Traditional Mental Health Care Research Articles

Mental health and exploitation, violence and abuse: the domestication of articles 5 and 16 of the African Charter on Human and Peoples’ Rights in Ghana and its implication for conventional and traditional mental healthcare

ABSTRACT:
 This article assesses the critical situation of inhumane and degrading treatment in the mental healthcare practice through a review of the interaction between the right to health and the right to be free from exploitation, violence and abuse. The article reflects on the domestication of articles 5 and 16 of the African Charter on Human and Peoples’ Rights and the status of exploitation, violence and abuse in conventional and traditional mental healthcare in Ghana. Since the enactment of the Ghanaian new and progressive mental health law in 2012, specific measures have been put in place to advance the protection of persons within the mental healthcare setting: mental healthcare workers, including traditional and faith-based practitioners, have been trained on human rights; guidelines have been published; and programmes such as the QualityRights initiative have been launched. A normative analysis, combined with literature review, interviews and field visits, help to uncover barriers impeding implementation of the law and reveal gaps that remain, which automatically leaves room for exploitation, violence and abuse. The paradigm shift from a rather paternalistic approach in mental healthcare to one that promotes and respects autonomy and dignity is slow. There is still much to be desired. This article argues that there is a need to reassess or further define domestic legal provisions allowing for involuntary treatment and restraints, establish a stronger human rights oversight body, strengthen cooperation between the formal and informal mental healthcare providers, and create a legal forum where persons whose rights have been infringed can seek redress. Ultimately, these advancements could ensure that the provided right, namely to be free from exploitation, violence and abuse in mental healthcare, translates into actual change.
 
 TITRE ET RÉSUMÉ EN FRANCAIS:
 Santé mentale et exploitation, violence et abus: l’incorporation en droit interne des articles 5 et 16 de la Charte africaine des droits de l’homme et des peuples et son incidence sur le système conventionnel et traditionnel des soins de santé mentale au Ghana
 RÉSUMÉ:
 Cette contribution examine la question des traitements inhumains et dégradants dans la pratique des soins de santé mentale à travers une analyse de l’interaction entre le droit à la santé et le droit de ne pas être soumis à l’exploitation, à la violence et aux abus. L’article se penche sur l’incorporation en droit interne des articles 5 et 16 de la Charte africaine des droits de l’homme et des peuples et sur l’état des lieux de l’exploitation, de la violence et des abus dans les soins de santé mentale conventionnels et traditionnels au Ghana. Depuis que la loi sur la santé mentale au Ghana a été promulguée en 2012, des mesures spécifiques ont été mises en place pour renforcer la protection des personnes impliquées dans le système des soins de santé mentale: des agents de santé mentale, notamment les tradi-thérapeutes et guérisseurs religieux, ont suivi une formation sur les droits de l’homme; des directives ont été publiées; et des programmes tels que l’initiative « Quality Rights » ont été mis en œuvre. Cette contribution se fonde sur une analyse normative et doctrinale, d’entretiens et de visites de terrain pour appréhender les obstacles à la mise en œuvre de la loi et de révéler les lacunes qui subsistent. Ces dernières continuent à causer l’exploitation, la violence et les abus. Le changement de paradigme, c’est-à-dire d’une approche paternaliste en matière de santé mentale vers une approche qui favorise et respecte l’autonomie et la dignité, est plutôt lent. Il reste donc fort à faire. Cette contribution postule qu’il est nécessaire de réévaluer ou de définir les dispositions légales nationales permettant un traitement et des contraintes involontaires, de mettre en place un organe de protection des droits de l’homme plus efficace, de renforcer la coopération entre les prestataires formels et informels de soins de santé mentale et de créer un forum juridique où les victimes des violations des droits de l’homme peuvent demander réparation. À terme, ces progrès pourraient faire en sorte que le droit prévu, à savoir de ne pas être soumis à l’exploitation, à la violence et aux mauvais traitements en matière de santé mentale, se traduise en un changement réel.

Mobile interventions targeting common mental disorders among pregnant and postpartum women: An equity-focused systematic review.

