Management Of Mental Health Problems Research Articles

The management of mental health problems among prisoners in England and Wales

This paper reviews the major organisational changes made to the delivery of mental healthcare in prisons in England and Wales since the turn of the century. These changes have included the introduction of 'in-reach' services for prisoners with serious mental illness, replicating the work of community mental health teams. In addition, healthcare budgets and commissioning responsibilities have been transferred to the National Health Service. Measures to reduce the rate of suicide in prisons are also considered.

La réforme des soins primaires de santé mentale au Québec et le rôle et les stratégies de coordination des omnipraticiens

The health and mental health systems in Quebec have recently been substantially transformed. At the heart of this restructuring, reforms aimed to strengthen primary care and to better integrate services, which are central trends internationally. This article summarizes Quebec's primary health and mental health reforms. It also presents the key role of general practitioners in the treatment of mental health disorders and their coordination strategies with the mental health care resources in the province. Numerous documents on the Quebec health and mental health reforms and the international literature on primary mental health care were consulted for this study. Information on general practitioner roles in mental health were based on administrative data from the Régie de l'assurance maladie du Québec (RAMQ) for all medical procedures performed in 2006. The data was compared with the results of a survey realized in the same year with 398 general practitioners in Quebec. Complementary qualitative data was collected through one hour interviews on a subsample of 60 of those general practitioners. The central aim of the Quebec healthcare reform was to improve services integration by implementing local healthcare networks. A population health approach and a hierarchical service provision were promoted. For a better access and continuity of care, family medicine groups and network clinics were also developed. The mental health reform (Action Plan in Mental Health, 2005-2010) was launched in this general context. It prioritized the consolidation of primary care and shared-care (i.e. increased networking between general practitioners and psychosocial workers and psychiatrists) by reinforcing the role of general practitioners in mental health, developing mental health interdisciplinary teams in primary care and adding a psychiatrist-respondent function in each Quebec local healthcare network. In mental health, general practitioners played a central role as the primary source of care and networking to other resources either primary or specialized health care services. Between 20-25% of visits to general practitioners are related to mental health problems. Nearly all general practitioners manage common mental disorders and believed themselves competent to do so; however, the reverse is true for the management of serious mental disorders. Mainly general practitioners practiced in silo without much relation with the mental health care resources. Numerous factors were found to influence the management of mental health problems: patients' profiles (e.g. the complexity of mental health problems, concomitant disorders), individual characteristics of the general practitioners (e.g. informal network, training); professional culture (e.g. formal clinical mechanisms), the institutional setting (e.g. multidisciplinary or not) and organizations of services (e.g. policies). Unfortunately, the Quebec health and mental health care reforms have not been fully implemented yet. Family medicine groups and networks clinics, primary mental health teams and psychiatrists-respondent are not optimally operational and therefore, are not having a significant outcome. Support mechanisms to help implement the reforms were not prioritized. Hindering factors should be identified and minimized to increase positive changes in the health and mental health systems. This article concludes on the importance of implementing continuums of care, especially local healthcare networks and best practices in mental health. Furthermore, strong strategies to support the implementation of changes should always accompany sweeping reforms.

Workplace mental health: developing an integrated intervention approach.

BackgroundMental health problems are prevalent and costly in working populations. Workplace interventions to address common mental health problems have evolved relatively independently along three main threads or disciplinary traditions: medicine, public health, and psychology. In this Debate piece, we argue that these three threads need to be integrated to optimise the prevention of mental health problems in working populations.DiscussionTo realise the greatest population mental health benefits, workplace mental health intervention needs to comprehensively 1) protect mental health by reducing work–related risk factors for mental health problems; 2) promote mental health by developing the positive aspects of work as well as worker strengths and positive capacities; and 3) address mental health problems among working people regardless of cause. We outline the evidence supporting such an integrated intervention approach and consider the research agenda and policy developments needed to move towards this goal, and propose the notion of integrated workplace mental health literacy.SummaryAn integrated approach to workplace mental health combines the strengths of medicine, public health, and psychology, and has the potential to optimise both the prevention and management of mental health problems in the workplace.

Preparedness of Lithuanian general practitioners to provide mental healthcare services: a cross-sectional survey.

