Patterns Of Mental Health Care Research Articles

Mental health policy reactions during the first year of the COVID-19 pandemic in two worst-hit WHO European countries: a narrative review and lessons for the aftermath of mental health care

Introduction: The COVID-19 pandemic has been challenging the health care systems and public wellbeing unprecedentedly. The United Kingdom and Turkiye were the countries worst hit by the pandemic in the World Health Organization European region. Purpose: This review investigated the mental health policies in these countries which draw a contrasting pattern of mental health care, sociodemographic background, and income level. Following the investigation, we recommended the possible directions to be pursued by European policymakers Methodology: The documents were picked from the health policy sections from the websites of international organizations (European Parliament, OECD, WHO, UN), online data and policy reports of national ministerial bodies, and general web search. Later, the papers were reviewed and the author identified the main concepts of the responses to discuss after policy review. The study was designed as a review; therefore, no statistical framework was conducted. Results: Identified concepts were as follows: a) continuing service provision for people with mental health conditions, b) digital mental health care interventions, c) building psychological resilience for citizens. Conclusions: A strategy only focusing on treating mental health conditions will not be sustainable during the post-pandemic era. It is essential to address mental health in all policies to foster a strong mental health care system

Depression, Anxiety, and Patterns of Mental Health Care Among Men With Prostate Cancer Receiving Androgen Deprivation Therapy.

Androgen deprivation therapy (ADT) use is associated with an increased risk of developing depression and anxiety. Little is known about how the mental health of these men is treated. We identified men with prostate cancer who received ADT between 2001 and 2015 using Optum's de-identified Clinformatics Data Mart Database. We determined the incidence of depression or anxiety diagnoses, mental health treatments, and the specialty of providers initiating psychotropic medications, after the start of ADT. Outcomes were compared with those of men with prostate cancer not receiving ADT and men without prostate cancer. Of 37388 men with prostate cancer treated with ADT, 3964 (10.6%) received a new diagnosis of depression or anxiety. Of those 3964 men, 1892 (47.7%) did not receive a documented treatment, 10 (0.3%) received psychotherapy, 1321 (33.3%) a selective serotonin reuptake inhibitor, and 744 (18.8%) a benzodiazepine. The median time from initiation of ADT to a depression or anxiety diagnosis was 9.3 months. Primary care physicians were the most common prescribers of psychotropic medications (72.2%). The proportion of men not receiving mental health treatments of interest (47.7%) was similar compared to men without prostate cancer (49.1%), but statistically significantly lower compared to men with prostate cancer not receiving ADT (52.7%). In men with prostate cancer receiving ADT with a new diagnosis of depression or anxiety, nearly half are not receiving mental health care while one in five is introduced to a benzodiazepine. Further investigation toward improving the mental health care for men on ADT is needed.

Continuity as patterning: A process perspective on continuity

This article extends previous research on how work continues in the face of disruption by theorizing continuity as patterning and highlighting the difference between continuity of a thing and continuity as a process. Based on interviews with people who continued providing mental health care during and after the disruption caused by Hurricane Katrina, we show that continuity is a dynamic process that entails people orienting to what actions they can take and how they can connect these actions into paths in an unfolding material, social, and personal situation. The paths, taken together, are a pattern of work (in our case, a pattern of mental health care). While recognizing that exogenous goals play a role, we highlight the importance of the endogenous experience of an activity in taking action and creating paths. Viewing continuity as patterning suggests new roles for organizations in supporting flexible responses to disruption.

Mental health needs among parents of children with cancer: A commercial claims data analysis.

