Mental Health Services For People Research Articles

'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services.

In line with the Australian Government's Vision 2030, this research foregrounds consumer experiences of recovery to inform the (co)design and delivery of mental health services for people living with complex needs and/or a severe and persistent mental health condition. The research takes a specialist focus on the regional setting, with data collected from client experiences within Western NSW, Australia, in the context of the National Disability Insurance Scheme (NDIS) implementation and inclusion of psycho-social disability within the NDIS service environment. Thirty-seven people aged 19-70 years living with complex needs and/or a diagnosis of a severe and persistent mental health condition were recruited from services where they had a care plan or where they were members of a consumer reference group for recovery-oriented services. A tripartite framework integrating recovery oriented, trauma-informed and collective impact approaches for a qualitative, arts-based (photovoice) study. In areas of the mental health service system that had not yet applied a personalised understanding of recovery or embraced trauma-informed practice there were a range of issues and gaps in service delivery relating to authentic relationships, belonging and connection, service cultures, trauma-informed care, and workforce investment. Clinical and non-clinical services need to ensure consistent person-centred and trauma-informed practice is implemented throughout the mental health service system to meet the needs of the consumer. An eight-point checklist serves as the basis for services to reflect on how they are working with consumers and to support the review of systems and clinical governance frameworks.

Interagency Coordination to Manage Co-Occurring Intellectual and Developmental Disabilities and Mental Health Conditions.

The authors aimed to identify barriers to and strategies for supporting coordination between state agencies for intellectual and developmental disability (IDD) or mental health to meet the mental health needs of people with co-occurring IDD and mental health conditions. Forty-nine employees of state agencies as well as advocacy and service delivery organizations across 11 U.S. states with separate IDD and mental health agencies were interviewed between April 2022 and April 2023. Data were analyzed with a thematic analysis approach. Interviewees reported that relationships between the IDD and mental health agencies have elements of both competition and coordination and that coordination primarily takes place in response to crisis events. Barriers to interagency coordination included a narrow focus on the populations targeted by each agency, within-state variation in agency structures, and a lack of knowledge about co-occurring IDD and mental health conditions. Interviewees also described both administrative (e.g., memorandums of understanding) and agency culture (e.g., focusing on whole-person care) strategies that are or could be used to improve coordination to provide mental health services for people with both IDD and a mental health condition. Strategies that support state agencies in moving away from crisis response toward a focus on whole-person care should be prioritized to support coordination of mental health services for individuals with co-occurring IDD and mental health conditions.

Change, Adversity, and Adaptation: Young People's Experience of the COVID-19 Pandemic Expressed through Artwork and Semi-Structured Interviews.

This study explores how young people's mental health was affected by the COVID-19 pandemic using artwork and semi-structured interviews. The mental health impacts of the pandemic are important to understand so that policy and practice professionals can support those affected, prepare and respond to future crises, and support young people who are isolated and restricted in other contexts. Co-designed participatory art workshops and interviews were conducted with 16-18-year-olds (n = 21, 62% female) from the London-based Longitudinal cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP). Artworks and interview transcripts were qualitatively co-and analysed with young people. From interviews, six themes were identified: adaptation, restriction, change, challenges, overcoming adversity, and lockdown life. From the artwork, four themes were identified: trapped, negative mental wellbeing, positive emotions, and technology. Everyday factors such as home environment, social support, hobbies, habits, and online education were key determinants of how challenged and restricted participants felt, and their capacity to overcome this. This demonstrates the importance of wider (social and environmental) determinants and supports a systems-level public health approach to young people's mental health. For example, young people's mental health services should collaborate with other sectors to address such determinants in a holistic way. Clearer guidance and support with occupation, relationships, environment, routine and activities could mitigate the negative mental health impacts of major environmental changes on young people.

Experiences of help-seeking from professional services for a child or young person's mental health concerns during the pandemic: A qualitative study.