BackgroundA large unmet need for mental healthcare in Lithuania is partially attributable to a lack of primary care providers with skills in this area. The aim of this study was to assess general practitioners’ (GPs) experience in mental healthcare and their perceptions about how to increase their involvement in the field.MethodsIn this cross-sectional study, a 41-item questionnaire was distributed to a random sample of 797 Lithuanian GPs in order to investigate current practices in their provision of mental healthcare as well as their suggestions for the improvement of mental healthcare services in primary care.ResultsThe response rate was 52.2%. Three-quarters of the GPs agreed that they feel responsible for the management of mental health problems, but only 8.8% of them agreed that “My knowledge in mental healthcare is sufficient”. Psychiatrists were identified as the mental healthcare team specialists with whom 32% of the respondents discuss the management of their patients with a mental disorder. Collaboration with psychologists and social workers was almost threefold lower (11.6% and 12.5%). Capacity-building of GPs was found to be among the most promising initiatives to improve mental health services in primary care. Other strategies mentioned were policy level and managerial measures as well as strengthening the teamwork approach in mental healthcare.ConclusionsThis study found a low self-reported competence of GPs in mental healthcare and low collaboration among GPs and other specialists in providing mental healthcare. For the situation to improve in the country, these findings point to a need for strategies to improve GPs’ expertise and teamwork in mental healthcare.

EPA-0575 – Audit to identify the number of patients with multiple diagnoses in a community mental health team in bedford, England

Background Patients with ‘simple’ mental health problems should be able to be managed exclusively in primary care. It is therefore anticipated that only the more complex cases would be referred to secondary care. In order to test this hypothesis, the number of patients registered with a community mental health team (CMHT) in Bedford, United Kingdom, who had received multiple psychiatric diagnoses in 2010, 2011 and 2013, was analysed. Method Using an anonymised database that contains all patient data, the proportions of patients with more than one diagnosis were audited for the months of August 2010, June 2011 and February 2013. The total number of patients registered was also determined. Results Many patients were found to have received multiple diagnoses. An increase in the proportion of patients with multiple diagnoses was observed; from 23.2% in 2010 to 25.2% in 2011 to 34.3% in 2013. Discussion Several psychiatric conditions are associated with particular psychiatric co-morbidities, which may be one reason why many of patients receive multiple diagnoses. The trend observed may reflect improving mental healthcare in primary care and therefore fewer referrals of patients with ‘simple’ mental health conditions to secondary care, thus causing the CMHT's caseload to become increasingly complex. It may also reflect improving communication between primary and secondary care, which may also lead to fewer referrals. Finally, the trend may merely reflect better use of the available database. Conclusion We have found that numerous patients received multiple diagnoses. We have also observed an increase in the proportion of such patients over three years, which may reflect improved management of mental health problems in primary care. Our results may therefore provide an incentive to establish formal shared care of psychiatric patients between primary and secondary care to improve patient management even further.

Management of Mental Health Problems Prior to and During Treatment of Hepatitis C Virus Infection in Patients With Drug Addiction

Psychiatric comorbidity is a common problem in patients with substance use disorders. Patients with psychiatric diseases and/or substance abuse have an increased risk for hepatitis C virus (HCV) infection. Furthermore, psychiatric problems occur frequently during antiviral treatment and may be associated with the use of interferon alpha (IFN-α) but also with the primary psychiatric condition. As a consequence, substance abuse and/or acute psychiatric problems are still important reasons for nontreatment of chronic HCV infection. However, prospective and controlled data from recent years showed that if an interdisciplinary treatment is provided, patients with substance use disorders and/or psychiatric diseases do not differ regarding sustained virologic response or IFN-α-associated complications such as depression when compared with controls. Moreover, depression as the most important acute IFN-α-associated psychiatric adverse event can be acutely treated or even prevented by antidepressant pretreatment. Other, more rare but severe complications such as mania, psychotic symptoms, or delirium need individual psychiatric interventions.