e18722 Background: Caring for a child diagnosed with cancer may adversely affect mental health (MH) of parents. However, little is known about MH care needs among parents of pediatric cancer patients. This study examined the patterns of MH care for parents of children diagnosed with cancer, as compared to parents of children without cancer. Methods: We used MarketScan® Commercial Database to identify continuously-insured parents of children receiving therapy for leukemia, lymphoma, central nervous system, bone, or gonadal cancers (aged ≤21 years at diagnosis) in 2009-2017. We also identified parents who matched eligibility criteria but had no child with cancer (with a randomly-assigned, fictitious date of cancer diagnosis) as controls. Outcomes included parents’ visits related to a MH disorder (anxiety, depression, substance use disorder [SUD], post-traumatic stress disorder [PTSD]) during six months before to 12 months after their child’s cancer diagnosis. Multivariable regressions were estimated to compare MH visits between 9,870 parents of pediatric cancer patients and 3,396,097 parents in the control group, adjusting for sociodemographic factors (parents’ age and sex, rurality, region, number of children in household) and presence of MH history. Among parents of pediatric cancer patients, we explored sociodemographic factors, MH history, and clinical factors (children’s cancer types, age at diagnosis, therapeutic modalities) associated with MH-related visits in multivariable regression analyses. Results: While the likelihood of MH history was similar between the two groups, a higher proportion of parents caring for cancer patients than controls had any visits related to anxiety (13.1%% vs. 9.5%), depression (9.6% vs. 7.5%), PTSD (0.5% vs. 0.4%), or any MH disorders (22.0% vs. 17.6%). These differences persisted in adjusted analyses. For example, parents of cancer patients were 24%, 37%, and 27% ( p-values < 0.001) more likely than controls to have any MH visits, anxiety-related visits, and depression-related visits, respectively. No difference was observed in SUD-related visits. Among MH care utilizers, no significant difference was observed in the number of MH visits. Among parents of cancer patients, those with MH history, mothers (vs. fathers), and parents of children with bone cancer (vs. leukemia) were more likely to have any MH visits ( p-values < 0.05). Parents whose children received surgery only and those with ≥3 children in household were less likely to have any MH visits ( p-values < 0.05). Conclusions: Parents of pediatric cancer patients have significantly higher needs for MH care as compared to the general parent population. Our finding underlines the importance of future interventions toward targeted MH counseling and supportive strategies for vulnerable parent groups, such as mothers and those caring for children undergoing more complex treatment plans.

Patterns of Mental Health Care Before Initiation of Telemental Health Services.

Use of telemental health has increased among rural Medicare beneficiaries, particularly among individuals with serious mental illness (SMI). Little is known about what leads to the initiation of telemental health. To categorize the different patterns of mental health care use before initiation of telemental health services among individuals with SMI. A cohort of rural beneficiaries with SMI (defined as schizophrenia/related psychotic disorders or bipolar disorder) with an index telemental health visit in 2010-2017 was built using claims for a 20% random sample of fee-for-service Medicare beneficiaries. The authors used latent class analysis to identify classes of mental health care use in the 6 months before the index telemental health visits. Across the classes, the authors also described characteristics of index and subsequent mental health visits. The cohort included 4930 rural Medicare beneficiaries with SMI. Three classes of mental health care use before initiation of telemental health were identified. The largest class (n=3066) had minimal use of primary care provider mental health care and the second largest class (n=1537) had minimal specialty mental health care. The smallest class (n=327) was characterized by recent hospitalization or emergency department care. In the overall cohort, index visits were frequently established visits and were often with specialty prescribers. Our findings highlight 3 distinct patterns of care before telemental health initiation, providing insight into the role that telemedicine may play in mental health care for rural Medicare beneficiaries with SMI. Overall, telemental health was most often used to maintain care with existing providers.

A Política Nacional de Saúde Mental: uma reflexão acerca dos retrocessos nos governos Temer e Bolsonaro

Historicamente, uma série de mudanças tem ocorrido nos padrões de atenção à saúde mental no Brasil, por meio da Reforma Psiquiátrica (RP) e da Reforma Sanitária (RS), representando significativas conquistas para a sociedade civil. No entanto, apesar dos avanços, a mercantilização das políticas sociais tem prevalecido na conjuntura brasileira, dada a ofensiva neoliberal que a acompanha desde a década de 1990. Neste sentido, o presente artigo tem como objetivo discutir acerca das principais tendências da Política de Saúde Mental (PSM) brasileira, fazendo um recorte dos frequentes riscos de retrocessos empreendidos pelos governos Temer e Bolsonaro. Para tanto, o método de análise da realidade que pareceu pertinente para este estudo foi o crítico-dialético. Foi realizado uma revisão bibliográfica das principais categorias do estudo (Contrarreforma e Reforma Psiquiátrica) e uma pesquisa documental das principais legislações da PSM, com abordagem qualitativa. A discussão deste estudo aponta, portanto, que a PSM tem se desenvolvido na realidade brasileira, articulando avanço e conservadorismo, sobretudo a partir das propostas de tais governos, sob a ordem de um neoliberalismo ortodoxo, quando se verifica a volta de uma organização das forças restauradoras da saúde mental contra a RP.

Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande).

Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.

Depression, anxiety, and patterns of mental health care among men with prostate cancer on androgen deprivation therapy (ADT).

