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.

José Luis Montoya Rico y las primeras reformas de la asistencia psiquiátrica de beneficencia / José Luis Montoya Rico and the initial reform of charitable psychiatric assistance

Revisamos en este artículo la producción escrita de José Luis Montoya Rico, psiquiatra de la Beneficencia Provincial en Oviedo, A Coruña y Alicante. Durante el tardofranquismo, escribió y dirigió los planes de reforma de la asistencia psiquiátrica en los Hospitales Psiquiátricos Provinciales de “La Cadellada”, Conxo y Jaén, dependientes de las Diputaciones Provinciales. El trabajo de Montoya ofrece una panorámica de la asistencia pública en materia de salud mental del país -estructura, necesidades y dificultades y referencias- e informa de las tensiones, modelos e influencias de la recepción profesional de la comunidad terapéutica durante ese mismo periodo. (AU)

This paper reviews José Luis Montoya Rico´s work, a psychiatrist in the Oviedo, A Coruña and Alicante charitable provincial hospitals. During the final years of Franco's dictatorship, Montoya wrote and advised the first reform plans of the “La Cadellada” and Conxo provincial mental hospitals. Montoyas’ work offers an overview of mental health care in Spain and contextualizes the professional reception of the therapeutic community during that period. (AU)

Epidemiología de la morbilidad psiquiátrica en el Ecuador / Epidemiology of psychiatric morbidity in Ecuador

RESUMEN Fundamento: La presencia cada vez más creciente de personas con trastornos psiquiátricos atendidas en servicios de salud públicos del Ecuador, suscita el desarrollo de estudios epidemiológicos que permitan conocer cómo se distribuyen estos trastornos entre los diferentes grupos, para una planificación adecuada de servicios de salud mental; sin embargo, existen estudios disponibles con diferencias en el diseño, los instrumentos y la selección de la muestra, que afectan los resultados y sus conclusiones, como son el subregistro y el sobre diagnóstico de trastornos mentales. Objetivo: Analizar diferencias metodológicas entre los estudios de morbilidad psiquiátrica en población general, asimismo, los diferentes resultados obtenidos de estas investigaciones. Metodología: Estudio comparativo de investigaciones de morbilidad psiquiátrica en población general, basado en el análisis de publicaciones durante el período 2000 al 2019 en el Ecuador. Resultados: Se registraron trece estudios, cuatro encuestas y dos estudios nacionales sobre consumo de drogas, uno de prevalencia psiquiátrica, y seis de tamizaje de trastornos mentales, en poblaciones con edades de 13 a 75 años. Los instrumentos más utilizados fueron de tamizaje y la clasificación diagnóstica más utilizada fue el Manual Diagnóstico y Estadístico de los Trastornos Mentales, cuarta versión (DSM-IV). La prevalencia empleada fue, puntual, último mes, anual y de vida. Los trastornos más frecuentes fueron la ansiedad, la depresión, el trastorno estrés postraumático y el de comportamiento debido al consumo de drogas. Conclusiones: Los estudios de morbilidad psiquiátrica realizados en Ecuador, son heterogéneos en el empleo de instrumentos, sujetos y cálculo de la muestra, así como sus resultados, por lo que es pertinente el desarrollo de investigaciones de este tipo, que se ajusten a la realidad y recursos del país, y que sus hallazgos, sean de utilidad en la planificación de servicios y políticas de salud mental en el Ecuador.

ABSTRACT Background: The growing presence of people with psychiatric disorders assisted in public health services in Ecuador, promotions the development of epidemiological studies that allow to know how these disorders are distributed among unlike groups, so for an adequate planning of mental health services; however, there are available studies with differences in the design, instruments and sample selection, which affect the results and conclusions, such as under-registration and over-diagnosis of mental disorders. Objective: To analyze methodological differences between studies of psychiatric morbidity of overall population, as well as the unlike results obtained from these investigations. Methodology: Comparative study of psychiatric morbidity research of overall population, based on the analysis of publications from 2000 to 2019 in Ecuador. Results: Thirteen studies were registered, four surveys and two national studies on drug use, one on psychiatric prevalence, and six on screening for mental disorders, in populations aged 13 to 75 years. Screening instruments were used the most, the same for the Diagnostic and Statistical Manual of Mental Disorders as the diagnostic classification, fourth version (DSM-IV). The prevalence used was point prevalence, last month, annual and of lifetime. The most frequent disorders were anxiety, depression, post-traumatic stress and behavior due to drug use. Conclusions: The studies on psychiatric morbidity conducted in Ecuador are heterogeneous in the use of instruments, subjects and sample calculation, as well as their results, so it is pertinent to develop researches from this nature adjusted to the country´s reality and resources, consequently, its findings be useful for the planning of mental health services and policies in Ecuador.

