Mental Competence Research Articles

114. DESIGNING AND EVALUATING A NOVEL MENTAL AND BEHAVIORAL HEALTH CURRICULUM

Background Pediatric mental and behavioral health disorders are a growing public health concern with immediate and long-term impacts for children, families, and society. Pediatricians are uniquely positioned, but often inadequately trained, to identify and address childhood mental and behavioral health needs. Design/Methods Two major learning domains were identified for a 2-week rotation in senior year: 1) screening, diagnosis, and treatment of depression, anxiety, and ADHD in outpatient pediatric settings; and 2) evaluation, de-escalation, and triage of children in acute mental health crises. Residents participate in repeated sessions in integrated behavioral health clinics, conduct screenings with social workers, perform intakes supervised by a child psychiatrist, and evaluate patients with acute mental health concerns in the emergency department with child psychiatrists, in the community with Boston Emergency Services Team, and in inpatient settings with the hospital's Behavioral Response Team. Self-directed learning activities provide individualized experiences tailored to residents’ interests. By random selection, half of senior residents will participate in the rotation during its first year. All senior residents were invited to complete a baseline survey at the beginning of the year evaluating their satisfaction with their behavioral health training thus far. Results Fourteen of 29 (48%) eligible seniors completed the baseline assessment, showing that residents were least satisfied with their training in titrating/initiating medications to treat depression and anxiety, and most satisfied with their training in agitation management (Figure). Thus far, 11 senior residents have participated in the rotation. Conclusions Many senior residents have received limited training in behavioral and mental health competencies. We developed a novel 2-week rotation that leverages hands-on experiences with child psychiatrists, social workers, and crisis response teams, as well as individualized self-directed learning, which we will follow-up with surveys to assess efficacy as our next steps.

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

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

Working at the Intersection of Palliative End-of-Life and Mental Health Care: Provider Perspectives.

Objective: Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort-particularly those with a comorbid, chronic and persistent mental illness (CPMI)-are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients. Method: Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis. Results: The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not. Conclusions: Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.

What do psychiatrists think about primary mental health competencies among family doctors? A WPA-WONCA global survey.

People with common mental disorders often seek medical attention from their family doctors. Thus, it is essential for family doctors to possess primary mental health knowledge. The aim of this study was to understand whether psychiatrists endorse the primary mental health competencies identified by the World Organization of Family Doctors and whether they agree that family doctors are demonstrating these competencies. A questionnaire was constructed based on 32 core competencies. Presidents of all World Psychiatric Association member societies were invited to complete the questionnaire or to forward it to local experts. According to the respondents, these competencies are considered relevant yet not sufficiently possessed by typical primary care doctors. Proposals are made to bridge this assumed competency gap.

Prediction of Psychological Well-Being in the Elderly by Assessing their Spirituality, Gratitude to God, and Perceived Social Support

Objectives: Today, psychological care for the elderly has received increasing attention due to potential threats posed by aging, loneliness, gradual decline in physical activity, increase of chronic diseases, social isolation, and physical and mental disabilities. The positive psychology approach to mental health seeks to promote the mental health of people by identifying and developing mental abilities and competences. The present study aimed to predict psychological well-being of the elderly based on the components of positive psychology including spirituality, gratitude to God, and perceived social support. Methods & Materials: This is a descriptive correlational study conducted on 211 elderly people aged 60-70 years (109 males and 102 females) who were selected randomly. Data collection tools were a demographic form (surveying age, gender, education, marital status, and socioeconomic status), and Paloutzian and Ellisons’ Spirituality Well-Being Scale, short form of Ryff’s Psychological Wellbeing Scale, Emmons and Crumpler’s Gratitude to God Questionnaire, and Zimet’s Multidimensional Scale of Perceived Social Support. Collected data were analyzed in SPSS software V. 22 by using descriptive (Mean and Standard Deviation), Pearson correlation test, and stepwise regression analysis. Results: Mean and Standard Deviation of different study variables were reported as follows: Psychological well-being =7.1±10.68; Spirituality =90.22±15.36; Gratitude to God =14.09±2.41; Social support from family members =21.6±4.2; Social support from friends =16.5±5.8; and Social support from significant others =20.23±5. The results of stepwise regression analysis indicated that spirituality (F1,209=62.02, P=0.001), social support from family members (F1,208=11.06, P=0.001), and gratitude to God (F1,207=4.80, P=0.001) could significantly explain 27% of the psychological well-being variance in the elderly. Conclusion: Increased spirituality, gratitude to God, and perceived social support especially from family members can improve psychological well-being of the elderly. Hence, Strengthening and paying special attention to their spiritual needs and perceived social support as well as planning health care for them can help increase their psychological well-being.

