Mental Health Care Planning Research Articles

Development and Implementation of Mental Healthcare Plans in Three Districts in Ghana: A Mixed-Method Process Evaluation Using Theory of Change.

In Ghana, a severe mental healthcare gap of 95-98% exists due to limited services. Ghana Somubi Dwumadie set out to address this by developing district mental healthcare plans (DMHPs) in three demonstration districts. Following the Programme for Improving Mental Healthcare model, district mental health operations teams were formed and used Theory of Change (ToC) to develop DMHPs. Key elements included training non-specialist health workers and enrolling individuals in relevant healthcare programmes. Evaluation methods included routine data, health facility surveys, and qualitative analysis within the ToC framework. Results showed improved integration of mental health services, enhanced case management through training, and increased service utilisation, shown through 691 service user enrollments. However, there was limited commitment of new resources and no significant improvement in primary care workers' capacity to detect priority mental health conditions. The study concludes that DMHPs, implemented with an integrated approach, can improve mental health service utilisation, contingent on committed leadership, resource availability, and stakeholder engagement.

Impact of Emergency Department Safety Planning on 30-Day Mental Health Service Use.

The aim of this study was to examine the association between emergency department (ED) safety planning and subsequent use of mental health care among individuals treated in the ED for suicidal behavior and to determine whether subsequent use differed by patients' receipt of recent mental health care. Data from 130 hospitals, derived from a 2017-2018 national hospital survey, were paired with national health insurance data from 2,328 patients with suicidal behavior treated in the EDs of these hospitals. Rates of ED readmission, inpatient admission, and outpatient mental health follow-up care in the 30 days after discharge from the index ED visit were examined. During the 30 days after discharge from the index visit, readmissions to the ED (18% vs. 22%) and inpatient admissions (12% vs. 15%) for suicidal behavior or other mental health issues were significantly lower among patients treated in the EDs that routinely implemented safety planning, compared with those that did not, respectively. Among patients who had not received mental health care within 30 days before the index visit, those treated in an ED implementing routine safety planning were about half as likely (adjusted risk ratio=0.60) as those treated in an ED without such planning to have an ED readmission. Safety planning was associated with fewer subsequent ED and inpatient admissions among patients treated in the ED for suicidal behavior. The authors recommend that safety planning be universally implemented in EDs and included in routine outpatient care.

Does nature-based social prescription improve mental health outcomes? A systematic review and meta-analysis.

A nature-based social prescription (NBSP) is an approach to improving mental health outcomes that involves prescribing nature-based interventions as complementary or alternative therapy to traditional ones. A variety of advantages are available from NBSP for people looking to enhance their mental well-being. The effect size of the nature-based social prescriptions (NBSPs) has not been thoroughly evaluated by systematic reviews and meta-analyses. The current study aimed to analyze existing studies and conduct a meta-analysis to determine the overall effect size of the nature-based social prescriptions (NBSP's) outcomes on mental health. By choosing the relevant papers from among those that were available, a meta-analysis was carried out in the current study. A systematic search of electronic databases (Pub Med, Web of Science, Scopus, Cochrane Library, Embase, CINAHL, and PsychINFO) was conducted to identify relevant studies. Studies were included if they evaluated the effects of NBSP on mental health outcomes. Effect sizes were calculated using the random effects model. Meta-analysis of interventions statistics shows that CBT (SMD -0.0035; 95% CI: [-0.5090; 0.5020]; Tau^2: 0.1011; Tau: 0.318), digital intervention (SMD -0.3654; 95% CI: [-0.5258; 1.2566]; Tau^2: 0.2976, Tau: 0.5455), music intervention (SMD -2.1281; 95% CI: [-0.4659; 4.7221]; Tau^2: 3.4046; Tau:1.8452), and psychological interventions (SMD -0.8529; 95% CI: [0.3051; 1.4007]; Tau^2: 0.1224; Tau: 0.3499) do not significantly impact. The other interventions [social belongingness, communication training, blue intervention, nature-based education, cognitive behavior group therapy (CBGT), social prescribing coordinator, self-help intervention, participatory, organizational intervention, inpatient services, brief diet, internet-based intervention, prenatal intervention, yoga and meditation, ergonomics training program, yoga nidra intervention, and storytelling] highlighted above are significant. The conclusion of the meta-analysis supports the idea that incorporating nature-based social prescription interventions into mental healthcare plans can effectively complement traditional therapies and improve mental health outcomes. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023412458, CRD42023412458.

