Joyce Lilian Dunlop

Joyce went to Trinity College Dublin to study medicine in 1954, where she enjoyed the Dublin University Biological Society and where she met the love of her life, Jim, a Scotsman, at the Dublin sailing school. After house jobs, Joyce spent some time in Northern Ireland, training in anaesthetics for obstetrics and gynaecology. Before coronavirus took hold, she was looking forward to a family holiday in Croatia in the summer with her three children, their spouses, and all her grandchildren, before her sudden death.

Psychiatrists as Partners in Suicide Prevention for Pediatric Medical Settings

The article discusses the role of psychiatrists and other mental health clinicians in preventing suicide, which remains a global public health crisis and the third leading cause of death among U.S. youth. Topics include effect of the COVID-19 pandemic on the pediatric mental health crisis, available tools to conduct a brief suicide safety assessment, and initiatives that can empower primary care providers to better address mental health concerns when specialty care is unavailable.

COPING WITH DEATH ANXIETY AND AWARENESS: EXPERIENCE WITH COVID-19 PATIENTS IN NEW YORK

Introduction: The global challenge that the Covid-19 pandemic represented for humanity, included local experiences and encounters from which helpful lessons may be drawn. Objectives: The primary objective was to assess and document death anxiety and death awareness among hospitalized intensive care unit (ICU) patients diagnosed with COVID-19 in a community-based teaching hospital. The secondary one was to reflect on mental health clinicians' therapeutic styles and skills when caring for patients in critical care settings. Methods: A series of hospitalized ICU patients diagnosed with COVID-19 at the height of the pandemic in New York City were evaluated in this study. Patients' psychological distress symptoms, death awareness, and death anxiety were measured using the Revised Death Anxiety Scale. Seventeen COVID-19 positive patients with various comorbidities who had been admitted to the ICU at Staten Island University Hospital were compared with seventeen COVID-19 negative patients with various comorbidities who had been seen and evaluated on the same ward over the same time period. The Revised Death Anxiety Scale (25 items) was used on all subjects by the deployed psychiatrists. The clinicians' experiences as recorded through diaries during this time were examined and reflected on. Results: Out of seventeen COVID-19 positive patients who participated in this case series, eleven responded with heigh death anxiety scores as compared to the seventeen COVID-19 negative patients in which only three subjects were observed to have high scores. From the very beginning, the COVID-19 pandemic brought to the forefront massive challenges for both psychiatrists and patients. These challenges immediately affected rapport-building, often leading to an atmosphere of trust, but also exposing patients to additional distress. Prior to furthering and facilitating therapeutic dialogue, psychiatrists had to "anesthetize the therapeutic situation,” decrease the arousal level and be attentive throughout the encounter. This attentiveness had to be individually organized and modulated as patients displayed different personality styles, with variations in their internal world and severity of medical condition. In due course, individual patterns of reactions were observed such as fantasies concerning isolation and separation, contrasting attachment styles, need for punishment and guilt feelings and activation of panic and helplessness. The latter was particularly challenging as both patient and physician could become easily trapped in feeling helpless and confused, with strong interpersonal and relational overlays. Compassionate gestures and sensibility in connectedness conveyed vitality and much needed hope. Discussion and Conclusions: Although death anxiety and death awareness seemed overwhelmingly prevalent among the COVID-19 positive patients in comparison to COVID-19 negative patients, differences have been observed in terms of being age-specific, having multiple comorbidities compounding on COVID-19 positive status (e.g., obesity and COPD). In general, the acute psychological distress of patients improved with medical treatment and when stabilized they were moved out of the ICU. Patients with high scores who had a COVID-19 positive status tended to have increased stay in the ICU. Future studies should assess the long-term consequences of COVID-19 on patients' general mental health and particularly death awareness and death anxiety. Additionally, health systems may use similar studies to understand the labor and costs borne by mental health clinicians as well as other clinicians working in such settings. In terms of medical education and liaison work, such research may inform training of clinicians in internal medicine, critical care, and mental health.

