Crisis Intercept Mapping for Community-Based Suicide Prevention: An Assessment of the Crisis Infrastructure and Future Considerations for 988.

Suicide is a significant public health problem, yet barriers to treatment remain. To address barriers and meet needs, Congress designated a new 988 dialing code to increase utilization of the National Suicide Prevention Lifeline. As a result, call volume increased, and demand for community-based crisis services is expected. To examine the availability of community-based crisis care, we analyzed information collected from 2020 to 2022 Crisis Intercept Mapping (CIM) technical assistance workshops conducted with communities across the country. We found that training and implementation of suicide risk screening, safety planning, lethal means safety, and follow-up were limited and inconsistent among communities in our study. Collaboration was variable, impacting the ability of communities to support care transitions. Participants described multiple barriers to the routine implementation of evidence-based care and identified potential solutions for addressing them. Findings suggest a need for relationship building and targeted education and training to meet future demand for crisis care.

Care integration goes Beyond Co-Location: Creating a Medical Home.

How to successfully integrate mental health and primary care remains a critically important question given the continued morbidity and early mortality of people with serious mental illness. This study investigated integration in a community mental health center (MHC) primarily treating people with SMI in a large, urban northeastern city where an on-site primary care center (PCC) was opened resulting in co-located mental health and primary care services being provided. Using focus groups and online surveys this study asked participants about their thoughts and interactions with the on-site PCC. Participants included staff from clinical, non-clinical, and leadership roles in the mental health center (MHC; PCC staff; and MHC clients who did not use the on-site PCC). MHC staff also offered their thoughts about and experiences with the on-site PCC one year and two years after the on-site PCC opened through an on-line survey. In both methods, staff reported limited awareness and expectations of the PCC in the first year. Staff indicated that successful care integration goes beyond co-location and peer health navigation can enhance integration. Finally, staff discussed desires for enhancing care integration and co-located services into a medical home that included communicating across medical records and providers at different agencies. Our results suggest that, in addition to the previously researched three C's of care integration (consultation, coordination, and collaboration), two more C's were essential to successful care integration: co-location and communication. Communication across medical records and providers at different agencies was an essential component of care integration, and co-location added increased ability to communicate across providers.

Primary Care's Challenges and Responses in the Face of the COVID-19 Pandemic: Insights From AHRQ's Learning Community.

The COVID-19 pandemic dramatically disrupted health care systems and delivery in the United States. Despite emotional, psychological, logistical, and financial stress, primary care clinicians responded to the challenges that COVID-19 presented and continued to provide essential health services to their communities. As the lead federal agency for primary care research, the Agency for Healthcare Research and Quality (AHRQ) identified a need to engage and support primary care in responding to COVID-19. AHRQ initiated a learning community from December 2020-November 2021 to connect professionals and organizations that support primary care practices and clinicians. The learning community provided a forum for participants to share learning and peer support, better understand the stressors and challenges confronting practices, ascertain needs, and identify promising solutions in response to the pandemic. We identified challenges, responses, and innovations that emerged through learning community engagement, information sharing, and dialog. We categorized these across 5 domains that reflect core areas integral to primary care delivery: patient-centeredness, clinician and practice, systems and infrastructure, and community and public health; health equity was crosscutting across all domains. The engagement of the community to identify real-time response and innovation in the context of a global pandemic has provided valuable insights to inform future research and policy, improve primary care delivery, and ensure that the community is better prepared to respond and contribute to ongoing and future health challenges.

Support for evidence-informed opioid policies and interventions: The role of racial attitudes, political affiliation, and opioid stigma.

Political affiliation, racial attitudes, and opioid stigma influence public support for public health responses to address opioid use disorders (OUD). Prior studies suggest public perceptions of the opioid epidemic are less racialized and less politically polarized than were public perceptions of the crack cocaine epidemic. Analyzing a cross-sectional, nationally representative sample (n = 1161 U.S. adults) from the October 2020 AmeriSpeak survey, we explored how political affiliation, racial attitudes (as captured in the Color-Blind Racial Attitudes Scale [CoBRAS]), and OUD stigma were associated with respondents' expressed views regarding four critical domains. Respondents with unfavorable attitudes towards Black Americans were less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and distributing naloxone for overdose prevention. Democratic Party affiliation was associated with greater support for all three of the above measures, and increased support for mandatory treatment, which may be seen as a substitute for more punitive interventions. Black respondents were also less likely to support expanding Medicaid funding, increasing government spending to provide services for people living with OUD, and of distributing naloxone. Our finding suggest that negative attitudes towards African-Americans and political differences remain important factors of public opinion on responding to the OUD epidemic, even after controlling for opioid stigma. Our findings also suggest that culturally-competent dialogue within politically conservative and Black communities may be important to engage public support for evidence-informed treatment and prevention.

