Public Mental Health Services Research Articles

Religious coping and suicidal ideation as a predictive model for suicide attempts

Background and objective: Religious coping can help understanding suicide in its prevention and intervention. The objective of this study was to investigate if religious coping and suicidal ideation could be used as a predictive model for suicide attempts.Methods: This is a survey and correlational delineation, carried out in southern Brazil with 260 adults assisted by the a public mental health service in two cities in northern Paraná from October 2020 to June 2021. For data collection, three instruments were used: The first one was a sociodemographic/clinical questionnaire to profile the participants; The second instrument was composed of 30 items dealing with impulsivity manifestations. The third instrument was used because it addresses coping and how people deal with everyday adversity through faith. Logistic regression analysis was used, through the SPSS®, v. 28. The dichotomous outcome variable was the suicide attempt, and the independent variables were a negative domain of the RCOPE scale. At first, three regression models were considered. A greater adherence happened only when the nominal variable “Have you ever tried to commit suicide?” qualified as an outcome variable.Results: The suicide attempt as an outcome and the other variables performing as predictive represented a higher sensitivity (96.8%) compared to the previous models. As the negative coping score was increased by 1 unit, there was also an increase in the chances of suicide attempting by 1.83 times (95% CI 1.11;3.00).Conclusions: It was discussed that religiosity has a positive impact on suicidal behavior, as it provides well-being/happiness, especially for those with mental disorders. This study would contribute to understanding the role and effects of religious coping in the process of counseling by healthcare workers. It is the first study to present predictive modelling for suicide attempt from negative religious coping. Hopefully, it would contribute to improve the process of counseling by mental health nurses and other healthcare workers.

Acceptability and feasibility of recovery-oriented group acceptance and commitment therapy for psychosis in routine practice: an uncontrolled pilot study.

Personal recovery is a persisting concern for people with psychotic disorders. Accordingly, mental health services have adopted frameworks of personal recovery, prioritizing adaptation to psychosis alongside symptom remission. Group acceptance and commitment therapy (ACT) for psychosis aims to promote personal recovery alongside improved mood and quality of life. The objectives of this uncontrolled, prospective pilot study were to determine whether 'Recovery ACT' groups for adults are a feasible, acceptable and safe program within public mental health services, and assess effectiveness through measuring changes in personal recovery, wellbeing, and psychological flexibility. Program feasibility, acceptability and safety indicators were collected from referred consumers (n=105). Adults (n=80) diagnosed with psychotic disorders participated in an evaluation of 'Recovery ACT' groups in Australian community public mental health services. Participants completed pre- and post-group measures assessing personal recovery, wellbeing, and psychological flexibility. Of 101 group enrollees, 78.2% attended at least one group session (n=79); 73.8% attended three or more, suggesting feasibility. Eighty of 91 first-time attendees participated in the evaluation. Based on completer analyses (n=39), participants' personal recovery and wellbeing increased post-group. Outcome changes correlated with the linear combination of psychological flexibility measures. 'Recovery ACT' groups are feasible, acceptable and safe in Australian public mental health services. 'Recovery ACT' may improve personal recovery, wellbeing, and psychological flexibility. Uncontrolled study design, completer analyses, and program discontinuation rates limit conclusions.

The Psychiatric Reform in Andalusia (Spain). Four decades of transformations in Public Mental Health Services

The article aims to present in a summarized way the most outstanding characteristics of the process of transformation of public structures of attention to mental health problems, officially initiated in Andalusia in June 1984, with the approval by Parliament of law on the subject.
 Throughout these almost 40 years the archaic structure of services that characterized psychiatric care has been transformed into a complex network of community orientation, surpassing the Psychiatric Hospitals and with a health sector integrated into the Public Health System and another intersectoral dependent on the FAISEM public Foundation.
 The text presents the previous characteristics, the lines of work developed, and the main results obtained, with a positive assessment in relation to the initial situation, but also with important aspects not adequately resolved and that need subsequent developments that, however, are not being addressed today.

