Patterns of Mental Health Service Utilisation: A Population-Based Linkage of Over 17 Years of Health Administrative Records.

A cross-sectoral partnership was formed in 2021 in support of the recommendations in an audit on access to state-funded mental health services. In this first paper, we aimed to describe the demographic and service utilisation of adults with a mental health diagnosis in the Western Australian state-funded health system from 2005 to 2021. Inpatient, emergency department, specialised (ambulatory) community mental health service, and death records were linked in individuals aged ≥ 18 years with a mental health diagnosis in Western Australia. Altogether, 392,238 individuals with at least one mental health service contact between 1st January 2005 and 31st December 2021 were included for analysis. Females, Aboriginal and/or Torres Strait Islander people, and those who lived outside major cities or in the most disadvantaged areas were more likely to access state-funded mental health services. While the number of individuals who accessed community mental health services increased over time (from 28,769 in 2005 to 50,690 in 2021), the percentage increase relative to 2005 was notably greater for emergency department attendances (127% for emergency department; 76% for community; and 63% for inpatient). Conditions that contributed to the increase for emergency department were mainly alcohol disorder, reaction to severe stress and adjustment disorders, and anxiety disorders. Sex differences were observed between conditions. The pattern of access increased for emergency department and the community plus emergency department combination. This study confirmed that the patterns of access of state-funded mental health services have changed markedly over time and the potential drivers underlying these changes warrant further investigation.

Vaping in mental health inpatient units: A qualitative study of consumer and staff views on electronic nicotine delivery systems.

OBJECTIVES: The aim of this qualitative study was to explore the subjective experiences of consumers and staff members regarding the availability of electronic nicotine delivery systems (ENDS) in inpatient mental health units. METHODS: Mental health consumers and staff members (n = 16) from rehabilitation and forensic inpatient units were interviewed in 2022. Thematic analysis of the transcripts was undertaken. RESULTS: Our study identified four themes: The high salience of nicotine use in inpatient units, delivering nicotine in a resource scarce environment, weighing up the harms of ENDS as a smoking cessation tool, and a need for fair and consistent policy. CONCLUSIONS: The main positive aspects identified were recognition of rights of consumers, a relative harm reduction compared to tobacco use, and ENDS as a positive factor in the therapeutic relationship. The main challenges identified were resourcing issues, ENDS being a potential source of tension and conflict and a lack of overarching policy guiding their use.

Evaluation of a Dialectical Behavior Therapy Didactic for Medical Trainees in an Acute Adolescent Inpatient Psychiatric Unit.

OBJECTIVE: Dialectical behavior therapy (DBT) is an evidence-based treatment for patients with suicidality and emotion dysregulation. There is increasing evidence of using DBT in psychiatric inpatient units for youth. On inpatient units, the majority of treatment is provided by psychiatry trainees, often with limited therapy experience. The study's objective was to assess the impact of a 1-h weekly DBT training for a range of medical trainees rotating through a child and adolescent acute inpatient unit. METHODS: Participants were 55 medical students, psychiatry residents, and child and adolescent psychiatry fellows who rotated on an inpatient unit for youth and participated in a 1-h DBT didactic. There was one group who attended less than four sessions and the other attended 5 or more sessions. A pre- and post-method design was used to collect data on participants' confidence, competence, and knowledge of DBT and working with suicidal youth. RESULTS: Comparing pre- and post-data for all participants, the DBT training was found to lead to significant benefits for trainees' comfort with therapy, prioritizing therapy during inpatient care, knowledge of DBT, comfort with DBT, and confidence in treating children and adolescents with suicidality. There were no significant differences in the type of trainee or dose of training. CONCLUSION: This study supports the benefit of a brief DBT didactic to provide training to a wide range of trainees to improve therapeutic care in an inpatient psychiatric unit for youth.

Use of a Novel Standardized Administration Protocol Reduces Agitation Pro Re Nata (PRN) Medication Requirements: The Birmingham Agitation Management (BAM) Initiative.

