Mental Health Care Policy Research Articles

Current policy and practice for the identification, management, and treatment of postpartum anxiety in the United Kingdom: a focus group study

BackgroundPostpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS.MethodsFour focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis.ResultsAnalysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety.ConclusionsFindings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication.

“The mother seems to traumatize her child”: Examining empathy, denial, and responsibility in day-to-day encounters of families and staff in immigration detention in Canada

This paper examines encounters of mothers and their children with detention facility staff during our fieldwork in immigration detention centres in Canada. We sought to understand how detainees and institutional staff understand each other and their roles within the broader system. Using a critical ethnographic frame that views the inner psychic worlds of subjects as contingent upon larger systems of power and oppression we organize our data around narrative and content themes. Our findings suggest that guards and staff see their roles as protectors of children, even as they communicate implicitly that these families are risks. Further, we propose that staff tend to project the aggressor onto the Other, in this case, migrant mothers, as a way to cope with the moral distress of witnessing the suffering of detained children, and with the burden of potential complicity. By describing how empathy, denial and responsibility are negotiated in these custodial spaces, we analyze the ways these micropolitical encounters can illuminate larger trends in the representation and reception of migrants with important implications for mental health care and border control practices and policy more broadly.

How the COVID-19 pandemic reshaped telepsychology: Insights from an Italian survey

The coronavirus disease 2019 (COVID-19) pandemic rapidly boosted the introduction of certain changes in mental healthcare services, consequently driving up the adoption of remote care delivery options. We conducted an online Italian survey to evaluate telepsychology use, attitudes, acceptance, and training needs, as well as to understand patient-professional interactions in video-consultations, aiming to inform future mental healthcare practices and policies. The current study's survey responses were collected using an anonymous, self-reported questionnaire on the ‘REDCap’ platform from 25 October 2022 to 26 July 2023. In total, 128 mental health professionals and 113 patients completed the survey. In our sample, 69 % of patients and 79.7 % of mental health professionals reported having used telepsychology during COVID-19 pandemic; in particular, 84.6 % of patients and 95.1 % of professionals selected video-consultation modality. Data showed that participants expressed high satisfaction with this communication tool. The increase in satisfaction was directly proportional to increase in the quality of interactions and in relation to the quality of the experiences. The critical factors influencing the video-consultation experience include communication style, information completeness, patient-centredness, and the comfort underscoring the central role of the professional-patient relationship, which, substantially, remains a key element in the psychological treatment process. These findings reinforce the need for continued refinement and expansion of telepsychology services, thus highlighting the potential for integrating innovative technologies into mental health practise.

Sectoral Differences in Depression Risk Among the Employed European Population

This paper analyses the relationship between gender, occupation, and depression in the population over 15 years of age, employed and residing in Europe. Using data from the European Health Survey, ordered econometric specifications are estimated for different sub-samples of individuals, according to the sector in which they are employed. The results show that gender is the most determining factor in the risk of depression, followed by the type of work schedule and other occupational characteristics of the individual. Thus, this article highlights the importance of considering the interaction between gender and occupation in the analysis of mental health. Finally, the implementation of mental health care policies for workers through occupational risk prevention plans is proposed as an effective way to address this issue.

