Competent Mental Health Research Articles

Twenty Years Post‐genocide: The Creation of Mental Health Competence among Rwandan Survivors Through Community‐based Healing Workshops

AbstractTwenty years after the genocide, many Rwandans still suffer from the psychological wounds of the past. The country's mental health agenda is based on individualised and psychiatric approaches that help some but cannot be provided on a large scale. Further, many reconciliation initiatives have been based on public testimonies, which have been shown to be potentially re‐traumatising, leading to calls for small‐scale community‐based approaches to healing, which constitute a middle way between individualised and public approaches. Drawing on the concept of ‘mental health competence’ (Campbell and Burgess, 2012), this study evaluates one such approach: the Life Wounds Healing workshops offered by the African Institute for Integral Psychology. Twenty‐one semi‐structured interviews were conducted with former workshop participants, staff members and the institute's founder to investigate their views on how these workshops can help genocide survivors. The results suggest that the workshops succeed in creating mental health competence by establishing a safe social space for people to open up, increasing people's critical understandings of the processes of pain — and potential for healing — that informs behaviour change, generating bonding social capital and offering participants' income‐generating possibilities. Copyright © 2015 John Wiley & Sons, Ltd.

BUILDING A WORKFORCE COMPETENCY-BASED TRAINING PROGRAM IN INFANT/EARLY CHILDHOOD MENTAL HEALTH.

This article describes findings from a project conducted in Western Australia (Mental Health Commission WA, 2015) that investigated the education and training needs of the Infant/Early Childhood Mental Health (I/ECMH) workforce. We examined international training programs and models of delivery in infant mental health, including a review of the current training available in Australia. Data collected from over 60 interviews were analyzed, and a staged delivery model for I/ECMH training and supervision that aligned with the Michigan Association for Infant Mental Health (2014) Competency Guidelines was recommended. These findings led to the purchase of the Michigan Association for Infant Mental Health (2014) for use in Western Australia. In a very short time, use of the Michigan Competency Framework by the Australian Association for Infant Mental Health West Australian Branch Incorporated has begun to change the training and education opportunities for upskilling the infant and early childhood workforce in Western Australia. It has resulted in a map to guide and develop training in the I/ECMH field for individual practitioners and professionals as well as for workplaces that will ultimately benefit Western Australian infants, young children, and their families during the perinatal period and in the early years.

Factors Influencing Mental Health Screening and Treatment Among Women in a Rural South Central Appalachian Primary Care Clinic.

Some of the most significant mental health concerns among US adults are depression, anxiety, substance abuse, and intimate partner violence. These concerns represent an ever-growing portion of the primary care population, especially in rural areas. However, few studies have examined factors influencing screening and treatment of these concerns by primary care providers, particularly in Appalachia. This study explores barriers and facilitators to mental health screening and treatment among women at a rural, primary care clinic in Appalachia. Eighteen patients and 4 providers were interviewed face-to-face. Thematic analysis was used to identify emergent themes. Patients identified 3 barriers (stigma, lack of support, and lack of education) and 2 facilitators (integrated care and positive experiences with providers). Providers identified 4 barriers (operational barriers, mental health competence, predicted patient reactions, and patient attitudes) and 3 facilitators (clinic characteristics, provider characteristics, and patient and provider education). Generally, patients focused more on individual and social factors influencing mental health service use, while providers were more aware of training gaps, logistical factors at the clinic, and systemic issues within the larger health care system. Both participant types emphasized specific interpersonal qualities and the importance of integrated services. Screening and treatment may be influenced by the availability and advertisement of integrated services, institutional support, strong patient-provider relationships, and provider training and experience. For rural south central Appalachia women, limited mental health resources may make these factors even more salient.

Job-related burnout among juvenile probation officers: Implications for mental health stigma and competency.

The high demands and responsibilities of probation work, particularly with juvenile clients, may lead to burnout, which can negatively impact how probation officers work with clients, particularly individuals with behavioral health concerns. Yet, research examining burnout and related outcomes among juvenile probation officers (JPOs) is limited. We surveyed 246 JPOs in a Midwestern state to identify the prevalence, predictors, and potential outcomes of burnout. JPOs reported moderate levels of burnout; about 30% of the sample scored in the high range for emotional exhaustion and cynicism. Contrary to study hypotheses, there were no group-level differences in burnout scores across gender, race/ethnicity, age, or education. In regression models, burnout was predicted by being White (vs. minority), serving in an urban (vs. rural) county, dissatisfaction with department guidelines, job dissatisfaction, viewing job role as more treatment-oriented along the enforcement-treatment continuum, and turnover intention. JPOs with burnout were more likely to endorse mental health stigma and lack of mental health competency to address juvenile clients with behavioral health concerns. Findings suggest burnout prevention and intervention programs should be considered for JPOs to increase job satisfaction, limit job turnover, reduce burnout, and possibly increase effective practices for managing juvenile clients with behavioral health needs.

