Informal Mental Health Research Articles

Rates and predictors of uptake of mental health support during the COVID-19 pandemic: an analysis of 26,720 adults in the UK in lockdown

PurposeThe coronavirus disease 2019 (COVID-19) pandemic has put a great strain on people’s mental health. A growing number of studies have shown worsening mental health measures globally during the pandemic. However, there is a lack of empirical study on how people support their mental health during the COVID-19 pandemic. This study aimed to examine a number of formal and informal mental health support. Further, it explored factors that might be associated with the use of different types mental health support.MethodsData from 26,720 adults in the UCL COVID-19 Social Study were analysed between 13th April 2020 and 3rd July 2020. Data were analysed using logistic and Poisson regression models.ResultsAbout 45% of people reported talking to friends or family members to support their mental health, 43% engaging in self-care activities, 20% taking medication, 9% speaking to mental health professionals, 8% talking to a GP or other health professional, and another 8% using helpline or online services. Gender, education, living status, loneliness, pre-existing mental health conditions, general depression and anxiety, coping and personality were found to be associated with the use of mental health support.ConclusionWhile the negative impacts caused by the COVID-19 pandemic are inevitable, people can play an active role in managing their mental health. Understanding the patterns and predictors of various kinds of mental health support during the pandemic is crucial for future service planning and delivery through recognising potential barriers to mental health care faced by certain groups.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Stakeholder perspectives of Community Mental Health Forums: a qualitative study in Sierra Leone

BackgroundMental health is the leading cause of disability worldwide. In the wake of both a civil war and an Ebola outbreak, Sierra Leone ranks as one of the lowest ranked countries on the Human Development Index (UNDP. Human Development Report 2015, Work for Human Development. The United Nations Development Programme; 2015). The WHO identified Sierra Leone among its priority countries for the piloting of its Mental Health Gap Action Programme (mhGAP). Aligned to these efforts, CBM and their affiliated partners employed the use of Community Mental Health Forums (CMHFs), facilitated by Mental Health Nurses (MHNs), as a sensitive and practical way of engaging key community stakeholders to discuss and address issues of mental health. This study sought firstly, to identify factors that affect the successful implementation of CMHFs, as identified by programme participants. Second, the study sought to identify what changes participants perceived as having taken place as a result of their participation in CMHFs.Methods10 MHNs and 52 forum participants were purposely selected to take part in key informant interviews and focus group discussions, conducted across eight districts in Sierra Leone. Interview transcripts were analysed across four rounds of coding, using a mixture of deductive and inductive approaches.ResultsResults identified three themes, Traditional Beliefs and Culture; Health System; and Inclusive Approaches as affecting the implementation of CMHFs in their districts. Participants further perceived that their participation in the Community Mental Health Forums resulted in changes taking place across the themes of Awareness and beliefs, Behaviours towards people experiencing psychological distress, and as leading to greater Collaboration and cooperation between formal and informal mental health practitioners.ConclusionsResults are discussed in the context of the extant literature and a novel framework, that incorporates multiple best practice recommendations and factors which influence the successful implementation of CMHFs is put forward.

Stakeholders' perspectives about the impact of training and sensitization of traditional and spiritual healers on mental health and illness: A qualitative evaluation in Ghana.

Prayer camps and traditional healers have emerged recently as alternative sources of mental health care in Ghana. To increase their knowledge and collaboration between formal and informal mental health care providers, training and sensitization was organized for them. This study aimed at assessing beneficiaries' views about the impact of this intervention. We adopted narrative approach to qualitative enquiry using purposive sampling strategy to recruit formal and informal mental health care providers in Ghana for an in-depth interview. We analyzed the data thematically using QSR NVivo 12. Participants enhanced their knowledge about mental health and illness. They reported increased collaboration between formal and informal health care providers. Community psychiatric nurses (CPNs) give injections to patients instead of chaining and using shackles as was initially practiced. There are also regular visits by CPNs to traditional and spiritual healers to discuss the care of the mentally ill patients in their facilities. There has been an increased collaboration among healers of mental illness resulting in quick recovery of patients who seek care at traditional and spiritual healers. There is also abolition of chaining and using of shackles by these healers, with increasing respect for the human rights of patients.

Informal mental health interventions for people with severe mental illness in low and lower middle-income countries: A systematic review of effectiveness.

