Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic.

Black, Indigenous, and People of Color (BIPOC) communities have weathered centuries of racism, causing transgenerational mental health consequences and hindering access to quality treatment. In this commentary, we describe the systemic challenges of engaging BIPOC to promote mental health equity during the COVID-19 pandemic. We then describe an initiative that illustrates these strategies, provide recommendations and further readings for academic institutions seeking to partner with community organizations to provide equitable mental health services to populations that have been traditionally overlooked.

The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era.

(1) Background: In the "post-COVID-19 era", there is a need to focus on properly assessing and addressing the extent of its well-established mental health collateral damage. The "Electronic Mental Wellness Tool" (E-mwTool) is a 13-item validated stepped-care or stratified management instrument that aims at the high-sensitivity captures of individuals with mental health disorders to determine the need for mental health care. This study validated the E-mwTool in a Spanish-speaking population. (2) Methods: It is a cross-sectional validation study using the Mini International Neuropsychiatric Interview as a criterion standard in a sample of 433 participants. (3) Results: About 72% of the sample had a psychiatric disorder, and 67% had a common mental disorder. Severe mental disorders, alcohol use disorders, substance use disorders, and suicide risk had a much lower prevalence rate (6.7%, 6.2%, 3.2%, and 6.2%, respectively). The first three items performed excellently in identifying any mental health disorder with 0.97 sensitivity. Ten additional items classified participants with common mental disorders, severe mental disorders, substance use disorders, and suicide risk. (4) Conclusions: The E-mwTool had high sensitivity in identifying common mental disorders, alcohol and substance use disorders, and suicidal risk. However, the tool's sensitivity in detecting low-prevalence disorders in the sample was low. This Spanish version may be useful to detect patients at risk of mental health burden at the front line of primary and secondary care in facilitating help-seeking and referral by their physicians.

Decreased Gut Microbiome Tryptophan Metabolism and Serotonergic Signaling in Patients With Persistent Mental Health and Gastrointestinal Symptoms After COVID-19.

INTRODUCTION: An estimated 15%-29% of patients report new gastrointestinal (GI) symptoms after coronavirus-19 disease (COVID-19) while 4%-31% report new depressive symptoms. These symptoms may be secondary to gut microbiome tryptophan metabolism and 5-hydroxytryptamine (5-HT)-based signaling. METHODS: This study used specimens from 2 patient cohorts: (i) fecal samples from patients with acute COVID-19 who participated in a randomized controlled trial testing prebiotic fiber and (ii) blood samples from patients with acute COVID-19. Six months after recovering from COVID-19, both cohorts answered questions related to GI symptoms and anxiety or depression. Microbiome composition and function, focusing on tryptophan metabolism-associated pathways, and plasma 5-HT were assessed. RESULTS: In the first cohort (n = 13), gut microbiome L-tryptophan biosynthesis during acute COVID-19 was decreased among those who developed more severe GI symptoms (2.0-fold lower log activity comparing those with the most severe GI symptoms vs those with no symptoms, P = 0.06). All tryptophan pathways showed decreased activity among those with more GI symptoms. The same pathways were also decreased in those with the most severe mental health symptoms after COVID-19. In an untargeted analysis, 5 additional metabolic pathways significantly differed based on subsequent development of GI symptoms. In the second cohort (n = 39), plasma 5-HT concentration at the time of COVID-19 was increased 5.1-fold in those with GI symptoms alone compared with those with mental health symptoms alone ( P = 0.02). DISCUSSION: Acute gut microbiome-mediated reduction in 5-HT signaling may contribute to long-term GI and mental health symptoms after COVID-19. Future studies should explore modification of 5-HT signaling to reduce post-COVID symptoms.

The impact of COVID-19 on self-reported burnout and health and mental health services in Nampula, Mozambique.

Background: The purpose of this study was to examine the impact of the COVID-19 pandemic on self-reported burnout of health workers, quality of care, and perceptions of COVID-19-related stigma in Mozambique. Method: We conducted a cross-sectional quantitative assessment of 170 frontline health workers in Nampula District, Mozambique, including 149 (87.6%) primary care providers and 21 (12.4%) mental health specialists. Results: Of the 170 frontline workers, only 10.1% of frontline workers were experiencing more professional burnout, whereas 33.3% felt it had lessened. The perceived impact on quality of care also varied, without any significant differences by sex, education level, or mental health training background. Compared to the beginning of the COVID-19 pandemic in March 2020, 42.3 and 38.1% providers felt that their ability to provide mental health and general health care, respectively, had worsened, compared to 57.7 and 61.9% who believed that either there was no change, or that the work had become easier. Likewise, 26.8% of providers felt that their ability to meet patients' needs had gotten more difficult, whereas 43.4% reported no change and 29.8% reported that it was easier. Twenty-two percent of providers reported an overall increase in caseloads since before the pandemic whereas the majority (67.9%) reported a decrease. Providers believed that 57.1% of people in general were afraid of people with COVID-19, 27.5% were afraid of a person recovered from COVID-19, and 39.9% were afraid of a person with family members with COVID-19. The perceived stigma about healthcare professionals was also low; only 27.4% believed that people in general were afraid of healthcare providers who deliver care to people with COVID-19. Conclusion: In contrast with other global studies, many healthcare workers in our sample reported a reduction in burnout, which may be associated with the lower overall caseloads seen during this period. Similarly, the quality of care was minimally impacted. More research is needed to determine whether the experience in Mozambique is unique, or similarly observed in other low-resource settings.