The immediate response to the Covid-19 pandemic saw school closures and a shift in provision to online health services for children and young people experiencing mental health concerns. This study provides mental health and referral services with an insight into difficulties experienced as well as recommendations on potential improvements. Semi-structured interviews with 11 parents and six young people. Reflexive thematic analysis was used to analyse the data. Parents and young people reported mixed experiences on accessing mental health support. Priorities and pressures on health services impacted the likelihood of choosing to seek and being able to obtain help. Parents and young people had varying expectations and experiences in help-seeking during the pandemic which were also impacted by others' experiences and views. For many, the relationship with the professional they were in contact with impacted their mental health treatment. Provision was sometimes accessed via private services due to long waiting lists or problems that did not "meet threshold". Understanding the experiences of seeking mental healthcare during the pandemic can inform improvements to access to services at a time when people are most vulnerable. Accessible provision other than private services needs to be made for those on waiting lists. For those who do not meet service threshold, intermediary support needs to be secured to prevent unnecessary exacerbation of symptoms and prolonged problems. If schools are to remain the hub for children and young people's mental health services, they should be considered essential services at all times.

Children and Young People's inpatient and PICU mental health services: transformation in an evidence vacuum

Children and Young People's inpatient and PICU mental health services: transformation in an evidence vacuum

Children and young people's reported contact with professional services for mental health concerns: a secondary data analysis.

Children and young people's mental health services have been under increasing pressure following COVID-19. Understanding, for which channels help is sought from, will highlight services needing support. This study aims to explore the professional services that parents of children, and young people get help from when they have a concern for the child's/their mental health. Secondary analysis of data is taken from Mental Health of Children and Young People in England Survey, 2017. 7608 reports of mental health-related contact with professional services from parents of 5-16year-olds and self-reports from young people aged 17-19 were available. Service contact was reported by Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis, age, gender and ethnicity. Less than two-thirds of children and young people with a DSM-V diagnosis (63.5% (95% CI 58.6-68.1) aged 5-10, and 64.0% (95% CI 59.4-68.4) aged 11-16) reported contact with any professional services. The figure was lower for those aged 17-19; 50.1% (95% CI 42.8-58.2), p = 0.005. Children and young people aged 5-16 from Black (11.7%; 95% CI 2.4-41.4), Asian (55.1%; 95% CI 34.7-73.9) and Mixed (46.0%; 95% CI 32.4-60.3) ethnic groups reported less contact with professional services compared to those from the White group (66.9%; 95% CI 63.5-70.2). Patterns of service access during the three main educational stages aid with understanding service need during childhood. These lower levels of reported service access for young people aged 17-19 with a DSM-V diagnosis and those in ethnic minority groups demand further investigation.

Mental health interventions for children and young people with long-term health conditions in Children and Young People's Mental Health Services in England.

Almost a quarter of children and young people (CYP) in England have a long-term health condition (LTC), which increases the risk of developing mental health difficulties. There is a lack of understanding regarding the routine provision and efficacy of mental health interventions for CYP with LTCs within Children and Young People's Mental Health Services (CYPMHS). This study analysed national service-reported data in England from two secondary datasets. Data were submitted by services between 2011 and 2019. We evaluated data on the presence or absence of a serious physical health or neurological issue, and which interventions were offered. A total of 789 CYP had serious physical health issues and 635 had neurological issues. The most common interventions delivered to CYP in either group have some evidence in the literature. Most CYP showed improvements across a range of outcomes. This study found that prevalence rates and psychological intervention and outcome data were widely under-reported across both datasets, posing questions about their utility for this population. Such data would benefit from triangulation with data from other sources to understand pathways of care for these young people and the extent to which clinical datasets underreport the number of CYP with LTCs.

Evaluation of a mental health service reform program, the Pathways to Community Living Initiative, for people with severe mental illness and complex needs.

The Pathways to Community Living Initiative (PCLI) aims to reform mental health care for people with severe and persistent mental illness (SPMI) and complex needs. This study reports independent evaluation findings on transitions from hospital and practice change in mental health services. Data for this mixed-methods evaluation were obtained from administrative collections and semi-structured interviews with PCLI program managers, teams and executive leads; aged care managers; and leaders in inpatient, community and older people's mental health services. Between July 2015 and December 2020, 674 participants (67% of those eligible for the PCLI) were transitioned from hospital to community. Of those transitioned, 21 required subsequent long-stay admissions. The PCLI introduced resources, clearly defined processes, and state-wide networks to guide changes in practice which are becoming embedded in the operations and governance of mental health services across New South Wales. Severe and persistent mental illness and complex needs can be managed in community settings with highly individualised planning and care, supported by specialised clinical teams in partnership with mental health, aged care and disability services. Evaluation findings highlight the importance of continued investment in rehabilitation psychiatry.

