Mental Facilities Research Articles

Covid-19 and mental health hospitalizations in Italy. Results from a multicenter longitudinal cohort

Abstract Background The impact of Covid-19 pandemic on mental health (MH) is still being assessed. The aim of this study was to evaluate the impact of Covid-19 on ordinary hospital admissions for psychiatric disorders in Italy. Methods The multicenter project “Covid-19 and mental health” (CoMeH), coordinated by the National Institute for Health, Migration and Poverty, enrolled an open cohort of subjects resident in three large areas of Italy (2018-2021) aged 10 + (N = 5,159,363), and followed-up until 2021. The study outcome was the first ordinary admission with a psychiatric disorder as main diagnosis (FMHA). Citizenship and deprivation level (DL) are the socioeconomic factor considered. Different groups of diagnosis were used to characterize the hospitalizations. The impact of Covid-19 on FMHAs was evaluated by interrupted time series (ITS) analysis, pre (until February 2020) and post (from March 2020) the outbreak of pandemic, using a step-change model. Results 11,171 FMHAs were observed. Patients hospitalized with a MH diagnosis were younger compared to the study population; the distributions by sex, deprivation level and citizenship were similar. A decrease of incidence of FMHAs was found after the outbreak of the pandemic, overall and for all group of diagnoses, except for post-traumatic stress disorders (PTSD). A reduction in adjusted FMHA rates after the onset of Covid-19 (RR 0.80[0.72-0.90]) were observed through multivariate ITS. The oldest patients had the lowest probabilities of FMHAs in pre Covid-19 and experienced the highest reduction in post-Covid19. PTSD presented trend in countertendency compared with the other diagnosis, with an immediate effect of Covid-19 increasing FMHAs (+97%), followed by a post-outbreak return to the pre-pandemic levels, below the counterfactual line. Conclusions Covid-19 pandemic determined a general reduction of admissions for psychiatric disorders. A significant impact was observed among the eldest (decrease) and for PTSD (increase). Key messages • Covid-19 pandemic determined a reduction of admissions for psychiatric disorders. • Older people were mostly affected. No significant socioeconomic impact was observed.

Barriers to advocacy for recovery and wellbeing: a mixed methods study of challenges faced by mental health hospital social workers in Ontario, Canada

ABSTRACT Although advocacy is a key process in social work practice, there is a dearth of research on the constraints experienced in engaging in this process. Drawing on a larger project on frontline social workers’ advocacy practices, this paper focuses on barriers hospital mental health social workers face as they advocate against systemic inequity and support recovery for clients with serious mental illness. Using descriptive statistics and reflexive thematic analyses of an online survey (n = 43) and in-depth interviews (n = 12), this article presents the intertwined macro, mezzo, and micro-level barriers social workers encounter as they advocate to promote client, family, and community wellbeing.

Stigma and fear of schizophrenia and severe mental illness: the positive effect of peer support

Purpose The purpose of this service user narrative is to highlight the stigma and prejudice that is often targeted at people with schizophrenia and severe mental illness, which causes fear and isolation. The therapeutic effect of peer support is further explored as offering hope, connection, aspirations, advocacy, autonomy and openness for service users as well as the possibility of recovery and a reduction in feelings of stigma, prejudice and exclusion. Design/methodology/approach Ben was diagnosed with paranoid schizophrenia in 2003, so this paper draws on over 20 years of experience of the harmful label of schizophrenia. In the last 15 months, he has been working as a peer worker on a men’s mental health ward in the East of England. He has kept a reflective journal and conducted participant observation on the ward, which informs this paper and its findings. Findings There are observations based on peer support on the ward in the last 15 months and over 20 years as a schizophrenic. People with schizophrenia and severe mental illness are stigmatised and experience discrimination and prejudice. This paper introduces the new idea and neologisms of schizophobia and insanophobia that people with severe mental illness will experience in their daily lives, in health and social care settings (such as the men’s ward), in education and in employment. People with mental illness are also often discriminated against as being a danger or a risk to themselves and others. They are often considered as aggressive or violent. Their diagnosis can stop them from getting a job, a mortgage or even from travelling to some places in the world. But this paper details the violent assault by a nurse on a patient while Ben was working on a long stay ward in a large psychiatric asylum in 1990. It is pertinent to note that things have progressed since the 1990's but there continues to be the stigmatisation of people with a severe mental illness, which requires societal and systemic change. In Ben’s experience, people with mental illness seem far more likely to experience violence upon their person rather than being violent towards other people, such as staff, members of the public, family or carers. Originality/value This service user narrative is a first person account, so it is original. It is of further value because it outlines the ways in which peer support can help with feelings of stigma and exclusion as well openness about hearing voices/ seeing things (hallucinations) and strange thought or beliefs (delusions).

Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis.

We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann-Whitney U = 25925, Z = -2.832, P = 0.005) and had longer hospital stays (Mann-Whitney U = 22816, Z = -4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann-Whitney U = 22 909.5, Z = -4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

Implementation of an electronic patient portal in routine mental health care of hospitals in Germany – evaluation of attitudes of healthcare providers

BackgroundThe use of digital tools such as electronic patient portals in different health care disciplines and settings has been increasing, but the rate of implementation in clinical practice still lags behind expectations. While studies have linked the use of electronic patient portals to positive health outcomes for patients, studies addressing the viewpoints of healthcare providers are rare.MethodsWe performed an online survey of attitudes of healthcare providers towards an electronic patient portal for mental health hospitals. The portal was developed by five communal providers of mental health care in different regions in Germany. The survey was carried out during the early phase of implementation of the portal.ResultsTwenty project leaders and 37 clinicians from five different mental health hospitals answered the questionnaire (response rate: 45% and 28%). Overall, acceptance of online applications among respondents was high. The healthcare providers mentioned perceived benefits (e.g. accessibility of new patient groups, use of therapy-free periods) as well as a number of technical, structural, organizational and staffing barriers for successful implementation in hospital settings (e.g. workload of healthcare providers and lack of staff, limited digital competences, unstable WLAN).ConclusionThe perceived barriers and facilitators of the implementation of online applications and electronic patient portals in mental health hospitals identified by healthcare providers may be taken into account. Improving commitment of the healthcare providers to implementation and use of digital interventions may help foster digitalisation in mental health hospitals.

Professional reintegration of stroke survivors and their mental health, quality of life and community integration

PurposeTo assess the association between professional reintegration and mental health, quality of life (QoL) and community reintegration of stroke survivors.MethodsUsing a cross-sectional study design, a structured questionnaire was administered to previously working stroke survivors, 18–24 months post-stroke. Data on sociodemographic characteristics, professional reintegration (prevalence of return to work (RTW), period of RTW, job placement, function at work, reintegration support, association of stroke with work and number of working hours), mental health (Hospital Anxiety and Depression Questionnaire), QoL (Stroke Specific Quality of Life Scale) and community integration (Community Integration Questionnaire) were reported by 553 stroke survivors.ResultsTwenty months after stroke, 313 (56.6%; 95%CI 52.4–60.8) stroke survivors had return to work. RTW was positively associated with both global and sub-domains scores of Community Integration Questionnaire (CIQ) (global CIQ β = 3.50; 95%CI 3.30–3.79) and with depressive symptomatology (β = 0.63; 95%CI 0.20–1.46) measured by the Hospital Anxiety and Depression Scale. No significant differences were found regarding QoL, according to RTW status. For those who RTW, no significant associations were found between any of the professional reintegration determinants assessed and mental health, QoL and community integration scores.ConclusionsRTW seems to be associated to better community integration after stroke, but appears to be negatively associated to stroke survivor’s mental health, namely considering depression symptoms. Future studies should explore the barriers to stroke survivors’ RTW and the challenges and strategies used to overcome them, to allow the development of professional reintegration policies.

