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INTRODUCTION: Ensuring the mental well-being of the health workforce is important in maintaining a robust healthcare system. This paper aims to describe the development of PsyHELP pocket guide and its potential to encourage the health workforce to recognise and seek help from mental health professionals for their mental health concerns. METHOD: Developed with the Health Belief Model (HBM) as its theoretical framework, this PsyHELP pocket guide integrates theoretical and practical strategies, employing a user-centric design that combines text, visuals, and interactive elements, such as QR codes linked to animation videos, to enhance engagement and accessibility. The content development involved a thorough literature review and was structured to align with the HBM, addressing various constructs that influence help-seeking. RESULT: The PsyHELP pocket guide series, conceptualised as multiple pocket guides, begins with foundational information about mental health and progresses to offer actionable strategies tailored for the health workforce. It addresses vital mental health concepts, combating stigma, recognising the need for professional help, and providing steps towards mental well-being, ensuring a comprehensive approach to mental health awareness and action among the health workforce. CONCLUSION: The PsyHELP pocket guide stands out as a promising resource, aiming to enhance mental health awareness and encourage help-seeking behaviours among the health workforce, fostering a supportive and mentally healthy work environment.
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Pessoal de Saúde , Saúde Mental , Humanos , Pessoal de Saúde/psicologia , Serviços de Saúde Mental/organização & administração , Comportamento de Busca de Ajuda , Mão de Obra em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Transtornos Mentais/terapiaRESUMO
BACKGROUND: Mental health in Puerto Rico is a complex and multifaceted issue that has been shaped by the island's unique history, culture, and political status. Recent challenges, including disasters, economic hardships, and political turmoil, have significantly affected the mental well-being of the population, coupled with the limitations in the accessibility of mental health services. Thus, Puerto Rico has fewer mental health professionals per capita than any other state or territory in the United States. OBJECTIVE: This comprehensive review examines the impact of disasters on mental health and mental health services in Puerto Rico. Given the exodus of Puerto Ricans from the island, this review also provides an overview of mental health resources available on the island, as well as in the continental United States. This review identifies efforts to address mental health issues, with the intent of gaining a proper understanding of the available mental health services, key trends, as well as observable challenges and achievements within the mental health landscape of the Puerto Rican population. DESIGN: A comprehensive search using the PRIMO database of the University of Central Florida (UCF) library database was conducted, focusing on key terms related to disasters and mental healthcare and services in Puerto Rico. The inclusion criteria encompassed studies on Puerto Rican individuals, both those who remained on the island and those who migrated post-disaster, addressing the mental health outcomes and services for adults and children. We included peer-reviewed articles published from 2005 onwards in English and/or Spanish, examining the impact of disasters on mental health, accessibility of services, and/or trauma-related consequences. RESULTS: In this scoping review, we identified 39 studies addressing the mental health profile of Puerto Ricans, identifying significant gaps in service availability and accessibility and the impact of environmental disasters on mental health. The findings indicate a severe shortage of mental health services in Puerto Rico, exacerbated by disasters such as Hurricanes Irma and Maria, the earthquakes of late 2019 and early 2020 that followed, and the COVID-19 pandemic, resulting in substantial delays in accessing care, and limited insurance coverage, particularly in rural regions. Despite these challenges, efforts to improve mental health services have included substantial federal funding and community initiative aimed at enhancing care availability and infrastructure. Limitations include the use of a single database, language restrictions, and potential variability in data extraction and synthesis. CONCLUSIONS: This scoping review highlights the significant impact of disasters on mental health in Puerto Rico and the challenges in accessing mental health services exacerbated by disasters. Despite efforts, significant gaps in mental healthcare and services persist, emphasizing the need for more rigorous research and improvements in infrastructure and workforce to enhance mental health outcomes for Puerto Ricans both on the island and in the continental United States.
