Public Mental Health Services Research Articles

Driving a motor vehicle and living with a mental health condition: The personal and professional experiences of consumer lived experience staff

AbstractIntroductionDriving a motor vehicle is an important activity for people living with a mental health condition, as it can support engagement in the community as part of recovery. There is little research exploring mental health consumers' experiences with driving and no found research on the role of mental health lived experience staff in assisting consumers with safe driving. It is essential to learn about consumers' experiences of driving to know the supports they find useful in understanding their driver responsibilities and self‐regulating their driving through periods of changing health and wellness. This study explored the personal and professional experiences of lived experience consumer staff related to driving a motor vehicle while also living with a mental health condition.MethodThe research was guided by the interpretive paradigm and codesign principles. Qualitative data were derived from semi‐structured interviews with (n = 9) lived experience consumers working in a public mental health service. Data were thematically analysed.Consumer and community involvementOur research team involved consumer and occupational therapy coresearchers.FindingsFive main themes were identified: (1) Driving means freedom and independence, (2) A nuanced understanding about the impact of mental health on driving, (3) I/we can manage: A range of strategies, (4) Driving is not something mental health staff tend to discuss, and (5) Do not beat around the bush, just talk about it.ConclusionConsumers want support and direct conversations about driving and their mental health, medication side effects, and strategies to gain their licence, maintain, or return to driving. Alongside mental health clinicians, consumer lived experience staff could play a vital role in supporting safe driving.

Australian community and inpatient general public sector mental health services between 2017-18 and 2021-22: Relative stasis in bed capacity, increasing outpatient demand, and stunted expenditure.

To descriptively analyse Australian public sector General Mental Health Services (GMHS) expenditure, ambulatory, and inpatient services, including key performance indicators (KPIs) in comparison with other subspeciality mental health services (MHS). We descriptively analysed data published by the Australian Institute of Health and Welfare (AIHW), including inpatient, ambulatory services, expenditure, and KPIs. From 2017-18 to 2021-22, per capita expenditure for Australian GMHS (18-64) rose by an average annual inflation-adjusted change of 2%. Overall bed numbers remained static, with non-acute beds declining, and commensurate expansion of acute beds. Community GMHS had high outpatient utilisation, with high rates of schizophrenia, schizoaffective disorder, and bipolar affective disorders as primary diagnoses in mid-life. From 2017-18 to 2021-22, GMHS inpatient and ambulatory episodes had decreasing rates of significant improvement and increasing rates of significant deterioration. Although GMHS has the highest overall population and service utilisation, there has been static bed availability and relatively small increases in expenditure which are occurring concurrently with worsening clinical outcomes. Evidence-based modelling of GMHS and outcomes is required to inform future service improvement.

Digital strategies of public youth mental health services to raise awareness of their existence

Abstract Background Data from a survey of the first part of the eHealthLit4teen Project show that adolescents in the city of Barcelona (12-16 years old) are not aware of the public youth mental health services (YMHS) available in the city. Considering the intensive use that young people make of digital platforms, YMHS might leverage these channels to raise young people’s awareness of available resources, which would impact on the help-seeking behaviours. The aim of this work is to analyse the social media strategies for the dissemination of public YMHS and emotional well-being services (promoted by the city council and the regional government) in Barcelona. Methods Identification of public YMHS and emotional wellbeing services, and interview on the use of social networks for dissemination with those responsible for the services and communication (March-April 2024). Analysis of the use of persuasive design and behavioural design techniques by the social media profiles of these services and, by way of contrast, the influencers who publish mental health content identified by the adolescents in the previous survey of the Project (March 2023). Results Public YMHS mainly rely on outreach through face-to-face visits to high schools. This format makes it easier for reluctant young people to access formal support, but more difficult for them to seek support because of stigma. In general, public YMHS do not show a clear strategy to disseminate their service on social media, and the information provided confusion between the characteristics of the services offered. Likewise, there is no widespread use of behavioural design or persuasive design techniques in the publications of health services on social media, nor in those of influencers. Conclusions Public YMHS do not make efficient use of the digital platforms that young people use intensively to raise awareness of their existence and increase usage. Key messages • There is no clear digital strategy for communicating public youth mental health services (YMHS), although they recognise that digital platforms can be a good means of dissemination. • YMHS need to be accessible on digital platforms to young people’s adults of reference (especially for younger teens), as they are the ones who seek out online the existence of this type of services.

