Mental Health Care Delivery System Research Articles

Towards a better understanding of mental health care delivery systems: From stories to system components

ABSTRACT The growing demand for better quality of care, together with an increasing awareness of limited resources, is bringing attention to the need for design in healthcare. In mental health, considered the largest single cause of disability in the UK, the need is great. Existing services often fail to meet current levels of demand and do not consistently deliver good quality care for all service users. The design of better delivery systems has the potential to improve service user experience and care outcomes. This paper reports how through the interactive and participatory method of storytelling, the key components of a mental health delivery system were identified. We explain each of the ten components and discuss their implications for system understanding and service design. A model of a mental health delivery system has also been proposed.

An evaluation of satisfaction with emergency department care in children and adolescents with mental health concerns.

We hypothesized that an association exists between satisfaction with ED mental health care delivery and patient and system characteristics. Primary: To evaluate overall satisfaction with ED mental health care delivery. Secondary: To explore aspects of ED mental health care delivery associated with general satisfaction, and patient and ED visit characteristic associated with total satisfaction scores and reported care experience themes. We enrolled patients < 18years of age presenting with a mental health concern between February 1, 2020 and January 31, 2021, to two pediatric EDs in Alberta, Canada. Satisfaction data were collected using the Service Satisfaction Scale, a measure of global satisfaction with mental health services. Association of general satisfaction with ED mental health care was evaluated using Pearson's correlation coefficient and variables associated with total satisfaction score was assessed using multivariable regression analyses. Inductive thematic analysis of qualitative feedback identified satisfaction and patient experience themes. 646 participants were enrolled. 71.2% were Caucasian and 56.3% female. Median age was 13years (IQR 11-15). Parents/caregivers (n = 606) and adolescents (n = 40) were most satisfied with confidentiality and respect in the ED and least satisfied with how ED services helped reduce symptoms and/or problems. General satisfaction was associated with perceived amount of help received in the ED (r = 0.85) and total satisfaction with evaluation by a mental health team member (p = 0.004) and psychiatrist consultation (p = 0.05). Comments demonstrated satisfaction with ED provider attitudes and interpersonal skills and dissatisfaction with access to mental health and addictions care, wait time, and the impact of COVID-19. There is a need to improve ED mental health care delivery, with a focus on timely access to ED mental health providers. Access to outpatient/community-based mental health care is needed to complement care received in the ED and to provide continuity of care for youth with mental health concerns.

The development of mental health care in Guangzhou, China

As an upper-middle-income country, China has a vast territory, a large population and substantial variations in the nature of mental health service provision. Guangzhou, one of the five biggest cities in China, is considered as indicative of the current development of mental health services in a more economically developed part of China. In this paper, we first introduce mental health services in Guangzhou and their historical development: from the rising development of mental health care (1949 to the mid-1960s), the stagnant development period of the psychiatric hospitals (1966–1976), the rapid development period of the psychiatric hospitals (1978 to the 1990s), to the integrated development period of community mental health care (2000–2020). This historical trajectory partly reflects the development of mental health services across China. Second, from the public health perspective, we introduce the current mental health care delivery system and resources in Guangzhou, including the psychiatric specialist hospitals, psychiatric units of general hospitals, and community mental health care. Third, based on the current mental health service system, we highlight community mental health care in Guangzhou. We will describe these elements of the mental health system under the following headings: organizational setup, management, and services. We also explore the design of community mental health service models and the challenges in the post-covid-19 era. Finally, we provide considerations and recommendations for mental health service delivery in Guangzhou in the future.

International experience in mental health provision in secondary schools

The protection of children's mental health is an important task, since missed opportunities for psychiatric care during this period are very difficult to make up for in the future. On the basis of research by domestic and foreign authors in recent years, we analyzed the foreign experience that has developed to date in providing psychological and psychiatric care to children in school settings from the position of their applicability in domestic practice. The current state of knowledge on models of mental health care for children in the school setting is reviewed, and possibilities for their use in mental health promotion are identified. Mental health services embedded in the educational system, both abroad and in Russia, synergistically promote mental health and education. The school as an organized collective provides a broad organizational opportunity to provide diagnostic and treatment interventions, as well as to equalize the availability of mental health care. However, it is currently recognized that the educational system and the mental health care delivery system are structurally, administratively and legislatively disconnected.

The Legality and Ethical Issues of Certifying Laypersons as Mental Health Counselors in India.

