Encounter Form Research Articles

GAMEPLANS: A template for robust digital evidence strategy development.

Law enforcement officers should now expect to encounter forms of digital evidence at most of their inquiries, and as a result ensure they are prepared to effectively deal with it. This should involve the production of a digital evidence strategy (DES) which describes those actions required of any investigative team to effectively identify, collect, examine, and evaluate any digital devices/data, while also defining the circumstances for when it is appropriate to conduct such tasks. To help officers to produce robust DESs this work provides a DES template which utilizes the "GAMEPLANS" acrostic to identify nine fundamental components that are required of all DESs-"G"-Grounds for investigation; "A"-Authorization; "M"-Method of investigation; "E"-Evaluation of the meaning of any findings; "P"-Proportionality; "L"-Logic; "A"-Agreement; "N"-Necessity; "S"-Scrutiny. Each of these components are described including the sub-tasks that are contained within each, which any officer constructing a robust and effective DES must address (and provide evidence of having addressed). To support this, a DES template file is also provided, which can be utilized by officers.

Pathways to specialist community perinatal mental health services: a two-site longitudinal retrospective service evaluation.

During pregnancy and the postpartum period, women's mental health can deteriorate quickly. Timely and easy access to services is critically important; however, little is known about the pathways women take to access services. Previous research has shown that women from ethnic minority groups in the United Kingdom experience more access issues compared to the White British women. To describe pathways taken to specialist community perinatal mental health services and explore how they vary across services and ethnic groups. This is a two-site, longitudinal retrospective service evaluation conducted in Birmingham and London during 6 months (1 July-31 December 2019). Electronic records of 228 women were accessed and data were extracted on help-seeking behaviour, referral process and the type of pathway (i.e. simple or complex). Data were collected using the adapted World Health Organization encounter form and analysed using uni- and multivariable analyses. The median time from the start of perinatal mental illness to contact with perinatal mental health services was 20 weeks. The majority of patients accessed perinatal mental health services through primary care (69%) and their pathway was simple, that is they saw one service before perinatal mental health services (63%). The simple pathway was used as a proxy for accessible services. In Birmingham, compared to London, more referrals came from secondary care, more women were experiencing current deterioration in mental health, and more women followed a complex pathway. Despite differences between ethnic groups regarding type of pathway and duration of patient journey, there was no evidence of difference when models controlled for confounders such as clinical presentation, general characteristics and location. The service's location was the strongest predictor of the type of pathway and duration of patient journey. The heterogeneity among categorised ethnic groups; data extracted from available electronic records and not validated with patient's own accounts of their pathways to care; unanalysed declined referrals; the study was conducted before the COVID-19 pandemic and pathways may be different in the post-COVID-19 period. The study provides important insights into how patients find their way to community perinatal mental health services. It shows that there is a great degree of variability in the time taken to get into these services, and the pathway taken. This variation does not come from different needs of patients or different clinical presentations but rather from service-level factors. The studied community perinatal mental health services in the United Kingdom operate with a significant degree of variability in the types and characteristics of patient pathways. Future research should explore these issues on the national and international levels. Additionally, future research should explore the reasons for the different pathways taken and the outcomes and risks associated with them. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/14.

"Instead, You're Going to a Friend": Evaluation of a Community-Developed, Peer-Delivered Online Crisis Prevention Intervention.

Online communities promote social connection and can be used for formal peer support and crisis intervention. Although some communities have programs to support their members' mental health, few programs have been formally evaluated. The authors present findings from a mixed-methods evaluation of the Stack Up Overwatch Program (StOP), a digital peer support intervention delivered in an online gaming community. Data were collected from members of the Stack Up Discord server between June and October 2020 and included chat messages, survey responses, encounter forms (documenting information from private interactions between users and peer supporters), and interviews with peer support team members. The authors analyzed data on demographic characteristics, mental health and crises, use of and experiences with StOP, and chat posts. Thematic analysis and descriptive statistics were combined in a joint display table, with mixed-methods findings explained in narrative form. The findings show that StOP provides users in crisis with a source of mental health support when other options have been exhausted and that military and veteran users valued the connections and friendships they formed while using it. Participants reported that StOP met needs for support and connection when formal services were inaccessible or did not meet their needs, and volunteer peer supporters detailed how StOP's design facilitates use of the intervention. Volunteering offered members of the peer support team a "family feeling" facilitated by the unique chat room structure. Community-based crisis prevention programs administered through chat rooms may provide valuable support to both users and peer support providers.

