Mental Health Services Research Research Articles

Network power and mental health policy in post-war Liberia.

This article traces the influence of network power on mental health policy in Liberia, a low-income, post-conflict West African country. Based on key informant interviews, focus group discussions and document analysis, the work uses an inductive approach to uncover how a network of civil society groups, government officials, diasporans and international NGOs shaped the passage, implementation and revision of the country's 2009 and 2016 mental health policies. With relations rooted in ties of information, expertise, resources, commitment and personal connections, the network coalesced around a key agent, the Carter Center, which connected members and guided initiatives. Network power was evident when these actors channelled expertise, shared narratives of post-war trauma and mental health as a human right, and financial resources to influence policy. Feedback loops appeared as policy implementation created new associations of mental health clinicians and service users, research entities and training institutes. These beneficiaries offered the network information from lived experiences, while also pressing their own interests in subsequent policy revisions. As the network expanded over time, some network members gained greater autonomy from the key agent. Network power outcomes included the creation of government mental health institutions, workforce development, increased public awareness, civil society mobilization and a line for mental health in the government budget, though concerns about network overstretch and key agent commitment emerged over time. The Liberian case illustrates how networks need not be inimical to development, and how network power may facilitate action on stigmatized, unpopular issues in contexts with low state capacity. A focus on network power in health shows how power can operate not only through discrete resources such as funding but also through the totality of assets that network linkages make possible.

Early developments of psychiatric epidemiology in Chile: a local history with global implications

Abstract This viewpoint discusses a conference paper titled: “Epidemiological research on mental morbidity in Chile”, which summarizes a handful of studies from 1950s in Chile covering conditions such as alcoholism, psychosis, epilepsy, and neurosis. These were the first psychiatric epidemiological population studies conducted in the Southern hemisphere, but they are largely unknown globally. We argue that the Chilean studies have important implications for modern psychiatric epidemiology, as well as for related fields such as global mental health and mental health services research. This piece starts by describing the general sociopolitical context and presenting the main methodological features of the studies. It focuses then on three specific implications for the field: 1) promoting decoloniality in psychiatric epidemiology; 2) ensuring methodological rigor and feasibility; and 3) informing the development of mental health policy and services.

Digital mental health interventions for the mental health care of refugees and asylum seekers: Integrative literature review.

This study aimed to provide a critical analysis of the current literature on the use of digital mental health interventions (DMHIs) for the management and treatment of mental health disorders among refugees and asylum seekers. These groups are among the most disadvantaged compared to the general population in terms of health and socio-economic status, due to conflicts and wars. The number of refugees fleeing their home countries is growing exponentially, and refugees experience trauma, torture, persecution and human right abuses, which have a profound effect on their mental health and overall well-being. The researchers conducted an integrative literature review from electronic databases Medline, CINAHL and Google Scholar, selecting articles published in English from 2010 to 2023. The thematic analysis of the 10 articles identified in the review revealed four main themes and two sub-themes: (1) types of digital health intervention/apps used; (2) barriers encountered in digital health intervention; (3) user experience of the digital health intervention and (4) mapping gaps. Two sub-themes were identified located in Theme 2: (2.1) Language and demographic barriers and (2.2) Structural barriers. The study showed that the use of DMHIs was associated with positive experiences among refugees and asylum seekers. Limited mental health care is offered to refugees and asylum seekers due to a range of logistical, political, economic, geographical, language, cultural and social barriers. DMHIs have the potential to overcome and/or moderate these barriers. The study concludes that the scaled implementation of effective DMHIs holds the possibility to improve the wider distribution of mental health care among refugees and asylum seekers. However, further research is needed to confirm the effectiveness of DMHIs and to scale up studies for their utilisation among this group. In summary, this study highlights the potential of DMHIs in improving the mental health care of refugees and asylum seekers. The results of this study have important implications for mental health service providers, policymakers and researchers to address the mental health needs of this vulnerable/priority group.

