Situational vulnerability within mental healthcare - a qualitative analysis of ethical challenges during the COVID-19 pandemic.

BACKGROUND: Mental healthcare users and patients were described as a particularly vulnerable group in the debate on the burdens of the COVID-19 pandemic. Just what this means and what normative conclusions can be derived from it depend to a large extent on the underlying concept of vulnerability. While a traditional understanding locates vulnerability in the characteristics of social groups, a situational and dynamic approach considers how social structures produce vulnerable social positions. The situation of users and patients in different psychosocial settings during the COVID-19 pandemic has not yet been comprehensively considered and ethically analyzed under the aspect of situational vulnerability. METHODS: We present the results of a retrospective qualitative analysis of a survey of ethical challenges in different mental healthcare facilities of a large regional mental healthcare provider in Germany. We evaluate them ethically using a dynamic and situational understanding of vulnerability. RESULTS: Difficulties in implementing infection prevention measures, restrictions of mental health services in favor of infection prevention, social isolation, negative health effects on mental healthcare users and patients, and challenges in implementing regulations on state and provider levels within the local specificities emerged across different mental healthcare settings as ethically salient topics. CONCLUSIONS: Applying a situational and dynamic understanding of vulnerability allows the identification of specific factors and conditions that have contributed to an increased context-dependent vulnerability for mental healthcare users and patients. These factors and conditions should be considered on the level of state and local regulations to reduce and address vulnerability.

The Elephant in the Room: A Cross-Sectional Study on the Stressful Psychological Effects of the COVID-19 Pandemic in Mental Healthcare Workers.

Despite extensive research on COVID-19's impact on healthcare workers, few studies have targeted mental health workers (MHWs) and none have investigated previous traumatic events. We investigated psychological distress in MHWs after the first lockdown in Italy to understand which COVID-19, sociodemographic, and professional variables represented greater effects, and the role of previous trauma. The survey included sociodemographic and professional questions, COVID-19 variables, and the questionnaires Life Events Checklist for DSM-5 (LEC-5), Impact of Event Scale-Revised (IES-R), and Depression Anxiety Stress Scales 21 (DASS-21). On the 271 MHWs who completed the survey (73.1% female; mean age 45.37), we obtained significant effects for contagion fear, experience of patients' death, increased workload, and worse team relationship during the first wave. Nurses were more affected and showed more post-traumatic stress symptoms, assessed by IES-R, and more depressive, anxiety, and stress symptoms, assessed by DASS-21. The strongest risk factors for distress were greater age, professional role, increased workload, worse team relationship, and separation from family members. Previous experience of severe human suffering and unwanted sexual experiences negatively impacted IES-R and DASS-21 scores. Being a psychiatrist or psychologist/psychotherapist and good team relationships were protective factors. Recent but also previous severe stressful events might represent relevant risk factors for distress, reducing resilience skills. Identifying vulnerable factors and professional categories may help in the development of dedicated measures to prevent emotional burden and support psychological health. Highlights: Psychological distress in mental health workers in the COVID-19 pandemic is more frequent in nurses, who experience more depression, anxiety, and post-traumatic stress symptoms. Previous and recent stressful events are risk factors for distress and should guide intervention strategies.

Psychiatric ward lockdown in Latin America: Experiences from the coronavirus pandemic

The political leaders of many Latin American countries reacted too slowly to the threat of the coronavirus pandemic. The preventive lockdown of a specialized psychiatric hospital provides the context for discussing both practical challenges and issues related to the structural ordering of mental health services. The pandemic has brought to the fore several structural problems and the need for innovative practices. Psychiatric inpatient services in Latin America have many modalities, given the rich history and influences of psychiatry in this area of the world, as well as the complexity that many schools of mental healthcare and mental health politics around the world have brought to it. The French and German schools of psychiatry served as the foundations of modern mental healthcare in the southern Latin American countries, while the northern Latin American countries have deep roots in the American model of mental healthcare. While the background in which mental healthcare takes place is varied, the impact of the COVID pandemic in Latin American countries has many points in common that makes the containment of the COVID-19 infection a complex phenomenon in itself. This chapter will cover the pandemic experience in Colombia, Argentina, and Peru. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Work-related experiences of mental health professionals during COVID-19 pandemic: a qualitative study

