Funding For Mental Health Services Research Articles

Supporting unpaid carers around hospital leave for people detained under the Mental Health Act (1983) in England: carer and practitioner perspectives

BackgroundWhen an individual is detained in hospital it is important that they maintain contact with their family, friends and communities as these can be helpful for their well-being and recovery. Maintaining these relationships is also important to unpaid carers (family or friends), but they can be strained by carers’ instigation of, or compliance with, the involuntary detention. Section 17 of the Mental Health Act (1983) in England and Wales allows for temporary leave from hospital, from an hour in the hospital grounds to going home for a few days. However, carers are not always involved in decisions around statutory s.17 leave, even where they are expected to support someone at home. This study aimed to explore how practice can be improved to better involve and support carers around s.17 leave.MethodsSemi-structured interviews and focus groups were held with 14 unpaid carers and 19 mental health practitioners, including four Responsible Clinicians, in three sites in England in 2021. The research explored views on what works well for carers around s.17 leave, what could be improved and the barriers to such improvements. Transcripts were analysed using reflexive thematic analysis.ResultsThree themes were identified in the analysis: the need for carer support and the challenges surrounding provision; challenges with communication, planning and feedback around s.17 leave; and inconsistency in involving carers around s.17 leave. Permeating all themes was a lack of resources presenting as under-staffing, high demands on existing staff, and lack of time and capacity to work and communicate with carers.ConclusionImplications include the need for more funding for mental health services for both prevention and treatment; staff training to increase confidence with carers; and standardised guidance for practitioners on working with carers around s.17 leave to help ensure consistency in practice. The study concluded with the production of a ‘S.17 Standard’, a guidance document based on the research findings consisting of 10 steps for practitioners to follow to support the greater involvement and support of carers.

Consent with complications in mind

Parity of esteem describes an aspiration to see mental health valued as much as physical. Proponents point to poorer funding of mental health services, greater stigma and poorer physical health...

Post-War Ukrainа: Psychological and Psychotherapeutic Perspectives

Increased funding: one of the biggest problems facing psychologists in Ukraine is the lack of resources and funding. Increased funding for mental health services and training could help improve the quality of care that psychologists can provide to their patients. The necessary recognition of mental health and the role of psychologists in providing care can help reduce stigma and increase collaboration between psychologists and other health professionals. More resources and educational materials in Ukrainian are needed to improve access to information and resources for Ukrainian psychologists, and to support the development of a strong, locally focused research base. Creating more jobs for psychologists, especially in underserved areas, can help increase access to mental health services for those who need them. Continuous education: psychologists. Education and public awareness can help encourage more people to seek help from psychologists and other mental health professionals. Of course, these steps are only a starting point and a solution to the complex problems faced by psychologists in Ukraine

The Impact of Financial Crises on Mental Health

Several economic factors can increase the risk of mental health problems, such as poverty, unemployment, debt and, on a broader scale, funding cuts for social welfare systems and lack of education. This review explores how economic factors impact mental health, with a particular focus on the impact of the current cost-of-living crisis. In many studies exploring the connection between finances and mental health, specific groups are more vulnerable, such as those with pre-existing mental health problems or unemployment.
 This review draws upon lessons learnt from previous economic crises. It proposes solutions to tackle the ongoing problem, such as anti-poverty measures, financial counselling and education, funding for mental health services and future research.

Coalition: Gun violence prevention policy should not equate violence with MH

Another spate of tragic mass shootings around the country including in Uvalde, Texas; Buffalo, New York; and Tulsa, Oklahoma have sparked action by lawmakers to address gun prevention efforts and solutions to preventing further tragedies. They continue work on federal legislation, which includes background checks for gun buyers under age 21 and preventing gun sales to domestic violence offenders. Although the legislative framework includes more funding for mental health services, advocates want to make sure these efforts do not include scapegoating people with mental health disabilities.

Stroke recovery - what are people talking about on Twitter?

