How to Mitigate the Mental Health Care Consequences of the COVID-19 Financial Crisis.

The COVID-19 pandemic has led to record unemployment claims and a weakened U.S. economy. This column reviews results of past research to examine how a recession might affect behavioral health and the treatment of mental and substance use disorders and suggests potential policy solutions. Despite increases in suicide and substance use, losses in employment-related health insurance could dampen treatment seeking. Federal, state, and local officials should be vigilant regarding suicide prevention. Individuals who lose employee insurance coverage should be protected through insurance marketplaces and Medicaid outreach and enrollment. Public and private coverage of telehealth, which has already been expanded, should continue beyond the pandemic. Federal support for community behavioral health organizations should continue to offset state and local budget cuts and ensure provision of needed treatment. The capacity of social services should be expanded as well as systems that facilitate client connection to social services.

[Psychosocial Emergency Care After the Death of a Parent: Guidelines for Dealing with Affected Children]. / Psychosoziale Notfallversorgung nach dem Tod eines Elternteils: Leitlinien für den Umgang mit betroffenen Kindern.

Psychosocial Emergency Care After the Death of a Parent: Guidelines for Dealing with Affected Children Does psychosocial emergency care after parental death affect children's mental health? Or do affected children consider psychosocial emergency care useful at all? And what do children really want in this situation? Against the background of these questions, data were collected both qualitatively and quantitatively from a sample of 35 affected children and adolescents. The results show no mental health differences between groups (children with PSNV, n = 11 and children without PSNV, n = 24). Nevertheless, affected children appear to evaluate psychosocial emergency care after parental death positively. The derived guidelines therefore represent a further step towards psychosocial emergency care adapted to the needs of children and can therefore serve as orientation for practice.

Integrating Pastoral and Clinical Identities: A Narrative Inquiry of Pastoral Counselors.

Narrative inquiry methodology was used to understand the lived experiences of two ordained pastoral counselors who obtained licensure as clinical mental health professionals, particularly in terms of their identity development and integration of pastoral and clinical identities. Data analysis from semi-structured interviews revealed rich experiences with five themes: the journey; God's call; self and identity; the role of mentors; and relationships. Implications for research and practice associated with pastoral counseling and counselor education are discussed.

Strategies to destigmatize mental illness in South Africa: Social work perspective.

Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers' perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.

Mala praxis en psiquiatría / Mal practice in psychiatry

La responsabilidad profesional médica (RPM) es la obligación de reparar las consecuencias de los actos profesionales y las omisiones que hayan causado un daño o perjuicio, ya sea por no haber puesto los medios necesarios o el cuidado adecuado en la asistencia a un paciente, ya sea por negligencia en su conducta o por incumplimiento de la lexartis. Actualmente, la lexartis ad hoc constituye el criterio para valorar la corrección de un acto médico concreto ejecutado por el médico. El interés y preocupación por la RPM son a la vez una problemática antigua y actual y en respuesta a dicha preocupación, desde hace años se dedican grandes esfuerzos a la denominada Seguridad Clínica. La Psiquiatría posee una serie de características específicas que deben tenerse en cuenta a la hora de valorar dicha RPM. La Psiquiatría tiene un riesgo muy bajo de reclamación y el porcentaje de casos en los que se considera probada la existencia de responsabilidad resulta igualmente bajo, pero existen ciertas actuaciones específicas que deben abordarse para la mejora de la seguridad clínica

Medical professional liability (MPL) is the duty to repair the consequences of professional acts and omissions that caused injury or prejudice either for failing means necessary or proper care in assisting a patient, whether they performed a negligent conduct or breached the lex artis. Currently, the lexartis ad hoc is the criterion for assessing the correctness of a particular medical procedure performed by the physician. The interest and concerns for the MPL are both ancient and current problems and in response to this concern, great efforts have been made regarding Clinical Safety. Psychiatry has a number of specific characteristics that must be taken into account when assessing this MPL. Psychiatry has a very low risk of claim and the percentage of cases in which responsibility is considered proven is equally low, but there are some specific actions to be taken to improve clinical safety in Psychiatry

Integrity of evidence-based practice: are providers modifying practice content or practice sequencing?

This study examined patterns of evidence-based treatment (EBT) implementation within community settings by evaluating integrity along separate dimensions of practice content (PC; a session included the prescribed procedure) and practice sequencing (a session occurred in the prescribed sequence) within a recent randomized effectiveness trial. We measured whether sessions showed integrity to PC and to flexible or linear practice sequences. Findings revealed that providers tended to incorporate content from the EBT protocol in most treatment sessions, but that the sequencing of the sessions was often modified, suggesting that providers are amenable to evidence-based procedures, but not necessarily their prescribed arrangement.

Community navigation to reduce institutional recidivism and promote recovery: initial evaluation of opening doors to recovery in Southeast Georgia.