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Desastres , Serviços de Saúde Mental , Porto Rico , Serviços de Saúde Mental/organização & administração , Humanos , Emergências , Acessibilidade aos Serviços de Saúde , Saúde MentalRESUMO
(1) Background: In the UK, mental health needs for children and young people (CYP) are rising, whilst access to care is declining, particularly in the North of England and post-COVID-19. However, Health Information Technologies (HITs) can simplify access to Child and Adolescent Mental Health Services (CAMHS), reduce waiting times, and provide anonymous support and reliable information. (2) Methods: A single-centre prospective observational study examined the impact of "CYP as One"-a digital referral point to CAMHS-on waiting times and referral rejection rates. (3) Results: Waiting times during the first 12 months of "CYP as One" implementation were compared to the 12 months prior using non-parametric tests. "CYP as One" demonstrated an increase of 1314 referrals, with self-referrals rising by 71%. Initial implementation showed an increase in waiting times by 16.13 days (53.89 days) compared to pre-implementation (37.76 days) (p < 0.001). However, months 10 (M = 16.18, p < 0.001), 11 (M = 17.45, p < 0.001), and 12 (M = 31.45, p < 0.001) implementation showed reduced waiting times. Rejection rates rose due to a 108% increase in referral volume. "CYP as One" improved access and reduced waiting times after the initial phase. (4) Conclusions: Further research is needed to assess its long-term impact and cost-effectiveness, particularly regarding specific mental health conditions and staff time.
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Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental , Encaminhamento e Consulta , Humanos , Adolescente , Serviços de Saúde Mental/organização & administração , Criança , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde do Adolescente/estatística & dados numéricos , Masculino , Feminino , Serviços de Saúde da Criança , Inglaterra , Listas de Espera , COVID-19RESUMO
Gender-affirming care is a framework that has developed over the past two decades and has experienced a rapid proliferation of empirical evidence. Given increased attention to transgender and gender diverse (TGD) youth in sociocultural spheres, there is a need to examine the current evidence base for effective gender-affirming mental health treatment. In this State of the Science review, we highlight general treatment frameworks that best support TGD youth and families in a variety of contexts, using gender-affirming psychosocial approaches. We use groupings of presenting concerns for TGD youth and families outlined by Coyne et al. (2020) to highlight differing mental health support needs, emphasizing the need for individual, contextually-based care models that consider aspects of gender-related marginalization and resilience. We further discuss needs for care access and equity and need for further attention in future research and intervention approaches.
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Pessoas Transgênero , Humanos , Pessoas Transgênero/psicologia , Adolescente , Masculino , Feminino , Serviços de Saúde Mental/organização & administração , Disforia de Gênero/terapia , Disforia de Gênero/psicologia , Assistência à Saúde Afirmativa de GêneroRESUMO
In recent years, digital mental health interventions (DMHIs) have emerged as a paradigm shift in care delivery that could expand the scale, efficiency, and effectiveness of psychological services. However, DMHI impact is constrained by issues related to limited reach, poor adoption, implementation barriers, and insufficient long-term maintenance. Organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) framework, this paper surveys the current state of DMHIs, highlighting research and practice gaps as well as potential strategies to move the field forward. Similarly, we discuss the role that emerging technologies and changes in the profession will play in shaping DMHIs in years to come. Finally, concrete and actionable steps to advance equity in the DMHI field are provided, with an emphasis on strategies to increase the representativeness of marginalized populations in DMHI research, the inclusion of these groups in the design and testing of DMHIs, and how to improve the contextual and cultural fit of DMHIs.
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Serviços de Saúde Mental , Humanos , Serviços de Saúde Mental/organização & administração , Telemedicina , Transtornos Mentais/terapia , Saúde Mental , Tecnologia DigitalRESUMO
The mental health of medical students is a crucial concern in contemporary medical education. This manuscript reports the availability and shape of psychological support for medical students in Poland in the backdrop of the COVID-19 pandemic and the Ukrainian crisis. A survey comprising 10 questions was distributed to 22 medical schools in Poland, with a 59% response rate. The findings reveal that psychological support programs are predominantly managed by internal university units. Funding sources vary, with some universities utilizing internal budgets and others leveraging European funds or external projects. The support modalities are primarily hybrid, catering to student preferences. Limitations exist in the number of consultations, although some universities provide extended support based on student needs. Assistance is offered in multiple languages, with additional programs like stress-reduction workshops and mindfulness training being available in several universities. A notable increase in demand for psychological support post-COVID-19 was reported, with some universities establishing their programs during or after the pandemic. The commentary highlights the rising need for mental health services among medical students and underscores the importance of flexible, inclusive, and well-funded support. The effective functioning of these programs aligns with the broader objective of fostering a resilient and emotionally balanced healthcare workforce.
