ABSTRACT
Background: Despite concerns on mental health problems related to lockdowns, recent reports revealed a reduction in psychiatric admissions in Emergency Departments (ED) during the lockdown period compared with the previous year in several countries. Most of the existing studies focused on the first lockdown not considering the different phases of the COVID-19 crisis. The present study aimed to analyse differences in ED admissions for psychiatric consultation during three different phases of the COVID-19 in Italy. Method(s): Information on ED admission the Santo Spirito Hospital in Rome for psychiatric consultations were retrospectively collected. The lockdown(March-June 2020) and the post-lockdown period (June 2020-June 2021) were compared to the pre-lockdown period(January 2019-March 2020). Multinomial logistic regression(MLR) was used to assess the risk of accessing ED for psychiatric consultation during the three periods. Result(s): 3871 ED psychiatric consultations were collected. A significant reduction of psychiatric consultations in ED during the lockdown period and the post-lockdown (H 762.45;p < .001) was documented. MLR showed that compared to pre-lockdown during the lockdown and post-lockdown patients were more likely to be men (RRR 1.52;95% CI 1.10-2.12) and more often diagnosed with non-severe mental illnesses (nSMI) (relative risk ratio [RRR] 1.53, 95% CI 1.10-2.15;and 1.72, 95% CI 1.42-2.08);during the lockdown, patients were also more often diagnosed with alcohol/substance abuse(RRR 1.70;95% CI 1.10-2.65). Conclusion(s): Several changes in the clinical characteristics of psychiatric consultations during and after the lockdown emerged;these may inform clinicians and future preventive strategies among community mental health services.
ABSTRACT
Professional-driven mental health services are often predicated on westernized beliefs of mental health and distress. This presumptuous view results in treatment solutions that are not suitable to (many) non-western contexts because they are neither culturally valid nor practically sufficient. Instead of promoting imported ideas of mental health, we encourage communities, including Hong Kong, from and for where the authors primarily theorize the current thesis, to turn to and strengthen the resources they employed before the medicalization of distress and suffering. Basic foundational elements in one's everyday life, which we present here as the Health Hexagon Model, should be promoted, especially healthy sleep, healthy diet, regular physical activity, closeness with nature, supportive kinships and friendships, and a sense of purpose, meaning, or sacredness. These elements are not novel;the importance of these basic elements has been recognized, distilled, and transmitted generation after generation. We advocate for communities to identify the missing or hampered fundamental elements in their lives and focus on finding methods that would help them adopt a lifestyle conducive to individual and collective health. This call-to-action is particularly timely as the global community fights for its survival against the coronavirus and ponders ways to cope with the seismic changes in lifestyle it has brought.Copyright © 2022 The Authors
ABSTRACT
As an upper-middle-income country, China has a vast territory, a large population and substantial variations in the nature of mental health service provision. Guangzhou, one of the five biggest cities in China, is considered as indicative of the current development of mental health services in a more economically developed part of China. In this paper, we first introduce mental health services in Guangzhou and their historical development: from the rising development of mental health care (1949 to the mid-1960s), the stagnant development period of the psychiatric hospitals (1966-1976), the rapid development period of the psychiatric hospitals (1978 to the 1990s), to the integrated development period of community mental health care (2000-2020). This historical trajectory partly reflects the development of mental health services across China. Second, from the public health perspective, we introduce the current mental health care delivery system and resources in Guangzhou, including the psychiatric specialist hospitals, psychiatric units of general hospitals, and community mental health care. Third, based on the current mental health service system, we highlight community mental health care in Guangzhou. We will describe these elements of the mental health system under the following headings: organizational setup, management, and services. We also explore the design of community mental health service models and the challenges in the post-covid-19 era. Finally, we provide considerations and recommendations for mental health service delivery in Guangzhou in the future.Copyright © 2023 The Authors
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Fear of choking is a relatively understudied phenomenon in older adults, despite the higher incidence of choking to death in this population and the associated mental health burden. This case report presents the use of a cognitive-behavioral (CBT) approach to treating choking phobia in an older adult in her 80s, with sessions conducted over the telephone during the COVID-19 pandemic. A reliable change in self-reported avoidance of solid food was observed, although indices of general distress appeared to have remained stable. By placing a seemingly focal problem (choking phobia) within a comprehensive conceptualization framework using gerontology, we were able to consider additional complexity related to aging-related beliefs and experiences of distress to address therapeutic opportunities and challenges, including the COVID-19 context.Copyright © 2022 Hogrefe.