Improving access to cancer information and supportive care services: A systematic review of mechanisms applied to link people with cancer to psychosocial supportive care services.

OBJECTIVE: Previous research has described the low uptake of psychosocial support services in people living with cancer. While characteristics of individuals using services have been examined, mechanisms applied to link individuals to support services are less frequently considered. This review aims to identify the mechanisms used to link people with cancer to support services and assess their impact. METHODS: Systematic searches of Pubmed, CINAHL, EMBASE and PsycINFO were conducted up to May 2020. Studies reporting service use associated with mechanisms to link adults with cancer to support services targeting emotional, informational, practical or social support needs were eligible. Eligible study designs included controlled trials, pre-post designs and observational studies. Study quality was assessed and a narrative synthesis of findings undertaken. RESULTS: A total of 10 papers (from 8,037 unique titles) were eligible. Testing the feasibility of the linkage mechanism was the primary aim in five (50%) studies. Three linkage mechanisms were identified: (a) outreach from the support service; (b) clinician recommendation/referral; (c) mailed invitation. Outreach was the most successful in connecting people with cancer to services (52%-90% use); clinician recommendation/referral was least successful (3%-28%). The impact of different linkage mechanisms for different demographic groups was not assessed. CONCLUSIONS: Outreach from services shows the most potential for increasing access to support services. However, the limited number of studies and limitations in the types of support services people with cancer were linked to, demonstrated the need for further work in this area. Identifying mechanisms that are effective for underserved, high-needs patient groups is also needed.

First Reactions and Attitudes of Psychiatric Workers in Budapest Psychiatric Care Units Regarding the COVID-19 Pandemic.

OBJECTIVE: To focus on the first feelings, attitudes, and planned reactions of psychiatric workers in Hungary to the news of the appearance of coronavirus disease 2019 (COVID-19) and to examine any differences between psychiatrists/psychologists and nurses/other professionals regarding these attitudes. METHODS: Hungarian psychiatric workers (N = 119) including psychiatrists/psychologists (n = 78) and nurses/other professionals (n = 41) participated in the study. To measure attitudes, a questionnaire was designed consisting of 7 questions and filled out within 1-3 days after the declaration of emergency in response to COVID-19 in Hungary on March 11, 2020. RESULTS: Psychiatric workers, especially psychiatrists/psychologists, regarded information gathering from valid sources as important. When examining the first feelings, we found that the psychiatrists/psychologists group tended to feel higher extent of anxiety, while the nurses/other professionals group showed higher extent of hope. When investigating willingness to work in the pandemic situation, a lower percentage of Hungarian psychiatric workers (58%) would choose to continue working compared to previous research. Answers to open-ended questions revealed that denial was the most frequent coping reaction. CONCLUSIONS: These differences could be attributed to the finding that psychiatrists/psychologists, who had faced the reality of the virus situation via the news, tended to have more realistic attitudes toward the virus, while nurses/other professionals, who had avoided valid information, tended to have less realistic attitudes.

The Continuum of Intervention Models in Integrated Behavioral Health.

The current models of clinical collaboration between physicians and psychologists/social workers in the pediatric outpatient primary care setting fall along a continuum of integration of services and philosophies of care. Domains of integration include physical office location, the targeted patient population, the level of professional adaptation to other professions' model of training, and the influence of current models of reimbursement. Included here is an analysis of those models based on each continuum of integration. Each model is discussed with respect to where it falls on each continuum.

Psychic burden development related to nursing work in Psychosocial Care Centers.

OBJECTIVE: to investigate the factors that are present in the work environment of the nursing team and that contribute to emergence of psychic burden in Psychosocial Care Centers III. METHODS: this is a descriptive and qualitative study carried out in three services located in Paraíba State. Data were obtained from an interview with a semi-structured script, and textual content was treated using the software Interface de R pour Analyzes Multidimensionnelles de Textes et de Questionneires. RESULTS: the factors that trigger psychic burden arise primarily from pace of work, precarious physical structure, work with users in mental distress, lack of management support, insufficient multidisciplinary team and lack of clinical supervision. CONCLUSION: the difficulties faced by nursing professionals in the work environment cause suffering at work and hinder the effectiveness and, consequently, the quality of nursing care.