A Description of Common Mental Disorders in Men Who Have Sex with Men (MSM) Referred for Assessment and Intervention at an MSM Clinic in Cape Town, South Africa

Men who have sex with men (MSM) have a higher prevalence of common mental disorders (CMD), as compared with heterosexual men. HIV infection is independently associated with higher rates of CMD. Given this context, and the high background community prevalence of HIV in South Africa, MSM are at even greater risk of developing CMD. The aim of this research was to investigate neuropsychiatric symptoms and disorders in MSM who were referred for assessment and management of mental health problems, in an MSM Clinic in urban Cape Town, South Africa. Twenty-five men were screened using the MINI, AUDIT, DUDIT, and IPDE Screener. Depression, suicidality, as well as alcohol and drug use disorders were highly prevalent in this group (44, 56, 48, and 56 % respectively). The personality disorder screening was suggestive of a high prevalence of personality disorders. The high prevalence of neuropsychiatric disorders in this sample supports the idea that integrated mental health services are needed to address the complex needs of this population. Adequate input into the mental health needs of this population could reduce the potential for HIV acquisition and transmission, improve adherence to treatment and care, and ensure the provision a comprehensive health service for MSM.

Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study

ObjectivesThe aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model. MethodA quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes. ResultsSix to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes. ConclusionsTraining professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.

Common mental disorder severity and its association with treatment contact and treatment intensity for mental health problems

Detailed population-based survey information on the relationship between the severity of common mental disorders (CMDs) and treatment for mental health problems is heavily based on North American research. The aim of this study was to replicate and expand existing knowledge by studying CMD severity and its association with treatment contact and treatment intensity in The Netherlands. Data were obtained from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face survey of the general population aged 18–64 years (n=6646, response rate=65.1%). DSM-IV diagnoses and disorder severity were assessed with the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0). Treatment contact refers to at least one contact for mental health problems made in the general medical care (GMC) or mental health care (MHC) sector. Four levels of treatment intensity were assessed, based on type and duration of therapy received. Although CMD severity was related to treatment contact, only 39.0% of severe cases received MHC. At the same time, 40.3% of MHC users did not have a 12-month disorder. Increasing levels of treatment intensity ranged from 51.6% to 13.0% in GMC and from 81.4% to 51.1% in MHC. CMD severity was related to treatment intensity in MHC but not in GMC. Sociodemographic characteristics were not significantly related to having experienced the highest level of treatment intensity in MHC. CONCLUSIONS. Mental health treatment in the GMC sector should be improved, especially when policy is aimed at increasing the role of primary care in the management of mental health problems.

The influence of food on mood

Annette Dunne explores the role of diet in the development, prevention, and management of mental health problems

‘Art Lift’ intervention to improve mental well‐being: An observational study from UK general practice

Arts for health interventions are emerging as an alternative option to medical management of mental health problems and well-being. This study investigated process and outcomes of an art intervention on patients referred by primary care professionals, including associations between patient characteristics (e.g., sex), progress through the intervention (e.g., attendance), and changes in mental well-being. Referral criteria included people with anxiety, depression, or stress; low self-esteem, confidence, or overall well-being; and chronic illness or pain. The study took place in U.K.-based general practitioner practices, with a total of 202 patients referred to a 10-week intervention. Patient sociodemographic information was recorded at baseline, and patient progress assessed throughout the intervention. Significant improvement in well-being was revealed for the 7-item (t = -6.049, d.f. = 83, P < 0.001, two-tailed) and 14-item (t = -6.961, d.f. = 83, P < 0.001, two-tailed) scales. Of referred patients, 77.7% attended and 49.5% completed. Most patients were female, and from a range of socioeconomic groups, and those who completed were significantly older (t = -2.258, d.f. = 145, P = 0.025, two-tailed). Findings reveal that this art intervention was effective in the promotion of well-being and in targeting women, older people, and people from lower socioeconomic groups.

Comparative quality of life in patients with depression and rheumatoid arthritis

We assessed the inter-relationships between the Short Form 36 (SF-36) physical and mental function in 220 patients with onset cases of mild and moderate depression and 913 adults with early and established rheumatoid arthritis (RA) through secondary analysis and compared both scores with the UK general population norms. In depression and RA the SF-36 total scores showed significant impairment across the spectrum of both domains compared with age-specific UK normative score. In RA mental health and role, mental scores were highly correlated with other SF-36 domains. In depression there was little evidence of such inter-relationships. Mental health and role mental domains were lowest in active RA (disease activity scores (DAS28) over 5.1). They had strong correlations with the vitality and social function SF-36 sub-scores and weak correlations with the physical function and role emotional sub-scores. Patients with long-term conditions require comprehensive care. At present it is unclear how best to combine treatment of RA synovitis with the management of mental health problems. Mental health symptoms are present from the earliest stages of RA and it may be appropriate to initiate multidisciplinary care as soon as practicable, although its efficacy requires a further detailed study across primary and secondary care.

