Public Mental Health Services Research Articles

A comparative study of access to inpatient psychiatric treatment in a public mental health service in Melbourne during COVID-19.

Introduction:Given the paucity of research on how COVID-19 pandemic-associated lockdowns have affected the access to inpatient treatment, the present study was carried out.Aims:This study aims to describe (1) the characteristics of patients who accessed inpatient treatment, (2) the length of inpatient stay and readmissions, and (3) the quality and safety of care as indicated by the type of admission (voluntary/compulsory) and seclusion use during the lockdown period.Materials and Methods:For this comparative database study conducted at North West Area Mental Health Service, the study group included patients who had an admission between March 16, 2020 (starting of social distancing measures in Victoria) and May 12, 2020 (when easing [Stage 1] of social restrictions started). The control group included patients admitted between March 16, 2019, and May 12, 2019. The hospital databases were sources of information.Results:The study and control groups included 104 and 109 patients, respectively. Compared to the control group, the study group had significantly more patients with separated relationship status, a lower number of severe mental illnesses (SMIs), a higher number of substance use disorders, and lower readmissions. A subanalysis within the lockdown period showed more voluntary admissions in the initial phase whereas more compulsory admissions in the later phase at trend significance.Conclusion:Patients with a separated relationship status and a substance use disorder sought inpatient treatment more than others. Aside from exploring the reasons for these findings, it is also important to investigate why SMIs and readmissions decreased during the lockdown period through further studies.

Distance to health services and treatment-seeking for depressive symptoms in rural India: a repeated cross-sectional study.

Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.

Competency to stand trial evaluations: A state-wide review of court-ordered reports.

Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence-related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court-ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post-restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.

A spatial analysis of Los Angeles County’s burden of serious mental illness in relation to public mental health service providers

Purpose The purpose of this paper is to identify regions of Los Angeles County with high burdens of serious mental illness and determine whether these regions align with those experiencing the greatest economic hardship. Design/methodology/approach This cross-sectional study analyzed the estimated prevalence of serious mental illness and the locations of publicly funded mental health service providers within each census tract of Los Angeles County. The burden of serious mental illness was calculated for each census tract using these variables and an optimized hot spot analysis was conducted to determine which regions were the most underserved in terms of serious mental illness. Findings There is a significantly higher burden of serious mental illness in Southeastern Los Angeles and Pomona Valley than in the rest of Los Angeles County (p = 0.01). The same can be said regarding the Lancaster-Palmdale area and San Fernando Valley (p = 0.05). These areas do appear to align with the areas of Los Angeles County with an economic hardship index in the fourth quartile. Originality/value Mental health initiatives targeting the four hot spot regions should be given priority by the County of Los Angeles. This is especially true when allocating funds from Proposition 63, which aims to address mental health disparities in underserved, unserved or inappropriately served populations.

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.

Youth Pathways: Evaluating the Influence of Gender, Involvement With the Public Mental Health System, Perceived Mental Health Need, and Traumatic Experiences on Juvenile Justice System Processing

This study examined the influence of gender, participation in public mental health services, perceived mental health need, and traumatic experiences on juvenile justice system processing. Data were collected on youth formally processed for delinquency or status offenses by a large statewide juvenile justice system and youth served by the state’s public mental health system during a 7-year period ( n = 271,427). The results indicated that accessing mental health services in the community or being viewed as having a mental health need by a juvenile probation officer increased the likelihood of youth being removed from their home by the juvenile justice system, especially for girls. While girls generally had decreased odds of out-of-home placement compared to boys, their odds significantly increased when combined with involvement in public mental health services and/or receiving a violation of probation. Once placed out of the home, boys discharged much more quickly than girls, with the rate of discharge being related primarily to the severity of their offenses. When controlling for relevant variables using propensity score matching, girls who experienced trauma or involvement with the public mental health system had a significantly lower rate of discharge from out-of-home placement than similarly matched boys.

Casting and scripting: Visibility, responsibility, and legitimacy in transcultural psychiatry apprenticeships in Paris.

