered from PP as `experts by experience' in identifying areas that need attention from a research and service perspectives. A total of 13 group meetings were conducted, in which 9 group meetings involved women with lived experiences of PP and 4 group meetings were with the family members involved in the care of women during the PP episode. Of the 58 participants, 23 women and two family members expressed their willingness to participate in future stakeholder meetings. Involvement of women with PP and their caregivers as stakeholders in mental health decision-making appears feasible in a LMIC setting and should be encouraged.

Cognitive Continuum Theory: Can it contribute to the examination of confidentiality and risk-actuated disclosure decisions of nurses practising in mental health?

Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory presents a single-system intuitive-analytical approach to examining and understanding nurse cognition, analogous to the recommended single-system approach to decision-making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a 'common sense' blending of intuitive and analytical cognition, whereby cues presented to a decision-maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition.

How Cultural Capital Shapes Mental Health Care Seeking in College

First-generation and working-class undergraduates not only experience mental health problems at higher rates than their more affluent peers, but are also less likely to seek treatment. We administered a mixed-methods survey to undergraduates at two institutions to investigate the relationship between cultural capital and mental health decision-making. Using two measures of cultural capital, we find that students with high cultural capital are more likely to seek mental health treatment than those with limited cultural capital. Additionally, analysis of our qualitative results reveals that while students with limited cultural capital make treatment decisions through a collectivistic lens (considering other people’s needs and opinions), those with high cultural capital tend to view treatment decisions through an individualistic lens (considering their own needs and opinions). These lenses capture both the barriers and facilitators to mental health care that students cite to explain their decision-making. Understanding how cultural capital shapes orientations to mental health care is necessary to facilitate help-seeking for students from all social class backgrounds.

An Ecological Model for High-Risk Professional Decision-Making in Mental Health: International Perspectives

Mental health professionals are frequently presented with situations in which they must assess the risk that a client will cause harm to themselves or others. Troublingly, however, predictions of risk are remarkably inaccurate even when made by those who are highly skilled and highly trained. Consequently, many jurisdictions have moved to impose standardized decision-making tools aimed at improving outcomes. Using a decision-making ecology framework, this conceptual paper presents research on professional decision-making in situations of risk, using qualitative, survey, and experimental designs conducted in three countries. Results reveal that while risk assessment tools focus on client factors that contribute to the risk of harm to self or others, the nature of professional decision-making is far more complex. That is, the manner in which professionals interpret and describe features of the client and their situation, is influenced by the worker’s own personal and professional experiences, and the organizational and societal context in which they are located. Although part of the rationale of standardized approaches is to reduce complexity, our collective work demonstrates that the power of personal and social processes to shape decision-making often overwhelm the intention to simplify and standardize. Implications for policy and practice are discussed.

Using gastrointestinal distress reports to predict youth anxiety risk: Implications for mental health literacy and community care.

This study investigates the generalizability and predictive validity of associations between gastrointestinal (GI) symptoms and youth anxiety to establish their utility in community mental health decision-making. We analyzed data from youth ages 3 to 21 years in volunteer cohorts collected in Los Angeles (N=327) and New York City (N=102), as well as the Healthy Brain Network cohort (N=1957). Youth GI distress was measured through items taken from the parent-reported Child Behavior Checklist (CBCL). We examined generalizability of GI-anxiety associations across cohorts and anxiety reporters, then evaluated the performance of these models in predicting youth anxiety in holdout data. Consistent with previous work, higher levels of gastrointestinal distress were associated with more parent-reported youth anxiety behaviors in all three cohorts. Models trained on data from the Healthy Brain Network cohort predicted parent-reported and child-reported anxiety behaviors, as well as clinician-evaluated anxiety diagnoses, at above chance levels in holdout data. Models which included GI symptoms often, but not always, outperformed models based on age and sex alone in predicting youth anxiety. Based on the generalizability and predictive validity of GI-anxiety associations investigated here, GI symptoms may be an effective tool for child-facing professionals for identifying children at risk for anxiety (Preprint: https://psyarxiv.com/zgavu/).

