Delivery Of Mental Health Care Services Research Articles

Mental Health Care in Poland

Abstract Background: Like in other industrialized countries, the development of Polish psychiatry has followed a typical trajectory, initially marked by the establishment of large mental health hospitals using an isolation-based care model. Subsequently, there has been a decline in these institutions, characterized by a reduction in the number of hospital beds, and an ongoing evolution toward decentralized community psychiatry, specifically mental health-care centers. The hospitalizations are for emergency/acute care only. The authors describe how clinical services and personnel training in Poland that have been adjusted in response to societal changes and global trends in mental health care. Methods: The authors collected and critically reviewed information based on literature relevant to the organization of mental health care in Poland. In addition, official government publications such as reports from the Central Statistical Office and Ministry of Health were perused to gather data on the population structure, gross domestic product, and the organizational structure of the mental health care and relevant health-care indices. Results: Mental health care in Poland is evolving and gradually improving, providing more opportunities for collaboration and networking among nongovernmental organizations, patients’ associations, and psychiatrists working toward common goals. Training curricula have been updated and/or modified, with new specialty and subspecialty trainings being offered to meet the demands of health-care professionals and patients alike. Conclusion: Demographic changes, the presence of Ukrainian war refugees, and global trends in psychiatry profoundly influence the delivery of mental health-care services in Poland.

Using Technology to Impact Maternal and Perinatal Mental Healthcare Service Delivery in South Africa

Using Technology to Impact Maternal and Perinatal Mental Healthcare Service Delivery in South Africa

Надання послуг з охорони психічного здоров'я на основі штучного інтелекту для підвищення резилієнсу українських військовослужбовців та ветеранів: заклик до співпраці

Russian aggression disrupted delivery of mental healthcare services for veterans in Ukraine. These causes required to create some new solutions about artificial intelligence based (AI-based) psychological services for Ukrainian defenders. Specialists from the Centre for veterans’ mental health “Forest Glade” of Ministry of Health of Ukraine have created a Telegram-based bot (Lisova Poliana Bot) to reach the specific needs of veterans and servicemen. Such form of AI-based service achieved positive feedback from soldiers, officers and volunteers and helped to partially unload the psychological service in wartime without excluding the Ukrainian defender from it. Therefore, AI solutions have a potential to be integrated in healthcare system. Given the great potential of artificial intelligence in the provision of services during the war, further comprehensive research and cooperation at the international level can be promising. We invite international researchers to cooperate in creating and delivering AI-based consulting tools for Ukrainian defenders.

NeuroBlu, an electronic health record (EHR) trusted research environment (TRE) to support mental healthcare analytics with real-world data

PurposeNeuroBlu is a real-world data (RWD) repository that contains deidentified electronic health record (EHR) data from US mental healthcare providers operating the MindLinc EHR system. NeuroBlu enables users to perform...

In Search for Comparability: The PECUNIA Reference Unit Costs for Health and Social Care Services in Europe.

Improving the efficiency of mental healthcare service delivery by learning from international best-practice examples requires valid data, including robust unit costs, which currently often lack cross-country comparability. The European ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) aimed to harmonize the international unit cost development. This article presents the methodology and set of 36 externally validated, standardized reference unit costs (RUCs) for five health and social care services (general practitioner, dentist, help-line, day-care center, nursing home) in Austria, England, Germany, Hungary, The Netherlands, and Spain based on unambiguous service definitions using the extended DESDE PECUNIA coding framework. The resulting PECUNIA RUCs are largely comparable across countries, with any causes for deviations (e.g., country-specific scope of services) transparently documented. Even under standardized methods, notable limitations due to data-driven divergences in key costing parameters remain. Increased cross-country comparability by adopting a uniform methodology and definitions can advance the quality of evidence-based policy guidance derived from health economic evaluations. The PECUNIA RUCs are available free of charge and aim to significantly improve the quality and feasibility of future economic evaluations and their transferability across mental health systems.

POSA402 Impact of Comorbid Cannabis Use Disorders in Schizophrenia: An Electronic Health Record Real World Data Study

Cannabis use is associated with worsening symptoms in people with schizophrenia but less is known about its impact on mental healthcare service delivery. To investigate healthcare utilization in people with schizophrenia with comorbid cannabis use disorder using real-world electronic health record (EHR) data.

A report on successful introduction of tele mental health training for primary care doctors during the COVID 19 pandemic.

