Mental Health Services Research Research Articles

The questions we ask – differences between the peer and allied health workforces

ABSTRACT Background: While there have been increased calls for mental health consumers to be involved in mental health services research, there is limited research exploring the research interests of this group. Aims: To compare the interests in different research topics of a peer workforce (people who are employed to use their lived experience of mental illness and recovery to support others) with those of Allied Health Professionals in a Hospital and Health Service. Method: A survey asking participants to rate their interest in researching various topics was distributed to the peer and allied health workforce. Differences between the two groups were tested with the Kruskal–Wallis test for independent samples. Results: The peer workforce consistently rated their interest in all questions as greater than the Allied Health Workforce with five of the seven questions showing statistically significant differences. The median ratings of interest for four of the seven topics were high for both the peer and allied health. These were primarily items on how to help. The peer workforce also expressed a greater interest in being involved in the research. Conclusions: Our study emphasises the importance of creating opportunities for including the peer workforce in all aspects of the research process.

Mental Health of Refugee Children and Youth: Epidemiology, Interventions, and Future Directions.

The number of refugee youth worldwide receives international attention and is a top priority in both academic and political agendas. This article adopts a critical eye in summarizing current epidemiological knowledge of refugee youth mental health as well as interventions aimed to prevent or reduce mental health problems among children and adolescents in both high- and low-to-middle-income countries. We highlight current challenges and limitations of extant literature and present potential opportunities and recommendations in refugee child psychiatric epidemiology and mental health services research for moving forward. In light of the mounting xenophobic sentiments we are presently witnessing across societies, we argue that, as a first step, all epidemiological and intervention research should advocate for social justice to guarantee the safety of and respect for the basic human rights of all refugee populations during their journey and resettlement. A constructive dialogue between scholars and policy makers is warranted.

Population-Based Approaches to Mental Health: History, Strategies, and Evidence.

There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.

Newcomers and Old Timers: An Erroneous Assumption in Mental Health Services Research.

Based on the premise that treatment changes people in ways that are consequential for subsequent treatment-seeking, we question the validity of an unrecognized and apparently inadvertent assumption in mental health services research conducted within a psychiatric epidemiology paradigm. This homogeneity assumption statistically constrains the effects of potential determinants of recent treatment to be identical for former patients and previously untreated persons by omitting treatment history or modeling only main effects. We test this assumption with data from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys; the weighted pooled sample is representative of noninstitutionalized U.S. adults (18+; analytic n = 19,227). Contrary to the homogeneity assumption, some associations with recent treatment are conditional on past treatment, including psychiatric disorder and race-ethnicity-measures of need and treatment disparities, respectively. We conclude that the widespread application of the homogeneity assumption probably masks differences in the determinants of recent use between previously untreated persons and former patients.

Child and Adolescent Mental Health Services in South Africa-Senior Stakeholder Perceptions of Strengths, Weaknesses, Opportunities, and Threats in the Western Cape Province.

Background: There is general consensus that child and adolescent mental health services in low- and middle-income countries have an urgent need to be strengthened. However, this require not only a universal understanding of services and service needs, but also in-depth local knowledge to inform relevant service strengthening. This study sought to explore the perspectives of senior child and adolescent mental health service providers and policy-makers in one South African province to identify strengths, weaknesses, opportunities, and threats to child and adolescent mental health services. Methods: A qualitative study was conducted with 13 purposively sampled senior child and adolescent mental health service providers, senior managers, and policy-makers from the Western Cape Province, using a half-day multi-stakeholder workshop format. Verbal and written data were recorded and coded for analysis. Two independent raters performed thematic analysis. Results: The comprehensive bio-psycho-social approach and strong specialist child and adolescent mental health service units were identified as strengths. Limited capacity, workload demands, inadequate and inequitable resource allocation, poor implementation of early detection and preventative policies, and overall neglect of child and adolescent mental health services, were identified as weaknesses. Collaborative working between child and adolescent mental health and pediatric services, and increased provincial government (Department of Health) involvement, were identified as potential opportunities to develop and strengthen child and adolescent mental health services. Silo working of agencies, societal stressors, inadequate infrastructure and other resources, and lack of dedicated funding for child and adolescent mental health, were identified as threats to the development of services. Conclusions: This analysis of strengths, weaknesses, opportunities, and threats reinforced the widespread neglect of child and adolescent mental health services in South Africa and highlighted areas for further research and advocacy. There is a clear need to explore the perspectives and experiences of service users and providers to generate comprehensive multi-stakeholder evidence that may identify positive "tipping points" for improvements and strengthening of child and adolescent mental health service delivery, training, and research.

