Community Mental Health Research Articles

Towards a Person-Centered Care Model Among Community Mental Health Services

Mental illness is widespread among adults and remains the foremost cause of years lived with disability. Despite its importance, there is a scarcity of research on person-centered care (PCC) from the viewpoints of mental health service users, particularly within clinical community mental health services. This study sought to investigate the potential for enhancing PCC through the lived experiences of individuals with mental health conditions who use local community mental health clinics (CMHC) in Malta. The goal was to obtain a thorough understanding of the current landscape, evaluate its strengths and weaknesses, and identify strategies for evolving the system towards a more PCC-focused model. A qualitative research design was utilized, following the principles of Interpretative Phenomenological Analysis (IPA) as described by Smith et al. (2009). Ten participants from Malta, including six women, who frequently visit CMHCs, were recruited through intermediaries. Each participant took part in a one-hour semi-structured interview, conducted at a mutually convenient time and location. These sessions were audio-recorded and transcribed verbatim for subsequent analysis. The analysis identified three main themes: Quality care, emotional support, and partnership and collaborative care, each comprising various sub-themes. The study illuminated both the strengths and shortcomings of the existing system and their implications for a PCC-oriented healthcare approach. While our findings reaffirm research on the critical role of empathy in care and other relevant factors, results also indicate that cultural factors in Malta, such as strong family ties, significantly influence the delivery of person-centered care (PCC), which may be relevant for other small communities. Furthermore, the research offers healthcare professionals (HCPs) a chance for ongoing professional development in accordance with the latest PCC principles.

Real-Time Exposure to Negative News Media and Suicidal Ideation Intensity Among LGBTQ+ Young Adults

With a recent surge in anti-lesbian, gay, bisexual, transgender, or queer (LGBTQ+) policies and associated news and media coverage, there is a need to study the association of LGBTQ+ focused news or media exposure and short-term changes in suicidal ideation (SI) among LGBTQ+ youth. To examine within-person direct and indirect associations between exposure to general and LGBTQ+ negative news or media and SI intensity through expectations of rejection. This intensive longitudinal cohort study used a smartphone-based ecological momentary assessment (EMA) protocol wherein participants responded to EMAs 3 times per day for 28 consecutive days. Young adults aged 18 to 24 years who self-identified as LGBTQ+, resided in Tennessee, and had past-year SI and at least mild depression (defined as a score ≥5 on the Patient Health Questionnaire-9) were eligible for inclusion. Participants were recruited through social media advertisements, LGBTQ+ community organizations, and mental and behavioral health clinics. Participants were recruited between March 30, 2023, and August 23, 2023, and data analyses were conducted from August 28, 2023, through April 20, 2024. At each EMA, participants reported on recent exposure to negative news or media. A 3-level categorical exposure variable denoted (1) no news or media exposure (reference); (2) exposure to general negative news or media; and (3) exposure to LGBTQ+ negative news or media. Each EMA also assessed expectations of rejection due to LGBTQ+ identity on a scale of 0 (not at all) through 10 (very much). Three primary outcomes assessed current (ie, "right now") intensity of active SI, passive SI, and self-harm ideation, each measured on a scale from 0 (not at all) to 10 (very strong). Multilevel modeling approaches were used to account for the hierarchical structure of EMA data, with assessments (level 1) nested within people (level 2). Linear mixed models and multilevel mediation models were used to examine within-person associations between exposure to negative news or media and the 3 primary outcomes, as well as the mediating role of expectations of rejection. Of 31 total participants, 22 were assigned female sex at birth (71%), and 16 (52%) self-identified as transgender or gender diverse. The median (IQR) participant age was 21 (18-22) years, and a total of 2189 EMAs were completed, with a median (range) compliance of 90.5% (41.7%-100%). At the within-person level, recent exposure to LGBTQ+ negative news or media was significantly associated with increased active SI (estimate [b], 0.14; 95% CI, 0.04-0.25; P = .009), passive SI (b, 0.23; 95% CI, 0.04-0.41; P = .02), and self-harm ideation (b, 0.13; 95% CI, 0.02-0.23; P = .02). No statistically significant associations were detected for exposure to general negative news or media. In multilevel mediation models, heightened expectations of rejection explained some of the total effect of exposure to LGBTQ+ negative news or media on active SI (23%) and passive SI (37%). This intensive longitudinal cohort study found that SI intensity modestly increased in the hours immediately following exposure to LGBTQ+ negative news or media among LGBTQ+ young adults. These findings have timely implications for research and intervention, particularly within sociopolitical and geographic contexts where news or media coverage about LGBTQ+ topics is intensified.

