Mental Health Clinicians Research Articles

Formal subtext analysis (FSA) in narrative interviewing

AbstractIn the framework of the plot theory of the Russian-Estonian semiotician Juri Lotman, a text is only considered narrative and eventful if it contains “…a fact which takes place, though it need not have taken place”. In this respect, Lotman models the event on the basis of description and prescription. This approach can be seen as a functional method for reconstructing the subtext. In previous studies, Lotman's event was considered a contradiction using predicate logical statements that do not allow error-free formal conclusions. However, the correct conclusions could be deduced based on deontic remodeling and its extension to the modal model of the possible worlds. In this way, the subtext of narrative texts could be formally deductible and the interpretation calculable. The aim of our study was to demonstrate this reformulation of Lotman’s event model and to discuss its application as an extension of Qualitative Comparative Analysis of narrative texts from qualitative interviews, one of the basic methods of data collection employed in qualitative research. The proposed model, named formal subtext analysis is illustrated by analyzing a narrative interview with a doctor from a German mental health clinic.

The relationship of early therapeutic alliance, baseline client symptom severity, and client race to duration in therapy and post client symptom severity

AbstractExtending the study of Shaw et al., this study aimed to determine whether early therapeutic alliance, baseline client symptom severity, and client race predicted treatment duration and post client symptom severity. Participants (N = 75) were clients at a community mental health clinic. Baseline client symptom severity, but not early therapeutic alliance, predicted post client symptom severity; client race predicted treatment duration. Collectively, early therapeutic alliance, baseline client symptom severity, and client race predicted post client symptom severity.

Ethical Dimensions of Digital Phenotyping Within the Context of Mental Healthcare

AbstractDigital phenotyping (DP) refers to the emerging field within digital (mental) health that involves the collection of data from individual’s digital devices (smartphones, wearable, Internet usage, etc.) to monitor and analyse their behaviours, activities and health-related patterns. That such ‘digital footprint’ data can be mined for behavioural insights is an intriguing idea, which has motivated an increasing amount of research activity, particularly in the field of digital mental health. Whilst of potentially revolutionary utility in (mental) healthcare, the idea of DP also raises a set of rich sociotechnical, ethical and philosophical considerations, and a cottage industry of sociotechnical and ethical critiques of DP has emerged, particularly within the humanities. Within this scene of early empirical investigation in the health/behavioural sciences on the one hand and general conceptual critiques from the humanities on the other, in this paper we instead explore a case for the potential utility of DP in circumstances of clinical mental health practice and examine its ethical dimensions in this context. After providing an explicatory framework for DP and making a case for it within this framework, we subsequently examine the ethical pros and cons of three topics pertaining to DP in clinical practice, namely (1) issues in psychometric assessment/testing, (2) the role and responsibilities of mental health practitioners with regard to DP technology, and (3) the value DP can afford clients in terms of self-awareness/empowerment and strengthening the therapeutic alliance with their clinician.

Short report: Integrated evaluations for autism spectrum disorder in pediatric primary care clinics.

Primary care providers often screen for autism during well child visits in the first few years of life and refer children for diagnostic evaluations when needed. However, most children do not receive a diagnosis until years later which delays access to services. Racism, socioeconomic status, and other systemic inequalities that limit access to health care further delay diagnostic evaluations. Mental health clinicians who work in primary care clinics can help address barriers to accessing diagnostic evaluation services once they are recommended by their primary care provider. However, mental health clinicians who work in primary care typically do not have training in diagnosing autism. The goal of this study was to evaluate a program training mental health professionals working in an urban primary care setting, primarily serving Black and Latinx families insured by Medicaid, to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through the Autism in Primary Care (APC) program. The wait time to access an evaluation through APC was significantly shorter than through standard avenues of care (e.g. referring to a separate autism clinic). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Conducting autism evaluations in primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.

Mothering and Mental Health Care: Moral Sense-Making Among Mexican-American Mothers of Adolescents in Treatment.

This article explores the experiences of Mexican American mothers who, confronted with the troubled emotions and behaviors of their adolescent children, felt compelled to seek help from mental health clinicians. Their experience is situated in the context of both psychiatrization, or the tendency to treat social problems as mental illness, and the landscape of contemporary mothering in the U.S., where maternal determinism, mother-blame, and the demand for intensive parenting hold sway. In this context, the moral crisis of mental health care-seeking for their children forces mothers to reconcile multiple competing stakes as they navigate the overlapping, and sometimes conflicting, moral-cultural worlds constituted by family and community, as well as mental health care providers. At the same time, it allows them an opportunity to creatively "reenvision" their ways of being mothers and persons. Their stories and struggles shed new light on contemporary conversations about psychiatrization, everyday morality, and mothering.

