Effects of stepped psychooncological care on referral to psychosocial services and emotional well-being in cancer patients: A cluster-randomized phase III trial.

OBJECTIVE: Emotional distress in cancer patients often goes unnoticed in daily routine; therefore, distress screening is now recommended in many national guidelines. However, screening alone does not necessarily translate into better well-being. We examined whether stepped psychooncological care improves referral to consultation-liaison (CL) services and improves well-being. METHODS: In a cluster-randomized trial, wards were randomly allocated to stepped versus standard care. Stepped care comprised screening for distress, consultation between doctor and patient about the patient's need for CL services, and provision of CL service. Primary outcomes were referral to psychosocial services and emotional well-being half a year after baseline, measured with the Hospital Anxiety and Depression Scale. A secondary endpoint was uptake of outpatient health care. Analysis employed mixed-effects multivariate regression modeling. RESULTS: Thirteen wards were randomized; 1012 patients participated. With stepped care (N = 570; 7 wards), 22% of the patients were referred to CL services and 3% with standard care (N = 442; 6 wards; odds ratio [OR] 10.0; P < .001). Well-being 6 months after baseline was 9.5 after stepped care (N = 341) and 9.4 after standard care (N = 234, ß -0.3; P = .71). After stepped care, patients with psychiatric comorbidity went more often to psychotherapists (OR 4.0, P = .05) and to psychiatrists (OR 2.3, P = .12), whereas patients without comorbidity used psychiatrists less often (OR 0.4, P = .04) than in standard care. CONCLUSIONS: Stepped care resulted in better referral to CL services. The patients' emotional well-being was not improved, but uptake of outpatient psychiatric help was increased in patients with psychiatric comorbidity and decreased in patients without.

Strategies to destigmatize mental illness in South Africa: Social work perspective.

Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers' perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.

Barriers and Facilitators in Providing Community Mental Health Care to Returning Veterans with a History of Traumatic Brain Injury and Co-occurring Mental Health Symptoms.

As Veterans from recent conflicts return from deployments, increasing numbers are seeking care for physical (e.g., history of traumatic brain injury) and mental health (e.g., depression, anxiety) symptoms. Data suggest that only about half of recent Veterans are seeking care within the Veterans Health Administration. As such, providers within the community are likely to require additional training to meet the unique needs of these Veterans and their families. Towards this end, meetings were held with administrators and clinicians at Colorado Community Mental Health Centers (CMHCs) to identify current barriers and facilitators, as they relate to working with Veterans with a history of TBI and co-occurring mental health conditions. On-whole, CMHC employees had limited experience with providing care to the cohort of interest. Additional training will assist with increasing capacity and a web-based toolkit was developed to facilitate the transfer of knowledge ( www.mirecc.va.gov/visn19/tbi_toolkit ).

Psychoeducation for schizophrenia in the Czech Republic: curriculum modification based on opinions of service users and providers.

OBJECTIVE: The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. METHODS: The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. RESULTS: Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. CONCLUSION: The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives' frustrations.

Stepped collaborative depression care: primary care results before and after implementation of a stepped collaborative depression programme.

BACKGROUND: Numerous intensive research projects to assess the effects of stepped collaborative care (SCC) for depressed patients have been reported in primary care, yet it is unclear how SCC is sustained in usual care. OBJECTIVE: To assess how SCC for depression is actually being used and how it performs in usual primary care by studying medical data that are routinely collected in family practice, outside the research setting. METHODS: Retrospective before and after comparison of electronic medical records (EMR) regarding the implementation of an SCC depression programme in a large primary care organization from 2003 to 2012. Depression care parameters included prevalences, minimal interventions, Beck Depression Inventory-2 (BDI-2), antidepressants, referrals to psychologists and psychiatrists and primary health care consumption. RESULTS: After programme implementation, differentiation between levels of depression severity increased, more patients were treated with minimal interventions and more patients were monitored with BDI-2. These effects occurred in both nonseverely and severely depressed patients, although they were larger for patients registered as nonseverely depressed. Antidepressant prescription rates and referral rates seemed not to have been influenced by the SCC programme. Health care consumption of the depressed patients increased significantly. CONCLUSIONS: The depression care parameters changed to a different extent and at a different pace than after previous implementation initiatives. Future research should identify whether SCC uptake in primary care is best enhanced by intensive external guidance or by making care providers themselves responsible for the implementation. Analyses of EMR can be valuable in monitoring the implementation effects, especially after research projects are completed.