Is Mental Health Competence in Childhood Associated With Health Risk Behaviors in Adolescence? Findings From the UK Millennium Cohort Study

PurposePromoting positive mental health, particularly through enhancing competencies (such as prosocial behaviors and learning skills), may help prevent the development of health risk behaviors in adolescence and thus support future well-being. Few studies have examined how mental health competencies in childhood are associated with adolescent health risk behaviors, which could inform preventative approaches. MethodsUsing UK Millennium Cohort Study data (n = 10,142), we examined how mental health competence (MHC) measured at the end of elementary school (11 years) is associated with self-reported use of cigarettes, e-cigarettes, alcohol, illegal drugs, antisocial behavior, and sexual contact with another young person at age 14 years. A latent measure of MHC was used, capturing aspects of prosocial behavior and learning skills, categorized as high MHC, high–moderate MHC, moderate MHC, and low MHC. Logistic and multinomial regression estimated odds ratios and relative risk ratios for binary and categorical outcomes, respectively, before and after adjusting for confounders. Weights accounted for sample design and attrition and multiple imputation for item missingness. ResultsThose with low, moderate, or high-moderate MHC at age 11 years were more likely to have taken part in health risk behaviors at age 14 years compared with those with high MHC. The largest associations were seen for low MHC with binge drinking (relative risk ratio: 1.6 [95% confidence interval: 1.1–2.4]), having tried cigarettes (odds ratio: 2.2 [95% confidence interval: 1.6-3.1]) and tried illegal drugs (odds ratio: 2.0 [95% confidence interval: 1.3-3.1) after adjusting for confounders (which attenuated results but largely maintained significant findings). ConclusionsMHC in late childhood is associated with health risk behaviors in midadolescence. Interventions that increase children's MHC may support healthy development during adolescence, with the potential to improve health and well-being through to adulthood.

Validity and reliability of Korean version Competency Assessment Tool-Mental Health

Abstract Objective To establish basic data for identifying the level of mental health care competency of general nurses through verification of the reliability and validity of Competency Assessment Tool-Mental Health in the development of a measurement tool for mental health care competency in Korea. Methods This study was conducted on nurses working at general wards, excluding those working at the Department of Psychiatry, in five hospitals with 200 beds or more located in Korea. Content, construct, concurrent validity, and internal consistency of the measurement were confirmed. Results As a result of the construct validity, the section on importance of skills and knowledge for mental health care had 21 items, whereas the section on benefits of additional education had 22 items. The internal consistency of measurement was confirmed as follows: Cronbach's α = 0.96 for the section on importance and 0.96 for the section on benefits section. Conclusions This study verified the high validity and reliability of the tool in assessing the mental health care competency of nurses, and it is believed to be significant as basic data for enhancing such competency.

Shall I Trust You? From Child-Robot Interaction to Trusting Relationships.