12100 Background: ADT is associated with an increased risk of depression and anxiety, raising the concern that a substantial portion of men with prostate cancer need mental health care. We sought to investigate the development of depression or anxiety and subsequent patterns of mental health care in men with prostate cancer on ADT. Methods: Clinformatics DataMart, a claims database of commercially insured patients, was used to identify men with prostate cancer who received ADT between 2001-2015 and had continuous enrollment for 1 year before and 2 years after starting ADT. We determined the rate of incident diagnoses of depression or anxiety and the incident use of mental health treatments - psychotherapy and psychiatric medications (≥ 5 day supply) - after the start of ADT. Results: Among 37,388 men in the final analytic cohort, 11.3% (n=4239, 95% confidence interval (CI) 11.0-11.6%) received new diagnoses of depression or anxiety: 5.8% depression (95% CI, 5.5-6.0%), 3.7% anxiety (95% CI 3.5-3.9%), and 1.8% both (95% CI, 1.7-1.9%). Those who received a diagnosis of depression or anxiety were more likely to be white (68% v. 64%, p<0.01); no differences were noted in age, education, or household income. Among those with a new diagnosis of depression or anxiety, 0.07% received psychotherapy (95% CI, 0.02-0.23%), 34.9% a selective serotonin reuptake inhibitor (95% CI, 33.5-36.4%), 11.6% a serotonin norepinephrine reuptake inhibitor (95% CI, 10.7-12.6%), and 19.9% a benzodiazepine (95% CI, 18.7-21.1%). Conclusions: Among men with prostate cancer receiving ADT, more than 1 in 10 received a new diagnosis of depression or anxiety. Of those, 1 in 5 were introduced to a benzodiazepine, a drug class with risks of dependence, cognitive impairment, falls, and fractures, whereas receipt of psychotherapy was rare. Further investigation into how to improve the mental health care of men on ADT is needed. [Table: see text]

Long‐ and short‐term inpatients with schizophrenia in China: Implications for community‐based service development

There is an increasing interest in the patterns of mental health care of people with serious mental illnesses in China, where outpatient and community-based care are not fully developed and long-term hospitalization is still not uncommon. Comparison of sociodemographic and clinical characteristics of long-term and short-term inpatients diagnosed with schizophrenia can be informative about pattern of treatment and their relationship to services needs. Seventy-three long-term schizophrenia inpatients (current length of stay of more than 5 years) were compared to 116 short-term schizophrenia inpatients (current length of stay of 30 days or less) assessed with the Individual Background Questionnaire, the Positive and Negative Syndrome Scale (PANSS) and the Social Support Rating Scale (SSRS). There was no significant difference between the groups on the total PANSS symptom score but the short-term inpatients scored significantly higher than their long-term counterparts on the Positive Syndrome sub-scale and the SSRS and lower on the Negative Syndrome sub-scale. Differences in symptomatology and social functioning may be related to better medication adherence and more extended social isolation among long-term inpatients while the increased positive symptoms are likely to reflect more acute disease process in short-term inpatients, and possibly poorer medication adherence. These differences may be especially pronounced in developing countries like China in which community-based services need to be more fully developed to facilitate medication adherence and prevent relapse, and to support community adjustment of socially isolated patients who otherwise require hospitalization.

Stroke and mental health care: a record linkage study.

Stroke is associated with psychiatric morbidity but little is known about mental health care use in stroke patients. A probability record linkage study was conducted linking stroke cases admitted to a teaching hospital serving a catchment area between 1987 and 1995 with records from a psychiatric case register covering the same area. Stroke patients had a more than twofold increased risk of contact with mental health care than individuals in the general population (yearly prevalences of respectively 88 and 39 per 1000; risk ratio 2.24; 95 % CI 2.04-2.45). One-third of all stroke admissions had had mental health care before and more than half had had mental health care after the stroke. In the year of admission for stroke, the probability of receiving mental health care was highest, while in the more remote years the risk was lower. Stroke is associated with an increased probability of contact with mental health services. The pattern of mental health care of a stroke patient is different from that of other mental health patients: more episodic and concentrated around the time of admission for stroke.

Analysis of patterns of mental health care with three different approaches (cross-sectional, longitudinal and dynamic).

This article attempts to provide an overview of different methods of analysis of information on service utilization from different approaches. A systematic review of the studies of pattern of care is done. The analysis of pattern of care has been divided into three different approaches: cross-sectional, longitudinal and dynamic. In cross-sectional studies, information on utilization is based on the total number of contacts with mental health services during a given period. In the second approach, called longitudinal, survival analysis is applied considering the interval of time between each contact. The third type of analysis, called here the "dynamic" approach, involves the application of mathematical models based on the Markov chain to analyse the probability of change from one type of contact to another. We emphasise the need for further studies designed to analyse data from psychiatric case registers with standardised models for mental health services utilization analysis.

Caring for depressed and suicidal older patients: a survey of physicians and nurse practitioners.