The effectiveness of interventions for people with severe mental illness delivered by informal community care providers in low and lower middle-income countries is not known. The aim was to conduct a systematic review of the impact of community-based interventions implemented by the informal sector for people with severe mental illness in these settings. Five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials) were searched for English-language publications using both keywords and MeSH terms. All study designs were included. Five papers, reporting data from five studies conducted in four low and lower middle-income countries in 2017, met the inclusion criteria for the review. Of the five included studies, three had a before and after design, one was a randomized controlled trial, and one a qualitative investigation. Most interventions with a low-moderate quality of evidence used informal community care providers to deliver either self-help groups, traditional healing treatments, and/or a rehabilitation program. The investigators reported data about improvements in the outcomes of intervention participants (psychosocial functioning, psychotic symptoms, and social inclusion) and positive impacts on their families (family's knowledge and skills of mental illness management, caregiving burden, social exclusion/stigma against people with severe mental illness, and financial burden). Cost-effectiveness of the intervention (in one study) found that it had a higher financial cost but greater effectiveness than the usual standard of care. Although only a small number of studies were identified, the review provides promising evidence of the professionally developed interventions for people with severe mental illness, delivered by the informal community workforce in low and lower middle-income settings. Training and supportive supervision for informal community care providers are crucial components of effective interventions.

Patterns of concordances in mhGAP-IG screening and DSM-IV/ICD10 diagnoses by trained community service providers in Kenya: a pilot cross-sectional study

The objective of this study was to determine the extent of concordance between positive screens for mental disorders by various trained community-based health workers using the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) and independently confirmed DSM-IV/ICD-10 diagnoses. This was a cross-sectional study conducted in Makueni County, Kenya. 40 nurses/clinical officers, 60 Community Health Workers (CHWs), 51 Faith Healers (FHs), and 59 Traditional Healers (THs) from 20 facilities were trained to screen and refer patients with eight priority mental health conditions using the mhGAP-IG. These referrals, as well as referrals from friends or family members, and self-referrals were assessed using the Mini International Neuropsychiatric Instrument (M.I.N.I.) Plus. Concordance between positive screens and M.I.N.I. Plus diagnoses was investigated. 15,078 community members agreed to participate in screening. Of these 12,170 (81%) screened positive for a mental disorder and were referred to their local clinics/hospitals. 8333 (68.5%) of those who were referred went for independent diagnostic assessment at the nearest facility. Positive predictive values varied with different providers and for different conditions. There was over 80% concordance between the initial screen and the M.I.N.I. Plus diagnoses across the different health providers and across all diagnoses. Both formal and informal mental health providers can be trained to successfully and accurately screen for mental health disorders using the mhGAP-IG symptoms. This suggests that community-based non-specialist providers may play a key role in decreasing the mental health treatment gap. Further policy implications are discussed.

Cultural brokers’ role in facilitating informal and formal mental health supports for refugee youth in school and community context: a Canadian case study

ABSTRACTRefugee youth, who experience developmental, settlement and/or premigration related challenges, rarely utilise mental health services due to systemic and cultural barriers. Cultural brokering, the act of linking different cultural groups to enhance practice and communication, is one approach to addressing barriers to mental health service provision experienced by refugees. Results from a qualitative case study in Canada identified informal and formal activities of four cultural brokers that facilitate the mental health and adaptation of refugee youth in schools: facilitating cultural integration and sense of belonging, bridging to settlement services, supportive counselling, facilitating referrals to mental health practitioners, educating about mental health, providing contextual information and cultural interpretation. Results provide initial insights into a holistic approach that could be used by mental health service providers to enhance service provision and the wellbeing of refugee youth in schools and community settings.

Informal mental health patients: what are they told of their legal rights?

PurposeThe purpose of this paper is to determine what written information is given to informally admitted patients in England and Wales regarding their legal rights in relation to freedom of movement and treatment.Design/methodology/approachInformation leaflets were obtained by a search of all National Health Service mental health trust websites in England and health boards in Wales and via a Freedom of Information Act 2000 request. Data were analysed using content analysis.FindingsOf the 61 organisations providing inpatient care, 27 provided written information in the form of a leaflet. Six provided public access to the information leaflets via their website prior to admission. Although the majority of leaflets were accurate the breadth and depth of the information varied considerably. Despite a common legal background there was confusion and inconsistency in the use of the terms informal and voluntary as well as inconsistency regarding freedom of movement, the right to refuse treatment and discharge against medical advice.Research limitations/implicationsThe research has demonstrated the value of Freedom of Information Act 2000 requests in obtaining data. Further research should explore the effectiveness of informing patients of their rights from their perspective.Practical implicationsWork should be undertaken to establish a consensus of good practice in this area. Information should be consistent, accurate and understandable.Originality/valueThis is the only research reporting on the availability and content of written information given to informal patients about their legal rights.

The Impact of Perceived Need and Relational Factors on Mental Health Service Use Among Generations of Asian Americans.