Health economics and services research in symbiosis: STREAMLINEing mental health services in Austria

Abstract Objectives The cost of mental diseases exceeds 4% of GDP in Europe. In Austria, every 5th person lives with mental ill-health (MIH). Ongoing epidemiological, demographic and societal changes increase the need for easily accessible, better integrated and good value services. In STREAMLINE, we combine, harmonize and implement the latest methods in human service mapping and economic costing to optimize future service provision and financing for MIH in Austria. Methods We comprehensively assess the availability, activity and affordability of human services targeting MIH in Vienna within the health and social care, education, labour and justice sectors based on a conceptual mind map. We identify services through extensive literature, document and web searches plus expert consultations. Services are mapped and costed according to the European PECUNIA methods: classification of the main service types using the international DESDE taxonomy of human services; development of Reference Unit Costs using the PECUNIA RUC templates with primary data; validation of the results with secondary data; compilation of a comprehensive multi-sectoral service catalogue; and synthesis for spatial and policy analyses. Results We identified 756 sources, 75% individual organisations, 5% multi-organisations and 20% existing provider lists. 84% relate to health and social care, 10% labour, and 3% education and justice sectors each. 58% deliver care to adults, 37% to children & adolescents, and 5% support carers. Further service mapping and RUCs will be presented. Discussion STREAMLINE pioneers in coordinated public mental health services and economics research at scale. Assessed levels of fragmentation call for better integration, improved transition, reduced spatial inequity and increased support for carers. Results increase the feasibility of service evaluations from a societal perspective. Planned public service atlas facilitates information and access for service users and carers. Funding: WWTF Key messages • New methods for harmonized health services and economics research allow comprehensive information for optimized future mental health service planning and financing. • Assessed levels of fragmentation highlight the need for better integration, improved transition, reduced spatial inequity and increased support for carers.

Growing the peer workforce in rural mental health and social and emotional well-being services: A scoping review of the literature.

Growing the mental health peer workforce holds promise for rural communities, but we currently lack an understanding of the guidance available to support the development, implementation and sustainability of this workforce in rural settings. Study aims are to: (1) determine the extent and nature of the literature that provides guidance for growing the peer workforce in rural mental health services; and (2) identify and explore any guidance relevant to rural peer work services dedicated to First Nations communities, including those promoting social and emotional well-being within this body of literature. A scoping review method was employed to identify relevant peer-reviewed and grey literature published between 2013 and 2022 across PsychInfo, Medline, Embase and CINAHL, Scopus and Informit HealthInfoNet databases, as well as targeted organisation websites and Google Advanced Search. A total of 26 unique studies/projects were included from the US, UK, Canada and Australia with public mental health, non-government/for purpose and private sector service settings represented in the literature. Grey literature, such as reports of evaluations and frameworks, formed the majority of included texts. While there is a lesser volume of rurally focused literature relative to the general peer work literature, this is a rich body of knowledge, which includes guidance concerning services dedicated to First Nations communities. Via synthesis critical considerations were identified for the development, implementation and sustainability of peer work in rural mental health services across six domains: 'Working with community members and stakeholders', 'Organisational culture and governance', Working with others and in teams, Professional expertise and experience, Being part of and working in the community and 'Local mental health services capacity'. While there are considerations relevant across a range of settings, the domains of: 'working with community members and stakeholders', 'being part of and working in the community' and 'local mental health services capacity', capture additional, distinct and nuanced challenges and opportunities for growing the peer work in rural services. The literature offers insights valuable for service planning, policy development and the allocation of resources to support rural peer workforce growth.

'Facilitators and barriers to recruitment in mental health research: A survey of psychiatrists and psychiatry registrars in training'.

To explore the attitudes of Royal Australian and New Zealand College of Psychiatrists (RANZCP) consultants and registrars towards recruitment of patients in mental health research. Specifically, we aimed to measure potential barriers and facilitators for recruitment and comment on strategies for improvement. A survey was distributed to 287 consultant and trainee psychiatrists working across South Australian public mental health services. The survey was hosted via SurveyMonkey and ran for 5weeks from April to June 2023. Participant's attitudes were recorded through use of Likert scale, yes/no and free-text response. In total, 88 responses were collected, corresponding to a 30.7% response rate. Participants were interested in mental health research, with 90.7% reading articles and 61.4% reporting personal research engagement. The factors that rated most highly as recruitment barriers were unawareness of current studies, competing clinical demands and not prioritising recruitment. Factors felt most strongly to facilitate recruitment included the presence of an onsite research assistant and the clinician viewing the trial as clinically relevant. While attitudes towards research were generally positive, many barriers to recruitment were identified. Increased advertising of current studies, presence of an onsite research assistant and reduction in clinicians' workload are likely to improve clinicians' capacity to recruit.

