Mental Health Care Institutions Research Articles

Algorithm of complex therapy and prevention of emotional burnout in doctors-psychiatrists during the war and its effectiveness

Abstract. The purpose - to develop and determine the effectiveness of the algorithm of complex therapy and prevention of emotional burnout (EB) among psychiatrists during the war, to resolve the issue of its recommendation for wide implementation in the system of mental health care institutions. The research sample, which was formed in compliance with the principles of biomedical ethics and based on informed consent, included 120 psychiatrists who worked in the city of Kyiv in the period from February 24, 2022. During 2022, the persons under examination were divided into three groups: the first group included 37 persons (30.8%) – doctors with no signs of professional maladjustment (PMA), and a low level of EB; the second group consisted of 57 persons (47.5% ) with signs of professional PMA, and a moderate level of EB; the third group consisted of 26 persons ( 21.7%) and they were respondents with clinically established and pronounced PMA, and a high level of EB. As a result of the study, the personal, psychopathological, psychosocial, professional and emotional-interpersonal factors of the formation and progression of EB among psychiatrists during the war were established, and their interrelationships in its genesis, on the basis of which the basic principles of a comprehensive approach to the therapy and prevention of EB were formulated for psychiatrists (complexity, personalization, phasing and availability), the main goals of treatment and prevention measures are defined and 4 therapeutic strategies of diagnosis, therapy and prevention are proposed within the framework of providing specialized medical care to psychiatrists during the war. These are recommended to be implemented taking into account the degree PMA as a key descriptor of EB, and in accordance with the key vectors of pathological changes in the respondents. The implementation and further evaluation of the effectiveness of the mentioned measures proved their effectiveness in eliminating manifestations of EB and PMA, normalization of mental state with levelling of psychopathological symptoms, improvement of social and psychological adaptation and quality of life of psychiatrists. The results obtained make it possible to recommend this algorithm for wide implementation in the practice of mental health care institutions.

PECULIARITIES OF ADAPTATION AND COURSE OF POST-TRAUMATIC STRESS DISORDER IN SERVICEMEN DEPLOYED TO INTENSE COMBAT ZONES

In the context of war, post-traumatic stress disorder (PTSD) emerges as one of the most prevalent psychological conditions, particularly among military personnel deployed in combat zones. The primary triggers for PTSD in military personnel often include the loss of comrades or the necessity to use lethal weapons, resulting in significant consequences. For PTSD to manifest, individuals must undergo a traumatic experience that exceeds normal human stress levels and leads to distress. The aim of this study is to investigate the course of PTSD in military personnel who have been exposed to intense combat operations and to explore their maladaptive manifestations. The study comprised 38 patients diagnosed with PTSD (F43.1) according to the ICD-10, who received treatment at the Regional Mental Health Care Institution for the Protection of the Armed Forces. All patients provided informed consent to participate in the study. A structured clinical diagnostic interview known as CAPS-DX was applied in this study. Developed based on the DSM-IV, this interview assesses the symptoms of posttraumatic stress disorder (PTSD), the duration of the disorder, and the degree of impairment of social functioning. The CAPS-DX scale provided insights into the presence of PTSD symptoms both currently and throughout the individual's life following psychotrauma. To diagnose psychosocial maladjustment and its characteristics, we employed the Psychosocial Maladjustment Scale by L. Herasymenko (2018). Clinical and anamnestic examinations revealed that 86% of servicemen had experienced multiple traumatic events, indicating a history of several psychotraumas. The study identified that the primary psychopathological manifestations of PTSD did not differ significantly from the traditional course of the disorder, but they were more intense and pronounced in this group of servicemen. The study has demonstrated that servicemen with combat experience and PTSD exhibited reduced levels of psychosocial adaptation. Their adaptive resources and capabilities, as well as their neuropsychological stability, were significantly diminished, along with a decrease in their communication abilities. Based on the overall level and quality of social and psychological adaptation, three levels of adaptation/maladaptation were distinguished among servicemen with combat-related PTSD: sufficient, partial, or maladaptation. It should be noted that the levels of adaptation were correlated with the severity of anxiety. Servicemen with sufficient adaptation typically exhibited low levels of anxiety, while those with partial adaptation showed an average level, and those with maladaptation displayed high levels of anxiety. The study revealed a spectrum of psychopathological manifestations in servicemen who were in the combat zone, ranging from semiotic complexes resembling panic attacks to psychogenic catalepsy. Furthermore, it was found that servicemen with combat experience and post-traumatic stress disorder had reduced levels of psychosocial adaptation, which correlated with the severity of anxiety.

