Mental Health Guidelines Research Articles

Psychological impact of COVID-19 among frontline financial services workers in Bangladesh

The COVID-19 pandemic has affected millions of people worldwide both physically and mentally. In resource-strapped countries, high levels of psychological distress caused by fear of getting infected with the deadly disease has been observed in densely populated communities and among frontline workers (e.g., healthcare workers and retail employees), who provide services without wearing the appropriate personal protective equipment. This study assessed the level of psychological distress among bank employees, who are also essential frontline workers. Data were collected from 120 bank employees by using a predesigned survey questionnaire consisting of Kessler Psychological Distress Scale (K10) questions. Nine out of ten respondents indicated that they were likely to experience mild to severe psychological distress, and 86.6% felt vulnerable to having close contact with a carrier of the rapidly spreading COVID-19 virus. The Chi-square test results indicated that married employees (36.37 vs 32.16) and those assigned in bank branches (36.34 vs 33.25) had a higher likelihood of experiencing psychological distress than those who were not married and those assigned in head offices, respectively. To address this issue, health policymakers and bank regulatory authorities must develop mental health interventions, treatments, and guidelines specific for bank employees.

Mental Health and Psychosocial Support During COVID-19: A Review of Health Guidelines in Sub-Saharan Africa.

The COVID-19 pandemic brought in its wake an unforeseen mental health crisis. The World Health Organization published a guideline as a way of supporting mental health and psychosocial well-being of different groups during this pandemic. The impact of the pandemic has pushed governments to put measures in place to curb not only the physical health of individuals but their mental health and psychosocial well-being as well. The aim of our paper was to review mental health guidelines of some Sub Saharan African (SSA) countries: (i) to assess their appropriateness for the immediate mental health needs at this time, (ii) to form as a basis for ongoing reflection as the current pandemic evolves. Guidelines were retrieved openly from internet search and some were requested from mental health practitioners in various SSA countries. The authors designed a semi structured questionnaire, as a self-interview guide to gain insight on the experience of COVID-19 from experts in the mental health sector in the various countries. While we used a document analysis approach to analyze the data, we made use of the Mental Health Preparedness and Action Framework to discuss our findings. We received health or mental health guidelines from 10 SSA countries. Cameroon, Kenya, South Africa, Tanzania, and Uganda all had mental health guidelines or mental health component in their health guidelines. Our experts highlight that the mental health needs of the people are of concern during this pandemic but have not been given priority. They go further to suggest that the mental health needs are slightly different during this time and requiring a different approach especially considering the measures taken to curb the spread of disease. We conclude that despite the provision of Mental Health and Psychosocial Support guidelines, gaps still exist making them inadequate to meet the mental health needs of their communities.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

The use of indicators for the management of Mental Health Services.

Objective:to identify indicators that can be used in the management of Mental Health Services.Method:an integrative review in which we adopted the Population, Concept, and Context strategy to formulate the following Guiding Question: “Which indicators can be used for the management of mental health services?”.Results:a total of 22 articles were included and divided into two main groups: countries with initial high income (54%) as well as low- and middle-income countries (46%). We identified 5 studies that had experienced the use of indicators, 5 studies that had reported partial implementation, 9 studies that did not report use or implementation, 1 study on the indicator selection process, 1 as an implementation pilot, and a final study with a discussion for implementation. High-income countries also find it difficult to implement mental health indicators. The main difficulties in adopting the use of indicators are lack of basic mental health services, financial resources, legislation, political interest, and guidelines for its management.Conclusion:it is unusual to find a descriptive comparison of quality monitoring programs at the system level in the technical-scientific literature related to mental health indicators.

Psychological factors in personal and clinical recovery in bipolar disorder

Background: Research into bipolar disorder (BD) has primarily focused upon clinical recovery (CR), i.e. symptom reduction, and overlooked personally meaningful recovery outcomes emphasized by service users. Personal recovery (PR) has been a major focus in the formulation of mental health policies and guidelines, and yet, research into factors influencing PR in BD is in its infancy. Methods: This study compared psychological associates of concurrent PR and CR, and determined psychological factors in PR prospectively at 6 months. Results: 107 participants completed baseline assessments, of whom 84% completed follow-up at 6 months. Controlling for potential confounders, multiple linear and ordinal regression models showed that some psychological factors underpinned both CR and PR at baseline: worse PR and CR outcomes were associated with higher negative self-dispositional appraisals and dysfunctional attitudes. Better PR, but worse CR ([hypo]mania related) were associated with higher adaptive coping. Additionally, better PR (but not CR) was associated with higher concurrent risk taking at baseline and predicted at follow-up by higher levels of baseline rumination. Better CR ([hypo]mania related), but not PR, was associated with lower impulsivity, but higher BAS processes. Limitations: Psychological and clinical factors were not measured at follow up and may have changed over time. Participants were a convenience sample. Conclusions: Understanding psychological factors driving recovery in BD is essential for refining the conceptual framework of PR, and informing psychological models and related interventions for BD. The identified differences in psychological factors highlight the importance of more individualised, PR focused therapeutic approaches.

Mental health guidelines for the care of people with spina bifida

Spina bifida’s (SB) impact on cognitive, physical, and psychosocial functioning places individuals at risk for mental health concerns. This article discusses the SB Mental Health Guidelines from the 2018 Spina Bifida Association’s Fourth Edition of the Guidelines for the Care of People with Spina Bifida and reviews evidence-based directions with the intention of helping individuals with SB achieve optimal mental health throughout the lifespan. Guidelines address clinical questions pertaining to the psychosocial impact of SB on mental health and adaptation, domains of mental health that are affected in individuals with SB, areas of resilience, common maladaptive behaviors that may impact people with SB, and resources or practices that are helpful in mitigating mental health issues in this population. Gaps in the research and future directions are discussed.

Rates of depression and anxiety in Italian patients with cystic fibrosis and parent caregivers: Implementation of the Mental Health Guidelines

BackgroundIndividuals with chronic respiratory conditions are at-risk for depression and anxiety. In the largest mental health screening study of over 6000 people with cystic fibrosis (CF) and 4000 parent caregivers (TIDES, 2014), rates of symptomatology were two to three times higher than in the general population. International guidelines recommend annual screening of mental health. This is the first study to implement these guidelines in one of the largest CF Centers in Italy. MethodsAll individuals with CF, 12 and older (n = 167) and caregivers of children with CF (n = 186), birth to 18, were screened. Health outcome data were also collected (i.e FEV1, BMI, pulmonary exacerbations, CF-related diabetes). Prevalence data and associations between psychological symptoms and health outcomes were examined. ResultsA high percentage of patients and parent caregivers reported scored above the clinical cut-off for depression and anxiety (37%–48% of adolescents, 45%–46% of adults, 49%–66% of mothers and fathers). Most scores fell in the mild range, however, over 30% were in the moderate to severe range. Elevations in depression and anxiety were correlated. Adolescents who had more pulmonary exacerbations reported higher anxiety. Adults with recent events of hemoptysis reported higher symptoms of depression. ConclusionsSymptoms of depression and anxiety were elevated in both individuals with CF and parents. Implementation of mental health screening was critical for identifying those in need of psychological interventions. These results strongly suggest that mental health should be integrated into physical health care for those with complex, chronic respiratory conditions, including COPD, PCD.

115. USING IMPLEMENTATION RESEARCH FRAMEWORK TO FOCUS ON PEDIATRIC MENTAL HEALTH

Surveys of pediatric program directors have identified the need for dissemination of mental health guidelines into pediatric training programs./Education on guidelines is challenging without an underlying framework for implementation./The Consolidated Framework for Implementation Research (CFIR) has been used in medical education settings. We utilized the CFIR to develop a multidisciplinary intervention that implemented 2011 AAP ADHD guidelines into an academic pediatric residency practice. Our desired outcomes included increasing confidence, improved use of Vanderbilt Screening and improved continuity of care for patients with ADHD. Utilizing the CFIR, we created a process to transform the un-adapted intervention (ADHD guidelines) into an adapted intervention directly applicable to patients. See figure 1. Providers were surveyed pre-intervention (PI), immediate post-intervention (IPI) and six months following intervention (FI). Investigators audited charts for conformity with the guidelines, continuity of care, intervals of visit, standardized documentation and receipt of Vanderbilt screening measures. Sixty-three providers participated. We aggregated data for the 63 and paired responses for 29 participants. When given the statement “there is a standard of care for patients,” 35.3% agreed PI, 82.4% agreed IPI and 83% agreed FI. Participants who indicated some or greater confidence in applying the AAP clinical guidelines moved from 31.8% PI to 86.4% IPI and 83.3% FI. Participants indicated that there was a teacher Vanderbilt available for their patients >50% of the time at 43% PI, 70.7% IPI and 83.3% FI. Respondents were asked “how often are you the primary care provider for patient visits regarding ADHD?” Participants answered that they were the PCP >50% of the time 22.9% PI, 23.7% IPI and 51.7% FI. The CFIR works as a framework to implement a mental health guideline into pediatric practice that may be superior to solely curriculum-based efforts alone. Outcomes continued to improve FI indicating potential longevity. Use of the CFIR framework could be expanded to implement more pediatric guidelines.

Do we need physical activity guidelines for mental health: What does the evidence tell us?

The aims of this commentary are to (1) examine the current global physical activity recommendations for adults and its relation to mental health, based on findings from meta-analyses primarily of prospective studies, and (2) determine whether there is a need to extend the scope/focus of existing guidelines to ensure they are mental health informed.

P450 Implementation of the mental health guidelines in the United States: screening outcomes and treatment referrals at 120 cystic fibrosis centres

P450 Implementation of the mental health guidelines in the United States: screening outcomes and treatment referrals at 120 cystic fibrosis centres

P447 Dissemination and implementation of the mental health guidelines in the United States: results of implementation in year 2 at 120 cystic fibrosis centres

P447 Dissemination and implementation of the mental health guidelines in the United States: results of implementation in year 2 at 120 cystic fibrosis centres

Effectiveness of a tailored implementation strategy to improve adherence to a guideline on mental health problems in occupational health care

BackgroundAs compliance to guidelines is generally low among health care providers, little is known about the impact of guidelines on the quality of delivery of care. To improve adherence to guideline recommendations on mental health problems, an implementation strategy was developed for Dutch occupational physicians (OPs). The aims were 1) to assess adherence to a mental health guideline in occupational health care and 2) to evaluate the effect of a tailored implementation strategy on guideline adherence compared to traditional guideline dissemination.MethodsAn audit of medical records was conducted as part of a larger RCT study. Participants were 66 OPs (32 intervention and 34 control) employed at one of six sites of an Occupational Health Service in southern Netherlands. OPs in the intervention group received multiple-session peer group training which focused on identifying and addressing barriers to using the guideline, using a Plan-Do-Check-Act approach. The control group did not receive training.Medical records of 114 workers sick-listed with mental health problems were assessed (56 intervention and 58 control). Guideline adherence was determined by auditing the records using 12 guideline-based performance indicators (PI), grouped into 5 PIs: process diagnosis, problem orientation, interventions/treatment, relapse prevention, and continuity of care. Differences in performance rates of the PIs between the intervention and control groups were analyzed, taking into account the cluster study design.ResultsOPs who received the training showed significantly greater adherence compared to the controls (p < .028) in 4 out of 5 grouped PIs, i.e. process diagnosis, problem orientation, interventions/treatment and relapse prevention. In one out of 12 PIs adherence was found adequate (53% of the medical records), in 6 PIs adherence was found minimal, and in 5 PIs the majority of the records showed no adherence.ConclusionsAn implementation strategy which addressed key barriers for change and tailor-made interventions improves adherence to an occupational health guideline for mental health problems compared to traditional guideline dissemination. However, adherence to the guideline recommendations is still far from optimal. To optimize adherence, it is recommended that implementation strategies focus on the workers level, organizational level, and the professional level.Trial registrationISRCTN86605310. Registered 30 June 2010.

Towards Practical Guidelines for Mental Health and Psychosocial Support after Emergencies in the Western Pacific Region

Introduction:The Western Pacific Region, comprised of 37 diverse countries and areas, is one of the world’s areas most prone to be affected by disaster. Seven of the top ten countries most at risk of a natural disaster are in this region. The Regional Agenda for Implementing the Mental Health Action Plan 2013-2020 in the Western Pacific identifies mental health in disasters and emergencies as a priority area and calls for a social movement for action on mental health and well-being. To increase understanding of and need for mental health and psychosocial support in emergency situations, regional guidelines are necessary. It is unclear to what degree international guidelines are applicable in this region.Aim:To synthesize the contents of available evidence-based guidelines and assess their potential to address the mental health and psychosocial needs of people in emergency settings in the Western Pacific Region.Methods:A systematic literature review of existing guidelines for mental health and psychosocial support in disasters and emergencies was conducted. Using the Appraisal of Guidelines for Research and Evaluation II instrument, the quality of each guideline was determined covering the following: (1.) scope and purpose, (2.) stakeholder involvement, (3.) rigor of development, (4.) clarity of presentation, (5.) applicability, and (6.) editorial independence.Results:The results provide an overview of the quality, number, and specificity of available guidelines. A framework was developed to categorize these guidelines on each stage of the disaster management cycle (prevention, preparedness, response, and recovery) while considering their guidance regarding coordination, monitoring, communication, human resources, and connection with regular health services.Discussion:The framework and its implications for further research and development are presented at the conference. We will specifically focus on the question, “What is needed to move from a reactive to a more proactive stance in policy and practice?”

Homo- and Heterotypic Trajectories in a Preschool to Primary-School Clinical Sample: A Prospective Study Related to Maternal Psychopathology.

Background: Most longitudinal or follow-up mental health studies describe developmental pathways using dimensional measures of psychopathology, but seldom using pathways described by clinical disorders.Objective: We aim to describe diagnostic pathways by homotypic (within the disorder continuity) and heterotypic development (between the disorder continuity), with maternal psychopathology as moderator for both trajectories.Methods: Clinically referred children (0–7 years; N = 83) were assessed at preschool age and at primary-school age through a clinical interview. We built a disorder cluster of emotional disorders (ED; F32, F40, F42, F43, F93.0, F93.1, F93.2, F93.8, F95), behavioral disorders (BD; F68.8, F90, F91, F91.3, F93.3, F93.9, F94), and specific early onset disorders (SEO; F50, F51, F70, F98.0, F98.1, F98.2, F98.8, F98.9). We describe the prevalence, comorbidity, and clinical trajectories of various types of homotypic and heterotypic development.Results: We observed a high rate of comorbidity throughout the study (62.6% at admission and 67.5% at follow-up) and in general, a high continuity of mental health problems from preschool to primary-school age children (69.9% of the sample showed continuity), with 50.6% of the sample showing homotypic and 44.6% showing heterotypic development. Hierarchical multiple regression analyses suggest that heterotypic development may be influenced by maternal psychopathology.Conclusion: Currently, evidence-based mental health guidelines for preschool populations are designed and evaluated assuming a homotypic development. However, our findings indicate that treatment interventions and outcome measures should also be designed and evaluated for heterotypic development especially in case of increased maternal psychopathology.

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application.

To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. Australian New Zealand Clinical Trials Registry ACTRN12618001580268.

Mental Health screening in cystic fibrosis centres across Europe

ObjectivesThe Cystic Fibrosis (CF) International Mental Health Guidelines Committee published consensus statements for screening and treating depression and anxiety in individuals with CF and their caregivers. This work aimed to evaluate the dissemination and implementation of the guidelines in Europe two years following their publication. MethodsA 28-item survey was developed by the multidisciplinary ECFS Mental Health Working Group and emailed to approximately 300 CF centres across Europe. The survey evaluated (a) who should be responsible for mental health (MH) care, (b) the current awareness and agreement of the guidelines, (c) the provision of recommended MH screening and follow-up care, and (d) successes, barriers and required resources/training needs. ResultsResponses were received from 187 centres (28 countries represented). There was consensus that a psychologist should be responsible for MH care, although members of the multidisciplinary team (MDT) believed they should also share this responsibility. Sixty-two percent of respondents were aware of the guidelines; 82% percent fully, and 12% partially, agreed with them. Fifty percent (94 centres) had implemented screening. In the past year approximately 6000 patients and 2000 caregivers had been screened, with 80% of respondents using the recommended screening tools. Respondents reported 551 referrals for moderate/severe psychopathology and 84 urgent suicide ideation referrals. ConclusionsThe challenges of different healthcare systems and language barriers are being overcome with a greater awareness of the importance of mental health among the MDT. MH screening is feasible and gaining momentum in both Western and Eastern Europe.

