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Kamali, Mahdis, Mariella Munyuzangabo, Fahad J. Siddiqui, Michelle F. Gaffey, Sarah Meteke, Daina Als, Reena P. Jain, et al. "Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review." BMJ Global Health 5, no. 3 (March 2020): e002014. http://dx.doi.org/10.1136/bmjgh-2019-002014.
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BackgroundOver 240 million children live in countries affected by conflict or fragility, and such settings are known to be linked to increased psychological distress and risk of mental disorders. While guidelines are in place, high-quality evidence to inform mental health and psychosocial support (MHPSS) interventions in conflict settings is lacking. This systematic review aimed to synthesise existing information on the delivery, coverage and effectiveness of MHPSS for conflict-affected women and children in low-income and middle-income countries (LMICs).MethodsWe searched Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Psychological Information Database (PsycINFO)databases for indexed literature published from January 1990 to March 2018. Grey literature was searched on the websites of 10 major humanitarian organisations. Eligible publications reported on an MHPSS intervention delivered to conflict-affected women or children in LMICs. We extracted and synthesised information on intervention delivery characteristics, including delivery site and personnel involved, as well as delivery barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data.ResultsThe search yielded 37 854 unique records, of which 157 were included in the review. Most publications were situated in Sub-Saharan Africa (n=65) and Middle East and North Africa (n=36), and many reported on observational research studies (n=57) or were non-research reports (n=53). Almost half described MHPSS interventions targeted at children and adolescents (n=68). Psychosocial support was the most frequently reported intervention delivered, followed by training interventions and screening for referral or treatment. Only 19 publications reported on MHPSS intervention coverage or effectiveness.DiscussionDespite the growing literature, more efforts are needed to further establish and better document MHPSS intervention research and practice in conflict settings. Multisectoral collaboration and better use of existing social support networks are encouraged to increase reach and sustainability of MHPSS interventions.PROSPERO registration numberCRD42019125221.
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Wood, Benjamin, and Per Kallestrup. "Benefits and Challenges of Using a Participatory Approach with Community-based Mental Health and Psychosocial Support Interventions in Displaced Populations." Transcultural Psychiatry 58, no. 2 (January 28, 2021): 283–92. http://dx.doi.org/10.1177/1363461520983626.
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The mental health burden of displaced communities is enormous and ever-increasing. Community-based Mental Health and Psychosocial Support (CB-MHPSS) interventions are seen as vital in addressing this challenge, and they have been lauded as being integral in the overall multi-level Mental Health and Psychosocial Support Intervention approach in humanitarian settings. This article assumes that CB-MHPSS innately require a participatory approach to truly benefit the targeted population. It explores important benefits and challenges of using a participatory approach with CB-MHPSS interventions, as well as identifying key considerations in their design and implementation. A literature review of the PubMed database, Web of Science, The Cochrane Library of Systematic Reviews, and defined ‘grey literature’ identified 42 relevant articles. Thematic analysis identified dilemmas raised by many of the authors, including: the disconnect between using a participatory community-based approach and evidence-based medicine; using locally derived versus standardised measures; incorporating local mental health expressions and idioms into the intervention versus using standardised diagnostic classifications; empowering communities versus falling into the hands of local power dynamics and agendas; and trying to allow for sufficient time to develop relationships and build trust with the targeted community. The findings can serve to encourage reflexivity and critical thinking in the design and implementation of future CB-MHPSS interventions, which will be required to develop robust evidence that supports CB-MHPSS interventions in displaced communities.
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Kohrt, Brandon A., Mark J. D. Jordans, and Christopher A. Morley. "Four principles of mental health research and psychosocial intervention for child soldiers: lessons learned in Nepal." International Psychiatry 7, no. 3 (July 2010): 57–59. http://dx.doi.org/10.1192/s1749367600005841.
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Child soldiers represent a challenging population for mental health and psychosocial support (MHPSS), as we have little evidence regarding their needs or the efficacy of interventions. Despite an increasing breadth of MHPSS interventions for children affected by war, very few are supported by evidence (Jordans et al, 2009). In a recent decade-long conflict, Maoists and the government of Nepal conscripted thousands of children to serve as soldiers, sentries, spies, cooks and porters. After the war ended in 2006, we began a project incorporating research into the development of interventions for former child soldiers. Through this work, conducted with Transcultural Psychosocial Organization (TPO) Nepal, we identified four key principles to guide research and intervention with child soldiers (Fig. 1). We present these principles as location- and context-specific examples of the growing effort to develop guidelines and recommendations for research and intervention in acute post-conflict settings (Inter-Agency Standing Committee, 2007; Allden et al, 2009).
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Otake, Yuko. "Community Resilience and Long-Term Impacts of Mental Health and Psychosocial Support in Northern Rwanda." Medical Sciences 6, no. 4 (October 24, 2018): 94. http://dx.doi.org/10.3390/medsci6040094.
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Recently, discussions have considered how mental health and psychosocial support (MHPSS) can build upon local resilience in war-affected settings. To contribute to the knowledge in this field, the paper explored the gap between MHPSS and local communities in terms of perceived mental health problems and healing processes, and how the gap could be filled. Qualitative research was conducted in northern Rwanda with 43 participants between 2015 and 2016. Findings revealed how three particular gaps can isolate MHPSS recipients in their local community. First, whereas MHPSS applies bio-psychological frameworks to post-genocide mental health, community conceptualisations emphasise social aspects of suffering. Second, unlike MHPSS which encourages ‘talking’ about trauma, ‘practicing’ mutual support plays a major role in the community healing process. Third, MHPSS focuses on one part of the community (those who share the same background) and facilitates their healing in intervention groups. However, healing in natural communities continues in everyday life, through mutual support among different people. Despite these gaps, MHPSS recipients can be (re)integrated into the community through sharing suffering narratives and sharing life with other community members. The paper highlights the ways in which MHPSS could inclusively support different social groups in the overall geographical community, allowing members to preserve the existing reciprocity and recover collective life through their own initiatives.
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Nguyen, Amanda, Anvita Bhardwaj, Kh Shafiur Rahaman, Suzit Barua, Karine Le Roch, Molly Lasater, Matthew Schojan, Catherine Lee, Kim Berg, and Sarah M. Murray. "Measuring the psychosocial wellbeing of Rohingya mothers in Cox’s Bazar, Bangladesh: Psychometric properties of an MHPSS assessment battery." F1000Research 11 (November 29, 2022): 1402. http://dx.doi.org/10.12688/f1000research.125654.1.
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Background: Psychosocial research in humanitarian settings has been historically dominated by a focus on distress and disorder. As such, there is a need to establish the validity of instruments for a broad range of psychosocial outcomes, particularly among highly affected and under-represented populations. The current study describes the adaptation and testing of multiple psychosocial instruments among displaced Rohingya mothers in Bangladesh. Methods: We used baseline data from 600 mothers of malnourished children aged 2 and under enrolled in an intervention study in Cox’s Bazar, Bangladesh. Instruments assessed distress (International Depression Symptom Scale [IDSS] and Kessler-6 [K-6]); functional impairment (World Health Organization Disability Assessment Schedule [WHODAS]); subjective wellbeing (global Satisfaction With Life [SWL] and Personal Wellbeing Index [PWI]; and, coping (Brief COPE and locally developed coping items). Instruments were piloted and refined, then used for data collection by Bangladeshi-Rohingya interviewer pairs. We conducted exploratory factor analysis, evaluated internal consistency, examined construct validity through correlation with other scales, and used regression models to explore demographic factors associated with psychosocial health. Results: Both the WHODAS and coping items fit 2-factor models; other scales were unidimensional. Cronbach’s alphas ranged from .76 to .90 for the refined scales. With the exception of coping, scale correlations supported construct validity; separate measures of the same construct were highly correlated, distress and impairment were moderately correlated, and both were inversely correlated with wellbeing. Correlates of poorer psychosocial health included relative socioeconomic disadvantage, current pregnancy, and being unmarried. Conclusions: Most of the standard psychosocial assessment tools performed adequately, but they did not appear to fully capture local experiences and included items of little local relevance. Findings highlight the need for further mixed methods research to develop a rich battery of instruments with cross-cultural validity, particularly for positive outcomes such as coping which was particularly challenging to assess.
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Ishaq, Sara, and Nashi Khan. "Perceived Aetiology and Therapeutic Attitudes: Mediating Role of Stigmatizing Attitudes in Substance Use Disorders." Pakistan Journal of Medical and Health Sciences 16, no. 10 (October 30, 2022): 761–65. http://dx.doi.org/10.53350/pjmhs221610761.
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Introduction: Substance Use Disorders (SUDs) are among the most stigmatized mental health condition in Pakistan’s health care system. Stigma serves as a chief barrier to successful treatment engagement including seeking, sustaining participation or receiving quality care by health care professionals. Purpose: The present study aimed to investigate the mediating role of stigmatizing attitudes in explaining the relationship between perceived aetiology and therapeutic attitudes. Method: Correlational research design and purposive sampling strategy were used to collect a sample of 100 MHP’s (N= 100) consisting of n= 36 (M=33.64, SD=8.34) psychiatrists and n= 64 (M=30.38, SD=7.30) psychologist from hospitals, addiction centers and universities. Results: Results indicated that bio-medical causal attributions predicted stigmatizing attitudes (i.e., permissiveness, non-stereotype treatment optimism and treatment intervention); however, only treatment intervention mediated the relationship between bio- medical causal attributions and therapeutic preparedness among MHPs. Similarly, psychosocial causal attributions predicted stigmatizing attitudes (i.e., non-stereotype and non-moralism), however neither of them mediated the relationship between psycho- social causal attributions and therapeutic preparedness among MHPs. Conclusion: The study highlights the importance of combined aetiological information in anti-stigma interventions, advance training, and informed curriculum to reduce stigma and increase therapeutic preparedness. Keywords: Perceived Aetiology, Therapeutic Attitudes, Stigmatizing Attitudes, Substance Use Disorders
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Gargano, Maria Caterina, Dean Ajduković, and Maša Vukčević Marković. "Mental Health in the Transit Context: Evidence from 10 Countries." International Journal of Environmental Research and Public Health 19, no. 6 (March 15, 2022): 3476. http://dx.doi.org/10.3390/ijerph19063476.
