Psychiatric Mental Health Care Research Articles

The role of the dually certified primary care/psychiatric mental health nurse practitioner in treating high-needs/high-cost patients.

National nursing organizations have called for nurses to provide leadership in care solutions for high-cost/high-needs vulnerable populations. In response to this call, important modifications are emerging in Doctor of Nursing Practice programs, including an increasing number of nurses pursuing dual certification in primary care and psychiatric mental health or primary care nurse practitioners returning for a postgraduate certificate in psychiatric mental health. This innovative role warrants examination, particularly because it relates to high-needs/high-cost patients such as those with serious mental illness (SMI). This article highlights two aspects of the role of the primary care/psychiatric mental health nurse practitioner (PC/PMHNP): one, to provide a vision of the PC/PMHNP as a unique solution for optimal care of vulnerable patients and two, to demonstrate potential contributions of the PC/PMHNP to the larger health care system. A case exemplar is used to illustrate role contributions of the PC/PMHNP in a high-needs/high-cost patient with SMI and complex co-occurring physical illness. Three capacities of the PC/PMHNP are discussed: depth and breath, expert engagement and rapport building, and full patient-centered care and flexibility. The case exemplar emphasizes the PC/PMHNP value through transitions across care settings and where gaps in service frequently occur. The impact of the PC/PMHNP on improved patient outcomes, patient and provider satisfaction, and cost savings are explored.

Self-Preparation and Professional Development of Nurses: Psychiatric Mental Health Care Issues

Today's mental health care needs are diverse. After the COVID-19 pandemic, factors related to individuals, the environment, and their interactions represent complex and cumulative risks. Physical and mental health problems rely on early detection, trust building, care engagement, and disease identification to provide complete psychiatric assessment, management, and continuum of care for affected people. Thus, early detection and intervention in nursing is beneficial for the discovery and treatment of psychological symptoms. However, the nursing profession is divided into multiple specialties, and the current education system lacks integrated interdisciplinary psychiatric mental healthcare training. In this article, the multifaceted aspects of mental health care services and interdisciplinary nursing professional development in mental health are explored, covering the roles and tasks of interdisciplinary nurses, the function and purpose of psychological care in hospitals, reflections on the role of school nursing in adolescent mental health issues, and novel developments in domestic and international psychiatric mental health care. It is hoped that this article can promote reflections on psychological health issues for nurses and help promote cross-disciplinary consensus on nursing strategies to facilitate cooperation among multidisciplinary nurses to promote more comprehensive quality of care, social participation, and professional innovation.

An Innovative Approach to a Multitrack Advance Practice Registered Nurse Program: The Integration of Psychiatric Mental Health and Primary Care Cohorts.

We describe how an online graduate nurse practitioner program combined psychiatric mental health nurse practitioner and primary care advanced practice registered nurse (AGNP/FNP/PNP) tracks into an integrated curriculum. Student evaluations and assessments, along with board certification scores, demonstrated improvement in identifying and managing behavioral health problems, as well as increased competence and collaboration with other nurse practitioner students. Details of the integrated curriculum are provided.

The effects of national mental health plans on mental health services development in Chile: retrospective interrupted time series analyses of national databases between 1990 and 2017

