Evaluation Of Mental Health Services Research Articles

Health through the eyes of youths: a qualitative study.

Emerging definitions of health have suggested a shift in focus to one's ability to manage their health condition, function, and social determinants of health. The construct of health for youths with mental health and substance use disorders (MHSU) is complex and multi-dimensional with interplay between biological, behavioral, and social conditions. Expanding definitions of health is crucial in the measurement of health and evaluation of integrated youth services (IYS) systems for people with MHSU disorders. Hence, it is critical to understand the construct of health from the perspective of a young person living with a MHSU disorder. This study was conducted using inductive thematic analysis. Three focus groups were conducted from July to August 2017. A total of 22 youths (17-24 years) took part in this study. Results showed that health is a multidimensional construct situated in the ecosystem of a person's environment. Health can be understood from two macro themes: Individual health and Determinants of health. It consisted of physical health, mental health, day-to-day functioning, and being in control of your own health condition. Systemic and social factors were factors that influenced the state of health. This study contributes to a conceptualization of good health in youth with MHSU disorders. This conceptualization can aid in the development of more accurate measures of health and functioning and the evaluation of mental health services for youth with MHSU.

Evaluation of mental health services delivered before and after the introduction of pilot Mental Health Centers in Poland using monitoring indicators.

The study assessed the performance of Mental Health Centres compared to previous non-integrated mental health facilities. The study used National Health Fund (NHF) data of individuals over 18 years treated in 27 centres (January 2017 - February 2020). Performance indicators from 19 months before (N = 124,497) and after the introduction of Mental Health Centres (N = 182,789) were compared for outpatient care, community treatment teams, inpatient wards and day wards. The total number of patients who received mental health care increased, compared to before the establishment of those Centres; whereas the number of hospitalisations decreased by 6% and the number of patient days per person decreased by 9%. Day care saw a 14% increase in admissions following the introduction of Mental Health Centres, with a 5% decrease in patient days per person. The proportion of patients in community care increased by 86%, in outpatient care by 62% and in day care by 14%. The number of first-time patients after the introduction of Mental Health Centres increased and the number of follow-up patients decreased. For all groups of mental disorders, the priority indicator in inpatient care decreased, while increasing in outpatient and community care for most groups of disorders. The results confirmed the effectiveness of the National Mental Health Protection Programme project in relation to the availability and reduction of inpatient treatment through Mental Health Centres. The methodology used in this study can be used for assessing the effectiveness of Mental Health Centre activities in subsequent stages of the pilot.

Development and content validity of the Person Experiences Interview Survey (PEIS): a measure of the mental health services experiences of people with developmental disabilities.

People with developmental disabilities and mental health service experiences have a right to be included in healthcare decisions, including the evaluation of their mental health services and providers. However, few self-report measures address this need. This study aimed to fill this gap by developing and evaluating the content validity, including comprehension, relevance, and comprehensiveness, of the Person Experiences Interview Survey (PEIS) with people with developmental disabilities and mental health experiences. The research team established a measurement framework based on the Family Experiences Interview Survey (FEIS), resulting in 21 PEIS items that were written in collaboration with young adults with developmental disabilities and mental health service experiences. Comprehension, relevance, and comprehensiveness were evaluated through cognitive interviews with people with developmental disabilities and mental health service experiences (respondents; n = 9) ages 23-49 years. Comprehensiveness and relevance were also evaluated in focus groups with family caregivers (n = 9) and mental health providers (n = 10) who serve this population. Two researchers independently coded open-ended responses to the PEIS for comprehension. A content validity index (CVI), indicating relevance, was calculated for each participant group for each item, and comprehensiveness was rated for item sets. Fifteen of the 21 items met the criteria of ≥80% comprehension, with 89-100% of responses containing all or some intended information. All items met the CVI ≥80% criterion in at least two of the three groups. In all item sets, between 1 and 4 family members or providers felt one question was missing. Respondents used the response scale in a manner that corresponded with their open-ended descriptions, and family caregivers and providers had positive feedback about the response scale's visual cues and number of choices. Using these findings, four items were removed and six items were revised, resulting in a 17-item measure. This study presents a novel and promising measure, the Person Experiences Interview Survey (PEIS). It also demonstrates that the employment of accessible methods allows people with developmental disabilities to meaningfully evaluate mental health services and providers. The PEIS shows great promise for application in the field by engaging those directly involved in the evaluation of mental health services and providers.

