Public Mental Health Care Research Articles

The Development of Operational Model Integrating Digital Technologies into Public Mental Healthcare Services in Nigeria

The availability and utilization of digital technologies can leverage the challenges of the sharp-depleting workforce due to the consistent migration of healthcare professionals (HCPs), the alarming ratio of the number of patients to HCPs, discretional use of digital technologies among HCPs in providing effective therapeutic interventions and mental healthcare services. This study aimed to develop an operational model that integrates digital technologies in mental healthcare service delivery for public facilities in Nigeria. The practice-oriented theory guides the development of the model. A qualitative method assessed the digital technologies used during the COVID-19 pandemic. A non-probability, purposive sampling technique that employed the snowball method was used in selecting the sixteen (16) HCPs from four (4) neuropsychiatric hospitals in South-West Nigeria. Thematic analysis was conducted on qualitative data. Findings from the qualitative analysis revealed several challenges in providing adequate and efficient services in public mental healthcare facilities in Nigeria, such as human resource challenges, brain drain, lack of infrastructure, and strains on HCPs. Findings from this study indicated that digital technologies are sparingly utilized in public mental healthcare service delivery due to a lack of policy and framework. HCPs perceive digital technologies to be beneficial to themselves and their clients. The highlighted benefits to patients are reduced stigmatization levels, decreased financial burden, enhanced accessibility to therapists, strengthened adherence, mitigated relapse incidences and improved intervention. The transition from the traditional/conventional space of mental healthcare service delivery to digital space requires a collaborative approach with Computer scientists (software developers, database administrators), Data scientists, investors, stakeholders and mental HCPs. The proposed model serves as a contemporary framework that the Government, policymakers in the Ministry of Health and management of mental health facilities in Nigeria can adopt, providing the needed awareness of the benefit of technological intervention.

Mortality in people with mental disorders in Poland during the COVID-19 pandemic: a nationwide, register-based cohort study

Purpose of review People with mental disorders in Poland have increased standardized mortality ratios (SMRs). This is the first study to assess all-cause mortality in people with mental disorders in Poland during the COVID-19 pandemic. Recent findings A nationwide, register-based cohort study utilizing data from the registry of healthcare services (2011–2020) and the all-cause death registry (2021) in Poland was conducted. Individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (ICD-10) from 2011 to 2020 were identified. SMRs were compared between people with a history of mental disorder and the general population. SMRs for the pandemic period were also compared with prepandemic SMRs calculated for 2019. No significant differences in SMRs were observed overall between 2021 and 2019. A minor increase in SMR was observed in 2021 for people treated only in outpatient mental health clinics. In 2021, a significant decrease in SMRs was shown for individuals with diagnoses from groups F10-F19 and F20-F29, and a significant increase in SMRs was observed for those with diagnoses from group F40-F48. Summary SMRs for people with any mental disorder in Poland in 2021 remained at comparable levels to those in 2019.

Utilizing a university and state collaboration to advance student training and support public mental health care.

Utilizing a university and state collaboration to advance student training and support public mental health care.

Depression, anxiety and coping mechanisms among mental healthcare practitioners during COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has placed the psychological functioning of mental healthcare practitioners under severe strain. Coping methods may affect mental health outcomes. The study examined the relationship between depression, anxiety, stress, and coping styles utilised by mental healthcare practitioners during the COVID-19 pandemic. Three private and one public mental healthcare facility in Bloemfontein, South Africa. Respondents completed the Depression, Anxiety and Stress Scale (DASS-21) and Brief Coping Orientation to Problems Experienced (Brief-COPE) inventories. An ordinal regression model was used to assess the relationship between coping styles, anxiety and depression. A total of 212 practitioners were included in the analysis. According to DASS-21 measures, approximately 41% and 28% of respondents had moderate to severe depressive and anxiety symptoms, respectively, with the highest prevalence among younger female respondents and nurses. The association between stress severity, anxiety and depression was significant. Avoidant coping methods and two approach coping strategies (planning and acceptance) were associated with depression and anxiety. Anxiety was linked to an increased likelihood of transitioning to higher avoidant categories, while participants with depression were less likely to move to higher avoidant or approach categories. Mental healthcare practitioners, especially nurses, experienced significant COVID-19-related psychological distress during the pandemic. Avoidant coping mechanisms may increase the risk of poor mental health outcomes. This study added data on the mental health effects of COVID-19 on mental healthcare practitioners, as well as psychological methods used to cope during the pandemic.

