Buprenorphine and Opioid Use Disorder Training: Graduate Nursing Curricula Recommendations.

Opioid use disorder (OUD) is a public health emergency, with a shortage of providers trained to prescribe buprenorphine for OUD treatment. We conducted a systematic review to examine advanced practice RN (APRN) and medical school programs that included OUD content or Drug Addiction Treatment Act waiver training and evaluate the outcomes of those curricular modifications. APRN and medical school programs that provided OUD content or waiver training saw improvements in students' knowledge and self-efficacy for managing buprenorphine treatment and reduced stigma toward individuals with OUD. Students' perceptions of training were largely positive, and the programs' results indicated improved practice outcomes related to the use of buprenorphine. Further inclusion of OUD content and training in APRN curricula will increase the number of capable buprenorphine prescribers, which will increase access to buprenorphine for individuals with OUD. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Effects of COVID-19 on School Nurse Mental Health Intervention Practices.

Mental health issues have been exacerbated by COVID-19; therefore we examined how the school nurses' role in addressing mental health changed during the pandemic. We administered a nationwide survey in 2021, guided by the Framework for the 21st Century School Nurse, and analyzed self-reported changes in mental health interventions by school nurses. Most mental health practice changes after the start of the pandemic occurred in the care coordination (52.8%) and community/public health (45.8%) principles. An overall decrease in students visiting the school nurse's office (39.4%) was seen, yet the frequency of students visiting with mental health concerns had increased (49.7%). Open-ended responses indicated that school nurse roles changed due to COVID-19 protocols, including decreased access to students and changes in mental health resources. These insights into the role of school nurses in addressing student mental health during public health disasters have important implications for future disaster preparedness efforts.

Correlates of mental health problems among students in Texas alternative high schools and school-level efforts to address mental health.

Students in alternative high schools (AHSs) are an understudied population who experience disproportionate levels of risk factors that contribute to mental health problems. Using logistic regression, we explored associations between mental health problems and risk and protective factors among students in Texas AHSs (n = 515; mean age 17.1 years; 51% female, 78% youth of color, 64% eligible for free/reduced lunch). Principals (n = 14) and lead health educators (n = 14) reported on school-level efforts to address mental health. Students reported, on average, 1.55 of 4 mental health problems in the past year. Logistic regression indicated that greater number of adverse childhood experiences, lower self-esteem, female gender, and sleep disruption (getting <8 h of sleep per night) were common contributors to symptoms of depression, anxiety, suicidal ideation, and PTSD with models showing medium-to-large effects (AUC: 0.73-0.81). We assessed school-level efforts to address mental health using descriptive statistics. At the school level, most (>50%) principals reported having policies and services to support student mental health, with the exception of having mental health/social services staff represented on school health councils (36%) and having Gay-Straight Alliances (21%). Most lead health educators (86%) reported educating AHS students about mental health, and many (57%) reported receiving professional development in mental health. Future research with a larger number of schools is needed to analyze whether school policies are statistically associated with student-level mental health outcomes. Such multi-level research can inform policies and practices for AHS student mental health.

Barriers to and Facilitators of Mental Health Help-Seeking Behaviors Among South Asian American College Students.

Despite the increasing size of the South Asian population in the United States, research on the mental health care wants and needs of this population is limited. The current study aimed to provide a better understanding of South Asian American college students' attitudes and behaviors with respect to professional help for psychological and mental health. Participants included 14 college students at a large central Texas university, aged at least 18 years and fluent in English, who identified ethnically as South Asian. Qualitative interviews held with participants included demographic questions. Five themes emerged from the interviews: Family Dynamics, Environment, University Resources, Access to Help, and Cultural Dynamics. High levels of mental illness, low levels of help-seeking, and unique identity interactions demonstrated a prevailing need for mental health support in South Asian American college students. Accessible mental health care in university settings can be a step toward providing appropriate mental health care for South Asian students most in need. [Journal of Psychosocial Nursing and Mental Health Services, 60(7), 32-38.].