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Most interventions for mental health and psychosocial support (MHPSS) have been developed in contexts and with populations that differ significantly from the realities of migration. There is an urgent need for MHPSS in transit; however, transit-specific aspects of MHPSS provision are often neglected due to the inherent challenges transit poses to traditional conceptualizations of practice. The Delphi method, which consisted of three iterative rounds of surveys, was applied with the goal of identifying challenges to and adaptations of MHPSS in the transit context. Twenty-six MHPSS providers working with refugees in 10 European transit countries participated; 69% of participants completed all three survey rounds. There was consensus that a flexible model of MHPSS, which can balance low intensity interventions and specialized care, is needed. Agreement was high for practice-related and sociopolitical factors impacting MHPSS in transit; however, the mandate of MHPSS providers working in the transit context achieved the lowest consensus and is yet to be defined. There is a need to rethink MHPSS in the refugee transit context. Providing MHPSS to refugees on the move has specificities, most of which are related to the instability and uncertainty of the context. Future directions for improving mental health protection for refugees, asylum seekers, and migrants in transit are highlighted.
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Tol, W. A., M. Purgato, J. K. Bass, A. Galappatti, and W. Eaton. "Mental health and psychosocial support in humanitarian settings: a public mental health perspective." Epidemiology and Psychiatric Sciences 24, no. 6 (September 24, 2015): 484–94. http://dx.doi.org/10.1017/s2045796015000827.
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Aims.To discuss the potential usefulness of a public health approach for ‘mental health and psychosocial support’ (MHPSS) interventions in humanitarian settings.Methods.Building on public mental health terminology in accordance with recent literature on this topic and considering existing international consensus guidelines on MHPSS interventions in humanitarian settings, this paper reflects on the relevance of the language of promotion and prevention for supporting the rationale, design and evaluation of interventions, with a particular focus on populations affected by disasters and conflicts in low- and middle-income countries.Results.A public mental health approach and associated terminology can form a useful framework in the design and evaluation of MHPSS interventions, and may contribute to reducing a divisive split between ‘mental health’ and ‘psychosocial’ practice in the humanitarian field. Many of the most commonly implemented MHPSS interventions in humanitarian settings can be described in terms of promotion and prevention terminology.Conclusions.The use of a common terminology across health, protection, education, nutrition and other relevant sectors providing humanitarian interventions has the potential to allow for integration of MHPSS activities in one overall framework, with diverse humanitarian practitioners working to achieve a common goal.
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Hendrickx, M., A. Woodward, D. C. Fuhr, E. Sondorp, and B. Roberts. "The burden of mental disorders and access to mental health and psychosocial support services in Syria and among Syrian refugees in neighboring countries: a systematic review." Journal of Public Health 42, no. 3 (October 24, 2019): e299-e310. http://dx.doi.org/10.1093/pubmed/fdz097.
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Abstract Background Exposure to conflict, violence and forced displacement can increase poor mental health among affected populations. Our aim was to examine evidence on the burden of mental disorders and access to and effectiveness of mental health and psychosocial support (MHPSS) services in Syria and among Syrian refugees in neighboring countries. Methods A systematic review was done following systematic review criteria. Twelve bibliographic databases and additional gray literature sources were searched for quantitative and qualitative studies. Descriptive analysis and quality assessment were conducted. Results Twenty-eight eligible studies were identified, of which two were with conflict-affected populations within Syria. Levels of post-traumatic stress disorder ranged from 16 to 84%, depression from 11 to 49%, and anxiety disorder from 49 to 55%. Common risk factors were exposures to trauma and having a personal or family history of mental disorder. Financial and socio-cultural barriers were identified as the main obstacles to accessing MHPSS care. Evaluations of MHPSS services, albeit from predominantly nonrandomised designs, reported positive treatment outcomes. Conclusions The MHPSS burden was high, but with considerable variation between studies. There are key evidence gaps on: MHPSS burden and interventions—particularly for those living within Syria; access and barriers to care; and implementation and evaluation of MHPSS interventions.
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Lasater, Molly E., Jennifer Flemming, Christine Bourey, Ashley Nemiro, and Sarah R. Meyer. "School-based MHPSS interventions in humanitarian contexts: a realist review." BMJ Open 12, no. 4 (April 2022): e054856. http://dx.doi.org/10.1136/bmjopen-2021-054856.
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ObjectiveThe aim of this review is to elucidate the characteristics of school-based mental health and psychosocial support (MHPSS) interventions in humanitarian contexts and the hypothesised mechanisms by which they influence well-being or learning outcomes.MethodsWe conducted a realist review and searched PubMed, Embase, Global Health, CINAHL, PsychInfo, PILOTS and grey literature through January 2022. Eligible studies included children age 6–12 years, were conducted in humanitarian contexts in low-income or middle-income countries, and focused on universal MPHSS prevention in an educational setting, using any study design. Data were extracted and analysed using narrative synthesis and realist analysis techniques to create ‘context–mechanism–outcome’ configurations that were iteratively developed to modify, refine and substantiate programme theories.ResultsTwenty-seven articles, representing 19 studies, were included in the review. We analysed data from 26 articles. Eleven evidenced-informed programme theories were developed at the levels of the child (n=4), teacher (n=3), caregiver (n=2), school environment (n=1) and school managers/administrators (n=1). At the child level, mechanisms related to strengthening coping skills, emotion regulation, interpersonal relationships led to improved psychosocial well-being or learning outcomes. At the teacher level, coping skills and the provision of support to students were linked to psychosocial well-being and learning outcomes. At the caregiver level, strengthening interpersonal bonds trigger improved psychosocial well-being, and at the school environment level, fostering feelings of security was linked to psychosocial well-being and learning outcomes. We did not find any evidence supporting the programme theory at the school managers/administrators level. We found limited evidence of positive impacts of the included interventions to support these programme theories.ConclusionsThese programme theories are a promising start towards ensuring school-based MHPSS interventions in humanitarian contexts better address the well-being and learning needs of children. Future research is needed to support these programme theories and enhance the evidence base.
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Dückers, Michel, Wera van Hoof, Andrea Willems, and Hans te Brake. "Appraising Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines—PART II: A Content Analysis with Implications for Disaster Risk Reduction." International Journal of Environmental Research and Public Health 19, no. 13 (June 25, 2022): 7798. http://dx.doi.org/10.3390/ijerph19137798.
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High quality mental health and psychosocial support (MHPSS) guidelines are indispensable for policy and practice to address the mental health consequences of disasters. This contribution complements a review that assessed the methodological quality of 13 MHPSS guidelines. We analyzed the content of the four highest-ranking guidelines and explored implications for disaster risk reduction (DRR). A qualitative explorative thematic analysis was conducted. The four guidelines proved largely similar, overlapping or at least complementary in their MHPSS definitions, stated purpose of the guidelines, user and target groups, terminology, and models used. Many recommended MHPSS measures and interventions were found in all of the guidelines and could be assigned to five categories: basic relief, information provision, emotional and social support, practical support, and health care. The guidelines stress the importance of monitoring needs and problems, evaluating the effect of service delivery, deliberate implementation and preparation, and investments in proper conditions and effective coordination across professions, agencies, and sectors. The MHPSS knowledge base embedded in the guidelines is comprehensive, coherent, and sufficiently universal to serve as the “overarching framework” considered missing yet vital for the integration of MHPSS approaches in DRR. Although application contexts differ geographically, this common ground should allow policymakers and practitioners globally to plan, implement, and evaluate MHPSS actions contributing to DRR, ideally together with target groups.
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Pedersen, Gloria A., Manaswi Sangraula, Pragya Shrestha, Pooja Lakshmin, Alison Schafer, Renasha Ghimire, Nagendra P. Luitel, Mark J. D. Jordans, and Brandon A. Kohrt. "Developing the Group Facilitation Assessment of Competencies Tool for Group-Based Mental Health and Psychosocial Support Interventions in Humanitarian and Low-Resource Settings." Journal on Education in Emergencies 7, no. 2 (2021): 334. http://dx.doi.org/10.33682/u4t0-acde.
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In humanitarian settings, mental health and psychosocial support services (MHPSS) are often delivered in group-based formats. Group interventions enable providers to reach more individuals when resources and technical expertise are limited. Group-based programs also foster social support, empathy, and collective problem-solving among the participants. To remedy the current lack of tools available to assess the group facilitation competencies of individuals delivering group-based MHPSS, we made it our objective to develop such a tool. Our approach, which focused on adults, complimented a similar initiative underway for children and adolescents. We reviewed MHPSS manuals to identify key group facilitation competencies, which include developing and reviewing group ground rules, facilitating participation among all group members, fostering empathy between members, encouraging collaborative problem-solving, addressing barriers to attendance, time management, and ensuring group confidentiality. We then developed the Group Facilitation Assessment of Competencies (GroupACT) Tool. The GroupACT is a structured observational tool for assessing these competencies during standardized role-plays with actor clients, or in vivo during the delivery of group sessions with actual clients. We conclude this article with guidance for using the GroupACT to assess facilitators' competencies in providing group-based MHPSS in the health, education, protection, and other sectors in humanitarian settings.
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Bangpan, Mukdarut, Lambert Felix, and Kelly Dickson. "Mental health and psychosocial support programmes for adults in humanitarian emergencies: a systematic review and meta-analysis in low and middle-income countries." BMJ Global Health 4, no. 5 (October 2019): e001484. http://dx.doi.org/10.1136/bmjgh-2019-001484.
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BackgroundHumanitarian emergencies are a major global health challenge with the potential to have a profound impact on people’s mental and psychological health. Effective interventions in humanitarian settings are needed to support the mental health and psychosocial needs of affected populations. To fill this gap, this systematic review synthesises evidence on the effectiveness of a wide range of mental health and psychosocial support (MHPSS) programmes delivered to adults affected by humanitarian emergencies in low and middle-income countries (LMICs).MethodsA comprehensive search of 12 electronic databases, key websites and citation checking was undertaken in 2015 and updated in May 2018. We included controlled trials published in English from 1980. We extracted data and assessed risk of bias prior to performing a meta-analysis using random effects models. When meta-analysis was not used, we narratively described individual trial effect sizes using forest plots.ResultsThirty-five studies were included. Overall, MHPSS programmes show benefits in improved functioning and reducing post-traumatic stress disorder. There are also indications from a limited pool of evidence that cognitive–behavioural therapy and narrative exposure therapy may improve mental health conditions. Other psychotherapy modalities also showed a positive trend in favour of MHPSS programmes for improving several mental health outcomes.ConclusionIn addition to MHPSS programme for improving mental health outcomes in adults affected by humanitarian emergencies in LMICs, there is also a need to generate robust evidence to identify potential impact on broader social dimensions. Doing so could aid the future development of MHPSS programmes and ensure their effective implementation across different humanitarian contexts in LMICs. Future research on MHPSS programmes which focus on basic services and security, community and family programmes, their cost-effectiveness and mechanisms of impact could also strengthen the MHPSS evidence base to better inform policy and practice decision-making in humanitarian settings.Protocol registration numberCRD42016033578.