Doing research in non-specialist mental health services for children and young people: lessons learnt from a process evaluation of the ICALM (Interpersonal Counselling for Adolescent Low Mood) feasibility randomised controlled trial

BackgroundThe rising prevalence of adolescent mild depression in the UK and the paucity of evidence-based interventions in non-specialist sectors where most cases present, creates an urgent need for early psychological interventions. Randomised controlled trials (RCTs) are considered the gold standard for obtaining unbiased estimates of intervention effectiveness. However, the complexity of mental health settings poses great challenges for effectiveness evaluations. This paper reports learning from an embedded process evaluation of the ICALM RCT which tested the feasibility of delivering Interpersonal Counselling for Adolescents (IPC-A) plus Treatment as Usual (TAU) versus TAU only for adolescent (age 12–18) mild depression by non-qualified mental health professionals in non-specialist sectors.MethodsA qualitative mixed methods process evaluation, drawing on Bronfenbrenner’s socioecological model to investigate key influences on trial delivery across macro-(e.g. policy), meso-(e.g. service characteristics) and micro-(e.g. on-site trial processes) contextual levels. Data collection methods included 9 site questionnaires, 4 observations of team meetings, policy documents, and 18 interviews with stakeholders including therapists, heads of service and managers. Thematic analysis focused on understanding how contextual features shaped trial implementation.ResultsThe ICALM trial concluded in 2022 having only randomised 14 out of the target 60 young people. At a macro-level, trial delivery was impacted by the COVID-19 pandemic, with services reporting a sharp increase in cases of (social) anxiety over low mood, and backlogs at central referral points which prolonged waiting times for mild cases (e.g. low mood). An interaction between high demand and lack of capacity at a meso-service level led to low prioritisation of trial activities at a micro-level. Unfamiliarity with research processes (e.g. randomisation) and variation in TAU support also accentuated the complexities of conducting an RCT in this setting.ConclusionsConducting a RCT of IPC-A in non-specialist services is not feasible in the current context. Failure to conduct effectiveness trials in this setting has clinical implications, potentially resulting in escalation of mild mental health problems. Research done in this setting should adopt pragmatic and innovative recruitment and engagement approaches (e.g. creating new referral pathways) and consider alternative trial designs, e.g. cluster, stepped-wedge or non-controlled studies using complex systems approaches to embrace contextual complexity.Trial registrationISRCTN registry, ISRCTN82180413. Registered on 31 December 2019.

From paper to practice: implementing integrated care for youth-at risk

Background: At present, professionals experience difficulties applying known facilitators and barriers of integrated care in practice [1]. This is particularly intricate when working with youth at-risk and their families. These families have a diversity of problems in different life-areas, that often do not seek or accept care, and with a continuing risk of crisis situations occurring. To improve integrated care for youth at-risk, we aimed at deepening insights into how to enable facilitators or overcome barriers when implementing integrated care for youth at risk.
 Targeted population and stakeholders: The overall study design comprises practice-based action research. The primary focus of this study is on the perspective of Youth Care professionals, policymakers and youth at-risk in the Dutch Youth Care system. This study is designed and monitored in co-creation with professionals, policymakers and youth representatives. By organizing learning sessions based on the results of the study, professionals and other stakeholders are stimulated to learn and improve the quality of care for youth at-risk. 
 Method: For the aim of this study, we conducted 31 semi-structured interviews, observations with different stakeholders and one learning session with a youth and parent representative, professionals, and policymakers within a network of an integrated care initiative for youth at-risk. To analyse the transcripts, learning session and observation reports, we conducted a thematic analysis both deductively and inductively.
 Results: The implementation of integrated care for youth at risk seemed to be influenced by three underlying mechanisms: mandate, care coordination, and professional autonomy. Neither mandate, nor care coordination, nor professional autonomy was reported as lying with one person or organization and shifted between them depending on the specific case. When there was a lack of, or insufficient agreement on professional autonomy, mandate, or care coordination, it became extremely difficult for the professionals involved to provide integrated care in practice. Specifically in crisis situations, when clarity on mandate, care coordination, and professional autonomy was urgent but often lacking in practice. This led to indecisiveness and inappropriate support or no care provision at all. At the same time when these mechanisms were present: integrated care for youth at-risk was more easily realized. 
 Conclusions: Providing integrated care for youth at-risk is a joint effort. The different organizations need to specify with every new case who is involved and what their role and responsibility is, in order to offer youth at-risk the care they need. Therefore, professionals and organizations need to realize, understand and act on the underlying mechanisms mandate, care coordination and professional autonomy when providing integrated care for youth at-risk. Future studies are needed to establish whether and if so, what, other underlying mechanisms are crucial when providing integrated care for youth at risk in practice and how these mechanisms are successfully implemented. 
 Reference: 1.Nooteboom LA, Mulder EA, Kuiper CH, Colins OF, Vermeiren RRJM. Towards integrated youth care: A systematic review of facilitators and barriers for professionals. Administration and Policy in Mental Health and Mental Health Services Research. 2020;48(1):88–105.

