Mental Health Care Nurses Research Articles

ASSISTÊNCIA DE ENFERMAGEM EM SAÚDE MENTAL A POPULAÇÃO ADOLESCENTE BRASILEIRA: REVISÃO DE LITERATURA

Adolescence is an element of the natural process of human growth. During this phase, individuals undergo essential changes to develop their capabilities, acquire experiences, and acquire fundamental values ​​to adapt to adulthood. The changes that occur during this phase can make adolescents' mental health more vulnerable. Nurses are considered essential professionals in mental health promotion and prevention interventions. To this end, the general objective of this study was to understand the role of nurses in mental health care for adolescents. To develop this research, an integrative review of the literature was carried out, of a descriptive and qualitative type, where the BVS and Google Scholar databases were selected, searching through them for delimited descriptors and bibliographic findings published between 2018 and 2024, in Portuguese. After reading, it became clear that the role of the nurse is to develop programs and strategies for intervention and promotion of mental health, which support adolescents and aim to promote social reintegration, autonomy, well-being and the appreciation of the subjectivity of users, with a focus on adherence and awareness of treatment and encouragement for seeking the service. It is concluded that the clinical practices of the nurse for adolescents with mental suffering are of utmost importance, having adequate skills for comprehensive care, which not only involves biological aspects, but also mental health in their professional practice.

Saudi Arabian Nurses' Motivations and Barriers to Employment in Inpatient Mental Health Facilities: A Qualitative Investigation.

The shortage of inpatient psychiatric mental health care nurses in Saudi Arabia represents an important health care challenge. The aim of this study was to illuminate perspectives of psychiatric mental health nurses employed in psychiatric inpatient settings about their employment experiences. This study adopted an exploratory qualitative approach using thematic content analysis. Ten professional nurses with psychiatric inpatient caring experience participated in two focus groups composed of Master of Nursing students. Four main themes emerged: inadequate professional skills and knowledge for psychiatric mental health care practice, negative public attitudes toward psychiatric/mental health nurses, concerns for personal safety, and alternatives and advantages. The findings of this study suggest that nurses' lack of interest in working in psychiatric units is not merely personal but also social and organizational. The study findings may encourage managers and authorities to develop measures to attract more mental health nurses to work in psychiatric units. Such strategies may include modification of nurses' skills, training, and professional knowledge, collegial supervision, mentoring, and working conditions and environment.

Testing a recovery-oriented nursing communication framework to encourage collaboration and discussion about aggression prevention: A mixed methods study.

Recovery-oriented practice is essential in healthcare, yet research exploring methods for integrating recovery-oriented principles in forensic mental health settings is limited. This study involved the co-development, with mental health care nurses and a lived experience expert, and testing of a recovery-oriented script for forensic mental health nurses to use when communicating with consumers at high-risk of imminent aggression. The aim was to examine whether nurses perceived the script as more empathic when the script included specific references to empathy, compared to an equivalent script that did not include empathic statements, and to explore nurses' perspectives on whether the script could help prevent aggression. Nurses (n = 54) working in a secure forensic mental health hospital were randomly allocated to read a script containing statements representing nine recovery-oriented principles that also included empathic statements, or an equivalent script that did not include empathic statements. After reading the script, the participants completed a questionnaire involving a recovery-oriented practice scale developed by the authors, measuring the extent to which the scripts reflected recovery-oriented principles, and open-ended questions about the script's potential to prevent aggression. Results revealed no significant difference in nurse perceptions of empathy between the two scripts. Content analysis indicated that nurses perceived the scripts could help prevent aggression.

