High-quality Mental Health Care Research Articles

“It’s a Circus”: Family Caregivers’ Perceptions on Accessing Mental Health Care for Individuals with Intellectual and Developmental Disabilities

ABSTRACT Background Previous research has demonstrated that individuals with intellectual and developmental disabilities (IDD) experience a variety of barriers in accessing mental health care and that family caregivers often play an integral role in helping individuals with IDD navigate these systems. However, little research has focused on family caregivers’ perceptions of accessing mental health services. Methods To better understand their perspectives, we analyzed responses to an open-ended question about challenges to accessing mental health resources for adults with IDD from 208 family caregivers. Responses were analyzed using a team-based approach to qualitative data analysis. Results We identified five themes that capture both systematic issues and personal or interpersonal challenges that reduce access to high quality mental health care among adults with IDD. In addition to the barriers, we also identified some accounts of families succeeding in accessing adequate mental health care. Conclusions We offer practical implications for research, policy, and practice that can help reduce barriers to mental health care for adults with IDD.

An Architecture for Transformation in Child Mental Health

This Viewpoint describes efforts to provide timely, comprehensive, and high-quality mental health care to a large population-representative subset of children within a single health system and demonstrate its potential impact and true cost.

Youth Mental Health in the Wake of the COVID-19 Pandemic.

In this article we examine the current state of youth mental health across the United States and in Delaware, and discuss the impact of the COVID-19 pandemic on the mental health and well-being of children and adolescents. We review available literature detailing the short- and long-term effects of the COVID-19 pandemic on youth mental health and discuss the resultant programmatic and legislative efforts in Delaware and nationally. The COVID-19 pandemic had a severe impact on the mental health of young people. The prevalence of depression and anxiety among children and adolescents, which was already increasing pre-pandemic, spiked after the pandemic's onset. Even as public health precautions have lifted, young people continue to struggle with mental health in conjunction with lower levels of educational achievement, hindered social development, increased screen time, diminished access to effective mental healthcare, and economic instability. The negative impact of the pandemic will continue to have ramifications on the health and wellbeing of young people for years to come. Compiling evidence examining mental health trends is an important first step to understanding the impact of the pandemic on child and adolescent mental health and developing effective solutions. Although the official state of emergency is over, the effects of the COVID-19 pandemic are far-reaching and long-lasting. It is imperative that legislators and program administrators in Delaware and nationally work to ensure that young people and their families have access to affordable, high quality mental healthcare.

A mixed methods analysis of existing assessment and evaluation tools (AETs) for mental health applications.

Mental health Applications (MH Apps) can potentially improve access to high-quality mental health care. However, the recent rapid expansion of MH Apps has created growing concern regarding their safety and effectiveness, leading to the development of AETs (Assessment and Evaluation Tools) to help guide users. This article provides a critical, mixed methods analysis of existing AETs for MH Apps by reviewing the criteria used to evaluate MH Apps and assessing their effectiveness as evaluation tools. To identify relevant AETs, gray and scholarly literature were located through stakeholder consultation, Internet searching via Google and a literature search of bibliographic databases Medline, APA PsycInfo, and LISTA. Materials in English that provided a tool or method to evaluate MH Apps and were published from January 1, 2000, to January 26, 2021 were considered for inclusion. Thirteen relevant AETs targeted for MH Apps met the inclusion criteria. The qualitative analysis of AETs and their evaluation criteria revealed that despite purporting to focus on MH Apps, the included AETs did not contain criteria that made them more specific to MH Apps than general health applications. There appeared to be very little agreed-upon terminology in this field, and the focus of selection criteria in AETs is often IT-related, with a lesser focus on clinical issues, equity, and scientific evidence. The quality of AETs was quantitatively assessed using the AGREE II, a standardized tool for evaluating assessment guidelines. Three out of 13 AETs were deemed 'recommended' using the AGREE II. There is a need for further improvements to existing AETs. To realize the full potential of MH Apps and reduce stakeholders' concerns, AETs must be developed within the current laws and governmental health policies, be specific to mental health, be feasible to implement and be supported by rigorous research methodology, medical education, and public awareness.

CULTURAL BELIEFS AND INTERPRETATION OF SYMPTOMS OF SCHIZOPHRENIA IN KENYA

This abstract provides a concise overview of the prevalence of cultural beliefs and their impact on the recognition and treatment of schizophrenia symptoms in Kenya, drawing from a review of relevant literature including "A survey of psychosis risk symptoms in Kenya," "Cultural Aspects of Major Mental Disorders: A Critical Review from an Indian Perspective," "Psychotic Symptoms in Kenya – Prevalence, Risk Factors, and Relationship with Common Mental Disorders," and "Exploring mental health practice among traditional health practitioners: a qualitative study in rural Kenya." This review reveals a complex interaction between traditional cultural beliefs that are held by many Kenyan communities and Western biomedical viewpoints on schizophrenia. Results of a survey conducted in Kenya on psychosis risk symptoms highlight the substantial overlap between symptoms that are distinctive to a culture and those that meet Western psychiatric standards. This overlap emphasizes how crucial it is to use culturally aware methods when diagnosing and treating schizophrenia in Kenya. Studies conducted on psychotic symptoms in Kenya show that a significant proportion of schizophrenia patients experience symptoms that are culturally specific, such as spirit possession and witchcraft beliefs. These culturally particular symptoms frequently impact behavior related to seeking help and adhering with treatment, with traditional healers having a significant role in the treatment of mental illness. Reliance on conventional healers, however, may impede treatment outcomes for people with schizophrenia and prolong the time it takes to receive evidence-based psychiatric therapy. It is important to consider the cultural perceptions and beliefs around the symptoms of schizophrenia in Kenya highlight the critical need for culturally competent methods to mental health treatment. Schizophrenia treatment initiatives must strike a careful balance between honoring various cultural viewpoints and encouraging cooperation between conventional healers and biological professionals. The creation of culturally appropriate therapies and the improvement of mental health literacy in Kenyan communities ought to be the top priorities for future research in order to guarantee that people with schizophrenia have fair access to high-quality mental health care.

Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study.

The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads. We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States.

Perinatal mental health care in the Italian mental health departments: a national survey.

Evidence on the negative outcomes of untreated mental disorders during pregnancy and in the first year after childbirth on women's and children's health has stimulated interest in how to develop and sustain high-quality mental health care during the perinatal period. In Italy, there is a lack of knowledge about how mental health services support women with perinatal mental disorders (PMDs). This study aims to describe the adoption of good practices for the prevention and care of PMDs by the Italian mental health departments (MHDs). This is a nationwide cross-sectional survey conducted online using LimeSurvey. Starting from the Ministry of Health Registry's 127 MHDs were invited to participate between February and March, 2023. Characteristics of the participating MHDs were reported as descriptive statistics. One hundred nineteen MHDs participated, with a response rate of 93.7%. Regarding the prevention of PMDs, 69 (58.0%) MHDs offer preconception counseling, whereas only 6 (5.0%) have information material for this purpose. Written integrated care pathways for PMDs are not available in 94 (79.7%) MHDs. A reference professional for psychopharmacological treatment during pregnancy or breastfeeding is available in 55 (46.2%) MHDs, while a specific treatment plan for women with PMDs is adopted by 27 (22.7%) MHDs. Thirty-four (28.6%) MHDs have established an outpatient clinic for PMDs, whereas there are no inpatient psychiatric facilities designed for mothers and infants (mother-baby units). There is a need to improve the care of women with PMDs in Italy. The provision of pre-conception counseling, integrated care pathways, and specialist skills and facilities for PMDs should be prioritized.

Understanding the uptake of virtual care for first and return outpatient appointments in child and adolescent mental health services: a mixed-methods study

ObjectiveTo describe patterns of virtual and in-person outpatient mental health service use and factors that may influence the choice of modality in a child and adolescent service.DesignA pragmatic mixed-methods approach...

Migration and mental health over the past 20 years: how has the situation evolved?

Abstract Background Poor mental health is heavily stigmatized, even more when it comes to migrant and ethnic minority groups (MEM). Belgium, with its long history of immigration, is a good case study for analysing mental illness (MI) prevalence and how it has evolved over time across ethnic groups. This paper aims to shed light on the prevalence of MI among MEM in Belgium, between 1997 and 2018. Its objective is to describe the potential disparities in MI prevalence over time by ethnicity. Methods The study used data from the six cross-sectional waves of the Belgian Health Interview Survey from 1997 to 2018 to assess the prevalence of MI among five major ethnic groups in Belgium, and to analyse potential disparities over time using logistic and linear regression models. The 12-item General Health Questionnaire was used to measure mental illness (score≥4), and the minimal clinically important difference (MID) was also calculated for MI severity. Results From 1997 to 2008, the proportion of people with MI was similar across ethnic groups. However, in 2013 and 2018, there was a significant increase in MI prevalence among Moroccan and Turkish respondents compared to Belgians. The study also found that Turkish respondents had a higher score of mental distress than Belgians from 2013 onwards. In 2018, having a mother born in a non-EU country was found to increase the risk of MI (β = 1.38, CI95%= 0.71;2.05), even after controlling for age, sex and education level. Conclusions Mental health inequalities between ethnic groups are on the rise in Belgium, particularly among the Moroccan and Turkish populations. Specific interventions and policies must be implemented to prevent the increase of MI among MEM, and ensure that high-quality mental health care is accessible to all, regardless of ethnicity. Additionally, we recommend better data collection in future research on ethnic mental health, especially on the country of birth of respondents and their parents. Key messages • This study describes the evolution of the prevalence of mental health risk among the migrant population in comparison with the native population in Belgium. • The results of this study can help us to understand the evolution of mental health risk since 1997 and to develop appropriate policies and interventions.

