Mental Health Foundation Research Articles

The Experience of International Medical Graduates (IMGs) at Birmingham and Solihull Mental Health Foundation Trust (BSMHFT): A Quality Improvement Project

The Experience of International Medical Graduates (IMGs) at Birmingham and Solihull Mental Health Foundation Trust (BSMHFT): A Quality Improvement Project

Reducing Emergency Prescriptions (FP10s) Requiring Electronic Shared Care Agreement (ESCA) by North Hub Community Mental Health Team (CMHT), Birmingham & Solihull Mental Health Foundation Trust (BSMHFT)

Reducing Emergency Prescriptions (FP10s) Requiring Electronic Shared Care Agreement (ESCA) by North Hub Community Mental Health Team (CMHT), Birmingham & Solihull Mental Health Foundation Trust (BSMHFT)

Understanding the Importance of Balanced Nutrition: Steps to Optimal Health

This article underscores the importance of balanced nutrition as the foundation of optimal health in an era of modern lifestyles and varied diets. Proper nutrition contributes to physical and mental health, and prevents chronic diseases such as obesity, diabetes and heart disease. Understanding the essence of balanced nutrition is considered the first step towards optimal health. The proposed research methodology includes literature analysis, population surveys, and interviews with nutritionists to understand the understanding and implementation of balanced nutrition. The results are expected to generate practical guidelines to promote a balanced diet. Balanced nutrition is considered an important foundation for physical and mental health, supporting organ function, healthy growth, a strong immune system, and preventing chronic diseases. It is also important during the growing years of children and adolescents, and plays a role in mental health by reducing the risk of depression and anxiety. Overall, understanding and implementing balanced nutrition is expected to help individuals and communities build healthy and sustainable lifestyles, improving physical, mental health and productivity.

Effects of social-ecological risk factors and resilience on the relationship between metabolic metrics and mental health among young adults

The correlation between metabolic metrics and mental health remains underexplored, with few in-depth studies examining whether this association exists among college students and whether it might be moderated by socio-ecological risk factors (SERFs) and mediated by resilience. A follow-up study design investigated the association between baseline metabolic metrics, SERFs and resilience and mental health. A multivariable linear regression model using the PROCESS method established the relationship of SERFs, resilience and metabolic metrics with mental health. Participants were 794 adolescents (mean age: 18.64 [±0.90] years). In multivariable linear regression, the high-level SERFs (β = 0.124), resilience (β = −0.042), LCI (β = 0.072), and RFM (β = 0.145) were associated with higher depression symptoms, while CVH (β = 0.602), TyG (β = 0.295), TyG-BMI (β = 0.004), and RC (β = −0.041) were not. An association was also observed between SERFs, resilience, RFM and anxiety. Resilience mediated the relationship between metabolic metrics and depression and anxiety, and SERFs moderated this relationship, demonstrating the relationship between resilience, metabolic metrics, SERFs and mental health. By revealing the potential sociological mechanism underlying the relationship between metabolic metrics and adolescents’ mental health, this study provides a theoretical basis for further exploration of the biological foundations of mental health.

Shifting Paradigms

Shifting Paradigms

Using imagery for acceptance and wellbeing in sport

Abstract The purpose of this article is to offer background and strategies to utilize mental imagery to enhance acceptance as a significant foundation for mental health and wellbeing in athletes. Sport possesses many threats to participants’ mental health and ability to flourish, including unrealistic expectations, pressure from others, and training demands. Although acceptance has been shown to be an important precursor to wellbeing, the prescribed culture of mental toughness in sport teaches athletes to be nonaccepting of mistakes and negative outcomes which often threaten their mental health. Athletes need to be educated and trained to practice acceptance as a strong, mature, mentally healthy response in terms of their self-perceptions, perceptions of others, and responses to external events. Mental imagery has a strong association with emotion and has been successfully used as an intervention technique to enhance physical and mental health. However, acceptance has not been an outcome of interest in most imagery interventions related to mental health, and future research on interventions to enhance acceptance is warranted. Some strategies and examples of using mental imagery to build acceptance and wellbeing are suggested.

Mental Health Outcomes for Young People Accessing Individual Placement Support Services: A Cohort Study.

