Problem Of Mental Health Care Research Articles

Theoretical foundations of clinical ethics consultation in psychiatry

Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice. Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare. Conceptual and ethical analyses. After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed. Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants.

Wachttijden op de polikliniek kinder- en jeugdpsychiatrie van het UZ Brussel: hoe sneller patiënten identificeren die minder kans hebben op doorstromen naar diagnostisch onderzoek?

Waiting times at the outpatient clinic for child and adolescent psychiatry at the University Hospital of Brussels: which factors are related to waiting times and the risk of being admitted for diagnostics? Long waiting lists are a major problem in mental health care for minors. In Flanders (Belgium), concrete data about waiting lists are limited. Gaining more insight into this problem and exploring possibilities to reduce waiting times are essential. This exploratory study of a retrospective cohort mapped the waiting times and population characteristics of all registered patients in the period of May 1, 2020 to April 30, 2021 who were placed on the waiting list for intake at the outpatient clinic for child and adolescent psychiatry of the University Hospital of Brussels. A logistic regression analysis was conducted to determine factors associated with the likelihood of rejection. Based on the data, a template for an online questionnaire was developed to help identify patients at high risk of being rejected more quickly. Half of the 382 registered patients moved on for further assessment. The median waiting time until intake was 17 weeks. The likelihood of being rejected increased as the parents’ total Strengths and Difficulties Questionnaire (SDQ) score decreased and with current involvement of psychological/psychiatric services. This study confirms the long waiting time for ambulatory multidisciplinary child psychiatric assessment within a university hospital. A significant proportion of the patients does not proceed for further assessment, which makes fast identification of these patients important. A proposal for an online questionnaire was developed for this purpose. Patients with an increased risk of rejection can be screened in the short term. Follow-up research with practical implementation and evaluation of the impact on waiting times is necessary.

PISANG GEN ALFA: Smartphone Application for Mental Health Families of Alpha Generation in Indonesia

Families with alpha generation in the industrial era 4.0 have problems in mental health care, however, effortare made to prevent the occurrence through health education. The prevention model in the industrial revolution era 4.0 used a mobile application on a smart phone. PISANG GEN ALFA is a smartphone application that contains the method of parenting, assertive care, and stress management. The purpose of this study is to develop PISANG GEN ALFA as an application for reducing mental health problems in families with alpha generation. The application was developed through two stages, the first was carried out by creating application content and sophisticated systems by technology experts. Furthermore, in the second stage, a perception test was performed in the fields of mental, pediatric, and maternity nursing. Then, 100 families with alpha generation children were assessed in Malang Regency, East Java, Indonesia using a learning media questionnaire, and Intraclass Correlation Coefficients (ICC) test. The application consists of Education menu about PISANG GEN ALFA, parenting in industrial revolution era 4.0, stress prevention and management, assertive care, and parenting tension. The statistical analysis showed the value of 0.875, while the average of 3 assessors was 0.964> 0.5 (high stability). Furthermore, from the diligence results, 86.78% of the families stated that the application was very suitable for use, while 13.22% commented that it was feasible. PISANG GEN ALFA was a health education application used for families with alpha generation children in reducing mental health problems during parenting.

The demography and disease burden of the homeless shelter population of Tshwane during COVID-19.

Homeless people are a vulnerable population susceptible to physical and mental health care problems. There are, however, limited studies and information regarding the health of the homeless population. To describe and understand the burden of disease among the homeless population in Tshwane District, Gauteng, South Africa. Data were collected from 15 different homeless shelters created during the South African 2020 coronavirus disease 2019 (COVID-19) lockdown in the Tshwane District, from April to July 2020. A cross-sectional survey was conducted among the homeless people in the shelters to provide information of self-reported conditions that the homeless populations at the shelters had during the lockdown period. The participants were also screened for medical conditions like, human immunodeficiency virus (HIV), hypertension (HPT) and diabetes mellites (DM). Results showed a total of 2066 homeless population out of which 1391 took part in the survey. Most of the participants consisted of African males 93.83%, with substance use prevalence in 52.77%. The study showed that the population was very reluctant to share information and had less chronic conditions than originally thought. Efforts should be made to improve education and research around the homeless population, by government and non-government facilities by building relationships with homeless shelters in their areas.Contribution:This study provides awareness of the homeless population's health and challenges, with the intention to attempt a better understanding of the population that may present themselves to primary healthcare (PHC) facilities and encourage future investigation into how to improve care.

