Using implementation science in youth mental health workforce development: Adapting to the COVID-19 pandemic in Australia

Aims: Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organization with a mission to reduce the impact of mental ill-health on young people, families and society, and one of only a few known research and clinical centres with a dedicated Knowledge Translation division. This paper provides a case study of the workforce development team within Orygen Knowledge Translation, outlining how implementation science informs their work and how the division has adapted its model of service support in the face of COVID-19. Method(s): Process data on training and resources developed and delivered by the workforce development team at Orygen over the period 2017-2021 was collated and synthesized with team reflections about the adaptations made by team in response to the COVID-19 pandemic. Results and Conclusion(s): Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. The COVID-19 pandemic facilitated profound and rapid changes to service delivery and development in Australian youth mental health. Implementation science offers flexible models to support a changing system.

Everybody hurts - What can physical health professionals learn about how mental health professionals support their own emotional resilience and mental health?

The physical aspects of ultrasonography, difficult posture with prolonged pressure exertion, have been extensively researched and addressed with advances in machine ergonomics, operator awareness of posture and positioning and workplace tools to identify musculoskeletal problems. The mental stresses are less well recognized and have only recently started getting investigated. Ultrasonography is a mentally challenging activity requiring long periods of intense concentration, empathy and communication of complex and often difficult information to patients and clinicians, all of which carries an emotional toll. Practitioners are also under increasing time and caseload pressures exacerbated by COVID recovery and chronic fatigue from two years of pandemic. A survey of UK obstetric sonographers showed 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively).1 While many Trusts provide training to support physical health, few radiology departments educate their staff on emotional resilience or offer regular support to either promote or maintain mental wellbeing. Training, when available, is often focused on the receiver and not on the impact of vicarious traumas experienced as a result of repeatedly discovering/delivering difficult outcomes to patients on a regular and prolonged basis. Few health professionals are face-to-face with their patient at point of significant discovery whether that information is imparted to the patient or not. Mental health professionals have adopted a traumainformed stance into their working practices. This has not only informed the direct clinical work with patients but is also evident in the way the workforce is supported by the trust. Regular supervision, reflective practice and debriefs are required and monitored by the trust, based on research in clinical psychology to inform best practice. Some of these practices could be applied to physical health professionals to address some of the emotional burdens experienced as part of day-to-day delivery of care.

A Feasibility Study of LORETA Z-Score Neurofeedback Training in Adults with Schizophrenia-Spectrum Disorder Experiencing Treatment-Resistant Auditory Verbal Hallucinations

Introduction: The incomplete effectiveness of interventions demands new ways to help people diagnosed with schizophrenia who experience auditory verbal hallucinations (SZ-AVH). We aimed to perform a feasibility study of low-resolution electromagnetic tomography analysis (LORETA) neurofeedback with people exhibiting treatment-resistant SZ-AVH. Method(s): We examined changes in resting-state quantitative electroencephalogram (qEEG) in four people with SZ-AVH (three male, one female) after LORETA Z-score neurofeedback training. Result(s): The study design had to be amended due to a national COVID-19 lockdown. Neurofeedback was well tolerated and no participants dropped out. Recruitment was the main feasibility issue. Barriers included a lack of knowledge of neurofeedback by patients and mental health teams, as well as the travel and time commitment involved. For the only patient who completed all 20 sessions, elevated frontal, central, and temporal theta absolute power measured at baseline normalized after treatment, but decreased temporal delta and an increase in coherence for all frequency bands were also found. Conclusion(s): Two key lessons were drawn for the feasibility of trials of EEG neurofeedback in this population. First, significant effort is needed to educate mental health professionals and patients about neurofeedback. Second, the equipment employed for neurofeedback training needs to be physically based at a site where patients routinely attend.Copyright © 2022. Amico et al.

Assessment of Stress, Anxiety, and Depression Levels Among COVID-19 Positive Patients Admitted in Rural Tertiary Care Hospital

Objective: The aim of the present study was to investigate the psychiatric distress, including stress, anxiety, and depression levels, among COVID-19 positive patients who were admitted between 01 July 2020 to 31 August 2020 to the COVID-19 isolation ward of the Uttar Pradesh University of Medical Sciences, Saifai, Etawah India. Participants included 100 patients, with 55 males and 45 females. The majority of admitted patients (81%) were illiterate. Out of 100 patients, 83 were married, 16 were unmarried, and only 1 was a widow. Method(s): Levels of anxiety, depression, and stress level were noted in admitted patients using Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9) depression assessment, and Perceived Stress Scale 4 (PSS-4) assessment techniques, respectively. Result(s): Patient Health Questionnaire (PHQ-9) depression assessment results showed minimal, mild, and moderate depression in 9, 25, and 66 patients, respectively, with a 10.6 median score of PHQ-9. Mild, moderate, and severe anxiety (GAD-7 score) was present in 22, 28, and 50 of the patients surveyed. The mean Perceived Stress Scale 4 (PSS-4) was also analyzed, and it reported 6.1 values. The results of the study demonstrated that the patients had a high label of psychiatric distress, but still, admitted patients believe that they will come out from this pandemic condition. Conclusion(s): Although patients claimed psychiatric distress and mental health illness, they still denied the requirement of any mental health professionals to minimize stress levels and were satisfied with the medical facilities available in a hospital located in a rural area.Copyright © 2022 Bentham Science Publishers.

Adaptation of a mobile app for early anxiety and depression intervention in university students in Chile: Participatory study

The high prevalence of mental health problems among university students poses a challenge when developing effective interventions, with digital technologies emerging as a potential resource to address this problem. The inclusion of student input in the design and development of such interventions is critical to improving their impact. This study contributed to the initial phase of a research project that aims to adapt and evaluate the feasibility and acceptability of an early intervention for anxiety and depression based on digital technologies for university students. Three participatory workshops were conducted with 13 university students in Chile to inquire about the features and content that a mental health mobile app should include to meet their needs and preferences. The workshop transcripts were analysed using inductive thematic analysis. The results of this study highlight the value of modifications such as the personalisation of some features of the app. The students recommended incorporating topics related to university life and the possibility of contacting a mental health professional, as well as the inclusion of peer interaction or other forms of support.Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Psychological Impacts of COVID-19 Pandemic

Thousands of millions of people faced devastating impacts around the world during COVID-19 pandemic. Not only anxiety or fear of COVID-19 dominated the negative psychological impacts, mental disorders such as depression, posttraumatic stress disorder, and sleep disturbance increasingly appeared during or after the pandemic. Apart from the confirmed patients, survivors of the viral infection, close family members, elders, children and adolescents, people quarantined, people with preexisting psychiatric conditions, frontline police, emergency medical services, and health-care workers, mental distress specific to the vulnerable groups should be recognized. Preventive strategies including self-regulations, leadership, and teamwork were highlighted. Specific evaluations for at-risk population and efficacious treatment such as cognitive behavioral treatment could be considered. This article delineated directions for mental health workers during pandemic.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Quality of life of a group of Ecuadorian health professionals in covid-19

Introduction: Covid-19 was the cause of a pandemic that claimed thousands of human lives. The pandemic has caused health professionals mental health problems that influence emotional, psychological and social well-being, which affects the way they think, feel and act in daily life. Objective(s): To de-termine the quality of life of health personnel during the Co-vid-19 pandemic in public institutions in the city of Cuenca. Material(s) and Method(s): Descriptive, cross-sectional and observational study. The study sample was 338 health professionals belonging to the Ministry of Public Health of the Canton Cuenca, province of Azuay-Ecuador, doctors, nurses, dentists, psychologists, assistants and biochemists who work at differ-ent levels of care were included. Two WHOQOL surveys and the Lazarus and Folkman scale of coping modes were used, for the tabulation of the data the RStudio statistical program was used. Result(s): In the psychological domain, no significant destructuring was found in the personnel studied. In the field of health, it should be noted that the personnel studied reported the inability to carry out the activities they need and the diffi-culty in moving from one place to another. Conclusion(s): When investigating the relationship of health personnel with the envi-ronment, no statistically significant alteration was found, but it was evidenced that social support is a protective factor for the mental health of personnel.Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

National Tele Mental Health Program (Tele MANAS) - An Initial Overview

Background (Dr Rahul Patley, Assistant Professor of Psychiatry- Goldman Sachs project, NIMHANS) The Government of India announced the National Tele Mental Health Programme (Tele MANAS) in the Union Budget in February 2022 to handle the aftermath of mental health issues arising out of the COVID-19 pandemic. It was launched on 10 Oct 2022 on World Mental Health Day as a 24X7 two-tier tele-mental health facility across India. Functioning of Tele Manas (Dr. Suchandra H H Assistant Professor of Psychiatry - Tele MANAS, NIMHANS & Dr C Naveen Kumar, Professor of Psychiatry, Principal Investigator of Tele MANAS, NIMHANS) A total of 51 Tele MANAS cells will be established across India to provide a broader range of mental health services (counselling, consultations, e-prescriptions, follow-ups, and linkages to in-person services) by various mental health specialists with five Regional Coordinating centres and 23 Mentoring Institutes. The NIMHANS function as the apex centre, NHSRC for resource mapping, and IIIT-B for technological support. Each Tele MANAS cell shall provide online services to callers through a trained counsellor and escalates to a mental health professional when needed. It also offers a linking service for inperson referrals to existing mental health resources. The curriculum of Tele MANAS (Dr Madhuri H Nanjundaswamy Assistant Professor of Psychiatry - Tele MANAS, NIMHANS & Dr Suresh Bada Math, Professor of Psychiatry, NIMHANS) The content of the curriculum includes components of training, manual preparation and accreditation courses for Tele MANAS Counsellors. The first edition of manuals were prepared and recently released by MoHFW. The training will be conducted in hybrid mode with both on-site and online components for Tele MANAS Counsellors. A selflearning module for counsellors is also planned. The concept of mental health in Tele MANAS (Dr Nileswar Das, Assistant Professor of Psychiatry- Goldman Sachs project, NIMHANS and Dr N Manjunatha, Additional Professor of Psychiatry, NIMHANS) Mental health in Tele MANAS is a spectrum concept that ranges from mental wellness to mental distress to mental illness. COVID-19 has increased mental distress exponentially compared to mental illness, emphasizing the need to focus on distress.

The Impact of Covid-19 on Mental Health Professionals in Oncology Pharmacy

Introduction: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, health professionals have shown an incredible commitment to their patients. The aim of this article is to assess the mental health of health professionals as the most prominent categories involved in the fight against the Sars-Cov-2 virus infection. Material(s) and Method(s): A mental health survey was sent to all ESOP members (.400 individuals in 62 countries) in March 2021 and February 2022. Survey, translated to 9 languages, and distributed online The calculations were performed using Excel (Microsoft Office 2016, Microsoft, Redmond, USA). The answers were analyzed with basic descriptive statistics. Results and discussion: In the February 2022 questionnaire, 70% of respondents said the role of pharmacists changed during the Covid-19 pandemic (23% involved in vaccine administration, 20% emitting of certificate of vaccination and 17% in vaccine prescribing) and 65% reported that there has been a significant increase in cooperation and understanding between different healthcare professionals. The results obtained on the assessment of the mental health and psychophysical wellbeing of the interviewees show that in March 2021, during the Covid-19 pandemic, 30% think that mental health is poor, unlike 15.85% of the interviewees in February 2022.The increase in the workload was significant, in both periods and a part of the interviewees think about leaving the profession (15%-2021vs19.92%-2022).We can note that 46% of the interviewees in March 2021 and 39.84% in February 2022 thought they would be comfortable receiving mental health care. Conclusion(s): Significant improvement of overall mental health and wellbeing in the transition from 2021 to 2022 gives us hope that healthcare professionals have learned to cope with the difficulties of the pandemic. Increased collaboration will increase the level of knowledge and further promote the development of an interdisciplinary approach.

Progression of dementia symptoms in old patients because of confinement in the COVID-19 pandemic era: challenges for mental health workers and caregivers

Currently, the whole world is experiencing a COVID-19 pandemic. The elderly are one of the populations with a high physical and mental risk of being affected by covid-19. Dementia is a psychiatric disorder that is often experienced by the elderly. We describe two cases of dementia that occurred during the COVID-19 pandemic situation. Both cases explain the condition of dementia patients during quarantine due to the implementation of the PSBB (confinement). Dementia patients have difficulty in understanding and complying with health protocols. The emergence of exacerbation symptoms and education on health protocols are challenging for caregivers during the COVID-19 pandemic. The role of mental health workers is important to help caregivers understand the causes of worsening symptoms of dementia patients because of changes in environmental conditions during the COVID-19 pandemic situation and provide examples for caregivers on how to educate patients with appropriate health protocols. Modification of activities during a pandemic and regular communication with caregivers can be a solution to addressing challenges.Copyright © 2023, Codon Publications. All rights reserved.

The Relationship between Burnout Syndrome and Working Alliance in Psichiatric Residential Facilities: A Focus on Schizofrenia Spectrum Disorder

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.

Survivor's Experiences of Psychological Challenges in COVID-19 Patients: An Internet-based Phenomenological Study

Background: Confirmed and suspected patients with SARS-CoV-2 may fear contagion to others and the severe consequences of the disease. Therefore, they may feel loneliness, denial, anxiety, depression, insomnia, and hopelessness, reducing treatment adherence. Objective(s): This study aimed to discuss the psychological challenges of survivors' experiences in SARS-CoV-2 infection. Method(s): This descriptive phenomenological study explored survivors' experiences of COVID-19 infection. Validated websites' stories and notes were used to collect data. The stories were transcribed and analyzed by Colaizzi's phenomenological analysis method. The authors screened the transcribed texts, extracted and summarized meaningful statements, and reported the themes indepen-dently. In addition, six criteria of authority, accuracy, objectivity, currency, coverage, and appearance were considered for evaluating web page quality. The data were analyzed using MAXQDA 10 software. Result(s): A total of 45 patients' stories with COVID-19 were analyzed. Four general themes and 11 sub-themes were extracted via reading stories and extracting themes, including stigma (the sub-themes of embarrassment, defame, and Hopelessness), horror (sub-themes of denial, not professional experience, and toward death), different lifestyles (the sub-themes of change, unfriended, and sleeplessness), and freedom (two sub-themes of calmness and Rescue). Conclusion(s): Based on the studies, the participants reported high rates of symptoms of fear, change, insomnia, and horror. Sup-porting COVID-19 patients in these critical conditions is one of the essential components of acute care measures. Specific interventions to promote mental health in exposed patients should be applied immediately and require special attention.Copyright © 2023, Journal of Kermanshah University of Medical Sciences.

E-tool for mental health prevention: a study of the receptivity and engagement in a large-scale group of subjects

Introduction: Due to the Covid-19 effects, mental health conditions are now, more than ever, affecting our daily lives - both personally and professionally. The average delay between the onset of first symptoms of a mental health disorder and seeking suitable healthcare is 11 years. The WHO states that the only sustainable way to reduce mental healthcare burden is by acting earlier. Objective(s): The aim of this project is to assess the receptivity and engagement of a mobile app for mental health prevention, amongst a large-scale and heterogeneous group of individuals. The main hypothesis under testing is that people are receptive to actively act towards mental health prevention, despite still being a very neglected and stigmatized topic. Method(s): A mobile app for mental health improvement and disease prevention was developed through the digitalization of positive psychology strategies, such as mood tracking, journaling, breathing exercises, among others, which are personalized to the user through biofeedback. The app aims at teaching people how to autonomously cope with mental health conditions, identifying early signs and redirecting them to proper mental health professionals. The app is being released for a population of 35,000 subjects resident in Portugal. Result(s): Receptivity and engagement metrics will be assessed on a weekly and monthly basis, for 3 months, segmented by different subject profiles. Mental health metrics will also be assessed, namely anxiety, depression, and burnout levels - using standard psychiatric scales. Conclusion(s): We have yet to draw conclusions from the project;however, we aim to achieve first results in due time.

National Mental Health Platform in Egypt, Revolution of Mental Health Services

Introduction: The General Secretariat of Mental Health and Addiction Treatment is a governmental body dedicated to the provision of mental health services in Ministry of Health in Egypt. Moreover, in response to the COVID-19 outbreak in Egypt, on line, advice tips, and counseling through the hotline services have became available through social media sites the past few months. Such digital remote MH services were very much welcomed by social media users. In the same time, for mental health professionals, the opportunity to provide help in this time of crisis - without an in-person consultation - was very desirable. In addition to the prevailing stigma of MH condition in the Egyptian culture, which this remote approach overcome it. Effective innovations in the field of mental health have the potential to change the face of mental health care, not only during pandemics but also in routine daily life. Objective(s): 1. Develop a National strategy for E-Mental Health in Egypt. 2. Develop the National mental health platform as a universal implementation tool. Method(s): This project conducted in collaboration with WHO in Egypt, It run in 3 phases: Strategy, planning and infrastructure: include needs assessment and software development. Finalizing infrastructure, adaptation of the content Deployment: include training of the service providers on the usage of the adapted M.H platform, launching and advocacy. Result(s): Development of E-Mental Health strategy, Development of National Mental Health Platform, Training of 50 therapists on digital mental health services. Conclusion(s): National Mental Health Platform is the future road of mental health services in Egypt.

Digital Psychiatry in the COVID-19 Era: the First Italian Cross-National Survey

Introduction: The COVID-19 pandemic led to the implementation of digital psychiatry (DP) in everyday clinical practice, resulting in the need for a skilled healthcare workforce. Objective(s): Our purpose was to investigate the level of training, knowledge and expertise of young mental health professionals and medical students in DP, as well as exploring their beliefs and experiences in this field. Method(s): An ad hoc cross-sectional survey was designed and administered to Italian medical students, psychiatry trainees, and early career psychiatrists. Result(s): Most of the sample declared that the topic of DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on DP. Nevertheless, they mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that the academic background should include a dedicated course/module (54.4%). Moreover, most subjects declared that DP is less effective than in-person interventions (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p<=0.05). Conclusion(s): During the current pandemic, DP represented an ideal response to the need for physical distancing by ensuring the advantage of greater access to care. However, DP interventions are still uncommon, and there remains a certain resistance to their use in mental health care. The lack of formal training during the academic training could be a limiting factor. Therefore, addressing these issues in academic settings could be crucial to spreading this innovative practice also in the post-COVID-19 era.

The impact of COVID-19 on clinical practice and wellbeing of global mental health professionals

Some of the most direct and brutal effects of the COVID-19 pandemic are experienced by health care professionals who are working in demanding environments while having to deal with their own fears of infection and mortality. To assess the impact of COVID-19 on the practice and well-being of global mental health professionals, we designed a three-part, longitudinal, internetbased study. Here we present data from part 1, implemented in June-July 2020 in six languages to members of WHO's Global Clinical Practice Network composed of 15,500 mental health practitioners. The study assessed COVID-19's impact on: work circumstances;occupational well-being;use and transition to telehealth;and expectations, needs and recommendations. 2,505 mental health professionals from 126 countries responded to the study (47% psychiatrists). 93.7% of respondents were currently practicing and 70.9% continued to see patients in person. The impact on clinical workload varied in terms of direction and extent depending on type of service provided and country of practice. Most participants had started or increased their use of telehealth services, and we identified a need for training to support telehealth use. Overall, clinicians scored high on well-being indices. However, a subset scored above the cutoff for low well-being and reported a significant number of post-traumatic symptoms. Five factors affected work-related stress: fear of infection, severe COVID-related events, life disruption, lack of adequate protection and role disruption. Data from this study will provide information relevant for the design, development, and integration of mental health services in the continuing pandemic, and in similar future scenarios.

HEALTH CARE UTILIZATION AMONG PATIENTS DISCHARGED ALIVE POST-COVID-19 HOSPITALIZATION

SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: To characterize the health care utilization (HCU) of patients after discharge from a hospitalization due to Coronavirus Disease 2019 (COVID-19). METHODS: Retrospective analysis from a national cohort using the Optum Clinformatics Data Mart. Included all adults hospitalized with a primary diagnosis of COVID-19 between April 2020 and March 2021, with prior 12 months of continuous enrollment. HCU of patients discharged to a home setting was evaluated in three periods (0-90 days;91-180 days;181-275 days post-discharge). HCU was defined as emergency department (ED) visits, inpatient (IP) admissions, rehabilitation/skilled nursing facility (SNF) admissions, outpatient (OP) and telemedicine visits and was expressed as the number of visits per 10,000 person-days to adjust for time from discharge. We also examined the distribution of office visits by provider specialty RESULTS: We identified 91,374 unique patients who were discharged alive after a hospitalization due to COVID-19. A greater percentage of patients was discharged to a home setting (n=63,674 or 65.6%: home 41.54%;home with home health services 14.65%: home with outpatient services 4.42%) than to a non-home setting (26.23%: i.e., SNF, hospice, rehabilitation facility, etc.). The patients discharged to a home setting were mostly white (58.8%), females (53.4%), whose mean age was 72.4 (SD± 12). The percentage of office visits to Primary care provider (57.8%;48.3%, 47.7%), Cardiology (7.7%;8.0%;7.4%) Pulmonary medicine (4.7%;3.9%;3.1%) varied in the 3 time periods evaluated. Additionally, the outpatient visits to endocrinology (1.3%, 1.6%, 1.7%), Neurology (1.1%, 1.5%, 1.5%), Physical Medicine & Rehabilitation (0.7%, 1.0%, 1.2%), Psychiatry (0.7%, 0.9%, 1.1%) and other mental health professionals (0.4%, 0.5%, 0.5%) increased over time. CONCLUSIONS: In our nationally representative study, health care utilization remains high among patients discharged to a home setting after a hospitalization due to COVID-19. Additionally, the use of mental health services increased overtime among survivors. CLINICAL IMPLICATIONS: Understanding post-discharge health care utilization of patients after an index hospitalization due to COVID-19 will help health systems prepare and allocate resources for the most likely to be used services. DISCLOSURES: No relevant relationships by Alexander Duarte No relevant relationships by Yong-Fang Kuo No relevant relationships by Shawn Nishi, value=Consulting fee Removed 04/03/2022 by Shawn Nishi No relevant relationships by Efstathia Polychronopoulou No relevant relationships by Daniel Puebla Neira No relevant relationships by Gulshan Sharma No relevant relationships by Mohammed Zaidan

Legislative framework and policies for mental health in india: A study of emerging trends

Mental health issues impose an enormous disease burden on societies across the world. Despite its enormous social burden, mental disorders continue to be driven into the shadows by stigma, prejudice and fear. The issue is becoming ever more urgent in light of the forced migration and sustained conflict in many countries of the world. The status of mental health care varies widely from country to country. Many countries already have policies to deliver services for mental health conditions in primary care settings but require system strengthening to achieve integration. Many countries deliver care mainly in institutional settings and need dedicated advocacy and support in phasing out long-stay institutions and developing community-based alternatives. Some countries may require support for policy development or to implement mental health reform efforts. Concerns about potential increases in mental health conditions had already prompted 90% of countries surveyed to include mental health and psychosocial support in their COVID-19 response plans, but major gaps and concerns remain.For much of the pandemic, services for mental, neurological and substance use conditions were the most disrupted among all essential health services reported by WHO Member States. Many countries also reported major disruptions in life-saving services for mental health, including for suicide prevention. Various legislative provisions and Policies have been formulated. Post pandemic, the government of India paid more attention to the concern of mental health and introduced initiatives hitting the target areas. World Health Organization’s most recent Mental Health Atlas showed that in 2020, governments worldwide spent on average just over 2% of their health budgets on mental health and many low-income countries reported having fewer than one mental health worker per 100000 people. The addition of National Tele Mental Health Programme will bridge the critical gap and make the whole digital health ecosystem holistic. Respecting the rights of persons with mental health problems will reduce stigmatizing and discriminatory behaviours.

Surveying the Prevalence of Mental Health Disorders among Healthcare Workers During the COVID-19 Pandemic ABS0140)

The COVID-19 pandemic has ravaged populations across the globe. The toll taken is unprecedented in the modern age. Aside from this obvious morbidity and mortality, there is an under-appreciated pandemic of mental illness that is sweeping across the world. Mental health issues in health care professionals have long since been identified to be a significant problem. Our experiences during previous similar epidemics have shown that such situations take a huge toll on the physical as well as mental health of personnel affected, either directly by infection or indirectly by the social and economic consequences of the pandemic. The health care worker may find him/herself in a very challenging situation, dealing simultaneously with multiple sources of stress in an ever-changing environment. These manifest in the form of serious mental issues such as depression, anxiety, stress, sleep disturbances, and posttraumatic stress disorder, to name a few. These can have a longlasting impact on the psychological makeup of the victims. We conducted this survey-based study to assess the prevalence of depression and anxiety among a wide range of personnel involved in health care, in different settings, working in the front line and nonfront line scenarios. Aims and objectives: To assess the prevalence of developing anxiety and depression among health care workers during the COVID-19 pandemic and to compare the prevalence thereof based on various factors such as occupation, pre-existing health issues, level of work, social background, working directly with infected patients. Materials and methods: Survey-based, prospective, observational cohort study including data collection over 1 month. The online survey was circulated as a Google Form and made available to all healthcare workers pan India. The study included the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) scale along with other personal information, gathered anonymously. The paired t-test and Mann- Whitney U-test were used to determine the statistical significance. Results: The mean age of the population was 39.9 years, with equal distribution among the sexes. 70% of subjects were married and 76% lived with their families. The commonest co-morbidities were hypertension (n = 66), obesity (n = 61), diabetes (n = 37). 60.4% had PG qualifications, 69.3% were treating physicians, and 49.4% were consultants. 90.3% worked in urban settings, 65.5% worked at the tertiary level. 37.4% worked directly with COVID-19 patients. 24.4% of respondents worked in ICU, 14.7% in OPD, 12% in ward settings. Gross prevalence of depression was 43% (mild: 22.6%, moderate 11.2%, moderate-severe 5.1%, severe: 3.9%). Prevalence of anxiety was 47% (mild 26%, moderate 13%, severe 7%). Depression was commoner among men (p = 0.04), those in a relationship (p = 0.00), those with children (p = 0.00) in older age groups, with higher positions and educational qualifications, and those with co-morbidities (p = 0.0). It was less prevalent in front-line workers, including physicians (p = 0.00). Among the front-line workers, depression and anxiety were more prevalent among physicians (p = 0.01). Depression was commoner in OPD and ED settings (p = 0.00), and less for people getting quarantine period (p = 0.00). Conclusion: Our survey shows a higher than average prevalence of anxiety and depression among health care workers in India as compared to non-pandemic periods. We have also identified groups that are at higher risk for mental health issues .