Protocol Development for a Qualitative Methodological Study Within a Trial (Qual-SWAT): The KARMA-Dep-2 Trial

Background Despite methodological improvements in clinical trial design and conduct more generally, methodological limitations persist in trials concerning mental health care. A qualitative Study Within A Trial (Qual-SWAT), embedded in the KARMA-Dep-2 host trial, will be undertaken to explore and gain an understanding of two methodological questions in randomised trials specific to mental health care: (1) what are the key barriers and enablers of participation in randomised trials in mental health; and (2) how can randomised trials become part of routine mental health care. These issues will be examined from patient-participant and clinician- / researcher-participant perspectives, in alignment with PRioRiTy research themes. Methods A descriptive qualitative study design will be used. Data will be collected via one-to-one semi-structured interviews, conducted via Microsoft Teams. The interview data will be analysed using Braun and Clarke’s Thematic Analysis approach. One-to-one interviews will be conducted with three participant groups (N = 30): 1) host trial patient-participants (n = 10); 2) potentially eligible host trial patient-participants who refused enrolment in the host trial (n = 10); and 3) clinician- / researcher-participants who are associated with work on the host trial (n = 10). Ethics and dissemination Ethical approval has been granted by St. Patrick’s Mental Health Services Research Ethics Committee, Ireland (Ref: Protocol 09/20). When the study is completed, a report will be prepared and submitted to the Health Research Board (HRB). Findings will be shared with the host trial team and study participants, and submitted for publication. Host trial registration ClinicalTrials.gov (NCT04939649); EudraCT (2019-003109-92). Official title: Ketamine as an Adjunctive Therapy for Major Depression - A Randomised Controlled Trial: [KARMA-Dep (2)].

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Editorial introductions.

Editorial introductions.

Protocol Development for a Qualitative Methodological Study Within a Trial (Qual-SWAT): The KARMA-Dep-2 Trial.

Despite methodological improvements in clinical trial design and conduct more generally, methodological limitations persist in trials concerning mental health care. A qualitative Study Within A Trial (Qual-SWAT), embedded in the KARMA-Dep-2 host trial, will be undertaken to explore and gain an understanding of two methodological questions in randomised trials specific to mental health care: (1) what are the key barriers and enablers of participation in randomised trials in mental health; and (2) how can randomised trials become part of routine mental health care. These issues will be examined from patient-participant and clinician- / researcher-participant perspectives, in alignment with PRioRiTy research themes. A descriptive qualitative study design will be used. Data will be collected via one-to-one semi-structured interviews, conducted via Microsoft Teams. The interview data will be analysed using Braun and Clarke's Thematic Analysis approach. One-to-one interviews will be conducted with three participant groups ( N = 30): 1) host trial patient-participants ( n = 10); 2) potentially eligible host trial patient-participants who refused enrolment in the host trial ( n = 10); and 3) clinician- / researcher-participants who are associated with work on the host trial ( n = 10). Ethical approval has been granted by St. Patrick's Mental Health Services Research Ethics Committee, Ireland (Ref: Protocol 09/20). When the study is completed, a report will be prepared and submitted to the Health Research Board (HRB). Findings will be shared with the host trial team and study participants, and submitted for publication. ClinicalTrials.gov ( NCT04939649); EudraCT ( 2019-003109-92). Official title: Ketamine as an Adjunctive Therapy for Major Depression - A Randomised Controlled Trial: [KARMA-Dep (2)].

Psychometric properties of the mock interview rating scale for schizophrenia and other serious mental illnesses.

Over the past 10 years, job interview training has emerged as an area of study among adults with schizophrenia and other serious mental illnesses who face significant challenges when navigating job interviews. The field of mental health services research has limited access to assessments of job interview skills with rigorously evaluated psychometric properties. We sought to evaluate the initial psychometric properties of a measure assessing job interview skills via role-play performance. As part of a randomized controlled trial, 90 adults with schizophrenia or other serious mental illnesses completed a job interview role-play assessment with eight items (and scored using anchors) called the mock interview rating scale (MIRS). A classical test theory analysis was conducted including confirmatory factor analyses, Rasch model analysis and calibration, and differential item functioning; along with inter-rater, internal consistency, and test-retest reliabilities. Pearson correlations were used to evaluate construct, convergent, divergent, criterion, and predictive validity by correlating the MIRS with demographic, clinical, cognitive, work history measures, and employment outcomes. Our analyses resulted in the removal of a single item (sounding honest) and yielded a unidimensional total score measurement with support for its inter-rater reliability, internal consistency, and test-retest reliability. There was initial support for the construct, convergent, criterion, and predictive validities of the MIRS, as it correlated with measures of social competence, neurocognition, valuing job interview training, and employment outcomes. Meanwhile, the lack of correlations with race, physical health, and substance abuse lent support for divergent validity. This study presents initial evidence that the seven-item version of the MIRS has acceptable psychometric properties supporting its use to assess job interview skills reliably and validly among adults with schizophrenia and other serious mental illnesses. NCT03049813.