Tele-psychotherapy during the COVID-19 pandemic: a mini-review.

The COVID-19 pandemic has dramatically changed psychotherapy practices. Psychotherapy around the world has shifted from predominantly face-to-face settings to overwhelmingly online settings since the beginning of the pandemic. Many studies have been published on this topic, but there has been no review of the literature focused on the experience of psychotherapists. Our goal was to identify the challenging issues of teletherapy, including the efficiency of online consultations and the extent to which they are accepted by therapists and patients. A PubMed literature search using the [("Teletherapy" OR "Telebehavioral health" OR "telepsychotherapy") AND ("COVID-19")] search string retrieved 46 studies focused on mental health professionals, as detailed in a PRISMA flow diagram. Two reviewers independently screened the abstracts and excluded those that were outside the scope of the review. The selection of articles kept for review was discussed by all three authors. Overall, the review contributes to the description and evaluation of tele mental health services, including teletherapy, online counseling, digital mental health tools, and remote monitoring.

How can practitioner action research support the design, implementation, and evaluation of on-campus mental health and addiction services?

ABSTRACT In every sector, the COVID-19 pandemic has highlighted the importance of mental health resources for wellbeing. Although scholars have long recognized the interdependent relationship between academic success and positive mental health, research that can be used to guide mental health service design and delivery in post-secondary institutions is relatively unexplored. Further, the experiences of practitioners, in their day-to-day operations toward understanding and responding to student mental health problems, are an under-recognized source of data that can contribute to more effective planning and implementation. The objective of this project is to use practitioner action research principles to design, implement, and evaluate a mental health and addiction services plan at Brock University in Ontario, Canada. This paper details what occurred in the plan-act-observe-reflect cycles as practitioners gathered qualitative data using interviews and the World Café methodology. Results show improvement in student satisfaction ratings with on-campus mental health services. Our experience reveals that practitioner action research is a useful framework for practitioners seeking a systematic process to contribute to both fields of knowledge and fields of practice.

COVID-19 infection at a psychiatric hospital in KwaZulu-Natal, South Africa: Clinical service planning and challenges.

South Africa had over 4 million cases of coronavirus disease 2019 (COVID-19) infections and more than 1 million COVID-19-related deaths. Despite the devastating psychological impact of the COVID-19 pandemic, there is little qualitative, critical evaluation of government mental health services in this resource-limited setting. The authors describe the clinical service plan and response to the COVID-19 pandemic at a government psychiatric hospital. KwaZulu-Natal, South Africa. A descriptive narrative overview of the specialised psychiatric hospital's clinical response (April 2020 - March 2021) to the COVID-19 pandemic was undertaken in the following domains: screening policy; testing and swabbing policy; staff training and monitoring; and restructuring the wards to accommodate mental health care users (MHCUs) with suspected cases of COVID-19. The in-depth narrative reviews led to the introduction of staff training, routine COVID-19 reverse transcription polymerase chain reaction (RT-PCR) testing of all MHCUs, the creation of designated quarantine and isolation facilities and screening of physical health status of patients with COVID-19 prior to transfer being implemented to prevent an outbreak or increased morbidity or mortality. Implementing a service plan early which included staff training, screening and routine COVID-19 testing services for psychiatric admissions in a rapidly evolving environment with few additional resources was challenging. The absence of guidelines early in the pandemic that addressed the unique needs of a clinical psychiatric inpatient population is a noteworthy learning point. The article highlights that the inpatient infrastructural requirements and clinical management protocols of acutely psychiatrically ill inpatients, in the context of infectious outbreaks, require dedicated task teams and bespoke policies.

