Mental Health Care For People Research Articles

Changing and unfinished narratives of the mental health impact of HIV in the UK

The mental health impacts of HIV have evolved significantly over the last four decades, in parallel with changes in the virus's overall health consequences. This study charts transformation in narratives about mental health problems associated with HIV over the course of the epidemic, as outlined by people with HIV (40%), professional carers (45%) and activists (25%) in the UK. In particular, our study examines evolving mental health impacts and changing service provision during three key periods: The early days of the epidemic; after the introduction of effective antiretroviral therapy (ART) in 1996; and in more recent times as HIV came to be regarded as a chronic manageable condition. Fifty-three participants were recruited: Male (68%), female (32%), White (90%), African/Afro Caribbean (6%) and South Asian (4%). Results indicate that despite important changes in the severity and nature of the mental health impact of HIV, there were persistent challenges, related to the long-term mental health consequences of HIV among earlier generations of people with HIV. There were additional challenges associated with ageing with HIV; the development of sexual dysfunction; and the possibility of neurocognitive impairment. The organization of mental health care for people with HIV moved from specialist teams to general practice, presenting challenges of mainstreaming care. The commissioning and delivery of mental health services need to be sensitive to this ever-changing social context and the potential for ‘left behind’ people living with HIV, despite the overall ‘naturalisation’ of HIV.

Partnership to tackle MH crisis for people with disabilities launched

The United Health Foundation, the philanthropic foundation of the UnitedHealth Group has awarded the nonprofit disability rights advocacy organization, The Arc of the United States, a three‐year, $2.5 million grant to improve mental health care for people with intellectual and developmental disabilities (IDD), a news release by The Arc stated. Up to 40% of people with IDD have co‐occurring mental health conditions, and this critical funding will help address their unmet mental health needs. Currently, only 1 in 10 children and adolescents with IDD and mental health disorders receive specialized services. These statistics highlight the need for training and awareness to ensure providers and caregivers are equipped to support the mental health needs of people with disabilities. This includes expanding access to quality mental health care services, improving coordination between disability and health systems, training over 2,000 providers and caregivers to recognize mental health needs in people with IDD, and launching public awareness campaigns to counteract stigma and misconceptions. A key component of the grant is partnering with the National Council for Mental Wellbeing to adapt its evidence‐based Mental Health First Aid program with information on IDD. Over three years, the United Health Foundation grant will help train caregivers, health care professionals, first responders, educators and family members to recognize the mental health needs of people with IDD and decrease the number of mental health crisis incidents experienced by this population.

Contribution of Psychological Support to Risky Behavior Management of Selected High-Learning Institution Students: A Case of Kepler College, Rwanda

The students at universities have many things that affect their mental health, including peer pressure, heavy workload, substance abuse, and relationship management. It is a great job to evaluate the contribution of psychological support that mainly helps these students attain a good level of emotional and social interaction and spiritual and mental stability with their families and the community at large as a tool for risky behavior management. The purpose of the study is to assess how psychological support affects managing risky behavior and mental health in university students. The study emphasizes the need to address elements that have an impact on students' mental health, including peer pressure, a demanding workload, drug misuse, and relationship management. Students are given psychological assistance in controlling risky behavior through the application of the theoretical frameworks of Choice Theory, Behavior Theory, and Cognitive Behavior Theory. The study technique includes a census of 100 people: 97 students from cohort 2019B, a career and alumni affairs coordinator, a school counsellor, and an academic advisor. To classify results, data analysis uses coding and tabulation. The study findings dispel the misconception that college students are mature people who do not need help and show that all of them need psychological treatment. According to the report, institutions should provide young people's mental health care a high priority while they are still developing into adolescents. With a correlation value of 0.285, the study found that obtaining mental help and preserving mental stability had notable beneficial associations. Additionally, there was a positive association between seeking out counselling services and using mental assistance to manage activities, with correlation values of 0.500 (p 0.01) and 0.001 (p 0.001, respectively). With a correlation value of 0.625 (p 0.001), a strong positive relationship, social interactions and emotional support were shown to be related.

