Multidisciplinary Mental Health Services Research Articles

Co-location of specialized mental health services in an intimate partner violence advocacy organization.

Historically, services for intimate partner violence (IPV) survivors predominantly focused on advocacy, resulting in service gaps for IPV survivors who need mental health care. When mental health services are offered, there are several barriers that limit treatment engagement. To address these gaps, a novel, integrated care model, comprised of psychiatrists, clinical psychologists, and social workers were embedded into the five New York City (NYC) Family Justice Centers (FJCs), to provide free co-located mental health care to adult survivors of IPV alongside the existing advocacy, social, and legal services. This article reports on the evaluation of the Health + Hospitals Family Justice Center Mental Health Program (FJCMHP) via: (i) seven focus groups with FJC clients and staff and Health + Hospitals (H+H) clinicians; and (ii) de-identified online surveys completed by 53 FJC clients and 130 FJC staff. Clients reported increased access to care, with 67.2% seeing a mental health clinician within two weeks of a request, and improvement in symptom relief, including sleep, mood, irritability, reduction in thoughts of self-harm, improved relationships with others, especially their children, and improved self-efficacy in parenting skills. Additionally, FJC staff reported satisfaction with the FJCMHP model, and increased understanding of clients' mental health needs. The evaluation results highlight the feasibility and tolerability of integrated mental health services in a non-medical setting. The evaluation also identifies areas for improvement, as well as the strengths of an integrated, multidisciplinary mental health service program for IPV survivors co-located in a non-medical, advocacy setting.

Challenges of the development of mental health care in Slovenia

With the implementation of The Mental Health Act in 2008 and The National Mental Health Programme in 2018, Slovenia made important progressive steps in the development of mental health care in the direction of community-based multidisciplinary approach on the primary level of the health and social care system. One of the main obstacles in the realization is the lack of mental health professionals – psychiatrists, psychologists and psyhotherapists. The increase of mental health problems during COVID-19 pandemic, like increased number of suicidal attempts, alcohol abuse, number of criminal attempts of domestic violence and mental health problems of children and adolescents, have further increased the need for the development of various forms of community-based multidisciplinary mental health services on the primary level.

Consumer perspectives of telehealth in ambulatory care in an Australian health network.

We aimed to explore consumer experiences of ambulatory telehealth services and whether consumer experiences differed according to whether they received their consultation using telephone or video technology. We conducted structured telephone interviews with patient consumers who had received a recent remote consultation by telephone or video call, at local ambulatory allied health or multidisciplinary services within a large public metropolitan public health network. Respondents were asked about their recent experience and future choices in relation to telehealth. Responses from consumers who received telephone and video consultations were compared. Consumers from community rehabilitation, community health, allied health outpatients, multidisciplinary specialist clinics and mental health services participated (n=379), of whom 245 received a telephone consultation (65%) and 134 a video consultation (35%). Almost half of respondents (49%) expressed preference for future face-to-face care and 29% reported they would choose to use telehealth over face-to-face consultation for a similar appointment again. Many commented that they would be influenced by the type of consultation required and expressed a desire to have a choice. Approximately 80% of both groups reported they had achieved the desired outcome from their telehealth consultation. Consumers using video were more likely to experience technical issues. Telehealth met the needs of most consumers, and responses were similar for telephone and video consultations.

Effective Peer Employment Within Multidisciplinary Organizations: Model for Best Practice.

This study sought a clearer understanding of organizational mechanisms reinforcing effective peer employment and organizational change from the perspectives of peer workers, non-peer staff and management in multidisciplinary mental health and substance use recovery services. Findings were used to develop a model for organizational best practice for peer employment and associated organizational change to promote recovery-oriented and person-directed services. Qualitative research was undertaken, involving 132 people participating in 14 focus groups and eight individual interviews. These people were employed across five U.S. multidisciplinary organizations providing mental health and substance use recovery services and deemed by a panel of experts to provide effective employment of peer workers. Study findings include the articulation of an interactive working model of best practice, comprising organizational commitment, organizational culture and effective organizational strategies necessary for a "whole-of-organization" approach to support authentic peer work and enable organizational transformation, to actualize recovery-oriented values and person-driven services. Strategies include Human Resources engagement, peers in positions of senior organizational authority, recurring whole of workforce training, along with peer training and peer-led supervision. Findings suggest whole-of-organization commitment, culture and practice are essential for the organizational transformation needed to support effective employment of peers in multidisciplinary environments.