Provider Directory Inaccuracy and Timely Access for Mental Health Care

Commercial plans were consistently more accurate than both Covered California marketplace and Medi-Cal plans. [...]plans were highly limited in providing timely access to urgent care and general appointments, although Medi-Cal plans outperformed plans from both other markets when it came to timely access. Am J Manag Care. 2023;29(2):96-102. https://doi.org/10.37765/ajmc.2023.89318 _____ Takeaway Points * California has some of the strictest network regulations. * Nonetheless, mental health provider directories are highly inaccurate. * Moreover, consumers also lack access to timely care in many cases. * It is time to rethink network regulation and invest more into oversight. _____ Mental health services have long been an afterthought in the US health care system, with lack of care compounding the stigmatization and exclusion that individuals struggling with mental health issues face.1-3 It is established that lack of access to these services may impose significant individual and societal costs.4 However, although a variety of statutory changes in the past 2 decades has expanded mental health coverage requirements, consumer access to mental health services remains limited,1,2,5,6 a situation that has only been exacerbated by the COVID-19 pandemic.7,8 Highlighting the lack of access, consumers are substantially more likely to see an out-of-network provider for mental health care than for other types of care.9-11 Yet, 2 potential barriers to accessing mental health care—the interlinked issues of inaccurate provider directories and inadequate provider networks—remain underassessed.4,12 Given the vital role that provider directories and provider networks play in connecting consumers to care, inaccurate provider directories and inadequate provider networks may potentially harm both the health and the financial well-being of consumers. Most obviously, there is the time-intensive administrative burden of combing through faulty directory entries and calling offices to find in-network doctors.13 But even more concerningly, the inability to locate an accessible in-network provider may lead to delayed or foregone care.4,14,15 Directory errors and inadequate networks also impose financial risks to consumers when consumers knowingly seek care outside of their network because there is not adequate access to in-network care.11,16-19 Evidence also suggests that these burdens disproportionately affect disadvantaged populations.20,21 Finally, directory errors raise systemic concerns about the efficacy of health care regulation because regulators extensively rely on directory data for regulatory assessments of networks.4,22 Concerns about inaccurate provider directories and inadequate provider networks have sparked limited policy responses at both the state and federal levels.4,23-25 The federal government has directory accuracy regulations in place for Medicare Advantage, Medicaid, and marketplace plans, and a federal law governing directory accuracy for all other plans came into effect in 2022.26 In addition, a minority of states have taken some action to improve directory accuracy, and slightly more than half of all states have put in place quantitative network adequacy standards.11,24,27 Overlapping policies specific to directories and networks are state and federal parity laws that aim to ensure adequate coverage of and access to mental health care.28 Although scholars have begun to pinpoint directory errors and timely access to appointments as key barriers to health care, most of what we know about provider directory accuracy and timely access is based on a small "secret shopper" survey conducted at a single point in time.11,29-31 The present analysis overcomes these limitations by making use of annual reports that nearly all plans regulated by the California Department of Managed Health Care (DMHC) must submit. [...]when making comparisons for accuracy and timely access across markets, we used t tests to determine whether differences are statistically significant.

Organized Psychiatry Provides Strength and Value to Mental Health Professionals

The article discusses the impact of organized psychiatry on mental health professionals. Topics include results of the 2018 Survey of America's Physicians: Practice Patterns and Perspectives, complaints received each year by the American Psychiatric Association (APA) when its membership renewals reach members, and the struggle by specialty organizations to keep members active during these changing times.

Telepsychiatry

The use of communication technologies to provide psychiatric services is broadly termed telepsychiatry. While telehealth is not new and has been in existence for over 50 years, the COVID-19 pandemic accelerated the use of this modality and demonstrated its advantages in healthcare delivery. Although on the surface telepsychiatry may simply appear to be the practice of psychiatry through videoconference, like any innovation it presents nuanced regulatory, liability, and practice considerations. Familiarity with relevant rules regarding licensure, prescribing, credentialing, malpractice coverage, and privacy and security is important prior to getting involved with providing virtual services. Clinical issues such as informed consent, establishing a physician-patient relationship, documentation, and standard of care must also be considered. In this chapter, we will review these key issues through the lens of enhancing clinical practices and reducing the risk of medical malpractice and licensure violation when providing these services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Telepsychiatry in the Arab world: A viewpoint before and during COVID-19