Reflections on culture in practice amongst team leaders and directors in Australian public mental health services

ABSTRACT Objective This study explores team leaders’ and directors’ perceptions of the facilitators and barriers to effective mental health care to meet the needs of culturally and linguistically diverse (CALD) clients in the public mental health system across greater Brisbane, Australia. This is critical given Australia’s cultural diversity and treatment limitations and gaps for CALD clients. Method A purposive sample of decision-makers working in the public mental health system (N = 6) completed semi-structured interviews. A thematic analysis was undertaken to identify dominant themes. Results Participants discussed planning, delivery, and evaluation of culturally inclusive and effective mental health care. When planning for culturally appropriate services, collaboration with internal services, such as multicultural specialist services, was the most frequently discussed facilitator, while limited resources were the most identified barrier. Clinicians’ cultural sensitivity and biases were identified as an important influence on service delivery. Participants identified significant gaps in evaluation and limited data collection to support the evaluation of cultural safety within services. Conclusion The findings provide insight into systemic factors affecting culturally inclusive and safe practices in an Australian public mental health setting. Implications for research, policy, and practice are discussed.

Younger people with dementia registered to public mental health services in Victoria, Australia.

Objectives Individuals living with young-onset dementia fall through the gaps of adult and geriatric services. Given that non-cognitive symptoms of dementia in younger people are often psychiatric and behavioural in nature, these people may contact mental health services. There is sparse information investigating the frequency of people with young-onset dementia who contact mental health triage in Victoria. Methods Triage data were obtained from the Victorian Agency for Health Information. The data contained demographics for people registered with Victorian mental health services. Consumers who had an International Classification for Diseases code for dementia and were aged less than 65 years were identified as people with young-onset dementia. Using information of the frequency of people with young-onset dementia who were registered with each area-based mental health service, population census statistics were used to make estimates of the frequency of young-onset dementia. Results Of the 6172 people who had a dementia diagnosis, 1020 of them were aged less than 65 years and had young-onset dementia. There were proportionally more men who had young-onset dementia compared to women. There were more people with young-onset dementia registered to rural mental health services compared to metropolitan services. Conclusion Findings provide important information for service planning in Victoria. Recommendations include upskilling and education for the assessment of dementia for those clinicians who work in mental health services, particularly in rural regions.

Referral reasons to a Victorian mental health triage service for individuals living with young-onset dementia.

Objectives Mental health triage services are the first contact for people wanting support for their mental health and provide access to public mental health services in Victoria, Australia. People living with young-onset dementia and their families may contact triage services seeking assistance for behaviour changes and pathways to care as there are few alternative services available. Methods The authors reviewed the minimum triage dataset from one of the largest mental health services in Victoria, Australia from 2018 to 2021 investigating reasons for referral for people with young-onset dementia. Results Of the 1766 referrals for 'dementia', 145 were for young-onset dementia. Of these, 69% were referred for behaviour changes. About half of the referrals for behaviour changes were triaged as 'advice only'. One-third of referrals were from general practitioners. Conclusions The availability of dementia-specific support services that could provide advice on dementia as well as advice for behaviour changes related to the disease could potentially ease the burden of phone calls received by mental health triage services.

Telemental health services during COVID-19 outbreak in Saudi Arabia

COVID-19, which was declared a pandemic by WHO, brings up many problems. Telemental health comes as a solution to mental problems that are difficult to deal with because of social and physical distancing policies. This study aims to describe the telemental health services in Saudi Arabia during the COVID-19 outbreak. This paper outlines the general approach Saudi Arabia has taken in delivering public mental health services. It describes several key areas of work: medical staff, COVID-19 patients and their families, and individuals who feel anxious due to COVID-19. A description of the program that Saudi Arabia has produced is described, which targeted various groups with various methods. The program from Saudi Arabia may assist in informing public mental health services during COVID-19 or other crises that other government agencies could consider adopting. There is limited published information on this topic in Saudi Arabia. This paper gives a piece of detailed information on mental health services during the COVID-19 outbreak.

