Mental health and wellbeing of health and aged care workers in Australia, May 2021 - June 2022: a longitudinal cohort study.

OBJECTIVES: To assess the mental health and wellbeing of health and aged care workers in Australia during the second and third years of the coronavirus disease 2019 (COVID-19) pandemic, overall and by occupation group. DESIGN, SETTING, PARTICIPANTS: Longitudinal cohort study of health and aged care workers (ambulance, hospitals, primary care, residential aged care) in Victoria: May-July 2021 (survey 1), October-December 2021 (survey 2), and May-June 2022 (survey 3). MAIN OUTCOME MEASURES: Proportions of respondents (adjusted for age, gender, socio-economic status) reporting moderate to severe symptoms of depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder scale, GAD-7), or post-traumatic stress (Impact of Event Scale-6, IES-6), burnout (abbreviated Maslach Burnout Inventory, aMBI), or high optimism (10-point visual analogue scale); mean scores (adjusted for age, gender, socio-economic status) for wellbeing (Personal Wellbeing Index-Adult, PWI-A) and resilience (Connor Davidson Resilience Scale 2, CD-RISC-2). RESULTS: A total of 1667 people responded to at least one survey (survey 1, 989; survey 2, 1153; survey 3, 993; response rate, 3.3%). Overall, 1211 survey responses were from women (72.6%); most respondents were hospital workers (1289, 77.3%) or ambulance staff (315, 18.9%). The adjusted proportions of respondents who reported moderate to severe symptoms of depression (survey 1, 16.4%; survey 2, 22.6%; survey 3, 19.2%), anxiety (survey 1, 8.8%; survey 2, 16.0%; survey 3, 11.0%), or post-traumatic stress (survey 1, 14.6%; survey 2, 35.1%; survey 3, 14.9%) were each largest for survey 2. The adjusted proportions of participants who reported moderate to severe symptoms of burnout were higher in surveys 2 and 3 than in survey 1, and the proportions who reported high optimism were smaller in surveys 2 and 3 than in survey 1. Adjusted mean scores for wellbeing and resilience were similar at surveys 2 and 3 and lower than at survey 1. The magnitude but not the patterns of change differed by occupation group. CONCLUSION: Burnout was more frequently reported and mean wellbeing and resilience scores were lower in mid-2022 than in mid-2021 for Victorian health and aged care workers who participated in our study. Evidence-based mental health and wellbeing programs for workers in health care organisations are needed. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12621000533897 (observational study; retrospective).

Changing cannabis policies and social work: Implications for students, families, and schools

State laws governing recreational and medicinal cannabis use are trending toward legalization, which has implications for school social workers and the students, families, and communities they serve. The patchwork of policies and conflicting public opinion sends mixed messages to youth and families who may lack sufficient information regarding risks of adolescent cannabis use. This article will explore topics relevant to legalization of cannabis including medical versus recreational use, racial overtones in marijuana policy, effects on student cognitive development and mental health, child welfare involvement, disparities in school discipline, criminal record expungement, and school-based cannabis prevention programs. The article will conclude with a summary of recommendations for schools. This article is a product of the research conducted by the Health Education and Leadership Scholars planning team at the University of Illinois for a policy-practice conference that was cancelled due to COVID-19. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Recent policy developments in promotion and prevention: a scoping review of national plans in Finland, Ireland, New Zealand, Scotland and Wales

Objective: Mental health promotion and primary prevention have been evident in government policies in recent decades and this focus may also be visible in response to the COVID-19 pandemic. However, there has yet to be a review of promotion and prevention in current mental health plans in relatively high-income countries with small populations. The objective of this review was to analyse recent government mental health plans in relatively high-income countries with small populations in order to compare and contrast their plans on promotion and prevention. Method: The review focussed on mental health policies, strategies or action plans published in English between 2017 and 2020 in Finland, New Zealand, the Republic of Ireland, Scotland and Wales. The research team developed an analytical framework for the review based on online interviews with policy and mental health experts and WHO guidance. Individual plans were then reviewed against the policy framework to produce an analysis in table form which provided the basis for a narrative discussion of developments. Results: There is evidence of attention in current mental health plans to 'whole of population' mental health and prevention which suggests a consensus on the need for action at this end of the spectrum. The extent of commitments to prevention and to reducing inequalities in mental health varies and is evidenced by commitments to cross-departmental structures for action on mental health and dedicated actions to reduce inequalities. Discussion: The results of this review can help to inform the development of national mental health policies. [ABSTRACT FROM AUTHOR] Copyright of Advances in Mental Health is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lions at the gate: How weaponization of policy prevents people of colour from becoming professional psychologists in Canada