The imposition of nation-wide lockdowns and sporadic transition to remote work produced unforeseen psychological challenges likely to impact the medium of care and workload of mental health professionals. The present study explored the lived occupational experiences of clinical psychologists, counsellors, and psychotherapists working in the National Health Service (NHS) and private practice in the UK during COVID-19 pandemic. Nineteen professionals (11 employed in the NHS and 8 working in independent settings) were interviewed about their professional experiences during first and second waves of the pandemic. Data were analysed using interpretative phenomenological analysis. Three main themes emerged from the analysis: (i) transition from face to face to online therapy;(ii) novel changes and wellbeing;and (iii) uncertain professional support in uncertain times. The findings suggest that lack of experience in providing online or telephonic psychotherapeutic services from home negatively impacted professionals' physical and psychological health and wellbeing. Thus, to cope with it, they availed psychological and structural support from colleagues, co-workers, clinical supervisors, managers, organisations, and professional bodies. This study adds to the existing body of research on the impact of the pandemic on UK-based mental health professionals and from an applied perspective, it highlights the need for skill-upgradation of professionals. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Telepsychology in Europe since COVID-19: How to Foster Social Telepresence?

All over the world, measures were taken to prevent the spread of COVID-19. Social distancing not only had a strong influence on mental health, but also on the organization of care systems. It changed existing practices, as we had to rapidly move from face-to-face contact to remote contact with patients. These changes have prompted research into the attitudes of mental healthcare professionals towards telepsychology. Several factors affect these attitudes: at the institutional and organizational level, but also the collective and personal experience of practitioners. This paper is based on an original European survey conducted by the EFPA (European Federation of Psychologists' Associations) Project Group on eHealth in 2020, which allowed to observe the variability in perceptions of telepsychology between countries and mental healthcare professionals. This study highlights different variables that contributed to the development of attitudes, such as motivations, acquired experience, or training. We found the "feeling of telepresence"-which consists of forgetting to some extent that we are at a distance, in feeling together-and social telepresence in particular as main determinants of the perception and the practice of telepsychology.

Mixed-reality-based human-animal interaction can relieve mental stress.

Introduction: Interacting with animals has been demonstrated to possess the healing benefits to humans. However, there are limitations in physical interaction due to COVID-19 and safety issues. Therefore, as an alternative, we created mixed-reality (MR)-based human-animal interaction (HAI) content and experimentally verified its effect on mental stress reduction. Methods: We created three types of interactive content: observing the movement of a non-reactive virtual cat, interacting with a virtual cat whose responses can be seen, and interacting with a virtual cat whose responses can be both seen and heard. The experiment was performed by 30 healthy young women, and a mental arithmetic task was used to induce mild mental stress before experiencing each content. During the experiment, the subject's electrocardiogram was continuously recorded, and the psychological state was evaluated through a questionnaire. Results: The results showed that MR-based virtual cat content significantly reduces mental stress and induces positive emotions after stressful situations. In particular, when the virtual cat provided audiovisual feedback, the activation amount of the parasympathetic nervous system and the increase of positive emotions were the greatest. Discussion: Based on this encouraging research result, this method should be further investigated to see if it can replace real HAI for human mental health management.

Mental health consequences of the COVID-19 pandemic: Results from a large-scale population-based study in Israel.

