An Overview of Mental Health Inequity


Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services.

Globally, the World Health Organisation (WHO) estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual’s well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual’s susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

Disparities in Accessing and Quality of Mental Health Care

There is a growing unmet need for mental health services and equity in the quality of these services. While these services often advertise themselves as being a support system and caregiver for any and all who need treatment or support, oftentimes certain aspects of an individual’s life, such as race, ethnicity, and sexual orientation, will determine the access and quality of care that they are given.

Due to a growing level of socioeconomic inequality among races, African Americans are less likely to have access to mental health care and are more likely to have lesser quality care when they do find it. African Americans and Hispanics are more likely to be uninsured or have Medicaid, limiting the amount and type of access that they have mental health outpatient sources. In one study, of all those who received mental health care, minority populations reported a higher degree of unmet needs and dissatisfaction with the services they were given (12.5% of whites, 25.4% of African Americans, and 22.6% of Hispanics reported poor care).

In addition, mental illnesses are often under and over diagnosed among different minority groups for various reasons. For example, schizophrenia is often over diagnosed in African Americans, whereas mood disorders, depression, and anxiety are under diagnosed. This serves as an example of how minority groups in the United States, such as African Americans, are at risk of being diagnosed based on stereotype and not properly assessed or treated for other mental health conditions that they may or may not be at risk for.

The LGBTQ population, while still open to the same disparities as racial minority groups, is often confronted with the problem of being denied mental health treatment because of the gender they identify as or their sexual orientation. In a study conducted by The National Centre for Transgender Equality and the National Gay and Lesbian Task Force, 19% of the LGBTQ sample reported being denied the healthcare they needed. In addition, 28% of the sample reported being harassed or even physically assaulted during the health visit. While denial of treatment and harassment during treatment are large causes of the disparities among mental health care quality, the lack of knowledge is also of concern among the LGBTQ population. As it is such a newly developing field of study, there is very little knowledge or research conducted that relate specifically to LGBTQ health and healthcare. Because of this, about 50% of the LGBTQ population report having to teach aspects of their health and treatment to the health care providers.

Socioeconomic Status Disparities

Refer to Socioeconomic Status and Mental Health.

Lack of socioeconomic resources can lead to development of traumatic experiences that precipitate into mental health disorders. For example, not having employment or having limited access to resources can influence the course of developing some of the most common mental health disorders, such as depression, anxiety, bipolar disorder, and psychological stress. Living with a mental health disorder can also contribute to disparities in receiving mental health care. Living with a mental health disorder could affect an individual’s economic status, which can additionally lead into their mental health quality as well as life expectancy.

Another socioeconomic factor that can lead to barriers and inequalities in accessing mental health care services include financial restraints. There has been a rise in cost for uninsured individuals in accessing mental health care services compared to individuals who have private or public insurance.

Education Disparities

Educational disparities can be defined as unjust or unfair differences in educational outcomes that can be a result of difference in treatment of certain minority groups in schools, varying socioeconomic statuses, and varying educational needs. These disparities in education can ultimately lead to issues of mental health. When this happens, less privileged groups get looped into the cascading effects of inequality.

Disparities in education, contributory to socioeconomic status, immigrant status, and ethnic/racial status can be another contributing factor to mental health inequality. Socioeconomic status plays a large role in the difference in access to educational resources. School districts are split geographically. Because the current funding for public schools comes from local property taxes, there is more incentive for high-status individuals to narrow the boundaries to not include lower income families from their school districts. Because each school district is then only encompassing one socioeconomic group, the programmes and quality are affected. This is where we begin to see the dramatic differences between school districts. While some schools offer amazing guidance departments, advanced classes, and phenomenal facilities, other areas struggle to find qualified and motivated teachers to teach basic classes. Although public education is something that is supposed to be a right for all, an individual’s socioeconomic status can greatly affect the quality of that education.

