High-quality Mental Health Services Research Articles

BackgroundWith the growing need for accessible, high-quality mental health services, especially during the COVID-19 pandemic, there has been increasing development and uptake of web-based interventions in the form of self-directed mental health platforms. The Big White Wall (BWW) is a web-based platform for people experiencing mental illness and addiction that offers a range of evidence-based self-directed treatment strategies. Drawing on existing data from a large-scale evaluation of the implementation of BWW in Ontario, Canada (which involved a pragmatic randomized controlled trail with an embedded qualitative process evaluation), we sought to investigate the influences on the extent to which people engage with BWW.MethodsIn this paper we drew on BWW trial participants’ usage data (number of logins) and the qualitative data from the process evaluation that explored participants’ experiences, engagement with and reactions to BWW.ResultsOur results showed that there were highly complex relationships between the influences that contributed to the level of engagement with BWW intervention. We found that a) how people expected to benefit from using a platform like BWW was an important indicator of their future usage, b) moderate perceived symptoms were linked with higher engagement; whereas fewer actual depressive symptoms predicted use and anxiety had a positive linear relationship with usage, and that c) usage depended on positive early experiences with the platform.ConclusionsOur findings suggest that the nature of engagement with platforms such as BWW is not easily predicted. We propose a theoretical framework for explaining the level of user engagement with BWW that might also be generalizable to other similar platforms.

Individuals with intellectual and developmental disabilities (IDD) are at high risk of co-occurring mental health conditions, including major depressive disorder, bipolar disorder, psychotic disorders, anxiety disorders, impulse control disorders, and others. Because of symptoms associated with these illnesses and with the disabilities themselves, these individuals are often served in a mental health service system framework. In this second of two articles on care for persons with IDD in the mental health system, the authors focus on policy and systems considerations to assist practitioners and administrators to provide high-quality mental health services for these individuals by recognizing existing infrastructures of support. The authors describe historical factors, including legislation and case law, that have led to greater inclusion of persons with IDD in mainstream settings; systemic barriers to integrating services for persons with IDD and Medicaid waivers and provisions of the Affordable Care Act designed to overcome such barriers; and considerations for treating persons with IDD in various settings, such as emergency departments and forensic settings. They propose approaches to developing the workforce, such as by training direct service professionals and utilizing the services of board-certified behavioral analysts. A robust continuum of care and service delivery system that is increasingly sophisticated in working with persons with IDD, with and without co-occurring mental illness, is critical to maximize the autonomy and community inclusion of these individuals.

Introduction. Stigma related to substance use disorders (SUDs) and alcohol use disorders (AUDs) is widespread and has significant implications for healthcare inequality. Stigmatization affects every aspect of care for individuals, leading to negative perceptions, limited resources, and reduced treatment outcomes. The negative attitudes of healthcare professionals towards this vulnerable group of patients further contribute to the problem. To address this issue, it is essential to raise awareness, challenge societal perceptions, and enhance support systems. Objectives and methods. This study aims to evaluate the level of work satisfaction among resident doctors when working with patients with substance-related issues, comparing psychiatric residents with those from other specialties. Additionally, it seeks to assess any differences in work satisfaction between patients with alcohol-related problems and those with drug-related problems. Anonymous data was collected through an online questionnaire, including demographic information, specialized training, and family history of substance use. Two validated questionnaires, the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) and the Drug and Drug Problems Perceptions Questionnaire (DDPPQ), were used to assess work satisfaction. Results. Both groups of medical residents reported discomfort when working with patients who had alcohol-related issues. However, there was a significant difference in work satisfaction related to alcohol use, with residents from other specialties reporting that is more rewarding to work with this group of patients. Similarly, psychiatry residents felt uncomfortable working with patients who used drugs, while residents from other specialties had a more neutral attitude. In terms of work satisfaction, psychiatry residents believed it was achievable with patients who used alcohol but had neutral responses regarding patients who used drugs. The opposite was observed among residents from other specialties. Conclusion. Stigma surrounding SUDs and AUDs significantly impacts healthcare delivery and patient outcomes. It is crucial to challenge societal perceptions, enhance support systems, and provide high-quality mental health and addiction services. Addressing negative attitudes among healthcare professionals is essential for improving collaboration and treatment outcomes. By promoting awareness, understanding, and a shift towards a public health perspective, the stigma associated with substance use can be reduced, leading to better outcomes for individuals and society as a whole.