New approaches for preventing repeated inpatient psychiatric stays, detention in jails and prisons, and homelessness among individuals with serious mental illnesses with established histories of such recidivism, while promoting recovery, are direly needed. We present findings from an initial program evaluation of a new community-based, recovery-oriented "community navigation" program in southeast Georgia, called Opening Doors to Recovery. Twenty-three in-depth interviews were conducted with key stakeholders, program participants, community navigation specialist team members, and referring mental health professionals to identify hopes and strengths, challenges and weaknesses, and recommendations pertaining to the new program. Cited strengths included teamwork and pooling of resources from various partners, as well as the novel recovery-based, community navigation team approach. An initial lack of fidelity processes across teams and an ongoing scarcity of safe and affordable housing were identified as weaknesses, with the latter seen as a liability of the overall mental health and social service systems rather than the program itself. Findings from this evaluation highlight strengths and opportunities of this new community navigation approach, including those related to the involvement of certified peer specialists and multiple community partners.

Implementation of the care programme approach across health and social services for dual diagnosis clients.

BACKGROUND: Care for clients with mental health problems and concurrent intellectual disability (dual diagnosis) is currently expected to be provided through the care programme approach (CPA), an approach to provide care to people with mental health problems in secondary mental health services. When CPA was originally introduced into UK mental health services in the 1990s, its implementation was slow and problematic, being hampered in part by problems occurring at a strategic level as health and social service organizations attempted to integrate complex systems. This article reports on a study of a more recent attempt to implement CPA for dual diagnosis clients in one mental health foundation trust, aiming to gauge progress and identify factors at the strategic level that were helping or hindering progress this time round. METHODS: The study took place in a mental health National Health Service (NHS) Foundation Trust in a large English city, which was implementing a joint mental health and intellectual disability CPA policy across five of its constituent boroughs. Semi-structured interviews with key informants at Trust and borough levels focused on the Trust's overall strategy for implementing CPA and on how it was being put into practice at the front line. Documentary analysis and the administration of the Partnership Assessment Tool were also undertaken. Data were analysed using a framework approach. RESULTS: Progress in implementing CPA varied but overall was extremely limited in all the boroughs. The study identified six key contextual challenges that significantly hindered the implementation progress. These included organizational complexity; arrangements for governance and accountability; competing priorities; financial constraints; high staff turnover and complex information and IT systems. The only element of policy linked to CPA that had been widely taken up was the Greenlight Framework and Audit Toolkit (GLTK). The fact that the toolkit had targets and penalties associated with its implementation appeared to have given it priority. CONCLUSION: None of the contextual challenges identified in this study were specifically related to CPA as a policy or to the needs and circumstances of dual diagnosis clients. Nevertheless, they inhibited the types of organizational change and partnership working that implementing CPA for a client group of this kind required. Unless these more generic factors are acknowledged and addressed when introducing policies such as CPA, the chances of effective implementation will inevitably be compromised.

The development of recovery competencies for in-patient mental health providers working with people with serious mental illness.

Delivering recovery-oriented services is particularly challenging in in-patient settings. The purpose of this study was to identify the most salient recovery competencies required of in-patient providers. Established methods for the development of competencies were used. Data collection included interviews with multiple stakeholders and a literature review. Data analysis focused on understanding how characteristics of the in-patient context influence recovery-enabling service delivery and the competencies associated with addressing these issues. Eight core competencies with four to ten sub-competencies were identified based on a tension-practice-consequence model. The competency framework can serve as a tool for tailoring workforce education.

Social network analysis of child and adult interorganizational connections.

OBJECTIVE: Because most programs serve either children and their families or adults, a critical component of service and treatment continuity in mental health and related services for individuals transitioning into adulthood (ages 14-25) is coordination across programs on either side of the adult age divide. METHODS: This study was conducted in Clark County, Washington, a community that had received a Partnership for Youth Transition grant from the Federal Center for Mental Health Services. Social Network Analysis methodology was used to describe the strength and direction of each organization's relationship to other organizations in the transition network. Interviews were conducted before grant implementation (n=103) and again four years later (n=99). RESULTS: The findings of the study revealed significant changes in the nature of relationships between organizations over time. While the overall density of the transition service network remained stable, specific ways of connecting did change. Some activities became more decentralized while others became more inclusive as evidenced by the increase in size of the largest K-core. This was particularly true for the activity of "receiving referrals." These changes reflected more direct contact between child and adult serving organizations. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The two separate child and adult systems identified at baseline appeared more integrated by the end of the grant period. Having greater connectivity among all organizations regardless of ages served should benefit youth and young adults of transition age. This study provides further evidence that Social Network Analysis is a useful method for measuring change in service system integration over time.

'Doing things differently'--working towards distributed responsibility within memory assessment services.