Dual diagnosis and their care pathways for help-seeking: A multicenter study from India.

Understanding pathways to dual diagnosis (DD) care will help organize DD services and facilitate training and referral across healthcare sectors. The aim of our study was to characterize the stepwise healthcare and other contacts among patients with DD, compare the characteristics of the first contact persons with common mental disorder (CMD) versus severe mental illness (SMI), and estimate the likelihood of receiving appropriate DD treatment across levels of contacts. This cross-sectional, descriptive study in eight Indian centers included newly enrolled patients with DD between April 2022 and February 2023. The research spans varied geographic regions, tapping into regional variations in disease burden, health practices, and demographics. The study categorized healthcare contacts by using the WHO Pathways Encounter Form. The sample (n = 589) had a median age of 32 years, mostly males (96%). Alcohol was the most common substance; SMI (50.8%) and CMD were equally represented. Traditional healers were a common first contact choice (18.5%); however, integrated DD care dominated subsequent contacts. Assistance likelihood increased from the first to the second contact (23.1% to 62.1%) but declined in subsequent contacts, except for a significant rise in the fifth contact (97.4%). In the initial contact, patients with CMD sought help from public-general hospitals and private practitioners for SUD symptoms; individuals with SMI leaned on relatives and sought out traditional healers for psychiatric symptoms. Recognizing the cultural nuances, advocating for integrated care, and addressing systemic challenges pave the way to bridge the gap in DD treatment.

Alcohol Dependence Care Pathway for Psychiatric Settings: A Cross-sectional Study from an Urban Psychiatric Center

Background: Alcohol use remains an important contributor to morbidity and mortality. There is a long-time gap between the onset of alcohol use and first contact for care. Poor referral systems and reduced awareness contribute to such delays. Yet few studies analyzed pathways to care exclusively in alcohol-dependent patients. Aims: The aim of this study was to understand the pathways traversed by alcohol-dependent patients before their access to psychiatric services and their association with sociodemographic and clinical characteristics. Methods: A cross-sectional study design was employed. All alcohol-dependent patients attending psychiatric outpatient department setting were recruited. Questionnaires including sociodemographic details, the Short Alcohol Dependence Data Questionnaire, and the World Health Organization encounter forms were used. Appropriate statistical tests were done using SPSS 20. Results: A total of 99 patients were inducted into the study. 44.44% consulted psychiatric services directly. There was a mean time lag of 15 years between the onset of alcohol use and first contact. There was a significant association between sociodemographic characteristics and the pathway chosen. Higher severity of dependence and longer duration of alcohol use were associated with patients visiting psychiatric services indirectly. The main source of referral was family members for the first contact and medical practitioner for a referral to psychiatric services. Conclusion: Understanding the pathway traversed is critical to planning effective interventions in alcohol-dependent patients. Sociodemographic variables seem to be important predictors for the pathway traversed. Although the referral system by medical practitioners is satisfactory, there is a huge gap in accessibility to psychiatric services. There is a need for community awareness programs to prevent time lag.

Exploring help-seeking pathways and disparities in substance use disorder care in India: A multicenter cross-sectional study.

Substance use disorders (SUDs) are among the leading causes of morbidity in the population. In low- and medium-income countries like India, there is a wide treatment gap for SUD. A multicentric study on the care pathways for SUD in India can help to understand service provision, service utilization, and challenges to improve existing SUD care in India. We aimed to map pathways to care in SUD. We compared the clinical and demographic characteristics of patients who first consulted specialized services versus other medical services. This was a cross-sectional study of consecutive, consenting adults (18-65 years) with SUD registered to each of the nine participating addiction treatment services distributed across five Indian regions. We adapted the World Health Organization's pathway encounter form. Of the 998 participants, 98% were males, 49.4% were rural, and 20% were indigenous population. Addiction services dominated initial (50%) and subsequent (60%) healthcare contacts. One in five contacted private for-profit healthcare. Primary care contact was rare (5/998). Diverse approaches included traditional healers (4-6%) and self-medication (2-8%). There was a 3-year delay in first contact; younger, educated individuals with opioid dependence preferred specialized services. There is a need to strengthen public healthcare infrastructure and delivery systems and integrate SUD treatment into public healthcare.