Accelerating youth mental health services research.

We describe a research program to advance youth mental health service research in Australia, addressing two core knowledge gaps: the lack of available routine outcome measures and lack of understanding of how to assess and monitor complexity and heterogeneity in illness presentation and trajectory. Our research identifies better routine outcome measures (ROM) that are: designed specifically for the developmental nuances of the 12-25-year age range; multidimensional; and meaningful to young people, their carers, and service providers. Alongside much-needed new measures of complexity and heterogeneity, these tools will inform service providers to better meet the needs of young people presenting with mental health problems.

Barriers to Meaningful Participatory Mental Health Services Research and Priority Next Steps: Findings From a National Survey.

A growing consensus has emerged regarding the importance of stakeholder involvement in mental health services research. To identify barriers to and the extent of stakeholder involvement in participatory research, the authors undertook a mixed-methods study of researchers and community members who reported participation in such research. Eight consultative focus groups were conducted with diverse groups of stakeholders in mental health services research (N=51 unique participants, mostly service users), followed by a survey of service users, family members, community providers, and researchers (N=98) with participatory research experience. Focus groups helped identify facilitators and barriers to meaningful research collaboration, which were operationalized in the national survey. Participants were also asked about high-priority next steps. The barrier most strongly endorsed as a large or very large problem in the field was lack of funding for stakeholder-led mental health services research (76%), followed by lack of researcher training in participatory methods (74%) and insufficiently diverse backgrounds among stakeholders (69%). The two most frequently identified high-priority next steps were ensuring training and continuing education for researchers and stakeholders (33%) and authentically centering lived experience and reducing tokenism in research (26%). These findings suggest a need for increased attention to and investment in the development, implementation, and sustainment of participatory methods that prioritize collaboration with direct stakeholders, particularly service users, in U.S. mental health services research. The findings also underscore the presence and potentially important role of researchers who dually identify as service users and actively contribute a broader orientation from the service user-survivor movement.

Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India.

Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.

Mental health service accessibility, development and research priority setting in Cambodia - a post-conflict nation

BackgroundThe limited health and social care infrastructure that existed in the 1970s in Cambodia was destroyed due to the Khmer Rouge. Mental Health service infrastructures have developed in Cambodia in the last twenty five years, however, they have been shaped significantly by very limited funding being made available for human resources, support services and research. The lack of research on Cambodia’s mental health systems and services is a significant barrier to the development of evidence-based mental health policies and practice. In order to address this barrier, effective research and development strategies are needed in Cambodia, which are based on locally well-informed research priorities. There are many possibilities for mental health research in LMIC countries such as Cambodia, therefore focused research priorities in these areas are needed to guide future research investment. This paper is the result of the development of international collaborative workshops, which focused on service mapping and research priority setting in the field of mental health in Cambodia. MethodsA nominal group technique was used to gather ideas and insights from a range of key mental health service stakeholders in Cambodia. Results: The key issues in service provisions for people with mental health issues and disorders, the interventions and programmes of support available, and currently needed, were identified. This paper also identifies five key mental health research priority areas which could form the basis for effective mental health research and development strategies in Cambodia. ConclusionThere is a clear need for the Cambodian government to devise a clear policy framework for health research. This framework could focus on the five research domains identified in this paper and could be incorporated within its National Health Strategic plans. The implementation of this approach would likely lead to the development of an evidence base which would allow the development of effective and sustainable strategies for mental health problem prevention and intervention. This would also contribute to promote the Cambodian government’s capacity to take the deliberate, concrete, and targeted steps necessary to address the complex mental health needs of its population.

Realigning theory with evidence to understand the role of care coordination in mental health services research.

Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.

Psychiatrization, assertions of epistemic justice, and the question of agency.