The burden of mental health conditions and consequent disability impacts are felt most in low- and middle-income settings. These settings are constrained by the limited availability of resources to provide even essential aspects of mental health care (MHC). Task shifting and sharing interventions have shown promise in delivering community-based MHC across such low-resource settings. Some counseling tasks such as friendship bench interventions have been successfully shifted to laypersons. However, ethical and legal concerns regarding laypersons' incorporation in MHC delivery systems have not been examined. To examine the ethical and legal concerns surrounding the certification of laypersons as community-based mental health counselors. We undertook an academic review of various legislations pertinent to MHC service delivery and the certification of allied health care professionals to inform on acceptable and tenable strategies toward incorporating such a task-shifted intervention. Scaling up the training of human resources to address access problems can be the first step in addressing the MHC access and treatment gaps. The certification of laypersons as community-based mental health counselors, although legally tenuous, can be pioneered by tertiary-level MHC institutions. This certification has sound ethical justification and is a progressive step toward realizing universal mental health coverage.

Impact of COVID-19 and telehealth on mental health in Bangladesh: a propensity score matching approach

COVID-19 have deteriorated mental health conditions in Bangladesh. The study aims to examine the impact of COVID-19 on mental health conditions through the propensity score matching method and establish the relationship between telehealth usage on mental health improvement during the COVID-19 pandemic. Nearest neighbor matching approach has been used to match treatment unit to nearest comparison unit and achieved balance between treatment and control groups on observable traits. A cross-sectional study on 89 participants was conducted from April to June 2020. ATE (average treatment effect) & ATET (average treatment effect of treated) techniques were used. Logistic regression was used to examine the causal relationship between telehealth usage on mental health improvement. The coefficient of ATE on the population was − 0.026, stating that on average, participants with no past physical health problems had fewer mental health issues than the participants with a past physical health problem. The coefficient on ATET was − 0.034. The association between telehealth usage on mental health improvement was highly significant as p value = 0.00 < 0.05 with OR of 70 at 95% CI. There was strong evidence of positive mental health outcomes through telehealth usage during the pandemic. Experts should develop sustainable adaptations of mental healthcare delivery systems in this field to mitigate the disparities in healthcare provision.

Drivers of County Engagement in Criminal Justice-Behavioral Health Initiatives.

Several large, county-level initiatives are underway to improve behavioral health care for justice-involved clients. Unfortunately, only about a quarter of counties participate in these efforts, leaving justice-involved populations at risk of poor mental health, substance use, and judicial outcomes. This study examined characteristics of 2,922 U.S. counties and county equivalents by whether they participated in these initiatives and found that crime and socioeconomic characteristics were not associated with participation. Participating counties had significantly more robust mental health and substance use care delivery systems. Nonparticipating counties may lack the expertise and basic delivery system prerequisites needed for participation in most national initiatives, further driving geographic disparities.

Evaluation Of District Mental Health Programme In The District Of Dharmapuri, Tamil Nadu, India And Evolution Of Mental Health Care Delivery System For Our State

District mental health programme was started in India with the idea of decentralizing mental health care. The plan was to train the general medical officers working in primary health centers so that they can identify and treat psychiatric disorders. After the district mental health programme was started, it is time to review its effects. In Dharmapuri, a district in Tamil Nadu, India, medical officers and paramedical personnel were trained and sensitized to identify psychiatric disorders and a district psychiatrist was posted in the district headquarters hospital, who would conduct psychiatric clinics in headquarters and taluk hospitals. We are evaluating the impact of these in terms of actual benefit to the community. A number of new case registrations, before and after the training of the paramedical personnel, a pattern of referral and the impact of starting the psychiatric clinics in taluk hospitals are all assessed. When the peripheral clinics were started, new case registrations increased by 142% in the taluk hospitals. After the training of the paramedical personnel, there was an increase of new cases in the peripheral clinics from 56 to 70. Based on this experience, a suitable pattern of community mental health care delivery system for our state is evolved, taking into consideration availability of qualified manpower, resources, an expectation of the public and WHO guidelines.

Overview of the Saudi National Mental Health Survey.