Context: To aid prioritisation of funding for stroke research, a Stroke Priority Setting Partnership is being conducted in the UK by The Stroke Association using surveys and workshops with stroke survivors, stroke carers and health professionals. Another valuable source of information about topics that require research is the social media platform Twitter. Objective: To ascertain common topics of discussion in relation to stroke recovery on Twitter amongst stroke survivors, their carers, and the general public. Study design and analysis: Content analysis of public posts on Twitter. Dataset: An electronic search of Twitter was performed to analyse the content of two major stroke discussion tags: #strokesurvivor and #strokerecovery. Tweets were collected using NCapture, an open-source extension for the internet browser Chrome. Tweets spanning 5 weeks over the course of January to February 2021 were analysed. Population studied: Tweets made by stroke survivors and their carers or other interested members of the public were included and those made by health professionals or organisations (e.g. charities or health care providers) were excluded. All tweets were fully anonymised and edited where necessary to omit any identifying information. Outcome measures: The content of each tweet was analysed thematically using NVIVO, with tweets being coded by their content and sentiment to identify trends in discussion. Results: 486 tweets were analysed following the removal of duplicate and unrelated material. From these, 6 themes were identified: motivation & positivity; raising of stroke awareness; experience of the stroke rehabilitation process; symptomatic aspects of stroke recovery; sharing of stroke-related resources; and concerns about COVID-19. Conclusions: Twitter's role as a space for peer-support and motivation amongst survivors was evident, as was its potential for promoting awareness of stroke and its sequalae to the public. Amongst the most prominent aspects of recovery discussed was the psychological impact of stroke, with users expressing difficulty in addressing the emotional sequalae in comparison to the physical aspects. This may be addressed by targeted funding of mental health services, and recognition of the specialised needs of stroke survivors. It is hoped that the findings of this project will be useful in guiding the apportioning of funding, as well as complementing the findings of the James Lind Alliance's Priority Setting Partnership.

Investigating the prevalence of anxiety and depression during the first COVID-19 lockdown in the United Kingdom: Systematic review and meta-analyses.

BackgroundThe COVID‐19 pandemic has had a significant impact on mental health. Specifically, the stringent lockdown restrictions have heightened anxiety and depression. Therefore, monitoring and supporting the mental health of the population during these unprecedented times is an immediate priority.MethodsIn this systematic review and meta‐analyses, articles that explored the prevalence of anxiety and depression during the first COVID‐19 lockdown in the United Kingdom were included. We searched the databases Embase, Medline (PubMed), Web of Science, and PsycINFO for cross‐sectional studies. We conducted meta‐analyses of prevalence rates using a random‐effects model, and the heterogeneity of studies was examined using the I 2 index.ResultsFourteen studies involving 46,158 participants were included in the review. The studies use clinical cut‐off scores on anxiety and depression measures to define cases. While the prevalence of anxiety was 31.00% (95% CI = 26.00 to 35.00), the prevalence of depression was 32.00% (95% CI = 29.00 to 35.00). The prevalence of anxiety pre‐pandemic was 4.65%, indicating a 26.35% increase. Whereas the prevalence of depression pre‐pandemic was 4.12%, indicating a 27.88% increase. Moreover, participants experienced a slightly greater prevalence of depression than anxiety by 1.00%.ConclusionsTo conclude, the first COVID‐19 lockdown in the United Kingdom increased the prevalence of anxiety and depression among the general population, compared to pre‐pandemic data. Hence, it is vital that policymakers and mental health services maximize their efforts to monitor mental health and provide interventions to support those in need.Practitioner points Clinical implications Awareness of the high prevalence of anxiety and depression during the first lockdown in the United Kingdom can inform policy development that substantial effort, time, and funding of mental health services are required to support those in need.Similarly, awareness of the prevalence of anxiety and depression in the United Kingdom can contribute to the development of nation‐specific interventions and initiatives. Limitations The current review focuses on the UK general population which does not allow the findings to be generalized to the global population.The indirect comparison of the current prevalence rates with the corresponding pre‐pandemic prevalence rates obtained from a different study sample increases individual differences, weakening the reliability of the findings.

Prevalence and Sociodemographic Correlates of Unmet Need for Mental Health Counseling Among Adults During the COVID-19 Pandemic.

