Category: Mental Health

Is More Clarification is Needed of Mental Health Practitioner’s Engagement Experiences in Early Intervention Settings?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Mental Health Practitioner Experiences of Engaging With Service Users in Community Mental Health Settings: A Systematic Review and Thematic Synthesis of Qualitative Evidence.

What is Known on the Subject?

Engagement is regarded as important and beneficial for service users and mental health services A universal definition of engagement is not yet fully agreed upon.

What this paper adds to existing knowledge?

Based upon their experience, mental health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users). Mental health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users.

What are the implications for practice?

Irrespective of professional background, the role of community mental health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement. Little is known about the engagement experiences of mental health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community mental health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings. Role descriptions and expectations of community mental health workers should account for the wide-ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes.

Background

Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals’ experiences and understanding of effective engagement have been published.

This review aimed to systematically identify, evaluate and synthesise results from these studies with a view to informing effective practice in this area.

Methods

Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners’ experiences of engagement in community mental health settings was conducted.

Results

Mental health practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualised person-centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users.

Conclusions

As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner’s engagement experiences in early intervention settings.

Reference

Henderson, P., Fisher, N.R., Ball, J. & Sellwood, W. (2020) Mental Health Practitioner Experiences of Engaging With Service Users in Community Mental Health Settings: A Systematic Review and Thematic Synthesis of Qualitative Evidence. Journal of Psychiatric and Mental Health Nursing. doi: 10.1111/jpm.12628. Online ahead of print.

Mental Health and Stress in Humanitarian Expatriates.

Published on by Andrew Marshall1 Comment

Research Paper Title

Mental Health and Stress in Humanitarian Expatriates.

Background

Humanitarian work is stressful and can have an impact on the mental health of humanitarian expatriates.

In order to reduce stress and its consequences, humanitarian organisations are implementing various measures to keep their staff healthy.

Humanitarian workers, on the other hand, must take care of themselves and apply self-protection mechanisms. Most humanitarian workers are doing well.

The treating doctor plays a key role in detecting people and behaviour at risk. they encourage the expatriate to use their resources and provide the adequate support and medical follow-up if necessary.

Collaboration with the staff health units of humanitarian organisations allows for optimal care of humanitarian workers’ medical conditions.

Reference

Perone, S.A., BAvarel, M., Suzic, D. & Chappuis, F. (2020) [Mental Health and Stress in Humanitarian Expatriates] [Article in French]. Revue Medicale Suisse. 16(693), pp.993-997.

What are the Perceptions of Mental Health and Perceived Barriers to Mental Health Help-Seeking Amongst Refugees?

Published on by Andrew Marshall1 Comment

Research Paper Title

Perceptions of Mental Health and Perceived Barriers to Mental Health Help-Seeking Amongst Refugees: A Systematic Review.

Background

Despite elevated rates of psychological disorders amongst individuals from a refugee background, levels of mental health help-seeking in these populations are low.

There is an urgent need to understand the key barriers that prevent refugees and asylum-seekers from accessing help for psychological symptoms.

This review synthesises literature examining perceptions of mental health and barriers to mental health help-seeking in individuals from a refugee background.

The researchers analysis, which complies with PRISMA reporting guidelines, identified 62 relevant studies.

Methods

Data extraction and thematic analytic techniques were used to synthesise findings from quantitative (n = 26) and qualitative (n = 40) studies.

Results

They found that the salient barriers to help-seeking were:

  • Cultural barriers, including mental health stigma and knowledge of dominant models of mental health;
  • Structural barriers, including financial strain, language proficiency, unstable accommodation, and a lack of understanding of how to access services, and
  • Barriers specific to the refugee experience, including immigration status, a lack of trust in authority figures and concerns about confidentiality.

Conclusions

The researchers discuss and contextualise these key themes and consider how these findings can inform the development of policies and programmes to increase treatment uptake and ultimately reduce the mental health burden amongst refugees and asylum-seekers.

Reference

Byrow, Y., Pajak, R., Specker, P. & Nickerson, A. (2020) Perceptions of Mental Health and Perceived Barriers to Mental Health Help-Seeking Amongst Refugees: A Systematic Review. Clinical Psychology Review. 75:101812. doi: 10.1016/j.cpr.2019.101812. Epub 2019 Dec 24.

Inclusion & Paternal Mental Health

Published on by Andrew Marshall1 Comment

Research Paper Title

Paternal Mental Health During the Perinatal Period: A Qualitative Systematic Review.

Background

To examine fathers’ experiences and needs associated with mental health during the perinatal period.