AimsTo describe changes in mental health services in Chile between 1990 and 2017, and to retrospectively assess the effects of national mental health plans (NMHPs) on mental health services development during this period.MethodsService data (beds in psychiatric hospitals, psychiatric beds in general hospitals, forensic psychiatric beds, beds in protected housing facilities, psychiatric day hospital places, and outpatient mental health care centers) were retrieved from government sources in Chile. Data were reported as rates per 100,000 population. We conducted interrupted time series analyses, using ordinary least-square regressions with Newey-West standard errors, to assess the effects of the 1993 and 2000 NMPHs on mental health services development.ResultsRates of short- and long-stay beds in psychiatric hospitals (per 100,000 population) were reduced from 4.3 to 3.2 and from 19.0 to 2.0 over the entire time span, respectively. The strongest reduction of short- and long-stay beds in psychiatric hospitals was seen between the 1993 and 2000 NMHPs (annual removal of − 0.14 and − 1.03, respectively). We observed increased rates of psychiatric beds in general hospitals from 1.8 to 4.0, beds in protected housing facilities from 0.4 to 10.2, psychiatric day hospital places from 0.4 to 5.0, outpatient mental health care centers from 0.1 to 0.8 and forensic psychiatric beds from 0.3 to 1.1 over the entire time span. The strongest annual increase of rates of psychiatric beds in general hospitals (0.09), beds in protected housing facilities (0.50), psychiatric day hospital places (0.16) and outpatient mental health care centers (0.04) were observed after the 2000 NMHP. Forensic psychiatric beds increased in the year 2007 (0.58) due to the opening of a new facility.ConclusionsThe majority of acute care psychiatric beds in Chile now are based in general hospitals. The strong removal of short- and long-stay beds from psychiatric hospitals after the 1993 NMHP preceded substantial expansion of more modern mental health services in general hospitals and in the community. Only after the 2000 NMHP, the implementation of new mental health services gained momentum. Reiterative policies are needed to readjust mental health services development.

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.

Dutch Forensic Flexible Assertive Community Treatment: Operating on the Interface Between General Mental Health Care and Forensic Psychiatric Care.

In the Netherlands, Forensic Flexible Assertive Community Treatment (ForFACT) is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life (e.g., financial debt, unemployment, or lack of daytime activities). The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge about these patients may enhance the effectiveness of ForFACT and therefore (further) reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care.

Time in Between

Molloy College, a private liberal arts college in New York, founded by the Dominican sisters of Amityville, partnered with PRN (Physicians, Residents, Nurses) Relief International and the Dominican Sisters in Jamaica to organize a twice-annual service trip providing primary care, speech-language pathology, psychiatric-mental health care, and medical/surgical teams in rural and urban Jamaica. During the week-long trips, medical staff and speech pathologists move in teams from clinic to clinic, while mental health professionals, along with midwives and psychiatric nurses, work exclusively with the residents and staff at Homestead Place of Safety in Stony Hill, St. Andrew in the northern outskirts of Kingston, Jamaica. The state-operated facility, established as a home away from home, houses girls between the ages of 12 and 18 who experienced neglect or abuse, victimization, and sexual assault, or those in conflict with the law. Music Therapy services were included as part of the mental health team for the first time in October 2016 and provided an outlet for self-expression, an opportunity to foster resilience, a strengthened sense of community, and a supportive response to trauma. In past years, the mental health team found that the girls engaged freely in creative outlets such as art [therapy], and that music was an integral part of their culture and daily routine. Music therapy was therefore recommended to help normalize the therapeutic process, increase engagement, and develop therapeutic rapport.

Zombies Wanted! Descriptions of Nurses in Psychiatric-Mental Health Care in Swedish Recruitment Advertisements

Knowledge of how nurses are described in recruitment advertisements can aid assessment of the current status of professional psychiatric-mental health nursing and inform services dealing with the challenges of nurse recruitment. This study used content analysis to explore descriptions of nurses in psychiatric-mental health care in a purposive sample of 75 recruitment advertisements collected in Sweden in February 2019. The descriptions were interpreted as focussing on their being willing and able to function in discouraging practice environments, matching the ideal of psychiatric-mental health nursing poorly. The study suggested a need to align the ideals and realities of the nursing profession.

Achieving Patient Satisfaction: Utilizing Telehealth Via an Academic-Practice Partnership.

