Mental health care 2.0.

While the COVID-19 pandemic has been a burden for our mental health, it also led to a surge in mental health care innovation. Appointments by telephone or video, as well as web- and app-based tools, have become part of a digital mental health revolution. Last year, US venture capitalists invested $5.1 billion in this area, a fivefold increase from 2019. But is this surge in activity actually leading to improvements for those with the greatest needs?

Barriers and facilitators to the integration of digital technologies in mental health systems: A protocol for a qualitative systematic review.

INTRODUCTION: Digital technology has the potential to improve health outcomes and health system performance in fragmented and under-funded mental health systems. Despite this potential, the integration of digital technology tools into mental health systems has been relatively poor. This is a protocol for a synthesis of qualitative evidence that will aim to determine the barriers and facilitators to integrating digital technologies in mental health systems and classify them in contextual domains at individual, organisational and system levels. METHODS AND ANALYSIS: The methodological framework for systematic review of qualitative evidence described in Lockwood et al. will be applied to this review. A draft search strategy was developed in collaboration with an experienced senior health research librarian. A systematic search of Medline, Embase, Scopus, PsycInfo, Web of Science and Google Scholar, as well as hand searching of reference lists and reviews will identify relevant studies for inclusion. Study selection will be carried out independently by two authors, with discrepancies resolved by consensus. The quality of selected studies will be assessed using JBI Critical Appraisal Checklist for Qualitative Research. Data will be charted using JBI QUARI Data Extraction Tool for Qualitative Research. Findings will be defined and classified both deductively in a priori conceptual framework and inductively by a thematic analysis. Results will be reported based on the Enhancing transparency in reporting the synthesis of qualitative research. The level of confidence of the findings will be assessed using GRADE-CERQual. ETHICS AND DISSEMINATION: This study does not require ethics approval. The systematic review will inform policy and practices around improving the integration of digital technologies into mental health care systems.

Acute mental health service use following onset of the COVID-19 pandemic in Ontario, Canada: a trend analysis.

BACKGROUND: The extent to which heightened distress during the COVID-19 pandemic translated to increases in severe mental health outcomes is unknown. We examined trends in psychiatric presentations to acute care settings in the first 12 months after onset of the pandemic. METHODS: This was a trends analysis of administrative population data in Ontario, Canada. We examined rates of hospitalizations and emergency department visits for mental health diagnoses overall and stratified by sex, age and diagnostic grouping (e.g., mood disorders, anxiety disorders, psychotic disorders), as well as visits for intentional self-injury for people aged 10 to 105 years, from January 2019 to March 2021. We used Joinpoint regression to identify significant inflection points after the onset of the pandemic in March 2020. RESULTS: Among the 12 968 100 people included in our analysis, rates of mental health-related hospitalizations and emergency department visits declined immediately after the onset of the pandemic (peak overall decline of 30% [hospitalizations] and 37% [emergency department visits] compared to April 2019) and returned to near prepandemic levels by March 2021. Compared to April 2019, visits for intentional self-injury declined by 33% and remained below prepandemic levels until March 2021. We observed the largest declines in service use among adolescents aged 14 to 17 years (55% decline in hospitalizations, 58% decline in emergency department visits) and 10 to 13 years (56% decline in self-injury), and for those with substance-related disorders (33% decline in emergency department visits) and anxiety disorders (61% decline in hospitalizations). INTERPRETATION: Contrary to expectations, the abrupt decline in acute mental health service use immediately after the onset of the pandemic and the return to near prepandemic levels that we observed suggest that changes and stressors in the first 12 months of the pandemic did not translate to increased service use. Continued surveillance of acute mental health service use is warranted.

Using a Patient Safety/Quality Improvement Model to Assess Telehealth for Psychiatry and Behavioral Health Services Among Special Populations During COVID-19 and Beyond.

Telehealth has been rapidly deployed in the environment of the Coronavirus 2019 (COVID-19) pandemic to help meet critical mental health needs. As systems of care use telehealth during the pandemic and evaluate the future of telehealth services beyond the crisis, a quality and safety framework may be useful in weighing important considerations for using telehealth to provide psychiatric and behavioral health services within special populations. Examining access to care, privacy, diversity, inclusivity, and sustainability of telehealth to meet behavioral and psychiatric care needs in geriatric and disadvantaged youth populations can help highlight key considerations for health care organizations in an increasingly electronic health care landscape.

A National Pediatric Telepsychiatry Curriculum for Graduate Medical Education and Continuing Medical Education.

Objectives: Our goal was to develop an open access nationally disseminated online curriculum for use in graduate and continuing medical education on the topic of pediatric telepsychiatry to enhance the uptake of telepsychiatry among child psychiatry training programs and improve access to mental health care for youth and families. Methods: Following Kern's 6-stage model of curriculum development, we identified a core problem, conducted a needs assessment, developed broad goals and measurable objectives in a competency-based model, and developed educational content and methods. The curriculum was reviewed by experts and feedback incorporated. Given the urgent need for such a curriculum due to the COVID-19 pandemic, the curriculum was immediately posted on the American Academy of Child and Adolescent Psychiatry and American Association of Directors of Psychiatric Residency Training websites. Further evaluation will be conducted over the next year. Results: The curriculum covers the six areas of core competence adapted for pediatric telepsychiatry and includes teaching content and resources, evaluation tools, and information about other resources. Conclusion: This online curriculum is available online and provides an important resource and set of standards for pediatric telepsychiatry training. Its online format allows for ongoing revision as the telepsychiatry landscape changes.