Over the past 2 decades, young people have increasingly sought acute mental health care in emergency departments (EDs).1,2 In this issue of Pediatrics, Nash et al3 examine ED length of stay for children with mental health conditions. They draw on 10 years of data from the National Hospital Ambulatory Medical Care Survey (2005–2015) to compare length of stay for visits with and without a mental health diagnosis. In their sample, 4.9% of pediatric ED visits had an associated mental health diagnosis, and mental health visits had 3.3-fold increased odds of a length of stay of ≥6 hours compared with non–mental health visits. Length of stay increased over the 10-year study period to nearly a quarter of visits lasting ≥6 hours. This increase in length of stay over time was driven primarily by visits with a mental health diagnosis only (ie, no accompanying physical health diagnoses). The study’s findings point to increasing friction in the process of accessing emergency mental health care for young people and highlight the importance of improving access to mental health services in an equitable way.Hispanic patients were nearly 3 times more likely to experience an ED stay >12 hours, compared with non-Hispanic white patients. Although the secondary data analysis in Nash et al3 was not positioned to explain this difference, racism, preferred language, and illness severity might play important roles. Hispanic youth are known to receive less mental health care and lower-quality mental health care than their non-Hispanic white peers.4 Hispanic youth are also underrepresented in clinical trials of mental health treatments, and there are disproportionately few mental health professionals of Hispanic ethnicity,5 which may further reduce the efficacy of available mental health treatments for this population. Nash et al3 suggest that individual institutions examine local data to ensure that children of all races and ethnicities, particularly Hispanic children, have equitable access to mental health services.Institutions may benefit from several interventions to improve the quality of mental health services. As a first step, they may audit how race, ethnicity, and preferred language are captured to ensure that the medical record accurately reflects a patient’s self-identity and sheds light on the disparities that prevent families from receiving language-concordant, high-quality mental health care. To further improve quality of care, institutions might seek feedback from Hispanic and Black families and develop interventions that address inequities in care, such as reducing delays to accessing interpreter services and/or mental health evaluations. Some barriers may be difficult to resolve in the ED setting alone and will require a systems-level approach. For example, ED leaders might participate in regional partnerships to work toward ensuring that expedient and language-concordant services are available not just in the ED but also in inpatient psychiatric units and community mental health services.The coronavirus disease 2019 pandemic has introduced new challenges to pediatric mental health care. Increases in frequency and severity of mental illness6 are compounded by disruptions in nonessential health care access and increased risks associated with being in a crowded ED or an inpatient psychiatric unit. Black and Hispanic families have borne an undue burden of grief,7 financial instability,8 and educational disruption9 because of the pandemic and may suffer worse mental health outcomes as well.10Policies to mitigate delays in accessing high-quality mental health services can help to alleviate these negative effects. The American Rescue Plan Act, a federal stimulus package approved by Congress on March 10, 2021,11 offers federal funding to states to develop and sustain robust state crisis response systems. Such funding may help broaden the network of mental health crisis services beyond EDs and serve as a streamlined access point for care, regardless of ability to pay. However, even if additional crisis services become available, some youth will require stabilization in an ED. For these patients, the highest-quality ED mental health services would expand beyond triage, assessment, and safety observation. Billing and reimbursement strategies that incentivize the provision of mental health care by ED providers, including safety planning,12 lethal-means reduction,13 and postdischarge mental health outreach,14 would enable more children to receive evidence-based mental health treatments more quickly.As health care leaders plan for the future of mental health care in the wake of the coronavirus disease 2019 pandemic, the findings in Nash et al3 can help guide their decisions. Strengthening pediatric community mental health resources, including crisis response services, would facilitate access to high-quality mental health care outside of the ED. In addition, engaging members of marginalized communities in health care services planning will help ensure equitable access to mental health care for all children.

Introduction: Low-income populations experience many barriers to accessing affordable, high-quality mental health services. One promising approach to improving access to care may be utilizing telemedicine in combination with expanding state Medicaid programs to cover low-income childless adults. This combination has the potential to reduce the prevalence of untreated mental illness; improve low-income populations' health and well-being; and save individuals', health care centers', and federal and state governments' money. Materials and Methods: A secondary data analysis on state Medicaid claims data was performed to calculate the percent difference in telemental health claims from 2014 through 2017 between two Medicaid expansion and two nonexpansion states in the Midwest. The percent change in claims during this time period within each of the four states was also calculated. Lastly, the difference between Medicaid telemental health utilization and other types of Medicaid telemedicine utilization was examined. Results: The Medicaid expansion states (Iowa and Minnesota) had 54% more telemental health claims per 10,000 state population than nonexpansion states (Nebraska and Wisconsin) from 2014 through 2017. During this time period, Iowa, Minnesota, and Nebraska experienced 481%, 329%, and 12% increases in Medicaid telemental health claims, respectively, and Wisconsin experienced a 10% decrease. Discussion and Conclusions: Medicaid telemental health utilization has been increasing since 2014 in the two Medicaid expansion states, especially in Iowa, while utilization has remained relatively constant in the two Medicaid nonexpansion states. This has implications for informing Medicaid policies, particularly with regard to Medicaid expansion and telemedicine reimbursement.