An individual’s immigration status also affects the quality of education received. While there are some immigrant groups which do well after immigrating to the United States, many do not have the same level of success. There are many barriers that prevent the academic success of immigrant children. These barriers include but are not limited to the fact that most parents of immigrant children do not understand the United States educational system, inadequate English as a Second Language programmes, and segregation. There are also differences in outcomes across immigrant generation, with first-generation immigrants performing better than subsequent generations. This is termed the immigrant paradox. These issues along with the psychological effects of acculturation (e.g. adapting to a whole new country, language, and culture) amplify educational inequality.

Disparities in education are the insufficiency of resources that are included but limited. These disparities usually targets socially excluded communities with low income. Statistics are used when measuring grades, GPA, test scores, and dropout rates to determine the success of students. By creating a system in which a person could never succeed can perpetuate inequalities, especially those suffering from mental health.

Spatial Disparities (Geographic Location)

Spatial disparities include, but are not limited to, where one lives, spends most of their time, where they receive most of their resources, and where they receive education. For example, minority races who live in higher poverty neighbourhoods are at higher risk for additional stresses and mental health disorders. Yet this population has been shown to experience more difficulties in accessing mental health services. Considering this cycle of needing care but not being able to receive care, inequality due to spatial location will likely remain and continue to limit access to mental health care without additional intervention to increase access to mental health services.

Many minorities including African Americans, Hispanics, and Asian Americans inhabit these poverty filled neighbourhoods due to factors being not in their favour in certain aspects of society. These neighbourhoods lack resources such as offices with psychiatrists or health clinics with good doctors who are trained to help those in need of mental health care. It would also be beneficial to make specific services just for those in high-poverty neighbourhoods who lack the resources so we can encourage those in need to get the help that they deserve. With adjustments made to meet these circumstances, the spatial disparities can be lowered and allow those who need the help to get it.

Ethnic and Racial Disparities and Predictors

There is inequality in mental health care access for different races and ethnicities. Studies have shown that minorities with low-income have less access to mental health care than low-income non-Latino whites. In addition to lack of access, minorities in the United States were more likely to receive poorer quality in mental health care and treatment compared to non-Latino whites individuals, leading to many minorities delaying or failing treatment. Studies have shown the African Americans have decrease access to mental health services and mental health care compared non-Latino white Americans. Many minorities have difficulty in finding care for mental health services.

The historical events that took place in the United States against African Americans have resulted in a distrust in the healthcare system. The stigma of mental healthcare in the African American community has caused an increased prevalence of these disorders as surveys have found that 12 million women and 7 million men suffer from some kind of mental health illness. Besides being the most vulnerable race to contract the Covid-19 virus, they also presented a higher incidence of mental health disorders. Research has shown that this community reacts better to treatment when it is offered by healthcare professionals as an alternative to other treatments. When considering why African Americans are so at-risk for mental health issues, it is important to consider how their race impacts their daily lives. Black individuals in this country still face discrimination, which leads to negative emotions, and these emotions could include feelings of social isolation. Not only are they made to feel as though they are not fully a part of our society, but they may also feel as though their non-black family members and friends do not fully understand their struggles. This could definitely lead to subjective social isolation, or a lack of feeling close to other people. One study revealed that subjective social isolation in African Americans is correlated to having any 12-month disorder listed in the DSM and to having a higher number of 12-month disorders listed in the DSM. Based on this reasoning, subjective social isolation could be one of the reasons why African Americans are an at-risk group when it comes to mental health struggles, and it would definitely make sense for this subjective social isolation to be a result of racism that still exists today. It is also important to consider the intersectionality of race and gender when thinking about mental health. The same study as mentioned above states that African American men are more likely to experience social isolation than African American women, which could make black men in this country even more at-risk for psychiatric disorders. When thinking about the racism in this country, this somewhat makes sense, because black men experience certain aspects of discrimination that are specific to their group. For example, African American men are often perceived as dangerous and have high rates of being arrested. When all of these risk factors are then combined with the stigma that all men face in terms of discussing mental health issues, this puts African American men at a very high risk for both developing psychiatric disorders and not feeling empowered enough to talk about their struggles. When we are talking about racial disparities in mental health, not only do we need to acknowledge the lack of access that minority groups have to the proper health care, but we also need to understand that being in a minority racial group puts individuals at a higher risk for developing psychiatric disorders in the first place. Then, it is crucial to consider some of the possible reasons for this and begin to ask how we could decrease the disparities in this country. All minority groups are especially at-risk for mental health issues, including racial minority groups, and this is linked to systemic racism.