Toward an Experimental Therapeutics Approach in Human Services Research.

Over the past decade, the experimental therapeutics approach has gained currency as an organizing framework for research in mental health. However, examples of this approach outside of person-directed therapeutic and preventive interventions have been relatively uncommon. This article describes an experimental therapeutics approach to mental health and human services research that considers the role of social and ecological determinants in a person's recovery from mental disorder. To illustrate this approach, this article decomposes an employment intervention to show three of its components and identifies the targets for two components: social relationships and health insurance. These targets can be engaged by provider-, community-, or policy-level interventions. Such applications of an experimental therapeutics approach to research on mental health services can enhance the rigor of studies and thereby contribute to the well-being of persons living with mental disorders in the United States.

Editorial introductions

Editorial introductions

Promoting and implementing family-focused interventions for families with parental mental illness: scoping and installation

ABSTRACT Objectives: This paper outlines the findings from the first stage of a research programme called PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and Children). This programme aims to identify, help implement and evaluate family-focused interventions for families where a parent has a mental illness, and promote a ‘think family’ service delivery agenda in the Republic of Ireland (RoI). Methods: An initial scoping study was undertaken to: (1) assess the nature and extent of family-focused practice (FFP) in adult (N = 114) and child (N = 69) mental health services in the RoI; (2) review the international literature; and (3) undertake site/service visits to assess readiness for, and inform the implementation of, FFP. Results: A national Expression of Interest (EoI) call led to 37 written submissions (20% response rate) plus six further requests for involvement from interested community services. Fifteen sites/services (35%) were included in the research following critical appraisal and consultation. FFP across services/sites was small-scale or non-existent. Following a literature review and other strategic/resource considerations, all sites were invited to deliver the Family Talk (FT) intervention; 12 agreed to do so; three sites will deliver other programmes. A series of activities was undertaken by the research team to support early implementation. Discussion: This first phase of the research provides a critical starting point for promoting, and assessing the development of, FFP in mental health services in the RoI. Some useful generalisable lessons are also identified in terms of building capacity and beginning to change practice in this field.

What Therapy Practices Do Providers Value in Youth Behavioral Health? A Measure Development Study.

Existing measures of attitudes toward evidence-based practices (EBPs) assess attitudes toward manualized or research-based treatments. Providers of youth behavioral health (N= 282) completed the Valued Practices Inventory (VPI), a new measure of provider attitudes toward specific practices for youth that avoids mention of EBPs by listing specific therapies-some of which are drawn from EBPs (e.g., problem solving) and some of which are not included in EBPs (e.g., dream interpretation). Exploratory factor analysis revealed two factors: practices derived from the evidence base (PDEB) and alternative techniques (AT). The PDEB scale was significantly correlated with scales on the Evidence-Based Practice Attitude Scale-50 (Aarons et al. in Administration and Policy in Mental Health and Mental Health Services Research, 39(5): 331-340, 2012), whereas the AT scale was not. Attitudes toward PDEB and AT were also related to provider characteristics such as years of experience and work setting. The VPI offers a complementary approach to existing measures of attitudes because it avoids mention of EBPs, which may help prevent biases in responses.

Behavioural and emotional problems among school children in Pakistan: A telephonic survey for prevalence and risk factors.