Perceived feasibility, acceptability and impact of the family involvement intervention for severe mental illness: a qualitative study in Masaka - Uganda

BackgroundThe burden of severe mental illness is high in low-resource settings like Uganda. But most affected people are not treated due to inadequacy of sectoral funding and trained mental health professionals. Medication has hitherto been the main method of treatment for severe mental illness worldwide. However, there is a growing realization that the use of community-based resource-oriented interventions like the family involvement are more effective and suitable for under-resourced settings. But there is a paucity of information about its applicability in Uganda.MethodsWe based the intervention at the mental health unit of Masaka Regional Referral Hospital, involving 30 patients with SMI, 60 family members and friends, and 6 mental health clinicians. It was delivered through regular monthly meetings of 5 patients, 10 caretakers, and 2 clinicians each, for six months. A purposive sample of 15 patients, 15 caretakers, and 6 clinicians participated in this qualitative evaluation study after 6 months. Data was collected using in-depth interviews. Atlas.Ti (version 7.0.82) computer software was used in data analysis. Both priori and grounded codes were used to code data.ResultsWe evaluated perceived feasibility, acceptability and impact of the intervention in the Ugandan context. The findings were largely positive. Feasibility was mainly driven by: the training of group facilitators, field support and supervision, prior relationship between participants, and scheduling and timing of meetings. Acceptability was supported by: anticipation of knowledge about mental illness, process and content of meetings, safety of meeting environment, and choice of participants and venue. Impact was majorly in domains of: knowledge about mental illness, psychosocial aspects of mental illness, networking and bonding, and patients’ quality of life. The success of the intervention would further be enhanced by its decentralization and homogenized composition of groups.ConclusionsThe intervention promises to spur improvement in the following main aspects of mental health services: accessibility since the meeting environment is more neutral and friendlier than the clinical setup; knowledge of mental illness; recognition of the important role of the family in management of mental illness; adoption of holistic approaches to mental illness; and quality of life of patients.

Mediating role of care partner burden among dementia care partners during post-hospital transition

Objectives This study examined the mediating role of care partner burden on the relationship between patient clinical factors (i.e. cognition, physical function, and behavioral and psychological symptoms of dementia [BPSD]) and care partner mental health (i.e. anxiety and depression) among dementia care partners at hospital discharge. Method The sample consisted of 431 patient and care partner dyads enrolled in the Family centered Function-focused Care (Fam-FFC) study; ClinicalTrials.gov identifier NCT03046121. Mediation analyses were conducted to test the role of care partner burden on the associations between patient clinical factors, and care partner anxiety and depression. Results Mediation models demonstrated that care partner burden partially mediated the relationship between patient physical function and care partner anxiety and depression, as well as patient BPSD and care partner anxiety and depression. Conclusion Findings highlight the need for clinicians and service providers to implement comprehensive strategies that address both patient clinical factors (i.e. physical function and BPSD) and care partner burden, to optimize care partner mental health outcomes during post-hospital transition.

Attachment, regulation, and competency framework in mental health services with youth experiencing homelessness: A qualitative study of clinician views

AimsAims were to 1) explore mental health clinicians’ experiences receiving training in the Attachment, Regulation, and Competency (ARC) framework, and 2) examine clinicians’ views of their own use of ARC when providing mental health services for youth experiencing homelessness (YEH). MethodParticipants included 10 clinicians with experience providing mental health services to YEH. Researchers collected data using a semi-structured interview guide and coded data following thematic analysis methods. ResultsClinicians described their ARC training and subsequent readiness to deliver ARC-informed services and provided feedback on how training could be improved. When reflecting on their use of ARC, they described the framework as inclusive, shared challenges and solutions to applying ARC in their work, and detailed how they promote attachment, regulation, and competency with YEH using this model. ConclusionClinicians emphasized the need for flexibility and creativity when using ARC-informed interventions in mental health care for YEH.