OBJECTIVES: To compare initial diagnostic hypotheses made by Allied Health Professionals (AHP) (mental health nurses, occupational therapists and social workers) with subsequent formal multidisciplinary formulation based upon the full possession of investigations, neuropsychological tests and brain imaging. Design Prospective analysis. DESIGN: Prospective analysis. SETTING: Home-based assessments, secondary care based multidisciplinary memory clinic. PARTICIPANTS: 90 consecutive referrals over a 3-month period. RESULTS: Fifty eight patients (64.4%) were diagnosed by the multi-disciplinary team as having a dementia. Twenty (34%) were classified as Alzheimer's disease, 28 (49%) of mixed sub-type and 9 (16%) of vascular origin. Together, AHP's were able to detect dementia with 91% accuracy (Kappa 0.81) sensitivity was 0.88 and specificity 0.97. The diagnostic accuracy for each professional group ranged from 88% to 93% (Kappa 74-90%). CONCLUSIONS: In this study, structured initial assessment by AHP's working in a Memory Assessment Service was shown to be an accurate method of determining a diagnosis of cognitive impairment, when compared with formal MDT judgment. It is suggested that such distributed responsibility affords a viable option for the future detection of early dementia.

Guidelines across the health and social care divides: the example of the NICE-SCIE dementia guideline.

Increasingly, mental health services are delivered through multidisciplinary teams and settings. This creates particular challenges for the development of evidence-based practice guidelines when different professional groups represented within teams might have different traditions and cultures in relation to what counts as 'evidence', and how that might be synthesized to produce guidance that supports best practice across professional divides. These challenges are explored in relation to integration between health and social care services, where social work in particular has traditionally expressed scepticism about guideline development where it does not incorporate knowledge drawn from qualitative research and perspectives of stakeholders such as service users and carers. This article takes the NICE-SCIE guideline on dementia care as an exemplar of how an integrated process of guideline development can deliver guidance for best practice across integrated mental health services. Finally, some of the issues still facing inter-professional guideline development are considered, and pointers given to eclectic approaches that are beginning to emerge from within social work.

Integrating mental health parity for homebound older adults under the medicare home health care benefit.

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.

Culture-sensitive therapy and salutogenesis: treating Israeli Bedouin of the Negev.

The Salutogenesis theory and its essential component, the sense of coherence (SOC) is an epigenetic concept. The SOC was defined as a 'way of being in the world'. As such it is most important that one's SOC will be intact for healthy mental status. Collisions between western and non-western cultures might interfere in the process of psychiatric and psychotherapeutic treatment. This review demonstrates the importance of a culture-sensitive approach and therapy and the usefulness of specific culture-sensitive services for certain non-western populations. We illustrate this approach by giving the example of the unique ways of treatment carried out among the Bedouin of the Negev region of Israel.

[The medical social characteristic of patients with psychic disorders addressed to medical institutions with various forms of property].

The article deals with the issues of enhancement of the psychiatric service. The analysis of the results of medical social study of the patients addressed for the medical care to public and commercial structures is given. The substantiation of necessity in enhancing the quality and effectiveness of out-patient psychiatric care service are presented and the various alternative models of its development as well.

[Psychological support for socially vulnerable people in the context of a periodic health examination]. / Soutien psychologique chez des personnes en fragilité sociale dans le cadre d'un examen périodique de santé.

Social vulnerability often leads to the expression of psychological distress. The Health Examination Center of Côtes d'Armor, in Quimper, experimented with the development and implementation of psychological counseling for a highly socio-economically vulnerable population. As part of a periodic health examination, the center offers psychological counseling to patients with pathological sleep disorders and who lack sufficient psychological support. The Health Examination Center's framework and the context of the periodic health examination have facilitated the establishment of a tailored non-stigmatizing intervention well-embedded within the institutional environment. Marginalized people in situations of psychological distress are offered an opportunity to be listened to, and to receive counseling, appropriate prevention services and access to care.

Deprofessionalization or postprofessionalization? Reflections on the state of social work as a profession.

Recent literature considering the state of the social work profession has primarily focused on concerns about deprofessionalization. This article provides an overview of the literature on professionalization and professional decline in order to situate the social work profession within a broader context. The article then describes the emergence of a new role for social workers in Canada that crosses the boundaries between clinical, managerial, and legal aspects of client care in the area of mental health forensics. It is argued that the future of social work's professionalization project around the world may not be as bleak as has been portrayed in the literature.

Have broad-based community and professional education programs influenced mental health literacy and treatment seeking of those with major depression and suicidal ideation?

Mental health literacy is the knowledge and beliefs about mental disorders that aid in their recognition, management, or prevention; it is also a determinant of help seeking. As such, it is presumed to be important in community suicide prevention programs. In Australia there have been a number of government, professional, and charitable organizations as well as pharmaceutical company suicide prevention initiatives which have been designed to enhance public and professional knowledge about mental disorders, particularly depression. This naturalistic study conducted between 1998 and 2004 in a random and representative population sample examined the changes in mental health literacy and treatment seeking of those with major depression, both with and without suicidal ideation, and those who were neither depressed nor suicidal. Results indicated that there was marked improvement in mental health literacy for all three groups, although there was less change for those most in need of intervention (i.e., those with major depression and suicidal ideation). Furthermore, there were fewer changes in appropriate treatment seeking in those with major depression and suicidal ideation. These findings are consistent with literature reporting limited problem solving and decision making in those who are suicidal, and indicate that there are limits to broadbased community education programs. More focused suicide prevention initiatives are required, specifically for those who are depressed and suicidal.