Specialist Mental Health Professionals Research Articles

Exploratory pedagogical research of a bespoke eye movement desensitisation and reprocessing therapy training for midwives

AbstractEye movement desensitisation and reprocessing (EMDR) therapy is a transdiagnostic, comprehensive, integrative, evidence‐based treatment intervention for post‐traumatic stress disorder (PTSD), complex PTSD, and perinatal PTSD. PTSD can arise from an experience of pregnancy or birth related trauma. Despite this, there is limited availability and access to EMDR therapy within the United Kingdom National Health Service. EMDR is a psychotherapeutic intervention which is usually delivered by highly specialist mental health professionals. However, with such a robust protocol, it is appropriate to consider if other health professionals should be trained to deliver EMDR. Humanitarian trauma capacity‐building projects in a global context have shown that task shifting can assist with addressing unmet mental health therapy needs. Midwives are highly skilled graduates working in the perinatal period who understand that women's emotional health is as important as their physical health. Therefore, it was proposed that EMDR knowledge and skills could be efficiently task shifted to midwives. The aim and objectives were to train midwives to deliver modified EMDR scripted protocols and techniques and explore qualitative and quantitative outcomes of a bespoke EMDR for midwives (EMDR‐m) educational programme. The online training was delivered to the midwives over 4 days with clinical practicums incorporated throughout. Pre and post‐tests demonstrated an increase in their EMDR knowledge, skills and confidence. EMDR Group Supervision provided by three experienced EMDR Accredited Practitioners was mandatory for 6 weeks post‐training and ongoing one‐to‐one supervision was made available. Midwives scored the course 9.6/10 (range 8–10) and described it as ‘amazing’ and ‘invaluable’. Challenges for the future include ring‐fenced time and an appropriate space to deliver the therapy. Those midwives who completed the training have progressed to deliver early EMDR‐m interventions in a perinatal mental health research study in their own Health and Social Care Trust (reported elsewhere).

"Attitudes to voices": a survey exploring the factors influencing clinicians' intention to assess distressing voices and attitudes towards working with young people who hear voices.

Due to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians' job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth. Nine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who hear voices, stigmatizing beliefs, and self-perceived confidence in voice-related practices (screening for, discussing and providing psychoeducation material about voice-hearing). Responses from youth mental health clinicians were compared with professionals working in adult mental health and primary care settings. This study also aimed to identify what youth mental health clinicians believe about assessing distressing voices in adolescents and how beliefs predict assessment intention. Compared to other clinicians, EIP clinicians reported the most positive job attitudes toward working with young voice-hearers, the highest self-efficacy in voice-hearing practices, and similar levels of stigma. Job attitudes, perceived behavioral control and subjective norms explained a large part of the influences on clinician's intention to assess voice-hearing across all service groups. In both CAMHS and EIP services, specific beliefs relating to the usefulness of assessing voice-hearing, and perceived social pressure from specialist mental health professionals regarding assessment practices predicted clinician intention. Clinicians' intention to assess distressing voices in young people was moderately high, with attitudes, subjective norms and perceived behavioral control explaining a large part of its variance. Specifically in youth mental health services, promoting a working culture that encourages opening and engaging in discussions about voice-hearing between clinicians, and with young people, and introducing supportive assessment and psychoeducation material about voice-hearing could encourage conversations about voices.

Family carers’ experiences of providing care for their adult relative with intellectual disabilities and mental health problems in Singapore

BackgroundFamilies in Singapore are primarily involved in the care of their relatives with intellectual disabilities and the study aimed to explore their experiences taking care of their relatives with intellectual disabilities and mental health problems. MethodNine unpaid family carers were interviewed. The interviews were analysed using Interpretative Phenomenological Analysis. ResultsAnalysis revealed four themes 1) Making sense of behaviours; 2) Staff are the experts; 3) Public reaction and 4) Worries and hopes for the future. ConclusionsFamily carers found it difficult to identify and manage the mental health symptoms of their relatives and sought help from specialist mental health professionals. They were satisfied with the specialist services and found psychotropic medication helpful to reduce the symptoms. Family carers expressed worries about their relative not being accepted by the public and did not make future care plans. More resources are needed to increase accessibility of specialist mental health services for people with intellectual disabilities. It is recommended for service providers to collaborate with family carers and provide them with resources and skills to empower them to care for their relatives with intellectual disabilities.

What do specialist mental health professionals think of the mental health services for people with intellectual disabilities in Singapore?