Characteristics of Clinical Supervision for Mental Health Nurses: A Survey Study Using the MCSS-26.

To describe the characteristics and perceived effectiveness of clinical supervision mental health nurses are receiving and further explore any statistical correlations between the perceived effectiveness and satisfaction with the supervisee, supervisor and supervision characteristics. A cross-sectional survey. An online survey was distributed to nurses working in public mental health services in Victoria, Australia. A universal recruitment approach was used, and 422 nurses participated in the survey. Of these, 220 nurses who are participating in clinical supervision were eligible for the MCSS-26 survey. A licensed MCSS-26 questionnaire. Mental health nurses in the studied environment were likely to receive individual supervision from a senior mental health nurse, with the most common frequency being monthly for 31-60 min, and half receiving it within their workplace location. Half of the participants chose their own supervisor. Our findings indicate that nurses who engage in clinical supervision outside of their immediate workplace and receive individual supervision from a nurse of the same grade perceive higher effectiveness. We also found that clinical nurses may find it most difficult to engage in effective clinical supervision due to time constraints. This study uniquely contributes to the current clinical supervision literature by reporting the uptake and detailed characteristics of supervision, a facet often overlooked in existing research. This study reported the characteristics of the supervision, supervisor and the supervisee that are associated with the effective clinical supervision. These insights can lead to tailored implementation strategies that consider the specific roles and settings of nurses. CROSS (Sharma etal. 2021). No patient or public contribution.

Implementing peer support into practice in mental health services: a qualitative comparative case study

BackgroundPeer workers are people with personal experience of mental distress, employed within mental health services to support others with similar experiences. Research has identified a range of factors that might facilitate or hinder the introduction of new peer worker roles into mental health services. While there is mixed evidence for the effectiveness of peer worker delivered interventions, there are no studies exploring how implementation might be associated with effect.MethodsThis was a qualitative comparative case study using data from interviews with 20 peer workers and their five supervisors. Peer workers delivered peer support for discharge from inpatient to community mental health care as part of a randomised controlled trial. In the trial, level of participant engagement with peer support was associated with better outcome (hospital readmission). Study sites with higher levels of engagement also had higher scores on a measure of fidelity to peer support principles. We compared data from sites with contrasting levels of engagement and fidelity using an analytical framework derived from implementation theory.ResultsIn high engagement-high fidelity sites, there was regular work with clinical teams preparing for working alongside peer workers, and a positive relationship between staff on inpatient wards and peer workers. The supervisor role was well resourced, and delivery of peer support was highly consistent with the intervention manual. In low engagement-low fidelity sites peer workers were employed in not-for-profit organisations to support people using public mental health services and in rural areas. Supervisors faced constrained resources and experienced barriers to joint working between organisations. In these sites, peer workers could experience challenging relationships with ward staff. Issues of geography and capacity limited opportunities for supervision and team-building, impacting consistency of delivery.ConclusionsThis study provides clear indication that implementation can impact delivery of peer support, with implications for engagement and, potentially, outcomes of peer worker interventions. Resourcing issues can have knock-on effects on consistency of delivery, alongside challenges of access, authority and relationship with clinical teams, especially where peer workers were employed in not-for-profit organisations. Attention needs to be paid to the impact of geography on implementation.Trial registrationISRCTN registry number ISRCTN10043328, registered 28 November 2016.

Exploring Psychologists’ Perspectives on Preparation and Practical Experience of Tele-Counseling