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Bosqui, Tania. "The toll of effectiveness studies on mental health interventions in the global south." Clinical Psychology Forum 1, no. 312 (December 2018): 20–21. http://dx.doi.org/10.53841/bpscpf.2018.1.312.20.
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Increasing focus on evidence-based interventions in global development has led to a neglect of root causes and systemic failures; this same criticism should be applied to the implementation of mental health and psychosocial support (MHPSS) programs in the global south.
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Ager, Wendy, Lennart Reifels, Jura Augustinavicius, and Lena Pschiuk. "Exploring current responses to the climate crisis in MHPSS interventions in humanitarian settings." Intervention 20, no. 1 (2022): 1. http://dx.doi.org/10.4103/intv.intv_3_22.
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Singh, Sukhmeet, Maryjane Roberts, Alexandra Clark, and Christabel Boyle. "An Audit and Quality Improvement Project Regarding the Management of Patients With Eating Disorders Within the West Glasgow CAMHS Team." BJPsych Open 8, S1 (June 2022): S10. http://dx.doi.org/10.1192/bjo.2022.96.
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AimsThere has been a significant increase in presentations of people with eating disorders (ED) within CAMHS in relation to the pandemic with a significant pressure on services to continue to provide evidence-based treatments for an expanding number of severely unwell patients. The first aim was to assess the quality of referrals received for patients with suspected ED and to then implement an intervention regarding the way that referrals are handled. The second aim was to establish a process for handling and monitoring patients already open to the service.MethodsAn initial and repeat survey was sent to staff within the team. The survey included the Mental Health Professional Stress Scale (MHPSS). An audit was conducted to establish the quality of referrals from GPs based on the Junior Marsipan guidelines. Data were collected on physical measures and the written content of referrals for March 2020–21 and March 2021–22.Duty clinicians were asked to screen referrals and prompt GPs to submit recordings of physical parameters for the referrals to be triaged. In addition, a weekly meeting in a “board round” format was implemented to discuss new referrals and 40–50 existing patients each week depending on risk. We developed a physical health monitoring clinic once per week.ResultsMHPSS scores remained high between initial and follow-up surveys, with slightly increased mean scores for workload, organisational structure and processes, and lack of resources. Referrals from 2020–2021 (N = 26) and those from 2021–2022 (N = 39) were screened. The majority had a diagnosis of anorexia nervosa. Most referrals had records of height and weight (73.1 to 82.1%). 53.8% of referrals in the re-audit period required prompting for physical recordings to be submitted. There was no change in the written content of referrals at re-audit, with only 46.2% recording risk, 51.3% recording estimated onset and 56.4% documenting body image.There was a slight reduction in the mean time between referral and diagnosis from 44.1 to 34.2 days. The weekly board round received positive feedback (N = 10) with 70–100% answering agree/strongly agree to statements such as manage patients’ care safely, obtaining urgent advice and physical monitoring.ConclusionThe processes summarised above have been successful in improving the efficiency surrounding the management of patients with ED. Unfortunately, there has been no improvement in the stress levels of staff; we hope to conduct a focus group to better understand this. A referral proforma should be developed by the wider service for GPs to complete.
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Segal-Engelchin, Dorit, Netta Achdut, Efrat Huss, and Orly Sarid. "CB-Art Interventions Implemented with Mental Health Professionals Working in a Shared War Reality: Transforming Negative Images and Enhancing Coping Resources." International Journal of Environmental Research and Public Health 17, no. 7 (March 28, 2020): 2287. http://dx.doi.org/10.3390/ijerph17072287.
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Research on mental health professionals (MHPs) exposed to a shared war reality indicates that they are subject to emotional distress, symptoms of posttraumatic stress disorder, and vicarious trauma. This article focuses on a CB-ART (cognitive behavioral and art-based) intervention implemented during the 2014 Gaza conflict with 51 MHPs who shared war-related experiences with their clients. The intervention included drawing pictures related to three topics: (1) war-related stressors, (2) coping resources, and (3) integration of the stressful image and the resources drawing. The major aims of the study were (1) to examine whether significant changes occurred in MHP distress levels after the intervention; (2) to explore the narratives of the three drawing and their compositional characteristics; and (3) to determine which of selected formats of the integrated drawing and compositional transformations of the stressful image are associated with greater distress reduction. Results indicate that MHP distress levels significantly decreased after the intervention. This stress-reducing effect was also reflected in differences between the compositional elements of the ‘stress drawing’ and the ‘integrated drawing,’ which includes elements of resources. Reduced distress accompanied compositional transformations of the stressful image. MHPs can further use the easily implemented intervention described here as a coping tool in other stressful situations.
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Tay, A. K., A. Riley, R. Islam, C. Welton-Mitchell, B. Duchesne, V. Waters, A. Varner, et al. "The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review." Epidemiology and Psychiatric Sciences 28, no. 5 (April 22, 2019): 489–94. http://dx.doi.org/10.1017/s2045796019000192.
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AbstractAimsDespite the magnitude and protracted nature of the Rohingya refugee situation, there is limited information on the culture, mental health and psychosocial wellbeing of this group. This paper, drawing on a report commissioned by the United Nations High Commissioner for Refugees (UNHCR), aims to provide a comprehensive synthesis of the literature on mental health and psychosocial wellbeing of Rohingya refugees, including an examination of associated cultural factors. The ultimate objective is to assist humanitarian actors and agencies in providing culturally relevant Mental Health and Psychosocial Support (MHPSS) for Rohingya refugees displaced to Bangladesh and other neighbouring countries.MethodsWe conducted a systematic search across multiple sources of information with reference to the contextual, social, economic, cultural, mental health and health-related factors amongst Rohingya refugees living in the Asia-Pacific and other regions. The search covered online databases of diverse disciplines (e.g. medicine, psychology, anthropology), grey literature, as well as unpublished reports from non-profit organisations and United Nations agencies published until 2018.ResultsThe legacy of prolonged exposure to conflict and persecution compounded by protracted conditions of deprivations and displacement is likely to increase the refugees' vulnerability to wide array of mental health problems including posttraumatic stress disorder, anxiety, depression and suicidal ideation. High rates of sexual and gender-based violence, lack of privacy and safe spaces and limited access to integrated psychosocial and mental health support remain issues of concern within the emergency operation in Bangladesh. Another challenge is the limited understanding amongst the MHPSS personnel in Bangladesh and elsewhere of the language, culture and help-seeking behaviour of Rohingya refugees. While the Rohingya language has a considerable vocabulary for emotional and behavioural problems, there is limited correspondence between these Rohingya terms and western concepts of mental disorders. This hampers the provision of culturally sensitive and contextually relevant MHPSS services to these refugees.ConclusionsThe knowledge about the culture, context, migration history, idioms of distress, help-seeking behaviour and traditional healing methods, obtained from diverse sources can be applied in the design and delivery of culturally appropriate interventions. Attention to past exposure to traumatic events and losses need to be paired with attention for ongoing stressors and issues related to worries about the future. It is important to design MHPSS interventions in ways that mobilise the individual and collective strengths of Rohingya refugees and build on their resilience.
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Manandhar, Rosina, Rachana Saha, Dipty Shrestha, and Rumina Malla. "Obstetric Emergency Drill: Does it Change our Knowledge and Skill?" Nepal Medical Journal 2, no. 1 (August 1, 2019): 74–81. http://dx.doi.org/10.37080/nmj.44.
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Introduction: Obstetric emergencies are unpredictable and inappropriate management of such events can result in serious maternal and neonatal morbidity and mortality. Simulation and drill provides obstetric emergency training in a safe environment with an aim of improving clinical outcome. The aim of this study was to evaluate the impact of obstetric emergency training on the change in the knowledge, clinical skill and teamwork performance of the participants in the management of common obstetric emergencies: eclampsia, shoulder dystocia and post-partum haemorrhage.
Methods: A hospital based interventional study was conducted amongst 11 residents, 4 medical officers and 45 interns. Pre-training and post-training assessment of the knowledge by using Multiple choice questions (MCQs), clinical skills by using Objective Structured Clinical Examination (OSCE) and teamwork performance by using Mayo High Performance Teamwork Scale (MHPTS) was undertaken in each of the modules: Eclampsia, Shoulder dystocia and Post-partum haemorrhage. Training intervention was undertaken by using standardized lectures and simulated clinical emergency scenarios. The changes in MCQs, OSCE and MHPTS scores were analyzed.
Results: There was a significant improvement in the mean MCQ score (p-value ˂0.001) and OSCE score (p-value ˂0.001), overall and individually, in each module. After the training, a greater number of participants could perform the clinical skill components. There was also a significant improvement in post training MHPTS score (p-value˂0.001). Conclusions: Obstetric emergency drill and training significantly increased the knowledge, clinical skills and teamwork performance of participants in the management of important obstetric emergencies.
Keywords: eclampsia; obstetric emergency; post-partum haemorrhage; shoulder dystocia; simulation.
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Franzoi, Isabella Giulia, Antonella Granieri, Maria Domenica Sauta, Monica Agnesone, Marco Gonella, Roberto Cavallo, Piergiorgio Lochner, Nicola Luigi Bragazzi, and Andrea Naldi. "Anxiety, Post-Traumatic Stress, and Burnout in Health Professionals during the COVID-19 Pandemic: Comparing Mental Health Professionals and Other Healthcare Workers." Healthcare 9, no. 6 (May 27, 2021): 635. http://dx.doi.org/10.3390/healthcare9060635.