Change management on the meso-level: Primary mental health care in Pallieterland, supported by Emergo/PANGG 0-18 (Flanders, Belgium)

Introduction: One of the main current challenges for the Belgian primary health care system is the integration of primary mental health care.
 Belgium is known to have a shortage of mental health professionals. Public mental health services are understaffed, resulting in long waiting lists. Private mental health professionals are too expensive for many people in psychological distress.
 Since 2019, a limited number of primary mental health consultations is reimbursed, to lower the financial threshold to access the private mental health sector. Since 2021, the primary mental health convention changed, towards higher renumeration for psychologists working in the convention, and starting more from a public mental health vision.
 This is a Belgian federal action. In Pallieterland and four other primary care zones, this action is coordinated by two mental health networks: Emergo (for adults) and PANNG 0-18 (for minors).
 In this article the focus is on the change management on the meso-level: how did and still does primary care zone Pallieterland help to implement this policy change?
 What we did: The first step was to have a representative of the mental health sector in the board of the primary care zone, a necessary navigator and go-between, facilitating communication efforts of the primary care zone towards the mental health sector.
 The second step was to help founding a local psychologists’ association. After some previous attempts, the start of the new convention showed to be a good momentum for the start of the local psychologists’ association. Their founders are good communicators, representing the local primary mental health professionals in the boards of both the primary care zone, and of the local implementation group of the new primary mental health care convention.
 The third step is to keep monitoring the implementation progress, making sure that all localities in the primary care zone are well served with reimbursed primary health care consultations.
 
 The primary care zone facilitated and still facilitates these processes, by using a diversity of communication platforms:
 - A monthly electronic newsletter, reaching local healthcare and social care professionals;
 - Siilo Connect, a “medical Whatsapp” respecting GDPR legislation and able to send messages both to the whole contact list and to specific professional groups. Sometimes we sent a targeted request to fill a survey related to this topic, whenever we needed input for local policy decisions;
 - Six-monthly platform meetings on relevant interdisciplinary topics, reaching local healthcare and social care professionals: we both gave dedicated time for this project on one platform meeting and gave short follow-up notices on other platform meetings;
 - Six-weekly board meetings and annual general meeting: short notices on the progress of implementation, allowing questions from diverse stakeholders.
 Conclusion: Summarizing the efforts of primary care zone Pallieterland towards the implementation of the new primary mental health convention through the lens of Donabedian’s theory (Structure – Process – Outcome), we found that we spent most energy and time in modelling the structures, and monitoring processes of communication/collaboration. At the moment, primary care zones don’t have access to any outcome indicator.
 

A framework for evaluating the implementation and maintenance of integration within the youth mental health system.

Given the global burden of disease of youth mental disorders, there remains a need to examine how to improve care for this population. Integrated care has been posited as a potential solution, but there is limited evidence on how best to design, staff, and evaluate different models of integrated care for youth mental health. This oral paper presents the findings of a narrative synthesis of the evidence on integrated models of mental healthcare for young people aged 12 to 25 within PubMed, SCOPUS, and PsycINFO databases. Our literature review aimed to: (1) define and summarise the literature on integrated models of mental healthcare for children and young people, and (2) evaluate the effectiveness of integrated models of youth mental healthcare in enhancing mental health outcomes, quality of life, satisfaction with care, and improving health service delivery in young people aged 12-25 years. To be included in our review, studies were English language peer-reviewed and grey literature from January 2001 – October 2021, which included systematic and/or scoping reviews that assess integrated mental healthcare for children and young people aged 12 to 25 years and studies evaluating models of integrated mental healthcare for children and young people using intervention and comparator groups (included in meta-analysis). To synthesise this literature, we generated intial inductive themes describing components of integrated care shared across the youth mental health system including, collaborative care, person centred care, population and evidence-based care, and governance and financing. We incorporated these themes within a deductive framework adapted from the World Health Organisation health system building blocks. These building blocks include service delivery; workforce; information systems and communication; products and technology; and finance along with the cross-cutting themes of leadership, governance, and policy and values. We then mapped these core components of integrated care onto the six intensity levels of integrated care developed by Heath and colleagues providing an overview of how integrated care can be operationalised in terms of health service building blocks. This framework can form a basis for the development of well-articulated models of youth integrated mental health pathways, assisting services identify what operational changes are needed to best implement and sustain integrated care in their own context. Planned future work involving this framework includes using it to map the integration of primary, secondary, tertiary, public, and private youth mental health services within the Australian health system.

