Review Of Health Research Articles

Procedural fairness in mental health review tribunals: the views of patient advocates

Mental health review tribunals face the difficult task of balancing an obligation to be efficient and accessible against the obligation to provide procedural fairness. We conducted focus groups with lawyers and advocates who support people with matters before the Queensland Mental Health Review Tribunal to ascertain their views on issues relating to procedural fairness in this particular forum. Consistent with similar studies in other jurisdictions, our participants expressed concerns about how well informed their clients were about the proceedings, the probative value of the evidence relied upon and the extent to which medical evidence is effectively challenged. We analyse the concerns raised by our participants in light of the limited Australian case law on procedural fairness in mental health review tribunals.

The association between mental health nurse to registered nurse ratio and patient outcomes in psychiatric inpatient wards: Protocol for a systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Nursing skill mix research has primarily focused on medical and surgical patients. The association between nursing skill mix and clinical outcomes for psychiatric inpatients has not been adequately explored. No systematic reviews have been reported that have examined the association between the ratio of mental health to registered nurses and patient outcomes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our protocol sets out, in detail, the methods we intend to follow to ensure that this review is conducted and reported to the highest possible standards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The review will summarize evidence about safe staffing in mental health inpatient units internationally. The review will inform health policy and planning of health services. ABSTRACT: Aim To assess the association between mental health nurse to comprehensive/general nurse ratio and relapse-determined by hospital admission-in adult psychiatric inpatients. Background information There is considerable variation in psychiatric inpatient nursing skill mix internationally. In most countries, wards are typically staffed by a mix of mental health and comprehensive/general nurses. To date, there have been no systematic reviews that have examined the association between the ratio of mental health to registered nurses and patient outcomes. Method We will systematically search five databases. Risk of bias will be determined using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis will be undertaken if there are at least two similar studies. Results For included studies, we will produce table summarizing risk of bias and extracted data. If we are able to undertake a meta-analysis, this will be reported as a forest plot. Discussion This paper sets out a detailed plan for a systematic review of mental health nurse skill mix research. Implications for practice High-quality evidence about the association between nursing skill mix and patient outcomes is important to inform the planning of mental health services internationally.

A Systematic Review of Mental Health-Improving Interventions in Veterinary Students.

Literature over the past 5 years has demonstrated that veterinary students globally are experiencing poor mental health. This has detrimental consequences for their emotional well-being and physical health, as well as implications for their future careers. Considering this issue, a systematic review was devised to investigate what interventions were being used, and what effect they had, in veterinary students. The review process involved a search of five databases, from which 161 records were retrieved. Following this, the screening process revealed seven articles eligible for appraisal. These studies investigated seven different interventions, six being cohort-level workshops/courses and one being a collation of several individual strategies. All seven studies reported that the interventions were effective to some degree in improving the mental health of their participants. However, the lack of repeat interventions and control groups limited the external validity of each intervention. A comparison to the research in medical students is briefly discussed. Three of the appraised articles were recommended for further investigation.

The frequency of references to decision-making capacity in reports to the NSW Mental Health Review Tribunal did not change after legislative reforms that promoted them

To assess the impact of a 2015 reform to the Mental Health Act 2007 (NSW) (MHA) that was interpreted as requiring a reference to decision-making capacity (DMC) in reports to the NSW Mental Health Review Tribunal (MHRT). A sample of reports to the MHRT were audited for references to the MHA's treatment criteria and DMC in periods before and after the reforms, and the frequency of references between the two periods was compared. The frequency of references to DMC did not change significantly after the reforms. (However, references to the 'least restriction' criterion increased markedly between the two periods). Despite legislative reforms and a supporting education campaign promoting the importance of consideration of DMC, references to DMC did not increase after the reforms.

Mental health during and after protests, riots and revolutions: A systematic review.