Feasibility, acceptability and preliminary evaluation of a user co-facilitated psychoeducational programme: a feasibility proof-of-concept randomised control trial

BackgroundMental health settings are increasingly using co-facilitation of educational group interventions in collaboration with patient partners and service users. However, despite promising results, limited information is available regarding the feasibility and satisfaction levels of these programmes among adults newly diagnosed with attention-deficit hyperactivity/impulsivity disorder (ADHD). Hence, this study aimed to determine the feasibility, acceptability, and preliminary effects of a user co-facilitated psychoeducational group programme for adults diagnosed with ADHD.MethodsThis feasibility proof-of-concept randomised controlled trial recruited outpatients from a Norwegian community mental health centre. Outpatients randomised to the intervention group (IG) received a psychoeducational programme supplementing Treatment As Usual (TAU), while the control group received TAU. Feasibility was determined by the acceptance rate, adherence rate, and dropout rate. Acceptability was measured with the Client Satisfaction Questionnaire and a 3-item scale measuring satisfaction with the received information. To test the preliminary effects, self-efficacy, symptom severity, and quality of life were measured at baseline and pre- and post-intervention.ResultsFeasibility was demonstrated; most of the patients were willing to enrol, participants attended 82% of the psychoeducational programme, and only 13% dropped out of the study. The between-group analyses revealed that the IG reported significantly greater mean satisfaction than the CG. Moreover, the intervention group was more satisfied with the information they received during the psychoeducational programme. Concerning the preliminary effects, the linear mixed model showed improvement in quality of life (the subscale relationship); however, other patient-reported outcomes did not show improvements.ConclusionsThis proof-of-concept randomised controlled trial supports the feasibility and acceptability of the user co-facilitated psychoeducational programme for patients newly diagnosed with ADHD in an outpatient setting. While preliminary findings indicate promise in enhancing patient-reported outcomes, a larger study is warranted to assess the intervention’s effectiveness rigorously.Trial registrationNCT03425, 09/11/2017.

Improving the Monitoring and Management of Clozapine-Induced Gastrointestinal Hypomotility (CIGH) in Community Mental Health Services: A Quality Improvement Approach.

Clozapine is the only approved antipsychotic for refractory schizophrenia to date. It can cause a range of serious and fatal adverse effects, including Clozapine-Induced Gastrointestinal Hypomotility (CIGH). While guidance is readily available to help manage CIGH effectively in hospital inpatients, practical recommendations applicable to the community (outpatient) setting are lacking. This project set out to improve the prevention, detection and management of CIGH in psychiatric outpatients. An initial baseline audit followed by quality improvement work was undertaken in a busy support worker-run community clozapine clinic focusing on, education and training, risk assessments and clinical documentation. The project was registered and managed using the Life QI web-based platform, where a set of primary and secondary drivers were defined and change ideas were executed. Qualitative and quantitative data were collected over a three-month period, demonstrating a significant improvement in clinical documentation (up from 36% to 99%). 23% of enhanced risk assessments resulted in treatment recommendations, modifiable risk factors were proactively discussed in 53% of clinic appointments and 65% of patients were provided with additional written information on CIGH. It was evident from staff and our patient feedback that further efforts would be required to continue to raise awareness about harms of unmanaged constipation among this client group. Future approaches may include enhanced collaborative efforts with primary care, and improving the skill mix in existing clozapine clinics, which could include the utilisation of mental health pharmacists.