Understanding inequalities in access to adult mental health services in the UK: a systematic mapping review

BackgroundPopulation groups experience differential access to timely and high-quality mental healthcare. Despite efforts of recent UK policies to improve the accessibility of mental health services, there remains a lack of comprehensive understanding of inequalities in access to services needed to do this. This systematic mapping review aimed to address this gap by identifying which population groups continue to be poorly served by access to adult mental health services in the UK, how access has been measured, and what research methods have been applied.MethodsSeven electronic databases were searched from January 2014 up to May 2022. Primary research studies of any design were included if they examined access to adult NHS mental health services in the UK by population groups at risk of experiencing inequalities. Study characteristics, measures of access, inequalities studied, and key findings were extracted. A best-fit framework approach was used, applying Levesque’s Conceptual Framework for Healthcare Access to synthesise measures of access, and applying a template derived from Cochrane Progress-Plus and NHS Long Term Plan equality characteristics to synthesise key findings associated with inequalities.ResultsOf 1,929 publications retrieved, 152 studies of various types were included. The most frequently considered dimensions of inequality were gender, age, and ethnicity, whilst social capital, religion, and sexual orientation were least frequently considered. Most studies researched access by measuring “healthcare utilisation”, followed by studies that measured “healthcare seeking”. Key barriers to access were associated with individuals’ “ability to seek” (e.g. stigma and discrimination) and “ability to reach” (e.g. availability of services). Almost half of the studies used routinely collected patient data, and only 16% of studies reported patient and public involvement.ConclusionsLittle appears to have changed in the nature and extent of inequalities, suggesting that mental health services have not become more accessible. Actions to reduce inequalities should address barriers to population groups’ abilities to seek and reach services such as stigma-reducing interventions, and re-designing services and pathways. Significant benefits exist in using routinely collected patient data, but its limitations should not be ignored. More theoretically informed research, using a holistic measurement of access, is needed in this area.Review registrationhttps://doi.org/10.17605/OSF.IO/RQ5U7.

Mental health among people with a migration background in Belgium over the past 20 years: how has the situation evolved?

BackgroundPoor mental health is highly stigmatized and stereotyped, even more when it comes to migrant and ethnic minority groups (MEM). Belgium, which has a long history of immigration, is a good case study for analysing how the prevalence of mental illness (MI) has evolved over time and how such evolution had differed between MEM. This paper seeks to explore the prevalence of MI and potential inequalities among MEM compared to native Belgians between 1997 and 2018, shedding light on this important issue.MethodsThe data set is composed of the six cross-sectional waves of the Belgian Health Interview Survey from 1997 to 2018. The 12-item General Health Questionnaire was used to assess the average level of mental health and the prevalence of MI (score ≥ 4) among five major MEM groups in Belgium (Belgian, Moroccan, Turkish, European migrants, and non-European migrants). Multivariate logistic and linear regression models were used to assess the likelihood of having a MI in the different MEM groups and survey years. The minimal clinically important difference (MID) was also calculated for the severity of MI.ResultsAfter controlling for socioeconomic status, the average marginal effect indicated a decrease in mental health among Moroccans and Turks in Belgium between 1997 and 2018, compared to Belgians. This result was confirmed by the Chi²-test, which showed that Turkish (χ²=17.75, p < 0.001) and Moroccans respondents (χ²=4.19, p < 0.04) had a higher overall level of mental distress than Belgians. Furthermore, in 2018, even after adjusting for age, sex and education level, having a mother born in a non-EU country increased the risk of mental illness.ConclusionsMental health inequalities between migrant and ethnic groups are on the rise in Belgium. To address this issue, particular attention should be given to the Moroccan and Turkish background populations. Specific interventions and policies must be implemented to prevent the increase of psychological distress among migrants and ethnic minorities, on the one hand, and ensure that high-quality mental health care is accessible to all, regardless of ethnicity, on the other hand. Additionally, we recommend that future research on ethnic mental healthcare includes better data collection on the country of birth of respondents and their parents.