BACKGROUND: Agitation management is a principal challenge on inpatient psychiatric units. Overreliance on common prescribing strategies of pro re nata (PRN) medication administration is problematic, given the tendencies to have overlapping or unclear indications. OBJECTIVE: Piloted project to determine whether a standardized protocol for agitation intervention may reduce PRN medication administration. METHODS: The Birmingham Agitation Management (BAM) interdisciplinary team uniquely connected the Brøset Violence Checklist (BVC) for assessment of agitation severity to a standardized PRN medication order set. Nurses on the piloted unit were trained on how to score the BVC and administer medications. Patients were assessed by the BVC every 4 hours and, based on their score, would receive no medication, low-dose benzodiazepine, high-dose benzodiazepine, or high-dose benzodiazepine plus antipsychotic. The primary end point compared the number of PRNs administered after novel protocol implementation with a retrospective cohort. Secondary measures included analysis of medication-related effects, seclusion, and physical restraint rates. RESULTS: 377 patients were included in the final analyses (184 pre-BAM, 193 BAM intervention group). No significant differences were seen in patient characteristics between groups. The total number of PRNs administered decreased by 42.5%, with both the mean and median number of administrations decreasing significantly (95% confidence interval [CI] = [1.68-5.75]; P < 0.001). A trend was noted between the number of PRNs administered and seclusion rates, but did not reach statistical significance (95% CI = [-7.28 to 60.31]; P = 0.124). CONCLUSIONS: In seemingly the first initiative of its kind, we found that a standardized agitation management protocol can help decrease the total number of PRN administrations for agitation without worsening of restraint rates and may possibly reduce the risk of adverse effects. These results require validation in specific, larger populations.

The supporting role of dogs in the inpatient setting: a systematic review of the therapeutic effects of animal-assisted therapy with dogs for children and adolescents in an inpatient setting.

Animal-assisted therapy (AAT) is becoming increasingly popular. The possibilities and guidelines for interventions and methods are very diverse. Currently, published studies mainly concentrate on effects in paediatrics, outpatient therapy and schools. Specific recommendations for AAT in the context of inpatient child and adolescent psychiatry do not exist. This systematic review will attempt to evaluate the existing studies in terms of their methodological quality and specify positive and negative effects, aiming to provide a decision-making aid for everyday clinical practice. A systematic literature search (PubMed/MEDLINE, APA PsycINFO, PubPsych, ProQuest, Google Scholar, and Cochrane Library) according to the PRISMA criteria resulted in 1,908 identified hits, of which 49 articles were reviewed in full text. Three raters contributed to the review of the articles using a criteria-guided codebook. This systematic review is listed in the PROSPERO database (CRD42022358909). Quality analysis was conducted using Effective Public Health Practice Project (EPHPP). Five studies were identified. The majority of these showed deficits in quality. Therapeutic effects and positive influences on the psychopathological status, interpersonal relationships and subjective well-being or attitudes towards canine-assisted therapy (CAT) could be identified. Current studies indicate positive therapeutic effects of CAT in the inpatient treatment of children and adolescents. A cautiously positive perspective is warranted, but a general recommendation for CAT cannot be given. CAT should be carefully considered, planned, and implemented by professionals. For the future, further randomised controlled studies including follow-up studies, larger subject groups and clinically evaluated interventions are necessary to validate the current results.

Substance Misuse among a Diverse Psychiatric Inpatient Sample: Suicidal Thoughts and Behaviors and Motivation to Change.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Difference in Psychiatric Hospital Admissions Between Cisgender and Transgender and Gender Nonconforming Youth, Before and During the Start of the COVID-19 Pandemic.

This retrospective study of 1101 children and adolescents examines differences in psychiatric admissions between cisgender and transgender/gender nonconforming (TGNC) youth between June 2018 and November 2021. Sociodemographic and clinical characteristics for each admission were extracted from medical records. We compared proportion of total admissions and clinical characteristics between cisgender and TGNC youth, during specified time frames of pre-COVID-19, during quarantine, and post-quarantine. During quarantine, 294 (89.9%) youth identified as cisgender and 33 (10.1%) youth identified as TGNC. Post-quarantine, 205 (88.4%) youth identified as cisgender and 27 (11.6%) identified as TGNC. TGNC patients had more history of mood disorders (p < 0.001), self-injurious behavior (p < 0.001), and suicide attempt (p = 0.007), whereas cisgender patients had more history of Attention-deficit/Hyperactivity Disorder (ADHD) (p = 0.011) and violence (p < 0.001) across each time frame of the study. TGNC patients were more likely to be admitted due to suicidal ideation (p = 0.003), whereas cisgender patients were more often admitted for aggression (p < 0.001). There was no change across COVID-19 time periods in terms of any psychiatric history variable among patients identifying as TGNC. The proportion of admitted youth identifying as TGNC increased by 8.1% from pre-COVID-19 to post-quarantine (p < 0.001). These findings suggest that TGNC youth might be particularly vulnerable to mental health crises when faced with pandemic-related stressors. Further research on the vulnerabilities of TGNC youth during sudden and extreme social changes and how this can impact their mental health is necessary, as global pandemics could and are anticipated to repeat.

