Shortage Of Mental Health Professionals Research Articles

Experience of Trained Primary Health Care Workers in Mental Health Service Delivery across Ogun State Nigeria

Background: In developing countries with shortage of mental health professionals, paramedics are trained in the delivery of mental health services. Knowledge of the experience of the trained health workers is useful in evaluating output of service and restructuring training package. This study was undertaken to determine the experience of trained primary health care (PHC) workers in mental health service delivery across Ogun State South west Nigeria. Methods: Aro Primary Care Mental Health Program (APCMHP) was developed for the training of 80 PHC workers across the state using adapted mhGAP intervention guide to assess and treat/ refer five priority conditions: Psychosis, Depression, Epilepsy, Alcohol & Substance Abuse and Other Significant Emotional Complaint (OSEC). Data was collected on their experience 12 months after commencement of service delivery. Descriptive statistics were used and appropriate ethical approval was obtained. Results: Out of the 80 PHC workers, attrition of 25 (31.3%) was recorded in 12 months period. 54 valid questionnaires were analyzed. There were 52 (96.3%) females and 90.7% were nurses. The mean (SD) age was 42.4 (16.3) years. A total of 473 patients were seen with diagnostic breakdown as follows: Psychosis (45.9%), Epilepsy (38.3%), Depression (10.1%), OSEC (3.2%) and Alcohol & Substance Abuse (2.5%). Diagnostic and treatment difficulty was reported for the following: Psychosis (23.1%), Depression (22.0%), Epilepsy (3.7%), OSEC (52.2 %) and Alcohol & Substance Abuse (57.1%). Personal fulfillment in mental service delivery was reported by 88.5%, while 94.3% reported that the program was helpful to the community. Good attitude of clients and relatives towards the program was identified by 86.8% of the PHC workers. Conclusion: Our study revealed a high personal fulfillment of the trained PHC workers in mental health service delivery. There is need for re-training of the PHC workers towards effective service delivery.

Further examination of predictors of turnover intention among mental health professionals.

Introduction Given the global shortage of mental health professionals, high turnover rates within this workforce are concerning. We used United States of America Veterans Health Administration data to add to the limited knowledge about this topic. Aim We examined predictors of turnover intention, or an employee's cognitive withdrawal from their job, in a large sample of direct care mental health professionals, separating among occupations to increase the pragmatic relevance of our findings. Method Survey data from 10997 mental health employees working in direct patient contact (2432 registered nurses, 3769 social workers, 2520 psychologists and 1276 psychiatrists) were used in a cross-sectional design with structural equationmodelling techniques for model testing. Results Job satisfaction was predicted by civility (courteous and respectful workplace behaviours) and supervisory support. Job satisfaction predicted emotional exhaustion which predicted turnover intention. Job satisfaction also directly predicted turnover intention and turnover plans. Discussion Predictors of job satisfaction included civility and supervisory support. Emotional exhaustion predicted turnover intention. Results inform organizational actions to address these work environment characteristics. Implications for practice Organizations can initiate culture changes to improve civility and develop supervisors' 'soft skills' in conjunction with technical expertise.

Brain drain: a challenge to global mental health.

The brain drain of medical professionals from lower-income to higher-income countries contributes to the current inequity that characterises access to mental healthcare by those in need across the world and hinders efforts to scale up mental health services in resource-constrained settings, especially in Nigeria and other West African countries. The migration of skilled workers is driven by a combination of the globalisation of the labour market and the ability of highly resourced countries to attract and retain specialists from poorer countries. If we are to ameliorate the worldwide shortage of mental health professionals, we need to find innovative ways of attracting young doctors into psychiatric training in all countries. We must also introduce measures to improve health worker retention in low- and middle-income countries.

Call to action: Interprofessional mental health collaborative practice in rural and northern Canada.