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COVID-19 , Serviços de Saúde Mental , Estudantes de Medicina , Humanos , COVID-19/epidemiologia , Estudantes de Medicina/psicologia , Polônia , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/provisão & distribuição , Ucrânia/epidemiologia , SARS-CoV-2 , Pandemias , Saúde Mental , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. OBJECTIVE: The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. METHODS: A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. RESULTS: The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). CONCLUSIONS: Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings.
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Assistência Ambulatorial , Humanos , Projetos Piloto , Adolescente , Feminino , Masculino , Adulto Jovem , Melhoria de Qualidade , Serviços de Saúde Mental/organização & administração , Transtornos Mentais/terapia , AdultoRESUMO
Introduction: Coronavirus disease (COVID-19) significantly impacted mental health and mental health services worldwide. We sought to explore the challenges faced by mental health services from the perspectives of service users, providers, and policymakers during the COVID-19 pandemic in Uganda and the strategies put in place to ensure the continuity of these services. Methods: qualitative data were collected using semi-structured interviews with eight mental health service users, four mental health workers, four hospital administrators, four district mental health focal persons, and two policymakers. The data were analyzed using thematic analysis. Results: the challenges reported by participants included human resource shortages, loss of space for service provision, low funding, drug shortages, changes in patient load, and lack of access to services due to restrictive measures. The adaptations included the use of innovative means like mobile phone technology, reorientation of health facility functioning to COVID-19 restrictions, using different methods to deliver medications, integration of mental health in general health services, and alternative financing for mental health services. Conclusion: the COVID-19 pandemic posed significant challenges to mental health service provision. Nevertheless, the health system responded by implementing various measures to ensure continuity of care. Further research is needed to evaluate the effectiveness and scalability of these innovations in the long term.
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COVID-19 , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental , Humanos , Uganda , COVID-19/epidemiologia , Serviços de Saúde Mental/organização & administração , Entrevistas como Assunto , Continuidade da Assistência ao Paciente/organização & administração , Pessoal de Saúde/organização & administração , Masculino , Feminino , Saúde Mental , Transtornos Mentais/terapia , Transtornos Mentais/epidemiologia , Adulto , Pesquisa QualitativaRESUMO
PURPOSE: This study aims to address the critical mental health challenges faced by individuals in prisons and places of detention. By introducing and validating a novel conceptual framework that integrates social determinants of health with the stress process model, this study aims to provide actionable insights for improving mental health care in correctional settings. The research seeks to inform policymakers, prison administrators and mental health professionals about effective interventions and systemic reforms that can reduce recidivism, enhance rehabilitation and promote a more humane and just criminal justice system. DESIGN/METHODOLOGY/APPROACH: This study uses a multi-method research design integrating a systematic literature review, qualitative interviews, multi-criteria evaluation (MCE) and a small-scale empirical study within a correctional facility. The systematic review follows PRISMA guidelines, analysing peer-reviewed articles, government reports and policy documents. Semi-structured interviews with 25 mental health professionals provide practical insights, whereas the MCE assesses intervention effectiveness based on expert consensus. The empirical study involves baseline assessments, intervention implementation and follow-up evaluations using validated tools, providing robust data to validate the proposed conceptual framework that integrates social determinants of health with the stress process model. FINDINGS: This study finds that mental health disorders are significantly more prevalent in prison populations than in the general population, with interventions like cognitive behavioural therapy (CBT), peer support programs and trauma-informed care showing considerable effectiveness in reducing symptoms. Emerging technologies such as AI and telemedicine present promising avenues for enhancing care but require careful ethical consideration. The research also highlights the critical role of social determinants and the importance of systemic reforms, such as reducing solitary confinement and integrating prison