Provision Of Psychiatric Care Research Articles

Analysis of changes in legislation on the provision of psychiatric care

Mental disorders are a serious problem in modern society. They affect millions of people around the world and have a significant impact on the quality of life and people's ability to function in a normal environment. In this regard, the issues of ensuring the rights of citizens suffering from mental disorders do not lose their relevance and require special attention from doctors, lawyers and the scientific community. There are a number of reasons for this, including: 1) an increase in the incidence of mental disorders among the population, especially among socially vulnerable groups such as refugees, orphans, victims of hostilities and natural disasters; 2) medical care for mentally ill people can be provided forcibly, and therefore requires firmly established procedural standards; 3) mentally ill people often pose a danger to both for themselves and for society, therefore, the existence of fair law-restrictive measures is necessary; 4) persons with the status of mentally ill should have guarantees of social protection and integration into society without violating personal freedom (in the case when patients are not socially dangerous). On September 1, 2024, Federal Law No. 465-FZ dated 08/04/2023 «On Amendments to the Law of the Russian Federation «On Psychiatric Care and Guarantees of Citizens' Rights in its Provision» will enter into force. This paper analyzes the adopted amendments, how they will affect law enforcement practice, whether they will create even more grounds for restricting the rights of patients in psychiatric hospitals, or are aimed at improving the legal regulation of psychiatric care.

Awakening on antipsychotic medication: A call to action.

Explore a lived experience perspective on using antipsychotic medicine and call to action for psychiatric rehabilitation practitioners to get involved in preparing people diagnosed with serious mental illness (SMI) to have a voice and choice in antipsychotic medication treatment. A first-person account of awakening on an antipsychotic medication for the first time is used to understand the lived experience and challenges of using it. Lessons learned are amplified through de-identified queries of the CommonGround database capturing concerns about antipsychotic medication of people diagnosed with SMI in public sector mental health clinics in the United States. Lived experience of "me-on-medicine" included embodied and perceptual changes to self when taking antipsychotic medications. Discordance between the team's goal and personal goals for medication treatment interfered with recovery. Analysis of more than 100,000 concerns about antipsychotic medications expressed by 57,370 CommonGround users showed the most frequent concerns are that medication is perceived as unhelpful (21%), side effects (13%), impact on health (12%), and concerns about feeling unmotivated to use medication (8%). Among CommonGround users below age 30, low motivation to take antipsychotics was the third most prevalent concern. Among CommonGround users over age 30, concerns about the impact on health were the third most dominant. Psychiatric rehabilitation practitioners can support people diagnosed with SMI getting prepared to participate in decision making about antipsychotic medications with psychiatric care providers by identifying concerns and building skills and strategies to negotiate the new "me-on-medicine." (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nursing students’ metaphors of first clinical experiences of encountering patients with mental disorders

BackgroundPsychiatric wards are one of the most stressful medical centers. Apprenticeship in mental health can cause feelings of stress and anxiety among nursing students. Investigating nursing students’ beliefs about mental illnesses is very important to improve nursing education. The present study aimed to identify nursing students’ metaphors for their first clinical experiences of encountering patients with mental disorders.MethodsThis descriptive qualitative study was conducted on 18 undergraduate nursing students studying in two nursing colleges at Guilan University of Medical Sciences, in the north of Iran, in 2022. The data were collected through semi-structured interviews and analyzed using Critical Metaphor Analysis by the MAXQDA 2007 software.ResultsThe analysis of nursing students’ metaphors led to the emergence of 36 metaphors and 5 categories. These categories were “experience of dealing with a mental patient is similar to fear mixed with excitement”, " patient is similar to an errant human”, " psychiatric hospital is similar to a prison”, “nurse is similar to a prison guard”, and “clinical instructor is similar to a supporter, sympathetic and knowledgeable friend”.ConclusionsThe results showed their negative attitude towards the psychiatric hospital and health care providers. It is suggested that the findings of this study be taken into consideration in the planning of clinical education of nursing students.

