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Background: Delivery of mental health interventions to youth in schools requires a cadre of community mental health workers (CMHWs) in addition to psychiatrists. Literature is sparse in the India context on the ethical and professional challenges faced by CMHWs, especially those working with youth. Hence, the aim of the study was to understand these challenges faced by CMHWs working in schools in urban Chennai and explore ways to overcome them. Methods: A qualitative study was done with CMHWs involved in the delivery of youth mental health (YMH) interventions, including mental health literacy, screening for mental disorders and mental health support to youth in schools in urban Chennai. Focus group discussions (FGDs) were conducted with the study participants and audio recorded. Transcription of the recording was done verbatim and coded for themes using a thematic analysis approach. Results: Two FGDs were conducted with a total of eight participants. The mean (± standard deviation) age of the participants was 27 ± 3.7 years; all having a master’s degree in either psychology, social work, or public health. The major themes that emerged were the meaning of ethics and professionalism, confidentiality, dilemma in decision making, incongruence between the requirements of student and school administration, and personal and professional challenges faced by CMHWs. Recommendations to overcome these challenges were also explored. Conclusion: The results indicate CMHWs face significant ethical challenges with confidentiality, and decision making while delivering YMH interventions in schools, highlighting the need for designing and implementing a framework to address these challenges.
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Objetivo: el objetivo de este estudio instrumental fue adaptar la versión española del Inventario de Burnout de Maslach (MBI-HSS) en una muestra (n = 544) de psicólogos y psiquiatras argentinos de entre 23 y 71 años de edad. Métodos: para evaluar la estructura interna del instrumento se realizó un análisis factorial confirmatorio (AFC) por medio del método de estimación de Máxima Verosimilitud robusto. La consistencia interna se calculó mediante el coeficiente de confiabilidad compuesta (fc). Resultados: el modelo inicial mostró índices de ajuste aceptables (CFI = .87, TLI = .86; RMSEA = .06; SRMR = .07). Tras la eliminación del ítem 12 del análisis, el ajuste del modelo mejoró satisfactoriamente (CFI = .91, TLI = .90, RMSEA = .05, SRMR = .06) confirmándose la estructura trifactorial. El cálculo de consistencia interna arrojó valores considerados muy buenos (fc > .70). Conclusión: se concluye que el MBI-HSS es una escala fiable y válida para la evaluación del Burnout en psicólogos y psiquiatras argentinos. Se discuten los resultados y sus posibles implicaciones en futuras investigaciones.
Objective: The aim of this instrumental study was to adapt the Spanish version of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) in a sample (n = 544) of Argentinian psychologists and psychiatrists aged 23 to 71. Method: A confirmatory factor analysis (CFA) was conducted to evaluate the internal structure of the instrument using the robust maximum likelihood estimation. Additionally, the internal consistency was calculated using the composite reliability (CR) coefficient. Results: The original structure provided an acceptable ût to the data (CFI = .87, TLI = .86, RMSEA = .06, SRMR = .07). However, the three-factor model had a closer fit to the data after excluding item 12 from the analysis (CFI = .91, TLI = .90, RMSEA = .05, SRMR = .06). The internal consistency yielded very good values (CR > .70). Conclusion: It is concluded that the MBI-HSS is a reliable and valid scale to measure burnout in Argentinian psychologists and psychiatrists. The results and their possible implications for future investigations are discussed in this paper.
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Resumen La ley 1616 de 2013 en Colombia busca garantizar el derecho a la salud mental, principalmente a niños, niñas y adolescentes; y se sustenta en una concepción de salud mental que integra diferentes disciplinas. Objetivo: explorar los significados de salud mental de la niñez y alternativas de abordaje que tienen algunos profesionales vinculados a la atención de niños y niñas en la ciudad de Medellín, Colombia. Metodología: investigación cualitativa en la que participaron 16 profesionales. Se llevaron a cabo entrevistas semiestructuradas y un grupo focal. La información fue transcrita y procesada mediante el programa Atlas.ti, siguiendo las orientaciones metodológicas de la teoría fundamentada para el análisis de información. Resultados: los significados de salud mental de la niñez de los profesionales entrevistados se han construido a partir de su formación académica, sin embargo, el rol que ejercen se encuentra delimitado por condiciones institucionales, políticas, económicas y sociales. Coexisten discursos biomédicos, socioeconómicos y de derechos sobre la salud mental de los niños. Discusión: existen barreras para la atención integral e integrada de la salud mental de los niños y niñas, tales como la falta de articulación institucional, las condiciones de vida precarias de la población vulnerable y las limitaciones del sistema de salud. Se considera necesario avanzar en la construcción de un concepto de salud mental adecuado a las características y contextos de desarrollo de la niñez.