Treatment gaps of 60-70%, reflecting, amongst many other factors, Human Resources shortfalls means that 150 million India never accessed mental healthcare. In Punjab, mental health training is required in primary health centers. A short-term synchronous training was conceptualized by the National Institute of Mental Health and Neurosciences. A total of 114 primary care doctors participated for the training. Substantial positive changes in knowledge, attitudes and practices were noted. Task sharing and capacity building initiatives can be undertaken during the pandemic to meet the demand for mental healthcare service delivery.

The Case for Co-production in Singapore's Mental Healthcare.

For better or worse, there exists a power differential between psychiatrists and their patients in mental healthcare. Co-production was proposed to be the “third space” to offer truce between the professional-patient tension in mental healthcare. In Singapore, co-production is a new, but growing, approach to mental healthcare service delivery. In this commentary, we argue that co-production is not just a novel way to provide service, but a moral imperative. Recovery Colleges and its adoption in Singapore is discussed in some detail to highlight how co-production may be applied in practice.

Supporting Risk-Aware Use of Online Translation Tools in Delivering Mental Healthcare Services among Spanish-Speaking Populations.

Neural machine translation technologies are having increasing applications in clinical and healthcare settings. In multicultural countries, automatic translation tools provide critical support to medical and health professionals in their interaction and exchange of health messages with migrant patients with limited or non-English proficiency. While research has mainly explored the usability and limitations of state-of-the-art machine translation tools in the detection and diagnosis of physical diseases and conditions, there is a persistent lack of evidence-based studies on the applicability of machine translation tools in the delivery of mental healthcare services for vulnerable populations. Our study developed Bayesian machine learning algorithms using relevance vector machine to support frontline health workers and medical professionals to make better informed decisions between risks and convenience of using online translation tools when delivering mental healthcare services to Spanish-speaking minority populations living in English-speaking countries. Major strengths of the machine learning classifier that we developed include scalability, interpretability, and adaptability of the classifier for diverse mental healthcare settings. In this paper, we report on the process of the Bayesian machine learning classifier development through automatic feature optimisation and the interpretation of the classifier-enabled assessment of the suitability of original English mental health information for automatic online translation. We elaborate on the interpretation of the assessment results in clinical settings using statistical tools such as positive likelihood ratios and negative likelihood ratios.

Monerdaktar: A large online mental health service to improve access to care in bangladesh during the COVID-19 pandemic

BackgroundMore than 92% of people in Bangladesh are deprived from any sort of mental health care due to severe scarcity of mental health professionals, widespread stigma, lack of awareness, the inability to travel from remote area to Dhaka and maintaining the cost of travel and clinics. Moreover, the COVID-19 crisis made the scenario worse. To solve this problem we designed, developed and implemented “Monerdaktar”.MethodsThe process development Monerdaktar- website and mobile application started with the initial idea and concept by TRS followed by extensive literature review and naturalistic observation of the mental health care service delivery from two tertiary hospitals in Bangladesh. We conducted 3 focus group discussion with the patients, their care givers, mental health professions. Based on the user feedback and technical suggestion of the mental health professional and IT professionals we developed the prototype of the Monerdaktar mobile application and website. After piloting for two months, the final version of the mobile application and website was finalized incorporating the feedback of the patients and experts.ResultMonerdaktar created the unique opportunity to connect with the most the reputed mental health professional both psychiatrists and clinical psychologists online. Moreover, monerdaktar delivered the service free of cost to more than 700 clients during the peak of COVID crisis in Bangladesh.ConclusionThe COVID-19 crisis has potentiated the acceptance and adaptation of the Moenrdaktar solved the long-standing crisis of access to mental health care in Bangladesh and ensure the evidence-based care from anywhere.DisclosureThe Monerdaktar website and mobile application was design and developed by under the leadership of Dr. Tanjir Rashid Soron. Though the initial support was delivered free of cost, the consulting expert psychiatrist and Clinical Psychologist may take their

Efforts and Challenges to Ensure Continuity of Mental Healthcare Service Delivery in a Low Resource Settings During COVID-19 Pandemic-A Case of a Kenyan Referral Hospital.

The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.

