ABSTRACT
Background/objectives: Telemental health (TMH) care has received increased attention, most recently due to the COVID-19 pandemic. Many treatment settings and clinicians were forced to rapidly shift to TMH modalities, including clinicians with limited exposure to and possibly negative attitudes toward alternative treatment delivery formats. With the shift to new modalities, effectiveness research is necessary to understand if patients are receiving the same quality of care as before the pandemic and their receipt of mostly in person services. This study compared the naturalistic treatment outcome trajectories for a cohort of patients who received in-person services prior to the pandemic and a distinct cohort of patients who received TMH services after the onset of the pandemic, in a community mental health setting with limited exposure to TMH prior to the COVID-19 pandemic. Materials and methods: We adopted a retrospective cohort design to examine treatment modality as a between-group moderator of symptom change trajectory on the self-report Patient Health Questionnaire (PHQ-9) in a sample of N = 958 patients in the Northeast United States. Treatment durations differed in the naturalistic treatment setting and we examined patient-reported outcomes up to a maximum of one year. Results: Statistically significant average decreases in symptom severity were found over the course of up to one year of treatment, yet the average outcome trajectory was not significantly different between two modality cohorts (in person delivery before the pandemic versus TMH delivery after pandemic onset). Conclusion: These findings suggest that even in a setting with limited exposure to or training in TMH, the average outcome trajectory for patients who received TMH was statistically similar to the outcome trajectory for patients in an earlier cohort who received in-person services prior to the pandemic onset. Overall, the results appear to support continued use of TMH services in community treatment settings.
ABSTRACT
Background: Individuals with serious mental illness(SMI) are at increased risk of hospitalization and mortality from respiratory infections, including COVID19, influenza, and pneumonia(1,2). Nonetheless, they are less likely to utilize vaccinations partly due to low health literacy, attitudinal hesitancy, and practical barriers(2,3). A multipronged approach is needed to address these barriers. Psychiatric clinics where patients are seen frequently and longitudinally provide an ideal venue for this approach with psychiatric providers being best positioned to promote healthy behavior of vaccination given their expertise in motivational interviewing and nudging(3). Mobile Vaccine Clinics(MVCs) in psychiatric settings can remove practical barriers to accessing vaccines. Method(s): Using a three-pronged approach, we first mobilized psychiatric providers at a community mental health center through in-service education to identify and address barriers to COVID19 vaccination in a cohort of 193 clozapine-treated patients from February to June 2021. Secondly, a vaccination monitoring tool was created in electronic medical records (EMR) to track vaccination intention, hesitancy, and uptake at each outpatient visit. We replicated the intervention in a neighboring psychiatric clinic not only to encourage COVID19 vaccines, but also influenza and pneumococcal vaccines. Finally, in collaboration with a pharmacy, we set up MVCs in psychiatric settings, offering COVID19 and influenza vaccines. Result(s): By June 30, 2021, the COVID19 vaccination rate in our pilot cohort was 84.5%, higher than the Massachusetts rate estimated to be between 62.5% and 77% at the time. While attitudinal hesitancy seemed to decrease over visits, practical barriers (scheduling, transportation, remembering appointments) commonly remained. Setting up MVCs subsequently increased the COVID19 vaccination rate to 93%, with many patients receiving the influenza vaccine simultaneously. In a short questionnaire about the MVC experience, nearly all participants reported it was easy accessing vaccines, with most preferring MVCs for future vaccinations. Discussion(s): When psychiatric providers were empowered to lead vaccine discussions with patients using a standardized vaccine monitoring tool in EMR, their patients had high COVID19 vaccination rates. Embedding MVCs in psychiatric settings was preferred and cost-effective (pharmacy was reimbursed by insurance), and removed practical barriers, particularly for those who may have cognitive limitations associated with SMI. Conclusion/Implications: This multi-pronged approach of integrating preventive care and mental health care in psychiatric settings was highly effective in maximizing vaccine uptake in people with SMI. Leveraging psychiatric providers and settings can help protect people with SMI against vaccine-preventable respiratory diseases, reduce health disparities, and benefit public health. References: 1. Olfson M, Gerhard T, Huang C, et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015;72(12):1172-81. 2. Siva N. Severe mental illness: reassessing COVID-19 vaccine priorities. The Lancet. 2021;397(10275):657. 3. Lim C, Van Alphen M, Freudenreich O. Becoming vaccine ambassadors: A new role for psychiatrists. Curr Psychiatry. 2021;20(8):10-1. Copyright © 2022
ABSTRACT
Background: The aggressive spread of COVID-19 and its heavy societal impacts have culminated in alternative explanations around government guidelines such as vaccination programmes and quarantine facilities. Some of these theories, especially those with paranoid themes, may raise concern for psychotic illness. This confers a unique challenge to mental health (MH) clinicians when presented with these beliefs. Objectives: We discuss a case study of a patient admitted to a MH unit in Western Australia who presented with a well-systematised belief system of a conspiratorial nature related to COVID-19 that contributed to weapon collection and preparing for 'doomsday'. We look at this case in relation to current literature to establish the difference between overvalued ideas vs mental illness in the context of COVID-19. Methods: Using the keywords 'COVID' and a combination of MH keywords, we searched for relevant articles on PubMed to help identify learning points in assessments of patients with themes of uncommon ideas surrounding COVID-19. Findings: The main themes suggest that conspiracy theories are common among the general population and some aspects of the belief have overlap with persecutory delusions. Important points to distinguish include the plausibility of the belief, the tendency to find like-minded individuals and the ability to contain those thoughts during appropriate events. Conclusion: As clinicians we have a duty to reduce unnecessary detainment and stress for those who have alternative theories but are not mentally unwell. Clinicians should be equipped with the ability to distinguish between overvalued ideas and mental illness to establish valid diagnoses and management.
