Using implementation science in youth mental health workforce development: Adapting to the COVID-19 pandemic in Australia

Aims: Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organization with a mission to reduce the impact of mental ill-health on young people, families and society, and one of only a few known research and clinical centres with a dedicated Knowledge Translation division. This paper provides a case study of the workforce development team within Orygen Knowledge Translation, outlining how implementation science informs their work and how the division has adapted its model of service support in the face of COVID-19. Method(s): Process data on training and resources developed and delivered by the workforce development team at Orygen over the period 2017-2021 was collated and synthesized with team reflections about the adaptations made by team in response to the COVID-19 pandemic. Results and Conclusion(s): Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. The COVID-19 pandemic facilitated profound and rapid changes to service delivery and development in Australian youth mental health. Implementation science offers flexible models to support a changing system.

A qualitative study exploring how youth use TikTok to learn about mental health and mental health services in British Columbia, Canada

Aims: Youth are increasingly seeking health information through online platforms, such as websites, social media, and online forums. TikTok emerged as a popular platform for disseminating and consuming health information during the COVID-19 pandemic. As such, this study aimed to explore how youth used TikTok to access information about mental health and mental health services during the pandemic. Method(s): Twenty-one interviews were conducted over Zoom with youth (ages 12-24) who lived in British Columbia, Canada and had accessed TikTok for mental health information during the pandemic. Interviews were audio-recorded, transcribed verbatim, and analysed thematically using an inductive approach. Result(s): Youth described TikTok as a safe place to talk about mental health and share personal experiences. This helped youth feel less alone with their struggles and facilitated conversations about mental health with friends, family, and service providers. Participants also described how mental health content on TikTok helped them be more mindful of their own mental health and the different resources and coping strategies available and encouraged them to seek services. For those hesitant or unable to access services, TikTok provided immediate support. Youth appreciated the ease of accessing this information, given the platform's engaging and digestible format (i.e., short videos) and predictive nature of its algorithm. However, participants expressed concerns with the spread of misinformation and the lack of verifiable information on the platform. Conclusion(s): TikTok is as a practical platform to disseminate mental health information to youth. However, efforts to establish strategies for preventing and reporting misinformation are warranted.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: Results of an international survey

Aims: The COVID-19 pandemic presented new difficulties for integrated healthcare worldwide. Our study aims to highlight developing needs for cooperation while describing structures and practices of consultation liaison (CL) services established during pandemic across Europe. Method(s): The cross-sectional survey used an ONLINE self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies cooperating in EAPM, and heads of CL services from June to October 2021 Results: 259 hospital CL services took part in the study (28.0% response rate). 222 (85.7%) of these services reported providing COVID-19-related mental health care (COVIDpsyCare). Among them, 192 services (86.5%) reported the development of specialized COVID-psyCare co-operation arrangements. 135 services (50.8%) provided specific COVID-psyCare for patients, 85 (38.2%) for relatives, and 171 (77.0%) for staff, with 56.3%, 14.6%, and 23.7% of time resources invested for these groups, respectively. Interventions for hospital staff, commonly related to the liaison function of CL services, were rated as being the most helpful. Regarding newly emerging demands, 129 (58.1%) CL services stated a need for communication and support among themselves concerning COVID-psyCare, and 142 (64.0%) suggested certain adjustments or enhancements that they thought were crucial for the future. Conclusion(s): Specific structure to provide COVID mental health care for patients, their relatives, or staff were implemented in over 80% of the participating CL services. Resources were primarily allocated for patient care, and staff assistance was mostly achieved through the implementation of specialized interventions. COVID psyCare's development calls for further intra- and interinstitutional cooperation.Copyright © 2023

Subjective experience of people with psychotic and bipolar disorders: Contributors to mental health and wellbeing during the COVID-19 pandemic and suggestions for improved care in future pandemics

