Delivery Of Psychiatric Services Research Articles

Perceived Stigma Toward Cognitive Impairment Among People With Schizophrenia.

Stigma toward schizophrenia spectrum disorders is pervasive and negatively influences service access and delivery. Cognitive impairment associated with schizophrenia (CIAS) is common, but its association with stigma is unknown. In this study, the authors examined whether individuals with CIAS receiving cognitive remediation treatment report experiencing CIAS-related stigma and sought to establish associations between CIAS-related stigma and recovery-relevant outcomes. Data from 48 individuals with schizophrenia spectrum diagnoses were drawn from a larger study evaluating cognitive remediation. Participants completed measures of CIAS-related stigma, internalized mental illness stigma, self-perceived cognitive impairment, cognitive performance, and interviewer-rated quality of life. CIAS-related stigma was commonly reported and significantly positively associated with internalized stigma and self-perceived cognitive impairment. CIAS-related stigma was also significantly negatively associated with motivation to engage in goal-directed behavior and daily activities. CIAS-related stigma exists and warrants additional exploration with regard to implications for psychiatric service delivery.

IMPACT OF CREATING MENTAL HEALTH HELPLINE AT A TERTIARY CARE PSYCHIATRIC SET-UP IN PAKISTAN DURING THE COVID -19 PANDEMIC

Objectives The objectives of this study were to analyze the calls received at a 24-hour helpline service set up at the Institute of Psychiatry during the first wave of the COVID-19 pandemic for the demographics of the service users, the reasons for calling the helpline phone, and the guidance provided. Design Descriptive retrospective clinical audit Place and Duration of Study The Institute of Psychiatry, from June 2020 and February 2021 Patients and Methods The entries made detailing the call records by psychiatry residents managing the helpline were analyzed. Data was extracted regarding age, area of residence, and reasons for calling by the service users of the helpline, as well as the advice given by the resident on call. The statistical analysis was performed using SPSS version 26, and findings were evaluated in terms of age, geographical distribution, reasons for seeking assistance, and the type of guidance provided thereof. Results Of the 102 calls analyzed, most of the callers were between 30 to 39 years of age (33.3%), and hailed from Rawalpindi (78.4%), followed by Kashmir (5.9%), Chakwal (4.9%) and Murree (3.9%). The most frequently stated reasons for calling were to ask about availability of out-patient services (36.3%), to have medication revised (23.5%), and to enquire about the side effects of medication (11.8%). Other reasons included recurrence of symptoms or lack of improvement in patients already taking treatment (15.7%) and to seek help regarding new psychiatric symptoms (12.7%). The responses given to the callers were invitation to come to the hospital (44.1%), provision of relevant information about the particular questions asked (for example, relating to hospital timings) (36.3%), adjustment of medications (11.8%), and prescribing medication with advice of physical follow-up (7.8%). Conclusion Despite psychiatric out-patient department being temporarily closed down during the initial waves of the COVID 19 pandemic, efforts were made to continue service provision through innovative means, like the 24-hour helpline service. There is a need to further incorporate the use of technology in the delivery of psychiatric services.

The perils of boarding: A call to achieve parity in the delivery of acute psychiatric services for children with COVID-19.

Boarding across pediatric healthcare systems is on the rise during the pandemic. Children with positive COVID-19 test results awaiting psychiatric placements in the emergency department or medical unit settings are at increased risk for decompensation with unmet psychiatric needs during a time of crisis marked by vulnerability. There is scant literature unveiling best practices on delivery of care for these patients to achieve acute crisis stabilization. Recent studies have uncovered substantial increases in mental health disorders among children during the pandemic compared to previous incidence and prevalence rates prior to the pandemic. From the published literature, two healthcare systems have initiated long-term planning, development, and implementation of biodome psychiatric units for patients with COVID-19 in need of acute crisis stabilization services. We sampled 100 acute inpatient child and adolescent psychiatric programs to discern their post-COVID positive clearance policies for admission. Findings were mixed among days of quarantine required, symptomology, covid-designated spaces vs. self-isolated rooms for psychiatric treatment, number of COVID negative retests, and additional considerations. We also review a range of considerations and recommendations for clinical practice and the health system in achieving parity in mental health care for these patients which in turn could contribute towards mitigating the rising global mental health crisis. Furthermore, increasing access to acute psychiatric services for these patients will also contribute towards the larger goal of the World Health Organization, Sustainable Developmental Goals of the United Nations, and Healthy People 2030 in increasing accessibility, quality and equity of mental health care for individuals on both global and national frontiers.

