Stigma in Mental Health at the Macro and Micro Levels: Implications for Mental Health Consumers and Professionals.

Despite increasing mental health promotion and advocacy, stigma persists and poses a significant threat to the healthy functioning at the macro and micro-sociological levels. Stigma is gradually evolving with the incorporation of broader social contexts at the micro and macro levels in which individuals, institutions and larger cultural constructs shape and influence the perception of what is different and therefore stigmatized. This theoretical paper based on literature underscores how mental health stigma discourages individuals from getting proper mental health treatment. The interface of mental illness, stigma, and mental health treatment has ethical and potentially moral implications.

Involuntary Processes: Knowledge Base of Health Care Professionals in a Tertiary Medical Center in Upstate South Carolina.

The involuntary hospitalization law provides a means by which love ones, caregivers and healthcare professionals can intervene when a mentally ill patient is a danger to self or others. Our study assessed the knowledge of professionals in one of the Greenville Health System (GHS) emergency department (ED) about the involuntary hospitalization process of mental health patients in South Carolina (SC). An eight item survey on the South Carolina involuntary hospitalization and commitment process was developed and distributed to GHS ED staff including: physicians, physician assistants, nurse practitioners, nurses, social workers and technicians. Our findings indicated that the knowledge base is not consistent across healthcare discipline, nor is it sufficient given that most professionals achieved less than 50% correct response. This study has implications for ongoing education for ED healthcare workers which will be of significant importance to promote beneficence and to uphold the standards of patientcentered practice and compassionate medicine.

Mental Health Visits: Examining Socio-demographic and Diagnosis Trends in the Emergency Department by the Pediatric Population.

The emergency department (ED) is increasingly being used for mental health visits by children and adolescents. It is estimated that 21-23% of youth have a diagnosable psychiatric or substance use disorder. Using data from the ED of a tertiary medical center, we examined trends in mental health diagnoses over a 5-year period. In school age children the most prevalent diagnoses were anxiety disorders (28.4%); disorders first usually diagnosed in infancy, childhood, or adolescence (26.5%), and mood disorders (18.6%). High school students were more likely to visit the ED for anxiety disorders (30%). Females (34.5%) presented more for anxiety disorders compared to males (22.7%). Mental health visits and diagnoses were higher during school months (September-May) and lower in the summer months (June-August). The diagnosis trends identified in this study have clinical implications that can contribute to evidence-based restructuring of mental health resources and screenings.

The Impact of Mental Health Services in a Pediatric Emergency Department: The Implications of Having Trained Psychiatric Professionals.

OBJECTIVES: This study assessed improvement in the emergency department (ED) length of stay and costs after implementation of an ED program which added board-certified psychiatrists and trained psychiatric social workers to the pediatric ED. METHODS: A retrospective medical record and administrative data review were conducted for all pediatric psychiatric visits of children aged 5 to 18 years who were seen and discharged from the Greenville Memorial Hospital ED between January 1, 2007, and June 31, 2013. These subjects were diagnosed by the ED physician at the time of the visit using codes ranging from 290.0 to 319.0 based on the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. RESULTS: The mean (SD) age of children in the postprogram period (14.3 ± 3.1) was younger than during the preprogram period (14.9 ± 3.1) (P < 0.001) with the greatest increase in the 11- to 15-year age group (42% vs 35%, respectively). Patients in the postprogram period were significantly more likely to be discharged to a psychiatric hospital than during the pre-program period (18% vs 9%, respectively). After the initiation of the program, ED length of stay decreased significantly from 14.7 to 12.1 hours (P < 0.001) and costs per visit decreased slightly from US $602 to US $588 (this difference was not statistically significant). CONCLUSIONS: Although this model of care has significant costs associated with it, the efficiency of care for psychiatric pediatric patients in the ED improved after targeted training of ED staff and provision of these specialized services within the ED.

The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements.

In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to recommend specific dosage ranges for the acute and maintenance treatment of first-episode and multi-episode schizophrenia and to endorse the practice of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge, including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia.