Evaluating the use of videoconferencing for handover and MDT meetings within an intensive support team

Purpose: This study aims to evaluate the use of videoconferencing when conducting multi-disciplinary team (MDT) and handover meetings within an NHS Adult Learning Disabilities Intensive Support Team (IST). The IST have been conducting MDT and handover meetings "virtually” since the start of the COVID-19 pandemic in March 2020, in line with government guidance. It is pertinent to evaluate the effectiveness of using videoconferencing, as the move to flexible, remote working is detailed within the NHS Long Term Plan. Design/methodology/approach: Participants were members of the IST. A mixed methods approach using an online questionnaire collected participant's views relating to the use of videoconferencing when conducting MDT and handover meetings, in comparison to previous face-to-face meetings. The questionnaire considered five key areas: accessibility, environment and communication, organisation, continuation of care and data protection and confidentiality. Results were collated and analysed. Findings: Improvements were reported relating to accessibility, as the virtual format allowed for easier attendance, provided greater flexibility in attending and inviting key stakeholders. A reduced sense of team connectedness was reported, related to the virtual environment. The majority of participants reported that they wish to continue to have the option to attend meetings virtually in future. Originality/value: There are no previous papers evaluating the use of videoconferencing within ISTs during the COVID-19 pandemic. This study suggests that the use of videoconferencing to conduct MDT and handover meetings is effective within the IST and highlights points for consideration moving forward. © 2023, Emerald Publishing Limited.

Trends of psychiatric emergencies during the COVID-19 health crisis in Italy

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.

Remote and digitally delivered mental health support for care-experienced young people: Some practice-based reflections in response to cummings (2023)

In a recent contribution to this journal, Cummings (2023) reports findings from a preliminary qualitative study of practitioner viewpoints regarding digitally delivered mental health support to care-experienced young people. Cummings' study highlights the need to engage with professional experiences of using digital methods with this group, both during and outside of the COVID-19 pandemic. A response to - and commentary on - Cummings' contribution is provided, to advance discussion of issues identified by the research. We reflect on our experience as practitioners and researchers working in and alongside specialist child and adolescent mental health service teams serving care-experienced children and young people. We focus on workspaces in remote working, therapeutic technique in online and telephone-based care, and virtues and challenges of remote care delivery. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Inequalities in Access to Mental Health Treatment by Australian Youths During the COVID-19 Pandemic.

OBJECTIVE: The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas. METHODS: Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12-25 years, 2015-2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates. RESULTS: Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%-7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18-25. A decreasing trend was observed for males ages 18-25 (3.5% reduction, 95% CI=2.5%-4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status. CONCLUSIONS: During 2020, young people's use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds.

Outcome trajectories in a county mental health clinic before and after telemental health: a retrospective COVID-19 cohort study.

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.

Understanding the psychological therapy treatment outcomes for young adults who are not in education, employment, or training (NEET), moderators of outcomes, and what might be done to improve them.

BACKGROUND: To determine: whether young adults (aged 18-24) not in education, employment or training (NEET) have different psychological treatment outcomes to other young adults; any socio-demographic or treatment-related moderators of differential outcomes; and whether service-level changes are associated with better outcomes for those who are NEET. METHODS: A cohort was formed of 20 293 young adults treated with psychological therapies in eight Improving Access to Psychological Therapies services. Pre-treatment characteristics, outcomes, and moderators of differential outcomes were compared for those who were and were not NEET. Associations between outcomes and the following were assessed for those that were NEET: missing fewer sessions, attending more sessions, having a recorded diagnosis, and waiting fewer days between referral and starting treatment. RESULTS: Those who were NEET had worse outcomes: odds ratio (OR) [95% confidence interval (CI)] for reliable recovery = 0.68 (0.63-0.74), for deterioration = 1.41 (1.25-1.60), and for attrition = 1.31 (1.19-1.43). Ethnic minority participants that were NEET had better outcomes than those that were White and NEET. Living in deprived areas was associated with worse outcomes. The intensity of treatment (high or low) did not moderate outcomes, but having more sessions was associated with improved outcomes for those that were NEET: odds (per one-session increase) of reliable recovery = 1.10 (1.08-1.12), deterioration = 0.94 (0.91-0.98), and attrition = 0.68 (0.66-0.71). CONCLUSIONS: Earlier treatment, supporting those that are NEET to attend sessions, and in particular, offering them more sessions before ending treatment might be effective in improving clinical outcomes. Additional support when working with White young adults that are NEET and those in more deprived areas may also be important.

Meaningful Activities and Recovery (MA&R): a co-led peer occupational therapy intervention for people with psychiatric disabilities. Results from a randomized controlled trial.