A Brief Scale to Assess Hospital Doctors' Attitudes toward Collaborative Care for Mental Health

Collaborative care may improve mental health management in hospital settings. However, no scales assess doctors' attitudes toward its 2 core components: mental health management by nonpsychiatric physicians and psychiatric consultation. Our objective was to develop and assess the reliability and validity of the Doctors' Attitudes Toward Collaborative Care for Mental Health (DACC-MH) Scale. Fifteen items assessing doctors' attitudes toward management of mental health problems (10 items) and psychiatric consultation (5 items) were administered to 225 physicians and surgeons from a London hospital. Item responses were dichotomous (agree or disagree). Confirmatory factor analysis models were conducted using Mplus for dichotomous data to identify items for inclusion in the DACC-MH and to test the validity of the 2 hypothesized factors. Known-groups validity was tested by comparing scores of surgeons and physicians, as physicians have been shown to view mental health management and psychiatric consultation more favourably. The 8-item DACC-MH included a 4-item Attitudes Toward Management of Mental Health Problems factor (Cronbach's a = 0.65) and a 4-item Attitudes Toward Psychiatric Consultation factor (alpha = 0.67; overall scale alpha = 0.70). Model fit was good (chi2 = 12.7, df = 11, P = 0.31; Comparative Fit Index = 0.99; Tucker-Lewis Index = 0.99; root mean square error of approximation = 0.03) with all factor loadings of 0.46 or greater. As hypothesized, physician scores were significantly higher than surgeon scores on both subscales, indicating more positive attitudes toward management of mental health problems and psychiatric consultation. Preliminary evidence was found for the validity of the DACC-MH, which will facilitate efforts to evaluate readiness of doctors to engage in collaborative mental health care.

“You may wade through them without seeing them”: General practitioners and their young patients with mental health problems

Objective: To gain insight into the management of children and adolescents with mental health problems by their GPs as the GPs describe it. Design: A qualitative analysis of data from focus group interviews with GPs. Setting: Western Coast of Norway. Subjects: A strategic sample of 19 GPs. Results: According to the informants psychosomatic and other internalizing disorders are the most frequent mental health problems in their practice. Their assessments were based on history taking, physical examination and acquired knowledge of development and prevalence of common health problems. Their interventions mostly consisted of parental counselling. Their assessments and interventions to a lesser extent relied on specific knowledge in child and adolescent psychiatry. Conclusion: The interested GP is in a good position to provide services to these patients. They have the parents’ trust, insight into family and local community, and essential general medical knowledge about management of mental health problems in this age group. There is need for mutual research and educational programmes between GPs and child and adolescent psychiatry to explore the interface between the fields.

Encounters between adolescents and general practice in Australia

To describe the nature of the encounters between adolescents and general practice in Australia. Data collected by the Bettering the Evaluation and Care of Health programme from 1998-2004 were analysed. Data for 10-14-year-old and 15-19-year-old males and females were compared with data for 25-29-year-olds. The outcome measures included: number of encounters compared with other age groups, reasons for encounter, problems managed, treatments prescribed and referrals made for key problems and types of consultations. Adolescents have the lowest rate of encounter with general practice, compared with all other age groups. Respiratory, skin, musculoskeletal and unspecified (fever, injury, weakness) problems accounted for the great majority of reasons for encounter and problems managed. Management of mental health problems, preventive health care and health education were very infrequently managed problems. Standard surgery consultations were more common among adolescents than among young adults. Adolescents have a relatively low rate of encounter with general practice and the problems managed are primarily physical ailments. There is great scope to improve delivery of preventive health care and to increase management of mental health problems.

Practitioner review: How can epidemiology help us plan and deliver effective child and adolescent mental health services?