The “Silent Firefighters”: an examination and evaluation of peer support sessions for medical laboratory professionals in Canada

PurposeThe Canadian Society for Medical Laboratory Science (CSMLS) Peer Support Project was a formal and virtual peer support group pilot for medical laboratory professionals in Canada to determine its application for CSMLS members and obtain information regarding the current state of medical laboratory professionals’ mental health, well-being and burnout. CSMLS learned what is contributing to stress at work, coping strategies and barriers to accessing support or help for their mental health among medical laboratory professionals.Design/methodology/approachThe qualitative and exploratory pilot study examined medical laboratory professionals from Canada. Two peer support groups were facilitated in April and May 2022 by a trained mental health clinician. Peer support delivery was virtual and delivered via Zoom. The purposive sample featured medical laboratory technologists, Educators and Supervisors/Directors who were CSMLS members. The qualitative analysis was conducted via analytical memos and incorporated both manual and NVivo software analysis.FindingsOverall themes were identified within the data analysis and included barriers to mental health care; increased stigma for mental health; mixed messaging regarding mental health; feeling invisible; medical laboratory professionals would like to manage stress better but their increasing workload demands and challenges with scheduling and staffing add to their stress. Participants also highlighted their role and its context using metaphors such as “the silent firefighters”, and “the Bass Guitar of the Hospital”. Based on the evaluations, the peer support sessions encouraged participants to address their own mental health, validate their experiences and increase their comfort level in discussing mental health.Social implicationsIt identified a potential resource for medical laboratory professionals and determined that further mental health resources would be beneficial for their field. It also identified their strong commitment to patient care and their role as a medical laboratory professional.Originality/valueTo the best of the authors’ knowledge, this study is one of the first to examine peer support as a mental health resource for medical laboratory professionals. Additionally, its focus was on a Canadian population with virtual delivery.

Developing mental health curricula and a service provision model for clinical associates in South Africa: a Delphi survey of family physicians and psychiatrists

BackgroundClinical associates are a health professional cadre that could be utilised in mental health task sharing in South Africa but this is training dependent. The objectives of the study were to identify the potential curricula content, training sites, and teaching modalities for undergraduate and potential postgraduate clinical associate mental health training and to identify the tasks that they should perform based on these curricula.MethodsWe utilised the Delphi method to reach consensus on items with the panel comprising psychiatrists and family physicians. The first round questionnaire of the Delphi survey was developed based on a literature review and the results from earlier phases of the overall study. The survey was administered electronically and consisted of three rounds. Following both the first and second rounds, an updated questionnaire was constructed omitting the items on which consensus was reached. The questionnaire consisted primarily of nine-point scales with consensus based on 70% of participants rating 1,2,3 or 7,8,9.ResultsThere were 26 participants in the first round with this number falling to 23 in later rounds. There was strong consensus on a training attachment to a mental health clinic at a community health centre (CHC) at undergraduate (96.2%) and postgraduate level (100%). Consensus was reached on the importance of training on the management of six categories of disorders at the undergraduate level and nine categories of disorders at the postgraduate level. Clerking patients as a teaching modality reached 100% consensus at both undergraduate and postgraduate levels. PHC clinics, CHCs and district hospitals reached consensus as appropriate settings for clinical associates to provide mental health services. In addition, GP practices and secondary hospitals reached consensus for those with postgraduate training. Consensus was reached on ten of the 21 listed tasks that could be performed based on undergraduate training and 20 of the 21 tasks based on a postgraduate qualification in mental health.ConclusionsThe Delphi panel’s recommendations provide a clear roadmap for enhancing mental health curricula for clinical associates, enabling their utilisation in mental health service provision. A future postgraduate mental health qualification for clinical associates would allow for expanded task sharing.

Self-harm and suicidal behaviors in children: perspectives of mental health clinicians.

Presentations for self-harm and suicidal behaviors are increasing in children and young people, although less is known about these presentations in children aged 12 years and under. This study aims to understand how mental health clinicians in public health services conceptualize, identify and respond to self-harm and suicidal behaviors in children. 26 mental health clinicians provided their perspectives through interviews or focus groups. Participant responses were analyzed using reflexive thematic analysis. Mental health clinicians described how self-harm and suicidal behaviors may present differently in children compared with adolescents, particularly with the methods used. Using developmentally appropriate language and including parents or carers when screening for self-harm and suicidal behaviors was recommended by clinicians. The inclusion of parents or carers throughout the treatment process was important for clinicians, including helping parents understand their child's behavior and manage their own distress. Clinicians also highlighted the benefit of collaborating with schools to support children, yet noted primary school staff require training in responding to child self-harm and suicidal behavior. The limited services available for children 12 years and under including emergency care services, was identified as a problem. Findings highlight the importance of timely assessment and interventions which include mental health and medical clinicians, parents, carers, and school staff to support children with self-harm and suicidal behaviors.