The purpose of this article is to shed light on how weaponized policy supports a system designed to exclude racialized individuals from becoming professional psychologists, contributing to the undersupply of mental health care providers, which in turn contributes to a mental health crisis in Canada. We first describe the origins of the current shortage and lack of diverse representation in professional psychology and conclude with a list of recommendations to dismantle historic and unjust policies. As explicit racism became more stigmatized over the decades, policy tools evolved to become more and give the veneer of fairness while maintaining the original exclusionary outcome. Weaponized policies are part of a much-used but little-examined structural toolkit that serves to disenfranchise disempowered groups. We illuminate the history and adoption of these policies with examples, show how they were explicitly created to prevent people of colour from gaining power through education, and how they protect existing racist systems. The absence of historical perspective in training gives aversive policies plausible deniability, making structural change difficult. These policies have metastasized and become entrenched, persisting covertly in a multitude of policies and procedures that continue to strangle educational opportunities for people of colour and deprive Canada of diverse registered professional mental health providers and leaders. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) L'objectif de cet article est de faire la lumiere sur la facon dont les politiques instrumentalisees soutiennent un systeme concu pour exclure les personnes racisees de la profession de psychologue, contribuant ainsi a la penurie de prestataires de soins de sante mentale, qui a son tour contribue a une crise de la sante mentale au Canada. Nous decrivons d'abord les origines de la penurie actuelle et du manque de representation diversifiee dans la psychologie professionnelle et nous concluons par une liste de recommandations visant a demanteler les politiques historiques et injustes. Le racisme explicite etant de plus en plus stigmatise au fil des decennies, les outils politiques ont evolue pour devenir plus abstraits et donner un vernis d'equite tout en maintenant le resultat d'exclusion initial. Les politiques instrumentalisees font partie d'une boite a outils structurelle tres utilisee, mais peu examinee qui sert a priver de leurs droits les groupes prives de pouvoir. Nous eclairons l'histoire et l'adoption de ces politiques a l'aide d'exemples, montrons comment elles ont ete explicitement creees pour empecher les personnes de couleur d'acceder au pouvoir par l'education, et comment elles protegent les systemes racistes existants. L'absence de perspective historique dans la formation donne aux politiques aversives un deni plausible, rendant difficile le changement structurel. Ces politiques se sont metastasees et se sont enracinees, persistant secretement dans une multitude de politiques et de procedures qui continuent a etrangler les possibilites d'education pour les personnes de couleur et a priver le Canada de fournisseurs et de dirigeants professionnels de la sante mentale agrees et diversifies. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement Professional psychologists provide vital mental health services as well as leadership for mental health centres, training initiatives, and academia. Their contributions are greatly needed as mental health services are becoming increasingly scarce due to the aftermath of the COVID-19 pandemic. As such, the profession must ensure that the field becomes accessible to people of colour trained to meet the mental health needs of our diverse Canadian population. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Engaging Stakeholders to Improve Care for Adults with Complex Health and Social Needs during a Public Health Emergency

A public health emergency such as the COVID-19 pandemic exacerbates the already challenging environment facing adults with complex health and social needs (ACHSN) and the systems of care that support them. Between September 2020 and April 2021, 51 participants representing six different stakeholder groups were engaged using interviews, asynchronous Delphi surveys, and a virtual stakeholder meeting to learn from their perspectives about the greatest needs and possible solutions affecting ACHSN populations during the COVID-19 pandemic and to develop a prioritized research agenda to improve care for ACHSN populations. Mental health and financial concerns were strongly and consistently endorsed as the most important issues. Future research priorities identified included both macro systems research such as testing alternative state-level models of payment for physical and mental health care and research that could be conducted at a local level (such as identifying needs for patient care navigation services and testing models of care navigation).

Emergency Removal of Supervision Requirements for Psychiatric Mental Health Nurse Practitioners: A Mixed-Methods Survey.

OBJECTIVE: Physician supervision of nurse practitioners (NPs) was temporarily waived in Massachusetts in response to a state of emergency due to the COVID-19 pandemic. The authors examined the impact of the scope-of-practice changes and pandemic-related demands on psychiatric mental health NPs (PMHNPs) during the state's first COVID-19 surge. METHODS: A mixed-methods Web-based survey was conducted in May and June of 2020. Fisher's exact test was used to compare associations across certification types, and inductive content analysis was applied to open-ended responses. RESULTS: The survey response rate was 41% (N=389 of 958), consisting of 26 PMHNPs and 363 other NPs. Compared with other NPs, PMHNPs were significantly more likely to work in a telehealth setting (42% vs. 11%, p<0.001), to spend more time working during the initial surge (50% vs. 26%, p<0.05), and to believe that the waiver improved clinical work (52% vs. 25%, p<0.01). Content analysis of PMHNPs' open-ended responses identified four themes: the supervision waiver reduced burden on PMHNPs, collaboration and mentorship models persisted, the pandemic exacerbated the already high demand for psychiatric care, and telehealth helped meet the high demand for such care. CONCLUSIONS: PMHNPs may be more sensitive to the scope-of-practice changes and telehealth expansion than other NPs because of the constraints of the psychiatrist shortage and high relative uptake of telehealth in psychiatric care. The interactions of workforce supply, telehealth expansion, and scope-of-practice laws are important to consider in the development of policies to improve access to mental health care.

