Mental Health Care For People Research Articles

Front-line service providers’ appraisal of Saskatchewan’s HIV services and strategy: A qualitative study

ABSTRACTThis qualitative study examined front-line health care providers’ understandings of the Saskatchewan Ministry of Health’s 2010–2014 HIV strategy, their capacity building needs, and perspectives on how well they were implementing HIV services. Providers’ experiences of engaging people living with HIV, community leaders, and communities affected by the epidemic reveal a need to strengthen interprofessional networks. Our findings also indicate the need for HIV services to respond to coexisting challenges, including substance use, violence, and mental health care for people living with HIV. Programs in rural northern Saskatchewan should also address homelessness, disparities in access to care, and HIV stigma issues.

Establishing core mental health workforce attributes for the effective mental health care of people with an intellectual disability and co-occurring mental ill health.

People with intellectual disability experience high rates of mental ill health but multiple barriers to access to quality mental health care. One significant barrier to access is a generalist mental health workforce that lacks capacity, and consensus on what constitutes core workforce competencies in this area. As such, the first step in developing a comprehensive strategy that addresses these barriers is to define the core mental health workforce attributes. Thirty-six intellectual disability mental health experts from across Australia participated in a modified online Delphi which aimed to reach consensus on the core attributes required of the generalist mental health workforce. At the end of each Delphi round, descriptive analyses and thematic analyses were completed. Consensus was reached among the participants for 102 attributes across 14 clinical domains. The results highlighted specific attributes in all areas of clinical practice, especially for communication (e.g., utilizes assistive communication technology), assessment (e.g., assess contributing factors to behaviours) and intervention (e.g., uses integrative interventions). A comprehensive strategy is required to facilitate the generalist mental health workforce to obtain these attributes.

Engaging and staying engaged: a phenomenological study of barriers to equitable access to mental healthcare for people with severe mental disorders in a rural African setting

BackgroundIn low-and middle-income countries, integration of mental health into primary care is recommended to reduce the treatment gap. In this study we explored barriers to initial and ongoing engagement of people with severe mental disorders (SMD) in rural Ethiopia after implementing integrated primary mental healthcare services.MethodsA qualitative approach was employed. In-depth interviews were conducted with 50 key informants: service users/caregivers engaged with care (n = 17), non-engagers and their caregivers (n = 10), those who had initiated treatment but disengaged and their caregivers (n = 12) and primary healthcare professionals (n = 11). Two focus group discussions were conducted with community health workers (10 per group). Thematic analysis was used.ResultsMost respondents reported improved access to care, usually equated with medication, and were motivated to remain engaged due to experienced benefits of care. However, four main barriers to engagement emerged. (1) Poverty: resulting in inability to pay for medication and undermining vital social support affected engagement for all respondents. (2) Unreliable medication supplies and lack of second line options for inadequate response or intolerable side-effects. (3) The long-term nature of the illness: expectations of cure, stigma of chronic illness, low awareness about the illness and treatment and declining social support over time. (4) The nature of SMD: difficulty conveying the person when acutely disturbed and no flexibility for proactive outreach or legal frameworks to provide care when patients lacked capacity. In those who never engaged, geographical inaccessibility was an important barrier. Alternative cultural explanations for illness were only mentioned as a barrier only by two of the respondents.ConclusionEconomic interventions may be needed to support ongoing engagement in care for people with SMD. Systems of care for chronic illness need to be strengthened in combination with legal frameworks. Expanded options for affordable and effective medication and psychosocial interventions are required for person-centred care.

Service user perspectives on coercion and restraint in mental health.

Coercion remains a central aspect of many people's mental healthcare. It can include the use of legislation to restrict freedoms, the use of physical restraint, the restriction of freedom of movement and/or association, and the forced or covert administration of medication. There is good evidence that the use of such measures can traumatise service users. This article reports the findings of a survey of service users regarding their experiences of coercion and restraint and embeds this in the wider international and institutional environment.