‘Comfortable, safe and valued’: an analysis of the impact of COVID-19 on Hertfordshire's Community Perinatal Team

AimsThis study aimed to assess the impact that the COVID-19 pandemic has had on the Hertfordshire Community Perinatal Team (CPT) group interventions and the innovations made.BackgroundThe CPT is a multidisciplinary mental health service that runs three groups: Circle of Security (CoS), Emotional Coping Skills (ECS) and a peer support group - Wellbeing and Lifestyle. The service has received an increase in referrals during the COVID-19 pandemic.MethodMethods: Team member and client semi structured interviews were conducted with answers transcribed in real time and analysed. Patient clinical records were accessed via PARIS and analysed in order to identify patient demographics within each group and whether these had changed during the pandemic. Clinical outcome measures and client feedback were evaluated to see whether the change in groups is impacting their clinical effectiveness.ResultResults: Innovations made by the CPT include: groups becoming virtual, launching of the new Circle of Security Group which helps women tackle the ‘Ghosts in the Nursery’ and strengthen maternal bonds, restructuring existing groups, breakout room forums and incorporating communication platform apps such as Whatsapp. The Wellbeing and Lifestyle Group increased in size and reach (7 women from 7 areas in 2019 vs 12 women from 12 areas in 2021) with an increased retention rate (71% in 2019 vs 100% in 2021) and a decreased attrition rate (29% in 2019 to 0% in 2021). The Emotional Coping Skills group experienced similar changes (10 areas represented in 2019 vs 15 different areas in 2021) with an increased retention rate (58% in 2019 vs 100% in 2021) and decreased attrition rate (42% in 2019 vs 0% in 2021).ConclusionThe Hertfordshire Community Perinatal Team has responded to the pandemic by innovating existing groups and creating new forums; many of which will continue on even after the pandemic ceases. The groups have acted as a lifeline for women breaking up the monotony and isolation of lockdown life and providing an invaluable space for women to be heard.

Perceptions of mental health assessment and resource-oriented music therapy assessment in a child and youth mental health service

ABSTRACT Introduction Music therapists are increasingly being employed in multidisciplinary mental health services. Assessment is usually undertaken early in mental health treatment and can significantly influence people’s engagement with therapy. However, little is known about how people perceive mental health assessment and music therapy assessment. Method The purpose of this qualitative study was to explore, through focus groups, young people’s perceptions of assessment in Child and Youth Mental Health Services (CYMHS) in Australia. Three young people discussed their recollections of mental health assessment in inpatient and outpatient CYMHS settings. Two of the young people reviewed a Resource-Oriented Music Therapy Assessment (ROMTA) devised by the first author and the Healthy Unhealthy uses of Music Scale (HUMS), envisaged music therapy assessment, and made suggestions for sensitive implementation. Results Thematic analysis revealed four themes regarding mental health assessment: not understanding; coming out feeling worse; getting through somehow and finally getting help. Based on these themes, participants suggested that music therapy assessment should be thoroughly explained and taken at the young person’s pace, that trust and rapport should be developed before asking personal questions and using quantitative measures, and that assessment tasks should be based on what young people are comfortable with. Discussion This research addresses a gap in the literature regarding young people’s perceptions of mental health assessment and music therapy assessment. In this study, young people indicated a preference for individualised, conversational approaches rather than standardised measures. Findings indicate that assessment should be supportive, collaborative and provide sufficient information to promote autonomy.

Anxiety and Adaptation of Behavior in Pregnant Zhuang Women During the COVID-19 Pandemic: A Mixed-Mode Survey.

PurposeThis study explored the impact of COVID-19 on the mental health and adaptation of behavior of Zhuang women in China to provide more specific guidance for the social and medical practice of pregnant women during public health emergencies.Participants and MethodsThis cross-sectional study recruited 446 pregnant Zhuang women from obstetric outpatient clinics in four tertiary hospitals and online maternity schools in Nanning, Guangxi, between February 24 and March 1, 2020. Self-designed questionnaires and the Self-Rating Anxiety Scale were used.ResultsDuring the COVID-19 pandemic, the prevalence rate of anxiety among women was 36.77%, and some adaptation of behavior was observed. Logistic regression analysis showed that pregnant women who had an annual household income of less than $7,000, were primiparous, went out for prenatal examination, wanted to self-monitor during pregnancy but did not know how to do it, believed that they should be strictly isolated at home and cancel prenatal examinations, and expected to receive pregnancy healthcare through teleconsultation services showed a higher risk of anxiety. Nevertheless, pregnant Zhuang women who were 22–35 years old, undergraduate-educated, and in their second trimester were less likely to suffer from anxiety.ConclusionThe COVID-19 pandemic has a significant psychological impact on pregnant women from ethnic minorities. Factors related to quarantine and social isolation policies appear to drive changes in behaviors and anxiety disorders. Multidisciplinary mental health services and culturally sensitive interventions are necessary for minority pregnant women, especially for low-income primiparous women in the first or third trimester.