Depression, anxiety and coping mechanisms among mental healthcare practitioners during COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has placed the psychological functioning of mental healthcare practitioners under severe strain. Coping methods may affect mental health outcomes. The study examined the relationship between depression, anxiety, stress, and coping styles utilised by mental healthcare practitioners during the COVID-19 pandemic. Three private and one public mental healthcare facility in Bloemfontein, South Africa. Respondents completed the Depression, Anxiety and Stress Scale (DASS-21) and Brief Coping Orientation to Problems Experienced (Brief-COPE) inventories. An ordinal regression model was used to assess the relationship between coping styles, anxiety and depression. A total of 212 practitioners were included in the analysis. According to DASS-21 measures, approximately 41% and 28% of respondents had moderate to severe depressive and anxiety symptoms, respectively, with the highest prevalence among younger female respondents and nurses. The association between stress severity, anxiety and depression was significant. Avoidant coping methods and two approach coping strategies (planning and acceptance) were associated with depression and anxiety. Anxiety was linked to an increased likelihood of transitioning to higher avoidant categories, while participants with depression were less likely to move to higher avoidant or approach categories. Mental healthcare practitioners, especially nurses, experienced significant COVID-19-related psychological distress during the pandemic. Avoidant coping mechanisms may increase the risk of poor mental health outcomes. This study added data on the mental health effects of COVID-19 on mental healthcare practitioners, as well as psychological methods used to cope during the pandemic.

Improving the Use of Sensory Approaches in an Acute Inpatient Mental Health Unit Using a Co-Designed Multifaceted Implementation Strategy.

Despite the therapeutic benefits of sensory approaches being well documented, little research has focused on improving their implementation in acute mental health units. The use of implementation frameworks to improve the use of evidence-based practices has shown promising results in healthcare; however, there is little evidence for their use in acute mental health units. A pre-post comparison design was used to determine the effect of an 11-month co-designed theory-informed multifaceted implementation strategy on the use of sensory approaches and the use of seclusion/restraint in one acute mental health ward. This study was guided by Integrated Knowledge Translation (IKT) and informed by the Behaviour Change Wheel (BCW) approach. Implementation strategies were co-designed and included provision of sensory materials/resources; education/training; prompts/reminders; modelling; audit and feedback; workplace coalition; and facilitation. Data were collected through pre- and post-project questionnaires (pre- n = 37, post- n = 40) and routine clinical data. Data were analysed using SPSS and thematic analysis. Data for matched pairs (n = 19) revealed significant improvements between pre- and post-perceived levels of knowledge and confidence in using sensory approaches. Significant increases were found in the use of sensory kits, weighted modalities and sensory assessment/plans. Post participants' recommendations to sustain the use of sensory approaches in their unit included ongoing training; funding; maintenance and supply of sensory equipment; increased staffing; and support from colleagues. This is the first study to use the IKT and BCW to design, facilitate and evaluate a co-designed, theory-informed implementation strategy to improve the use of sensory approaches in an acute mental health unit.

Seclusion and mechanical restraint in the wake of the COVID-19 pandemic: an increased use in mental health settings.

COVID-19 pandemic-related restrictions have significantly changed the environment and the delivery of direct care in all health services, including psychiatric hospitals. The aim of the study is two-fold: 1) to retrospectively assess the incidence of seclusion and mechanical restraint in a Quebec mental health hospital over 4 years; and 2) to assess the impact of the COVID-19 pandemic on their incidence. We conducted a retrospective study based on medical records from a Quebec mental health hospital collected (a) from April 2016 to March 2019), (b) from April 2019 to March 2020 (pre-COVID onset), and (c) from April 2020 to March 2021 (post-COVID onset). Descriptive statistics, chi square tests, Mann-Kendall test and Welch's t-test were performed. Following several years during which the use of restrictive measures remained stable, we have noted a significant increase within the first year following the COVID-19 pandemic. This increase can be seen in the use of both seclusion and restraints, which have risen 205% and 170% respectively. There are a multitude of factors associated with the incidence of seclusion and restraint that have the potential to be triggered during emergencies and global crisis situations, impacting in turn the rights of an already vulnerable population.