Physiologic measurements of cognitive load in clinical reasoning.

Cognitive load is postulated to be a significant factor in clinical reasoning performance. Monitoring physiologic measures, such as heart rate variability (HRV) may serve as a way to monitor changes in cognitive load. The pathophysiology of why HRV has a relationship to cognitive load is unclear, but it may be related to blood pressure changes that occur in a response to mental stress. Fourteen residents and ten attendings from Internal Medicine wore Holter monitors and watched a video depicting a medical encounter before completing a post encounter form used to evaluate their clinical reasoning and standard psychometric measures of cognitive load. Blood pressure was obtained before and after the encounter. Correlation analysis was used to investigate the relationship between HRV, blood pressure, self-reported cognitive load measures, clinical reasoning performance scores, and experience level. Strong positive correlations were found between increasing HRV and increasing mean arterial pressure (MAP) (p=0.01, Cohen's d=1.41). There was a strong positive correlation with increasing MAP and increasing cognitive load (Pearson correlation 0.763; 95 % CI [; 95 % CI [-0.364, 0.983]). Clinical reasoning performance was negatively correlated with increasing MAP (Pearson correlation-0.446; 95 % CI [-0.720,-0.052]). Subjects with increased HRV, MAP and cognitive load were more likely to be a resident (Pearson correlation-0.845; 95 % CI [-0.990, 0.147]). Evaluating HRV and MAP can help us to understand cognitive load and its implications on trainee and physician clinical reasoning performance, with the intent to utilize this information to improve patient care.

Water insecurity is associated with gender-based violence: A mixed-methods study in Indonesia

Gender Based Violence (GBV) is a global pandemic and water insecurity is increasing in intensity and extent. This study explores the association between these two global health threats. Cross-sectional, quantitative data were collected via surveys (n = 365 adult women) to measure household water insecurity (HWI) and women's experiences of GBV in the last year. Qualitative data were collected from semi-structured interviews (n = 24 men and women), two focus group discussions (n = 25 men and women) and a multi-stakeholder meeting (n = 35 men and women) to explore experiences, attitudes and risk factors associated with HWI and GBV. Multivariate logistic regression analysis showed that women in water insecure households were more than twice as likely to report experiencing GBV in the last year (OR = 2.2, CI: 1.0–4.9, p = 0.051). Examining household water insecurity scores as a continuous variable revealed an increased odds of reporting GBV with each increase in the HWISE score (OR = 1.1, CI: 1.0; 1.1, p < 0.001). Qualitative data indicates that the intersection between HWI, a patriarchal social organization and a caste system produced water-related conflicts between intimate partners, between daughters-in-law and their in-laws, and between masters and enslaved women. These results are presented using an integrated theoretical framework – a Feminist Political Ecology of Health (FPEH) – to illustrate the many ways women encounter and experience multi-dimensional forms of violence across scales in connection to water insecurity. The combination of robust qualitative and quantitative data presented in this study suggests that HWI may be causally related to GBV in this context.

Reflections of Black Married Working Mothers Managing Occupational Roles and Racism.

Black married working mothers encounter forms of racism, on the job and in society. However, little attention is given to how these experiences affect their work and family lives. Qualitative thematic analysis was used to examine the narratives of 91 Black women, aged 20 to 55 years, to explore the effects of racism on their key occupational roles of wife, employee, and mother. Four major themes emerged for being a Black employee. Two themes were linked to Black mothering. Five themes were identified for being a Black wife. Also, two new culturally derived occupational roles emerged: advocate and pioneer. Findings suggest that Black married working mothers have unique transformative experiences in their occupational roles solely due to their minoritized status, which impacts their wellbeing. Occupation-based research should focus on racism's impact on the wellbeing of minoritized groups as they engage in desired and meaningful occupational roles.