Protests, riots and revolutions have long been a part of human history and are increasing globally, yet their impact on mental health remains largely unknown. We therefore systematically reviewed studies on collective actions and mental health. We searched PubMed, Web of Science, PsycINFO and CINAHL Plus for published studies from their inception until 1 January 2018. Study quality was rated using the Newcastle-Ottawa Scale. We identified 52 studies (n = 57,487 participants) from 20 countries/regions. The prevalence of post-traumatic stress disorder ranged from 4% to 41% in riot-affected areas. Following a major protest, the prevalence of probable major depression increased by 7%, regardless of personal involvement in the protests, suggestive of community spillover effects. Risk factors for poorer mental health included female sex, lower socioeconomic status, exposure to violence, interpersonal conflicts, frequent social media use and lower resilience and social support. Nevertheless, two studies suggested that collective actions may reduce depression and suicide, possibly due to a collective cathartic experience and greater social cohesion within subpopulations. We present the first systematic review of collective actions and mental health, showing compelling evidence that protests even when nonviolent can be associated with adverse mental health outcomes. Health care professionals therefore need to be vigilant to the mental and psychological sequelae of protests, riots and revolutions. Further research on this emerging sociopolitical determinant of mental health is warranted.

Effect of Antenatal Mental Health Disorder on Fetal Growth: A Systematic Review

Background: Maternal mental disorders during pregnancy are associated with a range of adverse health outcomes for infants. Re­cent studies indi­cate the possible mechanism of maternal mental health disorders asso­ciated with fetal develop­ment through prog­ram­­ming effect. This study aimed to sys­tema­t­ically review the effect of ante­natal mental health disorders on fetal growth. Subjects and Method: This was a sys­tem­atic review. The articles were selected from Psyc­INFO, Medline, Web of Science, Em­­­base, and PubMed journal databases pu­blis­hed from July to Septem­ber 2018. The keywords for this review included maternal mental health AND fetal growth, post­partum de­p­ress­­ion AND fetal growth, maternal mental health AND fetal growth AND review. As many as 11 articles were selected for this stu­dy from 575 articles. Results: Maternal mental health during preg­nancy was associated with fetal head cir­cum­­ference growth through 2 mechanism: (1) In­creased maternal stress response modifies neu­ro­en­docrine function, which included changes in cortisol regulation, adreno­corti­co­tropic, adrena­line and nor­adrenaline hor­mo­nes levels; and (2) Decreased 11β-hydroxy­steroid dehydrogenase (11β-HSD2) enzyme regulation in placenta. It decreased11β-HSD2 level, increa­s­ed fetal gluco­corticoids circu­la­tion, and affect­ed on fetal head growth restriction. Conclusion: Maternal mental health during pregnancy is associated with fetal head circ­um­­fe­rence growth restriction. Keywords: maternal mental health, fetal head circumference, growth, systematic re­view Correspondence: Rina Tri Handayani. School of Health Scien­ces Mamba'ul 'Ulum, Surakarta, Jl. Ring Road Utara, Tawangsari, Mojosongo, Jebres, Sura­­ka­r­ta, Cen­tral Java. Email: trihandayan­ir­ina­@gmail­.­com: 085642224141 Journal of Maternal and Child Health (2020), 5(2): 147-153 https://doi.org/10.26911/thejmch.2020.05.02.04

Well-being and mental health interventions for Indigenous people in prison: systematic review.

