Professional Mental Health Workers Research Articles

Mental health interventions by lay counsellors: a systematic review and meta-analysis.

ObjectiveTo investigate the effectiveness of community-based mental health interventions by professionally trained, lay counsellors in low- and middle-income countries.MethodsWe searched PubMed®, Cochrane Central Register of Controlled Trials, PROSPERO and EBSCO databases and professional section publications of the United States National Center for PTSD for randomized controlled trials of mental health interventions by professionally trained, lay counsellors in low- and middle-income countries published between 2000 and 2019. Studies of interventions by professional mental health workers, medical professionals or community health workers were excluded because there are shortages of these personnel in the study countries. Additional data were obtained from study authors. The primary outcomes were measures of post-traumatic stress disorder, depression, anxiety and alcohol use. To estimate effect size, we used a random-effects meta-analysis model.FindingsWe identified 1072 studies, of which 19 (involving 20 trials and 5612 participants in total) met the inclusion criteria. Hedges' g for the aggregate effect size of the interventions by professionally trained, lay counsellors compared with mostly either no intervention or usual care was −0.616 (95% confidence interval: −0.866 to −0.366). This result indicates a significant, medium-sized effect. There was no evidence of publication bias or any other form of bias across the studies and there were no extreme outliers among the study results.ConclusionThe use of professionally trained, lay counsellors to provide mental health interventions in low- and middle-income countries was associated with significant improvements in mental health symptoms across a range of settings.

Life in a Time of Plague and Beyond

Plagues have come and gone throughout the course of human history. They can be extremely disruptive of societies through which they ravage and usually permanently change things even after the infections decrease. What can we learn from our past pandemics? What are the likely scenarios that could play out and to which professional mental health workers will have to respond? These topics will be examined herein.

Voice hearers’ experiences of the Making Sense of Voices approach in an NHS setting

ABSTRACT The ‘Making Sense of Voices’ (MsV), or ‘Maastricht’ approach has become established within large sections of the voice hearing community, as well as being adopted by some professional mental health workers. However, there has been limited research to assess this intervention. A recent case series using the MsV approach reported promising results across a number of standardised outcome measures. The current study reports on the voice hearers’ experience of having received the MsV intervention, through the use of “exit interviews” conducted as part of the case series. Individual participants’ experiences indicated a range of reactions to the intervention. Positive outcomes appeared to relate to a better understanding of voice hearing experiences and a greater sense of control over voices. Not all participants reported a positive experience of communicating with their voices. Outcomes are discussed within the context of potential common and distinct “ingredients” of the MsV approach, compared to other approaches to working with distressing voices.

Contemporary public perceptions of psychiatry: some problems for mental health professions

Social constructionist critiques of psychiatry have primarily focussed on the function of diagnosis for society. Less attention has been paid to the diverse ways that service users and carers have come to construct mental disorder. Social movements led by service users/survivors have worked to contest biomedical models whilst carer groups have campaigned for a greater emphasis on biomedicine. However, population-based research reveals a more complex picture, indicating that whilst public acceptance of biomedicine has grown, the public continue to see mental disorder as being highly influenced by social factors and display a high degree of ambivalence towards psychiatric treatment. Through focussing on debates in psychiatry, social work and nursing in the UK, we argue that public perceptions have particular consequences for the mental health professions. Specifically, they impact on the way that professionals can present themselves as holding a specialist knowledge base. Professional mental health workers therefore need to be transparent about the assumptions and limitations of psychiatric knowledge and base therapeutic decisions around the way in which service users and carers construct mental disorder.

Seeking Paths for Collaboration between Religious Leaders and Mental Health Professionals in Ghana

The treatment gap for mental illness is wide between low- and middle-income countries. The World Health Organization and other relevant bodies are seeking to reduce this gap through culturally innovative and sensitive programming. In Ghana, for example, only 2 % of the mentally ill access treatment, which means that 98 % do not receive care. Various discourses are ongoing to scale up mental health services in Ghana. One of these is the fostering of a collaborative framework between lay mental health workers (such as religious leaders or faith healers) and professional mental health workers. This article seeks to provide a framework within which collaborative linkages between religious leaders (e.g., the clergy, traditional healers) and professional mental health workers can be established. The article begins with a brief overview of Ghana’s mental health landscape, followed by a description of the challenges that make collaboration a difficult task. Next, the need for a holistic view of health in Ghana is addressed by examining Engel’s biopsychosocial model and Twumasi’s work on the complementary role of traditional systems. The essay ends by providing a three-step approach—understanding, task shifting, and broadened curricula—as a model to guide any collaboration between religious leaders and health practitioners in Ghana.