Mental health problems and vocational disengagement are often linked for young people in a self-reinforcing cycle. Integrated Individual Placement and Support (IPS) services can help to not only overcome educational/vocational challenges but also improve mental wellbeing. In a matched cohort study, we compared improvement rates in mental health and wellbeing outcomes for young people aged 15 to 25 who had received at least two integrated IPS services with those who had received standard youth mental health services only. Data came from headspace, Australia's National Youth Mental Health Foundation. The sample comprised 2128 participants: 544 received integrated IPS services; 1584 received standard mental health services. Four out of five IPS clients (81%) achieved positive outcomes on at least one of three mental health measures, a significantly higher proportion than matched clients who received standard services (75%). Logistic regressions estimated a 22% to 36% higher likelihood of achieving significant improvement for IPS clients. Greater improvements were evident for quality of life and potentially psychosocial functioning, but not psychological distress. Integrating an IPS program within a clinical setting not only achieves positive vocational outcomes, but also supports improvements in quality of life, psychosocial functioning and psychological distress that are greater or equal to the outcomes achieved through standard clinical care.

Depression as a Terminal Illness – is there a place for palliative care?

In 2020, there were 5,224 suicide deaths registered in England and Wales [1]. The Mental Health Foundation reports that ~70% are in patients with depression [2]. The number of attempted suicides is much higher– South West London and St George’s Mental Health Trust estimates that at least 140,000 people attempt suicide in England and Wales every year [3]. In suicidal depression, the psychological pain is often unbearable and feels overwhelmingly incompatible with life. One is no longer living; they are merely surviving and eventually, the exhaustion will lead to decompensation. This is marked by suicide. The goal is to end the suffering permanently and this is achieved through death.

OUT to IN: a body-oriented intervention program to promote preschoolers' self-regulation and relationship skills in the outdoors.

Time for movement and outdoor experiences has decreased in children's daily lives. Nevertheless, a growing body of research has shown that body-oriented interventions and outdoor time benefit preschoolers' social-emotional development, a foundation for mental health. OUT to IN is a body-oriented intervention program implemented outdoors, designed to promote preschoolers' social-emotional competence. This study aimed to evaluate the effects of OUT to IN on preschoolers' self-regulation and relationship skills. A cluster randomized trial with multi-method and multi-informant assessment was implemented including 233 children between 3 and 6 years (122 boys, Mage = 5.07 years), from 4 preschools (8 groups with OUT to IN intervention, 4 groups without intervention - control group). The 153 children allocated to the OUT to IN group participated in biweekly sessions for 10 weeks. OUT to IN sessions followed a body-oriented approach comprising exercise play, relaxation, and symbolization activities, implemented outdoors by a psychomotor therapist and the preschool teacher. Sessions enabled children to feel, observe and control their bodily states and understand the relationship between their bodies and emotions. Teachers participated in a brief course and on 20 biweekly relaxation sessions. Children's self-regulation was measured through specific tasks and a parent questionnaire. Relationship skills (i.e., empathy, communication, cooperation and sociability) were measured through parents' and preschool teachers' questionnaires. Mann-Whitney test was used to study differences at baseline between the OUT to IN group and the control group, and to study differences in the 10-week changes between both groups. Wilcoxon Test was used for intragroup comparisons. After the 10-week intervention period, children who participated in OUT to IN showed significant improvements on self-regulation and relationship skills (empathy, cooperation and sociability), in comparison to the control group who did not show any significant improvements. Large size effects (η2 > 0.14) were found for most of the variables related to self-regulation and small (η2 > 0.01), medium (η2 > 0.06) and large size effects (η2 > 0.14) were found for the variables related to relationship skills. OUT to IN showed to be an effective body-oriented intervention program in improving children's self-regulation and relationship skills, which are recognized foundations for mental health and well-being.

Exploring mechanisms andcontexts ina Peer Education Project to improve mental health literacy inschools inEngland: a qualitative realist evaluation.

Poor adolescent mental health calls for universal prevention. The Mental Health Foundation's 'Peer Education Project' equips older students ('peer educators') to teach younger students ('peer learners') about mental health. The peer-led lessons cover defining good and bad mental health, risk and protective factors, self-care, help-seeking and looking after one another. While previous pre-post evaluations have suggested effectiveness, the mechanisms through which the intervention improves mental health literacy remain unclear. We purposively recruited seven secondary schools across England from 2020 to 2022 and collected data through five observations, 12 staff interviews and 15 student focus groups (totalling 134 students; 46 peer educators aged 14-18 years and 88 peer learners aged 11-13 years). Our realist analysis adopted retroductive logic, intertwining deductive and inductive approaches to test the initial programme theory against insights arising from the data. We developed Context-Mechanisms-Outcome configurations related to four themes: (i) modelling behaviours and forming supportive relationships, (ii) relevant and appropriate content, (iii) peer educators feeling empowered and (iV) a school culture that prioritises mental health support. Our refined programme theory highlights key mechanisms, contexts conducive to achieving the outcomes and ways to improve training, recruitment and delivery to maximise effectiveness for similar peer-led initiatives.

