Model For Mental Health Services Research Articles

Research on Optimizing National Mental Health Literacy from the Perspective of Health in China: Significance and Approach

Improving the level of national mental health and strengthening the construction of social psychological service system are the necessary and important ways to promote the implementation of the Healthy China strategy. However, the gap between the requirements of Healthy China strategy for social mental health service system and the current situation of mental health service in China is still widespread. Promoting the public to form an effective demand for psychological help and establishing a new mental health service model is the key to bridge this gap. Optimizing mental health literacy is an important starting point and breakthrough to solve this problem. At present, the research on mental health literacy is undergoing a transformation from the paradigm of psycho-epidemiology to the paradigm of psychology and sociology. Taking contemporary China as the background, the reconceptualization of mental health literacy and the exploration of the current situation of Chinese mental health literacy in the new era is one of the core task of current psychological path research. The significance of this study is mainly reflected in: (1) promote the formation of effective demand for help and improve the level of public mental health; (2) enhance cultural selfconfidence and construct the theory of mental health literacy of contemporary Chinese people; (3) guide the supply side structural reform of mental health services and promote mental health equity; (4) reduce the burden of mental illness and help build a well-off society in an all-round way; (5) help build a social and psychological service system.

Developing a model for mental health services for children and young people with intellectual disability and/or autism in North West England

PurposeThis paper aims to improve community care for people with intellectual disabilities (ID) and/or autism. Lack of coordination between agencies leads to children and young people with the most complex needs falling between services. The North West Operational Delivery Network (ODN) for learning disability and autism set out to develop a model of care for mental health services for children and young people with ID and/or autism in North West England that would improve coordination between services and lead to better community care.Design/methodology/approachThe ODN held a series of good practice events and consultations with stakeholders in North West England to look at gaps in service provision, national guidelines and agree on a pathway for services.FindingsThe ODN decided to use the THRIVE framework as the basis for a specific model of care. Interventions were mapped against the THRIVE groupings, including pathways and team specifications for assessment and support for children with autism, and models for child and adolescent mental health service support for ID and/or autism, for keeping children and young people with behaviour that challenges in the community and transition.Originality/valueThis model aims to provide the North West England region with a clear multi-agency approach for supporting the needs of this population and supports multi-agency commissioning, gap analysis, earlier intervention and improving health outcomes for this population.

Stress, distress, and burnout among medical trainees: An institutional approach

In the recent changes in medical education and health-care systems, stressful work condition and concurrent destabilizing psychosocial dynamics can result in adverse consequences of medical trainee's mental health. This can range from the usual stress in a medical school to distress and long-term burnout emerging into psychological disorders often underrecognized and ill managed. Stigma and poorly integrated available mental health services, administration, peers, and families can be roadblocks to implement an effective campus mental health services. This article also provides a template of student mental health service model in our institution and suggested measures for a holistic professional grooming during medical curriculum.

“It's Not a Pattern of Behavior”: Proxy Deflection of Eviction Stigma by Community Care Providers

Community care is the “hospital without walls” model of mental health services that deinstitutionalized mental patients in the late‐twentieth century. Neoliberal reforms have challenged the implementation of community care by restricting access to permanent housing. Extreme poverty has rendered eviction commonplace for community care recipients. The mark of an eviction limits lease attainment. As a result, community care providers practice proxy deflection—redemption, externalization, and paternalism—to resist eviction stigma during the leasing process. This paper extends stigma research by examining resistance rather than imposition of stigma by social service providers, contextualizing resistance with the perspective of stigmatizers, and identifying resources that proxy resistance offers service recipients leasing up in stratified private rental markets during the neoliberal era.

T245. A MODEL 2.0 FOR EARLY INTERVENTION SERVICES FOR PSYCHOSIS: USING A LEARNING HEALTHCARE SYSTEM APPROACH TO IMPROVE EVIDENCE-BASED CARE