Worker, workplace or families: What influences family focused practices in adult mental health?

Introduction Family focused practice is thought to lead to positive outcomes for all family members. However, there are multiple barriers and enablers in adult mental health services to practitioners undertaking these actions. Aim The aim of this study was to examine the relative importance of worker, workforce and family factors to predict family focused practices (FFPs) in adult mental health services. Method Three hundred and seven adult mental health workers completed a 45 items family focused practice measure of 16 family focused practices. Thesis It was found that worker skill and knowledge about family work and an ability to assess the degree of parental insight into the child's connections to other family members and the community were important predictors of FFP, along with the closely related-worker confidence. While aspects of the worker, workplace and family each contribute to FFPs, this study highlighted the importance of worker skill, knowledge and confidence as central issues for adult mental health workers. Implications for practice Study implications include the need for training in specific FFPs, the provision of time to engage with clients on parenting issues and the need 5 to ensure that there are adequate services for workers to refer family members to.

Cost and outcome of behavioural activation versus cognitive behaviour therapy for depression (COBRA): study protocol for a randomised controlled trial

BackgroundCognitive behaviour therapy (CBT) is an effective treatment for depression. However, CBT is a complex therapy that requires highly trained and qualified practitioners, and its scalability is therefore limited by the costs of training and employing sufficient therapists to meet demand. Behavioural activation (BA) is a psychological treatment for depression that may be an effective alternative to CBT and, because it is simpler, might also be delivered by less highly trained and specialised mental health workers.Methods/DesignCOBRA is a two-arm, non-inferiority, patient-level randomised controlled trial, including clinical, economic, and process evaluations comparing CBT delivered by highly trained professional therapists to BA delivered by junior professional or para-professional mental health workers to establish whether the clinical effectiveness of BA is non-inferior to CBT and if BA is cost effective compared to CBT. Four hundred and forty patients with major depressive disorder will be recruited through screening in primary care. We will analyse for non-inferiority in per-protocol and intention-to-treat populations. Our primary outcome will be severity of depression symptoms (Patient Health Questionnaire-9) at 12 months follow-up. Secondary outcomes will be clinically significant change and severity of depression at 18 months, and anxiety (General Anxiety Disorder-7 questionnaire) and health-related quality of life (Short-Form Health Survey-36) at 12 and 18 months. Our economic evaluation will take the United Kingdom National Health Service/Personal Social Services perspective to include costs of the interventions, health and social care services used, plus productivity losses. Cost-effectiveness will explored in terms of quality-adjusted life years using the EuroQol-5D measure of health-related quality of life.DiscussionThe clinical and economic outcomes of this trial will provide the evidence to help policy makers, clinicians and guideline developers decide on the merits of including BA as a first-line treatment of depression.Trial registrationCurrent Controlled Trials ISRCTN27473954

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.

“Heaven and Hell on Earth” A critical discourse analysis of religious terms in Norwegian autobiographies describing personal experience of mental health problems

This article explores the use of religious terms in six Norwegian autobiographies written between 1925 and 2005 by people who themselves have been patients in the mental health services. Through a critical discourse analysis, we discuss the functions of religious discourse in the texts and its position in contrast to the medical discourse predominant in today's mental health services. It was found that religious (predominantly Christian) terms were used to varying degrees in all autobiographies as a means to capture the immensity and inherent ambivalence characteristic of mental health problems. Despite the “medical turn” in professional mental health discourse, there is no clear evidence of a decrease in the use of religious terms from the oldest to the most recent text. We propose that professional mental health workers to a larger extent take into account the religious dimension in therapy, and reflect on its larger historical and sociocultural context.