<p>以視訊為本的通訊諮商於新冠肺炎疫情期間在國內快速發展。鑑此，本研究奠基在建構主義觀點進行質性研究，以深入探究心理師對於通訊諮商之準備與實施經驗。透過立意取樣與滾雪球取樣，共18位心理師參與以線上視訊形式進行之半結構式個別訪談（5男、13女；年齡為30至55歲；從事通訊諮商時數範圍為6至380小時）。資料分析上採用分析抽象階層化概念（the ladder of analytical abstraction）進行。分析結果有二。（1）通訊諮商的準備包括三層面：（a）政策規範層面。現今存有申請流程繁瑣、實施細則不明確，以及規範與實務之落差等議題，增添準備困難，如何促進法規與實務間的契合誠為重點；（b）機構與心理師層面。因經驗缺乏，心理師在準備中且戰且走，目前強調以個案福祉與諮商倫理為經緯預先建構通訊諮商流程，並妥善設置設備及熟稔操作；（c）個案層面。心理師認為要積極催化個案對通訊諮商的準備與投入，進而共構治療同盟並維持諮商架構。（2）通訊諮商的實施經驗分為助益與限制。心理師大多表示通訊諮商與實體諮商具有共通性，可發揮諮商的基礎效益，且一定程度可打破空間與距離限制，以服務特定個案；然而通訊諮商可能出現三類型限制。首先，個案評估的精準性較低、諮商歷程較難掌握；再者，通訊諮商存有形式限制，包括進行體驗型諮商或多人諮商較為困難；最後，通訊諮商的服務對象有所限制，如危機個案或未成年個案。</p> <p> </p><p>The COVID-19 pandemic has impacted the public and society as a whole and has triggered a transformation of mental health services. Tele-counseling has become a feasible alternative to face-to-face counseling for maintaining safe social distancing practices while addressing the public’s mental health issues. The term ""telecounseling"" refers to methods of counseling through video, telephone, Internet calls, and other types of telecommunication that can be conducted over long distances. Features of tele-counseling include confidentiality and flexibility, which could help the public access mental health services by overcoming obstacles such as geographical and time constraints. Notably, Taiwan legalized tele-counseling in 2019, and it developed rapidly during the pandemic, especially video call tele-counseling; however, few studies thus far have explored this. To make Taiwan a tele-counseling-friendly environment, the present study, grounded in a constructivist perspective, employed a qualitative approach to deeply explore psychologists’ views on tele-counseling, thereby elucidating their preparation for tele-counseling and relevant practical experience. Through purposive and snowball sampling, licensed psychologists participated in semi-structured individual interviews via online video conferencing (5 males, 13 females; aged between 30 and 55 years, with a range of 6 to 380 hours of experience in tele-counseling). Data were analyzed using the ladder of analytical abstraction. As a result, two factors were highlighted. First, in terms of preparation for tele-counseling, the results revealed the following. (1) When it comes to policy and regulation, some problems still exist, including a cumbersome application process, unclear enforcement rules for tele-counseling applications and implementation, and differences between regulation and practice. These issues make preparation for tele-counseling more difficult; therefore, a way to facilitate alignment between regulations and practice (as well as investment in tele-counseling) is important for optimizing the preparation and implementation of tele-counseling. (2) Due to a lack of experience, institutions’ and psychologists’ preparation for tele-counseling still depends on how it progresses. They primarily emphasized that preparation should focus more on pre-developing the tele-counseling procedure based on clients’ well-being and professional ethics, as well as setting up tele-counseling equipment and becoming familiar with its operation. Moreover, psychologists should regularly engage in professional training for tele-counseling. This is a useful means of preparing for telecounseling. (3) It is necessary to facilitate clients’ attention and investment in tele-counseling sessions, thereby developing a therapeutic alliance and maintaining the framework of counseling together. This is important for the implementation of tele-counseling. Second, in terms of the practical experience of tele-counseling, the results revealed the following: (1) Some commonalities between tele-counseling and face-to-face counseling help maintain the efficiency of tele-counseling. (2) Tele-counseling can overcome the limitation of distance and space, thereby serving needs of specific clients. (3) The features of tele-counseling result in some potential restrictions. For example, psychologists often find it difficult to assess clients’ situations and grasp the entire counseling process, which drives them to put in more effort. Some forms and methods of counseling are restricted in telecounseling, so psychologists need to put more effort into preparing for counseling, or even adjusting the ways they counsel. In addition, potential candidates suitable for tele-counseling are limited; therefore, psychologists need to provide more follow-up services based on clients’ situations and needs. To summarize, the present study not only broadens the horizon of psychologists’ experiences of tele-counseling, but also proposes some useful practical suggestions for preparing for and implementing tele-counseling. This has important implications for the development of tele-counseling in Taiwan. However, this research is still limited, and further investigation is necessary to boost this development.</p> <p> </p>

Psicanálise e saúde mental infanto-juvenil: uma reflexão sobre o lugar da subjetividade nos CAPSi

The aim of this article is to discuss the work of the mental health teams in the Child and Adolescent Psychosocial Care Centers (CAPSi), in order to consider subjectivity as a factor of inclusion. The methodology used was based on applied psychoanalysis. Franco Basaglia's contributions were revisited in order to understand his influence on the Psychiatric Reform in Brazil and to elucidate the current practice of CAPSi. The current impasses in the field of subjectivity in the Psychiatric Reform are discussed and it is proposed to locate transversal surfaces that articulate the presence of a psychoanalytic approach to subjectivity in psychosocial care. The conclusion is that it is important to discuss a psychoanalytic approach to subjectivation in public mental health services, so that treatment in these services is not polarized between biological reductionism and psychosocial care.