The Contribution of Pondok Pesantren (Islamic Boarding School) to Developing Poor’s Mental Health

Islamic boarding schools (pondok pesantren) play a role not only in education but also in the development of mental health. Pondok Tetirah Dzikir (PTD) is one of the pondok pesantren that provides mental health services for people experiencing poverty, especially those suffering from mental disorders and drug abuse, by using TQN-based therapy (Thariqah Qadiriyah Naqsabandiyah). This research is a case study and qualitative research on the development of mental health in PTD. Results show some themes, including the patients as a guest, management of the boarding schools, the therapeutic process and the social relationship after therapy, were found.

Effectiveness and Benefits of Exercise on Older People Living With Mental Illness' Physical and Psychological Outcomes in Regional Australia: A Mixed-Methods Study.

Regular exercise is reported to improve depressive symptoms and quality of life for people experiencing mental illness. For older adults, including strength and balance can also decrease falls. Mental health services seldom include funding for Accredited Exercise Physiologist programs. A 9-week Accredited Exercise Physiologist-led program for older adults receiving mental health treatment with a community Older People's Mental Health Service was trialed in regional Australia. This clinician-conceived small-scale feasibility study utilized a two-phase concurrent triangulation mixed-method design to evaluate physical and psychological program outcomes and identify factors related to engaging in physical activity. This tailored exercise program led to improvements in measures of psychological distress and physical and psychological function. These changes corresponded with participants identifying benefits of exercising as a group of adults living with mental illness. Such findings suggest a supervised, individualized program for older mental health consumers confers physical and psychological benefits; however, further research evaluating exercise interventions with this population is required.

„You Won’t Break the Ice and Won’t Talk about It“: Mental Health Professionals’ Difficulties in Providing Assistance to Individuals who Later Suicide

Accessible and effective mental health services for people at risk of suicide are one of the cornerstones of suicide prevention. However, some people suicide while receiving such help, and it is important to understand the reasons for this. In the absence of a direct way to reveal the experiences of people who have received services and subsequently suicided, the professionals providing mental health services are an important source of information on this process. The main aim of this study was to describe the main difficulties experienced by professionals supporting people who later suicided. The sample included 15 mental health professionals (7 psychiatrists, 6 medical psychologists, and 2 social workers) who experienced patient suicide. The data were collected using semi-structured interviews, which were then analysed using thematic analysis. The following themes were identified in the stories of the participants: lack of collaboration from the patient, specific topics that were challenging to work with, treatment limitations, difficulties in assessing suicide risk, reactions experienced when working with the suicidal patient, and the role of the patient’s relatives. Therefore, the results of this study speak about the challenge of being with a patient in a suicidal crisis, who is not inclined to accept help, while bearing the limitations of the system and oneself as a specialist. This causes intense experiences of helplessness and anger.

The importance of digital mental health interventions to support people with diabetes-related psychological outcomes: a narrative review

PurposeDigital mental health interventions (DMHIs) are promising alternatives to traditional face-to-face psychological interventions to improve psychological outcomes in various chronic health conditions. However, their efficacy among people with diabetes is yet to be established. Therefore, this narrative review aims to identify the importance and need for evidence-based research on DMHIs targeting the psychological outcomes in people with diabetes.Design/methodology/approachUsing a narrative review approach, this study highlights the technological advancements in diabetes health care and identifies a need for developing DMHIs for people with diabetes.FindingsDMHIs are promising for improving psychological outcomes in people with diabetes. However, there is a need for further rigorous, controlled and high-quality diabetes-focused studies, to make firm conclusions on the effectiveness and appropriateness of DMHIs for patients with diabetes. This review also suggests that DMHIs based on psychological theories and studies with higher quality methodologies are also needed.Originality/valueThis review highlights the contemporary literature on diabetes and related technological advancements. The findings of this study serve as a basis of the improvement of policy on digital mental health services for people with diabetes, to impact the global burden of the disease.