Exploring primary mental healthcare nurses’ perceptions of the post-treatment needs of women admitted for psychiatric treatment

Primary mental healthcare nurses are an essential workforce that provide necessary inpatient psychiatric treatment. Continuity of care has become a significant aspect of the provision of mental health services. However, caring for South African healthcare users comes with challenges, including difficulties accompanying the provision of care for acutely ill patients with complex mental health problems. Therefore, this study explored the perceptions and experiences of primary mental healthcare nurses concerning the continuity of care required in post-inpatient psychiatric treatment for mental health users from low-income communities in the Western Cape. Through undertaking a study using a qualitative exploratory design and purposive sampling technique, and in which nine primary mental healthcare nurses from two psychiatric hospitals in the Western Cape were interviewed, the researchers were able to obtain a deeper understanding of the participants’ experiences. Four themes were identified during the reflexive thematic analysis namely: the roles and responsibilities of primary mental healthcare nurses, the lack of support within the current continuity-of-care system, barriers to continuity of care for women patients, and suggested improvements for quality of mental healthcare. It was evident that both women patients and primary mental healthcare nurses experienced various forms of marginalisation, discrimination, and gendered oppression. This intersectionality accentuates systemic issues within the current public healthcare system and highlights the stigmatisation of mental illness, especially among women. Overall, primary mental healthcare nurses have a plethora of roles and responsibilities within the primary healthcare sector, which hinder their ability to provide mental health services to women patients. Their reports highlight the needs of a specific patient population that first need to translate into changes that will assist in improving their roles as primary mental healthcare nurses. Their shared experiences of a lack of support from South Africa’s healthcare system were the focal points of this study.

Establishing an esketamine clinic in Australia: Practical recommendations and clinical guidance from an expert panel.

Major depressive disorder (MDD) can have severe impacts on function and quality of life. Up to one third of patients will have an inadequate response to their first line of treatment, with subsequent lines of therapy associated with lower remission rates and higher relapse rates. Recently esketamine has become available for Australian patients, and this agent provides an additional treatment option for those with MDD who have had an inadequate response to two or more antidepressant therapies during the current moderate to severe depressive episode. This paper provides an expert panel's practical recommendations and clinical guidance for establishing esketamine clinics in Australia. An expert panel (n = 11) comprising psychiatrists, mental health care nurses, pharmacists, and individuals with experience establishing esketamine clinics was convened in Sydney. The panel developed practical recommendations and clinical guidance, which were then further refined. Five key areas were identified: practical considerations for esketamine clinic set-up, including multidisciplinary care considerations; patient selection; administering esketamine; adverse event management and long-term follow-up. Guidance presented in this paper should assist Australian clinicians to set up an esketamine clinic, and provide practical advice on the infrastructure and clinical requirements for treatment of patients with this agent.

3.56 Shifting Tides: Quantifying the Changing Utilization and Prescribing Patterns of Advance Practice Nurses in Mental Health Care for Youths in the Illinois DCFS System From 2011 to 2023

3.56 Shifting Tides: Quantifying the Changing Utilization and Prescribing Patterns of Advance Practice Nurses in Mental Health Care for Youths in the Illinois DCFS System From 2011 to 2023

Aggression in mental health care: Opportunities for the future-A qualitative study on the challenges when defining and managing aggression across inpatient disciplines.

INTRODUCTION: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non-coercive measures. The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression-tolerating" workplace. Three implications for practice were identified: (1) It is vital for residential units to agree on a broad-based definition of aggression, (2) further primary research exploring the opportunities of non-coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers also needs further study.

Withdrawing Antipsychotics for Challenging Behaviours in Adults with Intellectual Disabilities: Experiences and Views of Prescribers.

International current best practice recommends the discontinuation of antipsychotics for challenging behaviours in people with intellectual disabilities (ID), due to lack of evidence of efficacy and risks of harmful side-effects. In clinical practice, discontinuation may be difficult. The aim of this study was to gain insight into prescribers' practice by investigating their experiences with the discontinuation of long-term antipsychotics for challenging behaviour. From professionals' associations thirty-four registered ID physicians, psychiatrists and specialist mental healthcare nurses were recruited who completed an online questionnaire in this survey-study. Almost all participants had attempted to deprescribe antipsychotics for their patients with ID. Sixty-five percent of participants achieved complete discontinuation in 0-25% of their patients, but none in over 50%. Barriers were a lack of non-pharmaceutical treatments for challenging behaviours and caregivers' and/or family concern. Seventy percent of participants indicated that their institutions had encouraged implementing their discontinuation policies in line with the new Dutch Act on Involuntary care and a new Dutch multidisciplinary guideline on problem behaviour in adults with ID. Support and facilitation of clinicians from institutions' managers and political and professional bodies may be helpful in further implementation of best practice in the treatment of challenging behaviour in people with ID.