Social Vulnerability and Mental Health Inequalities in the "Syndemic": Call for Action.

Covid-19 is referred to as a "syndemic," i.e., the consequences of the disease are exacerbated by social and economic disparity. Poor housing, unstable work conditions, caste, class, race and gender based inequities and low incomes have a profound effect on mental health and wellbeing. Such disparities are increasing between, among and within countries and are exacerbated by human rights violations, in institution and in society, stigma and discrimination. Social capital can mediate health outcomes, through trust and reciprocity, political participation, and by mental health service systems, which can be coercive or more open to demand of emancipation and freedom. Societal inequalities affect especially vulnerable groups, and Covid itself had a wider impact on the most socially vulnerable and marginalized populations, suffering for structural discrimination and violence. There are complex relations among these social processes and domains, and mental health inequalities and disparity. Participation and engagement of citizens and community organizations is now required in order to achieve a radical transformation in mental health. A Local and Global Action Plan has been launched recently, by a coalition of organizations representing people with lived experience of mental health care; who use services; family members, mental health professionals, policy makers and researchers, such as the International Mental Health Collaborating Network, the World Federation for Mental Health, the World Association for Psychosocial Rehabilitation, the Global Alliance of Mental Illness Advocacy Networks (GAMIAN), The Mental Health Resource Hub in Chennai, India, The Movement for Global Mental Health (MGMH) and others. The Action Plan addresses the need for fundamental change by focusing on social determinants and achieving equity in mental health care. Equally the need for the politics of wellbeing has to be embedded in a system that places mental health within development and social justice paradigm, enhancing core human capabilities and contrasting discriminatory practices. These targets are for people and organizations to adopt locally within their communities and services, and also to indicate possible innovative solutions to Politics. This global endeavor may represent an alternative to the global mental discourse inspired by the traditional biomedical model.

Examining Risk Factors for Mental Health During the COVID-19 Pandemic-Focusing on Older Adults in South Korea.

Objectives: Mental health is the cornerstone of public health, particularly for older adults. There is a clear need to examine the impact of COVID-19 on mental health among older adults in South Korea, where the incidence of COVID-19 was relatively low and widespread transmission was controlled without a national lockdown. Methods: This analysis included a total of 1917 participants from the Experience Survey on Healthcare Use of Older Adults, which was conducted for adults aged 65 years or older by face-to-face interview. Results: The results showed that older adults with a good understanding of COVID-19 public health measures were less likely to experience mental health problems. In contrast, those with a greater risk perception of contracting COVID-19 had higher odds of experiencing tension and anxiety in addition to sadness and depression. Older adults who had a greater fear of COVID-19 and perceived higher-risk of contracting COVID-19 experienced more sleep problems. Conclusion: The findings provide new evidence on the factors that influence the mental health of older adults in South Korea during the pandemic and suggest the development of policy interventions.

Editorial

The paper by Hussain and colleagues makes an important contribution to this field in undertaking a thematic synthesis of mental health policies published in England from 1999 to 2020, specifically focusing on ethnicity-related mental health issues. The findings from this synthesis demonstrate that ethnic mental health inequalities remain comparable over the past two decades and there are ongoing issues with a lack of data on the ethnicity of mental health services users and poor indicators of performance measurement on policy implementation. Mental health literacy remains an important public mental health issue, and the paper by Bink and Corrigan discusses a novel view on this topic by considering the implications of information overload in the ongoing development of public mental health education programmes.

Posttraumatic stress disorders and influencing factors during the COVID-19 pandemic: A cross-sectional study of frontline nurses.