Mental Health Reform Processes and Service Delivery Shift From the Hospital to the Community in Belgium and Hong Kong.

We aimed to illustrate and compare the processes of mental health policies aiming at a service delivery shift from the hospital to the community using implementation science, and to identify important implementation strategies. This study had a comparative case study design. The cases were the Belgian mental health reform, and the person-centered model of mental health in Hong Kong, China. Several documentary sources were reviewed, including the published literature and websites. Data on policy processes were extracted, analyzed using directed content analysis, and categorized into constructs of the conceptual model for evidence-informed policy formulation and implementation arranged for the mental health policy. Several similarities were identified in the strategies for active implementation and dissemination; official staff allocation, and training to the community psychiatric services, an approach to adjust the number of psychiatric hospital beds, and promoting collaboration between health care sectors and social welfare sectors. Under distinct social contexts, differences were found in all processes. Each of the described policy processes can serve as a model for countries in similar social contexts seeking to shift their psychiatric service delivery. Furthermore, our findings suggest widely applicable implementation strategies for policies aiming at a service delivery shift.

Psychiatric service delivery for older people in hospital and residential aged care: An updated systematic review.

To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons' mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes.

The Good, the Bad, and the Vision: Exploring the Mental Health Care Experiences of Transitional-Aged Youth Using the Photovoice Method.

Transitional-aged youth (TAY) between the ages of 16 and 24 experience higher rates of mental distress than any other age group. It has long been recognized that stability, consistency, and continuity in mental health care delivery are of paramount importance; however, the disjointed progression from paediatric to adult psychiatric services leaves many TAY vulnerable to deleterious health outcomes. In Spring 2019, eight TAY living with mental health challenges participated in a Photovoice study designed to: (1) illuminate their individual transition experiences; and, (2) support a collective vision for optimal mental health care at this nexus. Participants took photographs that reflected three weekly topics-the good, the bad, and the vision-and engaged in a series of three corresponding photo-elicitation focus group sessions. Twenty-four images with accompanying titles and captions were sorted into nine participant-selected themes. Findings contribute to an enhanced awareness of psychiatric service delivery gaps experienced by TAY, and advocate for seamless and supportive transitions that more effectively meet the mental health care needs of this population.

Implementation of telepsychiatry in Kenya: acceptability study.

COVID-19-related restrictions on in-person contact in healthcare, increasing psychiatric illness during the pandemic and pre-existing shortages of mental healthcare providers have led to the emergence of telepsychiatry as an attractive option for the delivery of care. Telepsychiatry has been promoted as economical and effective, but its acceptance in low- and middle-income countries is poorly understood. To explore the acceptance, experiences and perspectives of patients and healthcare providers in the uptake of telepsychiatry services in a middle-income country. Focus group discussions were conducted on the WhatsApp platform with patients and care providers who have engaged in telepsychiatry. Data were analysed using a thematic approach. Three main themes emerged from the five focus groups: (a) technical access, (b) user experience and (c) perceived effectiveness compared with face-to-face (in-person) interactions. Care providers reported challenges establishing rapport with the patient, particularly for initial sessions, maintaining privacy during sessions and detecting non-verbal cues on video. Patients cited internet connectivity problems, difficulty finding private space to have their sessions and cost as major challenges. Patients also felt in-person sessions were better for initial visits. Both patients and providers reported difficulties making insurance payment claims for telepsychiatry services. Overall, participants were mostly positive about telepsychiatry, citing its convenience and overall perceived effectiveness compared with in-person sessions. Telepsychiatry is an acceptable platform for delivery of out-patient psychiatric services in a middle-income country. Patients and providers appreciate the convenience it offers and would like it integrated as a routine mode of delivery of care.

Evaluating a Multicomponent Strategy to Address Burnout, Job Engagement, and Job Satisfaction Among Telepsychiatrists.