Resilience and work-related stress among mental health nurses in Jeddah, Saudi Arabia

Work-related stress is harmful physical and emotional reactions that can occur when there is a conflict between an employee’s work needs and his or her level of control to meet those demands. Work-related stress can come from multiple causes, however, when stress occurs in unmanageable amounts for the nurse, mental and physical changes may occur. Resilience gives people the mental toughness to deal with stress, trauma, adversity, and difficulties. The study aimed to explore the level of work-related stress among mental health care nurses and their resilience capacity at Eradah & Mental Health Complex–Eradah Services (EMHC-ES) in Jeddah, Saudi Arabia. A descriptive, correlational, cross-sectional research design was utilized taking the responses of 172 nurses. The questionnaire encompassed the Mental Health Professional Stress Scale (MHPSS) 42 items assessed on a four-point Likert scale and the Connor Davidson Resilience Scale (CD-RISC-10) 10-items assessed on a 5-point Likert scale. The results revealed a satisfactorily high level of resilience (M = 30.7 on a scale of 0-40) and a moderate level of stress among the participants (M = 1.86 on a scale of 0 to 3) with the mean subscale score was the highest for the workload associated stress and the lowest for the homework conflict-related stress. There was a near to significant correlation between the stress level and the resilience among the participants (p = .053). An appropriate strategy in health care organizations to assess stress, explore causes, and provide early management in mental health care settings is highly recommended.

Online video games and patient-staff power relations. A qualitative study of care and custody in forensic psychiatry.

Accessible summaryWhat is known on the subject? Frontline forensic mental health staff often face challenges when providing recovery‐orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward.Research shows that balancing between care and custody in everyday clinical practice is possible, but more practical nursing studies showing ways of balancing power relations are needed to guide clinical practice.Online video games are increasingly recognized as promising new tools to promote social relations, establish competencies and re‐articulate power relations in therapeutic environments. What the paper adds to existing knowledge? This paper provides insights into how using online video gaming interventions may influence the establishment of social power relations of staff and forensic psychiatric patients. It adds to existing research by providing a conceptual way to study and understand how mental health nurses may balance between care and custody, delivering care to accommodate patients' needs without compromising safety and security at the ward.This study answers a call in current research by providing qualified knowledge regarding the use of online video gaming to build and sustain therapeutic relations in mental health care. What are the implications for practice? Our paper suggests that balancing between care and custody is possible by using online video gaming interventions in forensic psychiatry. It moreover provides practice‐close knowledge that may inspire and guide clinical mental health nurses to further develop online video gaming interventions in mental health care for the benefit of their patients. IntroductionIn recovery‐oriented care, forensic psychiatric nurses must engage in care relationships with forensic psychiatric patients (FPs) whilst focussing on ward security. Online video games (OVGs) may provide a platform for negotiating power and social relations. Studies showing how OVG interventions may influence power balances in forensic psychiatric care are needed to guide clinical practice.AimOur aim was to study how power relations were articulated between FPs and staff in an OVG intervention in a Danish forensic psychiatric ward.MethodData consist of three months of observational data and interviews with three staff members and six patients. We used sociologist Pierre Bourdieu's framework of field, power and capital to analyze data.ResultsThe OVG intervention consisted of two power fields, “in‐game” and “over‐game.” In‐game concerned the practice of gaming. Over‐game described the organization of the gaming intervention. Specific logics, skills and symbolic capitals drove power in each field.DiscussionPower in‐game was open to FPs and staff, leading to symmetric power relations. Power over‐game was open to staff only, resulting in asymmetrical power relations.Implications for practiceOnline video game interventions may facilitate power balancing in forensic psychiatry. These insights may guide the development of new OVG interventions for patients and nurses in mental health care.