An analysis of demographic, socio-economic and clinical variables for mental illness and mental illness relapse in south-east nigeria

Mental health has come into the front burner of development challenges amid declining socio-economic outcomes, especially in developing countries. Insecurity, conflicts and extremely threatening events, which trigger mental disorders, are common in South-East Nigeria, with many military operations, unknown gunmen attacks and kidnapping leading to the cold-blood assassination and kidnap of dear ones. The study aimed to analyze the demographic, socio-economic and clinical variables for mental illness in South-East Nigeria. Consecutive sampling technique was used to obtain a three-year records of the cases of 380 index and 180 post-index points data of mental illness cases that met the inclusion criteria in a purposively selected public mental health hospital. Data were analyzed using both descriptive and inferential statistics, including frequency count, percentages, chi-square and multinomial logistic regression. Results showed that over a half (55.0%) of the patients were males, and 65.27% had post-primary education. The mean age of patients was 39.87 years. Slightly above half of the cases (55.26%) were single and 56.84% were unemployed. Schizophrenia (68.42%) topped the list of the cases. The rate of relapse was 52.1%, with males being in the majority (61.62%). About 61.62% of those who relapsed were unemployed, 9.60% were into business/trading, and 5.05% were professionals. Those with 5 years and above illness duration had a higher percentage of relapse (52.02%) as well as those with poor drug compliance (66.16%). The mean relapse age was 34.23 years. Educational status, employment status/social class, marital status, and age were socio-economic/clinical factors that associated strongly with relapse at p-value of 0.10. Patients with ≥ 5 and ≤ 3 years duration of illness were 1.17 times on the average more likely to have relapse than those with three or less than 3 years. Onset age for illness predicted 2.479 times more likelihood of relapse. Being employed and having more family support, as against being unskilled/unemployed and not having family support, reduce the likelihood of relapse by 1.110 times on the average. The study recommended policy formulation and implementation for protection against mental illness and mental healthcare provision and access; for tackling unemployment head-on; for improvement of the access to effective treatment of mental illness; and mass education, especially among unemployed, uneducated, singles, and under-35 years of age, to help reduce the high rate of relapse of mental illness in South-East Nigeria.

Effectiveness of Paliperidone Palmitate on Treatment Adherence and Relapse in the Adult Schizophrenia Population: A One-Year Mirror-Image Study in a Colombian Mental Health Care Facility.

The benefits of long-acting injectable antipsychotics have been documented in several observational studies, but data remain scarce in Latin America. This study aimed at evaluating the effectiveness of paliperidone palmitate once monthly (PP1M) on treatment adherence and relapse in the schizophrenia population followed in a government-funded mental health care facility in Colombia. A mirror-image study was conducted. Adult schizophrenia patients treated with oral antipsychotics who subsequently received ≥2 PP1M injections between Jan. 1st, 2015 and Oct. 31st, 2018 were included. The study consisted of two retrospective phases: 12 months before and after the first PP1M injection. Outcomes were treatment adherence (proportion of days covered ≥80%), hospitalized relapse, hospital length of stay, and non-hospitalised relapse. Effect of PP1M on outcomes was assessed through multivariable conditional Poisson regression. 123 patients were eligible (mean age, 30.3 years; 79.7% males). Adherence was 23.6% in the pre-phase and 89.4% in the post-phase (RR=3.77; 95%CI, 2.75-5.17). The proportion of patients with hospitalised relapse decreased from 46.3% to 35.0% (RR=0.76; 95%CI, 0.59-0.99). In the 75 (61.0%) patients who continued PP1M throughout post-phase, beneficial effect on hospitalised relapse was stronger (RR=0.64; 95%CI, 0.42-0.98). The proportion of patients with non-hospitalised relapse symptoms increased from 6.5% to 18.7% (RR=2.27; 95%CI, 1.11-4.64). PP1M initiation led to a dramatic improvement in treatment adherence and a decrease in hospitalised relapse. Observed increase in non-hospitalised relapse may be explained by a decrease in severity. Limitations are absence of a parallel comparison group and a generalisability limited to the population treated at this facility. Study provides data for the Latin America region and strength is the assessment of non-hospitalised relapse symptoms.