During the early 2010’s the Latino Community experienced an increase in cases of mental health disorders. Studies have shown that Latinos are more likely to present early symptoms of mental health disorders than non Latino-whites. Among Latinos, those without a legal status in the United States suffer a higher burden of being diagnose with a mental health disorders as their journey to the country has caused them to experience traumatizing events including sexual abuse, kidnapping, and the constant fear of deportation. Consequently, undocumented Latinos have a lower access to mental healthcare than US born Latinos because of the current political restrictions against this community.

After surveying individuals of different races, a study has shown that African Americans, Hispanics, and Asian Americans gain less access to the same type of mental services that non-minority whites get access to. A possible reason that the author stated:

“This theory postulates that Whites have a greater propensity to avoid living in poverty communities because they are more likely to enjoy social and economic advantages. Only seriously mentally ill Whites suffer from steep downward mobility and come to reside in high-poverty neighborhoods”.

Minorities have an absence of mental health support within their communities as a result of stigmas and stereotypes applied to those pursuing mental health guidance. Another barrier to the shortage of mental health support is the lack of this type of healthcare available because of the rural settings that contain a high population of minorities. External environmental factors, such as family, community, and work, can influence the inclination to reach out for mental health counselling.

This has been a problem for minority races that need the same services. It is an issue because African Americans, Hispanics, and Asian Americans need the services more in certain areas due to how biologically certain minority races are more likely to be diagnosed with a mental illness than whites.

Problems can extend to the point of racial beliefs of health professionals and researchers influencing the diagnoses and treatments developed for some communities. James Burgess Waldram wrote a 2004 text Revenge of the Windigo (the title referring to “Wendigo psychosis”, which he asserts is an artificial construction of anthropologists and psychologists) discussing the behavioural health industry’s difficulties successfully analysing and treating the needs of indigenous people in the United States and Canada.

Race is often difficult to acknowledge in mental health. Even when access to mental health therapies exists for minorities, oftentimes both the therapist and the patient can be reluctant to factor their own racial positioning into treatment or find it difficult to believe that some of their mental health stress is due to race. Both often favour explanations rooted in past experiences like family life, personal setbacks, and other potential barriers.

LGBTQ Disparities and Predictors

Sexuality plays a large role in the prediction of mental illnesses and overall mental health. Those who identify as lesbian, gay, bisexual, transgender, and/or queer have a higher risk of having mental health issues, most likely as a result of the continued discrimination and victimisation they receive at the hands of others. Members of this population are confronted with derogatory and hateful comments, whether through face-to-face communication or through social media, which affects their self-worth and confidence, leading to anxiety, depression, thoughts of suicide, suicide attempts, and suicide. These mental health effects are most commonly seen among adolescents, however, they are also prevalent among adults of all ages. The sources of discrimination and victimization that the LGBTQ population suffers from can be both external and internal. While parts of society today are not accepting of the LGBTQ community and make public statements to advertise their discontent, an identifying LGBTQ can also have low confidence and a lack of self-worth that furthers these negative mental health effects.

The most notable predictor of mental health illnesses among the LGBTQ population is family acceptance. Those of the LGBTQ population who receive little or no family support and acceptance are three times more likely to have thoughts of suicide than those who do have a strong family support system behind them. Oftentimes, the lack of familial support is more conducive of detrimental behaviours, such as drug and illegal substance abuse, which can cause further harm to the individual. Multiple aspects of lifestyles, including religion, can affect family support. Those who have strong family ties to religion may be less likely to seek support and help from family members due to fear of a lack of acceptance within the family, as well as within the religious community.