A qualitative study exploring nurses' experiences of supporting South Asian people with dementia and their family carers.

To explore nurses' experiences of providing support to South Asian (SA) people with dementia and their family carers and to identify barriers and enablers of good transcultural care. A qualitative, phenomenological design was used. Fifteen registered community and in-patient nurses were recruited via one NHS Mental Health Foundation Trust. Nurses were from diverse backgrounds (Black, Ghanaian, Irish, Mauritian and White), 13 females and 2 males, and had been qualified from between 2 and 49 years. One-to-one semi-structured interviews were conducted between July and October 2019. A thematic analysis identified three themes. 'Communication challenges' highlighted the impact of language barriers and the consequences of misunderstandings due to a dissonance in cultural values between nurses and interpreters. 'The bi-directional impact of culture' identified the two-way dynamics of transcultural work, the process of countering mutual stigma, and revealed an original perspective on how 'cultural desire' grows through practice experiences rather than being a prior motivation for learning. 'Learning experiences' showed that most learning was informal, experiential and prolonged, with nurses feeling they had unmet learning needs. Nurses have minimal training opportunities and are under-supported in their transcultural work, potentially perpetuating the disadvantages that SA people with dementia and their families face in relation to healthcare. Enhanced cultural understanding of self and others and application of specific communication strategies could support nurses, together with interpreters, to build rapport and effective working relationships with each other and service users. Transcultural nursing is a key competency, but nurses experience difficulties with providing care which is recognized as effective by SA family carers. The development of more acceptable and effective services requires improved mutual cultural understanding between nurses, interpreters and families, underpinned by joint brief training interventions, leading to more effective professional communication, better care outcomes and improved satisfaction with services.

Truth that Matters

Truth that Matters

Strengthening the HIV prevention cascade to maximise epidemiological impact in eastern Zimbabwe: a modelling study

HIV prevention cascades provide a systematic understanding of barriers to prevention. In this study we used mathematical modelling to understand the consequences of these barriers and how the cascade could be strengthened to maximise epidemiological impact, providing potentially important insights for programmes. We used an individual-based model of HIV transmission (PopART-IBM), calibrated to data from the Manicaland cohort from eastern Zimbabwe. HIV prevention cascade estimates from this cohort were used as probabilities for indicators in the model representing an individual's motivation, access, and capacity to effectively use pre-exposure prophylaxis, voluntary male medical circumcision, and condoms. We examined how current barriers affect the number and distribution of HIV infections compared with a no-barrier scenario. Using assumptions about how interventions could strengthen the HIV prevention cascade, we estimated the reduction in HIV infections over a 10-year period through addressing different elements of the cascade. 21 200 new potentially avertable HIV infections will occur over the next 10 years due to existing HIV prevention cascade barriers, 74·2% of the 28 500 new infections that would occur with existing barriers in a population of approximately 1·2 million adults. Removing these barriers would reduce HIV incidence below the benchmarks for epidemic elimination. Addressing all cascade steps in one priority population is substantially more effective than addressing one step across all populations. Interventions exist in eastern Zimbabwe to reduce HIV towards elimination, but barriers of motivation, access, and effective use prevent their full effect being realised. Interventions need to be multilayered and address all steps along the HIV prevention cascade. Models incorporating the HIV prevention cascade can help to identify the main barriers to greater effectiveness. National Institutes of Mental Health, Bill & Melinda Gates Foundation, and Medical Research Council Centre for Global Infectious Disease Analysis funding from the UK Medical Research Council and UK Foreign, Commonwealth & Development Office (FCDO).

Positive and negative impacts of elexacaftor/tezacaftor/ivacaftor: Healthcare providers' observations across US centers.

