Public Sector Mental Health Services Research Articles

Report of the House of Representatives Select Committee on Mental Health and Suicide Prevention: Commentary on an expanded psychologist role and decreased GP/psychiatrist leadership in private multidisciplinary primary mental healthcare.

This opinion paper discusses certain recommendations of the House of Representatives Select Committee on Mental Health and Suicide Prevention pertaining to psychology, GP and psychiatric professions. The Committee's recommendations may compromise patient care by undermining the ability of private sector medical specialists in providing direct clinical treatment and their role in the coordination of multidisciplinary teams. Expanding private psychological therapies without GP and private psychiatry support might increase the reliance on public hospital emergency departments and public sector mental health services for severe disorders and suicidal crises. Psychiatrists and GPs need to engage in more effective policy advocacy with the Australian Government, in order to maintain their roles in leading private sector collaborative multidisciplinary care.

Coping with Food Insecurity Among African American in Public-Sector Mental Health Services: A Qualitative Study.

While there are high rates of food insecurity among individuals with serious mental illnesses, and among African Americans, there is very little research on the ways African Americans in public-sector mental health services cope with food insecurity. This research paper presents qualitative data from a mixed methods study on the prevalence and management of food insecurity among African Americans using public sector mental health services. We interviewed 21 people about their everyday experiences of food insecurity and strategies they used to cope. While participants reported experiencing high levels of food insecurity, they also described the use of communal strategies to help them cope, including sharing food and cooking meals jointly, which seemed to reduce the negative effects of living with high levels of food insecurity as well as a serious mental illness. Policy innovations like communal gardens and kitchens provided through public mental health services may be particularly helpful.

Be like water: a personal strategy for clinical psychiatric research.

This paper describes, from the personal perspective of a mid-career researcher, principles and advice regarding the development of an embedded clinical psychiatric research program within a medical school and public sector mental health service. From this experience, some general principles are drawn. Through careful strategic planning, together with collaboration with the mental health service, it is possible to bootstrap and develop an embedded clinical research program.

Medicaid waivers and public sector mental health service penetration rates for youth.

To assist families of youth with serious emotional disturbance in financing youth's comprehensive care, some states have sought and received Medicaid waivers. Medicaid waivers waive or relax the Medicaid means test for eligibility to provide insurance coverage to nonpoor families for expensive, otherwise out-of-reach treatment for youth with Serious Emotional Disturbance (SED). Waivers promote treatment access for the most troubled youth, and the present study investigated whether any of several Medicaid waiver options-and those that completely omit the means test in particular-are associated with higher state-wide public sector treatment penetration rates. The investigators obtained data from the U.S. Census, SAMHSA's Uniform Reporting System, and the Centers for Medicare and Medicaid Services. Analysis employed random intercept and random slope linear regression models, controlling for a variety of state demographic and fiscal variables, to determine whether a relationship between Medicaid waiver policies and state-level public sector penetration rates could be observed. Findings indicate that, whether relaxing or completely waiving Medicaid's qualifying income limits, waivers increase public sector penetration rates, particularly for youth under age 17. However, completely waiving Medicaid income limits did not uniquely contribute to penetration rate increases. States offering Medicaid waivers that either relax or completely waive Medicaid's means test to qualify for health coverage present higher public sector treatment rates for youth with behavioral health care needs. There is no evidence that restricting the program to waiving the means test for accessing Medicaid would increase treatment access. (PsycINFO Database Record

Victoria's dependence on overseas trained doctors in psychiatry

This paper analyses Australia’s growing reliance on overseas trained psychiatrists (OTPs) for provision of public sector mental health services, particularly in rural and regional Victoria. A number of critical issues are highlighted, including State Governments’ and the Royal Australian and New Zealand College of Psychiatrists’ failure to provide appropriate preparatory and concurrent training to assist OTPs in professional adjustment and reaccreditation, and the failure of governments to pro-actively address the adequacy of future supply. Copyright. Monash University and the author/s

A systematic review of clinician-rated instruments to assess adults' levels of functioning in specialised public sector mental health services.