Social network analysis of child and adult interorganizational connections.

OBJECTIVE: Because most programs serve either children and their families or adults, a critical component of service and treatment continuity in mental health and related services for individuals transitioning into adulthood (ages 14-25) is coordination across programs on either side of the adult age divide. METHODS: This study was conducted in Clark County, Washington, a community that had received a Partnership for Youth Transition grant from the Federal Center for Mental Health Services. Social Network Analysis methodology was used to describe the strength and direction of each organization's relationship to other organizations in the transition network. Interviews were conducted before grant implementation (n=103) and again four years later (n=99). RESULTS: The findings of the study revealed significant changes in the nature of relationships between organizations over time. While the overall density of the transition service network remained stable, specific ways of connecting did change. Some activities became more decentralized while others became more inclusive as evidenced by the increase in size of the largest K-core. This was particularly true for the activity of "receiving referrals." These changes reflected more direct contact between child and adult serving organizations. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The two separate child and adult systems identified at baseline appeared more integrated by the end of the grant period. Having greater connectivity among all organizations regardless of ages served should benefit youth and young adults of transition age. This study provides further evidence that Social Network Analysis is a useful method for measuring change in service system integration over time.

Providing patient progress information and clinical support tools to therapists: effects on patients at risk of treatment failure.

The current study examined the effects of providing treatment progress information and problem-solving tools to both patients and therapists during the course of psychotherapy. Three hundred and seventy patients were randomly assigned to one of two treatment groups: treatment-as-usual, or an experimental condition based on the use of patient/therapist feedback and clinical decision-support tools. Patients in the feedback condition were significantly more improved at termination than the patients in the treatment-as-usual condition. Treatment effects were not a consequence of different amounts of psychotherapy received by experimental and control clients. These findings are consistent with past research on these approaches although the effect size was smaller in this study. Not all therapists were aided by the feedback intervention.

Reducing barriers to mental health and social services for Iraq and Afghanistan veterans: outcomes of an integrated primary care clinic.

BACKGROUND: Despite high rates of post-deployment psychosocial problems in Iraq and Afghanistan veterans, mental health and social services are under-utilized. OBJECTIVE: To evaluate whether a Department of Veterans Affairs (VA) integrated care (IC) clinic (established in April 2007), offering an initial three-part primary care, mental health and social services visit, improved psychosocial services utilization in Iraq and Afghanistan veterans compared to usual care (UC), a standard primary care visit with referral for psychosocial services as needed. DESIGN: Retrospective cohort study using VA administrative data. POPULATION: Five hundred and twenty-six Iraq and Afghanistan veterans initiating primary care at a VA medical center between April 1, 2005 and April 31, 2009. MAIN MEASURES: Multivariable models compared the independent effects of primary care clinic type (IC versus UC) on mental health and social services utilization outcomes. KEY RESULTS: After 2007, compared to UC, veterans presenting to the IC primary care clinic were significantly more likely to have had a within-30-day mental health evaluation (92% versus 59%, p < 0.001) and social services evaluation [77% (IC) versus 56% (UC), p < 0.001]. This exceeded background system-wide increases in mental health services utilization that occurred in the UC Clinic after 2007 compared to before 2007. In particular, female veterans, younger veterans, and those with positive mental health screens were independently more likely to have had mental health and social service evaluations if seen in the IC versus UC clinic. Among veterans who screened positive for ≥ 1 mental health disorder(s), there was a median of 1 follow-up specialty mental health visit within the first year in both clinics. CONCLUSIONS: Among Iraq and Afghanistan veterans new to primary care, an integrated primary care visit further improved the likelihood of an initial mental health and social services evaluation over background increases, but did not improve retention in specialty mental health services.

A collaborative care depression management program for cardiac inpatients: depression characteristics and in-hospital outcomes.