Evaluation of a mental health service reform program, the Pathways to Community Living Initiative, for people with severe mental illness and complex needs.

The Pathways to Community Living Initiative (PCLI) aims to reform mental health care for people with severe and persistent mental illness (SPMI) and complex needs. This study reports independent evaluation findings on transitions from hospital and practice change in mental health services. Data for this mixed-methods evaluation were obtained from administrative collections and semi-structured interviews with PCLI program managers, teams and executive leads; aged care managers; and leaders in inpatient, community and older people's mental health services. Between July 2015 and December 2020, 674 participants (67% of those eligible for the PCLI) were transitioned from hospital to community. Of those transitioned, 21 required subsequent long-stay admissions. The PCLI introduced resources, clearly defined processes, and state-wide networks to guide changes in practice which are becoming embedded in the operations and governance of mental health services across New South Wales. Severe and persistent mental illness and complex needs can be managed in community settings with highly individualised planning and care, supported by specialised clinical teams in partnership with mental health, aged care and disability services. Evaluation findings highlight the importance of continued investment in rehabilitation psychiatry.

Crisis and acute mental health care for people who have been given a diagnosis of a ‘personality disorder’: a systematic review

BackgroundPeople who have been given a diagnosis of a ‘personality disorder’ need access to good quality mental healthcare when in crisis, but the evidence underpinning crisis services for this group is limited. We synthesised quantitative studies reporting outcomes for people with a ‘personality disorder’ diagnosis using crisis and acute mental health services.MethodsWe searched OVID Medline, PsycInfo, PsycExtra, Web of Science, HMIC, CINAHL Plus, Clinical Trials and Cochrane CENTRAL for randomised controlled trials (RCTs) and observational studies that reported at least one clinical or social outcome following use of crisis and acute care for people given a ‘personality disorder’ diagnosis. We performed a narrative synthesis of evidence for each model of care found.ResultsWe screened 16,953 records resulting in 35 studies included in the review. Studies were published between 1987–2022 and conducted in 13 countries. Six studies were RCTs, the remainder were non randomised controlled studies or cohort studies reporting change over time. Studies were found reporting outcomes for crisis teams, acute hospital admission, acute day units, brief admission, crisis-focused psychotherapies in a number of settings, Mother and Baby units, an early intervention service and joint crisis planning. The evidence for all models of care except brief admission and outpatient-based psychotherapies was assessed as low or very low certainty.ConclusionThe literature found was sparse and of low quality. There were no high-quality studies that investigated outcomes following use of crisis team or hospital admission for this group. Studies investigating crisis-focused psychological interventions showed potentially promising results.

A Digital System (YouXin) to Facilitate Self-Management by People With Psychosis in China: Protocol for a Nonrandomized Validity and Feasibility Study With a Mixed Methods Design.