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Introduction: Literature, especially following the COVID-19 pandemic, has given considerable attention to burnout experienced by mental health professionals. Burnout is a multidimensional syndrome that has three indicators (1): emotional exhaustion (EE, fatigue that can be related to devoting excessive time and effort to a task that is not perceived to be beneficial), depersonalization (DP, distant or indifferent attitude towards work, and negative interactions with colleagues and patients), and reduced personal accomplishment (PA, negative evaluation of the worth of one's work and generalized poor professional self-esteem) for the worker. Burnout does not solely impact the wellbeing and quality of life of health professionals but also induces a decline in the quality of care provided to clients. Studies of mental health professionals have shown that this condition could be triggered by associated working stressors including overload, time pressure, understaffing, negative social climate in the workplace, conflicts with patients, job insecurity, and organizational changes. As burnout has important implications for the quality of care, it is essential that the factors which influence burnout and its implications are explored in different contexts, such as in the context of residential facilities (RFs). Workers in the field of mental health are more vulnerable to burnout, as compared with other health professionals (2) because of stigma of the profession, threats of violence from patients and patient suicide and highly demanding therapeutic relationships (3). In a systematic review and meta-analysis, O'Connor and colleagues (4) investigated the prevalence and determinants of burnout in mental health professionals highlighting that staff working in community mental health teams may be more vulnerable to burnout than those working in some other specialist community teams. The key issue that is often left out in literature is the measure of the quality of the health professionals' relationship with patients. Since both the health professional's burnout and the working alliance between them and patients are predictors of therapy outcomes, understanding how burnout affects health professionals' relationship with patients is crucial. Working Alliance (WA) is a well-established index of this relationship as it represents the degree to which a treatment dyad is engaged in collaborative work (5). This construct has an enormous literature in the field of psychotherapy, but it has not been studied in the common treatment of individuals diagnosed with severe mental illness in terms of its relationship with burnout. To our knowledge, this is the first study to investigate the link between burnout among health professionals working in psychiatric RF and WA between individuals with SSD and staff in RF. Method(s): This study is part of a large multicentric observational study conducted in Italy: the DiAPAson study. The final sample of this study includes 303 patients living in RFs (69.3% males;41.0+/-9.8 years) and 164 health workers (27.4% males;41.2+/-9.9 years) of the 99 participating RFs. After collecting sociodemographic data, standardized assessment tools including clinician-administered tools (e.g., psychiatric history, illness duration, lifetime hospitalization stay, total number of psychiatric hospitalizations in the last year, time in the RF, antipsychotic therapy, Brief Psychiatric Rating Scale - BPRS, and Specific Levels of Functioning Scale - SLOF) for patients and self-administered scales (the Italian version of the Working Alliance Inventory short form for Patients, WAI-P;the Italian version of the Working Alliance Inventory short form for Staff, WAI-S;and the Maslach Burnout Inventory, MBI for Staff) were collected. We investigated the relationship between sociodemographic and clinical variables, staff's burnout and working alliance. After rejecting the hypothesis of normality of the variables (by Kolmogorov Smirnov test), we computed correlation matrices calculating Spearman's correlation coefficients. We perfor ed all the analysis with SAS Studio, R and SPSS, considering a p<0.05 value as statistically significant. Result(s): The staff sample presented high mean DP (13.8+/-9.6) while