health care with broader public health systems, in improving inmate mental health and reducing recidivism. RESEARCH LIMITATIONS/IMPLICATIONS: This study's quasi-experimental design, while robust, may limit the generalizability of the findings to other correctional settings because of specific facility characteristics. Additionally, the sample size for qualitative interviews, although diverse, could have been larger to provide more nuanced insights, particularly for underrepresented groups. This study highlights the need for more longitudinal research to assess the long-term effects of interventions and the scalability of approaches across different cultural and legal contexts. Future studies should address these limitations by using more diverse sampling, larger sample sizes and extended follow-up periods. PRACTICAL IMPLICATIONS: This study provides actionable insights for policymakers and prison administrators, emphasizing the need to integrate evidence-based mental health interventions, such as CBT and trauma-informed care, into prison reform strategies. It highlights the importance of training correctional staff in mental health first aid and the potential of emerging technologies like AI and telemedicine to enhance care delivery in resource-limited settings. Implementing these recommendations could significantly improve inmate mental health outcomes, reduce recidivism rates and promote a more humane and effective correctional system, with broader benefits for public health and social equity. SOCIAL IMPLICATIONS: Improving mental health care in prisons has significant social implications, particularly in promoting social justice and reducing inequalities. Effective mental health interventions can help break the cycle of incarceration and recidivism, particularly in marginalized communities disproportionately affected by the criminal justice system. By addressing the mental health needs of incarcerated individuals, society can foster safer communities, reduce crime rates and alleviate the economic burden on the criminal justice and health-care systems. Furthermore, enhancing mental health care in prisons reflects a commitment to human dignity, fairness and the rehabilitation of offenders, contributing to a more just and compassionate society. ORIGINALITY/VALUE: This study introduces a novel conceptual framework that integrates social determinants of health with the stress process model, specifically tailored for correctional facilities. It provides original empirical data from a real-world prison setting, offering new insights into the effectiveness of mental health interventions, such as CBT and trauma-informed care. The study's value lies in its comprehensive approach, combining quantitative and qualitative methods, and its focus on underrepresented populations in correctional settings. By addressing significant gaps in the literature, this research offers practical recommendations for policymakers and practitioners, contributing to improved mental health outcomes and reduced recidivism.
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Transtornos Mentais , Saúde Mental , Prisioneiros , Prisões , Humanos , Prisioneiros/psicologia , Transtornos Mentais/terapia , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Determinantes Sociais da Saúde , Pesquisa Qualitativa , Serviços de Saúde Mental/organização & administraçãoRESUMO
BACKGROUND: People with severe mental illness frequently experience difficulties in other life domains, such as physical health conditions, comorbid substance abuse, unstable housing or structural poverty. The interaction between these difficulties creates a complex care need that often goes unmet. In addition, they regularly come into contact with the legal system and police, through penal as well as protective measures. AIM: To gain insight into the vision of actors from the judiciary and police into complex mental health care needs and judicial protective measures. METHOD: Qualitative semi-structured interviews were conducted with 15 actors from the judiciary system and police. RESULTS: Participants see the interaction of difficulties in different life domains as complex. They are critical of the provision of care for this population. Participants are very open towards intersectoral collaboration, but confidentiality and a lack of structural partnerships hinders this. Involuntary admission and legal guardianship are generally considered meaningful protective measures. CONCLUSION: In line with the vision of the mental health services, actors from the police and justice system consider the interaction between difficulties in different life domains as complex. They see a need for intensive, long-term and assertive care and a wide range of assisted living forms where integrated care is offered to people with complex mental health care needs. Judicial actors and police are willing to play a role in this. Further research into and development of accessible and, where necessary assertive, intersectoral care is necessary.