Transcultural psychiatry was developed in France to promote cultural and linguistic diversity and address the mental health needs of immigrants who were excluded from accessing other public mental health services. Professionals in health and social services refer patients to transcultural psychiatry consultations when miscommunications arise or when professionals determine that patients need culturally sensitive therapy. In transcultural psychiatry consultations, a group of therapists, composed primarily of psychologists and psychiatrists, as well as other health and social service professionals, receives a patient, the patient's family, and referring professionals. Previous research on transcultural psychiatry has emphasized the importance of culturally diverse therapy teams and the ways that therapists' diversity could permit patients to open up in consultation sessions. This study draws on ethnographic research in two transcultural psychiatry consultations in Île-de-France, and pays particular attention to the experiences of apprentice therapists, who were often graduate students in clinical psychology. Apprentice therapists reported being introduced to patients in ways that they would not choose themselves. As a result, therapists felt that they had to overemphasize their cultures or countries of origin and French therapists questioned their place in the group. This article describes how transcultural therapy groups are a theater in which belonging, identity, and Frenchness are contested and performed. Apprentice therapists proposed more intersectional and inclusive ways of portraying diversity in the transcultural groups.

When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven Implementation of Multiple EBPs for Children.

Therapist discontinuation of delivering an evidence-based practice (EBP) is a critical outcome in the community implementation of EBPs. This mixed methods study examined factors associated with therapist discontinuation within a large reimbursement-driven implementation of multiple EBPs in public children's mental health services. The study integrated quantitative survey data from 748 therapists across 65 agencies, and qualitative interviews from a subset of 79 therapists across 14 agencies. Therapists adopted, on average, 2.41 EBPs (SD = 1.05, range = 1-5), and nearly half (n = 355, 47.5%) reported discontinuing at least one EBP. Multi-level models were used to predict the binary outcome of discontinuation, and qualitative analyses were used to expand upon quantitative findings. Quantitative models revealed that therapist factors, including fewer direct service hours per week, a greater number of EBPs adopted, higher emotional exhaustion, and more negative attitudes toward EBPs in general were associated with discontinuation. In addition, EBP-specific factors including more negative perceptions of the particular EBP and lower self-efficacy for delivering the specific EBP predicted discontinuation. Themes from interview responses highlighted the importance of fit of the EBP with the agency's client base, as well as therapist perceptions of adequate EBP training supports, and the alignment of an EBP with therapists' professional goals. Together, the findings suggest the need for strategic sustainment planning interventions that target EBP fit (i.e., fit between adopted EBPs and agency target population, fit between EBP and therapist preferences and career goals) and support therapist self-efficacy in delivering EBPs.

Provider and consumer perspectives of community mental health services: Implications for consumer-driven care.

Public mental health services in the community are broad and continue to expand to address the multiple issues faced by those with serious mental illnesses. However, few studies examine and contrast how helpful consumers and providers find the spectrum of services. The present study examines the services at community mental health service clinics (CMHCs) from the perspectives of providers and consumers. There were 351 consumers and 147 providers from 15 CMHCs who rated and ranked the helpfulness of 24 types of common services. All of the agencies were participating in a Practice-Based Research Network (PBRN). Social support was the highest rated service by both types of respondents, and the creation of a welcoming environment was the highest ranked service by both. There were also areas of disagreement. Consumers identified traditional mental health services (individual therapy and medication services) as being most helpful to them whereas providers selected longer-term services that promote self-reliance (e.g., securing housing, and promoting self-sufficiency) as the most helpful. Understanding how consumers and providers perceive the range of CMHC services provided in usual care is important to develop new targets for intervention. A welcoming milieu and providing social support appear important to both, but significant differences exist between these groups regarding other aspects of services. This holds implications for the design and implementation of consumer-driven services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Report on a Series of workshops on "Mental Health Leadership" for Maharashtra State.