How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation

BackgroundPublic mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities.MethodsA qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates.ResultsFive overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and trust where people felt they were being treated with dignity and respect; (4) helped to overcome barriers to accessibility by making service access less costly and more time efficient, and (5) enhance the sustainability of services through better pooling of resources.ConclusionCo-locating public mental health services within communities impacts multiple social determinants of poor mental health. It has a role in reducing mental health inequalities by helping those least likely to access services. Operating practices that engender inter-service trust and resource-sharing are likely to support sustainability.

Disparities in COVID-19-Related Psychological Distress Among Recipients of a State's Public Mental Health Services.

The authors examined changes in perceived anxiety, stress, and mental health symptoms (i.e., psychological distress) reported by recipients of New York State public mental health services during the early months of the COVID-19 pandemic, as well as whether these changes varied by demographic characteristics or pandemic-related socioeconomic challenges. A statewide survey of service recipients (N=3,483) was conducted (May 8-June 22, 2020). Descriptive analyses were summarized, and logistic regression was used to evaluate associations between increases in reported psychological distress and age, gender, region of residence, race and ethnicity, socioeconomic challenges, and alcohol or drug use. Fifty-five percent of respondents (N=1,933) reported a slight or moderate increase in COVID-19-related psychological distress, and 15% (N=520) reported a substantial increase. In adjusted models, substantial elevations in psychological distress were associated with identifying as female (AOR=1.83, 95% CI=1.50-2.25), experiencing three or more pandemic-related socioeconomic challenges (AOR=2.41, 95% CI=1.91-3.03), and reporting increased use of alcohol or drugs (AOR=1.81, 95% CI=1.34-2.44). Compared with non-Hispanic/Latinx White service recipients, non-Hispanic/Latinx Black individuals had lower odds of reporting substantially increased psychological distress (AOR=0.59, 95% CI=0.45-0.76), as did non-Hispanic/Latinx Asian-descent individuals (AOR=0.28, 95% CI=0.12-0.64). In this large sample of recipients of New York State public mental health services, the COVID-19 pandemic's impact on psychological well-being was widespread and varied by gender, race and ethnicity, and socioeconomic vulnerability. These relationships must be considered in ongoing efforts to provide optimal care for this population.

The Perceptions of General Population About Mental Health Services in Baghdad, Iraq: A Qualitative Study

Background: Access to mental health services remains a challenge in many countries including Iraq, where mental illness is often stigmatized and marginalized. This can lead to negative outcomes such as decreased quality of life and increased morbidity and mortality.
 Objectives: The present study aimed to explore the perceptions of general population in Iraq towards mental health services and identify the challenges facing patient access to these services. Methods: This qualitative study included face-to-face semi-structured interviews with general population in primary health care centers and private pharmacies in Baghdad between (December 2022 through February 2023). Thematic analysis was used to identify recurring themes and sub-themes. Results: Thirty participants were recruited in this study. The study found that the general population in Iraq have negative perceptions towards mental health services. The repeated themes were "public social stigma," "lack of privacy in public healthcare settings," and "lack of psychotherapy sessions in mental health services." The social stigma" was further divided into sub-themes including stigma from family, friends, or co-workers. Lack of privacy indicated there are too many interruptions in the environment of public healthcare settings. Lack of non-pharmacological therapy in mental health services, was expressed as a feeling that only medication therapy was offered, while psychotherapy was not available. Conclusion: The findings suggest that a cultural awareness is needed to reduce the social stigma associated with mental illness and to increase trust in the public mental health services. The results also highlighted the need for improved privacy and culturally-sensitive mental health services. To improve access to mental health services, it is crucial that healthcare providers, social workers, and society work together to promote and destigmatize mental illness.