Trends in Behavioral Health Care Service Provision by Community Health Centers, 1998–2007

Trends in Behavioral Health Care Service Provision by Community Health Centers, 1998–2007

Trialog—an exercise in communication between consumers, carers and professional mental health workers beyond role stereotypes

Communications and collaborations between mental health care users and user activists, family carers and friends, and mental health professionals and policy makers outside and beyond traditional clinical and pedagogic encounters are needed to strengthen a rights-based approach in the field of mental health and further civil society involvement. The Trialogue experience – an exercise in communication between service users, families and friends and mental health workers on equal footing – is indicative of our capacity for surviving and gaining from serious discussions of adverse issues as well as the great possibilities of cooperative efforts and coordinated action.

The Wellness Recovery Action Plan (WRAP): Effectiveness with Chinese consumers

Education and knowledge have always been prized life quests for Chinese. The question however, is whether Western-style mental health education is acceptable to Chinese mental health consumers and whether it is useful in improving their knowledge and understanding of mental health and the process of recovery. Whilst there has been a plethora of psychoeducational material published, most offer passive learning or require little educator/learner interaction, let alone active participation.The aim of this paper is to present a pilot research on the acceptability, the applicability and the effectiveness of the Western concept of mental health recovery including the Wellness Recovery Action Plan (WRAP) programme in improving the effectiveness of recovery among the members of Bo Ai She (BAS), a Chinese mental health consumers’ self-help organisation in New Zealand.Qualitative research methods were used to undertake this research. Eight members of BAS and three professional mental health workers were interviewed, and proceedings from discussions in two focus groups comprising consumers and their family members have been included to form the data base.Key findings from this research affirmed that the WRAP programme has played a significant role in recovery for Chinese consumers in BAS. The results also suggested areas which needed to be modified in order to become a cultural-appropriate programme in Chinese mental health consumers’ recovery.

Enjeux cliniques et éthiques de la supervision externe des équipes en santé mentale

External supervision of teams is increasingly part of mechanisms put in place both in public networks and community organizations to contribute in supporting professional mental health workers in developing their abilities and improving their clinical practices. It also plays a role in the analysis of ethical questions and in the prevention of deontological errors. The supervision of teams also includes its share of challenges, notably with regards to group dynamics and mechanisms to favour in order for supervision to rightly adjust to the needs and levels of participating professionals. Finally, the supervisor must also consider his own ethical responsibilities towards those supervised and towards their clients.

Uganda mental health country profile

With the help of the International Consortium for Mental Health Policy and Services, data on country mental health services was gathered through a descriptive, cross sectional study. The study population included policymakers, health providers and consumers of health services. Data was collected at national level from relevant sectors including the Ministry of Health, Butabika National Referral Mental Hospital and four rural districts. The districts were purposively selected because of existing consumer groups. Quantitative data was collected by interviewer-administered questionnaire and record reviews at hospitals and district headquarters. It was observed that the country has inadequate numbers of mental health professionals with poor mental health funding. Such factors, compounded with inappropriate cultural beliefs, are major obstacles to the delivery of mental health services. There is however an attempt by the Government to improve mental health services. The current health policy is an opportunity to improve access to mental health care. Currently there is improved pre-service and in-service training for mental health workers with ongoing rehabilitation and remodelling of the mental health infrastructure in the country. The burden of mental disorders in Uganda is high in a country that is poorly resourced. The majority of the population is rural and still harbours negative cultural beliefs. There is a need to increase advocacy for mental health and develop capacity for professional mental and general health workers to be supported by appropriate policies, facilities and finances.

Psychiatric care in the Middle East: a "mental health supermarket" in the town of Lod.

It is often in times of political tension and hostilities that community mental health care is neglected. We describe a novel and creative community mental health program where a combination of professional mental health workers and an innovative mental health system network combine to provide a remarkably successful and tension free mental health care arrangement in an area of high political and intergroup hostility. The system, termed the "mental health supermarket," encompasses multi-component rehabilitation, hospital liaison and interagency collaborative care. The framework succeeds in settling fears and insecurities between various communities as well as catering to a fragmented and lower income community, while introducing an element of self-determination in personal mental health care.

Outreach interventions for the homeless mentally ill.