Social Stigma toward Persons with Opioid Use Disorder: Results from a Nationally Representative Survey of U.S. Adults.

Background: This study seeks to understand the general adult population's knowledge, attitudes, and stigma towards opioid use disorder (OUD), people with histories of opioid misuse, and policies related to OUD. Methods: We conducted a cross-sectional national survey of the U.S. adult population, using AmeriSpeak's® web, probability-based panel. The number of participants were 947 (493 females and 454 males) general population adults ages 19 -89 years old who completed a self-report survey covering: social stigma of OUD, opioid policy attitudes, perceptions of OUD as a crime, knowledge and beliefs about opioids and treatment, personal experience with opioids and the criminal justice (CJ) system, and demographics. Results: Thirteen percent self-reported ever misusing opioids, 3% reported an opioid overdose, and 14% reported personal experience with the CJ system. On average, the general adult population moderately endorses stigmatizing behaviors, agrees that OUD is a medical condition, agrees with policies to increase access to OUD treatment, and is less likely to endorse OUD as a crime. Having a disregard for OUD as a medical condition was most associated with higher levels of stigma, endorsing OUD as a crime, and disagreeing with policies to help people access OUD treatment. Conclusions: Our data provide guidance to policymakers concerning individuals with certain characteristics to target for public education efforts to reduce stigma and draw more support for public heath interventions for OUD. Our data also suggest that the content of this education should include improving understanding of OUD as a medical condition.

Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery support.

Background: "Recovery supports", often provided by persons in recovery themselves, have emerged over the last decade as important components of recovery-oriented systems of care for persons with substance use disorders.Aims: This study assesses the benefit of adding peer recovery supports to the care of adults with co-occurring psychosis and substance use.Method: 137 adults with both disorders who had at least one prior admission within the past year were recruited during an index hospitalization into a randomized trial of standard care vs skills training with and without a peer-led social engagement program. Participants were assessed at admission and at three and nine months post-discharge on symptoms, functioning, substance use, and other factors.Results: At three months, skills training was effective in reducing alcohol use and symptoms, with the addition of peer-led support resulting in higher levels of relatedness, self-criticism, and outpatient service use. At nine months, skills training was effective in decreasing symptoms and inpatient readmissions and increasing functioning, with the addition of peer support resulting in reduced alcohol use.Conclusions: Adding peer-led support may increase engagement in care over the short term and reduce substance use over the longer-term for adults with co-occurring disorders.

An Efficient Model for Designing Medical Countermeasure Just-in-Time Training During Public Health Emergencies.

Rapidly training numerous staff and volunteers to distribute and dispense medical countermeasures is challenging because of limited resources and evolving information during public health emergencies. The Applied Learning and Development Team within the Division of State and Local Readiness at the Centers for Disease Control and Prevention (CDC) proposes just-in-time training (JITT) templates that can be rapidly customized and implemented early in any public health emergency. The proposed template model aligns with modular training design research to increase relevance and rapid deployment of training. Two case studies are described to demonstrate the potential for training templates to support medical countermeasure responses: (1) customization and implementation of a JITT to prepare staff to work on a CDC task force during the 2016-2017 Zika virus response and (2) a new modular, customizable course to teach the basics about working at a point-of-dispensing site. Flexible JITT templates in these cases reduce the burden on emergency planners and trainers, allowing for rapidly developed, customized training viable for all emergency responses.

Development of a Response Inconsistency Scale for the Personality Inventory for DSM-5.

The advent of a dimensional model of personality disorder included in DSM-5 has necessitated the development of a new measurement scheme, specifically a self-report questionnaire termed the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012 ). However, there are many threats to the validity of a self-report measure, including response inconsistency. This study outlines the development of an inconsistency scale for the PID-5. Across both college student and clinical samples, the inconsistency scale was able to reliably differentiate real from random responding. Random responses led to increased scores on the PID-5 facets, indicating the importance of detecting inconsistent responding prior to test interpretation. Thus, this inconsistency scale could be of use to researchers and clinicians in detecting inconsistent responses to this new personality disorder measure.

Does Stigma Towards Mental Illness Affect Initial Perceptions of Peer Providers?