Nursing Staff in a Large Hospital System Underutilize Insurance-Based Mental Health Services.

Nurses are at high risk of burnout and subsequent mental health concerns due to problems with overstaffing, immense workload volume, and personal health risks associated with the job. Effective mental health treatments are available but potential barriers to receiving care may prevent nurses from benefiting. The Emotional Health and Well-Being Clinic (EHWC) at Houston Methodist is an outpatient mental health clinic offering therapy and medication management services for employees and employee dependents of our institution. The EHWC is uniquely positioned to observe how nurses utilize mental health services and to address barriers to effective care for this vital group of healthcare professionals. This paper provides descriptive data on the utilization of mental health services by nurses in the EHWC and a discussion of possible challenges faced by this group when seeking care. Based on these data, we propose potential solutions to ensure that nurses can achieve maximum benefit from outpatient mental health services.

Investigating the Relationship Between Clinical Characteristics, Mental Health, and Vascular Function in Minor Ischemic Stroke or Transient Ischemic Attack Patients.

Over the past decade, there has been extensive research exploring the relationship between vascular health and mental well-being, encompassing aspects such as mood and cognition. However, there is a notable gap in research focusing on the mental and vascular conditions of minor ischemic stroke or transient ischemic attack (TIA) patients, particularly within the Thai population. To investigate the clinical characteristics and mental issues related to vascular functions in patients who have experienced a minor ischemic stroke or TIA. This study, approved by the Buriram Hospital Ethics Committee (IRB: BR0033.102.1/8), adhered to the guidelines of the Helsinki Declaration and obtained informed consent from all participants. A prospective cross-sectional study was conducted at Buriram Hospital, a government regional hospital located in Buriram province, Thailand, involving twenty-three participants diagnosed with minor ischemic stroke or TIA. Measurements included clinical characteristics, Hospital Anxiety and Depression Scale-part Anxiety (HADS-A), Hospital Anxiety and Depression Scale-part Depression (HADS-D), mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), flow-mediated dilation (FMD), and brachial-ankle pulse wave velocity (baPWV). Linear regression analysis was employed to investigate the factors associated with vascular function (FMD and baPWV). The factor related to FMD was HADS-D (β = -0.5, 95% CI -0.33 to -0.04). Factors associated with baPWV included age (β = 0.51, 95% CI 5.05 to 39.50) and the duration of minor ischemic stroke or TIA (β = 0.48, 95% CI 25.41 to 290.99). FMD shows a connection with depressive symptoms in patients with minor ischemic stroke or TIA. Therefore, it is important to detect and provide appropriate treatment for depressive symptoms in these patients, as it may lead to improvements in vascular function and better cerebrovascular outcomes.

Interoceptive awareness in a clinical setting: the need to bring interoceptive perspectives into clinical evaluation.

Interoceptive awareness (IA) is crucial to understanding mental health. The Multidimensional Assessment of Interoceptive Awareness (MAIA) scale, available in approximately 30 languages, has gained global recognition for its research applicability. This review highlights the critical importance of integrating IA evaluation in clinical settings, advocating for the MAIA scale's potential as a screening tool. Through an examination of academic databases, including Scopus, PubMed, Google Scholar, and J-STOR, our analysis spans seven mental health domains: eating disorders (ED), depression, stress, anxiety, autism spectrum disorder (ASD), chronic pain, and suicide ideation (SI). Thirty-eight studies showed links between several dimensions of IA with different disorders. That is, ED was related to Body Trust and Self-Regulation; anxiety to Body Listening, Emotional Awareness, and Self-Regulation; depression to Noticing and Emotional Awareness; ASD to Trusting, Emotional Awareness, and Noticing; chronic pain to Not-Worrying and Self-Regulation; and SI with Trusting. These insights hold profound implications for both clinical practice and mental health research. Integrating IA assessments into standard clinical protocols has the potential to improve our understanding of pathology, enrich patient care, and enhance therapeutic strategies.