Telepsychiatry in the USA witnessed exponential growth in the last decade, having been proven to be a cost-effective and sustainable approach to delivering high-quality mental health services. This surge was aided by the availability of high-speed Internet, improved software, and an increase in demand paired with expanded reimbursement models. Despite a growing interest in adopting telepsychiatry programs, many health organizations continue to face challenges at the implementation stage. This review aims to identify the critical components and the associated challenges met at the planning, deployment, and maintenance phases of telepsychiatry program implementation. Four critical components for telepsychiatry implementation have been identified: (1) patient population, (2) originating site, (3) tele-clinician, (4) the information and communications technologies, and a potential fifth (5) a telepsychiatry organization to help align these components. Recommendations to anticipate and address these challenges include assessing the needs of the patient population, incorporating standardized processes and data analytics into existing organizations workflow, sourcing qualified and culturally competent tele-clinicians and providing ongoing clinical oversight, technological support, and monitoring of connectivity. The rapid growth of telepsychiatry programs in the USA is concomitant with a number of critical implementation challenges. Recommended strategies and applied solutions are discussed in this review.

ABSTRACT Public administration of mental health policy is an area that raises issues about human rights and dignity, equality of access to high-quality mental health services and the adequacy of financial resources. Globally, most people with mental health problems lack access to care services due mainly to the limited number of trained specialists, the stigma and discrimination associated with mental illnesses, and fragmented service delivery models. A widespread response to the growing demand for integrated care is the establishment of e-mental health services engaging primary and secondary healthcare specialists from different disciplines. In Estonia, evidence-based e-mental health solutions are being introduced to improve access to mental healthcare and to reduce the costs associated with treatment. However, awareness of the benefits of e-mental health solutions remains limited among healthcare professionals and the wider population. This article draws on findings from EU-funded research projects to examine the challenges Estonia faces in adopting e-mental health solutions. The author shows how the lack of public investment in evidence-based e-mental health interventions and the reluctance of relevant professionals to engage with e-mental health technologies have resulted in legal uncertainty, hindering full implementation of e-mental health policy in mental health services.

This study tested an integrated package for high-quality school mental health (SMH) services involving quality assessment and improvement, family engagement and empowerment, modular evidence-based practice, and implementation support. Within a two-year randomized controlled trial, 35 clinicians, who provided services to 529 students and their families, were randomly assigned to the enhanced quality assessment and improvement intervention condition and a comparison condition focused on promoting personal and staff wellness. Significant clinician-level findings were found for increased use and fidelity of evidence-based practices and greater use of structured assessments and sessions involving family members. Results are discussed in relation to needed methodological improvements in SMH treatment outcome research and increasing use of evidence-based practices by clinicians by adding accountability and incentives to training, coaching, and implementation support.

A common mental health assumption exists that all clinicians should be able to treat all problems and all clients. An unspoken belief among many clinicians is that nontraditional sexual preferences and feelings are driven by psychopathology. In contrast, in order to provide high-quality clinical treatment, a positive sexual health model advocates that the clinician exhibits interest in the client’s sexual issue, be trained and competent with the presenting problem, and provide therapy congruent with the clinician’s personal and professional values. Nontraditional clients and couples deserve that sexuality plays a positive role in their lives and relationship. Although the clinician needs to assess for psychopathology, it is crucial that the therapist not assume that nontraditional sexuality is motivated by psychopathology. All clients/couples deserve to be treated empathically and respectfully and receive high-quality mental health and sex therapy services.

Background: Mental health services in Sweden are confronted with globalization and refugee migration from conflict- and war-torn countries.Aim: To discuss how clinicians in Sweden can deal with a series of challenges in a changing globalized society, ranging from difficulties of overcoming barriers to help seeking to difficulties of identifying trauma and finding culturally adapted clinical tools.Method: Case vignettes are presented to exemplify challenges. Different approaches developed to support clinicians are presented.Results: The concepts of patient centered care and shared decision-making as well as the cultural formulation interview, are recommended to explore the significance of culture and context in psychiatric assessments. Acknowledging relational aspects of care and of paying attention to the patients’ social worlds in clinical work is also essential.Conclusions: The article includes recommendations for training as well as an appeal for the involvement of the wider society in the work to guarantee equitable and high-quality mental health services for some of the most vulnerable patient groups in society.

Advancing the knowledge, skills and attitudes of mental health nurses working with families and caregivers: A critical review of the literature.