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The psychological impact of the pandemic on healthcare workers has been assessed worldwide, but there are limited data on how mental health professionals (MHPs) have been affected. Thus, this paper aims to investigate anxiety, post-traumatic stress, and burnout in a sample of MHPs. We conducted a descriptive, cross-sectional study on 167 participants: 56 MHPs, 57 physicians working closely with COVID-19 patients, and 54 physicians not working closely with such patients. MHPs reported good overall mental health. Most MHPs reported no post-traumatic stress, and their scores were significantly lower compared to HPs working closely with COVID-19 patients. MHPs’ hyperarousal scores were also significantly lower compared to HPs working closely with COVID-19 patients, while their intrusion scores were statistically significantly lower than those of all other professionals. Multivariable logistic regressions showed that MHPs had lower odds of exhibiting state anxiety and low personal accomplishment compared to HPs not working closely with COVID-19 patients. In sum, MHPs seem to show almost preserved mental health. Thus, given the high mental healthcare demand during a pandemic, it would be useful to rely on these professionals, especially for structuring interventions to improve and support the mental health of the general population and other healthcare workers.
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Krijnen-de Bruin, Esther, Jasmijn A. Geerlings, Anna DT Muntingh, Willemijn D. Scholten, Otto R. Maarsingh, Annemieke van Straten, Neeltje M. Batelaan, and Berno van Meijel. "Evaluation of a Blended Relapse Prevention Program for Anxiety and Depression in General Practice: Qualitative Study." JMIR Formative Research 5, no. 2 (February 16, 2021): e23200. http://dx.doi.org/10.2196/23200.
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Background Existing studies have yet to investigate the perspectives of patients and professionals concerning relapse prevention programs for patients with remitted anxiety or depressive disorders in primary care. User opinions should be considered when optimizing the use and implementation of interventions. Objective This study aimed to evaluate the GET READY relapse prevention programs for patients with remitted anxiety or depressive disorders in general practice. Methods Semistructured interviews (N=26) and focus group interviews (N=2) with patients and mental health professionals (MHPs) in the Netherlands were performed. Patients with remitted anxiety or depressive disorders and their MHPs who participated in the GET READY study were interviewed individually. Findings from the interviews were tested in focus group interviews with patients and MHPs. Data were analyzed using thematic analysis. Results Participants were positive about the program because it created awareness of relapse risks. Lack of motivation, lack of recognizability, lack of support from the MHP, and symptom severity (too low or too high) appeared to be limiting factors in the use of the program. MHPs play a crucial role in motivating and supporting patients in relapse prevention. The perspectives of patients and MHPs were largely in accordance, although they had different perspectives concerning responsibilities for taking initiative. Conclusions The implementation of the GET READY program was challenging. Guidance from MHPs should be offered for relapse prevention programs based on eHealth. Both MHPs and patients should align their expectations concerning responsibilities in advance to ensure optimal usage. Usage of blended relapse prevention programs may be further enhanced by diagnosis-specific programs and easily accessible support from MHPs. International Registered Report Identifier (IRRID) RR2-10.1186/s12888-019-2034-6
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Przybylko, Geraldine, Darren Morton, Jason Morton, and Melanie Renfrew. "The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study." JMIR Mental Health 8, no. 11 (November 11, 2021): e29866. http://dx.doi.org/10.2196/29866.
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Background The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. Objective The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. Methods This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the “mental health” and “vitality” subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. Results On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. Conclusions Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx
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Perera, Camila, Kelly A. McBride, Áine Travers, Pia Tingsted Blum, Nana Wiedemann, Cecilie Dinesen, Byron Bitanihirwe, and Frédérique Vallières. "Towards an integrated model for supervision for mental health and psychosocial support in humanitarian emergencies: A qualitative study." PLOS ONE 16, no. 10 (October 6, 2021): e0256077. http://dx.doi.org/10.1371/journal.pone.0256077.
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Background Despite recent advances in the development and provision of mental health and psychosocial support (MHPSS) in humanitarian settings, inadequate supervision remains a significant barrier to successful implementation. The present study sought to incorporate broad stakeholder engagement as part of the first phase of development of a new Integrated Model for Supervision (IMS) for use within MHPSS and protection services in humanitarian emergencies. Methods Semi-structured interviews were conducted with 26 global mental health professionals. Data was analysed thematically, using a combination of inductive and deductive methods. Codes and themes were validated through co-author cross-checks and through a webinar with an expert advisory group. Results Results reinforce the importance of effective supervision to enhance the quality of interventions and to protect supervisees’ wellbeing. Participants generally agreed that regular, supportive supervision on a one-to-one basis and as a separate system from line management, is the ideal format. The interviews highlight a need for guidance in specific areas, such as monitoring and evaluation, and navigating power imbalances in the supervisory relationship. Several approaches to supervision were described, including some solutions for use in low-resource situations, such as group, peer-to-peer or remote supervision. Conclusion An integrated model for supervision (IMS) should offer a unified framework encompassing a definition of supervision, consolidation of best practice, and goals and guidance for the supervisory process.
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Shultz, James M., Louis Herns Marcelin, Sharon B. Madanes, Zelde Espinel, and Yuval Neria. "The “Trauma Signature:” Understanding the Psychological Consequences of the 2010 Haiti Earthquake." Prehospital and Disaster Medicine 26, no. 5 (October 2011): 353–66. http://dx.doi.org/10.1017/s1049023x11006716.
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AbstractThe 2010 Haiti earthquake was one of the most catastrophic episodes in history, leaving 5% of the nation’s population killed or injured, and 19% internally displaced. The distinctive combination of earthquake hazards and vulnerabilities, extreme loss of life, and paralyzing damage to infrastructure, predicts population-wide psychological distress, debilitating psychopathology, and pervasive traumatic grief. However, mental health was not referenced in the national recovery plan. The limited MHPSS services provided in the first eight months generally lacked coordination and empirical basis.There is a need to customize and coordinate disaster mental health assessments, interventions, and prevention efforts around the novel stressors and consequences of each traumatic event. An analysis of the key features of the 2010 Haiti earthquake was conducted, defining its “Trauma Signature” based on a synthesis of early disaster situation reports to identify the unique assortment of risk factors for post-disaster mental health consequences. This assessment suggests that multiple psychological risk factors were prominent features of the earthquake in Haiti. For rapid-onset disasters, Trauma Signature (TSIG) analysis can be performed during the post-impact/pre-deployment phase to target the MHPSS response in a manner that is evidence-based and tailored to the event-specific exposures and experiences of disaster survivors. Formalization of tools to perform TSIG analysis is needed to enhance the timeliness and accuracy of these assessments and to extend this approach to human-generated disasters and humanitarian crises.
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Hassan, G., P. Ventevogel, H. Jefee-Bahloul, A. Barkil-Oteo, and L. J. Kirmayer. "Mental health and psychosocial wellbeing of Syrians affected by armed conflict." Epidemiology and Psychiatric Sciences 25, no. 2 (February 1, 2016): 129–41. http://dx.doi.org/10.1017/s2045796016000044.
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Aims.This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.Methods.We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.Results.Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.Conclusions.Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.
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Renfrew, Melanie Elise, Darren Peter Morton, Maria Northcote, Jason Kyle Morton, Jason Scott Hinze, and Geraldine Przybylko. "Participant Perceptions of Facilitators and Barriers to Adherence in a Digital Mental Health Intervention for a Nonclinical Cohort: Content Analysis." Journal of Medical Internet Research 23, no. 4 (April 14, 2021): e25358. http://dx.doi.org/10.2196/25358.
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Background Digital mental health promotion interventions (MHPIs) present a scalable opportunity to attenuate the risk of mental health distress among nonclinical cohorts. However, adherence is frequently suboptimal, and little is known about participants’ perspectives concerning facilitators and barriers to adherence in community-based settings. Objective This study aimed to examine participants’ perceptions of facilitators and barriers to adherence in a web- and mobile app–based MHPI for a nonclinical cohort. Methods This qualitative study used inductive, reflexive thematic analysis to explore free-text responses in a postintervention evaluation of a 10-week digital MHPI. The intervention was administered using a web and mobile app from September to December 2018. Participants (N=320) were Australian and New Zealand members of a faith-based organization who self-selected into the study, owned a mobile phone with messaging capability, had an email address and internet access, were fluent in English, provided informed consent, and gave permission for their data to be used for research. The postintervention questionnaire elicited participants’ perceptions of facilitators and barriers to adherence during the intervention period. Results Key factors that facilitated adherence were engaging content, time availability and management, ease of accessibility, easy or enjoyable practical challenges, high perceived value, and personal motivation to complete the intervention. The primary perceived barrier to adherence was the participants’ lack of time. Other barriers included completing and recording practical activities, length of video content, technical difficulties, and a combination of personal factors. Conclusions Time scarcity was the foremost issue for the nonclinical cohort engaged in this digital MHPI. Program developers should streamline digital interventions to minimize the time investment for participants. This may include condensed content, optimization of intuitive web and app design, simplified recording of activities, and greater participant autonomy in choosing optional features. Nonetheless, participants identified a multiplicity of other interindividual factors that facilitated or inhibited adherence.
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Raine, Rosalind, Simon Carter, Tom Sensky, and Nick Black. "‘Referral into a Void': Opinions of General Practitioners and Others on Single Point of Access to Mental Health Care." Journal of the Royal Society of Medicine 98, no. 4 (April 2005): 153–57. http://dx.doi.org/10.1177/014107680509800404.
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In the past, British general practitioners (GPs) have referred patients to individual consultants. There is now a trend towards generic referral, whereby the specialist team is consulted via a single point of access. We examined the impact of this innovation on the relationship between GPs and specialists in mental health care. Sixteen groups of randomly selected GPs and mental health professionals (MHPs) in England discussed clinical scenarios involving the use of mental health interventions for patients with functional somatic symptoms. The meetings were audiotaped, transcribed and analysed to the point at which no major new themes were emerging. The final analysis was confined to a purposive sample of six of the sixteen groups, comprising 54 GPs and 15 MHPs. Although the rationale for the single point of access was clear to both GPs and MHPs, the approach erected boundaries because it impeded the establishment of professional relationships and transfer of knowledge. GPs thought the system reduced their capacity to be accountable to their patients and limited the potential for their own professional development. MHPs did not seem to be aware of GPs’ concerns. Effective interprofessional management of individual patients depends upon confidence in colleagues’ skills and good communication. Factors that hamper these must be addressed in the development of this system of referral.
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Cohen, Flora, and Lauren Yaeger. "Task-shifting for refugee mental health and psychosocial support: A scoping review of services in humanitarian settings through the lens of RE-AIM." Implementation Research and Practice 2 (January 2021): 263348952199879. http://dx.doi.org/10.1177/2633489521998790.