The Impact of Family Relations on a Sample of Egyptian Patients with Substance Use Disorder

Abstract Background Substance use disorders (SUD) present a complex condition characterized by uncontrolled substance use despite adverse consequences, often intertwined with social and family problems. Dysfunctional family relationships, including violence, stress, parental drug use, and poor communication, have been linked to adolescent drug use. The current study investigates the association between family relation dysfunction and substance use, aiming to understand the quality of this connection. Aim of the Work This case - control study aims to examine the relationship between family relations and substance use, assessing the impact on the type and severity of substance abuse. Specific objectives include exploring the association between family dysfunction and SUD, comparing family interaction in SUD patients and normal individuals, and evaluating variations in family interaction based on sociodemographic factors. Patients and Methods Seventy participants, comprising 35 SUD patients and 35 healthy controls, were recruited from EL-Abbsia Mental Health Hospital. Participants were assessed using socio- demographic data sheets, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Quality of Family Relationships Scale (KOBI), and Addiction Severity Index. Urine tests were conducted for psychoactive substances. Statistical analysis involved various tests, including t-tests, Mann-Whitney, chi-square, and correlation analyses. Results The study revealed a significant prevalence of smoking among SUD patients compared to controls, along with longer smoking duration and higher daily cigarette consumption. SUD patients exhibited increased medical issues and higher incidences of substance use, particularly cannabis and heroin. Family rejection and non-acceptance were significantly higher in SUD cases, correlating with the severity and duration of substance abuse. Conclusion The findings underscore the significant connection between family relationship dysfunction and substance use. Rejection and non-acceptance within the family environment emerge as crucial predictors of addiction. The study highlights the need for comprehensive interventions addressing family dynamics in substance abuse treatment.

Pharmacotherapy Effectiveness in Treating Mental Disorders in Kosovo's Specialized Institutions

Abstract: In various global regions, specialized institutions rigorously supervise pharmacological treatments for mental health disorders. In Kosovo, the absence of such dedicated infrastructure highlights the need for continuous evaluations to refine and enhance treatment practices. Objective: This study evaluates the effectiveness of pharmacotherapeutic strategies for mental health disorders at specialized centers in Kosovo. Methodology: The research followed the protocols set by the World Health Organization (WHO). Patient data were collected from medical records. A total of 400 patients were analyzed, selected randomly from different cities with sample sizes ranging from 50 to 90 per city. Results: Medication was administered orally in 106.8% of the cases, with no significant differences in administration methods between centers (Chi-Test = 36, p > 0.22) (Tab. 4). Most prescribed medications were classified as non-essential (85.9%). Of the medications prescribed, 69.2% were antipsychotics, 22.3% were anxiolytics, and 14.8% were antidepressants, making up 100% of all drugs used. Conclusion: In Kosovo's mental health facilities, oral administration is the predominant method (PO), with 22.9% of cases involving parenteral administration. The majority of prescribed medications were non-essential (85.9%). Antipsychotics were the most commonly prescribed (69.2%). Often, second-line medications are used as the initial treatment choice. The use of effective but high-risk medications is common (e.g., Clozapine at 100.0% from the SDA group). Ineffective medications were observed in 2.50% of cases, and a misalignment between treatment and drug indications occurred in 7.50% of cases.

“Cured, I Am Frizzled, Stale, and Small”: Jungian Individuation Realized in Robert Lowell’s Life Studies

Robert Lowell’s Life Studies won the National Book Award for Poetry in 1960 and is credited with initiating the confessional poetry movement, which included followers and students of Lowell such as Anne Sexton and Sylvia Plath. In Life Studies, Lowell channeled his 1950s experiences with bipolar disorder and mental health hospitalizations into poems such as “Man and Wife”, “Waking in the Blue”, and “Home After Three Months Away”. Lowell’s hard-won Life Studies triumph, though most recently analyzed through socioeconomic and “divine madness” lenses, can also be understood through Carl Jung’s individuation concept which posits that self-realization can be attained through the reconciliation of one’s own conscious and unconscious mental processes. This article argues that Lowell’s Life Studies poems, when examined through Jungian individuation, enabled Lowell to achieve self-realization, and paved the way for mentally ill individuals to learn how to achieve psychological wholeness through art.