Women's mental health and COVID-19: increased vulnerability and inequalities.

The impact of COVID-19 on mental health has become a relevant object of research. Studies have demonstrated that women have experienced greater mental health challenges, highlighting the importance of public health systems to address women's specific needs. This literature review explores the effects of the coronavirus pandemic on psychological distress among women, aiming to provide a comprehensive understanding of the subject and to explore how these research findings can guide public mental health care responses in crisis settings. A total of 131 studies were analyzed and four dimensions were discussed: study characteristics, factors impacting women's mental health in the pandemic setting, particularities of pregnancy and the postpartum period, and proposed interventions. Most studies exclusively addressed populations of adult women, predominantly during pregnancy and the postpartum period. Anxiety, depression, and stress were the most common outcomes. Lower education and income, preexisting mental health problems, and living alone or with children were risk factors for higher levels of anxiety and depression. A comprehensive care approach supported by public health policies and focused on intersectional factors, including race, socioeconomic status, and access to resources, is necessary to improve women's mental health care response in future crises.

An examination of the ohio scales, short form, hopefulness domain, youth- and caregiver-report versions in a community care setting

The current study examined the utility of the Ohio Scales, Hopefulness Scale (OS Hopefulness Scale; Ogles et al., 2004), a free multi-informant four-item measure of hopefulness used within a large statewide public mental health care system. Collectively, the six aims of this study (done for both youth- and caregiver-report versions) examined (a) the measure’s factor structure and (b) internal consistency, (c) the relationship between youth- and caregiver-reported hopefulness, (d) the measure’s relationships with numerous domains of psychopathology (e.g., depression, anxiety, delinquency) and (e) functioning, and (f) sensitivity to change. Using a sample of 986 participants, who were ethnically diverse (30.5 % multiethnic, n = 301), 61.0 % male (n = 601), with an average age of 12.74 (SD=3.46), the study found good factor structure, acceptable internal consistency, and a significant positive association between youth-reported and caregiver-hopefulness. Additionally, significant inverse relationships were found between caregiver-reported hopefulness with youth mental health problems and youth functioning; while youth-reported hopefulness was found to be significantly inversely related to youth mental health problems but not youth functioning. Finally, significant positive changes in hopefulness and significant inverse relationships with youth functioning were also evident at three-month follow up for both youth- and caregiver-reported hopefulness. The constellation of our findings demonstrates potential for this four-item measure of hopefulness to be a useful, efficient, and cost-effective tool with ethnically diverse samples, which are substantially different from samples included in previous studies of hopefulness. Implications and suggestions for future research are discussed.

The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil

This paper studies the Brazilian Psychiatric Reform, which reorganized the public mental health care provision by introducing mental health centers (CAPS) as a community-based substitute for inpatient care. Our research design exploits the rollout of CAPS in a difference-in-differences framework. We show that these centers increased outpatient mental health care production and reduced psychiatric hospitalizations. These reductions were more pronounced for long-stay admissions and among patients with schizophrenia. We find that the savings implied by fewer admissions do not offset the cost of the policy. Also, the reform did not reduce mental health mortality and it increased violent crimes. (JEL H51, I12, I18, O15)

The impact of widowhood on mental health: anxiety, depression, and stress among widowed women in Nepal.