Psychosis is one of the most disabling mental health conditions and causes significant personal, social, and economic burden. Accurate and timely symptom monitoring is critical to offering prompt and time-sensitive clinical services. Digital health is a promising solution for the barriers encountered by conventional symptom monitoring approaches, including accessibility, the ecological validity of assessments, and recall bias. However, to date, there has been no digital health technology developed to support self-management for people with psychosis in China. We report the study protocol to evaluate the validity, feasibility, acceptability, usability, and safety of a symptom self-monitoring smartphone app (YouXin; Chinese name ) for people with psychosis in China. This is a nonrandomized validity and feasibility study with a mixed methods design. The study was approved by the University of Manchester and Beijing Anding Hospital Research Ethics Committee. YouXin is a smartphone app designed to facilitate symptom self-monitoring for people with psychosis. YouXin has 2 core functions: active monitoring of symptoms (ie, smartphone survey) and passive monitoring of behavioral activity (ie, passive data collection via embedded smartphone sensors). The development process of YouXin utilized a systematic coproduction approach. A series of coproduction consultation meetings was conducted by the principal researcher with service users and clinicians to maximize the usability and acceptability of the app for end users. Participants with psychosis aged 16 years to 65 years were recruited from Beijing Anding Hospital, Beijing, China. All participants were invited to use the YouXin app to self-monitor symptoms for 4 weeks. At the end of the 4-week follow-up, we invited participants to take part in a qualitative interview to explore the acceptability of the app and trial procedures postintervention. Recruitment to the study was initiated in August 2022. Of the 47 participants who were approached for the study from August 2022 to October 2022, 41 participants agreed to take part in the study. We excluded 1 of the 41 participants for not meeting the inclusion criteria, leaving a total of 40 participants who began the study. As of December 2022, 40 participants had completed the study, and the recruitment was complete. This study is the first to develop and test a symptom self-monitoring app specifically designed for people with psychosis in China. If the study shows the feasibility of YouXin, a potential future direction is to integrate the app into clinical workflows to facilitate digital mental health care for people with psychosis in China. This study will inform improvements to the app, trial procedures, and implementation strategies with this population. Moreover, the findings of this trial could lead to optimization of digital health technologies designed for people with psychosis in China. DERR1-10.2196/45170.

The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project

BackgroundThe assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo).MethodsThirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions.Results29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26–1.44): 1.18 (1.07–1.29) in females, 1.60 (1.45–1.77) in males. Heterogeneity across areas was considerable in both cohorts.ConclusionsWe found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.

Service providers’ experiences of interpreter-assisted mental health care for people with refugee backgrounds.

Service providers’ experiences of interpreter-assisted mental health care for people with refugee backgrounds.

Family experiences of inpatient mental health care for people with dementia.

This study investigates family carers experiences of inpatient mental health care for people with dementia. A mental health inpatient admission for a person with dementia is usually considered when a person is distressed and this distress leads to behaviours that are assessed to be risky for the person or others. Participants included seven family carers whose relative with dementia had been cared for within a mental health ward in the United Kingdom UK within the last 5 years. Interviews were used to explore the circumstances that led to the admission, expectations of mental health care, and perceptions of care during the admission and support received by family carers. Participants described their distress at the time of admission and how the process of admission sometimes added to their distress. Carers often felt excluded from their relatives care in hospital and many felt a loss of their rights. Participants felt that the mental health admission had a negative impact on their relative with dementia. Mental health law and legislation was difficult to navigate and carers were concerned about how much knowledge and understanding of dementia staff have. Findings suggest that family carers may benefit from targeted support during their relatives admission. Mental health wards could do more to recognise the expertise in care and knowledge of the person with dementia of family carers and involve them in planning care. More research is needed to explore the experiences and outcomes of people with dementia during such admissions.

Substance use among people with severe mental illness during the COVID-19 pandemic and earthquakes: the role of community-based treatment

IntroductionThe COVID-19 pandemic has disrupted mental healthcare delivery in many countries. The restricted access to psychiatric services and double disasters (pandemic and earthquakes) coincided in Croatia, potentially placing people with severe mental illness (SMI) in a very vulnerable position.ObjectivesThe aim of this study was to examine the changes in substance use in people with SMI in the first and the second COVID-19 wave and co-occurring earthquakes. The secondary aim was to explore whether the type of treatment (community mental health teams (CMHT) vs. treatment as usual) influenced those changes.MethodsThis study was nested within the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE, Horizon 2020 research and innovation programme, grant agreement No 779362). The study involved 90 participants with SMI assessed at two time points: in May/June 2020 (during the first COVID-19 wave and after Zagreb earthquake) and in December 2020/January 2021 (during the second COVID-19 wave and after Petrinja earthquake). The changes in the use of psychoactive substances (alcohol, cannabis, other drugs, sedatives) were assessed using self-reported survey.ResultsThe increase in tobacco smoking behavior and the use of sedatives was observed in both COVID-19 waves in people with SMI. No increase was reported in cannabis and other drugs use, while less than 5% of participants reported increase in alcohol consumption. Not receiving CMHT service predicted the increase in sedative use.ConclusionsEnsuring accessible mental health care provided by CMHT is recommended for counteracting the negative effect of external stressors (such as pandemic and co-occurring earthquakes) on the increased substance use among people with SMI.Disclosure of InterestS. Levaj Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., S. Medved Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., J. Gerlach: None Declared, L. Shields-Zeeman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., F. Bolinski Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Bradaš Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Madžarac Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., I. Rojnić Palavra: None Declared, M. Rojnić Kuzman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362.