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Transtornos Mentais , Serviços de Saúde Mental , Polícia , Humanos , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/organização & administração , Transtornos Mentais/terapia , Transtornos Mentais/prevenção & controle , Necessidades e Demandas de Serviços de SaúdeRESUMO
BACKGROUND: For some ten years now the term ‘confused persons’ has gained prominence in the Netherlands. Introduced by the police, it gathered attention due to rising numbers of police calls, to become entangled with broader sentiments of unsafety due to serious incidents with people with mental disorders. Mental health services have struggled with the term, since it is no diagnosis and it often leads to misunderstandings and controversies. AIM: To explain 1. the origins of the term, 2. the numbers, 3. the impact on police, juicidal system and society, 4. possible explanations for misunderstood behaviour, and 5. leads for both health and safety services. METHOD: Overview of recent sources and previous own research. RESULTS: It is important to differentiate across type and severity of behaviours, between people with (serious) social difficulties and people with severe mental disorders, so they are not needlessly medicalized (too much professional involvement), legalized (resulting in punishment) or normalized (too little professional involvement). More attention is needed for the ‘normal life’ of people that are faced with intensive and often restrictive professional services, so more differentiated housing, working and living becomes available. Last, for some people it is necessary to maintain (professional) surveillance and/or guidance for their entire lives, both from a safety and human perspective. CONCLUSION: Confused or misunderstood behaviour is a broad concept that includes many causes with varying causes: from micro-organizational and collaboration problems to (macro) the social structure and culture in society. Focusing on a few well-defined groups, collaboration and system problems can be useful. The existing problems are not easy to solve and require sustainable investments in human willingness and expertise.
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Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Países Baixos , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/organização & administraçãoRESUMO
Background: People with severe mental illness who experience co-occurring substance use experience poor outcome including suicide, violence, relapses and use of crisis services. They struggle to access care and treatment due to a lack of an integrated and co-ordinated approach which means that some people can fall between services. Despite these concerns, there is limited evidence as to what works for this population. Objectives: To undertake a realist evaluation of service models in order to identify and refine programme theories of what works under what contexts for this population. Design: Realist synthesis and evaluation using published literature and case study data. Setting: Mental health, substance use and related services that had some form of service provision in six locations in the United Kingdom (five in England and one in Northern Ireland). Participants: People with lived experience of severe mental illness and co-occurring substance use, carers and staff who work in the specialist roles as well as staff in mental health and substance use services. Results: Eleven initial programme theories were generated by the evidence synthesis and in conjunction with stakeholders. These theories were refined through focus groups and interviews with 58 staff, 25 service users and 12 carers across the 6 case study areas. We identified three forms of service provision (network, consultancy and lead and link worker); however, all offered broadly similar interventions. Evidence was identified to support most of the 11 programme theories. Theories clustered around effective leadership, workforce development and collaborative integrated care pathways. Outcomes that are meaningful for service users and staff were identified, including the importance of engagement. Limitations: The requirement for online data collection (due to the COVID-19 pandemic) worked well for staff data but worked less well for service users and carers. Consequently, this may have reduced the involvement of those without access to information technology equipment. Conclusion: The realist evaluation co-occurring study provides details on how and in what circumstances integrated care can work better for people with co-occurring severe mental health and alcohol/drug conditions. This requires joined-up policy at government level and local integration of services. We have also identified the value of expert clinicians who can support the workforce in sustaining this programme of work. People with co-occurring severe mental health and alcohol/drug conditions have complex and multifaceted needs which require a comprehensive and long-term integrated approach. The shift to integrated health and social care is promising but will require local support (local expert leaders, network opportunities and clarity of roles). Future work: Further work should evaluate the effectiveness and cost-effectiveness of service models for this group. Study registration: This study is registered as PROSPERO CRD42020168667. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128128) and is published in full in Health Technology Assessment; Vol. 28, No. 67. See the NIHR Funding and Awards website for further award information.
There are very few services in the United Kingdom that currently provide a service for people with co-occurring severe mental health and alcohol/drug conditions. We identified a set of factors that are likely to promote better outcomes for people with co-occurring severe mental health and alcohol/drug conditions including commitment from leaders across organisations to address this issue and support staff training. A local expert clinical leader was seen to be important in enabling closer working between mental health and substance use. Service users and carers recognised that when care was co-ordinated, and staff demonstrated empathy and compassion, they were more likely to engage in treatment. Further work will be needed to evaluate how helpful some of the aspects of the models of care are in helping people in their recovery goals.