ObjectivesTo present background information for the Saudi National Mental Health Survey (SNMHS) on the Saudi mental healthcare delivery system and previous epidemiological research on the prevalence and treatment of mental disorders in the Kingdom of Saudi Arabia (KSA).MethodsArchival information and the results of a literature review are presented.ResultsKSA is the largest sovereign nation in the Middle East and the largest free market economy in the Middle East and North Africa. A national mental health policy has been in existence since 2006, but mental health spending still is less than in most other high‐income countries. The Ministry of Health has recently begun developing a new healthcare system based on a patient‐centered model of care that will integrate care of mental disorders with care of physical disorders. Previous epidemiological research on mental disorders in KSA has been limited, making the SNMHS important for policy planning purposes to obtain accurate estimates of prevalence, treatment, and barriers to treatment.ConclusionsThe SNMHS will provide valuable information for policy planning purposes on the burden of untreated mental disorders in KSA and barriers to treatment.

Stepping Up: Predictors of 'Stepping' within an iCBT Stepped-Care Intervention for Depression.

Internet-based cognitive behavioral therapy (iCBT) may overcome barriers to mental health care and has proven efficacious. However, this approach currently exists outside the existing mental health care delivery system. Stepped care is a proposed framework for integrating digital mental health (DMH) into health systems by initiating iCBT and “stepping up” care to a more intensive intervention should iCBT prove ineffective. This study explores pre-treatment factors associated with reaching stepping criteria among patients receiving iCBT. This exploratory analysis of a stepped care arm of a larger randomized trial examined participants who were stepped to a more intensive intervention if they did not respond to iCBT. The association of pre-treatment factors on stepping were examined using Kruskal–Wallis and Chi-square tests. One-fifth of the 151 participants met criteria for stepping within the 20-week treatment period. Only pre-treatment depression severity and treatment preference were associated with increased likelihood of stepping (p = 0.049 and 0.048, respectively). The low number of individuals who stepped provides support for iCBT as an effective, low intensity treatment for depression. The modest association of pre-treatment depression and preference to not receive iCBT may be useful in identifying patients who are less likely to respond.

Reflections on "Building Back Better" Child and Adolescent Mental Health Care in a Low-Resource Postemergency Setting: The Case of Sierra Leone.

Over the past three decades, Sierra Leone has experienced two major humanitarian crises: an armed conflict (1991–2002) and an Ebola virus disease outbreak (2014–2015). In addition to these country-wide crises, the capital Freetown experienced a mudslide affecting thousands of people in 2017. In response to these emergencies, donors and aid organizations showed an increased interest in supporting and implementing mental health and psychosocial support interventions. Despite these efforts, the mental health infrastructure of the country remains frail. Specifically, systemic improvements in the implementation of evidence-based mental health care for children and adolescents appear to be lacking. In this article, the Interactive Systems Framework for Dissemination and Implementation is used as a tool to analyze issues related to the development of a sustainable, contextually relevant child and adolescent mental health-care delivery system. The author draws on her long-term experience as a child mental health specialist in Sierra Leone. Observations and hypotheses are tested and supplemented by formal and informal reports and national and international literature. The three systems described by the Interactive Systems Framework are explored in the context of Sierra Leone: (1) Synthesis and Translation, (2) Support, and (3) Delivery. Interaction between the three Systems is discussed as critical to the successful dissemination and implementation of interventions. Ample attention is given to contextual factors that are believed to be paramount to the development of child and adolescent mental health care in Sierra Leone. The article concludes with a reflection on the usefulness of the Interactive Systems Framework in the dissemination and implementation of child and adolescent mental health-care interventions in low-resource, postemergency settings. It is suggested that, in addition to funding and policies, the child and adolescent mental health system in Sierra Leone could benefit from the development of contextually relevant interventions, improvement of capacity-building efforts, and acknowledgment of the role of community-based practitioners in the delivery of services. Local mental health experts, especially those trained in child and adolescent mental health, should be empowered to work together with culturally competent expatriate professionals to improve child and adolescent mental health care in Sierra Leone.

Nash-wo-Numa (childhood growth & development) study protocol: factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan

IntroductionAdolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation...