AIMS: To assess the extent of posttraumatic stress disorder (PTSD) symptoms and severity, factors motivating work continuation, and factors influencing PTSD development among frontline nurses caring for patients with COVID-19. BACKGROUND: The COVID-19 pandemic has an emotional toll on nurses. Exposure to traumatic events associated with the pandemic places frontline nurses at risk for developing PTSD. DESIGN: Cross-sectional study. METHODS: Frontline nurses (n = 370) who cared for COVID-19 patients in three governmental hospitals in the United Arab Emirates were recruited from November 2020 to January 2021. The self-reported Posttraumatic Diagnostic Scale (PDS) was used to assess PTSD. The motivational factors for work continuation explored were: work-related factors (e.g., availability of personal protective equipment and management recognition), family support, and obligation to care. We used correlation and multiple regression analyses to investigate factors that influenced PDS score, including sociodemographic characteristics (e.g., gender, age, exercising status, and general health status), work factors (e.g., hospital type [COVID vs non-COVID], prior work experience, and encountering deaths), and factors motivating work continuation. The reporting of this study was consistent with STROBE guidelines. RESULTS: In total, 36.2% participants had a probable PTSD diagnosis (PDS score ≥28) with most reporting unwanted memories. Family support (95.9%) and management recognition (90.8%) were the most frequently reported motivating factors. Factors significantly associated with higher PDS score were smoking, lack of management recognition, not exercising, and encountering COVID-19 deaths; the correlation and regression coefficients (b) were significant (p < 0.05). CONCLUSIONS AND IMPLICATIONS FOR NURSING/HEALTH POLICY: Policy makers must expand healthcare policies to address frontline nurses' mental health as a priority during the pandemic. Nurse leaders must be involved in health policy development to protect nurses in anticipation of and during global health emergencies.

A scoping review of international policy responses to mental health recovery during the COVID-19 pandemic.

The COVID-19 pandemic has affected people's physical and mental health. Quarantine and other lockdown measures have altered people's daily lives; levels of anxiety, depression, substance use, self-harm and suicide ideation have increased. This commentary assesses how international governments, agencies and organisations are responding to the challenge of the mental health impact of COVID-19 with the aim of informing the ongoing policy and service responses needed in the immediate and longer term. It identifies some of the key themes emerging from the literature, recognises at-risk populations and highlights opportunities for innovation within mental health services, focusing on the published academic literature, international health ministry websites and other relevant international organisations beyond the United Kingdom and Ireland. COVID-19 has challenged, and may have permanently changed, mental health services. It has highlighted and exacerbated pre-existing pressures and inequities. Many decision-makers consider this an opportunity to transform mental health care, and tackling the social determinants of mental health and engaging in prevention will be a necessary part of such transformation. Better data collection, modelling and sharing will enhance policy and service development. The crisis provides opportunities to build on positive innovations: the adaptability and flexibility of community-based care; drawing on lived experience in the design, development and monitoring of services; interagency collaboration; accelerating digital healthcare; and connecting physical and mental health.

Coronavirus Trauma and African Americans' Mental Health: Seizing Opportunities for Transformational Change.

The COVID-19 pandemic is a natural disaster of historic proportions with widespread and profound psychological sequelae. African Americans fall ill and die more than whites from COVID and more survivors and loved ones face psychological risk. African Americans also experience greater personal, social, and financial stress even when not personally touched by COVID illness, and they are again vulnerable as COVID diminishes African American community's capacity for mutual support. Enactment of the American Rescue Act of 2021 can moderate if not eliminate African Americans' greater adversity and greater psychological challenge; other provisions can move the mental health treatment system beyond its previous failure to reach African Americans as it constructively responds to the crisis that COVID presents. From outreach through trusted community actors and institutions for meeting African Americans' needs of varying intensity and duration, and by providing a spectrum of evidence supported interventions-culturally adapted as needed-newfound success can mark a turning point toward new approaches and lasting success.

Policies to Improve the Mental Health of People Influenced by COVID-19 in China: A Scoping Review.

Background: In response to the potentially concurrent mental health crisis due to the COVID-19 outbreak, there have been ongoing mental health policies put in place in China. This review aims to systematically synthesize the implemented national-level mental health policies released by the Chinese government during the COVID-19 outbreak, and summarize the implementation of those mental health policies. Methods: Six databases and two websites were systematically searched, including published studies and gray literature published between December 1, 2019 and October 29, 2020. Results: A total of 40 studies were included. Among them, 19 were national-level policies on mental health released by the Chinese government, and 21 studies reported data on the implementation of those mental health policies. Mental health policies were issued for COVID-19 patients, suspected cases, medical staff, the general population, patients with mental illness, and mental institutions. In the early stage of the COVID-19 epidemic, attention was paid to psychological crisis intervention. In the later stage of the epidemic, the government focused mainly on psychological rehabilitation. During the COVID-19 outbreak, more than 500 psychiatrists from all over China were sent to Wuhan, about 625 hotlines were notified in 31 provinces, several online psychological consultation platforms were established, social software such as TikTok, Weibo, and WeChat were used for psychological education, and many books on mental health were published. Responding quickly, maximizing the use of resources, and emphasizing the importance of policy evaluation and implementation quality were characteristics of the mental health policies developed during the COVID-19 outbreak. Challenges facing China include a low rate of mental health service utilization, a lack of evaluation data on policy effects, and no existing national-level emergency response system and designated workforce to provide psychological crisis interventions during a national emergency or disaster. Conclusions: This review suggests that China has responded quickly and comprehensively to a possible mental health crisis during the COVID-19 outbreak, appropriate mental health policies were released for different members of the population. As the epidemic situation continues to change, the focus of mental health policies has been adjusted accordingly. However, we should note that there has been a lack of separate policies for specific mental health issues during the COVID-19 outbreak.

Scientists in pyjamas: characterising the working arrangements and productivity of Australian medical researchers during the COVID-19 pandemic.

OBJECTIVE: To characterise the working arrangements of medical research scientists and support staff in Australia during the COVID-19 pandemic, and to evaluate factors (in particular: wearing pyjamas) that influence the self-assessed productivity and mental health of medical institute staff working from home. DESIGN: Prospective cohort survey study, 30 April - 18 May 2020. SETTING, PARTICIPANTS: Staff (scientists and non-scientists) and students at five medical research institutes in Sydney, New South Wales. MAIN OUTCOME MEASURES: Self-assessed overall and task-specific productivity, and mental health. RESULTS: The proportions of non-scientists and scientists who wore pyjamas during the day were similar (3% v 11%; P = 0.31). Wearing pyjamas was not associated with differences in self-evaluated productivity, but was significantly associated with more frequent reporting of poorer mental health than non-pyjama wearers while working from home (59% v 26%; P < 0.001). Having children in the home were significantly associated with changes in productivity. Larger proportions of people with toddlers reported reduced overall productivity (63% v 32%; P = 0.008), and reduced productivity in writing manuscripts (50% v 17%; P = 0.023) and data analysis (63% v 23%; P = 0.002). People with primary school children more frequently reported reduced productivity in writing manuscripts (42% v 16%; P = 0.026) and generating new ideas (43% v 19%; P = 0.030). On a positive note, the presence of children in the home was not associated with changes in mental health during the pandemic. In contrast to established researchers, early career researchers frequently reported reduced productivity while working at home. CONCLUSIONS: Our findings are probably applicable to scientists in other countries. They may help improve work-from-home policies by removing the stigma associated with pyjama wearing during work and by providing support for working parents and early career researchers.

Mental health of people in Australia in the first month of COVID-19 restrictions: a national survey.

OBJECTIVES: To estimate the population prevalence of clinically significant symptoms of depression, generalised anxiety, thoughts of being better off dead, irritability, and high optimism about the future, and of direct experience of COVID-19, loss of employment caused by COVID-19 restrictions, worry about contracting COVID-19, or major disadvantage because of the restrictions; to examine the relationship between these experiences and reporting mental symptoms. DESIGN, SETTING, PARTICIPANTS: Anonymous online survey of adult Australian residents, 3 April - 2 May 2020. MAIN OUTCOME MEASURES: Self-reported psychological status during the preceding fortnight assessed with the Patient Health Questionnaire 9 (PHQ-9; symptoms of depression) and the Generalised Anxiety Disorder Scale (GAD-7). Optimism about the future was assessed with a 10-point study-specific visual analogue scale. RESULTS: 13 829 respondents contributed complete response data. The estimated prevalence of clinically significant symptoms of depression (PHQ-9 ≥ 10) was 27.6% (95% CI, 26.1-29.1%) and of clinically significant symptoms of anxiety (GAD-7 ≥ 10) 21.0% (95% CI, 19.6-22.4%); 14.6% of respondents (95% CI, 13.5-16.0%) reported thoughts of being better off dead or self-harm (PHQ-9, item 9) on at least some days and 59.2% (95% CI, 57.6-60.7%) that they were more irritable (GAD-7, item 6). An estimated 28.3% of respondents (95% CI, 27.1-29.6%) reported great optimism about the future (score ≥ 8). People who had lost jobs, were worried about contracting COVID-19, or for whom the restrictions had a highly adverse impact on daily life were more likely to report symptoms of depression or anxiety, and less likely to report high optimism than people without these experiences. CONCLUSIONS: Mental health problems were widespread among Australians during the first month of the stage two COVID-19 restrictions; in addition, about one-quarter of respondents reported mild to moderate symptoms of depression or anxiety. A public mental health response that includes universal, selective and indicated clinical interventions is needed.