Abstract Colombian Law 1616 of 2013 seeks to guarantee the mental health right by giving priority to children and adolescents; it is based on a concept of mental health that integrates different disciplines. Objective: to explore the meanings and alternatives of approach in the children mental health professionals related to the attention of children in Medellin, Colombia. Methodology: qualitative research in which 16 professionals participated; semi-structured interviews and a focus group were carried out. The information was transcribed and processed in Atlas ti., following the methodological guidelines of the grounded theory for the analysis of the information. Results: Findings suggest that mental health professionals' meanings are built according to their academic training, nevertheless their role is limited by institutional, political, economic and social conditions. Biomedical, socioeconomic and right discourses coexist on children mental health meanings. Discussion: there are barriers to comprehensive and integrated services in mental health, such as the lack of institutional articulation, the vulnerable population precarious living conditions, and the limitations of the Colombian health system. It is necessary to advance in the construction of a mental health concept, appropriate to the characteristics and contexts of childhood development.
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Este artículo describe el diseño, implementación y evaluación de un adiestramiento para profesionales de ayuda que trabajan en instituciones de educación superior en Puerto Rico. Está dirigido al desarrollo de destrezas y conocimiento en la evaluación y el manejo del riesgo suicida en estudiantes universitarios-as. Se realizó un diseño cuasiexperimental de medidas repetidas con 39 profesionales de las disciplinas de consejería, psicología y trabajo social. Se encontraron diferencias estadísticamente significativas entre la pre y posprueba, t (38) = -9.281, p = 0. Los resultados sugieren que un adiestramiento basado en la evidencia que utilice como guía las competencias e incorpore el uso de ejercicios prácticos aumenta el conocimiento y destrezas de intervención de profesionales de la salud mental en la evaluación y manejo de riesgo suicida.
This article describes the design, implementation and evaluation of a suicide risk assessment and management training for professionals working in institutions of higher education in Puerto Rico. We conducted a quasiexperimental design with 39 professionals in counseling, psychology and social work. Statistically significant differences were found between pre and post-tests, t (38) = -9.281, p = 0. Results suggest that an evidence-based training that follows the core competencies and includes practical exercises, increases the knowledge and intervention skills of mental health professionals in the assessment and management of suicide risk.
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Background & objectives: Mental health professionals have varied attitudes and views regarding informed consent and confidentiality protections in psychiatric research and clinical care. The present study was designed to understand the knowledge and views of mental health professionals (MHPs) regarding informed consent and confidentiality protection practices. Methods: Mental health professionals (n=121) who were members of the Delhi Psychiatric Society, were invited to participate in this questionnaire-based study of their knowledge and attitudes regarding informed consent and confidentiality. Half of them expressed willingness to discuss participation and gave initial oral consent (n=62); of these, 31 gave written informed consent to participate and completed the questionnaires. The questionnaires included both forced choice (yes / no / do not know) and open-ended questions. Questionnaires content reflected prominent guidelines on informed consent and confidentiality protection. Results: Attitudes of the majority of the participants towards informed consent and confidentiality were in line with ethical principles and guidelines. All expressed the opinion that confidentiality should generally be respected and that if confidentiality was breached, there could be mistrust of the professional by the patient/participant. The mean knowledge scores regarding informed consent and confidentiality were 8.55 ± 1.46 and 8.16 ± 1.29, respectively. Interpretation & conclusions: The participating mental health professionals appeared to have adequate knowledge of basic ethical guidelines concerning informed consent and confidentiality. Most respondents were aware of ethical issues in research. Given the small sample size and low response rate, the significance of the quantitative analysis must be regarded with modesty, and qualitative analysis of open-ended questions may be more valuable for development of future research. Increased efforts to involve mental health professionals in research on ethical concerns pertinent to their work must be made, and the actual practices of these professionals with regard to ethical guidelines need to be studied.
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Pesquisa qualitativa que analisa dois grupos focais realizados em 2009 com vinte trabalhadores de dois CAPS I da região de Porto Alegre, para verificar a sua percepção diante do aumento de demandas que a expansão do crack tende a gerar sobre as redes locais de saúde mental. Propôs-se que debatessem o que lhes parecia fonte de sobrecarga e insatisfação em geral e, especificamente, em função das demandas de usuários de crack. Os resultados mostram forte preocupação com a instabilidade dos contratos de trabalho, levando à falta de projeção no futuro. Além disso, o acúmulo de tarefas para suprir carências das equipes, justificando-se o limitado interesse em planejar ações de longo prazo e a opção por tarefas menos complexas. Consideraram-se problemas na rotina de trabalho as ordens judiciais e a interferência de agentes públicos, pedido expresso de hospitalização, familiares sem postura cooperativa, querelantes e usuários desmotivados para o tratamento ou reingressando no serviço. As equipes parecem estar no centro um conflito entre a impossibilidade de se evitar o surgimento de demandas da população usuária das redes locais de saúde, o que se evidencia no contexto do uso de crack, e os limites da gestão, ampliando o desgaste e a sobrecarga percebidos.