A journey through Russian mental health care: A review and evaluation

Mental health disorders are among the leading causes of disease and long-term disability globally and, therefore, are one of the greatest challenges for public health. Modern approaches to mental health care (MHC) promote the reduction of inpatient bed numbers in favor of flexible community and outpatient services; however, the implementation of these policies requires significant cultural, conceptual, and structural changes. After the collapse of the Soviet Union in 1991, and the inevitable repercussions in Russian MHC that followed, major public sector and social transformations occurred. The purpose of this article is to understand the development of Russian MHC after this collapse–-the main tendencies, priorities, and directions; what was neglected; and how differing levels of transformation affected the system. Two main coordinated systems have been used to support the research aims: European models of care and the Soviet model. To fully understand the current situation of MHC in Russia, an analysis of relevant policy documents, special programs, laws, and scientific literature was conducted. The results indicate that on a discursive level the MHC delivery system in contemporary Russia is developing towards more modern models and principles. However, there has been a fairly constant “tendency to ignore” some important topics: stigma, social inclusion, independent living of patients, etc. Furthermore, it seems that the Russian MHC system is still dominated by psychiatrists, and cooperation with other specialists in state care and health professionals from private practices and NGOs is not common.

Self–care practices among social workers: do they predict job satisfaction and turnover intention?

ABSTRACTThe current health and mental health care delivery system in the United States strives to provide efficient quality care at a lower cost. This cost-effective approach and recent budget cuts have created new challenges for social workers. This study explores the relationships between self-care strategies, role stress, job autonomy, and job satisfaction and turnover intention. Four-hundred sixty-nine social workers were surveyed to assess multiple measures of self-care including professional support, professional development, coping strategies, and professional resilience, and their effects on job satisfaction and turnover intention. Role stress and job autonomy were also examined in relation to job satisfaction and turnover intention. The results supported the main hypotheses that claimed that self-care strategies are associated with both job satisfaction and turnover intention. The author discusses the important implications of these findings in education and training of both students and practitioners.

¡HOLA, Amigos! Toward Preventing Anxiety and Depression in Older Latinos

Given the prevalence and morbidity of depression and anxiety in later life, the inadequacies of current treatment approaches for averting years living with disability, the disparities in access to the mental healthcare delivery system, and the workforce shortages to meet the mental health needs of older Latinos, development and testing of innovative strategies to prevent depression and anxiety are of great public health significance and have the potential to change practice. Although impediments to good depression and anxiety outcomes exist for all older adults, they are even more pronounced for older Latinos, who tend to have fewer socioeconomic resources. These factors underscore the need for prevention-based interventions that are effective, scalable, relevant, respectful, and specific to this population. The Happy Older Latinos are Active (HOLA) program is a community health worker-led, multicomponent, health promotion intervention. The diverse needs and circumstances of older Latinos (highly sedentary, culture-specific health beliefs, service disparities) were incorporated into the design of HOLA to reduce risk factors and improve health-related outcomes associated with common mental disorders in this group. The authors describe HOLA (highlighted in this case example) and why health promotion interventions like HOLA may hold promise as effective, practical, and nonstigmatizing interventions for preventing common mental disorders in older Latinos who are at risk for developing these disorders.

An Integrated Psychogeriatric Care paradigm in Greece

Backround : Elderly are frequently afflicted by more than one pathological condition and are more vulnerable to dementia and depression, diseases that are of chronic nature and require repeated monitoring. Such patients face the greatest difficulties to gain access to mental health care services. In the context of an integrated care project, the 1st Department of Psychiatry developed a tele-psychogeriatric service, consisting of a tele-psychogeriatric unit (T-psyGU) and a mobile tele-psychogeriatric unit (MT-psyGU) for home care services. The aim of this program was the delivery of diagnostic, therapeutic and educational approaches to demented or depressed patients and their families, that live in remote and underserved areas, through the implementation of new technology in the geriatric mental health care delivery system and to connect health care services provided by different sources. Methods : - Setting: rural and urban underserved areas ( Andros Island) - Staffing: social workers and GP supervised by geriatric psychiatrists based at Eginition Hospital - Intervention: standard protocols to screen, identify and treat depression, dementia and BPSD - Technology: iPad and android technology able to transmit and receive patient’s image and data of psychometric testing. The resulting application is a standalone tool that contains all the pre-existing tests which are useful for the health care professionals visiting a remote patient. Access to Wi-Fi network allows the synchronization of each patient’s data into a central system, accessible to accredited personnel. - Health care services connected: Health care Center, Home care, Social Services, Mobile Psychiatric Unit, Local GP’s - Outcome measures: number of new cases, use of psychotropic drugs, visits to hospitals, suicide prevention, number of health care services connected, follow up visits. - Funding: 2012-2013 Stavros Niarhos Foundation (SNf). From 2013-2015 Andros island Charities Results : During 2012-2015, 198 patients with depression and/or dementia were monitored with more of 889 videoconference appointments. 7 patient admissions were arranged. Compared to previous usual care, the intervention resulted in better recognition of psychiatric symptoms, better use of psychotropic drugs and less use of antipsychotics or sedative–hypnotics, better follow up, fewer visits to tertiary care were recorded and faster resolution of suicidal ideation. Caregivers showed improvement in distress and they expressed their satisfaction about the new service. There were an improvement in connecting Health care services mostly with social services, tertiary health care services and Health center. Conclusions : The successful application of this integrated collaborative service through communication technology in geriatric mental health care offers the opportunity to mental health specialists to reach elderly people in remote areas and to connect different health care services. It seems that, Andros could be a working paradigm of an evolving integrated psychogeriatric care service.

