Mental Health Care Teams Research Articles

Perspectives of Pharmacists Towards Patient-Centred Mental Health Pharmacy Services: A Focus Group Study

Introduction: The rising prevalence of mental illness is a growing concern. Integrating pharmacists into mental health care teams could help address this challenge by improving service quality and accessibility for patients. This study investigates pharmacists' opinions regarding treatment care in the Kuantan and Pekan areas and their attitudes toward patient-centred mental health pharmacy services. Methods: A qualitative study was conducted with 63 pharmacists around Kuantan and Pekan, Pahang, utilising a focus group discussion (FGD) style. The pharmacists were selected through purposive sampling from 2 general hospitals, 2 district health offices, and 1 teaching hospital. All locations are primary healthcare in Malaysia. The focus group topic guide was created using the relevant literature research. The entire interviews were audio-recorded and then transcribed verbatim. Thematic analysis was performed inductively to analyse the data. Results: This study involved 14 focus group sessions with all 63 pharmacists participating. Every interview was in person at the designated sites. From the interviews, 6 key themes were identified. 1. Role of pharmacists in mental health care. 2. Pharmacists-patients’ interactions. 3. Interprofessional collaborations with other healthcare workers. 4. Challenges and barriers. 5. Training needs for pharmacists and lastly 6. Improvement on the role of pharmacists and future practice. Conclusion: This research explores Malaysian pharmacists' perspectives on mental health treatments. It highlights pharmacists' potential contributions to mental health care, the challenges they face when assisting patients with mental health conditions, and the current limitations of mental health services in Malaysia's primary healthcare settings, hospitals, and Klinik Kesihatan.

Attitudes of Nursing Students towards Individuals with Mental Illness before and after Attending the Mental Health Nursing Course: comparative study

Background: Psychiatry nurses are an integral component of a multidisciplinary mental health-care team. This study aims to investigate the level of attitude toward mental illness among nursing students before and after psychiatric nursing course. Method: A descriptive design was utilized in this study. Total sample was 303 nursing students the sample included all 3rd and fourth year students who did not study psychiatric nursing course 103 nursing student and 200 study psychiatric nursing in west bank university. tools were utilized to measure the variables of the study: Personal data questionnaire, attitudes toward mental health nursing.Results: nursing students who did not attend the psychiatric course reported a moderate level of attitude toward mental illness. While, the study showed that the nursing students who attended the psychiatric nursing course reported a high level of attitudes toward mental illness. The study also found that there are significant statistical differences among nursing students who have taken the psychiatric course and who have not taken the course regarding attitudes toward mental illness, when the differences were in favor of the students who have attended the psychiatric nursing course. Results showed that gender, age, place of residence, and university were not significant variables among nursing students, who did not attend the psychiatric course, while experience with someone who suffering from mental health conditions was a significant variable. Whereas, gender, age, university, and experience with someone who suffering from mental health condition were not significant variables among nursing students who attended the psychiatric course, but Place of Residence showed significant differences, in favor of students who are living in camps. Conclusions: The need for the psychiatric nursing course to be mandatory educated for nursing students and other healthcare professions. Due to its importance into providing enrich and empower information for students.

Incorporation of A Peer to Peer Professional Figure in A Community Mental Health Care Team in Spain

Incorporation of A Peer to Peer Professional Figure in A Community Mental Health Care Team in Spain

Changes in Acute Care Pharmacist Prescribing and Laboratory Ordering over Time: CAPLET Study.