Effect of a Logotherapy-Based Empowerment Program for Achieving Self-Reliance Among Persons Living Houseless

The lives of houseless individuals are characterized by powerlessness, meaninglessness, hopelessness, and despair, yet they have a desire to escape homelessness. While the economic aspect is essential for escaping homelessness, psychological resources are crucial, as they form the basis of the strength needed to achieve independence. The study aimed to examine the effectiveness of a logotherapy-based empowerment program developed to strengthen the capabilities of persons living houseless and ultimately develop competencies that serve as a foundation for self-reliance. The study was performed in a homeless support center for men living houseless in South Korea using a repeated-measures design with a control group. The experimental group received an eight-session empowerment program over 8 weeks. The participants were assessed at three intervals: pretest, posttest immediately after the program, and follow-up test 4 weeks after the posttest. The follow-up tests were completed by 22 and 16 participants in the experimental and control groups, respectively. We found that the empowerment program significantly enhanced the meaning of life, hope, and empowerment of houseless individuals. Community mental health nurses, who are in a position to interact with persons living houseless, must empower them to escape homelessness and achieve self-reliance, an important goal for this population.

Service Providers' Perspectives of an Integrated Community Mental Health Service in the UK.

This qualitative service evaluation aims to provide in-depth insights of service providers' perspectives of a new integrated community mental health service piloted in one NHS Integrated Care Board locality in South West England, UK, considering to what extent the service is meeting the mental health support needs of adults who are in between primary and secondary care services. In total, 21 semi-structured remote interviews were carried out in June-August 2023 with service providers and lived experience representatives. The evaluation was carried out through a researcher in residence -placement. Qualitative analysis drew on framework and thematic analysis, which was completed using Nvivo 20. Thematic analysis drew on a framework of context, mechanisms and intended or unintended consequences. These showed that service providers' positive expectations of the service were undermined by insufficient integration, which was evident from the imbalances in information flow and presence of pre-existing provider specific practices. The evaluation found several improvement opportunities: a need for deepening integration beyond the initial service development phase; aligning working practices with service delivery aims and ensuring that new services are not rolled out prematurely before service delivery practices have been fully developed.

A - 71 Cross-Cultural Comparison of Cognitive Performance between Americans and Cameroonians while Controlling for Age and Education

Abstract Objective The development of cognitive abilities varies based on social and cultural factors. Given the expansion of neuropsychological measures internationally, an accurate understanding of performance across different countries is necessary to understand the appropriateness of different cognitive tests. To expand the existing knowledge base, this study explores the differences in cognitive test performance between Cameroonian and American adults. Methods The Cameroonian sample, 250 adults ages 22–72 (mean age = 42.91 [SD = 13.76], 52% male, mean education = 13.54 [SD = 4.58]) resided in Yaoundé, Cameroon. Participants were tested at a district center. Deidentified data from a community mental health center’s archival database comprised the American sample. A one-factor between MANCOVA examined differences in performance on selected measures between Americans and Cameroonians after controlling for age and education. Results Age and education statistically significantly affected scores on all selected subtests except for WMS-IV Logical Memory I. Additional analyses revealed that performance still differed between conditions while controlling for age (F (6, 749) = 33.87, p < 0.001; Wilk’s ∧ = 0.787, partial ŋ2 = 0.21), and education (F (6, 749) = 18.95, p < 0.001; Wilk’s ∧ = 0.868, partial ŋ2 = 0.13) for WAIS-IV Digit span, WAIS-IV Symbol search, WAIS-IV Coding, Stroop color word, and WMS Logical Memory I & II subtests. Conclusion Age and education are important predictors of performance on cognitive tests. The importance of appropriately norming new assessments and re-norming older assessments is underscored when those variables are controlled for and differences in performance are maintained between the two conditions. Current findings indicate that cultural differences and their effect on cognitive development explain performance beyond age and education level.