Evaluation of an Adaptive Implementation Program for Cognitive Adaptation Training for People With Severe Mental Illness: a cluster-randomized controlled trial

IntroductionCognitive Adaptation Training (CAT) is a psychosocial intervention focusing on reducing the impact of cognitive disorders on daily functioning in people with severe mental illness (SMI). Similar to many evidence based practices (EBP), implementation of CAT in routine care lags behind, despite the established effectiveness of the intervention. This so called ‘science-to-service gap’ is a widespread problem in mental health care. We developed an innovative implementation program to facilitate implementation of CAT and similar interventions in routine care.ObjectivesThe aim of this study is to evaluate the effectiveness of the implementation program and to determine factors that impede or facilitate the implementation process.MethodsWe conducted a multicenter cluster randomized controlled trial comparing the implementation program to a single training program in four mental health institutions (a total of 21 rehabilitation teams) in The Netherlands. Focus groups, semistructured interviews and questionnaires were used at multiple levels of service delivery (service user, professional, team, organization). Assessments took place before, during and after implementation and at follow-up, adding up to a total duration of 14 months. Data were analyzed using multilevel modeling.ResultsData collection is complete and analyses on the effectiveness of the implementation program are ongoing. Preliminary analyses show that team climate (p<.008) and organizational climate (p<.043) significantly predict the attitudes of mental health providers toward EBP.ConclusionsThis implementation research may provide important information about the implementation of psychosocial interventions in practice and may result in a program that is useful for Cognitive Adaptation Training, and possibly for psychosocial interventions in general.DisclosureNo significant relationships.

Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial

BackgroundAdherence to treatment, i.e. the extent to which a patient’s therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram.MethodsTwenty participants with moderate to severe depression were 1–1 randomized to either (1) 5 mg MPH + 10 mg escitalopram or (2) placebo + 10 mg escitalopram with the possibility for a dose increase at 4 weeks. A Bayesian analysis was conducted to evaluate the outcomes.ResultsFirst, neither percent Pill count nor Medication Electronic Monitoring System adherence showed that MPH was superior to placebo. In fact, placebo showed slightly higher adherence rates on the primary (7.82% better than MPH) and secondary (7.07% better than MPH) outcomes. There was a less than 25% chance of MPH augmentation showing at least as good or better adherence than placebo. Second, both groups showed a significant effect of treatment on the QIDS-SR with a median effect of an 8.6-point score reduction. Third, neither subjective measures of adherence attitudes nor socio-demographic covariates had a significant influence on the primary or secondary outcome variables.ConclusionsThese data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression.ClinicalTrials.gov identifierNCT03388164, registered on 01/02/2018.

Stigma among Saudi Youth: Across-sectional Study on Secondary and Intermediate School Adolescent Attitudes towards Serious Mental Illness in Taif City 2019

