Outpatient Psychiatric Services Research Articles

Association between preferred language and use of mental health services among home care recipients with schizophrenia spectrum and other psychotic disorders: A retrospective cohort study in Ontario, Canada, 2010 to 2015

Language is an important demographic factor that may impact patients’ interactions with the healthcare system. This may become more apparent for individuals with a mental illness. The objective of this study was to evaluate whether individual language was associated with the use of inpatient and outpatient psychiatric services among home care recipients with schizophrenia spectrum and other psychotic disorders. We conducted a population-based retrospective cohort study using health administrative data. The study population included all individuals aged 18–105 with schizophrenia spectrum and other psychotic disorders, identified via a validated algorithm, who were receiving home care in Ontario, Canada between January 1, 2010 and December 31, 2015. Home care data was used to identify patients’ primary language, categorized as Anglophone, Francophone, or Allophone. Mental health service use was evaluated over a one-year period following their first home care assessment in the study period and included the rate of outpatient psychiatrist visits and mental health-related emergency department (ED) visits and hospitalizations. Multivariable regression evaluated the association between primary language and mental health service use. The cohort consisted of 9,436 patients (85.8% Anglophones, 3.3% Francophones, 11.0% Allophones). Mental health service use was low among all linguistic groups during the one-year study period, with 53.4% with no outpatient psychiatrist visits and 83.3% and 83.0% with no mental health-related hospitalizations or ED visits, respectively. Francophones had a higher rate of mental health-related hospitalizations compared to Anglophones (adjusted relative risk = 1.36, 95% confidence interval 1.02–1.80), with no differences in hospitalization rates between Allophones and Anglophones. Language was not associated with the rate of outpatient psychiatrist visits or mental health-related ED visits. Mental health service use among homecare patients with schizophrenia spectrum and other psychotic disorders was low. While Francophones had a higher hospitalization rate than Anglophones, language was otherwise not associated with mental health service use.

Individual Burden of Illness Index in Bipolar Disorder Remission: A Cross-Sectional Study.

A population-based method for estimating disease burden is commonly used. Nevertheless, these measurements do not entirely capture the comprehensive burden of illness on an individual patient. To address the problem, the Individual Burden of Illness Index (IBI index) Index was created and validated, specifically for major depressive disorder. The IBI represents the overall influence of the condition, encompassing distress from symptom intensity, functional impairment, and the patient's quality of life. The aim of the study was to approve and validate the IBI index for the integral assessment of disease burden in patients with bipolar disorder (BD) in remission. The cross-sectional study was conducted in the outpatient psychiatric services in Saint Petersburg, Russia, from April through October 2020. Eighty-five patients aged 18 to 45 (mean age 36.6±5.7 years) with BD (type I - 75%, n=64; type II - 25%, n=21) in remission were examined. The study procedure included a structured clinical interview and the use of clinical scales: the World Health Organization's Quality of Life Questionnaire, Hamilton Rating Scale for Depression (HDRS), Young Mania Rating Scale (YMRS), and Personal and the Social Performance Scale. The principal component analysis in accordance with the adjusted one showed that the burden of illness in patients with BD in remission is directly related to the severity of residual depressive symptoms, reflected in the HDRS score: as the HDRS score increases (0.27, p <0.001), residual mania (-0.14, p <0.001), social functioning (-0.06, p <0.001), and quality of life (-0.04, p <0.001) decrease. In contrast, when there are remaining residual mania symptoms, as indicated by the YMRS score, the result tends to be a lower burden, better social functioning, and enhanced quality of life. The study has demonstrated through statistical means a successful adaptation and validation of the previously calculated IBI index for patients with BD in remission. Residual affective symptoms were shown to have different impacts on the social functioning of patients with BD in remission, indicating the need for a timely assessment and targeted therapy of these symptoms in such patients.