Community mental health care after self-harm: A retrospective cohort study.

Presentation to hospital after self-harm is an opportunity to treat underlying mental health problems. We aimed to describe the pattern of mental health contacts following hospital admission focusing on those with and without recent contact with community mental health services (connected and unconnected patients). We undertook a data linkage study of all individuals admitted as a general or psychiatric inpatient to hospital after self-harm in New South Wales, Australia, between 2005 and 2011. We identified the proportion of admissions where the patient received subsequent in-person community mental health care within 30 days of discharge and the factors associated with receipt of that care. A total of 42,353 individuals were admitted to hospital for self-harm. In 41% of admissions, the patient had contact with a community mental health service after discharge. Patients connected with community mental health services had 5.33 (95% confidence interval = [5.09, 5.59]) times higher odds of follow-up care than unconnected patients. Other factors, such as increasing age and treatment as a psychiatric inpatient, were associated with lower odds of follow-up community care. Our study suggests that full advantage is not being taken of the opportunity to provide comprehensive mental health care for people who self-harm once they have been discharged from the inpatient setting. This is particularly the case for those who have not previously received community mental health care. There appears to be scope for system-level improvement in the way in which those who are treated for self-harm are followed up in the community.

Prisoner mental health care for people with intellectual disability

ABSTRACTPersons with intellectual disabilities are likely to be misdiagnosed and end up in prisons for petty offences. The rates of criminal behaviours will be influenced by social and cultural factors. What is seen as illegal behaviour in one society may not be so in another. Cultures also play a major and significant role in defining deviant behaviour and defining what is abnormal. Thus relationship between intellectual disability and criminal behaviour deserves better understanding and research. In hospital or care settings as well as in prisons, clinicians must be sensitive to the role intellectual disability may play in contributing to mental ill-health and behavioural problems. Clinicians must have the skills to identify intellectual disability and its consequences. Wherever possible, depending upon local needs, court diversion schemes and pathways be identified and developed through all agencies who may be involved in caring for persons with intellectual disability.

Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study.

ObjectiveThe aim of this study was to explore mental health care utilization patterns in primary and specialized mental health care of people with unexplained or explained physical symptoms.MethodsData were derived from the first wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face cohort study among the general population aged 18–64 years. We selected subjects with medically unexplained symptoms (MUS) only (MUSonly; n=177), explained physical symptoms only (PHYonly, n=1,952), combined MUS and explained physical symptoms (MUS + PHY, n=209), and controls without physical symptoms (NONE, n=4,168). We studied entry into mental health care and the number of treatment contacts for mental problems, in both primary care and specialized mental health care. Analyses were adjusted for sociodemographic characteristics and presence of any 12-month mental disorder assessed with the Composite International Diagnostic Interview 3.0.ResultsAt the primary care level, all three groups of subjects with physical symptoms showed entry into care for mental health problems significantly more often than controls. The adjusted odds ratios were 2.29 (1.33, 3.95) for MUSonly, 1.55 (1.13, 2.12) for PHYonly, and 2.25 (1.41, 3.57) for MUS + PHY. At the specialized mental health care level, this was the case only for MUSonly subjects (adjusted odds ratio 1.65 [1.04, 2.61]). In both the primary and specialized mental health care, there were no significant differences between the four groups in the number of treatment contacts once they entered into treatment.ConclusionAll sorts of physical symptoms, unexplained as well as explained, were associated with significant higher entry into primary care for mental problems. In specialized mental health care, this was true only for MUSonly. No differences were found in the number of treatment contacts. This warrants further research aimed at the content of the treatment contacts.

Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial.

BackgroundTask sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country.Methods/DesignA randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18 months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12 months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and cost-effectiveness will be further evaluated at 18 months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status.DiscussionEvidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation’s mental health Gap Action Programme to scale-up mental health care globally.Trial registrationNCT02308956 (ClinicalTrials.gov). Date of registration: 3 December 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1191-x) contains supplementary material, which is available to authorized users.