BACKGROUND: Activity and participation are critical to health and wellbeing. Limited evidence exists on how to support people with mental illness in participating in everyday activities. AIM: To investigate the effectiveness of Meaningful Activities and Recovery (MA&R), a co-led peer occupational therapy intervention focusing on activity engagement, functioning, quality of life, and personal recovery. METHODS: In a statistician blinded, multicenter RCT including 139 participants from seven community and municipal mental health services in Denmark, participants were randomly assigned to 1) MA&R and standard mental health care or 2) standard mental health care. The MA&R intervention lasted 8 months and consisted of 11 group sessions, 11 individual sessions, and support to engage in activities. The primary outcome, activity engagement, was measured using Profile of Occupational Engagement in People with Severe Mental Illness (POES-S). Outcomes were measured at baseline and post-intervention follow-up. RESULTS: Meaningful Activities and Recovery was delivered with high fidelity and 83% completed the intervention. It did not demonstrate superiority to standard mental health care, as intention-to treat analysis revealed no significant differences between the groups in activity engagement or any of the secondary outcomes. CONCLUSION: We did not find positive effects of MA&R, possibly because of COVID-19 and related restrictions. Fidelity assessments and adherence rates suggest that MA&R is feasible and acceptable. However, future studies should focus on refining the intervention before investigating its effectiveness. TRIAL REGISTRATION: The trial was registered 24/05/2019 at ClinicalTrials.gov NCT03963245.

Qualitative Study of Certified Peer Specialists' Experiences Delivering Peer Support Services During the COVID-19 Pandemic.

OBJECTIVE: The purpose of this qualitative study was to examine the experiences of certified peer specialists (CPSs) in delivering telehealth services during the COVID-19 pandemic. METHODS: Fourteen semistructured interviews with CPSs were conducted from August to November 2020. Data were analyzed by using thematic analysis. RESULTS: Helpful support from employers during the transition to telehealth included clear communication and access to training on telehealth technologies. Main barriers and facilitators were related to interpersonal relationships and logistical factors. CPSs reported that telehealth allowed them to continue to support the peers they serve but that the quality of interactions was not as good as with in-person services. Logistical challenges included inadequate equipment and Internet access. CONCLUSIONS: To support CPSs in delivering telehealth, employers can engage them in open and transparent communication about guidelines for service delivery, provide training and equipment, and allow them the flexibility to tailor service delivery modalities to the peers they serve.

The reasons for the appeal letter from the directors of Community Mental Health Centers

The appeal signed in January 2023 by 91 directors of Community Mental Health Centers addressed to the highest political authorities of Italy is discussed. It begins with an analysis of the critical situation in which public psychiatric care finds itself, especially after the COVID19 pandemic and in the presence of a problematic social and economic situation. The validity of the biopsychosocial paradigm in community mental health is affirmed. The link between mental health and justice is addressed, and the need for a discussion table among all the actors involved is suggested. The paragraphs of this article are the following: "An appeal to raise awareness", "The objectives", "Mental health and justice", "The resources", "The mental health professionals", "Some conclusive perspectives".

The Health Hexagon Model: Postulating a holistic lifestyle approach to mental health for times and places of uncertainty

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

Black men, mental health & the national health service

This paper emerged from a talk delivered to the community and members of the Tower Hamlets African and Caribbean Mental Health Organisation (THACMHO) for Black History Month in October 2022. A growing body of evidence exposes the persistence of racism and inequality within health service provision and the psychological professions. This has led to a commitment across all professional bodies to address as a significant matter. This paper explores the links between racism and intergenerational trauma and the consequences on Black men's mental health. The author probes the gaps in services and inequalities using a psychoanalytic lens. Men from Africa and the Caribbean face disproportionate rates of mental health diagnoses and poor care provision. However, little or no consideration is given to intergenerational trauma and cultural factors. At the heart of the paper sits the question: What happens to Black men in the mental health system and why? The author considers whether cultural insensitivity might be a barrier to accessing mental health care and explores the differential treatment options, outcomes, and possible reasons and solutions for the future. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Development of Community Mental Health Infrastructure in Thailand: From the Past to the COVID-19 Pandemic

Thailand is an upper middle-income country located in the center of mainland Southeast Asia with a population of 66.17 million as of 2021. The aim of this review article is to illustrate the development of community mental health in our country. We have divided the article into five main sections: namely, the mental health service infrastructure, the community mental health system, human resources, mental health financing, public education, and links to other sectors. Mental health care has been integrated into primary care since 1982, resulting in a major shift in focus on mental health at the community level;however, mental health problems and the mental health gap in service accessibility remain present, especially during the current COVID-19 pandemic. Community mental health care has been extended to networks outside the health care system, including the community authorities. It has been provided with psychiatric care and rehabilitation, together with the promotion of mental health and prevention of mental disorders for improving accessibility to services, especially during a pandemic situation. Finally, future challenges to face community mental health have been outlined, such as insufficient staff to develop rehabilitation service facilities for people with chronic, serious mental illnesses;identifying supporting funding from other stakeholders;and mental health care for persons with long COVID living in the community. © 2022, Eco-Vector LLC. All rights reserved.

The development of mental health care in Guangzhou, China

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

Intergenerational Integration in Community Building to Improve the Mental Health of Residents-A Case Study of Public Space.