Can targeting information on cancer-related psychosocial services by male gender and rurality improve attitude to service use in this difficult-to-engage population?

OBJECTIVE: Rural men affected by cancer are difficult to engage in psychosocial support services. This exploratory study tested whether exposure to printed brochures describing services, distinguished by a focus on rural men affected by cancer, resulted in more positive help-seeking attitudes than exposure to material focused on rural location only or generic cancer support material. METHODS: Targeted versions of a South Australian Cancer Council service brochure were developed to enhance cultural appropriateness, consistent with the Elaboration Likelihood Model. Rural men affected by cancer were recruited via supportive accommodation and randomized to receive one of the three brochures. The primary outcome was positive attitude to help-seeking at post-test (between 1 and 2 days). Negative attitudes to help-seeking, intention to seek help, perceived isolation, and service use were secondary outcomes; perceived information relevance at immediate post-test was also measured. RESULTS: Analysis (N = 114) indicated no detectable group differences (rurality/male gender, n = 33; rurality, n = 41; control, n = 40) on primary or secondary outcome measures (p > 0.05). Participants' existing service use was high, due to the recruitment methods. Support service information was primarily sourced from other people (e.g., friends/family, 22.22%; medical professionals, 27.27%). CONCLUSIONS: Existing service use rates suggest that ceiling effects obscured any potential benefit from demographic targeting of materials. Further research should consider building understanding about the acceptability of targeting techniques in this population, replication with materials designed with greater consumer input, and employ samples recruited outside a support service.

How to Mitigate the Mental Health Care Consequences of the COVID-19 Financial Crisis.

The COVID-19 pandemic has led to record unemployment claims and a weakened U.S. economy. This column reviews results of past research to examine how a recession might affect behavioral health and the treatment of mental and substance use disorders and suggests potential policy solutions. Despite increases in suicide and substance use, losses in employment-related health insurance could dampen treatment seeking. Federal, state, and local officials should be vigilant regarding suicide prevention. Individuals who lose employee insurance coverage should be protected through insurance marketplaces and Medicaid outreach and enrollment. Public and private coverage of telehealth, which has already been expanded, should continue beyond the pandemic. Federal support for community behavioral health organizations should continue to offset state and local budget cuts and ensure provision of needed treatment. The capacity of social services should be expanded as well as systems that facilitate client connection to social services.

Management of Rehabilitation needs of "Unknown" Traumatic Brain Injury Survivors: A Medical and Psychiatric Social Work Perspective.

Traumatic brain injuries [TBI] caused by road traffic accidents [RTA] are a serious health problem for people of all countries across the globe. RTA will be a leading cause of mortality, morbidity, disabilities and creating many rehabilitation needs. Hence, this, article highlights the clinical concerns, burden, challenges, role of medical and psychiatric social worker, rehabilitation strategies and practical guidelines needed for successful rehabilitation of the unknown and abandoned TBI survivors.

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa.

BACKGROUND: Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS: We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS: The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS: Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

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.

The social-psychiatric service and its role in compulsory hospitalization.

Coercive measures are a sensitive, much-discussed ethical and legal issue in the psychiatric context. Hence, the identification of their predictors and ways of prevention are of utmost importance. The present study aimed to determine the impact of the social-psychiatric services (SPS) in North Rhine Westphalia (NRW) on involuntary admissions according to the German Mental Health Act and to identify predictors for the reduction of these involuntary admissions. A dataset including details from 31 districts and 23 towns in NRW over a time period of 10 years (2005-2014) was analysed regarding the number of involuntary admissions, gender and age of admitted patients, and person/institution initiating the compulsory act. All 56 SPS in NRW were contacted for information on the number of clients/contacts, home visits, areas of responsibility and their involvement in involuntary admissions. Thirty SPS participated in the survey. We found a significant increase of involuntary admissions over time with significantly higher proportions of male patients and patients younger than 60 years in every year. Regarding the characteristics of SPS, a negative correlation between the number of clients contacting the SPS on their own initiative and low-income households was observed. Additionally, the number of clients contacting the SPS on their own initiative was significantly higher in districts/towns associated with lower involuntary admission rates. These data suggest that patient-based factors were of great importance in the context of involuntary admissions. Furthermore, the SPS and home treatment should be strengthened and intensified to achieve lower involuntary admission rates.