Psychology Internship Training Amidst COVID-19: Balancing Training Opportunities, Patient Care, and Risk of Exposure.

The emergence of the 2019 novel coronavirus (COVID-19) has dramatically altered how psychologists deliver its training. At least for the time being, virtual care has become the primary method for delivering mental health services. This has allowed patients and clinicians to continue to access and provide services in a way that would have been impossible years ago. Not only has this shift impacted patients, but it has also impacted supervision and training. The impact has been especially profound on inpatient units where the psychiatric and medical acuity is high of patients and the therapeutic milieu is an important aspect of treatment. The purpose of this paper is to review the impact of COVID-19 on pre-doctoral psychology interns during their rotation on an inpatient psychiatry unit at the start of the pandemic (January to June of 2020) and use these experiences to onboard the next class of interns in the new academic year (July 2020 to June 2021) using a hybrid model of in-person and virtual training experiences. At the end of 2020/2021 rotation, we voluntarily asked interns to complete a questionnaire that was developed based on the qualitative experiences of the previous class to assess the effectiveness of this hybrid model. We also surveyed multi-disciplinary staff members who were essential personnel and required to work in person during this time about their experiences of safety and support. With this information, we explore and offer guidance to other inpatient training sites who are likely to encounter similar challenges during this time. In particular, we discuss the integration of virtual technology into this training experience, as well as the restructuring of clinical and supervisory experiences. We highlighted several short-term strategies that we have flexibly adapted to our inpatient unit. The lessons learned herein seek to guide supervisors and trainees alike in adapting their psychology training programs to meet the evolving demands of COVID-19.

Factors influencing length of hospital stay among veterans admitted to an inpatient psychiatric unit.

It is well established that Veterans are at increased risk for mental health problems and associated hospitalization. While hospitalization is appropriate for acute stabilization, prolonged stays can contribute to reduced quality of life, increased healthcare expenditures, and trauma exposure with associated trauma-related symptoms. To reduce inpatient psychiatric length of stay and to improve patient outcomes, it is imperative that risk factors for prolonged length of stay are elucidated. The purpose of this retrospective chart review was to examine demographic and clinical characteristics and their association with inpatient psychiatric length of stay in a sample of Veterans. Demographic information collected included age and race. Clinical characteristics collected included primary admitting psychiatric diagnosis, number of psychiatric emergencies during hospitalization, utilization of restraint or seclusion, observation status, 30-day readmission status, adherence to psychiatric follow-up appointments post-discharge, and presence of suicidality. A total of 820 Veterans were included in the analysis. Age, primary psychiatric diagnosis, occurrence of a psychiatric emergency, and observation status were significant predictors of length of stay (F = 24.39, p < .001). There were significant differences in the average length of stay between Veterans with substance use disorders and those with psychotic disorders (B = 0.576, p < .001). Likewise, Veterans with neurocognitive disorders also had longer lengths of stay than those without neurocognitive disorders, respectively (B = 0.014, p < .001). In summary, quality of mental health care can be improved by reducing length of stay, but additional understanding related to risk factors is first needed.

Validating Psychometric Properties of a Revised Patient Version of the Combined Assessment of Psychiatric Environments (CAPE).

BACKGROUND: Measuring patient experience is an essential challenge in the inpatient behavioral health population. AIM: This initiative analyzed the psychometric properties of a revised version of the patient Combined Assessment of Psychiatric Environments (p-CAPE-R) survey. METHODS: The p-CAPE was revised to encompass the interdisciplinary treatment team and implemented on five inpatient psychiatric units at an academic medical center. A psychometric analysis was performed on the p-CAPE-R. RESULTS: Analysis of factor loadings with a large sample (n = 786) revealed a more coherent item structure under the "staff competency and engagement" and "treatment effectiveness" domains than presented in the original instrument development research. CONCLUSIONS: Although the p-CAPE-R reflects a more useful and psychometrically sound instrument than the original p-CAPE, further analysis and revision to reflect the entire interdisciplinary team is warranted.