This review focuses on ways in which epidemiological research can inform mental health service development and clinical practice. Data from epidemiological studies can provide cross-sectional and secular estimates of the prevalence of psychopathology to support rational service development. Epidemiological surveys have difficulties in finding large enough samples of children with rare disorders, although these disorders are often severely debilitating and require extensive service input. Systematic surveillance provides a rigorous method for studying rare disorders and events. Only a minority of children with impairing psychopathology reach mental health services, although a larger proportion have mental health related contacts with other services. The gap in provision is such that an expansion of mental health services is unlikely to reach all children who could benefit, suggesting that mental health professionals need to develop innovative strategies to increase the number of children seen and the effectiveness of interventions that they receive. Training and supervision of non-mental-health professionals working with children in the identification and management of mental health problems is also extremely important. Most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child's difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope. Studies consistently suggest that the region in which the child lives affects the likelihood of service contact, but studies of other characteristics predicting service contact are so contradictory that studies should only be (cautiously) applied to similar populations to assess which types of children may currently be falling through gaps in service provision. Academics are beginning to explore the use of structured measures developed for epidemiological studies in clinical assessment and outcome monitoring.

Assessing the risk of suicide at triage

Summary Mental health related presentations to Australian emergency departments are steadily increasing. There is a growing incidence of depression, substance abuse, and other mental illnesses in the Australian population. Mental health problems will contribute 15% of the total world disease burden by 2020. Triage nurses are pivotal to the early detection and management of mental health problems. The rapid assessment of mental health presentations at triage requires skill, knowledge, experience and confidence. One of the more complex aspects of triage is suicide risk assessment.

Evaluation of the sustained implementation of a mental health learning initiative in long-term care

This paper describes an innovative education program for the management of mental health problems in long-term care (LTC) homes and the evaluation of its longer-term sustainability. Since 1998, the "Putting the P.I.E.C.E.S. Together" learning initiative has been providing education sessions and related learning strategies aimed at developing the knowledge and skills of health professionals who care for older persons with complex physical and mental health needs and associated behaviors, in Ontario, Canada. A major focus of this province-wide initiative was the development of in-house Psychogeriatric Resource Persons (PRPs). Evaluation of this initiative included the completion of pre- and post-education questionnaires (over three data collection time periods) assessing learner confidence (N = 1,024 and 792, for pre- and post-education, respectively) and session evaluation questionnaires gathering feedback on the session (N = 2,029 across all sessions). A survey of LTC homes in Ontario (N = 439, 79% of the homes in the province) was conducted to assess longer-term sustainability. Ratings of the sessions indicated that they were relevant to learners' clinical practice. There were significant increases in ratings of ability to recognize and understand challenging behaviors and mental health problems, and in ability to use a variety of assessment tools. Few homes (15%) do not have a PRP; over 50% of the staff who completed the first session in 1999 continue to serve as a PRP and to apply learned skills. A learning initiative with supportive and reinforcing strategies can develop in-house PRPs to enhance the care of the elderly in LTC. Incorporation of PRP functions into job descriptions and management support contributed to the success of this initiative. This study highlights the importance of work environments that support and reinforce the use of learned skills to the success of continuing education and quality improvement initiatives in LTC.

Psychiatric Disorder and Separation From Military Service: A 10-Year Retrospective Study

This study investigated the association between the onset of psychiatric morbidity and separation from military service over a 10-year period (1991-2001). The prevalence of affective, anxiety, somatic, and substance use disorders was assessed in 2,215 male Australian Navy personnel with the Composite International Diagnostic Interview. The onset of a psychiatric disorder during military service was related to a 19% greater risk of separation overall. The majority of those leaving military service did so in the first year after symptom onset. Personnel who remained in service past this period had no significantly elevated risk of separation in subsequent years. Psychiatric morbidity represents a significant potential cost to defense forces. Improved recognition and early management of mental health problems among military personnel may improve retention rates.

Psychiatric Disorder and Separation From Military Service: A 10-Year Retrospective Study

This study investigated the association between the onset of psychiatric morbidity and separation from military service over a 10-year period (1991-2001). The prevalence of affective, anxiety, somatic, and substance use disorders was assessed in 2,215 male Australian Navy personnel with the Composite International Diagnostic Interview. The onset of a psychiatric disorder during military service was related to a 19% greater risk of separation overall. The majority of those leaving military service did so in the first year after symptom onset. Personnel who remained in service past this period had no significantly elevated risk of separation in subsequent years. Psychiatric morbidity represents a significant potential cost to defense forces. Improved recognition and early management of mental health problems among military personnel may improve retention rates.