Although mental health awareness has increased for the LGBTQ+ community, the aging citizens of this community are still struggling to have their voices heard. Research has shown that compared to heterosexuals and other groups in the LGBTQ+ community, older people have a higher incidence of suffering from mental health disorder. One of the most common reasons why older citizens refrain from seeking mental health care is due to the past discrimination by medical professionals. In addition to the lack of knowledge, this group is marginalised due to the lack of funding as most of the funds go to campaigns for the younger LGBTQ+ population.

Sex and Gender Disparities and Predictors

While gender differences among those with mental health disorders are an underdeveloped field of study, there are gender specific aspects to life that cause disparities. Gender is often a determinant of the amount of power one has over factors in their life, such as socioeconomic status and social position, and the stressors that go along with these factors. The location of genders and sex within the social construct can be a great determinant of risks and predictors of mental health disorders. These disparities in gender can correlate to the disparities in the types of mental health disorders that individuals have. While all genders and sexes are at risk of a large variety of mental health illnesses, some illnesses and disorders are more common among one sex than another. Women are twice as likely as men to be diagnosed with forms of depression as depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men. On the other hand, men are three times more likely to be given a diagnosis of a social anxiety disorder than women.

Sex can also be a determinant of other aspects of mental health as well. The time of onset of symptoms can be different dependent on one’s sex. Women are more likely to show signs of mental illnesses, such as depression, earlier and at a younger age than men. Many believe this to be a correlation with the onset time of puberty. As a result of social stigmas and stereotypes within society, women are also more likely to be prescribed mood-altering medications, whereas men are more likely to be prescribed medications for addictions. Further research on the mental health disparities among sex and gender is needed in order to gain a deeper knowledge of the predictors of mental health and the possible differences in treatments.

Adult women are at a high risk of experiencing mental health disorders during their pregnancy, however, most physicians do not address this until the postpartum period. With anxiety and depression being the most common ones, these disorders can affect both the pregnant woman and the baby’s life. The most common reasons for mental health disorders in this community were domestic abuse, fear of loneliness and previous medical history of mental disorders. The Covid-19 pandemic was a difficult time for those who were pregnant as isolation, one of the main causes for anxiety and depression, was mandated. Studies showed that during the pandemic, while the mental health of middle class pregnant women living in New York City improved, pregnant women living under a low socioeconomic status were more vulnerable to suffer from psychological disorders.

Current Initiatives in Achieving Mental Health Equality

Because mental health inequality is largely due to disparities in health insurance, ways to improve mental health equity must come from changes in healthcare policies. Much of mental health disparity comes from a lack of access to healthcare in low socioeconomic communities and, often, underprivileged minorities. This lack of access can arise from geographic isolation, poor funding and incentive for health care providers, inefficient health care coverage or highly stigmatised and discriminatory community attitudes surrounding mental health. Also, changing the content of healthcare literature and education to include mental health is equally important. The United States has made strides to break down the stigmas surrounding mental health, but the rate of such stigma is currently still on the rise. Potentially linked to such high stigma and miseducation, mental health is also still not considered to be a significant part of basic health care plans. In order for individuals to receive the treatment necessary for mental illness, it must be first acknowledged as a real, treatable illness.

In May 2013, the World Health Assembly adopted a new action plan to address mental health over the following 8 years. This plan is called the Comprehensive Mental Health Action Plan 2013-2020. This plan is an indicator of the global importance of mental health and includes goals for global mental health improvement. This plan also addresses mental health inequalities by acknowledging the need for greater access in low and middle-income countries.

Global Mental Health Inequalities

There is major inequality in the mental health field on a global scale, especially in developing countries. The number of people with a mental health condition is substantial, while clinicians are underappreciated and under resourced.

Around 30% of people globally suffer from a mental disorder in any given year, and more than two thirds of those individuals do not receive the necessary care. The most common mental health disorders globally are depression, alcohol and substance abuse, and psychosis. The consequences of mental health inequalities include unneeded suffering and premature death, increased stigma and marginalisation, a lack of investment in mental health workforce and infrastructure and limited or no treatment for people suffering from these conditions.

