Policy Statement: Mental Well-being among Anthropologists at Universities: A Call for System Transformation.

The Anthropology of Mental Health Interest Group affirms that the state of mental health in Academic Anthropology needs serious attention and transformation. We respond to structural inequities in academia that exacerbate mental distress among graduate students and other anthropologists who experience oppression, by putting forward a policy statement with recommendations to create more equitable learning and working environments.

Assessing Collaborative Care in Mental Health Teams: Qualitative Analysis to Guide Future Implementation.

The Collaborative Care Model (CCM) is an evidence-based approach for structuring care for chronic health conditions. Attempts to implement CCM-based care in a given setting depend, however, on the extent to which care in that setting is already aligned with the specific elements of CCM-based care. We therefore interviewed staff from ten outpatient mental health teams in the US Department of Veterans Affairs to determine whether care delivery was consistent or inconsistent with CCM-based care in those settings. We discuss implications of our findings for future attempts to implement CCM-based outpatient mental health care.

Factor structure of the Q-LES-Q short form in an enrolled mental health clinic population.

PURPOSE: The Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) is a recovery-oriented, self-report measure with an uncertain underlying factor structure, variously reported in the literature to consist of either one or two domains. We examined the possible factor structures of the English version in an enrolled mental health population who were not necessarily actively engaged in care. METHODS: As part of an implementation trial in the U.S. Department of Veterans Affairs mental health clinics, we administered the Q-LES-Q-SF and Veterans RAND 12-Item Health Survey (VR-12) over the phone to 576 patients across nine medical centers. We used a split-sample approach and conducted an exploratory factor analysis (EFA) and multi-trait analysis (MTA). Comparison with VR-12 assessed construct validity. RESULTS: Based on 568 surveys after excluding the work satisfaction item due to high unemployment rate, the EFA indicated a unidimensional structure. The MTA showed a single factor: ten items loaded on one strong psychosocial factor (α = 0.87). Only three items loaded on a physical factor (α = 0.63). Item discriminant validity was strong at 92.3%. Correlations with the VR-12 were consistent with the existence of two factors. CONCLUSIONS: The English version of the Q-LES-Q-SF is a valid, reliable self-report instrument for assessing quality of life. Its factor structure can be best described as one strong psychosocial factor. Differences in underlying factor structure across studies may be due to limitations in using EFA on Likert scales, language, culture, locus of participant recruitment, disease burden, and mode of administration.

Leveraging anthropological expertise to respond to the COVID-19 global mental health syndemic.

This commentary asks anthropologists to work within communities to actively address the global mental health impact of COVID-19 and contribute to the pandemic response. Multiple social and physical losses, worsened by numerous factors, have produced syndemic traumatic stress and suffering across populations, highlighting persistent inequalities further amplified by the effects of COVID-19. Specifically, anthropologists can work to contribute to the development of mental health programs; confront the racialization of COVID-19 alongside marginalized communities; support real-time policy making with community responses; and innovate transparent collaborative research methods through open science. This pandemic can serve as an opportunity to prioritize research endeavors, public service, and teaching to better align with societal needs while providing new opportunities for synergy and collaborations between anthropologists in and outside the academy. Anthropologists collaborating directly with mental health clinicians and the public can contribute to knowledge specifically through direct program development and implementation of interventions designed to improve mental well-being. Innovating to find impactful solutions in response to the unprecedented mental health challenges exacerbated by the COVID-19 pandemic has the potential to promote more equitable recovery around the world.

Collaborative chronic care model implementation within outpatient behavioral health care teams: qualitative results from a multisite trial using implementation facilitation.

BACKGROUND: This paper reports on a qualitative evaluation of a hybrid type II stepped-wedge, cluster randomized trial using implementation facilitation to implement team-based care in the form of the collaborative chronic care model (CCM) in interdisciplinary outpatient mental health teams. The objective of this analysis is to compare the alignment of sites' clinical processes with the CCM elements at baseline (time 1) and after 12 months of implementation facilitation (time 2) from the perspective of providers. METHODS: We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at times 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at times 1 and 2. RESULTS: We conducted 27 and 31 telephone interviews at times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At time 1 and time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from time 1 to time 2 were work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at time 2 compared to time 1, while others had reductions. For the provider decision support element, we saw little change in the extent of its implementation. CONCLUSIONS: Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes in place at time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements-especially in the use of clinical information systems and linking with community resources. TRIAL REGISTRATION: Clinical Trials NCT02543840 .

An Exploratory Analysis of Self-Reported Protective Factors against Self-Harm in an Enrolled Veteran General Mental Health Population.

INTRODUCTION: The purpose of this study is to characterize self-reported protective factors against suicide or self-harm within free-response comments from a harm-risk screening. MATERIALS AND METHODS: Veterans enrolled in Department of Veterans Affairs mental health care were administered a self-harm and suicide screening as part of the baseline assessment in an ongoing implementation trial. Veterans indicated if they had thoughts of harming themselves and if so, what kept them from acting on them. Responses were coded based on established Centers for Disease Control protective factor categories. Descriptive analyses of demographic factors (such as age, gender, and race), clinical factors, and quality of life measures were conducted across groups depending on levels of self-harm risk. RESULTS: Of 593 Veterans, 57 (10%) screened positive for active thoughts of self-harm or suicide. Those with thoughts of self-harm had lower quality of life scores and higher rates of depression diagnoses. Of those individuals, 41 (72%) reported protective factors including Personal Resources (17%), Community Resources or Relationships (68%), and Other including pets and hobbies (15%). Those with stated protective factors had higher rates of employment and lower rates of PTSD diagnoses. CONCLUSION: This is one of the first open-response studies of harm-risk protective factors, allowing for a patient-centered approach that prioritizes the individual's voice and values. New protective factors emerged through the open-response format, indicating important factors that kept Veterans safe from self-harm or suicide such as pets and hobbies. Increasing focus on strengths and positive aspects of Veterans' lives that serve as protective factors may ultimately improve mental health treatment and prevention of suicide and self-harm.