Challenges facing the psychiatric reform and mental health care in Brazil: Critical unmet needs and prospects for better integrating the public and university sectors

In Brazil, two main mental health care sectors (public and academic) coexist, interact, and tension each other with distinct, antagonistic views and ethos, producing a scenario of distancing and mistreatment. All the leading players involved need to take a new stance to openly discuss the roots of their divergences and accept the challenge of formulating a minimally joint and integrated project for the Brazilian mental healthcare system policy and practices.Here we present and discuss five critical unmet needs of the mental health system that should be tackled through more integrated work between the public and university sectors aiming at: 1. Providing better emergency care, including, when required, inpatient treatment in general hospital psychiatric units for patients with severe mental disorders in acute episodes; 2. Optimizing the use of clozapine, granting a trial for all patients with treatment-resistant schizophrenia and other severe psychoses; 3. Updating the list and protocols of use of psychiatric drugs available in the Brazilian Unified Health System; 4. Updating psychosocial rehabilitation interventions; 5. Implementing a two-way collaboration between the network of mental health services, especially the CAPS, and Primary Care Centers to offer integrated healthcare, addressing thus the high physical morbidity of patients with severe mental disorders.Psychiatric reform in Brazil has gone a long way in the past few decades toward community-centered mental health care. It was never an easy process, proper funding was always a challenge, and the risk of political drawbacks loomed, particularly in the last years. We believe the country has the necessary resources to deliver high-quality and accessible mental health care. Now is the time to better integrate the public and university sectors to address the critical issues and move forward with the psychiatric reform agenda.

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Veterans Health Administration Outpatient Psychiatry Staffing Model: Longitudinal Analysis on Mental Health Performance

BackgroundAn adequate supply of mental health (MH) professionals is necessary to provide timely access to MH services. Veterans Health Administration (VHA) continues to prioritize the expansion of the MH workforce to meet increasing demand for services.ObjectiveValidated staffing models are essential to ensure timely access to care, to plan for future demand, to ensure delivery of high-quality care, and to balance the demands of fiscal responsibility and strategic priorities.DesignLongitudinal retrospective cohort of VHA outpatient psychiatry, fiscal years 2016–2021.ParticipantsOutpatient VHA psychiatrists.Main MeasuresQuarterly outpatient staff-to-patient ratios (SPRs), defined as the number of full-time equivalent clinically assigned providers per 1000 veterans receiving outpatient MH care, were calculated. Longitudinal recursive partitioning models were created to identify optimal cut-offs for the outpatient psychiatry SPR associated with success on VHA’s measures of quality, access, and satisfaction.Key ResultsAmong outpatient psychiatry staff, the root node identified an outpatient SPR of 1.09 for overall performance (p < 0.001). For metrics associated with Population Coverage, a root node identified an SPR of 1.36 (p < 0.001). Metrics associated with continuity of care and satisfaction were associated with a root node of 1.10 and 1.07 (p < 0.001), respectively. In all analyses, the lowest SPRs were associated with the lowest group performance on VHA MH metrics of interest.ConclusionsEstablishing validated staffing models associated with high-quality MH care is critical given the national psychiatry shortage and increasing demand for services. Analyses support VHA’s current recommended minimum outpatient psychiatry-specific SPR of 1.22 as a reasonable target to provide high-quality care, access, and satisfaction.

Collaboration Key to Psychiatry’s Future and a Mentally Healthy Nation, Levin Says