Senior Mental Health Scenarios in Thai Buddhist Contexts: A Qualitative Study

This study delves into the global mental health challenges confronting the elderly within Thailand’s Buddhist context. It explores seniors’ perspectives on mental health distress, factors, and interventions, alongside monks’ viewpoints on traditional Buddhist approaches and their role in addressing these challenges. Our thematic analysis of qualitative research engaged 36 participants, comprising health volunteer monks and seniors from Northern Thailand, to identify primary themes and sub-themes. The perspectives on senior mental health scenarios highlight seniors’ experiences of stress, anxiety, sadness, and loneliness, influenced by factors like age, health, family, finances, and social isolation. Interventions encompass health care, religious practices, and community support. Monks advocate for integrating Buddhism into daily life, encouraging active participation, and addressing senior mental health issues, emphasizing their pivotal role, the embodiment of monastic ideals, and the challenges hindering their involvement. The research highlights the significance of empowering monastic involvement, acknowledging monks as representatives of monastic principles, even in the face of obstacles limiting their participation. This study uncovers a trend in Thai Buddhist communities where physical health and religious aspects take precedence over the mental well-being of seniors. It advocates for a comprehensive approach that integrates religious and mental health strategies, highlighting Buddhism’s impact on seniors’ mental wellness. The implications span spirituality, religious studies, mental health, and elderly care policy, emphasizing the crucial role of Buddhist practices and monks in enhancing the mental well-being of the elderly.

Mapping community-based youth mental health services in Tasmania, Australia.

Tasmania has the most rurally and remotely dispersed population of young people in Australia with high rates of youth experiencing mental ill health and socioeconomic disadvantage. Standard descriptions of mental healthcare provision are necessary for evidence-informed mental healthcare policy, planning and implementation. This systematic scoping study aimed to: (1) map and describe the characteristics of community-based youth mental health services (including substance-use) for young people in Tasmania, Australia and (2) identify gaps in service accessibility and provision. A list of eligible services was developed through a systematic search and consultation with key stakeholders. Data were collected from a representative from each eligible service via an interview or online survey. A standardised framework was used to classify, describe and map services. Thematic analysis was used to analyse service providers' perceived gaps to service access and provision. Twenty-eight community-based mental health services for youth were identified, predominantly located in the major city of Tasmania's three service regions. Service gaps include the 'missing middle', lack of integrated supports and limited service capacity. The findings highlight the limited availability, accessibility and capacity of youth mental health services across Tasmania. Recommendations focus on increasing accessibility of rural/regional supports, provision of assertive outreach, psychosocial support, integrated care and strengthening the rural mental health workforce. These findings may inform the (re)design/(re)development of community-based youth mental health services in Tasmania. The findings may also guide evidence-informed mental health service planning, decision-making, development and implementation of integrated models of youth mental health care across Australia.

Age Disparities in Prevalence of Anxiety and Depression Among US Adults During the COVID-19 Pandemic

High levels of anxiety and depression were documented shortly after the arrival of the COVID-19 pandemic and were more prevalent in younger adults than in older adults. Knowing whether these age disparities persisted throughout multiple years of the COVID-19 pandemic and identifying associated factors will help guide health policy. To investigate age disparities in anxiety and depression during the COVID-19 pandemic. This cross-sectional study consisted of a nationally representative online survey administered between April 2020 and August 2022 and included US adults who were not incarcerated. Data were analyzed between March and September 2022. The first 27 months of the COVID-19 pandemic included wide variation in infection rates, turbulence in US political and social life, and geopolitical instability. Primary exposures include individuals' age and economic precarity and pandemic-related events (eg, weekly state-level case counts and individual vaccination status). Symptoms of anxiety and depression were assessed via responses to 2-item screeners (Generalized Anxiety Disorder 2-item for anxiety and Patient Health Questionnaire-2 for depression). An individual's symptoms were identified as clinically elevated if scores exceeded validated thresholds. This study included 3 028 923 respondents (mean [SD] age, 48.9 [17.0] years; 1 567 603 [51.8%] female). In multiple regression analyses that include state fixed effects and survey-week fixed effects, likely anxiety and depressive disorders among 291 382 (40%) and 238 505 (33%) of adults aged 18 to 39 years, respectively, compared with 357 820 (31%) and 274 534 (24%) of adults aged 40 to 59 years and 225 295 (20%) and 183 695 (16%) adults aged 60 years and older. Levels declined throughout the pandemic period for those aged 40 years and older but remained elevated for younger adults. Analyses identified several associated factors of these age disparities. Younger adults' anxiety and depression increased more than older adults' after surges in COVID-19 case counts but decreased less following vaccination against the virus. Additionally, approximately one third of the age gap among individuals with depression and anxiety was attributed to economic precarity, to which younger adults are disproportionately exposed. In this cross-sectional study of anxiety and depression during the COVID-19 pandemic, economic precarity was associated with high anxiety and depression among younger adults in the US compared with older adults in the US. These findings suggest a need for greater mental health care and economic policies targeted toward younger adults.