In Alberta, pharmacists may obtain additional prescribing authorization (APA) and a practice identification number (PRAC-ID) for ordering laboratory tests. Pharmacists working within Alberta Health Services were mandated by the employer to attain APA by 2018, whereas laboratory ordering has been in place since 2009. Five acute care sites within the Calgary Zone had a computerized provider order entry (CPOE) system that allowed tracking of these activities. To describe changes in prescribing and laboratory ordering by acute care pharmacists over time and to compare these activities across hospitals, sites, and specialty teams. A retrospective, descriptive review of acute care pharmacist orders for medications and laboratory tests was completed using data from the CPOE system for the period 2018 to 2021. Over the study period, the rates of prescribing and laboratory ordering by pharmacists increased by 67.5% (from 1423 to 2383 per full-time equivalent [FTE]) and by 5.5% (from 235 to 248 per FTE), respectively. Pharmacists at the 5 hospitals increased their prescribing rates during that time (by proportions ranging from 7% to 176%). Cardiology, intensive care, and mental health teams had the largest increases in prescribing rates, whereas mental health, hospitalist, and intensive care teams had the greatest increases in rates of laboratory ordering. In each year of the study, the most frequently ordered medication for adult patients was vancomycin, and the most frequently ordered laboratory test was measurement of vancomycin before dose administration. The proportion of medication orders conveyed verbally decreased from 60.0% to 47.4% over the study period. The application of expanded scope of practice increased among acute care pharmacists, to a greater extent for prescribing than for laboratory ordering; however, the proportion of verbal medication orders remains high, a situation that should be addressed to improve patient safety. This study showed that prescribing and laboratory ordering are complementary, given that the top medications and laboratory tests were frequently related. The results of this study can be used for practice development and as the basis for further research within an expanded CPOE system.

Model development for bespoke large language models for digital triage assistance in mental health care

Contemporary large language models (LLMs) may have utility for processing unstructured, narrative free-text clinical data contained in electronic health records (EHRs) — a particularly important use-case for mental health where a majority of routinely-collected patient data lacks structured, machine-readable content.A significant problem for the United Kingdom’s National Health Service (NHS) are the long waiting lists for specialist mental healthcare. According to NHS data (NHS Digital, 2024), in each month of 2023, there were between 370,000 and 470,000 individual new referrals into secondary mental healthcare services. Referrals must be triaged by clinicians, using clinical information contained in the patient’s EHR to arrive at a decision about the most appropriate mental healthcare team to assess and potentially treat these patients.The ability to efficiently recommend a relevant team by ingesting potentially voluminous clinical notes could help services both reduce referral waiting times and with the right technology, improve the evidence available to justify triage decisions.We present and evaluate three different approaches for LLM-based, end-to-end ingestion of variable-length clinical EHR data to assist clinicians when triaging referrals. Our model is able to deliver triage recommendations consistent with existing clinical practices and its architecture was implemented on a single GPU, making it practical for implementation in resource-limited NHS environments where private implementations of LLM technology will be necessary to ensure confidential clinical data are appropriately controlled and governed. Code available at: https://github.com/NtaylorOX/BespokeLLM_Triage.

Adolescents with eating disorders during the COVID-19 pandemic: Changes in social ties and healthcare modalities.

Introduction. The COVID-19 pandemic has had a profound impact on the health of young people worldwide, especially on people with eating disorders (EDs) due to the stress, anxiety, and changes experienced in access to health care. Objective. To explore adolescents' perceptions on changes in their social ties and the modalities of health care for patients with EDs. Population and methods. Qualitative study using in-depth interviews with adolescents with EDs seen at a teaching hospital during the COVID-19 pandemic. Results. Fifteen adolescents were interviewed; their mean age was 18 years; 93% were girls. Anorexia nervosa was observed in 86.6%. The most relevant negative aspects perceived were discomfort with family life (80%) and dissatisfaction with social media content regarding body image and dieting (73%). The aspects perceived as positive were peer support (66%) and improvements in eating habits (66%). The main change identified regarding the management before the COVID-19 pandemic was online followup by the mental healthcare team (73%). Conclusion. The adolescent population with EDs during the mandatory social isolation period reported discomfort with family life and dissatisfaction with social media content regarding body image and dieting. Notwithstanding this, adolescents highlighted peer support and improvements in their eating habits as positive aspects.

Integrative Care for Challenging Behaviors in People with Intellectual Disabilities to Reduce Challenging Behaviors and Inappropriate Psychotropic Drug Prescribing Compared with Care as Usual: A Cluster-Randomized Trial.

People with intellectual disabilities (IDs) often present with challenging behaviors (CBs) mostly due to inappropriate environments and mental and physical disorders. Integrative care is recommended to address CBs. However, in clinical practice, psychotropic drugs are often prescribed off-label for CBs, although the effectiveness is unclear, and side effects frequently occur. We conducted a cluster-randomized controlled study to investigate the effect of integrative care provided by a collaboration of an ID specialized mental healthcare team and participants' own ID service providers' care team on reducing CBs and inappropriate off-label psychotropic drug prescriptions compared with care as usual. Participants (N = 33, aged 19-81 years) had a moderate, severe, or profound intellectual disability and used off-label psychotropic drugs. The primary outcome measures were the Aberrant Behavior Checklist and the total dose of psychotropic drug prescriptions. At the study endpoint of 40 weeks, we found no effect of the intervention on the total ABC score and on the total dose of psychotropic drug prescriptions. In the intervention group, however, the psychotropic drug dose decreased significantly, while CBs did not change. The small sample size and not-completed interventions due to organizational problems may have affected our findings. This study illustrates the difficulties in the implementation of integrative care.

Care Bermuda, families of the patients with chronic mental disorders in Iran surrounded by psychosocial problems and needs: a qualitative study

Background: A mental disorder is characterized by a clinically significant impairment of cognition, emotion regulation, or behavior. As a result of the shift in care from medical centers and hospitals to home care, we now see a change in the treatment of patients with chronic mental disorders. Consequently, families have become the main support system in the progressive care of these patients, leading to psychological and social problems. The current qualitative study investigated the social and psychological health needs and problems of family caregivers of patients with chronic mental disorders in Iran’s cultural and social context. Methods: This was a content analysis qualitative study. The study was conducted in three psychiatric hospitals in Farabi, Noor, Modares. Purposive sampling was done and continued until data saturation. Semi-structured, face-to-face, and individual interviews were conducted with 49 participants (15 family caregivers of patients with CMD and 34 members of the mental health care team). Data analysis was done using the conventional content analysis method. Results: Eight hundred seventy-five primary codes were obtained, which were classified into 10 subcategories and 3 main categories of ʻhealth challenges of caregiverʼ, ʻconfused concept of careʼ and “the need for a coherent support system. Conclusion: In Iranian society, after the patient is discharged from the hospital or care center, family members will change their role to the most important caregivers of these patients. The psychological and social health of these caregivers is destroyed because of the problems they have in providing care for their patients and their needs, which are not met.

Influence of General Health on Quality of Life by the Caregiver and Burden Care as a Mediator: Bayesian Estimator Structural Equation Analysis

Objectives: To test structural equation models of General Health on quality of life by the caregiver and burden care as a mediator. Methods: The quality of life scale was administered to 297 caregivers of persons with schizophrenia. The models were examined using maximum likelihood confirmatory factor analysis (ML-CFA) and Bayesian structural equation modeling (BSEM). The path analysis with direct and indirect effects was discussed in the model. Results: The results reveal that the models fit well for evidence-based. The BIC 1412.998 < 3161.387, DIC 1365.247 < 3094.673, and WAIC 1370.802 < 3094.651 were the lowest BIC of the models and displayed a simple and parsimonious factor-loading pattern. Conclusions: Overall, both of the scales demonstrated excellent measurement properties supporting its relevance to comprehensively measure caregivers' impact and burden on persons with schizophrenia. Psychiatric and mental health care teams and clinical researchers could use the quality of life scale to generate strategies to support the family caregiver and measure the multidisciplinary treatment team interventions' outcomes.

How can we provide a better response to crisis for people with psychiatric problems in the community in the region of Flanders? 

Despite the socialisation of care and the increasing focus on recovery and experiential expertise, the story of the client with for example psychotic experiences and that of his informal network is still insufficiently listened to. As a result, there is a great risk that the focus of care is primarily on the client's clinical recovery and that strengths and other relevant factors in the network remain underexposed and are not timely addressed. We find that, in practice, it often takes a lot of effort and time to re-establish ties with the informal network after clinical recovery. On top of this, the care landscape in Flanders is very fragmented and the route to care is difficult.
 Open Dialogue is a system of mental health care, first developed in Finland, which has two essential ingredients: a therapeutic and philosophical approach to being with people in a time of crisis/need, and a way of organizing mental health services that maximises the possibility of being able to respond to people in such a way and in a timely manner. It usually starts with arranging a ‘network meeting’ in the community, as soon as possible after initial contact with the service. The ‘persons(s) at the centre of concern and significant members of their social network can participate [in the meeting], along with a professional team of two or more persons.
 "On the Road with Open Dialogue" is a 2-year research project (September 2021 – September 2023) in which researchers, in close cooperation with the field and clients, prepare, analyse the steps for implementation and realise a translation and initial implementation of the "Open Dialogue" principles to the context of teams within mental health services.
 Our participatory action research involves 3 outpatient and 2 residential teams within Mental Health services in the region of Limburg, Flanders. Through focus groups, we identify supporting and impeding factors using the Consolidated Framework of Implementation Research, CFIR.
 Six co-creation sessions have taken place in which the principles of "Open Dialogue" are worked on together with at least 2 ambassadors per team. Learning from each other is central. The outcome is a roadmap of the approach translated to the context of the professional mental healthcare teams.
 
 The research-goal is to identify which factors could lead to sustainable implementation of Open Dialogue in Flanders region? At this stage of the study, results of the process and initial findings from focus group analysis can be reported. We found that "Open Dialogue" is not a methodology you can just adopt. It requires a process-based and thorough development of practice adapted to the current workings of mental health care. The drive of the ambassadors (of the participating teams) to continue working with "Open Dialogue" stems from the drive to improve care. Taking small steps gives the experience of being closer to why they chose a job as a caregiver. Advanced training in Open Dialogue is seen as a necessary basis to continue with dialogism and reflection.

Unraveling complexity in changing mental health care towards person-centered care.

Mental health care (MHC) needs to shift towards person-centered care to better meet people's individual needs. Open Dialogue (OD) is well-aligned with this perspective and brings it into practice. This study focuses on exploring the change process within a pilot project involving three MHC teams as they transition to a person-centered OD practice. Our aim is to identify and reflect on the challenges faced by MHC professionals in adopting person-centered care, and shedding light on the underlying complexity of these challenges. By gaining a better understanding of these obstacles, we hope to contribute to the adoption of the person-centered approach in MHC practice. Our research employed a qualitative design, involving a total of 14 semi-structured interviews with MHC professionals who were either trained in OD, OD trainees, or MHC professionals without OD training. To analyze the data, we utilized a hybrid approach that combined deductive - and inductive thematic analysis. We identified four distinctive challenges: (1) understanding and knowledge transfer, (2) (inter)personal process, (3) emotional discomfort, and (4) the need for multi-stakeholder participation and support. In practice, these challenges intersect and the appearance of and relationships between these challenges are not linear or disentangleable. Upon careful consideration of these interdependent challenges, it became evident that embedding a person-centered approach like OD brings about systemic change, leading to an unfamiliar situation X. The research findings indicated that understanding and conveying the concept of person-centered care in practical settings poses significant challenges. The field of knowledge management helps to capture the complexity of understanding and transferring this knowledge. The change process necessitates an (inter)personal process and elicits emotional discomfort, as person-centered OD practice confronts a deeply entrenched paradigm in MHC. Achieving a shared understanding of person-centered care requires dedicated time and attention, while introducing this approach prompts broader discussions on underlying values and human rights in MHC. Current implementation efforts may underestimate or overlook these underlying values, but initiating an open dialogue can serve as an initial step in addressing the complexities.

Interprofessional Team Collaboration for Routine and Emergent Mental Health Concerns Among Collegiate Student-Athletes: A Case Series from the Association for Athletic Training Education Research Network.

Collegiate student-athletes experience an increasing number of mental health concerns. To help address these concerns and provide high-quality health care for student-athletes, institutions of higher education are being encouraged to create interprofessional health care teams that are specifically dedicated to managing mental health. We interviewed 3 interprofessional health care teams who collaborate to manage routine and emergency mental health conditions in collegiate student-athletes. Teams represented all 3 National Collegiate Athletics Association (NCAA) divisions and included athletic trainers, clinical psychologists, psychiatrists, dietitians and nutritionists, social workers, nurses, and physician assistants (associates). The interprofessional teams indicated that the existing NCAA recommendations helped to solidify members and roles of the mental health care team; however, they all believed their teams would benefit from more counselors and psychiatrists. Teams had different mechanisms for referral and accessing mental health resources on their campuses, which may make on-the-job training for new members of the team an organizational necessity.

The impact of COVID-19 vaccination on psychiatric symptoms in schizophrenia patients: A retrospective study.