BackgroundIn Canada, 26.3% of people reporting having mental disorders have indicated that they did not receive adequate care for their mental illness. However, early and evidence-based treatment can significantly reduce the severity of mental illnesses. Early Intervention Services (EIS) for psychosis are an example of such an intervention. EIS are widely recognized as a more effective treatment than routine care for early psychosis. Most Canadian EIS for psychosis follow recommendations on clinical components of care (i.e., easy and rapid access, a case management team approach); however, evidence-based interventions (e.g., measurement-based care or integrated psychosocial interventions) are not always available. Overall, various barriers limit the provision of quality care in the mental health sector, including EIS for psychosis treatment. These barriers include insufficient funding at a time of increasing demand; lack of services; lack of evidence- and measurement-based treatments; and insufficient training for staff and resources for patients. Innovative solutions are required. This presentation describes how e-mental health (eMH) technologies can mitigate these barriers, thus increasing access to evidence-based treatments.MethodsUsing a learning healthcare system approach, this 2.0 mental health services model aims to (a) identify, describe, and explain the factors affecting the routine incorporation and sustainability of eMH technologies in EIS for psychosis, and (b) optimize the methods associated with the development, adaptation, and evaluation of eMH technologies in real clinical settings. These aims are achieved by implementing three e-MH projects and unpacking the co-design/adaptation process and test the implementation, evaluation, and sustainability of eMH interventions and their effects on patient outcomes.ResultsThe learning healthcare system is considered a new research paradigm able to promote quality, safety, and value in health care. Three project are at the core of this learning healthcare system for psychosis: (1) e-Mental Health Assessment and Monitoring (Project A: DIALOG+/e-Pathways to care): (a) To promote evidence- and measurement-based care in EIS for psychosis and (b) to use such technologies (such as electronic data capture platforms and data visualization) to support shared decision-making during treatment; (2) e-Treatment (Project B: CBT/pathways to care game-based interviews): (a) To facilitate the access and use of e-cognitive behavioral therapy (e-CBT) interventions in EIS for psychosis and (b) to support the treatment of secondary illnesses/comorbidities (depression and anxiety); (3) Web-based Training (Project C e-Training): (a) To co-produce web-based training and evaluate its effects on building capacity for the use of eMH technologies in EIS for psychosis and (b) to deliver psycho-educational interventions and continuing education training through interactive case-based learning.DiscussionThis work is timely. The innovative use of the rapid learning system approach in EIS for psychosis will offer a unique opportunity for integrating technologies and data into clinical practice, and should bring meaningful benefits to patients and promote Quebec’s open science research.

一种基于互联网+的新型心理健康服务模式——附在新冠肺炎疫情期间的应用分析

一种基于互联网+的新型心理健康服务模式——附在新冠肺炎疫情期间的应用分析

File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: an Australian case study

BackgroundOver the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework – the Collaborative Recovery Model could be sustained over time.MethodThe study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier.ResultsThe file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the ‘Action Plan Review’ audit item.ConclusionsA comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible.

A mixed methods evaluation of an integrated adult mental health service model

BackgroundThe Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a ‘one-stop’ mental health service hub.MethodsWe conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale — Domains and Stages (RAS–DS) scores at intake and review (n = 108); (2) RAS–DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation.ResultsInterviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS–DS measurements, averaging 5 months apart. RAS–DS ‘total recovery’ scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS–DS domains (‘Looking forward’, p < 0.001; ‘Mastering my illness’, p < 0.001; and ‘Connecting and belonging’, p = 0.001). Corresponding improvements, except in ‘Connecting and belonging’, were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant.ConclusionsDespite the lack of a control group and small follow-up sample size, Floresco’s integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.

Promoting Integrated Mental Health Care Services in Disaster Response Programs: Lessons Learned After the Impact of Hurricane María in Puerto Rico.

Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.

Training of adult psychiatrists and child and adolescent psychiatrists in europe: a systematic review of training characteristics and transition from child/adolescent to adult mental health services

BackgroundProfound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training.MethodsA systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training.ResultsThirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively.ConclusionThree models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training.

Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model.

Aims: Community-based residential alternatives to hospitalization are an emerging service model. Evidence for their acceptability and effectiveness is promising but limited. Prevention and Recovery Care (PARC) services are one such residential model, offering short-term subacute treatment and care (usually between 7 and 28 days). PARC services in Victoria, Australia, are designed to support consumers with severe mental illness to either avoid a psychiatric hospital admission (step-up care) or transition from hospital back into the community (step-down care). As a precursor to a series of studies investigating the appropriateness, effectiveness and efficiency of PARC services, we aimed to investigate whether a typology of PARC services can be developed. Methods: A manager or other appropriately knowledgeable staff member from each of the 19 adult PARC services included in the study completed a tool based on PARC operational guidelines (the Victorian PARC service mapping questionnaire) and a validated instrument measuring the quality of care in residential mental health settings (the Quality Indicator for Rehabilitative Care, QuIRC). Thirty (of 42) stakeholders participated in a modified Delphi study to select 23 from the available 230 variables for entry into a hierarchical cluster analysis. Results: Cluster analysis produced three clusters of equal dissimilarity. At the 90% confidence level, there were four variables which were significantly different between clusters. These were the year the PARC was opened, the QuIRC Living Environment domain score, the proportion of all admissions that were a step-down admission from an inpatient unit, and how often families were invited to care meetings. Sensitivity analyses suggested the findings were robust to the method used to identify clusters. Conclusions: Although PARC services were broadly similar, their identified differences suggest there is variable model implementation across Victoria sufficient to generate a PARC service typology. This typology may prove important for interpreting differences in outcomes experienced by consumers and carers using PARC services, when applied in our analyses of service effectiveness. The value of conducting service mapping and typology studies is underscored. Further research to characterize subacute residential services, including recovery-promoting features of the built environment, is warranted.