Functioning is one of the key domains emphasised in the routine assessment of outcomes that has been occurring in specialised public sector mental health services across Australia since 2002, via the National Outcomes and Casemix Collection. For adult consumers (aged 18-64), the 16-item Life Skills Profile (LSP-16) has been the instrument of choice to measure functioning. However, review of the National Outcomes and Casemix Collection protocol has highlighted some limitations to the current approach to measuring functioning. A systematic review was conducted to identify, against a set of pre-determined criteria, the most suitable existing clinician-rated instruments for the routine measurement of functioning for adult consumers. We used two existing reviews of functioning measures as our starting point and conducted a search of MEDLINE and PsycINFO to identify articles relating to additional clinician-rated instruments. We evaluated identified instruments using a hierarchical, criterion-based approach. The criteria were as follows: (1) is brief (<50 items) and simple to score, (2) is not made redundant by more recent instruments, (3) relevant version has been scientifically scrutinised, (4) considers functioning in a contemporary way and (5) demonstrates sound psychometric properties. We identified 20 relevant instruments, 5 of which met our criteria: the LSP-16, the Health of the Nation Outcome Scales, the Illness Management and Recovery Scale-Clinician Version, the Multnomah Community Ability Scale and the Personal and Social Performance Scale. Further work is required to determine which, if any, of these instruments satisfy further criteria relating to their appropriateness for assessing functioning within relevant service contexts, acceptability to clinicians and consumers, and feasibility in routine practice. This should involve seeking stakeholders' opinions (e.g. about the specific domains of functioning covered by each instrument and the language used in individual items) and testing completion rates in busy service settings.

What future is there for counselling in the NHS?

British Journal of Healthcare AssistantsVol. 10, No. 3 Health MattersWhat future is there for counselling in the NHS?Gillian ProctorGillian ProctorSearch for more papers by this authorGillian ProctorPublished Online:10 Mar 2016https://doi.org/10.12968/bjha.2016.10.3.145AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Cooper M (2008) Essential Research Findings In Counselling And Psychotherapy. Sage, London Google ScholarCORE IMS (2016) CORE IMS. www.coreims.co.uk/About_CORE_IMS.html (accessed 7 January 2016) Google ScholarDepartment of Health (2013) Mental Health Payment By Results Guidance. http://tinyurl.com/dy7apfg (accessed 7 January 2016) Google ScholarEconomist/Ipsos MORI Issues Index (2015) The NHS remains the most important issue facing Britain. http://tinyurl.com/gr39e6q (accessed 7 January 2016) Google ScholarFrancis R (2013) The Mid Staffordshire NHS Foundation Trust Inquiry. Independent inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005–March 2009. http://tinyurl.com/ol8et82 (accessed 7 January 2016) Google ScholarFugard A (2015) The ethics of national routine outcome monitoring policies; a case for taking action. Clinical Psychology Forum 267: 11–5 Google ScholarFulford KWM, Dickenson DL, Murray TH (2002) Healthcare Ethics And Human Values. Blackwell, Oxford Google ScholarKristeva J (1982) Powers Of Horror: An Essay On Abjection. Columbia University Press, New York NY Google ScholarNuffield Trust/Institute for Fiscal Studies (2015) Understanding Competition and Choice in the NHS. www.nuffieldtrust.org.uk/our-work/projects/understanding-competition-choice-nhs (accessed 7 January 2016) Google ScholarOffice for National Statistics (2009) Psychiatric morbidity among adults living in private households, 2007. HMSO, London Google ScholarProctor G (2002a) The NHS in 2015: science fiction or a scary possibility? Healthcare Counselling and Psychotherapy Journal 2(3): 2–6 Google ScholarProctor G (2002b) The Dynamics Of Power In Counselling And Psychotherapy: Ethics, Politics And Practice. PCCS Books, Ross-on-Wye Google ScholarProctor G (2006) Therapy: opium for the masses or help for those who least need it. In: Proctor GCooper, MSanders PMalcolm B (eds) Politicising The Person-Centred Approach: An Agenda For Social Change. PCCS Books, Ross-on-Wye Google ScholarRizq R (2011) IAPT, anxiety and envy: a psychoanalytic view of NHS primary care mental health services today. British Journal of Psychotherapy 27(1): 37–55 Crossref, Google ScholarRizq R (2013) States of abjection. Organization Studies 35(9): 1277–97 Crossref, Google ScholarRizq R (2014) Perverting the course of therapy: the fetishisation of governance in public sector mental health services. http://tinyurl.com/zzgy9lz (accessed 7 January 2016) Google ScholarSanders P, Hill A (2014) Counselling For Depression: A Person-Centred And Experiential Approach To Practice. Sage, London Google ScholarStrathern M (1997) ‘Improving ratings’: audit in the British university system. European Review 5(3): 305–21. doi: https://doi.org/10.1002/(SICI) 1234-981X(199707)5:3<305::AIDEURO184>3.0.CO;2-4 Crossref, Google ScholarWainwright T (2015). Ethics and quality improvement systems. Clinical Psychology Forum 271: 9–12 Google ScholarUKCP/BPC (2013) Quality psychotherapy services in the NHS: summary findings from the UKCP and BPC members' survey. http://tinyurl.com/gpysjko (accessed 7 January 2016) Google Scholar FiguresReferencesRelatedDetails 2 March 2016Volume 10Issue 3ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 10 March 2016 Published in print 2 March 2016 Information© MA Healthcare LimitedPDF download

Parental perceptions of barriers to mental health services for young people.