Translation and Validation of the Dutch Version of the Spiritual Care Competence Questionnaire (SCCQ-NL)

The importance of spirituality in the treatment of mental illness is increasingly acknowledged, but mental healthcare professionals often feel they lack specific competence. An instrument is missing to quantify the spiritual care competence of mental healthcare professionals in the Netherlands. The aim of this study was thus to translate the Spiritual Care Competence Questionnaire (SCCQ) into Dutch and validate it for use in mental healthcare. After translation, the SCCQ-NL was distributed in a cross-sectional design among 3497 healthcare professionals in two mental healthcare institutions (MHIs) in the Netherlands. In the sample of 730 completed questionnaires, exploratory factor analysis revealed seven factors: perception of spiritual needs competencies, team spirit, spiritual self-awareness, documentation competencies, empowerment and proactive opening competencies, knowledge about other religions, and conversation competencies. One item was deleted during the process. Internal consistency for the 25-item SCCQ-NL subscales is sufficient with Cronbach’s alpha ranging from 0.64 to 0.81. Conversation competencies and perception of spiritual needs scored highest in the sample, next to knowledge about other religions and empowerment competencies, while spiritual self-awareness, team spirit and documentation competencies scored the lowest. Small but significant differences in several subscale scores were found for profession, identifying oneself as a believer, practicing prayer and/or meditation, age and working years. The SCCQ-NL can be used for the assessment of spiritual care competencies and for the planning and evaluation of training and improvement strategies.

Five-year trends in help-seeking among young people from a tertiary mental health care institution in Chennai.

Five-year trends in help-seeking among young people from a tertiary mental health care institution in Chennai.

'I am proud of how I handled it'. Exploring the impact of the COVID-19 pandemic and related restrictions on well-being of adults with severe mental illness using qualitative methods.

The coronavirus disease 2019 (COVID-19) pandemic and related restrictions globally impacted mental health, particularly for those with pre-existing severe mental illness (SMI). This qualitative study examined how adults with SMI perceived the effects of the COVID-19 pandemic and related restrictions in the Netherlands, focusing on their personal recovery, well-being and daily life, including an exploration of factors influencing these effects. Semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Reflexive thematic analysis was applied. Purposive sampling was used to ensure diversity of individuals with SMI (i.e., age, gender, diagnosis, cultural background and mental healthcare institution). Twenty participants (median age: 45 years [SD: 12, 8]; 11 females) were interviewed between May and July 2023. Findings revealed a wide range of experiences: while some individuals reported a negative impact on their existing psychiatric symptoms, others described adaptability, resilience and even positive effects of COVID-19 restrictions on their mental health and well-being. Factors influencing the heterogeneic perceptions of the COVID-19 pandemic and related restrictions include the availability of trusted social relationships and enduring interactions with health professionals. Personalised support, both socially and professionally, is crucial for addressing fears, building resilience, reducing isolation and encouraging positive coping strategies for individuals with SMI during external crises. In this project, a participatory research approach that integrated the lived experience perspective helped uncover the unique perceptions of people with SMI with regard to the pandemic and related restrictions. The study used a participatory action research approach, with experts-by-experience involved in every stage of the project as part of the research team. This included engagement with the funding application process, recruitment strategies for interviews, developing the interview guide, piloting the interview, interpreting findings, and knowledge dissemination activities.