Pregnant and postpartum women face major psychological stressors that put them at higher risk of developing common mental disorders, such as depression and anxiety. Yet, their limited access to and uptake of traditional mental health care is inequitable, especially during the COVID-19 pandemic. Mobile interventions emerged as a potential solution to this discontinued healthcare access, but more knowledge is needed about their effectiveness and impact on health equity. This equity-focused systematic review examined the effectiveness and equity impact of mobile interventions targeting common mental disorders among pregnant and postpartum women. We systematically searched MEDLINE, EMBASE, PsychINFO and 3 other databases, from date of database inception and until January 2021, for experimental studies on mobile interventions targeting pregnant and postpartum women. We used pooled and narrative synthesis methods to analyze effectiveness and equity data, critically appraised the methodological rigour of included studies using Cochrane tools, and assessed the certainty of evidence using the GRADE approach. Our search identified 6148 records, of which 18 randomized and non-randomized controlled trials were included. Mobile interventions had a clinically important impact on reducing the occurrence of depression (OR = 0.51 [95% CI 0.41 to 0.64]; absolute risk reduction RD: 7.14% [95% CI 4.92 to 9.36]; p<0.001) and preventing its severity perinatally (MD = -3.07; 95% CI -4.68 to -1.46; p<0.001). Mobile cognitive behavioural therapy (CBT) was effective in managing postpartum depression (MD = -6.87; 95% CI -7.92 to -5.82; p<0.001), whereas other support-based interventions had no added benefit. Results on anxiety outcomes and utilization of care were limited. Our equity-focused analyses showed that ethnicity, age, education, and being primiparous were characteristics of influence to the effectiveness of mobile interventions. As the COVID-19 pandemic has increased the need for virtual mental health care, mobile interventions show promise in preventing and managing common mental disorders among pregnant and postpartum women. Such interventions carry the potential to address health inequity but more rigorous research that examines patients' intersecting social identities is needed.

25.2 ETHICAL DILEMMAS/CHALLENGES IN PSYCHIATRIC TREATMENT OF CHILDREN WITH INTELLECTUAL DEVELOPMENTAL DISORDERS DURING COVID-19

The objectives of this presentation are to: 1) present information on the challenges faced by psychiatry practitioners in providing effective, ethical, and evidence-based pharmacological treatment to individuals with intellectual developmental disorders (IDDs) during the sudden disruption of care due to COVID-19; and 2) discuss steps taken to overcome these challenges and how they could positively inform future care. A review of the current evidence-based literature on this topic along with a presentation of real-life cases from the presenter’s clinical practice of youth with IDD and severe complex behaviors will be completed. Ethical and treatment-related legal dilemmas will be discussed. Participants will gain understanding of the successful adaptations to traditional mental health care that was made during the COVID-19 pandemic and gain ideas on incorporating some of these helpful strategies moving forward in providing treatment to these families with special needs. The COVID-19 pandemic disproportionally affected families of youth with IDD. Sudden disruption in skill building and behavioral therapies along with academic and in-home supports led to worsening of problem behaviors and mental health conditions in these individuals. Psychiatrists were placed in the role of managing rapid decompensation of symptoms while adapting to newer ways of providing care without the usual community supports available to these families, which included being creative about utilizing pharmacological interventions to manage worsened and unmasked mental health symptoms in this population.

Psychotheraputic Dimensions of an Islamic-Sufi-Based Rehabilitation Center: A Case Study

Due to limitedprofessional mental health facilities in Indonesia, traditional and faith-based mental health care isessential to provide an alternative treatment. This study explored the therapeutic aspects of treatment at Pesantren Tetirah Dhikr (PTD), an Islamic-Sufi-based rehabilitation center for people with mental illness and drug addiction in Yogyakarta, Indonesia. We employed a case-study method to understand the process of therapy and the theoretical ideas behind the practice. We conducted interviews with the Kyai (head of PTD), his assistants, and sixteen patients (called santri). The results of a thematic analysis revealed that the practice of dhikr was the essential therapeutic component for improving the participants' mental health. From an Islamic psychological perspective, the process of therapy at PTD was comparable with the process of purification of the soul in Sufism. This process comprised three stages: takhalli (purifying the soul from reprehensible attributes), tahalli (adorning the soul with noble and praiseworthy attributes), and tajalli (attaining of a pure soul). From a transpersonal psychology perspective, the effect of dhikr was comparable with the therapeutic benefits of meditation practice and other psychotherapy.