Clinical social work in Aotearoa New Zealand: Origins, practice, and future implications

INTRODUCTION: Clinical social work is practised with individuals, groups and families in areas concerned with mental health and counselling for people’s wellbeing. As a field of practice, it has been insufficiently researched and often not understood in Aotearoa New Zealand. This article provides an overview of clinical social work in Aotearoa New Zealand.APPROACH: This is a theoretical article that discusses the development of social work, and clinical social work, in this country; attention is paid to professionalisation debates and registration. There is an overview of the social work training landscape and post-qualifying mental health specialisation options, with a brief discussion about the New Entry to Specialist Practice model for social workers. Theoretical underpinnings of clinical social work interventions are canvassed, including systemic models, recovery approaches, strengths-based models, indigenous models, narrative therapy, cognitive behavioural therapy and dialectical behaviour therapy. Four vignettes of clinical social work are presented, before a discussion about the future implications for clinical social work in Aotearoa New Zealand.CONCLUSION: Clinical social workers have a range of knowledge and skills to work with people in mental distress. A challenge is issued to clinical social workers to continue to uphold social work values within multidisciplinary mental health services. The development of a clinical scope of practice in the context of recent mandatory registration for social workers is recommended.

'I think we're getting a bit clinical here': A qualitative study of professionals' experiences of providing mental healthcare to young people within an Australian rural service.

This paper contributes to scholarship on the medicalisation of mental health support for young people through a case study of a multidisciplinary mental health service in rural Australia. All staff (n=13) working at the service participated in semi-structured, individual interviews. Transcripts of interview data were read and selectively coded and interpreted in relation to the overarching question of how participants view and experience mental health care provision to a diverse range of young people. Following analytical reflection, codes pertaining to engagement, accessibility and care provision were re-examined using the concept of medicalisation to understand the biomedical underpinning of mental healthcare and how this plays out in the experiences and perceived challenges participants talked about in responding to the mental health concerns of diverse young people. The resulting analysis is presented under five theme headings: (a) privileging clinical expertise and priorities within service provision, which was an important source of conflict for some participants; (b) 'multidisciplinary' teams-a 'difficult kind of culture at times'; (c) articulations of where cultural barriers lie; (d) the tracks along which young people are directed to 'engage' with 'mental health'; and (e) a clinical 'feel' to space. We suggest that service and system investment needs to be given to alternative ways of thinking about and approaching mental health and care provision that are cognisant of, and engage with, the inherent connections between individual circumstance and social, place, cultural, economic and political contexts. This is particularly relevant to the provision of care in rural contexts because of limited service options and the complexities of access and providing care to a diverse range of young people living in isolated environments. Interdisciplinary frameworks need to be enacted and services must acknowledge their own cultural positions for alternative ways of working to become possibilities.

Domestic violence against women and the COVID-19 pandemic: What is the role of psychiatry?

A heightened risk of domestic violence has been associated with infection-reducing measures undertaken by governments during the COVID-19 pandemic. Psychiatric services can play a key role in addressing this issue by (a) addressing certain risk factors for perpetration of domestic violence through, for example, assertive identification and management of substance misuse; (b) providing support, advocacy and treatment services for victims of domestic violence; and (c) multi-agency working to strengthen medical and social responses to domestic violence. At a time like this, it is important that multi-disciplinary mental health services are strengthened, rather than depleted, in order to address the pressing issues at hand.

Using Participatory Methods to Engage Multidisciplinary Clinical Staff in the Embedding of Trauma-Informed Care and Practice Principles in a Sub-Acute Mental Health Inpatient Unit.