The present study examined generational differences in the patterns and predictors of formal and informal mental health service utilization among a nationally representative sample of 1850 Asian Americans from the National Latino and Asian American Study. We focused on the effects of perceived need and relational factors on service utilization among 1st-, 1.5-, and 2nd-generation Asian Americans. Results of hierarchical logistic regression showed significant intergenerational differences. Specifically, 1.5-generation Asian Americans exhibited distinctive pattern of service use, with perceived need being associated with a higher likelihood of using formal mental health services, but only for those with high level of social support. First- and second-generation Asian Americans, on the other hand, perceived need was independently associated with formal service use, and a significant predictor of informal service use for first generation. Greater family conflict was also associated with greater use of formal and informal services for both first- and second generations. However, family cohesion was associated with only informal service use among first -generation Asian Americans. Implications for mental health service policy were discussed.

Psychosis and help-seeking behavior in rural KwaZulu Natal: unearthing local insights.

BackgroundGrowing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of formal and informal community service providers, we aimed to uncover descriptions of people with psychosis in a rural South African community and illuminate the potential complexities of their help-seeking journeys.MethodsWe conducted a qualitative study of 40 key informant interviews and seven focus groups with stakeholders (traditional leaders, traditional healers, religious leaders, health care nurses, heads of non-governmental organizations, schoolteachers, community caregivers) in a rural Zulu community (Vulindlela). Thematic analysis of the data was performed using the inductive analysis approach.ResultsInterviewees discussed 32 individuals with probable psychosis in their community and provided rich descriptions of their symptoms. A complex picture of help-seeking behavior, primarily involving informal mental health service providers, emerged. Over half of the reported cases had no contact with formal health services in the course of their help-seeking journey; while more than two-thirds never attended a hospital and only 1 in 8 accessed a psychiatric hospital.ConclusionsOur results highlight the important role of informal care providers in LMICs as well as the need for more research on mental illness and local providers in non-hospital contexts. Community stakeholders can contribute to a fuller understanding of these issues, thereby assisting in the creation of appropriate and effective mental health interventions for rural South African communities like Vulindlela.

Informal Mental Health Support in the Asian American Community and Culturally Appropriate Strategies for Community-Based Mental Health Organizations

ABSTRACTMuch of the literature on culturally appropriate services is focused on barriers to service provision; less is known about how organizations can reduce these barriers. Through qualitative interviews, this study examined how informal helpers within the Asian American community are helping individuals with unmet mental health needs and how mainstream mental health organizations might learn from their experiences. Themes identified include (a) informal assistance, (b) working with the community, (c) gaining trust, and (d) cultural and language appropriateness. By implementing some of the strategies suggested in this paper, mainstream organizations can better serve the mental health needs of Asian Americans.

Between modern and traditional values: Informal mental health help-seeking attitudes according to Israeli Arab women, primary care patients and their providers.

Israeli Arab women under-utilize mental health services. The present study evaluated the use of alternative services for dealing with depression and anxiety among Israeli Arab women and primary care providers. Four focus groups with primary care patients and two focus groups with primary care providers were conducted. Constant comparisons were employed in order to identify major themes related to informal help-seeking behaviors. Three informal help-seeking behaviors were identified: (a) social support, divided into extended family and neighbors versus nuclear family and close friends; (b) religiosity, divided into inner, direct practices and beliefs versus externally mediated ones; and (c) self-help techniques, such as engagement in activities and distancing oneself from the situation. Both social support and religiosity were viewed with ambivalence by primary care patients and providers. The findings suggest that the Arab population in Israel might be lacking informal sources of support at times of mental health needs.

Trick or treat? Muslim Thangals, psychologisation and pragmatic realism in Northern Kerala, India

Thangals are an endogamous community in Kerala, India, of Yemeni heritage who claim direct descent from the Prophet Muhammad's family. Due to their sacrosanct status, many thangals work as religious healers and thus are part of the informal mental health care system in Northern Kerala. Using the case of one thangal healer as an illustration of the many ritual healers in Kerala who engage the modern discourse of psychology in their practices, I argue that the psychologisation of ritual healing is part of a wider trend: the increasing rationalisation and scientification of traditional medical practices, whereby an increasing number of traditional healers negotiate science, modernity and religion and position their practice within these contested fields. Based on the analysis of this thangal's healing practice in the local context of Northern Kerala, I further argue that in order to understand "ritual" healing, scholars should emphasise pragmatic realism more than doctrinal purity.