Back to table of contents Next article Annual MeetingFull AccessCollaboration Key to Psychiatry’s Future and a Mentally Healthy Nation, Levin SaysMark MoranMark MoranSearch for more papers by this authorPublished Online:8 Jun 2023https://doi.org/10.1176/appi.pn.2023.07.7.15AbstractLevin introduced a major APA Foundation campaign titled “Mental Health Care Works,” dedicated to encouraging Americans to seek treatment for mental and substance use disorders when they need it.“Collaboration, innovation, and leadership are key components of progress for psychiatry and for the future of mental health care in America,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., citing the theme of this year’s APA Annual Meeting, at the Annual Meeting’s Opening Session.“It seems like just yesterday that we were here in San Francisco celebrating the 175th anniversary of our Association back in 2019, where we celebrated our past,” Levin recalled. “The events of the past few years have underscored the importance of innovation, collaboration, and of claiming our future as experts in the connection between mind, body, and brain.”“Integrated health systems that emphasize the total health of a patient are the way forward.,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A.Levin said this year’s presidential theme is a timely one. “In order to chart the best course for our future, we must collaborate with other medical specialties and outside groups; pursue and embrace innovative treatments, technologies, and solutions to persistent problems; and motivate our members and psychiatrists everywhere in the world to take a leadership role in affecting positive change in our profession,” he said.Collaboration is especially important, he said, noting that most patients who need care for mental or substance use disorders first find care in an emergency department or primary care setting. “For years we have espoused the benefits of the collaborative care model and the potential they have for addressing the immense demand of mental health care, reducing costs, and improving outcomes for our patients,” Levin said. “Integrated health systems that emphasize the total health of a patient are the way forward.”Levin used the occasion to introduce a major APA Foundation campaign titled “Mental Health Care Works,” dedicated to encouraging Americans to seek treatment for mental and substance use disorders when they need it.“Our goal for this campaign is to reinforce the idea that the work that psychiatrists do every day is essential to the health and well-being of our nation … and that it is courageous and life-affirming to seek it out.” He added that achieving a mentally healthy nation is well worth the investment of whatever time and money are necessary.“We must emphasize that no one is immune from mental health challenges, nor is anyone beyond help,” he said. “By embracing our humanity and promoting community, we can socialize the idea that mental illness and addiction are not moral failings, but are treatable illnesses like any other physical ailment.”Levin reminded attendees of several positive trends for APA—membership numbers are trending upward, with more than 38,000 psychiatrists, and the association is more diverse in race, gender, and geography.“We are embracing and supporting this change, as it is a reflection of the ever-diversifying patient population in our country,” Levin said. He hailed especially the place of international medical graduates (IMGs) in American psychiatry. “I myself am an IMG and am heartened to see how invested our members are in ensuring that their colleagues who are IMGs feel supported and are able to integrate into our system successfully,” he said.He emphasized that principles of diversity, equity, inclusion, and belonging are inseparable from APA’s mission as a medical association.“Equality and health equity cannot truly happen unless we address the social determinants of health and mental health that cause and worsen barriers and gaps in care,” he said. “These principles are our guiding light as we work to support and facilitate diversity in our profession and improve access to high-quality mental health care for minority and underrepresented groups, including women and the LGBTQ+ community.” ■ResourcesMental Health Care Works campaign site ISSUES NewArchived

Using Digital Measurement-Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data.

A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children's symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members' depressive symptom T-scores remained largely stable throughout their involvement. As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc.

A Systemwide Postpartum Inpatient Maternal Mental Health Education and Screening Program

ObjectiveTo expand a hospital system’s maternal mental health program to standardize screening for perinatal mood and anxiety disorders. DesignQuality improvement initiative using a continuous Plan–Do–Study–Act (PDSA) cycle. Setting/Local ProblemIn a hospital system consisting of 66 maternity care centers across the United States, there was significant variation in maternal mental health screening, referral, and education practices. The COVID-19 pandemic and increasing rates of severe maternal morbidity further elevated system-level concern about the quality of maternal mental health care being provided. ParticipantsPerinatal nurses. MethodsAn “all-or-none” bundle methodology was used to measure adherence to a system standard for maternal mental health screening, referral, and education. InterventionsA toolkit was designed internally to support streamlined implementation and ensure standardization for screening, referral, and education. This comprehensive toolkit includes screening forms, a referral algorithm, staff education, patient education literature, and a community resource list template. Training on how to use the toolkit was provided to nurses, chaplains, and social workers. ResultsThe initial system bundle adherence rate was 76% (2017) in the first year of the program. The following year, the bundle adherence rate increased to 97% (2018). Despite the disruption caused by the COVID-19 pandemic, this mental health initiative has maintained an overall adherence rate of 92% (2020–2022). ConclusionThis nurse-led quality improvement initiative has been successfully implemented across a geographically and demographically diverse hospital system. The initial and sustained high rates of adherence with the system standard for screening, referral, and education illustrate perinatal nurses’ commitment to the delivery of high-quality maternal mental health care in the acute care setting.