Care Plan Templates in Adult Community Mental Health Teams in England and Wales: An Evaluation.

Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A 'high/low' typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person's care. This study was not registered.

Mapping community-based youth mental health services in Tasmania, Australia.

Tasmania has the most rurally and remotely dispersed population of young people in Australia with high rates of youth experiencing mental ill health and socioeconomic disadvantage. Standard descriptions of mental healthcare provision are necessary for evidence-informed mental healthcare policy, planning and implementation. This systematic scoping study aimed to: (1) map and describe the characteristics of community-based youth mental health services (including substance-use) for young people in Tasmania, Australia and (2) identify gaps in service accessibility and provision. A list of eligible services was developed through a systematic search and consultation with key stakeholders. Data were collected from a representative from each eligible service via an interview or online survey. A standardised framework was used to classify, describe and map services. Thematic analysis was used to analyse service providers' perceived gaps to service access and provision. Twenty-eight community-based mental health services for youth were identified, predominantly located in the major city of Tasmania's three service regions. Service gaps include the 'missing middle', lack of integrated supports and limited service capacity. The findings highlight the limited availability, accessibility and capacity of youth mental health services across Tasmania. Recommendations focus on increasing accessibility of rural/regional supports, provision of assertive outreach, psychosocial support, integrated care and strengthening the rural mental health workforce. These findings may inform the (re)design/(re)development of community-based youth mental health services in Tasmania. The findings may also guide evidence-informed mental health service planning, decision-making, development and implementation of integrated models of youth mental health care across Australia.

Evaluation of a pilot online education program to develop midwives’ knowledge, skill and confidence in perinatal mental health in rural South Australia

One in five women will experience perinatal anxiety and/or depression. In South Australia, a rural health service identified a high proportion of women with risk of perinatal mental health challenges and sought additional education for midwives. In response, a six-week facilitated, online perinatal mental health education program (e-PMHEP) was piloted. AimThe aim of this study was to evaluate the effectiveness of the (e-PMHEP) for rural midwives, nurses and Aboriginal maternal infant care practitioners. MethodProgram evaluation incorporated a validated online pre/post survey to assess self-reported knowledge, skill and confidence regarding perinatal mental healthcare. Additional questions sought feedback on satisfaction and feasibility. FindingsSixteen participants from rural South Australia engaged in the project from June to August 2022. Twelve participants completed the online pre/post survey. The overall pre/post knowledge scores were statistically significant (t = 2.73, 8df, p = 0.025) with improvement from the pre to post-test. Pre/post data also showed a measurable increase in confidence and skills. All respondents agreed that the content addressed their learning needs and would recommend this program to other practitioners. DiscussionThe e-PMHEP appeared beneficial in developing knowledge, skills and confidence regarding perinatal mental healthcare in rural midwives and practitioners. Only a third of practitioners routinely developed a mental health care plan with women. Key strengths of the program included the accessible content, and the combination of an experienced mental health clinician and a facilitator with lived experience. ConclusionProviding an accessible, facilitated online perinatal mental health education program could be beneficial for rural midwives.

Patient-centered health care planning in acute inpatient mental health settings: a best practice implementation project.