This study aimed to determine the prevalence and correlates of unmet need for mental health counseling among U.S. adults during the COVID-19 pandemic. Data from the December 9-21, 2020, cross-sectional Household Pulse Survey (N=69,944) were analyzed. Overall, 12.8% of adults reported an unmet need for mental health counseling in the past month, including 25.2% of adults with a positive screen for depression or anxiety. Among adults with a positive screen, risk factors associated with an unmet need for mental health counseling included female sex, younger age, income below the federal poverty line, higher education, and household job loss during the pandemic, while protective factors included Asian and Black race. Over one-quarter of U.S. adults with a positive screen for depression or anxiety experienced an unmet need for mental health counseling during the pandemic. Policy makers should consider increasing funding for mental health services as part of pandemic relief legislation.

Trump, Biden Differ on Approach to MH Policies

Trump, Biden Differ on Approach to MH Policies

The Productivity Commission's Draft Report illustrates the benefits and risks of economic perspectives on mental healthcare.

In 2018, the Australian Government instructed the Productivity Commission to examine the social and economic effects of poor mental health, as well as make recommendations on how they might be addressed. The resulting Draft Report demonstrates both the benefits and risks of an economic approach to these issues. Some of the broader systemic recommendations have merit such as the need for stepped care, coordinated crisis management and the important role of welfare, housing and the workplace in improving mental health. However, there are areas of concern, particularly for mental health services in the public sector. One is a disproportionate emphasis on prevention and intervention in the early years of life for strategies where evidence for effectiveness is limited. Another is the introduction of market-based approaches such as shadow billing or a commissioner/provider split to the funding of mental health services across Australia. Among the numerous problems of such market-driven approaches are the increased costs of additional bureaucracy and the lack of commissioner expertise in planning services or evidence-based practice. As a result, similar arrangements have been abandoned in other jurisdictions. The Commission's final recommendations and the Australian Government's response are awaited and the resulting changes to the mental health system, and beyond, may well be influenced by the COVID-19 pandemic. However, reform should be based on evidence and achieved without increasing administrative complexity.

The need for early intervention for psychosis to persist throughout the COVID-19 pandemic and beyond.

In the last three decades, early intervention for psychosis (EIP) services have been established worldwide and have resulted in superior symptomatic and functional outcomes for people affected by psychotic disorders. These improved outcomes are a result of reducing delays to treatment and the provision of specialised, holistic interventions. The COVID-19 pandemic poses significant challenges to the delivery of these services, such as undetected cases or long delays to treatment. Furthermore, the COVID-19 pandemic will likely increase the mental health needs of communities, including the incidence of psychotic disorders. In this perspective piece, we provide suggestions as to how EIP services can adapt within this environment, such as utilising novel technologies. Finally, we argue that despite the economic consequences of the pandemic, the funding for mental health services, including EI services, should be increased in line with the need for these services during and beyond the pandemic.

Thoughts on Connections Between COVID-19 Pandemic And Climate Crisis

Thoughts on Connections Between COVID-19 Pandemic And Climate Crisis

IMPlementation of An online Relatives\u2019 Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use

BackgroundDespite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar.MethodsA mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team.ResultsIn all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT’s long-term availability.ConclusionsDigital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions.Trial registrationStudy registration: ISCTRN 16267685.

The economic impact of violence perpetration in severe mental illness: a retrospective, prevalence-based analysis in England and Wales