This study explores a range of barriers that parents encountered in accessing mental health services. The study also explored whether parents experienced similar barriers to accessing services in 2003 and 2013. One hundred and thirty-four parents of young people attending an initial assessment at a Child and Adolescent Mental Health Service (CAMHS) or headspace centre completed a questionnaire assessing 10 general barriers to care. These data were compared to those collected from 129 participants at CAMHS in 2003. The ranking of barriers to mental health care for their children was similar for both survey years, with 'wait time being too long' and 'help being too expensive' the two highest ranked barriers. Cost factors were related to not knowing that the services did not charge fees and having to take time off work to attend appointments. Multiple referral steps and uncertain wait times were the main concerns regarding wait times. The overall strength with which barriers were endorsed remained relatively low; however, at least 40% of the sample agreed they had experienced four of the barriers in both years. Despite relatively low endorsement of barriers, there are substantial proportions of parents who experienced some barriers to services, and services should continue working to reduce them to facilitate timely access. There is a particular need for more service-related information to clarify that public sector mental health services do not charge fees. Methods such as rapid initial assessment and actively managing wait lists may go some way to reducing perceived wait time barriers.

Service transformation plans in the Eastern Cape informed by a needs-based gap analysis

Objectives. Part I of this research paper presented a needs and gap analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape Province, South Africa. It identified deficits and inequitable distribution of human resources and beds in the province. In this article, Part II, the authors propose a plan for public sector mental health services to address the human resource needs in the poorer eastern regions of the province. The plan focuses on human resource training and development. Methods. Evidence-based data on staff development in mental health from low-middle income countries were utilised to develop strategies to increase staff capacity to address unmet need. A financing model with a poverty index was developed to sustain a needs-based plan. Databases searched included Pubmed, Medline, Google and Google Scholar. The key words used included: mental health, mental health training, mental health resources, mental health in low-middle-income countries, mental health policy and plans, mental health needs- based planning, primary healthcare, primary mental healthcare, mental health financing. In addition the websites of the World Health Organization and the World Psychiatric Association were searched for similar resources. Conclusions. It is feasible, with careful attention to planning and implementation of evidence-based tools, to improve public mental health service delivery in this province. Sustained political will and professional commitment will ensure successful delivery of mental health services in a resource-limited province.

Service transformation plans in the Eastern Cape informed by a needs-based gap analysis

&lt;p&gt;&lt;strong&gt;Objectives.&lt;/strong&gt; Part I of this research paper presented a needs and gap analysis for the management of schizophrenia, bipolar mood disorder and major depression for the Eastern Cape Province, South Africa. It identified deficits and inequitable distribution of human resources and beds in the province. In this article, Part II, the authors propose a plan for public sector mental health services to address the human resource needs in the poorer eastern regions of the province. The plan focuses on human resource training and development. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods.&lt;/strong&gt; Evidence-based data on staff development in mental health from low-middle income countries were utilised to develop strategies to increase staff capacity to address unmet need. A financing model with a poverty index was developed to sustain a needs-based plan. Databases searched included Pubmed, Medline, Google and Google Scholar. The key words used included: mental health, mental health training, mental health resources, mental health in low-middle-income countries, mental health policy and plans, mental health needs- based planning, primary healthcare, primary mental healthcare, mental health financing. In addition the websites of the World Health Organization and the World Psychiatric Association were searched for similar resources.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions.&lt;/strong&gt; It is feasible, with careful attention to planning and implementation of evidence-based tools, to improve public mental health service delivery in this province. Sustained political will and professional commitment will ensure successful delivery of mental health services in a resource-limited province.&lt;/p&gt;

Staff and bed distribution in public sector mental health services in the Eastern Cape Province, South Africa