Cost-Effectiveness of a Web-Based Program for Residual Depressive Symptoms: Mindful Mood Balance.

Mindful Mood Balance (MMB) is an effective Web-based program for residual depressive symptoms that prevents relapse among patients with partial recovery from major depressive episodes. This cost-effectiveness analysis was conducted from the health plan perspective alongside a pragmatic randomized controlled trial of MMB. Adults were recruited from behavioral health and primary care settings in a large integrated health system and randomly assigned to MMB plus usual depression care (MMB+UDC) or UDC. Patients had at least one prior major depressive episode; a current score of 5-9 on the Patient Health Questionnaire-9, indicating residual depressive symptoms; and Internet access. Program costs included recruitment, coaching, and MMB licensing. Center for Medicare and Medicaid fee schedules were applied to electronic health record utilization data for psychotropic medications and psychiatric and psychotherapy visits. Effectiveness was measured as depression-free days (DFDs), converted from PHQ-9 scores collected monthly for 1 year. Incremental cost-effectiveness ratios were calculated with various sets of cost inputs. A total of 389 patients (UDC, N=210; MMB+UDC, N=179) had adequate follow-up PHQ-9 measures for inclusion. MMB+UDC patients had 29 more DFDs during follow-up. Overall, the incremental cost of MMB+UDC was $431.54 over 12 months. Incremental costs per DFD gained ranged from $9.63 for program costs only to $15.04 when psychiatric visits, psychotherapy visits, and psychotropic medications were included. MMB offers a cost-effective Web-based program for reducing residual depressive symptoms and preventing relapse. Health systems should consider adopting MMB as adjunctive to traditional mental health care services.

The experiences of peer-facilitators delivering a physical activity intervention for emergency service workers and their families

IntroductionEmergency service workers (e.g. police, fire, ambulance officers) are regularly exposed to occupational stressors and potentially traumatic events, resulting in an increased risk of poor mental and physical health. For example, emergency service workers are twice as likely to experience suicidal thoughts compared to the general population and one in ten will develop posttraumatic stress disorder. Despite this, emergency service workers face barriers to accessing traditional mental healthcare. Physical activity is non-stigmatising and may help improve the mental and physical health of this population; however, novel ways to help people engage are needed. Peers with lived experience may be well-placed to co-deliver physical activity programs alongside health professionals. The aim of this study was to understand the experiences of peer-facilitators co-delivering an online physical activity intervention for emergency service workers and their families. MethodsQualitative interviews were conducted with 6 peer-facilitators. Interviews were audio recorded, transcribed, and analysed using exploratory thematic analysis. ResultsTwo main themes were explored. The first theme related to the value of lived experience that reflected two subthemes, i) credibility and relatedness by virtue of experience; and ii) knowledge and confidence by virtue of experience. The second theme related to the impact of the peer-facilitator role on the peers themselves, whereby peer-facilitators reported an increased sense of purpose and social connection. DiscussionThis qualitative study provides insights into how peer-facilitators can complement health professionals in the delivery of physical activity interventions for emergency service workers. Further research is needed to elucidate training requirements and safety protocols.

Case studies from the digital clinic: integrating digital phenotyping and clinical practice into today’s world

The following case series provides several examples from the Digital Clinic, an outpatient mental health program which uses smartphone technology to augment traditional mental health care. The themes highlighted in this piece, expanding emotional-awareness, symptom tracking, and medication management, provide real-clinical examples of how the Digital Clinic offered remote mental health care to a diverse group of people. Furthermore, the following piece demonstrates to practicing clinicians how digital technologies, like smartphone apps, can diversify methods of clinical engagement, assist with collecting health metrics in a safe and ethical manner, and promote person centred care. With the COVID-19 pandemic forcing re-evaluation of how mental health services are provided, it is critical to ensure that digitally infused systems of care, like the Digital Clinic, are effective, accessible, and scalable.