Characterizing food environments of hospitals and long-term care facilities in the Netherlands: a mixed methods approach

BackgroundHospitals and long-term care facilities, which are key institutions to serve health and well-being, have an important exemplary role in providing supportive food environments to encourage healthy and sustainable food choices. The objective of this study is to characterize the physical, socio-cultural, political and economic dimensions of the food environment for health care receivers, health workforce and visitors in healthcare settings, and make comparisons between the food environment of hospitals and long-term care facilities.MethodsTo characterize the food environment in healthcare settings, two sub-studies were conducted. In sub-study 1, semi-structured interviews were held with staff members (n = 46) representing 11 hospitals and 26 long-term care facilities (rehabilitation centres, nursing homes, institutions for people with intellectual disabilities and mental healthcare institutions). In sub-study 2, staff members audited the food environment in hospitals (n = 28) and long-term care facilities (n = 36) using a predefined checklist.ResultsThe food environment in Dutch healthcare settings varies substantially between locations although noticeable differences between hospitals and long-term care facilities were identified. Hospitals and larger long-term care facilities featured more often restaurants and utilized central spaces for preparation of meals, while smaller long-term care facilities often operated as household-like settings. Type of healthcare shaped the socio-cultural food environment, with hospitals primarily emphasizing nutrition for fast recovery, while long-term care facilities more often as an instrument (i.e., to structure the day). Participants highlighted the importance of food policies and broad organizational support for realizing and regulating improvement of the food environment. Yet, long-term care facilities were less familiar with national guidelines for food environments compared to hospitals. Several economical aspects, like profit motives, strict budgets and contracts with external parties affected and shaped the food available within all healthcare settings.ConclusionsThis study characterized the food environment in Dutch healthcare settings. Disclosed differences between hospitals and long-term care facilities should be incorporated in strategies for a transition of the food environment. Future research should investigate the underlying mechanisms of the healthcare food environment attaining all healthcare stakeholders - health care receivers, staff and visitors - while prioritizing sustainability alongside healthiness.

Clinical validation of the nursing diagnosis of impaired mood regulation among individuals with experience of mood disorders

AbstractPurposeThe aim of the study was to validate the defining characteristics (DCs) of the nursing diagnosis impaired mood regulation using related criteria in an African context.MethodsThis descriptive study was conducted in two tertiary mental healthcare institutions in Nigeria. Richard Fehring's clinical diagnostic validity model was employed to collect data from 87 individuals experiencing mood problems. Their scores were validated with other criteria, and the influence of socio‐demographic and clinical variables on participants’ identification of the DCs was determined using analysis of covariance (ANCOVA). The significance level was 0.05.FindingsFive of the 27 DCs validated were rated major, 5 considered not characteristics, and the rest were minor characteristics of the diagnosis. A two‐way subject ANCOVA was significant for diagnosis alone, F (2, 87) = 7.41, p = 0.006 (after eliminating the effect of age and gender of the participants), and when combined with duration of illness, F (38, 87) = 2.38, p = 0.036. A positive but weak correlation was found between the DC scale and mood disorder questionnaire, rs (85) = 0.353, n = 87, p = 001 with R2 = 0.102, but a positive and strong correlation with patient health questionnaire, rs (85) = 0.733, n = 87, p = 000 with R2 = 0.565.ConclusionsThe DCs listed in NANDA‐I nursing diagnoses manual were valid for the nursing diagnosis. However, there are additional characteristics that would further enhance the applicability of the diagnosis.Implications for nursing practiceThe result of this study will contribute immensely to the identification of individuals experiencing problems with mood regulation that would otherwise have been missed, thus facilitating early intervention and good outcome. Furthermore, additional characteristics validated in this study offered opportunity for further research on the diagnosis.

Treatment Preferences of Adolescents and Young Adults with Depressive Symptoms: A Discrete Choice Experiment.

Depression in adolescents and young adults is common and causes considerable disease burden while hampering their development, leading to adverse consequences in later life. Although treatment is available, young people are a vulnerable group regarding uptake and completion of treatment. To improve this, insight into youth's preferences for treatment is essential. The aim of this study was to investigate patient preferences for depression treatment in a Dutch sample aged 16-24 years using a discrete choice experiment (DCE). The study was conducted in The Netherlands between October 2018 and June 2019, and included 236 adolescents and young adults with current depressive symptoms or previous treatment. The DCE included five attributes (treatment type,frequency of appointment, waiting time, effectiveness, evaluation of therapeutic alliance) with corresponding levels. Results were analysed using latent class analysis. Results show a general preference for individual psychotherapy, treatment with high frequency, high effectiveness, short waiting time and a standard evaluation of the therapeutic alliance ('click' with the therapist) early in treatment. Latent class analysis revealed three different patterns of preferences regarding treatment type and willingness to engage in therapy. The first class showed a strong preference for individual therapy. The second class, including relatively older, higher educated and treatment-experienced participants, preferred high frequency treatment and was more open to different forms of therapy. The third class, including lower educated, younger and treatment-naïve adolescents showed reluctance to engage in therapy overall and in group therapy specifically. In this DCE, three classes could be identified that share similar preferences regarding treatment effectiveness, waiting time and evaluation of the therapeutic alliance, but varied considerably in their preference for treatment type (individual, group, or combined psychotherapy) and their willingness to engage. The results from this study may inform mental health care providers and institutions and help optimize professional care for adolescents and young adults with depressive symptoms, improving engagement in this vulnerable group.