Appropriateness of psychopharmacological therapies to psychiatric diagnoses in persons with autism spectrum disorder with or without intellectual disabilities: a cross-sectional analytic study

ABSTRACT Background Observational studies highlighted high rates of psychotropic medication in persons with autistic spectrum disorder (ASD) with or without intellectual disability, which seems to be associated with the management of problem behaviors more than co-occurrent psychiatric disorders. The purpose of the study is to investigate psychopharmacology use and diagnoses of co-occurrent psychiatric disorder (PD) in persons with ASD attending a public mental health service in Emilia Romagna, Italy. Methods The present study is a multicenter, cross-sectional study. Results 275 persons out of 486 (56.5%) resulted to receive at least one psychotropic drug, compared to 74 persons (15.2%) that were diagnosed with a PD. 63.6% were on poly-pharmacotherapy (2–10 compounds), with 37.8% receiving 3 or more medications. Antipsychotics were the most frequently prescribed class of psychotropic drugs (89%), followed by antiepileptics/mood stabilizers/lithium (42.1%) and anxiolytics (BDZ) (38.5%). Most common psychiatric disorders were psychotic disorders (29.7%), followed by anxiety disorders (17.5%), bipolar disorders (12.2%), and depressive disorders (9.4%). Conclusions Our findings support earlier research showing that many individuals with ASD receive pharmacotherapy without being diagnosed with a co-occurring psychiatric disorder, indicating that the main reasons for prescription and the type of compound frequently have little to no link with specific psychopathology.

Investigating Attraction and Retention of Staff Within Public Mental Health Services in Victoria, Australia: Protocol for a Mixed Methods Study.

A large proportion of Australians are affected by mental illness each year, and treatment gaps are well known. To meet current and future demands and enable access to treatment that is safe, effective, and acceptable, a robust and sustainable mental health workforce is required. Factors reported to attract people to work within the mental health sector include aspiring to help others, having an interest in mental health and human behavior, the desire to make a difference and do something worthwhile, personal lived experience, recognition, and value of discipline-specific roles. However, despite the various reasons people enter the public mental health workforce, recruitment and retention continue to be ongoing challenges. To date, there has been limited investigation into understanding which factors are most relevant to the current Victorian workforce. Furthermore, a comparison to health care workers outside of mental health is also needed to better understand the specific needs of staff within the mental health sector. This study aims to explore factors related to attraction, recruitment, and retention of the public mental health workforce in Victoria, Australia. The study is a multisite, mixed methods cross-sectional study to be conducted at 4 public hospital services within Victoria, Australia: 2 in metropolitan and 2 in regional or rural locations. Current, previous, and nonmental health workers will be asked to complete a 20-25-minute web-based survey, which is developed based on previous research and offered participation in an optional 30-60-minute semistructured interview to examine personal experiences and perceptions. Both aspects of the project will examine factors related to attraction, recruitment, and retention in the public mental health workforce. Differences between groups (ie, current, past, and nonmental health workers), as well as location, discipline, and health setting will be examined. Regression analyses will be performed to determine the factors most strongly associated with retention (ie, job satisfaction) and turnover intention. Qualitative data will be transcribed verbatim and thematically analyzed to identify common themes. As of May 2023, we enrolled 539 participants in the web-based survey and 27 participants in the qualitative interview. This project seeks to build on current knowledge from within Australia and internationally to understand role and service/system-related issues of attraction, recruitment, and retention specifically within Victoria, Australia. Seeking up-to-date information from across the health workforce may provide factors specific to mental health by illuminating any differences between mental health workers and health care workers outside of mental health. Furthermore, exploring motivators across health care disciplines and locations to enter, stay in, or leave a role in public mental health settings will provide valuable information to support how the sector plans and develops strategies that are fit for purpose. DERR1-10.2196/48855.