Studying trust in the context of human–robot interaction is of great importance given the increasing relevance and presence of robotic agents in the social sphere, including educational and clinical. We investigated the acquisition, loss, and restoration of trust when preschool and school-age children played with either a human or a humanoid robot in vivo. The relationship between trust and the representation of the quality of attachment relationships, Theory of Mind, and executive function skills was also investigated. Additionally, to outline children’s beliefs about the mental competencies of the robot, we further evaluated the attribution of mental states to the interactive agent. In general, no substantial differences were found in children’s trust in the play partner as a function of agency (human or robot). Nevertheless, 3-year-olds showed a trend toward trusting the human more than the robot, as opposed to 7-year-olds, who displayed the reverse pattern. These findings align with results showing that, for 3- and 7-year-olds, the cognitive ability to switch was significantly associated with trust restoration in the human and the robot, respectively. Additionally, supporting previous findings, we found a dichotomy between attributions of mental states to the human and robot and children’s behavior: while attributing to the robot significantly lower mental states than the human, in the Trusting Game, children behaved in a similar way when they related to the human and the robot. Altogether, the results of this study highlight that similar psychological mechanisms are at play when children are to establish a novel trustful relationship with a human and robot partner. Furthermore, the findings shed light on the interplay – during development – between children’s quality of attachment relationships and the development of a Theory of Mind, which act differently on trust dynamics as a function of the children’s age as well as the interactive partner’s nature (human vs. robot).

We Are on the Same Team: Child Psychiatry and the School System

As former public school teachers now in child psychiatry training and practice, we continue to be struck by the disconnect between the K-12 education system and psychiatric care. As teachers, we often felt unsupported by the medical community, and now as physicians we struggle to negotiate appropriate roles as collaborators with schools. Constraints on funding, time, and privacy often limit the expansion of mental health competency training for teachers and clinical services in schools. Under-resourced communities are particularly vulnerable to these barriers to mental health care. As local experts, psychiatrists can partner with schools to improve teacher competence and strengthen referral networks.

Simulation-based medical education can be used to improve the mental health competency of emergency physicians.

We explored the feasibility of developing, running and evaluating a simulation-based medical education (SBME) workshop to improve the knowledge, skills and attitudes of emergency department (ED) doctors when called on to assess patients in psychiatric crisis. We designed a four-hour workshop incorporating SBME and a blend of pre-reading, short didactic elements and multiple-choice questions (MCQs). Emergency department nurses (operating as SBME faculty) used prepared scripts to portray patients presenting in psychiatric crisis. They were interviewed in front of, and by, ED doctors. We collected structured course evaluations, Debriefing Assessment for Simulation in Healthcare (DASH) scores, and pre- and post-course MCQs. The pilot workshop was delivered to 12 ED registrars using only existing resources of the Psychiatry and Emergency Departments. Participants highly valued both 'level of appropriateness' (Likert rating μ = 4.8/5.0) and 'overall usefulness' (μ = 4.7/5.0) of the programme. They reported an improved understanding of the mental state and of relevant legal issues and rated the debriefings highly (participant DASH rating: n = 193; score μ = 6.3/7.0). Median MCQ scores improved non-significantly pre- and post-course (7.5/12 vs 10/12, p = 0.261). An SBME workshop with these aims could be delivered and evaluated using the existing resources of the Psychiatry and Emergency Departments.

Utilising acupuncture for mental health; a mixed‐methods approach to understanding the awareness and experience of general practitioners and acupuncturists