Background: Stigma is a fundamental barrier to individuals seeking out mental health treatment in the Middle East. The impact of stigma may be amplified if the engagement in and utilization of mental health services for psychosis further stigmatizes individuals and their families Stigma toward mentally ill individuals acts as a barrier to accessing care and receiving treatment. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatization of psychiatric disorders is widespread. Negative attitudes towards mental illness are influenced by culture and affect people’s behavior differently depending on their cultural background. This is not to say that younger people have no stigma towards the mentally ill. Attitudes towards various aspects of mental illness, including its conceptualization and stigma towards the mentally ill are thought to form at an early age. The most urgent problem of mental health care in is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. Aim of the study: This study aims to explore the dimensions of stigma and social tolerance and examine its correlates in the younger, population of Taif city. Method: cross sectional study conducted at secondary and intermediate schools at Taif city in 2019. Sample population consists the participants were youths aged 14-18 years old residing and studying in Taif at the time of data collection. Our total participants were (400) .Results: The Mean+ SD age of the sample was (16.923±1.582). Regarding of age was (13-32) and regarding the gender were 225 (57.7%) participants were male while females was (42.3%). most of the sample is shown secondary education was (89.2%) while preparatory was (10.8%) most of participant were Saudi nationality was(95.6%) a significant relation between age and Physical danger, Class thinking, Personal space where respectively (P-value=0.032, 0.000, 0.029) and r Respectively (0.108, 0.183.), Non-Saudi students had higher for contact with mentally ill individuals compared with Saudi students. Conclusion: We propose the following initiatives to reduce stigma toward mental illness in the KSA: (a) Health education to families to enable them to support their affected relatives, (b) Increase cooperation between psychiatrists and faith healers and (c) Health education programs to the young people in schools to increase their awareness and understanding of mental illnesses and to combat negative stereotypes.

Psychological Management of Rape Survivors Suffering from Post-Traumatic Stress Disorder: Practitioners’ Perspectives

South Africa has consistently had high reports on the prevalence of rape, and post-traumatic stress disorder (PTSD) is the most common mental healthcare problem associated with rape. However, it seems that the provision of mental healthcare services for rape survivors is an acute challenge in the North West province and South Africa in general. Thuthuzela care centres provide care for rape survivors and these centres are located in public hospitals that mostly have mental health institutions that are well equipped with mental healthcare practitioners to assist rape survivors. This study explored and described the perceptions of mental healthcare practitioners regarding the psychological management of rape survivors suffering from PTSD in the North West province in South Africa. The study used a qualitative exploratory, descriptive and contextual research design to explore and describe the perceptions of mental healthcare practitioners regarding the psychological management of rape survivors suffering from PTSD. Data were collected using the purposive sampling method among mental healthcare practitioners through focus group discussions. Tesch’s method was used to analyse perceptions obtained from the participants. Five themes emerged: barriers to the psychological management of PTSD, assessments confirming diagnosis of PTSD, the use of various psychotherapeutic interventions, psychopharmacological management, and the involvement of various stakeholders. Therefore, recommendation is made for the implementation of effective psychotherapies such as debriefing, supportive counselling, trauma-focused cognitive behavioural therapy, the provision of selective serotonin reuptake inhibitors, and brain working recursive therapy for the management of PTSD from post-rape experiences. Recommendations for the development of psychological management guidelines for rape survivors suffering from PTSD are also made for future research.

On Solving the Problem of Mental Health Care with the Social Work Input

In difficult conditions of the external military aggression and aggravated internal political and social problems in Ukraine, the level of mental health disorders is growing, thus encouraging social change. Purpose. The study aims to identify possibilities and ways of bringing in social work in solving the problem of mental health care in Ukraine. Design/Methodology Approach. Theoretical research methods were used to find out opinions of experts, including persons with mental illness, on the challenges and needs of the mentally disabled in Ukraine. Qualitative content analysis of the narrative interviews with clients of the social organization and expert interviews was done to identify opportunities for involving social workers by the example of Lviv. Results. The study reveals the retrospective and explores the current state of addressing the problem of mental health care in Ukraine. It offers the problem solution based on attracting social work. Limitations and strengths of the study. The difficult times Ukraine is going through complicate the introduction of innovations in the social sphere, health care and education. This, however, stimulates change to improve its citizens’ well-being and health. Practical/Social Value. The initiative to train social workers for professional activity in mental health care supports the population health improvement. Originality/Conclusions. The findings show the need for the social work input in mental health care in Ukraine. The social work education is addressing the need, also involving a community health clinic

Why do psychiatric patients attend or not attend treatment groups in the community: A qualitative study.

