How can Psychiatric Mental Health Nurse Practitioners Meet Rural Mental Health Challenges?

Research Paper Title

Psychiatric Mental Health Nurse Practitioners Meeting Rural Mental Health Challenges.


To describe the current rural mental health system crisis in the United States and how psychiatric mental health nurse practitioners (PMHNPs) can holistically mitigate this systemic issue.


Respective to the objective, relevant literature is reviewed.


PMHNPs have successfully increased access to care in under-served rural communities by practising at the fullest extent of their scope without mandated supervision, utilising telepsychiatry practice, while expanding PMHNP rural mental health education and research to meet and absolve pressing rural mental health challenges.


Current evidence supports that rural mental health care improves when PMHNPs have full scope of practice, utilise telepsychiatry, engage in related scholarly activity, and have formalised education and training for rural health care delivery, which collectively answer the professional and moral call serving the under-served rural population with mental illness.


Finley, B.A. (2020) Psychiatric Mental Health Nurse Practitioners Meeting Rural Mental Health Challenges. Journal of the American Psychiatric Nurses Association. 26(1):97-101. doi: 10.1177/1078390319886357. Epub 2019 Nov 15.

Maternal Mental Health MATTERS: Yes it Does

Research Paper Title

Maternal Mental Health MATTERS.


Depression and anxiety during pregnancy and the postpartum period are common and have significant negative impacts on mother and child.

Suicide is a leading cause of maternal mortality.

Evidence-based efforts for screening, assessment, and treatment improve maternal and infant mental health, as well as overall family health, throughout the lives of women and children.


Kimmel, M. (2020) Maternal Mental Health MATTERS. North Carolina Medical Journal. 81(1), pp.45-50. doi: 10.18043/ncm.81.1.45.

Is there a Gender Difference in Mental Health Literacy that Affects Mental Health Attitude?

Research Paper Title

Mental Health Literacy Affects Mental Health Attitude: Is There a Gender Difference?


In the current study, the researchers aimed to compare the levels of and factors associated with mental health attitude between males and females. Of particular interest was ascertaining the degree to which mental health literacy was related to mental health attitude and whether this relationship would vary by gender.


A total of 732 participants aged 18 years or more were recruited from attendees at the 2016 Minnesota State Fair. They used the Mental Health Literacy Scale (MHLS) to measure attitude toward and literacy of mental health.


The multivariate analysis reported that males’ mental health attitude was significantly lower than females. Some factors associated with mental health attitude differed by gender as well. Among men, receiving more social support, experiencing higher levels of depression, and being married predicted greater mental health attitude. Among women, older age was associated with lower mental health attitude levels. However, mental health literacy was the strongest factor regardless of gender. Men and women with greater mental health literacy had a more positive mental health attitude.


Provision of tailored mental health literacy education both for males and females could potentially improve the public’s mental health attitude toward mental illness.


Lee, H.Y., Hwang, J., Ball, J.G., Lee, J., Yu, Y & Albright, D.L. (2020) Mental Health Literacy Affects Mental Health Attitude: Is There a Gender Difference? American Journal of Health Behaviour. 44(3), pp.282-291. doi: 10.5993/AJHB.44.3.1.

The Challenges of a Pandemic in Secure Psychiatric Settings

“Before COV-19, the phrase “parity of esteem” was ubiquitous.

Policy makers and politicians emphasised the importance of high quality mental healthcare, insisting it was on an equal footing with physical healthcare.

Most mental health professionals viewed this with some cynicism, especially those working in secure inpatient settings.

Is it reasonable to expect parity when it comes to covid-19? Arguably it would not be reasonable to expect the same focus on, for example, PPE and testing as that directed towards the acute emergency services and intensive care.

However, inpatient units struggled with the lack of central guidance on managing patients who had been diagnosed with or were suspected of having covid-19.

Patients with serious mental disorders are at high risk of physical health problems. While they are acutely unwell, they:

  • May not have the capacity to understand the need to self-isolate;
  • May be unable or unwilling to be tested; and
  • If agitated, will be unlikely to be able to practice social distancing.

Mental health trusts have been struggling:

  • With protocols and the availability of testing;
  • With managing the direct contacts of patients; and
  • Like other settings, with sourcing appropriate PPE.

There is intense debate about the apparent lack of appropriate legal frameworks. In the case of a voluntary or inform patient, can the Mental Health Act be used? The Mental Capacity Act is not appropriate as it applies top decisions in the patient’s best interests, not for the protection of others.