&lt;p&gt;&lt;strong&gt;Background. &lt;/strong&gt;The Eastern Cape Province of South Africa is a resource-limited province with a fragmented mental health service. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective. &lt;/strong&gt;To determine the current context of public sector mental health services in terms of staff and bed distribution, and how this corresponds to the population distribution in the province.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method. &lt;/strong&gt;In this descriptive cross-sectional study, an audit questionnaire was submitted to all public sector mental health facilities. Norms and indicators were calculated at provincial and district level. This article investigates staff and bed distribution only.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results. &lt;/strong&gt;Results demonstrated that within the province, only three of its seven districts have acute beds above the national baseline norm requirement of 13/100 000. The private mental health sector provides approximately double the number of medium- to long-stay beds available in the public sector. Only two regions have staff/population ratios above the baseline norm of 20/100 000. However, there are significant differences in this ratio among specific staff categories. There is an inequitable distribution of resources between the eastern and western regions of the province. When compared with the western regions, the eastern regions have poorer access to mental health facilities, human resources and non-governmental organisations. &lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion. &lt;/strong&gt;Owing to the inequitable distribution of resources, the provincial authorities urgently need to develop an equitable model of service delivery. The province has to address the absence of a reliable mental health information system.&lt;/p&gt;

Staff and bed distribution in public sector mental health services in the Eastern Cape Province, South Africa

Background. The Eastern Cape Province of South Africa is a resource-limited province with a fragmented mental health service. Objective. To determine the current context of public sector mental health services in terms of staff and bed distribution, and how this corresponds to the population distribution in the province. Method. In this descriptive cross-sectional study, an audit questionnaire was submitted to all public sector mental health facilities. Norms and indicators were calculated at provincial and district level. This article investigates staff and bed distribution only. Results. Results demonstrated that within the province, only three of its seven districts have acute beds above the national baseline norm requirement of 13/100 000. The private mental health sector provides approximately double the number of medium- to long-stay beds available in the public sector. Only two regions have staff/population ratios above the baseline norm of 20/100 000. However, there are significant differences in this ratio among specific staff categories. There is an inequitable distribution of resources between the eastern and western regions of the province. When compared with the western regions, the eastern regions have poorer access to mental health facilities, human resources and non-governmental organisations. Conclusion. Owing to the inequitable distribution of resources, the provincial authorities urgently need to develop an equitable model of service delivery. The province has to address the absence of a reliable mental health information system.

Lessons from the past: Historical perspectives of mental health in the Eastern Cape

&lt;p&gt;The development of mental health services in the Eastern Cape Province is inextricably entwined in South Africa’s colonial history and the racist policy of apartheid. Prior to the development of mental hospitals, mental health services were provided through a network of public and mission hospitals. This paper explores the development of early hospital and mental health services in the Eastern Cape from the time of the Cape Colony to the dissolution of apartheid in 1994, and highlights the influence of colonialism, race and legislation in the development of mental health services in this province. The objective is to provide a background of mental health services in order to identify the historical factors that have had an impact on the current shortcomings in the provision of public sector mental health services in the province. This information will assist in the future planning and development of a new service for the province without the stigma of the past. This research indicates that one lesson from the past should be the equitable distribution of resources for the provision of care for all that inhabit this province, as enshrined in South Africa’s constitution.&lt;/p&gt;&lt;div&gt; &lt;/div&gt;

Lessons from the past: Historical perspectives of mental health in the Eastern Cape

Mental healthcare provision in the Eastern Cape Province is inextricably entwined with the province’s colonial past and, in later years, by the introduction of the policy of apartheid and the Bantustans. These laid the foundation for an inequitable distribution of mental health services in the province. The objective of this article is to provide a background for the historical factors that have had an impact on the provision of public sector mental health services. The archives of the British Medical Journal and the South African Medical Journal and universities in South Africa were accessed to obtain the information presented here. History and geography played a pivotal role in shaping the Eastern Cape first into Bantustans and later the Eastern Cape Province in

Perverting the course of therapy: the fetishisation of governance in public sector mental health services

In this paper, I draw on Freudian and Lacanian psychoanalytic theory to consider the notion of perversion and fetishisation within the context of contemporary UK public mental health services which have been subject to New Public Management restructuring. Offering an organisational case example based on clinical experience within an expanded NHS mental health service, I explore how services that are subject to neo-liberal regulatory and performance management systems sponsor a perverse organisational solution to the anxieties and difficulties of dealing with psychologically distressed patients. I conclude that theorising the unconscious dynamics of perversion and fetishism may provide an opportunity to rethink governmentality, offering a potentially fruitful means of addressing recent political concerns about the negative impact of a ‘target culture’ on public sector health services.

The roles of individual and organizational factors in burnout among community-based mental health service providers.