BACKGROUND: Depression in cardiac patients is common, under-recognized, and independently associated with mortality. OBJECTIVES: Our objectives in this initial report from a 6-month longitudinal trial were to determine whether a collaborative care program improves rates of depression treatment by discharge among patients hospitalized with acute cardiovascular disease, and to assess key clinical characteristics of depression in this cohort. METHOD: This was a prospective, randomized trial comparing collaborative care and usual care interventions for depressed cardiac patients who were admitted to cardiac units in an urban academic medical center. For collaborative care subjects, the care manager performed a multi-component depression intervention in the hospital that included patient education and treatment coordination; usual care subjects' inpatient providers were informed of the depression diagnosis. RESULTS: The mean Patient Health Questionnaire-9 for subjects (N = 175) was 17.6 (SD 3.5; range 11-26), consistent with moderate-severe depression. The majority of subjects had depression for over one month (n = 134; 76.6%) and a prior depressive episode (n = 124; 70.8%); nearly one-half (n = 75; 42.9%) had thoughts that life was not worth living in the preceding 2 weeks. Collaborative care subjects were far more likely to receive adequate depression treatment by discharge (71.9% collaborative care vs. 9.5% usual care; p < 0.001). CONCLUSION: Depression identified by systematic screening in hospitalized cardiac patients appears was prolonged, and of substantial severity. A collaborative care depression management model appears to vastly increase rates of appropriate treatment by discharge.

Culture-sensitive therapy and salutogenesis: treating Israeli Bedouin of the Negev.

The Salutogenesis theory and its essential component, the sense of coherence (SOC) is an epigenetic concept. The SOC was defined as a 'way of being in the world'. As such it is most important that one's SOC will be intact for healthy mental status. Collisions between western and non-western cultures might interfere in the process of psychiatric and psychotherapeutic treatment. This review demonstrates the importance of a culture-sensitive approach and therapy and the usefulness of specific culture-sensitive services for certain non-western populations. We illustrate this approach by giving the example of the unique ways of treatment carried out among the Bedouin of the Negev region of Israel.

Building capacity in social service agencies to employ peer providers.

OBJECTIVE: While there is evidence that peer providers are valuable to service delivery teams, the agencies where they work face difficulties in fulfilling the potential of including peers on staff effectively. The purpose of this article is to report findings of a pilot test of a workplace strategy that promoted inclusion of peer providers at social service agencies by building organizational capacity to support people with mental health conditions in peer provider roles. The strategy included training, goal setting and ongoing consultation. METHODS: Seventy-one peer, non-peer and supervisory staff participated from 6 agencies over a one year period. Goal attainment scaling and data from in-depth interviews about perceptions of differences in the ways in which staff are supported, administered prior to and after the consultation period, were used to assess strategy impact. RESULTS: Most frequently staff set goals to respond to role conflict or a lack of support. Staff that met or exceeded their goals utilized the formal structure of consultation to improve communication among themselves, had leadership that sanctioned changes and felt that their participation was of value to the organization and contributed to their individual development. Strategy participation promoted inclusion by initiating changes to policies and practices that devalued the peer provider role, increased skill sets, and formalized lines of communication for sharing information and understanding related to peer providers. CONCLUSIONS: Findings demonstrate that a strategy of training, goal setting and consultation can positively affect perceptions of inclusion, and promote implementation of practices associated with inclusive workplaces.

Use of Reimbursed Psychology Videoconference Services in Australia: An Investigation Using Administrative Data.

BACKGROUND: In November 2017, the Australian government approved reimbursement for psychology consultations conducted by videoconference under the Better Access initiative to address inequitable access of mental health services across regions in Australia. OBJECTIVE: This project uses publically available activity data from the Medicare Benefits Scheme to quantify the uptake of videoconference for psychology resulting from the initiative change. METHODS: Data were extracted from the Medicare Benefits Schedule item reports using the item codes for standard consultations and the new item codes for videoconference consultations. Activity data from 2 years before and the first year of the change to the Better Access initiative were compared to examine the uptake of videoconference for psychology. Data were stratified by allied health profession, sex, age and state jurisdiction. RESULTS: In the 1-year period after the introduction of reimbursed videoconference consultations, approximately 5.7 million in-person consultations and 4141 videoconference consultations were funded by Medicare in Australia. Videoconference consultations comprised 0.07% of the total consultations performed in that 1-year period and showed an increased trajectory. The results can guide future research into evaluating the clinical outcomes of patients via both in-person and videoconference delivery modes. CONCLUSIONS: Videoconference mental health services were used in the first year that they were available, although they only accounted for a small percentage of all mental health consultations provided by allied health professionals. This finding lays the foundation for future work which could examine the effectiveness of the scheme in reducing inequity and investigating the economic benefits of the expanded initiative to the government and society.