This paper presents qualitative research analyzing two focus groups with twenty workers in Psychosocial Care Centers (CAPS I) in Porto Alegre, southern Brazil, in 2009. They were invited to discuss overwork and dissatisfaction with work in general and also recent demands of crack cocaine users on the local mental health networks. Workers in both groups reported a strong concern about the instability of employment contracts, leading to limited ability to plan their futures. In addition, the accumulation of tasks to replace absenteeism in teams leads to a limited interest in long-term action planning and the option for less complex tasks. Court orders, the interference of public officials and requests of hospitalization, are considered unfavorable routine conditions in the perception of health workers, as well as uncooperative and quarrelsome family members and unmotivated users for resuming treatment. The teams seem to be the center of a conflict between the impossibility of avoiding the emergence of demands of crack users who apply to local health networks and the limits established by management, increasing dissatisfaction and perceived overwork.
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Humans , Attitude of Health Personnel , Cocaine-Related Disorders , Community Mental Health Centers , Crack Cocaine , Cocaine-Related Disorders/therapy , Qualitative ResearchABSTRACT
CONTEXTO: A literatura acerca da maneira como a população geral estigmatiza indivíduos com distúrbios mentais aumentou consideravelmente nas últimas décadas. Mas a dúvida sobre se os psiquiatras também estigmatizam seus pacientes ainda permanece. OBJETIVO: O presente estudo visou avaliar as atitudes de psiquiatras brasileiros em relação aos indivíduos com esquizofrenia. MÉTODOS: Dos cerca de 6.000 participantes do Congresso Brasileiro de Psiquiatria em 2009, 1.414 psiquiatras concordaram em participar do estudo. Entrevistas face a face foram realizadas utilizando um questionário que avaliava o estigma em três dimensões: estereótipos, distância social e preconceito, todas relacionadas a alguém com esquizofrenia. Opinião sobre medicações psicotrópicas e tolerância aos efeitos colaterais também foram avaliadas. Dados sociodemográficos e profissionais foram coletados. RESULTADOS: Psiquiatras brasileiros tenderam a estereotipar negativamente pessoas com esquizofrenia. Estereótipos negativos correlacionaram-se com uma melhor opinião sobre medicações psicotrópicas e com maior tolerância a efeitos colaterais. Idade maior correlacionou-se com estereótipos positivos e com menor preconceito. CONCLUSÃO: Os psiquiatras estigmatizam indivíduos com esquizofrenia e possivelmente têm certa dificuldade em admitir esse fato. Campanhas antiestigma para profissionais de saúde mental devem ser promovidas.
BACKGROUND: Literature on how the general population stigmatizes individuals with mental disorders has increased considerably over the last decades. But the question remains if psychiatrists also stigmatize their patients. OBJECTIVE: The present study aimed to assess Brazilian psychiatrists' attitude towards individuals with schizophrenia. METHODS: Out of the approximately 6,000 participants of the 2009 National Psychiatry Congress in Brazil, 1,414 psychiatrists agreed to undergo the survey. Face-to-face interviews were conducted using a questionnaire that assessed stigma in three dimensions: stereotypes, social distance and prejudice towards a person with schizophrenia. Their opinion on psychotropic drugs and tolerance of side-effects were also assessed. Socio-demographic and professional data were collected. RESULTS: Brazilian psychiatrists tend to negatively stereotype individuals with schizophrenia. More negative stereotypes correlated with a positive opinion on psychotropic drugs and with a higher tolerance of side-effects. Higher age was correlated with positive stereotyping and with less prejudice. DISCUSSION: Psychiatrists stigmatize individuals with schizophrenia and possibly find it difficulty admit this fact. Anti-stigma campaigns among mental health professionals should be promoted.
Subject(s)
Schizophrenia , Stereotyping , Allied Health Personnel , Prejudice , PsychiatryABSTRACT
OBJECTIVES: The aim of this study was to investigate how mental health professionals in Korea evaluate the burden of disease caused by psychiatric disorders and to propose future directions of the public mental health policies. METHODS: A questionnaire was mailed to 240 mental health professionals, who were composed of psychiatrists from mental hospitals and staffs who are nurses, clinical psychologists and social workers working in the community mental health centers in June, 2004. Two hundred twenty four out of two hundred forty subjects (93.3%), which were composed of 104 psychiatrists and 120 staffs, completed the questionnaire. The questionnaire included 6-item questions about the burden of disease in Korea. RESULTS: Mental health professionals reported that the five diseases with the biggest burden were malignant neoplasms, traffic accidents, schizophrenia, alcohol use disorders and cerebrovascular diseases, consecutively. The burden of alcohol use disorders, cerebrovascular diseases, traffic accidents, unipolar depressive disorder and malignant neoplasms are expected to increase over the next several years. The proportions of psychiatric disorders among all the diseases in terms of burden of disease and medical costs were estimated as 18.4% (+/-12.8) and 12.0% (+/-11.7) respectively. CONCLUSION: This study showed that many of Korean mental health professionals have under-estimated burden of psychiatric disorders, especially, unipolar depressive disorder. It would be necessary to emphasize the importance of unipolar depressive disorder in applying educational and public programs for the mental health professionals, as well as for the general population.