Qualitative studies were meta-synthesised using the steps outlined by Sandelowski and Barroso.

Six databases (PubMed, Embase, PsycINFO, CINAHL, Scopus and ProQuest) were searched for qualitative studies from each database’s inception to 24 June 2019.

Methods

Studies were critically appraised using the Critical Appraisal Skills Programme tool. Qualitative data were extracted, meta-summarised, then meta-synthesised.

Results

Fourteen studies were included and four themes were identified:

  1. Negative feelings and psychological difficulties;
  2. Role strain and role conflict with multiple sources;
  3. Coping strategies that buffered negative feelings and psychological difficulties; and
  4. Support needs to enhance mental health.

Conclusions

Fathers reported poor mental health and expressed needs to enhance their mental health across the perinatal period. Future studies can focus specifically on paternal mental health. The development of theory-guided, family inclusive, technology-based healthcare services are needed to manage mental health. Healthcare providers can promote positive mental health to prepare fathers, increasing their awareness to manage their mental health and to seek timely help.

Impact

Problem-focused coping (i.e. support and problem-solving with partners and childcare involvement) helped fathers to buffer their negative feelings and psychological difficulties. Future studies should focus on paternal mental health rather than on general fathering experiences. Healthcare providers should focus on promoting positive mental health and well-being. Policymakers should create awareness on paternal mental health across the perinatal period.

Reference

Shorey, S. & Chan. V. (2020) Paternal Mental Health During the Perinatal Period: A Qualitative Systematic Review. Journal of Advanced Nursing. 76(6), pp.1307-1319. doi: 10.1111/jan.14325. Epub 2020 Feb 25.

Primary Healthcare & Categories of Mental Health Programmes

Published on by Andrew MarshallLeave a comment

Research Paper Title

Innovative Mental Health Initiatives in India: A Scope for Strengthening Primary Healthcare Services.

Background

Mental health burden is a major health concern worldwide.

In the last few decades, we are witnessing innovations that are successfully addressing gaps in the mental health service delivery in Indian context.

This is an opportune time to explore existing innovative mental health initiatives in the country and integrate viable interventions to primary healthcare facilities to strengthen public mental healthcare delivery.

Methods

A descriptive review of literature on innovative mental health programs in India was carried out.

The initial search from google scholar and PubMed database yielded 1152 articles, of which 1,114 were excluded that did not meet inclusion criteria.

Full texts of 38 articles were reviewed and finally 22 studies were included for the study.

Results

Based on the review, most innovations are broadly summarised into five categories:

  1. Quality improvement mental health programmes;
  2. Community-based mental health programmes;
  3. Non-specialist mental health programmes;
  4. Mobile technology-based mental health programmes; and
  5. Tele-mental health programmes.

These promising innovations in treatment and care can be customised as per the context for scale up and integrated into the primary healthcare system through the District Mental Health Programme.

Conclusions

The innovative approach not only makes mental health services more accessible and affordable but also empowering in nature by encouraging community members in early detection, prevention of mental illness and appropriate treatment referral to existing primary health care services.

Reference

Pandya, A., Shah, K., Chauhan, A. & Saha, S. (2020) Innovative Mental Health Initiatives in India: A Scope for Strengthening Primary Healthcare Services. Journal of Family Medicine and Primary Care. 9(2), pp.502-507. doi: 10.4103/jfmpc.jfmpc_977_19. eCollection 2020 Feb.

What Does Mental Health Have to Do With Well-Being?

Published on by Andrew Marshall1 Comment

Research Paper Title

What Does Mental Health Have to Do With Well-Being?

Background

Positive mental health involves not the absence of mental disorder but rather the presence of certain mental goods.

Institutions, practitioners, and theorists often identify positive mental health with well-being.

There are strong reasons, however, to keep the concepts of well-being and positive mental health separate.

Someone with high positive mental health can have low well-being, someone with high well-being can have low positive mental health, and well-being and positive mental health sometimes conflict.

But, while positive mental health and well-being are not identical, there is an informative conceptual connection between them.

Positive mental health usually contributes instrumentally to the living of a good human life, where a good human life includes (but is not limited to) well-being.

Reference

Keller, S. (2020) What Does Mental Health Have to Do With Well-Being? Bioethics. 34(3), pp.228-234. doi: 10.1111/bioe.12702. Epub 2019 Nov 29.

A Brief Outline of Online Mental Health Services in China During the COVID-19 Outbreak

Published on by Andrew MarshallLeave a comment

Research Paper Title

Online Mental Health Services in China During the COVID-19 Outbreak.

Background

At the start of 2020, the 2019 coronavirus disease (COVID-19), originating from Wuhan in Hubei province, started to spread throughout China. As a result of the rapidly increasing numbers of confirmed cases and deaths, both medical staff and the public have been experiencing psychological problems, including anxiety, depression, and stress. Since January 2020, the National Health Commission of China have published several guideline documents, starting with the notification of principles for emergency psychological crisis intervention for the COVID-19 epidemic on 26 January, then the notice on establishing psychological assistance hotlines for the epidemic on 02 February, and most recently, guidelines for psychological assistance hotlines during the COVID-19 epidemic on 07 February 7.

During the severe acute respiratory syndrome epidemic in 2003, internet services and smartphones were not widely available. Therefore, few online mental health services were provided for those in need. The popularisation of internet services and smartphones, and the emergence of fifth generation (5G) mobile networks, have enabled mental health professionals and health authorities to provide online mental health services during the COVID-19 outbreak. Fast transmission of the virus between people hinders traditional face-to-face psychological interventions. By contrast, provision of online mental health services is safe. To date, several types of online mental health services have been implemented widely for those in need during the outbreak in China.

Firstly, as of 08 Febreuary 2020, 72 online mental health surveys associated with the COVID-19 outbreak could be searched for via the WeChat-based survey programme Questionnaire Star, which target different populations, including medical staff (23 of the surveys), patients with COVID-19 (one survey), students (18 surveys), the general population (nine surveys), and mixed populations (21 surveys); in Hubei province (five surveys), other provinces (15 surveys), all provinces, municipalities, and autonomous regions (36 surveys), and unspecified areas of China (16 surveys). One such multi-centre survey involving 1563 medical staff, with the centre at Nanfang Hospital, Southern Medical University (Guangzhou, China) as one of the study sites, found the prevalence of depression (defined as a total score of ≥5 in the Patient Health Questionnaire-9) to be 50·7%, of anxiety (defined as a total score of ≥5 in the Generalized Anxiety Disorder-7) to be 44·7%, of insomnia to be 36·1% (defined as a total score of ≥8 in the Insomnia Severity Index), and of stress-related symptoms (defined as a total score of ≥9 in the Impact of Events Scale-Revised) to be 73·4%. These findings are important in enabling health authorities to allocate health resources and develop appropriate treatments for medical staff who have mental health problems.

Secondly, online mental health education with communication programmes, such as WeChat, Weibo, and TikTok, has been widely used during the outbreak for medical staff and the public. In addition, several books on COVID-19 prevention, control, and mental health education have been swiftly published and free electronic copies have been provided for the public. As of 08 February, 29 books associated with COVID-19 have been published, 11 (37·9%) of which are on mental health, including the “Guidelines for public psychological self-help and counselling of 2019-nCoV pneumonia”, published by the Chinese Association for Mental Health.

Finally, online psychological counselling services (eg, WeChat-based resources) have been widely established by mental health professionals in medical institutions, universities, and academic societies throughout all 31 provinces, municipalities, and autonomous regions in mainland China, which provide free 24-h services on all days of the week. Online psychological self-help intervention systems, including online cognitive behavioural therapy for depression, anxiety, and insomnia (e.g. on WeChat), have also been developed. In addition, several artificial intelligence (AI) programmes have been put in use as interventions for psychological crises during the epidemic. For example, individuals at risk of suicide can be recognised by the AI programme Tree Holes Rescue, by monitoring and analysing messages posted on Weibo, and alerting designated volunteers to act accordingly.

In general, online mental health services being used for the COVID-19 epidemic are facilitating the development of Chinese public emergency interventions, and eventually could improve the quality and effectiveness of emergency interventions.

Reference

Liu, S., Yang, L., Zhang, C., Xiang, Y., Liu, Z., Hu, S. & Zhang, B. (2020) Online Mental Health Services in China During the COVID-19 Outbreak. Lancet Psychiatry. 7(4), pp.e17-e18. doi: 10.1016/S2215-0366(20)30077-8. Epub 2020 Feb 19.

Autistic Pride Day (18 June)

Published on by Andrew MarshallLeave a comment

Autistic Pride Day, originally an Aspies for Freedom initiative, is a pride celebration for autistic people held on 18 June each year.

Autistic pride recognises the importance of pride for autistic people and its role in bringing about positive changes in the broader society.

Autistic Pride

On 18 June every year, organisations around the world celebrate Autistic Pride Day, with events around the world, to connect with one another through autistic events and demonstrate to allistic people (those not on the autism spectrum) that autistic people are unique individuals who should not be seen as cases for treatment.