Purpose: Telepsychiatry, a subset of telemedicine, has been increasingly studied to meet the growing demands for psychiatric care. The utility of telepsychiatry is relevant now more than ever as the world endures the COVID-19 global pandemic. This paper describes the prior state and the changes that the COVID-19 outbreak brought to telepsychiatry in a selected group of Arab countries of the Middle East and North Africa (MENA) region. Patients and Methods: We invited twelve early-career psychiatrists from different Arab nations to share information related to telepsychiatry in their respective countries before and during the COVID-19 pandemic. The information was collected using a semi-structured guide. This was complemented by a search for relevant articles in five search engines using terms such as "COVID-19," "telepsychiatry," and "Arab world". Results: Before the pandemic, digital mental health services were provided in several Arab countries, mainly through hotlines and messaging services. The COVID-19 pandemic has marked a major shift in digital psychiatric services in the Arab MENA world, through the transformation of many clinics and some hospitals into digital mental health systems. Many non-governmental organizations also started remote initiatives for psychological support and psychiatric counseling. Three main barriers of patient-related, healthcare-related, and system-related hurdles of using telepsychiatry emanated from the analysis. Conclusion: The use of digital mental health services varies between different Arab countries. Even though some nations have laws that regulate the provision of such services, most struggle with multifactorial barriers. As affordable and attainable solutions cannot only rely on training and recruiting more psychiatrists, telepsychiatry would help meet the exceeding demands in the Arab world, particularly after the COVID-19 outbreak. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Cyberchondria (Compulsive Digital Usage related to health): An Overview

Cyberchondria is one of the major concern now-a-days. Cyberchondria refers to the excessive and repeated digital health-related searching of information resulting in increased in anxiety. Such searches are compulsive and obsessional in nature. Amid the COVID-19 pandemic, cyberchondria became regular among population, as they surfed internet sites related to COVID-19 symptomatology, management etc. Surfing for digital information about symptoms and illnesses on the Internet is very common and very beneficial. However, now-a-days it is seen that this online surfing is distressing population making them more prone to hypochondriasis, panic attacks, anxiety and non-compliance with treatment. Cyberchondria management is the major among health care professionals.

A new challenge for child psychiatrists: Inpatient care management during coronavirus pandemic

The first objective of this article;is to define, as the child psychiatry inpatient service team, the approaches to patients who need both professional help and treatment in terms of mental health and need protection from an infection during the Covid-19 outbreak. Secondly, to evaluate the adaptation of the clinical skills (mechanism) to this critical process. A great burden is imposed on health systems during COVID-19 Pandemic. In this process, it is essential to follow the guidelines on transmission of infection and provide inpatient service treatment for child and adolescent in urgent need of mental health treatment. Length of hospitalization may be shorter in the pandemic period and high rate of antipsychotic use and predominance of patients with insufficient response to monotherapy may be related to hospitalization of patients with more severe disease during pandemic period. Timely organized regulations in psychiatry clinics can be effective against risk of transmission. This study shows the importance of how the pandemic process and the psychiatric disease treatment process can be carried out together. The continuation of the treatment services with infectious prevention measures in the field of mental health during pandemic times has an crucial place. As the healthcare professionals in the field of Child and Adolescent Mental Health, we think that it may be important to share inpatient service functioning and experiences in the face of the COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Telepsychiatry in the Arab world: A viewpoint before and during COVID-19

Purpose: Telepsychiatry, a subset of telemedicine, has been increasingly studied to meet the growing demands for psychiatric care. The utility of telepsychiatry is relevant now more than ever as the world endures the COVID-19 global pandemic. This paper describes the prior state and the changes that the COVID-19 outbreak brought to telepsychiatry in a selected group of Arab countries of the Middle East and North Africa (MENA) region. Patients and Methods: We invited twelve early-career psychiatrists from different Arab nations to share information related to telepsychiatry in their respective countries before and during the COVID-19 pandemic. The information was collected using a semi-structured guide. This was complemented by a search for relevant articles in five search engines using terms such as "COVID-19," "telepsychiatry," and "Arab world". Results: Before the pandemic, digital mental health services were provided in several Arab countries, mainly through hotlines and messaging services. The COVID-19 pandemic has marked a major shift in digital psychiatric services in the Arab MENA world, through the transformation of many clinics and some hospitals into digital mental health systems. Many non-governmental organizations also started remote initiatives for psychological support and psychiatric counseling. Three main barriers of patient-related, healthcare-related, and system-related hurdles of using telepsychiatry emanated from the analysis. Conclusion: The use of digital mental health services varies between different Arab countries. Even though some nations have laws that regulate the provision of such services, most struggle with multifactorial barriers. As affordable and attainable solutions cannot only rely on training and recruiting more psychiatrists, telepsychiatry would help meet the exceeding demands in the Arab world, particularly after the COVID-19 outbreak. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Psychiatry training goes virtual: the experience of the first online edition of the EPA Research Summer School

Introduction: The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely. Objective(s): To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19. Method(s): The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a breaking the ice session one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty. Result(s): Participants were divided on a voluntary basis into three working groups: 1) Drug repurposing: overcoming challenges in pharmacoepidemiology 2) Psychopathological research in psychiatry;3) How to conduct a cross-sectional survey?. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants. Conclusion(s): Although the remote format limits social interactions during the Summer School, overall participants' high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.