Abstract- Poster

Depression is a significant contributor to work related disability, morbidity and mortality. Further, depression is associated with significant economic burden and disturbance in all the domains of life. Due to COVID pandemic and associated losses, psychological morbidity especially depression has increased significantly. There is a disproportionate shortage of mental health professionals in our country. Hence, there is an unwarranted need to prevent as well as treat depression.In this context, the World Health Organization highlighted the role of nurses in mental health care through project ATLAS. Project ATLAS with the help of International Council of Nurses demonstrated that there is lack of proper training in mental health for nurses and recommended that training in mental health must be incorporated in nursing curriculumIn this background, the present Workshop is planned to train Nursing officers at AIIMS Jodhpur, a tertiary care institute in north-western India for combating depression by providing the following modules for building up skills for the appropriate roles.Module 1: Screening for depression and history takingModule 2: Assessing suicidal risk and interventionModule 3: Treatment including Psychoeducation, Medication adherence, Behavioral activation, Modified Electroconvulsive therapy procedure

Risk Factors of Metabolic Syndrome in Community-Dwelling People with Schizophrenia.

This study investigated the prevalence and risk factors of metabolic syndrome in 100 community-dwelling people with schizophrenia registered in mental health facilities in Seoul, Korea. This study was conducted between 12 September and 15 November 2019. This study used a cross-sectional descriptive design. The data included were general and disease-related characteristics, diagnostic tests for metabolic syndrome, lifestyles, depression, and social support. The analysis of collected data was done by using the SPSS 24.0 program. The prevalence of metabolic syndrome was 42.0%. Higher body mass index (odds ratio [OR] = 1.60, 95% CI = 1.16–2.18, p = 0.004), and depression (OR = 1.22, 95% CI = 1.06–1.42, p = 0.008) were associated with higher risks of metabolic syndrome, while physical activity and weight control (OR = 0.71, 95% CI = 0.54–0.94, p = 0.018), dietary habits (OR = 0.72, 95% CI = 0.54–0.93, p = 0.011), and medication and health management (OR = 0.52, 95% CI = 0.31–0.86, p = 0.012) were associated with lower risks. Mental health care nurses need to recognize the high prevalence of metabolic syndrome in people with schizophrenia in the community and provide differentiated, customized lifestyle improvement programs based on the body mass index and depression status of each person with schizophrenia. Furthermore, comprehensive lifestyle improvement programs and health examination services that people with schizophrenia can easily adhere to should be developed.

‘It comes with the territory’ - Staff experience with violation and humiliation in mental health care - A mixed method study

BackgroundThe aim of this study was to investigate staff's experiences with violation and humiliation during work in mental health care (MHC). A total of 1160 multi-professional MHC staff in Norway responded to an online questionnaire about their experiences with different kinds of violation and humiliation in the MHC setting. In addition, a sample of professionals (eight MHC nurses) were recruited for in-depth individual interviews. MethodThe study used an explorative mixed method with a convergent parallel design; this included a web-based questionnaire to MHC staff in combination with individual interviews. The sample is considered to be equivalent to staff groups in MHC in Norway. ResultsBetween 70 and 80% of the staff reported experiencing rejection, being treated with disrespect, condescending behaviour or verbal harassment. Male workers were significantly more often victims of serious physical violence, and women were significantly more often targets for sexual harassment. In interviews, participants said they considered being exposed to violence and humiliation to be part of the job when working in MHC, and that experience, as well as social support from colleagues, helped MHC practitioners to cope better with violent situations and feel less humiliated at work. DiscussionA high amount of MHC staff report experiences of being violated and humiliated during work. The participants' perceptions of the users and their behaviour seem to influence their experience of feeling violated and humiliated. Knowledge about the dynamics of aggression between staff and users in MHC may be used in safeguarding staff and users, prevent coercion and heighten the quality of care.

Workplace Violence and Its Effects on Burnout and Secondary Traumatic Stress among Mental Healthcare Nurses in Japan.