The Need for Integration of Religion and Spirituality into the Mental Health Care of Culturally and Linguistically Diverse Populations in Australia: A Rapid Review

Australia is a multicultural and linguistically diverse country. Despite the vital role of religion/spirituality in the mental health of people from culturally and linguistically diverse (CALD) backgrounds, it is not commonly included in their mental health care. A rapid review was conducted to critically evaluate the studies that identified relevant religious/spiritual aspects regarding mental health care for CALD communities. After a systematic search and screening, sixteen empirical studies were included. The findings of the review suggest that people from CALD backgrounds draw strength and comfort from their religion to support mental health. Religious/spiritual practices were identified as effective mental health strategies by CALD people. Religious leaders were noted to be important sources of mental health support and guidance for individuals from some CALD communities. Collaboration of religious leaders in the mental health care, and integration of religious/spiritual practices into mainstream mental health interventions, may improve mental health care for people with CALD backgrounds.

Assisting People with Psychosis to Overcome Obstacles to Living in the Community: Recovery-Oriented Case Management

<p>個案管理是社區精神病人精神照護服務的核心工作，而社區心理衛生中心在新版的精神衛生法中被賦予此項職責。已有明確的個案管理實證研究指出，資源連結模式有其侷限，而有效的元素包含穩固的治療性結盟、外展服務與為其需求提供連續性與整合性的服務。呼應衛生福利政策白皮書「以人為中心，社區為導向，康復為目標」的宣示，本文建議在精神病人個案管理服務中，康復導向應與問題導向並重，採用實證與促進康復的工作方法，並重視社區心理衛生中心對於服務使用者的心理與社會的可近性。方法包括：在分級納入康復的指標、彈性調整外展服務的焦點、將同儕納入個案管理服務中，以及架構社區心理衛生中心各類員工的康復導向在職教育訓練。</p> <p> </p><p>Case management is a core service in community mental health care for people with major mental illness and a responsibility granted to community mental health centers by the new Mental Health Act of 2022. Empirical case management studies have reported that limitations exist in broker model. Studies also reveal that effective elements include strong therapeutic alliance, outreach services, and needs-based continual and integrated services in case management process. In response to the White Paper of the National Health and Welfare Policy 2025 in which person-centered, community-oriented, and recovery-targeted care is emphasized, we suggest that case management services targeting people with psychosis be both recovery-oriented and problem-oriented. Evidence-based and recovery-promoting care approaches should be adopted, and emphasis must be placed on the psychological and social accessibility of the community mental health centers to service users. This involves introducing recovery indicators into the client grading system, flexibly adjusting the focus of outreach services, involving peer support and workers in case management services, and establishing recovery-oriented on-the-job education for all employees in community mental health centers.</p> <p> </p>

Cost-effectiveness of implementing a suicide prediction tool (OxMIS) in severe mental illness: Economic modeling study.