Disproportionate increase in cannabis use among people with serious psychological distress and associations with psychiatric service use in the United States, 2009–2019

BackgroundCannabis use is on the rise, but it is unclear how use is changing among individuals with serious psychological distress (SPD) compared to the general population as well as what associations this may have with mental health service use. MethodsRetrospective cohort study using the National Survey on Drug Use and Health (NSDUH) 2009–19 public use files of 447,228 adults aged ≥ 18 years. Multivariable logistic regression and predictive margin methods were used to estimate linear time trends in any and greater-than-weekly levels of cannabis use by year and SPD status and rates of psychiatric hospitalization and outpatient mental health care.Findings: Rates of any and weekly-plus cannabis use increased similarly among individuals with SPD compared to those without from 200 to 2014 but more rapidly in SPD every year from 2015 to 2019 (p < 0.001). Among individuals with SPD, no use was associated with a 4.2 % probability of psychiatric hospitalization, significantly less than less-than-weekly (5.0 %, p = 0.037) and weekly-plus cannabis use (5.1 %, p = 0.028). For outpatient mental health care, no use was associated with a 27.4 % probability (95 % CI 26.7–28.1 %) of any outpatient care, significantly less than less than weekly use (32.6 % probability, p < 0.001) and weekly-plus use (29.9 % probability, p = 0.01). ConclusionsCannabis use is increasing more rapidly among individuals with SPD than the general population, and is associated with increased rates of psychiatric hospitalization and outpatient service use. These findings can inform policy makers looking to tailor regulations on advertising for cannabis and develop public health messaging on cannabis use by people with mental illness.

Treatment-seeking threshold and accessibility of psychiatric outpatient services in Switzerland: the relationship with stigma and self-esteem.

Perceived stigmatization and low self-esteem are linked to poorer mental health outcomes, but their impact on treatment-seeking thresholds and the importance of outpatient service location remain unclear. The study included 525 outpatients of the University Psychiatric Clinic (UPK) Basel, Switzerland, of whom 346 were treated at inner city services and 179 at services located on the main site of the UPK at the outer city limits. Perceived discrimination and devaluation (PDD), self-esteem (SE), treatment-seeking threshold (TST), and accessibility were measured via a self-reported questionnaire. The PDD consisted of 12 items evaluating beliefs about the level of stigma towards individuals with mental illness in the general population on a 5-point Likert scale. SE, TST and accessibility were assessed through single-item 7-point Likert scales. PDD and SE were positively correlated (p < 0.001), suggesting that lower perceived stigma was linked to higher self-esteem, and were not associated with TST. The relationship between PDD and SE remained consistent after controlling for age, gender, and nationality. Age was negatively correlated with TST (p = 0.022), while gender did not significantly influence any of the variables. There was little variation regarding PDD, with emergencies at the site of the psychiatric clinic and substance use disorder (SUD) patients reporting higher levels of stigmatization. Emergency patients and those with SUD and personality disorder reported the lowest SE ratings. TST showed a broad range and was highest for emergency services and transcultural psychiatry patients. Differences in accessibility were mainly linked to the location, with outpatient service users in the inner city reporting better accessibility (p < 0.001) and higher SE (p = 0.009). In comparison to patients using services with planned contacts only, patients in emergency settings differed by higher TST (p = 0.018) and better ratings of accessibility (p = 0.004). In conclusion, there was a relevant amount of stigmatization, impaired self-esteem, and, for some outpatient services, high thresholds to seek treatment. Future research should explore other factors influencing TST. The findings highlight the need to address stigmatization and accessibility when planning mental health services.

Distance Decay Effects in a Swiss Mental Health Services System

To investigate psychiatric service use depending on distances (travel times) to inpatient and outpatient service sites. Retrospective cohort analysis of all patients aged 18-64 years who had been treated in a Swiss psychiatric services system in 2022. Outpatient service utilization rates decreased statistically significantly with increasing distance (travel time by public transportation) between the place of residence and the responsible outpatient clinic. For inpatient utilization, the distance decay effects were much less strong and did not always reach a statistically significant level. In an easily accessible and economically reasonable psychiatric services system, inpatient and specialized services should be organized centrally, while general outpatient psychiatric services should be planned decentralized and close to the communities where people live.

Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study.

Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations.

Dialogue in the Median Group: Inter-subjectivity that helps to reclaim the fused, confused, obsessed Mind. Part II: Clinical case and research

A Median Group session supervised by Pat de Maré is presented with discussion. Research is described in which Median Groups were convened in an open psychiatric out-patient service in the community and in a closed psychiatric ward of a general hospital. Their efficacy and the participants’ satisfaction and that of the department staff are described.