A survey of personnel and services offered in 32 outpatient US clozapine clinics.

BACKGROUND: Clozapine clinics can facilitate greater access to clozapine, but there is a paucity of data on their structure in the US. METHODS: A 23-item survey was administered to participants recruited from the SMI Adviser Clozapine Center of Excellence listserv to understand characteristics of clozapine clinics. RESULTS: Clozapine clinics (N = 32) had a median caseload of 45 (IQR = 21-88) patients and utilized a median of 5 (IQR = 4-6) interdisciplinary roles. The most common roles included psychiatrists (100%), pharmacists (65.6%), nurses (65.6%), psychiatric nurse practitioners (53.1%), and case managers (53.1%). The majority of clinics outreached to patients who were overdue for labs (78.1%) and had access to on-site phlebotomy (62.5%). Less than half had on call services (46.9%). CONCLUSIONS: In this first systematic description of clozapine clinics in the US, there was variation in the size, staffing, and services offered. These findings may serve as a window into configurations of clozapine teams.

HERO Wellness Scale: Examining a new mental wellness scale.

BACKGROUND: Mental wellness has traditionally not been tracked by mental health clinicians. The aim is to examine the reliability and validity of the HERO Wellness Scale. METHODS: Eighty-four college students (age ≥18) with and without psychiatric morbidity from a small, private college in the north-central United States enrolled in the WILD 5 Wellness Program-a longitudinal, quasi-experimental clinical trial that included 2 groups (intervention and waitlist). Mental wellness scores at the beginning of the WILD 5 intervention were assessed by the HERO Wellness Scale and the World Health Organization-Five (WHO-5) Well-Being Index. RESULTS: Internal consistency was calculated from baseline data (N = 84) using Cronbach's alpha for the 5-item HERO composite = .93. The corrected item-total correlations were adequate (>.50), ranging from .67 (resilience) to .86 (mental wellness). The HERO Wellness Scale covers a representative sample of the domain of wellness. It diverges from WHO-5 items by specifically assessing for well-established positive psychology traits such as happiness, enthusiasm, resilience, and optimism. CONCLUSIONS: The HERO Wellness Scale showed good validity and reliability, and should be considered for individual-level assessment of mental wellness. The HERO Wellness Scale adds to the body of knowledge in psychiatry, nursing, and psychology.

Recognizing the Risk Factors, Signs, and Symptoms of Domestic Minor Sex Trafficking in Mental Health Clinical Practice.

The purpose of the current article is to educate psychiatric providers on domestic minor sex trafficking (DMST). Psychiatric providers (e.g., psychiatric-mental health nurse practitioners, psychiatrists, physician assistants, therapists, case managers) interact with victims of sex trafficking but may fail to recognize the signs of victimization and the risk factors associated with becoming a victim of DMST. This educational article offers an overview of the definitions of sex trafficking, and the risk factors, prevalence, and health consequences of DMST. It also summarizes what is known about how those at-risk for DMST and DMST victims interact with the mental health care system. Mental health professionals provide a crucial point of contact with these populations and must strive to prevent, identify, and respond to DMST and at-risk youths. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 21-28.].

Wellness Interventions in Psychiatrically Ill Patients: Impact of WILD 5 Wellness, a Five-Domain Mental Health Wellness Intervention on Depression, Anxiety, and Wellness.