A smartphone-based intervention for young people who self-harm (‘PRIMARY’): study protocol for a multicenter randomized controlled trial

BackgroundSelf-harm in young people is a public health concern connected with severe mental health problems, such as personality pathology. Currently, there are no specific evidence-based interventions available for young people who self-harm. Therefore, we developed PRe-Intervention Monitoring of Affect and Relationships in Youth (PRIMARY), a smartphone-based intervention, co-designed by clinicians and young people with lived experience of mental ill-health. PRIMARY combines the Experience Sampling Method (ESM) with weekly report sessions. The study aims to examine the effectiveness of PRIMARY with regard to reducing self-harm, and improving emotion regulation and quality of relationships.MethodsThis study is a multicenter, parallel groups, randomized controlled trial (RCT) comparing the PRIMARY intervention to a waiting list control group. PRIMARY comprises 28 consecutive days of questionnaires five times each day (i.e., ESM) and four weekly report sessions. Participants will comprise 180 young people referred for treatment to the participating Dutch mental healthcare institutions and (1) are aged 12 to 25 years, and (2) engaged in ≥ 1 act of self-harm in the past year. Participants are randomly allocated to a study group after screening in a 1:1 ratio by an independent researcher using computer-generated randomization sequences with stratified block randomization by age (12 to 15 years / 16 to 25 years). Staff will conduct assessments with all participants at baseline (Wave 1), after 28 days (Wave 2), and in a subsample after 10 weeks of subsequent specialized treatment (Wave 3). The primary outcomes are self-harm, emotion regulation, and quality of relationships. Secondary outcomes include patient and clinician satisfaction. Exploratory analyses of ESM data will examine the relationship between emotions, social relationships, and self-harm.DiscussionThe results of this trial will clarify whether an innovative smartphone-based intervention is effective for reducing self harm and improving emotion regulation and the quality of social relationships. It has the potential to fill a treatment gap of interventions specifically targeting self-harm. If proven effective, it would provide an accessible, easy-to-implement, low-cost intervention for young people. Furthermore, the ESM-data will allow detailed analyses into the processes underlying self-harm, which will contribute to theoretical knowledge regarding the behavior.Trial registrationISRCTN42088538 (https://doi.org/10.1186/ISRCTN42088538), retrospectively registered on the 26th of October 2022.

Trust of patients and families in mental healthcare providers and institutions: a cross-cultural study in Chennai, India, and Montreal, Canada.

Cross-cultural psychosis research has typically focused on a limited number of outcomes (generally symptom-related). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to fundamental treatment processes like trust. Addressing this gap, we studied two similar first-episode psychosis programs in Montreal, Canada, and Chennai, India. We hypothesized higher trust in healthcare institutions and providers among patients and families in Chennai at baseline and over follow-up. Upon treatment entry and at months 3, 12 and 24, trust in healthcare providers was measured using the Wake Forest Trust scale and trust in the healthcare and mental healthcare systems using two single items. Nonparametric tests were performed to compare trust levels across sites and mixed-effects linear regression models to investigate predictors of trust in healthcare providers. The study included 333 patients (Montreal = 165, Chennai = 168) and 324 family members (Montreal = 128, Chennai = 168). Across all timepoints, Chennai patients and families had higher trust in healthcare providers and the healthcare and mental healthcare systems. The effect of site on trust in healthcare providers was significant after controlling for sociodemographic characteristics known to impact trust. Patients' trust in doctors increased over follow-up. This study uniquely focuses on trust as an outcome in psychosis, via a comparative longitudinal analysis of different trust dimensions and predictors, across two geographical settings. The consistent differences in trust levels between sites may be attributable to local cultural values and institutional structures and processes and underpin cross-cultural variations in treatment engagement and outcomes.