Assessing the quality of the care offer for people with personality disorders in Italy: the QUADIM project. A multicentre research based on the database of use of Mental Health services

BackgroundItaly can be viewed as a laboratory to assess the quality of mental healthcare delivered in a community-oriented system, especially for severe mental disorders, such as personality disorders. Although initiatives based on clinical indicators for assessing the quality of mental healthcare have been developed by transnational-organisations, there is still no widespread practice of measuring the quality of care pathways delivered to patients with severe mental disorders in a community-oriented system, especially using administrative healthcare databases. The aim of the study is to evaluate the quality of care delivered to patients with personality disorders taken-in-care by mental health services of four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).MethodsA set of thirty-three clinical indicators, concerning accessibility, appropriateness, continuity, and safety of care, was implemented using regional healthcare utilization databases, containing data on mental health treatments and diagnosis, hospital admissions, outpatient interventions and exams and drug prescriptions.RESULTS31,688 prevalent patients with personality disorders treated in 2015 were identified, of whom 2,331 newly taken-in-care. One-in-10 patients received a standardized assessment, the treatment discontinuity affected half of the cases. 12.7% of prevalent patients received at least one hospitalization, 10.6% in the newly taken-in-care cohort. 6-out-of-10 patients had contact with community-services within 14 days from hospital discharge. Access to psychotherapy and psychoeducational treatments was low and delivered with a low intensity. The median of psychosocial interventions per person-year was 19.1 and 9.4, respectively, in prevalent and newly taken-in-care cases. Nearly 50% of patients received pharmacological treatments.ConclusionsHealthcare utilization databases were used to systematically evaluate and assess service delivery across regional mental health systems; suggesting that in Italy the public mental health services provide to individuals with personality disorders suboptimal treatment paths.

Spotless Life: A Mizrachi Woman’s Encounter with Israel’s State Services

ABSTRACT This article provides an in-depth examination of a case study from my research that focuses on Mizrachi women’s encounters with the welfare and public mental health services in Israel. The article examines the lived experiences of Dorit, an 80-year-old Mizrachi woman, and her encounters with various state services, through lenses of gender, psychoanalysis, violence, and sexuality. Dorit’s narrative unveils the intricate nature of her interactions with state entities, as well as the multitude of identities she embodies: womanhood, Mizrachi heritage, motherhood, and her additional roles—immigrant, domestic violence survivor, the spouse of an emotionally disabled man, and a woman struggling in poverty. The article draws from LaMothe’s work on the creation of potential spaces (Winnicott), a transitional sphere of experiencing between reality and fantasy essential for emotional growth, within marginalized and disadvantaged communities. As she faces gender discrimination, systemic racism, and the stigma of the “dirty Mizrachi,” Dorit develops coping mechanisms and survival strategies, deriving from the potential spaces created by her ancestry and religious practice, which revolve around three key aspects: wit, faith, and cleanliness. By sharing Dorit’s story, I aim to present a broader perspective on challenges and obstacles faced by women from marginalized groups when and while accessing public services. Simultaneously, I wish to highlight resilience and resistance strategies that emerge even in the most difficult life circumstances.

A practical development protocol for evidence-based digital integrative arts therapy content in public mental health services: digital transformation of mandala art therapy.

The fundamentals of digital transformation include the conversion of the traditional method into a digital format to develop a standardized system that collects, analyzes, and processes quantitative data. This study aims to provide a comprehensive understanding of the development process and key elements of evidence-based digital integrative arts therapy. The "Digital Mandala" service in the "Mental Health App" produced as part of a national public mental health project for personalized depression management is adopted to explain how to convert the existing mandala art therapy into digital format. A living lab approach has been applied, which can be used to address the nation's mental health challenges by promoting collaboration, innovation, and evidence-based solutions. Evidence-based digital content requires evidence that covers the structural process, the effects of existing methods, and the components and meanings of each detailed scene. In this section, we provide five stages of the development process, including preliminary research, design, development, commercialization, and advancement. Consequently, clinical elements, integrative arts therapy features, and data factors are defined as the key principles of evidence-based digital integrative arts therapy. Based on the data factors found in this study, it will be possible to create an evaluation dataset of digital integrative arts therapy content for managing depression. Additionally, the large-scale public data can be analyzed through artificial intelligence technology, which is expected to be used as a basis for deriving significant results in a new form, going further than the existing evaluation method. This research is significant because it establishes the foundation for digital transformation in the field of art therapy for public mental health services and investigates its potential.

Mental Health Clinician Attitudes about Service User and Family Agency and Involvement in Recovery-Oriented Practice.