In South Asia, particularly in regions with strong patriarchal norms, widowhood is stigmatized, compounding the negative impact of grief and partner loss. This study measured the prevalence of mental health symptoms among widows in Nepal and its relationship to demographic variables. This cross-sectional study surveyed 588 Nepalese widows from six districts in Nepal (mean age = 52.62, SD = 13.99) who had lost their spouses within the past two years. Participants completed the Anxiety, Depression and Stress Scale (ADSS). Analyses examined prevalence of anxiety, depression, and stress symptoms, using standard ADSS cut-points. Level of anxiety, depression, and stress symptoms measured by the ADSS in the sample were also compared with female psychiatric and nonpsychiatric normative ADSS data, and were compared with one available comparison sample (a sample of older Nepalese women). Measures of association between ADSS scores and demographic variables were computed. Results showed that a high percentage of the Nepalese widows reported moderate to severe symptoms of anxiety, depression, and stress. They also endorsed significantly higher levels of anxiety, depression, and stress symptoms relative to normative data and the comparison sample. Stress scores were significantly negatively correlated with age, Anxiety and Depression scores were associated with income under the poverty line, and Depression scores were associated with homemaker status. These findings confirm the high emotional distress among widowed women in Nepal, and establish the relationship between emotional distress and poverty, homemaker status, and age. These findings can inform public health efforts and mental health care providers regarding the mental health needs of widows in Nepal.

Exploring barriers to seek mental health services among patients with severe mental illness and their caregivers in a modified assertive community treatment program: A qualitative thematic analysis.

Affordability, lack of public mental healthcare facilities, inadequate insurance coverage, and stigma and discrimination are barriers to mental healthcare utilization in India. There is limited research on these barriers and the factors influencing the use of mental health services. To explore the barriers to seeking mental healthcare for individuals with severe mental illness and their caregivers in a modified assertive community treatment program. In a qualitative study using a descriptive thematic analysis, we conducted in-depth interviews with 19 adults, including seven individuals with severe mental illness and twelve caregivers. All the participants had been in the modified assertive community treatment program for at least two years. Using thematic analysis, we identified and grouped codes into subthemes and then clustered into themes. Three major themes on barriers to seeking mental health services emerged: service-related factors, societal-related factors, and illness-related factors. Service-related factors included affordability, accessibility and geographical disparity, and noncoverage under insurance schemes. Societal-related factors included social stigma and discrimination, lack of mental health service knowledge and seeking other forms of treatment, and poor social support. Illness-related factors included poor insight into the illness and no relief from the symptoms despite medication. Barriers to seeking mental healthcare can be categorized as service-related, societal-related, and illness-related. Identifying these factors will improve mental health service delivery.

Self-perceived relations between artistic creativity and mental illness: a study into lived experiences.

To explore the self-perceived relationships between experiences of creativity and mental illness and to understand the meanings behind these relationships. The idea that mental illness and artistic creativity are somehow related dates back to ancient times. There is some evidence for an actual correlation, but many questions remain unanswered on the nature and direction of the relationship. Qualitative contributions to the debate are scarce, and mainly focus on the potential benefits of participation in the arts for people with mental illness. An explorative, interpretive study. Twenty-four professional and semi-professional artists with self-reported experience with mental illness, were recruited purposively. Unstructured in-depth interviews were conducted and transcripts were subjected to interpretive analysis, guided by a hermeneutic phenomenological frame. Participants experience a range of interactions between artistic creativity and mental illness. Three constitutive patterns describe what these interactions look like: "flow as a powerful force"; "ambiguous self-manifestation"; and "narrating experiences of suffering." The findings show that both the concept of creativity and the concept of mental illness, as well as their interrelationships, are layered and complex phenomena that can take on different meanings in people's lives. The findings provide starting points for further research that goes beyond the polarized academic debate. Understanding the experiences of artists with mental illness can help shape the role of art in public mental health and mental health care.

“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.

Concentrated transdiagnostic and cross-disciplinary micro-choice based group treatment for patients with depression and with anxiety leads to lasting improvements after 12 months: a pilot study

BackgroundA concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up.MethodsThis was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19–47 (mean age 32.5, SD = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 (SD = 7.9) years. Mean number of prior treatment courses was 3.5 (SD = 3.3; range 0–20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up.ResultsValidated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly (p < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89–3.68), whereas some moderate (0.60–0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up.ConclusionsThe concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up.Trial registrationClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022.