The objective was to investigate the impact of COVID-19 vaccination on anxiety, depression, stress perception, and psychiatric symptoms in patients with schizophrenia, and to explore severity of psychiatric symptoms is associated with vaccine hesitancy in individuals with schizophrenia. Mental health symptoms were evaluated in 273 hospitalized schizophrenia patients who received COVID-19 vaccination, and in 80 patients who refused vaccination, both before and after immunization. The study assessed the effects of vaccination on psychiatric symptoms and the potential association between vaccination behavior and psychological distress. Our findings suggest that COVID-19 vaccination is associated with a small worsening of schizophrenia symptoms in older inpatients. Moreover, vaccination behavior may increase anxiety, depression, and stress perception in hospitalized schizophrenia patients, which has implications for the mental health care team working in the context of the pandemic. The study highlights the importance of monitoring the mental health status of patients with schizophrenia during the COVID-19 pandemic, particularly in relation to vaccination behavior. Further research is needed to better understand the mechanisms underlying the observed effects of COVID-19 vaccination on psychiatric symptoms in patients with schizophrenia.

Developing Relational Coordination: A Qualitative Study of Outpatient Mental Health Teams.

Previous studies have shown Relational Coordination improves team functioning in healthcare settings. The aim of this study was to examine the relational factors needed to support team functioning in outpatient mental health care teams with low staffing ratios. We interviewed interdisciplinary mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. We conducted qualitative interviews with 21 interdisciplinary team members across three teams within two medical centers. We used directed content analysis to code the transcripts with a priori codes based on the Relational Coordination dimensions, while also being attentive to emergent themes. We found that all seven dimensions of Relational Coordination were relevant to improved team functioning: frequent communication, timely communication, accurate communication, problem-solving communication, shared goals, shared knowledge, and mutual respect. Participants also described these dimensions as reciprocal processes that influenced each other. In conclusion,relational Coordination dimensions can play pivotal roles in improving team functioning both individually and in combination. Communication dimensions were a catalyst for developing relationship dimensions; once relationships were developed, there was a mutually reinforcing cycle between communication and relationship dimensions. Our results suggest that establishing high-functioning mental health care teams, even in low-staffed settings, requires encouraging frequent communication within teams. Moreover, attention should be given to ensuring appropriate representation of disciplines among leadership and defining roles of team members when teams are formed.

Innovative Models of Geriatric Mental Health Services

The demographics of residents residing in long term care facilities is changing in many ways. There is a substantial increase of those admitted with serious mental illness, and at a younger age. Greater than 50% of residents have a neurodegenerative illness, such as dementia, and subsequently they all will experience behavioral and psychological symptoms of dementia during their admission. The new ICD-10 codes are integral to quality care and outcomes for this population. Most current approaches to the behavioral health needs of this population fall short of meeting resident and facility needs. This presentation seeks to consider a bold, interprofessional, and integrated approach to the bedside care of geriatric mental health services in long term care. Consideration includes proper ICD-10 code diagnosis and a culture of care that emphasizes the patient as an individual to improve quality of life and quality of care. This falls directly in line with the President's Commission on Aging Quality and Best Practices in Geriatric Psychiatric services and includes: a multidisciplinary team approach, specific geriatric expertise, individualized assessment, collaborative treatment planning between the consultant and facility staff, as well as a strong educational component. Current barriers to success will be explored to improve overall performance of the mental healthcare team.

Leadership, Centering Equity Vital to Future of Medical Education

Leadership, Centering Equity Vital to Future of Medical Education

Coming Up…

The American Psychiatric Association will hold its Mental Health Services Conference, “Facing Our Future Together: Empowering mental health care teams with practical solutions to emerging challenges,” Oct. 13–14 in Washington, D.C. Visit https://psychiatry.org/psychiatrists/meetings/the‐mental‐health‐services‐conference for more information.

Engaging Veterans With Serious Mental Illness in Primary Care.