Depression and Suicide in Children and Adolescents.

1. Gary R. Maslow, MD, MPH* 2. Kathleen Dunlap, MD, MPH† 3. Richard J. Chung, MD‡ 1. *Department of Psychiatry and Behavioral Sciences, Department of Pediatrics, Duke University School of Medicine, Durham, NC. 2. †Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC. 3. ‡Adolescent Medicine, Duke University Medical Center, Departments of Pediatrics and Medicine, Duke University School of Medicine, Durham, NC. Despite national recommendations, screening for adolescent depression is generally uncommon and is typically characterized by regional and racial/ethnic disparities. This variability in practice may leave some adolescents disproportionately vulnerable to untreated depression. Further education about depression in general and specifically regarding screening may help address such disparities. After completing this article, readers should be able to: 1. Describe the diagnostic criteria and initial assessment of depression. 2. Outline screening and management strategies for depression. 3. Discuss risk factors for and presentations of suicidal thoughts and behaviors. 4. Determine the acute management and secondary prevention of suicidality. Depression is underrecognized and undertreated in adolescents, with close to 75% of depressed adolescents not receiving treatment. Untreated depression in adolescence is associated with various adverse adult outcomes, including lower educational attainment and poorer physical health. Beyond the suffering and impaired functioning that depressed adolescents experience as well as the potential for future negative outcomes, the reality is that some affected adolescents commit suicide, further heightening the need for proactive assessment and treatment. Given the persistent shortage of mental health clinicians in the United States, significant emphasis has been placed on increasing the role of pediatricians in addressing this burden. In fact, a key pediatric quality metric that has garnered interest in recent years is screening for adolescent depression in primary care settings. In addition, the American Academy of Pediatrics included recognition and initial management of depression in its 2009 policy statement on recommended mental health competencies in primary care. (1) Given that adolescents with depression often present initially in the primary care setting, pediatricians are …

Psychiatrists Want to Do More for Toronto’s Growing Immigrant Population

Even when immigrants report mental health issues, many may have a tough time accessing culturally competent mental health care.

The Current and Ideal State of Mental Health Training: Pediatric Resident Perspectives

Phenomenon: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. Approach: The purpose of this study is to describe pediatric residents’ experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Findings: Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and dissemination to enhance trainees’ MH knowledge and skills to provide optimal MH care for children.

Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale

Lack of reliable and valid measures of therapist competence is a barrier to dissemination and implementation of psychological treatments in global mental health. We developed the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale for training and supervision across settings varied by culture and access to mental health resources. We employed a four-step process in Nepal: (1) Item generation: We extracted 1081 items (grouped into 104 domains) from 56 existing tools; role-plays with Nepali therapists generated 11 additional domains. (2) Item relevance: From the 115 domains, Nepali therapists selected 49 domains of therapeutic importance and high comprehensibility. (3) Item utility: We piloted the ENACT scale through rating role-play videotapes, patient session transcripts, and live observations of primary care workers in trainings for psychological treatments and the Mental Health Gap Action Programme (mhGAP). (4) Inter-rater reliability was acceptable for experts (intraclass correlation coefficient, ICC(2,7) = 0.88 (95% confidence interval (CI) 0.81–0.93), N = 7) and non-specialists (ICC(1,3) = 0.67 (95% CI 0.60–0.73), N = 34). In sum, the ENACT scale is an 18-item assessment for common factors in psychological treatments, including task-sharing initiatives with non-specialists across cultural settings. Further research is needed to evaluate applications for therapy quality and association with patient outcomes.