Pharmacogenomic Characterization of Childbearing-Aged Individuals With Mood Disorders in a Tertiary Care Perinatal Mental Health Clinic.

Pharmacogenomic Characterization of Childbearing-Aged Individuals With Mood Disorders in a Tertiary Care Perinatal Mental Health Clinic.

Risk prevalence, readiness and confidence to change lifestyle risk factors among clients of community mental health services.

People with mental health conditions have high rates of chronic physical diseases, partially attributable to lifestyle risks factors. This study examined risk prevalence among community mental health service clients, their readiness and confidence to change, and associations with participant characteristics. Cross-sectional survey of adult clients from 12 community mental health services across 3 local health districts in New South Wales, Australia, collected from 2021 to 2022. Participants (n = 486) completed a telephone interview determining five risk factors, and readiness and confidence to change these. Multiple binary logistic regression models determined associations between readiness and confidence (for each risk), and participant characteristics (demographics and diagnosis). Participants most commonly reported a diagnosis of schizophrenia (36.7%) or depression (21.1%). Risk factors were prevalent: ranging from 26% (harmful alcohol use) to 97% (poor nutrition). High readiness was greatest for smoking (68%), weight (66%) and physical inactivity (63%), while confidence was highest for changing alcohol use (67%). Two significant associations were identified; females were more likely than males to have high readiness to change nutrition (odds ratio = 1.14, confidence interval = [1.13, 2.34], p = 0.0092), with males more likely to have high confidence to change physical activity (odds ratio = 0.91, confidence interval = [0.45, 0.99], p = 0.0109). Many participants were ready and confident to change risk factors. Gender influenced readiness to change nutrition and physical activity confidence. Training to upskill mental health clinicians in provision of preventive care that builds confidence and readiness levels may aid in supporting positive behaviour change.

Enhancing patient-clinician collaboration during treatment decision-making: study protocol for a community-engaged, mixed method hybrid type 1 trial of collaborative decision skills training (CDST) for veterans with psychosis

BackgroundPatient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDST’s feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDST’s effectiveness in comparison with an active control and further evaluate implementation feasibility.MethodsThe planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation.DiscussionIf CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally.Trial registrationClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.

Disability Training and Programme Conduciveness in Counselor Education: A Preliminary Assessment

ABSTRACT Counselors from all speciality areas should be prepared to serve people with disabilities (PWDs). Thus, we examined how counselling students in CACREP accredited programmes evaluate their disability training and their programmes’ disability conduciveness, and how it differs by speciality area. Effects of discrimination, ableism, power, privilege, and oppression on the life of PWDs, disability multicultural counselling competencies, and environmental, attitudinal, and individual barriers for PWDs were the training areas with highest three mean scores, indicating greater student satisfaction. Specific skills for leading a group consists of PWDs, sexual and reproductive concerns of PWDs, and parenting by parents with disabilities had the lowest three mean scores, indicating lower level of satisfaction. Results highlighted the inadequacy in disability training for clinical mental health and school counselling programmes. For disability conduciveness, almost one-fourth of the participants reported their programmes not meeting any of the criteria.

Optimizing Measurement Potential in Mental Health Clinical Practice: The Canadian Personal Recovery Outcome Measure (C-PROM) study

Optimizing Measurement Potential in Mental Health Clinical Practice: The Canadian Personal Recovery Outcome Measure (C-PROM) study

Child-parent agreement on the SDQ: The role of child-parent attachment and parental feelings.

Children and their parents often provide divergent reports regarding their mental health on the Strengths and Difficulties Questionnaire (SDQ). These discrepancies may impede the diagnostic processes. The present study aimed to explore how a child's attachment to the parent and parental feelings may explain some of the variability between parent's and children's reports on the SDQ. Data were collected using self-report questionnaires from 277 children and their parents (n = 421) who were referred to a public mental health clinic. This information was classified into clinical categories (normal and abnormal) and analyzed using multinomial logistic regression. The agreement rates between children and parents on the normality of children were high in general and across gender and age. Insecure attachment to parents positively and significantly predicted the agreement of child and parent reporting abnormality and disagreement when parents reported normality and children reported abnormality. Parental anger positively and significantly predicted disagreement in reports in which parents reported abnormal anger and children reported normal anger. These findings highlight the importance of assessing informant variability in association with emotional and relationship variables as clinically meaningful information for a clinical diagnosis.