Veterans with serious mental illness (SMI) are at substantial risk for premature mortality. Engagement in primary care can mitigate these mortality risks. However, veterans with SMI often become disengaged from primary care. The US Department of Veterans Affairs (VA) measures and reports at VA facilities primary care engagement among enrolled veterans with SMI. This quarterly metric enables VA facilities to identify targets for quality improvement and track their progress. To inform quality improvement at our VA facility, we sought to identify promising practices for supporting engagement in primary care among veterans with SMI. We conducted semistructured telephone interviews from May 2019 through July 2019 with a purposeful sample of key informants at VA facilities with high levels of engagement in primary care among veterans with SMI. All interviews were recorded, summarized using a structured template, and summaries placed into a matrix. An interdisciplinary team reviewed and discussed matrices to identify and build consensus around findings. We interviewed 18 key informants from 11 VA facilities. The strategies used to engage veterans with SMI fell into 2 general categories: targeted outreach and routine practices. Targeted outreach included proactive, deliberate, systematic approaches for identifying and contacting veterans with SMI who are at risk of disengaging from care. In targeted outreach, veterans were identified and prioritized for outreach independent of any visits with mental health or other VA services. Routine practices included activities embedded in regular clinical workflows at the time of veterans' mental health visits, assessing, and connecting/reconnecting veterans with SMI into primary care. In addition, we identified extensive formal and informal ties between mental health and primary care that facilitated engaging veterans with SMI in primary care. VA facilities with high levels of primary care engagement among veterans with SMI used extensive engagement strategies, including a diverse array of targeted outreach and routine practices. Intentionally designed organizational structures and processes and facilitating extensive formal and informal ties between mental health and primary care teams supported these efforts. Additional organizational cultural factors were especially relevant to routine practice strategies. The practices we identified should be evaluated empirically for their effects on establishing and maintaining engagement in primary care among veterans with SMI.

Mental health treatments in an Italian prison: the Parma integrated approach

IntroductionMental health interventions for Italian (and European) prisoners with mental disorders remain a problematic issue, despite radical changes in general psychiatric care and a 2008 major government reform transferring mental health care in prison to the National Health Service. Indeed, according to the American Psychological Association, 64% of incarcerated individuals report mental health concerns.Objectives The aim of this study is to describe the mental health intervention model implemented since January 2020 for prisoners allocated in the Parma Penitentiary Institutes (PPI). This approach is specifically based on specialized, “person-centered” and “person-tailored” therapeutic-rehabilitation plans in line with psychiatric treatments usually provided in community mental health-care centers of the Parma Department of Mental Health.MethodsAll the processes and procedures included in the PPI intervention model were first carefully described, paying special attention to the service for newly admitted prisoners and each typology of specialized therapeutic-rehabilitation treatment potentially provided. Additionally, a preliminary descriptive process analysis of the first six months of clinical activity was also performed.Results Since January 2020, 178 individuals entered the PPI service for newly admitted prisoners. In total, 83 (46.7%) of them were engaged in the services of the PPI mental health-care team (35 with pathological addiction and 48 with mental disorders): 56 prisoners were offered an integrated mental health intervention and 27 exclusively an individual psychological or psychiatric treatment.ConclusionsThe results support the potential applicability of an integrated mental health intervention in prison, planning a person-tailored rehabilitation in close collaboration with the prisoners, their families and the local mental health/social services.DisclosureNo significant relationships.

Beyond Shared Care in Child and Adolescent Psychiatry

Abstract Based in the multicultural context of Montreal, Quebec, Canada, this article reviews shared care and collaborative care models which privilege consultations between primary and specialty care in children's mental health. An overview of Canada's two largest child psychiatric epidemiological studies outlines the nonclinical community prevalence in Ontario (18.5%) and Quebec (15%) of children's mental health problems along with salient family and community risk factors. Given the high prevalence of children's mental health problems and the burden of care undertaken by primary care practitioners, the interface between the first line of care and mental health services is crucial yet often characterized by poor communication, a lack of mutual comprehension, and limited collaboration. Collaborative mental health care has been defined as “a family physician or other primary care provider working together with a psychiatrist or other mental health worker in a mutually supportive partnership.” This definition is extended to describe a spectrum of partnerships in child and adolescent psychiatry (CAP): shared care, collaborative care, and related collaborative community practices. The author's experience with these models is presented with an overview of a pilot study on CAP shared care in Montreal. Two other recent trends in Quebec are explored: an innovation called “Medical Specialists Responding in Child and Adolescent Psychiatry” for community mental health-care teams and the pair aidant or “peer helper” model reaching out to patients and families with a member who suffers from mental health problem to serve as a helper, a model, and part of the support network.