The Coronavirus Act 2020 give public health officers the power to impose isolation on someone suspected of being infected, but this seems unlikely to extend to inpatient units.

If parity of esteem is ever going to be meaningful, the challenges of safely and securely managing coivd-19 in the most seriously unwell patients with mental disorders needs to be given a higher priority.”


O’Brien, A. (2020) The Challenges of a Pandemic in Secure Psychiatric Settings. BMJ 2020;369:No.8247, pp.318-319.

Misophonia: Quirk of Human Behaviour or Mental Health Condition?


By analogy with misogyny and misanthropy, misophonia ought to mean hatred of noise.

In fact, it is a recent coinage used to label the phenomenon of strong aversive reactions to sounds originating in other people’s oral or nasal cavities, such as chewing, sniffing, slurping, and lip smacking.

A report of a large series of cases seen in the Netherlands suggests that misophonia is well on its way to becoming a new psychiatric disorder (see below) (Jager et al., 2020).

Some commentators have expressed concern at the creeping medicalisation of quirks of human behaviour (BMJ, 2020).

What is Misophonia?

  • It is also known as Selective Sound Sensitivity Syndrome.
  • Misophonia is a disorder in which certain sounds trigger emotional or physiological responses that some might perceive as unreasonable given the circumstance.
  • Those who have misophonia might describe it as when a sound “drives you crazy.”
  • Their reactions can range from anger and annoyance to panic and the need to flee.

Research Paper Title

Misophonia: Phenomenology, comorbidity and demographics in a large sample.


Analyse a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition.


This observational study of 779 subjects with suspected misophonia was conducted from January 2013 to May 2017 at the outpatient-clinic of the Amsterdam University Medical Centres, location AMC, the Netherlands. The researchers examined DSM-IV diagnoses, results of somatic examination (general screening and hearing tests), and 17 psychological questionnaires (e.g. SCL-90-R, WHOQoL).


The diagnosis of misophonia was confirmed in 575 of 779 referred subjects (74%). In the sample of misophonia subjects (mean age, 34.17 [SD = 12.22] years; 399 women [69%]), 148 (26%) subjects had comorbid traits of obsessive-compulsive personality disorder, 58 (10%) mood disorders, 31 (5%) attention-deficit (hyperactivity) disorder, and 14 (3%) autism spectrum conditions. 2% reported tinnitus and 1% hyperacusis. In a random subgroup of 109 subjects the researchers performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities. Psychological tests revealed perfectionism (97% CPQ>25) and neuroticism (stanine 7 NEO-PI-R). Quality of life was heavily impaired and associated with misophonia severity (rs (184) = -.34 p = < .001, p = < .001).


This was a single site study, leading to possible selection–and confirmation bias, since AMC-criteria were used.


This study with 575 subjects is the largest misophonia sample ever described.

Based on these results the researchers propose a set of revised criteria useful to diagnose misophonia as a psychiatric disorder.


BMJ 2020;369:m1843.

Jager, I., de Koning, P., Bost, T., Denys, D. & Vulink, N. (2020) Misophonia: Phenomenology, comorbidity and demographics in a large sample. PloS One.

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

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.


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.


Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (; 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.


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.


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.


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.

Research Paper Title

Mental Health and Stress in Humanitarian Expatriates.


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.


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.

National PTSD Awareness Day

National PTSD Awareness Day is a day dedicated to creating awareness regarding PTSD (Post Traumatic Stress Disorder). It is acknowledged annually on the 27th of June. The US Senate officially designated this day in 2010. In 2014 the Senate designated the whole month of June as PTSD Awareness Month.

In the US, 6.8% of adults will experience PTSD in their lifetimes with women twice as likely as men to experience it (10.4% to 5%) frequently as a result of sexual trauma. Veterans are another group highly likely to experience PTSD during their lives, with Vietnam War veterans at 30%, Gulf War veterans at 10%, and Iraq War veterans at 14%.

On this day, organisations that work with employees, consumers, and patients at risk for the condition work to get information about symptoms and treatments for it out to the public in the hopes that when more people know about the disease more people who suffer from it will get treatment. The US Department of Defence is one of the major organisations involved as June is full of days relating to the military.

You can find out more about raising PTSD awareness from the US Department of Veterans Affair’s National Centre for PTSD and PTSDUK.

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

Research Paper Title

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


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.


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


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.


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.


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

Research Paper Title

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


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.


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


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.


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.


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.


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.