Inpatient Mental Health Treatment Research Articles

Psychotic symptoms with and without a primary psychotic disorder in children requiring inpatient mental health admission.

Psychotic symptoms are relatively common in children and adolescents attending mental health services. On most occasions, their presence is not associated with a primary psychotic disorder, and their clinical significance remains understudied. No studies to date have evaluated the prevalence and clinical correlates of psychotic symptoms in children requiring inpatient mental health treatment. All children aged 6 to 12years admitted to an inpatient children's unit over a 9-year period were included in this naturalistic study. Diagnosis at discharge, length of admission, functional impairment, and medication use were recorded. Children with psychotic symptoms without a childhood-onset schizophrenia spectrum disorder (COSS) were compared with children with COSS and children without psychotic symptoms using Chi-square and linear regressions. A total of 211 children were admitted during this period with 62.4% experiencing psychotic symptoms. The most common diagnosis in the sample was autism spectrum disorder (53.1%). Psychotic symptoms were not more prevalent in any diagnosis except for COSS (100%) and intellectual disability (81.8%). Psychotic symptoms were associated with longer admissions and antipsychotic medication use. The mean length of admission of children with psychotic symptoms without COSS seems to lie in between that of children without psychotic symptoms and that of children with COSS. We concluded that psychotic symptoms in children admitted to the hospital may be a marker of severity. Screening for such symptoms may have implications for treatment and could potentially contribute to identifying more effective targeted interventions and reducing overall morbidity.

Service User Experience of Receiving Remote Inpatient Mental Health Treatment via the Homecare Service

The Homecare Service was developed as a response to the COVID-19 pandemic, providing all the elements of a mental health inpatient programme remotely, in the comfort and safety of the service user’s home thus reducing the need for a physical admission. The aim of this study was to explore service user experiences of a remote virtual inpatient care at an Irish independent mental health service. All participants who had a virtual admission in a 3-month period were invited to complete a series of questions via an online survey. Three open-ended questions generated qualitative data from this mixed methods study, which were thematically analysed. Three themes reflected service user experience: ‘The Homecare Service: a viable alternative to inpatient care’; ‘Importance of relationships’ and ‘Technology and Homecare.’ Overall, there was general satisfaction with the service. This study provided a good opportunity to identify issues that have emerged considering the prompt implementation of the initiative. Feedback relating to improvements can be implemented in future service delivery.

Admission rates and clinical profiles of children and youth with eating disorders treated as inpatients before and during the COVID-19 pandemic in a German university hospital.

Children and youth at risk for mental health disorders, such as eating disorders (ED), were particularly affected by the COVID-19 pandemic, yet evidence for the most seriously affected and thus hospitalized youth in Germany is scarce. This crosssectional study investigated anonymized routine hospital data (demographic information, diagnoses, treatment modalities) of patients admitted (n = 2,849) to the Department of Child and Adolescence Psychiatry, Psychosomatics and Psychotherapy (DCAPPP) of a German University Hospital between 01/2016 and 02/2022. Absolute and relative number of inpatients with or without ED prior to (01/2016-02/2020) and during the COVID-19 pandemic (03/2020-02/2022) were compared. The effect of school closures as part of social lockdown measures for COVID-19 mitigation on inpatient admission rate was explored as it has been discussed as a potential risk factor for mental health problems in youth. During the COVID-19 pandemic, ED inpatient admission rate increased from 10.5 to 16.7%, primarily driven by Anorexia Nervosa (AN). In contrast to previous reports, we found no change in somatic and mental disorder comorbidity, age or sexratio for hospitalized youth with ED. However, we did observe a shortened length of hospital stay (LOS) for hospitalized youth with and without ED. In addition, non-ED admissions presented with an increased number of mental disorder comorbidities. In contrast to our hypothesis, school closures were not related to the observed increase in ED. In summary, the COVID-19 pandemic was associated with an increased rate of inpatient treatment for youth suffering from AN, and of youth affected by multiple mental disorders. Accordingly, we assume that inpatient admission was prioritized for individuals with a higher burden of disease during the COVID-19 pandemic. Our findings pinpoint the need for adequate inpatient mental health treatment capacities during environmental crises, and a further strengthening of child and adolescence psychiatry services in Germany.