The current project aimed to improve the quality of health care by promoting evidence-based practice (EBP) regarding mental health care planning (MHCP) for adult inpatients. The implementation of the best evidence in the process of developing and documenting nursing care plans is currently an important legal requirement that contributes to increasing the quality of care. This implementation project was based on the JBI evidence implementation approach and included a baseline audit of seven criteria, implementation of strategies, and a follow-up audit. The project was conducted in an acute psychiatric setting at a university hospital in Bucharest, Romania. The sample included 17 nurses and 30 ward patients. The baseline audit revealed low compliance (33%-37%) for criterion 3 (a comprehensive care plan) and criterion 4 (patient involvement); moderate compliance (55%) for criterion 1 (care plan for all patients); and increased compliance (97%-100%) for criterion 2 (assessment of patient's needs), criterion 5 (education of patients/caregivers), criterion 6 (providing a copy at discharge), and criterion 7 (education of professionals). As a result of implementing the most appropriate strategies, the maximum improvement (100%) was observed across all five audit criteria that were found to be deficient in the baseline audit. The development and implementation of strategies adapted to specific care need to play a key role in the implementation of EBP. In this case, educating nurses, facilitating nurses' access to EBP for care planning, and improving procedures proved effective in achieving maximum compliance with all the audit criteria.

A scoping review of research on mental health conditions among young construction workers

Purpose Current research on mental health in the construction industry is fragmented, making it difficult to obtain a complete picture of young construction workers’ mental health conditions. This situation adversely affects research progress, mental health-care planning and resource allocation. To address this challenge, the purpose of this paper was to identify the themes of mental health conditions among young construction workers and their prevalence by geographical location. Design/methodology/approach The scoping review was conducted using meta-aggregation, guided by the CoCoPop (condition [mental health], context [construction industry] and population [construction workers 35 years old and younger]) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews) frameworks. Findings A total of 327 studies were retrieved, and 14 studies published between 1993 and 2022 met the inclusion criteria. The authors identified 13 mental health conditions and categorized them under nine themes. Mood disorders, anxiety disorders and substance-related disorders constituted the most researched themes. Studies predominantly focused on young male workers in the Global North. The prevalence estimates reported in most of the studies were above the respective country’s prevalence. Originality/value This review extends previous studies by focusing specifically on the themes of mental health conditions and giving attention to young construction workers whose health needs remain a global priority. The study emphasizes the need to give research attention to lesser-studied aspects of mental health, such as positive mental health. The need to focus on female construction workers and on homogenous sub-groups of young workers is also emphasized. The findings can guide future systematic reviews on the identified thematic areas and help to plan the development of interventions.

Treatment Seeking Children and Youth who have Experienced Warzone Trauma: Examining the Mental Health Care Planning Needs.

This study compares mental health treatment-seeking children and youth who have experienced warzone-related trauma to other treatment-seeking children and youth to determine similarities and differences and aid in care planning. Data from 53 agencies across Ontario from 2015-2022 were analysed, resulting in a sample of 25,843 individuals, 188 of which met the warzone and immigration criteria. Individuals who experienced warzone-related trauma were less likely to: (a) have a psychiatric diagnosis; (b) speak English, and; (c) have close friends. Collaborative Action Plans (CAPS) related to traumatic life events, parenting, and informal support were triggered at a higher rate for those who experienced warzone-related trauma compared to those who did not. This study highlights areas where children and youth who have experienced warzone-related trauma require improved access to services. Findings also highlight issues related to a needs-based approach to service delivery to facilitate improved outcomes for these vulnerable children and their families.

Towards implementation of context-specific integrated district mental healthcare plans: A situation analysis of mental health services in five districts in Ghana.

Access to quality mental health services in Ghana remains poor, yet little is known about the extent of the access gaps and provision of mental health services at the district level in Ghana. We aimed to conduct an analysis of mental health infrastructure and service provision in five districts in Ghana. A cross-sectional situation analysis was conducted using a standardised tool to collect secondary healthcare data, supplemented by interviews with key informants, across five purposively selected districts in Ghana. The Programme for Improving Mental Health Care (PRIME) situation analysis tool was adapted to the Ghanaian context and used for data collection. The districts are predominantly rural (>60%). There were severe challenges with the provision of mental healthcare: there were no mental healthcare plans, supervision of the few mental health professionals was weak and unstructured, access to regular supplies of psychotropic medications was a major challenge, and psychological treatments were extremely limited given the lack of trained clinical psychologists. There were no available data on treatment coverage, but we estimate this to be <1% for depression, schizophrenia, and epilepsy across districts. Opportunities for mental health systems strengthening include: the commitment and willingness of leadership, the existence of the District Health Information Management System, a well-established network of community volunteers, and some collaboration with traditional and faith-based mental health service providers. There is poor mental health infrastructure across the five selected districts of Ghana. There are opportunities for strengthening mental health systems through interventions at the district healthcare organisation, health facility, and community levels. A standardised situation analysis tool is useful for informing district-level mental healthcare planning in low-resource settings in Ghana and potentially other sub-Saharan African countries.