Aims: People with psychotic and bipolar disorders were particularly vulnerable to poor mental health and wellbeing in the early phases of the COVID-19 pandemic. However, their subjective experience of what they were most worried about concerning the pandemic, what contributed most to how they were doing, and what they suggest the mental health services could do to improve care during a pandemic, requires investigation. Method(s): Three months after the outbreak of COVID-19, 520 people with psychotic and bipolar disorders responded to an online survey about the pandemic impact on mental health and wellbeing, including three open-ended questions. The material was analysed using thematic analysis. Result(s): The participants' main worries were: fear of the virus itself;fear of protective measures;fear of a completely changed world;fear of social consequences;and fear of poor mental health. These worries involved others as much as themselves. Participants' experience of main positive contributors were: a slower pace of life;more time to reflect;maintaining daily routine;keeping up social contact;and mental health service availability. The most prominent suggestions to improved mental health services were: stay open;be proactive;and individualize treatment. Conclusion(s): In the early stages of the pandemic people with psychotic and bipolar disorders were equally worried about the pandemic consequences for others and the world at large, not just for themselves. Positive contributors to wellbeing included increased calm and time to respite. They suggested that mental health services remain available and flexible during future pandemics.

External and service factors influencing outcomes in a model of stratified mental health services for Young People

Background: Stratified care aims at matching the intensity and setting of mental health interventions to the needs of help-seeking Young People. In Australia, a 5-tiered system of mental health services is in operation. To aid patient triage to the most appropriate tier, a Decision Support Tool (DST) has been developed and is being rolled out nationally Methods: We analysed outcome data pre-and post-enrolment of about 1500 Young People (aged 16-25) referred to a Youth Mental Health Service delivering medium- and high intensity psychological treatment programs (tiers 3 and 4). We compared outcomes in both tiers during three 12-month periods: (a) in the inaugural phase of tier 4, prior to service saturation and stringent triaging, and prior to the COVID-19 pandemic (2019);(b) during the COVID-19 pandemic when all services were delivered remotely over phone- and video facilities, and when DST triaging was introduced (2020);(c) following return of face-to-face consultations, in a situation of service saturation and stringent DST triaging (2021) Findings: About 22% of Young People in the tier 3 program experienced reliable improvement according to their Kessler-10 (K-10) scale ratings, regardless of changing circumstances. In contrast, 40% of people in the tier 4 program reliably improved during the inaugural phase When circumstances and service delivery changed (COVID-19 restrictions service saturation, DST triaging), the rate of reliable improvement halved to about 20% Conclusion(s): Access to higher intensity psychological programs improves treatment outcomes for help-seeking Young People. However high-intensity services are more sensitive to external and service factors than less intense treatment models.

Meeting the service needs of youth with and without a self-reported mental health diagnosis during COVID-19

Background: The COVID-19 pandemic catalyzed major changes in how youth mental health (MH) services are delivered. Understanding youth's MH, awareness and use of services since the pandemic, and differences between youth with and without a MH diagnosis, can help us optimize MH services during the pandemic and beyond. Objective(s): We investigated youth's MH and service use one year into the pandemic and explored differences between those with and without a self-reported MH diagnosis. Method(s): In February 2021, we administered a web-based survey to youth, 12-25 years, in Ontario. Data from 1373 out of 1497 (91.72%) participants were analyzed. We assessed differences in MH and service use between those with (N=623, 45.38%) and without (N=750, 54.62%) a self-reported MH diagnosis. Logistic regressions were used to explore MH diagnosis as a predictor of service use while controlling for confounders. Result(s): 86.73% of participants reported worse MH since COVID-19, with no between-group differences. Participants with a MH diagnosis had higher rates of MH problems, service awareness and use, compared to those without a diagnosis. MH diagnosis was the strongest predictor of service use. Gender and affordability of basic needs also independently predicted use of distinct services. Conclusion(s): Various services are required to mitigate the negative effects of the pandemic on youth MH and meet their service needs. Whether youth have a MH diagnosis may be important to understanding what services they are aware of and use. Sustaining pandemic-related service changes require increasing youth's awareness of digital interventions and overcoming other barriers to care.Copyright © 2023, Canadian Academy of Child and Adolescent Psychiatry. All rights reserved.