Clinician actions in response to Adverse Childhood Experience (ACE) screening

Background and ObjectiveAdverse Childhood Experiences(ACEs) have a powerful influence on mental health, physical health, and life expectancy. Screening for ACEs and the clinician response to ACEs are critical to addressing the health and well-being of children; however, little is known about the actions clinicians take in response to ACE screening. Therefore, we aimed to examine clinician responses to ACE screening at five California pediatric clinics in a large public health care system. MethodsPatient demographics, indicators of social and behavioral determinants of health (e.g., housing insecurity), the number of ACEs endorsed on a screening instrument, and the actions clinicians took in response to each ACE screen were collected. Data was collected from May to October 2021. These data were used to examine the association between number of ACEs reported and clinician response, controlling for patient demographics and their social and behavioral determinants of health using multiple logistic regression. ResultsFive participating pediatric clinics conducted 2,652 ACE screens in six-months. Clinicians documented an action twice as often when ACEs were present, after controlling for patient demographics and their social and behavioral determinants of health (odds ratio(OR) = 2.2, 95 % confidence interval(CI): 1.5–3.3, p-value < 0.0001). Clinicians were three times more likely to record referrals to mental health clinicians, social workers, and community organizations relative to anticipatory guidance when the number of ACEs increased from one to three to four or more (OR=3.2, 95 %CI: 1.6–6.5, p < 0.0001). ConclusionFindings provide early information that ACE screening results are associated with patient care.

The relationship between mental health literacy and community attitudes towards mental illness: is myths about schizophrenia a mediator?

The relationship between mental health literacy and community attitudes towards mental illness: is myths about schizophrenia a mediator?

"So Many Other Things Improve" with Transdiagnostic Treatment for Sleep and Circadian Problems: Interviews with Community Providers on Treating Clients with Serious Mental Illness.

Community mental health centers (CMHCs) offer invaluable, publicly-funded treatment for serious mental illness (SMI). Unfortunately, evidence-based psychological treatments are often not delivered at CMHCs, in part due to implementation barriers, such as limited time, high caseloads, and complex clinical presentations. Transdiagnostic treatments may help address these barriers, because they allow providers to treat symptoms across multiple disorders concurrently. However, little research has investigated CMHC providers' experiences of delivering transdiagnostic treatments "on the ground," particularly for adults with SMI. Thus, the aim of the present study was to assess CMHC providers' perspectives on delivering a transdiagnostic treatment - the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) - to adults diagnosed with SMI. In the context of a larger parent trial, providers were randomized to deliver a standard version of TranS-C (Standard TranS-C) or a version adapted to the CMHC context (Adapted TranS-C). Twenty-five providers from the parent trial participated in a semi-structured interview (n = 10 Standard TranS-C; n = 15 from Adapted TranS-C). Responses were deductively and inductively coded to identify themes related to Proctor's taxonomy of implementation outcomes. Four novel "transdiagnostic take homes" were identified: (1) transdiagnostic targets, such as sleep, can be perceived as motivating and appropriate when treating SMI, (2) strategies to bolster client motivation/adherence and address a wider range of symptom severity may improve transdiagnostic treatments, (3) balancing feasibility with offering in-depth resources is an important challenge for transdiagnostic treatment development, and (4) adapting transdiagnostic treatments to the CMHC context may improve provider perceptions of implementation outcomes.

Creating communities that care: social representation of mental health in two urban poor communities in Ghana

Building caring communities is fundamental to achieving a community-based approach to mental health. Understanding how communities perceive mental illness provides critical insight into fostering mental health awareness and care. We explored the perceptions of mental illness among members of two urban poor communities in Accra, Ghana. Qualitative data were collected from 77 participants through key informant interviews, focus group discussions, and situated conversations. Using theory-driven thematic analysis based on social representations theory, findings revealed cognitive-emotional representations of mental illness. The communities demonstrated high awareness of the multilevel factors contributing to mental illness risk and experiences, drawing on five sources of knowledge: embodied, common sense, medical, cultural, and religious. Mental illness representations informed the classification and legitimization of mental illness based on the severity of conditions and the identity of sufferers. These findings provide valuable insights for planning community mental health interventions that address both social and institutional care needs.

Caring for Veterans With Depression and Cancer: An Overview for Civilian Nurse Clinicians.

Veterans put their lives on the line to serve our country, but their well-being is often threatened by multifaceted health issues related to military service, including elevated rates of lung cancer and depression. A significant percentage of Veterans have lost faith in mental health care or are unable to breach stigma-related barriers to seek and engage in this care. Veterans' lack of trust can be exacerbated by community mental health clinicians who have had little experience with Veterans and feel inadequately prepared to address their complex needs. The following databases were searched: PubMed, CINAHL Plus with Full Text, and Google Scholar; as well as the U.S. Department of Veterans Affairs website. Results indicated that 50% of Veterans use civilian health care and perceive that civilian nurses lack knowledge of military culture and related trauma. The current review offers civilian mental health professionals an overview of Veterans' unique issues and provides resources and practical suggestions for helping them overcome barriers to mental health care. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Predicting anxiety treatment outcome in community mental health services using linked health administrative data

Anxiety disorders is ranked as the most common class of mental illness disorders globally, affecting hundreds of millions of people and significantly impacting daily life. Developing reliable predictive models for anxiety treatment outcomes holds immense potential to help guide the development of personalised care, optimise resource allocation and improve patient outcomes. This research investigates whether community mental health treatment for anxiety disorder is associated with reliable changes in Kessler psychological distress scale (K10) scores and whether pre-treatment K10 scores and past health service interactions can accurately predict reliable change (improvement). The K10 assessment was administered to 46,938 public patients in a community setting within the Western Australia dataset in 2005–2022; of whom 3794 in 4067 episodes of care were reassessed at least twice for anxiety disorders, obsessive–compulsive disorder, or reaction to severe stress and adjustment disorders (ICD-10 codes F40–F43). Reliable change on the K10 was calculated and used with the post-treatment score as the outcome variables. Machine learning models were developed using features from a large health service administrative linked dataset that includes the pre-treatment K10 assessment as well as community mental health episodes of care, emergency department presentations, and inpatient admissions for prediction. The classification model achieved an area under the receiver operating characteristic curve of 0.76 as well as an F1 score, precision and recall of 0.69, and the regression model achieved an R2 of 0.37 with mean absolute error of 5.58 on the test dataset. While the prediction models achieved moderate performance, they also underscore the necessity for regular patient monitoring and the collection of more clinically relevant and contextual patient data to further improve prediction of treatment outcomes.

Impact of the COVID-19 Pandemic on Turnover Rates Among Staff in Community Mental Health and Substance Use Organizations.

This article explores the historic impact of the COVID-19 pandemic on turnover rates among staff in community mental health and substance use organizations in the United States. While existing literature extensively covers turnover in physical healthcare settings, the mental health and substance use sector's unique challenges have received less attention. The study utilizes a six-year dataset from a large multi-service organization in the northeast to analyze turnover patterns before, during, and after the pandemic. Key findings include a spike in turnover during the pandemic, particularly in Hospital Diversion Programs, and significant variations by age and gender. Despite the pandemic not significantly affecting overall turnover rates, the results offer insights into specific groups at risk for turnover, such as staff under 29 years old. The study concludes by discussing the implications for targeted retention strategies, especially as mental health organizations nationwide adopt the Certified Community Behavioral Health Center model.

Long-Term Impact of Community Psychiatric Care on Quality of Life amongst People Living with Schizophrenia: A Systematic Review.

The review examines the long-term impact of community psychiatric care on improving the quality of life of people with schizophrenia. It addresses the global burden of this disorder and the need for effective community-based care strategies. A systematic literature search was conducted in databases such as CINAHL, Medline, Web of Science, Sage and ScienceDirect, with the search lasting until March 2024 and following the PRISMA guidelines. The inclusion criteria targeted studies that addressed the long-term effects of community mental health care for people aged 18 years and older with schizophrenia and included both quantitative and qualitative research designs. Studies unrelated to the research question or with significant methodological flaws were excluded. The risk of bias was assessed using GRADE and GRADECERqual, in addition to critical appraisal using the Joanna Briggs Institute (JBI) checklists. Independent screening and data extraction was performed, with results summarised by thematic analysis. In total, 11 studies met the inclusion criteria and included cross-sectional, cohort, qualitative and randomised controlled trial designs. The results showed that community psychiatric care significantly improves the quality of life, well-being and social integration of people with schizophrenia. Effective interventions identified include psychoeducation, cognitive behavioural therapy, social skills training and individualised care plans. However, challenges such as limited resources, labour shortages and social stigma, particularly in low-income neighbourhoods, were also identified. This study highlights the importance of continuous, personalised, multidisciplinary community-based care for sustainable mental health outcomes. Further research is recommended to investigate the long-term impact and strategies to overcome implementation challenges.

Treatment Outcomes for Asian Americans Diagnosed with Schizophrenia Spectrum Disorder.

We implemented a pilot study to investigate symptoms and functional outcomes of Asian Americans treated in urban community mental health centers for a diagnosis of schizophrenia spectrum disorder. Furthermore, we investigated whether these outcomes differed between East and Southeast Asians. We collected quantitative data from 75 participants recruited using a nonprobability sampling strategy from six urban community mental health centers. We used the Positive and Negative Syndrome Scale (Kay et al. in Schizophrenia Bulletin 13(2):261-276, 1987) and the Strauss and Carpenter Outcome Scale (Strauss and Carpenter in Archives of General Psychiatry 27(6):739-746, 1972) to measure their symptoms and functional outcomes. To compare the outcomes between East and Southeast Asians, we used a multivariable logistic regression model, which adjusted for the estimated effects of age, sex assigned at birth, and age at onset of illness for each outcome examined. The data shows that the treatment outcomes for this group are poor. Only a small number of participants experienced symptomatic remission (30.67%), role restoration (34.67%), and clinical recovery (21.33%). The majority of those who did not experience clinical recovery had difficulties sustaining symptomatic remission and restoring role functioning (54.67%). However, more participants achieved social restoration (68.00%). The results did not vary by national origin groups and sex assigned at birth. However, the participant's age, the age at which the illness began, or both determined whether the treatment outcomes were favorable. Findings underscore the need for interventions that improve symptom control to increase the likelihood of other favorable outcomes.

Evaluating the feasibility and effectiveness of an LGBTQ+ cultural humility training for community mental health providers

BackgroundLGBTQIA+ patients face significant physical and mental health disparities, and providers often lack the training and knowledge to meet their needs. PurposeThe purpose of this quality improvement project was to evaluate the feasibility and effectiveness of an LGBTQIA+ cultural humility training program. MethodsUsing a pre-posttest design, 20 community mental health center employees completed surveys on knowledge, attitudes, and skills related to working with LGBTQIA+ patients before and after completion of an interactive online training module. ResultsResults showed statistically significant improvement in clinical preparedness. DiscussionFurther research is needed to determine the impact of improved provider knowledge and skills on patient outcomes.

Mental health challenges within the LGBTQ community: A societal imperative.