Cost-effectiveness analysis needs to be considered when introducing new tools and treatments to clinical services. The number of new assessment tools in mental health has rapidly expanded, including suicide risk assessment. Such suicide-based assessments, when linked to preventative interventions, are integral to high-quality mental health care for people with severe mental illness (SMI). We examined the cost implications of implementing Oxford Mental Illness and Suicide (OxMIS), an evidence-based, scalable suicide risk assessment tool that provides probabilistic estimates of suicide risk over 12 months for people with SMI in England. We developed a decision analytic model using secondary data to estimate the potential cost-effectiveness of incorporating OxMIS into clinical decision-making in secondary care as compared to usual care. Cost-effectiveness was measured in terms of costs per quality-adjusted life years (QALYs) gained. Uncertainty was addressed with deterministic and probabilistic sensitivity analysis. Conducting suicide risk assessment with OxMIS was potentially cheaper than clinical risk assessment alone by £250 (95% confidence interval, -786;31) to £599 (-1,321;-156) (in 2020-2021 prices) per person with SMI and associated with a small increase in quality of life (0.01 [-0.03;0.05] to 0.01 QALY, [-0.04;0.07]). The estimated incremental cost-effectiveness ratio of implementing OxMIS was cost saving. Using probabilistic sensitivity analysis, 99.96% of 10,000 simulations remained cost saving. Cost-effectiveness analysis can be conducted on risk prediction models. Implementing one such model that focuses on suicide risk in a high-risk population can lead to cost savings and improved health outcomes, especially if explicitly linked to preventative treatments.

Coroners' perspectives on deaths in custody in Australia

Australian coroners have several functions in death in custody investigations – they fulfil judicial, pastoral, preventative and data collection roles. We interviewed six coroners from three Australian states to investigate coroners' perspectives on current issues in deaths in custody. In this paper, we present the results of our research on three key areas of interest: Indigenous deaths in custody; recommendations that are commonly made but not implemented; and the role of the coronial process in death in custody investigations. Our sample size was small, however the coroners we interviewed provided some important insights on these issues. A key finding of this research is that official statistics on the number and rate of Indigenous deaths in custody may be inaccurate. Coroners expressed particular concern about the adequacy of mental health care of people in custody, and they were supportive of alternative approaches to death investigations that involved restorative approaches.

London and Its Asylums, 1888-1914: Politics and Madness, by Robert Ellis

Reviewed by: London and Its Asylums, 1888-1914: Politics and Madness by Robert Ellis Leslie Topp (bio) London and Its Asylums, 1888-1914: Politics and Madness, by Robert Ellis; pp. viii + 296. Cham, Switzerland: Palgrave Macmillan, 2020, $119.99, $89.00 ebook. Scholars of Victorian asylums are often faced with archival and primary sources that are if anything too rich and interesting: case notes, daily logs, photographs, and inspectors' reports that bring these immense institutions to life in all their problematic human complexity. Robert Ellis, by contrast, has been brave enough to tackle a very different set of sources, much drier and more impenetrable. London and Its Asylums, 1888-1914: Politics and Madness is not, despite its title, directly concerned with the British capital's psychiatric institutions, but rather with the bureaucratic structures that oversaw them (and poor people's mental healthcare more generally) at the end of the nineteenth century and the beginning of the twentieth. The sources that Ellis digests and deploys [End Page 512] are the products of administrative bureaucracy, above all the carefully compiled minutes of twenty-six-years' worth of committee meetings. The result of this herculean task is an account that, while requiring some effort and persistence to read, offers an original and compelling angle on the history of mental healthcare, particularly as it was affected by electoral politics. The Local Government Act of 1888 created the London County Council (LCC), setting up for the first time a municipal government for all of London. In one stroke, this new body became responsible for the institutional care and treatment of residents who were deemed to need confinement due to mental disturbance and who could not pay for their maintenance, a group of people who were still referred to throughout this period as "pauper lunatics" (10). The LCC took on responsibility for the management and funding of four existing asylums, completed one which had been in the planning stages, and built six further asylums. Altogether, by 1914, this group of institutions housed thousands of patients. The Local Government Act meant that for the first time in England, institutional mental healthcare was the responsibility of a democratically elected body. Ellis's decision to focus on London and the LCC results in an in-depth study of how this combination of democratic local politics and the provision for (and control of) this large, growing, and very vulnerable group worked in practice. London's exceptional status as a world city and capital of empire, and its vast scale, give his findings wide relevance. Central to Ellis's argument is his insistence that the sources show that mental healthcare in the period was not the "non-contentious" science-led area of public policy it was often presented to be later in the twentieth century (49). (Indeed, Ellis points out that the neglect of mental healthcare under the Conservative austerity politics of the 2010s in the UK shows that this area still cannot be separated from political positions.) The years covered by the book witnessed two distinct party-political regimes within the LCC: the Progressives, who were aligned with the Liberals at the national level, had a majority until they lost the 1907 election to the Municipal Reformers, who were aligned with the Conservatives. The contrasting approaches of the two parties allow Ellis to open up new key insights into why asylums and asylum-based practices developed in the ways they did. And, often, this had nothing to do with internal psychiatric debates. For instance, the Municipal Reformers had as a central plank of their platform control over spending and keeping taxes down. The very large asylums they built represented not an impressive commitment to a marginalized group, but, in the context of laws that compelled local councils to build asylums, an attempt at savings through economies of scale and a deprioritization of patients' and their families' needs to have institutions closer to their homes and accessible for visiting. Ellis also shows that the Council made itself aware (through impressive transnational networks) of international tendencies in asylum design toward the so-called villa asylum, but instead chose to persist with outmoded corridor-system designs in order to control budgets. Under the...