Longitudinal trajectories of anxiety and depression in subjects with different mental disorders after one year in the COVID-19 pandemic

The aim of this study was to prospectively assess the development and trajectories of anxiety and depressive symptoms among subjects with different mental disorders, during the 3rd wave of the COVID-19 pandemic (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A sample of 527 subjects, with different DSM-5 diagnoses, was enrolled at nine Italian psychiatric outpatient services. Assessments at T0 and T1 included the Generalized Anxiety Disorder 7-Item (GAD-7) for anxiety symptoms, and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Differences in anxiety and depressive symptoms rates emerged across different mental disorders and a general improvement at T1 was detected for all of them in both the GAD-7 and PHQ-9 scores, except for Psychosis and Obsessive-Compulsive Disorder (OCD). Patients with Feeding and Eating Disorders (FED) reported statistically significantly higher: GAD-7 scores than those with Bipolar Disorder (BD), at both times, and Anxiety Disorders at baseline; PHQ-9 scores than all other diagnostic categories, at both times. Unemployment, no COVID-19 infection, OCD were predictive variables related to GAD-7 scores at T1, while being unmarried, BD or FED related to PHQ-9 scores at T1. Subjects with mental disorders reported anxiety and depressive symptoms during the third pandemic wave and most of patients showed an improvement over a 3-month follow-up, despite differences emerged among diagnostic categories and for the variables involved. Further studies are needed to deepen knowledge on pandemic impact on patients with mental disorders.

Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach.

Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house-developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology.

Implementing Video Consultations in a Rural Psychiatric Outpatient Clinic: A Feasibility Study

Introduction. Multiple efficacy studies have shown that treatment provided via video consultation (VC) can be equivalent to in-person (IP) consultation for people with psychiatric diagnoses. However, despite the great promise of VC, it has not been widely implemented in psychiatric outpatient services. This study investigated the feasibility aspects of VC in clinical practice and examined a range of factors associated with the implementation of this modality of treatment within psychiatric outpatient services. Methods. This study had a pragmatic design, where 40 consecutive referrals for people with anxiety, personality, or depressive disorders were given the choice to receive eight weekly treatment sessions via VC or IP modality within an outpatient psychiatric setting. Information on demand, acceptance, engagement, implementation, and potential negative effects for treatment conducted via VC were collected to help identify factors that may impact on the uptake of VC within the psychiatric outpatient service. Results. There was a high demand and acceptance for VC, with 44% (n = 15) of the patients choosing to receive eight weekly treatment sessions via VC, and acceptance was rated highly. Engagement with VC modality was good, with only a very small percentage (13%, n = 2) not completing treatment. A good level of working alliance was established and largely maintained throughout treatment for patients and case managers. There were differences in the utilization of VC compared to the IP modality, with the VC modality having a greater focus on supportive counseling and IP modality having a greater focus on psychotherapy. Overall, the duration of treatment conducted via VC was also slightly shorter than that of IP consultations. There were no negative effects registered for consultations via video. Conclusions. Findings suggest a high patient demand and acceptance for VC within psychiatric services, with good levels of engagement and alliance reported. Differences in focus and duration in VC compared to IP may reflect clinicians’ different attitudes and/or approaches to providing treatment, depending on whether it is VC or IP consultations.

One-year prevalence and psychiatric comorbidity of borderline personality disorder in a medical certificate population: a registry study of psychiatric outpatients in community mental health care in the city of Oulu