SummaryBackgroundCalls for increased funding for mental health services require many lines of evidence in support, including estimates of economic impact. One understudied source of cost is violence perpetrated by individuals with severe mental illness. Estimating this economic impact can inform budget planning across several government sectors and emphasise the importance of violence prevention. Therefore, we aimed to provide a comprehensive estimate of the economic costs of violence perpetrated by people with severe mental illness.MethodsFor this retrospective analysis, we used a prevalence-based modelling approach to estimate the annual economic cost of violent incidents committed by people with severe mental illness in England and Wales during 2015–16. The model was based on secondary data, including the association between violence and severe mental illness, illness prevalence, recidivism, absolute numbers of violent incidents in 2015–16, and costs to society per violent crime, by area of spending. Uncertainty was addressed with probabilistic and deterministic sensitivity analyses that tested the effect of underreporting of domestic violence and distributions of crime types in individuals with severe mental illness.OutcomesThe estimated annual economic impact of violence perpetrated by people with severe mental illness was £2·5 (95% CI 1·4–4·5) billion in England and Wales in 2015–16, or 5·3% of the total estimated societal cost of violence. The largest contributors to the cost of violent crime perpetrated by individuals with severe mental illness were the cost of physical and emotional harm to victims (£1·4 [95% CI 0·8–2·5] billion), followed by lost productivity of victims (£348.0 [190·0–628·8] million), while the combined cost to the police and criminal justice system was £561·3 (305·9–1009·2) million and the cost to health services was £136·7 [74·3–246·3] million. The additional cost to secure forensic care was estimated to be £487·7 (302·0–709·1) million.InterpretationThe economic impact of violence perpetrated by individuals with severe mental illness is potentially important. Preventing violence, especially through services for individuals with comorbid substance misuse, and reducing recidivism might lead to cost savings at a governmental and individual level, in addition to the clinical and societal benefits.FundingWellcome Trust, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, and NIHR Applied Research Collaboration Oxford and Thames Valley.

Transitioning to community-based mental health service delivery: opportunities for Ukraine

ABSTRACT Background and objectives: Ukraine’s mental health system has been found to be inadequate and unresponsive to the needs of the population, in view of its emphasis on inpatient service delivery. This study sought to identify potential changes to the organization and financing of mental health services within the Ukrainian health system that would facilitate the delivery of mental health services in a community-based setting. Methodology: A systematic literature review was undertaken to identify organizational and financing features that have been successfully used to enable and incentivize the delivery of community-based mental health services in Central or Eastern European and/or former Soviet Union countries. Results: There was limited literature on the organizational and financing features that facilitate the delivery of community-based care. Key facilitators for transitioning from institution-based to community-based mental health service delivery include; a clear vision for community-based care, investment in the mental health system, and mechanisms that allow health funding to follow the patient through the health system. Conclusions: Ukraine should adopt strategic purchasing mechanisms to address inefficiency in the financing of its mental health system, and prioritize collaborative planning and delivery of mental health services. Ongoing reform of the Ukrainian health system provides momentum for instituting such changes.

Irish Medical Organisation Doolin Memorial Lecture 2019: rhetoric and reality in mental health-Ireland and the world.

This Doolin Memorial Lecture presents six suggestions for positive change in Ireland's mental health services, focused on legislation and rights: (a) revision of the Mental Health Act 2001 in line with existing recommendations, to better protect and promote a broad range of rights, including rights to treatment and liberty (which are related); (b) enhanced forensic mental health care to better protect and promote both treatment and liberty in this population; (c) prompt full implementation of the Public Health (Alcohol) Act 2018 to reduce alcohol-related harm and the opportunity cost of alcohol problems in the health service; (d) implementation of the Assisted Decision-Making (Capacity) Act 2015 to provide decision-making supports to the 29.4% of medical/surgical inpatients and 52.6% of psychiatry inpatients who lack full decision-making capacity for treatment decisions; (e) judicious medicalisation of our response to individual cannabis use (although legalisation is not advised); and (f) enhanced recognition of the social rights of the mentally ill, especially the right to housing. Attention to these areas would improve the quality of life and quality of liberty of people with mental illness and their families. Progress in these areas needs to be underpinned by enhanced involvement of service-users in planning and provision of care, increased funding of mental health services and particular attention to groups who are currently underserved, including children and adolescents. Enhanced attention to these areas would also help advance Ireland's national mental health policy, "A Vision for Change", which has yet to be implemented in full. That, too, would help.