INTRODUCTION: Contemporary evidence notes the COVID-19 pandemic greatly impacted the utilization of physical and mental health services worldwide. The present study was therefore designed to evaluate the changes in the utilization of mental health services during the first year of the COVID-19 pandemic compared to previous years as well as to estimate the moderating role age had on these changes. MATERIALS AND METHODS: Psychiatric data was collected from n = 928,044 individuals living in Israel. Rates of receipt of psychiatric diagnoses and purchases of psychotropic medication were extracted for the first year of the COVID-19 pandemic and for two comparison years. The odds of receiving a diagnosis or of purchasing a psychotropic medication during the pandemic were compared to control years using uncontrolled logistic regression models and controlled and logistic regression that accounted for differences between ages. RESULTS: There was a general reduction of about 3-17% in the odds of receiving a psychiatric diagnosis or purchasing psychotropic medications during the pandemic year compared to control years. The bulk of tests conducted showed that reduction in the rates of receiving diagnoses and purchasing medications during the pandemic were evident or more profound in the older age groups. An analysis of a combined measure conclusive of all other measures revealed decreased rates of utilizing any service examined during 2020, with rates decreasing as age increases up to a decrease of 25% in the oldest age group (80-96). DISCUSSION AND CONCLUSION: Changes in utilization of mental health services reveal the interplay between psychological distress that has been documented to increase during the pandemic and people's reluctance to seek professional assistance. This appears to be especially prominent among the vulnerable elderly, who may have received even less professional help for their emerging distress. The results obtained in Israel are likely to be replicated in other countries as well, given the global impact of the pandemic on adults' mental health and individuals' readiness to utilize mental healthcare services. Future research on the long-term impact of the pandemic on utilization of mental healthcare services is warranted, with an emphasis on the response of different populations to emergency situations.

Integrating technology in mental healthcare practice: A repeated cross-sectional survey study on professionals' adoption of Digital Mental Health before and during COVID-19.

As a consequence of the outbreak of the COVID-19 global pandemic in the spring of 2020, large-scale social distancing measures were implemented, resulting in the forced adoption of online or digital forms of psychological treatment. This sudden transition to digital care offered a unique opportunity to investigate if and how this experience impacted mental healthcare professionals' perceptions and use of Digital Mental Health tools. The current paper presents findings of a repeated cross-sectional study consisting of three iterations of a national online survey in the Netherlands. This survey contained open and closed questions on professionals' adoption readiness, frequency of use, perceived competency, and perceived value of Digital Mental Health collected in 2019 (before the pandemic), in 2020 (after the first wave), and in 2021 (after the second wave). The inclusion of data gathered prior to the COVID-19 pandemic offers a unique window to assess how professionals' adoption has developed through this transition from voluntary to mandatory use of Digital Mental Health tools. Our study also re-assesses the drivers, barriers, and needs of mental healthcare professionals after having gained experience with Digital Mental Health. In total, 1,039 practitioners completed the surveys (Survey 1: n = 432, Survey 2: n = 363, and Survey 3: n = 244). Results indicate that compared to the period before the pandemic, there was a particularly large increase in use, competency, and perceived value regarding videoconferencing. Small differences were also found for some other basic tools that were crucial to ensure the continuation of care, such as e-mail, text messaging, and online screening, but not for more innovative technologies, such as virtual reality and biofeedback. Many practitioners reported to have gained skills regarding Digital Mental Health and experienced several benefits of it. They expressed the intention to continue with a blended approach, using Digital Mental Health tools in combination with face-to-face care, focused on situations in which they found it to have specific added value, such as when clients are unable to travel. Others were less satisfied with the technology-mediated interactions and remained more reluctant to future use of DMH. Implications for broader implementation of Digital Mental Health and future research are discussed.

Mental healthcare for young and adolescent LGBTQ+ individuals in the Indian subcontinent.