Escalating rates of childhood mental health disorders constitute a serious issue for countries like Pakistan. However, due to a scarce number of studies on childhood behavioural problems, understanding the magnitude and gap of the problem is a challenge. Thus, the present study is intended to bridge this gap. This study provides estimates for prevalence, associated demographic risk factors and the impact of behavioural and emotional problems among school children. A sample of children (n = 800) from public schools of Islamabad were selected using two-stage cluster random sampling. Data were collected from parents through telephonic interviews using the Strengths and Difficulties Questionnaire. Prevalence of overall behaviour problems accounted for 15.9%. For conduct problems, estimates were around 26.6%, for emotional problems 22.5%, for peer problems 13%, for hyperactivity 10.6% and for social problems 3% in the initial analysis. Mother's education also appeared to be a significant predictor for mental health problems of youth, where low maternal education was associated with high prevalence and higher impact of emotional and behavioural problems in the present sample. Prevalence estimates of the current study call for attention towards improving mental health services and access to children who are at risk or are having mental health problems. In the context of scarcity of the data from countries like Pakistan, the findings should be considered a call for mental health service providers, researchers and policymakers to scale up mental health services for youth in Pakistan.

Implementation of early detection and intervention services for psychosis in Central and Eastern Europe: Current status.

Unequal development of early detection (ED) and early intervention (EI) programs/services for psychosis has been shown across Europe. The present report aims to fill in the knowledge gap regarding the implementation and several other important aspects of ED/EI services in Central and Eastern Europe (CEE), a region with highly underdeveloped mental health service research. A 17-item questionnaire was created to address the information regarding ED/EI organization and factors limiting their implementation. This questionnaire was distributed to professionals recognized as experts in the field from 23 CEE countries. The data were collected between December 2017 and February 2018. We found that ED/EI services were rather an exception than a rule in CEE. The majority of the countries involved in the present survey reported no national plans or programmes for ED/EI development. The existing services were mostly state-funded, hospital-based, healthcare sites for both adolescent and adult help-seekers. The lack of adequate infrastructure, finances and governmental support, as well as the insufficient number of staff, were identified as the most important factors limiting service implementation. Although ED/EI services for psychosis exist in some CEE countries, this could be largely attributed to enthusiastic individuals and organizations, rather than to a strategic development. To the best of our knowledge, this was the first mapping of ED/EI development in the region, which could be used as a starting point to plan the improvement of services, to accelerate their implementation and to facilitate timely detection of and intervention in psychosis across Europe.

Machine Learning, Natural Language Processing, and the Electronic Health Record: Innovations in Mental Health Services Research.

An unprecedented amount of clinical information is now available via electronic health records (EHRs). These massive data sets have stimulated opportunities to adapt computational approaches to track and identify target areas for quality improvement in mental health care. In this column, three key areas of EHR data science are described: EHR phenotyping, natural language processing, and predictive modeling. For each of these computational approaches, case examples are provided to illustrate their role in mental health services research. Together, adaptation of these methods underscores the need for standardization and transparency while recognizing the opportunities and challenges ahead.

Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects.

BackgroundEfficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings.ObjectiveThe goal of this program of research is to apply insights from behavioral economics and participatory design to advance the science and practice of implementing evidence-based practice (EBP) for individuals with psychiatric disorders across the life span.MethodsProject 1 (Assisting Depressed Adults in Primary care Treatment [ADAPT]) is patient-focused and leverages decision-making heuristics to compare ways to incentivize adherence to antidepressant medications in the first 6 weeks of treatment among adults newly diagnosed with depression. Project 2 (App for Strengthening Services In Specialized Therapeutic Support [ASSISTS]) is provider-focused and utilizes normative pressure and social status to increase data collection among community mental health workers treating children with autism. Project 3 (Motivating Outpatient Therapists to Implement: Valuing a Team Effort [MOTIVATE]) explores how participatory design can be used to design organizational-level implementation strategies to increase clinician use of EBPs. The projects are supported by a Methods Core that provides expertise in implementation science, behavioral economics, participatory design, measurement, and associated statistical approaches.ResultsEnrollment for project ADAPT started in 2018; results are expected in 2020. Enrollment for project ASSISTS will begin in 2019; results are expected in 2021. Enrollment for project MOTIVATE started in 2018; results are expected in 2019. Data collection had begun for ADAPT and MOTIVATE when this protocol was submitted.ConclusionsThis research will advance the science of implementation through efforts to improve implementation strategy design, measurement, and statistical methods. First, we will test and refine approaches to collaboratively design implementation strategies with stakeholders (eg, discrete choice experiments and innovation tournaments). Second, we will refine the measurement of mechanisms related to heuristics used in decision making. Third, we will develop new ways to test mechanisms in multilevel implementation trials. This trifecta, coupled with findings from our 3 exploratory projects, will lead to improvements in our knowledge of what causes successful implementation, what variables moderate and mediate the effects of those causal factors, and how best to leverage this knowledge to increase the quality of care for people with psychiatric disorders.Trial RegistrationClinicalTrials.gov NCT03441399; https://www.clinicaltrials.gov/ct2/show/NCT03441399 (Archived by WebCite at http://www.webcitation.org/74dRbonBD)International Registered Report Identifier (IRRID)DERR1-10.2196/12121

A Preliminary Study to Determine Comprehensive Research and Development Plans for Promoting Mental Health Services.

ObjectivesThe aim of this study was to analyze research and development projects in mental health services in Korea, using priority evaluation of mental health promotion policies to determine direction of the service.MethodsAn online survey was conducted that targeted experts in the mental health service regarding promotion of mental health in Korea in 2016. The survey was based on 32 policy projects that resulted from 12 strategies according to 4 policy objectives.ResultsAnalysis of 32 mental health projects were assessed regarding the possibility of technology development success, magnitude of the ripple effect, and necessity of a national response. It was observed that 3 policy projects relevant to suicide, had a high relative priority. This was followed by policies for improvement of health insurance and the medical benefit cost system, and policies for reinforcement of crisis psychological support such as those for disaster victims.ConclusionThe prioritization of mental health services should place an emphasis on promotion of a healthy mental lifestyle, rehabilitation support for patients with serious mental illness, and reinforcement of social safety networks for suicide prevention.

IMPROVING MENTAL HEALTH CARE ACCESS, ENGAGEMENT, AND DELIVERY AMONG DIVERSE, UNDERSERVED POPULATIONS

It is well-established that racial/ethnic minority older adults, and other underserved groups, including older adults with severe mental illness, have unmet need for mental health care. Mental health services researchers use a variety of methodologies, such as surveys, interventions, qualitative interviews, and large-scale data analytic techniques, to better assess this unmet need for care, as well as to identify and implement methods to improve access to, engagement in, and delivery of high quality care. This session will highlight some of the truly exceptional and diverse work that has been done in the area of geriatric mental health services research. Using mental health services research methodology, speakers will present data on disparities in mental health care, prevention of mental illness, health promotion, and technology. Particular attention will be paid to the diversity of methods mental health services researchers employ in order to address the diverse and complex mental health needs of older adults.

Tools and Techniques of Implementation Science to Support Wide-Spread Adoption of Biodiversity Literacy Standards