The burden of unmet mental health needs perpetuates a cycle of inequalities that impact a person’s overall health and wellbeing. Many developing countries lack policies that address the basic needs and rights of people suffering from mental illnesses. According to research, patients in developing countries frequently leave hospitals without knowing their diagnosis or what medications they are taking, they wait too long for referrals, appointments, and treatment, and they are not respected or given adequate emotional support.

There is astounding disparity that exists between the prevalence of mental problems around the world and the resources available for mental health. Globally, only 2% of national budgets are devoted to mental health. Due to a lack of finances and the ability to adequately treat their patients, some nations merely have warehouses to serve as hospitals where patients are isolated from the rest of society. The few psychiatric hospitals that do exist in developing countries are frequently overcrowded, understaffed, and may not offer the necessary level of care. Most psychiatric hospitals are located in urban areas, away from family members, which increases social isolation and costs for families. Integrating mental health into primary health care could help solve these problems on a global scale.

Adolescents Mental Health

Mental health is as an ongoing issue for adolescents. Researchers claim that preventing mental health problems, which commonly start in adolescence, is both doable and necessary. Schools have emerged as an target for involvement due to the high number of young people who experience mental health issues and the low number of those who have access to expensive and time-consuming therapies. Studies have demonstrated that preventative programs that take place in clinics or other healthcare settings are more beneficial to teenagers, despite the possibility that they may be successful in schools. Social media may be a valuable resource for young people who are socially isolated and who are struggling with mental health issues. But, especially in girls and underrepresented groups, social media use has also been related to sadness, suicide, and self-harm.

By facilitating easier access to interventions and resources that have been scientifically proven effective as well as by simplifying some steps in the diagnostic, monitoring, and health indicators, digital technologies have the potential to revolutionise the way that services for young people with mental health issues are provided. There are many ways mental health can effects an adolescents directly and indirectly. Lower grades, conflicts with parents and a lack of social relationship are few of the indirect ways a child can be effects. Whereas, changes in mood states, is one sign of a direct affect of mental health on adolescents.

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Book: Supporting Student Mental Health in Higher Education

Brain Changer eBook

Book Title:

Supporting Student Mental Health in Higher Education.

Author(s): Samuel Stones and Jonathan Glazzard.

Year: 2019.

Edition: First (1st).

Publisher: Critical Publishing Ltd.

Type(s): Paperback and Kindle.


Student mental health is a key consideration in higher education at the moment with recent reports identifying a major gap in provision by universities and how ill-equipped academics feel to support students. This book addresses these concerns, providing comprehensive guidance and workable evidence-informed strategies and interventions to help those working with students to support them effectively. It is suitable for lecturers, personal tutors, student counsellors, course leaders, heads of department and administration staff with responsibility for student support.

Changing Attitudes & Stigma toward Mental Health in Nursing Students

Research Paper Title

Attitudes and stigma toward mental health in nursing students: A systematic review.


This systematic review seeks to ascertain whether mental health-specific education reduces stigmatising attitudes in nursing students.


A systematic review of the literature was performed.


Thirteen studies met the inclusion criteria.

Most of the results show an improvement in attitudes toward mental health, both in theory and clinical experience, but a greater improvement toward these stigmatising attitudes was observed in clinical placements than in theory.


Mental-health-specific training seems to improve perceptions toward mental health.

Clinical placement underpins theory, leading to a decrease in negative attitudes and stigma regarding mental health.


Palou, R.G., Vigue, G.P. & Tort-Nasarre, G. (2020) Attitudes and stigma toward mental health in nursing students: A systematic review. Perspectives in Psychiatric Care. 56(2), pp.243-255. doi: 10.1111/ppc.12419. Epub 2019 Jul 28.

What is the Current Situation School Mental Health in ASEAN Countries?

Research Paper Title

Current Situation and Comparison of School Mental Health in ASEAN Countries.


School-based mental health interventions are considered to have potential for the promotion of mental health in developing countries.

The researchers held a workshop to discuss the promotion of mental health in schools in southeast Asian countries.