Preventing and managing burnout among psychiatrists in the United States is a national priority. Telepsychiatry is a promising web-based modality for the delivery of psychiatric services that has the potential for reducing burnout rates. However, it may also be associated with certain occupational challenges such as social and professional isolation, which may impact telepsychiatrists' performance and well-being. Therefore, it is important to develop ways to enhance retention rates of telepsychiatrists and reduce their risk of burnout. In this study, we examine approaches implemented by a telepsychiatry organization between 2018 and 2019, as part of a strategy to enhance the job satisfaction, engagement, and well-being of telepsychiatrists. This article describes the development, implementation, and outcomes associated with this strategy. Individual and organizational-level outcomes showed overall higher job satisfaction, higher retention rates, and higher output rates over the period in which the strategy was implemented compared with previously, which translate to increased access to mental health care services for patients and imply a reduced risk of burnout among telepsychiatrists. Given the risk for social, professional, and academic isolation among telepsychiatrists, organizational engagement efforts are advisable, feasible, and may be associated with significant improvement in satisfaction and retention among telepsychiatrists. Our findings have important implications for enhancing the performance and job satisfaction of telepsychiatrists and potentially reducing burnout rates in this population of providers. Effective strategy efforts included: (1) enhancing and standardizing recruitment efforts to ensure proper matching of the psychiatrist with organization, site, and patient population; (2) ensuring congruence between the individual's and the organization's values; (3) providing support for nonclinical administrative tasks; (4) maintaining professional and social communication, support, and supervision via multiple channels.

Introducing the new culture section of BJPsych Bulletin.

This editorial launches the new culture section in the journal. Without any unchallengeable definition of 'culture', potential contributors may consider submissions under four headings: the arts and humanities relating to practice; regulatory culture; becoming a cultured practitioner; and psychiatry's cultural context. A new article type, 'Cultural reflections', has been created, and submissions may reflect any appropriate methodology, including those from the arts. Peer review (from methodologies outside psychiatry if appropriate) will assure quality. Our objectives are to establish BJPsych Bulletin as the 'journal of record' for cultural studies relevant to psychiatric service delivery and demonstrate equivalent quality between them and scientific studies.

Frontline 2020: the new age for telemental health

Telemental health care has been widely available for several decades and encompasses the remote delivery of psychiatric and psychological services.1 Telemental health care has been found to be effective in assessing and diagnosing mental health conditions across the lifespan and ethnic groups.2 Benefits of telemental health include the engagement of friends or family and the wider professional network in consultations; savings in the time required to deliver health care;3 and the reach to populations that might not be able to access mental health services owing to lack of, or insufficient service provision or high care costs.