The 10th EAMHID International Congress: integrating different approaches in the neurodevelopmental perspective – the mental health care evolution timeline

Purpose – The purpose of this paper is to provide a summary of main outcomes of the 10th EAMHID International Congress and a critical overview of some key contributions. Design/methodology/approach – A discussion on the impact of the neurodevelopmental perspective on mental health care achievements and failures in the field of intellectual disability (ID) and autism spectrum disorders (ASD). Findings – The considerable progress in the field of mental health care for people with ID that has been made in the last 30 years and that is reflected through the 350 papers presented in this Congress represents the continuation of the work of great pioneers, such as Frank Menolascino, Felix Platter or William I. Gardner, who have been honoured by the EAMHID in the naming of the congress rooms, and the dedication of the poster award. The neurodevelopmental perspective was confirmed to be the current most valued conceptual framework to explain relations across systems and to support multi-level, transnosographic, life-long, interdisciplinary approaches in the production of aetiological insight and good-quality intervention for mental health problems; on the other hand it might determine a premature abandonment of the traditional nosology and the appearance of very broad spectrum conditions covering the full range of psychopathology. Also psychopharmacology was extensively considered, with the explicit aim to raise the attention of researchers and clinicians on this neglected topic. Unfortunately, adults with ID/ASD are still deprived of the right to receive treatments that are based on strong evidence, as it is for the general population. Originality/value – This editorial outlines the second part of a special issue that offers a comprehensive and varied collection of papers from the contributions to the 10th International Congress of the EAMHID.

Suicidal ideation reported by adults with Type 1 or Type 2 diabetes: results from Diabetes MILES-Australia.

To examine the prevalence and correlates of suicidal ideation (SI) in a community-based sample of adults with Type 1 or Type 2 diabetes. Participants were 3338 adults aged 18-70 years with Type 1 diabetes (n = 1376) or Type 2 diabetes (non-insulin: n = 1238; insulin: n = 724) from a national survey administered to a random sample registered with the National Diabetes Services Scheme. Depression and SI were assessed using the Patient Health Questionnaire, and diabetes-specific distress with the Problem Areas In Diabetes scale. Separate logistic regression analyses by diabetes type/treatment were used to determine relative contribution to SI. Overall, we observed a SI rate of 14% in our sample. Participants with Type 2 diabetes using insulin reported more frequent depressive symptoms, and were more likely to report recent SI (19%) compared with those with either Type 1 diabetes or Type 2 diabetes not using insulin (14 and 12%, respectively). After controlling for depression, there was little difference in the prevalence of SI between diabetes types/treatments, but higher diabetes-specific distress significantly increased the odds of SI. As SI is a significant risk factor for a suicide attempt, the findings have implications for healthcare professionals, pointing to the importance of adequate screening and action plans for appropriate follow-up of those reporting depression. Our findings are also indicative of the psychological toll of diabetes more generally, and the need to integrate physical and mental healthcare for people with diabetes.

Testing a model of facilitated reflection on network feedback: a mixed method study on integration of rural mental healthcare services for older people

ObjectiveTo test a management model of facilitated reflection on network feedback as a means to engage services in problem solving the delivery of integrated primary mental healthcare to older people.DesignParticipatory...

Schizophrenia in a Primary Care Setting.

In recent years, the focus of mental health care for people with schizophrenia has shifted from an expectation of lifelong disability to a 'recovery' approach in which patients and specialists anticipate discharge to management within primary care. Although the active symptoms of mental illness are generally well-managed with modern pharmacotherapy, primary care physicians often express concern about their lack of understanding and expertise in general management of schizophrenia. Moreover, the ability of patients to access care for their physical disorders in a timely fashion together with a higher prevalence of physical co-morbidities is likely to be responsible for the greater mortality and premature death of this already stigmatised and disadvantaged group. This paper focuses on new evidence over the past 5 years, considering the management of physical and mental health of schizophrenia patients in primary care, optimal processes and the reasons why these may not always be realised in practice.