Indigenous people are overrepresented in prison populations of colonised justice systems, and Indigenous prisoners in these countries are at a particularly high risk of poor mental health and well-being. There is an acute need to ensure the access of these groups to culturally appropriate, evidence-based interventions. To conduct a systematic review, evaluating quantitative and qualitative evaluations of mental health and well-being interventions designed for Indigenous people in custody. A search of relevant peer-reviewed journal articles to August 2019 was conducted. The focus was on colonised countries under a Western model of justice and health, including Canada, Australia, New Zealand and the USA. The review utilised Scopus, Web of Science, PubMed, PsycNET, EBSCO, Proquest Criminal Justice Database and Informit. Of the 9283 articles initially found, only three quantitative and two qualitative evaluations of mental health or well-being interventions for Indigenous people in custody were identified. None were randomised controlled trials. Culturally based interventions appeared to have high acceptability and potential for increased recovery from trauma, reduced alcohol-related problems and lower reoffending. However, no studies quantitatively assessed mental health or well-being outcomes. As yet there is no high-quality evidence on the impact on mental health and well-being from interventions specifically for Indigenous prisoners, although existing studies suggest programme features that may maximise acceptability and impact. There is a moral, social and practical imperative to build a strong evidence base on this topic.

Taking a reflexive turn: Non-adversarial justice and mental health review tribunals

Mental health law and practice has been instrumental in the development of non-adversarial justice, particularly through the development of therapeutic jurisprudence which emerged from insights gathered in the mental health context. The expanding articulation of non-adversarial perspectives beyond mental health is, in turn, reshaping critical debate about current mental health tribunal practice. Tribunals are also being encouraged to consider human rights perspectives. Human rights concerns and non-adversarial perspectives intersect with the long-standing debates in mental health tribunal practice about participation, representation and the role of the tribunal in the management of a dispute. They also raise new questions about the scope of the tribunal powers with respect to the oversight of medical treatment decisions and the provision of medical services. This article considers the intersection of human rights and non-adversarial justice perspectives in mental health review tribunals. It examines the common conceptual ground occupied by human rights and non-adversarial justice and considers four 'psycho-legal soft spots' in tribunal practice. These are the timing of tribunal review, the participation of the person in tribunal hearings, legal representation before tribunals and the scope of tribunal powers. This article argues for an integration of non-adversarial justice and human rights perspectives.

A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers.

Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes. Methods: In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological s. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes. Results: The identified studies described forms and conditions of social participation—both in the host country and transnationally—that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress. Conclusions: There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes.

The Mental Healthcare Act 2017 of India: A challenge and an opportunity.

The Mental Healthcare Act 2017 replaced the Mental Health Act 1987, subsequent to India's ratification of the United Nations Convention on the Rights of Persons with Disabilities in 2007. The Mental Healthcare Act (MHCA) 2017 upholds patient autonomy, dignity, rights and choices during mental healthcare and thus marks a bold step in India's mental health legislation. This new Law marks a major shift in the way mental healthcare is delivered, as it aims to protect and promote the rights of people during the delivery of mental healthcare. Within this Act, a capacitous individual cannot be coerced into receiving treatment for mental illness and inpatient admissions can be 'independent' or 'supported'. 'Supported admission' replaces involuntary admission from the previous legislation. State mental health authorities and mental health review boards will play a major role in the implementation of the new Act. The Mental Healthcare Act 2017 is aimed at bringing about radical transformation to mental healthcare in India.

Forensic patients, treating psychiatrist and the Mental Health Review Tribunal - An ethical question?

In inpatient forensic settings, a psychiatrist is expected to wear 'Two Hats', as a treating physician and as an expert to provide risk assessments and expert advice to the judicial authorities for leave and release decisions. Although dual roles have long been accepted as an inevitable part of independent forensic practice, there are additional ethical challenges for the treating psychiatrist to provide an expert opinion. This paper examines the specific ethical ambiguities for a treating psychiatrist at the interface of legal process related to leave and release decisions in the treatment of forensic patients. While respect for justice is the prevailing ethical paradigm for court-related forensic work, the medical paradigm should remain the key ethical framework for psychiatrists in treatment settings. Thus, psychiatrist should be aware of possible adverse consequences in acting as forensic experts for their patients. A conscientious adherence to clinical facts and awareness of the 'Two Hats' ethical pitfall can serve as important reference points in framing the psychiatric evidence in the decision-making process and safeguard treating psychiatrist's role.