Shared within health care is needed in rural and northern Canada where residents are challenged with greater social and health disparities. Compared to their urban counterparts, Canadians in these areas experience lower socioeconomic status; higher rates of disability; higher rates of unemployment; higher mortality rates; difficulty with transportation, thereby limiting access to essential health services; and higher rates of chronic illness (Barbopoulos & Clark, 2003; Canadian Institute for Health Informatics, 2006). Downsizing of hospitals in rural and northern areas is causing outmigration of health care services to centralized urban areas, forcing rural Canadians to travel greater distances to access health care services (Canadian Collaborative Mental Health Initiative [CCMHI], 2006). A lack of access to health care is frequently noted as a key issue facing rural and northern residents (Donato, 2015; Haggarty, Ryan-Nicholls, & Jarva, 2010; McIlwraith & Dyck, 2002; Ryan-Nicholls, 2004). Shortages of mental health professionals in rural, northern, and Aboriginal communities in Canada are well documented (Kulig & Williams, 2012; McIllwariath & Dyck, 2002; Pawlenko, 2005).Interprofessional mental health collaborative practice (IMHCP) is an emerging and vital response to meet the mental health-related demands in rural and northern Canada and is an enhancement of the current Canadian health practice of Interprofessional Practice (IPP; (CCMHI, 2006; Coffey & Anyinam, 2015; Commission on the Future of Health Care in Canada [CFHC], 2002; Haggarty et al., 2010; Heath et al., 2015). IPMHC involves developing and maintaining effective interprofessional working relationships with professionals, paraprofessionals, students, mental health consumShelley ers, families, and communities to ensure optimal health outcomes (Canadian Interprofessional Health Collaborative [CIHC], 2010). Effective collaboration requires individual professionals to reframe their views from the traditional 'we know best' mind-set to a holistic approach (CCMHI, 2006; Coffey & Anyinam, 2015; Petrie, 1976). Pearce and Sims (2001) define shared as leadership that emanates from members of teams, and not simply from the appointed leaders (p. 115). It is the authors' contention that psychology must fully embrace a shared role in IMHCP in rural and northern communities, not only within clinical practice but also within professional psychology associations and regulatory bodies. We discuss the opportunities and challenges this may create and how the scholarly literature can guide our next steps.BackgroundThe Romanow Report (CFHC, 2002) continues to be one of the most influential documents in modern health care delivery in Canada. Over the past decade, recommendations from this document have led to systemwide advances in IPP and interprofessional education (IPE). In response, provincial and territorial directives have been targeting collaborative practice as one of their priorities in streamlining quality health care (Canadian Health Services Research Foundation, 2011; Coffey & Anyinam, 2015; Health Professions Regulated Advisory Council [HPRAC], 2006; Province of Nova Scotia, 2014). IPP is now an explicit expectation within most standards of practice for self-regulated health care professions in Canada and is mandated by their respective regulatory bodies (Human Resources Professionals Association, 2015). National organisations specifically designed to promote awareness and education in this field, such as the CIHC (2010), are also emerging. As well, IPE is expanding within universities across Canada, supporting multimodal opportunities for clinical simulations in IPP (Church et al., 2010; Cornish et al., 2003; Curran et al., 2012; Dalhousie University, 2015a; Donato, 2015).Yet within rural and northern communities, there remain challenges with efficiently implementing IMHCP because these large, isolated geographic areas are being serviced by low numbers of health professionals representing a small number of disciplines. …

The Mental Health Education Gap among Primary Care Providers in Rural Nepal.

In low- and middle-income countries, the majority of individuals with mental illness go untreated largely because of a severe shortage of mental health professionals. Global initiatives to close the mental health treatment gap focus on primary care providers delivering this care. For this to be effective, primary care providers require the skills to assess, diagnose, and treat patients with mental illness. To assess primary care providers' training and experience in caring for mental health patients, the authors conducted five focus groups at three isolated district hospitals in rural Nepal where there was no access to mental health professionals. Primary care providers reported limited training, lack of knowledge and skills, and discomfort in delivering mental health care. To address the mental health education gap, primary care providers in Nepal, and perhaps other low- and middle-income countries, require more training during both undergraduate and graduate medical education.

Building The Mental Health Workforce Capacity Needed To Treat Adults With Serious Mental Illnesses.

There are widespread shortages of mental health professionals in the United States, especially for the care of adults with serious mental illnesses. Such shortages are aggravated by maldistribution of mental health professionals and attractive practice opportunities treating adults with less severe conditions. The Affordable Care Act (ACA) and legislation extending mental health parity coverage are contributing to an increasing demand for mental health services. I consider four policy recommendations to reinvigorate the mental health workforce to meet the rising mental health care demand by adults with serious mental illnesses: expanding loan repayment programs for mental health professionals to practice in underserved areas; raising Medicaid reimbursement for treating serious mental illness; increasing training opportunities for social workers in relevant evidence-based psychosocial services; and disseminating service models that integrate mental health specialists as consultants in general medical care. Achieving progress in attracting mental health professionals to care for adults with serious mental illnesses will require vigorous policy interventions.

Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa.

BackgroundPerinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town.MethodsQualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa.ResultsThe findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual.ConclusionThe development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0873-y) contains supplementary material, which is available to authorized users.