Implementation lessons from the transition to telehealth during COVID-19: a survey of clinicians and young people from youth mental health services.

Whilst telehealth may overcome some traditional barriers to care, successful implementation into service settings is scarce, particularly within youth mental health care. This study aimed to leverage the rapid implementation of telehealth due to COVID-19 to understand the perspectives of young people and clinicians on how telehealth impacts service delivery, service quality, and to develop pathways for future uses. Youth mental health service users (aged 12-25) and clinicians took part in an online survey exploring service provision, use, and quality following the adoption of telehealth. Service use data from the period were also examined. Ninety-two clinicians and 308 young people responded to the survey. Service use was reduced compared to the same period in 2019, however, attendance rates were higher. Across eight domains of service quality, the majority of young people reported that telehealth positively impacted service quality, and were significantly more likely to rate telehealth as having a positive impact on service quality than clinicians. There was high interest in continuing to use telehealth as part of care beyond the pandemic, supporting its permanent role in youth mental health care for a segment of service users. Future work should explore how best to support its long-term implementation.

Increased Australian outpatient private practice psychiatric care during the COVID-19 pandemic: usage of new MBS-telehealth item and face-to-face psychiatrist office-based services in Quarter 3, 2020.

OBJECTIVE: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists' uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July-September), 2020. We compare these to the same quarter in 2019. METHOD: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July-September), 2019, of face-to-face consultations for the whole of Australia. RESULTS: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15-30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations. CONCLUSIONS: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.

Psychiatry's Past Can Be Psychiatry's Future.

In the last half of the 20th century, psychiatry lost many of the conditions needed for unhindered practice. I compiled from searches of the literature the 20th century changes in the arenas of psychiatric practice and the sources of these changes. I determined how these changes are shaping 21st century health and well-being. The neglect of the severely mentally ill, first in Bedlams and now on Boulevards, reflects a wide loss of resources. Psychiatry's patients have lost a past of community-based mental health services, interdisciplinary care teams, preventive consultation with social agencies, and, with reimbursements targeted for 15-minute visits, time adequate with the physician to individualize diagnosis and treatment. With the Covid-19 and other epidemics, economic inequalities, an economic crisis, unrest over police violence, and racism, psychiatry can find in its past the resources to engage 21st century psychiatric and other problems.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

History of the future of proactive school psychology: Historical review at our 75th APA anniversary to transcend the past, excel in the present, and transform the future.

The purpose of this article was to historically review the field of school psychology for the 75th Anniversary of the founding of the Division of School Psychology (DSP) of the APA. Past and present proactive school psychology was evaluated and recommendations for the future were offered in light of historic APA DSP goals. Since its inception, the DSP has worked with APA to protect and expand school psychology as a foundational service area within health service psychology. This article examines the challenges in the field, highlights current issues, and calls for a proactive and transformational future. The article concludes with suggestions from history to adopt current approaches to emulate the transformative vision of proactive school psychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Diagnosis and treatment of post-traumatic stress disorder during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has caused unprecedented stress globally, and the associated medical and health-related traumatic experiences pose significant risks for the development of post-traumatic stress disorder (PTSD), and the exacerbation of pre-existing PTSD, among patients, general practitioners (GPs) and healthcare staff. OBJECTIVE: The aim of this article is to provide guidance to GPs and healthcare staff working in Australia about the diagnosis and treatment of both newly developed and pre-existing PTSD in the COVID-19 context. Case studies are presented; the authors discuss whether pandemic-related PTSD is different to PTSD caused by different types of traumatic exposure, and the associated implications for treatment. DISCUSSION: The role of GPs in the management of PTSD during the COVID-19 pandemic remains central, involving early detection, assessment and referral. Moreover, health professionals are not immune to the mental health effects of the pandemic and are encouraged to maintain their wellbeing and to seek professional treatment if needed.

Redesigning Public Mental Health Systems Post-COVID-19.

The COVID-19 pandemic has disrupted public mental health systems across the country, nowhere more than in New York State (NYS). The authors describe the NYS public health agency's response to the pandemic and offer ideas for redesigning public mental health systems post-COVID-19.

Editorial Perspective: Rethinking child and adolescent mental health care after COVID-19.

While COVID-19 pandemic has allegedly passed its first peak in most western countries, health systems are progressively adapting to the 'new normality'. In child and adolescent mental health services (CAMHS), such organizational envisioning is needed to cope with the foreseeable psychological effects of prolonged social isolation induced by nation-wide public health measures such as school closure. CAMHS need to ensure flexible responses to the psychopathological consequences of evolving societal dynamics, as dramatically actualized by the unexpected COVID-19 pandemic. This would imply (a) shifting the focus of intervention from symptom reduction and containment of acute crises in a comparatively small number of severe cases to a broader preventive strategy, guided by a gradient of increasing intensity and specificity of treatment; (b) promoting smooth access pathways into services and encouraging participation of families; (c) adopting a transdiagnostic staging model to capture the developmental fluctuations from subsyndromal to syndromal states and back, with related changes in the intensity of the need of care; and (d) implementing digital tools to encourage help-seeking and compliance by digitally native youth.