Adaptations of an Integrated Behavioral Health Program During COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has consistently been described as an “unprecedented” global health crisis. While the focus has been primarily on the medical and economic impact of the pandemic, psychological sequelae are anticipated. Primary care is the main point of access for mental health care in the United States, making it the ideal locale to provide psychological services for a larger proportion of the population than traditional mental health care settings. The aim of this paper is to describe how our multi-state, multi-site integrated primary care program adapted and applied cognitive behavioral therapy in the context of COVID-19. Access to mental health care was disrupted despite burgeoning mental health concerns, necessitating novel approaches to providing care. A stepped-care approach was implemented within our primary care practice, which consisted of a combination of low-intensity, high-yield stress management and resiliency building resources and cognitive behavioral therapy that were delivered flexibly based on patient preference, technological capabilities, state ordinances, insurance coverage, and institutional policies. The lessons learned from this experience can inform other integrated primary care clinics in responding to the current and future pandemics.

Potential Benefits of Remote Continuous Care for Depression

Depression is a burdensome and costly disease. Treatment is not sought by over half of depressed patients, and many who suffer remain depressed despite treatment. Furthermore, there is no single treatment efficacious for all patients, with optimal outcomes precluded by access, adherence, and patient satisfaction issues. The recent proliferation of telehealth solutions has increased access to care, especially during the COVID pandemic, but problems with several of its traditional types of delivery models still exist. Rather than the provision of traditional episodic mental health care, creative mental health solutions that can provide continuous care with frequent patient-provider interactions are urgently needed. This Perspective explores how digital health solutions enable the provision of continuous types of remote care to provide relief for some of the access and capacity problems exacerbated by requirements for face-to-face types of care.

Effectiveness of an Interpersonal Psychotherapy (IPT) Group Depression Treatment for Head Start Mothers: A Cluster-Randomized Controlled Trial

Background: Maternal depression is known to be a serious problem with higher rates among poor and racial/ethnic minority mothers that can have numerous negative impacts on their children. These mothers have less access to effective care and may be wary of traditional mental health care because of the stigma. The purpose of this study was to test whether an adaptation of an Interpersonal Psychotherapy group for perinatal depression could be effective in reducing depressive symptoms of mothers whose children were enrolled in Head Start. Methods: Forty-nine mothers, randomized by site, were recruited into the intervention group, 70 into the control group. They were measured on depressive symptoms, parenting stress, parenting behavior, and parent child interaction at intake, at end of the group, and 6 months following. Results: The intervention group was lower in depressive symptoms at the end of treatment with a further decrease 6 months post intervention. There was no change in the control group. The intervention group also improved in parenting stress. Limitations: The sample size for the intervention group was smaller than desired. Conclusions: This study supports the effectiveness of this 12 session IPT group which was highly effective for a population of Head Start mothers. It is a strategy that can be adapted to other settings that serve low income mothers.

Digital Mental Health in Ireland: Effectiveness and the Future of the Service

Purpose: Mental disorders are serious concern in our society. In the era of digital technology, Telemental health and mental health apps are becoming an avenue where people seek mental health support, but in general very little is known about the effectiveness of the service considering the complexities surrounding mental disorder as a disease. In the light of COVID-19 pandemic, researchers noticed a spike in anxiety levels amongst the populace, prompting more people to use the service. The purpose of this study is to evaluate the users of the service to check the effectiveness, the cost of the service, and to ask whether users will opt for the service in the future. Design and Methods: Three major questions were asked to adult participants (ages 18-35 years; n=50). Female participants(n-25) and Male participants (n-25).Within the semi-structured interviews, participants were also allowed to share their lived experiences to enhance this study. The questions are as follows: 1. The effectiveness of the service in terms of recovery 2. The cost of service 3. The question about the future use of the service. Differences in groups and research variables were compared across the demographics. To measure psychopathology, PHQ-9, GAD-7, SAQ, Insomnia Severity Index and ASI-Lite were used to evaluate the conditions and description of the participants. This evaluation is employed to validate the patient's threshold for Telemental health intervention. Results: The people that are more likely to use the service in the future were female (85%) than their male counterpart (64%), but the groups are similar concerning the effectiveness of the service. When controlled for gender, male (85%) and female (80%) were more satisfied with the service they receive and record a positive outlook of their conditions. Compared with first-time users of the service, regular users mention service providers as key to their recovery. Participants (18-35 years, n-50) describe depression, anxiety, addictions and insomnia as the reason for the use of the service, issues responsive to neuropsychotherapeutical and cognitive behavioural therapy. About the cost, the participants (68%) seem to be satisfied with the cost while (32%) would prefer cost re-duction. (Mean age-25.96 years) and (s.d-5.32). Implications: This data shows the effectiveness of Telemental health service. If expanded on a larger scale, it can take the pressure off the traditional mental health care system in Ireland, giving the practitioners time to focus on severe mental conditions. However, variables in the contextual description of patient's experiences will require value-based treatment where individual factors (bio-psycho-social analysis) are needed to be incorporated into the treatment. Besides, the data also reveals that continuous destigmatization of mental disorders will encourage men to opt for the service if societal judgment diminishes. Translating this data to the global data on mental disorders means that those regions, including rural areas without mental health support, that is, traditional mental health care infrastructure, their governments should be encouraged to implement Telemental health service as the effectiveness is confirmed through this data. This may help reduce the morbidity numbers linked with disorders globally, thus improving the well-being of patients.