Reliability and validity of the English, Chinese, Korean, Indonesian, and Vietnamese versions of the public health research foundation stress checklist short form

BackgroundForeign nationals residing in Japan account for approximately 2% of the total population (i.e., approximately 2.6 million people). Of these, 12% are not proficient in speaking Japanese and 25% experience difficulty reading Japanese. Therefore, a simple, convenient, and accurate scale in the native language of foreign nationals is required to support their mental health. In this study, the Public Health Research Foundation Stress Checklist Short Form (PHRF-SCL (SF)) was translated into five languages and the reliability and validity of the translations were confirmed.MethodsThe five translated versions of the PHRF-SCL (SF) have been reverse-translated into the original language, Japanese. The creator confirmed that there were no inconsistencies between the Japanese and reverse-translated versions. A total of 777 adults aged 18–64 years participated in the study. They were asked to complete the native language versions of the PHRF-SCL (SF) and Depression Anxiety Stress Scale 21 (DASS 21) online.ResultsAn exploratory factor analysis yielded the same four-factor structure as the original. Internal consistency was confirmed by the alpha coefficients of the subscales. Participants were classified into two groups on the basis of the severity classification obtained from each subscale of the DASS 21. Scores of PHRF-SCL (SF) are significantly higher in groups classified as symptomatic by DASS 21, thereby confirming construct validity. Concomitant validity was confirmed based on correlations with the DASS 21.ConclusionsEnglish, Chinese, Korean, Indonesian, and Vietnamese versions of the PHRF-SCL(SF) have been prepared. Although these versions are subject to further statistical analysis, the results were sufficiently substantiated for practical use. This scale is expected to contribute to the promotion of mental health services for people from these countries.

The Influence of Comorbidity and Perceived Complexity on Outcomes of Referrals to Children and Young Person Mental Health Services (UK): A Mixed Methods Vignette Study.

Children and young people (CYP) with long-term physical conditions (LTCs) are four times more likely to develop mental health disorders yet many cannot access Children and Young People's Mental Health Services (CYPMHS) or evidence-based interventions. This study aimed to understand the reasons for this; presence of an LTC neurodevelopmental disorder, or service requirements. 79 CYP mental health practitioners were randomly assigned to read vignettes depicting a hypothetical referral letter for a child with a mental health condition alone (n = 27), mental health condition and LTC (n = 25), or mental health condition and neurodevelopmental disorder (Autism Spectrum Disorder-ASD) (n = 27), answering questions about their likelihood of accepting the referral and proposed treatment plan. There were no significant differences between accessing CYPMHS or being offered first line evidence-based interventions in those with a LTC or ASD compared to those without. However, additional perceived complexity was frequently provided as a reason for rejecting referrals and not offering evidence-based intervention, with clinicians' predicted success of intervention significantly lower for these CYP. Clinicians were significantly more likely to suggest adapting the intervention in the LTC and the ASD groups to account for additional perceived complexity. The research suggests a need for additional services for CYP with LTCs and those with neurodevelopmental disorders, as well as training/awareness for clinicians.

Challenges to the provision of home care and support for people with severe mental illness: Experiences and perspectives of patients, caregivers, and healthcare providers in Dar es Salaam, Tanzania.

A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.

The importance of clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their mental health services in Europe

BackgroundTo study clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their Child and Adolescent Mental Health Service (CAMHS) and its association with mental health indicators, transition recommendations and mental health service (MHS) use. Methods763 CAMHS users from eight European countries were assessed using multi-informant and standardised assessment tools at baseline and nine months follow-up. Separate ANCOVA's and pairwise comparisons were conducted to assess whether clinicians' and parents' awareness of young people's suicidal behaviour were associated with mental health indicators, clinician's recommendations to continue treatment and MHS use at nine months follow-up. Results53.5 % of clinicians and 56.9 % of parents were unaware of young people's self-reported suicidal behaviour at baseline. Compared to those whose clinicians/parents were aware, unawareness was associated with a 72–80 % lower proportion of being recommended to continue treatment. Self-reported mental health problems at baseline were comparable for young people whose clinicians and parents were aware and unaware of suicidal behaviour. Clinicians' and parents' unawareness were not associated with MHS use at follow-up. LimitationsAspects of suicidal behaviour, such as suicide ideation, -plans and -attempts, could not be distinguished. Few young people transitioned to Adult Mental Health Services (AMHS), therefore power to study factors associated with AMHS use was limited. ConclusionClinicians and parents are often unaware of suicidal behaviour, which decreases the likelihood of a recommendation to continue treatment, but does not seem to affect young people's MHS use or their mental health problems.

Short Research Article: Do demographic, socioeconomic and clinical characteristics influence the number of psychological intervention sessions attended by young people in need of mental health care?