The coronavirus disease (COVID-19) pandemic has led to a significant change in the way healthcare is dispensed. During the pandemic, healthcare inequities were experienced by various sections of society, based on gender, ethnicity, and socioeconomic status. The LGBTQ individuals were also affected by this inequity. There is a lack of information on this topic especially in the developing countries. Hence this issue requires further exploration and understanding. Previous literature briefly explored the mental, physical, and emotional turmoil faced by the LGBTQ community on a regular basis. They feared rejection by family and friends, bullying, physical assault, and religious biases. These issues prevented them from publicly speaking about their sexual orientation thereby making it difficult to collect reliable data. Although they require medical and psychological treatment, they are afraid to ask for help and access healthcare and mental health services. Being mindful of these difficulties, this article explores the various underlying causes of the mental health problems faced by LGBTQ individuals, especially, in the Indian subcontinent. The article also examines the status of healthcare services available to Indian sexual minorities and provides recommendations about possible remedial measures to ensure the well-being of LGBTQ individuals.

The Impact of COVID-19 and Telehealth Services on Attrition Rates in Psychotherapy.

Attrition in psychotherapy has been identified as a significant obstacle in the productive delivery of mental health services. Defined generally as the ending of a treatment prior to proper optimal benefit, attrition both hinders treatment efficacy and costeffectiveness in therapy. With the demands for quality mental health services increasing, resources must be identified to reduce barriers to such services. The COVID-19 pandemic has resulted in the emergence of one potential resources: telehealth services. The current study aims to identify how COVID-19 and telehealth services have influenced attrition by analyzing attrition rates from both before and during the pandemic in a community health center where a transition to telehealth was made at the start of the pandemic. In addition, the variables of age, gender, socioeconomic status, and insurance coverage were also tested as potential predictors of attrition. Using de-identified patient information, clients who had participated in therapy services within a six-month period at a community health center (N = 329) were selected. A survival analysis was used to assess the time taken from initial appointment to the point of attrition. Results indicated that those who attended therapy via telehealth were less likely to stop attending treatment than those who participated in therapy in person. Individuals who used both in-person and telehealth visits were the least likely to terminate treatment prematurely. Clinical implications include the need for therapists to offer both telehealth and in-person services in order to give clients more resources to reduce a large barrier to needed mental healthcare treatment. Supplementary Information: The online version contains supplementary material available at 10.1007/s10591-023-09661-0.

Emotions in Mental Healthcare and Psychological Interventions: Towards an Inventive Emotions Recognition Framework Using AI

One of the major impacts of COVID-19 in the nations is mental health issues. Constant mental health issues can cause disorders, as well as mortality. The growing demand for mental healthcare treatment and limited healthcare resources across the world has shown the need for an inventive framework solution. Artificial Intelligence (AI), Big Data Science, 5G, and Information Communication Technology (ICT) have proven to be able to bring many great improvements and could be the potential way forward to develop such a framework. AI could be a very effective tool to help the healthcare sector to provide more efficient services to patients with mental health issues through their emotions. This paper presents the initial overview and outcomes of the ongoing research programme to develop a proactive multimodal emotion AI recognition framework that detects emotion from various input data sources for early detection of mental health illnesses, as well as provides the required psychological interventions effectively and promptly when required. The data will be collected from various smart wearables and ad-hoc devices, facial expressions, and speech signals. Then, these data will be interpreted using AI into emotions. These emotions will be utilised using AI-based psychological system, which will provide immediate and customized interventions, as well as transmit critical data to the healthcare provider's central database system for monitoring and supplying the required treatments. © 2022 The authors and IOS Press.

Smart Solutions to Keep Your Mental Balance.

Due to the coronavirus pandemic international conflicts, dramatic changes of daily living have been enforced, including new ways of providing patient assistance, based on artificial intelligence. The influence of these changes on people's mental health is still insufficiently analyzed and explored. Chatbots like Woebot, Wysa and Tess are gaining popularity, being attractive and easy to use. These achievements led us to develop a new application, being still in the testing phase, which has a positive impact on mental healthcare issues. It is a conversational system capable to diagnose people's negative, depressive, and anxious emotions during chatting, and to act as a psychological therapist and virtual friend. The proposed system, throughout the conversation, succeeds to decrease the patient's insecurity sentiments, by comforting their mood. In fact, an intelligent assistant for different mental health issues like stress, anxiety and depression, could become a very helpful information system.