Intelligent Conversational Agents in Mental Healthcare Services: A Thematic Analysis of User Perceptions

Abstract Background: The emerging Artificial Intelligence (AI) based Conversational Agents (CA) capable of delivering evidence-based psychotherapy presents a unique opportunity to solve longstanding issues such as social stigma and demand-supply imbalance associated with traditional mental health care services. However, the emerging literature points to several socio-ethical challenges which may act as inhibitors to the adoption in the minds of the consumers. We also observe a paucity of research focusing on determinants of adoption and use of AI-based CAs in mental healthcare. In this setting, this study aims to understand the factors influencing the adoption and use of Intelligent CAs in mental healthcare by examining the perceptions of actual users. Method: The study followed a qualitative approach based on netnography and used a rigorous iterative thematic analysis of publicly available user reviews of popular mental health chatbots to develop a comprehensive framework of factors influencing the user’s decision to adopt mental healthcare CA. Results: We developed a comprehensive thematic map comprising of four main themes, namely, perceived risk, perceived benefits, trust, and perceived anthropomorphism, along with its 12 constituent subthemes that provides a visualization of the factors that govern the user’s adoption and use of mental healthcare CA. Conclusions: Insights from our research could guide future research on mental healthcare CA use behavior. Additionally, it could also aid designers in framing better design decisions that meet consumer expectations. Our research could also guide healthcare policymakers and regulators in integrating this technology into formal healthcare delivery systems. Available at: https://aisel.aisnet.org/pajais/vol12/iss2/1/ Recommended Citation Prakash, Ashish Viswanath and Das, Saini (2020) "Intelligent Conversational Agents in Mental Healthcare Services: A Thematic Analysis of User Perceptions," Pacific Asia Journal of the Association for Information Systems: Vol. 12: Iss. 2, Article 1. DOI: 10.17705/1pais.12201

Promoting Resilience Among College Student Veterans Through an Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study.

Military veterans' stigmatized views on mental disorders and traditional mental health care considerably reduce veterans' access to mental health services. The present study aimed to refine a previously developed non-stigmatizing smartphone-app intervention based on the principles of acceptance and commitment therapy for college student veterans with posttraumatic stress disorder (PTSD). To this end, we tested the acceptability of the developed prototype using a mixed-method study design. A total of nine student veterans participated in the study by using the app intervention and completing pre-post study measures and a post-intervention qualitative interview. The results showed that the intervention was highly acceptable. The results of the qualitative data analysis highlighted relevant themes related to strategies for improving the content, delivery, and structure of the intervention. The results also showed that, despite a decrease in the participants' adherence as the intervention progressed, there was a consistent improvement in the participants' resilience, PTSD, and rumination. Based on the results, the intervention was revised for prospective feasibility and efficacy testing. Our results highlight the need to use a collaborative approach in the early stage of the development of self-management PTSD interventions.

Assessing Real-Time Moderation for Developing Adaptive Mobile Health Interventions for Medical Interns: Micro-Randomized Trial.