The LGBTQ community faces specific stressors rooted in societal discrimination, bias, and marginalization, impacting mental health significantly. Persistent discrimination, exclusion, and heteronormative expectations are identified as social determinants that contribute to heightened stress levels, resulting in increased rates of anxiety, depression, and suicidality. Moreover, the COVID-19 pandemic has also severely affected the physical and mental health of a large percentage of the population, particularly impacting the health of marginalized individuals such as LGBT individuals. Studies consistently reveal alarming mental health disparities between LGBTQ individuals and their heterosexual counterparts, with elevated rates of mood disorders, substance abuse, and self-harm. Transgender individuals, in particular, face unique challenges, including high rates of gender dysphoria and discrimination-induced mental distress. The concept of intersectionality within the LGBTQ community emphasizes the compounded burden faced by individuals with multiple marginalized identities, necessitating tailored mental health strategies. The societal context, including legal and policy frameworks, plays a pivotal role in shaping the mental health and scope for LGBTQ individuals. Supportive frameworks, such as anti-discrimination laws, marriage equality, and healthcare policies, contribute to societal acceptance and individual well-being. Additionally, efforts to destigmatize LGBTQ identities, comprehensive sex education, and public awareness campaigns challenging stereotypes are crucial for fostering a more inclusive societal mindset. Establishing robust support networks within the LGBTQ community, including initiatives providing mental health resources, counseling, community spaces, and allyship programs, is vital for community resilience. These efforts not only contribute to the well-being of individuals within the LGBTQ community but also work toward creating a more inclusive society. In conclusion, addressing mental health challenges within the LGBTQ community requires a multifaceted approach involving societal understanding, legal support, destigmatization efforts, and robust community resources. By acknowledging and comprehending the unique struggles faced by the LGBTQ community, society can collectively work toward building a more compassionate, supportive, and inclusive environment for all individuals, irrespective of their sexual orientation or gender identity.

Building a culture of workforce wellness using implementation science-informed strategies: A qualitative content analysis.

Successfully addressing burnout in health and human services settings is a topic of growing interest and impact in the field. Implementation science gives us strategies to build organizational readiness to create a culture of workforce wellness. This study used strategies for identifying and preparing wellness champions and building feedback loops to begin to build a culture of workforce wellness. The primary aim of this study was to assess perspectives on establishing feedback loops across all levels of the organizational hierarchy. This study took place in a community mental health organization that provides services across four different states. Champions in each state were identified and connected with leaders and teams. The champions supported the engagement of leaders and the design of feedback loops. Champions remained engaged throughout the process of assessing needs and sharing workforce wellness data. A qualitative content analysis was conducted on data collected during meetings that were intended to create organizational practice to policy feedback loops. Staff across all levels of the organizational hierarchy shared feedback and participated in facilitated reflective discussion. Participants offered several suggestions for addressing burnout. Across all participants, workplace connections were perceived as a protective factor against burnout. This implementation science strategy to help combat burnout is an effective and feasible way to include frontline staff voices and build connection and trust between leaders and staff in health and human services settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mental health of the Pacific Island Nation communities: What the rest in the world can contribute to and learn from?

Creating Futures initiative has established a network of mental health professionals, researchers, and community members from the Pacific Island Nations (PIN), Australia, and New Zealand to address the growing challenges of mental health conditions compounded by the climate change crisis. The enormous amount of work done in Global Mental Health can be particularly helpful to improve population-level mental health. However, translation of this evidence base into practice poses several challenges. This perspective paper discusses the role of local culture and health systems context in determining the feasibility and acceptability of implementing and scaling up evidence-based interventions designed in an American-European context. The paper also advocates development (and evaluation) of mental health interventions in the PIN communities particularly and Global South generally and exporting these interventions to the rest of the world. COVID-19 crisis underlined the role of global cooperation as well as national level 'self-reliance'. In this post COVID-19 world, it will be desirable for the mental health community to cooperate and collaborate to scale up evidence-based interventions through rigorous contextualization and at the same time main-stream mental health interventions developed in the Global South by incorporating them in the Global Mental Health discourse.