This review report aimed to summarise the current situation of school mental health in Association of Southeast Asian Nations (ASEAN) countries as reported by their representatives in this workshop.


To summarise the current situation of ASEAN countries in relation to school mental health, the researchers qualitatively analysed the content of the discussions from four perspectives:

  1. Laws and regulations;
  2. Mental health services;
  3. Teacher training on mental health; and
  4. Mental health education for students.


With regard to school mental health laws and regulations, this report could not provide clear conclusions because the laws were reported through the personal understanding of the public officers.

The results show that mental health services in schools are centred on professionals such as guidance counsellors, although the coverage varied among the different ASEAN countries.


Only Singapore conducted mental health training for teachers in a comprehensive way, and the number of people who were actually trained in other countries was very limited.

Cambodia, Malaysia, Myanmar, Philippines, Singapore, and Thailand included mental health education for students in health education or life skills subjects.


Nishio, A., Kakimoto, M., Bermardo, T.M.S. & Kobayashi, J. (2020) Current Situation and Comparison of School Mental Health in ASEAN Countries. Pediatrics International: Official Journal of the Japan Pediatrics Society. 62(4), pp.438-443. doi: 10.1111/ped.14137.

Reviewing the Challenges & Mental Health Issues of Academic Trainees

Research Paper Title

The Challenges and Mental Health Issues of Academic Trainees.


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.


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.

Education & Training should Aim to improve the Recognition & Treatment of Postpartum OCD

Research Paper Title

Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period.


Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterised by obsessions and compulsions.

Obsessions are defined as intrusive, recurrent and distressing thoughts, images or impulses, whereas compulsions are defined as repetitive behaviours or mental acts.

While there is an associated distress, and indeed oftentimes, the individual’s awareness that these behaviours are excessive and unreasonable, the individual continues to be disabled by an inability to cease their compulsions.

The postpartum period may herald the onset of OCD or precipitate an exacerbation of the preexisting OCD symptoms.

Common OCD symptom clusters occur in the postpartum period, with specific challenges associated with motherhood and lactation.

Areas Covered

This brief review aims to review the extent and nature of publications evaluating pharmacological treatment of OCD in the postpartum period.

Expert Opinion

Education and training should aim to improve the recognition and treatment of postpartum OCD.

Due to the limited nature of studies, more research is required to assess the role of selective serotonin reuptake inhibitors in the postpartum period.


Brakoulias, V., Viswasam, K., Dwyer, A., Raine, K.H. & Starcevic, V. (2020) Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period. Expert Opinion on Pharmacotherapy. 21(2), pp.163-165. doi: 10.1080/14656566.2019.1700229. Epub 2020 Jan 1.

Education: Text-based Coaching Protocols for Digital Mental Health Interventions

Research Paper Title

Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions.


A body of literature suggests that the provision of human support improves both adherence to and clinical outcomes for digital mental health interventions.

While multiple models of providing human support, or coaching, to support digital mental health interventions have been introduced, specific guidance on how to develop coaching protocols has been lacking.

In this Education Piece, the authors provide guidance on developing coaching protocols for text-based communication in digital mental health interventions.

Researchers and practitioners who are tasked with developing coaching protocols are prompted to consider the scope of coaching for the intervention, the selection and training of coaches, specific coaching techniques, how to structure communication with clients and how to monitor adherence to guidelines, and quality of coaching.

Their goal is to advance thinking about the provision of human support in digital mental health interventions to inform stronger, more engaging, and effective intervention designs.


Lattie, E.G., Graham, A.K., Hadjistavropoulos, H.D., Dear, B.F., Titov, N. & Mohr, D.C. (2019) Guidance on defining the scope and development of text-based coaching protocols for digital mental health interventions. Digital Health. doi: 10.1177/2055207619896145. eCollection 2019 Jan-Dec.

What Can We Learning from Nurses’ Experiences of Events involving Physiological Deterioration of Consumers in Acute Inpatient Mental Health Settings?

Research Paper Title

Clarity, confidence, and complexity: Learning from nurses’ experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings.