Changing multidisciplinary team practice is difficult, even in circumstances where the staff support such change. This methodology paper describes the successful use of respectful and participatory methods and processes to engage multidisciplinary clinical staff in practice change. These methods are described and discussed in relation to a clinical practice change project that sought to embed trauma-informed care and practice (TICP) in a sub-acute mental health unit. TICP is a critical new paradigm for multidisciplinary mental health services that involves the recognition of the high rates of abuse and trauma suffered by those with mental illness and the need to both understand the effects of this abuse and trauma and to respond to them appropriately. The principles of the paradigm need to be introduced throughout mental health services, but especially in inpatient units where a predominantly biomedical perspective can preclude a more holistic approach. This paper outlines the background of TICP and describes in detail the four TICP-compatible, participatory methods and processes used to engage staff in the embedding of TICP principles in their everyday practice. The participatory approaches employed reflected TICP principles and addressed issues including the engagement of staff in the change project, the identification of TICP-compatible care practices currently used in the unit, the identification of issues related to the further embedding of TICP in everyday care, and the generation of solutions to the issues raised. The processes undertaken were underpinned by a heuristic framework to maintain staff engagement. This paper is not intended to be a recipe for TICP change. However, the methods and processes described may be adapted to be of practical use in the design of TICP and other practice change initiatives in multidisciplinary clinical settings.

A Chinese Perspective of Coronavirus Disease 2019 Outbreak through a Social Psychiatric Lens

The 2019 Coronavirus disease (COVID-19) has posed an emerging threat to global public health and brought challenges to policy-makers. Concerns are rising about the potential mental distress among frontline health-care workers, patients infected with COVID-19, and the public during the epidemic. We aimed to share a Chinese perspective through a social psychiatric lens to better respond to public emergencies. The Chinese government has implemented a number of mental health care measures, including an issue of national guidance on the COVID-19 response in mental health management. We propose that the government should set up a national platform for remote psychological services, increase the number of psychological rescue personnel, and built a joint psychosomatic rescue system for disasters, accidents, and epidemics. Establishing a psychological service system and developing a pool of multidisciplinary mental health service teams are essential to improve the capacity for crisis intervention. Strengthening the interactive system of popular science and health education may mitigate potential negative psychological impacts. We suggest priorities the needs of vulnerable groups with developing mental illness, including depression and posttraumatic stress disorder in longer-term strategic programs.

Collaborative Team Reflective Practice in Trauma Service to Improve Health Care.

The importance of reflection and reflective practice is repeatedly reported in trauma literature, with the process of reflective practice being noted as invaluable for clinicians working within trauma settings. Although the literature on medical primary response trauma teams has reported clinicians' management of clinical roles and additional stressors, the practical applications and benefits of reflective practice insofar have not been identified in relation to complex trauma within multidisciplinary mental health services. This study aimed to identify the issues influencing the capacity for collaborative team reflective practice in a multidisciplinary child trauma mental health service within a UK National Health Service trust. Semistructured interviews were used to investigate the issues influencing the capacity for collaborative team reflective practice. The data were fully transcribed verbatim and analyzed using thematic analysis. The results suggest that clinicians working in a multidisciplinary child trauma service experience a positive benefit from collaborative team reflective practice, but that barriers exist, which influence the capacity to reflect. These include the management of reflective practice within the service, and department and service demands including the nature of the work/cases. Recommendations for the service and for future research are suggested to improve the capacity for collaborative team reflective practice.

A fuller picture: Evaluating an art therapy programme in a multi-disciplinary mental health service

Art therapy has a long history in mental health care but requires an enhanced evidence based in order to better identify its precise role in contemporary services. This paper describes an evaluation of an art therapy programme in an acute adult psychiatry admission unit in Ireland. A mixed method research design was used. Quantitative data were collected through a survey of 35 staff members and 11 service-users. Qualitative data included free-text comments collected in the survey and individual feedback from service-users. Both methods aimed to assess the role of art therapy as part of a multidisciplinary mental health service. Thematic content analysis was employed to analyse qualitative data. Staff demonstrated overwhelming support for art therapy as one element within multidisciplinary services available to patients in the acute psychiatry setting, qualitative feedback associated art therapy with improvements in quality of life and individual support, and emphasised its role as a nonverbal intervention, especially useful for those who find talking therapy difficult. Creative self-expression is valued by staff and service-users as part of the recovery process. Recommendations arising from the research include continuing the art therapy service, expanding it to include rehabilitation patients, provision of information and education sessions to staff and further research to identify other potential long-term effects. The low response of staff and small sample in this study, however, must be noted as limitations to these findings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Study of sociodemographic profile of juvenile boys admitted in an observation home