STRATEGIES FOR IMPROVEMENT OF MENTAL DISORDERS IN CENTRAL HOSPITAL, WARRI

This paper clinically analysizes the cases of mental disorder in Warri and its ‘environs as recorded in the central hospital Warri and its environs. A population of 159 recorded cases including adult males, females and children were used for the study. Two research hypothesis and three research question were formulated and the instruments of data collection were interview and observation. The result shows that there is an increase in the prevalence of mental disorders in Warri and its environs with women experiencing more mental disorders than men. Similarly, same types of mental disorder are more prevalent than others in Warri and its environs. Strategies such as a holistic approach by mental health professionals, government adequate intervention in mental health care are recommended as improvement strategies in the mental health care delivery system in Nigeria.

The Relationship between the NHS (UK) and the Voluntary Sector Organisations in Mental Healthcare Services Delivery: Performance Improvement through Dialogical Collaboration

The study was initiated to explore the difficulties that frequently appear to plague the relationship between the NHS and the Voluntary Sector as regards mental health service delivery. It was found that the performance of the mental healthcare delivery system is subject to a number of criticisms. The latter could be attributed to low levels of collaboration and communication between social actors involved. Based on interviews, focus group discussions and results from the literature a number of possible ways to improve the system were identified. The results of the study are expected to contribute to the improved designed of health care systems and of performance management concerning the mental health services. Various attempts to improve performance in the past were explored and criticised. One important obstacle to success was identified as a lack of understanding in the NHS and in the Voluntary Sector - of the implications of the use of externally generated performance criteria versus the use of internally generated self-organised criteria. A conceptual model was developed to help clarify these notions as management tool. It includes the idea of a spiral development and of ‘complete collective satisfaction'.

Recruitment and retention of mental health care providers in rural Nebraska: perceptions of providers and administrators

The nationwide shortage of mental health professionals is especially severe in rural communities in the USA. Consistent with national workforce statistics, Nebraska's mental health workforce is underrepresented in rural and frontier parts of the state, with 88 of Nebraska's 93 counties being designated as federal mental health professional shortage areas. Seventy-eight counties have no practicing psychiatrists. However, supply statistics alone are inadequate in understanding workforce behavior. The objective of this study was to understand mental health recruitment and retention issues from the perspectives of administrators and mental healthcare professionals in order to identify potential solutions for increasing the mental health workforce in rural communities. The study used semi-structured focus groups to obtain input from administrators and mental health providers. Three separate focus groups were conducted in each of four regions in 2012 and 2013: licensed psychiatrists and licensed psychologists, licensed (independent) mental health practitioners, and administrators (including community, hospital, and private practice administrators and directors) who hire mental health practitioners. The transcripts were independently reviewed by two reviewers to identify themes. A total of 21 themes were identified. Participants reported that low insurance reimbursement negatively affects rural healthcare organizations' ability to attract and retain psychiatrists and continue programs. Participants also suggested that enhanced loan repayment programs would provide an incentive for mental health professionals to practice in rural areas. Longer rural residency programs were advocated to encourage psychiatrists to establish roots in a community. Establishment of rural internship programs was identified as a key factor in attracting and retaining psychologists. To increase the number of psychologists willing to provide supervision to provisionally licensed psychologists and mental health practitioners, financial reimbursement for time spent in this activity was identified as important. The present study showed that a comprehensive approach is needed to address workforce shortage issues for different types of professionals. In addition, systemic issues related to reimbursement and other financial aspects must be resolved to strengthen the overall rural mental healthcare delivery system.

Telepsychiatry: Promise, Potential, and Population Health

Telepsychiatry: Promise, Potential, and Population Health