Elexacaftor/tezacaftor/ivacaftor (ETI) has been associated with unprecedented clinical improvements, transforming the management of cystic fibrosis (CF). However, side effects with implications for safety and well-being have been reported, including neuropsychiatric changes. This study aimed to better characterize the emerging positive and negative impacts of ETI. The Cystic Fibrosis Foundation's Mental Health Advisory Committee distributed a 26-item survey to US CF care teams to assess clinician observations of patient-reported experiences with ETI. Survey responses measured the prevalence of these effects in five domains: (1) positive physical and psychological effects, (2) sleep difficulties, (3) cognitive difficulties, (4) worsening mental health, and (5) concerns about the future and finances. Seventy-five healthcare providers responded from a pediatric, adult, and combined centers. Positive physical effects of ETI and increased optimism were reported in the upper quartiles (50%-100%) and rated as having a significant impact on daily functioning. Sleep and cognitive difficulties were reported in 1%-24%, with slight impacts on functioning, and psychological symptoms (e.g., increased stress, depression, anxiety) and new psychiatric medications were reported in 1%-24%, with moderate impacts. Concerns about the future were reported in 1%-24%, with minimal impacts. Across US centers, providers most often observed positive physical effects of ETI. However, a variety of negative side effects were also reported, including sleep disruptions and worsening psychological functioning, which should be systematically monitored by CF teams. These national-level data are a first step in evaluating the prevalence and consequences of these side effects and can directly inform future studies.

Placenta DNA methylation levels of the promoter region of the leptin receptor gene are associated with infant cortisol

The intrauterine environment and early life stress regulation are widely recognized as an early foundation for lifelong physical and mental health. Methylation of CpG sites in the placenta represents an epigenetic modification that can potentially affect placental function, influence fetal development, and ultimately impact the health of offspring by programming the hypothalamic-pituitary-adrenal (HPA) axis stress response during prenatal development. Leptin, an adipokine produced by the placenta, is essential for energy homeostasis. It is also epigenetically regulated by promoter DNA methylation. Mounting evidence suggests that leptin also affects the stress response system. Though heterogeneity in the early stress response system may influence life-long mental and physical health, few studies explicitly examine the heterogeneity in the newborn stress response system. Less is known about leptin's association with the human hypothalamic-pituitary-adrenocortical (HPA) axis early in life. This study sought to serve as a proof of concept study investigating the relationship between newborn cortisol output trajectories and placental leptin DNA methylation in 117 healthy newborns from socioeconomically and racially- and ethnically-diverse families. We characterized heterogeneity in newborn cortisol output during the NICU Network Neurobehavioral Scales exam in the first week of life with latent growth mixture models. We then evaluated whether leptin promoter (LEP) methylation in placental samples was associated with newborn cortisol trajectories. Our findings suggest that increased placental LEP methylation, which corresponds to decreased leptin production, is associated with infant cortisol trajectories marked by increased cortisol output in the NNNS exam. These results provide important insights into the role of placental leptin DNA methylation in human newborn HPA axis development and subsequent developmental origins of health and disease processes.

Young Children's Mental Health Improves Following Medicaid Expansion to Low-Income Adults.

We investigate whether the Affordable Care Act's Medicaid expansion, implemented in 2014, improved the mental health of young children whose parents are in the policy's target population. We study children ages 2 to 3 in families with incomes less than 138% of the federal poverty level. We use restricted National Health Interview Survey data covering the United States from 2010 to 2018 to conduct an event study-a flexible version of difference-in-differences-of the Medicaid expansion's effects on Mental Health Indicator values for young children. We estimate effects using ordered logit regression. Children's mental health was statistically significantly better in Medicaid expansion states, compared with non-expansion states, in 3 of 4 post-expansion years. There were no differences between expansion and non-expansion states in the pre-expansion period, lending support to the causal interpretation that the expansion improved children's mental health. While Medicaid expansion targets low-income adults, our evidence indicates it improves low-income children's mental health. The expansion is a two-generation investment in prevention. It helps lay a foundation for strong mental health in children's early years and beyond.

Qalbun Saliim: The Concept of A Clean Heart as A Foundation for Mental Health According to Ibnu Qayyim al Jauziyah

The topic of mental health is being campaigned hotly. It's quite difficult to care for human rights over their mentality because things that are alleged to be strengthening factors for mental health such as wealth, throne, and family on several occasions play the opposite role. This paper tries to offer a solution to the initial phenomenon, by elaborating on the concept of qalbun saliim, or a clean heart in Islam as the foundation for achieving mental health. None other because the heart has an important role in human beings, because if this heart is damaged then the whole human being is damaged. By using qualitative methods (library research) and documentation techniques in data collection, this paper will examine the literature of Ibn Qayyim al Jauziyyah regarding the nature of the creation of the heart, the types of conditions it is in, the diseases that infect it, the healing steps to it, to its urgency for human life. This discussion is interesting to study because the concept of qalbun saliim has not been widely used as a reference by mental health activists.