Quality of life, social support, and pathways of care among persons with psychiatric disorders—A cross-sectional study

Background: Patients with psychiatric disorders have varied psychosocial realities embedded in the community context. Help-seeking behavior is extremely crucial in determining the prognosis and outcome of interventions. Objectives: (1) To assess the levels of quality of life, perceived social support, and decision to first seek help. (2) To assess the association of socio-demographic variables with these domains. Materials and Methods: A cross-sectional descriptive survey with 100 psychiatric patients in a tertiary care setting employed three scales, namely WHOQOL-BREF, PSSS, and WHO Pathways Encounter form. Results: Patients had higher levels of quality of life and perceived social support. The majority of patients chose health professionals over faith healers at the onset of symptoms, had higher reliance on family members, and continued with hospital visits till the third follow-up. Sex, occupation, and marital status were associated with perceived social support, and duration of illness was associated with help-seeking behavior. Conclusions: Community-based interventions must include holistic services and reduce the gap between onset and first contact, leading to higher quality of life and perceived social support.

Original Research: Can a Palliative Care Lay Health Advisor–Nurse Partnership Improve Health Equity for Latinos with Cancer?

ABSTRACT Purpose: A palliative care infrastructure is lacking for Latinos with life-threatening illness, especially in rural regions of the United States. The purpose of this study was to develop and evaluate a community-based palliative care lay health advisor (LHA) intervention for rural-dwelling Latino adults with cancer. Methods: An exploratory mixed-methods participatory action research design was carried out by an interprofessional research team that included community and academic members. Fifteen Latino community leaders completed a 10-hour palliative care training program and then served as palliative care LHAs. Although 45 Latinos with cancer initially agreed to participate, four withdrew or died and six were not reachable by the LHAs, for a final total of 35 patient participants. The trained palliative care LHAs delivered information on home symptom management and advance care planning to assigned participants. Palliative care nurses led the training and were available to the LHAs for consultation throughout the study. The LHAs made an average of three telephone calls to each participant. The Edmonton Symptom Assessment System–Revised (ESAS-r) and the four-item Advance Care Planning Engagement Survey (ACPES-4) were administered pre- and postintervention to determine the intervention's effectiveness. Encounter forms were transcribed, coded, and analyzed using case comparison. Results: The major finding was that significant improvements were shown for all four items of the ACPES-4 among both the LHAs (posttraining) and the participants (postintervention). Information on advance care planning was shared with 74.3% of the 35 participants. Participants showed clinical improvement in physical symptom scores and clinical deterioration in emotional symptom scores following the intervention, although these changes did not reach statistical significance. The advisors noted that participants were anxious about how to explain cancer to children, the uncertainty of their prognosis, and medical expenses. This sample was younger than those of other cancer studies; 51.4% were under age 50 and 73.1% had at least one child in the home. Conclusions: A community-based palliative care LHA–nurse partnership was shown to be a feasible way to engage in conversations and deliver information about advance care planning to rural-dwelling Latino adults with cancer. The positive results led to the regional cancer center's decision to select “cultural care” as its 2022 goal for maintaining its accreditation with the Commission on Cancer.

Barriers and facilitators to seeking care for persons with acute brain infections: a cross sectional study

Background: Acute brain infections including encephalitis are less common but serious conditions characterized by the inflammation of the brain requiring immediate accurate diagnosis and management. For many infections appropriate therapies exist, but the outcome is often less desirable because of failure to receive appropriate treatment on time due to multiple factors. The aim of the study was to understand the barriers and facilitators towards receiving care for persons with acute brain infections in a low resource setting. Methods: The study design was cross sectional exploratory study. Consecutive patients presenting to neurology department of a tertiary referral care center for Neuropsychiatry in South India from July 2020 to September 2020 with the diagnosis of acute brain infections were assessed using the modified Kuppuswamy scale, Glasgow coma scale, the pathway scale: encounter form, patient centered health services in India and client socio-demographic and service receipt inventory. Results: A total of 110 participants, both male and female, were recruited for the study. The average age was 39.64±16.5 years, with more female (65.45%) representation. 29% of individuals reported continued use of traditional practices while seeking care for the brain infections. Costs associated with care increased with the increase in duration of infection. There are major barriers and facilitators which either prohibit or facilitate care for persons with acute brain infections. Conclusions: Acute brain infections continuing to be a public health challenge in developing country context, and the recognition that the delay in treatment causes significant disability, it becomes imperative to focus on the social, cultural, economic, environmental factors to understand the barriers and facilitators to health seeking among this population.