Patterns of mental health care provision in urban areas: A comparative analysis for local policy in the ACT.

Urbanisation presents specific mental health challenges, requiring a better understanding of service availability in urban areas for mental health care planning. Our objective is to analyse patterns of urban mental healthcare provision in Australia, and compare these with relevant national and international regions to inform urban mental healthcare policy and planning. Following a health ecosystems approach, we use a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE), and Mental Health Care Atlases, to compare the availability, bed capacity and diversity of services providing specialised mental health or psychosocial care that are universally accessible (ie provided at no or low cost only in all relevant care sectors in four Australian and three international urban regions. We used a heuristics approach and an homogeneity test. Applicability to local policy was assessed using the Adoption Impact Ladder. Community care was less developed in Australia than internationally, except in the case of residential care in Australian Capital Territory, our reference area. Alternatives to hospitalisation were scarce across all regions. The Atlas was applicable to regional and local mental health planning. Differences in pattern of care between regions has implications for planning, equality of access to care and prioritisation of resources. An ecosystems approach is relevant to service planning in mental healthcare at local level.

The psychological impact of genocide on the Yazidis.

The genocide against the Yazidis by the Islamic State of Iraq and Al-Sham (ISIS) in the Sinjar area of Northern Iraq has costed many lives and has also caused a psychological long-term impact in this minority. This impact can be seen among individual survivors. Additionally, there is a large number of direct and indirect victims and for this reason, the impact can also be observed on the level of the group and society in this region at large. The research examines three different population groups (Yazidis members who had been exposed to violence by terrorist group actions, those not exposed to this experience as they were living in an area not directly exposed to ISIS violence, and a control group of non - Yazidi general population members). In total, 425 participants (age range 15-78) took part in the study and participated in interviews using standard scales to measure general physical and mental health. The results demonstrate that psychological stress and suicidality are higher among the Yazidis survivors of violence than in the other Yazidi participants. Psychological disorders after a genocide and war in post-conflict populations should receive more attention in the planning of mental health care and prevention and should be seen as a major problem, especially in camp settings and displaced persons besides the usual increased prevalence of posttraumatic stress and other disorders covered by research so far in this context.

Suicidal Behaviors and Risk Taking Among Homeless Individuals: A Systematic Review and Meta-Analysis.

The present systematic review and meta-analysis study aimed to determine sociodemographic characteristics, risky behaviors, mental health disorders, and substance use disorders associated with suicide behaviors including suicidal ideation and suicide attempts among homeless individuals. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched to identify the relevant studies published between January 1, 1995 and November 1, 2022. After initial evaluation of 9,094 papers, a total of 23 studies met the eligibility criteria. Results of the present study showed that chronic physical illnesses, violent behaviors, mood and psychotic disorders, and substance use disorders were significantly associated with both suicidal ideation and suicideattempts, while being older, having a history of physical abuse, and having mood and post-traumatic stress disorders were associated with suicide attempts only. The present study's findings suggest a crucial need for facilitating access to mental healthcare plans and promoting mental healthcare seeking among homeless individuals.

Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland: controlled interrupted time series analysis

ObjectiveTo determine whether the withdrawal of the Quality and Outcomes Framework (QOF) scheme in primary care in Scotland in 2016 had an impact on selected recorded quality of care, compared...