The Effect of the Covid-19 Pandemic on Mental Health (Children, Adolescents, Young Adults) and Mental Health Service: Systematic Review

The impact of the COVID-19 pandemic on mental health in young age groups (chil-dren, adolescents, and young adults) has a higher prevalence than individuals at other stages of the lifecycle. The implementation of mental health services faces more barriers to professional care than in the pre-pandemic period. This study aims to identify the effect of sociodemographic and Public Health and Sosial Measures on the mental health of young age groups and mental health services during the COV-ID-19 pandemic. We conducted a mixed-methods-integrated approach to synthesize the findings and drew results using mixed-methods analysis. Literature finding was conducted in seven databases. The selection procedure followed the f low diagram of the Preferred Reporting Items for Systematic Review and Meta-Analyses. Inclusion criteria included all types of research that looked at the impact of COVID-19 on mental health and mental health services. There are 44 articles included, and the quality assessment shows that the study was evaluated as 80% and 100% quality criteria met. During the implementation of Public Health and Social Measures, the young age group experienced mental health problems, including stress, depression, anxiety, sleeping disorder, eating disorder, and post-traumatic stress disorder related to socioeconomic status, academic, and social factors. This systematic review proves that the COVID-19 pandemic affects the mental health of the young age group and mental health services. © 2022, Universitas Negeri Semarang. All rights reserved.

Using innovative population-level data to understand the mental health impact of community-level events on young people: An example from the COVID-19 pandemic in Victoria

Aims: Since the onset of the COVID-19 pandemic, a significant rise in mental ill-health has been observed globally in young people, particularly amongst those in their final years of secondary school. The students' negative experiences coincide with a critical transitional period, which can subsequently disrupt milestones in social and educational development. This study aims to use innovative population-level data to map the impact of the pandemic on students entering higher education. Method(s): Tertiary education application data for Victorian students were obtained from the Victorian Tertiary Admissions Centre both pre-pandemic (2019/2020) and pandemic (2020/2021). Prevalence of mental health special considerations were compared between cohorts across geographical areas and applicant demographic subgroups. Relative risk regression models were used to understand the role of different risk factors. Result(s): The rate of mental health special considerations increased by 38% amongst all applications (pre-pandemic: 7.8%, n = 56 916;pandemic: 10.8%, n = 58 260). The highest increases were observed amongst students in areas with severe lockdown experiences and areas impacted by 2019/2020 black summer bushfires. The increases were higher amongst year 12 students and students with other preexisting risk factors (e.g., physical condition, learning disability). However, interestingly slightly higher increases were observed in areas with higher socioeconomic status, which is potentially related to inequality in mental health service access. Conclusion(s): As the consequences of mental health difficulties and academic disruption in youth can be long-lasting, it is critical to establish a mental health supportive framework both in and outside of higher education to facilitate young people's recovery from the pandemic.

Towards gold standard care for peripartum women admitted to general intensive care units

Introduction: Critically-ill obstetric patients admitted to general intensive care units (ICU) are a rare and unique population for whom excellent care is essential to prevent devastating physical and psychological morbidity. Admissions are often unanticipated and can present challenges to obstetric and intensive care MDTs. 2018 Enhanced Maternal Care (EMC) Guidelines provide standards for caring for these women, and the 2022 Ockenden review exposed the association of peripartum ICU admission with undertreated psychological trauma and a desire for individualised debriefing [1,2]. We audited the care of obstetric admissions to general ICUs in our quaternary centre. We sought evidence of psychological morbidity to improve follow-up pathways in line with 2022 Ockenden actions. Method(s): Retrospective online case note review of maternity admissions to general ICUs between 1/1/2021-1/1/2022 compared to EMC audit standards. Exclusion criteria: <22/40 gestation, >6/52 postpartum and admissions to our level 2 labour ward high dependency unit. Result(s): 25 patients were admitted to general ICUs over 12 months. Median age was 35-39 years, mean parity was 1. The commonest indication was obstetric haemorrhage (n = 10). 15 of 25 patients required level 3 care, median length of stay was 1.5 days. Documentation of daily obstetric MDT ward round was variable, as was mother-baby contact. 0 of 25 women were seen in obstetric anaesthesia clinic after discharge, only 1 received outpatient ICU follow-up. 50% of postnatal admissions (n = 14) had documentation of significant psychological distress. In response a local checklist was developed with key colleagues to support collaborative working and standardise quality care. It includes automatic referral into obstetric anaesthesia clinic and access to a novel perinatal mental health service. Discussion(s): A peripartum admission to ICU is highly likely to be experienced as traumatic [2]. The incidence of obstetric ICU admissions may increase in the context of greater clinical complexity of the UK pregnant population and COVID-19, whilst the non-anaesthetic ICU workforce may have little obstetric training. Obstetric anaesthetists are therefore uniquely skilled to facilitate quality resuscitation and referral to ICU, but gold-standard holistic care extends beyond admission. We believe regular audit and dedicated local care pathways which incorporate proactive debriefing and psychological health can improve the care of this important group of women.Copyright © 2023 Elsevier Ltd