Autistic Pride Day was first celebrated in 2005 by Aspies for Freedom (AFF) and it quickly became a global event which is celebrated widely online and offline. AFF modelled the celebration on the gay pride movement. According to Kabie Brook, the co-founder of Autism Rights Group Highland (ARGH), “the most important thing to note about the day is that it is an autistic community event: it originated from and is still led by autistic people ourselves”, i.e. it is not a day for other charities or organisations to promote themselves or stifle autistic people. The rainbow infinity symbol is used as the symbol of this day, representing “diversity with infinite variations and infinite possibilities”.

During gay pride and other LGBTQ events, a rainbow flag is used featuring a white infinity symbol on a tri-colour background. LGBT+ autistic charity Twainbow oversaw the selection and online voting in 2015. Due to various reasons a rainbow infinity symbol is sometimes used.

Autistic pride points out that autistic people have always been an important part of human culture. Being autistic is a form of neurodiversity. As with all forms of neurodiversity, most of the challenges autistic people face come from other people’s attitudes about autism and a lack of supports and accommodations (ableism), rather than being essential to the autistic condition. For instance, according to Larry Arnold and Gareth Nelson, many autism-related organisations promote feelings of pity for parents, rather than fostering understanding. Autistic activists have contributed to a shift in attitudes away from the notion that autism is a deviation from the norm that must be treated or cured. Autistic self-advocacy organisations, which are led and run by autistics, are a key force in the movement for autistic acceptance and autistic pride.

New Scientist magazine released an article entitled “Autistic and proud” on the first Autistic Pride Day that discussed the idea.

Themes

  • 2005 Acceptance not cure – main event of 2005 was in Brasília, capital of Brazil.
  • 2006 Celebrate Neurodiversity – main events of 2006 were an Autistic Pride Summer Camp in Germany and an event at the Scienceworks Museum in Melbourne, Australia.
  • 2007 Autistics Speak. It’s time to listen.
  • 2008 Without a theme.
  • 2009 Without a theme.
  • 2010 Perspectives, not fear.
  • 2011 Recognize, Respect, Include.
  • 2012 No theme – main event of 2012 was in Herzliya Park, in Israel.
  • 2013 No theme – main event of 2013 was in Sacher Park, in Jerusalem, Israel.
  • 2015 No theme – main events were in Reading, UK, Hyde Park in London, UK, and Haifa, Israel.
  • 2016 No theme – main events were in Reading, UK, Hyde Park in London, UK, Manchester UK, and Ramat HaSharon, Israel, Nebraska.
  • 2017 No theme – main events were in Hyde Park, London, U.K., Reading U.K., Manchester UK and Modiin, Israel, and Nebraska.
  • 2018 No theme – main events were in Hyde Park, London, U.K., Reading U.K., Manchester UK and Tel Aviv, Israel.
  • 2019 No theme – main events were in Hyde Park, London, U.K., Reading U.K., Manchester UK, Paris, France, Lincoln, Nebraska, and for the first time, an Autistic Pride march in Galway, Ireland.

Mental Health & COVID-19: Psychological Impacts that Merit Consideration now Rather than Later

Published on by Andrew MarshallLeave a comment

Research Paper Title

Mental health in the COVID-19 pandemic.

Background

During any outbreak of an infectious disease, the population’s psychological reactions play a critical role in shaping both spread of the disease and the occurrence of emotional distress and social disorder during and after the outbreak. Despite this fact, sufficient resources are typically not provided to manage or attenuate pandemics’ effects on mental health and well-being. While this might be understandable in the acute phase of an outbreak, when health systems prioritise testing, reducing transmission and critical patient care, psychological and psychiatric needs should not be overlooked during any phase of pandemic management.

There are many reasons for this. It is known that psychological factors play an important role in adherence to public health measures (such as vaccination) and in how people cope with the threat of infection and consequent losses. These are clearly crucial issues to consider in the management of any infectious disease, including COVID-19. Psychological reactions to pandemics include maladaptive behaviours, emotional distress and defensive responses. People who are prone to psychological problems are especially vulnerable.

All of these features are in clear evidence during the current COVID-19 pandemic. One study of 1,210 respondents from 194 cities in China in January and February 2020 found that:

  • 54% of respondents rated the psychological impact of the COVID-19 outbreak as moderate or severe;
  • 29% reported moderate to severe anxiety symptoms; and
  • 17% reported moderate to severe depressive symptoms.