Bridging the Gap: Integrating Awareness of Polycystic Ovary Syndrome Into Mental Health Practice.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Individuals with PCOS report reduced quality of life compared with those without PCOS, with possible contributing factors including infertility, hirsutism, irregular menses, and weight gain. Recent literature also supports increased associations between PCOS and co-occurring psychiatric conditions, particularly depression, anxiety, bipolar disorder, and eating disorders. It is concerning that a higher prevalence of suicidal ideation has been observed in individuals with PCOS. Given the high rates of psychiatric burden among those with PCOS, psychiatric care providers are well suited to be on the front lines of screening for psychiatric symptoms as well as initiating treatment. Current interventions include lifestyle changes (improving exercise and nutrition), pharmacological treatments (e.g., insulin-sensitizing agents, oral contraceptives, and psychotropic drugs), and psychotherapeutic interventions (e.g., cognitive-behavioral therapy and mindfulness-based therapy). This review provides an overview of recent research on the prevalence of comorbid psychiatric conditions, a foundation in PCOS-specific symptom screening and diagnosis, and an overview of treatments for psychiatric symptoms among individuals with PCOS.

Study to determine the epidemiology of treatment-resistant depression among the Saudi Arabian population: A cross-sectional study.

Depression is a common mental health disorder that affects millions of people worldwide. Globally, major depressive disorder (MDD) is a public health concern; nearly, it affects more than 300 million people. The coronavirus disease 2019 (COVID-19) pandemic lockdown, travel restrictions, social distancing, and COVID-19 vaccine acceptance have aggravated psychological disorders, such as depression and suicidal tendencies. Treatment-resistant depression (TRD) is typically defined as a lack of response to at least two different antidepressant medications or psychotherapies. TRD is common and has been associated with higher comorbidities and prolonged duration of illness, leading to a substantial medical and economic burden. A cross-sectional study was designed to determine the epidemiology and estimate the prevalence of TRD in Abha City, Assir Region, Kingdom of Saudi Arabia. The study includes adult patients who were attended to the psychiatry department and aged 18-65 years diagnosed with major depressive depression. A total of 651 study participants were recruited. Of the total 651 depressive disorder cases, 134 (20.6%) were reported as TRD and the remaining 517 (79.4%) were nontreatment-resistant depressive cases. Of the 651 depression participants, 176 (27%) were males and 475 (73%) were females. More than one-quarter (180 (28%)) had been associated with chronic morbidity. One-tenth of the depressive patients were suffering from thyroid disorders, followed by hypertension (10%), autoimmune diseases (10%), and diabetes mellitus (8%). TRD emerged as a threat to public health and challenging psychiatric care providers, and further innovative techniques and effective newer drugs to treat depression need to be researched. The treatment complaint mechanism is warranted, encouraging people to get treatment from the psychiatrist by removing the stigma of mental illness, which is needed to improve the quality of life of TRD patients.

Barriers and Needs of Mental Health Nursing Practitioners toward the Provision of Physical Health Care for Individuals with Severe Mental Illness: Findings from a Cross-Sectional Survey in India

Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse’s attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse’s workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.

Slouching towards engagement: interactions between people using psychedelics naturalistically and their healthcare providers.

There is substantial public interest in psychedelics as potential treatments for psychiatric conditions. However, most psychedelics are criminalized under federal law in the USA, so it is unclear whether use occurs with clinical support. Our objective was to assess whether naturalistic psychedelic use occurs with clinical support, interactions between those using psychedelics and healthcare providers (psychiatrist, therapist, or primary physicians), and use characteristics. We conducted an online, anonymous, confidential, cross-sectional survey of adults reporting psychedelic use (N = 1221) through a psychedelics advocacy event and social media between 9/18/2022 and 11/5/2022. We assessed participant disclosure of psychedelic use with their psychiatric care provider (PsyCP) and/or primary care provider (PCP), desire for provider support, access to support, and rate of taking prescribed psychoactive medications alongside psychedelics. Among participants with such care providers, 22% disclosed psychedelic use to their PCP vs. 58% to their PsyCP. Participants were less confident in PCP vs. PsyCP ability to integrate psychedelics into treatment. Common reasons for nondisclosure included stigma, inadequate provider knowledge, and legal concerns. 23% reported taking psychedelics on the same day as potentially interacting psychiatric medications (e.g., anxiolytics, antidepressants). Despite 81% of participants desiring therapist support during psychedelic experiences, only 15% had received such support. Our results show that psychedelic use is generally disconnected from primary and psychiatric clinical care. This disconnection may result in safety issues, including inadequate screening for contraindicated conditions, lack of support during emergent adverse events, and drug interactions. Enhanced clinical education and orienting drug policy towards known harms and benefits of psychedelics is needed.

Perceptions toward issues in cancer care for people with mental illness among psychiatric care providers: A questionnaire study.

