Telehealth: Reducing Patients' Greenhouse Gas Emissions at One Academic Psychiatry Department.

OBJECTIVE: Academic and organizational leaders in psychiatry and all other medical fields are negatively impacted by climate change. The COVID-19 pandemic prompted a rapid shift to the use of more telehealth by behavioral health clinicians. The purpose of this study was to estimate the reduction of patients' greenhouse gas emissions during this rapid shift at one academic psychiatry institution. METHODS: The authors extracted data associated with all outpatient visits to all 26 psychiatry clinics from March 16, 2020, to December 31, 2020. Once the patients' travel miles saved by confirmed virtual visits were calculated, the authors used the standard ratio from the US Environmental Protection Agency (EPA) to calculate the total quantity of CO2 that would be emitted if the visits had occurred in person. RESULTS: During the study period, a total of 47,582 outpatient behavioral health visits with 3975 unique patients were completed. The majority of these departmental visits were telehealth (85%), with most of the telehealth visits conducted using real-time audio-video platforms (75.7%). Subtracting emissions from patient technology during telehealth visits from the estimated patient transport values produced a net savings of greenhouse gas emissions of 867,011 kg CO2. This amount is equal to the greenhouse gas emissions from 189 passenger vehicles driven for 1 year according to the EPA. CONCLUSIONS: This study shows that converting in person, face-to-face behavioral health visits to telehealth has the potential to increase both energy efficiency and conservation through a reduction in greenhouse gas emissions due to reduced patient travel. If these values were extrapolated to the total adult US population who have visits for behavioral health reasons, we estimate that conversion to virtual visits could save approximately 830,000 metric tons of CO2 annually. Organizational leaders should consider these societal benefits when making decisions regarding development and support of telehealth.

Social support among people with mental illnesses on probation.

OBJECTIVE: Justice-involved people with mental illnesses, in general, experience poor criminal justice outcomes (i.e., high rates of recidivism and probation revocations) and are at increased risk of homelessness, unemployment, stigma, trauma, and poor physical health. Low social support is repeatedly associated with worse mental health outcomes in the general population but little is known about social support among probationers with serious mental illnesses. METHOD: To address these gaps in the literature, we used an observational cross-sectional study design and data from a large, randomized controlled trial of specialty mental health probation to examine self-reported social support and its relationships with mental health functioning and other outcomes for individuals with serious mental illnesses on supervised probation. RESULTS: Probationers who self-reported lower levels of social support also reported greater mental health symptomatology and reported lower quality relationships with their probation officers. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Low social support among probationers with mental illnesses has important implications for mental health and criminal justice practice and policy. Coordinating services between the criminal justice and mental health systems to offer opportunities for social support and meaningful community engagement for those with mental illnesses who are on probation could improve a number of mental health and criminal justice outcomes for this population. Peer support and supported employment services, for example, in addition to outpatient mental health services, could be two strategies that could address social isolation and help individuals living with mental illnesses optimize their recovery and rehabilitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using the Consolidated Framework for Implementation Research to examine implementation determinants of specialty mental health probation.

BACKGROUND: Specialty mental health probation (SMHP) is designed to improve outcomes for the large number of people with serious mental illnesses who are on probation and/or parole. The evidence for specialty mental health probation is promising; however, little is known about the implementation challenges and facilitators associated with SMHP. To address this gap, we used the consolidated framework for implementation research (CFIR) to analyze 26 interviews with stakeholders representing multiple agencies involved in the implementation of SMHP. RESULTS: Results indicate a number of challenges and facilitators related to the inner setting, outer setting, implementation process, and characteristics of individuals. CONCLUSIONS: Findings suggest that complex and cross-sectoral interventions are context-dependent and introduce a number of challenges and facilitators related to multiple CFIR domains. Consequently, agency administrators implementing these types of interventions should consider small pilot studies and develop implementation strategies tailored to the local implementation context.

Statewide mental health training for probation officers: improving knowledge and decreasing stigma.

BACKGROUND: The large and growing number of probationers with mental illnesses pose significant challenges to the probationer officers who supervise them. Stigma towards mental illnesses among probation officers is largely unstudied and the effectiveness of training initiatives designed to educate probation officers about mental illness is unknown. To address these gaps in the literature, we report findings from a statewide mental health training initiative designed to improve probation officers' knowledge of mental illnesses. A single-group pretest posttest design was used and data about stigma towards mental illnesses and knowledge of mental illnesses were collected from 316 probation officers. Data were collected prior to and shortly after officers viewed a series of educational training modules about mental illnesses. RESULTS: Officers' knowledge of mental illnesses increased and officers demonstrated lower levels of stigma towards persons with mental illnesses as evidenced by scores on a standardized scale. CONCLUSION: Mental health education can help decrease stigma and increase knowledge of mental illnesses among probation officers. More research is needed to assess the impact of these trainings on probationers' mental health and criminal justice outcomes.

Segmented Versus Traditional Crisis Intervention Team Training.

There are more than 2,500 Crisis Intervention Teams (CIT) in operation across the country. Results of research on the effectiveness and impact of CIT are mixed. One aspect of CIT training that has yet to be examined is the expert-derived suggestion that 40 consecutive hours of training is an essential element of CIT for law enforcement officers. That is, CIT training is delivered in one 40-hour week, but it is unclear whether the training could be delivered in segments and still achieve its desired outcomes. Segmented training could make CIT more accessible to smaller, particularly rural, law enforcement agencies. Can segmented CIT achieve outcomes similar to those of traditional CIT training? We compared the knowledge and attitudes of 47 police officers who received traditional CIT training and 32 officers who received segmented CIT training. Our findings suggest that segmented CIT training and traditional CIT training produce comparable results regarding officers' knowledge of mental illness and attitudes toward persons with mental illness, providing preliminary support for this adaptation to the delivery of CIT training.