BACKGROUND: The efficacy of individual wellness interventions are well studied in relation to their respective impacts on psychiatric and mental wellness. To date, there is limited research on programs that incorporate multiple wellness domains and measure psychiatric and wellness markers. AIM: To assess the psychiatric and wellness impact of a nonpharmacologic wellness intervention on subjects receiving psychiatric treatment. METHOD: Forty-one adults with a psychiatric disorder completed the first 30 days of WILD 5 Wellness (Wellness Interventions for Life's Demands), a 90-day self-management mental wellness program that incorporated exercise, mindfulness, sleep, social connectedness, and nutrition. Subjects recorded participation in both workbooks and online surveys. Participants were recruited nationally via online and outpatient clinic advertisements. Wellness and mental health were measured on Days 1 and 30 of the intervention via five instruments: the Patient Health Questionnaire-9 for mood, the Generalized Anxiety Disorder 7-Item Scale for anxiety, the Sleep Condition Indicator for sleep quality, the Sheehan Disability Scale for functionality in psychiatric patients, and the HERO Wellness Scale, which measures happiness, enthusiasm, resilience, optimism, and overall mental wellness. RESULTS: Subjects reported statistically significant improvements across all measures on Day 30. CONCLUSION: The research suggests that this multidomain wellness program may be a valuable adjunct to traditional psychiatric treatment and an accessible tool for all health care providers.

Telehealth in Mental Health Nursing Education: Health Care Simulation With Remote Presence Technology.

The feasibility of integrating remote presence technology within a simulation scenario for psychiatric-mental health nursing (PMHN) students to develop telehealth competencies was evaluated. A wireless, audiovisual robot from Double® Robotics, maneuverable by smartphone or tablet computer, was used to simulate the facilitation of students' patient assessment and treatment decisions from a distant location for 32 weeks (total hours of robotic simulation = 32). Qualitative data were collected to assess student and faculty satisfaction, as well as for feasibility evaluations. Overall, students participating in the telehealth-enabled simulations reported moderate (9 of 36 students) to strong (25 of 36 students) value for the use of telemedicine within the simulation in a 3-point Likert scale post-simulation survey. These results illustrate the feasibility of using a remote presence robot in an educational simulation environment. Remote presence in clinical simulations can contribute to workforce preparation to apply telehealth-enabled communication in PMHN settings. [Journal of Psychosocial Nursing and Mental Health Services, 57(7), 23-28.].

State Nursing Licensure Questions About Mental Illness and Compliance With the Americans With Disabilities Act.

The current article describes a review of U.S. states and the District of Columbia boards of nursing pre-licensure applications, which were collected, summarized, and evaluated to assess compliance with the Americans With Disabilities Act (ADA). Less than one half (n = 21) of RN licensing boards do not ask questions about mental illness on pre-licensure applications. Of the 30 boards that ask questions about mental illness, eight focus on current disability, which is legal under the ADA. The remaining 22 boards ask non-ADA-compliant questions by targeting specific diagnoses, focusing on historical data in the absence of current impairment, and/or requiring a prediction of future impairment. Nursing boards are urged to join colleagues in law, psychology, and medicine in using ADA-acceptable applications by eliminating mental health questions or limiting them to current impairment queries. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 17-22.].

Screening for Bipolar I Disorder and the Rapid Mood Screener: Results of a Nationwide Health Care Provider Survey.

Objective: Effective screening for bipolar I disorder can lead to enhanced assessment, improved diagnosis, and better patient outcomes. The Rapid Mood Screener (RMS), a new bipolar I disorder screening tool, was evaluated in a nationwide survey of health care providers (HCPs).Methods: Eligible HCPs were asked to describe their opinions/current use of screening tools, assess the RMS, and evaluate the RMS versus the Mood Disorder Questionnaire (MDQ). Results were stratified by primary care and psychiatric specialty. Findings were reported using descriptive statistics; statistical significance was reported at the 95% confidence level.Results: Among respondents (N = 200), 82% used a tool to screen for major depressive disorder (MDD), while 32% used a tool for bipolar disorder. Most HCPs were aware of the MDQ (85%), but only 29% reported current use. According to HCPs, the RMS was significantly better than the MDQ on all screening tool attributes (eg, sensitivity/specificity, brevity, practicality, easy scoring; P < .05 for all). Significantly more HCPs reported that they would use the RMS versus the MDQ (81% vs 19%, P < .05); 76% reported that they would screen new patients with depressive symptoms, and 68% indicated they would rescreen patients with a depression diagnosis. Most HCPs (84%) said the RMS would have a positive impact on their practice, with 46% saying they would screen more patients for bipolar disorder.Discussion: In our survey, the RMS was favorably evaluated by HCPs. A large percentage of respondents preferred the RMS over the MDQ and indicated that it would likely have a positive impact on clinicians' screening behavior.