Workplace violence (WPV) in healthcare settings has drawn attention for over 20 years, yet few studies have investigated the association between WPV and psychological consequences. Here, we used a cross-sectional design to investigate (1) the 12-month prevalence of workplace violence (WPV), (2) the characteristics of WPV, and (3) the relationship between WPV and burnout/secondary traumatic stress among 599 mental healthcare nurses (including assistant nurses) from eight hospitals. Over 40% of the respondents had experienced WPV within the past 12 months. A multivariate logistic regression analysis indicated that occupation and burnout were each significantly related to WPV. Secondary traumatic stress was not related to WPV. Our results suggest that WPV may be a long-lasting and/or cumulative stressor rather than a brief, extreme horror experience and may reflect specific characteristics of psychological effects in psychiatric wards. A longitudinal study measuring the severity and frequency of WPV, work- and non-work-related stressors, risk factors, and protective factors is needed, as is the development of a program that helps reduce the psychological burden of mental healthcare nurses due to WPV.

Spiritual Perspectives and Comfort Levels of African American Families and Mental Health Nurses within the Context of Depression

Background: The purpose of this study was to explore spiritual perspectives and comfort levels of African American families and mental health care nurses within the context of depression. This study aimed to support the idea of testing a theoretical framework designed to increase comfort levels of nurses striving to incorporate spirituality within their practice and to assist in endorsing a culturally sensitive treatment option in population health for African American families within the context of depression. Method: The participants consisted of mental health nurses (N = 30) between the ages of 29 and 68 years, and 30 African American families (N = 63) with members between the ages of 17 and 85 years. The nurses reported working with individuals who had an Axis I diagnosis of clinical depression. The families included members who self-reported an Axis I diagnosis of clinical depression and no other mental illnesses. All participants lived in the Hampton Roads, Virginia, area at the time of the study. A descriptive statistical quantitative design and a phenomenological qualitative method were used. All participants’ spiritual perspectives were measured by the spiritual perspective scale (SPS), and comfort levels were measured by the spiritual comfort level indicator (SCLI). Results: Findings indicate the families and nurses had high scores on the SPS. However, the families scored significantly higher on the SCLI. Conclusions: Implications for nursing practice and research include using the theoretical framework to help increase cultural competence and comfort levels of nurses incorporating spirituality into their practice and population health.

A student-facilitated community-based support group initiative for Mental Health Care users in a Primary Health Care setting

Background: South African Mental Health Care (MHC) legislation advocates for supportive rehabilitative services in Primary Health Care (PHC) settings. PHC settings are often understaffed and MHC nurses in these settings overburdened with high patient loads. Alternative cost-effective psycho-social intervention strategies must be explored to supplement the overstrained MHC sector to meet the rehabilitative and supportive needs of service users in community settings. Using a social constructionist epistemology, this study aimed to highlight the value of a community-based support group for MHC users at a Tshwane District Community Health Centre. This was done by exploring the meaning group members attached to the group. The intervention was a collaborative partnership between a local University Psychology Department and the Department of Health, Tshwane District, utilising post-graduate psychology students as group facilitators.Methods: Qualitative research methods were applied. Data were collected using semistructured interviews and a collage-making and storytelling method. Thematic analysis highlighted the main themes representing the meaning the five participants ascribed to the group.Results: The findings suggest that the group offered the participants a sense of belonging and a means of social and emotional support. The group also created opportunity for learning, encouraged mental and physical mobilisation and stimulation, and served as an additional link to professional services. Conclusion: The findings suggest that student-facilitated support groups could offer a viable supplement for offering support to service users in PHC settings. The group assisted MHC users to cope with symptoms, social integration, and participating in meaningful activities as part of rehabilitation services.

A student-facilitated community-based support group initiative for Mental Health Care users in a Primary Health Care setting

BackgroundSouth African Mental Health Care (MHC) legislation advocates for supportive rehabilitative services in Primary Health Care (PHC) settings. PHC settings are often understaffed and MHC nurses in these settings overburdened with high patient loads. Alternative cost-effective psycho-social intervention strategies must be explored to supplement the overstrained MHC sector to meet the rehabilitative and supportive needs of service users in community settings. Using a social constructionist epistemology, this study aimed to highlight the value of a community-based support group for MHC users at a Tshwane District Community Health Centre. This was done by exploring the meaning group members attached to the group. The intervention was a collaborative partnership between a local University Psychology Department and the Department of Health, Tshwane District, utilising post-graduate psychology students as group facilitators. MethodsQualitative research methods were applied. Data were collected using semi-structured interviews and a collage-making and storytelling method. Thematic analysis highlighted the main themes representing the meaning the five participants ascribed to the group. ResultsThe findings suggest that the group offered the participants a sense of belonging and a means of social and emotional support. The group also created opportunity for learning, encouraged mental and physical mobilisation and stimulation, and served as an additional link to professional services. ConclusionThe findings suggest that student-facilitated support groups could offer a viable supplement for offering support to service users in PHC settings. The group assisted MHC users to cope with symptoms, social integration, and participating in meaningful activities as part of rehabilitation services.