BackgroundMental health presents a significant burden of disease and a large, and increasing, number of patients are self-selecting forms of CAM, including acupuncture, as an adjunct, or standalone treatment for the management of their mental health. General practitioners (GPs) play an important role in integrated care management of primary mental health, and in most cases act as the primary provider and access point for further services. However, the interaction and collaboration between GPs and acupuncturists in relation to shared mental health care has not been investigated.This research explores interprofessional communication between GPs and acupuncturists in New Zealand concerning mental health care. The aim of this research was to understand the barriers to communication, and to facilitate collaboration between the two participant groups. MethodsThe project utilised a mixed methods multiphase design, with both qualitative and quantitative inquiry, and involving the convergence of data and analyses. A nationwide survey of 400 GPs and 250 acupuncturists was conducted. Univariate data was analysed using descriptive statistics, which included frequencies and percentages for categorical data. This was followed by individual semi-structured interviews of 13 purposively sampled acupuncturists, and 14 GPs which was analysed using thematic analysis. This design consisted of three distinct phases: quantitative, qualitative, implementation and reflection. ResultsBoth provider groups acknowledged the complexities of working within mental health care, and supported the development of specific mental health competencies in light of the recognition of the limitations surrounding current mental health care. The unfamiliarity of acupuncture's evidence-base to both provider groups was an identified barrier, yet both groups acknowledged that while practice is informed by the evidence, there are many other factors that also inform clinical practice. ConclusionsThis study is the first in New Zealand to seek quantitative data and qualitative views regarding alignment about mental health management approaches and the use of acupuncture. This has the potential of improving healthcare outcomes through better inter professional communication and by contributing to better trans-cultural understandings on healthcare issues. The results of this research, whilst looking at the communication model between acupuncture and primary health care, will have easily generalizable findings for other necessary interprofessional communication strategies.This is the first time that the role and potential of the relatively untapped resource base of acupuncture within the health sector has been investigated within a New Zealand context.

Euthanasia and physician-assisted suicide for patients with depression: thought-provoking remarks.

Euthanasia and medical assistance in dying entail daunting ethical and moral challenges, in addition to a host of medical and clinical issues, which are further complicated in cases of patients whose decision-making skills have been negatively affected or even impaired by psychiatric disorders. The authors closely focus on clinical depression and relevant European laws that have over the years set firm standards in such a complex field. Pertaining to the mental health realm specifically, patients are required to undergo a mental competence assessment in order to request aid in dying. The way psychiatrists deal and interact with decisionally capable patients who have decided to end their own lives, on account of sufferings which they find to be unbearable, may be influenced by subjective elements such as ethical and cultural biases on the part of the doctors involved. Moreover, critics of medical aid in dying claim that acceptance of such practices might gradually lead to the acceptance or practice of involuntary euthanasia for those deemed to be nothing more than a burden to society, a concept currently unacceptable to the vast majority of observers. Ultimately, the authors conclude, the key role of clinicians should be to provide alternatives to those who feel so hopeless as to request assistance in dying, through palliative care and effective social and health care policies for the weakest among patients: lonely, depressed or ill-advised people.

Do foundation doctors meet the mental health competencies in the foundation programme curriculum?

Do foundation doctors meet the mental health competencies in the foundation programme curriculum?

Pediatric Mental Health and the Power of Primary Care: Practical Approaches and Validating Challenges.

With over 300 school shootings in the past 5 years, the unprecedented use of online social media, and the growing demands of academia, mental illness is quickly becoming one of the top causes of morbidity and mortality in the pediatric population. In the past year, 90% of children in the U.S. visited their pediatric primary care provider (PCP), giving PCPs a unique opportunity to address the mental health needs of their patients. The author conducted a comprehensive review of the literature. This clinical paper seeks to validate the mental health competency of pediatric PCPs, identifies current challenges, and outlines practical approaches to care. The consequences of untreated pediatric mental illness are indisputable. Pediatric PCPs have an obligation to address the growing pediatric mental health crisis directly. By utilizing standardized screening tools, referring to established clinical guidelines, seeking continuing education, and developing a comprehensive list of available resources, pediatric PCPs can incorporate mental health care into primary care.