BackgroundNon-attendance of treatment groups in the community has been a long-standing problem in mental health care. It has been found to have financial ramifications for services, worsen outcomes for those that do not attend and negatively impact on therapeutic group processes. There is a need to gain a better understanding of patients’ reasons for attending or not attending. This study aimed to explore patient views on facilitators and barriers to the attendance of treatment groups in the community.MethodsThe study used interview data collected as part of three studies that investigated treatment groups for psychiatric patients in the community. Sixty-seven interview transcripts were analysed using the framework method.ResultsFive themes relating to facilitators of group attendance were identified: opportunity for autonomy; self-acknowledging need and therapist encouragement; optimal group format and safe environment; interest in content and enjoyment; actual and expected benefits of attendance. Four themes related to barriers: not being sufficiently informed; concerns about social interactions and the unknown; limited accessibility; and negative group dynamics.ConclusionTo facilitate attendance and reduce attrition to treatment groups in the community clinicians should address patient’s wishes for information, capture their interest in the group modality, and potentially offer a ‘trial’ session. Furthermore, they should make the group location and time as accessible as possible and create a moderately sized group of six to eight patients. In these groups, mutual respect, feelings of safety and encouragement appear essential to make patients feel they can benefit from attendance.

Mindfulness-based cognitive therapy for patients with chronic, treatment-resistant depression: A pragmatic randomized controlled trial.

BackgroundChronic and treatment‐resistant depressions pose serious problems in mental health care. Mindfulness‐based cognitive therapy (MBCT) is an effective treatment for remitted and currently depressed patients. It is, however, unknown whether MBCT is effective for chronic, treatment‐resistant depressed patients.MethodA pragmatic, multicenter, randomized‐controlled trial was conducted comparing treatment‐as‐usual (TAU) with MBCT + TAU in 106 chronically depressed outpatients who previously received pharmacotherapy (≥4 weeks) and psychological treatment (≥10 sessions).ResultsBased on the intention‐to‐treat (ITT) analysis, participants in the MBCT + TAU condition did not have significantly fewer depressive symptoms than those in the TAU condition (–3.23 [–6.99 to 0.54], d = 0.35, P = 0.09) at posttreatment. However, compared to TAU, the MBCT + TAU group reported significantly higher remission rates (χ 2(2) = 4.25, φ = 0.22, P = 0.04), lower levels of rumination (–3.85 [–7.55 to –0.15], d = 0.39, P = 0.04), a higher quality of life (4.42 [0.03–8.81], d = 0.42, P = 0.048), more mindfulness skills (11.25 [6.09–16.40], d = 0.73, P < 0.001), and more self‐compassion (2.91 [1.17–4.65], d = 0.64, P = 0.001). The percentage of non‐completers in the MBCT + TAU condition was relatively high (n = 12, 24.5%). Per‐protocol analyses revealed that those who completed MBCT + TAU had significantly fewer depressive symptoms at posttreatment compared to participants receiving TAU (–4.24 [–8.38 to –0.11], d = 0.45, P = 0.04).ConclusionAlthough the ITT analysis did not reveal a significant reduction in depressive symptoms of MBCT + TAU over TAU, MBCT + TAU seems to have beneficial effects for chronic, treatment‐resistant depressed patients in terms of remission rates, rumination, quality of life, mindfulness skills, and self‐compassion. Additionally, patients who completed MBCT showed significant reductions in depressive symptoms. Reasons for non‐completion should be further investigated.

Multiproblem Families Referred to Youth Mental Health: What's in a Name?