Background:This research aimed to investigate the views and experiences of specialist mental health professionals working with adults with intellectual disabilities and mental health problems in Singapore in order to gain insight into the functioning of the local specialist intellectual disability mental health service and how it may be improved.Methods:Eight staff members from specialist service were interviewed. The transcriptions of the interviews were analysed using thematic analysis.Results:Analysis revealed four themes (1) Identifying their roles; (2) Ensuring continuity of care; (3) Disempowerment of service users and (4) Improving clinical practice.Conclusions:Participants identified the challenges they faced working with this population. They highlighted the importance of building therapeutic relationships during the treatment process and discussed the stigma that people with intellectual disabilities face in the community. Recommendations and implications are discussed in relation to service provision, improving staff knowledge and recruiting more staff to work in this field.

Screening for anxiety, depression, and anxious depression in primary care: A field study for ICD-11 PHC

BackgroundIn this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. MethodsThe study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study. Screening scales as well as a structured diagnostic interview, the revised Clinical Interview Schedule (CIS-R), adapted for proposed decision rules in ICD-11 PHC, were administered to 1488 participants. ResultsA score of 3 or more on one or both screening scale predicted 89.6% of above-threshold mood or anxiety disorder diagnoses on the CIS-R. Anxious depression was the most common CIS-R diagnosis among referred patients. However, there was an exact diagnostic match between the screening scales and the CIS-R in only 62.9% of those with high scores. LimitationsThis study was confined to those in whom the PCP suspected psychological distress, so does not provide information about the prevalence of mental disorders in primary care settings. ConclusionsThe two five-item screening scales for anxiety and depression provide a practical way for PCPs to evaluate the likelihood of mood and anxiety disorders without paper and pencil measures that are not feasible in many settings. These scales may provide substantially improved case detection as compared to current primary care practice and a realistic alternative to complex diagnostic algorithms used by specialist mental health professionals.

Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries.

The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development, borne out of powerful advocacy using public health, economic and human rights arguments. As funding comes on line for scale-up of evidence-based mental health care by task-sharing with primary care, it is time to take stock about care for people affected by severe mental illness (SMI). The existing evidence base for task shared care for SMI provides an imperative to get started, but is skewed towards relatively more affluent and urban populations in middle-income countries where specialist mental health professionals provide most of the care. Randomised, controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving understanding of the quality, safety, effectiveness and acceptability of more widely generalisable care for people with SMI. A sub-group of people with SMI have more complex and long-term needs for care, with a high risk of homelessness, imprisonment and human rights violations as family and social supports become overwhelmed. Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation, recovery and empowerment of people with SMI, but rigorous comparative studies are needed to identify the most efficient, effective and scalable approaches to care. Health system constraints are emerging as the over-riding barriers to successful task-sharing, highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality, improving wellbeing and achieving better social outcomes. Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI.

Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries

BackgroundLittle is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.MethodsA situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.ResultsThe PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.ConclusionsThe low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.

A multi-level framework to guide mental health response following a natural disaster

Abstract Natural disasters can cause significant distress, grief, loss and hardship, and mental health is a key public health issue that needs to be addressed as part of a wider psychosocial response to assist affected communities. Most people who live through a natural disaster, including bereaved individuals, will not require the attention of specialist mental health professionals. In addition, because many people will cope or ‘bounce back’ on their own and with the support of others, we should be careful to not interfere with the natural coping processes of community members. In the aftermath of the Victorian bushfires in Australia in 2009, a three-level framework was developed that outlined three levels of response to enhance the capacity of lay community members as well as health and welfare personnel to provide evidence-informed care, support and interventions.

Mental health emergencies: using a structured assessment framework

People who have mental health crises while attending emergency departments require immediate assessment and management, and staff need to be prepared to meet the specific needs of this patient group. This article provides an overview of the Public Psychiatric Emergency Assessment Tool, which is used by Lancashire Constabulary, among others, to share information with healthcare professionals. By using the tool, practitioners can organise and structure the information they acquire during patient assessments, and from accompanying carers, paramedics or police. They can then pass this information on to specialist mental health professionals.

Lessons learned in developing community mental health care in Australasia and the South Pacific

This paper summarizes the findings for the Australasia and Pacific Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health services in the region; discuss policies, plans and programmes; chart progress towards achieving community-oriented services, and detail the lessons learned.

Alcohol misuse: screening and treatment in primary dental care

Unlike primary medical care, primary dental care services are used by patients on a regular, prevention-orientated basis. This provides the primary dental healthcare team with unique opportunities to intervene, particularly as asking patients about their levels of alcohol consumption is a routine component of medical history taking. Effective treatment options include motivational advice, information leaflets and, when necessary, referral to specialist mental health professionals in consultation with the patient’s medical practitioner.