Psychosocial care for women survivors of the tsunami disaster in India.

OBJECTIVES: I investigated the effectiveness of Psychosocial Care, a community-based mental health initiative for survivors of the 2004 tsunami disaster in India. METHODS: Mental health teams from the National Institute of Mental Health and Neurosciences (NIMHANS) in India implemented a train-the-trainer model of psychosocial care in one of the worst tsunami-affected areas of south India. Three months of psychosocial care was provided for an intervention group of women, but not for a control group recruited from an exposed neighboring village. Impact of Event Scale (IES) scores--both total scores and scores for subscales on hypervigilance, avoidance, and intrusion--were compiled for both the intervention and control groups and used as outcome measures. RESULTS: For the intervention group, posttest total IES and subscale scores were significantly lower than pretest scores (P < .001), indicating improvement in symptoms. Posttest total IES and subscale scores were significantly lower for the intervention group than for the control group (P < .001). CONCLUSIONS: Psychosocial care is an effective mental health strategy for women survivors of disasters and should be an integral component of disaster response in resource-poor countries.

[The characteristic of population participating in a community-based rehabilitation program]. / Charakterystyka populacji objetej srodowiskowym systemem rehabilitacji i wsparcia spolecznego.

AIM: The difficulties in social functioning of the mentally ill are widely documented in specialist literature. The social affects addressed to the mentally disabled are an attempt to overcome this particular disability. The aim of the presented research is the characterization of the social group participating in a community-based rehabilitation program realized on Warsaw area. METHOD: 103 long-term patients with mental disorders provided with a community-based rehabilitation program were the participants in the study. They were not hospitalized at the time when the research was conducted. The following instruments were used: the Questionnaire and Map of Social Support by Bizon, the individual interview, and the questionnaire especially prepared for the needs of this research. RESULTS: The studied group consists of people with a long-standing period of illness, with numerous hospitalizations, constantly remaining under psychiatric care. The tested persons are singles and demanding a strong social support. Their individual social networks of support are sparse and in a large part compensated by therapists from the support institution. The tested group highly values the influence of the local rehabilitation program on their functioning. CONCLUSIONS: The chronically mental ill persons show numerous difficulties in their social functioning. Participation in the social support programs protects them against successive hospitalizations. During the last year, preceding the research, the amount of hospitalizations was significantly lower than in the period preceding the taking care by the local systems. It is necessary to treat the local rehabilitation programs as an effective mechanism supporting the functioning of the chronically mental ill people.

The economic and social burden of compulsive hoarding.

The aim of the present study was to determine the economic and social burden of compulsive hoarding in a large sample of individuals with self-identified hoarding, as well as a separate sample of family members of individuals who hoard. Self-identified hoarding participants (N=864, 94% female, 65% met research criteria for clinically relevant compulsive hoarding) and family informants (N=655, 58% described a relative who appeared to meet research criteria for compulsive hoarding), completed an internet survey. Questions were derived in part from those used in the National Comorbidity Survey (NCS), and when possible, hoarding participants were compared to NCS participants. Compulsive hoarding was associated with an average 7.0 work impairment days in the past month, equivalent to that reported by individuals with psychotic disorders and significantly greater than that reported by female NCS participants with all other anxiety, mood, and substance use disorders. Severity of hoarding predicted the degree of work impairment after controlling for age, sex, and non-psychiatric medical conditions. Hoarding participants were nearly three times as likely to be overweight or obese as were family members. Compared to female NCS participants, hoarding participants were significantly more likely to report a broad range of chronic and severe medical concerns and had a five-fold higher rate of mental health service utilization. Eight to 12% had been evicted or threatened with eviction due to hoarding, and 0.1-3.0% had a child or elder removed from the home. These results suggest that compulsive hoarding represents a profound public health burden in terms of occupational impairment, poor physical health, and social service involvement.