Baltimore Health Department Helps Affected Citizens After Riots

Baltimore Health Department Helps Affected Citizens After Riots

Kennedy Honored for Tireless Advocacy on Behalf of People With Mental Illness

Back to table of contents Previous article Next article Association NewsFull AccessKennedy Honored for Tireless Advocacy on Behalf of People With Mental IllnessVabren WattsVabren WattsSearch for more papers by this authorPublished Online:12 Jun 2015https://doi.org/10.1176/appi.pn.2015.6b5AbstractPatrick Kennedy notes that the 2008 Wall Street bailout played a major role in the passage of the Mental Health Parity and Addiction Equity Act.While it has been years since the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 became law, the fight for equal access to mental health care for millions of Americans has just begun, according to former Rep. Patrick Kennedy, who was presented with APA’s Patient Advocacy Award last month during the annual meeting in Toronto. Patrick Kennedy tells annual meeting attendees that the fight for parity mental health services must maintain momentum under a reformed health care system.David HathcoxKennedy—who is outspoken about his personal experience of living with bipolar disorder and recovery from substance use disorder—received the award for his work as one of the nation’s leading advocates for individuals living with mental illness and substance use disorders.Kennedy was the author and lead sponsor of the MHPAEA, a law that provides access to mental health care for tens of millions of Americans at the same coverage levels as other kinds of medical care. In the lecture he presented after receiving the award, Kennedy spoke candidly about how the passage of MHPAEA was achieved.“From 2001 to 2008 there was very little support of the bill,” Kennedy explained. Movement finally came, however, when the Emergency Economic Stabilization Act of 2008—known as the Wall Street bailout—was dumped into HR 1424, which housed MHPAEA. Kennedy credited former Connecticut Sen. Chris Dodd, who was then chair of the Senate Banking Committee, with this action. “The Mental Health Parity and Addiction Equity Act did not come to pass because of rallying on the Capitol. It passed due to legislative maneuvering and without anyone knowing it,” Kennedy said. Though Kennedy described the bill’s passage as a “major accomplishment,” it only marked the beginning of the fight to ensure the needs of those living with mental illness were heard. “We, as advocates and mental health professionals, have to make sure that the new system of health care has mental health services as a routine part of health care,” stressed Kennedy, “and will provide reimbursements based on valuing mental health care and treatment for addiction,” particularly for early intervention and screening. “We must demand that mental conditions are ultimately treated the same as other medical conditions, such as cancer, heart disease, and diabetes.” Kennedy also called for improvements to be made to the criminal justice and community health systems, since all too often individuals with mental illness land in the criminal justice system by default. Kennedy closed by saying that addressing problems related to the delivery and reimbursement of mental health care will benefit not only patients with mental illness and substance abuse disorders, but the country as a whole. “I am really honored and very appreciative of being recognized by an organization that is continually fighting to advance better practices and treatments in mental health care for people like myself,” Kennedy told Psychiatric News.Kennedy is currently working on One Mind, which is a national coalition seeking to develop new treatments and cures for brain illness and injury and reduce the stigma surrounding mental illness, and One Mind for Research, which is dedicated to achieving dramatic enhancements in research funding and collaboration for all brain disorders in the next decade. ■ ISSUES NewArchived

Evaluating a new model of nurse-led emergency department mental health care in Australia; perspectives of key informants