BackgroundIndividuals in stressful work environments often experience mental health issues, such as depression. Reducing depression rates is difficult because of persistently stressful work environments and inadequate time or resources to access traditional mental health care services. Mobile health (mHealth) interventions provide an opportunity to deliver real-time interventions in the real world. In addition, the delivery times of interventions can be based on real-time data collected with a mobile device. To date, data and analyses informing the timing of delivery of mHealth interventions are generally lacking.ObjectiveThis study aimed to investigate when to provide mHealth interventions to individuals in stressful work environments to improve their behavior and mental health. The mHealth interventions targeted 3 categories of behavior: mood, activity, and sleep. The interventions aimed to improve 3 different outcomes: weekly mood (assessed through a daily survey), weekly step count, and weekly sleep time. We explored when these interventions were most effective, based on previous mood, step, and sleep scores.MethodsWe conducted a 6-month micro-randomized trial on 1565 medical interns. Medical internship, during the first year of physician residency training, is highly stressful, resulting in depression rates several folds higher than those of the general population. Every week, interns were randomly assigned to receive push notifications related to a particular category (mood, activity, sleep, or no notifications). Every day, we collected interns’ daily mood valence, sleep, and step data. We assessed the causal effect moderation by the previous week’s mood, steps, and sleep. Specifically, we examined changes in the effect of notifications containing mood, activity, and sleep messages based on the previous week’s mood, step, and sleep scores. Moderation was assessed with a weighted and centered least-squares estimator.ResultsWe found that the previous week’s mood negatively moderated the effect of notifications on the current week’s mood with an estimated moderation of −0.052 (P=.001). That is, notifications had a better impact on mood when the studied interns had a low mood in the previous week. Similarly, we found that the previous week’s step count negatively moderated the effect of activity notifications on the current week’s step count, with an estimated moderation of −0.039 (P=.01) and that the previous week’s sleep negatively moderated the effect of sleep notifications on the current week’s sleep with an estimated moderation of −0.075 (P<.001). For all three of these moderators, we estimated that the treatment effect was positive (beneficial) when the moderator was low, and negative (harmful) when the moderator was high.ConclusionsThese findings suggest that an individual’s current state meaningfully influences their receptivity to mHealth interventions for mental health. Timing interventions to match an individual’s state may be critical to maximizing the efficacy of interventions.Trial RegistrationClinicalTrials.gov NCT03972293; http://clinicaltrials.gov/ct2/show/NCT03972293

Implementation of a novel return-to-work approach for persons with affective disorders in a traditional vocational rehabilitation context: a case study

BackgroundThe person-centred Individual Enabling and Support (IES) model is a novel return-to-work (RTW) intervention for people with affective disorders that was developed from evidence-based supported employment for persons with severe mental illness. Typically, supported employment is integrated into mental healthcare and provides a network around the service user and close collaboration with employment and insurance services and employers. Introducing integrated models into a highly sectored welfare system that includes traditional mental healthcare and vocational rehabilitation is challenging. Greater knowledge is needed to understand how facilitating or hindering factors influence this introduction. The aim of this study was to investigate essential components in implementation of the IES model.MethodsA case-study was conducted and included four mental healthcare services. Data collection was comprised of semi-structured interviews with 19 key informants, documentation from meetings, and reflection notes. Analyses were performed according to directed content analysis, using the components of the Consolidated Framework of Implementation Research (CFIR) as a guiding tool. Fidelity assessments were performed at 6 and 12 months.ResultsAnticipating RTW support for the target group, and building collaborative relationships and a network with employment specialists that engaged staff in every organization were components that resulted in the greatest facilitation if IES implementation. Barriers consisted of difficulty in integrating employment specialists into the mental healthcare teams, insufficient engagement of first line managers, reorganization and differing perceptions of the IES model fit into a traditional vocational context. Delivery of the IES model had good fidelity.ConclusionsThe IES model can be implemented with good fidelity, several model advantages, and context adaptation. Team integration difficulties and negative perceptions of model fit in a traditional vocational rehabilitation context can be overcome to a certain degree, but this is insufficient for sustainable implementation on a larger scale. Policy and guidelines need to promote integrative and person-centred RTW approaches rather than a segregated stepwise approach. Further implementation studies in the traditional vocational rehabilitation context are needed.

EMental health service use among Australian youth: a cross-sectional survey framed by Andersen's model.