Decriminalising being Black with mental illness

Mental illness should not be a death sentence. Being Black should not be a death sentence. Yet, in 2020 alone we have witnessed how these intersecting identities—Blackness and having a mental illness—have disproportionately led to the murder of Black people by police officers in the USA. 1 Manke K Stark racial bias revealed in police killings of older, mentally ill, unarmed Black men. https://news.berkeley.edu/2020/10/05/stark-racial-bias-revealed-in-police-killings-of-older-mentally-ill-unarmed-black-men/Date: Oct 5, 2020 Date accessed: October 28, 2020 Google Scholar The deaths of George Floyd, Ahmaud Arbery, Rayshard Brooks, and Breonna Taylor focused international attention on excessive force used by police. These deaths sparked global protests, centring the Black Lives Matter movement and drawing attention to the grim reality that in the USA Black people are at an increased risk of death at the hands of the police. 1 Manke K Stark racial bias revealed in police killings of older, mentally ill, unarmed Black men. https://news.berkeley.edu/2020/10/05/stark-racial-bias-revealed-in-police-killings-of-older-mentally-ill-unarmed-black-men/Date: Oct 5, 2020 Date accessed: October 28, 2020 Google Scholar The Washington Post database shows that Black people are killed by police at more than twice the rate of White people, despite constituting only 13% of the US population. 2 The Washington PostFatal Force. https://www.washingtonpost.com/graphics/investigations/police-shootings-database/Date: Oct 28, 2020 Date accessed: October 28, 2020 Google Scholar Frontline 2020: the new age for telemental healthTelemental health care has been widely available for several decades and encompasses the remote delivery of psychiatric and psychological services.1 Telemental health care has been found to be effective in assessing and diagnosing mental health conditions across the lifespan and ethnic groups.2 Benefits of telemental health include the engagement of friends or family and the wider professional network in consultations; savings in the time required to deliver health care;3 and the reach to populations that might not be able to access mental health services owing to lack of, or insufficient service provision or high care costs. Full-Text PDF What has happened to children's wellbeing in the UK?“Modern life has been chipping away at children's happiness over time”; this statement was the pessimistic conclusion of The Good Childhood Report 2020,1 which focused on wellbeing in children between the ages of 10 and 15 years across the UK. The report emphasised that children in the UK, especially girls, are among the most unhappy and least satisfied in Europe. The UK ranked lowest of 24 European countries in its proportion of children aged 15 years with high life satisfaction, lowest in its proportion with a positive sense of purpose in life, and second highest in its proportion with high sadness levels. Full-Text PDF Perspectives of lived experience across continents: our reality and call for universal health coverageThe Global Action Plan,1 signed by major global health agencies, provides a framework that guides collective action towards universal health coverage (UHC) and accelerates progress on the health-related Sustainable Development Goals.2 However, according to WHO, the world remains a long way from meeting its 2030 targets. Additionally, the COVID-19 pandemic has highlighted how fragile our health systems are in the provision of quality and holistic care. The Global Mental Health Peer Network (GMHPN) aims to highlight the lived experiences of people in various world regions, showcasing that if true recovery is to be achieved, UHC must include the most vulnerable individuals among us and the uniqueness of diverse lived experiences. Full-Text PDF COVID-19 offers an opportunity to reform mental health in IndiaThe pre-COVID-19 scenario for mental health in India was grim. One in seven Indians had mental disorders of varying severity in 2017,1 and Indians accounted for 26·6% of the global suicide deaths in 2016.2 The proportional contribution of mental disorders to the total disease burden in India is estimated to have almost doubled between 1990 and 2017,1 and 5·1% of the adult population is estimated to have some level of suicidality.3 Like elsewhere, the variety and extent of the implications of the COVID-19 pandemic for mental health are yet to be fully understood in India. Full-Text PDF

Rapid design and deployment of intensive outpatient, group-based psychiatric care using telehealth during coronavirus disease 2019 (COVID-19).

COVID-19 has demanded unprecedented actions in the delivery of outpatient psychiatric services, including the rapid shift of services from in-person to telehealth in response to public health physical distancing guidelines. One such shift was to convert group-level intensive outpatient psychiatric (IOP) interventions to telehealth. Historically, telehealth in psychiatric care has been studied in provider-patient interactions, but has not been as well studied for group telehealth service delivery. During the COVID-19 outbreak, providing group-based interventions was important in order to care for high-risk individuals who needed structured psychotherapy group support. However, the delivery of services via telehealth led to special challenges that were unable to be fully accommodated by the preexisting telehealth infrastructure. Rapid feasibility testing and adoption of technology was needed to support IOP services to minimize infectious spread while delivering group services to high-risk psychiatric patients. This article describes the processes and workflows for service delivery and early results of telehealth for IOP services in 2 adolescent treatment programs. In addition, the article highlights early observations around safety and quality and the role of telehealth policy and payment.

When Religion Reinforces Stigma: a Call to Bridge the Gap

When Religion Reinforces Stigma: a Call to Bridge the Gap

Epidemiology of Interpersonal Trauma among Women and Men Psychiatric Inpatients: A Population-Based Study.

