Primary Mental Health Providers Research Articles

A Veterans Affairs' perspective in response to Best Practice Model Subcommittee attribute statements for outpatient psychiatric pharmacists.

We applaud the work published by Lee et al1 and the best practice model subcommittee in their attribute statements for defining the optimal recommendations for outpatient psychiatric pharmacy practice. This serves as an excellent foundation in standardizing the expectations for clinical pharmacist practitioners (CPP) within outpatient mental health (MH) settings and our group believes these defined statements are being applied at the Department of Veterans Affairs (VA).2 Measurement-based care, suicide assessment, and comprehensive medication management (CMM) are all standards of care for VA outpatient MH CPP.3 The goal of our letter is to highlight the VA MH CPP model and the advancements in access, quality impact, and standardization.Integrating the MH CPP into the team-based care model significantly improves access to care, primarily when the CPP is utilized as a primary MH provider. Many strong CPP practices within the VA have been identified, including CPP integration into primary care MH services, outpatient MH clinics, specialty MH, and residential rehabilitation programs. Other strategies utilized by VA MH CPP to optimize access include utilizing analytics to target specific clinical interventions (population management), posthospital discharge appointments, and enhanced patient care in suicide risk stratification.In October 2017, the VA Pharmacy Benefits Management (PBM) partnered with the Office of Rural Health to increase access to care for veterans by utilizing MH CPPs as MH prescribers. Within 2½ years from its inception, 40 MH CPPs were hired, which increased direct patient care access and quality by providing CMM for 51 210 rural-residing patients.4 Due to the initiative's positive impact on patient care, an additional 46 MH CPP were hired in FY20/21, which demonstrates the importance of optimizing the MH CPP role in the team-based care model.MH CPP within the VA have established guidance for how to create a positive impact in the VA's internal performance metrics, including population management, continuity of care, experience of care, behavioral health screenings, and suicide risk management. They are also instrumental in serving as facility champions for psychotropic stewardship and safety. One of the attribute statements proposed by Lee et al1 recommends prescriptive authority and/or a collaborative practice agreement. In collaboration with VA PBM, a care coordination agreement (CCA) was created for MH CPP and establishes a partnership between MH and pharmacy services. This CCA covers many of the attribute statements, including attribute statements 14-24 and 27. The CCA is approved by service leadership and the chief of staff to ensure these attribute statements are being upheld. The PBM has also developed a business rules document to guide standardization of MH CPP practice within the VA. This includes in-depth descriptions defining clinical pharmacy practice, patient care delivery, optimizing access and integration, and documentation of workload.Overall, the VA has taken great strides to advance the practice of MH CPPs. Current practice by VA MH CPPs incorporates many of the attribute statements. We are hopeful that these well-developed attribute statements will help foster all psychiatric pharmacists to practice at the highest level of care, achieve reimbursement for clinical services, and bolster patient and provider satisfaction.

Bringing creative psychotherapies to primary NHS Mental Health Services in the UK: A feasibility study on patient and staff experiences of arts for the blues workshops delivered at Improving Access to Psychological Therapies (IAPT) services

AbstractThere have been several arguments for the need to generate evidence‐based creative forms of psychological interventions in Improving Access to Psychological Services (IAPT), the main primary mental health provider in hospitals in England, UK. In this feasibility study, we sought to identify helpful and unhelpful factors of a new creative group psychotherapy, titled Arts for the Blues. We also wanted to find out whether the research tools used were acceptable and sensitive. We therefore engaged a group of seven patients attending an IAPT service in the North West of England, and a group of six staff working in the same service, to attend one creative workshop each, followed by a focus group. The two focus groups were transcribed and analysed using thematic analysis. We also collected pre‐ and post‐measures of depression (PHQ‐9) and anxiety (GAD‐7), measures commonly used in IAPT services, plus measures of well‐being (WHO‐5), the PANAS, and goal‐setting, which were considered for acceptability and sensitivity. We received largely positive responses from service users and staff in the use of creative methods in psychotherapy. Although the measures used had limitations due to the short duration of one‐off creative workshops, we found that they were sensitive enough, easy to complete and, thus, were acceptable. We concluded that Arts for the Blues is a promising intervention in IAPT, especially since it is shaped by service users and staff working in these services. Further work is needed to establish the effectiveness of this new intervention.

The Next Step in Integrated Care: Universal Primary Mental Health Providers.

Current models of mental health care often do not address three barriers to mental health: the binary view of mental illness (healthy vs. mentally ill), stigma, and prevention. Care models where some patients are selected for referral or consultation with a mental health professional can reinforce this binary view and the stigma associated with seeing mental health services. By only selecting patients who currently are experiencing mental health problems, current integrated care models do not offer sufficient avenues for prevention. To address these barriers, this article proposes building on current models through the development of primary mental health providers (PMHPs). PMHPs-like primary care providers-would provide regular check-ups, assessments, prevention interventions, first-line treatment, or referral to more specialized professionals. This universal approach will help decrease the binary view of mental health, decrease the stigma of seeing a mental health professional through universal access, and improve prevention efforts.

Longitudinal Association of Therapeutic Alliance and Clinical Outcomes in Supported Housing for Chronically Homeless Adults

General psychotherapy research has underscored the importance of the therapeutic alliance in client outcomes. This study examined the association between therapeutic alliance and client outcomes specifically between chronically homeless clients in a supported housing program and their case managers. Using data from a federal supported housing initiative, participants were categorized into those who rated their therapeutic alliance with case managers at 3months as relatively high (top 75th percentile; n=123), relatively low (bottom 25th percentile; n=128), or did not identify any primary mental health provider at 3months (n=205). Controlling for baseline differences, there were no group differences on any outcomes, except that participants who rated high therapeutic alliance at 3months reported the highest subjective quality of life and perceived social support. Client outcomes in supported housing may rely more on practical assistance and access to other services than the quality of the therapeutic relationship with their primary mental health provider.

Trainings in Suicide Awareness: A Focus on School Settings

School counselors at all grade levels are faced with student suicidal ideation on a regular basis. As the primary mental health providers at their sites, school counselors are the ideal professionals to provide suicide awareness training for school staff and students. School counselors were surveyed regarding the type of suicide awareness training they provided to staff and students and their reasons for not providing training, if that was the case. Results from this exploratory survey suggested that few school counselors provide suicide awareness training to staff or students. Implications for school counselors and administrators are included.

Predictors of psychological distress in family caregivers of persons with psychiatric disabilities.

The purpose of the study was to determine the relationships of primary and secondary stressors, and informal and formal supports, to psychological distress in 154 family caregivers of persons with psychiatric disabilities. All caregivers were members of self-help groups located in the Province of Quebec in Canada. Psychological distress was significantly lower among older caregivers, those working full time, and those experiencing lower objective and subjective burdens. Contrary to the hypotheses, caregivers who perceived more support from friends and had more contacts with their relatives' primary mental health providers experienced a higher level of psychological distress.

Reversing the Criminalization of Mental Illness

In 1972, a federal court reinforced the deinstitutionalization of state psychiatric hospitals when they held that people with mental illness have a constitutional right to treatment (Wyatt v. Stickney, 1972). Although many states released patients and closed hospitals in response to this decision, they neglected to provide adequate community-based treatment resulting in the unintended reinstitutionalization of this population into our state and local jails. Recently, many state and local stakeholders have come together to address this situation. This article will discuss how the criminal justice system has become a primary mental health provider and strategies being utilized to reform the current system.