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Transtornos Mentais , Serviços de Saúde Mental , Transtornos Relacionados ao Uso de Substâncias , Humanos , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Serviços de Saúde Mental/organização & administração , Reino Unido , Irlanda do Norte , Feminino , Masculino , Grupos Focais , AdultoRESUMO
Effective team-based care is necessary for implementation of the integrated care models recommended to improve behavioral health access. Many models rely on social work-ers who are trained to deliver behavioral health care as an interprofessional team member. In this article, we highlight two social work programs utilizing interprofessional educa-tion to enhance team-based care competence.
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Prestação Integrada de Cuidados de Saúde , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental , Equipe de Assistência ao Paciente , Serviço Social , Humanos , North Carolina , Serviço Social/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Relações Interprofissionais , Competência ClínicaRESUMO
The increasing shortage of psychiatrists in the workforce is a well-documented and alarming trend. In light of this workforce shortage, psychiatrists bear a professional and ethical responsibility to identify strategies to increase access to mental health treatment and thereby reduce the impact of the psychiatrist shortage on patients and on the greater health system. One such strategy is the collaborative care model (CoCM), which has demonstrated efficacy in the mental health treatment of both pediatric and adult populations. In this article, the CoCM is presented as one effective strategy to address the behavioral workforce shortage. Current themes observed from the clinical practice of psychiatric collaborative care in a pediatric collaborative care setting are discussed with contemplation of future directions.
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Psiquiatria Infantil , Humanos , Criança , Serviços de Saúde Mental/organização & administração , Psiquiatria , Comportamento Cooperativo , Equipe de Assistência ao Paciente , Colaboração Intersetorial , PsiquiatrasRESUMO
INTRODUCTION: The Activating Lived Experience Leadership (ALEL) project was a South Australian participatory action research project that aimed to improve the ways lived experience is recognised, valued and integrated across mental health and social sector systems. ALEL was completed during 2019-2021, where it engaged 182 participants in generating community action and research knowledge. OBJECTIVE: Our paper discusses the project's processes of building a collective partnership among lived experience leaders and other leaders from within the sector, so that the actions and strategies identified through research could be implemented by systems-level impact. We describe the collaborative process and key learnings that resulted in eight key action areas for transformative systems change in South Australia. METHODS: The project invited a diverse range of self-identified lived experience and other leaders to be involved in a PAR process featuring formal qualitative research (focus groups, surveys and interviews) as well as community development activities (leaders' summit meetings, consultations, training and community of practice meetings). These processes were used to help us describe the purpose, achievements and potential of lived experience leadership. Project priorities and systems-level analysis was also undertaken with lived experience sector leaders and project advisors across two leaders' summit meetings, integrating research outcomes with sector planning to define high-level actions and a vision for transformational change. RESULTS: Participatory action research as informed by systems change and collective impact strategies assisted the project to generate detailed findings about the experiences and complexities of lived experience leadership, and collective responses of how systems could better support, be accountable to and leverage lived experience perspectives, experience and peer-work approaches. CONCLUSION: Systems change to define, value and embed lived experience leadership benefits from collective efforts in both formal research and sector development activities. These can be used to generate foundational understandings and guidance for working together in genuine ways for transforming mental health and social sector systems, experience and outcomes. PUBLIC CONTRIBUTION: Members of lived experience communities codesigned the project, and contributed to project governance and the development of all findings and project reports.