Objective Borderline personality disorder (BPD) is a common disorder in healthcare settings but estimates of BPD prevalence vary greatly. This study aimed to estimate the one-year prevalence of BPD in psychiatric outpatients and analyze the psychiatric comorbidity presented with BPD. Method The data comprised 18–60-year-old patients who had a BPD diagnosis recorded in their medical certificate B (mcB) and were treated in specialized psychiatric outpatient services in the city of Oulu, northern Finland, in 2014. An mcB is a comprehensive summary of a patient’s medical history written by a doctor, and patients need it in the Finnish healthcare system when applying for social benefits and rehabilitation measures. Results The prevalence of BPD was 12.8% among patients with an mcB treated in the psychiatric outpatient services. BPD was 3.0 times more common in female than male psychiatric outpatients with an mcB. The most common comorbid psychiatric disorders written in mcBs of BPD patients were mood (81.0%) and anxiety (39.2%) disorders. The only statistically significant gender difference was found in behavioral and emotional disorders (16.7% in men, 1.6% in women). Conclusions The mcB-based BPD prevalence estimate and psychiatric comorbidity was consistent with previous studies researching psychiatric outpatients with BPD. McBs appear to be a reliable and comprehensive data source for diagnostic information in research.

Autism in adult psychiatric out-patients: self-reported suicidal ideation, suicide attempts and non-suicidal self-injury.

The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.

Childhood trauma is associated with early-onset but not late-onset suicidal behavior in late-life depression.

To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults. Cross-sectional study. Inpatient and outpatient psychiatric services in Pennsylvania. Our sample included 224 adults aged 50+ (M ± SD = 62.5 ± 7.4) recruited into three depressed groups: (1) 84 suicide attempters, (2) 44 suicide ideators, and (3) 58 non-suicidal comparisons, and a non-psychiatric healthy comparison group (N = 38). The Childhood Trauma Questionnaire measured experiences of childhood trauma such as emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse. Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30 years old. Overall, we found group differences in emotional and physical abuse and neglect in both genders and sexual abuse in females, but not in males. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups. Consistently, early-onset attempters more often met criteria for current or lifetime PTSD relative to late-onset attempters and most comparison groups. Late-onset attempters had similar levels of childhood trauma as other depressed groups. Our study reaffirms that there are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt and that trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.

The Impact of Covid-19 Pandemic on Mental Health Services: A Comparison Between First Psychiatric Consultations Before and After the Pandemic.

A high rate of onset or exacerbation of several mental disorders has been observed during the COVID-19 pandemic. However, the risk contributing to mental distress during the pandemic remains unclear. The study aims to evaluate the risk of the onset of mental disorders by comparing the number of requests for the first psychiatric consultation before and after the COVID-19 pandemic at the psychiatric outpatient services of Varese, a small town in Northern Italy. This observational retrospective study aims to compare the requests for the first psychiatric consultation at the outpatient services of Varese during the 14-month period before COVID-19 pandemic (from 1st January 2019 to 28th February 2020) versus the 14-month period after the pandemic (from 1st March 2020 to 31st May 2021) extracted from the server SIPRL-Psicheweb database (Sistema Informativo della Psichiatria, Lombardy Region). For each patient, socio-demographic features and clinical data (psychiatric diagnosis, psychiatric comorbidities, previous psychiatric records, and previous hospitalization in the psychiatric ward) were collected. Three hundred ninety-five consultations were made during the pre-COVID period and 346 during the post-COVID period. No statistically significant difference was found between the number of first consultation requests in the two periods evaluated but a slight decrease in the total number during the pandemic period (395 vs 346; p=0.07) can be noticed. In the subjects of the pre-COVID group, a statistically significant association was detected with no previous psychiatric records ("absent") and with stressor-related disorders. In the post-COVID group, a statistically significant correlation between "present" previous records and anxiety-depressive disorders emerged. It has been observed that anxiety-depressive disorders increased in the post-COVID-19 period compared to the pre-COVID-19, instead of stressor-related disorders. This might be because stressor-related disorders may be treated by general practitioners with no psychiatric interventions. Most of the first consultations during the period of the COVID-19 pandemic were for patients who already had contact with psychiatric services.The study shows an increasing request for care by more severe patients in the first phase of the SARS-CoV-2 pandemic. Further research is needed to investigate the long-term impact of the COVID-19 pandemic on emergency departments and hospital services.