Disordered eating and the perinatal period: A systematic review and best evidence synthesis of mental health and psychosocial correlates

This paper systematically reviews the literature to date on the relationship between disordered eating and mental health, psychological and social factors during pregnancy and the post-partum period, as well as the direction of associations. Peer reviewed articles were sourced from seven databases: PsycINFO, CINAHL, Psychology and Behavioural Sciences Collection, Academic Search Complete, Scopus (MEDLINE), Web of Science, and Proquest. A quality review and best evidence synthesis was conducted. The final review included 11 prospective cohort and 14 cross sectional/retrospective studies. According to a synthesis of findings, a strong level of evidence supports an association between disordered eating during pregnancy and depressive and anxiety symptoms during pregnancy. There was also a limited level of evidence for the association between disordered eating and obsessive-compulsive symptoms during pregnancy and between disordered eating and depressive symptoms during the post-partum period. No directions of associations could be determined. On the basis of initial findings, it is recommended that depressive and anxiety symptoms be monitored in conjunction with any disordered eating concerns during perinatal care. Given the significance of the childbearing years to the health and well-being of both mother and infant, further prospective cohort studies in this area are necessitated.

Variations in involuntary hospitalisation across countries

Variations in involuntary hospitalisation across countries

Rates of use of community treatment orders in Australia

ObjectivesThe variable and changing rates of use of involuntary community treatment orders (CTOs) in the treatment of people living with mental illness are not well-documented or well understood. This new study sought to determine contemporary rates of use in Australia, where local jurisdictions were previously shown to have varied and shifting rates of use that were high by world standards. MethodsAustralian state and territory mental health review tribunals, health departments, and/or offices of the chief psychiatrist were surveyed for the most recent published annual data on the total number of individual people placed on a CTO and/or the total number of CTOs made. FindingsContemporary rates of CTO use in Australia range from 40.0 per 100,000 population (in Western Australia) to 112.5 per 100,000 (in South Australia). Since the last national survey, the rates of people subject to CTOs fell into in two jurisdictions (Victoria and Western Australia). However, rates of CTOs made were higher than previous figures in all jurisdictions reporting data. Use of CTOs in Australia varies considerably within and between jurisdictions. ConclusionsAustralian jurisdictions continue to use CTOs at high and varying rates, despite unresolved questions about their role and impact. Transparency and accountability around their use would be improved by regular and nationally uniform public reporting of CTO data. Further research into how and why CTOs are used may also provide opportunities to respond to factors driving their use and thereby reduce the use of coercion in mental health care.

Community Resources for Forensic Mental Health Aftercare in Zimbabwe

This study sought to identify and describe existing forensic mental health aftercare facilities in Zimbabwe. A descriptive qualitative research design was applied to the study. Twenty-nine participants were purposively sampled. Semi-structured interviews were conducted. Thematic analysis of data was done. Three aftercare centers were identified. The link between special institutions where patients are discharged from and these centers is dependent on the Mental Health Review Tribunal. Models of care in these centers revolve around agro based livelihood activities. Social workers, nurses, nurse aides and volunteers from various medical background constitute care teams in the forensic mental health aftercare facilities. There is however, poor engagement within the identified aftercare facilities and also with mainstream psychiatric services.

Dealing with statutory bodies under the Mental Healthcare Act 2017.