The purpose of this study was threefold, namely (1) to differentiate between multiproblem families and control families on characteristics and processes within the family based on a theoretical framework, (2) to identify multiproblem families by establishing cut-off scores on various questionnaires, and (3) to categorize multiproblem families into subtypes by cluster analyses. Various questionnaires were administered to multiproblem families (n = 85) and control families (n = 150). Results showed that what we propose to refer to as multiproblem families present a broad range of problems on seven domains: (1) child factors, (2) parental factors, (3) childrearing problems (inadequate or inconsistent parenting), (4) family functioning problems, (5) contextual problems, (6) social network problems, and (7) mental health care problems. Further, reliable cut-off scores were established for various questionnaires. Finally, three types of families were found: (1) community-problem families, (2) multiproblem families, and (3) child-focused mild-problem families. This paper looks to advance an evidence-based definition and assessment of "multiproblem families" suggesting the possible value of defining and assessing multiproblem families in relation to these seven dimensions. Moreover, the classification of multiproblem families stresses the importance of providing tailored treatments.

EPA-0341 – Medical students’ psychological peculiarities as the basis of their psychoprophylaxis

Mental health care problem is highly significant for people who suffer from a long-lasting emotional and informational stress, especially for medical students. The aim of research is to determine the relation between the anxiety level and the psychological defense mechanism of medical students. Used methods: Taylor's method of anxiety determination and R. Plutchik's method of life styles. 66 students of the 4 th course of the medical and stomatological departments were examined, among them 52 women and 14 men aged between 20 and 23. It was discovered that the average level with a tendency to high (51,51%) and high level (43,94%) were the most frequently recorded level anxiety. Though, a low and a very high level of anxiety were not registered. It means that the cohort had mainly neurotic and partially the borderline level of personality organization. For women the overstandard rates were established by regression and projection, the displacement, compensation and intellectualization rates were very low. For men- the overstandard rates were established by projection and displacement; intellectualization, substitution and reaction formation rates were very low. With the increase of anxiety rates, the average rates of denial, displacement, regression and reaction formation alsoincreased. Compensation and intellectualization had the opposite effect during the increase of anxiety level. Thus, the psycho-prophylactic and psycho-corrective methods for students should be based on their psychological peculiarities. In practical terms, this means determining real reasons of many conflicts, predicting your own behavior and the behavior of other people in emotionally meaningful situations.

Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.

Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies

The aim of this review is to identify consistent themes among the qualitative literature on stigma as experienced by patients with schizophrenia receiving community mental health care. With the treatment focus of schizophrenia nowadays shifting more and more towards community-based mental health care, professionals need to be aware of the increased vulnerability of their clients in their social environment as a result of stigma towards their disease. In-depth knowledge on stigma is critical in order to offer a dignifying community mental health care. A systematic search of the qualitative literature in Web of Science, PubMed, PsycINFO and Francis was performed to review the subjective experiences and ideas on stigma in outpatients with schizophrenia. Three major themes were identified in 18 studies and need to be taken into consideration when implementing an adequate community mental health care: (i) the continuing existence of stigma inherent in the health care setting, (ii) the importance of relational aspects of stigma encounters in daily life and (iii) the significance of the behavioural aspects related to previous stigma experiences and beliefs among patients. Despite much effort in community treatment, patients still experience stigma and discrimination. Community mental health care professionals should not only be aware of structural problems in mental health care, but should also pay considerable attention towards the relational and behavioural aspects in their clients' life concerning stigma. Furthermore, they have the crucial role in the community to raise awareness about stigma in order to increase their clients' acceptance in society.

Exposures to Violence and Trauma among Children and Adolescents in Our Global Society

Globally, hundreds of children and adolescents witness acts of violence and trauma on a daily basis. Notably, children and adolescents exposed to violence and trauma may display mild-to-severe psycho-social- emotional and mental health care problems. Also, exposures to violence and trauma among children and adolescents have resulted into an alarming global health care issue for our society. All health care providers (HCP’s) must continue to actively engage in early identification, screening, assessing, and treating children and adolescents who self-disclose exposures to violence and trauma.

Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study

BackgroundNon-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure.The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region.MethodsPopulation-based (n=206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4months and when patients withdrew more than 80% of the packs required.Results5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives=3months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42).ConclusionsIn the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.