How to engage people experiencing severe and persistent mental illness in qualitative research: a descriptive and reflexive analysis

ABSTRACT Purpose People experiencing severe and persistent mental illness (SPMI) constitute a vulnerable population within the healthcare system and society. Similarly in research, there are perceived challenges in qualitative studies with this population due to several factors, including (self-)stigma, assessment of decision-making capacity, reduced communication skills and the (perceived) risk of adverse events, resulting in its scarcity. Methods In this contribution, the authors share their practical experiences of conducting qualitative research among this group of people, specifically addressing sensitive topics such as ongoing intensive care within a mental health facility and end-of-life care. Both advantageous and challenging factors that were encountered during different research phases -the preliminary phase, conducting the interviews and the concluding phase are systematically outlined. Results The findings highlight conscientious conducted in accordance with established standards, albeit with a deliberate embrace of non-conventional approaches while advocating an attitude of critical, ethical reflection. Adequate preparation, fostering creative approaches and adaptable communication to establish rapport and authentic interaction, thorough follow-up and support for all involved are equally crucial to sustain effective qualitative research. Conclusion Engaging people experiencing SPMI in research is as a cornerstone for empowerment—a feasible aspiration. Their inclusion in research endeavours is imperative, because first-hand narratives are key in shaping comprehensive and compassionate care practices for those experiencing severe and persistent mental illness.

The relationship between psychological capital and humanistic caring ability among mental health nurses in Saudi Arabia

BackgroundThe ability to provide humanistic care has a significant impact on the therapeutic relationships in psychiatric services, which in turn influences patients’ outcomes.AimTo examine the relationship between psychological capital and humanistic care ability among mental health nurses in Saudi Arabia.MethodsA descriptive correlational research design was implemented in this study. A convenience sampling method was used to collect information from 500 mental health nurses from a governmental mental health facility. The data were collected using the psychological capital questionnaire and the caring ability inventory.ResultsThe results revealed high levels of psychological capital and humanistic care ability among mental health nurses. Psychological capital significantly predicted humanistic care ability (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:{R}^{2}=$$\\end{document} 0.630, F(1,498) = 851.16, p< 0.001). Also, there were significant relationships between sociodemographic variables and psychological capital (age, educational level, and professional title) and humanistic care ability (age and years of experience).ConclusionPsychological capital was found to be be positively associated with the humanistic care ability of mental health nurses. The findings of this study suggest that nursing managers should explore strategies from the viewpoint of positive psychology to enhance the psychological capacity of mental health nurses to provide humanistic care abilities, which can effectively improve nurses-patients’ relationships and outcomes in clinical practice.

Geographic Access to Community Mental Healthcare and Adherence to Treatment Among Patients with Schizophrenia Spectrum Disorders

Non-adherence to antipsychotic medications is a commonly recognized problem that can lead to lack of follow-up for patients with schizophrenia spectrum disorders, increasing risk for psychotic symptoms, hospitalizations, and decreased quality of life. We conducted a secondary data analysis of electronic health record data of patients with schizophrenia spectrum disorders (n = 1,341) in Central Florida to explore relationships between geographic access to mental healthcare facilities, socioeconomic factors, and follow-up visits, and whether these conditions contributed to adherence over 1 years’ time. Using Geographic Information Systems among six mental health facilities, spatial analysis and logistic regression indicated that patients had 27.9% increased odds (p = 0.02) of adherence to treatment when travel time to facilities was 30 min or less. Spatial autocorrelation revealed significant positive clusters in areas with low travel time (15 min or less). Patients who had Medicaid, a case manager and/or a life skills coach, medication side effects, a substance use disorders history, and/or closer proximity to mental healthcare services, had an increased likelihood of attending four or more follow-up visits in 1 year. Identifying effects of spatial and non-spatial variables on non-adherence to treatment can provide useful insights for developing targeted interventions to improve treatment outcomes.

Predicting Mental Health Hospitalizations Among First Nations Adults in Residential Treatment

Indigenous peoples in Canada experience disproportionately higher rates of hospitalization for mental health and substance use concerns than non-Indigenous populations. Ambulatory care sensitive conditions are community-level markers of mental illness which can theoretically be managed through community-based health services, and therefore should not require urgent care services. Previous mental health related ambulatory sensitive conditions have included psychotic and mood disorders; however, limited research has explored these relationships of increased hospitalization among specific health disorders with Indigenous populations. This study analyzed predictors of prior mental health hospitalizations among a predominately First Nations population seeking residential treatment for substance use. We hypothesized that increased co-morbid mental health concerns would predict increased hospitalizations for mental health concerns, and this relationship would be moderated by higher Adverse Childhood Experience (ACE) scores. Logistic regression showed that for every increase in each reported mental health concern, the odds of prior hospitalization was 1.6 times higher among this sample, although ACEs did not moderate this relationship. Participants with depressive, anxiety-related, psychotic, and personality-related disorders reported proportionally more hospitalization. Although study results suggest ACEs are not a useful predictor of hospitalization, their presence has previously shown to exacerbate co-morbid concerns, and thus, may influence prior hospitalization history indirectly. Further research can explore relationships between exposure to childhood trauma and hospitalization, particularly in consideration of access to tertiary mental health services.