A 30-Day Adjunct Wellness Intervention for the Management of Extra-Articular Symptoms of Rheumatoid Arthritis: A Formative Study.

Individuals with rheumatoid arthritis (RA) continually fall short of treatment targets using standard drug therapies alone. There is growing evidence that emphasizing physical and mental wellness is equally crucial for improving functioning among people with RA. The purpose of this formative study is to examine the feasibility of offering the wellness-based intervention ("KickStart30") in patients with RA. Thirteen individuals with RA on targeted immune modulators (a biologic or JAK inhibitor) enrolled in the KickStart30 program. Participants completed self-report measures of RA-specific disability (eg, pain) and other functional areas (eg, mood) in a pre- versus post- intervention design. Paired samples t-tests (and Related-Samples Wilcoxon Signed Rank Tests for non-normal distributions) detected statistically significant results for 10 of 12 measures, including reductions in pain (M = 4.54 to M = 3.54; p = .025; BPI), functional disability (M = 0.94 to M = 0.73, p = .032; HAQ-II), cognitive and physical dysfunction (M = 25.46 to M = 13.54, p < .001; CPFQ), depressive symptoms (M = 9.31 to M = 5.54, p = .003; PHQ-9), anxiety (M = 5.69 to M = 3.23, p = .005; GAD-7), insomnia (M = 11.62 to M = 17.32, p = .007; Note: higher scores on the SCI indicate less insomnia), stress-related eating (M = 75.46 to M = 84.54, p = .021; Note: higher scores on the EADES indicate less stress-related eating), along with significant increases in mindfulness (M = 62.54 to M = 67.85, p = .040; MAAS), mental wellness (M = 4.46 to M = 5.69; HERO), and well-being (Md = 8.00 to Md = 5.00, p = .004; WHO-5). All significant measures had medium to large effect sizes (Cohen's d). The study gives preliminary support for the possibility that the adjunct intervention may have an effect.

Supporting the Mental Health Workforce During and After COVID-19.

The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.

Is it depression or is it bipolar depression?

This review is intended to guide primary care providers in differentiating patients with bipolar depression from those with unipolar depression and inform patient management. Up to 64% of clinical encounters for depression occur in primary care, with misdiagnosis of bipolar depression common in both primary care and psychiatry. Although bipolar disorder is characterized by manic, hypomanic, and depressive episodes, the most common and debilitating symptomatic presentation is depression. Misdiagnosis as unipolar depression is common, often resulting in mistreatment with an unopposed monoamine antidepressant. Antidepressants are often ineffective for treating bipolar depression and may cause detrimental consequences such as treatment-emergent hypomania/mania, rapid cycling, or increased suicidality. Factors that are suggestive of bipolar disorder versus unipolar depression include early-onset depression, frequent depressive episodes, family history of serious mental illness, hypomania/mania symptoms within the depressive episode, and nonresponse to antidepressants. Comorbid medical (e.g., cardiovascular disease, hypertension, obesity) and psychiatric (e.g., attention-deficit/hyperactivity disorder, anxiety disorder, personality disorders, and substance use disorder) conditions are common and contribute to premature mortality for patients with bipolar disorder compared with the general public. Cariprazine, fluoxetine/olanzapine, lurasidone, and quetiapine are approved to treat bipolar depression; only cariprazine and quetiapine are approved to treat both bipolar mania and depression. Primary care providers who can differentiate presenting symptoms of bipolar depression from unipolar depression and offer appropriate treatment options will optimize patient care in clinical practice. Relevant information for this review was identified through a multistep literature search of PubMed using the terms bipolar depression/bipolar disorder plus other relevant terms.