APA Foundation’s Executive Director Honored With Presidential Award

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPA Foundation’s Executive Director Honored With Presidential AwardSearch for more papers by this authorPublished Online:27 Jan 2023https://doi.org/10.1176/appi.pn.2023.02.2.37AbstractRawle Andrews Jr., Esq.Rawle Andrews Jr., Esq., executive director of the APA Foundation, was presented the President Joseph R. Biden Jr. Lifetime Achievement Award for Volunteer Service in a Washington, D.C., ceremony in January.The award is presented on behalf of Points of Light, AmeriCorps, President Biden, and Vice President Kamala Harris to individuals across the country whose service positively impacts their home communities and inspires others around them to take positive action as well. A minimum of 4,000 hours of volunteer service is required to be eligible for the award.“It is an honor to be counted among the trailblazers and pioneers who have been selected to receive this award,” said Andrews. “The greatest reward of doing good is always seeing its positive impact on the lives of others in the community—together we truly lift one another up. That is why service is, and will remain, a huge part of my life and our work across the APA family.”“It is wonderful to see Rawle Andrews recognized for his long record of service, which we’ve seen shine through in many ways since he joined the Foundation,” said Saul Levin, M.D., M.P.A., APA’s CEO and medical director. “We congratulate him for this honor and for what he achieves through the Foundation for mental health.” ■ ISSUES NewArchived

“I didn't even know headspace had the drug thing until today”: A socio-ecological analysis of access to drug and alcohol interventions in integrated youth health care services

BackgroundWith 150 centers Australia-wide, the headspace National Youth Mental Health Foundation is an exemplary integrated youth health service. Headspace centers provide medical care, mental health interventions, alcohol and other drug (AOD) services, and vocational support to Australian young people (YP) aged 12 to 25 years. Co-located headspace salaried youth workers, private health care practitioners (e.g. psychologists, psychiatrists, and medical practitioners) and in-kind community service providers (e.g. AOD clinicians) form coordinated multidisciplinary teams. This article aims to identify the factors influencing the access to AOD interventions for YP, in the Australian rural headspace setting; as perceived by YP, their family and friends, and headspace staff. MethodsThe study purposively recruited YP (n = 16), their family and friends (n = 9), and headspace staff (n = 23) and management (n = 7) in four headspace centers in rural New South Wales, Australia. Recruited individuals participated in semistructured focus groups about the access to YP AOD interventions in the headspace setting. The study team thematically analyzed the data through the lens of the socio-ecological model. ResultsThe study identified convergent themes across groups and found several barriers to the access of AOD interventions; 1) YP's personal factors, 2) YP's family and peer attitudes, 3) practitioner skills, 4) organizational processes and 5) societal attitudes were all identified as negatively impacting access to YP AOD interventions. Practitioners' client-centered stance, and the youth-centric headspace model were factors that were considered as enablers of engagement of YP with an AOD concern. InterpretationWhile this Australian example of an integrated youth health care model is well placed to provide YP AOD interventions, a mismatch existed between practitioner capability and YP needs. The sampled practitioners described limited AOD knowledge, and low confidence in providing AOD interventions. At the organizational level, multiple AOD intervention supply and utilization issues occurred. Taken together, these problems likely underlie previous findings of poor service utilization and low user satisfaction. ConclusionClear enablers exist for AOD interventions to be better integrated into headspace services. Future work should determine how this integration can be achieved and what early intervention means in relation to AOD interventions.

Assessing the Feasibility of a Peer Education Project to Improve Mental Health Literacy in Adolescents in the UK

Many mental health problems begin in adolescence and occur on a spectrum of severity: early recognition and intervention is important. This study is a quantitative feasibility study of the Mental Health Foundation’s Peer Education Project (PEP). Attrition, psychometric properties of questionnaires, indications of improvement on a range of outcomes, and sample size required for a powered trial of effectiveness were assessed. 203 students completed the survey both pre and post-intervention. It was found that existing previously-validated measures had good psychometric properties, with two new questionnaires demonstrating reasonable reliability (self-help confidence alpha = 0.78, mental health knowledge alpha = 0.59). There were indications of improvement in help-seeking intentions, the number of sources likely to seek help from, and mental health knowledge from pre- to post-intervention. A future trial of PEP with a sample of approximately 36 schools, researcher-led data collections, and help-seeking intentions or sources as a primary outcome appears to be feasible.