Images that speak: A Portuguese Photovoice study on the psychosocial experience of a migrant population from Cape Verde after a first episode of psychosis.

Several migrant populations have been identified worldwide as high-risk groups for psychosis because of their experience of social adversity. Recent evidence suggests that the local contexts in which these populations live should be addressed in their complexity to take into account individual and larger societal environmental aspects. This study aimed to assess the lived experiences of a group of migrant Cape Verdean patients, who had been recently hospitalized for a first episode of psychosis in a mental health service on the outskirts of Lisbon, Portugal. The study used Photovoice, a qualitative participatory research method in which people's experiences are documented through photography. Six individuals were recruited, and five weekly sessions were conducted to collect data that were analyzed thematically. Emergent themes addressed two main categories of well-being and illness. Participant concepts of well-being were rooted in a definition of freedom encompassing cultural expression, conveyed by familiar environments and supporting communities. Cultural differences may be experienced as important obstacles for well-being and can be associated with feelings of oppression and guilt. Participants' accounts focused on positive aspects of life despite illness and on personal concepts of recovery. The study findings contribute to knowledge of the dynamics of migrants' social experience and underscore the importance of socially and culturally informed mental healthcare institutions.

Élever le bricolage à la dignité du savoir-y-faire avec le symptôme

AimsThis article proposes to question the dimension of “inventive craftwork” in clinical practice, and to open up the field of its complexity, by taking as a basis the singular elaborative work of several young people participating in workshops within a mental healthcare institution. If today the notions of the unconscious, subjectivity, the patients’ word, desire, enjoyment, and lust are reduced to the bare minimum, and if the neuroscientific approach might ultimately ignore the field of the unconscious as some debates suggest, we will expose other horizons : that of the value of the word, that of the “clinical at the bedside,” that of the function of the symptom, and that of inventive “craftwork” as a singular creation. We will insist on the following postulate : rather than considering a subject as deficient, we will, instead, consider them as a subject attempting to deal with their anxiety. Beyond the question of understanding, we will strive not to back down in the face of psychosis, thus following the recommendations of previous psychiatrists. MethodFirst, we will move away from a deficitary approach, as it is commonly understood today, in order to restore to their rightful places the function of the symptom and the welcoming of a singular subjective “oddness.” We will rely on the words of the teenagers who participated in and with whom we worked in the offered creative workshops. This description will consist in highlighting the singular logic at work in each young person, and how each of them teaches us their own way of dealing with their symptom. We will propose to learn from the singular language of these subjects participating in the workshops to receive the inventive way in which they deal with the suffering they are facing. Then, we will revisit the questions of art, creation, and sublimation in the work of Sigmund Freud. If the inventor of psychoanalysis thinks of creation as illusory, as difficult to understand through analysis, as drawing on the child's play, or even as sublimation, by exploring these patients’ contributions, we will look at the works of several psychoanalysts who succeeded Freud, or who read him from different point of view. Donald Woods Winnicott worked extensively on the dimension of play and creativity in his clinical practice with children. He also looked at what he called the “creative lifestyle.” This author shifts from Freudian sublimation to opening the field of transitionality. In his Seminar on the Ethics of Psychoanalysis Jacques Lacan questioned the sublimation of and the destiny of the trieb by demonstrating how this destiny consists in elevating its primary goal to the rank of a shareable work. This literature review will allow us to question the dimension of creation within clinical practice. With the Freudian model alone not being able to account for the creative impulse, Jacques Lacan also proposed the concept of the sinthome, in the last years of his teaching, and especially between 1975 and 1976. We will therefore consider this concept of the sinthome; and to measure, distinguish, and compare it to what more contemporary authors call “sinthomation” or even “sinthomization.” This choice of perspective aims at setting in motion, demonstrating, and pinpointing what we mean, clinically, by “inventive craftwork.” ResultsIn the workshops, we observe how important it is to take seriously the inventive solutions of each of the subjects with whom we work. We can also observe the importance of measuring the “transference manoeuvre.” In our encounter with the subject-at-work, there is much to gain in paying attention to the subject's inventiveness, as well as that of the clinician. DiscussionBy studying the etymological roots of the terms “craftwork” and “invention,” we will question the path of this inventive craftsman, a path that leads to surprise as well as to the possibility not only to find but also to ricochet. The craftsman is also described by Claude Levi-Strauss, in The Savage Mind, as “the one who works with his own hands” by “roundabout means” and who makes do “with the means at hand.” We will try to grasp how craftwork clinically summons an essential function of defending oneself against an unbearable real. ConclusionIf, in any case, the question of creation is sometimes considered as a matter of sublimation, “craftwork” will be raised to the dignified position of a means of dealing with the symptom. The clinical examples given here illustrate and emphasize an art of resourcefulness.