A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

Providing high quality mental health services is one of the key objectives for national governments declared by WHO, where professional groups providing psychological help play an important role. Confusion among the professional groups in the field poses difficulties both for the professionals and service users. The paper aims to review the studies focused on the identity of professional groups providig psychological help with a special emphasis on used methodological approaches. In the first section of the paper concepts used in the relevant studies are discussed, proposing collective professional identity as the most appropriate theoretical idea to ground the future research in the given field. The second section of this paper analyses the methodological approaches applied in mentioned studies. Collective identity of professionals is conceived by the sholars in given field as a multidimensional concept which is studied both quantitatively and qualitatively. Thus far quantitative research methods are more common, but benefits of qualitative research in the future are also stressed. The results of literature review will serve as the theoretical background for studying professional groups providing psychological help in Latvia.

Introduction: Within the current mental health policy in Ireland, Vision for Change (HSE, 2006), people with intellectual disabilities (I.D.) (target population) should have access to high quality mental health services, including an I.D. specific multi-disciplinary community mental health team. Historically mental health services for this population were poorly developed, without a clear policy or implementation strategy. Services that did exist were often embedded within social care services, with unclear pathways and models of care. Resources are being allocated to Mental Health of Intellectual Disability (MHID) services on an ongoing basis. Therefore the requirement to develop a clear strategy of implementing Vision for Change (HSE, 2006) for MHID was clear. Aim: To develop a clear programme of development of MHID services for children and adults, for full national implementation across mental health and social care services (key stakeholders). The timeline for the programme is 2 years beginning July 2016. The programme involves a number of key stages including: Scoping and mapping of existing resources Defining a clear pathway to care Developing clear governance arrangements Developing clinical activity metrics Key initial results from this programme will be presented including key service mapping data, as well as planned governance and care pathway arrangements. As this is a national programme, it is envisaged that there will be full be transferability of services achieved through collaboration and partnership across the relevant key divisions, organisations, disciplines and with Service Users and their families. Given the inclusive nature of the design of the programme, it’s sustainability potential is strong Developing a complex programme of service development involving existing and new resources across different service divisions requires services to be planned in an integrated manner. The intended impact of this programme is to improve the quality of mental health care and service experience.

ABSTRACTThe Community Counseling, Education, and Research Center (CCERC) model addresses a critical public health need for accessible, affordable, high-quality mental health services focused on wellness. Within a southeastern urban community, the multicultural and social justice foundation of the model responds to systemic needs and creates an optimal learning environment for counselor education graduate students, unavailable in traditional health-care and human service systems. A client study is offered to demonstrate the application of the model.

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

Except for dementia and depression, little is known about common mental disorders in elderly people. To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people. The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65-84 years) living in selected catchment community areas of participating countries. One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders. Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.

Background: Shortened life expectancy of people with mental illness is now widely known and the focus of research and policy activity. To date, research has primarily reflected perspectives of health professionals with limited attention to the views and opinions of those most closely affected. The voice of carers is particularly minimal, despite policy stipulating carer participation is required for mental health services.Aim: To present views and opinions of carers regarding physical health of the people they care for.Methods: Qualitative exploratory. Two focus groups and one individual interview were conducted with 13 people identifying as carers of a person with mental illness. Research was conducted in the Australian Capital Territory. Data analysis was based on the thematic framework of Braun and Clarke.Results: Two main themes were interaction between physical and mental health; and, carers’ own physical and mental health. Participants described the impact of mental illness and its treatments on physical health, including their own.Conclusions: Carers are acknowledged as crucial for the delivery of high quality mental health services. Therefore they have an important role to play in addressing the poor physical health of people with mental illness. Hearing their views and opinions is essential.

The cumulative strain of 14 years of war on service members, veterans, and their families, together with continuing global threats and the unique stresses of military service, are likely to be felt for years to come. Scientific as well as political factors have influenced how the military has addressed the mental health needs resulting from these wars. Two important differences between mental health care delivered during the Iraq and Afghanistan wars and previous wars are the degree to which research has directly informed care and the consolidated management of services. The U.S. Army Medical Command implemented programmatic changes to ensure delivery of high-quality standardized mental health services, including centralized workload management; consolidation of psychiatry, psychology, psychiatric nursing, and social work services under integrated behavioral health departments; creation of satellite mental health clinics embedded within brigade work areas; incorporation of mental health providers into primary care; routine mental health screening throughout soldiers' careers; standardization of clinical outcome measures; and improved services for family members. This transformation has been accompanied by reduction in psychiatric hospitalizations and improved continuity of care. Challenges remain, however, including continued underutilization of services by those most in need, problems with treatment of substance use disorders, overuse of opioid medications, concerns with the structure of care for chronic postdeployment (including postconcussion) symptoms, and ongoing questions concerning the causes of historically high suicide rates, efficacy of resilience training initiatives, and research priorities. It is critical to ensure that remaining gaps are addressed and that knowledge gained during these wars is retained and further evolved.

Continuity of care for youth in foster care with serious emotional disturbances