Clinical correlates of COVID-19 disease in psychiatric outpatients

IntroductionPatients suffering from psychiatric illness represent a population that is particularly vulnerable to the SARS-CoV-2 virus and to the pandemic situation due to several factors.ObjectivesWe aimed in our study to determine the rate of COVID-19 infection and to identify its correlated factors in outpatients of the psychiatry department of Monastir, Tunisia.MethodsThis is a descriptive and analytical cross-sectional study conducted on 178 outpatients at the department of psychiatry (Monastir, Tunisia) over a period of one month (from March 2022 to April 2022). Data was collected via a questionnaire focused on two main attributes: (1) sociodemographic and clinical characteristics; (2) questions about the COVID-19 personal and family history.ResultsThe mean age of our population was 44.9±13.7 years. The majority of them (81.5%) had a chronic evolution of their psychiatric disorder (&gt; 2 years) and 68.7% were hospitalized at least once in psychiatry. Psychosis was the most represented disorder with 57.3% compared to mood disorders and anxiety disorders. Among our population, thirty seven patients (21%) had a SARS-CoV-2 infection and 3.1% required hospital care. The infection by the virus of a family member was reported by 46% of cases and 2.5% had intrafamilial death due to COVID-19 disease. Patients with depressive disorder were the most affected (55%). COVID-19 infection was significantly associated with gender (p=0.02), marital status (p=0.016), diagnosis (p=0.001), treatment (p=0.02) and intrafamilial spread of the disease (p&lt;10-3).ConclusionsPatients with psychiatric disorders experience a distinct burden of the COVID-19 disease. Awareness of the vulnerability of this population and psychiatric institutions is necessary in order to adapt mental health care planning and implement preventive measures during potential subsequent pandemics.Disclosure of InterestNone Declared

Mental Health and Quality of Life for Health Workers During the COVID-19 Pandemic: A Systematic Review

Background: COVID-19, a strain of the coronavirus that causes acute respiratory syndrome, first appeared in the Chinese city of Wuhan and quickly spread throughout the world in early 2020. The COVID-19 pandemic has changed health care systems around the world and affected the mental health of healthcare workers and their quality of life.Aim: to review the existing scientific evidence regarding mental health and quality of life of health workers during the COVID-19 pandemic. Methods: This study was taken from the pubmed, ScienceDirect, and Ebsco databases identified between December 2019 to July 2021 and was limited to peer-reviewed research written in English, quantitative research on mental health and quality of life with a cross sectional approach. Articles that fit the criteria are then analyzed using the critical appraisal tool that is appropriate for results of the research. Results: The results showed an increase in mental disorders, including stress, anxiety, depression, and PTSD in health workers. This is caused by several factors, namely 1) stressors that contribute to the work environment 2) work pressure components, 3) epidemic components, 4) family-related components. This condition can affect the quality of life of health workers. Conclusion: Research evaluating the direct and indirect association of mental disorders on the mental health of healthcare professionals is urgently needed to improve treatment, mental health care planning and for preventive measures during a potential next pandemic.

India’s path towards better mental health in a pandemic

COVID-19 has wide-ranging effects on population health including mental health, particularly in low-and-middle-income countries (LMICs). Outbreak and interventions such as quarantine and isolation against it have contributed to psychosocial adversities. We aimed to review the state of India’s mental healthcare planning, identify the gaps in the health systems and policies, and present cost-effective and scalable solutions. Necessary background information was triangulated through an iterative literature review of the policy, preprint, and peer-reviewed research literature. We focused on the following themes-a) health system capacity, policy, and law for India, b) psychological impact of COVID-19 outbreak in India, c) psychological impact of interventions against COVID-19, and d) best practices across countries for mental health management during the pandemic. We used qualitative synthesis to identify health systems and policy gaps to generate short- and long-term solutions supported by high-grade evidence for effectiveness, cost-effectiveness, and adaptation feasibility in India. The Indian health system has several shortcomings in its mental health care that became pronounced during the current COVID-19 pandemic. To overcome these, long-term goals should include increased public financing, increased human resources production, integration of health emergency and mental health policies and legislation. Immediate needs could be met by scale-up of task-shifting initiatives and telepsychiatry services in rural regions. In the ongoing pandemic, employing school-based psychosocial interventions, public awareness campaigning, subverting misinformation through broadcast legislations, and stigma reduction for general mental illnesses are pertinent. These solutions can help bridge the gaps in mental health care in India.