ABSTRACT
Background: During the last financial year, 101 internal emergencies were declared in West Australian (WA) hospitals due to inadequate capacity. This number is predicted to increase as the WA borders open. Observational experience at our hospital suggests that a significant number of general medical patients are occupying beds for prolonged periods of time for non-acute reasons. These include: awaiting placement to aged care facilities or transitional care placement (TCP), transfer to mental health units and National Disability Insurance Scheme (NDIS) for further discharge planning. Aim: To quantify the amount of acute medical beds that are occupied by patients who do not require a tertiary hospital bed for management of their condition. So as to assess the impact on patient flow and justify the need for a step-down unit at a secondary facility. Methods: This was a non-blinded prospective study whereby general medical units were audited every 8 days over a 5-week period to capture variation across different days of the week. A General Physician trainee assessed all general medical patients and concluded whether a tertiaryhospital bed was required. Criteria for non-tertiary beds includes patients who were awaiting permanent placement, respite, NDIS or mental health unit beds. Primary outcome measured was the daily proportion of patients not requiring acute tertiary care. Secondary outcomes measured were the reasons for ongoing hospital stay, patient factors contributing to this and the length of stay attributable to non-acute care. Results: The average daily proportion of general medical inpatients that do not warrant tertiary care was 21.5% (range 16% - 23%). Those awaiting placement to residential aged care facilities, TCP or respite contributed the most to ongoing hospital admissions (55.9%). Other reasons included awaiting NDIS approval (17.6%), mental health unit admission (17.6%) and transfer to rural residences (8%). More than half of the patients were over 65 years of age (64.7%). 58.8% of these patients were independent with activities of daily living, while the remaining 41.2% required assistance. Most common presenting complaints includes falls (23.5%) and infection;pneumonia, urinary tract infection, cellulitis and sepsis of unclear source (23.5%). Dementia with behavioural and psychological disturbance contributed 11.8%, mental health was 8.8%, neurological presentations (CVA, TIA, seizures) was 8.8%, gastrointestinal issues contributed 5.9%, and other reasons totaled 8.8%. More than half of the patients had a psychiatric comorbidity (58.8%) and close to half had cognitive impairment (41.2%). Average length of stay for non-acute care was 19.2 days. Proportion of patients with lengths of stay less than 10 days and 10-20 days was equal (35.3%), 5.9% for 20-30 days, 8.8% for 30-40 days, 2.9% for 40-50 days and 11.8% for more than 50 days. Conclusion: This study highlights the factors contributing to the burden faced by WA Health including lack of available beds, disruption in patient flow, and ramping. To address this, we have identified a significant proportion of general medical inpatients that could be stepped down to an alternate facility. In the context of the COVID-19 pandemic, efficient bed flow is paramount to ensure timely patient care and appropriate allocation of resources.
ABSTRACT
Background: The COVID-19 pandemic prompted a rapid re-organization of mental health services, favouring a widespread diffusion of remote consultations and a reduction of face-to-face interventions. Aims of the Study: We employed a registry-based approach to (i) compare the overall functioning of outpatient services in Lombardy in 2019 and 2020, and (ii) report the distribution of telepsychiatry interventions in these settings. Methods: We summarized descriptive information on demographic and clinical data retrieved from all regional community-based mental health centres in 2019 and 2020, grouped according to regional provinces. We then described the progression of remote vs. in-person consultations (first psychiatric visits, psychiatric control visits, team meetings, group and individual psychotherapy, family interviews, social and nursing support, psychoeducation, daily and social skills training and job placement) during the course of 2020. Results: In the first semester of 2020, the number of outpatient service contacts was consistently lower than the previous year (-10,59%), with the largest drop recorded in March and May (-21,89% and -16,86% respectively). This trend normalized during the second semester (-0,60% in 2020). Only a minority of total consultations were recorded as remote delivery (11,70% overall), with the highest percentage at the end of the year (24,10% in November). The majority of remote consultations involved patients diagnosed with psychotic, mood, personality and anxiety disorders (22,87%, 22,27%, 17,69 and 11,37% respectively). Remote consultation types were distributed as follows: 24,04% were psychiatric control visits, 19,24% individual or group psychotherapy, 14,10% nursing support, 11,57% team meetings, 9,73% interview with families, 7,86% psychoeducation activities, 7,03% daily and social skills training activities, 3,43% social support activities,0,45% job placement activities and 0,06% first psychiatric visits. Discussion: Before the current Covid-19 crisis, telepsychiatry was largely unexploited in Italy. Our data reveal the extent and characteristics of its implementation in the mental health services of the country's most populous region. Implications for Health Policies: A clarification of the magnitude of current telepsychiatry implementation will aid policymakers who face the task of shaping future mental health services.