Objective Young adults aged 18-24 years often delay or avoid seeking help for their mental health concerns. eMental health, the use of the Internet to deliver mental health information, services and care, offers a low-cost, easy-access option. However the factors that influence online help-seeking among this cohort remain unclear. Methods Andersen's healthcare utilisation model was adapted to examine correlates of eMental health use among Australian youth. In all, 161 young adults completed an online survey comprising sociodemographic questions, online feature preferences, the Actual and General Help-seeking Questionnaires, Berkman-Syme Social Network Index, General Self-Efficacy Scale, Service Obstacles Scale and Depression, Anxiety and Stress Scales. Results Almost 70% of young people reported having previously accessed some form of online support for their personal or emotional problems. This included informal information via social media and formalised counselling services. Notably, perception of service satisfaction was low. Hierarchical logistical regression identified two significant predisposing factors to subsequent online help-seeking: prior face-to-face service use and living or cohabitating with others. Conclusions eMental health is accessed by young people in Australia, yet more needs to be done to better integrate this service model into the healthcare system. This includes training and education for consumers and professionals about existing, effective programs. What is known about this topic? eMental health platforms can bridge the gap between technology and conventional mental health care. Despite its rapidly expanding evidence base, the implementation of eMental health into the Australian healthcare system remains slow. More work needs to be done to elucidate the factors underlying preferences for online help-seeking. What does this paper add? Young adult perspectives on the delivery of mental health information, services and care via the Internet are examined in accordance with a major conceptual model, namely Andersen's behavioural model of health services use. The majority of those surveyed reported having accessed some form of online support for an emotional issue, although dissatisfaction with the quality of this support was expressed. Andersen's model can guide future research in this area and potentially help target eMental health initiatives to individual service users' needs. What are the implications for practitioners? eMental health interventions offer an alternative for young adults who have difficulty accessing traditional mental health care services, but are also an adjunct to those experiencing mild to moderate symptoms of mental illness. Practitioners can introduce young adults to eMental health by discussing the benefits and limitations and by providing information about available and secure online programs delivered by trusted service providers.

Family involvement in eating disorder treatment among Latinas

ABSTRACTLatinos are less likely to seek health care for eating disorders and more likely to drop out of treatment than members of other ethnic groups, highlighting existing challenges to engagement in traditional mental health care. This study explored the role of family in the treatment of adult Latinas with eating disorders through content analysis of family sessions adjunctive to cognitive behavioral therapy. This study yielded insight into the experiences of 10 Latinas with eating disorders (M age = 39.90 years) and 10 relatives (M age = 39.50) from the Promoviendo una Alimentación Saludable trial who were randomly selected to receive six family enhancement sessions. Data from 53 sessions were analyzed using a qualitative content analysis approach. Family intervention might serve as a valuable adjunct to conventional treatment by positively influencing social, family, and emotional support for Latinas with eating disorders.

Exploring modern trends and advances in mental health treatment in the 21st century-mobile mental health

Background: Mobile mental health (mHealth) has revolutionized mental health treatment by integrating technology into patient care, emphasizing patient-centered care (PCC). This shift has transformed patients from passive recipients to active participants in managing their health through technology. Telemental health (TMH) and e-mental health (eMH) are key components, leveraging the Internet and mobile technologies for mental health services. Aim: This review article explores modern trends and advancements in mental health treatment in the 21st century, focusing on the role of mobile technologies in enhancing mental health care. Methods: A comprehensive review of literature and current practices related to mHealth and eMH was conducted. The review included analysis of mobile health applications, telepsychiatry models, and emerging technologies in mental health treatment. Results: The article highlights significant advancements in mobile mental health, including the growth of mental health apps, the use of ecological momentary assessment (EMA) for real-time data collection, and the integration of mobile technologies into traditional mental health care. Trends indicate increased usage of mobile applications for mental health support, though challenges remain in app evaluation and integration into clinical practice. Conclusion: Mobile mental health technologies offer promising enhancements to traditional mental health care by providing accessible, flexible, and cost-effective solutions.