Implementation science boasts tools and techniques to increase the chances of adoption of best practices to a wide variety of users. Theoretical roots of implementation science are present in education, mental health and health services research. This talk will highlight the application of implementation science principles to the wide-spread adoption of biodiversity data literacy standards. Perspectives from key stakeholders including biology instructors of all ranks at community colleges, minority serving institutions, primarily undergraduate institutions, research intensive universities, biodiversity researchers, and scientific society leaders and policy makers, will be presented according to need, fit, resources, capacity and readiness to support the implementation of biodiversity data literacy standards in undergraduate biology curriculums. Through systematic exploration of the facilitators and barriers to the implementation of biodiversity data literacy standards across multiple participants and people groups, specific action steps will be highlighted to address such barriers. Consistent with the Vision and Change in Undergraduate Biology Education: A Call to Action, this talk will describe the collaborations completed and in-process by the BLUE network that support an accessible student and data-centered pedagogy, designed to support diverse and underrepresented learners. For example, core biodiversity data literacy competencies will be described according to field leaders and perceived barriers to implementation of these competencies will provide a springboard for further discussion and action. Principles of implementation science explicitly recognize that best practices such as biodiversity data literacy standards, are useful only if they reach diverse intended users – otherwise, best practices and core competencies may have the opposite effect – contributing to educational and health disparities. This talk will highlight the active implementation strategies BLUE has employed to support engagement across distinct people groups to support implementation of these standards. As opposed to developing standards and having a “wait and hope” approach to these standards distilling to undergraduate biology curriculums, strategies discussed in this talk will serve as a catalyst for wide-spread adoption of the standards scientists have worked so rigorously to foster.

Psychotherapy of psychotic disorders

Psychotherapy of psychotic disorders Abstract. The efficacy of psychotherapy for individuals with psychotic disorders is well documented and its implementation is recommended by international guidelines. Goals of psychotherapeutic interventions are reduction of symptoms, prevention of relapse, improvement of cognitive, emotional and social functioning, social integration and participation, and enhancement of quality of life as well as self-perception. Cognitive-behavioral and family interventions, cognitive and social trainings as well as psychoeducation are particularly recommended according to the literature. Fundamental factors for a favorable treatment result are a profound therapeutic relationship, a therapeutic setting according to patients' needs, and a specific coordination with other interventions within the individual treatment concept. The implementation of evidence-based psychotherapeutic interventions for individuals with psychotic disorders in clinical routine practice seems to be most challenging for future mental health service organization and research.

NorthBEAT’s Capacity-to-Consent Protocol for Obtaining Informed Consent from Youth Evaluation Participants: An Alternative to Parental Consent

Abstract: Ethical practice compels evaluators to obtain informed consent from evaluation participants. When those participants are minors, parental consent is routinely sought. However, seeking parental consent may not be appropriate in all evaluation contexts. This practice note presents one context (mental health services research in rural Canada) where seeking parental consent for youths’ participation in research was considered unethical and unfeasible. We present a two-step “capacity-to-consent” protocol that we developed to obtain consent from youth participants. This protocol offers an ethical and feasible alternative to seeking parental consent for youth. The implications for evaluation practice are discussed.

Session 327 - Improving Mental Health Care Access, Engagement, and Delivery among Diverse, Underserved Populations: Collaborations From the Geriatric Mental Health Services Research T32 Postdoctoral Fellowship

Session 327 - Improving Mental Health Care Access, Engagement, and Delivery among Diverse, Underserved Populations: Collaborations From the Geriatric Mental Health Services Research T32 Postdoctoral Fellowship

Bisexual Women's Experience of Microaggressions and Microaffirmations: A Community-Based, Mixed-Methods Scale Development Project.

In order to better serve bisexual women, clinicians and researchers need tools that accurately reflect and capture bisexual women's experiences of stigma and affirmation. These tools are essential as research indicates that bisexual women experience poorer mental health than either heterosexual or lesbian women. Our community-based study developed and psychometrically evaluated the Bisexual Microaggression and Microaffirmation Scales for Women (BMMS-W). We held focus groups and advisory committee meetings with bisexual women to identify common experiences of microaggressions and microaffirmations and drafted over 200 potential survey items. Exploratory factor analysis of data from 382 participants across Canada and the U.S. yielded five microaggression factors (dismissal; mistrust; sexualization; social exclusion; and denial of complexity) and four microaffirmation factors (acceptance; social support; recognition of bisexuality and biphobia; and emotional support). Confirmatory factor analysis of data from a separate sample of 323 participants across Canada and the U.S. tested the model. The development of the BMMS-W responds to calls to examine the distinctiveness of bisexual women's experience and gives mental health service providers and researchers a tool to better understand their experiences.