Background: World Health Report estimated that 20% of children and adolescent suffer from a disabling mental illness worldwide. Incidences of vagrancy, delinquency and crime have been growing among steadily increasing juvenile population in the last few years. Various studies have revealed the presence of difficult family environment, lower socio-economic status, and low parental education associated with the psychiatric morbidity in children. Given the growth of juvenile delinquent population, epidemiologic data of this high risk group is becoming increasingly important. Therefore this study was undertaken to study the sociodemographic profile of male juvenile admitted in an observation home.Methods: This cross sectional study was conducted in an Observation Home for Boys. The study sample consists of 50 boys aged between 6-16 years. Out of 50, 20 juveniles under conflict of law and 30 under care and protection were included.Results: All the juveniles in this study were belonging to the lower socioeconomic status. Delinquency was significantly more common in older age group (12-16 years) than younger age group (6-11 years). The maternal education and school dropout rate had significant correlation with delinquency in our study, found to be more common in juveniles under conflict of law than those under care and protection.Conclusions: Establishment of multidisciplinary mental health services at each juvenile center of India, for complete rehabilitation of the juveniles admitted there, under social justice system is immediately required.

A fuller picture: evaluating an art therapy programme in a multidisciplinary mental health service

Art therapy has a long history in mental healthcare, but requires an enhanced evidence base in order to better identify its precise role in contemporary services. This paper describes an...

Social Work in the Veterans Administration Hospital System: Impact of the Work

Social workers in the Veterans Administration (VA) hospital system are faced with numerous challenges to best address the ongoing health and mental health needs of those who serve in the military. Social workers in the VA system serve diverse roles on the multidisciplinary medical teams and mental health services and are integral to the VA hospital environment. Most social workers feel positive about their work and their contributions to the care of the military. Despite positive feelings about their work, social workers are also prone to compassion fatigue and burnout as the work, especially with returning veterans from Afghanistan/Iraq, often extracts a toll. This article details the experience of social workers in the VA hospital system; it describes the impact of the work on the social workers, noting levels of compassion satisfaction, compassion fatigue, and burnout.

Evidence-based psychological interventions for adult survivors of torture and trauma: A 30-year review

In this paper we review research evidence on psychosocial interventions for adult survivors of torture and trauma. We identified 40 studies from 1980 to 2010 that investigated interventions for adult survivors of torture and trauma. Population subtypes include resettled refugees, asylum seekers, displaced persons, and persons resident in their country of origin. Settings include specialized services for torture and trauma, specialized tertiary referral clinics, community settings, university settings, as well as psychiatric and multidisciplinary mental health services. Interventions were delivered as individual or group treatments and lasted from a single session to 19 years duration. The studies employed randomized controlled trials, nonrandomized comparison studies and single cohort follow-up studies. In all, 36 of the 40 studies (90%) demonstrated significant improvements on at least one outcome indicator after an intervention. Most studies (60%) included participants who had high levels of posttraumatic stress symptomatology. Improvements in symptoms of posttraumatic stress, depression, anxiety, and somatic symptoms were found following a range of interventions. Little evidence was available with regard to the effect on treatment outcomes of the amount, type, or length of treatment, the influence of patient characteristics, maintenance of treatment effects, and treatment outcomes other than psychiatric symptomatology. The review highlights the need for more carefully designed research that addresses the shortcomings of current studies and that integrates the experience of expert practitioners.

Managing Risk: Clinical Decision-Making in Mental Health Services

Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patient's health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.

Not Just Talk: What a Psychosocial Primary Care Mental Health Service Can Do

This descriptive study reports on the development of an inner-city, multi-disciplinary primary care mental health service which expanded its mainly problem-based casework approach to incorporate a well-being focus in the form of community development, health promotion, teaching and training. Work undertaken over one year (2006–2007) with a total of 762 service users is examined for the service population's profile and the range and type of direct work undertaken, with examples. Indirect work is outlined to illustrate the service's collaboration with other mainstream and third-sector agencies. Mutual learning across settings and disciplines was central to this mixed, psychosocial portfolio. The team's work reflected their perspective that mental disorder and mental health are embedded in community processes, and that policies and services which seek to remedy mental disorder by individualised therapies or risk management alone may fail to address the connectedness of service users' mental health with their material, social and personal environments.