Public mental health services in Southern China and related health outcomes among individuals living with severe mental illness

Background Although national policies in China are comprehensive and instructive, a wide disparity exists between different cities. The current status of public mental health services by region in China remains unclear. This study aimed to investigate policies related to public mental health services, the contact coverage of public mental health services and outcomes of service users.MethodsA cross-sectional study was carried out in Southern China, between April 2021 and March 2022. Considering the geographical location, socioeconomic development levels, and prevalence of severe mental illness, four cities including Wuhan, Changsha, Guangzhou, and Shenzhen were selected. Relevant service providers were asked to report data on mental health policies and facility-related information, including mental health resources, registration rates of patients, management rates of patients, and medication rates of patients. Eligible patients were invited to report service user-related data, including contact coverage of public mental health services and their outcomes. SPSS 26.0 was used for data analysis.ResultsThe four cities in Southern China have made different efforts to develop public mental health services, primarily focusing on socio-economically disadvantaged individuals. Community health centers in Guangzhou and Shenzhen reported having more professional human resources on mental health and higher mental health budgets for patients. The contact coverage rates of most public mental services were higher than 80%. Patients in Changsha (B = 0.3; 95%CI: 0.1–0.5), Guangzhou (B = 0.2; 95%CI: 0.1–0.3), and Shenzhen (B = 0.3; 95%CI: 0.1–0.4) who received social medical assistance services reported higher levels of medication adherence. Patients in Wuhan (B = -6.5; 95%CI: -12.9--0.1), Guangzhou (B = -2.8; 95%CI: -5.5--0.1), and Shenzhen who received community-based rehabilitation services reported lower levels of disability (B = -2.6; 95%CI: -4.6--0.5).ConclusionsThere have been advances in public mental health services in the four Southern cities. The contact coverage rates of most public mental health services were higher than 80%. Patients’ utilization of public mental services was associated with better health outcomes. To improve the quality of public mental health services, the government should try to engage service users, their family members, and supporters in the design, delivery, operationalization, and evaluation of these public mental health services in the future.

Australian specialised mental healthcare labour shortages: Potential interventions for consideration and further research.

Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions. The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions.

Research-related knowledge, understanding and practice in public mental health: the voices of social workers and occupational therapists

IntroductionPrevious studies have explored facilitators and barriers to research conducted by allied health professionals in general medical settings. Since the mental health system is acknowledged to be significantly under-funded and more poorly functioning than general medical services, it is unclear whether the published facilitators and barriers also apply to mental health settings. This study sought to explore the research-related knowledge, understanding and practices of allied mental health clinicians based in a large public mental health service.MethodsA mixed methods study recruited 59 occupational therapists and social workers working in a dedicated metropolitan public mental health service in Melbourne, Australia. Quantitative survey results are reported elsewhere. Semi-structured interviews were conducted with 16 survey responder volunteers. Thematic analysis was conducted on the qualitative survey and interview data.ResultsFour main themes were identified: research must connect with clinical practice; fragments of knowledge; research in practice; and research is not part of my professional identity. The third theme, research in practice, comprised four subthemes: no time for research in clinical roles, missing communication, lack of ownership, and what I need to do research.ConclusionsThis study found that research and research-related activities were not considered part of the mental health social workers and occupational therapists’ professional identities. Dealing with this issue may be instrumental to the realization of these clinicians’ professional peak-body associations’ code of practice and to government mandated practice standards. We provided several strategies to encourage both clinicians and services to view research-related activities as an everyday part of clinical roles. This is especially important if we think of allied health evidence-based practice requiring a reasonable level of research-related skills and/or competencies to appraise, practice, evaluate and adapt their evidence-based practice.