This study sought to describe patterns of mental health care for depressed and suicidal geriatric patients by primary care physicians (MDs) and nurse practitioners (NPs). A probability sample of 300 Illinois MDs from the AMA Physician Masterfile and a national sample of 595 NPs from the American Academy of Nurse Practitioners were surveyed. Sixty-three percent of MDs and 61 percent of NPs responded regarding their approaches to assessing, treating, and referring older adult patients who were depressed or suicidal. Respondents rated their confidence in assessing and treating depression and suicidality and identified barriers to mental health treatment in a primary care setting. Both similarities and differences were found among MDs and NPs in their patterns of managing depressed and suicidal older adults. NPs used more varied approaches in assessing, treating, and referring their geriatric patients with mental health problems. MDs relied more heavily on psychotropic medications for the treatment of depression and on psychiatrists when referring suicidal older patients. NPs were more likely than MDs to note lack of training and referral resources as barriers to treating depression of older patients. NPs rated their training in geriatric mental health more favorably than MDs. In terms of assessment of depression, preferred treatment approaches, the use of referral resources, and perceived barriers to mental health care, there appears to be a greater orientation towards a psychosocial approach among NPs. Primary care MDs and NPs often have different perspectives that in combination could enhance the mental health care of geriatric patients.

Changing patterns of mental health care in Greece (1984–1996)

Greece joined the European Community in 1981 and, three years later, the Commission of the European Communities provided financial and technical assistance under EEC Regulation 815/84 for the modernisation of the traditional psychiatric care system, with the emphasis on decentralisation of mental health services and the development of community-based services, as well as on deinstutionalization of long-stay patients and improvement of conditions in public mental hospitals. Over the last 11 years, the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards extramural care and rehabilitation. The role of the large mental hospitals has gradually been diminished and a large number of long-stay patients have been deinstitutionalised. It is commonly accepted that the EEC-funded psychiatric reform programme, despite inadequacies and constraints, had an impact on the changing mental health scene in Greece.

Patterns of mental health care among Mexican Americans.

1. Extending cultural care beyond language enhances the use of mental health services and fosters a mutually agreed-on plan of care. 2. Understanding cultural characteristics facilitates an understanding of behavior, family and social dynamics, and adaptation patterns to stress that can empower clients to work toward their goals and validate the impact of emotions and behaviors on others. 3. Culturally appropriate mental health care reflects a synthesis among communication, space, social organization, time, environmental control, and biological variables.

The impact of VA reorganization on patterns of mental health care.

Back to table of contents Previous article Next article ColumnFull AccessDatapoints: The Impact of VA Reorganization on Patterns of Mental Health CareRobert Rosenheck, M.D., and Thomas Horvath, M.D. Robert RosenheckSearch for more papers by this author, M.D., and Thomas HorvathSearch for more papers by this author, M.D. Published Online:1 Apr 2006https://doi.org/10.1176/ps.49.1.53AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In October 1995 the Veterans Health Administration of the Department of Veterans Affairs (VA) was restructured into 22 Veterans Integrated Service Networks serving geographically defined populations. The goal of this decentralization was to transform the VA health care system from one focused on acute inpatient care and medical specialization to one grounded in ambulatory and primary care (1).Table 1 presents national VA workload data on unduplicated counts of patients treated in specialized inpatient and outpatient psychiatric and substance abuse programs in fiscal years 1993 through 1997, before and after the reorganization.The number of inpatients treated annually in both psychiatric and substance abuse programs declined by less than 1 percent in the three fiscal years preceding the reorganization (1993 through 1995) but fell by 19 percent in the second year after the reorganization. However, the number of inpatients receiving substance abuse services fell by almost 50 percent, far exceeding the 7 percent drop for psychiatric inpatient services. In contrast, the number of outpatients receiving psychiatric and substance abuse services increased steadily both before and after the reorganization.Changes in the intensity of care, measured by the average length of inpatient stay per episode and the average annual number of outpatient contacts per user, paralleled trends in inpatient and outpatient service use. The biggest changes occurred in substance abuse services, with decreases in the length of inpatient stays and increases in the number of user contacts.The number of patients who received any specialty mental health treatment, either inpatient or outpatient, increased by about 8 percent in the two years following the reorganization. However, 4,538 fewer veterans (about 3 percent) received substance abuse treatment in fiscal year 1997 than in 1995, the year before the reorganization.Dr. Rosenheck is director of the Northeast Program Evaluation Center of the Veterans Affairs Connecticut Healthcare System in West Haven and clinical professor of psychiatry at Yale University in New Haven, Connecticut. Dr. Horvath is chief consultant for mental health at VA headquarters in Washington, D.C., and professor of psychiatry at the State University of New York at Stony Brook. Address correspondence to Dr. Rosenheck, Northeast Program Evaluation Center (182), VA Medical Center, 950 Campbell Avenue, West Haven, Connecticut 06516. With this issue Harold Alan Pincus, M.D., and Terri L. Tanelian, M.A., become coeditors of this column.Table 1. Annual workload (unduplicated patient counts) and service intensity of VA mental health services, fiscal years 1993 through 1997, before and after VA's reorganizationTable 1. Annual workload (unduplicated patient counts) and service intensity of VA mental health services, fiscal years 1993 through 1997, before and after VA's reorganizationEnlarge table