Online Support Shows Potential of Tech-Based MH Care, Insel Says

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessOnline Support Shows Potential of Tech-Based MH Care, Insel SaysNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:13 Jun 2018https://doi.org/10.1176/appi.pn.2018.6b22AbstractOnline counseling networks like the Crisis Text Line or 7 Cups show how simple technological approaches can reduce delays in care and build online help communities.“There has been a dramatic shift in the service economy in the last few years,” said Thomas Insel, M.D., in the lecture he presented at APA’s 2018 Annual Meeting last month. “How people expect to get goods and services has fundamentally changed.” Technology can expand the reach of mental health services as well as offer certain advantages, says Thomas Insel, M.D.David HathcoxThe field of medicine is not exempt from these changes: he noted that companies like Google and Facebook are betting that the way that people get health care now—through traditional doctor visits and medical facilities—will be changing. Large tech firms invested over $3 billion in health care last year, looking to leverage the power of Big Data and social networks for new health care screening and delivery models.“From their point of view, why not try and bend the curve?,” Insel asked. He noted that today’s health care, especially mental health care, is constrained by imprecise diagnoses, lack of access to treatment, delays in treatment initiation, and fragmented care. These shortcomings and barriers to care are a shame, Insel continued.Adding technology to tested mental health interventions could make these treatments work more consistently and reach more people, Insel said. “I call it high tech for high touch,” he said. “It’s like putting treatment on steroids.” Insel noted the success of the Crisis Text Line, a text-based counseling service for people experiencing thoughts of suicide or self-harm. According to the company’s website, “Every texter is connected with a crisis counselor, a real-life human being trained to bring texters from a hot moment to a cool calm through active listening and collaborative problem solving.” An algorithm used by the company enables messages to be interpreted for severity and triaged to the appropriate professionals.Another company providing a similar service is 7 Cups. (Insel disclosed that he serves on the company’s board.)7 Cups is an online and text-message-based peer-support network in which people who want to talk can search for an online “listener” who meets their needs. Some encounters may involve crises but others are on a broad topics—for example, discussions of relationship problems or frustrations. Individuals who complete a listening session are eligible to participate in a short training session and become listeners themselves—thus expanding the reach of the online support community. While these “listeners” are nonprofessional, 7 Cups also offers online therapy services through messaging and voice options with licensed therapists for a modest fee (for example, $150 for a month of unlimited chatting).“This whole company consists of 15 people working without a central office, and their therapists served over 575,000 people in California last year,” Insel said. By comparison, psychotherapists working in brick-and-mortar settings in the state served around 480,000 people in same period. Insel acknowledged that 7 Cups may not necessarily be providing higher quality psychotherapy, but he pointed out that the company does routinely fire psychotherapists who don’t meet quality standards. And if online methods can deliver effective therapy, the potential could be enormous. Though Insel had referenced several criticisms about traditional mental health care, he did say that one area where psychiatry is not faltering is in the quality of treatment it provides. He doesn’t typically hear psychiatrists tell him they cannot give good care. “They say that they have a lot of barriers to providing care, but when they can give care, it works.” ■ ISSUES NewArchived

Classification of SmartMentalTech Services and Application for Comprehensive Mental Healthcare Stepped-Care Model (CMHSCM): Health Psychological Approach

The study investigates the existing smart mental healthcare technologies and analyses the views of potential users in order to devise a comprehensive mental healthcare stepped-care model (CMHCSM) for managing individual preventive care or treatment. The development of various SmartMentalTech solutions may meet the growing demands in mental healthcare intervention and also overcome the limitations of traditional mental healthcare system regarding accessibility. South Korea and Japan have had a relatively high suicide rate and a rising prevalence of mental illness, with the prospect of using a category of products referred to as smart technologies in mental healthcare, hence SmartMentalTech. To investigate the application feasibility of a SmartMentalTech prototype for mental healthcare in South Korea and Japan, this comparative research examined various associated parameters. However, the rapid growth of mental healthcare technology may cause confusion among users regarding the best options to choose. To resolve this, a Health Psychological Approach was adopted and the comprehensive mental healthcare stepped-care model (CMHCSM) was applied. The findings of this study have thus classified 12 types of SmartMentalTech that have been applied to CMHCSM. In the choice of technology types, there were some differences between South Korean and Japanese users. The study concludes that SmartMentalTech should be promoted as an accompanying solution that is readily accessible for the users and describes the four steps of the stepped-care approach for comprehensive management. Further research in the form of an evidence-based analysis of the 12 types of smart technologies use in mental healthcare is recommended.