Preventive psychiatry: a paradigm to improve population mental health and well-being

The government's Public Health White Paper for England sets out a utopian vision of how to prevent and remedy mental health problems. The public health approach relies on primary prevention, promoting individual responsibilities and resilience, while also sustaining existing services and tackling inequalities. These ambitions are consistent with the preventive psychiatric paradigm, and with the best of evidence-based psychiatric practice. Although the evidence on cost-effectiveness of public mental health interventions is growing, the challenge is to ensure that specialist knowledge informs policy, practice and research so that inequalities are not compounded. Specialist mental health professionals are needed to inform and lead public health reforms.

Improving the skills of rural and remote generalists to manage mental health emergencies

People living in rural and remote areas have been found to suffer higher rates of mental illness and psychological distress than their urban counterparts. However, rural and remote Australians also suffer from a lack of specialist mental health services. Mental health consumers are concerned about the lack of access to specialist mental health care and report poor service quality and stigmatizing staff attitudes when presenting with mental health emergencies at acute care facilities. Standards for the Mental Health Workforce released in 2002 promote respect for the individual, their family and carers; best practice in the assessment, early detection and management of acute illness; promotion of mental health and safety; and the prevention of relapse. These standards are for generalists providing care to mentally ill patients; their family and carers in the acute care setting; as well as specialist mental health professionals. Up-skilling generalists in rural and remote areas to respectfully and effectively manage mental health emergency care is a priority. A short course, 'Managing Mental Health Emergencies' was developed by the Australian Rural Nurses and Midwives in 2002. Almost 750 participants had completed the course at the time of the evaluation. The objectives of the course were to: develop an increased knowledge of mental health presentations and gain confidence in managing and assessing mental health clients; gain an understanding of the referral processes in the local environment; gain an insight into the impact of mental health emergencies on individuals, their family and carers; and identify strategies to minimise the impact of managing mental health emergencies on the healthcare team. The model of training matched what is known to be best practice in rural and remote health practitioner development in emergency care, being local, interdisciplinary, and engaging local expert service providers while being overseen by a national steering committee. The evaluation consisted of a pre- (n=456) and post-course (n=163) survey, and follow-up interviews with participants between 3 and 6 months post-course (n=44). The pre- and post-survey identified that, as a result of the course, participants had improved confidence in seeking information about suicide ideation, were significantly more able to differentiate between substance intoxication and psychosis (χ(2)[df=1, n=619] =140.9, p<.000); and between dementia and delirium (χ(2)[df=3, n=619] =126.5, p<.000). The follow-up interview notes were analysed using thematic analysis. Three themes were used: changing attitudes; changing clinical practice; and communication. Participants had reflected on their attitudes following the course and recognized how these had been stigmatizing. Many participants reported putting their new skills into practice and reported better recognition of non-verbal cues and better information seeking from family members, past history and police. The Managing Mental Health Emergencies course is a valuable addition to the emergency courses available to rural and remote healthcare providers.

Cultural Features as Advantageous to Therapy: A Singaporean Perspective

Singapore is a nation comprised of a multicultural, multiethnic population. When working with non-Western clients, cultural differences are sometimes experienced as obstacles to therapy. However, it is important to note that many features of Asian culture and lifestyle can be protective and unique solutions can be derived from the individual or family’s culture and context. This article hopes to add to the existing literature through a discussion of how systemic therapy is amenable to the Singaporean context and how specific cultural features of the Singaporean Chinese, while presenting at times as obstacles to therapy, can also be seen as potential strengths and employed as resources when working with these families.

Detection of child mental health problems in the school setting

AbstractSchools are an important setting for identification of children with mental health Problems, for referral to specialist mental health Professionals, and for preventive interventions. To ensure optimal Provision of mental health interventions, it is necessary understand how school Systems already identify and support such students. Focus groups with 77 teachers, guidance officers, and school principals in southeast Queensland explored how these school personnel perceive their students’ mental health difficulties. The eight groups identified existing child mental health problems and were aware of a number of early signs of mental health problems. Participants expressed concerns that children with internalising problems were not receiving appropriate Services, and they identified several barriers to effective communication with families and within the education sector. There are implications for the development of evidence-based approaches in the primary and secondary prevention of mental health problems in children.

Employment of counsellors and mental health professionals by fundholding general practices

Recent surveys have shown that general practitioners have begun to employ practice counsellors. The recent establishment of fundholding practices has made it possible for general practitioners (GPs) to be direct purchasers of health services. The number and nature of counsellors and specialist mental health professionals directly employed by fundholding practices is reported.

Specialist mental health treatment in general practice: a meta-analysis.

A meta-analysis of studies was carried out to compare treatment by specialist mental health professionals in the general practice setting and 'usual GP treatment'. Overall, treatment by specialist mental health professionals had a 10% greater success rate.