To reduce cancer care disparities in people with mental illness, this study aimed to quantify psychiatric care providers' perceptions regarding issues that are insufficiently addressed or difficult to address. Psychiatric care providers at 23 psychiatric hospitals in Japan were surveyed using mail questionnaires. Respondents were asked to rate 15 items with four categories related to insufficiencies/difficulties in cancer care for patients with mental illness on a five-point Likert scale. We analyzed the proportion of respondents who answered "insufficient/difficult" for each item. A total of 255 (76.3%) psychiatric care providers responded. For questions related to the skills and attitudes of psychiatric professionals, 48.3%-58.4% of respondents perceived that efforts for supporting cancer screening and treatment were insufficient. For the questions related to collaborations between cancer and psychiatric care providers, 75.3% of respondents perceived that inpatient visits between psychiatric and cancer hospitals were insufficient. For the questions related to in-psychiatric-hospital medical systems, 50.2%-87.2% of respondents perceived that support for screening, diagnosis/treatment, and palliative care for psychiatric inpatients were insufficient/difficult. 41.9%-57.4% of respondents perceived that social services in the community were insufficient. This study clarified the level of insufficiency/difficulty perceived by psychiatric care providers regarding issues related to cancer care for people with mental illness. Psychiatric care providers are required to have knowledge and skills in cancer screening and treatment. To improve access to cancer prevention, treatment, and palliative care, it may be helpful to establish systems to promote coordination between cancer hospitals and psychiatric hospitals.

Nurse views of obstacles encountered by nurses in Saudi Arabia during the provision of psychiatric care

BackgroundNursing staff within the mental health sector are major actors in delivering healthcare. They face considerable obstacles that may hinder the provision of high-quality care to patients with mental health challenges. AimThe current study offers a description of mental health nurses' viewpoints, insights into obstacles encountered during their experiences, and recommendations for enhancing psychiatric inpatient nursing care and achieving progress toward the goals set out by Saudi Vision 2030. MethodsThe study employed a phenomenological qualitative design. Semistructured interviews were conducted with 10 currently practicing mental health nurses during two focus group sessions. The inductive data produced underwent member and peer checking. Emergent themes and subthemes were extracted. ResultsTwo main themes and related subthemes were identified. The first theme—obstacles faced by mental health nurses—was composed of the following subthemes: policy at institutions; clear job roles; low professional self-confidence and inadequate support; stressed, insecure, and unsafe; and stigmatization. The second theme—recommendations to improve the quality of mental health nursing—was composed of two subthemes: to enhance mental health awareness and improve professional skills and education. ConclusionThe data suggest that maintaining high-quality nursing standards within an inpatient psychiatric facility requires a consistent and accountable organizational structure, which can lead to fostering the development and improvement of relevant nursing skills through continuing education, improved awareness of mental health disorders and care within the community, and initiatives to combat the stigma of mental disorders among patients, families, and communities.

Onychophagia Progressing to Extensive Finger Amputation: A Brief Review Addressing Severe Body-Focused Repetitive Behavior Disorder in an Adult

Individuals engaging in repetitive, persistent and intentional behaviors resulting in significant self-injury can, for many medical and psychiatric care providers, stir vexing questions as to how such behavior should be conceptualized and managed. Onychophagia (nail-biting), categorized as a Body-Focused Repetitive Behavior Disorder (BFRBD) in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition , is a common oral habit, observed in both children and adults. For most persons, the nail-biting is merely a cosmetic concern that does not attract clinical attention. Although more extreme forms of this behavior can manifest with moderate complications, we present an unusual case of an adult for whom persistent onychophagia progressed to significant injury to his hands due to recurrent osteomyelitis. Emerging research exploring the underpinnings of severe forms of BFRBDs are discussed. This case illuminates management challenges that can arise when clinicians fail to recognize the condition and highlights the need for early coordinated multidisciplinary intervention to mitigate the behavior and its sequelae longitudinally. [ Psychiatr Ann . 2023;53(3):145–148.]