Referral to hepatology is lower in patients with excessive alcohol use who have mental health disorders despite a high fibrosis-4 index.

Alcohol use disorder (AUD) is a multifaceted disease, and integration of AUD treatment between mental health and hepatology is necessary to improve outcomes. We aimed to ascertain whether patients with excessive alcohol use (EAU) and high FIB-4, which is a non-invasive method to identify advanced liver disease, are appropriately referred to hepatology and detect which clinical barriers, if any, might pertain. Records of patients with excessive alcohol use between 2013 and 2023 were extracted from a large public system. Demographics, alcohol-related hospitalizations, mental health conditions, Charlson comorbidity index (CCI) and referral patterns were evaluated. Comparisons were made between those referred to hepatology versus not. 1131 subjects showed evidence of EAU but on further review, 189 were in alcohol-remission. The remaining 942 (636 men, age 55.7 ± 14.5 years, 548 white, 363 black, 19 Hispanic) subjects with CCI 2.61 ± 2.23 were further analyzed for FIB-4 score and referral patterns. 316 patients had active EAU and a high FIB-4, of whom only 116 (37%) were referred to hepatology. Patients with alcohol-related mental health concerns and admitted for trauma were less likely to be referred. Logistic regression showed referral was higher with alcohol-related liver hospitalizations (OR: 9.25, 95% CI: 4.90-17.47, p < 0.001), higher CCI (OR: 6.23, 95% CI: 3.00-12.94, p < 0.0001) and lower with mental health admissions (OR: 0.36, 95% CI: 0.15-0.48, p < 0.001) or mental health diagnoses (OR: 0.36, 95% CI: 0.15-0.82, p = 0.02) and increasing age (OR: 0.95, 95% CI: 0.92-0.97, p < 0.001). In a large public health system, almost 63% of patients with EAU and FIB-4 >2.67 are not referred to hepatology for evaluation. Patients not referred were more likely to have alcohol-related mental-health hospitalizations and mental health diagnoses, while those with liver-related hospitalizations and comorbidities were more likely to be referred. Greater education of mental health providers and for teams taking care of inpatients admitted with alcohol-related mental health concerns would better integrate care and improve outcomes for patients with higher risk for advanced liver disease.

Implementation and Service Delivery Status of the Mental Health Law in the Province of Zamboanga del Norte

Mental health had been a growing concern while mental illness had been increasing in number worldwide. The enactment of the Mental Health Law or RA 11036 in 2018 hoped to bring about better delivery of mental health services as well as uphold the rights of patients. This led the proponent to investigate the implementation and service delivery status of the mental health law in the province of Zamboanga del Norte. Employing a descriptive-qualitative design, the study assessed the implementation of the various government agencies on the Mental Health Law as well as the delivery of mental health services in the province of Zamboanga del Norte. There were 50 mental health professionals interviewed through phone, messenger, and Google form using a structured interview guide. Data gathered through the interviews were analyzed using thematic analysis. Results revealed that most of the government agencies were able to implement the law rating from 35.72% to 100% of the implementation. Eleven themes emerged such as poor knowledge about the mental health law, no proper seminars/training about mental health law, mental health is not a priority program, lack of coordination with the various agencies involved, difficulty managing mental health crises, non-inclusive mental health program, insufficient mental health services, multitasking of mental health providers, lack of mental health professionals, stigmatized attitude towards mental illness and support from LGU. It was revealed in this study that the implementation of the mental health law in the province is not fully implemented. Furthermore, the delivery of mental health services is also insufficient. As a recommendation, the primary implementing agency must exert more effort in cascading the law to all implementing agencies and mental health professionals down to the barangay level for the law to be understood and implemented. In addition, mental health services should be improved as well as the inclusion of a mental health facility.