Teacher Perspectives on Their Role and the Challenges of Inter-professional Collaboration in Mental Health Promotion

This paper explores the teacher role in inter-professional collaboration in mental health promotion and identifies teachers’ perceived challenges to collaborative work in this field. Data are derived from a mixed method design, with three focus group interviews (n = 15) and survey research (n = 771) conducted with Norwegian K-12 teachers. The findings show that teachers perceive their gatekeeping role to be prominent, in that they are front line professionals to identify students’ mental health problems and, if necessary, make referrals to mental health services. However, teachers realize that mental health promotion encompasses more than the assessment of difficulties, and they call for more support and information through inter-professional collaboration in order to extend their engagement in student mental health beyond the gatekeeping role. Based on this, six main challenges to inter-professional collaboration are identified. These are the challenges of: (1) communication and confidentiality, (2) time constraints, (3) contextual presence and understanding, (4) cross-systems contact, (5) school leadership and (6) teacher competence in mental health.

Family well‐being, parenting, and child well‐being: Pathways to healthy adjustment

Family well‐being provides a foundation for positive parenting and child well‐being. Many previous studies have outlined the possible connections between family well‐being, parenting, and child well‐being, yet translating research into practice continues to be problematic. The purpose of this article is to review the current literature (from 2000 to 2014) on family and child well‐being in order to create a model of well‐being that is useful for both researchers and practitioners. The model builds upon Bronfenbrenner's Ecological Systems Theory, and is differentiated from other prominent models of family functioning by focusing on bolstering family strengths and well‐being (as opposed to ameliorating family stress, risk, or deficits) and on supporting child well‐being (as opposed to treating maladjustment). The model addresses family well‐being (parental well‐being, family self‐sufficiency, and family resiliency), developmental parenting (affection, responsiveness, encouragement, teaching, engagement, positive discipline, and co‐parenting), and child well‐being (physical and mental health, self‐regulation, social and cognitive competence). Direct and indirect connections between model components and possible moderating factors are discussed. A theory of change model is proposed as a tool for practitioners from a variety of disciplines and fields to guide their work with families. Recommendations for clinicians, limitations of the model, and future directions are discussed.

The Mental Health Crisis Grows On: A Descriptive Analysis of DOC Systems in America

Research has established that a large portion of prisoners have diagnosed mental health problems. Although the importance of providing mental health treatment for prisoners has been recognized, it is not clear what services state prison systems offer. The current study uses data obtained from content analyses, mail surveys, and phone interviews of mental health chief administrators of state prison systems to describe the norm in terms of mental health care and related services provided to state prison inmates. Findings indicate that most systems have dedicated and competent mental health staff working in their systems and that state systems are committed to providing needed services to inmates with mental illnesses. There are, however, also several obstacles, such as a lack of adequate staffing and resources, limited housing and bed space for prisoners with mental illnesses, and a lack of postrelease services.

Promoting school mental health competencies: exploring the utility of decision cases for pre-service learning

Preparation of the school mental health (SMH) workforce is an important priority. Significant gaps remain, however, in our understanding of which pre-service training strategies may be most effective for promoting essential cross-disciplinary SMH competencies. In response, this paper describes the case method of teaching and provides pilot evaluation data demonstrating the potential value of this pedagogical strategy for promoting these SMH competencies. Specifically, 173 pre-service social work graduate students completed a seven-item survey and answered four open-ended questions related to their learning and how it might influence their practice. Quantitative data revealed that students' reported knowledge gains related to the two SMH competency domains assessed – interprofessional and cross-systems collaboration. Qualitative data revealed that students not only gained knowledge in these domains, but also gained knowledge across the other five SMH competency domains as well. Student responses also sugge...

Student Expectations About Mental Health and Aging

Drawing from stereotype embodiment theory this study contributes to existing literature by examining whether and how expectations regarding mental health and aging changed for students enrolled in an undergraduate gerontology course at a Canadian research university (N = 51). At the beginning and end of the course, data from an open-ended word association exercise and the Expectations Regarding Aging (ERA-12) survey was collected and later analyzed. Investigators used content analysis and quantization to examine the word association data and statistical tests to analyze the mental health subscale (ERA-MHS). Findings were integrated and presented in a convergence code matrix. Results show that overall participants had more favorable expectations over time; in particular, ERA-MHS scores indicated less favorable expectations at Time 1 (M = 48.86) than at Time 2 (M = 65.36) significant at p < .01, while terms like “successful aging” increased and terms like “depressed” decreased. Findings have implications for geriatric mental health competencies of students in the health professions.