Omgaan met zorgweigering bij een persoon met een ernstige psychiatrische aandoening en een levensbedreigende ziekte: een casusbespreking

Dealing with refusal of care by patients with a severe psychiatric disorder in combination with a life-threatening condition: a case report Providing good care for persons with a severe psychiatric disorder in combination with a life-threatening condition is a major challenge for health care providers. By means of a case report, the authors analyze the situation of a 65-year-old woman with Korsakov’s disease, depressive symptoms and aplastic anemia. She refuses to be examined and treated, despite many efforts on the part of the caregivers and relatives, as well as the seriousness of the situation. The team has to switch from a curative to a palliative approach in a short space of time. Various areas of tension are assessed: appraising the decision-making capacity of the person requesting care, dealing with refusal of care in a life-threatening situation, and involving and coordinating the various parties concerned, including the psychiatric and somatic care providers, administrator and family. The case uniquely illustrates the challenges described in international literature and recent local studies. The authors plead for the importance of the liaison function between psychiatric and somatic care and the central role of the general practitioner associated with the psychiatric facility. The careful clarification of the legal capacity of the patient who refuses life-saving care, the added value of ethical consultation in order to come to a supported approach and to channel moral distress, and the involvement of a palliative support team within a psychiatric setting are also crucial elements in the approach.

Initial evidence of the effectiveness of a short, online Recovery College Model: a co-learning model to support mental health in the context of the Covid-19 pandemic

Introduction. The Covid-19 pandemic (C-19) has a negative impact on the mental health of the general population and in particular, women, people with chronic physical illness or psychiatric conditions, students and health care providers. Targeting these needs, the Recovery College (RC) model offers a new and innovative approach based on co-learning and learner diversity. The model provides a co-learning space where at-risk populations and the general public learn together and collectively equip themselves to better address psychological well-being and mental health issues. Objective. The objective is to present the initial results of the RC co-learning model in a short online format to meet the pressing needs of mental health intervention in the C-19 context. Method. A pre-post research design with repeated measures was used. Results. Results suggest improved knowledge and use of tools to support mental health interventions, self-management strategies, anti-stigma attitudes, and protection against increased anxiety. Conclusion. This RC model allows people from all backgrounds to participate in an innovative co-learning model in which experiential knowledge is central to learning to stimulate reflection and change in attitudes and behaviors.

ПРАВОВИЙ СТАТУС МЕДИЧНИХ ПРАЦІВНИКІВ, ЯКІ НАДАЮТЬ ПСИХІАТРИЧНУ ДОПОМОГУ

The scientific article is devoted to the problems of legal regulation of the legal status of medical workers who provide psychiatric care. The norms of legislation and by-laws that regulate the work of psychiatrists were studied. The papers of scientists who researched the legal status of doctors were reviewed. It is stated that the legal status of medical workers who provide psychiatric care is determined by the Labor Code of Ukraine, the Fundamentals of Health Care Legislation, the Law of Ukraine On Psychiatric Care, and by-laws of Ukraine. The theoretical foundations of the legal status of doctors who provide psychiatric care were studied. It is proposed to define the legal status of psychiatrists as a set of special rights, duties, legal restrictions, and terms of employment that determine the provision of medical care to persons suffering from mental illnesses. The requirements for the level of education and qualification of medical workers who provide psychiatric care are determined. The special professional rights and duties of medical workers during the provision of medical care were studied. The peculiarities of the legal regulation of working time and rest time of psychiatrists were studied. Features of criminal and administrative liability for violation of patients’ rights were established. A list of legal restrictions was established for medical professionals regarding the advertising and distribution of medicinal products obtained directly from pharmaceutical manufacturers. Proposals for amendments to the current legislation to improve the legal status of medical workers who provide psychiatric care have been formulated. It is proposed to enshrine in the Law of Ukraine On Psychiatric Care the peculiarities of legal regulation of labor relations of employees of health care institutions that provide psychiatric care. It is necessary to establish administrative responsibility for patients’ rights violations during the provision of psychiatric care in KUpAP.

Роль нейминга в здравоохранении. От психиатрической больницы к центру психического здоровья

An urgent issue today is to increase the confidence of citizens in the healthcare system. Moreover, the issue of trust is of particular importance in the provision of psychiatric care, due to the high level of stigmatization of this area of medicine. The purpose of the study was to assess the significance for patients of the names of medical organizations in the profile of «psychiatry». Materials and methods. In 2021 Kirov Regional Clinical Psychiatric Hospital named after Academician V.M. Bekhterev changed its name and became the Center for Psychiatry and Mental Health Academician V.M. Bekhterev. A survey was conducted of 216 patients who applied or are undergoing treatment at the Center of Psychiatry and Mental Health named after Academician V.M. Bekhterev, using a specially designed questionnaire consisting of 24 questions. The results obtained were statistically processed. Results. A large proportion of the respondents had one or another mental disorder, and more than half are worried because of this, to one degree or another. One-fifth of the respondents indicate that their rights were violated due to their mental disorders. All this points to the problems that exist to this day associated with the stigmatization of patients with mental disorders, as well as the stigmatization of the psychiatric service itself. 43% of respondents noted that the name of a medical organization has an impact on their trust in a medical organization. The patients surveyed gave the highest rating to the name «Mental Health Center». Conclusions. Thus, the name of a medical organization directly affects the trust of patients in it. In addition, the name also affects the subjective assessment of the quality of medical care provided in a medical organization.