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Background: Decades of war, famines, natural disasters, and political upheaval have led to the largest number of displaced persons in human history. The refugee experience is fraught with obstacles from preflight to resettlement, leading to high rates of mental distress including post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of mental health services for refugees in transit. To meet the needs of this vulnerable population, researchers are experimenting with teaching lay community members basic tools for the delivery of mental health and psychosocial support services (MHPSS). However, there are research gaps about the use of implementation science to inform the delivery of applicable interventions, especially within low resource settings, and even less in the humanitarian context. Methods: This review utilizes an implementation science framework (RE-AIM) to assess the reach, effectiveness, adoption, implementation, and maintenance of these interventions. Studies included varying interventions and modes of delivery within refugee camp and urban settings. A comprehensive search strategy led to the inclusion and analysis of 11 unique studies. Results: While current research documents adaptation strategies, feasibility, and fidelity checks through routine monitoring, there is still a dearth of evidence regarding capacity building of lay providers in humanitarian settings. Barriers to this data collection include a lack of homogeneity in outcomes across studies, and a lack of comprehensive adaptation strategies which account for culture norms in the implementation of interventions. Furthermore, current funding prioritizes short-term solutions for individuals who meet criteria for mental illnesses and therefore leaves gaps in sustainability, and more inclusive programming for psychosocial services for individuals who do not meet threshold criteria. Conclusion: Findings contribute to the literature about task-shifting for MHPSS in humanitarian contexts, especially illuminating gaps in knowledge about the lay counselor experiences of these interventions. Plain language summary: There is a growing number of refugees forced to make homes in temporary camps or urban centers as they await resettlement, a process that can last decades. These refugees are at risk of serious mental health outcomes due to ongoing stress and trauma. One strategy commonly used in global mental health is the training of lay providers to deliver basic mental health and psychosocial programming to communities. While this tactic is currently being tested in refugee settings, there is limited evidence about the implementation of this strategy. The following scoping review aims to assess the implementation of task-shifting interventions within refugee settings, through the use of a robust implementation science framework.
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Spronken, Maitta, Evelien P. M. Brouwers, Jeroen K. Vermunt, Iris Arends, Wido G. M. Oerlemans, Jac J. L. van der Klink, and Margot C. W. Joosen. "Identifying return to work trajectories among employees on sick leave due to mental health problems using latent class transition analysis." BMJ Open 10, no. 2 (February 2020): e032016. http://dx.doi.org/10.1136/bmjopen-2019-032016.
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ObjectivesTo develop effective return to work (RTW) interventions for employees on sick leave due to mental health problems (MHPs), a better understanding of individual variation in the RTW process is needed. We investigated which RTW trajectories can be identified among employees with MHPs in terms of RTW duration and relapse occurrence during the RTW process. Additionally, we examined how different RTW trajectories can be described in terms of personal and work characteristics.MethodsLongitudinal sickness absence registry data were collected retrospectively from the largest Dutch occupational health service. Quantitative RTW information as well as personal and work characteristics were extracted. In total, 9517 employees with a sickness absence due to MHPs were included in the analyses (62 938 data points; RTW durations from 29 to 730 days).ResultsA latent class transition analysis revealed five distinct RTW trajectories, namely (1) fast RTW with little chance of relapse, (2) slow RTW with little chance of relapse, (3) fast RTW with considerable chance of relapse, (4) slow RTW with considerable chance of relapse and (5) very fast RTW with very small chance of relapse. Differences between employees in the slower and faster trajectories were observed regarding gender, age, type of MHP, organisation sector and organisation size but not regarding part-time work.ConclusionsRTW trajectories among employees with MHPs showed large individual variability and differed on personal and work characteristics. Knowledge on different RTW trajectories and their characteristics contributes to the development of personalised RTW treatments, tailored to specific individuals and organisations.
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Lau, Geoffrey, Pamela Meredith, Sally Bennett, David Crompton, and Frances Dark. "A capability framework to develop leadership for evidence-informed therapies in publicly-funded mental health services." International Journal of Public Leadership 13, no. 3 (August 14, 2017): 151–65. http://dx.doi.org/10.1108/ijpl-08-2016-0030.
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Purpose It is difficult to replicate evidence-informed models of psychosocial and assertive care interventions in non-research settings, and means to determine workforce capability for psychosocial therapies have not been readily available. The purpose of this paper is to describe and provide a rationale for the Therapy Capability Framework (TCF) which aims to enhance access to, and quality of, evidence-informed practice for consumers of mental health services (MHSs) by strengthening workforce capabilities and leadership for psychosocial therapies. Design/methodology/approach Guided by literature regarding the inadequacies and inconsistencies of evidence-informed practice provided by publicly-funded MHSs, this descriptive paper details the TCF and its application to enhance leadership and provision of evidence-informed psychosocial therapies within multi-disciplinary teams. Findings The TCF affords both individual and strategic workforce development opportunities. Applying the TCF as a service-wide workforce strategy may assist publicly-funded mental health leaders, and other speciality health services, establish a culture that values leadership, efficiency, and evidence-informed practice. Originality/value This paper introduces the TCF as an innovation to assist publicly-funded mental health leaders to transform standard case management roles to provide more evidence-informed psychosocial therapies. This may have clinical and cost-effective outcomes for public MHSs, the consumers, carers, and family members.
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Hinski, Sandra, Nancy J. Cooke, Nathan McNeese, Ayan Sen, and Bhavesh Patel. "A Human Factors Approach to Building High-Performance Multi- Professional Cardiac Arrest Teams." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 5, no. 1 (June 2016): 68–71. http://dx.doi.org/10.1177/2327857916051006.
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Background: The American Heart Association (AHA) estimates that annually there are approximately 200,000 in-hospital cardiac arrests (IHCA). Hospitals have implemented multidisciplinary teams trained in advanced cardiac life support (ACLS) to provide care during these events. Outcome measures of these team’s effectiveness are typically mortality rates at discharge and reduction of unplanned cardiac arrest occurring outside of the ICU. Neither is a sensitive measure of team effectiveness. Methods: Using a retrospective analysis of 10 simulated code blue events we developed a metric of team effectiveness for code blue teams that also identifies specific teamwork weaknesses. Results: The new ASU-Mayo metric was highly correlated with Mayo high performance team scale (MHPTS) (r (6) = .71), team emergency assessment measure (TEAM) (r (6) = .84), and the observational skill-based assessment tool for resuscitation (OSCAR) (r (6) = .89) metrics as well as the ratings of the subject matter experts (r (6) = .88). Conclusions: We developed a team performance metric that allows for the identification of performance gaps therefore, can allow for targeted intervention with the intention of providing trainees richer feedback on performance. Also, it will generate quantitative assessments of the value of mock code exercises and can be used to evaluate interventions. Our understanding of teamwork during a simulated code blue event was also enhanced.
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Acquah-Gyan, Emmanuel, Princess Ruhama Acheampong, Aliyu Mohammed, Timothy Kwabena Adjei, Emmanuel Agyapong, Sampson Twumasi-Ankrah, Augustina Sylverken, Michael Owusu, and Ellis Owusu-Dabo. "User experiences of a mobile phone-based health information and surveillance system (mHISS): A case of caregivers of children under-five in rural communities in Ghana." PLOS ONE 17, no. 1 (January 21, 2022): e0261806. http://dx.doi.org/10.1371/journal.pone.0261806.
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Background The rapid advancement of mobile technology has fueled the use of mobile devices for health interventions and for improving healthcare provision in underserved communities. Despite the potential of mHealth being used as a health information and surveillance tool, its scale-up has been challenging and, in most cases, unable to advance beyond the pilot stage of implementation. The purpose of this study was to explore user experiences of a mobile phone-based interactive voice response (IVR) system among caregivers of children under-five in rural communities in the Asante Akim North District of Ghana. Methods The study adopted an exploratory design. A convenience sampling technique was used to recruit 35 participants who had used an IVR system for at least six months for the study. About 11 in-depth interviews and three focus group discussions were conducted among participants using a semi-structured interview guide. Thematic content analysis was utilized for the analysis of data in this study. Result The system was found to be acceptable, and the attitude of caregivers towards the system was also positive. The study discovered that the mobile phone-based Health Information and Surveillance System (mHISS) was useful for improving access to healthcare, communicating with health professionals, served as a decision support system, and improved caregivers’ awareness about self-management of childhood illnesses. Poor network quality, unstable electricity power supply, and dropped/cut calls served as significant barriers to using the mHISS system. Conclusion The mHISS system was generally acceptable and could help improve access to healthcare and identify children with severe health conditions during outbreaks of diseases.
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Lussetti, M., and R. De Lilla. "Collaborative care for treating common mental disorders in the community. Developing a clinical pathway for early intervention in Southeast Tuscany." European Psychiatry 41, S1 (April 2017): S339. http://dx.doi.org/10.1016/j.eurpsy.2017.02.296.
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IntroductionCommon mental disorders (CMD) have a 12-month prevalence over 7% in the Italian population. Only 16,9% of people are treated by the health services, despite the high cost in disability and loss of productivity.ObjectivesTo improve access to low-intensity CBT (LI-CBT) treatments in primary care.AimsTo organize a clinical pathway in which general practitioners (GPs) identify the early signs of CMD and promote a collaborative care with a team of mental health practitioners (MHPs).MethodsA small team of MHPs outlined and implemented, in collaboration with a group of 9 GPs, a clinical pathway to treat CMD in stepped care. Guided self-help was the first and main intervention. Group and individual CBT were offered–when needed–as a second and third step. If the user opted for drug treatment, a psychiatrist conducted one or two sections of consultation to the GP. The MHP team was fully integrated within the community mental health center (CMHC). PHQ-9 and GAD-7 were rated at each appointment.ResultsWith a mean of 5,3 appointments, 90 persons were treated in 1 year. 68% reached recovery (both PHQ-9 and GAD-7 < 10), a result in line with the best performing English Clinical commissioning groups in the IAPT project.ConclusionsA small multi-professional team of MHP can build with GPs a simple clinical pathway able to reach high standards of care with relatively small resources offering LI-CBT integrated with drug treatment and high intensity care.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Adeyeye, Kemi, John Gallagher, Helena M. Ramos, and Aonghus McNabola. "The Social Return Potential of Micro Hydropower in Water Networks Based on Demonstrator Examples." Energies 15, no. 18 (September 10, 2022): 6625. http://dx.doi.org/10.3390/en15186625.