Screening and prevalence of cardiometabolic risk factors in patients with severe mental illness: A multicenter cross-sectional cohort study in the Netherlands

BackgroundDue to increased cardiometabolic risks and premature mortality in people with severe mental illness (SMI), monitoring cardiometabolic health is considered essential. We aimed to analyse screening rates and prevalences of cardiometabolic risks in routine mental healthcare and its associations with patient and disease characteristics. MethodsWe collected screening data in SMI from three mental healthcare institutions in the Netherlands, using most complete data on the five main metabolic syndrome (MetS) criteria (waist circumference, blood pressure, HDL-cholesterol, triglycerides, fasting blood glucose) within a 30-day timeframe in 2019/2020. We determined screened patients' cardiometabolic risks and analysed associations with patient and disease characteristics using multiple logistic regression. ResultsIn 5037 patients, screening rates ranged from 28.8% (waist circumference) to 76.4% (fasting blood glucose) within 2019–2020, and 7.6% had a complete measurement of all five MetS criteria. Older patients, men and patients with psychotic disorders had higher odds of being screened. Without regarding medication use, risk prevalences ranged from 29.6% (fasting blood glucose) to 56.8% (blood pressure), and 48.6% had MetS. Gender and age were particularly associated with odds for individual risk factors. Cardiometabolic risk was present regardless of illness severity and did generally not differ substantially between diagnoses, in−/outpatients and institutions. ConclusionsDespite increased urgency and guideline development for cardiometabolic health in SMI last decades, screening rates are still low, and the MetS prevalence across screened patients is almost twice that of the general population. More intensive implementation strategies are needed to translate policies into action to improve cardiometabolic health in SMI.

Applying the Model of the European Foundation for Quality Management to evaluate quality of care alongside the merger of mental health care institutes in Amsterdam: a five year pre–post study

Abstract Background Health care reforms over the past decades in the Netherlands enforced institutions to enhance quality and to contain costs. To cope with the policy context, a majority of mental health care institutes applied a merger strategy and hence large mental health care organizations were created. This study assesses the impact of a merger and the related quality management approach on the quality of care of three large Dutch mental health care institutes in Amsterdam. The nine criteria of the Model of the European Foundation for Quality Management (EFQM Model) with 32 criteria parts for total quality management were used. Method A case study with a pre–post design was applied, with the EFQM baseline (pre) and follow-up (post) assessments using the standardized EFQM protocol with a 0%–100% scoring system. The baseline status of 2007–2008 was scored and validated by seven independent certified assessors. During a period of 5 years, the merge was conducted, enhancing the quality management and effectuating the findings of the advice of the feedback report. An EFQM post-assessment of the status of 2012–2013 was carried out by five independent certified assessors applying the strict EFQM assessment protocol. The statistics of pre–post differences were evaluated. The study can be seen as a before–after assessment of a naturalistic experiment. Results The comparison of the nine EFQM criteria before and after the merger on the bases of the scores of the assessors shows an overall improvement from 358 to 425 points on the EFQM scale 0–1000. There is one slight deterioration concerning criterion 8: Society Results, five criteria show positive changes. The top three criteria with the highest improvement are 1: Leadership (15% improvement), 5: Processes, Products, and Services (12%), 6: Customer Results (15%). The overall statement of the audit team of 2013 is ‘The merged organisation strives for effectiveness, which leads to better results in most of the areas.’ Learning from the results is one recommendation of the assessors for the future. Conclusion The conduced merge of three Dutch mental health care institutions in Amsterdam showed an improvement of quality based on the criteria of the EFQM Model over a period of 5 years. This naturalistic experiment can stimulate further studies about mergers. The systematic and transparent approach and documentation can facilitate mutual learning.

