Increased Australian outpatient private practice psychiatric care during the COVID-19 pandemic: usage of new MBS-telehealth item and face-to-face psychiatrist office-based services in Quarter 3, 2020.

OBJECTIVE: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists' uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July-September), 2020. We compare these to the same quarter in 2019. METHOD: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July-September), 2019, of face-to-face consultations for the whole of Australia. RESULTS: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15-30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations. CONCLUSIONS: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.

Australian private practice metropolitan telepsychiatry during the COVID-19 pandemic: analysis of Quarter-2, 2020 usage of new MBS-telehealth item psychiatrist services.

OBJECTIVE: The Australian Commonwealth Government introduced new psychiatrist Medicare-Benefits-Schedule (MBS)-telehealth items in the first wave of the COVID-19 pandemic to assist with previously office-based psychiatric practice. We investigate private psychiatrists' uptake of (1) video- and telephone-telehealth consultations for Quarter-2 (April-June) of 2020 and (2) total telehealth and face-to-face consultations in Quarter-2, 2020 in comparison to Quarter-2, 2019 for Australia. METHODS: MBS item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with a baseline of the Quarter-2, 2019 (April-June 2019) of face-to-face consultations for the whole of Australia. RESULTS: Combined telehealth and face-to-face psychiatry consultations rose during the first wave of the pandemic in Quarter-2, 2020 by 14% compared to Quarter-2, 2019 and telehealth was approximately half of this total. Face-to-face consultations in 2020 comprised only 56% of the comparative Quarter-2, 2019 consultations. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations comprised 38% of the total telehealth provision (for new patient assessments and longer consultations). CONCLUSIONS: There has been a flexible, rapid response to patient demand by private psychiatrists using the new COVID-19-MBS-telehealth items for Quarter-2, 2020, and in the context of decreased face-to-face consultations, ongoing telehealth is essential.

Itinerário terapêutico e assistência à saúde de usuários de drogas na rede de atenção psicossocial / Therapeutic itinerary and health care for drug users in the psychosocial care network / Itinerario terapéutico y atención sanitaria para usuarios de drogas en la red de atención psicosocial

Objetivo: compreender a percepção de usuários de drogas acerca do itinerário terapêutico e da assistência à saúde na Rede de Atenção Psicossocial. Método: Pesquisa de abordagem qualitativa desenvolvida com usuários de drogas assistidos em um Centro de Atenção Psicossocial Álcool e outras drogas nos meses de março a maio de 2019. A coleta dos dados foi a partir da entrevista semiestruturada e analisados por meio da análise temática. Resultados: evidenciou-se que os usuários de drogas fazem uma ampla peregrinação na rede de saúde em busca de acolhimento e que a assistência à saúde está pautada em um modelo manicomial, centrado na medicalização em alguns serviços. Conclusão: a assistência prestada nos serviços de âmbito territorial não acolhe o usuário e nem garante a integralidade do cuidado, o que faz com que esses peregrinem pela Rede

Objective: to understand the perception of drug users about the therapeutic itinerary and health care in the Psychosocial Care Network. Method: Qualitative research conducted with drug users assisted at a Psychosocial Care Center for Alcohol and other drugs from March to May 2019. Data collection was based on the semi-structured interview and analyzed using thematic analysis. Results: it was evidenced that drug users make a wide pilgrimage in the health network in search of welcoming and that health care is based on a mental hospital model, centered on medicalization in some services. Conclusion: the assistance provided in the services of territorial scope does not welcome the user and does not guarantee the integrality of care, which makes these pilgrims through the Network

Objetivo: comprender la percepción de los usuarios de drogas sobre el itinerario terapéutico y asistencial en la Red de Atención Psicosocial. Método: investigación cualitativa realizada con usuarios de drogas atendidos en un Centro de Atención Psicosocial por Alcohol y otras drogas de marzo a mayo de 2019. La recolección de datos se basó en la entrevista semiestructurada y se analizó mediante análisis temático. Resultados:se evidenció que los usuarios de drogas realizan un amplio peregrinaje en la red de salud en busca de acogida y que la atención sanitaria se basa en un modelo de hospital psiquiátrico, centrado en la medicalización de algunos servicios. Conclusión: la asistencia prestada en los servicios territoriales no acoge al usuario y no garantiza la integralidad de la atención, que realizan estos peregrinos a través de la Red

Lo sonoro musical, un universo posible al margen de las palabras

Relato del tratamiento de un paciente, que asistió al servicio de salud mental durante siete años, especialmente a sesiones de musicoterapia, donde pudo escribir material de su autoría.

Knowledge of health practitioners regarding mental health integration into human immunodeficiency virus management into primary healthcare level.

BACKGROUND: Mental disorders are common among people living with human immunodeficiency virus (HIV). Human immunodeficiency virus infection is associated with neurological complications, which may negatively affect antiretroviral treatment, leading to virologic as well as immunologic failure. The integration of mental healthcare services into HIV services at a primary healthcare level is vital, as this is the first contact point for most patients accessing healthcare services. OBJECTIVES: The aim of this study was to determine the knowledge of healthcare professionals about the integration of mental healthcare services into HIV services at a primary healthcare level. METHOD: This study was a quantitative descriptive study, designed to determine the knowledge of healthcare professionals towards integrating mental healthcare services into routine services at primary healthcare centres. The purposive sampling method was employed to select the 200 healthcare professionals who participated in this study. RESULTS: The majority of the healthcare professionals (91%) who participated in this study had limited knowledge regarding the integration of mental healthcare services into HIV services at a primary healthcare level. Very few (9%, n = 18) had adequate knowledge about the integration of mental healthcare services into HIV services. CONCLUSION: Most of the participants had limited knowledge about the subject matter. This, therefore, shows that all stakeholders involved need to implement initiatives to address this knowledge gap.

Fútbol y psicoanálisis: una experiencia entre varios

En el Centro de Salud Mental Nº 1 de la Ciudad de Buenos Aires, el equipo de Niños Tarde comenzó en 2018 a integrar a los niños en tratamiento a un taller de fútbol, pensado como un espacio en el cual pudieran jugar con otros, y posibilitar múltiples transferencias e intervenciones. Se describe cómo fueron desarrollándose las actividades de este dispositivo.

Analysis of psychiatric services provided to children and youth in 2010-2016 based on the National Health Fund data. / Analiza swiadczen psychiatrycznych udzielonych populacji rozwojowej w latach 2010­2016 na podstawie danych Narodowego Funduszu Zdrowia.

OBJECTIVES: In Poland, there is no systematic epidemiological research on mental disorders of children and adolescents in the general population, as well as a register dedicated to mental disorders. The aim of the presented study is to analyze psychiatric services reported to the National Health Fund that were provided to children and adolescents in the years 2010-2016. METHODS: The starting point of this study was report entitled Maps of health needs in mental disorders published by the Ministry of Health. The analysis concerns all mental health services provided to children and adolescents in the years 2010-2016. The analysis covers seven largest, in terms of the number of patients, groups of mental disorders according to ICD-10 in children and adolescents. RESULTS: In the years 2010-2016, both the number of psychiatric service users under the age of 18 years and the total number of healthcare services have increased in almost all of analyzed areas. Unusually high increase in the number of services provided in the ad hoc mode in A&E department was registered, with a very small share of services provided in home environment. In almost all analyzed groups of mental disorders, there was a greater number of boys, as well as residents of a town/city. Only in the group of neurotic disorders associated with stress and in the somatic form a slightly higher number of girls was noticed. CONCLUSIONS: In the years 2010-2016, an increase in the number of registered cases in the population of children and adolescents and the number of services in almost all of the analyzed areas was observed. High increase in services provided in the ad hoc mode in A&E department and a small share of services provided in the home environment indicates significant discrepancy between the needs and the availability of resources.

Promoting Integrated Mental Health Care Services in Disaster Response Programs: Lessons Learned After the Impact of Hurricane María in Puerto Rico.

Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.

Implementation research for public sector mental health care scale-up (SMART-DAPPER): a sequential multiple, assignment randomized trial (SMART) of non-specialist-delivered psychotherapy and/or medication for major depressive disorder and posttraumatic stress disorder (DAPPER) integrated with outpatient care clinics at a county hospital in Kenya.

BACKGROUND: Mental disorders are a leading cause of global disability, driven primarily by depression and anxiety. Most of the disease burden is in Low and Middle Income Countries (LMICs), where 75% of adults with mental disorders have no service access. Our research team has worked in western Kenya for nearly ten years. Primary care populations in Kenya have high prevalence of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD). To address these treatment needs with a sustainable, scalable mental health care strategy, we are partnering with local and national mental health stakeholders in Kenya and Uganda to identify 1) evidence-based strategies for first-line and second-line treatment delivered by non-specialists integrated with primary care, 2) investigate presumed mediators of treatment outcome and 3) determine patient-level moderators of treatment effect to inform personalized, resource-efficient, non-specialist treatments and sequencing, with costing analyses. Our implementation approach is guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. METHODS/DESIGN: We will use a Sequential, Multiple Assignment Randomized Trial (SMART) to randomize 2710 patients from the outpatient clinics at Kisumu County Hospital (KCH) who have MDD, PTSD or both to either 12 weekly sessions of non-specialist-delivered Interpersonal Psychotherapy (IPT) or to 6 months of fluoxetine prescribed by a nurse or clinical officer. Participants who are not in remission at the conclusion of treatment will be re-randomized to receive the other treatment (IPT receives fluoxetine and vice versa) or to combination treatment (IPT and fluoxetine). The SMART-DAPPER Implementation Resource Team, (IRT) will drive the application of the EPIS model and adaptations during the course of the study to optimize the relevance of the data for generalizability and scale -up. DISCUSSION: The results of this research will be significant in three ways: 1) they will determine the effectiveness of non-specialist delivered first- and second-line treatment for MDD and/or PTSD, 2) they will investigate key mechanisms of action for each treatment and 3) they will produce tailored adaptive treatment strategies essential for optimal sequencing of treatment for MDD and/or PTSD in low resource settings with associated cost information - a critical gap for addressing a leading global cause of disability. TRIAL REGISTRATION: ClinicalTrials.gov NCT03466346, registered March 15, 2018.

Evaluating time in health care: What are we busy about?

At the end of the day, there are both economic and less tangible benefits to having predictable clinic operations in which people's medical and behavioral health needs are met. These different benefits, stemming from changes in how time is used, are relevant to a wide range of stakeholders including administrators, clinicians, and patients. In short, time is one of our most important resources in health care. Therefore, time studies have a crucial role to play in advancing the implementation of integrated care. In this editorial we describe several methods for measuring time and invite readers to consider which of these (or another method you're aware of) balances your needs for precision and feasibility of measurement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Inclusion of mental health in primary health care: care strategy in the territory / Inclusión de la salud mental en la atención primaria de salud: una estrategia de cuidado en el territorio / Inclusão da saúde mental na atenção básica à saúde: estratégia de cuidado no território

ABSTRACT Objective: To analyze the strategies, challenges and possibilities of the articulation between mental health and primary health care from the perspective of health managers. Method: Exploratory, qualitative research carried out with 28 managers of mental health and primary care. The data were collected through semi-structured interviews between July and November 2013 and submitted to thematic content analysis. Results: The inclusion of mental health actions in primary care made it possible, in the view of managers, to increase users' access to the care they need. This care strategy allows the extension of care practices in the territory, with matrix support as the main tool for the implementation of this care strategy. Final considerations: The articulation between primary care and mental health is a powerful device for psychosocial care, but it demands a new conformation of the Psychosocial Care Centers (Caps) and primary care services.

RESUMEN Objetivo: analizar las estrategias, los desafíos y las posibilidades de articulación entre la salud mental y la atención primaria de salud desde la perspectiva de los gestores de la salud. Método: investigación exploratoria y cualitativa, realizada con 28 gestores de salud mental y de la atención primaria. En la recopilación de datos se utilizaron entrevistas semiestructuradas, realizadas en el período entre julio y noviembre de 2013, las cuales se sometieron al análisis de contenido temático. Resultados: desde la perspectiva de los gestores, la inclusión de las acciones de salud mental en la atención primaria permitió que los usuarios amplíen el acceso al cuidado que necesitan. Esta estrategia de atención permite difundir las prácticas de cuidado en el territorio, y cuenta con un apoyo central como la principal herramienta para implementar esta estrategia de cuidado. Consideraciones finales: la articulación entre la atención primaria y la salud mental es un mecanismo clave en la atención psicosocial, sin embargo, demanda una nueva conformación de los Centros de Atención Psicosocial (Caps) y de los servicios de la atención básica.

RESUMO Objetivo: analisar as estratégias, desafios e possibilidades da articulação entre a saúde mental e a atenção básica à saúde a partir da perspectiva de gestores da saúde. Método: pesquisa exploratória, qualitativa, realizada com 28 gestores de saúde mental e atenção básica. Os dados foram coletados por meio de entrevistas semiestruturadas, entre julho e novembro de 2013, e submetidos à análise de conteúdo temática. Resultados: a inclusão das ações de saúde mental na atenção básica possibilitou, na visão dos gestores, a ampliação do acesso dos usuários aos cuidados de que necessitam. Esta estratégia de atenção possibilita extensão das práticas de cuidado no território, tendo o apoio matricial como a principal ferramenta para a implementação dessa estratégia de cuidado. Considerações finais: a articulação entre a atenção básica e a saúde mental é um dispositivo potente para a atenção psicossocial, porém, demanda uma nova conformação dos Centros de Atenção Psicossocial (Caps) e dos serviços da atenção básica.

Inclusion of mental health in primary health care: care strategy in the territory.

OBJECTIVE: To analyze the strategies, challenges and possibilities of the articulation between mental health and primary health care from the perspective of health managers. METHOD: Exploratory, qualitative research carried out with 28 managers of mental health and primary care. The data were collected through semi-structured interviews between July and November 2013 and submitted to thematic content analysis. RESULTS: The inclusion of mental health actions in primary care made it possible, in the view of managers, to increase users' access to the care they need. This care strategy allows the extension of care practices in the territory, with matrix support as the main tool for the implementation of this care strategy. FINAL CONSIDERATIONS: The articulation between primary care and mental health is a powerful device for psychosocial care, but it demands a new conformation of the Psychosocial Care Centers (Caps) and primary care services.

A Care Coordination Model Can Facilitate Interagency Collaboration When Designing Recovery-Oriented Services.

The purpose of the current article is to highlight the potential of a care coordination model in promoting interagency collaboration when designing recovery-oriented services. The authors argue the case using exemplars from the literature and lessons learned from Australia's Partners in Recovery initiative. Interagency collaboration is paramount when designing a recovery-oriented service system. A care coordination model has the potential to overcome most challenges that preclude implementation of service system integration. Although the care coordination model is relatively new in recovery-oriented services and effectiveness studies of this model have yet to be undertaken, the model has the potential to be a viable alternative to service system integration. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 38-43.].

Mental health as a dimension for the care of teenagers.

OBJECTIVE: To analyze the demands in the field of mental health from the perspective of teenagers. METHOD: A descriptive study with a qualitative approach, having comprehensiveness as an analytical category. It was carried out with 21 teenagers of both genders, students of two public schools of a municipality of the countryside of Bahia state. The empirical material was produced through reflection workshops and analyzed through the technique of Discourse Analysis. RESULTS: Teenagers value the indissociability between body and mind, recognize lack of attention to the psychological dimension in the health network, and point to mental disorders as resulting from contexts of life and lack of Health Care. CONCLUSION: Health services need to be structured to attract teenagers, to recognize singularities through professionals trained in welcoming, listening and accountability. It is urgent to fulfill what is defined in public policies and in specific programs, and that comprehensiveness has a centrality as a perspective to be realized.

Integrating Health and Mental Health Services: A Past and Future History.

The authors trace the modern history, current landscape, and future prospects for integration between mental health and general medical care in the United States. Research and new treatment models developed in the 1980s and early 1990s helped inform federal legislation, including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act, which in turn are creating new opportunities to further integrate services. Future efforts should build on this foundation to develop clinical, service-level, and public health approaches that more fully integrate mental, medical, substance use, and social services. [AJP AT 175: Remembering Our Past As We Envision Our Future July 1928: A President Takes Stock Adolf Meyer: "I sometimes feel that Einstein, concerned with the relativity in astronomy, has to deal with very simple facts as compared to the complex and erratic and multicontingent performances of the human microcosmos, the health, happiness and efficiency of which we psychiatrists are concerned with." (Am J Psychiatry 1928; 85(1):1-31 )].

Utilization of primary care among college students with mental health disorders.

OBJECTIVE: Our goal was to assess whether integration of behavioral and medical services in college settings is associated with decreased use of primary care by patients with mental health diagnoses (MHDs). METHOD: The cohort consisted of 80,219 patients with at least 1 MHD in 21 universities. Two levels of service integration were defined: "standard"-universities with separate electronic health records (EHR) systems and minimal clinical collaboration between services, and "enhanced"-universities with shared EHR and collaborative patient care. Frequency, the total number of primary care visits, and complexity, the total visit length for primary care per unit time, were compared by using multilevel models. RESULTS: Nine schools met the criteria of enhanced clinical integration; a tenth school shifted to enhanced service during the study period. Student and patient demographics and clinical diagnoses were similar between the 2 categories. When controlling for variance in age, sex, and total time in school, patients with MHDs in standard systems had 15.72% (95% confidence interval [CI]: 10.77%-20.44%) more primary care visits and 22.88% (95% CI: 21.42%-24.38%) more time than patients in enhanced systems. CONCLUSIONS: Students with MHDs have significantly lower utilization of primary care services in integrated health care systems, but only a minority of institutions nationally have adopted this model of care. Although further research is needed to specifically assess differences in health outcomes and perceived suffering, it is possible that reduced primary care visits in enhanced integrative service settings with robust mental health support indicates overall reduction in perceived suffering for patients/clients. (PsycINFO Database Record

A preliminary survey of pediatricians' experiences with and preferences for communication with mental health specialists.

INTRODUCTION: Pediatricians are more likely than mental health (MH) specialists to manage children's MH concerns, and multiple factors complicate their abilities to do so adequately. Integrated care initiatives mitigate systems-related shortcomings that hamstring MH management in primary care. These initiatives, which improve outcomes for adults, are not widespread for youth. Integrated health care for children with MH concerns requires regular collaborative communication among pediatricians and MH specialists. The nature and quality of this communication in typical practice are not fully clear. METHOD: We conducted an anonymous pilot survey of 123 pediatric primary care providers from 41 states. We examined respondents' experiences with and attitudes about collaborative communication barriers and strategies. RESULTS: Respondents estimated that 28% of their patients had MH concerns. Nearly 30% reported discomfort treating these concerns, 54% described MH care resources in their communities as inadequate, and 24% of pediatricians reported no communication at all with MH specialists about shared patients. Actual contact among communicators was less frequent than desired. Satisfaction with communication was low. Barriers to satisfactory communication included systems factors, inconsistent/nontimely responses from specialists, and the perception that MH specialists are unwilling to communicate. DISCUSSION: Many pediatricians appear to view communication with MH specialists as less systematic than it ought to be. Efforts to address communication barriers may advance integrated care aims and mitigate pediatricians' perceptions of MH treatment resource inadequacy. As an important step toward integration, MH specialists should consider prioritizing systematic ongoing collaborative communication about shared patients. (PsycINFO Database Record