Conclusion

This conclusion presents some closing thoughts on the concepts discussed in the preceding chapters of this book. The book is produced during the COVID-19 pandemic, an event that has drawn attention to the importance and fragility of good mental health. It presents the use of the Level of Service Inventory-Revised, Mental Health Service Evaluation and the Global Assessment of Functioning in probation in Ireland. The book discusses the use of the Kessler-6 in London and the idea that currently mental health services would be overloaded if screening positive on this measure alone was used to initiate a referral. It outlines the use of the Autism Quotient-10 to identify 'possible autism' and the Adult Asperger Assessment to gather a more detailed picture. The book discusses the use of drug specialists in probation practice. It highlights the central importance of a positive and consistent relationship between a person under supervision and their Probation Practitioner for positive mental health. This is important to build trust in order for an individual to be open about their mental health needs, and to minimise the potential trauma and stress that may result from having to retell a difficult story. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Trends of psychiatric emergencies during the COVID-19 health crisis in Italy

Background: Despite concerns on mental health problems related to lockdowns, recent reports revealed a reduction in psychiatric admissions in Emergency Departments (ED) during the lockdown period compared with the previous year in several countries. Most of the existing studies focused on the first lockdown not considering the different phases of the COVID-19 crisis. The present study aimed to analyse differences in ED admissions for psychiatric consultation during three different phases of the COVID-19 in Italy. Method(s): Information on ED admission the Santo Spirito Hospital in Rome for psychiatric consultations were retrospectively collected. The lockdown(March-June 2020) and the post-lockdown period (June 2020-June 2021) were compared to the pre-lockdown period(January 2019-March 2020). Multinomial logistic regression(MLR) was used to assess the risk of accessing ED for psychiatric consultation during the three periods. Result(s): 3871 ED psychiatric consultations were collected. A significant reduction of psychiatric consultations in ED during the lockdown period and the post-lockdown (H 762.45;p < .001) was documented. MLR showed that compared to pre-lockdown during the lockdown and post-lockdown patients were more likely to be men (RRR 1.52;95% CI 1.10-2.12) and more often diagnosed with non-severe mental illnesses (nSMI) (relative risk ratio [RRR] 1.53, 95% CI 1.10-2.15;and 1.72, 95% CI 1.42-2.08);during the lockdown, patients were also more often diagnosed with alcohol/substance abuse(RRR 1.70;95% CI 1.10-2.65). Conclusion(s): Several changes in the clinical characteristics of psychiatric consultations during and after the lockdown emerged;these may inform clinicians and future preventive strategies among community mental health services.

User centred design of Orygen virtual worlds: The next generation of telehealth for youth mental health care

Background: Rapid uptake of telehealth during the COVID-19 pandemic has opened a gateway to improving access to mental health care. However, existing platforms are not fit-for-purpose, resulting in poor treatment engagement. Virtual worlds (VW) are an innovative technology whereby users can meet and interact in real time using personally tailored avatars within 3D virtual environments. VWs may improve engagement and access to youth mental health care by offering a fun and interactive social space, with customizable features capable of supporting delivery of psychosocial treatment. The aim of this study was to develop a purpose-built VW designed to support delivery of youth mental health care. Method(s): A user centred design framework was employed to develop a prototype of Orygen Virtual Worlds (OVW) across 8 sessions with 8 young people with lived experience. Sessions progressed from basic concept validation, through to persona and journey mapping, and finishing with several user testing sessions to iteratively develop the prototype. Result(s): End users (young people) were overall very positive about the potential for VWs to supplement youth mental health services. Iterative feedback and testing identified core features needed to ensure the platform was usable, safe and capable of delivering effective individual, group and peer interventions. Conclusion(s): This presentation will showcase the development of this innovative new platform for delivering engaging, accessible and effective youth mental health care for hard-to-reach youth. Results will be discussed in context of the unique development approach informed by user centred design principles and implementation science.