A WeChat-based self-compassion training to improve the treatment adherence of patients with schizophrenia in China: Protocol for a randomized controlled trial.

BackgroundAt present, adherence to antipsychotic treatment is often poor, leading to the recurrence of symptoms. This increases the likelihood of the patient experiencing disability and thus increases the disease burden for the patient, their family, and society as a whole. However, to date, there is no clear evidence regarding the effect of medication adherence interventions on outcomes for patients with schizophrenia. Moreover, the traditional intervention methods are limited by manpower and resources in low- and middle-income countries. Recent studies have demonstrated that increasing a patient’s level of self-compassion may improve their treatment adherence. Online mental health care interventions have advantages in terms of feasibility and acceptability for patients with schizophrenia. In this regard, a WeChat-based self-compassion training protocol to improve patient treatment adherence was designed in this study and will be evaluated in the future to determine its impact on patients with schizophrenia.MethodsThe protocol for the randomized controlled trial (RCT) is based on the SPIRIT 2013 statement. This parallel RCT will aim to recruit 392 patients with schizophrenia who will be randomized at a 1:1 ratio into a 3-week intervention or control group. Both groups will receive routine care. The intervention group will also receive WeChat-based self-compassion training, which requires participants to complete three tasks every day, including a reading task, a meditation task, and a self-compassion journal task. The control group will receive WeChat-based psychological health education, which will only require participants to read positive articles about psychological health every day. Medication adherence, self-compassion, stigma, and social support will be measured at baseline (T0), immediately after the intervention (T1), and 3 weeks after the intervention (T2). Program feasibility will be evaluated throughout the course of the study, and acceptability will be measured immediately after the intervention (T1).Expected results:The intervention described here will address the barriers to accessing mental health care for people with schizophrenia, including patients’ desire for independent management, difficulty accessing providers, and concerns about privacy and stigma. The current study provides guidance for clinical nurses to carry out psychological intervention, with the ultimate aim of addressing the problems associated with a shortage of psychological professionals in low- and middle-income countries.

Expanding access to substance use services and mental health care for people with HIV in Alabama, a technology readiness assessment using a mixed methods approach

BackgroundAlabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a large rural burden of disease. Mental health (MH) and substance use disorders (SUD) represent obstacles to HIV care in rural areas lacking Medicaid expansion and infrastructure. Evidence-informed technologies, such as telehealth, may enhance SUD and MH services but remain understudied in rural regions.MethodsWe conducted a readiness assessment using a mixed methods approach to explore opportunities for enhanced SUD and MH screening using electronic patient reported outcomes (ePROs) and telehealth at five Ryan White HIV/AIDS Program-funded clinics in AL. Clinic providers and staff from each site (N = 16) completed the Organizational Readiness to Implement Change (ORIC) assessment and interviews regarding existing services and readiness to change. People with HIV from each site (PLH, N = 18) completed surveys on the acceptability and accessibility of technology for healthcare.ResultsSurveys and interviews revealed that all clinics screen for depression annually by use of the Patient Health Questionnaire-9 (PHQ9). SUD screening is less frequent and unstandardized. Telehealth is available at all sites, with three of the five sites beginning services due to the COVID-19 pandemic; however, telehealth for MH and SUD services is not standardized across sites. Results demonstrate an overall readiness to adopt standardized screenings and expand telehealth services beyond HIV services at clinics. There were several concerns including Wi-Fi access, staff capacity, and patients’ technological literacy.A sample of 18 people with HIV (PWH), ages 18 to 65 years, participated in surveys; all demonstrated adequate technology literacy. A majority had accessed telehealth and were not concerned about it being too complicated or limiting communication. There were some concerns around lack of in-person interaction and lack of a physical exam and high-quality care with telehealth.ConclusionThis study of PWH and the clinics that serve them reveals opportunities to expand SUD and MH services in rural regions using technology. Areas for improvement include implementing routine SUD screening, expanding telehealth while maintaining opportunities for in-person interaction, and using standardized ePROs that are completed by patients, in order to minimize stigma and bias.

Accessibility of migrants to mental health services

IntroductionCultural barriers and prejudices of mental healthcare professionals may promote inequalities in the provision of care to immigrant population and have a negative impact in provided service quality.ObjectivesTo identify barriers and facilitators of immigrants’ accessibility to mental health services.MethodsA literature review has been made through PubMed database.ResultsImmigrants’ accessibility to mental health services may be related to social insurance problems, inadequate knowledge about their health rights, inadequate knowledge of the local language, as well as the bureaucracy of Greek State which may complicate mental health examination and treatment. The challenges faced by mental healthcare professionals in terms of diagnosis and treatment of migrants include communication difficulties due to linguistic and cultural differences as far as verbal presentation of symptoms and illness behavior is concerned. Culturally competent mental health professionals should work to erase racism and prejudice, to be familiar with cultural issues and have adequate knowledge related to cultural groups, to learn the life story of each patient separately and encourage patients to explain how their illness affects their lives, promoting a trustful communication environment in the context of healthcare provision.ConclusionsExploring the specific needs of migrants as well as assessing the degree of satisfaction from their access to healthcare services are essential to providing integrated mental health care for people from different culture.DisclosureNo significant relationships.

“Flexible Assertive Community Mental Health Teams for the Treatment of Psychosis in Extraordinary Circumstances during Pandemics and Earthquakes 2020/2021: are we Flexible Enough?”

During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1DisclosureNo significant relationships.

Exploring the extent of mental health practice: content and cluster analysis of techniques used in HIV testing and counselling sessions in Uganda

ABSTRACT There is an urgent need for greater provision of mental health services to people living with HIV. HIV testing and counselling (HTC) sessions diagnose HIV and offer appropriate psychosocial support and behavioural messages to support people to link into HIV care. It is not known to what extent HTC currently addresses mental health. We examined transcriptions of 166 audio-recorded HTC sessions delivered in Uganda against a checklist of mental health techniques. Hierarchical cluster analysis explored co-occurrence of techniques. Core counselling skills were very commonly present, and co-occurred. Assessment techniques were not commonly seen. Specific therapy techniques to treat anxiety or depression were not present. HTC staff are a resource for delivering mental health care for people with HIV, owing to their strong fundamental counselling skills. However, training is needed in assessment and evidence-based therapies. Provision of fuller assessment and interventions may increase detection and signposting for mental health and alcohol use, both of which may affect linkage into care. HTC staff have fundamental skills that could also be developed to train and supervise other staff to provide much needed mental health support to people living with HIV. Future research should develop brief mental health interventions for delivery by HTC staff.