Bill Would Include Psychiatrists in Loan Repayment Program in Calif.

Bill Would Include Psychiatrists in Loan Repayment Program in Calif.

The Empirical Evidence for Telemedicine Interventions in Mental Disorders.

This research derives from the confluence of several factors, namely, the prevalence of a complex array of mental health issues across age, social, ethnic, and economic groups, an increasingly critical shortage of mental health professionals and the associated disability and productivity loss in the population, and the potential of telemental health (TMH) to ameliorate these problems. Definitive information regarding the true merit of telemedicine applications and intervention is now of paramount importance among policymakers, providers of care, researchers, payers, program developers, and the public at large. This is necessary for rational policymaking, prudent resource allocation decisions, and informed strategic planning. This article is aimed at assessing the state of scientific knowledge regarding the merit of telemedicine interventions in the treatment of mental disorders (TMH) in terms of feasibility/acceptance, effects on medication compliance, health outcomes, and cost. We started by casting a wide net to identify the relevant studies and to examine in detail the content of studies that met the eligibility criteria for inclusion. Only studies that met rigorous methodological criteria were included. Necessary details include the specific nature and content of the intervention, the research methodology, clinical focus, technological configuration, and the modality of the intervention. The published scientific literature on TMH reveals strong and consistent evidence of the feasibility of this modality of care and its acceptance by its intended users, as well as uniform indication of improvement in symptomology and quality of life among patients across a broad range of demographic and diagnostic groups. Similarly, positive trends are shown in terms of cost savings. There is substantial empirical evidence for supporting the use of telemedicine interventions in patients with mental disorders.

Abstract: Workplace Setting of Mental Health Nursing Program Graduates in Rwanda

Background: The department of Mental Health Nursing (MHN) at the University of Rwanda was founded in 1998.Until that time, Rwanda had faced a huge shortage of mental health professionals; specifically, there were 1 psychiatrist, 3 mental health nurses and very few clinical psychologists (less than 5) in the country. The purpose of creating the Mental Health Nursing program was to foster the mental well-being of Rwandans who survived the tragic events related to the 1994 genocide against the Tutsi.The aim of this study was to evaluate the MHN graduates’ work place settings in relationship to mental health needs in Rwanda. This was a descriptive study. The respondents were graduates from 2000-2014 and the collection of data related to their workplace was made using phone calls to all former students. About 326 out of 348 (93.67%) were reached and for the 22 (6.32%) we did not manage to get information about them. Results: Since its existence, the department has graduated 348 mental health nurses at the A1 level who are integrated in the national existing pyramidal structure of care. The employment rate was 90.79 % and most of them were working in hospitals: 26.43% in district hospitals and 24.13% in referral hospitals. Conclusion: The current professional placements of the mental health nursing workforce in Rwanda ascertain that these placements correlate with the National Mental Health Policy. All structures of the national health system are provided but they are far from reaching the grassroots level and mental health needs of the population, 26, 1% of which had PTSD. Further placement of MHN must reinforce the community level, including Health Centers. Keywords: mental health nursing, work place, Rwanda

Recruitment and retention of mental health care providers in rural Nebraska: perceptions of providers and administrators

The nationwide shortage of mental health professionals is especially severe in rural communities in the USA. Consistent with national workforce statistics, Nebraska's mental health workforce is underrepresented in rural and frontier parts of the state, with 88 of Nebraska's 93 counties being designated as federal mental health professional shortage areas. Seventy-eight counties have no practicing psychiatrists. However, supply statistics alone are inadequate in understanding workforce behavior. The objective of this study was to understand mental health recruitment and retention issues from the perspectives of administrators and mental healthcare professionals in order to identify potential solutions for increasing the mental health workforce in rural communities. The study used semi-structured focus groups to obtain input from administrators and mental health providers. Three separate focus groups were conducted in each of four regions in 2012 and 2013: licensed psychiatrists and licensed psychologists, licensed (independent) mental health practitioners, and administrators (including community, hospital, and private practice administrators and directors) who hire mental health practitioners. The transcripts were independently reviewed by two reviewers to identify themes. A total of 21 themes were identified. Participants reported that low insurance reimbursement negatively affects rural healthcare organizations' ability to attract and retain psychiatrists and continue programs. Participants also suggested that enhanced loan repayment programs would provide an incentive for mental health professionals to practice in rural areas. Longer rural residency programs were advocated to encourage psychiatrists to establish roots in a community. Establishment of rural internship programs was identified as a key factor in attracting and retaining psychologists. To increase the number of psychologists willing to provide supervision to provisionally licensed psychologists and mental health practitioners, financial reimbursement for time spent in this activity was identified as important. The present study showed that a comprehensive approach is needed to address workforce shortage issues for different types of professionals. In addition, systemic issues related to reimbursement and other financial aspects must be resolved to strengthen the overall rural mental healthcare delivery system.

Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems.

Mental disorders are significant contributors to the global burden of disease (1). While they occur across all levels of socio-economic status, the majority of populations in low- and middle-income countries (LMICs) do not have access to effective psychological and pharmacological interventions (2). Key barriers to sustainable delivery of psychological therapies in LMICs include limited mental health funding and infrastructure, chronic shortage of mental health professionals, lack of treatments adapted to the local context, and challenges associated with training and supervision. Implementation of low-intensity psychological interventions by trained para-professionals is one potential solution to this problem (3,4) which is receiving significant attention as part of global mental health research agendas (e.g.,(5)). A number of low-intensity interventions have demonstrated clinical benefit and utility in high-income settings. For example, early analyses of the UK’s Improving Access to Psychological Therapies programme (IAPT,(6)) found a substantial reduction in depression and anxiety in people who attended at least two sessions of low-intensity interventions. Additionally, a recent meta-analysis challenged conventional thinking and provided support for low-intensity interventions as an effective treatment even for individuals with symptoms of severe depression (7). Evidence for the applicability of psychological interventions by non-specialists in LMICs is mounting (8,9). For instance, group interpersonal psychotherapy facilitated by local para-professionals has been shown to be effective in rural Uganda among depressed adults compared to usual care at six month follow-up (10). In rural Pakistan, Rahman et al (11) found that local community health workers could effectively deliver a locally adapted cognitive-behavioural intervention for perinatal depression. Mothers receiving the treatment demonstrated significant clinical improvement on depression symptoms, showed less disability and better overall and social functioning. Finally, a comparatively more intensive transdiagnostic intervention, the Common Elements Treatment Approach (CETA), has shown promising results for the treatment of symptoms of depression, anxiety and post-traumatic stress in Burmese refugees when delivered by para-professionals (12). To fill the gap between mental health needs and access to quality care, and extend the current research on low-intensity interventions in LMICs, the World Health Organization (WHO) – as part of its Mental Health Gap Action Programme (mhGAP) – has begun to develop and test low-intensity psychological interventions. The current paper focuses on one such intervention, named Problem Management Plus (PM+).

Online Information Searches and Help Seeking for Mental Health Problems in Urban China.

In recent years, the Internet has emerged as an alternative information source on mental health problems. Yet, the profile of the typical Internet help seeker is to be determined. Based on data from a household survey of 2558 Beijing residents, the study investigates online information searches and help seeking for mental health problems. Multinomial logistic regressions are estimated for respondents' access to the Internet, and mental-health-related information searches and help seeking on the Internet for the whole community sample and the most psychologically distressed subsample. The study identifies a digital divide in online help seeking for mental health issues based on age, migration and hukou status, and socio-economic factors. Youth and high socio-economic status are significant predictors of Internet access and use. Among the whole community sample, rural-to-urban migrants are less likely to have access to the Internet and search information or seek help online. Among the most psychologically distressed subsample, urban-to-urban migrants are significantly more likely to have access to the Internet and search information or seek help online. Given the shortage of mental health professionals in China, online information dissemination and guided self-help, if properly designed, could offer a means to reach large numbers of individuals in a cost-effective manner.

Searching for a Screener: Examination of the Factor Structure of the General Health Questionnaire in Malaysia

Although mental health program development and service delivery have progressed in Malaysia since its independence in 1957, a shortage of mental health professionals remains a main barrier to mental health care ( Haque, 2005 ). Stigma and cultural beliefs about mental illness may further impede psychological help-seeking. An easy-to-use mental health screener such as the 12-item General Health Questionnaire (GHQ-12) could be used to streamline mental health service delivery and to facilitate integration into primary health care settings. In this study, we conducted a Multigroup Confirmatory Factor Analysis (MGCFA) across English and Chinese language versions for the GHQ-12 to examine the fit of existing factor structures for the GHQ-12. Participants were Malaysian college students of diverse ethnicities attending 2 schools in Malaysia who completed English or Chinese versions of the GHQ-12 (English subsample, n = 151, Chinese subsample, n = 127). Results suggested that an eight-item version of Ye’s (2009) model provided the best fit for both language versions. However, some items on the Chinese version appear to underestimate general psychological distress compared with the English version, thus potentially limiting its utility. Possible reasons for differential item performance and implications of the study are discussed.