Inpatient Care Utilization Following Mobile Crisis Response Encounters Among Racial/Ethnic Minoritized Youth

There has been an increase in youth psychiatric emergencies and psychiatric inpatient hospitalizations in recent years. Mobile crisis response (MCR) services offer an opportunity to meet acute youth mental health needs in the community and to provide linkage to care. However, an understanding of MCR encounters as a care pathway is needed, including how patterns of subsequent care may vary by youth race/ethnicity. The current study examines racial/ethnic differences in the rates of inpatient care use following MCR among youth. Data included Los Angeles County Department of Mental Health (LACDMH) administrative claims for MCR in 2017 and psychiatric inpatient hospitalizations and outpatient services from 2017-2020 for youth aged 0 to 18 years. In this sample of 6,908 youth (70.4% racial/ethnic minoritized youth) who received an MCR, 3.2% received inpatient care within 30 days of their MCR, 18.6% received inpatient care beyond 30 days of their MCR, and 14.7% received repeated inpatient care episodes during the study period. Multivariate models revealed that Asian American/Pacific Islander (AAPI) youth were less likely to receive inpatient care, whereas American Indian/Alaska Native (AI/AN) youth were more likely to receive inpatient care following MCR. Youth age, primary language, primary diagnosis, and insurance status also predicted future inpatient episodes. Findings highlight differential rates of inpatient use following MCR among AAPI and AI/AN youth relative to youth from other groups. Alternative interpretations for the findings are offered related to differential levels of need and disparate penetration of community-based outpatient and prevention-focused services.

The impact of COVID-19 quarantine on mental health: an observational study from an outpatient service for non-psychotic patients in Russia (Moscow)

We aimed to compare psychiatric hospital visits during the COVID-19 quarantine period with the same period in 2019, to reveal the predictors of underutilization of mental health services. We then investigated the fluctuation of telemedicine service during the quarantine period. The retrospective study included patients with non-psychotic mental disorders who consecutively visited the Moscow clinic. The number of outpatient visits, inpatient admissions, sociodemographic factors were analyzed. We assessed the sample within two periods - the “quarantine period” (March 30 - June 9, 2020) and “control period” (March 30 - June 9, 2019). Psychiatric visits decreased in older, retired and disabled persons, and increased among the unemployed. In multivariate analysis, the reduction became significant for the number of inpatient admissions. Telemedicine calls gradually increased from the start of the service, but decreased towards the end of the quarantine. In conclusion, referrals to outpatient and inpatient psychiatric services decreased during the quarantine period, with newly established TMS potentially compensating for that decrease. The strongest factor associated with visits during the pandemic is employment status.

Outpatient psychiatric service use is associated with a reduced risk of 1-year readmission and mortality following alcohol-related hospitalizations: A historical cohort study.

Alcohol-related hospitalizations are common and associated with high rates of short-term readmission and mortality. Providing rapid access to physician-based mental health and addiction (MHA) services post-discharge may help to reduce the risk of adverse outcomes in this population. This study used population-based data to evaluate the prevalence of outpatient MHA service use following alcohol-related hospitalizations and its association with downstream harms. This was a population-based historical cohort study of individuals who experienced an alcohol-related hospitalization between 2016 and 2018 in Ontario, Canada. The primary exposure was whether an individual received follow-up outpatient MHA services from either a psychiatrist or primary care physician within 30 days of discharge from the index hospitalization. The outcomes of interest were alcohol-related hospital readmission and all-cause mortality in the year following discharge from the index alcohol-related hospitalization. Information on health service use and mortality was captured using comprehensive health administrative databases. The associations between receiving outpatient MHA services and the time to each outcome were assessed using multivariable time-to-event regression. A total of 43,343 individuals were included. 19.8% of the cohort received outpatient MHA services within 30 days of discharge. Overall, 19.1% of the cohort was readmitted to hospital and 11.5% of the cohort died in the year following discharge. Receiving outpatient MHA services was associated with a reduced hazard of alcohol-related hospital readmission (adjusted hazard ratio [aHR] 0.94, 95% confidence interval [CI]: 0.88-0.99) and all-cause mortality (aHR: 0.74, 95% CI: 0.66-0.83) after adjusting for demographic and clinical covariates. Short-term outcomes following alcohol-related hospitalizations are poor. Facilitating rapid access to follow-up MHA services may help to reduce the risk of recurrent harm and death in this population.