BACKGROUND: Academic-practice partnerships are a key component of the provision of innovative patient-centered care throughout a health care system. As consumers gain access to more health care options, patient satisfaction is becoming increasingly important. Patients' satisfaction depends on their perception during utilization of health care services. AIM: The purpose of the project was to assess patients' level of satisfaction with the utilization of a telehealth service to receive psychiatric-mental health care. METHOD: The project used a quantitative survey research design comprising a sample of patients receiving treatment for a psychiatric-mental health disorder. Utilizing telehealth, trained nursing students assisted in the provision of follow-up mental health care to patients residing in a rural area. Participating patients completed the 10-item Telehealth Satisfaction Scale questionnaire on conclusion of the follow-up appointment. RESULTS: Questionnaire responses were scored on a 4-point Likert-type scale, with high scores indicating greater satisfaction. Item means ranged from 3.4 to 3.82. CONCLUSIONS: As a positive association was found between patient satisfaction and the utilization of telehealth as part of an academic-clinical partnership, results suggest that the project was a worthwhile innovative endeavor. The telehealth intervention proved to be a sufficient alternative method of in-person follow-up visits for patients receiving treatment for psychiatric-mental health disorders.

Public attitudes towards depression and schizophrenia in an urban Turkish sample.

Stigma towards mental illness influences help-seeking behavior and prevents individuals with a mental illness from seeking the appropriate treatment for their condition. In Turkey, a shift from inpatient psychiatric mental health care towards a community-based, low-threshold system highlights the importance of understanding public attitudes towards the mentally ill. This study aims to underpin developments in mental health care through culturally sensitive research. Public stigma towards schizophrenia and depression is examined for the first time simultaneously in a community sample. Unlabeled case vignettes of either schizophrenia or depression as well as an assessment of mental illness attribution and the desire for social distance (SDS) were presented to an urban Turkish sample (N = 295). Analysis of variance revealed that attribution to mental illness determines significant levels of stigma for schizophrenia, however not for depression. Furthermore, desire for social distance (SDS) was significantly higher for the schizophrenia condition compared to depression. Depression and schizophrenia evoke different reactions within the Turkish population, specifically the attribution to mental illness increases stigma. This finding is discussed in light of the contact hypothesis, and furthermore contextualized within literature on familiarity with depression symptoms on the one hand, and perceived dangerousness and symptom severity of schizophrenia on the other hand. Implementation of timely and culturally sensitive adapted interventions within the ongoing reform of the Turkish mental health care system is recommended.

Experiences of Family Members of Persons With Mental Illness: A Qualitative Inquiry

The shortage of skilled and experienced health workers, lack of facilities, limited psychiatric care and inaccessible mental health care services in the uMsunduzi Municipality in Northern KwaZulu-Natal are causes of concern. With limited access to health services and resources, family members have no choice, but to take care of mentally ill relatives. These underlying problems have warranted the need to explore the experiences of family members living with mentally ill relatives. A qualitative, exploratory, descriptive design was used to collect data by in-depth one-on-one interviews and findings were analyzed using Tesch’s method of data analysis. This study showed that the uMsunduzi Municipality needed assistance with resources to support family members living with their mentally ill relatives and family members’ lack of knowledge and experience emerged as a major factor that influenced the care, treatment and rehabilitation of their mentally ill relatives. Compounded by inadequate mental health facilities and infrastructure as well as  the implications of the non-implementation of the acts, policies, processes and procedures in the uMsunduzi Municipality; this study recommends the need to enhance community education of all health professionals, providing relevant training in mental illness management. A shared decision-making process is vital, so that a collaborative partnership between family members and health professionals across KZN is established. This will in turn enhance the lived experiences of family members and mentally ill patients.

Psychiatric-Mental Health Nursing: Data-Driven Policy Platform for a Psychiatric Mental Health Care Workforce.

To describe the development of a data-driven policy platform for psychiatric nurses roles and outcomes to alleviate the current mental health crisis in the United States. Drawing on census data, statistical reports, and analysis of the current psychiatric mental health nursing (PMHN) workforce, a data-driven policy platform is designed to recruit, train, and prepare psychiatric nurses for addressing the nation's mental health crises. As noted by the Institute of Medicine's 2010 & 2016 reports on the future of nursing, the largest available health care workforce is not being used effectively, particularly to address the nation's mental health care needs. The development of a data-driven platform provides direction for psychiatric nurses in developing the workforce to meet the national mental health crisis. From education through practice and research, psychiatric-mental health nursing must build and share a data-driven, relationship-to-care platform emphasizing how PMHN care affects patient outcomes. Using a data-based platform to grow supportive public opinion, psychiatric mental health nursing can build a workforce to modify national accreditation standards and laws supporting data-driven PMHN care. The specialty profession must also seek to modify the nursing profession's attitude toward embracing data-driven platform of care relationships to psychiatric mental health outcomes.