A systematic review of current approaches to managing demand and waitlists for mental health services

PurposeTimely access to effective treatment is a primary goal for mental health services; however, when demand exceeds available resources, services may place clients on a waitlist or restrict services. This paper aims to identify approaches used by mental health services to manage service demand and waitlists.Design/methodology/approachA review of research literature between 2009 and 2019 was conducted using the Medline, PsycINFO, CINAHL, Embase and Cochrane databases. Articles were screened and assessed against inclusion criteria and the methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool.FindingsIn total, 20 articles were located that met the inclusion criteria. Five demand management approaches were identified, namely, walk-in models, triage processes, multi-disciplinary care, patient-led approaches and service delivery changes.Research limitations/implicationsThis review identifies effective approaches that services can consider adapting to their local setting; however, further research is needed to demonstrate the clinical effectiveness of services provided under these models.Originality/valueThis review makes a valuable contribution to mental health care service delivery by detailing the strategies that services have adopted to manage demand and, where available, comparative outcomes with traditional service delivery models.

Three tier mental health-care service delivery during COVID-19 pandemic in India

The world is concerned about managing COVID-19 pandemic and its consequences. The COVID-19 has not only affected physical health and the economy but impacted the mental health of people globally. It has created a parallel epidemic of psychological distress. Experts envision a gigantic influx of patients needing mental health care, with needs far greater than the nation's existing public health systems can deal with. This paper discusses Indian scenario of mental health issues fueled by COVID-19 pandemic and strategies to address mental health emergency by adopting unconventional sustainable measures and formally integrating mental health into public health preparedness and emergency response plans of the country.

Mobile Phones as a Medium of Mental Health Care Service Delivery: Perspectives and Barriers among Patients with Severe Mental Illness.

Background:The use of mobile phone technology to support various components of health care delivery (often referred to as mHealth) is on the rise. Little systematic information, however, is available on user felt needs and barriers to mHealth approaches among people with severe mental illness (SMI). Our objectives were to elicit user needs, preferences, and barriers to using mobile phones for health care service delivery among people with SMI.Materials and Methods:A cross-sectional study was carried out among 75 subjects with SMI between August 2017 and October 2017. All patients had a minimum illness duration of two years or more and a Global Assessment of Functioning score of less than 70. Information on user perspectives was elicited using a 10-item structured questionnaire, to assess mobile phone usage patterns, felt needs, barriers, and preferences, developed for use in patients with SMI.Results:Majority of the patients reported using mobile phones and were favorably disposed to mHealth approaches. Voice calls (n = 47, 62.7%) were the most preferred mode of service delivery. The most preferred service frequency was twice-weekly (n = 31, 41.3%), followed by once-weekly (n = 22, 29.3%). Majority (n = 47, 62.7%) reported no barriers to mobile phone usage, whereas 14 (18.6%) perceived a lack of necessity of mobile phones as a service delivery medium. Reminders about medication and appointments through mobile phones (n = 35, 46.6%) were the most felt needs, followed by crisis helplines (n = 27, 36.0%) and information about mental health services (n = 22, 29.3%).Conclusion:These findings support the use of mHealth approaches in resource-constrained settings and provide specific inputs to refine the modalities of mHealth service delivery.

Patient’s Race May Influence Access to MH Care Following Overdose

Back to table of contents Previous article Next article Clinical & ResearchFull AccessPatient’s Race May Influence Access to MH Care Following OverdoseTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:13 Aug 2019https://doi.org/10.1176/appi.pn.2019.8b23AbstractA study finds disparities among those who receive a mental health assessment after a deliberate overdose.Patients who are members of racial or ethnic minorities may be less likely than white patients to receive a mental health assessment during hospitalization for a deliberate overdose, a study in Psychiatric Services in Advance has found.All patients who are suspected of intentional overdose should receive a mental health assessment before discharge, says Elizabeth Charron, M.P.H.Elizabeth Charron, M.P.H., of the Department of Public Health Sciences at Clemson University and colleagues reviewed the records of 2,489 adults aged 18 to 64 years who were hospitalized for deliberate drug overdose in South Carolina in 2012 or 2013. They found that the vast majority of patients—94%—received a mental health assessment during their hospitalization. However, compared with white patients, black patients were 48% less likely to receive an assessmen, and patients who identified as other races or ethnicities (such as Asian or Hispanic) were 76% less likely to receive an assessment. They also found that black patients were 40% less likely than white patients to be discharged to an inpatient psychiatric facility. Patients of other races and ethnicities were slightly more likely than whites to be discharged to an inpatient psychiatric facility.“It is unclear whether the disparities we observed were due to implicit provider bias, cultural differences in patient preferences for care, socioeconomic differences between groups, or other clinically relevant factors,” the researchers wrote.Charron told Psychiatric News that she was not surprised by the findings.“In South Carolina, there are perpetual disparities in health and health care among racial-ethnic minorities, particularly African Americans. This study fits into the broader body of evidence highlighting the scope of disparities in American health care,” Charron said. “Understanding factors related to receiving [mental health] services is important in developing strategies for closing gaps in mental health care service delivery.”The researchers also analyzed the types of drugs used in the overdoses. They found that patients who had overdosed on drugs such as psychotropics, central nervous system stimulants, and central nervous system depressants were nearly 70% more likely to receive a mental health assessment than those who overdosed on opioids or sedative-hypnotics.“This result stood out to us given the scope of the opioid epidemic. Opioid abuse has been linked to increased risk of depression and suicide, so we did not expect that mental health assessments would be lower in this group,” Charron said.One possible explanation, noted in the study, is that patients who overdose on opioids and sedative-hypnotics generally do not present with psychological symptoms, whereas those who overdose on drugs such as cocaine or methamphetamine often have symptoms such as agitation or acute psychosis.The researchers acknowledged limitations of their study, notably that they could not determine whether the patients intended suicide or self-harm by deliberately overdosing. Nonetheless, mental health screening in this population should be routine, said Charron.“Anyone suspected of being admitted for an intentional overdose should receive a mental health assessment before discharge,” Charron said. “Hospitals and health systems can establish a standardized discharge planning protocol for persons receiving inpatient treatment for intentional overdose.”The authors reported no outside funding for this study. ■Disparities in Access to Mental Health Services Among Patients Hospitalized for Deliberate Drug Overdose” is posted here. ISSUES NewArchived