Santería as Informal Mental Health Support Among U.S. Latinos with Cancer

This article explores and examines Santería's function as a culturally congruent informal mental health support that assists U.S. Latinos to cope with the psychosocial sequelae of living with cancer. Research has demonstrated that Santería serves as a mediating institution for many Latinos. The tradition functions as both a religion and a health care system within various Latino subgroups and has functioned as an informal mental health service in occurrences of health versus illness.

Contextualizing Social Support: Pathways to Help Seeking in Latinos, Asian Americans, and Whites

The present study investigated how social support is utilized in diverse ethnic/racial groups and how these patterns of social support utilization affect help seeking for mental health problems. Analyses of a nationally representative sample of Latinos (n = 2,554), Asian Americans (n = 2,095), and Whites (n = 4,180) were undertaken to investigate ethnic/racial differences in family and friend support and determine whether the association between social support and service use (informal and formal) varies by ethnicity/race, adjusting for demographics, generation status, and lifetime mental health diagnosis. Compared to Whites who had the greatest levels of family and friend support, Latinos reported the lowest level of friend support, while Asian Americans reported the lowest level of family support. Although family support was not a significant predictor of informal or formal treatment for any ethnic/racial group, friend support for Latinos and Asian Americans, in contrast to Whites, was associated with a greater likelihood of seeking lifetime informal treatment. Cultural norms may influence the use of social support among ethnic/racial groups. For Latinos and Asian Americans, greater reliance on and disclosure to friends may potentially initiate a pathway to informal mental health services, perhaps by lessening the stigma associated with service use.

Informal and formal mental health: preliminary qualitative findings

BackgroundNorthern-based research on mental health support, no matter the specific profession, helps to inform instruction of new practitioners and practitioners already working in rural or isolated conditions. Understanding the complexities of northern mental health support not only benefits clients and practitioners living in the North, but also helps prepare psychologists and counsellors preparing to work in other countries with large rural and isolated populations. The qualitative phase is part of a multi-year research study on informal and formal mental health support in northern Canada involving the use of qualitative and quantitative data collection and analysis methods.ObjectiveThe main objective of the qualitative phase interviews was to document in-depth the situation of formal and informal helpers in providing mental health support in isolated northern communities in northern British Columbia, northern Alberta, Yukon and Northwest Territories (NWT). The intent of in-depth interviews was to collect descriptive information on the unique working conditions of northern helping practitioners for the development of a survey and subsequent community action plans for helping practitioner support.DesignTwenty participants in northern BC, Yukon and NWT participated in narrative interviews. Consensual qualitative research (CQR) was used in the analysis completed by 7 researchers. The principal researcher and research associate then worked through all 7 analyses, defining common categories and themes, and using selections from each researcher in order to ensure that everyone's analysis was represented in the final consensual summary.ResultsThe preliminary results include 7 main categories consisting of various themes. Defining elements of northern practice included the need for generalist knowledge and cultural sensitivity. The task of working with and negotiating membership in community was identified as essential for northern mental health support. The need for revised codes of ethics relevant to the reality of northern work was a major category, as was insight on how to best sustain northern practice.ConclusionMany of the practitioners who participated in this study have found ways to overcome the biggest challenges of northern practice, yet the limitations of small populations and lack of resources in small communities to adequately address mental health support were identified as existing. Empowering communities by building community capacity to educate, supervise and support formal and informal mental health workers may be the best approach to overcoming the lack of external resources.

Mental health and aging initiative: intervention component effects

The objective of this investigation is to evaluate the Mental Healthiness and Aging Initiative (MHAI) intervention. The MHAI was created to promote awareness and knowledge about mental health/substance (MH/SA) use and aging issues in rural Kentucky, USA, due to limitations in formal and informal mental health care and treatment resources as a result of multilevel barriers in rural regions and effects on health, wellbeing and quality of life. This investigation took place between 2010 and 2011 in two rural counties in Kentucky. Participants from two counties were recruited through an email solicitation sent to Kentucky cooperative extension agents (university-affiliated community liaisons). Individuals participated in a two-hour intervention session covering facts and information, application exercises, and community tools for addressing late-life mental health and substance abuse. Effectiveness was evaluated by examining changes in attitudes and knowledge about MH/SA and aging from pre-test to post-test and again 3 months and 6 months later. The evaluation survey examined mental health and substance abuse awareness (six questions) and knowledge (13 questions) and was previously piloted and designed for the current study ensuring face validity. Seven individual linear mixed models were analyzed using each of the six awareness questions and an additional model using an aggregate score across the knowledge questions representing the total percent correct for knowledge questions. The participating sample (n=55) was 65.35 years of age on average, with the majority being female (85%), white (100%), married (69%), living with a spouse/partner only (68%), high school educated (57%) and having a total household income averaging US$44,199. The findings indicated sustained improvement in awareness and knowledge about MH/SA and aging. Results also indicated that there is a need to improve maintenance of knowledge regarding older adult alcohol consumption risk, clinical provider communication about mental health, identifying/recognizing mental health problems, and older adult retention of their mental abilities based on long-term retention rates. These indicators had below 90% correctness at 6 months, despite having 90%+ accuracy at post-assessment, immediately after the intervention administration. This study demonstrates that community interventions for MH/SA awareness and knowledge are effective within majority rural regions. As currently designed, implementing the MHAI intervention program is feasible. Evidence from the current study indicates that community residents (including rural individuals) can be recruited to participate in a program about MH/SA and aging, and as an outcome have increased awareness and knowledge about MH/SA and aging. Future research will need to explore how to utilize MHAI-type intervention programs to a point where the mental health of rural adults can be improved. Specifically, further investigation is needed to examine whether community mental health awareness interventions, such as the MHAI intervention program, can lead to earlier detection of MH/SA issues among older adults and increase treatment rates. If so, community mental health workers and facilities can expect such interventions to increase local residents' awareness of their services and likelihood of utilizing mental health services. Future research needs to enhance generalizability and ensure that improved knowledge and awareness translates into improved mental health in rural regions.

Primary mental health care for survivors of collective sexual violence in Rwanda

This paper draws attention to the obligation and opportunity to respond to the mental health impacts of collective sexual violence (CSV) among genocide–rape survivors in post-genocide Rwanda. Qualitative data gathered from CSV survivors who were members of Rwandan women's genocide survivor associations are presented to illustrate how they strive to overcome adversity while seeking access to quality mental health care and using informal community mental health services. The results reveal that a system of high quality, holistic health and mental health care is yet needed to meet Rwandan CSV survivors' complex and serious health and mental health needs. Given that a rural health system, modelled on community-based, comprehensive HIV/AIDS care and treatment, is currently being implemented in Rwanda, we recommend enhancements to this model that would contribute to meeting the mental health care needs of CSV survivors while benefiting the health and mental health system as a whole within Rwanda.

Use of formal and informal mental health resources by cancer survivors: differences between rural and nonrural survivors and a preliminary test of the theory of planned behavior

Previous research has identified rural residence as a risk factor for poorer mental health (MH) outcomes in cancer survivors. This may be due to less use of various MH resources due to poorer access and less favorable attitudes and social norms related to MH resource utilization. The present study sought to examine use of MH resources in rural and nonrural survivors and identify factors associated with MH resource use. Cancer survivors (n=113, 1-5 years postdiagnosis) completed a questionnaire packet and telephone interview. Accessibility and postdiagnosis use of various formal and informal MH resources were assessed along with constructs potentially linked to use of MH resources by the Theory of Planned Behavior (TPB; personal attitude, social norm, perceived behavioral control). Results indicated no widespread differences between rural and nonrural cancer survivors in MH resource use although some evidence suggested poorer accessibility and less use of mental health professionals and cancer support groups among rural survivors. In general, rural survivors reported less favorable personal attitudes and social norms regarding MH resource use. TPB constructs accounted for a significant portion of variance in use of most MH resources with personal attitudes generally being the strongest predictor of MH resource use. Additional research is needed to expand the search for factors, particularly modifiable factors, which might account for disparities in MH outcomes between rural and nonrural survivors.

Carers’ views on respite care for adults with mental disorders

Although respite care has the potential to reduce carer burden, few published studies have investigated respite care for mental health carers. The purpose of this primarily qualitative study was to examine informal mental health carers’ perceptions of respite care. Participants were 106 carers caring for an adult with mental illness recruited through carer support organizations. Carers provided written responses to open-ended questions covering four areas: barriers, positive and negative aspects, and improvements associated with respite care. A total of 36% had accessed respite care and 64% had never accessed respite care. The most frequently reported respite themes for both users and non-users in each of the four areas relevant to carers and care recipients were: barriers – care-recipient’s reluctance to use respite; carer positives – caregiving relief; care recipient positives – socializing and participation in activities; carer negatives – problematic characteristics of the service; care recipient negatives – lack of suitable activities; carer improvements – increased access and availability of services; care recipient improvements – greater support and understanding of mental health issues. Findings indicate that respite care services should be tailored to the demands of mental health caregiving providing flexibility in options across factors such as frequency, duration, location, transport access, support levels, staff training, activities and routines, graduated entry, type of respite (e.g., in-home, hospital, drop-in centre), and crisis/acute respite.