Loneliness and related factors among people with schizophrenia in Japan: a cross-sectional study.

Introduction Loneliness among people diagnosed with schizophrenia living in communities can decrease quality of life and may contribute to suicide. Aim The aim of this study was to examine the levels of loneliness among Japanese people diagnosed with schizophrenia and to identify individual and environmental factors related to their loneliness. Method A cross-sectional survey was conducted with 264 people diagnosed with schizophrenia who use local activity support centres in urban areas. The self-administered questionnaires included questions on loneliness, demographic characteristics, individual factors including self-efficacy for community life and self-esteem, and environmental factors including social isolation, community integration and service use. Results The study results indicated that people diagnosed with schizophrenia in Japan experience higher levels of loneliness, corroborating results from other countries. Multiple regression analysis showed that a lower level of self-efficacy for community life, self-esteem, community integration and social isolation predicted a higher level of loneliness, accounting for 55.3% of variance. Implications for Practice Public health nurses in mental health care in Japan can work with individuals diagnosed with schizophrenia and communities using the technique to assist them with continuous activity and cooperating with community resources and educational institutions in order to decrease and prevent loneliness.

Nurses’ Perceptions of Spirituality and Spiritual Care in Different Health Care Settings in the Netherlands

This paper shows similarities and differences in perceptions and competences regarding spirituality and spiritual care of nurses in different health care settings. Research on this specific topic is limited and can contribute towards a nuanced implementation of spiritual care in different nursing care settings. Four hundred forty nine nurses in different health care settings completed a questionnaire concerning spirituality and spiritual care, spiritual care competence, and personal spirituality. Respondents reported a generic (instead of more specific) view of spirituality and spiritual care, and they perceived themselves to be competent in providing spiritual care. Compared to nurses in hospital settings, nurses in mental health care and home care have a more generic view of spirituality and spiritual care and report a higher level of competence. Next to this, they perceive themselves more as spiritual persons. Future research is needed to develop further understanding in setting specific factors and their influence on nurses’ views and competence regarding spiritual care. Nursing education and management should consider an emphasis on spiritual competence development related to working settings of nurses.

Mental health problems of undocumented migrants in the Netherlands: A qualitative exploration of recognition, recording, and treatment by general practitioners

Objective. To explore the views and experiences of general practitioners (GPs) in relation to recognition, recording, and treatment of mental health problems of undocumented migrants (UMs), and to gain insight in the reasons for under-registration of mental health problems in the electronic medical records. Design. Qualitative study design with semi-structured interviews using a topic guide. Subjects and setting. Sixteen GPs in the Netherlands with clinical expertise in the care of UMs. Results. GPs recognized many mental health problems in UMs. Barriers that prevented them from recording these problems and from delivering appropriate care were their low consultation rates, physical presentation of mental health problems, high number of other problems, the UM’s lack of trust towards health care professionals, and cultural differences in health beliefs and language barriers. Referrals to mental health care organizations were often seen as problematic by GPs. To overcome these barriers, GPs provided personalized care as far as possible, referred to other primary care professionals such as social workers or mental health care nurses in their practice, and were a little less restrictive in prescribing psychotropics than guidelines recommended. Conclusions. GPs experienced a variety of barriers in engaging with UMs when identifying or suspecting mental health problems. This explains why there is a gap between the high recognition of mental health problems and the low recording of these problems in general practice files. It is recommended that GPs address mental health problems more actively, strive for continuity of care in order to gain trust of the UMs, and look for opportunities to provide mental care that is accessible and acceptable for UMs.