Pathways to care in alcohol use disorders: A cross-sectional study from a tertiary hospital in South India

The study examined the pathway patients with alcohol use disorders followed to access tertiary care psychiatry services. We assessed 110 patients and one family member for each patient who sought psychiatry care for alcohol-related problems for the first time using the WHO encounter form. Only 5.5% of patients followed a direct pathway. The rest reached the tertiary hospital after third, fourth, and fifth encounters with other service providers such as traditional and faith healers, medical practitioners, and general hospitals. Although the family decided to seek the first consultation, medical professionals played a pivotal role in referring patients to psychiatry care.

Impacts of the COVID-19 Pandemic on a Community-Based, Palliative Care Lay Advisor Project for Latinos with Cancer

The COVID-19 pandemic posed challenges to a community-based participatory research (CBPR) project for rural-dwelling adults with cancer in eastern North Carolina. This project trained Latino community leaders as palliative care lay advisors (PCLAs) to deliver information on cancer symptom management and advance care planning (ACP). Pandemic impacts were assessed using data from team meetings and fieldnotes, journal memos, online booster sessions, participant encounter forms and digital correspondence. Three key results were: 1) the disproportionate effects of COVID -19 on PCLAs and their communities; 2) the need for a major study redesign that extended the recruitment region and changed the mode of intervention delivery; and 3) the adoption of new channels of communication. Online discussions and in-person meetings with PCLAs sustained engagement, resulting in a two-year, 73 percent retention rate, and addressed community concerns about COVID-19. Applied outcomes included the selection by the regional cancer center of a 2022 goal to improve cultural care for Latinos and the empowerment of PCLAs as community advocates. The challenges created by COVID-19 were met by the study team’s ongoing commitment to CBPR principles, flexible adaptations to a changing environment, and strong relationships forged with community members and advocacy groups.

Forum: Searching for a Global Solidarity: A Collective Auto-Ethnography of Early-Career Women Researchers in the Asia-Pacific

Abstract This forum critically reflects on discrimination faced by early-career women international relations (IR) scholars in the Asia-Pacific region in their workplaces and beyond. By taking a self-ethnographic perspective, six contributors from five countries provide an engaging overview of difficulties they face in their everyday lives. Against the backdrop of this diverse and globalizing region, the contributors are all academic migrants in search of employment and learning opportunities within the Asia-Pacific region and beyond. They lead migratory lives by frequently crossing ideational and material boundaries to contribute to a more diverse IR knowledge base, and they encounter numerous difficulties and forms of discrimination. This forum has two aims. First, in reflecting on the contributors’ own lived experiences, it highlights the diversity of issues faced by early-career women scholars in this region. Second, it calls for novel, more inclusive forms of solidarity that appreciates diversity as plurality across any divides.

Change in attitude and help-seeking pattern of caregivers and patients with mental disorders in the community - Recent findings from India.

The researchers utilised a cross-sectional study design. A face-to-face interview was used to collect data using the WHO Encounter Form. Using a successive sample technique, patients with various diagnoses of mental illness undergoing Psychiatry outpatient therapy at a tertiary care medical college were included in the study. In terms of gender, ladies (53.3%) were seen to use psychiatric services more than males (46.7%) from an urban or semi-urban background. For dissociative disorders, the median time from onset to first contact with a care provider was 0.1 years; 0.3 years for mood episodes; 0.6 years for anxiety disorders; one year for psychotic disorders; and seven years for Substance Use Disorders (SUD). However, interaction with current psychiatric services took an average of six months for dissociation; 3.5 years for mood disorders; three years for anxiety disorders; six years for psychotic disorders; and a maximum of seventeen years for SUD. Participants in the study who had a family history of mental illness sought care more quickly (OR = 4.3, 95 percent CI 1.19 to 7.11, P = 0.03). The fact that 73 percent of patients have a GP or mental health professional as their first point of contact for various mental diseases is good. Higher education status, urban background, dwelling closer to the mental health centre, and having a biological attribution model for psychological illness were the other clinical and demographic characteristics important for quicker paths to mental health treatment. In most cases of psychosis and SUD (substance use disorders), there is still a significant delay in receiving modern psychiatric therapy. The number of initial contacts with Native Healers ha s decreased. The majority of people said mental illness was caused by environmental or biological factors. Education and scientific information regarding mental health have aided the process of seeking treatment, and there should be a provision of training programmes for family physicians and community health professionals to facilitate the process of help-seeking behavior of psychiatric patients in the Indian subcontinent.