“It is worth hanging in there” – Psychotherapeutic experiences shaping future motivation for outpatient psychotherapy with refugee clients in Germany

BackgroundA high prevalence of mental disorders in refugees contrasts with a low rate of treatment and limited access to health care services. In addition to pre-, peri- and post-migration stress, language, cultural barriers together with lack of information about cost reimbursement, and access to German (mental) health care institutions are discussed as barriers to use of available services. Such barriers together with insufficient experience of treating traumatized refugee clients may lower therapists’ motivation and facilities to accept refugee clients. A model project called “Fearless” trained, and supervised therapists, translators, and peer counsellors to reduce these barriers and increase therapists’ motivation and engagement in future treatment of refugees.MethodsFrom a total 14 therapists participating in the project N = 13 were available for semi-structured interviews. The interviews were scheduled during or after their outpatient psychotherapy of refugee clients and lasted one hour on average. Based on qualitative assessment strategies, open questions addressed the therapists’ experience of challenges, enrichments, and motivation throughout the therapy. Therapists’ responses were analyzed using content structuring qualitative content analysis.ResultsThree major challenges modulated therapists’ future motivation for treating refugee clients: specific bureaucratic efforts (e.g., therapy application), organizational difficulties (e.g., scheduling appointments), and clients’ motivation (e.g., adherence, reliability). Still, most interviewed therapists (n = 12) evaluated the therapy as enriching and expressed their motivation to accept refugee clients in the future (n = 10).ConclusionResults recommend the reduction of bureaucratic effort (e.g., regular health insurance cover for all refugees) and implementation of organizational support (e.g., peer counsellors) in support of therapists’ motivation for future treatment of refugee clients. Further structural support e.g., with organizing and financing professional translators and referring refugee clients to psychotherapists should be deployed nationwide. We recommend the training in, and supervision of, the treatment of refugee clients as helpful additional modules in psychotherapy training curricula to raise therapists’ motivation to work with refugee clients.

The Experience Sampling Method: A New Way of Assessing Variability of the Emotional Dimensions of Religiosity and Spirituality in a Dutch Psychiatric Population.

Religiosity and spirituality (R/S) are often regarded as being relatively stable over time. The present exploratory experience sampling method (ESM) study aims to assess the variability of three R/S parameters concerning affective representations of God and spiritual experiences in a psychiatric population. Depressed in- and outpatients self-identifying as being spiritual or religious participated, from two Dutch mental health care institutions. The twenty-eight participants rated momentary affective R/S-variables up to 10 times per day over a 6-day period when prompted by a mobile application. All three examined R/S parameters varied significantly within the day. ESM examination of R/S showed good compliance and little reactivity. This indicates that ESM offers a feasible, usable, and valid way to explore R/S in a psychiatric population.

Post-pandemic self-reported mental health of mental healthcare professionals in the Netherlands compared to during the pandemic - an online longitudinal follow-up study.

The mental health of professionals was under pressure during- and post-pandemic. Initially, the focus was mainly on the health workers in the hospitals, but over time the pressure shifted to other sectors, including mental health care. An increase in workload and decrease in mental health of healthcare professionals in mental health care can lead to a decrease in the available care capacity. In an earlier online survey of mental health professionals, 1,300 professionals from a large number of mental healthcare institutions were involved. In this study, conducted in September 2021, about half of the respondents reported increased levels of stress. Feelings of anxiety, anger, and sadness were also increasingly experienced due to the COVID-19 pandemic. Furthermore, 4.2% replied that they were considering resigning their jobs. One of the recommendations of this previous study was to monitor these professionals repeatedly to be able to make an estimate of the stress and vision of work during the course of the pandemic and afterwards. Following this recommendation, the online survey was repeated. The aim of the current online longitudinal follow-up study was to re-evaluated mental status of healthcare workers. 510 healthcare workers participated in this follow-up survey. The reported mental health complaints were significantly higher during compared to post-pandemic. Respondents were less able to maintain work/life balance during the pandemic and even reported a shift to work. However, the majority of respondents indicated that they had restored this balance post-pandemic. Moreover, more sick leave was reported post-pandemic than during the pandemic and more frequent absences post-pandemic. This highlights the importance of focusing on resilience over training and career.

