Suicidal behavior in new patients presenting to the Telepsychiatry services in a Tertiary Care center: An exploratory study.

BACKGROUND: The COVID-19 pandemic has led to expansion of telepsychiatry services and formulation of telemedicine guidelines. However, the telemedicine guidelines are not very clear about psychiatric emergencies, such as suicidal behaviour, resulting in psychiatrists facing dilemma about handling such situations. AIM: To evaluate the prevalence of suicidal behaviour in new patients presenting to the Telepsychiatry services in a Tertiary Care centre. METHODS: 1065 new adult patients (aged > 18 years) registered with telepsychiatry services were assessed for suicidal behaviour, in the form of death wishes, suicidal ideations, plans, attempts (lifetime/recent) and non-suicidal self-injurious behaviour (NSSI) (lifetime/recent). RESULTS: In terms of suicidal behaviour, in the last few weeks prior to assessment 14.4% of the patients had death wishes, 2.4% had thoughts of killing themselves, 0.9% had attempted suicide in the lifetime and 0.6% in the last few weeks, 1.1% had active suicidal ideations at the time of assessment, 0.6% had active suicidal plan, 1.3% had history of NSSI in the lifetime and 0.5% had NSSI behaviour in the last few weeks. Based on the current suicidal behaviour, 1.3% of the patients were asked to report to the emergency immediately, 0.5% were given an appointment within 72 h for follow-up, and 14.4% were explained high risk management. CONCLUSIONS: Overall prevalence of suicidal behavior is relatively low in new patients seeking psychiatric help through telepsychiatry services.

Public mental health: required actions to address implementation failure in the context of COVID-19.

Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.

International professional practices in mental health, organization of psychiatric care, and COVID-19: A survey protocol.

OBJECTIVE: Our project aims to provide: an overview of the impact of the COVID-19 pandemic on the field of mental health professionals in 23 countries;a model of recommendations for good practice and proposals for methods and digital tools to improve the well-being at work of mental health professionals and the quality of services offered during crisis and post-crisis periods;an in-depth ethics review of the assessment of the use of numerical tools for psychiatry professionals and patient support, including teleconsulting. METHODS: This is a large international survey conducted among 2,000 mental health professionals in 23 countries over a 12-month period. This survey will be based on 30 individual interviews and 20 focus group sessions, and a digital questionnaire will be sent online to 2,000 professionals based on the criteria of gender, age, professional experience, psychiatric specialty, context of work in psychiatry, and geographical location. Regarding the development of telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital tools will be carried out on 100 clients of psychiatry professionals in France and Belgium. DISCUSSION-CONCLUSION: This study will contribute to the co-construction of an international organization and monitoring system that takes into account psychiatric health professionals as major resources to fight against the COVID-19 pandemic and to develop efficient processes for preparing and anticipating crises by reducing psychosocial risks as much as possible. This project also aims to design tools for remote medicine and to develop the use of numerical tools for monitoring and supporting professionals and helping professionals to build the conditions for satisfactory operational work during crises and post-crisis situations, using adapted organizational methods. Our ongoing research should support professionals in the search for existing concrete solutions to cope with emergency work situations while maintaining an optimal quality of life.

Behavioral Health in the Pandemic: Making the Shift from Mental Illness to Mental Well-Being.

SUMMARY: Fighting the global COVID-19 pandemic has shifted from immediate response efforts to recognition of the long-term effects on the mental health and well-being of the general population and healthcare workforce. Leaders need to understand the vital role of behavioral health services in a population-based, integrated healthcare framework and address the needs of the behavioral health workforce to successfully deploy services in their organizations and communities.During the ongoing national response to COVID-19, three major trends have emerged: (1) a shift to telehealth and digital care, (2) greater awareness of the impact on the workforce of the shift to digital care, and (3) an open dialogue to counteract the stigma and discrimination related to mental illness and to emphasize mental well-being instead. When they address stigma and discrimination, healthcare leaders embrace a more holistic approach that welcomes behavioral health professionals as equal, vital members of the care team. They help their organizations advance the mental well-being of all.

Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool.

Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.

The role of Colombian psychiatrists in the midst of the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic is having an impact on multiple levels, one being the way of providing mental health care services. A study was proposed in order to identify the standpoints regarding the role we must assume as psychiatrists in the setting of this pandemic in Colombia. METHODS: A study was developed employing a Delphi-type methodology. Three types of psychiatrist were included for the application of the instrument: directors of academic psychiatry programmes, directors of mental health institutions and private practitioners. RESULTS: Responses were collected over the course of a month (between April and May) by 24 participants corresponding to 14 private practitioners (58.3%), 6 heads of academic programmes (25.1%) and 4 directors of mental health services (16.6%). The results, grouped around the psychiatric work, describe the impact generated by the pandemic and the possible role of the specialist. CONCLUSIONS: Consistency was identified around the need to provide a differential approach according to the vulnerabilities of each group of people exposed to the pandemic; as well as the remote provision of health care through technology, often using videoconferencing.

Mental health interventions for college and university students during the COVID-19 pandemic: A critical synthesis of the literature.

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Mental Health Clinician Leaders in "Lockstep" as a Necessary Means to Address Care Challenges during the Pandemic.

Clinical environments that provide mental health and addictions care have been challenged during the COVID-19 pandemic due to health human resource shortages. This paper provides some insights gleaned from nurse and physician leaders working together during the pandemic in the mental health context to tackle some of these challenges. Key takeaways are provided.