There has been a steady rise in the number of homeless mentally ill in Britain. This article reviews the scale of the problem and identifies the need for change within mental health services in order to address this challenge. It is argued that mainstream psychiatric services need to become more diverse and open in their approach to this potentially isolated group of users. The authors suggest that this could be achieved by embracing assertive outreach interventions. Innovative projects using a range of care providers, including voluntary workers, past users of the service and professional mental health workers, are discussed as an alternative framework to traditional services. In conclusion, the article highlights some of the professional and social implications for psychiatric nurses and mental health practice.

The relation of coping, appraisal, and burnout in mental health workers.

This study was undertaken as an attempt to determine the relationship between individual coping (in response to stressful work events) and concomitant symptoms of burnout and the relationship between coping and burnout as moderated by secondary cognitive appraisal. Professional mental health workers (N = 234) employed by a state psychiatric facility completed the Ways of Coping Checklist (revised) (Lazarus & Folkman, 1984) and a measure of secondary appraisal, after reporting a typical stressful work event. They also completed the Maslach Burnout Inventory (Maslach & Jackson, 1986) and a demographic questionnaire. Results suggested that individual coping was related to burnout. Escape-avoidance was the primary coping strategy related to all three symptoms of burnout: emotional exhaustion, depersonalization, and lack of personal accomplishment. Secondary appraisal did not moderate the relation of coping and burnout.

Attitudes toward mental health professionals in a hospital-based community mental health center.

This study examined the attitudes of several diverse subject groups in a large medical center toward various mental health professionals. The groups consisted of: general hospital staff; professional mental health workers; and psychiatric in-patients. Subjects evaluated a selection of 11 professional health related role titles (clinical psychologist, physician, psychiatrist, etc.) and the categories "me" and "mental patient" by marking a series of 19 seven-step rating scales, each composed of bipolar anchoring adjectives. Additionally, a "familiarity" rating for each of the role titles was obtained. An "understanding" and a "value" cluster were derived from the 19 adjectives along with an overall favorability-unfavorability score for each role title. It was expected that subjects would "value" mental health professional roles more strongly than they would indicate an "understanding" of these same roles. Secondly, it was expected that the hospital setting itself, the subject's role within that setting, and the degree of familiarity with the role being rated would have a significant impact on the subject's attitude. Results generally supported the above expectations. Overall ratings of the professional groups were consistently high, with less difference between the "health" designations (physician, nurse) and the "psych" designations than has been previously reported in the literature.

A Psychoeducational Approach for Treatment of Depression in Elders

Sixty-eight community residing older adults completed a 6 week behaviorally oriented course to learn skill for coping with depression. Courses were co-led by pairs of professional mental health workers or by paraprofessional staff of centers serving seniors. There was a decline in depression from pre to post measures that was still apparent at two month followup. Both life satisfaction and activity level were also increased, while negative cognitions were decreased. Comparisons between subjects taught by the two kinds of leaders indicated that there were essentially no differences in outcome between the two groups. Positive aspects of a psychoeducational model as reflected in this course include: acceptability to elders who may not wish to identify themselves as patients; relative effectiveness in a short time for relief of depressive symptoms and related distress; and relatively low cost per participant due to the use of paraprofessionals.

The Clergy's Attitudes About Mental Illness, Counselling, and the Helping Professions

The clergy are often referred to as gatekeepers of the mental health system. In this capacity, the clergy's attitudes assume considerable importance since they are likely to affect the working relationships between pastors and professional mental health workers. A questionnaire was therefore developed to assess the clergy's attitudes about mental illness, counselling, and the helping professions, and delivered to 163 pastors in British Columbia; 102 (62.6%) returned the completed questionnaire by mail. It was found that the clergy: (a) most commonly selected psychological reasons (e.g., “stress in living”) rather than spiritual reasons (e.g., “stunted spiritual growth”) for mental illness; (b) were strongly in support of the aims of community mental health; (c) felt that counselling was effective when it corrected maladaptive thought patterns and allowed the expression of feelings; (d) ranked pastoral counselling as more effective than psychology, psychiatry, or social work; and (e) were more likely to be sympathetic towards community mental health if they were non-fundamentalistic in theology. Overall, results showed the clergy to be a highly promising resource for the community mental health movement and its workers.