HCV screening, investigation and management in persons with SUD admitted to Mount Carmel Hospital, Malta

IntroductionIndividuals who suffer from substance use disorder (SUD) are at increased risk of Hepatitis C (HCV). Mount Carmel Hospital (MCH) is the only public service in-patient mental health care facility on the island of Malta. Individuals with SUD are referred to MCH for support with comorbid mental health conditions.ObjectivesTo assess whether current practice meets the UK Clinical Guidelines on Drug Misuse and Dependence (2017) recommendations- yearly screening for HCV, further testing and referral to infectious disease specialists for those who screen positive for HCV. To compare current practice at MCH, Malta with other countries in the European Union and United Kingdom.MethodsRetrospective analysis of HCV screening, investigation and referral practices as recorded on iSoft Clinical Manager records for SUD-related admissions to MCH under the care of addiction specialists in 2022 (n=120). Admissions data were provided by the data protection office, with permission from the Chairman of the Department of Psychiatry, and de-identified at source to safeguard patient confidentiality.Results60% (n=72) of the SUD inpatient population underwent screening for HCV according to guideline recommendations. 37% (n=44) of this cohort has received a positive HCV antibody result. 32 persons had HCV RNA load records, 34% (n=11) of whom had a detectable viral load. 50% (n=17) of those who screened positive for HCV were offered an appointment with an infectious disease specialist within the year, 7 attended. The table below compares HCV status between our group and published data for the UK, Austria and Greece. Despite heterogeneity in study designs and populations (we describe an inpatient cohort with diagnosed SUD, not all of whom inject drugs) comparable proportions have undergone HCV screening in the preceding twelve months and similar proportions have chronic HCV infection.% Tested in past year for HCV% HCV antibody positive% HCV RNA detectable% HCV clearedMalta (MCH 2022)60373466England, Wales, N. Ireland (UAMS 2021)43572674Scotland (NESI 2020)58558119Austria (EMCDDA 2019)59854456Greece (EMCDDA 2019)/615446ConclusionsMost SUD inpatients at MCH undergo HCV screening according to guideline recommendations but current practice falls short of ideal coverage and follow-up care. Current screening practices and chronic HCV infection rates at MCH are comparable to other countries in the EU and UK.Disclosure of InterestNone Declared

A community service doctor's experiences of mental healthcare provision in rural Eastern Cape.

Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area.Contribution:The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa.

Mental health interventions in Italian prisons: are we ready for a new model? Suggestions from the Parma experience.

Mental health interventions for Italian prisoners with mental disorder remain a problematic issue, despite radical changes in psychiatric care and a 2008 major government reform transferring mental health care in prison to the National Health Service. Indeed, prison has increasingly become a place of severe psychological distress, where also serious mental illnesses sometimes occur. In this contribution, we commented on the recommendations recently proposed by the Emilia-Romagna Region on how structuring mental healthcare interventions in all regional jails. Moreover, starting from the findings reported in recent epidemiological studies examining the prevalence of mental disorders in Emilia-Romagna prisons, we proposed a new treatment model for mental health and pathological addictions in jail, which took into account the current incidence of inmates with severe mental illness, psychological distress due to incarceration, and substance use disorder. Perhaps, this new intervention model (specifically centered on clinical psychology and case management by intramural mental health professionals) requires a vision able to overcome the classical "medical-centered" approach, which still too often permeates many sectors of public mental healthcare services. In our opinion, if we decide to look at the moon, we shouldn't dwell too much on the finger pointing to it.

Which factors affect job satisfaction of doctors in psychiatry?

