Gaps In Mental Health Care Research Articles

The Ethical Conundrums of “Precision Psychiatry”

The Ethical Conundrums of “Precision Psychiatry”

Risking vulnerability: Enacting moral agency in the is/ought gap in mental health care.

To explore how healthcare providers in acute care mental health settings navigate ethically challenging situations, enact moral agency, practice in congruence with ethical standards and mitigate moral distress (MD). Grounded theory, a qualitative methodology. Over 18months between 2015 and 2017, we reviewed documents, conducted observations and interviewed multidisciplinary participants (N=27) from inpatient and emergency departments. Participants either provided direct care (N=14) or were in leadership positions (N=13). Data were analysed iteratively using constant comparison, coding, memoing and theorizing, which continued until saturation was reached in July 2016. The basic social process of how healthcare professionals enacted moral agency, Risking Vulnerability, occurred in the context of Systemic Inhumanity, a constant source of MD. Participants Risked Vulnerability, balancing professional obligations, clinical expertise and organizational processes with their own vulnerability in the system as they strove to practice ethically. Risking Vulnerability was composed of Pushing Back, Working Through Team Relationships and Struggling with Inhumanity. Healthcare professionals' moral agency occurred at the nexus of structure (organizational constraints) and agency (persons). Given this, interventions for MD should be directed at all levels of healthcare to support moral agency, promote ethical practice and improve care. Sociopolitical elements such as austerity measures undermined ethical practice at the level of direct care. Enactment of moral agency is dynamic, influencing experiences of MD: participants supported by leadership or colleagues to enact moral agency noted that they were not stuck in MD. Interventions supporting moral agency throughout the healthcare system are necessary to mitigate experiences of MD. Findings enhance our understanding of the role of action in the experience of MD.

Suicide prevention in psychiatric patients.

An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low- and middle-income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti-suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow-ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision-making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care.

In Case You Haven't Heard…

The Confess Project Barber Coalition is a nonprofit created to help Black men and boys become the best version of themselves, CNN reported Jan. 25. Their mission is to bridge the gaps in mental health care by providing a safe space for people to talk openly about the struggles they face. Since it began in 2016, the Barber Coalition has spread to 16 cities across the Southeast and Midwest and trained more than 200 barbers to be mental health advocates for their communities. The group hosts online training courses, group support calls and individual check‐ins for its member barbers to circumvent the lockdowns and social distancing guidelines the pandemic has brought on. Most barbers are already trained to build relationships and trust with their clients. Lorenzo Lewis, founder of the Confess Project, takes that one step further by teaching his members how to engage in active listening and guide their clients to talk about issues in their lives. From there, the barbers have undergone training on stigma reduction and validation so they can provide clients with positive reinforcement for whatever they are facing.

A long road to go: Rural inpatient mental health research

In the United States, it is estimated that approximately 1 in 10 children will require mental health services; however, there is also a shortage in the supply of pediatric mental health care providers in the country. This shortage is further exacerbated in rural areas, which forces families and patients to travel even greater distances for needed mental health care. In this volume of The Journal, Bettenhausen et al report the results of a retrospective cohort of rural children in the United States with a mental health hospitalization. There are few studies that focus on pediatric rural mental health issues. Bettenhausen et al document where children are receiving such inpatient care, as well as explore differences in outcomes based on the hospital location and type (children's hospital, metropolitan non-children's hospital, and rural hospital) (Figure). They found that only 1 in 5 children in rural areas who had a mental health hospitalization received care in a rural hospital. In addition, the authors found that the length of stay was higher at non-rural hospitals compared with rural hospitals; however, the 30-day readmission frequency was much lower at these non-rural hospitals. This is a descriptive study that has limitations, but it describes a potential gap in mental health care, based on readmission rates, provided by rural hospitals. Further work is needed to determine the reasons for such variation in outcomes, as well as develop and test new interventions. However, given the recent acceleration in the uptake of telemedicine, it may be possible to bridge geographic issues for isolated rural hospitals to mitigate differences in access to pediatric mental health professionals. More work needs to be done and this study in just one step in a long road ahead. Article page 240 ▸ Hospitalization Outcomes for Rural Children with Mental Health ConditionsThe Journal of PediatricsVol. 229PreviewTo identify where rural children with mental health conditions are hospitalized and to determine differences in outcomes based on location of hospitalization. Full-Text PDF

Addressing the gaps in mental health care for internally displaced persons.

Addressing the gaps in mental health care for internally displaced persons.

Social milieu: Arelevant concept for a better understanding of stigma and help-seeking?

The sociocultural interconnections surrounding stigmatizing attitudes and the treatment gap in mental healthcare are complex and insufficiently understood. Is the social milieu including personal values apotentially useful instrument for psychiatric research into attitudes and healthcare provision? This article describes individual barriers to treatment which pertain to literacy and attitudes, with contextualization of the social milieu concept. It gives a narrative review of the literature (PubMed, PsycINFO, Google Scholar) relating to the associations of different social milieu dimensions (e.g. sociodemographics, values, place of residence, ethnicity) with stigmatizing attitudes and utilization of psychiatric treatment options. Sociodemographically, lower educational attainment and male gender are often associated with psychiatric undertreatment and prevailing stigmatizing attitudes towards mental illness and its treatment. Simple sociodemographic parameters alone appear to be insufficient for predicting stigma and undertreatment. Stigmatizing attitudes and mental health literacy constitute important individual barriers to treatment. These sociodemographic and individual aspects can culminate in certain social milieus. This could allow the identification of specific target groups and communication requirements for interventions. The concept of the social milieu constitutes apotentially important and so far barely used intersection between sociology and medicine. Against the backdrop of rising public polarization and social inequality, the concept could contribute to achieving abetter understanding of the stigma of mental illness. It appears to be of relevance in anumber of ways for secondary and tertiary preventive considerations regarding the treatment gap in mental healthcare.

Evaluation of Electronic Mental Health Implementation in Northern Territory Services Using the Integrated "Promoting Action on Research Implementation in Health Services" Framework: Qualitative Study.

BackgroundElectronic mental health is a promising strategy to bridge the treatment gap in mental health care. Training workshops have been delivered to service providers working with Aboriginal and Torres Strait Islander people at a primary health care level to raise awareness and knowledge of electronic mental health approaches.ObjectiveThis study aimed to understand service providers’ perspectives and experiences of electronic mental health adoption. More specifically, it aimed to use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to further identify and understand how different factors facilitate or impede electronic mental health uptake within primary health care settings providing services to Aboriginal and Torres Strait Islander people.MethodsQualitative interviews were conducted with 57 service providers working with Aboriginal and Torres Strait Islander people, who had undergone electronic mental health training workshops.ResultsSeveral factors related to innovation (electronic mental health approach), recipients (service providers as an individual and as a team), and context (local, organizational, and external contexts) were found to influence electronic mental health uptake. Particularly, organizational readiness, in terms of information technology resources and infrastructure, policies, workforce and culture, and processes to mandate electronic mental health use, were found to be significant impediments to electronic mental health utilization. These findings led to the development of a three-phase implementation strategy that aims to enhance electronic mental health adoption by addressing organizational readiness before and post electronic mental health training.ConclusionsThe i-PARIHS provides a useful determinant framework that deepens our understanding of how different factors impede or facilitate electronic mental health adoption in this setting. This insight was used to develop a practical and comprehensive implementation strategy to enhance the utilization of electronic mental health approaches within primary health care settings, involving three phases: pretraining consultations, training workshops, and post-training follow-up support.

Building Emotional Resilience in Youth in Lebanon: a School-Based Randomized Controlled Trial of the FRIENDS Intervention.

In Lebanon, approximately one in four adolescents suffers from a psychiatric disorder. Alarmingly, 94% of adolescents with a mental disorder have not sought any treatment. This study assessed the effectiveness of an evidence-based school-based universal mental health intervention (the FRIENDS program) in reducing depression and anxiety symptoms in middle school students in Lebanon. A total of 280 6th graders aged 11-13years were recruited from 10 schools in Beirut. Schools were matched on size and tuition and randomly assigned to intervention or control groups. The FRIENDS program was translated into Arabic, adapted, and then implemented by trained mental health professionals during 10 classroom sessions over 3months. We assessed sociodemographic and relevant psychological symptoms by self-report, using the Scale for Childhood Anxiety and Related Disorders (SCARED), Mood and Feelings Questionnaire (MFQ), and Strengths and Difficulties Questionnaire (SDQ), at baseline. We re-administered these scales at 3months post-intervention. There was a significant time × group interaction for the SDQ emotional score (p = 0.011) and total MFQ score (p = 0.039) indicating significant improvement in depressive and emotional symptoms in the intervention group. Subgroup analysis by gender showed a significant time × group interaction for the total SCARED score (p = 0.025) in females but not in males (p = 0.137), consistent with a reduction of anxiety symptoms in this stratum of the intervention group as compared with the control group. The FRIENDS program was effective in reducing general emotional and depressive symptoms among middle school students in this Lebanese study population. This intervention provides an opportunity for promoting mental health in Lebanese schools and reducing the treatment gap in mental health care.

Psychiatric hospital reform in low-income and middle-income countries Structured Individualised inTervention And Recovery (SITAR): a two-arm pragmatic randomised controlled trial study protocol

IntroductionLow-income and middle-income settings like India have large treatment gaps in mental healthcare. People with severe mental disorders face impediments to their clinical and functional recovery, and have large unmet...

Development and Evaluation of a Mental Health Training Program for Community Health Workers in Indonesia.

The treatment gap in mental health care in Indonesia is a critical issue due in large measure to the dearth of professional mental health staff. In response to this need, our team designed a mental health training program for existing community health workers. The training program was offered to 65 participants at 2 (two) community primary care center (Puskesmas); we evaluated the training program with quantitative and qualitative methods. We assessed the gains in knowledge using a 20-question knowledge assessment test. In addition, in Puskesmas 1, the test was repeated as a follow-up test 4months after the training. Statistical analysis showed that the differences between pre-test and post-test scores were significant in both Puskesmas 1 (p = 0.004) and Puskesmas 2 (p < 0.001). This study concluded that the model of integrative training appears effective for preparing Indonesian CHWs to recognize and respond to needs for mental health care.

Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China.

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.

California launches $50 million program for school‐based MH care

The California State Legislature is calling on local school districts to come up with new ways to fill big gaps in mental health care for children and teens, setting aside $50 million this year for schools willing to try new ways of detecting and preventing mental illness through campus‐based services, the Mountain View Voice reported Aug. 2. The Mental Health Student Services Act, established through budget legislation this year, launches a grant program where county behavioral health departments — largely responsible for publicly funded mental health care — can partner with local schools to create campus‐based mental health services. The goal is to reach students before mental illness becomes severe and disabling, preventing suicide, dropouts, homelessness and suffering. The act builds on a common trend among California lawmakers, who have sought over the last three years to migrate the role of mental health care from the clinic to the classroom. Santa Clara County Superintendent Mary Ann Dewan said she is prepared to pursue the funding. When asked whether the added responsibility of providing mental health care could become a burden on public schools, Dewan said she believes schools can balance mental and behavioral services on top of academics — so long as they receive adequate funding and trained, qualified staff.

From Diagnoses to Ongoing Journey: Parent Experiences Following Congenital Heart Disease Diagnoses

Using qualitative and quantitative methods, the current cross-sectional study examined parents' experiences at the time of their child's diagnosis, what they thought helped their child recover, barriers to support, and identified needs for future models of care. The sample included 26 parents (22 mothers, 3 fathers, and 1 mother/father pair) of children with CHD, ranging in age between 6 months and 4 years with a mean age of 2 years. Qualitative results were organized around five themes: (a) They (medical team) saved my child's life, (b) My child is going to be okay, (c) Not out of the woods, (d) Optimizing support for my child and myself, and (e) What still gets in the way. Parents uniformly expressed a need for greater mental health support for their children as well as programs to improve parents' skill and confidence, with no difference between age groups (< 2 years and > 2 years of age). Common barriers to service included distance and time off work. Parents' experiences informed both acute and long term implications following CHD diagnoses, and highlight current gaps in mental health care. Direction for clinical care and improved intervention opportunities are discussed.

Mental Health Care Gap: The Case of the Slovak Republic.

This study explored unmet mental health and social care needs in the Slovak Republic and their adverse human rights consequences. We estimated treatment gap for persons aged 15-64years in year 2015 affected by depressive, anxiety, substance use and schizophrenic disorders by comparing local treated prevalence rates with population estimated rates for Europe. Two-thirds of people with depressive disorders and over 80% of those with anxiety disorders and alcohol dependence were not receiving treatment. There was no treatment gap for persons with schizophrenia. Fifty-one percent of those eligible for disability pension on the grounds of mental disorders failed to receive it. We discuss the implications of the estimated gaps in mental health and social care and consequent human rights violations that may result from the current system of mental health care in Slovakia.

Should Mental Health Be Addressed in Schools? Preliminary Views of In-School Adolescents in Ibadan, Nigeria

Background: School mental health programs have the potential to bridge the gap in mental health care for young people. There are limited data on the views of young people about these programs in developing countries. Objectives: The study aimed to determine the views of school-going adolescents on addressing mental health issues in schools. Methods: In this study, 379 students completed an open-ended semi-structured questionnaire on the suitability of addressing mental health concerns in schools. A subset of students who received a targeted school-based mental health intervention provided additional information on their experience. Data were analyzed using thematic analysis. Results: The majority of the students indicated that school was not a suitable place for addressing mental health issues. Concerns cited included the deviation from the primary aims of the school system, lack of resources, and the potential for stigmatization. However, the subset of students who received a targeted mental health intervention found it helpful and wished the program could be made more widely available in schools. Conclusions: This suggests that if well targeted and appropriately delivered, the school-based mental health interventions have the potential to reach Nigerian adolescents in need of mental health interventions, who would; otherwise, be without support.

Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers.