Scale-Up Study Protocol of the Implementation of a Mobile Health SBIRT Approach for Alcohol Use Reduction in Mozambique.

BACKGROUND: Hazardous drinking imposes a major public health burden worldwide, especially in low-income countries such as Mozambique. Implementation of the Screening, Brief Intervention, Referral to Treatment (SBIRT) approach to address problem drinking is recommended. However, evidence regarding the best strategies to implement SBIRT at scale is needed. METHODS: Guided by the Reach Effectiveness Adoption Implementation Maintenance model, the authors will conduct a 2-year, cluster-randomized, hybrid type-2 implementation-effectiveness trial in 12 districts in Mozambique evaluating implementation, clinical effectiveness, outcomes, and cost. Eight districts will be randomly assigned to a mobile application-based health SBIRT condition and four to SBIRT-Conventional Training and Supervision. Interventions will be delivered by clinic-based community health workers. The Consolidated Framework for Implementation Research will guide the authors' mixed-methods assessments throughout the study. RESULTS: The study arm showing better cost-effectiveness will be scaled up in the other arms' districts. During this 12-month scale-up phase, Ministry of Health personnel will be charged with providing training, clinical activities, and supervision in all 12 districts without research team support. The SBIRT scale-up phase is critical to identify facilitators and barriers for tracking internal and external factors in clinics that continue using the superior arm and those that switch to it. NEXT STEPS: In a multistep process with stakeholders from multiple sectors, outcomes and lessons learned from this study will inform the development of an implementation tool kit to guide SBIRT scale-up of community services addressing hazardous drinking in other low- and middle-income countries and low-resource settings in high-income countries.

Comparison of counseling methods to promote employment for HIV+ ADULTS.

BACKGROUND: Despite improved health and during a strong job market (pre-COVID-19), a substantial proportion of HIV+ adults remained unemployed. This study sought to provide time-limited counseling to promote employment goals. OBJECTIVE: To determine whether behavioral activation (BA) or supportive counseling (SC), would be more effective in promoting vocational goals (full or part-time, paid or volunteer). METHODS: The study included two groups: those with clinically significant fatigue, who were first treated with armodafinil. Once their fatigue diminished, they were enrolled in the counseling program. Those without fatigue were enrolled directly. Both BA and SC interventions were manualized, consisting of eight individual sessions plus a follow-up. RESULTS: 116 participants entered counseling, including 87 assigned to BA and 29 to SC. Of these, 79 completed counseling or found a job by session eight. By follow-up, 51%of BA versus 41%of SC participants had found jobs, a non-significant difference either clinically or statistically. CONCLUSIONS: Multiple issues contributed to difficulty in employment, including gaps in resumes, loss of contact with former colleagues, and uncertainty about career direction. Ongoing barriers included substance use, housing instability, ambivalence about forfeiting government benefits, as well as inadequately treated depression. Success in employment for about half of participants is, in this context, a reasonable outcome.

Justice for George Floyd and a reckoning for global mental health.

In the wake of George Floyd's killing by police in Minneapolis and the global response inspired by Black Lives Matter, it is time for the field of global mental health to reexamine how we have acknowledged and addressed racism in our institutions, our research, and our mental health services. In solidarity with street level responses, this is an important opportunity to understand and collaboratively respond to public demand for systemic change. To respond effectively, it is vital to (1) be aware of the colonial history that influences today's practices, and move forward with anti-colonial and anti-racist actions; (2) identify where and why diversity and representation are lacking in the global mental health workforce, then follow steps to combat these disparities; and (3) work with communities and institutions to end both police violence and structural violence.

Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response.

OBJECTIVE: COVID-19 is an international public health crisis, putting substantial burden on medical centers and increasing the psychological toll on health care workers (HCW). METHODS: This paper describes CopeColumbia, a peer support program developed by faculty in a large urban medical center's Department of Psychiatry to support emotional well-being and enhance the professional resilience of HCW. RESULTS: Grounded in evidence-based clinical practice and research, peer support was offered in three formats: groups, individual sessions, and town halls. Also, psychoeducational resources were centralized on a website. A Facilitator's Guide informed group and individual work by including: (1) emotional themes likely to arise (e.g., stress, anxiety, trauma, grief, and anger) and (2) suggested facilitator responses and interventions, drawing upon evidence-based principles from peer support, stress and coping models, and problem-solving, cognitive behavioral, and acceptance and commitment therapies. Feedback from group sessions was overwhelmingly positive. Approximately 1/3 of individual sessions led to treatment referrals. CONCLUSIONS: Lessons learned include: (1) there is likely an ongoing need for both well-being programs and linkages to mental health services for HCW, (2) the workforce with proper support, will emerge emotionally resilient, and (3) organizational support for programs like CopeColumbia is critical for sustainability.