Providers’ Implicit and Explicit Stereotypes About Mental Illnesses and Clinical Competencies in Recovery

We examined community providers’ stereotypes about mental illnesses and their association with clinical competencies among mental health professionals in Washington State’s community mental health system (N = 584). Mental Health Competence and Recovery Implicit Association Tests were developed. The Competency Assessment Instrument (CAI) measured provider competencies in rehabilitation. Bivariate and multivariate analyses were used to examine the associations between stereotypes and clinical competencies. On average, providers did not differentially associate the concepts of competence or recovery with physical illnesses versus mental illnesses. However, providers that implicitly associated recovery more with physical illnesses had lower clinical competency scores (p = .03). Explicit stereotypes were associated with lower competency scores. Providers’ stereotypes about mental illnesses are predictors of clinical competencies.

Development of a scoring system for non-specialist ratings of clinical competence in global mental health: a qualitative process evaluation of the Enhancing Assessment of Common Therapeutic Factors (ENACT) scale.

Task-sharing is the involvement of non-specialist providers to deliver mental health services. A challenge for task-sharing programs is to achieve and maintain clinical competence of non-specialists, including primary care workers, paraprofessionals, and lay providers. We developed a tool for non-specialist peer ratings of common factors clinical competency to evaluate and optimize competence during training and supervision in global mental health task-sharing initiatives. The 18-item ENhancing Assessment of Common Therapeutic factors (ENACT) tool was pilot-tested with non-specialists participating in mental health Gap Action Programme trainings in Nepal. Qualitative process evaluation was used to document development of the peer rating scoring system. Qualitative data included interviews with trainers and raters as well as transcripts of pre- and post-training observed structured clinical evaluations. Five challenges for non-specialist peer ratings were identified through the process evaluation: (1) balance of training and supervision objectives with research objectives; (2) burden for peer raters due to number of scale items, number of response options, and use of behavioral counts; (3) capturing hierarchy of clinical skills; (4) objective v. subjective aspects of rating; and (5) social desirability when rating peers. The process culminated in five recommendations based on the key findings for the development of scales to be used by non-specialists for peer ratings in low-resource settings. Further research is needed to determine the ability of ENACT to capture the relationship of clinical competence with client outcomes and to explore the relevance of these recommendations for non-specialist peer ratings in high-resource settings.

Music Therapy As a Tool of Psychotherapy in Adolescence Cancer Patients

ABSTRACT Aim: Adolescents cancer patients not only have substantial physical, cognitive, emotional and interpersonal problems but also added burden of a life threatening disease. Persistent body image concerns somatic preoccupation, disruptions in heterosexual relationships and deficit in social competence have all been documented in this age group. Integration of conventional and complementary modes of therapy can be helpful in case of psychological problems This study examines adolescent cancer patients and their parents perspectives about music and music therapy's role in their lives. Methods: We assessed 100 patients in their adolescence with their families in the Psycho oncology department of Netaji Subhas Chandra Bose Cancer Research Institute during July 2006 to December 2013. Among total patients 42% were ALL, 12% were NHL, 6% were Hodgkin disease, 12% were Rhabdomyosarcoma, 8% were PNET, 8% were Germ cell Tumor, 4% were brain tumor, 4% were Osteosarcoma and rest 4% were soft tissue and other patients. We examined their family functioning, mental health, self-esteem, and social competence. Music sessions for individuals and groups based on their needs and tastes were designed. The patients could listen music of their choice, play instruments themselves, writes songs or simply talk about music they liked. Results: Out of 100 patients 80% had excellent psychological functioning without serious social issues. They expressed a positive effect. Among them 10% expressed a little depression, 8% of the teenagers thought that their families were less attentive than the case with their counterparts. These adolescents were maladjusted to the society also. Two patients (2%) were reluctant to command. Majority of the patients who had psychological disturbances, responded well to Music therapy and agreed to proceed with their treatment except a few terminal cases. Positive effects may carry over into children's home lives and vicariously support families. Out of 20 patients psychologically challenged adolescents, 18 patients came back to normal state of mind after music therapy Conclusions: Hence we recommend psychotherapy strongly in their adolescent period in frequent intervals. Music therapy can be excellent tool for psychotherapy in the adolescent paediatric and cure strongly recommended Disclosure: All authors have declared no conflicts of interest.

Risk and protective factors for relapse among individuals with schizophrenia: a qualitative study in Dar es Salaam, Tanzania.