A complex population: Nurse's professional preparedness to care for medical-surgical patients with mental illness

Globally, patients with the co-morbidity of physical and mental illness experience greater health complexities than the general population. Yet nurses caring for medical-surgical patients with a secondary diagnosis of mental illness are often unprepared for these complexities. This paper focuses on professional experiences from a more extensive parent study that evaluated components of nursing preparedness (nursing care self-efficacy and mental health care competency) to provide care for medical-surgical patients who also have mental illness. The parent study explored characteristics of variables (personal, educational and professional) more frequently associated with and more predictive of nursing preparedness. Discussed will be the findings from characteristics of professional experiences that best indicated nurse preparedness to care for medical-surgical patients with mental illness. A descriptive correlational design was used with a convenience sample of RNs (N = 260) from a tertiary health system in the south-eastern United States. Findings significantly indicated three characteristics of professional experiences - mentoring, frequency of care and continuing education – best prepare a registered nurse to care for this complex population. Further research is necessary to locate, grow and develop mentors and to construct accessible, affordable continuing education regarding care of this population for a prepared nursing workforce and work environment.

Animal Minds in the Media: Learning Outcomes for a Critical-Analysis Assignment for Students of Comparative Cognition

Students of comparative cognition must learn to read and evaluate scholarly writings such as journal articles and textbooks, and to think critically about information they hear from talks and lectures from experts in the field. They also must develop a healthy skepticism for popular-media portrayals of the mental and behavioral competencies of animals, whether those appear in serious formats such as documentaries and non-refereed popular science magazines or blogs, or even in media portrayals of animals that are intended purely for entertainment. Across a ten-year period, students in either a senior psychology course or a freshman honors seminar completed multiple assignments each semester called “Animal Minds in the Media” requiring identification and evaluation of popular media portrayals of the cognitive capabilities of animals, viewed through the lens of the comparative-psychology literature. The assignment was designed to motivate students to cultivate scientific skepticism and develop a “comparative psychologist’s way of seeing the world” by identifying implications or assumptions of popular-media treatment of animals and by bringing scientific literature to bear on the question of whether animals can actually think in the way implied by the commercial, comic, film, meme, or other media example.

Forensic Neuropsychological Aspects of Competency Evaluations: Financial and Legal Competency in Older Adults

Clinical assessment of mental competence and capacity in older adults, particularly the capacity to manage one’s financial and legal matters, is an issue of increasing significance within the context of an aging baby boomer population. Together with escalating demands on caregivers, hospitals, and facilities caring for people experiencing cognitive decline, dementia, brain injury and chronic illnesses, and with the increased longevity, changing demographics and societal pressures have triggered debates regarding decisions surrounding wealth transfer via wills and estate planning. Furthermore, these changes parallel the growth of court challenges to legal and medical competence findings, with an enhanced emphasis on ethical and responsible professional practices. With evolving social and economic perspectives on retirement, older adults, from “blue collar” to professional status, now remain longer in employment markets. Thus, we anticipate a higher prevalence of cognitive and associated functional disability both in the workforce and in the general population. In this context, concern emerges regarding vulnerability of persons with cognitive decline to exploitation. With escalating demands for competency assessments, a lack of clear evidence-based guidelines for these evaluations has the potential for significant harm to older adults, their families, and the public. Thus, we define competency and review its relationship with financial and legal capacity and decision-making, neurocognitive functions, and specific functional domains relevant to older adults (e.g., financial management). We then propose a step-by-step model for constructing financial competency assessments for older adults.

Functional Capability and Job Competence of Part-Time Postretiree Workers in Higher Academic Institutions

In recent years, there has been an increasing interest in working in the academe after retirement. This study determined the relationship between the functional capacity (physical and mental capacities) of working retirees and their job competence. A method with a descriptive design was used to investigate this relationship. One hundred and two working retirees were interviewed in 11 public and 17 private higher education institutions in Eastern Philippines. Cross-tabulation analysis, specifically Somers’ D, was used to determine the relationship between physical and mental functioning and job competence. Working retirees have satisfactory job competence and high physical and mental capacities. There is an association between the physical and mental functioning of working retirees and their job competence. Maintaining physical and mental capacities is crucial in providing high-quality work performance even after retirement. Effective human resources management strategies for maintaining health and well-being are greatly needed to achieve high-quality job outcomes.