Contextual issues in the implementation of mental health legislation

Mental Health services in Victoria, Australia have seen major reform over the past 30 years. Rights based mental health legislation and major structural changes supported a reduction in bed based services and the development of a strong community mental health sector from the mid 1990's. Community Treatment Orders were established in the Mental Health Act (1986) and widely used across the State. Reformed legislation in 2014 brought greater emphasis on supported decision making and recovery orientation. Funding for mental health services did not keep pace with significant population growth, with consequent reduction in bed availability and intensity of community based services.This paper considers the impact of funding and service availability on the intended policy and practice directions of mental health legislation with particular consideration of the impact on the utilisation of Community Treatment Orders.

Understanding the Changing Patterns of Behaviour Leading to Increased Detentions by the Police under Section 136 of the Mental Health Act 1983

The number of detentions by the police under section 136 of the Mental Health Act has significantly increased over recent years. Over the same period, relative funding of mental health services has declined. The implication is that the latter has in some way caused the former. In this study, the behaviours of people resulting in their detention are examined, as are the motivations of the officers detaining them. Over the last 30 years, behaviours leading to detention have changed significantly. They were overwhelmingly violent, abusive, aggressive, or delusional but now they overwhelmingly relate to self-harm. Treatment rates following detention 30 years ago were over 90% but now this has fallen to around 20%. The lowest treatment rates 30 years ago were for detentions for threats of self-harm and this remains so now. There has also been the emergence of a ‘risk-averse’ culture in policing, fearful of ‘deaths in police contact’, which may have significantly contributed to this increase in detentions. This has resulted in the creation of a new ‘patient pathway’ which gives priority access, through the police, to otherwise difficult to access mental health services. Restricting this pathway explains how ‘street triage’ schemes reduce detentions. Where the officer is advised by a Health professional not to detain a person, they are then indemnified for any subsequent outcomes. In the absence of such advice, officers feel they have no choice but to detain, where there are threats of self-harm.

Determinants of subjective well-being in people with psychosis referred for psychological therapy in South London.

Improving subjective well-being (SWB) for people with mental health problems is a United Kingdom national health priority and is increasingly important in justifying funding of mental health services. Aside from the economic advantages, maximizing SWB confers obvious individual and clinical benefits for people with severe mental illness, such as psychosis. Gaining a better understanding of well-being and its determinants will enable current evidence-based interventions to be targeted and refined appropriately. This study therefore sought to identify the cross-sectional correlates of SWB in an Improving Access to Psychological Therapies for people with Severe Mental Illness psychosis demonstration site, to inform a future longitudinal investigation. Participants with a psychosis or bipolar spectrum diagnosis referred to the demonstration site (n=410) rated SWB as part of their initial assessment before starting psychological therapy. Potential influencing factors including age, gender, ethnicity, employment status, illness duration, perceived social support, perceived coping, and psychotic symptoms (voices and beliefs) were also assessed. Regression analyses showed that unemployment (β=-.16, p<.001), lack of social support (β=-.20, p<.001), distressing beliefs (β=-.12, p=.004), and poorer coping (β=-.43, p<.001) were associated with reduced SWB, together accounting for 43% of the variance in well-being, F(5, 392)=58.42, p<.001; mean SWB=39.09, SD=11.61. This study provides preliminary insights into the determinants of SWB in a large sample of people with psychosis. Improving employability, social interactions, coping strategies, and psychotic symptoms may improve SWB. Further longitudinal investigation will determine the potential value of preferentially targeting these areas in therapy to meet national requirements to prioritize well-being outcomes. Average well-being in people with psychosis was lower than SWB previously reported for the general population. Unemployment, lack of social support, poorer coping, and distressing beliefs were all associated with lower levels of well-being in people with psychosis. Psychological interventions targeting the positive symptoms of psychosis may impact on well-being. Greater focus on promoting social contact and inclusion and facilitating a return to employment may further improve well-being outcomes following psychological intervention. The cross-sectional design of the study does not allow for firm conclusions about the causal relationship between well-being and associated factors in psychosis. The study was carried out within a particular service context, and the findings need replicating before they can be considered to be generalizable outside this setting.

Health advocacy and the funding of mental health services reform.

Health advocacy and the funding of mental health services reform.