ABSTRACT
INTRODUCTION: The pandemic, a source of stress for individuals, has developed or worsened symptoms of anxiety or depression. The pandemic required a new organization of the Mental Health Services. The UOSM 3 of the ASL Salerno predicten a new assistance path, to guarantee continuity to the patients taken into care and to manage the new requests related to the pandemic. SCOPE OF THE WORK: The incidence in 2020 of the different diagnosis classes and the distribution of socio-demographic variables (age, sex, occupation) was measured, comparing it with previous years. It was evaluated how the presence of anxiety-depressive, obsessive-compulsive and post-traumatic stress spectrum symptoms affected areas of psychosocial functioning. MATERIALS AND METHODS: Through the GDSM Company Information System, the volumes of users who had at least one access to the Service from 01/01/2018 to 31/12/2020 were detected. The volumes of users who had turned to the Service for medico-legal reasons, for taking charge, for taking on treatment and for consultancy were compared. The distribution of diagnoses over the total of those taken in care was verified. RESULTS: The results agree with recent studies, for the percentage of taken in care and distribution of diagnoses. Over the past 3 years there has been a decrease in the incidence and at i there has been a significant increase in the incidence of diagnoses of neurosis. The data show that levels of anxiety, depression, and stress-related symptoms increased during the lockdown period, especially in women, and that this affected the subjects' psychosocial functioning.
ABSTRACT
The coronavirus pandemic and related social distancing measures have brought about dramatic changes in people's lives. In particular, health workers have been forced to change their activities both for the different needs of patients and for preventive measures against the spread of the virus. This study is aimed at comparing the urgent psychiatric consultations (UPC) performed at the outpatient Mental Health Center (MHC) of Modena during the coronavirus outbreak period, from 1 March to 31 August 2020, with the same period in 2019. We retrospectively collected in a database the demographic and clinical characteristics of patients who required UPC in the MHC during the 6-month observation periods in both 2019 and 2020. Data were statistically analyzed. We analyzed 656 urgent psychiatric consultations in 2019 and 811 in 2020, requested by 425 patients in 2019 and 488 in 2020, respectively. In the pandemic period, we observed an increase in the total and daily number of UPC which were more frequently required by patients in care at local outpatient services in comparison with the previous period. During 2020, an increased number of UPC was carried out remotely and the outcome was more frequently represented by discharge at home, avoiding hospitalization as much as possible. In the course of the coronavirus pandemic, MHC had to face an increased demand for clinical activity especially from the most clinically and socially vulnerable patients, who more frequently required UPC in outpatient psychiatric services.
Subject(s)
COVID-19 , Emergency Services, Psychiatric , Mental Disorders , Pandemics , Referral and Consultation , Adult , Ambulatory Care Facilities , COVID-19/epidemiology , COVID-19/psychology , Emergency Services, Psychiatric/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Mental Disorders/therapy , Middle Aged , Referral and Consultation/statistics & numerical data , Retrospective StudiesABSTRACT
Faced with the rapid spread of the novel coronavirus disease (COVID-19), a global public health threat, psychiatric hospitals are under huge pressure to prevent and control nosocomial infection. The current research analyzed the COVID-19 infection control practices in a regional mental health center in China and addressed how this type of medical institutions could enhance their ability to prevent and control hospital transmission of major respiratory diseases and general management of nosocomial infection risks. Firstly, hospital-related risks of COVID-19 were analyzed, and targeted prevention and control measures were then established. Pre- and post-intervention theoretical knowledge of nosocomial infection control, hand hygiene compliance and accuracy, use of personal protective equipment, and disinfection and sterilization effectiveness were evaluated and compared. All the indexes displayed significant improvements following the implementation of the prevention and control measures. Up to the submission of this paper, the mental health center had obtained no suspected or confirmed case of COVID-19 infection due to hospital transmission. The findings provide empirical evidence for the effectiveness of the COVID-19 preventive strategies and have important implications for integrated and characterized infection control in mental health centers during a major epidemic. The establishment of the transitional isolation ward and air fumigation using traditional Chinese medicine for patients and staff are preventive measures worthy of further discussion and dissemination.