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Background:Psychotic disorders carry a substantial burden on public health. There is divergence between high burden of mental illness and comparatively low likelihood of obtaining treatment. Hence, concept of pathway to care is being studied where the help seeking behaviour of patient and family; subsequent accessibility to health care services are evaluated.Aim:To find out pathways of help-seeking behaviour and to assess the association of socio-demographic, clinical and health care service factors with pathway of care of patients with psychotic spectrum disorders.Methodology:A cross sectional study was conducted on patients presenting to psychiatry OPD, KIMS, Hubballi diagnosed with schizophrenia and other psychotic spectrum disorders (as per ICD 10, F20-29). A semi-structured proforma was used to obtain socio-demographic, clinical details of the patient based on WHO encounter form.Results:A total of 60 cases of first episode psychosis were assessed. Mean age of the patients was 33.87±10.94 years. Majority of them were females, belonged to rural background and were married. Mean duration of psychotic illness was 7.5 months. Majority of them 55% had first contact with a faith healer. Only 18.3% had their first contact to a psychiatrist. On an average, the first contact ever was initiated after 2 months of illness onset.Conclusion:Referral to psychiatric services is often delayed leading to increased duration of untreated psychosis and burden of care. The service providers and policy makers’ needs to be sensitised about appropriate and accessible psychiatric services, providing easy and favourable pathway of care for psychiatric patients.

Pathways to mental health care in Nepal: a 14-center nationwide study

BackgroundPathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes.MethodsThis was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed.ResultsMost of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt.ConclusionsFaith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.

Pathways to care and supernatural beliefs among patients with psychotic disorders in Nepal

BackgroundLonger pathways to care worsen the course of psychotic illness as well. The study aimed to assess the pathways to care, supernatural beliefs, and impact on the duration of untreated psychosis in patients with schizophrenia. It was a cross-sectional, observational study that involved 133 patients and their caregivers. Supernatural Attitude Questionnaire and World Health Organization Encounter form for Pathways to care were used to evaluate the pathways to care, supernatural beliefs in caregivers, and duration of untreated psychosis. SPSS descriptive and non-parametric tests were used for analysis.ResultsOverall, 59.4% of the participants had a non-medical person as the first treatment contact. Duration of untreated psychosis (DUP) for the whole study sample was 6.04 (SD 15.14) months and when it was compared among the first contact with a medical person (mean 4.43; SD 14.39) and non-medical person (mean 7.15; SD 15.63), the later had significantly longer (Mann-Whitney U = 1278; p < 0.001) DUP. More than half of the patients had one or more supernatural beliefs. Having supernatural beliefs and carryout rituals related to these beliefs is associated with a higher number of visits to different professionals before reaching a psychiatrist.ConclusionsPatients with psychosis and their caregivers seek first help from non-medical persons, especially faith healers. This is associated with a longer duration of untreated psychosis and supernatural beliefs in caregivers. Thus, there is a need to improve mental health literacy and have public awareness programs to address the belief systems and clarify the prevailing myths in society.

“I’m also prepared to not find me. It's great when I do, but it doesn't hurt if I don't”: crip time and anticipatory erasure for disabled archival users

Using data collected through semi-structured interviews with disabled archival users, this article foregrounds disabled people's relationships with time, specifically to pasts and representations thereof in archival material. It illustrates the ways in which disabled people use their knowledge of how disability is understood—in archives and in society—to anticipate their erasure in archival material. First, focusing on the past, this data illustrates the prevalence of disability stereotypes, tropes, and limited perspectives within the records that document disabled people. Second, in witnessing such representations (or lack thereof), disabled researchers described how they are affectively impacted in the present moment: witnessing the violence of the past is emotionally difficult for many disabled people researching their histories. Third, using past experiences of archival erasure, interviewees described coming to expect and anticipate future absences—anticipation as an affective mode helped them prepare to encounter forms of erasure, to protect themselves against possible harms, and to hope for something different, all of which reflects their experiences of how disability is understood in society. This data reflect the way anticipation is a central facet of crip time—the multiple ways that disabled people experience time, pace, and temporal moments—to show how disabled people feel through multiple temporal landscapes and approach historical and archival representation.