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

ABSTRACTIn 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.

F132. IDENTIFICATION OF PATIENTS WITH RECENT ONSET PSYCHOSIS IN KWAZULU NATAL, SOUTH AFRICA: A PILOT STUDY WITH TRADITIONAL HEALTH PRACTITIONERS AND DIAGNOSTIC INSTRUMENTS

BackgroundThere is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data is available of low- and middle-income countries (LMICs). Obtaining valuable evidence from under-represented regions such as Sub-Saharan Africa holds the promise of advancing our knowledge and understanding of psychosis and will provide a strong basis for redressing inequities in service provision for people with psychotic disorders living in LMICs. Many patients in these countries remain undetected and untreated, partly due to lack of formal health care facilities. This study in rural South Africa aimed to investigate if it is possible to identify patients with recent onset psychosis in collaboration with traditional health practitioners (THPs).MethodsWe developed a strategy to engage with THPs. Key to the collaboration between psychiatry, THPs and the local community, was the building of trust by recognizing and acknowledging local authorities, mutual respect for health constructs, taking time to find common ground, and adaptation of the procedures to sociocultural norms. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent onset psychosis to the study. At referral, the THPs rated probability of psychosis (“maybe disturbed” or “disturbed”). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated.ResultsIn six months, 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP “disturbed” rating was 53.8%. Test characteristics of the CAPE were poor.DiscussionThis pilot study in rural South Africa found that it is possible to identify patients with recent onset psychosis in collaboration with THPs. THPs not only grasped the concept of psychosis, they recognized “being disturbed” as a condition that is often difficult to treat and for which collaboration with psychiatric mental health care might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of patients with psychosis in LMIC.

Becoming a Specialist Nurse in Psychiatric Mental Health Care

Background Specialist nurse students are upon graduation certified to have increased their professional competence to an advanced level. But how do specialist nurse students themselves experience and understand their professional competence and its development upon graduation? This is what this study aims at describing. Method This study has a phenomenographic approach. Data consists of student written narratives. Results The participants understood their professional competence developed in various degrees as a transformation in me and a transition in my encounter with the patient. Being able to integrate theory in practice was crucial for this competence to develop. Conclusion The specialist programme needs to support students in developing an alliance with the patient and promote patients’ self-management, self-efficacy and promote students’ possibility to integrate theoretical knowledge into practice. The result becomes an important input in the formulation of the assessment criteria for professional competence.

Assessment of Job Stress for Nurses in Psychiatric Hospitals at Baghdad City

Objectives: The aim of study is to assess job stress for nurses who are working in psychiatric hospitals in Baghdad city and its relation to socio-demographic characteristics of the nurses. Methodology: descriptive analytic study was conducted on 100 nurses were present in at three psychiatric hospitals in Baghdad city. The data are collected through the use of constructed questionnaire which divided into two sections; the 1st section included general information (demographical characteristic) of nurses. The 2nd section was based on job stress scale; it's consisting five domains which are: Dealing with patients and their families, Workload, problems with doctors, Problems with supervisors and Conflict relating peers. The content validity of the instrument was established through penal of (11) experts. Reliability of the questioner was 93%. Descriptive data analysis was done through frequency, percentage mean, standard deviation and inferential data analysis was done by Independent t-test, Analysis of variance (ANOVA). Results: the results show the majority of nurses were middle age male, married, graduated of nursing institutes, have less than or equal 5 years of experienced in psychiatric hospitals, most of them participated in training courses related to psychiatric mental health care inside Iraq, while few of them participated in the courses outside Iraq. Results revealed that both nurses (male& female) suffering of moderate level of stress in their work in all of domains and there was a significant relationship between nurse's stress and their training courses especially outside the country. Conclusion: the results revealed that job stress in all domains were found moderate among nurses in psychiatric mental health hospitals because of lack of participation in training courses and especially outside country. Recommendation: Reconsider and improving of employees in psychiatric nursing profession by establishing training courses (especially in psychiatry- mental health nursing) inside and outside of country in order to develop nurses' skills according to scientific programs through development of nurse's abilities and performance.