The impact of free choice in alcohol treatment. Primary outcomes of the self-match study

IntroductionA paternalistic approach to treatment planning is common, but there is a growing interest in involving clients in the planning of their own treatment, both in medical care and psychotherapy. Several studies on matching patients to treatment have failed to improve outcome. Studies on Shared Decision-Making in mental health are encouraging but somewhat ambiguous in addiction treatment. ObjectiveThis study investigated whether self-matching (Informed Choice) to treatment improves alcohol consumption, retention, and quality of life. Method402 consecutive clients (female 46.7 %, mean age 47.4) seeking treatment for alcohol use disorder at the outpatient clinic in Odense, Denmark were enrolled in this single-blinded randomized controlled trial. Clients randomized to the intervention group watched an 8-minute video presentation of the treatments and then chose the treatment they preferred. Clients in the treatment as usual (TAU) group were allocated to treatment by an evidence-based algorithm. Measurements on alcohol consumption, quality of life, and retention in care were completed at baseline and 6-month follow-up. ResultsThere was no significant difference on primary and secondary outcome measures between the Informed Choice group and TAU group at 6-month follow-up. 80 % of clients in the Informed Choice group were satisfied with being randomized to self-matching whereas 24 % in the TAU group were satisfied with being assigned by expert matching. ConclusionOur hypothesis, that outcome is improved if clients choose their own treatment, was not supported. However, an important finding is that client self-matching is just as beneficial as expert matching.

Emerging mental health challenges, strategies, and opportunities in the context of the COVID-19 pandemic: Perspectives from South American decision-makers.

ABSTRACTObjective.To identify emerging mental health problems, strategies to address them, and opportunities to reform mental health systems during the COVID-19 pandemic in South America.Methods.An online questionnaire was sent to mental health decision-makers of ministries of health in 10 South American countries in mid-April 2020. The semi-structured questionnaire had 12 questions clustered into three main sections: emerging challenges in mental health, current and potential strategies to face the pandemic, and key elements for mental health reform. We identified keywords and themes for each section through summative content analysis.Results.Increasing mental health burden and needs were reported as direct and indirect consequences of the COVID-19 pandemic. National lockdowns challenge the delivery and access to mental health treatment and care. Strategies to meet mental health needs rely heavily on timely and adequate responses by strengthened mental health governance and systems, availability of services, virtual platforms, and appropriate capacity-building for service providers. Short- and medium-term strategies focused on bolstering community-based mental health networks and telemedicine for high-risk populations. Opportunities for long-term mental health reform entail strengthening legal frameworks, redistribution of financial resources, and collaboration with local and international partners.Conclusions.Mental health and psychosocial support have been identified as a priority area by South American countries in the COVID-19 response. The pandemic has generated specific needs that require appropriate actions, including implementing virtual interventions, orienting capacity-building toward protecting users and health providers, strengthening evidence-driven decision-making, and integrating mental health and psychosocial support in high-level mechanisms guiding the response to COVID-19.

Burden of Treatment Resistant Depression (TRD) in patients with major depressive disorder in Ontario using Institute for Clinical Evaluative Sciences (ICES) databases: Economic burden and healthcare resource utilization

IntroductionThe burden of treatment-resistant depression (TRD) in Canada requires empirical characterization to better inform clinicians and policy decision-making in mental health. Towards this aim, this study utilized the Institute for Clinical Evaluative Sciences (ICES) databases to quantify the economic burden and resource utilization of Patients with TRD in Ontario. MethodsTRD, Non-TRD Major Depressive Disorder (Non-TRD MDD) and Non-MDD cohorts were selected from the ICES databases between April 2006-March 2015 and followed-up for at least two years. TRD was defined as a minimum of two treatment failures within one-year of the index MDD diagnosis. Non-TRD and Non-MDD patients were matched with patients with TRD to analyze costs, resource utilization, and demographic information. ResultsOut of 277 patients with TRD identified, the average age was 52 years (SD 16) and 53% were female. Compared to Non-TRD, the patients with TRD had more all-cause visits to outpatient (38.2 vs. 24.2) and emergency units (2.7 vs. 2.0) and more depression-related visits to GPs (3.06 vs. 1.63) and psychiatrists (5.88 vs. 1.95) (all p < 0.05). The average two-year cost for TRD patients was $20,998 (CAD). LimitationsThis study included patients with only public plan coverage; therefore, overall TRD population and cash and private claims were not captured. ConclusionsPatients with TRD exhibit a significantly higher demand on healthcare resources and higher overall payments compared to Non-TRD patients. The findings suggest that there are current challenges in adequately managing this difficult-to-treat patient group and there remains a high unmet need for new therapies.