no high mean EE (3+/-3.5) neither low mean PA (38.4+/-5.7) were found according to O'Connor and colleagues' indications (4). Data show significative correlations between: MBI EE and BPRS (beta=0.17;p=0.005), SLOF (beta=-0.12;p=0.048) and WAI-S (beta=-0.17;p=0.003);MBI DP and BPRS (beta=0.22;p<0.001), SLOF (beta=-0.18;p=0.003), WAI-S (beta=-0.19;p=0.001), and WAI-P (beta=-0.13;p=0.028);MBI PA and patients' education years (beta=-0.146;p=0.014) and WAI-S (beta=0.26;p<0.001). Conclusion(s): The result of our large multicentric observational study suggested that health professionals working with SSD patients reported high scores on MBI for the DP domain. This datum is particularly worrying considering the theoretical framework that in 1978 brought to the reform of the Italian Health System that abolished the Psychiatric Hospitals in favor of a community-based treatment approach where the RF where conceived as a temporal intensive approach for the treatment of the most severe conditions, specifically thought to avoid long term seclusion, institutionalization, and patients' depersonalization. In our sample the burnout, specifically higher EE and DP was associated with more severe symptomatology (as measure with BPRS) and poor socio-occupational functioning. These associations are consistent with previous reports. Lower sense of PA was instead reported in working with patients with higher education grade. This effect could be partially associated with the WA. In fact, our data reported greater sense of PA with higher scores of WA as perceived by the staff, again associated with working with patients with lower education grade. WA as perceived by the staff significantly associate with other burnout domains, being inversely correlated with EE and DP. On the other hand, WA rated by the patients was also inversely associated with DP burnout domain. Even though no causal relationship could be assumed from our data, the clear association between burnout and WA, specifically regarding the DP domain, strongly reinforce the need to further investigate the WA between health professionals and RF patients suffering from SSD. Intervention directed toward the improvement of WA could be a complementary way to improve the quality of care provided to severe SSD patients and a way to reduce burnout.
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Introduction: The COVID-19 pandemic caused changes to how healthcare services are utilised and delivered. Objective(s): We examine the impact of COVID-19 on the pattern of emergency patient presentations referred on to the community mental health team and the impact of utilising telemedicine on time to follow-up. Method(s): We retrospectively reviewed all clinical records of patients currently attending our service. We identified presentations to the emergency department (N=119) who were subsequently referred on for mental health follow-up. Result(s): Patients being referred to our team from emergency departments were significantly younger during, mean age 33.1 years (SD=12.3) compared to before the pandemic, mean age 40.0 years (SD=14.5), p=0.006 and a higher proportion were new patients during, 55.8%, compared to pre-pandemic period 33.3%, p=0.015. There was also a higher proportion of patients presenting with suicidal ideation and lower proportions of affective, psychosis and suicidal/self-injurious acts during the pandemic period compared to before, p=0.006. The ratio of female to male patients on the other hand were similar during both periods, p=0.853. There appeared to be no difference in median time to follow-up pre and during the pandemic (6.0 vs 5.5 days, p=0.995). Further analysis also found no significant impact on time to follow-up upon implementing telemedicine consultations, with median days to initial follow-up of 6 days pre-pandemic, 4.5 days during pandemic + prior to telemedicine and 6.5 days during pandemic + telemedicine, p=0.602. Conclusion(s): This study provides preliminary data on the impact of COVID-19 on mental health emergency presentations and utilization of telemedicine on time to follow-up by CMHTs.
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During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams' contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.1.