Reflections From Dutch Advanced Nursing Practice Students on Psychiatric Mental Healthcare in the United States

An international clinical learning experience is a unique opportunity to witness another nursing and healthcare system. The Master of Advanced Nursing Practice (MANP) program at Rotterdam University of Applied Sciences in the Netherlands, mandates an international experience. Semi-structured qualitative interviews, a focus group session and written reflections were used for data collection with 6 Dutch MANP nursing students who specialized in psychiatric mental healthcare. Five major themes were revealed from the data. The themes identified were as follows: (1) pride and passion for mental health profession (2) role diversity within psychiatric mental health nursing (3) nursing leadership at the organization level (4) comparable Westernized approaches to mental healthcare and (5) differences in access to care. Incorporating a mandatory international clinical experience is a beneficial tool to promote a global understanding of the unique advanced practice nursing student's academic and professional development. The international clinical learning experience is considered a highlight of the 2-year MANP program. The students are able to gain a new and broader vision of the APN role and a greater appreciation for the Dutch healthcare system.

The development of psychiatric and mental health nursing in Taiwan

Psychiatric mental health is critical to ensuring the health and wellbeing of individuals, families, and communities. While psychiatric mental health work continues to become increasingly complex and challenging, the demand for psychiatric nurses with evidence-based skills continues to grow. Psychiatric mental health nurses (PMHNs) are the primary providers of professional psychiatric mental health care services. PMFNs emphasize humanistic values and focus on servicing patient and family needs. In Taiwan, the Psychiatric Mental Health Nursing Association constructs the competence-credentialing model for psychiatric mental health nursing that underpins the values, attitudes, and beliefs of PMHNs and ensures that the mental health nursing practice promotes public health and wellbeing. In addition, this association promotes advanced psychiatric nursing education, research, and practice, influences the national health agenda, and discusses and disseminates information on psychiatric mental health care issues in order to influence the direction, nature, and quality of psychiatric and mental health care.

Championing Person-First Language

At the heart of recovery-oriented psychiatric mental health care are the dignity and respect of each person and the ways in which helping professionals convey a person's uniqueness, strengths, abilities, and needs. "Person-first language" is a form of linguistic expression relying on words that reflect awareness, a sense of dignity, and positive attitudes about people with disabilities. As such, person-first language places emphasis on the person first rather than the disability (e.g., "person with schizophrenia" rather than "a schizophrenic"). This article champions the use of person-first language as a foundation for recovery-oriented practice and enhanced collaborative treatment environments that foster respect, human dignity, and hope.

“It’s Not Just a Job. This Is Where We Live. This Is Our Backyard”: The Experiences of Expert Legal and Advocate Providers With Sexually Assaulted Women in Rural Areas

Sexual assault research has focused almost exclusively on urban areas, and research examining the experiences of expert service providers is nearly nonexistent. The purpose of this study was to add to the understanding of providers' experiences in working with sexually assaulted women in rural communities. Secondary victimization theory suggests that the nature of postassault expert interventions may have an adverse impact on victims. The focus of this hermeneutic phenomenological study was to explore the lived experiences of providers regarding their interactions with sexual assault survivors living in rural communities. Data were gathered from prosecutors, law enforcement, crisis center advocates, social workers, and victim-witness associates. Data analysis led to the identification of five significant themes: (a) rural-specific confidentiality issues, (b) resource needs in a rural setting, (c) the connection between victim blaming and low levels of reporting, (d) negative provider views of the community, and (e) smaller communities provided better victim care. Psychiatric nurses and mental health care systems have many opportunities to intervene with abused women in inpatient, outpatient, and other community settings. In primary and acute care setting, nurses should assess patients for a history of violence using multiple screening questions and should also educate victims and their families about available resources.