Fatty acid intake and prevalence of depression among Brazilian graduates and postgraduates (CUME Study)

BackgroundDietary fatty acids are related to the development of several inflammatory-related diseases, which may include depression. So, the association between fatty acids, culinary oils and fat intake and depression in highly educated Brazilians was evaluated. MethodsMulticenter cross-sectional study using baseline data from the Cohort of Universities of Minas Gerais. The diagnosis of depression was self-reported, and the daily intake of fatty acids was assessed using a 144-item food frequency questionnaire (FFQ). ResultsA total of 7157 participants (68.83 % women) with a median age of 33 years were included. The prevalence of depression was 12.60 % (N = 902). In the adjusted analyses, it was observed that individuals with the highest intake of omega-6 fatty acids (n-6) (OR: 1.36, 95 % CI 1.11–1.67) had a higher prevalence of depression. This increased n-6 intake was identified as a risk factor for depression only among male participants, while among overweight participants, higher n-6 intake was also positively associated with depression. Conversely, a higher ratio of polyunsaturated to monounsaturated and saturated fatty acids (PM/S) was also found to be positively associated with depression, but this association was observed only among non-overweight participants. No associations were found between the consumption of culinary oils or fats and depression. LimitationsCross-sectional design limits the assessment of causality. The use of the FFQ can make estimates more difficult. ConclusionHigher consumption of n-6, and higher PM/S ratios were associated with depression, and individual factors can interfere. The mental health care policies should include specific nutritional strategies.

The Lived Experiences of Burnout in Clinical Psychologists in Pakistan: A Phenomenological Study

Clinical psychologists are compelled to encounter the challenging conditions of psychologically ill clients in their exacerbating journey. They must bear the emotional burden of apprehension, worry, overtiredness, and mental fatigue. The adverse lived experiences of clinical sessions, psychotherapy, and counseling lead to work-related mental stress and emotional exhaustion. Consequently, burnout has been one of the main precursors that mental health professionals are constantly dealing with. The research study aims to explore the lived experiences of burnout among clinical psychologists and identify the coping strategies used by these clinical psychologists in Pakistan. The study uses the qualitative phenomenology method to evaluate the respondents' experiences. The purposive sampling technique was used to conduct semi-structured interviews with six clinical psychologists. Using interpretative phenomenological analysis, the four themes of lived experiences of burnout and the five themes of coping strategies emerged. Results suggest that clinical psychologists have encountered burnout mainly due to workplace conditions, caregivers' attitudes, a state of helplessness, and societal stereotypes. They cope with burnout because of family-work balance, a support system, religious affiliation, and determined personality traits. The findings contribute new aspects of knowledge about the burnout phenomenon and help shape mental healthcare policies. There remains a need for further rigorous investigation of burnout to establish a formal policy for the mental health of clinical psychologists.

Democracy Therapy: Lessons from ThriveNYC

Abstract Despite massive unmet needs, U.S. mental health care systems and policy continue to aim too low. Laments about brittle foundations-including inadequate funding, fragmentation, stigma, lack of parity, ineffectiveness, unavailability, overmedicalization, and coercion-all share the same source. The mental health system is not working because it has been chasing the wrong goal: to treat illness, rather than to enable people to do nurturing things together. A focus on community nurturing and caring changes everything. It yields better treatment approaches while also engaging with the mutually reinforcing and desperately needed work of social cohesion, emotional well-being, participatory action, and communal learning and connection. In fact, the nurtured emotional health of individuals is fundamental to humane and resilient societies and to democracy itself. And in the face of environmental collapse and the related unraveling of core institutions, the stakes have never been higher. This essay makes the case for a paradigm shift in care and explores a recent effort to implement it at scale: ThriveNYC. The successes and especially the failures of ThriveNYC point to the possibilities and challenges of this essential mission.