The article is a report on a series of workshops conducted by the National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India in collaboration with the Government of Maharashtra for the local leaders responsible for leading, organizing and delivering public mental health services throughout the state of Maharashtra. The overarching aim of these workshops was to sensitize and orient the participants on the mental health services offered/provided by NIMHANS, the collaborative activities between NIMHANS and Govt. of Karnataka to further the cause of public mental health and also to showcase the scope of DMHP (District Mental Health Program) activities in Karnataka. The professionals were divided into 5 batches as per their specialty or role i.e. Psychiatrists, Psychologists and Social Work besides the health administrators (Civil Surgeons and District Health Officers). Each batch underwent the training 2-3 days. Major areas covered included: Farmers' suicide, programs, policies and laws for the elderly, orientation to the new Mental Health Care Act 2017 and a fully functioning District Mental Health Program (DMHP).

"We sold the buffalo to pay for a brain scan" - a qualitative study of rural experiences with private mental healthcare providers in Uttar Pradesh, India.

The majority of persons with mental distress (PWMD) in India do not have access to care, and even those who seek care are pushed to attend private providers, given the weak and largely absent public mental health services framework. The aim of this study was to examine the experiences in help-seeking and with unethical health service provision among persons with mental distress in the Saharanpur and Bijnor districts of Uttar Pradesh. In-depth interviews were conducted with twenty persons with mental distress and their caregivers. Thematic analysis yielded four key findings about help-seeking: first, that it was syncretic and persistent; second, that expenditure for private care was high and often catastrophic; third, that investigations and care provided were pharmacological and predominantly irrational and excessive; and lastly, that help-seeking was abandoned. This study demonstrates that PWMD are particularly vulnerable to exploitation by private providers with illnesses that are stigmatising, poorly understood, chronic, relapsing, and disabling and that often require complex management. Responding to mental distress requires multiple empowering and interacting policy and programme initiatives that must include regulation of private and public providers, resources, and actions to strengthen public and primary mental healthcare and promotion of mental health competence in communities.

National Reforms in Mental Health and Social Care Services: Comparative, Text-Based Explorations of Consumer Involvement and Service Transparency.

Consumer involvement and service transparency have, in recent years, become inherent components of policy guiding the provision of public mental health and social care services. The current study wished to deepen insights on these issues, as they unfold in public services reforms in Israel and England, through an examination of key policy documents describing reforms in both countries. The results of this research show the often tacit ways policy can "talk the inclusive talk", but only limitedly "walk the inclusive walk", offering some interesting observations regarding the linkage between involvement and transparency in mental health and social care services.

Meaning and Management of Multiple Medications Among Public Mental Health Service Users.

Public mental health service users frequently manage multiple health conditions, and are often prescribed multiple medications. While medications are useful tools in treating diagnosed mental illnesses, they bring management challenges and also can carry complex meanings for the individuals taking them. This study utilized a qualitative methodological approach to examine the experience and meaning of polypharmacy among public mental health services users. This sample of service users (n = 26) who were prescribed multiple medications described three distinct types of challenges they faced in managing medications: related to information, material tasks, and self-stigma. Nevertheless, respondents reported creative and resilient strategies to manage these challenges. Findings build on previous literature and reflect the increasing need to focus on challenges related to polypharmacy. Furthermore, findings indicate that low levels of literacy and high levels of material disadvantage, which are common among public mental health service users, complicate the management and meaning of multiple medications.

Towards a Recovery Orientated Mental Health Service

Background: In 2006, in a policy document entitled a Vision for Change(Department of Health, 2006), Ireland undertook to move towards a modern,recovery orientated public mental health service characterised by holisticcare, individualised care planning, the provision of accessible support,increased involvement of service users in decisions about their treatmentand care and greater continuity of care across the mental health services.More than a decade on, it remained unclear to what extent Irish mentalhealth services had progressed towards the modern, recovery orientatedsystem outlined in A Vision for Change (Department of Health, 2006).

A mixed methods evaluation of an integrated adult mental health service model

BackgroundThe Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a ‘one-stop’ mental health service hub.MethodsWe conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale — Domains and Stages (RAS–DS) scores at intake and review (n = 108); (2) RAS–DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation.ResultsInterviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS–DS measurements, averaging 5 months apart. RAS–DS ‘total recovery’ scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS–DS domains (‘Looking forward’, p < 0.001; ‘Mastering my illness’, p < 0.001; and ‘Connecting and belonging’, p = 0.001). Corresponding improvements, except in ‘Connecting and belonging’, were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant.ConclusionsDespite the lack of a control group and small follow-up sample size, Floresco’s integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.