A cohort study using secondary data assessed associations between baseline characteristics and psychological sessions attended in young persons discharged from a Children and Young People's Mental Health Service in 2019. There were 584 persons who attended a median of seven sessions. On multivariable regression analysis, males attended fewer sessions than females, young people from more affluent communities attended more sessions than those from poorer communities and those presenting with eating disorders and self-harm in particular attended more sessions than those with anxiety. Addressing why these associations occur may improve mental health care in young persons.

‘Say hi to the lady on the television’: A review of clinic presentations and comparison of telepsychiatry and in‐person mental health assessments for people with intellectual disability in rural New South Wales

AbstractPeople with intellectual disabilities (ID) experience high levels of psychiatric comorbidity and difficulties accessing services, particularly in rural areas. An Intellectual Disability Mental Health Outreach Clinic was established to provide specialised psychiatric care in rural Australia through telepsychiatry and in‐person assessment. The study aims were to (i) contrast the characteristics of clinic attendees assessed by telepsychiatry or in‐person; (ii) assess the feasibility of care delivery by synchronous videoconference (telepsychiatry) or in‐person; and (iii) assess acceptability to, and experiences of, participating carers (family members, non‐government organisation workers or Community Mental Health Case Managers). An audit of clinical records was conducted of clients reviewed by the Clinic between August 2018 and April 2021. A survey of carers, either employed or family members, evaluated Clinic acceptability and experiences with the Clinic assessment, and as well as perceptions of thoroughness, accessibility, and ease. Of 145 people with ID, 46% were reviewed by telepsychiatry. These 67 telepsychiatry clients were more likely to have milder ID (p < 0.01) and were seen more frequently (p < 0.05) than the 78 clients with in‐person reviews. Results from the carer survey (31.7% response rate, n = 46/145) indicated high overall service acceptability, with telepsychiatry perceived to offer more convenient appointment times (91% agreed vs. 75% of in‐person, p < 0.05). The high uptake of telepsychiatric review indicates that it is feasible and acceptable to carers of people with ID and comorbid mental health concerns. Telepsychiatry is a potential tool to address equity of access to mental health services for people with ID—particularly those from disadvantaged and rural populations.

Transforming access to care for serious mental disorders in slums (the TRANSFORM Project): rationale, design and protocol.

This paper introduces the TRANSFORM project, which aims to improve access to mental health services for people with serious and enduring mental disorders (SMDs - psychotic disorders and severe mood disorders, often with co-occurring substance misuse) living in urban slums in Dhaka (Bangladesh) and Ibadan (Nigeria). People living in slum communities have high rates of SMDs, limited access to mental health services and conditions of chronic hardship. Help is commonly sought from faith-based and traditional healers, but people with SMDs require medical treatment, support and follow-up. This multicentre, international mental health mixed-methods research project will (a) conduct community-based ethnographic assessment using participatory methods to explore community understandings of SMDs and help-seeking; (b) explore the role of traditional and faith-based healing for SMDs, from the perspectives of people with SMDs, caregivers, community members, healers, community health workers (CHWs) and health professionals; (c) co-design, with CHWs and healers, training packages for screening, early detection and referral to mental health services; and (d) implement and evaluate the training packages for clinical and cost-effectiveness in improving access to treatment for those with SMDs. TRANSFORM will develop and test a sustainable intervention that can be integrated into existing clinical care and inform priorities for healthcare providers and policy makers.

Understanding mental health from the perception of Middle Eastern refugee women: A critical systematic review

Women from a refugee background suffer higher psychological distress levels than men with a refugee background. Conceptualisation of mental health plays an important role in using mental health services for people from refugee groups. The purpose of this review is to synthesize literature describing how Middle Eastern refugee women perceive mental health and its influence on mental health service utilisation. The review is registered with Prospero, and we conducted an analysis that complies with PRISMA guidelines and identified 8 relevant documents, including 6 peer-reviewed papers, and two dissertations. The findings of four qualitative, three mixed-method, and one quantitative studies were synthesized through data extraction and thematic analysis. Based on the findings, cultural beliefs, values, and expressions play a critical role in understanding mental health. These included: (a) culturally influenced idioms of distress in conceptualising mental health (b) the role of stigma in mental health perception and service utilisation. (c) a preferred method such as professional services or lay techniques including prayer and social support for mental health treatment. The discussion section contextualizes and examines these key themes to consider how a better understanding of mental health can be used to support the development of programs and policies to increase the use of mental health services by individuals from a refugee background. This may, in the end, lead to reduced burdens of diseases related to mental health among those seeking asylum or seeking refugee status.