Depressive/Anxiety Disorders in People with Early Onset Dementia in South Korea

Abstract Background Early-onset dementia (EOD) relatively occurs at a young age. We know that the burden of family care and difficulties in economic activities greatly affect not only EOD but also the family. However, the healthcare policy for EOD is still less than that for late-onset dementia (LOD). In addition, there are few studies on mental disorders of EOD using national data in South Korea. We aimed to analyze the current status of depressive/anxiety disorders in EOD using national data and provide basic data for establishing EOD mental healthcare services and policies. Methods A total of 3,882,915 EOD and LOD with depressive/anxiety disorders were compared for gender, residential area, health insurance premium, and type of insurance using NHIS DB (National Health Insurance Service Database) from 2016 to 2021. Results There were differences according to socio-economic demographic factors for both depressive/anxiety disorders. During the observation period, the diagnosis rate of depressive/anxiety disorders in EOD was higher than LOD. After adjusting for gender, residential area, health insurance premium, and type of insurance, the risk of depressive disorder was 1.87 times higher (i.e., EOD higher, adjusted odds ratio [aOR]: 1.87, 95% confidence interval [CI]: 1.78-1.95) among EOD compared to LOD. The risk of anxiety disorder was 1.24 times higher (aOR: 1.24, 95% CI: 1.16-1.32) among EOD compared to LOD. Conclusions During the observation period, the diagnosis rate and risk of depressive/anxiety disorders in EOD were much higher than LOD. Therefore, this study suggests that mental healthcare services for EOD should be provided, treatment burden and economic difficulties should be reduced, and additional research on preventing and treating mental disorders should be conducted. Key messages • The diagnosis rate and risk of depressive/anxiety disorders in EOD were much higher than LOD. • The healthcare policy for EOD is still less than that for LOD.

Economic evaluation of 27,540 patients with mood and anxiety disorders and the importance of waiting time and clinical effectiveness in mental healthcare

Understanding the drivers of health and economic cost for the treatment of mental health conditions is critical to meet the accelerating demands for care. We conducted an economic evaluation of real-world healthcare-systems data from 27,540 patients receiving care for a mood or an anxiety disorder within the UK National Healthcare Service. Using Markov models built on discrete health states to compare the cost-effectiveness of different interventions, we show that the principal drivers of healthcare cost relate to waiting times and treatment effectiveness. We find that internet-delivered cognitive behavioral therapy has a ‘dominant’ incremental cost-effectiveness ratio relative to standard care, offering similar clinical effectiveness but with shorter treatment times. In most healthcare systems, the clinical effectiveness of mental healthcare remains unquantified, and long treatment times are common. The potential for these findings to inform mental healthcare policy is substantial, particularly around immediacy of access and the importance of outcomes-focused quality management.

NCMHR advocates for recovery‐oriented services on many fronts

The National Coalition for Mental Health Recovery (NCMHR; www.ncmhr.org) was established in 2006 to ensure persons with lived experience of mental health challenges would have a voice to shape the development and implementation of mental health care and social policies at the national and state levels.

Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial.

For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU ("apps"), (2) mobile app + volunteer support + TAU ("volunteers"), or (3) TAU only as the control group ("TAU"). They were asked to submit a mobile app-based questionnaire during 4 measurement time points at monthly intervals. A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078.

SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India.

The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.

Schizophrenia and the COVID-19 pandemic: A narrative review from the biomedical perspective.