Positively Adapting to a Changed Reality

Introduction:Following the New Zealand November 2016 earthquake, mental health staff were deployed to assist with the immediate levels of distress in the community. The work included working with individuals, couples and families, staff wellbeing sessions, psychosocial education, and participating in outreach clinics to isolated communities.Aim:Aware of international evidence and the experience following the 2010/11 earthquakes, the aim was to provide mental health assistance to address issues as early as possible with the intent that this would reduce the future demands on specialist services.Methods:Following the response phase, a small team of mental health specialists formed the Recovery and Wellbeing Team working in the affected communities undertaking clinical, consult, advisory, and educational work as needed. The team flexed and evolved to meet the changing needs. A range of data was collected and analyzed to monitor the work and the outcomes of this team.Findings:With additional support provided following the earthquake, there has been a significant positive change in the numbers of referrals to secondary mental health services in Christchurch. A new model of care has now been collaboratively developed, as the mental health system positively adapted to a changed reality. This model is essentially an easily accessed, early intervention, comprehensive model of mental health service to maintain the positive gains.Discussion:Following a significant disaster, all involved will benefit from some form of psychosocial support. For most, this will be achieved through the person’s own networks. For some, the event will trigger responses from previous traumatic experiences and a few mental health supports will be required. Having skilled professionals with the ability to cope with the constantly changing needs, and who are available to meet people at the earliest opportunity, has enabled issues to be resolved rather than leaving these issues to escalate over time.

Psychosocial Interventions to Reduce Compulsory Psychiatric Admissions: A Rapid Evidence Synthesis

BackgroundCompulsory mental health hospital admissions are increasing in several European countries but are coercive and potentially distressing. It is important to identify which mental health service models and interventions are effective in reducing compulsory admissions. MethodsWe conducted a rapid evidence synthesis to explore whether there is any evidence for an effect on compulsory admissions for 15 types of psychosocial intervention, identified by an expert group as potentially relevant to reducing compulsory admission. A search for randomised controlled trials (RCTs) reporting compulsory admission as a primary or secondary outcome or adverse event was carried out using clinical guidelines, recent systematic reviews, and database searches postdating these reviews. FindingsWe found 949 RCTs reporting on the interventions of interest, of which 19 reported on compulsory admission. Our narrative synthesis found some evidence for the effectiveness of crisis planning and self-management, while evidence for early intervention services was mixed. We did not find evidence to support adherence therapy, care from crisis resolution teams and assertive community treatment, but numbers of relevant studies were very small. We found no trials which tested effects on compulsory admission of the nine other intervention types. InterpretationCrisis planning and self-management interventions with a relapse prevention element are most promising for preventing compulsory admissions. Given our broad search strategy, the lack of evidence demonstrates that there is an urgent need for more research on interventions which may reduce compulsory admissions. FundingIndependent research commissioned and funded by the National Institute for Health Research Policy Research Programme.

The comparison of patients with schizophrenia in community mental health centers according to living conditions in nursing home or home

Objective: Community mental health centers constitute the core of the community-based mental health service model. Some of the patients enrolled in these centers that provide support to individuals and their families with severe mental disorders are staying in a nursing home. In this study, it was aimed to compare the sociodemog- raphic, clinical and drug treatment characteristics of the patients living in nursing home with the patients living at home. Methods: The study included a total of 135 patients who were diagnosed with schizophrenia according to DSM-5 criteria and who attended to rehabilitation program at community mental health centers of Selcuk University Faculty of Medicine, Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, Konya Numune Hospital and Konya Eregli State Hospital at least one day in a month. The study design was retrospective, the data collection forms were filled using hospital medical records. Results: A total of 135 patients with schizophrenia were included in the study. While 82 (60.7%) of the patients were living at home, 53 (39.3%) were in the nursing home. The rate of male patients in the nursing home, the average age, the number of days they participated in the rehabilitation program, the duration of the illness, and the smoking rate were significantly higher than the patients who were living at home. When all patients using multiple antipsychotics were evaluated, positive correlation was found between the number of drugs and side effect scale score, Positive and Negative Syndrome Scale total score. According to the logistic regression analysis to determine the variables predicting the use of single antipsychotic or multiple antipsychotic drugs, the male gender and the number of hospitalizations were found to increase the rate of combined drug use. Discussion: In order to improve the service provided in community mental health centers, it is necessary to identify the need areas of patients according to living conditions in nursing home or home, to share the good practices in psychosocial interventions and to increase the awareness in drug treatments in order to make new arrangements in line with the recommendations of the treatment guidelines.

Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study

IntroductionIncreased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a...

Design for mobile mental health: an exploratory review

A large number of mobile mental health apps are available to the public but current knowledge about requirements of designing such solutions is scarce, especially from sociotechnical and user centred points of view. Due to the significant role of mobile apps in the mental health service models, identifying the design requirements of mobile mental health solutions is crucial. Some of those requirements have been addressed individually in the literature, but there are few research studies that show a comprehensive picture of this domain. This exploratory review aims to facilitate such holistic understanding. The main search keywords of the review were identified in a cross-disciplinary requirements workshop. The search was started by finding some core references in the healthcare databases. A wider range of references then has been explored using a snowball method. Findings showed that there is a good understanding of individual design requirements in current literature but there are few examples of implementing a combination of different design requirements in real world products. The design processes specifically developed for mobile mental health apps are also rare. Most studies on operational mobile mental health apps address major mental health issues while prevention and wellbeing areas are underdeveloped. In conclusion, the main recommendations for designing future mobile mental health solutions include: moving towards sociotechnical and open design strategies, understanding and creating shared value, recognizing all dimensions of efficacy, bridging design and medical research and development, and considering an ecosystem perspective.

The effect of a youth mental health service model on access to secondary mental healthcare for young people aged 14-25 years.

Aims and methodThe Norfolk Youth Service was created in 2012 in response to calls to redesign mental health services to better meet the needs of young people. The new service model transcends traditional boundaries by creating a single, 'youth friendly' service for young people aged 14-25 years. The aim of this study was to investigate the effect of the transition to this new model on patterns of referral, acceptance and service use. We analysed routinely collected data on young people aged 14-25 years referred for secondary mental healthcare in Norfolk before and after implementation of the youth mental health service. The number of referrals, their age and gender, proportion of referrals accepted and average number of service contacts per referral by age pre- and post-implementation were compared. RESULTS: Referrals increased by 68% following implementation of the new service model, but the proportion of referrals accepted fell by 27 percentage points. Before implementation of the youth service, there was a clear discrepancy between the peak age of referral and the age of those seen by services. Following implementation, service contacts were more equitable across ages, with no marked discontinuity at age 18 years.Clinical implicationsOur findings suggest that the transformation of services may have succeeded in reducing the 'cliff edge' in access to mental health services at the transition to adulthood. However, the sharp rise in referrals and reduction in the proportion of referrals accepted highlights the importance of considering possible unintended consequences of new service models.Declaration of interestsNone.

Some People May Need it, But Not Me, Not Now: Seeking Professional Help for Mental Health Problems in Urban China.

In recent years, various levels of the Chinese government have undertaken the task of developing new models of community-based mental health services. Greater availability and higher quality will not result in substantial improvements if those suffering from mental illnesses do not use the services. This article examines not only people's cultural perception of mental health and help-seeking but also their practical concerns and preferences about mental health service provision in urban China. The study analyzes qualitative data from in-depth interviews with 50 respondents who belong to the most psychologically distressed subgroup (with the Kessler Psychological Distress Scale (K10) score ≥ 25) identified in a household survey in Beijing. While stigma about mental illness and help-seeking is real and well described, most interviewees are also not aware of the availability of professional mental health services. They believe that professional services target the upper-middle and upper classes, and are outside the sphere of their daily life and socio-economic status. The interviewees do not welcome the prospect of a mental health clinic or treatment center in their neighborhood due to concerns about stigma and confidentiality; instead, they support the creation of mental health referral services and promotion programs within the community or on the Internet. The findings suggest that the development of community-based mental health services in mainland China should take into account not only the cultural constraints that make people reluctant to seek professional help but also the structural inadequacies that deter potential user groups from accessing such services.

The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model - RETRACTION.

[This retracts the article DOI: 10.1192/bji.2017.14.].

The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model - RETRACTED.

Mental health services for youths within the juvenile justice system remain a contemporary global discourse. To bring perspectives from under-resourced regions, we examine the current limitations of some globalised models for mental health services within the juvenile justice system in Nigeria. The important, multi-systemic steps needed to adapt the system for modern mental health promotion and services are highlighted.