Telemedicine and the Utilization of Outpatient Mental Health Services By Patients with Incident Major Depressive Disorder during the COVID-19 Pandemic

Objectives: To examine the role of telemedicine in providing access to outpatient psychotherapy for children and young adults with incident major depressive disorder (MDD) before and during the COVID-19 pandemic, overall and by race and ethnicity. Method(s): Medical claims from a large, national insurer were retrospectively analyzed to identify two cohorts of individuals aged 10-26 years old, based on incident diagnosis ("index") date of MDD (pre-COVID: March-December 2018, COVID: March-December 2020). We tracked health care utilization, utilization by site of care, modality of care, and psychotherapy Results: The majority of patients in the two cohorts (pre-COVID: N=7,758, COVID: N=8,517) were White (78.9% and 78.8%, respectively), followed by Hispanic (11.5% and 10.9%), Black (6.6% and 7.1%), and Asian (3.0% and 3.2%). While pre-index utilization was similar between cohorts, the COVID cohort had 919 psychotherapy visits per 1,000 patients compared to 735 for the pre-COVID cohort in the month post-index. The increase in visits is largely attributable to an increase in telemedicine visits for the COVID cohort. Similarly, psychotherapy visits increased for all racial and ethnic groups in the COVID cohort compared to the pre-COVID cohort in the month post-index: 22.3% for Whites (931 visits per 1,000 patients in COVID cohort vs. 759 in pre-COVID cohort), 45.0% for Asians (951 vs. 656), 20.5% for Blacks (792 vs. 657) and 46.5% for Hispanics (860 vs. 587). Conclusion(s): Telemedicine increased access to mental health services during the pandemic across races and ethnicities, but racial and ethnic disparities persisted. Health systems should capitalize on the telehealth infrastructure developed during the pandemic to sustain this increased access to care while continuing work to reduce disparities.Copyright © 2023

Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications.

BACKGROUND: The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. OBJECTIVE: This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. METHODS: Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. RESULTS: The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. CONCLUSIONS: Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes.

Association between immigrant concentration and mental health service utilization in the United States over time: A geospatial big data analysis.

Immigrants (foreign-born United States [US] citizens) generally have lower utilization of mental health services compared with US-born counterparts, but extant studies have not investigated the disparities in mental health service utilization within immigrant population nationwide over time. Leveraging mobile phone-based visitation data, we estimated the average mental health utilization in contiguous US census tracts in 2019, 2020, and 2021 by employing two novel outcomes: mental health service visits and visit-to-need ratio (i.e., visits per depression diagnosis). We then investigated the tract-level association between immigration concentration and mental health service utilization outcomes using mixed-effects linear regression models that accounted for spatial lag effects, time effects, and covariates. This study reveals spatial and temporal disparities in mental health service visits and visit-to-need ratio among different levels of immigrant concentration across the US, both before and during the pandemic. Tracts with higher concentrations of Latin American immigrants showed significantly lower mental health service utilization visits and visit-to-need ratio, particularly in the US West. Tracts with Asian and European immigrant concentrations experienced a more significant decline in mental health service utilization visits and visit-to-need ratio from 2019 to 2020 than those with Latin American concentrations. Meanwhile, in 2021, tracts with Latin American concentrations had the least recovery in mental health service utilization visits. The study highlights the potential of geospatial big data for mental health research and informs public health interventions.

The impact of COVID-19 on access to mental health services and the use of teletherapy as an alternative form of treatment

The aim of this research study is to determine the impact of COVID-19 on access related to mental health services and also explain the use of teletherapy as an alternative form of treatment. This research study is based on secondary research data analysis to determine the research study data collected from websites related to the ratios of COVID-19 also that mental health services. Determine the research study used E-views software, and the generated result included descriptive statistics, correlations, the dickey fuller test analysis, the histogram, and state, also that explain the variance and test of equality between them. The overall result shows COVID-19 shows a direct impact on mental health services;teletherapy directly links with mental health services. Benefits make teletherapy the best online therapy session for overcoming various types of depression and mental illness in patients. Also, teletherapy is an alternative form of mental health service that is mostly provided to people affected due to the pandemic conditions of the coronavirus.Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.

Disruptions in Health Care among Mwccs Participants during the Covid-19 Pandemic

Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.

Social worker to therapist: Adaptation of role while addressing inequities in mental health care

Background: 2020 was a year of transformation in cystic fibrosis (CF) care. Many adults with CF started elexacaftor/tezacaftor/ivacaftor while COVID- 19 was unfolding. Occurring almost simultaneously, these two events created a dramatic shift in the disease landscape. Hospital admissions plummeted, and physical health improved. Clinic appointments turned virtual, and people with CF sheltered at home for months. These changes created opportunities for CF team members to adapt roles to meet evolving needs. Social work hours devoted to inpatient care, end of life, and discharge planning could be reallocated to other areas. Although many patients improved from a physical standpoint, mental health problems increased. Between 2020 and 2022, demand for mental health services increased exponentially, creating a national mental health crisis, but inequities in insurance coverage existed between physical and mental health care. Finding a mental health provider became an almost impossible task. This author sought to address insurance inequity and increased demand for mental health services by offering cognitive behavioral therapy (CBT) sessions to adults with CF to optimize their health andwellbeing. CBT is considered an evidence-based approach for most mental health problems. Method(s): Eight adults at the Stanford Adult CF Center were referred for CBT with social work from August 2021 to April 2022. Referrals were based on mental health crisis, mental health screenings, insurance barriers, and availability of mental health providers. Therapy sessions were offered via telehealth as part of the multidisciplinary care at the CF center. Patients were not billed for the sessions. The number of sessions was variable, with a mean of 10.5 sessions per patient. The frequency and content of sessions were tailored to patients' unique needs. Referrals were accepted on a continuous basis, space available. Mental health problems included anxiety, depression, alcohol use disorder, trauma, and gender dysphoria Results: All eight patients receiving CBT demonstrated significant improvement in mental health symptoms, as evidenced by a mean reduction in Patient Health Questionnaire-9 score of 3 and General Anxiety Disorder-7 score of 3.3. (Six of 8 patients were screened before and after therapy.) Other measures of improvement were patient selfreport as documented in therapy notes, sessions being tapered or discontinued as goals were met, and reduction in or stoppage of psychotropic medications. Conclusion(s): Mental health is a vital component of health and should be properly addressed as part of CF care. Although mental health care in CF has come a long way, patients continue to lack proper access to trained providers, especially those with expertise in CBT and CF. Given the current mental health crisis and shortage of therapists to meet newdemands, there are serious implications for long-term health outcomes for people with CF. As more studies are published demonstrating the effectiveness of CBT and other forms of therapy in the CF population, CF providers can adapt roles to implement new interventions in addressing mental health problems as part of CF care rather than referring patients to community providers who often are poorly positioned to meet their needs. The Stanford CF program will continue to use social work role to provide mental health servicesCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

The Italian psychiatric services organization during the COVID-19 pandemic

BACKGROUND: The present study aims to monitor how the Italian psychiatric services changed their organizations by adapting to the COVID-19 pandemic and considering the different incidence rates of the SARS-CoV-2 infection spread in the different Regions of Italy. METHOD(S): An on line "ad hoc" questionnaire was created and administered to all Italian Mental Health Departments. The questionnaire included various typologies of mental health setting such as Mental Health Service (MHS), the psychiatric therapeutic community (TC) and the psychiatric hospital ward (PH);the Region of Italy belonging to each participants is considered in accordance to the incidence of new cases per 100.000 inhabitants, as published by the Higher Institute of Health in the bulletin of 20 April 2020. Moreover, 9 questions were administered to investigate any challenges in several aspects influenced by the pandemic. RESULT(S): One hundred seventeen questionnaires were received, complete in their answers, 66 of which belonged to MHSs, 27 to TCs and 24 to PHs. The answers collected according to psychiatric settings were all statistically significant (P<0.05), except for item no.8 concerning the periodic checks of healthcare workers in the search for SARS-CoV-2 infection (p=0.432). Considering the answers received according to the incidence rate of new cases of COVID-19 per 100.000 inhabitants, as reported in the Higher Institute of Health on 20 April 2020, there was no significant statistical difference among the answers for all the items of the questionnaire, with the exception of item no.5 regarding patient care procedures (P=0.004) as at least partially - if not totally - all the psychiatric settings considered changed their procedures for patient care according to the incidence rate of the pandemic. CONCLUSION(S): The pandemic required providing greater assistance to both psychiatric patients already in treatment and to the new ones, the new accesses. On the other hand, however, the pandemic condition had strongly affected the provision of assistance mainly by reducing the provision of services, especially on the community and thus giving priority to the management of the COVID-19 pandemic.Copyright © 2021 EDIZIONI MINERVA MEDICA.