From Leros asylum to community-based facilities: levels of functioning and quality of life among hostel residents in Greece.

The pattern of mental health care in Greece is undergoing a major transformation. The Leros Projects I and II supported the development of 13 community hostels located throughout the Greek mainland. These hostels provide residential care to more than 100 former psychiatric inpatients, mainly from Leros asylum. The present study evaluates the impact of the resettlement process on the residents' perceived quality of life (QoL) together with an examination of the residents' psychiatric and behavioural functioning four years after the move from hospital. The target sample (n = 99) comprised of individuals who may be considered 'chronic' psychiatric patients with a long history of institutionalisation and many are socially deprived with few family ties. The residents' functioning profile indicates a range of different levels of abilities. The QoL findings show that the majority of residents (70%) perceived the movement from the traditional hospital regime to the community hostels as being a positive change and expressed their satisfaction (74%) with the new living situation. This study demonstrates that even the most dependent, chronic psychiatric patients in Greece can be maintained in community settings and are able to articulate generally reliable and valid responses concerning the impact of service changes.

Changing patterns of mental health care in Germany

Changing patterns of mental health care in Germany

Recent trends in mental health services in Italy: an analysis of national and local data.

This paper reviews trends in Italian mental health services after the implementation of the 1978 Mental Health Act. Data available at the national level on public and private inpatient services, community mental health centres, residential and day care facilities are presented and discussed. Findings from two case-register areas, where comprehensive community services according to the Mental Health Act have been implemented, are discussed. Public mental hospitals are no longer used for psychiatric treatment, except for a small number of long stay patients. General hospital psychiatric units are the only setting in the public sector where psychiatric patients can be admitted. In private mental hospitals, the number of residents has decreased, while admissions have remained stable. However, community services are unevenly distributed and residential facilities are generally lacking. Little is known about quality of care provided, although data from some pilot studies are encouraging. Stable admission rates to forensic mental hospitals suggest that the criminalization of mentally ill has not increased. The effect of changing patterns of mental health care on suicide rates are discussed.

Patterns of mental health care in a seaside lodging house

Much of the medical care of the long-term mentally ill falls to the general practitioner (Wilkinson et al, 1985) and, for example, a survey in Buckinghamshire showed that these patients consult their general practitioner (GP) twice as often as mental health services. Lodging house dwellers are known to show an increased prevalence of major mental illness and to suffer much secondary social handicap, presenting a challenge to helping services of all disciplines. For this reason we chose a lodging house in which to explore further the relationships between mental illness and residents' present contact with their GP, mental health services and other local sources of help.

Mental Health/Mental Illness

Part 1 Patterns of mental health care: current and evolving patterns of mental health care community-based treatment settings for mental disorders home care setting - client and family issues impatient hospitalization - the mental health treatment team and the therapeutic milieu legal and ethical issues in mental health nursing. Part 2 Concepts of psychiatric/mental health nursing: establishing the therapeutic nursing environment building a person-centered therapeutic relationship delivering mental health care in a continuum of settings. Part 3 Basic concepts of mental health: human development and needs influence of family and social environment on the individual the structure and development of personality. Part 4 Mental health and mental disorder: human emotions stress - effective coping and adaptation stress - ineffective coping and defence mechanisms mental status exam. Part 5 Nursing the client with a mental disorder: nursing process in the mental health setting nursing diagnosis in the mental health setting nursing care planning with specific types of disordered mental states nursing care of the older adult with a mental disorder. Part 6 Categories of mental disorders: disorders usually first diagnosed during infancy, childhood, or adolescence delirium, dementia, and amnestic and other cognitive disorders substance-related disorders schizophrenia and other psychotic disorders mood disorders anxiety and somatoform disorders personality disorders. Part 7 Intervention and treatment of mental disorders: crisis intervention milieu therapy and behaviour modification group therapy psychopharmacology and electroshock treatment of mental disorders.