Evaluation of the home care service: a remote inpatient service for people requiring mental health care

Background/Aims In response to the COVID-19 pandemic, St Patrick's Mental Health Services introduced a home care package, offering all the elements of the inpatient programmes, but provided to the service user remotely in their own home. A survey was used to evaluate service user experiences of receiving remote inpatient mental health treatment via the home care service. Methods All participants who had a virtual admission were invited to complete a quantitative survey online. Data were inputted into the Statistical Package for Social Sciences software and a descriptive analysis was completed. Results A total of 88 participants completed the online survey, the majority of whom were women (62.5%) and between the ages of 61 and 70 years (28.4%). Diagnosis was most often depression (60.2%) or anxiety (29.4%) and almost 66% of participants had previous inpatient experience. Staff rated most highly by participants were the consultant psychiatrist (96.7%), ward-based nursing staff (95.2%) and their psychologist (92.3%). The highest rating statements, which participants rated as part of a questionnaire, were around technology options (87.1%), one-to-one work with a clinician (81.3%) and arranging collection of medicine (81%). Conclusions Preliminary scores on this survey demonstrate that remote care is an effective way to improve access, enhance quality and provide efficient care. Further research should consider clinical outcomes with this model compared to standard care.

Conducting Women’s Groups in the Inpatient Unit: Empowering a High-Risk Population by Preventing Unplanned Pregnancies

AbstractIntroductionWomen with mental illness are 5x more likely to experience an unplanned pregnancy due to lower rates of effective contraception use; they also experience higher rates of adverse pregnancy outcomes. Education about women’s reproductive health and family planning are not routinely offered in inpatient mental health and addiction treatment settings.MethodsWeekly women’s groups on the inpatient psychiatry unit were led by psychiatry residents who were trained and provided a script. Groups focused on structured contraception education followed by an open-discussion format.Data collected included the percentage of women with history of contraception use, child protective service involvement, unplanned pregnancies, abortions, and percentage of women who found the group helpful. Special care was taken to discuss contraception as a tool for empowering women to make their own decisions about their contraceptive needs.ResultsThirteen sessions were conducted, and attendance among women on the inpatient unit was 42%. Out of the 32 patients who participated, 100% found the group beneficial and responded they would share information they learned with women outside the group. 26.4% self-identified as using contraception, 50% had unplanned pregnancy, 23.6% have had an abortion, and 26.4% have had child protective services involvement.Dissemination of contraceptive information in these women’s groups effectively led women to consider options that were available to them and seek contraceptive methods that were appropriate to their situation. Women reported they gained a better understanding of the medical, emotional, and financial implications of unplanned pregnancies. The groups were conducted in an open-discussion format that allowed women to participate in shared experiences; in many cases, the discussions were therapeutic. Feedback from patients and unit staff was positive. Many patients requested further groups to discuss issues women face, such as domestic violence and experiences as a mother.ConclusionsConducting women’s groups on the inpatient unit is critical in view of the poor access to healthcare that vulnerable women who seek inpatient psychiatric care experience. The groups on the inpatient unit are unique because it is often the only time these women have an opportunity for crucial, gender-specific preventative healthcare. These groups should further lead to appropriate referral and follow-up with primary care or women’s clinic providers.Ongoing efforts will be put forth to increase group attendance, to incorporate participation from unit staff, and to build this group into a resident curriculum for group therapy.FundingNo Funding

YOUTH AS TRUTH-TELLERS AND RIGHTS-HOLDERS: LEGAL AND INSTITUTIONAL REFORMS TO ENABLE YOUTH HOUSING SECURITY

In the first pan-Canadian study on youth homelessness, 57.8% of youth reported prior involvement with child protection services. Indeed, transitions from government institutions (e.g., child/youth protection, inpatient mental health treatment, the youth justice system) represent common pathways into homelessness for youth across North America. This article examines young people’s experiences navigating youth protection services to identify institutional, legislative, and policy processes that pose problems for youth experiencing or at risk of homelessness, as well as processes that show promise for the promotion of the interests, protection, and well-being of youth. Our participatory youth research team explored homeless youth’s histories of involvement with youth protection services, seeking to clarify the sociolegal mechanisms in and beyond the youth protection system that make young people vulnerable to homelessness. Youth and adult co-researchers interviewed 38 individual youth (aged 16–29) who completed 64 qualitative institutional history interviews. According to our analysis, young people identified the following sociolegal practices as implicated in their experiences of homelessness: the use of totalizing institutions, the criminalization of runaways, the abrupt cessation of service delivery at 18 years of age, a systemic failure to view youth as rights-holders, and an overly complex emancipation process.