Psychosocial Services for Individuals With Serious Mental Illness/Severe Emotional Disturbance: Clinical Practice Guideline Toolkit.

This article presents a short, easy-to-use guideline for clinicians working with people with serious mental illness, particularly those with schizophrenia, schizoaffective disorder, delusional disorders, other psychotic disorders, or depression with significant impact on functioning, and may be of use for those working with individuals with bipolar disorder. This guideline is not meant to supplant the more detailed, excellent clinical practice guidelines that have been developed and published. Rather, the charts and explanation presented here are designed as a step-by-step tool that clinicians can use to ensure they are following the most appropriate course of action and providing the best psychosocial rehabilitation services possible for persons with these disorders. Program managers can use this tool to evaluate the processes used in their system to ensure that appropriate services are offered for the individuals in their care. This guideline is also not meant as a substitute for comprehensive training in the practice of assessment and treatment for individuals with serious mental illness. Very little detail is provided about the disorders, appropriate assessments, and interventions because clinicians providing services to people with these disorders should have received the specialized training necessary to appropriately deliver the services needed by these individuals.

Client Attitudes toward Integrating Religion and Spirituality in Mental Health Treatment: Scale Development and Client Responses.

This article describes the development, validation, and responses to the first administration of the Religious/Spiritually Integrated Practice Assessment Scale-Client Attitudes (RSIPAS-CA). A total of 1,047 U.S. adults responded to an online survey administered by Qualtrics, which included the RSIPAS-CA for secondary analysis. Of those, 245 indicated they were either current or former mental health clients and thus were asked to complete a 10-item instrument assessing clients' attitudes toward integrating religion and spirituality (RS) in mental health treatment. A confirmatory factor analysis showed the current sample's data approached an adequate fit, and the instrument's reliability was considered very good (α = .89). Descriptive analyses indicated that clients have mixed views regarding who should initiate the discussion of RS, but a majority responded favorably toward integrating RS in practice. The article ends with a general comparison between client responses to the current survey and clinical social workers' responses to the practitioners' RSIPAS. It also discusses implications for research based on the scale development and implications for practice and education, based on client preferences.

Social services support and expenditure for children with autism.

This article provides information about children with autism who are supported by English social services departments based on the Children in Need Survey 2001 (CIN2001). In 119 authorities, 6310 children were recorded as having a diagnosis of autism or related conditions, probably about one-quarter of all children with such diagnoses and about half of those actually supported. Demographically, this group appears similar to children with autism generally: there are more boys than girls, and learning, communication and behaviour difficulties are common. CIN2001 shows that mean social services support costs tend to be quite high, particularly compared with other disabled children. There are very considerable variations between social services departments in reported numbers and spending. It is unlikely that this variation can be attributed to the prevalence of autism, and more likely that it reflects the case recognition and service provision policies of local agencies.

U.S. Army Social Work Care Manager Program: an initial program analysis.

Since the Global War on Terror, the U.S. Army has been transforming to meet national security needs. The transformation includes Army mental health programs serving soldiers and their families. These programs must be relevant to the needs of soldiers and their families and effective at maintaining the force throughout the Global War on Terror. The Army Social Work Care Manager Program was initiated in July 2003 to enhance mental health support for combat veterans and their families. This study provides an initial assessment of this program. A seven-item provider questionnaire was administered to 66 care managers (N=66) to obtain an initial assessment of their utilization and satisfaction. Findings from 33 (n=33) respondents revealed diverse usage across and within installations and modest satisfaction with their jobs. Additionally, the biggest challenges care managers faced were resourcing and supervision. Recommendations for additional research, policy, and practice are provided in this study.

A German psychiatric care program aiming to improve patients’ compliance – Patients’ view

Noncompliance is a worldwide problem in medical care, leading to prolonged recovery times and rehospitalizations. Especially in the field of psychiatry, consistent therapy compliance is crucial. Hence the Munich Integrated Care program for patients suffering from psychiatric disorders aims at improving patients’ compliance. To bring to light participants' personal experiences with the program, we conducted group interviews that we evaluated using qualitative methods. We shed light on what aspects make a psychiatric health care program so valuable in the eyes of its participants that it can develop its effect as a relapse-preventive agent. We found that in this program, patients experienced safety, stability, support, hope, motivation and understanding.