Healthcare practitioners' views of comprehensive care to mental healthcare users in a community setting.

BACKGROUND:  Comprehensive care means ensuring quality services, protecting rights, promoting available social services and using protocols and standards that emphasise quality assurance for all mental healthcare users (MHCUs). It also involves advocacy, early detection and rehabilitation, as well as encouraging appropriate patient-centred care to ensure adequate psychiatric care. However, according to research, there is a vacuum in the provision of comprehensive mental healthcare to MHCUs. As a result, there is an immediate need to consult healthcare providers on providing comprehensive community-based care to MHCUs. OBJECTIVES:  The purpose of this study was to explore and describe the views of healthcare practitioners on the aspects that hinder providing comprehensive care for MHCUs, the role players needed to execute comprehensive care and what can be done to improve comprehensive care for MHCUs in the community setting in one of the subdistricts of the North West province (NWP), South Africa (SA). METHOD:  A qualitative research design that was exploratory, descriptive and contextual was adopted. The healthcare practitioners that took part in the study were chosen through purposive sampling. The sample size was established through data saturation, and 19 telephonic semistructured individual interviews were held with registered nurses and one medical doctor. Tesch's eight steps were used to analyse the data. RESULTS:  The four main themes identified were: (1) healthcare practitioners' understanding of comprehensive care to MHCUs, (2) factors hindering comprehensive care to MHCUs, (3) stakeholders needed for providing comprehensive care to MHCUs and (4) suggestions for improving comprehensive care to MHCUs. CONCLUSION:  Healthcare practitioners in the community advocate for the need for comprehensive psychiatric treatment. They are of the view that greater coordination of psychiatric services will improve mental treatment and minimise relapse in MHCUs. To sustain integrated psychiatry, stakeholders and other psychiatric programmes must be included.Contribution: The findings and conclusions of this study indicated that improvement is needed in mental healthcare in general, and all relevant aspects to improve comprehensive care among MHCUs in a community setting should be given full attention.

Analysis of the utilization, processes, and outcomes of inpatient mental healthcare during the first three waves of the COVID-19 pandemic in the federal state of North Rhine-Westphalia, Germany.

Background: During the first phase of the Coronavirus-19 disorder (COVID-19) pandemic in the spring of 2020, utilization of inpatient mental healthcare was significantly reduced. We now report on a long-term observational study of inpatient mental healthcare in a large psychiatric hospital association in North Rhine-Westphalia, Germany, covering the second and third pandemic waves of autumn and winter 2020 followed up until June 2021. Objectives: Analysis of the changes of inpatient and day patient mental healthcare utilization in an association of psychiatric hospitals during the COVID-19 pandemic from January 2020 until June 2021. Materials and methods: We used the statistics database of the association of the nine psychiatric hospitals of the Rhineland Regional Council (Landschaftsverband Rheinland, LVR). We compared the case numbers of the pandemic period with previous years and analyzed changes in the diagnostic spectrum, rates of coercion and therapeutic outcomes. We also analyzed age, gender, diagnoses and coercive measures of patients tested positive for COVID-19 during inpatient psychiatric healthcare. Results: Case rates were reduced during and after the COVID-19 pandemic episodes of 2020 and the following months of spring and summer 2021. Changes varied between diagnostic groups, and there were even increases of case numbers for acute psychotic disorders. Coercive measures increased during the pandemic, but therapeutic outcomes were maintained at the pre-pandemic level. Women and patients of higher ages were overrepresented among psychiatric inpatients with COVID-19. Conclusion: The COVID-19 pandemic led to over during reductions of inpatient psychiatric hospital admissions and changes of the diagnostic spectrum accompanied by increased rates of coercive measures. These effects may reflect an overall increased severity of mental disorders during the COVID-19 pandemic, deferrals of inpatient admissions or a lack of outpatient mental healthcare services utilization. To differentiate and quantitate these potential factors, further studies in the general population and in the different mental healthcare sectors are needed. In order to reduce the number of COVID-19 cases in psychiatric hospitals, vaccination of people of higher ages and with dementias seem to be the most needed strategy.

Physical and psychological (in)stability in extreme situations: physics models for understanding health stability

Introduction: The COVID-19 pandemic has shown how quickly and drastically everyday life can change in extreme situations. Objective(s): To investigate how external factors can affect human health - mentally and physically - and what indicators herald the proximity to a critical upheaval. Method(s): Using theories from theoretical physics and psychology, researchers from Heidelberg University and Karlsruhe Institute of Technology will observe emotional reaction via an 'infinitesimal stimulus' (f) to an image that gives the 'infinitesimal displacement' (d). While both the stimulus and the reaction are chosen to be small - and hence keep a person well within their emotional stability - the ratio (d/f ) provides us a quantitative measure of the individual's susceptibility i.e. reaction sensitivity. Over a six-month phase, we hope to correlate the individual susceptibility with the person's general emotional state and to define a threshold reaction to indicate a person's proximity to an emotional instability. Semistructured interviews of extreme cases give us further insight into correlations between emotional states and susceptibility. Result(s): If an increased susceptibility in an individual actually precedes a long-term change in mood, then regular susceptibility measurements can be used, for instance, to detect depression at an early stage. We are particularly curious to observe the extent to which models from physics can be applied to society and the individual. Conclusion(s): The final output is to integrate practical implementation aspects into the medical curricula in a transdisciplinary manner. If possible, a formula for understanding health stability should be formulated that would be highly innovative for the medical field.

The elephant in the room: the stressful psychological effects of COVID-19 pandemic in mental healthcare workers

Introduction: Despite the large amount of research concerning the impact of COVID-19 on health care workers, to date few targeted MHWs. Moreover, none has investigated the vulnerability due to exposure to previous traumatic events among health care workers. Objective(s): This study aimed to investigate the psychological distress in MHWs after the first lockdown imposed by the COVID-19 pandemic in the more impacted regions of the North of Italy, to understand which COVID-19, sociodemographic and professional variables as well as previous stressful life experiences, could have had greater negative effects. Method(s): The online survey occurred from 28-June to 10-August 2020. This included questions regarding sociodemographic factors, professional information, COVID-19 exposure. Moreover, three validated self-report questionnaires were administered: Life Events Checklist for DSM-5 (LEC-5), Impact of Event Scale-Revised (IESR), Depression Anxiety Stress Scales-21 (DASS-21). Result(s): 271 MHWs completed the survey. At least 20% had elevated levels of psychological distress with post-traumatic symptoms. Stratifying for professional roles, the nurses resulted the most affected, with significantly higher scores in terms of intrusive thoughts, hyperarousal and avoidance behaviors. Several variables affected psychological distress in MHWs, but stronger effects were done by age, professional roles, increased workload and worst working environment during COVID-19 pandemic, to had experienced the separation of family members, but also had experienced during their life of a severe human suffering (physical and/or psychological) on oneself or on a loved one. Conclusion(s): Our data underlying the importance of recent but also previous severe stressful events as risk factors to develop post-traumatic symptoms reducing the resilience of the subjects investigated.

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.

Mental Health and Perceived Awareness of the South Asian Indian Community during the COVID-19 Pandemic: A Systematic Review of Findings

The scope of the United Nations Development Programme (2019) emphasizes combating adaptive challenges, building resilience, and sustainability. This systematic review offers a range of perspectives through an in-depth overview of existing literature on the coronavirus disease 2019 (COVID-19) pandemic and the psychological impact it is having on the South Asian community in India. The selected studies focused on COVID-19 were mixed;however, the consensus among articles had themes relating to fear, stress, and anxiety. The results yielded 17 unique articles. Overall, the review supports the understanding of challenges related to mental healthcare and the attitudes and awareness of South Asians toward the COVID-19 pandemic. This review aims to assist healthcare providers to be better informed on the impact of COVID-19 on South Asians. © 2022 Hogrefe Publishing.