Efficacy of compulsory community treatment and use in minority ethnic populations: A statewide cohort study.

There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment. We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders. Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year. We identified 7432 cases and controls from January 2013 to February 2017 (total n = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results. In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.

Service user experiences of clinical psychology within an adult mental health service: an IPA study

Purpose The purpose of this paper, a qualitative study, is to explore service users’ experiences of attending clinical psychology within a public community adult mental health service. Design/methodology/approach Six individuals who had completed at least 16 sessions of psychotherapy participated in semi-structured interviews. Data were transcribed and analysed using interpretative phenomenological analysis. Findings The results showed the following overarching domains: the relationship and its impacts, structure and focus, and participant factors – timing/readiness. The importance of the use of language was also identified. Participants appeared to value a sense of humanity within the relationship. Interestingly, the personal impact of therapy as perceived by the participants was not focussed on symptom reduction, but on broader changes. The results are discussed in relation to the relevant literature. Practical implications Suggested principles for practice include maintaining attentiveness to relational factors, to client factors such as readiness for change and to the use of structure and flexibility. The use of recovery focussed and alliance measures are recommended. Originality/value For clinical psychologists providing psychotherapy within the public system, there are valuable lessons we can learn from asking the service users directly about their experiences, in terms of focussing on the human element of the relationship, and striking a balance between professionalism and humanity.

Surviving the Heart of Darkness: reflections on the experience of psychiatrists working in public mental health services in Australia.

We reflect upon the bleak experiential landscape of psychiatrists working in underfunded, under-resourced and demoralised public mental health services through the metaphorical narrative of Joseph Conrad's Heart of Darkness. It remains difficult to navigate through the Heart of Darkness. We suggest some navigable markers that may stave off metaphorical running aground.

Attitudes toward standardized assessment tools and their use among clinicians in a public mental health service

The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone using the Attitudes toward Standardized Assessment (ASA) Scales. Clinicians working in the adult mental health field scored significantly higher on use of diagnostic interviews, pre–post evaluations, and ongoing evaluations, whereas clinicians working in the child/adolescent mental health field scored significantly higher on use of screening instruments and held more positive attitudes towards using standardized assessment tools. Attitudes toward standardized assessment tools predicted use of such tools, and results were found to be similar to a study on US clinicians. Whereas the US study only found attitudes regarding the practicality of using such instrument as an independent predictor of assessment use, the current study found that attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone were independent predictors of use.

Adolescents' Use of Digital Technologies and Preferences for Mobile Health Coaching in Public Mental Health Settings.

Objective: Youth with mental illnesses often engage in unhealthy behaviors associated with early mortality from physical diseases in adulthood, but interventions to support positive health behaviors are rarely offered as part of routine mental health care for this group. Digital health technology that is desirable, accessible, and affordable has the potential to address health behaviors in public mental health settings where many adolescents with severe mental health problems receive care. The aims of this study were to examine how adolescents receiving public mental health services use digital technology and social media and to explore their preferences using technology to support health and wellness.Methods: Using a convergent parallel mixed methods design, we surveyed adolescents ages 13–18 from four community mental health centers in one state and conducted focus group interviews to explore their perspectives on using digital technology and social media to receive health coaching and connect with peers to support healthy behaviors. The survey and focus group data were merged to inform the future development of a digital health intervention for adolescents receiving public mental health services.Results: Of 121 survey respondents (mean age 15.2, SD = 1.5), 92% had a cell phone, 79% had a smartphone, 90% used text messaging, and 98% used social media. Focus group interviews revealed that adolescents were interested in receiving strengths-based mobile health coaching, and they preferred structured online peer-to-peer interactions in which a professional moderator promotes positive connections and adherence to privacy guidelines.Conclusions: Adolescents receiving public mental health services in this study had access to smartphones and were frequent social media users. These data suggest that digital health interventions to promote health and wellness among adolescents may be scalable in community mental health settings. Adolescent participants suggested that digital health interventions for this group should focus on strengths and online peer support for health promotion should include a professional moderator to foster and manage peer-to-peer interactions.