Best practice in perinatal mental healthcare

Journal of Health VisitingVol. 11, No. 3 EditorialBest practice in perinatal mental healthcarePolly MoffatPolly MoffatE-mail Address: [email protected]Editor, JHVSearch for more papers by this authorPolly MoffatPublished Online:13 Mar 2023https://doi.org/10.12968/johv.2023.11.3.93AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Institute of Health Visiting, Maternal Mental Health Alliance (2023) Supporting High-Quality Perinatal Mental Health Care. https://maternalmentalhealthalliance.org/news/ihv-mmha-resource-inform-high-quality-perinatal-mental-health-care (accessed 7 March 2023) Google ScholarNHS England, NHS Improvement (2021) Involving and Supporting Partners and Other Family Members in Specialist Perinatal Mental Health Services.’ Good Practice Guide. www.england.nhs.uk/wp-content/uploads/2021/03/Good-practice-guide-March-2021.pdf (accessed 7 March 2023) Google Scholar FiguresReferencesRelatedDetails 2 March 2023Volume 11Issue 3ISSN (print): 2050-8719ISSN (online): 2052-2908 Metrics History Published online 13 March 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedPDF download

Challenges in the Borderline Personality Disorder diagnostic in clinical practice in community: results of a pilot study

IntroductionBorderline personality disorder (BPD) has a significant presence in outpatient psychiatric practice worldwide, but data on the clinical features of patients with BPD in Russia are limited. Clinicians experience a number of difficulties in diagnosing BPD, which is also due to the high comorbidity of BPD with other mental disorders (affective, anxiety, other personality and addictive disorders).ObjectivesThe aim of this pilot study was to investigate clinical characteristics of mental health care for patients с BPD in real clinical practice in community in Saint-Petersburg, Russia.MethodsFifty patients (72% female; n=36; mean age 22.4±4.3) who were treated in an outpatient community care were included in the study. Diagnosis was made according to the ICD-10 criteria (F60.31), as it does in clinical practice in Russia. Research methods included a clinical-catamnestic method.ResultsThe age of onset of BPD symptoms was 14.9±2.7. It was found that 50% of patients had previously received inpatient (20%, n=10) and outpatient (30%, n=15) psychiatric care unrelated to the current mental condition, that is, not due to the BPD. 16% of patients (n=8) referred for the first time for psychiatric care in adolescence. The vast majority of patients (86%; n=43) were not diagnosed with BPD when they first consulted a psychiatrist. Prior to the diagnosis of BPD, patients were diagnosed with mental disorders due to organic brain injury (4%), affective disorders (44%), schizophrenia spectrum disorders (12%), anxiety disorders (20%) and other personality disorders (6%). On average, it took 7.5±4.0 years from the date of first psychiatric assessment before the diagnosis of BPD was confirmed. At the time of inclusion in the study, patients were diagnosed with the following comorbid mental health conditions: affective disorders (12%), anxiety disorders (6%), eating disorders (4%), and addictive disorders (2%).ConclusionsThe hypodiagnosis of BPD in the early stages of the disorder has been identified, making it challenging to obtain high quality mental health care in a timely manner. The frequent comorbidity between BPD and other mental disorders has been confirmed. The study demonstrates the relevance of introducing programs (including education) to improve the diagnosis and study of comorbidity of BPD in real clinical practice. The pilot study results provide the basis for a project to investigate approaches to differential diagnosis and evaluation of treatment strategies for patients with BPD.Disclosure of InterestNone Declared

The United States must improve its data infrastructure to ensure high-quality mental health care.

Use of and spending on mental health services in the United States more than doubled over the past two decades. In 2019, 19.2% of adults received mental health treatment (medications and/or counseling) at a cost of $135 billion. Yet, the United States has no data collection system to determine what proportion of the population benefited from treatment. Experts have for decades called for a learning behavioral health care system: a system that collects data on treatment services and outcomes to generate knowledge to improve practice. As the rates of suicide, depression, and drug overdoses in the United States continue to rise, the need for a learning health care system becomes even more pressing. In this paper, I suggest steps to move toward such a system. First, I describe the availability of data on mental health service use, mortality, symptoms, functioning, and quality of life. In the United States, the best sources of longitudinal information on mental health services received are Medicare, Medicaid, and private insurance claims and enrollment data. Federal and state agencies are starting to link these data to mortality information; however, these efforts need to be substantially expanded and include information on mental health symptoms, functioning, and quality of life. Finally, there must be greater efforts to make the data easier to access such as through standard data use agreements, online analytic tools, and data portals. Federal and state mental health policy leaders should be at the forefront of efforts to create a learning mental health care system.