Issues of cancer care in people with mental disorders as perceived by cancer care providers: A quantitative questionnaire survey.

To reduce cancer care disparities, this study aimed to clarify the difficulties in cancer care for people with mental disorders as perceived by cancer care providers. Cancer care providers at 17 designated cancer hospitals in Japan were surveyed using mail questionnaires. Respondents were asked to rate 29 items related to difficulties or insufficiencies in cancer care for patients with mental disorders on a five-point Likert scale. We analyzed the proportion of respondents who answered "difficult/insufficient" in each item. We also calculated the proportions of responders stratified according to the presence of psychiatric support systems within their hospitals. A total of 388 (58.4%) cancer care providers responded. Among the issues related to "difficulties in diagnosing and treating cancer," support for decision-making, assessment of treatment adherence, and assessment of physical symptoms were perceived as most difficult (73.5%-81.5% of respondents). Among the issues related to 'difficulties or insufficiencies in collaboration among multidisciplinary health care providers,' the issue of advance consultation and sharing information with the patient's primary psychiatric care provider was perceived as most difficult (52.2%). Among the issues related to "insufficiencies of in-hospital and community medical systems," education to provide reasonable accommodation was perceived as most insufficient (47.4%). The perceived difficulties of over half of the issues varied significantly between hospitals depending on the level of psychiatric support systems. This study clarified the difficulties of cancer care in patients with mental disorders as perceived by cancer care providers. Some issues may be resolved by psychiatric liaison teams.

«Psychiatry without shackles»: The formation of psychiatric care in Chernivtsi in late 19th – early 20th centuries

The article presents transformation of medical care for patients with mental disorders and the establishment of psychiatric care in Chernivtsi in the late 19th century. Since the proclamation of Bukovyna as the crown land of the Austro-Hungarian Empire, the provision of psychiatric care has changed. A psychiatric service appeared and helped to understand what a mental disorder really is. There was a transition to a scientific interpretation and a scientific approach to providing psychiatric care.The authors research and systematize information from various available sources, various articles, information messages, data from the state archives of Chernivtsi region, etc.It is known that the model of the regional psychiatric hospital in Chernivtsi was developed by the latest requirements for the construction of mental health facilities in Austria and other European countries of the time.At the beginning of the 20th century, the Bukovynian psychiatric hospital was extremely modern, equipped with all necessary equipment and the location of the wards in accordance with the standard of the time. Leading doctors were involved, as well as local ones, who had the opportunity to train at the University of Vienna and psychiatric hospitals. 15 hectares of land were allocated for the territory of the hospital, which was located outside the city on the territory of the former Strazagasse (Storozha) and Maisgasses (Kukurudziana) streets, now Mussorgsky Street.The opening of the regional psychiatric hospital in Bukovyna took place on May 1, 1902. The structure of the psychiatric hospital included 6 buildings, as well as the administration building and other technical facilities.The purpose of the article was to highlight the main historical moments of assisting persons with mental disorders in Chernivtsi in the late 19th and early 20th centuries. Describe the historical chronology from the first psychiatric ward at the city hospital to a separate regional psychiatric hospital in Bukovyna. The methodology of the article is a synthesis of the historical chronology of psychiatric care as part of health care in Chernivtsi.The history of the emergence of psychiatric services in Chernivtsi has experienced ups and downs that corresponded to challenging conditions of the time. The transformation of mental service changed from the worldview and level of development of contemporary science. We can observe changes from mystification to the formation of psychiatry, as real modern neuroscience with an evidence-based approach and humane treatment of patients. Through the ages, different countries and changes in the understanding of the aetiology and pathogenesis of mental disorders, Chernivtsi remains the centre of mental health in Bukovyna.