This study defined intergenerational integration in communities at a theoretical level and verified whether a series of measures could facilitate negotiation and communication between community residents and other stakeholders to generate a positive and healthy community environment and gradually improve intergroup relations. Specifically, we applied community psychology and used Hongqiao New Village in Shanghai, China, as a research site to explore intergenerational conflict in public community spaces. The research was divided into two stages: an input stage and an output stage. In the input stage, participatory research and tea parties were used to deeply explore residents' public space requirements. In the output stage, we tested the validity of the theory by using the Intergenerational Attitude Scale to investigate whether the intergenerational relationships were changed by the co-creation intervention. The results showed that the intervention caused a decrease in the incidence of conflict between residents using the square and caused some children to join the older groups in their activities. We thus propose a theoretical system model of intergenerational integration strategies that incorporates elements of integration, disagreement, and synergy in intergenerational interactions. Overall, this paper provides new ideas for building a community environment that supports mental health and improves intergenerational relationships and social well-being.

Availability and Accessibility of Mental Health Services for Youth: A Descriptive Survey of Safety-Net Health Centers During the COVID-19 Pandemic.

Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) are critical access points for families with adolescents needing mental health care, especially those enrolled in Medicaid. However, barriers exist which may reduce their accessibility. This study aims to describe the availability and accessibility of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. Approximately one year after the COVID-19 pandemic began in the U.S., a comprehensive sample of 117 CMHCs and 117 FQHCs were called and administered a 5-minute survey. Approximately 10% of health centers were closed, and 20% (28.2% of FQHCs and 7.7% of CMHCs) reported not offering outpatient mental health services. Despite CMHCs having 5.4 more clinicians on staff on average, reported wait times were longer at CMHCs than FQHCs. These findings indicate that online directories intended to be a comprehensive and accessible resource, such as the SAMHSA Treatment Locator, are often inaccurate or out-of-date.

Effect of COVID-19 pandemic on utilisation of community-based mental health care in North-East of Italy: A psychiatric case register study.

AIMS: WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services' utilisation, by considering psychiatric diagnoses and type of mental health contacts. METHODS: The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1) outpatient care, (2) social and supportive interventions, (3) rehabilitation interventions, (4) multi-professional assessments, (5) day care. A 'difference in differences' approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated. RESULTS: In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients' characteristics considered (except for people aged 18-24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (-33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673; p-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions. CONCLUSIONS: Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.

The impact of the COVID-19 pandemic and earthquake on mental health of persons with severe mental illness: A survey study among people receiving community mental health care versus treatment as usual in Croatia.

BACKGROUND: The COVID-19 pandemic led to the disruption of mental health services in most countries. Croatia has been developing and strengthening its mental health system, including the introduction of community mental health teams (CMHT) for persons with severe mental illness (SMI), whose implementation was ongoing during the pandemic through the RECOVER-E project. AIMS: The aim of this study was to assess the differences in mental health outcomes, perceived social support and healthcare utilization in the group of participants receiving treatment as usual (TAU group) compared to the group receiving TAU and additional care by the CMHT (CMHT group) during the COVID-19 pandemic and two earthquakes. METHOD: This is a cross-sectional survey administered among 90 participants with SMI at two time points: in May/June 2020 (first COVID-19 wave, earthquake) and in December 2020/January 2021 (second COVID-19 wave, earthquake). RESULTS: A significantly larger proportion of participants from the CMHT group visited the general practitioners in both waves of COVID-19 (first wave: CMHT 72.1%, TAU 44.2%, p = .009; second wave: CMHT 91.1%, TAU 64.1%, p = .003), as well as psychiatric services in the second wave (CMHT 95.3%, TAU 79.5%, p = .028). The use of long-acting injectables was also more frequent in the CMHT group (p = .039). Furthermore, analysis of the first wave showed higher perceived support of significant others (p = .004) in the CMHT group. We did not identify any differences in mental health outcomes between groups in either wave. CONCLUSIONS: While mental health outcomes did not differ between TAU and CMHT group, people in CMHT used services and treatments more frequently than those in TAU during the pandemic, which may indicate that CMHT services enable the continuity and accessibility of care for people with SMI under the circumstances where standard care is interruped (for example pandemic, disaster conditions).

A survey on the use of remote consultation for people with intellectual disability: The experience of community intellectual disability teams

Since COVID-19, remote consultation (by telephone and video) has become widespread. This study investigated the experience of using remote consultation in Specialist Intellectual Disability Community services. A total of 126 health staff working across eight Specialist Intellectual Disability Community teams in the NHS Health Board of Greater Glasgow and Clyde were asked to complete a short Likert-scale survey about remote consultation. There were 61 (48%) respondents from a range of disciplines. Overall, respondents were positive about remote consultation but found it was often inadequate to complete a full patient assessment. Moving forwards, respondents wanted around 60% of all consultations to remain face-to-face. It was significantly more difficult to engage and communicate with patients with more severe levels of disability. Remote consultation has been successful, but there is still a need for face-to-face assessment in intellectual disability services, particularly when working with people with more severe levels of disability.

Choking Phobia in an Older Adult: A Telephone-Based CBT Case Study Informed by Gerontology

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.