Peers (i.e. people with lived experience of mental illness and/or addictions) are being hired in large numbers to offer support for people with serious mental illnesses, but little is known about how peer providers are viewed. The goal of this study was to measure reactions towards actors posed as peer providers. Half of study participants interacted with an actor portraying a psychiatrist and half interacted with an actor portraying a peer provider. Ratings such as liking, feeling comfortable, as well as time spent talking were measured. Participants did not report preferring actors in either condition and did not talk more or have less silence with actors in either condition. Participants also were equally willing to see actors portraying peer providers again in the future and recommend them to a family member. Among participants who had received mental health services, there was a trend towards viewing actors portraying peer providers as more friendly and effective. These positive initial perceptions suggest that stigma towards people with mental illness does not taint the initial perception of peer providers.

Barriers and Facilitators of Healthcare for People with Mental Illness: Why Integrated Patient Centered Healthcare Is Necessary.

Understanding barriers and facilitators of healthcare for people with mental illness is essential for healthcare and mental healthcare organizations moving towards patient centered care. This paper presents findings of a measure on barriers and facilitators of healthcare completed by 204 patients being served at a co-located wellness center (primary healthcare clinic) located in an urban mental health center. The top 10 results show important findings for planning healthcare services that are responsive to the needs of people with mental illness. Basic structural issues as a result of poverty are extremely important (transportation, housing, payment) as well as difficulty with public healthcare that often involves long wait-times for appointments and at the doctor's office and hours that might not be convenient. Healthcare services that want to meet the needs of people with mental illness need to address these issues. What facilitates healthcare is not just removing the barriers to receiving healthcare services but instead involves more interpersonal aspects of healthcare such as liking your provider, being able to talk with your provider, feeling your provider cares about you and listens to you. Structural supports such as also being in mental health services, having systems for remembering appointments, and/or having appointment times that are convenient also facilitate seeking healthcare. Facilitating healthcare seeking also seems to involve a sense of agency-looking forward to taking charge of your health and feeling capable of following healthcare provider instructions. Healthcare systems for people with mental illness need to support these facilitators to give care-seekers the support they need. Key points are provided on how organizations and staff can work more effectively in implementing patient centered care.

The cycle of classification: DSM-I through DSM-5.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created in 1952 by the American Psychiatric Association so that mental health professionals in the United States would have a common language to use when diagnosing individuals with mental disorders. Since the initial publication of the DSM, there have been five subsequent editions of this manual published (including the DSM-III-R). This review discusses the structural changes in the six editions and the research that influenced those changes. Research is classified into three domains: (a) issues related to the DSMs as measurement systems, (b) studies of clinicians and how clinicians form diagnoses, and (c) taxonomic issues involving the philosophy of science and metatheoretical ideas about how classification systems function. The review ends with recommendations about future efforts to revise the DSMs.

Mental health professionals' natural taxonomies of mental disorders: implications for the clinical utility of the ICD-11 and the DSM-5.

OBJECTIVE: To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD-11). METHOD: 517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses. RESULTS: Clinicians' taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians' consensus classification structure was different from ICD-10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), but in many respects consistent with ICD-11 proposals. CONCLUSIONS: The clinical utility of the ICD-11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians.

Seven essential strategies for promoting and sustaining systemic cultural competence.

Racial and ethnic disparities are disturbing facets of the American healthcare system that document the reality of unequal treatment. Research consistently shows that patients of color experience poorer quality of care and health outcomes contributing to increased risks and accelerated mortality rates relative to their white counterparts. While initially conceptualized as an approach for increasing the responsiveness of children's behavioral health care, cultural competence has been adopted as a key strategy for eliminating racial and ethnic health disparities across the healthcare system. However, cultural competence research and practices largely focus on improving provider competencies, while agency and system level approaches for meeting the service needs of diverse populations are given less attention. In this article we offer seven essential strategies for promoting and sustaining organizational and systemic cultural competence. These strategies are to: (1) Provide executive level support and accountability, (2) Foster patient, community and stakeholder participation and partnerships, (3) Conduct organizational cultural competence assessments, (4) Develop incremental and realistic cultural competence action plans, (5) Ensure linguistic competence, (6) Diversify, develop, and retain a culturally competent workforce, and (7) Develop an agency or system strategy for managing staff and patient grievances. For each strategy we offer several recommendations for implementation.

The Relationship between Substance Use Stigma and COVID-19 Vaccine Hesitancy.