Patients’ acceptability and implementation outcomes of a case management approach to encourage participation in colorectal cancer screening for people with schizophrenia: a qualitative secondary analysis of a mixed-method randomised clinical trial

ObjectivesWe examined the efficacy of case management (CM) interventions to encourage participation in colorectal cancer screening for patients with schizophrenia. This study aimed to clarify patients’ acceptability of the intervention...

Utilization of psychiatric services prior to suicide- a retrospective comparison of users with and without previous suicide attempts

Introduction The aim was to investigate psychiatric health care utilization two years before death by suicide among individuals with previous suicide attempts (PSA) compared with those without (NSA). Method A retrospective population-based cohort study was conducted including 484 individuals who died by suicide in Sweden in 2015 and were in contact with psychiatric services within the two years preceding death, identified through the Cause of Death register. Data on psychiatric health care two years before death, including suicide attempts according to notes in the medical record was used. Associations between having at least one PSA vs. NSA and health care utilization were estimated as odds ratios (OR) with 95% confidence intervals (CI) by logistic regression analyses. Results Of the 484 individuals included, 51% had PSA. Those with PSA were more likely than NSA to have received a psychiatric diagnosis [OR 1.96 (CI 95% 1.17–3.30)], to have ongoing psychotropic medication [OR 1.96 (CI 95% 1.15–3.36)] and to have been absent from appointments during the last three months [1.97 (1.25–3.13)]. In addition, elevated suicide risk was more often noted in the psychiatric case records of those with a PSA than those without [OR 2.17 (CI 95% 1.24–3.79)]. Conclusion The results underline the importance of improved suicide risk assessment as well as thorough diagnostic assessment and when indicated, psychiatric treatment as suicide preventive interventions regardless of PSA. Furthermore, the larger proportion of absence from appointments in individuals with PSA may indicate a need of improved alliance between psychiatric care providers and individuals with PSA. HIGHLIGHTS Being assessed with elevated suicide risk was more common among those with previous attempt/s (PSA). One-fifth of all with no previous attempt (NSA) had no psychiatric diagnosis, compared to one in ten in those with PSA. Receiving psychotropic medication was more common among those with PSA.

Survey of non-conventional mental health care facilities in C\xf4te d\u2019Ivoire: first stage

BackgroundMental illnesses and disabilities as well as epileptic diseases remain an important public health issue. In Côte d’Ivoire, the provision of psychiatric care and specialised psychosocial facilities is almost non-existent. This study is based on the hypothesis that the care of people suffering from mental illness and epilepsy in Côte d’Ivoire is mainly in the hands of non-conventional mental health care facilities, including so-called ‘Prayer Camps’. These work according to traditional and spiritual principles and are mostly not registered or controlled by the Ivorian authorities.MethodsThis study is the first stage of a multi-stage study. For the first stage, a quantitative method with an exploratory and descriptive aim was chosen. 541 non-conventional mental health care facilities in Côte d’Ivoire were mapped, typologised according to their spiritual orientation and treatment methods, and examined according to some charactersitics. Semi-structured interviews with 435 facility leaders were conducted.ResultsThe article provides a typology of four types of non-conventional mental health care facilities in Côte d’Ivoire including Christian Prayer Camps, Traditional Healing Centres, Phytotherapy Centres, and Roqya Centres. It explores their administrative embedding, the qualification of the facility leaders as well as their willingness, in principle, to cooperate with conventional mental health care centres. A considerable number of non-conventional expressed a desire or acceptance of cooperation with psychiatric organisations.ConclusionsThe next stage of this multi-stage study will be to assess the clinical and legal situation of the patients in these centres. The aim is to interview the patients in order to analyse their perceptions and to capture the concerns of relatives and staff in the centres as well as the human rights situation in a mixed-method study. The long-term objective is to establish future cooperation between conventional psychiatric care providers and suitable non-conventional mental health care facilities and to implement a community mental health care policy in Côte d’Ivoire.

How to Transition Patients Back From Psychiatric Care to Primary Care: An Access Initiative Protocol Development.

This column describes the initial steps to develop a bidirectional access initiative between outpatient psychiatric and primary care clinics within an academic medical center. The authors analyzed electronic health record data (N=2,837 patients), interviewed psychiatric and primary care providers, assembled a work group, and identified five patient tracks (treatment optimization, psychiatric continuity, specialty clinic, psychotherapy, and community referral). Over 16 months, the number of patients scheduled for new psychiatric diagnostic evaluations with medical services increased from 62.5 to 116.0 per month without significant change in the no-show rate for evaluations within the psychiatric outpatient clinic.