Narrative Understanding, Value, and Diagnosis: A Particularist Account of Clinical Formulations and Shared Decision-making in Mental Health

In this article, I deploy the notions of narrative and discernment as complementary support tools in understanding the moral significance of the first-person perspective in mental health. My aim is to develop and extend moral particularism’s emphasis on the significance of context and the general problem of relevance in understanding the dynamics of practical judgement and shared decision-making as applied to comprehensive diagnosis and integrated treatment. I argue that it is a mistake to think of the values embedded in responsible integrated care and patient involvement as either determined by the individual patient’s autobiographical narrative or as determined by the ‘top-down’ conception of health as presented in the biomedical model. What is missing in accounting for the idea of clinical decision-making as a shared enterprise is a relational account of the person and the wider diagnostic treatment context in understanding the process of perspective-taking. Such reorientation of focus makes available a distinctive conception of clinical knowledge, in which claims to objective meaning in patient narratives are criticised not as false per se, but as failing to yield the insight into the problem it was the point of those claims to provide

The Influence of Non-Clinical Patient Factors on Clinical Decision Making: Uncovering the Impact on Mental Health

BackgroundUnderstanding how non-clinical patient factors (NCpF) such as gender, educational level and socioeconomic status impact clinical decisions regarding one’s mental health is important for appropriate and equitable care.&#x0D; Main AimThis research aims to i) investigate the feasibility of using administrative health data to investigate clinical decision making in mental health; ii) understand the impact of NCpF on mental health-related diagnosis, treatment, and referral decisions.&#x0D; Methods/ApproachThree waves of the Welsh Health Survey, containing a five-item Mental Health Inventory (Short- Form SF36), and NCpF information were used to create our interest cohort.&#x0D; The records with a low SF36, a ‘gold standard’ identifier of common mental health conditions, were then linked to the healthcare records datasets (Primary Care GP Dataset, Patient Episode Database for Wales, Emergency Department Dataset, Outpatient Referral Dataset, Annual District Death Extract) securely stored on the Secure Anonymised Information Linkage Databank.&#x0D; ResultsWe will present the methodological challenges and benefits of using administrative data the study of decision making in mental health.&#x0D; The differences in NCpF between those with a low SF36 and a mental health diagnosis, symptoms and treatment as well as those with a similar SF36 score but no diagnosis, symptoms or treatment recorded will be presented and discussed.&#x0D; ConclusionAdministrative data can provide a unique opportunity to investigate issues related with clinical decision-making in mental health and improve health equity. Having a better understanding of the influence of NCpF on mental health decisions is necessary to prevent inequity in mental health care.

Advance decision-making in mental health – Suggestions for legal reform in England and Wales

This paper argues that existing English and Welsh mental health legislation (The Mental Health Act 1983 (MHA)) should be changed to make provision for advance decision-making (ADM) within statute and makes detailed recommendations as to what should constitute this statutory provision. The recommendations seek to enable a culture change in relation to written statements made with capacity such that they are developed within mental health services and involve joint working on mental health requests as well as potential refusals. In formulating our recommendations, we consider the historical background of ADM, similarities and differences between physical and mental health, a taxonomy of ADM, the evidence base for mental health ADM, the ethics of ADM, the necessity for statutory ADM and the possibility of capacity based ‘fusion’ law on ADM. It is argued that the introduction of mental health ADM into the MHA will provide clarity within what has become a confusing area and will enable and promote the development and realisation of ADM as a form of self-determination. The paper originated as a report commissioned by, and submitted to, the UK Government's 2018 Independent Review of the Mental Health Act 1983.

A comparative study of job satisfaction among nurses, psychologists/psychotherapists and social workers working in Quebec mental health teams

BackgroundThis study identified multiple socio-professional and team effectiveness variables, based on the Input-Mediator-Output-Input (IMOI) model, and tested their associations with job satisfaction for three categories of mental health professionals (nurses, psychologists/psychotherapists, and social workers).MethodsJob satisfaction was assessed with the Job Satisfaction Survey. Independent variables were classified into four categories: 1) Socio-professional Characteristics; 2) Team Attributes; 3) Team Processes; and 4) Team Emergent States. Variables were entered successively, by category, into a hierarchical regression model.ResultsTeam Processes contributed the greatest number of variables to job satisfaction among all professional groups, including team support which was the only significant variable common to all three types of professionals. Greater involvement in the decision-making process, and lower levels of team conflict (Team Processes) were associated with job satisfaction among nurses and social workers. Lower seniority on team (Socio-professional Characteristics), and team collaboration (Team Processes) were associated with job satisfaction among nurses, as was belief in the advantages of interdisciplinary collaboration (Team Emergent States) among psychologists. Knowledge sharing (Team Processes) and affective commitment to the team (Team Emergent States) were associated with job satisfaction among social workers.ConclusionsResults suggest the need for mental health decision-makers and team managers to offer adequate support to mental health professionals, to involve nurses and social workers in the decision-making process, and implement procedures and mechanisms favourable to the prevention or resolution of team conflict with a view toward increasing job satisfaction among mental health professionals.