Mental health service use in children at risk of significant harm: A record linkage study of a child protection register

Children with experience of maltreatment, abuse or neglect have higher prevalence of poor mental health. In the United Kingdom, child protection services identify children at risk of significant harm on the Child Protection Register (CPR) and intervene to reduce risk. Prevalence and incidence of mental health service use among this population of children are not well understood. We analysed records from one Scottish Local Authority's CPR, linked to electronic health records for all children in the broader health board region aged 0–17 years. We described mental health service use among children with a CPR registration using measures of mental health prescribing and referrals to child and adolescent mental health services (CAMHS). We calculated age- and sex-specific incidence rates for comparison with the general population. Between 2012 and 2022, we found 1498 children with a CPR registration, with 69% successfully linked to their health records. 20% were registered before birth and median age at registration was 3 years. Incidence rates in all measures of mental health service use were higher in children with a CPR record across all ages (at outcome) and genders compared to the general population. The largest absolute difference was for boys aged 5–9 with a CPR record, who had 31.8 additional mental health prescriptions per 1000 person-years compared to the general population (50.4 vs. 18.6 prescriptions per 1000 person-years, IRR: 2.7). Girls aged 0–4 years with a CPR registration had the largest relative difference, with a rate of CAMHS referral 5.4 times higher than the general population (12.3 vs. 2.3 per 1000 person-years). Our reproducible record linkage of the CPR to health records reveals an increased risk of mental health service use during childhood. Our findings have relevance to public mental health surveillance, service prioritisation and wider policy aiming to reduce childhood exposure to risk of harm.

Three things we learned along the way: lessons for training in psychiatric epidemiology.

The coronavirus disease 2019 (COVID-19) pandemic, and its associated mortality, morbidity, and deep social and economic impacts, was a global traumatic stressor that challenged population mental health and our de facto mental health care system in unprecedented ways. Yet, in many respects, this crisis is not new. Psychiatric epidemiologists have recognized for decades the need and unmet need of people in distress and the limits of the public mental health services in the United States. We argue that psychiatric epidemiologists have a critical role to play as we endeavor to address population mental health and draw attention to 3 areas of consideration: elevating population-based solutions; engaging equitably with lived experience; and interrogating recovery. Psychiatric epidemiology has a long history of both responding to and shaping our understanding of the relationships among psychiatric disorders and society through evolving methods and training, and the current sociohistorical moment again suggests that shifts in our practice can strengthen our field and its impact. This article is part of a Special Collection on Mental Health.

Prediction of Bangladeshi Urban Children’s Mental Health for the Effect of Mobile Gaming Using Machine Learning

The popularity of mobile gaming is increasing globally, fueled by technological advancements, high-quality smartphones with gaming features, and widespread internet access. A large number of young people and also children are mainly involved in different types of mobile gaming, primarily online mobile gaming, which is a matter of concern for society. This addiction leads to various psychological issues, including mental health problems, loneliness, introversion, insomnia, and a lack of self-control. Bangladesh’s lack of public mental health facilities exacerbates this challenge, particularly in rural areas. To address this issue, we have developed a machine learning model to predict the level of mental health issues faced by Bangladeshi urban children due to gaming addiction. A total of 1996 data were collected from urban parents about their children's gaming activities and categorized them as 'Serious,' 'Partial,' and 'Normal.' The dataset was then split into a 70:30 ratio for training and testing purposes. K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Multinomial Naïve Bayes, & Random Forest were applied as the machine learning approaches for prediction. Here, the Support Vector Machine gives good accuracy (92.75%), and other classifiers have different accuracy. The research highlights the significance of addressing gaming addiction in children and the potential of machine learning technology in predicting mental health issues, particularly in the absence of public mental health services. The study concludes by proposing the expansion of the research to include smartphone and mobile gaming addiction among Bangladeshi rural children and ensure a holistic approach to tackling the broader issue of technology-related addiction.

“It Felt Like I Was Being Tailored to the Treatment Rather Than the Treatment Being Tailored to Me”: Patient Experiences of Helpful and Unhelpful Psychotherapy

ABSTRACT Objective This qualitative study explores patients’ experiences of psychotherapy, focusing on elements perceived as helpful or unhelpful and suggestions for improvement in the context of public mental health care. Methods A total of 148 adults (Mean age = 32.24, SD = 9.92) who had been or are currently receiving psychological treatment from the National Health Service (NHS) responded to an online survey. The survey included open-ended questions regarding their experiences of psychotherapy, asking them to identify helpful or unhelpful aspects, and suggestions for improvement. Using thematic analysis, key themes were identified. Results The analysis highlighted the patient’s preference for personalized treatment, the importance of therapeutic alliance, the demand for depth in therapy, and life skills and agency as therapeutic outcomes. Participants suggested improvements such as more tailored approaches and stronger therapist-patient relationships, supporting an adaptable, patient-centered model. Conclusion The study highlights challenges in public mental health services where patients might feel their specific needs are not being recognized and met and underscores the importance of personalized treatment plans that satisfy and evolve with patient needs, suggesting that therapists must be attentive and responsive to individual desires to enhance the patient experience.