The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review.

Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community-based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer-reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms.

Conference summary of "Ten days, on-site training of basic module of 'primary care psychiatry program' for primary care doctors of Uttarakhand".

Treatment gaps of 60-70%, reflecting, amongst many other factors, Human Resources shortfalls means that 150 million India never accessed mental healthcare. In Punjab, mental health training is required in primary health centers. A short-term synchronous training was conceptualized by the National Institute of Mental Health and Neurosciences. A total of 114 primary care doctors participated for the training. Substantial positive changes in knowledge, attitudes and practices were noted. Task sharing and capacity building initiatives can be undertaken during the pandemic to meet the demand for mental healthcare service delivery.

Rural realities in service provision for substance abuse: a qualitative study in uMkhanyakude district, KwaZulu-Natal, South Africa

Background: Substance abuse is recognised as a worldwide concern, contributing significantly to morbidity and mortality in South Africa. There is minimal research that has considered influences in mental health care service delivery in rural and disadvantaged communities in South Africa.
 
 Methods: A qualitative study with substance abuse service providers in uMkhanyakude rural district of KwaZulu-Natal was undertaken to gain insight into the experiences and challenges in service delivery. Focus groups and semi-structured interviews were conducted with various stakeholders (n = 29) in the rural district.
 
 Results: The findings of the study suggest that service providers experience challenges in service delivery in this rural area. The effects of culture (amarula festival and ancestral worship) exacerbate the use of substances; the high rate of unemployment and poverty lead to the produce of home-brewed substances for sustainable living; a lack of resources poses threats to service delivery; the poor prioritisation of mental health care services and a lack of monitoring and evaluation of services in the district were highlighted.
 
 Conclusions: Despite this being a single district study, findings reflect the need for a district, provincial and national standard for substance abuse rehabilitation services in addition to the improvement of monitoring and evaluation for quality improvement. There is also a need to respond to the gaps that exist in after-care and community-based or decentralised substance abuse services that are essential in such areas, which are under-resourced despite the high prevalence of substance users.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1272232

Rural realities in service provision for substance abuse: a qualitative study in uMkhanyakude district, KwaZulu-Natal, South Africa

Background: Substance abuse is recognised as a worldwide concern, contributing significantly to morbidity and mortality in South Africa. There is minimal research that has considered influences in mental health care service delivery in rural and disadvantaged communities in South Africa.Methods: A qualitative study with substance abuse service providers in uMkhanyakude rural district of KwaZulu-Natal was undertaken to gain insight into the experiences and challenges in service delivery. Focus groups and semi-structured interviews were conducted with various stakeholders (n = 29) in the rural district.Results: The findings of the study suggest that service providers experience challenges in service delivery in this rural area. The effects of culture (amarula festival and ancestral worship) exacerbate the use of substances; the high rate of unemployment and poverty lead to the produce of home-brewed substances for sustainable living; a lack of resources poses threats to service delivery; the poor prioritisa...

Telemental health in Brazil: past, present and integration into primary care

Background Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization. Objective To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care. Methods Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication. Results The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care. Discussion Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research.