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Micro hydropower (MHP) provides a viable renewable energy solution from which individuals, organisations and communities can also derive social value and benefits. Desk studies and literature reviews show limited studies that (a) quantify the social impact of MHPs in water networks and (b), establish evaluation methods for such analysis. To date, most studies relating to MHP projects have focused on physical and technological parameters, as well as cost and environmental factors that influence their design, installation, operation, and maintenance. Less attention has been given to the intangible social, political, and institutional considerations, which are also important for the acceptability and adoption of renewables such as MHPs, and for their performative longevity. This study addresses these gaps. The social return on investment (SROI) method was used as the basis to quantify the cost and social returns of three MHP demonstrators in a public and private water supply, and irrigation network in Europe. The value inputs and outputs from each case were analysed and a SROI range of between 2.6 and 5.8 euros for each one euro invested was determined. The findings were further evaluated using sensitivity tests. This work serves as a useful first step to establishing a SROI benchmark range for MHP schemes in water networks, extrapolatable for other renewable energy interventions. They also highlight the opportunities and challenges of quantifying and forecasting the social returns of MHPs to guide future work.
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Landi, Giulia, Mattia Marchi, Mohamed Yassir Ettalibi, Giorgio Mattei, Luca Pingani, Valentina Sacchi, and Gian Maria Galeazzi. "Affective and Sexual Needs of Residents in Psychiatric Facilities: A Qualitative Approach." Behavioral Sciences 10, no. 8 (August 3, 2020): 125. http://dx.doi.org/10.3390/bs10080125.
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Background: The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings. Methods: Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data). Results: Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17); (b) affective needs (N = 11); (c) personal experiences (N = 61); (d) regulation of sexual relations (N = 18); (e) Mental Health Professionals’ (MHPs) openness towards the topic (N = 17); (f) MHPs’ responses to RPFUs’ sexual behaviors (N = 33); and (g) RPFUs proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs’ affective and sexual needs as well as to provide effective solutions to manage them. Conclusions: RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies.
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Jones, Kimberley A., Isabella Freijah, Lindsay Carey, R. Nicholas Carleton, Peter Devenish-Meares, Lisa Dell, Sara Rodrigues, et al. "Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review." Journal of Religion and Health 61, no. 2 (March 15, 2022): 1051–94. http://dx.doi.org/10.1007/s10943-022-01534-4.
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AbstractThe aim of this research was to describe the evidence examining the approaches taken by mental health providers (MHPs) and chaplains to address symptoms related to moral injury (MI) or exposure to potentially morally injurious events (PMIEs). This research also considers the implications for a holistic approach to address symptoms related to MI that combines mental health and chaplaincy work. A scoping review of literature was conducted using Medline, PsycINFO, Embase, Central Register of Controlled Trials, Proquest, Philosphers Index, CINAHL, SocINDEX, Academic Search Complete, Web of Science and Scopus databases using search terms related to MI and chaplaincy approaches or psychological approaches to MI. The search identified 35 eligible studies: 26 quantitative studies and nine qualitative studies. Most quantitative studies (n = 33) were conducted in military samples. The studies examined interventions delivered by chaplains (n = 5), MHPs (n = 23) and combined approaches (n = 7). Most studies used symptoms of post-traumatic stress disorder (PTSD) and/or depression as primary outcomes. Various approaches to addressing MI have been reported in the literature, including MHP, chaplaincy and combined approaches, however, there is currently limited evidence to support the effectiveness of any approach. There is a need for high quality empirical studies assessing the effectiveness of interventions designed to address MI-related symptoms. Outcome measures should include the breadth of psychosocial and spiritual impacts of MI if we are to establish the benefits of MHP and chaplaincy approaches and the potential incremental value of combining both approaches into a holistic model of care.
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Zivin, Kara, Jennifer Kononowech, Matthew Boden, Kristen Abraham, Molly Harrod, Rebecca K. Sripada, Helen C. Kales, Hector A. Garcia, and Paul Pfeiffer. "Predictors and Consequences of Veterans Affairs Mental Health Provider Burnout: Protocol for a Mixed Methods Study." JMIR Research Protocols 9, no. 12 (December 21, 2020): e18345. http://dx.doi.org/10.2196/18345.
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Background In the Veterans Health Administration (VHA), mental health providers (MHPs) report the second highest level of burnout after primary care physicians. Burnout is defined as increased emotional exhaustion and depersonalization and decreased sense of personal accomplishment at work. Objective This study aims to characterize variation in MHP burnout by VHA facility over time, identifying workplace characteristics and practices of high-performing facilities. Methods Using both qualitative and quantitative methods, we will evaluate factors that influence MHP burnout and their effects on patient outcomes. We will compile annual survey data on workplace conditions and annual staffing as well as productivity data to assess same and subsequent year provider and patient outcomes reflecting provider and patient experiences. We will conduct interviews with mental health leadership at the facility level and with frontline MHPs sampled based on our quantitative findings. We will present our findings to an expert panel of operational partners, Veterans Affairs clinicians, administrators, policy leaders, and experts in burnout. We will reengage with facilities that participated in the earlier qualitative interviews and will hold focus groups that share results based on our quantitative and qualitative work combined with input from our expert panel. We will broadly disseminate these findings to support the development of actionable policies and approaches to addressing MHP burnout. Results This study will assist in developing and testing interventions to improve MHP burnout and employee engagement. Our work will contribute to improvements within VHA and will generate insights for health care delivery, informing efforts to address burnout. Conclusions This is the first comprehensive, longitudinal, national, mixed methods study that incorporates different types of MHPs. It will engage MHP leadership and frontline providers in understanding facilitators and barriers to effectively address burnout. International Registered Report Identifier (IRRID) PRR1-10.2196/18345
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Vranda, Mysore Narasimha, Channaveerachari Naveen Kumar, D. Muralidhar, N. Janardhana, and P. T. Sivakumar. "Barriers to Disclosure of Intimate Partner Violence among Female Patients Availing Services at Tertiary Care Psychiatric Hospitals: A Qualitative Study." Journal of Neurosciences in Rural Practice 09, no. 03 (July 2018): 326–30. http://dx.doi.org/10.4103/jnrp.jnrp_14_18.
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ABSTRACT Background: Intimate partner violence (IPV)/domestic violence is one of the significant public health problems, but little is known about the barriers to disclosure in tertiary care psychiatric settings. Methodology: One hundred women seeking inpatient or outpatient services at a tertiary care psychiatric setting were recruited for study using purposive sampling. A semi-structured interview was administered to collect the information from women with mental illness experiencing IPV to know about their help-seeking behaviors, reasons for disclosure/nondisclosure of IPV, perceived feelings experienced after reporting IPV, and help received from the mental health professionals (MHPs) following the disclosure of violence. Results: The data revealed that at the patient level, majority of the women chose to conceal their abuse from the mental health-care professionals, fearing retaliation from their partners if they get to know about the disclosure of violence. At the professional level, lack of privacy was another important barrier for nondisclosure where women reported that MHPs discussed the abuse in the presence of their violent partners. Conclusion: The findings of the study brought out the need for mandatory screening of violence and designing tailor-made multicomponent interventions for mental health care professionals at psychiatric setting in India.
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Pelletier, Jean-Francois, Janie Houle, Marie-Hélène Goulet, Robert-Paul Juster, Charles-Édouard Giguère, Jonathan Bordet, Isabelle Hénault, et al. "Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study." JMIR Research Protocols 9, no. 12 (December 18, 2020): e22500. http://dx.doi.org/10.2196/22500.
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Background In times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated. Objective This paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting. Methods PSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups—patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)—compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test. Results This pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020. Conclusions Study results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study. Trial Registration ClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324 International Registered Report Identifier (IRRID) PRR1-10.2196/22500
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Schönfeld, Leon, Jan B. Hinrichs, Steffen Marquardt, Torsten Voigtländer, Cornelia Dewald, Wolfgang Koppert, Michael P. Manns, Frank Wacker, Arndt Vogel, and Martha M. Kirstein. "Chemosaturation with percutaneous hepatic perfusion is effective in patients with ocular melanoma and cholangiocarcinoma." Journal of Cancer Research and Clinical Oncology 146, no. 11 (June 20, 2020): 3003–12. http://dx.doi.org/10.1007/s00432-020-03289-5.
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Abstract Background Chemosaturation with percutaneous hepatic perfusion (CS-PHP; Hepatic CHEMOSAT® Delivery System; Delcath Systems Inc, USA) is a novel interventional procedure, which delivers high doses of melphalan directly to the liver in patients with liver tumors while limiting systemic toxicity through hemofiltration of the hepatic venous blood. We have previously shown promising efficacy for patients with ocular melanoma (OM) and cholangiocarcinoma (CCA) within our single-center and multi-center experiences. The aim of this study was to analyze the safety and efficacy of CS-PHP after 141 treatments at Hannover Medical School, Germany. Methods Overall response rates (ORR) were assessed according to Response Evaluation Criteria In Solid Tumors (RECIST1.1). Median Overall survival (mOS), median progression-free survival (mPFS), and median hepatic PFS (mhPFS) were analyzed using the Kaplan–Meier estimation. Results Overall, 60 patients were treated with CS-PHP in the salvage setting from October 2014 until January 2019 at Hannover Medical School with a total of 141 procedures. Half of the patients were patients with hepatic metastases of ocular melanoma (OM) (n = 30), 14 patients had CCA (23.3%), 6 patients had hepatocellular carcinoma (10%), and 10 patients were treated for other secondary liver malignancies (16.7%). In total, ORR and disease stabilization rate were 33.3% and 70.3% (n = 25), respectively. ORR was highest for patients with OM (42.3%), followed by patients with CCA (30.8%). Independent response-associated factors were normal levels of lactate dehydrogenase (odds ratio (OR) 13.7; p = 0.015) and diagnosis with OM (OR 9.3; p = 0.028). Overall, mOS was 9 months, mPFS was 4 months, and mhPFS was 5 months. Patients with OM had the longest mOS, mPFS, and mhPFS with 12, 6, and 6 months, respectively. Adverse events included most frequently significant, but transient, hematologic toxicities (80% of grade 3/4 thrombopenia), less frequently hepatic injury up to liver failure (3.3%) and cardiovascular events including two cases of ischemic insults (5%). Conclusion Salvage treatment with CS-PHP is safe and effective particularly in patients OM and CCA. Careful attention should be paid to possible, serious hepatic, and cardiovascular complications.