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Liderança , Humanos , Austrália do Sul , Pesquisa Qualitativa , Pesquisa Participativa Baseada na Comunidade , Pesquisa sobre Serviços de Saúde , Grupos Focais , Serviços de Saúde Mental/organização & administração , Comportamento CooperativoRESUMO
BACKGROUND: The use of digital tools such as electronic patient portals in different health care disciplines and settings has been increasing, but the rate of implementation in clinical practice still lags behind expectations. While studies have linked the use of electronic patient portals to positive health outcomes for patients, studies addressing the viewpoints of healthcare providers are rare. METHODS: We performed an online survey of attitudes of healthcare providers towards an electronic patient portal for mental health hospitals. The portal was developed by five communal providers of mental health care in different regions in Germany. The survey was carried out during the early phase of implementation of the portal. RESULTS: Twenty project leaders and 37 clinicians from five different mental health hospitals answered the questionnaire (response rate: 45% and 28%). Overall, acceptance of online applications among respondents was high. The healthcare providers mentioned perceived benefits (e.g. accessibility of new patient groups, use of therapy-free periods) as well as a number of technical, structural, organizational and staffing barriers for successful implementation in hospital settings (e.g. workload of healthcare providers and lack of staff, limited digital competences, unstable WLAN). CONCLUSION: The perceived barriers and facilitators of the implementation of online applications and electronic patient portals in mental health hospitals identified by healthcare providers may be taken into account. Improving commitment of the healthcare providers to implementation and use of digital interventions may help foster digitalisation in mental health hospitals.
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Atitude do Pessoal de Saúde , Portais do Paciente , Humanos , Alemanha , Portais do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Masculino , Feminino , Hospitais Psiquiátricos , Registros Eletrônicos de Saúde , Adulto , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Pessoal de Saúde/psicologiaRESUMO
BACKGROUND: In Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams. METHOD: Semi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis. RESULTS: Peer workers found their experience in the workplace was influenced by their colleagues and the organisation's understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy. CONCLUSION: This study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings.
Assuntos
Serviços de Saúde Mental , Cultura Organizacional , Grupo Associado , Pesquisa Qualitativa , Humanos , Serviços de Saúde Mental/organização & administração , Feminino , Austrália , Masculino , Entrevistas como Assunto , Adulto , Pessoa de Meia-Idade , Local de Trabalho/psicologia , Local de Trabalho/organização & administração , Liderança , Atitude do Pessoal de SaúdeRESUMO
BACKGROUND: Locking or confinement of persons with severe mental illness has been common in Indonesia. In 2010, the Ministry of Health declared a policy that persons who were locked (pasung) should be unlocked or freed (bebas) from confinement and provided mental health services. This study is an empirical evaluation of the effectiveness of one Bebas Pasung program in Indonesia at two-year follow-up. METHODS: From medical records in Soerojo Mental Hospital, Magelang, Central Java, 114 persons with severe mental illness who had been unlocked, treated, and returned to the community from four districts served by the hospital were identified. At two-year follow-up, 62 caregivers were able to be contacted and willing to participate in a study. Data were collected from hospital records about condition of the patient at time of "unlocking" and at discharge, and primary caregivers were interviewed about the previous locking and care of the patient since return, as well as experiences of caregiving. RESULTS: We provide descriptive data concerning history of illness, reasons for locking, type of confinement, and care of the individual since return. 58% of those unlocked were men, 80% had diagnoses of schizophrenia, and mean age was 35. At follow-up, 24% of this sample had been re-locked; only 44% took medications regularly, including 33% of those re-locked and 47% of those not relocked. A majority cared for themselves, half were partially or fully productive, and the quality of life of family caregivers improved significantly since their family member was unlocked, treated, and returned home. CONCLUSIONS: This program successfully unlocked, treated, and returned to their homes persons with severe mental illness living in pasung or restraints. Findings suggest such unlocking programs need to be linked more closely to community-based mental health and rehabilitation services, maintain care of the patient, and provide a path toward recovery.
Assuntos
Transtornos Mentais , Humanos , Indonésia/epidemiologia , Masculino , Feminino , Adulto , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Cuidadores/psicologia , Pessoas Mentalmente Doentes/psicologia , Serviços de Saúde Mental/organização & administração , Quarentena/psicologia , Seguimentos , Esquizofrenia/terapia , Qualidade de Vida , Adulto JovemRESUMO
Pediatric primary care is widely available in the United States and can help address the growing public health crisis in child and adolescent mental health by providing integrated behavioral health services. This article provides an overview of 3 common models of behavioral health integration in pediatric primary care settings: 1) the Child Psychiatry Access Program model, 2) the Primary Care Behavioral Health model, and 3) the Collaborative Care Model. Pediatric primary care practices may evaluate the different features of each model before adopting an approach for integration and consider tailoring it to their practice environments.