The mental labyrinth of postgraduate research: a qualitative study of postgraduate mental health and wellbeing and the impact of the supervisory relationship

AbstractPostgraduate research students (PGRs) experience disproportionately high levels of psychological distress. Many factors contribute to this poor mental wellbeing and relate to each other in complex and dynamic ways. However, the relationship between PGRs and their supervisor(s) is known to strongly affect the wellbeing of the former. This study explores the mental health and wellbeing of PGRs with a focus on the role of the student—supervisor relationship. Using combined qualitative data from a large survey of PGRs and focus groups and reflexive thematic analysis, we found that PGRs experience the overarching process of obtaining a research degree as a mental labyrinth. Three constituent themes were identified: (1) inequity in navigating the labyrinth, (2) the labyrinth as a place of uncertainty and isolation, and (3) supervisors as labyrinth guides, not mental care providers. The results suggest that significant inequities exist which contribute to poorer mental wellbeing in particular subgroups of PGRs, both in general and specifically in relation to the supervisory relationship. Experiences of loneliness and ambiguity around progress were also identified as being detrimental to mental health. Furthermore, although supervisors can be a vital source of support and have a positive influence on PGR mental health, students recognise supervisors cannot reasonably be expected to act as professional mental health care providers and institutions must do more to provide equitable access to mental health support services.

Two years of ethics reflection groups about coercion in psychiatry. Measuring variation within employees’ normative attitudes, user involvement and the handling of disagreement

BackgroundResearch on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees’ attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams.MethodsWe used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0–T1–T2). Mixed models were used to account for dependence of data in persons who participated more than once.ResultsIn total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data.ConclusionsThis study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since—despite the intrinsic value of participating in ERG or MCD—CES inherently aims, and should aim, at improving clinical practices.

VR-SOAP, a modular virtual reality treatment for improving social activities and participation of young people with psychosis: a study protocol for a single-blind multi-centre randomized controlled trial

BackgroundYoung people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Causes of these problems are multifaceted, but culminate in difficulties with interacting in daily life social situations. Current treatments have only moderate effects on social functioning and often target one specific domain. Virtual reality (VR) has the potential to improve the treatment of social interaction difficulties. We developed a modular VR treatment for social functioning and participation (VR-SOAP). In this study, the effect of this intervention will be investigated in a randomized controlled trial (RCT).MethodsA total of 116 participants (age 18–40) with a DSM-5 diagnosis of schizophrenia spectrum or other psychotic disorder and problems with social functioning will be recruited from mental healthcare institutes in the Netherlands. Participants will be randomized to the experimental condition (VR-SOAP) or active VR control condition (VRelax). VR-SOAP consists of 14 sessions and 5 modules addressing causes of impaired social functioning: four optional modules (1–4) and one fixed module (5). Vrelax consists of 14 sessions that entail psychoeducation, stress management, relaxation techniques, and the exploration of relaxing environments in VR. Primary outcomes are quantity and quality of social contacts, leisure activities and social participation, measured with the experience sampling method (ESM). Secondary outcomes are psychiatric symptoms, social behaviour, social cognition, self-esteem, self-stigma and paranoid thoughts. Treatment effects will be compared at pre-treatment (baseline), post-treatment and at 6-month follow-up.DiscussionIf VR-SOAP proves to be effective, it provides therapists with a much-needed tool to improve social functioning of young adults with a psychotic disorder. Additionally, since the treatment consists of multiple modules targeting different transdiagnostic factors, this trial might provide input for new treatments to improve social functioning in a range of symptoms and disorders, e.g. mood, autism spectrum and anxiety disorders.Trial registrationOn the 10th of November 2021, this trial was registered prospectively in the Dutch Trial Register as NL9784.