Machine learning identifies different related factors associated with depression and suicidal ideation in Chinese children and adolescents

BackgroundDepression and suicidal ideation often co-occur in children and adolescents, yet they possess distinct characteristics. This study sought to identify the different related factors associated with depression and suicidal ideation. MethodsA nationwide cross-sectional survey collected data from Chinese children and adolescents aged 8 to 18 (N = 160,962; 48.91 % girls). The survey included inquiries about demographics, depression, suicidal ideation, anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, bullying, and being bullied. Fifteen machine learning algorithms were conducted to identify the different related factors associated with depression and suicidal ideation. Additionally, we conducted external validation on an independent sample of 1,812,889 children and adolescents. ResultsOur findings revealed seven related factors linked to depression and six associated with suicidal ideation, with average accuracy rates of 86.86 % and 85.82 %, respectively. For depression, the most influential factors were anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, experience of bullying, and age. Similarly, anxiety, non-suicidal self-injury, perceived stress, internet addiction, academic burnout, and age emerged as paramount factors for suicidal ideation. Moreover, these related factors showed notable variations in their predictive capacities for depression and suicidal ideation across different subgroups. ConclusionAnxiety emerged as the predominant shared factor for both depression and suicidal ideation, whereas the other related factors displayed distinct predictive patterns for each condition. These findings highlight the critical need for tailored strategies from public mental health service providers and policymakers to address the pressing concerns of depression and suicidal ideation.

Almost one in five emergency department presentations are by mental health clients: a secondary data analysis.

Mental health-related emergency department (ED) presentations are steadily increasing, including presentations for both mental health and non-mental health concerns by existing clients of mental health services. The study aim was to examine and compare mental health clients and non-clients' ED presentations, identify data and clinical gaps and make recommendations for improvement. De-identified 2017/2018 ED data were used to describe presentations for current and recent (within last 5 years) clients of specialist public mental health and addiction services, compared to presentations of non-mental health clients. Of 49,170 presentations, 18% were by clients of mental health services. Compared to other ED presenters, mental health clients were often younger, female and Māori, required more urgent care and waited longer. Mental health-related International Classification of Diseases (ICD) codes/referrals were most common for presentations by current mental health clients, whereas pain and trauma were often the reason for prior mental health clients' presentations. Discharge diagnoses rarely included self-harm behaviour, and admissions for these clients were more commonly by ED rather than mental health services. Mental health clients are common in ED. Enhanced mental health data capture and improved systems and processes are needed to ensure that ED staff can better meet their often-complex needs.

A cost-effectiveness analysis of a housing and recovery program for people with severe and persistent mental illnesses and precarious housing

ABSTRACT The Doorway program supports people with Serious and Persistent Mental Illnesses (SPMIs) receiving care within Victoria’s public mental health system and who are precariously housed. This paper reports on its cost-effectiveness. The study design was difference-in-differences involving a Treatment-As-Usual comparison group (TAU) using deidentified client records. The primary outcome measure was the proportion of days of secure housing per participant during the study and pre-study periods. Similarly, health service usage was also extracted from participants’ records. The cost of public mental health service usage was then estimated, including using governmental published data. The program’s Incremental Cost Effectiveness Ratio (ICER) and Cost-effectiveness Acceptability Curve were estimated using the bootstrap method. An ICER threshold of Australian $50,000 per additional person housed (hereafter A$) at 100% was set to determine cost-effectiveness and the probability of cost effectiveness at A$50,000. Mean total costs (secure housing and mental health service usage) were greater for the Doorway group compared to the TAU group (A$22,987). Mean percentage of days securely housed was also greater for the Doorway group (by 45.4%). The ICER value was A$50,613, the probability of this being 83.1%. The Doorway intervention was both more costly and more effective. Its cost-effectiveness approximated the pre-specified ICER threshold.