An Audit of Mental Health Care Plans in Community Mental Health Services for Older Persons in Rural Communities in a State in Australia.

Mental health care planning is an important part of holistic, patient-centred care provision. Rural older adults represent a vulnerable population with unique and complex care needs requiring robust care planning approaches. This study's aim was to audit care plan documentation for rural older Australians against quality standards. A retrospective review of the care plans from electronic case records was performed for all patients who were 65years or older and managed by rural community mental health teams over a 12-month period. 72.1% of patients had a care plan available. Multiple assessment areas were sparsely documented, such as cognition (32%), self-harm risk assessments (29.8%), visual impairment (5.5%), hearing issues (5%) and Advance Care Directives (35.4%). This study highlighted the need for the development and implementation of a care plan template specific to rural older patients. Further research into care planning processes and barriers to implementation is also required for this population.

Evaluation of the Psychological Impact of COVID-19 Pandemic on Chinese Patients with Common Mental Disorders in Primary Care: A Cross-Sectional Study

Purpose: Our study aimed to evaluate the psychological impact of COVID-19 pandemic on Chinese patients with common mental disorders in primary care in Hong Kong. Method: A cross-sectional study was conducted on 102 Chinese patients with common mental disorders and being followed up in two public integrated mental health clinics in Hong Kong from 1st November 2020 to 31st January 2021. Patients would be evaluated about the impact of COVID-19 pandemic on their mood and daily life by using a questionnaire which assessed social distancing effects, financial impact, relationship with family, anxiety and depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 Questionnaire (GAD-7) would also be used to assess patients’ mood symptoms. Factors which were related to COVID-19 pandemic and associated with anxiety or depressive symptoms would be analysed. Results: The mean age of the subjects was 58.0 years and more patients were female (77.5%). There were 84.3% and 72.5% of patients reported their anxiety and depressive symptoms being affected by COVID-19 pandemic respectively. It was found that 17.6% of patients had their income decreased or were unemployed. About one-third (30.4%) of patients indicated that their relationship with their family was worsened while 8.8% was improved. Social distancing was significantly associated with anxiety (p = 0.006) and depressive symptoms (p 0.001) in patients with common mental disorders. Conclusion: There was considerably more psychological impact including an increase in anxiety and depressive symptoms due to COVID-19 pandemic in Chinese patients with existing common mental disorders in primary care. Primary care physicians should raise their awareness of the psychological impact of COVID-19 pandemic on their patients. Our findings shed light on mental health care planning and preventive measures during the COVID-19 pandemic and potential subsequent pandemics.

Mindfulness Based Interventions Framework in District Mental Health Programme in India

The management of Common Mental Disorders (CMDs) in the Indian context is a complex issue and India has constrained mental health services infrastructure in District Mental Health Programme (DMHP) setting. Mental health interventions should be specific and feasible and relevant in the Indian population. DMHP is an important tier and bridged the gap between the tertiary care centres and the primary health care centres. Mindfulness-based interventions are effective in the management of common mental disorders in the community setting. Mindfulness based Cognitive therapy would reduce depressive relapse in patients. Mindfulness skills improves effective self-regulation of anxiety related cognition, emotion, sensation and behaviour. In DMHP training framework of mindfulness skills based sub-modules, mindfulness-based stress reduction, mindfulness-based cognitive therapy, acceptance and commitment therapy (ACT) modules could be incorporated. This framework targets relationship to thoughts and feelings (both physical and emotional) via decentring. This framework which is a practical, feasible strategy in the management of CMDs in DMHP setting of various states in India. Developing a need-based mindfulness-based interventions framework would be instru-mental in guiding the planning and prioritization of mental health care in India in 21st century