Recovery-oriented practice (ROP) is a framework focusing on recovery through hope, choice, and meaning, to live with or without enduring symptoms and challenges. To examine clinicians' attitudes about the involvement of service users and family or supporters in ROP. A bespoke Qualtrics survey obtained views of mental health clinicians working in an Australian public mental health service about service user and family involvement in ROP, using a five-point Likert scale of agreement and free-text responses. Data were analysed with descriptive statistics and content analysis methods. Two hundred and three clinicians completed the survey. Most (79%) clinicians agreed with the statement that service users want clinicians to use ROP principles, and the majority (63%) also 'strongly believed' that ROP made a difference to service users' mental health outcomes. Only 15% 'strongly agreed' and 57% somewhat agreed with the statement that service users know what treatment is best for them, and only 20% of clinicians 'strongly agreed' that supporters of service users believed in and wanted ROP for their family member or friend. This study adds to the literature on clinicians' views about ROP and shows that although clinicians are supportive of ROP, they also express substantial ambivalence about whether service users and families know what treatment is best. For ROP implementation to be successful, workforce training needs to support clinicians to reflect on these views with service users and families, and to encourage supported decision making. Future studies should focus on changes in clinicians' views and practice post ROP training.

Measuring Performance of Rural Mental Healthcare Services in Saudi Arabia.

Recently, the Saudi government has proposed several initiatives to promote mental health, including the national program named Wazen. The objective of this study was to observe the performance of mental hospitals using a balanced scorecard through this federal program. Secondary quantitative analysis was implemented utilizing the Wazen report program data in 2022. The report adopted a balanced scorecard (BSC) concept. The study focused on 19 mental health facilities (Eraddah Hospitals) in the Ministry of Health (MOH) regions. The MOH's annual statistical report for 2018 and 2022 was reviewed to explore more about beds, staff, and the number of new mental disorder cases. Data were analyzed using Microsoft Excel 365 and the Statistical Package for Social Sciences (SPSS Version 25) software. Mental health hospitals were classified into three categories. Most rural hospitals had lower performance in the yellow threshold value that might need improvement. The data shows that the mean of all hospital performance in some domains ranged, yielding 70% staff engagement and 77% continued educational activity, indicating unsatisfactory performance across public mental health services. The means score of access to care was 97.0% and 94.7%, marking the better mental health services provided. Between 2018 and 2022, there was a significant rise in the prevalence of mental disorders, as evidenced by the number of new patients and outpatients indicated by specific mental diseases, including conditions of psychological development (F80-F98). The high quality of mental healthcare is manifested by therapeutic ethos with a high degree of interaction between professional careers and service users. The former is enhanced by highly educated, competent, compassionate, self-aware, and specialized healthcare professionals in mental health. When assessing mental healthcare services, we recommend considering providers' and professionals' conditions for successful implementation in alignment with patient experience.

Peer-support groups for suicide loss survivors: a systematic review

ABSTRACT Despite the increase in research on suicide bereavement, the effectiveness of peer-support group programs in promoting the grief process and mental health of suicide loss survivors remains unclear. The goal of our study was to determine the effectiveness of peer-support group programs for suicide loss survivors. A systematic review (PROSPERO ID: CRD42022307591) of articles published from January 2000 to December 2021 was applied in the databases PubMed, Web of Science, Scopus, and SciELO. Articles written in English, Spanish, or Portuguese with full text availability were included in this review to perform a narrative synthesis of the results and a bias analysis. 12 qualitative and two quantitative studies, were selected. No evidence of efficacy in reducing suicidal behavior was found. Qualitative studies highlighted that these types of groups provide social support, enabling individuals to cope with grief and mitigating psychological discomfort. In conclusion, from evidence-based medicine, results on peer-support groups for suicide loss survivors has a low level of certainty and an insufficient grade of recommendation. Nevertheless, qualitative studies indicate the potential benefits of these programs. The prevailing use of qualitative methodologies accounts for a participatory and subjective epistemology, typical of community programs such as peer-support programs. Finally, both quantitative and qualitative perspectives are necessary for the integration and validation of mutual support groups for suicide survivors in public mental health services.