To identify behavioral health provider perspectives on gaps in mental health care for youth with rheumatologic conditions. Social workers (n = 34) and psychologists (n = 8) at pediatric rheumatology centers in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) completed an online survey assessing current practices and mental health care needs of youth with rheumatologic conditions. Responses were compared to a published survey of CARRA rheumatologists (n = 119). Thematic analysis of 20 semi-structured interviews with behavioral health providers was performed. One-third of CARRA centers (n = 100) had no affiliated social worker or psychologist. Only 1 behavioral health provider reported current universal mental health screening at their rheumatology clinic, yet routine depression screening was supported by >85% of behavioral health providers and rheumatologists. Support for anxiety screening was higher among behavioral health providers (90% versus 65%; P < 0.01). Interviews illustrated a need for interventions addressing illness-related anxiety, adjustment/coping/distress, transition, parent/caregiver mental health, and peer support. Limited resources, lack of protocols, and patient cost/time burden were the most frequent barriers to intervention. Inadequate follow-up of mental health referrals was indicated by 52% of providers. More behavioral health providers than rheumatologists favored mental health services in rheumatology settings (55% versus 19%; P < 0.01). Only 7 social workers (21%) provided counseling/therapy, and interviews indicated their perceived underutilization of these services. Behavioral health providers indicated an unmet need for mental health interventions that address illness-related issues affecting youth with rheumatologic conditions. Implementation of mental health protocols and optimizing utilization of social workers may improve mental health care for these youth.

E-mental health: Promising advancements in policy, research, and practice.

The increasing need for mental health services in the population is posing significant challenges for the health system. It is therefore important to identify new approaches to delivering care that are sustainable and scalable in terms of reach and impact. E-mental health is one approach that shows promise in addressing the treatment gap in mental healthcare. E-mental health involves leveraging the Internet and related technologies such as smartphone apps, web sites, and social media to deliver mental health services. Over the past decade, this field has made significant advancements in Canada and internationally. In this article, the author introduces the e-mental health field and provides an overview of promising Canadian developments in relation to policy, research, and practice. In addition, the article discusses some of the challenges facing the wide-scale implementation of e-mental health and identifies priority areas of focus for health leaders to advance the field.

Qualitative research investigating the mental health care service gap in Chinese burn injury patients

BackgroundPsychological disturbances are prevalent in people with burn injuries; however, psychological services are rarely accessiblepost-burn injury in China. The objective of this qualitative study was to explore and conceptualize the obstacles to delivering mental health care in burn injury patients.MethodsThe researchers used a grounded theory research approach to interview sixteen burn injury patients, five nurses, four rehabilitation therapists, five medical doctors, and eight caregivers regarding their experiences with current health care services and barriers.ResultsAn explorative model was generated from the data, and the relationships among the categories were identified. People’s beliefs, knowledge, socioeconomic status, cultural understanding of mental health, and social stigma appear to play key roles in the public health approach to post-burn health promotion and post-burn psychosocial interventions.ConclusionThe model proposed in our research highlights the need to focus on the underlying social, economic, and cultural determinants of mental health care. The underlying social determinants of the mental health care gap that is responsible for the ill-prepared health care must be addressed.

Hospitalization for mental health related ambulatory care sensitive conditions: what are the trends for First Nations in British Columbia?

BackgroundIndigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption. The objective of this study was to provide a baseline profile of hospitalization rates for mental health-related Ambulatory Care Sensitive Conditions among First-Nations living both on and off reserve in British Columbia, Canada, and explore the relationship between local access to health services and mental health-related hospitalization rates.MethodsA population-based time trend analysis of mental health-related Ambulatory Care Sensitive Conditions hospitalizations was conducted using de-identified administrative health data. The study population included all residents eligible under the universal British Columbia Medical Services Plan and living on and off First Nations reserves between 1994/95 and 2009/10. The definition of mental health-related Ambulatory Care Sensitive Conditions included mood disorders and schizophrenia, and three different change measures were used to operationalize avoidable hospitalizations: 1) rates of episodes of hospital care, 2) rates of length of stay, and 3) readmission rates. Data were analyzed using generalized estimating equations approach, controlling for age, sex, and socio-economic status, to account for change over time.ResultsOur findings show that First Nations living on reserve have higher hospitalization rates for mental disorders compared to other British Columbia residents up until 2008. Those living off reserve had significantly higher hospitalization rates throughout the study period. On-reserve communities served by nursing stations had the lowest rates of hospitalization whereas communities with limited local services had the highest rates. Compared to other British Columbia residents, all First Nations have a shorter length of stay and lower readmission rates.ConclusionsThis study suggests that despite reduced rates of hospitalization for mental-health related Ambulatory Care Sensitive Conditions over time for First Nations, gaps in mental health care still exist. We argue greater investments in primary mental health care are needed to support First Nations health. However, these efforts should place equal importance on prevention and the social determinants of health.