Two parallel public health epidemics affecting the United States include the COVID-19 pandemic and a rise in substance use disorders (SUDs). Limited research has examined the potential relationship between these two epidemics. Our objective was therefore to perform an exploratory study in order to examine the association between public stigma toward people with a past history of opioid, methamphetamine, cocaine, and alcohol use disorder and COVID-19 vaccine hesitancy. A national sample of U.S. adults (N = 6515) completed a survey which assessed the degree of negative perceptions toward individuals with a past history of substance use disorders (referred to as substance use stigma) and COVID-19 vaccine hesitancy, along with variables such as racial prejudice, source of health news, and other demographics. We evaluated four multivariable logistic regression models to predict COVID-19 vaccine hesitancy, utilizing substance use stigma toward opioids, methamphetamine, cocaine, and alcohol use as independent variables. We found that COVID-19 vaccine hesitancy was positively associated with substance use stigma toward opioid (AOR = 1.34, p < 0.05), methamphetamine (AOR = 1.40, p < 0.01), and cocaine (AOR = 1.28, p < 0.05) use, but not alcohol use (AOR = 1.06, n.s.). Predictive models that incorporate substance use stigma may therefore improve our ability to identify individuals that may benefit from vaccine hesitancy interventions. Future research to understand the underlying reasons behind the association between substance use stigma and COVID-19 vaccine hesitancy may help us to construct combined interventions which address belief systems that promote both substance use stigma and vaccine hesitancy.

How the global call for elimination of pediatric HIV can support HIV-positive women to achieve their pregnancy intentions.

The global call to eliminate new pediatric HIV infections requires a comprehensive approach, including consideration of the pregnancy intentions of HIV-positive women. This paper presents a literature review on the interface between pediatric HIV elimination and the pregnancy intentions of HIV-positive women, focusing on the four prongs of prevention of mother-to-child transmission: primary prevention of HIV infection in women; preventing unintended pregnancies in HIV-positive women; preventing transmission of HIV from infected women to their infants; and providing care, support and treatment to HIV-positive women, their children and their families. The paper describes the role of pregnancy intentions in determining appropriate health services for HIV-positive women - including family planning, reproductive and obstetric care, and HIV-related services - and explains how these essential health services are linked to improving maternal health, reducing child mortality and eliminating pediatric HIV. The paper provides context for the recent UNAIDS-led call to eliminate pediatric HIV, which will require a complete, integrated approach to providing family planning, maternal and child health, and HIV-related services for all HIV-affected individuals and families. Ensuring that HIV-positive women have access to high-quality health services to enable them to choose whether and when to have children is an essential component of this approach.

Do clinicians conceptualize DSM-IV disorders hierarchically?

OBJECTIVE: All classification systems of psychopathology use hierarchical categories. The purpose of the two studies in this article was to test whether clinicians think hierarchically about mental disorders. METHOD: Seventy six clinicians were asked to sort 67 diagnostic categories into groups using different instruction sets, either to make progressively larger and smaller groups of diagnoses (Study 1) or to place similar groups next to each other (Study 1 and Study 2). RESULTS: Clinicians' sortings of mental disorders had a hierarchical structure regardless of the methodology, profession, expertise, and instructional set used. CONCLUSIONS: Given that all modern diagnostic systems have been hierarchical, it is important to know that clinicians' thinking is also hierarchical.

The Organizational Multicultural Competence Assessment (OMCA): A tool to assess an organization's multicultural competence and adherence to the National Standards for Culturally and Linguistically Appropriate Services in Health and Healthcare (the National CLAS Standards).

Objective: Behavioral health organizations must respond to the needs of increasing numbers of multicultural populations, as the world population continues to diversify. The goal of this research was to develop a measure to assess the multicultural competence of a behavioral health agency using a quick and efficient but comprehensive strategy that utilizes input from multiple staff members. Method: The Organizational Multicultural Competence Assessment (OMCA) was developed through a review of existing cultural competence assessment measures and item generation from researchers and policy makers. 469 staff from all departments of a U.S. state-operated and funded behavioral health facilities were asked by the CEO of their agency to complete the 45-item survey. Findings: Principal components analysis revealed seven factors that accounted for 64% of the variance in item responses: Governance, Policies, and Procedures; Staff Training and Service Delivery; Addressing Stigma and Discrimination; Accessibility of Services; Community Relationships; Quality, Monitoring, and Evaluation; and Human Resource Development. Items within factors showed high internal reliability. Conclusions and Implications for Practice: This measure may be used on an ongoing basis as a quality improvement tool to assess an agency or system's multicultural competence and adherence to the CLAS standards. Future research can investigate the relationship between scores on this measure and organization-level recovery oriented, client health, and person-centered outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An "oasis within a desert," but the desert remains: Clubhouse members' experiences of social belonging and societal oppression.