Preliminary evaluation of A Home Within psychotherapy with clients with a history of foster care

Children and youth in foster care often experience numerous traumas both in and out of the child welfare system, and as a result many need access to mental health support. Researchers report low utilization rates of mental health services among individuals who have lived in foster care, often attributed to barriers to both access and receipt of consistent mental healthcare. A Home Within is a national nonprofit organization that aims to reduce these barriers to mental healthcare for those with past or current involvement in foster care by facilitating their access to consistent pro bono psychotherapy for “as long as it takes.” Eighty-five A Home Within therapists completed interviews with trained research assistants at two time points. Interviews included 44 closed- and open-ended questions regarding therapist demographics, client demographics, clients’ presenting concerns and mental health status, and treatment description. Repeated measures analysis of variance (ANOVA) models showed significant decreases in all five outcomes from baseline to termination of treatment. The associated effect sizes for length of time in treatment were medium to large for depression, anxiety, conduct disorder, and perpetrating aggression/violence. There was a small to medium associated effect size for peer relationship problems and the effect of time was not significant for cohabitation relationship problems. Findings provide preliminary support for continued development and evaluation of mental health services facilitated through A Home Within among clients currently or previously in foster care.

User-Led Mental Health Service Evaluation: The Contribution of User-Focused Monitoring to Recovery-Oriented Quality Development

User-focused monitoring (UFM) is a method of user-led mental health service evaluation that focuses on strengthening user involvement and developing the quality of services. Despite an increased emphasis on user involvement and the recovery orientation of services, scientific knowledge remains limited regarding how such goals can be realised. In this study, our aim is to explore UFM with a specific focus on how recovery processes are examined through the method in order to discuss how UFM can be developed in order to support a recovery orientation in mental health service evaluation. We sampled 20 Swedish UFM reports for qualitative analysis, and we found that UFM is a promising method for integrating a personal recovery perspective in service evaluations. By being performed peer-to-peer, the method has the unique ability to gather experiential knowledge regarding the situation of service users. UFM especially contributes to exploring service users’ experiences related to social connectedness and user involvement in services. We also discuss how the method can be developed to further support a recovery orientation in UFM. This might be achieved by integrating a process-oriented approach in the evaluations and by including the user informants’ own goals and views on what constitutes meaningful support in UFM. Suggestions for future developments concern incorporating personal recovery perspectives in the training of user monitors and creating structures for aggregating the knowledge produced through UFM.

Self-reported needs of people living with psychotic disorders: Results from the Australian national psychosis survey.

Person-centered care is a collaborative approach to health care. To provide effective, person-centered care to people living with severe mental illness, it is necessary to understand how people view their own needs. The Perceived Need for Care Questionnaire (PNCQ) was used in the Australian National Survey of High Impact Psychosis (SHIP) to deepen understanding and evaluate, at a population level, the needs of Australian adults living with psychotic illness. SHIP participants were 1,825 adults, aged 18–65 years, living with psychotic illness and in contact with public specialized mental health services across Australia in 2010. The survey package included demographic and clinical items, and various scales including the PNCQ appraising a comprehensive range of life domains. Logistic regressions measured the impact that various demographic, clinical and psychosocial independent variables (e.g., loneliness, health-related quality of life, disability, accommodation type) had on the likelihood of inadequately met PNCQ domain-related need. Over two-thirds of people living with psychosis reported at least two areas of unmet need for care despite most being in contact with mental health services. Work or using one's time and socializing, counseling, and self-care domains had the largest proportion of inadequately met needs (range between 49 and 57%). Feelings of loneliness and/or social isolation were significantly associated with unmet needs across all PNCQ domains, except for financial needs. Health-related quality of life was significantly associated with unmet needs across all domains, except for housing needs. Disability was significantly associated with unmet social, occupation (work or time use), housing and medication-related needs. Consumers view their needs for care as unmet across many life areas despite being in contact with mental health services. Loneliness, unmet psychosocial needs, and health-related quality of life appear strongly interconnected and warrant greater attention in the delivery of person-centered care for people living with psychosis. Support to address social, work or time use and housing related needs among people living with psychosis appears less well targeted toward those with disability. Results underscore the link between quality of life, recovery and needs. These inter-relationships should be considered in mental health services research and evaluation.