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study.

The aims of this paper are to: (i) explore the experiences of involvement of mental health service users, their caregivers, mental health centre heads and policy makers in mental health system strengthening in three low- and middle-income countries (LMICs) (Ethiopia, Nepal and Nigeria); (ii) analyse the potential benefits and barriers of such involvement; and (iii) identify strategies required to achieve greater service user and caregiver participation. A cross-country qualitative study was conducted, interviewing 83 stakeholders of mental health services. Our analysis showed that service user and caregiver involvement in the health system strengthening process was an alien concept for most participants. They reported very limited access to direct participation. Stigma and poverty were described as the main barriers for involvement. Several strategies were identified by participants to overcome existing hurdles to facilitate service user and caregiver involvement in the mental health system strengthening process, such as support to access treatment, mental health promotion and empowerment of service users. This study suggests that capacity building for service users, and strengthening of user groups would equip them to contribute meaningfully to policy development from informed perspectives. Involvement of service users and their caregivers in mental health decision-making is still in its infancy in LMICs. Effective strategies are required to overcome existing barriers, for example making funding more widely available for Ph.D. studies in participatory research with service users and caregivers to develop, implement and evaluate approaches to involvement that are locally and culturally acceptable in LMICs.

Spot the difference: shared decision-making and supported decision-making in mental health

Respecting a person’s choices about the mental health services they do or do not use is a mark of quality support, and is often pursued for moral reasons, as a rights imperative and to improve outcomes. Yet, providing information and assistance for people making decisions about the mental health services can be a complex process, and has been approached in various ways. Two prominent approaches to this end are ‘shared decision-making’ and ‘supported decision-making’. This article considers each of these approaches, discussing points of similarity and difference and considering how the two might complement one another. By exploring the contribution that each approach can make, we conclude by proposing how future application of these approaches can account for the broader context of decisions, including support for ongoing decision-making; the multitude of service settings where decision-making occurs; and the diversity in supportive practices required to promote active involvement.

Evidence-Based Practice in Therapeutic Recreation: An Examination of Clinical Decision-Making in Mental Health

There are repeated calls for evidence-based practice (EBP) in therapeutic recreation (TR) as a means to improve client outcomes, ensure consistency and communication among professionals, create protocols and criteria for client assessments, and increase recreation therapists’ (RTs) research capacity. The purpose of this study was to understand what influences RTs’ clinical decision-making in a mental health setting. A qualitative research approach with ethnographic techniques was used. The study consisted of two phases: journaling and a focus group. A systematic, inductive approach guided analysis of the data from 10 RTs located in different workplaces within one Canadian health region. Findings suggested that while RTs had a common practice philosophy, their use of research evidence in decision-making was limited. A lack of infrastructure supporting service provision including minimal clinical leadership, few opportunities for mentorship, and contextual factors such as limited resources influenced clinical decision-making. Implications for research and practice are provided.Subscribe to TRJ

The introduction of a legal framework for advance directives in the UN CRPD era: The views of Irish service users and consultant psychiatrists

Summary The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) requires us to engage in new approaches to mental health decision-making and to develop a range of support strategies. Advance directives (ADs) are considered to be appropriate measures for supporting legal capacity by enabling individuals to clearly state their ‘will and preferences’ in a legal document and to appoint a trusted person to communicate these wishes. This article examines the issues arising in relation to the introduction of ADs from the perspective of 111 Irish service users 1 and 100 consultant psychiatrists. The aim of the empirical study was to determine the views of service users and consultant psychiatrists towards the introduction of ADs and the extent they will be supported in Ireland. This was achieved by examining the views and preferences of both stakeholder groups, and the perceived benefits and barriers to implementation. The empirical study was the first national survey exploring the introduction of ADs for mental health decisions in Ireland. The survey found broad support for ADs among Irish stakeholders, but varying implementation preferences. Ireland currently lacks a legislative framework for ADs, but it is proposed to incorporate them into new capacity legislation in the near future. This is viewed as a key step towards Irish ratification of the UN CRPD. The article makes recommendations for the introduction and implementation of an appropriate legal framework for ADs in Ireland and other jurisdictions in the UN CRPD era.

Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.