Impact of the COVID-19 Pandemic on General Hospital Physicians Work and Mental Health: An International Cross Sectional Study

COVID-19 pandemic had an important impact in mental health across all countries and populations. However, health care professionals, particularly those in the front line have been subjected to increased levels of stress, workload, deterioration of work environment and working conditions while potentially being afraid of contracting the infection themselves or infecting love ones due to the higher risk of contagion when dealing with infected patients. Some studies have stressed out this impact showing increased levels of burnout, depression, hopelessness, stress and post-traumatic stress in all physicians however, the impact of the pandemic may have been different depending on the specialty. We intended to study the impact of COVID-19 pandemic for doctors working at general hospitals and liaison psychiatrists dealing with COVID-19 patients in Europe. We developed and applied online questionnaires to physicians working at general hospitals and psychiatrists working at liaison services, in different European countries (Portugal, Italy, Belgium, Greece, Poland, Croatia), in order to determine what were their working conditions and it they reported mental health symptoms during the pandemic. This questionnaire included demographic data, questions about working conditions when dealing with general and COVID patients and the Hospital Anxiety and Depression scale (HADS). It was distributed thought email and social media platforms used by doctors. This work has been approved by each local Ethics committee and all participants signed an informed consent.

Psychopathology & the nature of the Self

Psychopathology is the systematic study of abnormal psychological experience and includes the precise description, definition and categorisation of abnormal phenomena. In this lecture I will focus on the potential role of psychopathology as a means of revealing the underlying brain processes that make possible our experience of reality. I will examine phantom limb phenomenon, Charles Bonnet Syndrome, musical hallucinations and autoscopy to illustrate and develop my thesis. My ultimate aim is to demonstrate that the value of psychopathology is over and above the merely descriptive and that its value includes theorising about neural mechanisms.

Burnout, stress and intentions to leave work in New Zealand psychiatrists; a mixed methods cross sectional study.

BACKGROUND: Demand for mental health services in New Zealand and internationally is growing. Little is known about how psychiatrists are faring in this environment. This study aimed to investigate wellbeing of psychiatrists working in the public health system in New Zealand, identify the main risk factors for work-related stress, gauge perceptions of how workload has changed over time, assess job satisfaction and whether individuals intend or desire to leave their work. METHODS: Psychiatrists working in New Zealand who were also members of the Association of Salaried Medical Specialists were invited to participate in an online survey. Main outcome measures were degree of burnout and stress experienced at work. Supplementary measures included perceived workplace demands and levels of support. Predictor variables included perceptions of changes to workloads over time, degree of job satisfaction and intentions to leave work. Logistic regression assessed characteristics associated with burnout and job satisfaction as well as intentions to leave work. Free text comments were analysed thematically alongside quantitative trends. RESULTS: 368/526 responded (70% response rate). 34.6% met the criteria for burnout and 35.3% scored with high work stress. There were no significant patterns of association with demographic variables but significant correlation with all but one predictor variable; having experienced a change to the demands of the on-call workload. 45% agreed they would leave their current job if able and 87% disagreed that they are working in a well-resourced mental health service. Respondents emphasised the impact of growing workloads and expressed concerns about their ability to provide optimal care in these circumstances. CONCLUSIONS: High burnout appears to affect one in three psychiatrists in New Zealand. Many attribute their feelings of burnout to demand for their services. These findings may assist with better workforce planning for psychiatry and emphasises potential consequences of demand for and poor resourcing of mental health services for the retention and wellbeing of doctors in psychiatry worldwide.

Telepsychiatry

The use of communication technologies to provide psychiatric services is broadly termed telepsychiatry. While telehealth is not new and has been in existence for over 50 years, the COVID-19 pandemic accelerated the use of this modality and demonstrated its advantages in healthcare delivery. Although on the surface telepsychiatry may simply appear to be the practice of psychiatry through videoconference, like any innovation it presents nuanced regulatory, liability, and practice considerations. Familiarity with relevant rules regarding licensure, prescribing, credentialing, malpractice coverage, and privacy and security is important prior to getting involved with providing virtual services. Clinical issues such as informed consent, establishing a physician-patient relationship, documentation, and standard of care must also be considered. In this chapter, we will review these key issues through the lens of enhancing clinical practices and reducing the risk of medical malpractice and licensure violation when providing these services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Digital Technology in Psychiatry: Survey Study of Clinicians.

BACKGROUND: Digital technology has the potential to transform psychiatry, but its adoption has been limited. The proliferation of telepsychiatry during the COVID-19 pandemic has increased the urgency of optimizing technology for clinical practice. Understanding clinician attitudes and preferences is crucial to effective implementation and patient benefit. OBJECTIVE: Our objective was to elicit clinician perspectives on emerging digital technology. METHODS: Clinicians in a large psychiatry department (inpatient and outpatient) were invited to complete a web-based survey about their attitudes toward digital technology in practice, focusing on implementation, clinical benefits, and expectations about patients' attitudes. The survey consisted of 23 questions that could be answered on either a 3-point or 5-point Likert scale. We report the frequencies and percentages of responses. RESULTS: In total, 139 clinicians completed the survey-they represent a variety of years of experience, credentials, and diagnostic subspecialties (response rate 69.5%). Overall, 83.4% (n=116) of them stated that digital data could improve their practice, and 23.0% (n=32) of responders reported that they had viewed patients' profiles on social media. Among anticipated benefits, clinicians rated symptom self-tracking (n=101, 72.7%) as well as clinical intervention support (n=90, 64.7%) as most promising. Among anticipated challenges, clinicians mostly expressed concerns over greater time demand (n=123, 88.5%) and whether digital data would be actionable (n=107, 77%). Furthermore, 95.0% (n=132) of clinicians expected their patients to share digital data. CONCLUSIONS: Overall, clinicians reported a positive attitude toward the use of digital data to not only improve patient outcomes but also highlight significant barriers that implementation would need to overcome. Although clinicians' self-reported attitudes about digital technology may not necessarily translate into behavior, our results suggest that technologies that reduce clinician burden and are easily interpretable have the greatest likelihood of uptake.

Telepsychiatry During the COVID Pandemic: Reflection from India

Introduction: Recent advancements in information technology and access to smartphone have expanded the scope of healthcare delivery services across the globe. Telemedicine is making healthcare affordable and more accessible to the needy in situations like the present pandemic. Although telepsychiatry services were underutilised initially in India due to various barriers, its role in delivering healthcare services, has gained pace since the last few years. During the coronavirus disease (COVID-19) pandemic, India introduced telemedicine practice guidelines (March, 2020), and telepsychiatry operational guidelines (May, 2020), to remove barriers and promote equitable access. In the wake of COVID-19 pandemic various mental health institutes across India relied heavily upon telepsychiatry services to provide care. National Institute of Mental Health and Neuro Sciences, Bangalore being an Institute of National Importance has introduced different modules to provide clinical care to the mentally ill. Objectives: In this article, the authors provide an experiential account of various clinical services provided by our institute through telepsychiatry means across India during the COVID-19 pandemic. Conclusion: These clinical service modules have tremendous potential to increase the use of technology in providing quality care to the unreached population, bridging the treatment gap for psychiatric disorders globally and developing countries in particular.

Tele-Mentoring and Monitoring of the National Mental Health Program: A Bird’s-Eye View of Initiatives from India

Objective: To provide a glimpse of various digital programs and modules that are being implemented across the country by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India (an institution of national importance under the Ministry of Health and Family Welfare, Government of India;one of its mandates is to develop innovative strategies to improve mental health capacity building as part of the National Mental Health Program, a publicly funded health program to cater to the public health need posed by psychiatric disorders). Design: The information is presented in a narrative fashion by organizing the activities into three categories of digital training methods: webinar mode, blended mode and hybrid mode. Results: Cadres ranging from lay-counsellors (volunteers in the community), non-specialist health workers to professionals including medical officers are covered with these initiatives. During the period from August 2016 till December 2020, more than 16 million man hours of training is delivered for more than 35,000 participants from across the country. Conclusions: These have a tremendous potential to exponentially increase skilled human resources capable of providing quality care to hitherto unserved remote areas of the rural hinterland and ultimately reduce the burgeoning treatment gap. In-depth outcome assessments are the need of the hour.