Employing telehealth strategies for opioid addiction during COVID-19: implications for social work health care.

As the COVID-19 global pandemic continues, more than 40 states have reported increases in opioid-related mortality. The issue of service access and delivery poses a major concern for those struggling with mental illness and substance use disorders in the United States. To ensure the continuity of health care during the pandemic and the co-occurring opioid crisis, the United States continues to adapt its healthcare delivery strategies, which include the introduction of telehealth. Telehealth is a relatively new concept and requires rapid systems changes as well as adjustments from both service providers and recipients. The proper adaptation to the new service delivery method could result in process optimization and improved outcomes for those struggling with opioid dependency. This study aims to bring attention to the opioid crisis that may be overlooked in light of the global pandemic and encourage social workers and other mental health professionals to utilize modern technological advancements to improve service delivery to their clients. This paper offers a literature review with four themes: (1) a retrospect on pain and opioids, (2) current telehealth models and practical strategies, (3) social work roles and functions in telehealth care, and (4) next steps and implications of telehealth for social work as a much-needed health-care delivery tool at the clinical and community social work practice level.

Plan A, Plan B, and Plan C-OVID-19: adaptations for fly-in and fly-out mental health providers during COVID-19.

Mental health providers have rapidly pivoted their in-person practices to teletherapy and telehealth interventions to address the increased demand for mental health services during the COVID-19 crisis. The change to service delivery has emphasised challenges for mental health service providers, particularly in regions that rely on fly-in and fly-out (FIFO) mental health service providers who are no longer able to travel to their places of work. In this qualitative study, we examined the impact of COVID-19 on the delivery of mental health services in Inuit Nunangat. Using a participatory action research methodology, we conducted semi-structured interviews with eight FIFO mental health service providers to understand their experiences and implement strategies to effectively deliver mental health services in a pandemic. We identified three themes through thematic analysis: 1) Service providers identify the challenges in adapting their practices to meet individual and community needs; 2) Service providers recognise the opportunities for enhancements to service delivery; 3) Service providers identify telemental health services as a potentially effective adjunct to in-person sessions. The findings support reconceptualising post-pandemic mental health service delivery to include both face-to-face and telemental health services.

Supporting the Mental Health of Nurses through Digital Tools.

Absenteeism rates among nurses have increased across Canada over the last several years, with work environment challenges and staffing shortages being possible contributors. With the onset of the COVID-19 pandemic, nurses have worked under increasingly stressful conditions. Unsurprisingly, many nurses are facing mental health challenges. Digital tools to support and enhance access to mental health services are one strategy to support the mental health of nurses. This paper outlines the digital tools and virtual programs available to support the mental health of nurses, recognizing that there is no single solution to address the mental health challenges faced by Canadian nurses during these difficult times.

Letter to Editor. Polish recommendations for conducting online visits in psychiatric care. / List do Redakcji. Polskie rekomendacje w zakresie prowadzenia wizyt online w opiece psychiatrycznej.

no summary.

Mental health services during the first wave of the COVID-19 pandemic in Europe: Results from the EPA Ambassadors Survey and implications for clinical practice.

BACKGROUND: The COVID-19 pandemic caused an unprecedented worldwide crisis affecting several sectors, including health, social care, economy and society at large. The World Health Organisation has emphasized that mental health care should be considered as one of the core sectors within the overall COVID-19 health response. By March 2020, recommendations for the organization of mental health services across Europe have been developed by several national and international mental health professional associations. METHODS: The European Psychiatric Association (EPA) surveyed a large European sample of psychiatrists, namely the "EPA Ambassadors", on their clinical experience of the impact of COVID-19 pandemic on the treatment of psychiatric patients during the month of April 2020 in order to: a) identify and report the views and experiences of European psychiatrists; and b) represent and share these results with mental health policy makers at European level. Based on the recommendations issued by national psychiatric associations and on the results of our survey, we identified important organisational aspects of mental health care during the peak of the first wave of the COVID-19. RESULTS: While most of the recommendations followed the same principles, significant differences between countries emerged in service delivery, mainly relating to referrals to outpatients and for inpatient admission, assessments and treatment for people with mental disorders. Compared to previous months, the mean number of patients treated by psychiatrists in outpatient settings halved in April 2020. In the same period, the number of mentally ill patients tested for, or developing, COVID-19 was low. In most of countries, traditional face-to-face visits were replaced by online remote consultations. CONCLUSIONS: Based on our findings we recommend: 1) to implement professional guidelines into practice and harmonize psychiatric clinical practice across Europe; 2) to monitor the treatment outcomes of patients with COVID-19 and pre-existing mental disorders; 3) to keep psychiatric services active by using all available options (for example telepsychiatry); 4) to increase communication and cooperation between different health care providers.

The mental health of health workers in the pandemic.

Increased readiness to discuss sensitive topics will play a key role in alleviating the psychological stress on health workers responding to the coronavirus disease 2019 (COVID-19) pandemic. Andréia Azevedo Soares reports.

The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model.

BACKGROUND: Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. OBJECTIVE: This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. METHODS: A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health-related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre- and post-COVID-19 social and economic conditions. RESULTS: Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health-related ED presentations by 10.33% (95% interval 8.58%-12.19%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post-COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. CONCLUSIONS: The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed.