Comparing Telerehabilitation and In-Person Interventions in School-Based Occupational Therapy for Specific Learning Disorder A Randomized Controlled Trial.

Objective: This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population. Materials & Methods: The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests). Results: Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes. Conclusion: In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR's transformative role in enhancing the holistic well-being of children with SLDs.

Factors Influencing the Integration of Traditional Medicine and Mainstream Medicine in Mental Health Services in West Africa: A Systematic Review Using Narrative Synthesis.

This study explored the enablers and obstacles to the integration of traditional medicine and mainstream medicine in mental health services in West Africa. This study is a systematic review conducted in accordance with the relevant parts of the Preferred Reporting Items for Systematic reviews and Meta-analyses. Keywords searches were done in databases, and other reference lists were also searched. The Rainbow model of integrated care and a thematic analysis framework were used to account for the factors influencing the integration of traditional medicine and mainstream medicine in mental health services in West Africa. A total of 12 studies met the eligibility criteria after the evaluation of 6413 articles from databases and reference lists. The themes of: policy and implementation; different conceptualisation of mental health/referrals; trust issues, and education and training, were enablers or obstacles of integration depending on how they worked to facilitate or hinder integration. There was an indication of little integration of TM and MM at the macro, meso and micro levels in mental health services in West Africa. Though the study does cover all the West African states evenly, it is recommended that policy-makers and stakeholders interested in integration should ensure integration activities, especially policies, cut across all the levels of the rainbow model of integrated care and are planned and aligned at the macro, meso and micro levels instead of using ad hoc measures, informal initiatives or placing TM services in MM mental health services, which do not amount to integration.

Tackling social inequalities in health: Assessing contexts for implementing integrated health access for people with severe mental illness.

Social inequalities in health are a complex problem that often emerge at the interfaces between different sectors, such as health and social care, and the corresponding transitions between different provider organisations. Vulnerable people are typically in greater need of accessing different sectors of the health system and therefore often experience lack of coherence in their treatment pathway. We aimed to examine the contexts of health systems that influence initiatives concerned with integrated health access. We used the theory of Organizational Fields to study the contexts for implementing Flexible Assertive Community Treatment (FACT) in Central Denmark Region and three municipalities in the region. We collected 33 documents and conducted six qualitative interviews with professionals involved in FACT to understand the contexts of implementing integrated health access. We found that contexts for implementing FACT are highly complex, as they are divided between health and social care (horizontal complexity) and between national and the sub-national levels of the region and the municipalities (vertical complexity). This leads to conflicting demands on implementation. Local contexts of collaboration may offer a lever to handle these demands, but these are likely to vary. Analysis of how complex health system contexts influence implementation is important to understand how changes might become sustainable and help to tackle social inequalities in health.

Mental Health Literacy and Education of Complementary Medicine Practitioners: A Cross-Sectional Study.

An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners' mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health-including suicide risk-were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner's surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.

Perceptions of community mental health services among culturally diverse adult Singaporeans with major depressive disorder: A descriptive qualitative study.

Persons with major depressive disorder (PMDDs) often experience pernicious ramifications on the biopsychosocial aspects of their health. While community mental health services (CMHSs) in Singapore are increasingly leveraged to meet the escalating demand for mental healthcare, shortcomings such as a substantial treatment gap and the lack of holistic, culturally sensitive care have been highlighted. Of note, the perspectives of the service users, which have hardly been studied in the literature, are crucial to our understanding of their needs to continuously improve CMHSs. Accordingly, this qualitative descriptive study explored the perceptions and experiences of community-dwelling adults with major depressive disorder in their use of CMHSs in Singapore. Seventeen adults with major depressive disorder purposefully sampled from a CMHS provider were interviewed through a semi-structured guide between October and November 2021. Data analysis via Braun and Clarke's six-step thematic framework yielded five themes corresponding to three different phases: pre-CMHS encounter ((i) procrastination to seek help and (ii) factors influencing CMHS utilization); intra-CMHS encounter ((iii) incongruous perceptions of the impacts on biopsychosocial health and (iv) differing perceptions and experiences of culturally sensitive care); and post-CMHS encounter ((v) enhancing CMHSs for PMDDs based on end-users' experiences). Our findings underscore the need to improve the delivery of personalized mental healthcare services, use of settings- and culturally-specific anti-stigma strategies, and nationwide mental health literacy in symptom recognition and awareness of help-seeking resources.

The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence.

The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence is not well understood. To address this we conducted a systematic review and meta-synthesis of qualitative studies. Our search strategy included electronic searches of 18 databases and grey literature, citation tracking and reference list screening. Studies were eligible if they presented qualitative data from racially and/or ethnically minoritised women or girls, who had experienced sexual violence at any age and described their experiences of receiving treatment from statutory mental health and/or substance use services. Studies were analysed using meta-ethnography. Fourteen papers based on 12 individual studies were included. Analysis developed three main themes: (1) understanding minoritised women holistically, (2) processing the trauma and beginning the healing and (3) the need for social connectedness and empowering relationships. For minoritised women to benefit from treatment, mental health and substance use services need to challenge the dynamics of the multiple traumas minoritised women experience. Knowledge and understanding of the racial trauma minoritised women experience is limited and many are subjected to further harm from racist practices occurring in some treatment services. Offering culturally safe, trauma-informed care which promotes anti-racist practices may help improve mental health and substance use service responses to minoritised women who have experienced sexual violence.

A bite of dark chocolate? Black humour in mental health services.

OBJECTIVE: Black humour permits expression of what may otherwise be unspeakable and is observed and used by staff working in mental health services. The aim of this study was to identify how humour, particularly black humour, was perceived by different health professionals in psychiatric practice. METHODS: Participants were invited to complete a survey. Data was collated and statistically analysed by a biostatistician. Chi square and univariate tests were performed to identify associations between categories. RESULTS: The sub-question relating to the benefits of black humour was analysed. Main findings were that the majority of staff perceived black humour to be beneficial in psychiatric practice (n = 564 of 710 total; 79.4%), particularly if they used general and black humour with patients, families and colleagues. Those who observed black humour being used collegially about patients and families were more likely to find black humour beneficial; and even those uncomfortable with black humour being used by colleagues were more likely to see the benefits of black humour. CONCLUSION: Black humour was perceived to be beneficial in mental health settings when used mindfully, sensitively and in context. Further study with patients and relatives may shed light on how widely the perception of benefit is shared.

Centros de Atenção Psicossocial e formação profissional para oferta das Práticas Integrativas e Complementares: estudo com profissionais ofertantes dos serviços / Psychosocial care centers and professional training for the provision of integrative and complementary practices: a study with professionals offering these services / Centros de Atención Psicosocial y formación profesional para oferta de las Prácticas Integradoras y Complementarias: estudio con profesionales ofertantes de los servicios

Estudos sobre a formação em Práticas Integrativas e Complementares têm se concentrado na análise curricular dos cursos da Saúde e as pesquisas abrangendo as percepções dos profissionais a respeito dos processos formativos devem ser mais elucidadas. O estudo objetiva identificar os processos de formação e capacitação dos profissionais ofertantes de Práticas Integrativas e Complementares nos Centros de Atenção Psicossocial de uma região metropolitana. Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 45 profissionais, as quais foram posteriormente analisadas segundo a Análise de Conteúdo Temática. As pós-graduações, graduação, formações em serviço e o ensino privado foram as trajetórias adotadas pelos profissionais, revelando a existência de uma formação difusa para a oferta no cenário investigado. Esses resultados podem subsidiar o planejamento de estratégias educacionais para a ordenação dos recursos humanos em Práticas Integrativas e Complementares.(AU)

Studies of training in integrative and complementary practices have concentrated on the analysis of the curriculums of health courses and further more in-depth research into professionals' perceptions about training processes is needed. This study aimed to identify training processes and capacity building for professionals who offer integrative and complementary practices in psychosocial care centers in a metropolitan region. We conducted an exploratory descriptive study involving semi-structured interviews with 45 professionals. The interview transcripts were analyzed using content analysis. The most common routes taken by the professionals were post-graduate qualifications, degrees, in-service training and private education. The results reveal that training in this area was diffuse. Our results can inform the development of educational strategies for the organization of human resources in the area of integrative and complementary practices.(AU)

Los estudios sobre la formación en Prácticas Integradoras y Complementarias se han concentrado en el análisis curricular de los cursos de la salud y las investigaciones que incluyen las percepciones de los profesionales con relación a los procesos de formación deben elucidarse más. El objetivo del estudio es identificar los procesos de formación y capacitación de los profesionales ofertantes de Prácticas Integradoras y Complementarias en los Centros de Atención Psicosocial de una región metropolitana. Se trata de un estudio descriptivo, exploratorio, de abordaje cualitativo. Se realizaron entrevistas semiestructuradas con 45 profesionales que fueron posteriormente analizadas según el Análisis de Contenido Temático. Los postgrados, graduación, formaciones en servicio y la enseñanza privada fueron las trayectorias adoptadas por los profesionales, revelando la existencia de una formación difusa para la oferta en el escenario investigado. Esos resultados pueden subsidiar la planificación de estrategias educativas para la ordenación de los recursos humanos en las Prácticas Integradoras y Complementarias.(AU)

Mental health professionals' perspectives on the relevance of religion and spirituality to mental health care.

BACKGROUND: A large body of evidence indicates that spiritual and religious backgrounds, beliefs, and practices (SRBBPs) are related to better psychological health. Spirituality and religion (R/S) are also important aspects of multicultural diversity. There is evidence that clients would like to talk about their spirituality, and that including it in assessment and treatment planning can be beneficial. However, the extent to which practicing mental health professionals view SRBBPs as relevant to mental health and clinical practice is unclear. METHODS: A survey examining several aspects of addressing SRBBPs in clinical practice was distributed to 894 professionals across mental health disciplines, including psychiatry, psychology, social work, marriage family therapy, licensed professional counselors, certified chemical dependency counselors, and psychiatric mental health nurses. RESULTS: 89% of mental health professionals agreed that clinicians should receive training in R/S competencies. There were no differences between mental health disciplines in ratings of importance of such training. Younger individuals and those who identify as more spiritual were more likely to consider R/S training as important. Although 47.1% of professionals had not received much R/S training, many perceived themselves to be highly competent in R/S clinical integration practices (57.8% considered themselves able to display them very much or completely). In addition, respondents with more R/S training evaluated themselves as more proficient in R/S clinical integration. Nearly two-thirds (65.2%) of respondents reported encountering few to no barriers to engaging in R/S competent mental health care. CONCLUSIONS: There is a growing consensus among mental health care professionals that mental health professionals should be trained in R/S competencies. Strong agreement exists that basic R/S competencies include respect, empathy, examination of bias, and routine assessment of R/S in mental health care. Four in five of those surveyed agree that more active competencies, such as identifying and addressing religious and spiritual struggles and problems and helping clients explore and access R/S strengths and resources should be included, whereas one in five report less comfort with these competencies.

unDerstandIng the cauSes of mediCation errOrs and adVerse drug evEnts for patients with mental illness in community caRe (DISCOVER): a qualitative study.

Background: It is estimated that 237 million medication errors occur in England each year with a significant number occurring in the community. Our understanding of the causes of preventable medication errors and adverse drug events (ADE) affecting patients with mental illness is limited in this setting. Better understanding of the factors that contribute to errors can support the development of theory-driven improvement interventions. Methods: Remote qualitative semi-structured interviews with 26 community-based healthcare professionals in England and Wales were undertaken between June-November 2022. Recruitment was undertaken using purposive sampling via professional networks. Interviews were guided by the critical incident technique and analysed using the framework method. Any data that involved speculation was not included in the analysis. Independent analysis was carried out by the research team to extract themes guided by the London Protocol. Results: A total of 43 medication errors and 12 preventable ADEs were discussed, with two ADEs having an unknown error origin. Prescribing errors were discussed most commonly (n = 24), followed by monitoring errors (n = 8). Six contributory factor themes were identified: the individual (staff); the work environment; the teams/interfaces; the organisation and management; the patient; and the task and technology. The individual (staff) factors were involved in just over 80% of all errors discussed. Participants reported a lack of knowledge regarding psychotropic medication and mental illnesses which accompanied diffusion of responsibility. There were difficulties with team communication, particularly across care interfaces, such as ambiguity/brevity of information being communicated and uncertainty concerning roles which created confusion amongst staff. Unique patient social/behavioural contributory factors were identified such as presenting with challenging behaviour and complex lifestyles, which caused difficulties attending appointments as well as affecting overall clinical management. Conclusion: These findings highlight that the causes of errors are multifactorial with some unique to this patient group. Key areas to target for improvement include the education/training of healthcare professionals regarding neuropharmacology/mental illnesses and enhancing communication across care interfaces. Future research should explore patient perspectives regarding this topic to help develop a holistic picture. These findings can be used to guide future intervention research to ameliorate medication safety challenges for this patient group.

O papel do CAPS I na vida de seus usuários: um estudo a partir dos itinerários terapêuticos / The role of CAPS I in the lives of its users: a study based on therapeutic itineraries / El papel del CAPS I en la vida de sus usuarios: un estudio basado en itinerarios terapéuticos

Este artigo buscou compreender, a partir do itinerário terapêutico de pessoas em sofrimento psíquico e egressas de internação psiquiátrica, a inserção do centro de atenção psicossocial como equipamento de cuidado em suas trajetórias. Trata-se de estudo inspirado na Epistemologia Qualitativa de Gonzalez Rey no qual foram realizadas entrevistas com seis pessoas, de 27 a 52 anos, em tratamento em um Centro de Atenção Psicossocial tipo 1, e para análise do material transcrito foram adotados procedimentos inspirados no conceito de indicadores de González Rey e na análise temática de conteúdo. Neste artigo, foram discutidas duas categorias: (1) "O manicômio está presente" e (2) "CAPS: espaço de convivência e substituto da vida social?". Os indicadores apontaram que a internação psiquiátrica foi um recurso utilizado após inserção em CAPS, o qual é destacado mais como local de convívio do que de produção de autonomia e de desinstitucionalização. No percurso dos usuários, as internações ocorreram em hospitais gerais, hospitais especializados e comunidades terapêuticas. Os serviços de atenção primária não aparecem como ponto de cuidado à saúde mental, os serviços de urgência estão presentes na atenção às crises, dando ao CAPS contornos de um serviço para a convivência e não para o cuidado na crise. (AU)

Based on the therapeutic itinerary of individuals experiencing psychic distress and who have undergone psychiatric hospitalization, this study aimed to comprehend the integration of the Center of Psychosocial Attention as a care facility along their path. The study is inspired by Gonzalez Rey's Qualitative Epistemology, in which interviews were conducted with six individuals aged between 27 and 52, receiving treatment at a type 1 Center of Psychosocial Attention. Procedures inspired by González Rey's concept of indicators and thematic content analysis were employed to analyze the transcribed material. This paper will discuss two categories: (1) "The presence of the psychiatric hospital," and (2) "CAPS: A space for interaction and a substitute for social life?" The indicators reveal that psychiatric hospitalization was resorted to after involvement with CAPS, which is perceived more as a space for coexis-tence than for fostering autonomy and deinstitutionalization. As per the users' itineraries, hospitalizations occurred in general hospitals, specialized hospitals, and therapeutic communities. Primary care services do not emerge as a focal point for mental health care, whereas emergency services are present for crisis intervention, portraying CAPS as a service more geared towards coexistence rather than crisis management.

Este artículo buscó comprender, a partir del itinerario terapéutico de las personas en distrés psicológico y las dadas de alta de hospitalización psiqui-átrica, la inserción del centro de atención psicosocial como equipamiento de atención en sus trayectorias. Se trata de un estudio inspirado en la Epistemo-logía Cualitativa de González Rey, en el que se realizaron entrevistas a seis personas, de 27 a 52 años, en tratamiento en un Centro de Atención Psicosocial tipo 1 y para el análisis del material transcrito, procedimientos inspirados por el concepto de indicadores de González Rey y el análisis de contenido temático. En este artículo se discutirán dos categorías: (1) "Está presente el asilo" y (2) ¿"CAPS: espacio de convivencia y sustituto de la vida social?". Los indicadores señalaron que la hospitalización psiquiátrica fue un recurso utilizado después de la inserción en CAPS, que se destaca más como un lugar de socialización que para producir autonomía y desinstitucionalización. En el curso de los usuarios, los ingresos se realizaron en hospitales generales, hospitales especializados y comunidades terapéuticas. Los servicios de atención primaria no aparecen como un punto de atención en salud mental, los servicios de emergencia están presentes en la atención de crisis, dando al CAPS los contornos de un servicio de convivencia y no de atención en crisis. (AU)

Understanding inequalities in access to adult mental health services in the UK: a systematic mapping review.

BACKGROUND: Population groups experience differential access to timely and high-quality mental healthcare. Despite efforts of recent UK policies to improve the accessibility of mental health services, there remains a lack of comprehensive understanding of inequalities in access to services needed to do this. This systematic mapping review aimed to address this gap by identifying which population groups continue to be poorly served by access to adult mental health services in the UK, how access has been measured, and what research methods have been applied. METHODS: Seven electronic databases were searched from January 2014 up to May 2022. Primary research studies of any design were included if they examined access to adult NHS mental health services in the UK by population groups at risk of experiencing inequalities. Study characteristics, measures of access, inequalities studied, and key findings were extracted. A best-fit framework approach was used, applying Levesque's Conceptual Framework for Healthcare Access to synthesise measures of access, and applying a template derived from Cochrane Progress-Plus and NHS Long Term Plan equality characteristics to synthesise key findings associated with inequalities. RESULTS: Of 1,929 publications retrieved, 152 studies of various types were included. The most frequently considered dimensions of inequality were gender, age, and ethnicity, whilst social capital, religion, and sexual orientation were least frequently considered. Most studies researched access by measuring "healthcare utilisation", followed by studies that measured "healthcare seeking". Key barriers to access were associated with individuals' "ability to seek" (e.g. stigma and discrimination) and "ability to reach" (e.g. availability of services). Almost half of the studies used routinely collected patient data, and only 16% of studies reported patient and public involvement. CONCLUSIONS: Little appears to have changed in the nature and extent of inequalities, suggesting that mental health services have not become more accessible. Actions to reduce inequalities should address barriers to population groups' abilities to seek and reach services such as stigma-reducing interventions, and re-designing services and pathways. Significant benefits exist in using routinely collected patient data, but its limitations should not be ignored. More theoretically informed research, using a holistic measurement of access, is needed in this area. REVIEW REGISTRATION: https://doi.org/10.17605/OSF.IO/RQ5U7 .

Emerging integrated care models for children and youth with mental health difficulties in Norway: a horizon scanning study.

BACKGROUND: The implementation of Integrated Care Models (ICMs) represents a strategy for addressing the increasing issues of system fragmentation and improving service customization according to user needs. Available ICMs have been developed for adult populations, and less is known about ICMs specifically designed for children and youth. The study objective was to summarize and assess emerging ICMs for mental health services targeting children and youth in Norway. METHODS: A horizon scanning study was conducted in the field of child and youth mental health. The study encompassed two key components: (i) the identification of ICMs through a review of both scientific and grey literature, as well as input from key informants, and (ii) the evaluation of selected ICMs using semi-structured interviews with key informants. The aim of the interviews was to identify factors that either promote or hinder the successful implementation or scale up of these ICMs. RESULTS: Fourteen ICMs were chosen for analysis. These models encompassed a range of treatment philosophies, spanning from self-care and community care to specialized care. Several models placed emphasis on the referral process, prioritizing low-threshold access, and incorporating other sectors such as housing and child welfare. Four of the selected models included family or parents in their target group and five models extended their services to children and youth beyond the legal age of majority. Nine experts in the field willingly participated in the interview phase of the study. Identified challenges and facilitating factors associated with implementation or scale up of ICMs were related to the Norwegian healthcare system, mental health care delivery, as well as child and youth specific factors. CONCLUSION: Care delivery targeting children and youth's mental health requires further adaptation to accommodate the intricate nature of their lives. ICMs have been identified as a means to address this complexity by offering accessible services and adopting a holistic approach. This study highlights a selection of promising ICMs that appear capable of meeting some of the specific needs of children and youth. However, it is recommended to subject these models to further assessment and refinement to ensure their effectiveness and the fulfilment of their intended outcomes.

Recovery-oriented nursing service for people with schizophrenia in the community: An integrative review.

Background: The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. Objective: This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. Design: The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Data Sources: Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Review Methods: Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Results: Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. Conclusion: This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals' quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.

A Trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-Informed Approach to Suicide Prevention in School: Black Boys' Lives Matter.

Black boys have been dying by suicide at an increasing rate. Although the reasons for this increase are unknown, suicide in Black boys is likely influenced by multiple, intersecting risk factors, including historical and ongoing trauma. Schools can serve as an important mechanism of support for Black boys; however, without intentional anti-racist frameworks that acknowledge how intersecting identities can exacerbate risk for suicide, schools can overlook opportunities for care and perpetuate a cycle of racism that compromises the mental health of Black youth. By recognizing their own implicit biases, modeling anti-racist practices, listening to and recognizing the strengths and diversity of Black youth, and fostering school-family-community partnerships, school psychologists can help transform the school environment to be a safe and culturally affirming place for Black youth. This paper outlines how school psychologists can apply a trauma- and Justice, Equity, Diversity, and Inclusion (JEDI)-informed approach to suicide prevention in order to more holistically support Black boys, disrupt patterns of aggressive disciplinary procedures, and improve school-based suicide prevention programs. By applying this lens across a multitiered systems of support (MTSS) framework, school psychologists can help to prevent the deaths of Black boys and begin to prioritize the lives of Black boys.

Exploring intersections and integration of sexual reproductive health and mental health among adolescents and young adults: Areas of collaboration and lessons learned.

This special issue of the Bulletin of the Menninger Clinic addresses mental health issues in the field of sexual and reproductive health. The goal is to highlight important overlaps between reproductive and gender health concerns and mental health symptomatology. The issue includes topics around social determinants of health and their effects on reproductive health; the reproductive health sequelae of eating disorders; mental health challenges faced by gender diverse youth and strategies to mitigate these effects; integration of sexual health services and mental health care; and lessons for mental health advocates from the sex education realm. This special issue features areas of intersectoral collaboration among public health, medical, and mental health professionals to positively impact patients' holistic wellness.

Perspectives on an enhanced 'Improving Access to Psychological Therapies' (IAPT) service addressing the wider determinants of mental health: a qualitative study.

BACKGROUND: A new Health and Wellbeing pathway was introduced into the Improving Access to Psychological Therapies (IAPT) service in one geographical area of the UK in 2021 to address the wider determinants of mental health problems. It comprised assisted signposting to wider services and physical health promotion. This qualitative study aimed to understand stakeholders' experiences of implementing and receiving this new support and the barriers and facilitators to its delivery. METHODS: Forty-seven interviews were conducted, with service developers (n = 6), service deliverers (n = 12), service users (n = 22) and community and clinical partners (n = 7), as part of a larger mixed-methods evaluation. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis. RESULTS: Three themes spanned all participant groups and represented key aspects of the service: (1) identifying suitability, (2) a holistic service, and (3) moving forward. The sub-themes represent the barriers and facilitators to processes working in practice, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment, tailoring the support and delivery mode, and increasing transparency around continued care to drive sustained benefits. LIMITATIONS: Service users may have been selected due to their positive experiences of IAPT and were not demographically representative of the population, although participants' experiences of the service did suggest variation in our sample. CONCLUSIONS: The Health and Wellbeing pathway was perceived as having a positive impact on mental health and could reduce the burden on therapeutic services. However, service- and individual-level barriers need to be addressed to enhance statutory and community support links, manage service users' expectations, and improve accessibility for certain groups.

Psychosocial Factors Associated with Substance Use among Secondary School Students in Ilorin, Nigeria.

BACKGROUND: Adolescent substance use is a global concern. Identifying factors associated with it can help in preparing prevention programmes. OBJECTIVES: The objectives were to determine the sociodemographic factors associated with substance use and the prevalence of associated psychiatric morbidity among secondary school students in Ilorin. MATERIALS AND METHODS: Instruments used were a sociodemographic questionnaire, a modified WHO Students' Drug Use Survey Questionnaire, and the General Health Questionnaire-12 (GHQ-12) which was used to determine psychiatric morbidity, using a cut-off score of 3. RESULTS: Substance use was associated with older age groups, male gender, parental substance use and poor relationship with parents, and urban location of school. Reported religiosity did not confer protection against substance use. The overall prevalence of psychiatric morbidity was 22.1% (n= 442). Psychiatric morbidity was more common among users of opioids, organic solvents, cocaine and hallucinogens, with current opioid users having ten times the odds of psychiatric morbidity. CONCLUSION: Factors influencing adolescent substance use serve as a substrate for interventions. A good relationship with parents and teachers are protective factors, while parental substance use calls for holistic psychosocial support. The association of substance use with psychiatric morbidity highlights the need to incorporate behavioural treatment in substance use interventions.

CONTEXTE: La Consommation de Substances Psychoactives chez les Adolescents est une Préoccupation Mondiale. L'Identification des Facteurs qui y sont Associés Peut Aider à Préparer des Programmes de Prévention. OBJECTIFS: Déterminer les facteurs socio-démographiques associés à la consommation de substances psychoactives chez les élèves du secondaire à Ilorin. Déterminer la prévalence de la morbidité psychiatrique chez les étudiants et son association avec la consommation de substances. MATÉRIAUX ET MÉTHODES: Les instruments utilisés étaient un questionnaire sociodémographique, un questionnaire modifié de l'enquête de l'OMS sur la consommation de drogues par les étudiants, et le Questionnaire de santé générale-12 (GHQ-12) qui a été utilisé pour déterminer la morbidité psychiatrique, en utilisant un score seuil de 3. RÉSULTATS: La consommation de substances psychoactives était associée à des groupes d'âge plus élevés, au sexe masculin, à la consommation de substances psychoactives par les parents et à une mauvaise relation avec les parents, ainsi qu'à la localisation urbaine de l'école. La religiosité déclarée ne confère pas de protection contre la consommation de substances. La prévalence globale de la morbidité psychiatrique était de 22,1% (n= 442). La morbidité psychiatrique était plus fréquente chez les consommateurs d'opioïdes, de solvants organiques, de cocaïne et d'hallucinogènes, les consommateurs actuels d'opioïdes ayant dix fois plus de chances de souffrir de morbidité psychiatrique. CONCLUSION: Les facteurs qui influencent la consommation de substances psychoactives chez les adolescents servent de substrat aux interventions. Une bonne relation avec les parents et les enseignants sont des facteurs de protection, tandis que la consommation de substances par les parents nécessite un soutien psychosocial global. L'association entre la consommation de substances et la morbidité psychiatrique souligne la nécessité d'intégrer un traitement comportemental dans les interventions en matière de consommation de substances. Mots clés: Santé des adolescents, médecine des adolescents, services de santé mentale en milieu scolaire, consommation d'alcool avant l'âge légal, toxicomanie, oral, pédopsychiatrie. Traduit avec.

Improving access to mental health care: a system dynamics model of direct access to specialist care and accelerated specialist service capacity growth.

OBJECTIVE: To simulate the impact on population mental health indicators of allowing people to book some Medicare-subsidised sessions with psychologists and other mental health care professionals without a referral (direct access), and of increasing the annual growth rate in specialist mental health care capacity (consultations). DESIGN: System dynamics model, calibrated using historical time series data from the Australian Bureau of Statistics, HealthStats NSW, the Australian Institute of Health and Welfare, and the Australian Early Development Census. Parameter values that could not be derived from these sources were estimated by constrained optimisation. SETTING: New South Wales, 1 September 2021 - 1 September 2028. MAIN OUTCOME MEASURES: Projected mental health-related emergency department presentations, hospitalisations following self-harm, and deaths by suicide, both overall and for people aged 15-24 years. RESULTS: Direct access (for 10-50% of people requiring specialist mental health care) would lead to increases in the numbers of mental health-related emergency department presentations (0.33-1.68% of baseline), hospitalisations with self-harm (0.16-0.77%), and deaths by suicide (0.19-0.90%), as waiting times for consultations would increase, leading to disengagement and consequently to increases in adverse outcomes. Increasing the annual rate of growth of mental health service capacity (two- to fivefold) would reduce the frequency of all three outcomes; combining direct access to a proportion of services with increased growth in capacity achieved substantially greater gains than an increase in service capacity alone. A fivefold increase in the annual service growth rate would increase capacity by 71.6% by the end of 2028, compared with current projections; combined with direct access to 50% of mental health consultations, 26 616 emergency department presentations (3.6%), 1199 hospitalisations following self-harm (1.9%), and 158 deaths by suicide (2.1%) could be averted. CONCLUSION: The optimal combination of increased service capacity growth (fivefold) and direct access (50% of consultations) would have double the impact over seven years of accelerated capacity growth alone. Our model highlights the risks of implementing individual reforms without knowledge of their overall system effect.

Integrating Behavioral Health and Primary Care: Turning a Duet Into a Trio.

Family physicians are at the front lines of mental health concerns and distress, yet often feel stymied in their attempts to fully support patients' biopsychosocial needs within the barriers of a fragmented health care system. This article describes a practice transformation designed to facilitate more empowered care experiences. We reflect on our interdisciplinary work as a family physician and a behavioral health consultant working closely together in a Primary Care Behavioral Health model within a university setting. We describe our collaborative approach to a composite character from clinical practice: a college student with symptoms of psychomotor depression who screened negative for mood and anxiety concerns. Akin to a musical ensemble, wherein the inclusion of each voice turns a solo into a symphony, we describe key details of interdisciplinary collaboration which promotes holistic care for patients and fulfilling biopsychosocial practice for us as colleagues.