A Program for Valuing Mental Health Lived Experience in Social Work Education

ABSTRACT Participation and involvement of service users, carers, and families into the design, delivery, evaluation, and development of mental health policy and services is now a standard expectation. As social workers are employed in mental health settings, it is vital that graduates understand and ethically engage with mental health consumers, survivors, ex-patients, and family (CSX + F) in a meaningful and authentic manner. We argue this extends to fostering critical understandings of dominant discourses about distress, trauma, diagnosis, and intervention as a routine component of social work education. The Valuing Lived Experience Program (VLEP) described in this article within the Curtin University School of Allied Health aims to meaningfully embed the voices of people with lived experience of mental distress, trauma, and service use into the education of tertiary students and academics. Lived experience education in social work is vitally important and requires appropriate resourcing, clear purpose and principles, and attention to the democratisation of knowledge in order to achieve epistemic justice. In this article, the authors describe and contextualise the VLEP as a contemporary example of how lived experience in social work education can occur and be developed. IMPLICATIONS Meaningful participation of people with mental health lived experience is important to social work education. Lived experience education needs to be underpinned by clear ethical and theoretical principles for teaching and learning. Programs that rigorously engage with lived experience in mental health education can make a positive contribution to critical understandings of mental distress.

No service is an island: towards an ecosystem approach to mental health service evaluation.

No service is an island: towards an ecosystem approach to mental health service evaluation.

Measuring the quality of mental health services from the patient perspective in China: psychometric evaluation of the Chinese version of the World Health Organization responsiveness performance questionnaire

ABSTRACT Background Despite the large population of patients with mental disorders and the rapid development of mental health services in China, there are few evaluations of Chinese mental health services from the patient perspective. Relevant instruments with robust psychometric properties are lacking. Objective This study aimed to translate, adapt and validate the WHO responsiveness performance questionnaire for measuring the quality of hospital mental health services among Chinese patients. Methods The adaption of the translated questionnaire incorporated experts’ and patients’ opinions. For psychometric testing, 193 outpatients and 168 inpatients completed outpatient and inpatient modules, respectively. Results The adapted questionnaire adhered to the WHO framework of responsiveness domains, and just four items had some wording changes. Item missing rates were below 6%. Both the outpatient and inpatient modules had acceptable internal reliability (Cronbach’s α = 0.837 and 0.730) and most domains had desirable average inter-item correlation coefficients. The confirmatory factor analysis indicated an acceptable model fit for the inpatient module, while some goodness-of-fit indices for the outpatient module were a little outside of the recommended ranges. Except for ‘talking privately’ from the domain of confidentiality (both outpatient and inpatient modules) and ‘waiting time’ from the domain of prompt attention (the inpatient module), factor loadings of all other items were above 0.5. Conclusions The Chinese version of the responsiveness performance questionnaire has acceptable feasibility, reliability, and validity in general and it can be used to measure, assess and improve the quality of mental health services in China.

Adaptation of infant mental health services to preterm infants and their families receiving neonatal intensive care unit services during the COVID-19 pandemic.

Multiple changes and stressors at the family, hospital, and societal levels have resulted from the COVID‐19 pandemic that impact the early social environment of infants in Neonatal Intensive Care Unit (NICU) settings. This manuscript reviews these pandemic‐related adversities, including hospital‐wide visitor restrictions, mask requirements that interfere with caregiver facial expressions, parental anxiety about virus transmission, and reduced support services. We will further describe adaptations to mental health service delivery and approaches to care in the NICU to mitigate increased risk associated with pandemic‐related adversities. Adaptations include integration of technology, staff education and support, and delivery of activity kits to encourage parent–infant bonding. Data was collected as part of routine program evaluation of infant mental health services from one 50‐bed NICU setting and describes family concerns, barriers to visitation, and utilization of mental health services during the pandemic. Concerns related to COVID‐19 rarely emerged as the primary presenting issue by the families referred for infant mental health services from April through December of 2020. However, a number of families indicated that infection concerns and visitation restrictions posed significant challenges to their parenting and/or coping. There were significant discrepancies noted between the visitation patterns of families with public and private insurance. Several adaptations were developed in response to the multiple challenges and threats to infant mental health present during the COVID‐19 pandemic.

18.1 Diagnoses and Treatment After Juvenile Justice Mental Health Service Evaluation

The aim of this poster is to compare diagnoses and medications prescribed in secure juvenile detention before and after evaluation by a trauma-informed mental health service. Participants included all consecutive admissions to New York City secure juvenile detention facilities between September 17, 2015 and October 30, 2016 (N = 1638). A total of 322 participants were referred to a facility-based mental health service for diagnostic evaluation and medication treatment as indicated. Prior historical diagnoses and medication usage were abstracted from history gathered during the evaluation and any other available records. Following evaluation, there were significantly higher rates of diagnoses for disruptive behavioral (73.3% vs 17.1%; p < 0.001), substance-related (52.8% vs 4.7%; p < 0.001), trauma-related (46.3% vs 3.1%; p < 0.001), and depressive (14.3% vs 8.1%; p = 0.008) disorders. There were significantly lower rates for bipolar disorders and non–DSM-5 diagnoses. Prescription rates after evaluation were significantly less for antipsychotics (8.7% vs 35.1%; p < 0.001), psychostimulants (24.5% vs 38.2%; p < 0.001), and mood stabilizers (2.2% vs 9.6%; p < 0.001), and significantly more for sleep aids (14.9% vs 6.2%; p < 0.001). These data are among the first to compare diagnoses and treatment following detention-based treatment with those received prior to admission to juvenile detention. The results highlight the high and inappropriate use of antipsychotics and mood stabilizers. They also show higher rates of trauma-related, depressive, and disruptive behavioral diagnoses following evaluation that support the need for trauma-informed and nonpharmacological treatment in detention. The higher rates of substance-related diagnoses following evaluation underscores the need for substance use treatment programs within juvenile detention.

White House nominates Delphin‐Rittmon, for SAMHSA head

Miriam E. Delphin‐Rittmon, M.D., since 2015 the commissioner of the Connecticut State Department of Mental Health and Addiction Services, was nominated to be assistant secretary for mental health and substance use at the federal Department of Health and Human Services by the White House last week. In her role as SSA (Single State Authority), Delphin‐Rittmon has been committed to promoting recovery‐oriented, integrated and culturally responsive services and systems that foster dignity, respect and meaningful community inclusion. In addition, through her 20‐year career in the behavioral health field, Delphin‐Rittmon has extensive experience in the design, evaluation and administration of mental health, substance use and prevention services and programs, and has received several awards for advancing policy in these areas. Most recently, she received the 2019 State Service Award from the National Association of State Drug and Alcohol Directors and the 2016 Mental Health Award for Excellence from the United Nations Committee on Mental Health.

Inside the black box of youth participation and engagement: Development and implementation of an organization-wide strategy for Orygen, a national youth mental health organization in Australia.

The involvement of young people in the development, implementation and evaluation of youth mental health services, policy and research programs is essential to ensure they are appropriate and responsive to the needs of young people. Despite the increasingly central role that youth engagement and participation plays internationally, such activities are rarely described in detail. This article aims to provide a thorough description of the development and implementation of an organization-wide, 3-year Youth Engagement and Participation Strategy for Orygen, a national youth mental health organization in Australia. A descriptive account of the development and implementation of the Strategy, with detailed examples of programs and initiatives. The Strategy was developed based on available evidence, focus groups with key stakeholders and best practice principles. The implementation of the Strategy resulted in a number of programs being delivered that involved a range of young people from across Australia. Despite being successful overall, a number of challenges were experienced. Ongoing considerations include ensuring diversity of partnerships, 'raising the bar' of youth participation and creating meaningful pathways. Youth participation and engagement within a youth mental health context is best seen as an evolving ambition that must remain flexible to the needs of all stakeholders. Despite some challenges and ongoing fine-tuning, it is possible to successfully implement youth participation and engagement across all areas of youth mental health, including service design and delivery, research and translation, and policy.

Are parents\u2019 geographical origin associated with their evaluation of child and adolescent mental health services? Results from a national survey in Norway

The objective was to assess the association between parents’ geographical origin and their evaluation of outpatient child and adolescent mental health services (CAMHS). Data were collected in a national parent’s experience survey of all outpatient CAMHS in Norway in 2017. Following exclusions, 16,143 parents were part of the study, of which 5932 responded (36.1%). Diagnosis and global psychosocial functional level were collected from the National Patient Register. Multilevel regression was used to assess the association between parents’ geographical origin and parent evaluation of the outpatient CAMHS on ten indicators. Sentiment and content analysis was conducted on open-ended comments from parents. The estimated regression coefficients showed that parents born in Eastern Europe scored the services significantly poorer than parents born in Norway on outcome of treatment (− 7.73, p < 0.01), general satisfaction (− 5.53, p < 0.05), ease of getting in contact with health personnel outside of scheduled appointments (− 17.04, p < 0.001), and knowledge of the services that the child has received at the service (− 10.63, p < 0.001). Parents born in Asia/Africa/South America scored the services similar as Norwegian parents on eight of ten indicators, better on one (waiting time) and poorer on one (ease of getting in contact). Sentiment analysis showed that 54% of the comments from parents born in Eastern Europe were negative, compared to 42% for the Norwegian group and 36% for Asia/Africa/South America. The parents’ evaluation of the outpatient CAMHS were partly associated with their geographical origin, with parents born in Eastern Europe reporting poorer experiences than parents born in Norway.

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

The 11th Australian Rural and Remote Mental Health Symposium Communiqué.

Análise da produção de estudos com métodos mistos na avaliação de serviços de saúde mental

Objetivo: analisar os desenhos de pesquisa de métodos mistos produzidos sobre avaliação de serviços de saúde mental. Método: estudo de análise documental, realizado nos meses de abril a junho de 2019, o qual analisou os desenhos de pesquisas de métodos mistos de avaliação de serviços de saúde mental, realizadas entre 2006 e 2016, por um grupo de pesquisa em enfermagem. Resultados: são apresentados três estudos de métodos mistos de avaliação de serviços de saúde mental da região sul do Brasil, todos desenvolvem-se a partir de uma dinâmica de integração similar. São apresentadas as etapas de integração, os objetivos, a metodologia e os eixos analíticos. Considerações finais: a realização de estudos de métodos mistos possibilitou a identificação de pontos de integração e convergência entre as abordagens quantitativas e qualitativas. Ressalta-se o potencial da metodologia para estudos avaliativos.

The Healthcare Triple Aim in the Recovery Era.

Recovery is the guiding vision of mental health systems and policy. However, skepticism has emerged about whether the paradigm can achieve its sought goals. We argue that embedding recovery within a quality improvement framework, such as the Triple Aim, would increase leverage for systems change and advance recovery practice. The Triple Aim's goals of improving healthcare outcomes, quality, and costs are pertinent to mental health systems, although action is also needed to address the social determinants of health. Accordingly, we propose the recovery-oriented Triple Aim, which could be used to guide policy development and evaluation of mental health services.