Modelling Associative-Semantic Content as Regards the Logic-of-Semantics Dimension of the Adolescents’ Speech

Objective. The article deals with the analysis of the trends in the logic of the semantic organization of the speech and mental activity of adolescents as regards the dimension of the available semantic environment and that of the speech competences of an individual. It is stated that information about the world is systematized by human consciousness in the form of an associative-verbal field, whose producing and modelling is one of the ways of representing the speech competence of an individual shaping his/her destiny.
 Materials & Methods. In view of the above, an empirical research of the distinctive features of expanding semantic content of the adolescents' speech consciousness as regards the dimension of the logic-of-semantics organization of the mental and speech activity was performed using the diagnostic potential of a free associative experiment. A system of relevant ways of construction and associative expansion of meanings in the semantic field of the speech consciousness of adolescents was chosen as the subject of the research.
 Results. Drawing on the results of the frequency analysis of the use of typical associative patterns for organizing the semantic field of speech, it was stated that the most represented among adolescents is a semantic way of reasoning based on the identification signs of the general contour of the trigger word at the level of its meaning. It was proved that the greatest changes in the logic of expanding associative semantic content are observed among older adolescents, which is interpreted as the result of fundamental changes in the strategies for cognitive processing of information flows.
 Conclusions. A conclusion was drawn about the stable tendency towards the standardization and unification of speech in adolescents during their transition to adulthood, and the reduction in the heuristic resource of the intellectual activity of older adolescent pupils was noted. In this context, the purposeful formation of speech and mental competences of an individual, the acquisition by adolescents of efficient methods of the logic-of-semantics organization of the associative semantic content of speech is defined as a necessary prerequisite for the personality development, as well as that for the speech and mental development of an individual.

Associations between mental health competence and indicators of physical health and cognitive development in eleven year olds: findings from the UK Millennium Cohort Study

BackgroundPositive mental health may support healthy development in childhood, although few studies have investigated this at a population level. We aimed to construct a measure of mental health competence (MHC), a skills-based assessment of positive mental health, using existing survey items in a representative sample of UK children, and to investigate its overlap with mental health difficulties (MHD), socio-demographic patterning, and relationships with physical health and cognitive development.MethodsWe analysed the UK Millennium Cohort Study (MCS) when children were aged 11 years. Maternal (n = 12,082) and teacher (n = 6739) reports of prosocial behaviours (PS) and learning skills (LS) were entered into latent class models to create MHC measures. Using descriptive statistics, we examined relationships between MHC and MHD, and the socio-demographic patterning of MHC. Associations between MHC and physical health and cognitive development were examined with relative risk ratios [RRR] (from multinomial models): BMI status (healthy weight, overweight, obesity); unintentional injuries since age 7 (none, 1, 2+); asthma symptoms (none, 1, 2+); and tertiles of test scores for verbal ability, spatial working memory and risk-taking. Models were adjusted for potential confounding.ResultsFour MHC classes were identified [percentages for maternal and teacher reports, respectively]: high MHC (high PS, high LS) [37%; 39%], high-moderate MHC (high PS, moderate LS) [36%; 26%]; moderate MHC (moderate PS, moderate LS) [19%; 19%]; low MHC (moderate PS, low LS) [8%; 16%]. Higher MHC was less common in socially disadvantaged children. While MHC and MHD were associated, there was sufficient separation to indicate that MHC captures more than the absence of MHD. Compared to children with high MHC, those in other MHC classes tended to have poorer physical health and cognitive development, particularly those with low MHC or high-moderate MHC. For example, children with maternal-report Low MHC were more likely to have experienced 2+ unintentional injuries (RRR: 1.5 [1.1–2.1]) and to have lower verbal ability scores (RRR: 2.5 [1.9–3.2]). Patterns of results were similar for maternal- and teacher-report MHC.ConclusionMHC is not simply the inverse of MHD, and high MHC is associated with better physical health and cognitive development. Findings suggest that interventions to improve MHC may support healthy development, although they require replication.