ABSTRACT
Background: The SARS-CoV-2 pandemic caused a public health emergency with profound consequences on physical and mental health of individuals. Emergency Rooms (ER) and Community Mental Health Services (CMHS) played a key role in the management of psychiatric emergencies during the pandemic. The purpose of the study was to evaluate urgent psychiatric consultations (UPCs) in the ERs of the General Hospitals and in the CMHS of a Northern Italian town during the pandemic period. Methods: This monocentric observational study collected UPCs carried out in ER from 01/03/2020 to 28/02/2021 (the so called "COVID-19 period") and the demographic and clinical characteristics of patients who required UPCs in the 12-months period, comparing these data with those collected from 01/03/2019 to 29/02/2020 (the so called "pre-COVID-19 period"). The same variables were collected for UPCs carried out in CMHS from 01/03/2020 to 31/01/2021 and compared with those collected from 01/03/2019 to 31/01/2020. The data, were statistically analyzed through STATA 12-2011. Results: In ER, we reported a 24% reduction in UPCs during the COVID-19 period (n = 909) in comparison with the pre-COVID-19 period (n = 1,194). Differently, we observed an increase of 4% in UPCs carried out in CMHS during the COVID-19 period (n = 1,214) in comparison with the previous period (n = 1,162). We observed an increase of UPCs in ER required by people who lived in psychiatric facilities or with disability pension whereas more UPCs in CMHS were required by older people or those living in other institutions compared to the previous period. In the COVID-19 period, the most frequent reasons for UPCs in ER were aggressiveness, socio-environmental maladjustment and psychiatric symptoms in organic disorders whereas in CMHS we reported an increase of UPCs for control of psychopharmacology therapy and mixed state/mania. Conclusion: In light of our findings, we conclude that the most vulnerable people required more frequent attention and care in both ER and CMHS during pandemic, which disrupted individuals' ability to adapt and induced many stressful reactive symptoms. In order to reduce the impact of the COVID-19 pandemic on mental health, psychological support interventions for the general population should be implemented, having particular regard for more psychologically fragile people.
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Background: COVID-19 has highlighted the essential role of vaccination in preventing illness, modifying illness severity and averting hospital care. Mental health (MH) service users have low vaccination rates for many conditions, but evidence on individual and health system impacts is limited. Methods: The NSW Mental Health Living Longer links population-wide data from NSW hospitals and community MH services. We calculated hospitalisation rates and incidence rate ratios for vaccine-preventable conditions including hepatitis, influenza and pneumococcal pneumonia, comparing MH service users to other NSW residents. Rates were standardised for age and socio-economic disadvantage. Results: Over 12 months there were 14,530 vaccine preventable admissions in NSW, occupying 94,241 bed days. MH service users had a more than fourfold increased risk of admission for vaccine-preventable conditions (adjusted incidence rate ratio = 4.7;95% confidence interval = [4.5, 5.0]), with the highest relative risk in people aged 40-65 years. One-quarter of total excess potentially preventable bed days in MH service users were due to vaccine-preventable conditions, including respiratory illness. MH service users comprised 2.3% of the NSW population but contributed nearly 15% of vaccine-preventable bed days. Additional analyses will be presented examining specific conditions, demographic and clinical subgroups. Conclusion: Low vaccination rates have serious impacts for MH service users. Strategies to overcome barriers and support vaccination uptake could have quick and substantial benefits for individuals and health systems. Supporting uptake of COVID-19 vaccination will be essential to avoid further amplifying health inequalities for people using MH services.
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People with major depressive disorder continue to be marred by chronically pernicious yet preventable outcomes in the biopsychosocial aspects. With the reallocation of healthcare resources towards the fight against the coronavirus 2019 pandemic, much emphasis has been placed on existing community mental health interventions to ameliorate the disruption of mental health services. Moreover, the recent propulsion of community mental health services by the World Health Organization Mental Health Action Plan 2013-2030 ignited the need to bolster existing community interventions by providing comprehensive, responsive and integrated mental healthcare. The enhanced emphasis on mental healthcare in the community and the heightened demands of people with major depressive disorder underscores the need to explore the current state of community mental health interventions. This scoping review examined 51 primary studies published from year 2010 to 2020 using Arskey & O'Malley's five-stage framework and provided an overview of the impact of existing community mental health interventions for people with major depressive disorder. Findings using thematic analysis have recommended the adoption of person-centred community mental healthcare via the biopsychosocial approach for people with major depressive disorder. Enablers of community mental health interventions were driven by culturally appropriate care and augmented by technology-driven modalities. Challenges and gaps of community mental health interventions include the perpetuation of stigma and misconception, complex demands of persons with major depressive disorder and lack of holistic and long-term outcomes. Given the impact of major depressive disorder on the various biopsychosocial aspects, it is envisioned that our insights into the enablers and barriers of community mental health interventions will guide prospective interdisciplinary and nurse-led interventions in holistically improving the care of persons with major depressive disorder in the community settings.