Small clinical samples suggest that psychiatric inpatients report a lifetime history of interpersonal trauma. Since past experiences of trauma may complicate prognosis and treatment trajectories, population-level knowledge is needed about its prevalence and correlates among inpatients. Using health-administrative databases comprising all adult psychiatric inpatients in Ontario, Canada (2009 to 2016, n = 160,436, 49% women), we identified those who reported experiencing physical, sexual, and/or emotional trauma in their lifetime, 1 year, and 30 days preceding admission. We described the prevalence of each type of trauma, comparing women and men using modified Poisson regression, and identified individual-level characteristics associated with lifetime trauma history using multivariable logistic regression. 31.7% of inpatients reported experiencing trauma prior to admission. Lifetime prevalence was higher in women (39.6% vs. 24.1%; age-adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.65 to 1.71), including sexual (22.7% vs. 8.4%; aPR = 2.81; 95% CI, 2.73 to 2.89), emotional (33.3% vs. 19.4%; aPR = 1.76; 95% CI, 1.72 to 1.79), and physical trauma (24.2% vs. 14.8%; aPR = 1.68; 95% CI, 1.65 to 1.72). Factors most prominently associated with lifetime trauma were witnessing parental substance use (adjusted odds ratio [aOR] = 8.68; 95% CI, 8.39 to 8.99), female sex (aOR = 2.29; 95% CI, 2.23 to 2.35), and number of recent stressful life events (aOR = 1.62; 95% CI, 1.59 to 1.65). These results suggest that trauma-informed approaches are essential to consider in the design and delivery of inpatient psychiatric services for both women and men.

Increasing Access to Psychiatric Services in Schools: The Bridge Program.

One in 5 youth experience a psychiatric disorder in any given year, but fewer than half of these youth receive mental health services. This lack of service utilization is often attributed to structural and perceptual barriers, and school-based mental health programs have been proposed as a means of addressing these barriers and increasing youths' access to services. While universal prevention programs and targeted treatments may benefit most youth receiving services in schools, collaborations between schools and child psychiatry may benefit youth with the most severe symptoms and the greatest impairment. This article describes the Bridge Program, a school-based psychiatric program funded by a county-wide mental health tax initiative designed to provide psychiatric services in local schools without any out-of-pocket expenses for youth and families within 10 days of referral. Two case reports provide a description of the delivery of psychiatric services through the Bridge Program. Future research is needed to compare the feasibility and effectiveness of different approaches to increasing access to youth psychiatric care.

Creating Effective Psychiatric Services for High Acuity Children and Families: May the Force Be With Us

Jennifer Havens, MD, will outline the many challenges to the delivery of effective psychiatric services to children and families, with an emphasis on the needs of high-acuity youth across the care continuum.

Recent Advances in Delivering Mental Health Treatment via Video to Home.

Telemental health has rapidly evolved as technology and policy advances have allowed new and innovative approaches, including the remote delivery of services directly to patients' homes. This review examined the literature on video to home (VTH) delivery of mental health services to synthesize information regarding (1) the comparative clinical effectiveness of VTH to in-person mental health treatment, (2) impact of VTH on treatment adherence, (3) patient and provider satisfaction with VTH, (4) cost effectiveness of VTH, and (5) clinical considerations for VTH use. Clinical effectiveness, treatment adherence, and patient satisfaction outcomes are comparable for VTH and in-person delivery of psychotherapy and psychiatric consultation services. Clinical applications for VTH have expanded in an effort to provide mental health care to difficult to reach, underserved populations. VTH is less costly than in-person care when assuming that patients could employ existing personal technologies. VTH delivery offers a safe and effective option for increasing access to mental health care for patients who face logistical and stigma-related barriers to receiving in-person treatment. VTH should be routinely offered to patients as an option for receiving care, maximizing patient choice, and coordination of care.

Psychiatric Genomics and Mental Health Treatment: Setting the Ethical Agenda

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health.

Bridging the Gap: Geriatric Telepsychiatry Consultations to a Rural PACE Program

The older adult population is growing. Limited numbers and access to trained geriatric psychiatrists hinder access to timely and appropriate geriatric mental health care, particularly in rural areas. Programs for All-Inclusive Care of the Elderly (PACE) provide person-centered care to nursing home-eligible community-dwelling elderly, in whom mental health conditions including dementia and depression are highly prevalent. However, access to mental health care across PACE programs remains an under-resourced need. Telepsychiatry, the exchange of health care-related information and delivery of psychiatric services using videoconferencing technology (VCT) from a distance is one vehicle to reduce this barrier. The Institute of Medicine has identified the importance of telehealth technologies to enhance access to and quality care for older adults, particularly those in rural areas of the USA. This report describes the development and implementation of a geriatric telepsychiatry consultation service between an academic medical center and a rural PACE program.

APA Honors Innovative Programs in Psychiatric Service Delivery

APA Honors Innovative Programs in Psychiatric Service Delivery