BackgroundMental health nurse services have existed in Emergency Departments (ED) for many years. However, there is considerable variation in the way these services operate, and no standardised model of care has been articulated. AimTo evaluate an extended hours nurse practitioner-led mental health liaison nurse (MHLN) service based in an ED in Sydney Australia. MethodsAs part of a larger mixed-methods study, semi-structured interviews were conducted with a sample of ED patients and nursing, medical and psychiatry staff (N = 46). Newly recruited MHLNs were interviewed at the commencement and conclusion of the study period. This paper presents the qualitative component from the evaluation. ResultsThe new service was met with high levels of approval by patients and staff. MHLN team members were challenged by their new role but considered the service reduced waiting times, provided therapeutic benefits, and enhanced communication and support for emergency staff. ConclusionA nurse practitioner-led extended hours MHLN service embedded within the ED team structure provides prompt and effective access to specialised mental health care for people with ‘undifferentiated health problems’ and removes a significant workload from nursing and medical staff.

Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM.

There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.

A multidimensional integrated framework to improve inpatient mental health care of people with intellectual disability

A multidimensional integrated framework to improve inpatient mental health care of people with intellectual disability

Mental Health Problems Affecting People Who Have HIV and AIDS in Malawi: A Review

Malawi is located in the southern part of Africa with a population of more than 16 million people. The country is ravaged with HIV and AIDS epidemic of which the prevalence rate is at 14%. The people who have HIV/AIDS are also affected by mental and psychological disorders. Nevertheless, very little is known about mental health care of people who have HIV and AIDS in Malawi. We did literature search using AJOL, Proquest, PsychINFO, Google Scholar and HINARI search engines and the search yielded scanty (12) research studies on the mental health of people with HIV and AIDS that were conducted in Malawi between 2006-2014. Twelve (12) studies that were reviewed focused on prevalence of mental disorders among people who have HIV and AIDS; nurses’ knowledge and skills for providing mental health care to people living with HIV and AIDS (PLWHA); perceived risk of HIV infection among people who have mental health problems; substance abuse and HIV/AIDS issues and awareness of interaction between HIV/AIDS and Mental health. In conclusion, the review shows that people with HIV infection are also affected by mental health problems such as depression and substance abuse. They receive some mental health care in general settings at ART clinics because mental health care is integrated into general health care delivery system. Therefore, it is necessary that health professionals who are generalists should be equipped with adequate knowledge and skills for providing mental health care to care to people with HIV and AIDS.

Integrating Mental Health Care for People Living with HIV

Integrating Mental Health Care for People Living with HIV

Using a Collaborative Approach to Unite Physical Health Needs and Mental Health Care of People with Severe Mental Illness

The aim of the Mental Health Clinical Collaborative (MHCC) was to apply a quality improvement methodology to improve the assessment of physical health for consumers of adult mental health services across Queensland. It is well documented that people with severe mental illness are at increased risk of early mortality due to poor physical health, including cardiovascular disease and other chronic physical health disorders (Brown, Kim, Mitchell & Inskip, 2010; Foley et al, 2013). It was proposed that encouraging the monitoring of physical health would increase staff focus on the physical health as well as the mental health needs of this population. A collaborative methodology was used to bring together sixteen public mental health service organisations across Queensland to implement service improvement activities and improve physical health assessments in people with serious mental illness. A clinical indicator was developed and data from existing Queensland Health databases were used to provide six-monthly reports on statewide and individual service progress. In conjunction with this, statewide forums, individual service presentations and a secure intranet site were provided to enable networking, collaborative target setting and peer review. Improvement in the MHCC Physical Health Assessment clinical indicator was demonstrated across the state over a two-and –half year period with an increase in the number of physical health assessments recorded from 12% to 49%. Significant improvement was demonstrated in fifteen services across the state. The results suggest that the implementation of a collaborative methodology for targeted aspects of clinical work in mental health can assist with statewide service improvement. Moreover, providing services a regular opportunity, at statewide forums, for services to showcase the local implemented changes allows for demonstration of local ownership of these improvements. It would seem that the introduction of a physical health monitoring indicator increased the focus of mental health staff on the importance of addressing the physical health needs as part of routine care for people with serious mental illness.