India has an enormous burden of mental illness. In spite of the recognition of this population of people living with mental illness, the treatment gap continues to be about 83%. In order to meet this vast unmet need and in the view of aligning the mental health legislation with the international standards and the UN-Convention on the Rights of Persons with Disabilities, the Mental Healthcare Act 2017 was passed and enforced recently. The provisions in the act have been controversial from its conception. Now after the enforcement of the act, all mental health professionals (MHPs) have a legal binding to follow the provisions in the law. The MHPs are accountable to the statutory bodies – the Central Mental Health Authority, State Mental Health Authority (SMHA), Mental Health Review Board, and finally, the High Court or the Supreme Court. The Mental Healthcare Act (MHCA) and relevant articles/documents obtained pertaining to MHCA and their evaluation were reviewed, the major focus being on the role of statutory/regulatory bodies. Furthermore, an attempt was made to summarize the previous experiences in inspection of mental health establishments by SMHA of Karnataka. We concluded that the MHCA will have both positive and negative aspects. Many of the provisions in the law may appear unclear and unrealistic by many practitioners. However, it becomes precautionary for the MHPs to be well equipped with the MHCA and be acquainted with the requirements of the statutory bodies for ensuring a safe practice. The outcome of the implementation of the act will become evident only with time.

Approach to and practical challenges in certification in Psychiatry.

Psychiatrists and mental health professionals (MHPs) are often requested to provide a certificate in connection with admission, treatment, fitness, competence, administration, legal proceedings, or welfare measures and benefits for persons with mental illness. The role of Psychiatrist and MHPs in providing a certificate is an integral part of clinical practice and more so with the implementation of the Mental Healthcare Act, 2017 (MHCA 2017). While issuing a certificate, keeping patient information confidential is a challenging task for a professional as the patient care in psychiatry involves multiple stakeholders (Central and State Mental Health Authorities, Mental Health Review Board, MHPs including psychiatrist, and caregivers). There is limited training at undergraduate or postgraduate level in documentary practices and certification. This article tries to address some of the issues related to certification, professional and legal accountability, and attempts to remove some of the ambiguities associated with the certification process in psychiatry.

Physical activity and exercise as a universal depression prevention in young people: A narrative review.

The aim of this narrative summary was to examine the efficacy of physical activity and exercise as a universal prevention for depression in young people. We conducted a search of the literature in the open-access evidence database of controlled trials and systematic reviews in youth mental health, an initiative between Orygen, The National Centre of Excellence in Youth Mental Health and headspace, National Youth Mental Health Foundation. In April 2018, we searched for all papers published between 1980 and 2017 relating to "Depressive Disorder" under the "Universal Prevention" illness stage and classified as "Physical activity/Exercise" under the treatment/intervention classification. Systematic reviews, randomized control trials (RCTs) and controlled clinical trials were all included. A total of 11 papers were returned. Three of these studies were observational and eight studies were controlled trials. The reviewed studies indicate that exercise and physical activity might be an effective universal depression prevention intervention for young people. Three of the controlled studies had a passive control group or no control group and only one study had longer-term follow-up. No trial used a longitudinal design to determine if interventions prevent the onset of new cases of depression. The studies reviewed in the current review demonstrate a bidirectional relationship between physical activity, exercise and adolescent mental health. The results of the current review suggest that physical activity and exercise programs designed to increase the level of activity in young people should be implemented to be attractive and achievable to young people that may have poor psychological health.

Clinical Considerations for Emerging Adults with Eating Disorders and Transition to Adult-Based Care

ABSTRACTEating disorders most commonly emerge during middle to late adolescence and can endure over the course of young adulthood. The length and involvement of empirically supported treatments and the use of an interprofessional care team often necessitate strategic and individualized transition planning as a process prior to the transfer of care to an adult-based system/provider. This article describes clinical models and processes for transition to adult-based mental health care and reviews current research on transition in eating disorders. Clinical considerations during transition to adulthood are presented with an emphasis on developing autonomy and caregiver support, resilience and motivation, and managing longitudinal barriers. Case examples of navigating the transition process with young adults who have eating disorders are included.

The mental health review

GPs provide care to a large number of patients with mental health problems, and regularly perform mental health reviews. This article aims to highlight the need for a comprehensive review of patients diagnosed with severe mental illness and introduces a template to help complete the mental health review. The article focuses on the mental health review of patients with a diagnosis of schizophrenia (and other psychotic disorders), bipolar affective disorder and severe depression.