BackgroundRelapse in people with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of people with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families, the mental health sector and the country’s economy. So far no study has been done to address relapse in Tanzania. The purpose of the study was to explore perspectives on risk and protective factors influencing relapse of people with schizophrenia and their caregivers attending Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania.MethodsA qualitative study was conducted, involving in-depth interviews of seven people with schizophrenia who are out-patients and their seven family caregivers at MNH. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all study participants. The recorded information was transcribed and analyzed using NVivo 9 computer assisted qualitative data analysis software.ResultsPersonal risk and protective factors for relapse, environmental risk and protective factors for relapse and suggestions to reduce relapse were the main themes that emerged from this study. People with schizophrenia and their caregivers (all of whom were relatives) perceived non adherence to antipsychotic medication as a leading risk factor of relapse; other risks included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protective factors. Participants suggested strengthening mental health psycho-education sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening the nurse-patient therapeutic relationship in provision of mental health care.ConclusionsThis study calls for improvement in mental health care service delivery to individuals with schizophrenia. Establishing a curricular in mental health nursing that aims to produce competent mental health nurse force would improve nursing practice in mental health care service delivery.

The Current and Ideal State of Mental Health Training: Pediatric Program Director Perspectives

ObjectiveTo assess pediatric residency program director (PD) perceptions of the current state of mental health (MH) training, their receptivity to curricular changes, and perceptions of their residents' knowledge and skills in MH care. MethodsWe performed a cross-sectional study utilizing a Web-based survey of pediatric residency PDs to assess program characteristics, learning modalities PDs currently had or would implement, and their knowledge of the new American Academy of Pediatrics' MH competencies. PDs then ranked their residents' knowledge and skills for 29 MH competencies. Analyses included descriptive statistics and bivariate and multivariate analyses to assess for associations between variables, particularly MH model of care and perceived competence. ResultsNinety-nine PDs (51%) responded. A total of 87% of PDs reported that MH care was taught as part of another rotation, yet PDs were receptive to curricular changes. Only 45% of PDs were aware of the 2009 American Academy of Pediatrics competencies, and PDs infrequently rated their residents' MH skills and knowledge to be above average. Attention-deficit/hyperactivity disorder (ADHD) was an exception: 64% reported above-average ADHD knowledge in diagnoses and 57% in treatment. There was an association between enhanced MH services in continuity clinics and perceived resident systems-based practice (P < .01) and medical knowledge (P = .04). ConclusionsPDs acknowledged that MH training is not emphasized, leading to deficiencies in their residents' knowledge and skills in MH care. The receptivity of PDs suggests the need for targeted dissemination of national guidelines or curriculum. Integrated models of care may be one way to improve resident competencies, but this deserves further study.

Outcome Results From Yo Veo

Objective: This study reports results from the outcome evaluation of Yo Veo, a visual intervention with schoolteachers, which structures conversations about challenges that teachers face teaching Latino/Latina immigrant students. Method: The intervention was delivered to teachers at two middle schools in the southeastern United States, one with a large and another with a growing proportion of Latino/Latina students. Questionnaire data were collected from 46 teachers at baseline, posttest, and 9-month follow-up. Measures were adapted at the second school as part of the pilot process. Results: Results show improvements in teachers’ scores on cultural competency, multicultural teaching practices, positive classroom management strategies, beliefs about parental involvement, mental health competency, knowledge of barriers to mental health service access, and attitudes toward undocumented immigrants. Measures on which there was no change or changes in the negative direction are also discussed. Conclusions: Yo Veo is a promising approach for promoting awareness, attitudes, and understanding among teachers working with Latino/Latina immigrant students and families. Further research is required to prepare the intervention for wider testing and dissemination.

Community collaboration as a disaster mental health competency: a systematic literature review.

Disasters impact the mental health of entire communities through destruction and physical displacement. There is growing recognition of the need for disaster mental health competencies. Professional organizations such as the AAFP and the ASPH recommend engaging with communities in equal partnership for their recovery. This systematic study was undertaken for the purpose of reviewing published disaster medicine competencies to determine if core competencies included community cooperation and collaboration. A search of Internet databases was conducted using major keywords "disaster" and "competencies". Articles eligible contained laundry lists of basic core competency curriculum beyond emergency response. Data were qualitatively analyzed to identify types of competencies, and the degree of community cooperation. A total of 12 studies were reviewed. Only one study listed competencies specifying community cooperation, although others refer indirectly to it. Findings suggest competency-based education programs could do more to educate future disaster health professionals about the importance of community collaboration.