Development, Pilot Implementation, and Short-term Outcome of an Outpatient Psychiatric Crisis Intervention Service for Patients with Suicide Risk

Background: In many developing countries, most patients referred for hospitalization for high suicide risk are deprived of adequate care, mainly because of limited psychiatric facilities. Objectives: We aimed to investigate the short-term outcomes of an outpatient psychiatric crisis intervention (PCI) service enhanced with case management for patients with suicide risk where hospital admission was impossible because of the bed shortage. Methods: We developed a service model provided by a team of psychiatry residents, psychologists, and social workers supervised by a faculty psychiatrist. We piloted it in Roozbeh Psychiatry Hospital for patients when hospitalization was indicated for suicidality, but admission was not possible due to the bed shortage. This study followed an action research design and methodology. The sample was selected from individuals referred to Roozbeh Hospital. All subjects who fulfilled the inclusion criteria were included in the study. Convenience sampling was used for the satisfaction assessments. Results: The PCI provided the service to 173 patients. The suicide risk was resolved in 48 (27.7%) patients. The remaining consisted of individuals finally hospitalized when beds were available (73 patients, 42.2%) or dropped out of the service (52 patients, 30.1%). Most patients (86%) were satisfied with the service. Only one non-lethal suicide attempt was reported in the two-month follow-up. Conclusions: An outpatient crisis service for suicidality enhanced with case management may reduce the need for hospitalization. However, randomized controlled studies are needed to establish its effectiveness.

Comparison of Delivery of Care Before and During COVID-19 Within an Academic Outpatient Psychiatry Practice.

Introduction: The COVID-19 pandemic has challenged outpatient mental health clinics. This article compares care delivery and patient characteristics before and during the COVID-19 pandemic in outpatient mental health clinics within an academic health system. Methods: A retrospective cohort study was conducted in patients who received outpatient psychiatric services at two clinics (A and B). The investigators compared care delivery with patients with mental health conditions prepandemic (January 1-December 31, 2019) and midpandemic (January 1-December 31, 2020) periods. Care delivery was defined as the number and type of new and return visits (telehealth and face-to-face visits), patients with recorded measurement-based care (MBC) outcomes, and communication capability between patients and providers. Results: During the prepandemic period, 6,984 patients were seen in Clinics A and B, resulting in 57,629 visits. In the midpandemic period, 7,110 patients were served, resulting in 61,766 total visits. Medication management visits increased from 2019 to 2020; number of visits with documented outcome measures increased by 90% in Clinic A and 15% in Clinic B. The number of MyChart messages per patient increased more than twofold during the midpandemic period. The number of new visits with primary diagnosis of anxiety disorders increased in CY2020 and the number of visits with primary diagnosis of major depressive/mood disorders decreased in CY2020. Payor mix did not vary between the two periods although there was variability between payor mix at the two primary clinic locations. Discussion: The study suggests that there was no detrimental impact on access to care between the prepandemic and midpandemic periods within the health system. Mental health visits while pivoting to telehealth increased during the midpandemic period. Transition to telepsychiatry improved the ability to administer and document MBC.

Demystifying treatment disposition patterns for psychiatrically high-risk youth referred for intensive outpatient psychiatric services: The role of demographics and telehealth.

Intensive outpatient (IOP) psychiatric treatment is increasingly deployed to meet the needs of psychiatrically high-risk youth; however, documentation of treatment disposition for in-person and/or telehealth modalities following treatment referral is largely unknown. The current study examined psychiatrically high-risk youth baseline treatment disposition patterns and explored variations according to treatment modality (telehealth vs. in-person). Using archival records of 744 adolescents (Mage = 14.91, SD = 1.60) admitted to a psychiatric IOP, multinomial logistic regressions revealed that commercially insured youth fared better than non-commercially insured youth with respect to treatment completion. When treatment modality was accounted for, youth treated on telehealth were no more likely to be psychiatrically hospitalized compared to youth treated with in-person services. However, youth treated on telehealth dropped out due to excessive absences or withdrawal/refusal to a greater extent than those treated in person. Future studies should examine clinical outcomes in addition to treatment disposition patterns to further understand youth's course of treatment at intermediate level of care settings (e.g., IOP).