P01-346-Current priorities of investigation of mental health of growing generation

Complex approach allows identifying from many-sided positions integrative trends in research of mental health of growing generation. The case in point is evolutionary analysis of risk factors, role of adverse microsocial environment, negative impact of exogenous-organic and endogenous harms. In this aspect of relevance is distinguishing and all-sided development of new branch of the contemporary medicine – micropsychiatry (for this there are interesting basic data on grounding and propriety of description ecological fetal syndrome reflecting, in particular, influence of microdoses of radiation of negative consequences of the Semipalatinsk polygon etc.). Avalanche-like growth of indices of child homelessness and neglect is explained by consequences of microsocial crisis that is experienced by Russian family: this makes extraordinarily relevant problem of social orphanhood. The great attention must be paid to problem of mental health care of participants of pedagogical process (in a-chain-like-way “parent-child-teacher”).Researchers and physicians of child-adolescent subdivision of SI Mental Health Research Institute TSC SB RAMSci conduct work on psychotherapy of childhood and adolescence. In addition, there are many-year results of trials in the field of child-adolescent transculturology, conducted under auspices of the International Association of Ethnopsychologists and Ethnopsychotherapists (with active participation of Siberian scientists and physicians).Efforts of young researchers and representatives of older generation promote the successful development of new media, organizing-medical and preventive technologies allowing resolving the complex of tasks in heightening and mastering “quality of life” of Russian families, strengthening of the individual and societal health of the population of various regions of the country.

Development of an intervention program to increase effective behaviours by patients and clinicians in psychiatric services: Intervention Mapping study.

BackgroundHealth clinicians perceive certain patients as 'difficult' across all settings, including mental health care. In this area, patients with non-psychotic disorders that become long-term care users may be perceived as obstructing their own recovery or seeking secondary gain. This negative perception of patients results in ineffective responses and low-quality care by health clinicians. Using the concept of illness behaviour, this paper describes the development, implementation, and planned evaluation of a structured intervention aimed at prevention and management of ineffective behaviours by long-term non-psychotic patients and their treating clinicians.MethodsThe principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the intervention. Qualitative (individual and group interviews), quantitative (survey), and mixed methods (Delphi-procedure) research was used to gain a broad perspective of the problem. Empirical findings, theoretical models, and existing evidence were combined to construct a program tailored to the needs of the target groups.ResultsA structured program to increase effective illness behaviour in long-term non-psychotic patients and effective professional behaviour in their treating clinicians was developed, consisting of three subsequent stages and four substantial components, that is described in detail. Implementation took place and evaluation of the intervention is being carried out.ConclusionsIntervention Mapping proved to be a suitable method to develop a structured intervention for a multi-faceted problem in mental health care.

Limited English proficiency as a barrier to mental health service use: A study of Latino and Asian immigrants with psychiatric disorders

Language barriers pose problems in mental health care for foreign-born individuals in the United States. Immigrants with psychiatric disorders may be at particular risk but are currently understudied. The purpose of this study was to examine the effect of limited English proficiency (LEP) on mental health service use among immigrant adults with psychiatric disorders. Drawn from the National Latino and Asian American Study (NLAAS), Latino and Asian immigrant adults aged 18–86 with any instrument-determined mood, anxiety, and substance use disorder (n = 372) were included in the present analysis. Results from hierarchical logistic regression analyses showed that having health insurance, poor self-rated mental health, and more psychiatric disorders were independently associated with higher probability of mental health service use in the Latino group. After controlling for all background characteristics and mental health need factors, LEP significantly decreased odds of mental health service use among Latino immigrants. None of the factors including LEP predicted mental health service use among Asian immigrants, who were also the least likely to access such services. LEP was a barrier to mental health service use among Latino immigrants with psychiatric disorders. This study suggests that future approaches to interventions might be well advised to include not only enhancing the availability of bilingual service providers and interpretation services but also increasing awareness of such options for at least Latino immigrants. In addition, further investigation is needed to identify factors that can enhance access to mental health care services among Asians.