Evaluating Veterans Response Teams and Police Interventions on Veterans' Health Care Utilization.

This study examined the effects of veteran-specific cooperative police interventions, including a Veterans Response Team (VRT) and broad collaboration between local police departments and a Veterans Affairs (VA) medical center police department (local-VA police [LVP]), on veterans' health care utilization. Data were analyzed on 241 veterans (51 received VRT and 190 received LVP intervention) in Wilmington, Delaware. Nearly all veterans in the sample were enrolled in VA health care at the time of police intervention. Veterans who received VRT or LVP interventions showed similar increases in use of outpatient and inpatient mental health and substance abuse treatment services, rehabilitation services, ancillary care services, homeless programs, and emergency department/urgent care services after 6 months. These findings suggest the importance of relationship building among local police departments, VA Police, and Veterans Justice Outreach to create pathways to care to ensure that veterans are connected to needed VA health care services.

PEDIATRIC MENTAL HEALTH BOARDING CRISIS: CHALLENGES AND OPPORTUNITIES FOR DEVELOPING PROGRAMS

There is a substantial increase in emergency department (ED) visits and hospitalizations for youth experiencing mental health crises, which has worsened with COVID-19. Youth requiring inpatient mental health treatment often stay in the ED or are admitted to an inpatient medical unit while waiting for placement as a psychiatric inpatient; this practice is referred to as “boarding.” The participants of this Clinical Perspectives will learn about challenges related to the pediatric mental health boarding crisis and opportunities to develop clinical interventions and programs by innovative, collaborative, and multidisciplinary approaches.

Psychotherapeutic Consultation Services in the Workplace: A Longitudinal Analysis of Treatments and Sick Leave Using Health Insurance Data

BackgroundPsychotherapeutic consultation services in the workplace (PSIW) have been developed to provide collaborative mental health care for employees. The aim of this study was to analyze participant characteristics, the role of PSIW in treatment courses, and the development of sick leave before and after PSIW start.MethodsRoutine data from PSIW and health insurance of 155 participants were analyzed descriptively and by means of a multilevel negative binomial regression.ResultsEighty-four percent of users were male, and 72% were diagnosed with a mental disorder. The number of PSIW consultations varied from 1 to 13 (mean = 4). For 34% of participants, PSIW sessions were sufficient, 33% received a recommendation for outpatient psychotherapy, and 20% for inpatient mental health treatment. While recommendations for inpatient treatment displayed a high adherence rate (74%), recommendations for outpatient treatment were followed by 37%. Compared with the period of a half-year before PSIW, sick-leave days were reduced from the period of the second half-year after PSIW start and in the subsequent observed half-year periods. Trajectories of sick leave by subgroups showed differences.ConclusionsPSIW is a flexible care offer, and results indicate a possible effect of PSIW on sick leave. In future studies, control group designs and inclusion of further variables are needed.

Is It Time for the Mental Health Field to Consider Unplanned Discharge a Key Metric of Patient Safety?

Mental health lacks robust measures to assess patient safety. Unplanned discharge is common in mental health populations and associated with poor outcomes. Clarifying whether unplanned discharge varies across settings may highlight the need to develop measures to reduce harms associated with this event. Unplanned discharge rates were compared across the Department of Veterans Affairs' acute inpatient and residential mental health treatment settings from 2009 to 2019. Logistic regression was used to create facility-level, adjusted unplanned discharge rates stratified by setting. Results were described using central tendency. Among 847,661 acute inpatient discharges, the mean unplanned discharge rate was 3.3% (range, 0%-18%). Among 358,117 residential discharges, the mean unplanned discharge rate was 17.9% (range, 1%-48.3%). Unplanned discharge is a marked problem in mental health, with large variation across treatment settings. Unplanned discharge should be measured as part of patient safety efforts.