Notwithstanding possible response bias, these are very high proportions – and it is likely that some people are at even greater risk. During the 2009 H1N1 influenza outbreak (‘swine flu’), a study of mental health patients found that children and patients with neurotic and somatoform disorders were significantly over-represented among those expressing moderate or severe concerns.

Against this background, and as the COVID-19 pandemic continues to spread around the world, the authors hypothesise a number of psychological impacts that merit consideration now rather than later.

In the first instance, it should be recognised that, even in the normal course of events, people with established mental illness have a lower life expectancy and poorer physical health outcomes than the general population. As a result, people with pre-existing mental health and substance use disorders will be at increased risk of infection with COVID-19, increased risk of having problems accessing testing and treatment and increased risk of negative physical and psychological effects stemming from the pandemic.

Second, we anticipate a considerable increase in anxiety and depressive symptoms among people who do not have pre-existing mental health conditions, with some experiencing post-traumatic stress disorder in due course. There is already evidence that this possibility has been under-recognised in China during the current pandemic.

Third, it can be anticipated that health and social care professionals will be at particular risk of psychological symptoms, especially if they work in public health, primary care, emergency services, emergency departments and intensive or critical care. The World Health Organisation has formally recognised this risk to healthcare workers, so more needs to be done to manage anxiety and stress in this group and, in the longer term, help prevent burnout, depression and post-traumatic stress disorder.

There are several steps that can and should be taken now to minimise the psychological and psychiatric effects of the COVID-19 pandemic.

First, while it might be ostensibly attractive to re-deploy mental health professionals to work in other areas of healthcare, this should be avoided. Such a move would almost certainly worsen outcomes overall and place people with mental illness at disproportionate risk of deterioration in physical and mental health. If anything, this group needs enhanced care at this time.

Second, the authors recommend the provision of targeted psychological interventions for communities affected by COVID-19, particular supports for people at high risk of psychological morbidity, enhanced awareness and diagnosis of mental disorders (especially in primary care and emergency departments) and improved access to psychological interventions (especially those delivered online and through smartphone technologies). These measures can help diminish or prevent future psychiatric morbidity.

Finally, there is a need for particular focus on frontline workers including, but not limited to, healthcare staff. In the USA, the Centres for Disease Control and Prevention offer valuable advice for healthcare workers in order to reduce secondary traumatic stress reactions, including increased awareness of symptoms, taking breaks from work, engaging in self-care, taking breaks from media coverage and asking for help. This kind of advice needs to be underpinned by awareness of this risk among employers, enhanced peer-support and practical assistance for healthcare workers who find themselves exhausted, stressed and feeling excessive personal responsibility for clinical outcomes during what appears to be the largest pandemic of our times.

Even in this emergency circumstance, or especially in this emergency circumstance, we neglect mental health at our peril and to our long-term detriment.

Reference

Cullen, W., Gulati, G. & Kelly, B.D. (2020) Mental Health in the COVID-19 Pandemic. QJM: An International Journal of Medicine. 113(5), pp.311-312.

What Progression has there been of Mental Health Services During the COVID-19 Outbreak in China?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Progression of Mental Health Services During the COVID-19 Outbreak in China.

Background

The novel coronavirus disease (COVID-19) has been rapidly transmitted in China, Macau, Hong Kong, and other Asian and European counterparts.

This COVID-19 epidemic has aroused increasing attention nationwide.

Patients, health professionals, and the general public are under insurmountable psychological pressure which may lead to various psychological problems, such as anxiety, fear, depression, and insomnia.

Psychological crisis intervention plays a pivotal role in the overall deployment of the disease control.

The National Health Commission of China has summoned a call for emergency psychological crisis intervention and thus, various mental health associations and organisations have established expert teams to compile guidelines and public health educational articles/videos for mental health professionals and the general public alongside with online mental health services.

In addition, mental health professionals and expert groups are stationed in designated isolation hospitals to provide on-site services.

Experts have reached a consensus on the admission of patients with severe mental illness during the COVID-19 outbreak in mental health institutions.

Nevertheless, the rapid transmission of the COVID-19 has emerged to mount a serious challenge to the mental health service in China.

Reference

Wen, Li., Yuan, Yang., Zi-Han, Liu., Yan-Jie, Zhao., Qinge, Zhang., Ling, Zhang., Teris, Cheung. & Yu-Tao, Xiang. (2020) Progression of Mental Health Services During the COVID-19 Outbreak in China. International Journal of Biological Sciences. 16(10), pp.1732-1738. doi: 10.7150/ijbs.45120. eCollection 2020.