Background Recent reports have described challenges in retaining and recruiting psychiatrists in public mental health care. To improve the work situation for doctors, the Norwegian Psychiatric Association (NPA) conducted surveys to explore job satisfaction among its members. The purpose of this study is to explore how doctors in mental health services perceive their work, and factors affecting their job satisfaction. Material and methods A Questback survey was sent to all employed members of NPA in June 2020 and in December 2021. In the first survey, 670 members (37%) responded and 903 (43%) in the second. Job satisfaction was measured on a Likert scale from one to five. Linear regression was used to examine associations between work-related factors and job satisfaction. Results In 2021, more than half of the respondents (56%) were satisfied, 16% were dissatisfied and 27% were neutral. The oldest and youngest doctors were most satisfied (p < 0.001). Partial treatment responsibility was related to reduced job satisfaction (β = −0.23, p < 0.001) as well as access to an experienced colleague (β = 0.39, p < 0.001), time for direct patient contact (β = 0.17, p < 0.001) and ability to treat patients in a satisfactory manner (β = 0.52, p < 0.001). Job satisfaction decreased from 2020 to 2021. Conclusions Psychiatrists seem to be torn between treating their own patients and having medically responsible for other therapists’ patients. Time for patient contact and discussions with colleagues are crucial for psychiatrists’ well-being at work.

Chronotherapy for patients with a depressive episode treated in a public outpatient mental healthcare clinic in Norway: protocol for a randomised controlled trial

IntroductionDepression is highly prevalent in outpatients receiving treatment for mental disorders. Treatment as usual (TAU) usually consists of either psychotherapy and/or antidepressant medication and often takes several weeks before clinical...

Assessed and self-perceived unmet needs for mental health care in the general population in Antwerp

Introduction: A public mental health care approach requires knowledge about which proportion of the population needs mental health care, and which people need it but don’t seek or receive it and why.&#x0D; Who is it for? We investigated (unmet) needs for mental health care in the general population to optimize the distribution of mental health care services, which benefits all Antwerp citizens who need mental health care.&#x0D; Involvement and engagement: Important stakeholders who were involved are the (Antwerp) psychiatric hospitals, who funded the research and were involved in the design of the study and interpretation of results. The involvement and engagement of (ex) patients in mental health care was limited, but a pilot test of the survey was conducted with this group.&#x0D; Method: A representative sample was invited in 2021 to participate in a population survey about mental wellbeing and mental health care use in Antwerp. A total of 1208 individuals aged 15 – 80 years old participated. We investigated unmet needs for mental health care using a normative approach (assessed mental health problems) and subjective approach (self-perceived mental health problems)&#x0D; Results: A total of 10.4% of the sample was defined as having a need for mental health care but only half of them used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Among all people who did not use mental health care, 12.1% perceived a mental health need (fully unmet), and 23.3% of mental health care users perceived the care as insufficient (partially unmet), leading to a total population prevalence of 14.0% perceived unmet needs. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people.&#x0D; Learning: Estimates of met and unmet mental health needs are complex given the diversity of operationalizations of different levels of need, and can only be established by a dialectic of individual and populational perspectives. Assessed and perceived (unmet) mental health needs are both relevant and complementary but are related to different factors. Nonetheless, a general conclusion is that the prevalence of unmet mental health needs is high. Some vulnerable groups should be targeted for detection of mental health problems and interventions, for example through outreaching care.&#x0D; Next steps: Further research should explore how assessed and perceived needs interact, and how this is predictive of help seeking and mental health outcomes.

Diagnostic profiles and trauma history among treatment-seeking young adults with positive post-traumatic stress disorder screens: Findings and implications for public mental health care.

This study examined diagnostic profiles and trauma history among treatment-seeking young adults with positive PTSD screens in public mental health care. Screening for trauma history and PTSD symptoms was implemented in a community mental health service system. 266 treatment-seeking young adults (aged 18-35) endorsed trauma exposure with a score of at least 45 on the DSM-IV PTSD Checklist, indicating probable PTSD. Young adults with positive PTSD screens were predominantly female, minority, and diagnosed with mood disorders. Of those with positive screens, only 15% had a chart diagnosis of PTSD; 17.3% (ages 18-24) versus 14.1% (ages 25-35). Variables significantly associated with a decreased likelihood of PTSD detection included a diagnosis of schizophrenia or bipolar disorder, exposure to fewer types of traumatic events, male gender, and white race. Routine PTSD screening for young adults receiving public mental health care should be prioritized to address long-term impacts of trauma.

Treatment Focus Diffusion is Associated with Long-term Outcomes in Youth Public Mental Health Care

Treatment Focus Diffusion is Associated with Long-term Outcomes in Youth Public Mental Health Care