Thus far, the concept of epistemic injustice in the context of psychiatry has been discussed more widely by clinical academics than by authors with personal experience of psychiatrization. It is from the latter perspective that I critique the practice of attributing testimonial injustice solely to the "stigma against mental illness", and point to psychiatric diagnosing itself as a principal enabler and re-producer of this form of injustice. In relation to hermeneutical justice, I take a closer look at initiatives seeking to incorporate (collective) first-person knowledge into the epistemic systems that currently dominate mental-health service provision and research. Highlighting the incompatibility of psychiatric knowledge claims with first-person ways of knowing, I discuss some of the issues and challenges involved in achieving epistemic justice for psychiatrized people and advancing our collective knowledge base. Finally, I turn to the questions of identity and agency in these processes.

Innovative Mental Health Services Research Not Involving Clinical Trials (NIMH)

Federal Grants & ContractsVolume 47, Issue 5 p. 7-7 Grants Alerts Innovative Mental Health Services Research Not Involving Clinical Trials (NIMH) First published: 31 January 2023 https://doi.org/10.1002/fgc.32846Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume47, Issue52 February 2023Pages 7-7 RelatedInformation

Development of a social skills training programme to target social isolation using virtual reality technology in primary mental health care.

People with severe mental illness often have a small or no network of friends and limited contact with their family and live social isolated lives. We developed a social skills training programme to be administered by public mental health professionals in helping those with mental illness to overcome their social isolation. The programme was developed over 3years in close collaboration among psychologists, service users, municipal mental health professionals, mental health service researchers and a local firm providing virtual reality (VR) training. We started with the simplest available equipment, that is, a cardboard headset combined with a smartphone, then we used Oculus Quest and now Oculus Quest 2. The resulting programme is comprised of eight steps from: 1) identify service user's primary and secondary goals to 8) three-month follow-up. Several factors made adoption and implementation of VR technology possible in a relatively short timeframe: namely, the municipality and service users were involved from the beginning of the development process, efforts were made to introduce VR to mental health professionals and allow them to reflect on its usability, solutions were low-tech and low cost, and the long-term research collaboration was established without municipal financial obligations.

"Shifting the Curve": New Developments and Challenges in the Field of Public Mental Health

In recent years, the field of public mental health has received increasing attention in national and international research. However, a key challenge remains to map this field in its interdisciplinarity across the entire spectrum of mental health and lead the discourse between public health, psychiatric epidemiology, mental health promotion, prevention, and health services research in order to realize more fully its innovative potential for improving mental health at the population level. In this interdisciplinary discourse, a number of fundamental conceptual and methodological issues arise, which will be discussed in this essay in relation to Geoffrey Rose's population strategy. In a national initiative across relevant learned societies that has recently been formed, these issues are currently starting to be addressed, also in relation to fundamental causes of social and health inequalities, which ultimately is geared towards more tangible strategies for improving mental health at the population.

Self-reported needs of people living with psychotic disorders: Results from the Australian national psychosis survey.

Person-centered care is a collaborative approach to health care. To provide effective, person-centered care to people living with severe mental illness, it is necessary to understand how people view their own needs. The Perceived Need for Care Questionnaire (PNCQ) was used in the Australian National Survey of High Impact Psychosis (SHIP) to deepen understanding and evaluate, at a population level, the needs of Australian adults living with psychotic illness. SHIP participants were 1,825 adults, aged 18–65 years, living with psychotic illness and in contact with public specialized mental health services across Australia in 2010. The survey package included demographic and clinical items, and various scales including the PNCQ appraising a comprehensive range of life domains. Logistic regressions measured the impact that various demographic, clinical and psychosocial independent variables (e.g., loneliness, health-related quality of life, disability, accommodation type) had on the likelihood of inadequately met PNCQ domain-related need. Over two-thirds of people living with psychosis reported at least two areas of unmet need for care despite most being in contact with mental health services. Work or using one's time and socializing, counseling, and self-care domains had the largest proportion of inadequately met needs (range between 49 and 57%). Feelings of loneliness and/or social isolation were significantly associated with unmet needs across all PNCQ domains, except for financial needs. Health-related quality of life was significantly associated with unmet needs across all domains, except for housing needs. Disability was significantly associated with unmet social, occupation (work or time use), housing and medication-related needs. Consumers view their needs for care as unmet across many life areas despite being in contact with mental health services. Loneliness, unmet psychosocial needs, and health-related quality of life appear strongly interconnected and warrant greater attention in the delivery of person-centered care for people living with psychosis. Support to address social, work or time use and housing related needs among people living with psychosis appears less well targeted toward those with disability. Results underscore the link between quality of life, recovery and needs. These inter-relationships should be considered in mental health services research and evaluation.