Reflexões sobre os conceitos de cidadania e sujeito em psicanálise na Atenção Psicossocial / Reflections on the concepts of citizenship and subject in psychoanalysis in Mental Health / Reflexiones sobre los conceptos de ciudadanía y sujeto en psicoanálisis en la Salud Mental

A captura da cidadania como princípio das práticas de saúde mental e discurso a ser incorporado subjetivamente pelo louco cria um impasse na própria atitude subversiva pretendida pela Reforma Psiquiátrica Brasileira. A Psicanálise sustenta o ato de escuta do sujeito, em uma posição de autoria, responsabilização pelo seu sofrimento e sustentação de seu desejo, estando aí uma possível contribuição da psicanálise para a luta antimanicomial. A partir de uma pesquisa analítica, de enfoque qualitativo, aborda-se os significantes de cidadania e de sujeito em psicanálise e quais as implicações práticas e políticas de tais concepções para o cotidiano dos Centros de Atenção Psicossocial. Aposta-se em uma contribuição teórica e política ao apontar as diferenças entre o trabalho orientado pela cidadania e aquele orientado pelos efeitos do inconsciente, sem objetivar, contudo, uma oposição entre essas perspectivas de trabalho.(AU)

The capture of citizenship as a principle of mental health practices and discourse to be subjectively incorporated by the crazy creates a standoff in the subversive attitude intended by the Brazilian Psychiatric Reform. Psychoanalysis supports the act of listening to the subject, in a position of authorship, responsibility for their suffering and support of their desire, being there a possible contribution of psychoanalysis to the antimanicomial fight. Based on an analytical research, with a qualitative focus, the article approaches the signifiers of citizenship and subject in psychoanalysis and what are the practical and political implications of such conceptions for the daily life of the Psychosocial Care Centers. It is based on a theoretical and political contribution in pointing out the differences between work oriented by citizenship and that guided by the effects of the unconscious, however, without objecting to an opposition between these perspectives of work.(AU)

La captura de la ciudadanía como principio de las prácticas de salud mental y discurso a ser incorporado subjetivamente por el loco crea una dificultad en la actitud subversiva pretendida por la Reforma Psiquiátrica Brasileña. El psicoanálisis sostiene el acto de escucha del sujeto, en una posición de autoría, responsabilización por su sufrimiento y sustentación de su deseo, estando ahí una posible contribución del psicoanálisis a la lucha antimanicomial. A partir de una investigación analítica, de enfoque cualitativo, se abordan los significantes de ciudadanía y de sujeto en psicoanálisis y cuáles las implicaciones prácticas y políticas de tales concepciones para el cotidiano de los Centros de Atención Psicosocial. Se apunta en una contribución teórica y política al apuntar las diferencias entre el trabajo orientado por la ciudadanía y aquel orientado por los efectos del inconsciente, sin embargo, sin objetivar una oposición entre esas perspectivas de trabajo.(AU)

Clinical activism in community-based practice: The case of LGBT affirmative care at the Eromin Center, Philadelphia, 1973-1984.

The Eromin Center was founded in Philadelphia in 1973, aiming to provide lesbian, gay, bisexual, and transgender (LGBT) affirmative mental health treatment 6 months before the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM-II; American Psychiatric Association, 1968). This study of archival records and oral histories with Eromin Center staff and volunteers reveals an iterative and improvisational approach to community-based affirmative care. Rather than waiting for national leadership or institutional change, they aimed to respond directly to otherwise unrecognized needs of LGBT people through psychotherapy and social services-what we are calling clinical activism. Without training or guidance from research, they tended to base their work on their own experiences, an approach with inherent limitations in particular because most of the staff were White, cisgender, and identified as gay and lesbian. They attempted to address these limitations until Eromin's closing in 1984. Largely overshadowed by the broader policy changes in mental health care, Eromin's work provides a crucial case study in community-based clinical activism and affirmative practice with continuing salience today. (PsycINFO Database Record (c) 2019 APA, all rights reserved).