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Musotsi, Protus, Phiona Koyiet, NeenibBihnan Khoshaba, AveenHussein Ali, Fahad Elias, MuhammadWaduallah Abdulmaleek, Ken Simiyu, and Eva Rosenkranz. "Highlighting Complementary Benefits of Problem Management Plus (PM+) and Doing What Matters in Times of Stress (DWM) Interventions Delivered Alongside Broader Community MHPSS Programming in Zummar, Ninewa Governorate of Iraq." Intervention 20, no. 2 (2022): 139. http://dx.doi.org/10.4103/intv.intv_7_22.
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Dewald, Cornelia Lieselotte Angelika, Jan B. Hinrichs, Lena Sophie Becker, Sabine Maschke, Timo C. Meine, Anna Saborowski, Leon Jonas Schönfeld, Arndt Vogel, Martha M. Kirstein, and Frank K. Wacker. "Chemosaturation with Percutaneous Hepatic Perfusion: Outcome and Safety in Patients with Metastasized Uveal Melanoma." RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren 193, no. 08 (February 3, 2021): 928–36. http://dx.doi.org/10.1055/a-1348-1932.
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Purpose Chemosaturation percutaneous hepatic perfusion (CS-PHP) allows selective intrahepatic delivery of high dose cytotoxic melphalan in patients with curatively untreatable liver tumors while limiting systemic toxicity through hemofiltration of the hepatic venous blood. Aim of this study was to investigate the response to therapy, survival and safety of the CS-PHP procedure in patients with liver-dominant metastatic uveal melanoma (UM). Materials and Methods Overall response rate (ORR) and disease control rate (DCR) were assessed according to Response Evaluation Criteria In Solid Tumors (RECIST1.1). Median overall survival (mOS), median progression-free survival (mPFS) and hepatic progression-free survival (mhPFS) were analyzed using Kaplan-Meier estimation. Adverse events were evaluated with Common Terminology Criteria for Adverse Events (CTCAE) v5. Results Overall, 30 patients were treated with 70 CS-PHP in a salvage setting from October 2014 to January 2019. In total, ORR and DCR were 42.3 % and 80.8 %, respectively. Overall, mOS was 12 (95 % confidence interval (CI) 7–15) months, and both, mPFS and mhPFS were 6 months, respectively (95 % CI 4–10; 95 % CI 4–13). Adverse events (AE) most frequently included significant but transient hematologic toxicities (87 % of grade 3/4 thrombocytopenia), less frequent AEs were hepatic injury extending to liver failure (3 %), cardiovascular events including one case of ischemic stroke (3 %). Conclusion Salvage treatment with CS-PHP is effective in selected patients with UM. The interventional procedure is safe. Serious hepatic and cardiovascular events, although rare, require careful patient selection and should be closely monitored. Key Points: Citation Format
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Jaworska, Natalia, Elisea De Somma, Bernice Fonseka, Emma Heck, and Glenda M. MacQueen. "Mental Health Services for Students at Postsecondary Institutions: A National Survey." Canadian Journal of Psychiatry 61, no. 12 (July 9, 2016): 766–75. http://dx.doi.org/10.1177/0706743716640752.
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Objective: Although the high prevalence of mental health issues among postsecondary students is well documented, comparatively little is known about the adequacy, accessibility, and adherence to best practices of mental health services (MHSs)/initiatives on postsecondary campuses. We evaluated existing mental health promotion, identification, and intervention initiatives at postsecondary institutions across Canada, expanding on our previous work in one Canadian province. Methods: A 54-question online survey was sent to potential respondents (mainly front-line workers dealing directly with students [e.g., psychologists/counsellors, medical professionals]) at Canada’s publicly funded postsecondary institutions. Data were analyzed overall and according to institutional size (small [<2000 students], medium [2000–10 000 students], large [>10 000 students]). Results: In total, 168 out of 180 institutions were represented, and the response rate was high (96%; 274 respondents). Most institutions have some form of mental health promotion and outreach programs, although most respondents felt that these were not a good use of resources. Various social supports exist at most institutions, with large ones offering the greatest variety. Most institutions do not require incoming students to disclose mental health issues. While counselling services are typically available, staff do not reliably have a diverse complement (e.g., gender or race diversity). Counselling sessions are generally limited, and follow-up procedures are uncommon. Complete diagnostic assessments and the use of standardized diagnostic systems are rare. Conclusions: While integral MHSs are offered at most Canadian postsecondary institutions, the range and depth of available services are variable. These data can guide policy makers and stakeholders in developing comprehensive campus mental health strategies.
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Green, Cori M., John Walkup, and William Trochim. "2201 A multi-stakeholder analysis on preparing future pediatricians to improve the mental health of children." Journal of Clinical and Translational Science 2, S1 (June 2018): 78. http://dx.doi.org/10.1017/cts.2018.274.
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OBJECTIVES/SPECIFIC AIMS: (1) Develop a concept map of ideas from diverse stakeholders on how to best improve training programs. (2) Assess the degree of consensus amongst stakeholders regarding importance and feasibility. (3) Identify which ideas are both important and feasible to inform policy and curricular interventions. METHODS/STUDY POPULATION: Concept mapping is a 4 step approach to data gathering and analysis. (1) Stakeholders [pediatricians (peds), MH professionals (MHPs), trainees, parents] were recruited to brainstorm ideas in response to this prompt: “To prepare future pediatricians for their role in caring for children and adolescents with mental and behavioral health conditions, residency training needs to...”. (2) Content analysis was used to edit and synthesize ideas. (3) A subgroup of stakeholders sorted ideas into groups and rated for importance and feasibility. (4) A large group of anonymous participants rated ideas for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis grouped ideas into clusters. Average importance and feasibility were calculated for each cluster and were compared statistically in each cluster and between subgroups. Bivariate plots were created to show the relative importance and feasibility of each idea. The “Go-Zone” is where statements are feasible and important and can drive action planning. RESULTS/ANTICIPATED RESULTS: Content analysis was applied to 497 ideas resulting in 99 that were sorted by 40 stakeholders and resulted in 7 clusters: Modalities, Prioritization of MH, Systems-Based, Self-Awareness/Relationship Building, Clinical Assessment, Treatment, and Diagnosis Specific Skills. In total, 216 participants rated statements for importance, 209 for feasibility: 17% MHPs, 82% peds, 55% trainees. There was little correlation between importance and feasibility for each cluster. Compared with peds, MHPs rated Modalities, and Prioritization of MH higher in importance and Prioritization of MH as more feasible, but Treatment less feasible. Trainees rated 5 of 7 clusters higher in importance and all clusters more feasible than established practitioners. DISCUSSION/SIGNIFICANCE OF IMPACT: Statements deemed feasible and important should drive policy changes and curricular development. Innovation is needed to make important ideas more feasible. Differences between importance and feasibility in each cluster and between stakeholders need to be addressed to help training programs evolve.
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Krijnen-de Bruin, Esther, Anna DT Muntingh, Evelien M. Bourguignon, Adriaan Hoogendoorn, Otto R. Maarsingh, Anton JLM van Balkom, Neeltje M. Batelaan, Annemieke van Straten, and Berno van Meijel. "Usage Intensity of a Relapse Prevention Program and Its Relation to Symptom Severity in Remitted Patients With Anxiety and Depression: Pre-Post Study." JMIR Mental Health 9, no. 3 (March 16, 2022): e25441. http://dx.doi.org/10.2196/25441.
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Background Given that relapse is common in patients in remission from anxiety and depressive disorders, relapse prevention is needed in the maintenance phase. Although existing psychological relapse prevention interventions have proven to be effective, they are not explicitly based on patients’ preferences. Hence, we developed a blended relapse prevention program based on patients’ preferences, which was delivered in primary care practices by mental health professionals (MHPs). This program comprises contact with MHPs, completion of core and optional online modules (including a relapse prevention plan), and keeping a mood and anxiety diary in which patients can monitor their symptoms. Objective The aims of this study were to provide insight into (1) usage intensity of the program (over time), (2) the course of symptoms during the 9 months of the study, and (3) the association between usage intensity and the course of symptoms. Methods The Guided E-healTh for RElapse prevention in Anxiety and Depression (GET READY) program was guided by 54 MHPs working in primary care practices. Patients in remission from anxiety and depressive disorders were included. Demographic and clinical characteristics, including anxiety and depressive symptoms, were collected via questionnaires at baseline and after 3, 6, and 9 months. Log data were collected to assess the usage intensity of the program. Results A total of 113 patients participated in the study. Twenty-seven patients (23.9%) met the criteria for the minimal usage intensity measure. The core modules were used by ≥70% of the patients, while the optional modules were used by <40% of the patients. Usage decreased quickly over time. Anxiety and depressive symptoms remained stable across the total sample; a minority of 15% (12/79) of patients experienced a relapse in their anxiety symptoms, while 10% (8/79) experienced a relapse in their depressive symptoms. Generalized estimating equations analysis indicated a significant association between more frequent face-to-face contact with the MHPs and an increase in both anxiety symptoms (β=.84, 95% CI .39-1.29) and depressive symptoms (β=1.12, 95% CI 0.45-1.79). Diary entries and the number of completed modules were not significantly associated with the course of symptoms. Conclusions Although the core modules of the GET READY program were used by most of the patients and all patients saw an MHP at least once, usage decreased quickly over time. Most patients remained stable while participating in the study. The significant association between the frequency of contact and the course of symptoms most likely indicates that those who received more support had more symptoms, and thus, it is questionable whether the support offered by the program was sufficient to prevent these patients from relapsing. International Registered Report Identifier (IRRID) RR2-10.1186/s12888-019-2034-6
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Callum, Jeannie, Calvin Yeh, Mark McVey, Andrew Petrosoniak, Stephanie Cope, Troy Thompson, Victoria Chin, et al. "A Regional Massive Hemorrhage Protocol: Designed with a Modified Delphi Technique to Obtain Consensus." Blood 134, Supplement_1 (November 13, 2019): 5792. http://dx.doi.org/10.1182/blood-2019-121501.
