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Reviewing the Challenges & Mental Health Issues of Academic Trainees

Published on by Andrew Marshall1 Comment

Research Paper Title

The Challenges and Mental Health Issues of Academic Trainees.

Background

In the last decade, mental health issues have come to the foreground in academia. Literature surrounding student mental health continues to grow as universities try to implement wellness services and study the mental health of their students.

Studies vary greatly in terms of measurement tools, timeframe, sample demographics, as well as the chosen threshold of symptom severity for diagnosis.

This review attempts to summarise, contextualise and synthesise papers that pertain to the challenges faced by academic trainees at the undergraduate, graduate and post-graduate level.

The evidence for, and against, the common claim of increasing prevalence of mental health issues among students in recent years is discussed.

While some studies support this claim, it is difficult to reach a definitive conclusion due to numerous confounding factors such as increased help-seeking behaviour, greater awareness of mental health issues and weak methodology.

The prevalence of depression, anxiety, suicidal and self-injurious behaviour, distress and general mental illness diagnoses are discussed.

Other issues known to influence mental health, such as sexual assault and bullying, are briefly addressed.

Finally, select studies on a few wellness strategies that may improve mental health of trainees, such as mindfulness, are summarised, along with diverse recommendations for individual students, universities, and academia as a whole.

Reference

Eleftheriades, R., Fiala, C. & Pasic, M.D. (2020) The Challenges and Mental Health Issues of Academic Trainees. F1000Research. 9:104. doi: 10.12688/f1000research.21066.1. eCollection 2020.

Would Strengthening Community Health Systems for Mental Health Improve Access & Increase Utilisation of Services?

Published on by Andrew Marshall1 Comment

Research Paper Title

Strengthening Mental Health Systems in Zambia.

Background

Studies in mental health care for low resource settings indicate that providing services at primary care level would significantly improve provision and utilisation of mental health services.

Challenges related to inadequate funding were noted as significant barriers to service provision, with the contribution of low knowledge of mental health conditions and stigma in the community.

This study aimed to explore the barriers to the use of mental health services in Zambia, suggesting health systems thinking approaches to solving these challenges.

Methods

Primary data were collected through individual interviews from 12 participants; primary caregivers, health workers from public health institutions that treat mental health conditions and policymakers and implementers.

The digitally recorded responses were transcribed and analysed using thematic analysis.

Results

Key barriers to care included inadequate funding, few human resources, poor infrastructure and stigma.

Barriers to care at policy, facility and individual or community level could be alleviated by strengthening the mental health system.

Engagement of community health workers and increasing efforts to sensitise the community about mental health would prove beneficial.

Conclusions

Strengthening the community health systems for mental health could improve access and increase utilisation of services.

Reference

Munakampe, M.N. (2020) Strengthening Mental Health Systems in Zambia. International Journal of Mental Health Systems. 14:28. doi: 10.1186/s13033-020-00360-z. eCollection 2020.

Mental Health: Model Navigator!

Published on by Andrew Marshall1 Comment

Research Paper Title

Mental Health Navigation – A Model.

Background

The need for mental health care services is a growing concern around the world.

This article proposes a conceptual model for the role a mental health care navigator to meet the growing needs of consumers who are seeking greater access to fragmented and confusing mental health care services.

This conceptual model proposes integrating mental health into primary care with a more patient-centered approach to the care of the whole person.

This approach is congruent with The Ottawa Charter for Health Promotion Charter calling for the reorienting of health services focusing on the total needs of the individual as a whole person.

Although USA focused, the model has potential for sharing across countries to build capacity for mental health care in other countries around the world.

The conceptual model focuses on matching consumer mental health care needs with the correct mental health care services.

This would ensure that patients get the appropriate mental health care services while allowing the primary care physician to maintain the role of coordinator of care for all of the patient’s health care needs.

The main intent of the model is to stimulate discussion and exploration around the role of a proposed mental health care navigator that can lead to creating models reflecting local need and adaptation.

Successful models can lead to collaborative discussion encouraging capacity building in other countries.

The authors maintain that coordination of health care, including mental, medical and surgical care, is the best approach to controlling costs and ensuring the health of the whole person.

Reference

Knesek, G. & Hemphill, T. (2020) Mental Health Navigation – A Model. Health Promotion International. 35(1), pp.151-159. doi: 10.1093/heapro/day109.

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

Published on by Andrew Marshall1 Comment

Research Paper Title

Psychiatric Mental Health Nurse Practitioners Meeting Rural Mental Health Challenges.

Background

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.

Methods

Respective to the objective, relevant literature is reviewed.

Results

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.

Conclusions

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.

Reference

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

Published on by Andrew MarshallLeave a comment

Research Paper Title

Maternal Mental Health MATTERS.

Background

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.

Reference

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

Misophonia: Quirk of Human Behaviour or Mental Health Condition?

Published on by Andrew Marshall1 Comment

Introduction

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.

Objective

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

Methods

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).

Results

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).

Limitations

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

Conclusions

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.

References

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. https://doi.org/10.1371/journal.pone.0231390.

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

Published on by Andrew Marshall1 Comment

Research Paper Title

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

Background

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.

Methods

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.

Results

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.

Conclusions

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

Reference

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

Published on by Andrew MarshallLeave a comment

“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.”

Reference

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?

Published on by Andrew MarshallLeave a comment

Introduction

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.

Objective

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

Methods

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).

Results

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).

Limitations

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

Conclusions

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.

References

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. https://doi.org/10.1371/journal.pone.0231390.

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.