An investigation comparing primary and secondary substance cravings between mental health and substance use disorder program inpatients

Background: Mental illness symptoms can trigger substance use cravings, which are strongly associated with relapse. Aim: Our study examines differences in substances craved among adults entering inpatient mental health (MH) and substance use disorder (SUD) treatment programs in 2018. Method: Our sample includes 2,486 adults; 1,686 adults admitted to MH programs and 800 adults admitted to SUD programs. We conducted chi-square tests and Fisher’s exact tests to determine group differences, with a Bonferroni correction to adjust the alpha for multiple tests. Results: We found that patients programmed to SUD services more often reported alcohol (39.99 vs. 49.63%; x2 (1, N = 2,488) =20.56, p<0.001) and opioid (8. 00% vs. 35.88%; x2 (1, N = 2,488) =299.48, p < 0.001) cravings. Patients programmed to MH primary more often reported cannabis (16. 35% vs. 1.00%; x2 (1, N=2,488) =299.48, p<0.001), stimulants (10.25% vs. 6.13%; x2(1, N =2,488) = 11.36, p < 0.001), and “other substances” cravings (21.45% vs. 3.25; x2 (2, N = 2,488) =136.52, p <0.001). Both groups mostly did not report secondary cravings. Conclusions: Because cravings can negatively impact treatment success of patients with co-occurring disorders, cravings should be assessed upon admission to mental health or SUD inpatient treatment.

The Forensic Supplement to the interRAI Mental Health Assessment Instrument: Evaluation and Validation of the Problem Behavior Scale.

Background: Numerous validation studies support the use of the interRAI Mental Health (MH) assessment system for inpatient mental health assessment, triage, treatment planning, and outcome measurement. However, there have been suggestions that the interRAI MH does not include sufficient content relevant to forensic mental health. We address this potential deficiency through the development of a Forensic Supplement (FS) to the interRAI MH system. Using three forensic risk assessment instruments (PCL-R; HCR-20; VRAG) that had a record of independent cross validation in the forensic literature, we identified forensic content domains that were missing in the interRAI MH. We then independently developed items to provide forensic coverage. The resulting FS is a single-page, 19-item supplementary document that can be scored along with the interRAI MH, adding approximately 10–15 min to administration time.We constructed the Problem Behavior Scale (PBS) using 11 items from the interRAI MH and FS. The Developmental Sample, 168 forensic mental health inpatients from two large mental health specialty hospitals, was assessed with both an earlier version of the interRAI MH and FS. This sample also provided us access to scores on the PCL-R, the HCR-20 and the VRAG. To validate our initial findings, we sought additional samples where scoring of the interRAI MH and the FS had been done. The first, the Forensic Sample (N = 587), consisted of forensic inpatients in other mental health units/hospitals. The second, the Correctional Sample (N = 618) was a random, representative sample of inmates in prisons, and the third, the Youth Sample (N = 90) comprised a group of youth in police custody.Results: The PBS ranged from 0 to 11, was positively skewed with most scores below 3, and had good internal consistency (Cronbach's Alpha = 0.80). In a test of concurrent validity, correlations between PBS scores and forensic risk scores were moderate to high (i.e., r with PCL-R Factor two of 0.317; with HCR-20 Clinical of 0.46; and with HCR-20 Risk of 0.39). In a test of convergent validity, we used Binary Logistic Regression to demonstrate that the PBS was related to three negative patient experiences (recent verbal abuse, use of a seclusion room, and failure to attain an unaccompanied leave). For each of these three samples, we conducted the same convergent validity statistical analyses as we had for the Developmental Sample and the earlier findings were replicated. Finally, we examined the relationship between PBS scores and care planning triggers, part of the interRAI systems Clinical Assessment Protocols (CAPs). In all three validity samples, the PBS was significantly related to the following CAPs being triggered: Harm to Others, Interpersonal Conflict, Traumatic Life Events, and Control Interventions. These additional validations generalize our findings across age groups (adult, youth) and across health care and correctional settings.Conclusions: The FS improves the interRAI MH's ability to identify risk for negative patient experiences and assess clinical needs in hospitalized/incarcerated forensic patients. These results generalize across age groups and across health care and correctional settings.