Reconciling mental health, public policing and police accountability

The paper evaluates a range of policy documents, parliamentary debates, academic reports and statutes in an attempt to contextualise the condition of mental health policing in England and Wales. It establishes that mental health care plays an important role in public policing and argues that police organisations need to institute urgent reforms to correct a prevailing culture of complacency. An unethical cultural attitude towards mental health care has caused decision-making and the exercise of police discretion to be neither well informed nor protective in many cases, resulting in the substandard treatment of people with mental health problems. The paper argues that changes introduced by the Policing and Crime Act 2017 and the revised College of Policing mental health guidelines do not go far enough and that more extensive root-and-branch reforms are needed.

An Ethnographic Study of Mental Healthcare Services for People with Mental Illness in Rural Thailand

ABSTRACTLittle is known about access to healthcare services among people with mental illness in rural Thailand. This study describes a contextual understanding of access to mental healthcare services for people with mental illness in three selected villages located in a rural district in Northeastern Thailand. An ethnographic approach was adopted wherein in-depth interviews and site observation were conducted. In all, 14 participants were interviewed, 9 persons with mental illness and 5 caregivers, between January and July in 2017. The study described how people with a mental illness and their primary caregivers experience access to mental health services. Three major cultural theme patterns emerged during the analysis: Theme 1- family stress: avoiding repercussion from the bad experience, Theme 2 - waking before dawn: the most important rule to abide by, and Theme 3- going quickly only to remain silent and still: the duty of a good patient. This study has provided an insight into the experiences of people with mental illness accessing mental health services, which is of importance for improving the queuing system at the outpatient mental health clinic and guidelines for healthcare providers interacting with patients and their families.

Health Policy in Nepal: An Assessment of Clinical Guidelines in Relation to the Burden of Disease

Background: Clinical guidelines provide health workers with valuable information on how to diagnose and treat patients. In many low-income countries, there appears to be a lack of appropriate clinical guidelines for conditions with high rates of morbidity; Nepal is one such nation. It is useful to examine clinical guidelines in relation to disease burden to establish any gaps which might be addressed through changes in policy and practice.Methods: The research adopted a mixed-methods approach, quantifying disease burden both nationally and in five districts served by PHASE Nepal – an NGO working in health and development – before contrasting this with available clinical guidelines in Nepal. Key informant interviews were subsequently conducted to gain greater insight into disease burden and guideline availability.Results: Of the 10 diseases found to be most burdensome in the PHASE-served districts, 3 lacked any context-specific guidelines. NCDs were found to be prevalent at both district and national level, yet guideline provision for such conditions was minimal. Mental illness was highlighted by interview participants as a growing problem; however, Nepal does not currently have any utilisable clinical guidelines for mental health. Missing data was identified as a significant issue, with lack of mortality data hindering accurate quantification of local and national disease burden.Conclusions: There is evident need for more context-appropriate clinical guidelines in Nepal to effectively diagnose and treat diseases that are most burdensome within communities. Improving health data quality is fundamental to ensuring policy makers are equipped with accurate information from which to develop appropriate protocol.Journal of Manmohan Memorial Institute of Health SciencesVol. 3, No. 1, 2017, page: 24-35

Ethnographic case study of a community day center for asylum seekers as early stage mental health intervention.

Clinical guidelines in refugee mental health increasingly advocate phased approaches to intervention that foreground the provision of pragmatic and social support in contexts of ongoing instability. However, the impact of such interventions has rarely been explored from the perspective of refugees themselves. We conducted ethnographic research on the experiences and perceptions of users of an intervention embodying this approach: a community Day Center for asylum seekers in Montreal. Data comprising 15 interviews and field notes from 50 participant observation visits were analyzed using an established theoretical framework to identify mechanisms supporting self-perceived wellbeing among users in the domains of safety, social networks, justice, identity/roles, and existential meaning. Results shed light on how this nonspecific buffering intervention responds to the threats and pressures asylum seekers themselves identify as most salient in the immediate postflight context. These findings are discussed in relation to emerging theoretical frameworks in refugee mental health that emphasize agency, justice, and the role of local ecologies. We conclude that the Day Center shows significant promise as an innovative early stage mental health intervention for precarious status migrants and merits further research and evaluation. (PsycINFO Database Record