The objective of the current study was to capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer.

Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus, and cancer.

There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting.

Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting.


An exploratory, descriptive study was employed using focus groups to gather narrative data which was then subject to qualitative analysis.

Eleven mental health inpatient wards within a local health district in Sydney, Australia were studied, comprising ward-based nurses (n = 64) and nurse unit managers (n = 8).

This paper follows the COREQ guidelines for reporting qualitative health research.


Qualitative data analysis revealed three themes central to the nurses’ experience:

  1. Lack of clarity (subthemes: procedures and leadership accountability);
  2. Confidence in the workforce (subthemes: knowledge & skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and
  3. Complexity (subthemes: complexity as the new norm, and suitability of the mental health environment).


The themes found in this study can be used to guide and inform health care policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer.

Findings provide a rich dataset for the generation of measurement tools and protocols to guide physical healthcare and evaluate performance.


Brunero, S., Everett, B., Ramjan, L.M., Salamonson, Y., Steel, K., Johnson, A.M., Stokes, M., Langdon, R. & Dickens, G.L. (2019) Clarity, confidence, and complexity: Learning from nurses’ experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings. Journal of Clinical Nursing. doi: 10.1111/jocn.15126. [Epub ahead of print].

Teachers’ Perceptions of their Learners’ Mental Health Problems

Research Paper Title

A qualitative study on teachers’ perceptions of their learners’ mental health problems in a disadvantaged community in South Africa.


The combination of extensive poverty, violence and HIV has potential mental health impacts on children in Southern Africa.

This article is nested in a broader study to evaluate the strength and difficulties questionnaire (SDQ) among Sotho speakers, and assess the mental health status of children made orphans by AIDS.

The aim of this study was to describe the mental health problems that the teachers perceive among learners in their classrooms, to understand what the teachers saw as causing these problems and to identify potential approaches to address these problems within the school setting.


As part of the larger study, 10 teachers were purposively selected to write a report describing the mental health problems among learners in their class.

These findings were discussed at two later meetings with a larger grouping of teachers to validate the findings and obtain additional input.


The teachers were concerned about the emotional state of their pupils, especially in relation to depression, anxiety, substance abuse, scholastic problems and aggression.

These problems were felt to arise from the children’s lived context; factors such as poverty, death of parents and caregivers from AIDS and trauma, parental substance abuse and child abuse.

The teachers expressed a desire to assist the affected learners, but complained that they did not get support from the state services.


Many learners were evaluated by teachers as struggling with mental health issues, arising from their social context.

The teachers felt that with support, schools could provide assistance to these learners.


Skinner, D., Sharp, C., Marais, L., Serekoane, M. & Lenka, M. (2019) A qualitative study on teachers’ perceptions of their learners’ mental health problems in a disadvantaged community in South Africa. Curationis. 42(1), pp.e1-e7. doi: 10.4102/curationis.v42i1.1903.

What are the Factors Associated with Anxiety Disorders among Patients with Substance Use Disorders

Research Paper Title

Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study.


Estimate the rate of anxiety disorders (AD) and associated factors among patients with substance use disorder (SUD) in Lebanon.


A cross-sectional study, conducted between April and September 2017, enrolled 57 inpatients with SUD.


The rate of AD in patients with SUD was 61.4%. The university level of education compared to the primary level of education (ORa = 0.221) was significantly associated with lower anxiety among patients with SUD. Being sexually abused and having a family history of depression tended to significance.


AD is widespread in Lebanon and high rates of anxiety in patients with SUD were found, warranting the implementation of strategic interventions and establishing national policies and legislation for mental health services to provide optimal care.


Haddad, C., Darwich, M.J., Obeid, S., Sacre, H., Zakhour, M., Kazour, F., Nabout, R., Hallit, S. & Tahan, F.E. (2019) Factors associated with anxiety disorders among patients with substance use disorders in Lebanon: Results of a cross-sectional study. Perspectives in Psychiatric Care. doi: 10.1111/ppc.12462. [Epub ahead of print].