Understanding the mental health experiences of adult men with intellectual disabilities in Singapore

PurposeThis study aims to explore the experiences of people with intellectual disabilities in Singapore receiving inpatient mental health treatment. To date, there has not been any research that examines the views and experiences of this population in Singapore. The research examines how the participants view their mental health problems and their experiences of the services they received.Design/methodology/approachA qualitative design was chosen to address the research question. Six adult men with intellectual disabilities were recruited from the tertiary hospital and interviewed. The transcripts of these interviews were analysed using interpretative phenomenological analysis.FindingsFour super-ordinate themes were identified; awareness of mental health problems; yearn for a life outside the ward; interacting with other people and finding purpose.Originality/valueThe participants reported that they struggled with being segregated from their families and communities following an inpatient admission. They were able to report on the emotional difficulties that they experienced and hoped to find employment after their discharge from the hospital. They talked about reconstructing their self-identity and forming friendships to cope with their hospital stay. This research is one of its kind carried out in a non-western society and the findings are discussed in the light of how mental health professionals can best support people with intellectual disabilities during their inpatient treatment.

Experience of stigmatization in children receiving inpatient and outpatient mental health treatment: a longitudinal study

Mental health-related stigma is poorly understood, and minimal research has focused on the experience of stigma from children’s perspectives. We sought to investigate whether children treated as inpatients and outpatients had different experiences of stigma over time and whether stigma is linked to global functioning cross-sectionally and longitudinally. Children, aged 8–12 years, receiving treatment within a national specialist mental health inpatient unit were matched for age, gender and diagnosis with children receiving outpatient treatment (N = 64). Validated measures of stigma, global functioning and symptom severity were collected at the start of treatment and upon discharge from the ward for inpatients, and a similar timeframe for their individually matched outpatients. Latent change score models and partial correlation coefficients were employed to test our hypotheses. No differences in most aspects of stigma between children treated as inpatients and outpatients were observed, except for personal rejection at baseline and self-stigma at follow-up favouring outpatients. A reduction in stigma was observed in societal devaluation, personal rejection and secrecy for inpatients, and self-stigma and secrecy for outpatients between the two assessments. Societal devaluation declined at a higher rate among inpatients compared to outpatients, albeit reductions in stigma were comparable for all remaining measures. No association was found between the change in stigma and change in global functioning. Future research may offer further insights into the development and maintenance of stigma and identify key targets for anti-stigma interventions to reduce its long-term impact.

Feasibility of computerised positive mental imagery training as a treatment adjunct in in-patient mental health settings: randomised controlled trial

Background Positive affect and anhedonia are important but challenging targets for mental health treatments. Previous research indicates the potential of a computerised cognitive training paradigm involving generation of positive mental imagery, termed positive mental imagery training (PMIT), to increase positive affect and reduce anhedonia. Aims Our main aim was to investigate the feasibility of PMIT as a positive affect-focused, transdiagnostic adjunct to treatment as usual for patients in in-patient mental health settings. Method We ran an open feasibility, randomised controlled trial with three parallel arms: treatment as usual; treatment as usual plus PMIT; and treatment as usual plus an active comparator, cognitive control training. Fifty-seven patients from two different in-patient mental health treatment clinics in Germany were randomised in a 1:1:1 ratio. PMIT and cognitive control training comprised an introductory session followed by eight 15-min training sessions over 2 weeks. Clinical outcomes such as positive affect (primary outcome measure) and anhedonia were assessed at pre- and post-training, and at a further 2-week follow-up. Results Adherence was good and attrition was low. The patterns of results for the outcome data were not consistent with a specific effect of PMIT on positive affect, but were more consistent with a specific effect on anhedonia. Conclusions The results indicate feasibility and potential promise of a larger efficacy trial investigating PMIT as a treatment adjunct in in-patient mental health settings. Limitations include lack of researcher blinding, small sample size and lack of pre-specified feasibility outcomes. Anhedonia may be a more suitable primary outcome for a future larger trial.

Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting.

BackgroundPostpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories.ObjectiveThe aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development.MethodsThis is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation.ResultsThe start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)–approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged.ConclusionsData collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior.Trial RegistrationClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630International Registered Report Identifier (IRRID)DERR1-10.2196/31072

Irregular hospital discharge from acute inpatient and residential mental health treatment settings in a large integrated healthcare system

ObjectiveIrregular discharge is a concern among mental health populations and associated with poor outcomes. Little is known about the relationship between irregular discharge and treatment setting. Because care processes differ between acute inpatient and residential settings, it is important to evaluate irregular discharge in these settings. MethodA retrospective study was conducted in patients with mental health conditions admitted to acute inpatient or residential mental health settings in the Department of Veterans Affairs, 2003–2019. Logistic regression and multivariate Cox proportional hazards were used to evaluate factors associated with irregular discharge risk in the first 90- days of admission. ResultsAmong 1.8 million discharges, 7.4% had an irregular discharge within 90- days of admission. Younger age was a central predictor of risk. Irregular discharge rates were four-fold higher in residential versus acute settings. When accounting for length of stay (LOS) across settings, there was a modest higher risk of irregular discharge from acute versus residential settings (HR = 1.06, 95% Confidence Interval 1.04–1.07). ConclusionsPatients are at high risk for irregular discharge from acute and residential settings when they are young. LOS is an important determinant of irregular discharge risk.. Interventions are needed to address drivers of irregular discharge.

Comorbid chronic tic disorder and tourette syndrome in children requiring inpatient mental health treatment.

Children needing admission to an inpatient mental health unit often present with severe neuropsychiatric disorders characterised by complex psychopathology. We aimed to examine all admitted children with comorbid chronic tic disorder (CTD) and Tourette syndrome (TS) over a 10-year period and determine the clinical significance of these diagnoses. A retrospective, naturalistic study was conducted, comparing children with and without CTD/TS in terms of co-morbid diagnoses, medication use, access to education, aggression contributing to the admission, duration of admission, functional outcomes and satisfaction with treatment. Data were analysed using Chi-square/Fisher's exact test and t-test for categorical and continuous variables, respectively, and subsequently with unadjusted and adjusted linear and logistic regression analyses. A relatively high proportion of children had co-morbid CTD/TS (19.7%). There was a significant association with co-morbid obsessive-compulsive disorder, intellectual disability and autism spectrum disorder but not attention deficit hyperactivity disorder. CTD/TS were associated with longer admissions even after adjustments for confounding but did not seem to be independently associated with other examined clinical characteristics. The prevalence of CTD/TS in children needing inpatient treatment is significant. In our sample, comorbid CTD/TS seem to represent a marker of overall symptom severity as evidenced by longer admissions.

States Should Remove Barriers to Advanced Practice Registered Nurse Prescriptive Authority to Increase Access to Treatment for Opioid Use Disorder.

In October 2018, President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. This piece of legislation addresses treatment, prevention, recovery, and enforcement with particular attention to access in rural areas. It contains numerous provisions to improve needed access to treat substance use disorders and especially opioid use disorder (OUD), including mandatory coverage of medications for OUD, partial elimination of Medicaid payment for inpatient mental health treatment, and state planning grants to increase provider capacity. Many of these provisions would be significantly enhanced by removing barriers to prescriptive authority for Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and other state-specific titles for nurses whose scope allows the prescription of controlled substances. This policy brief includes a history of the role of APRNs in the delivery of medications for OUD, scope of practice restrictions related to prescriptive authority as a barrier in their ability to deliver care for this vulnerable population, and actionable strategies that APRNs can take to advocate for an increased role in providing care.

Men with Depression and Inpatient Mental Health Treatment: Professionals' Perspectives on Treatment Needs and Aims

To meet mental health needs in men with depression, gender sensitive services are needed and recommended. Therefore, mental health professionals' views on care needs among men with depression that should be met by gender-sensitive services were assessed and consequences for inpatient treatment are considered. Semi-structured interviews were conducted with 33 mental health professionals focusing on men's specific needs in depression treatment against the background of male gender role expectations. Qualitative Content Analysis was performed using MAXqda-Software. Men with depression benefit from individual talk with staff and structured activity during treatment. Men-only groups are assessed as enabling critical reflection of aspects of masculinity. Physical activities and handicraft enable men to examine their performance level. Services focusing on men's specific needs are assessed as helpful but largely inexistent. Expectations of social gender roles and their implications for mental health treatment should be considered in both mental health professional training and mental health treatment.