The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic in 2020 caused a rapid worsening of global mental health. Patients with severe mental disorders, including schizophrenia, are at higher risk of being infected. The neuroinvasive potential of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has been confirmed. The aim of this article was to present a narrative and comprehensive review of multidimensional associations between schizophrenia and COVID-19 with special emphasis on common biological pathways. Online searches were performed in the PubMed database and covered the publication period until September 17, 2022. Search terms included "psychosis", "schizophrenia", "inflammation" and "COVID-19". Viewed as a neuroinflammatory state, schizophrenia shares several neurobiological mechanisms with the COVID-19. Environmental stress, common comorbidities of schizophrenia and adverse effects of antipsychotic treatment are associated with the higher severity and mortality of the COVID-19. Additionally, more frequent relapses of psychosis have been observed, and might be related to lower treatment adherence. In the context of clinical manifestation, higher level of negative symptoms has been identified among patients with schizophrenia during the pandemic. Improvements in mental health care policy and treatment adjustment are necessary to protect people with schizophrenia who are the population that is particularly vulnerable to the consequences of the COVID-19 pandemic. Future research will show if prenatal infection with the SARS-CoV-2 increases a risk of psychosis.

Transtornos Mentais Comuns em quilombolas rurais do Norte de Minas Gerais, Brasil

The scope of this article is to assess the prevalence and factors associated with Common Mental Disorders (CMD) in "quilombolas" (Afro-Brazilian residents of quilombo settlements) in rural communities located in the North of Minas Gerais, Brazil. It is a cross-sectional study of 2019 based on structured interviews and application of a Self-Reporting Questionnaire (SRQ-20). Binary logistic regression was conducted. The prevalence of CMD was 38.7%. There was a higher preponderance of CMD among female quilombolas (OR: 2.69; 95%CI 2.00-3.62), with 1 to 8 years of schooling (OR: 1.70; 95%CI 1.15-2,51), family income of 1 to 1,5 minimum wages (OR: 2.51; 95%CI 1.60-3.94); who suffered discrimination in health services (OR: 2.44; 95%CI 1.44-4.13); with self-reported lung disease (OR: 2.10; 95%CI 1.25-3.54), heart disease (OR: 1.58; 95%CI 1.01-2.50) chronic renal failure (OR: 1.97; 95%CI 1.08-3.94), and negative self-perception of health (OR: 3.07; 95%CI 2.31-4.07). The high prevalence of CMD revealed in this study demonstrates the need for mental health care policies aimed at vulnerable populations, such as quilombola communities, in order to mitigate mental suffering and promote professional contextualized care for the idiosyncrasies of health and living conditions of this population group.

Patterns of mental health care provision in urban areas: A comparative analysis for local policy in the ACT.

Urbanisation presents specific mental health challenges, requiring a better understanding of service availability in urban areas for mental health care planning. Our objective is to analyse patterns of urban mental healthcare provision in Australia, and compare these with relevant national and international regions to inform urban mental healthcare policy and planning. Following a health ecosystems approach, we use a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE), and Mental Health Care Atlases, to compare the availability, bed capacity and diversity of services providing specialised mental health or psychosocial care that are universally accessible (ie provided at no or low cost only in all relevant care sectors in four Australian and three international urban regions. We used a heuristics approach and an homogeneity test. Applicability to local policy was assessed using the Adoption Impact Ladder. Community care was less developed in Australia than internationally, except in the case of residential care in Australian Capital Territory, our reference area. Alternatives to hospitalisation were scarce across all regions. The Atlas was applicable to regional and local mental health planning. Differences in pattern of care between regions has implications for planning, equality of access to care and prioritisation of resources. An ecosystems approach is relevant to service planning in mental healthcare at local level.

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico.

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

The development of a creative work rehabilitation organisation.

Work as therapy has a place in mental healthcare, but there is disagreement about how and why it might be helpful, and how best to conceptualise or represent those benefits. Over the last 50 years, occupational and industrial therapy sheltered workshops have been key elements in the provision of work activities in psychiatric settings, and community-based horticultural activities and creative craft work have offered additional approaches. Using archival material, interviews, witness seminars and personal reflections, this article charts the birth and initial growth of Restore, a charity providing creative work-based services in Oxfordshire between 1977 and 1988. Although Restore might be understood as a response to national trends in mental healthcare policy and research, its trajectory reflects local contingencies.