Persons living with mental health challenges are at increased risk of stigma, social isolation, and social exclusion. Due to its emphasis on member participation and community, the clubhouse model of mental health may help address these issues. In this study, we examined experiences of social belonging and of various social determinants of mental health among members attending a psychosocial clubhouse. Twelve members of a large psychosocial clubhouse were interviewed regarding their experiences of community life and belonging. Phenomenological qualitative methods were utilized to examine the meaning and structure of these experiences. Members overwhelmingly experienced the clubhouse as a central site of belonging ("an oasis"), but members also recounted devastating portraits of life in the outside world ("a desert"). This world presented fundamental restrictions on their movement and speech and held deeply sedimented norms pertaining to who is considered valuable, productive, and even human, which they were reminded of through an endless tyranny of questions ("what do you do," "where do you live," etc.). Life in the clubhouse presented an alternative world for members to experience nourishment, dignity, reaffirmed personhood, and a sense of beauty. And yet, the desert outside remained. Implications of these findings for clubhouses, mental health practice, and sociopolitical and community engagement are discussed, including the need to address profound deprivations and power imbalances within the wider world, beyond the walls of humane spaces such as these. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

National variability in Americans' COVID-19 protective behaviors: Implications for vaccine roll-out.

Protective behaviors such as mask wearing and physical distancing are critical to slow the spread of COVID-19, even in the context of vaccine scale-up. Understanding the variation in self-reported COVID-19 protective behaviors is critical to developing public health messaging. The purpose of the study is to provide nationally representative estimates of five self-reported COVID-19 protective behaviors and correlates of such behaviors. In this cross-sectional survey study of US adults, surveys were administered via internet and telephone. Adults were surveyed from April 30-May 4, 2020, a time of peaking COVID-19 incidence within the US. Participants were recruited from the probability-based AmeriSpeak® national panel. Brief surveys were completed by 994 adults, with 73.0% of respondents reported mask wearing, 82.7% reported physical distancing, 75.1% reported crowd avoidance, 89.8% reported increased hand-washing, and 7.7% reported having prior COVID-19 testing. Multivariate analysis (p critical value .05) indicates that women were more likely to report protective behaviors than men, as were those over age 60. Respondents who self-identified as having low incomes, histories of criminal justice involvement, and Republican Party affiliation, were less likely to report four protective behaviors, though Republicans and individuals with criminal justice histories were more likely to report having received COVID-19 testing. The majority of Americans engaged in COVID-19 protective behaviors, with low-income Americans, those with histories of criminal justice involvement, and self-identified Republicans less likely to engage in these preventive behaviors. Culturally competent public health messaging and interventions might focus on these latter groups to prevent future infections. These findings will remain highly relevant even with vaccines widely available, given the complementarities between vaccines and protective behaviors, as well as the many challenges in delivering vaccines.

Opioid Use Disorder Stigma, Discrimination, and Policy Attitudes in a National Sample of U.S. Young Adults.

PURPOSE: A small fraction of people with opioid use disorder (OUD) receives appropriate care. Public opinion about addiction contributes to the availability and accessibility of effective treatment services. Little is known about such attitudes toward OUD among young adults, a population at heightened risk for OUD onset. The current study examined endorsement of social stigma, discrimination, and policy attitudes about OUD and hypothesized correlates of such attitudes (familiarity with OUD, criminal justice involvement, respondent demographic characteristics). METHODS: A national sample of 190 young adults (weighted n = 408; 69% female, 42% White, non-Hispanic) aged 19-29 years completed web and telephone surveys covering opioid social stigma, discrimination, policy attitudes, personal experience with opioids, and criminal justice, and participant characteristics (age, sex, race, education, employment, income). Linear regressions were performed to examine associations between respondent characteristics and attitudes. RESULTS: Young adults, on average, endorsed moderate levels of stigma and discrimination toward people with OUD and support for treatment-oriented policies. Stigma was positively associated with discrimination and negatively associated with support for policies favorable to people with OUD. Regression results revealed that more negative attitudes toward OUD were endorsed as a function of older age and less personal experience or familiarity with OUD. CONCLUSIONS: Heterogeneity in young adults' attitudes about OUD may be explained, in part, by personal characteristics and familiarity with OUD. Adolescence may be an opportune developmental period to prevent or reduce public stigma related to OUD and MOUD and increase public attitudes in support of expanded access to effective OUD treatments.