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Background: The cornerstone of a massive hemorrhage protocol (MHP) is the rapid delivery of blood components to mitigate the consequences of hemorrhagic shock, coagulopathy, and hypothermia in the exsanguinating patient pending definitive hemorrhage control. MHPs are used to facilitate protocol activation/termination, mobilize an interdisciplinary team, provide immediate access to blood, prioritize rapid blood testing, and commence hypothermia-prevention strategies. Non-randomized, before-after implementation studies have found an association between MHPs and improved patient outcomes, including mortality. There is variability in MHP implementation rates, content, and protocol compliance due to challenges presented by infrequent activation, variable team performance, and patient acuity. Methods: We used a modified Delphi technique to establish the framework for a standardized Provincial MHP toolkit and develop quality indicators. We assembled a panel of 36 content experts to represent relevant stakeholders at 150 Ontario hospitals. Panelists included physicians, nurses, and technologists from anesthesia, trauma, obstetrics, hematology, transfusion, emergency, transport, critical care, as well as representation by blood suppliers and patients. The group represented the diverse geographic healthcare program including academic, pediatric, suburban, and small rural hospitals. Panelists were required to attend a two-day MHP forum and complete all rounds of the Delphi. Panelists used digital surveys (LimeSurvey, Hamburg, Germany) to independently review 43 statements and 8 quality indicators drafted by a steering committee. Each statement was rated on a 7-point Likert scale from "definitely should not" to "definitely should include". Disposition of items was based on critieria determined a priori on the median Likert score. Round 1: (1) score at least >5.5 incorporated as written, (2) 2.6-5.4, discussed at the forum with all panelists, with a 2nd round revision, (3) <2.5, removed from further rounds, unless there was a strong opposition by the panel and a revision drafted for the second round. Novel statements and quality indicators could be added in the first round. No additional statements were added after round two. For the 2nd and 3rd rounds: (1) >5.5, accepted, (2) 2.4-5.4, rewritten and sent for round 3, (3) <2.4, removed. Merging or division of statements could occur where appropriate. Results: After 3 rounds, consensus was reached for 42 statements and 8 quality indicators. A 100% response rate was achieved from panelists in all three rounds. There were four main areas that required additional rounds and major modifications: (1) selection of the name of the protocol; (2) selection of the laboratory resuscitation targets; (3) determination of the pack configurations; and, (4) clarification of the role of rVIIa. The obstacle to selecting a unified name for the protocol was that many of the hospitals already had longstanding MHPs with specific names. Consensus on the laboratory targets and pack configuration was achieved by splitting statements into sub-sections. The rVIIa statement required three rounds of review to ensure the phrasing satisfied all the panelists for this controversial therapy. Interpretation: We believe that harmonization of MHPs in our region will simplify training, increase uptake of evidence-based interventions, enhance communication, improve patient safety, and ultimately improve outcomes. We highlight areas that need additional study: (1) RCTs are needed to determine if MHPs improve patient outcomes. (2) A "streamlined" version for community hospitals for stabilization before transfer to a tertiary care centre must be tested. (3) Activation and termination criteria have not been validated. (4) The frequency and type of laboratory testing has not been investigated. (5) Laboratory targets for resuscitation must be tested. (6) Does maintaining normothermia decrease transfusion? (7) Can fibrinogen concentrates and PCCs can be considered equivalent to cryoprecipitate and plasma, respectively? (8) Does compliance with the selected quality indicators result in improved outcome? These MHP recommendations will provide the basis for the design of local MHPs including specific recommendations for pediatric patients and for hospitals where definitive hemorrhage control may not be available. Disclosures Arnold: Novartis: Honoraria, Research Funding; Bristol-Myers Squibb: Research Funding; Rigel: Consultancy, Research Funding; Principia: Consultancy. Pai:Novartis: Honoraria. Sholzberg:Takeda: Honoraria, Research Funding; Baxalta: Honoraria, Research Funding; Baxter: Honoraria, Research Funding. Zeller:Canadian Blood Services: Consultancy; Pfizer: Other: Advisory Board; Ontario Ministry of Health and Long Term Care: Consultancy. Pavenski:Ablynx: Honoraria, Research Funding; Bioverativ: Research Funding; Shire: Honoraria; Alexion: Honoraria, Research Funding; Octapharma: Research Funding.
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Mörkl, Sabrina, Linda Stell, Diana V. Buhai, Melanie Schweinzer, Jolana Wagner-Skacel, Christian Vajda, Sonja Lackner, et al. "‘An Apple a Day’?: Psychiatrists, Psychologists and Psychotherapists Report Poor Literacy for Nutritional Medicine: International Survey Spanning 52 Countries." Nutrients 13, no. 3 (March 2, 2021): 822. http://dx.doi.org/10.3390/nu13030822.
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Nutritional interventions have beneficial effects on certain psychiatric disorder symptomatology and common physical health comorbidities. However, studies evaluating nutritional literacy in mental health professionals (MHP) are scarce. This study aimed to assess the across 52 countries. Surveys were distributed via colleagues and professional societies. Data were collected regarding self-reported general nutrition knowledge, nutrition education, learning opportunities, and the tendency to recommend food supplements or prescribe specific diets in clinical practice. In total, 1056 subjects participated in the study: 354 psychiatrists, 511 psychologists, 44 psychotherapists, and 147 MHPs in-training. All participants believed the diet quality of individuals with mental disorders was poorer compared to the general population (p < 0.001). The majority of the psychiatrists (74.2%) and psychologists (66.3%) reported having no training in nutrition. Nevertheless, many of them used nutrition approaches, with 58.6% recommending supplements and 43.8% recommending specific diet strategies to their patients. Only 0.8% of participants rated their education regarding nutrition as ‘very good.’ Almost all (92.9%) stated they would like to expand their knowledge regarding ‘Nutritional Psychiatry.’ There is an urgent need to integrate nutrition education into MHP training, ideally in collaboration with nutrition experts to achieve best practice care.
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Sathiyaseelan, Anuradha, Sathiyaseelan B., and Tanmayi Suhas Desai. "Challenges of Indian Girls with Maternal Schizophrenia." Biomedical and Pharmacology Journal 12, no. 2 (June 7, 2019): 863–73. http://dx.doi.org/10.13005/bpj/1711.
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Schizophrenia, earlier known as dementia praecox, is considered to be one of the most devastating mental illnesses due to its impact on the individual as well as family members. The Indian context characterized by one’s rootedness to family, warrant enquiry about difficulties and burnouts faced by girl children. When it is the mother who is suffering from the illness, there tends to be a huge lag in terms of primary care giving. A disturbed home environment along with inadequate parenting have shown to adversely affect the girl children. The present qualitative research study aimed to explore challenges faced by the girl children with maternal schizophrenia with the help of 43 Mental Health Professionals (MHPs) across India. Interpretative Phenomenological Approach (IPA) was adopted and interviews were conducted using a validated interview guide. Thematic analysis revealed that girl children whose mothers are diagnosed with schizophrenia faced challenges in self, family and social sphere of life. Neglect, self blame and the question ‘why me’ were recurrent themes. They experienced difficulties in cognitive, behavioral and social domains. The added burden of family responsibilities and social stigma made the surroundings challenging. Exploring the world of girls with maternal schizophrenia would deepen our understanding about impact of schizophrenia on family members and aid us develop interventions to support the care givers.
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Coverdale, John, Ian Falloon, and Sarah Turbott. "Sexually Transmitted Disease and Family Planning Counselling of Psychiatric Patients in New Zealand." Australian & New Zealand Journal of Psychiatry 31, no. 2 (April 1997): 285–90. http://dx.doi.org/10.3109/00048679709073833.
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Objective: We aimed to determine the attitudes and behaviours of mental health professionals (MHPs) including psychiatrists towards identifying and reducing their own patients' risk for sexually transmitted diseases and unwanted pregnancies. Method: 102 of all of the 162 mental health professionals serving predominantly chronically psychiatrically ill adult outpatients and inpatients in Waitemata district responded to an anonymous questionnaire (response rate = 63%), concerning their own attitudes and behaviours towards identifying and counselling patients on their risk for sexually transmitted diseases and unwanted pregnancies. Results: Mental health professionals reported that, on average, they had counselled 14% of their own male patients and 21% of their own female patients on sexually transmitted diseases, including AIDS prevention, and that more of their own patients were at risk than were counselled. They also reported that they had counselled 5% of their own male patients and 17% of their own female patients about family planning. Forty-two per cent of mental health professionals indicated that they had insufficient knowledge about sexually transmitted diseases to educate patients, 72% indicated that when it came to risky sexual behaviours chronic psychiatric patients were much the same as other people, and 33% or more felt uncomfortable discussing topics of condom use and patients' sexual preferences. Conclusion: These results suggest that family planning and sexually transmitted diseases risk preventive interventions for psychiatric patients need to overcome mental health professionals' own barriers to risk prevention.
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Drissi, Nidal, Sofia Ouhbi, Leena Amiri, Fadwa Al Mugaddam, Reem K. Jan, and Minna Isomursu. "A Conceptual Framework to Design Connected Mental Health Solutions in the United Arab Emirates: Questionnaire Study." JMIR Formative Research 6, no. 2 (February 7, 2022): e27675. http://dx.doi.org/10.2196/27675.
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Background Connected mental health (CMH) is a field presenting information and communications technology–based mental care interventions that could help overcome many mental care delivery barriers. Culture and background influence people’s attitudes, preferences, and acceptance of such solutions. Therefore, the suitability of CMH solutions to the targeted population is an important factor in their successful adoption. Objective The aim of this study is to develop a framework for the design and creation of CMH solutions suitable for the UAE context. The framework is based on investigating enablers and barriers of CMH adoption in the United Arab Emirates, from the mental health professional's (MHP) perspective and from related literature. Methods A survey of literature on relevant studies addressing the use of technology for mental care in Arab countries, and a web-based questionnaire-based survey with 17 MHPs practicing in the United Arab Emirates investigating their attitudes and views toward CMH was conducted. Results from the questionnaire and from related studies were analyzed to develop the design framework. Results On the basis of findings from the literature survey and analyzing MHP answers to the web-based survey, a framework for the design of CMH solutions for the UAE population was developed. The framework presents four types of recommendation categories: favorable criteria, which included blended care, anonymity, and ease of use; cultural factors including availability in multiple languages, mainly Arabic and English, in addition to religious and cultural considerations; technical considerations, including good-quality communication, availability in formats compatible with mobile phones, and providing technical support; and users’ health and data safety considerations, including users’ suitability testing, confidentiality, and ensuring MHP integrity. Conclusions CMH has the potential to help overcome many mental care barriers in the United Arab Emirates in particular and in the Arab world in general. CMH adoption in the United Arab Emirates has a potential for success. However, many factors should be taken into account, mainly cultural, religious, and linguistic aspects.