Hong Kong: recent development of mental health services

SummaryFrom a very deprived baseline, mental health services in Hong Kong have undergone some growth over the past decade. The number of inpatient beds for psychiatric treatment dropped by one-third, but the community mental health service expanded significantly. A number of low-resource phase-specific and age-specific treatment programmes were introduced, with promising initial results. However, there remain many challenges, including a serious shortage of well-trained mental health professionals. Much more investment in mental health workforce development is required to meet the service needs not only of today, but also of tomorrow.

Peer support program for veterans in rural areas.

Peer support program for veterans in rural areas.

AIDS in South Africa: Therapeutic interventions to strengthen resilience among orphans and vulnerable children

Worldwide, approximately 10% of the 34.2 million individuals infected by human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are under the age of 18. Additionally, 17.8 million children have experienced one or both parents dying of HIV/AIDS. In comparison to other countries, South Africa has the highest per capita of recorded HIV/AIDS cases. These deaths have altered the social landscape by compromising the security and stability of communities and families. In order to address these challenges, research-based and practitioner-recommended interventions are offered to strengthen South African children's resilience and to facilitate their emotional well-being. In particular, orphans and vulnerable children (OVC) affected by HIV/AIDS must be supported in continuing their education and staying connected with immediate family, extended family, peers, and teachers. Acknowledging the shortage of mental health professionals, school psychologists are encouraged to prepare teachers and caregivers to share responsibility in implementing interventions to support OVC.

Attracting psychologists to practice in rural Australia: The role of work values and perceptions of the rural work environment

To investigate whether psychologists' career/work values and perceptions of the rural work environment influence their intentions or choice to practise in a rural location beyond the effect of rural background. Online, cross-sectional survey assessed rural background, work values and perceptions of the reinforcers available in rural and urban work environments. One hundred and eighty-nine first year psychology students (78.8% women) and 124 registered psychologists (84.7% women). Students' intention to practise in a rural location and psychologists' choice of practice location. Rural environments were seen as offering psychologists less opportunity than urban environments to fulfil their need for lifestyle, prestige, management and scholarly pursuits, but more opportunity for service and autonomy. Practitioners and students who placed less value on prestige were more likely to have worked in a rural area or be intending to do so. High value of service was also a predictor of rural intentions. Perceptions that rural work environments offered opportunities for scholarly pursuits increased the odds that a psychologist had spent time practising in a rural area. Person-environment fit was not significant. Recruitment and retention strategies to address the shortage of mental health professionals in rural areas need to consider perceptions of the work environment and how to fulfil practitioners' work values.

Late-life mental health education for workforce development: brain versus heart?

There is a shortage of mental health professionals to care for a growing geriatric population. Though not mutually exclusive, clinical and didactic educational experiences promote cognition, whereas affective knowledge (attitude) is promoted through nonclinical exposure to seniors. This study evaluates the relative impact of cognition and attitude on career interests among healthcare students. We developed 13 interactive, video documentary "lessons" on late-life mental health presenting didactic material along with stories of actual patients and families. Four of these lessons were viewed at 1-week intervals by 42 students from medical school and graduate programs of social work, psychology, and nursing. Knowledge, attitudes, and inclinations toward working with seniors were assessed. Both cognition and attitudes toward seniors improved. Linear regression shows that change in attitude, not cognition, predicts interest in working with seniors. Educational experiences that promote affective learning may enhance interest in geriatric careers among healthcare students.

Child psychopharmacology: Is it more similar than different from adult psychopharmacology?

Despite having a large chunk of human population, Asian countries face shortage of mental health professionals. There is further shortage of doctors dealing with special groups of population like the children, the elderly, and the medically ill. However, in this era of super-specializations, are the basic principles of general psychopharmacology being forgotten? Dealing with child population is different and often more difficult than adult population but are management guidelines for the two populations vastly divergent? A close look at this paints a different picture. Psychotherapies applied in adults and those in children and adolescents are disparate owing to cognitive, social, emotional, and physical immaturation in children and adolescents. But the drugs for the treatment of pediatric psychiatric disorders are mostly similar to those prescribed for adults (case in point -bipolar disorders, obsessive compulsive disorder, schizophrenia). Rather than focusing energy on propagating the differences in assorted subgroups of population, honing of skills regarding intricacies of psychopharmacology is required to be emphasized. Detailed history taking, careful evaluation of the patient, sound diagnostic formulation, and prescribing medications which are tailor made to the patient will all go a long way in ensuring a functional recovery of the patients irrespective of the group they belong to.