Public-sector mental health care providers are at high risk for burnout, which negatively affects not only provider well-being but also the quality of services for clients and the functioning of organizations. This study examines the influence of demographics, work characteristic, and organizational variables on levels of burnout among child and adolescent mental health service providers operating within a public-sector mental health service system. Additionally, given the dearth of research examining differences in burnout levels among mental health subdisciplines (e.g., social work, psychology, marital and family therapy) and mental health programs (e.g., outpatient, day treatment, wraparound, case management), analyses were conducted to compare levels of burnout among multiple mental health disciplines and program types. Surveys were completed by 285 providers across 49 mental health programs in a large urban public mental health system. Variables representing dimensions of organizational climate and transformational leadership accounted for the greatest amount of variance in provider reported burnout. Analyses demonstrated significantly lower levels of depersonalization among wraparound providers compared to traditional case managers. Age was the only demographic variable related to burnout. Additionally, no significant effects were found for provider discipline or for agency tenure and caseload size. Results suggest the need to consider organizational development strategies aimed at creating more functional and less stressful climates and increasing levels of transformational leadership behaviors in order to reduce levels of burnout among clinicians working in public mental health settings for youth and families.

Food Insecurity Among Adults With Severe Mental Illness

Food Insecurity Among Adults With Severe Mental Illness

A review of social inclusion measures

Social inclusion is crucial to mental health and well-being and is emphasised in Australia's Fourth National Mental Health Plan. There is a recognition that a measure of social inclusion would complement the suite of outcome measures that is currently used in public sector mental health services. This paper is an initial scope of candidate measures of social inclusion and considers their suitability for this purpose. We identified potential measures through searches of PsycINFO and Medline and a more general Internet search. We extracted descriptive and evaluative information on each measure identified and compared this information with a set of eight criteria. The criteria related to the measure's inclusion of four domains of social inclusion outlined in Australia's Fourth National Mental Health Plan, its usability within the public mental health sector and its psychometric properties. We identified 10 candidate measures of social inclusion: the Activity and Participation Questionnaire (APQ-6); the Australian Community Participation Questionnaire (ACPQ); the Composite Measure of Social Inclusion (CMSI); the EMILIA Project Questionnaire (EPQ); the Evaluating Social Inclusion Questionnaire (ESIQ); the Inclusion Web (IW); the Social and Community Opportunities Profile (SCOPE); the Social Inclusion Measure (SIM); the Social Inclusion Questionnaire (SIQ); and the Staff Survey of Social Inclusion (SSSI). After comparison with the eight review criteria, we determined that the APQ-6 and the SCOPE-short form show the most potential for further testing. Social inclusion is too important not to measure. This discussion of individual-level measures of social inclusion provides a springboard for selecting an appropriate measure for use in public sector mental health services. It suggests that there are two primary candidates, but neither of these is quite fit-for-purpose in their current form. Further exploration will reveal whether one of these is suitable, whether another measure might be adapted for the current purpose or whether a new, specifically designed measure needs to be developed.

Planning estimates for the provision of core mental health services in Queensland 2007 to 2017

To derive planning estimates for the provision of public mental health services in Queensland 2007-2017. We used a five-step approach that involved: (i) estimating the prevalence and severity of mental disorders in Queensland, and the number of people at each level of severity treated by health services; (ii) benchmarking the level and mix of specialised mental health services in Queensland against national data; (iii) examining 5-year trends in Queensland public sector mental health service utilisation; (iv) reviewing Australian and international planning benchmarks; and (v) setting resource targets based on the results of the preceding four steps. Best available evidence was used where possible, supplemented by value judgements as required. Recommended resource targets for inpatient service were: 20 acute beds per 100,000 population, consistent with national average service provision but 13% above Queensland provision in 2005; and 10 non-acute beds per 100,000, 65% below Queensland levels in 2005. Growth in service provision was recommended for all other components. Adult residential rehabilitation service targets were 10 clinical 24-hour staffed beds per 100,000, and 18 non-clinical beds per 100,000. Supported accommodation targets were 35 beds per 100,000 in supervised hostels and 35 places per 100,000 in supported public housing. A direct care clinical workforce of 70 FTE per 100,000 for ambulatory care services was recommended. Fifteen per cent of total mental health funding was recommended for community support services provided by non-government organisations. The recommended targets pointed to specific areas for priority in Queensland, notably the need for additional acute inpatient services for older persons and expansion of clinical ambulatory care, residential rehabilitation and supported accommodation services. The development of nationally agreed planning targets for public mental health services and the mental health community support sector were identified as priorities.

Evidence supports the obvious: suicides need not happen

Evidence supports the obvious: suicides need not happen