What was the New Freedom Commission on Mental Health?

Introduction

The New Freedom Commission on Mental Health was established by US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings. The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximise the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.

A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission’s findings as a launching point for recommending widespread reform of the nation’s mental health system.

A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed ‘atypical antipsychotic drugs’, such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behaviour issues. These drugs were later found to cause increased rates of sudden death in patients.

In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people.

Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative’s wider objectives are to foster chemical behaviour control of American citizens, contrary to civil liberties and to basic human rights.

Reports

Interim Report

The commission issued an interim report on 01 November 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care.

Final Report

On 22 July 2003, the President’s commission returned a report containing nineteen formal recommendations, organised under six proposed national goals for mental health. The commission emphasised recovery from mental illness, calls for consumer and family-centred care, and recommendations that states develop a more comprehensive approach to mental health.

The commission reported that “despite their prevalence, mental disorders often go undiagnosed,” so it recommended comprehensive mental health screening for “consumers of all ages,” including preschool children, because “each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders.”

In contradiction, the Congressional Research Service, stated the commission did not specifically recommend a nationwide screening programme for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Recommendations

Noting the country’s services for people with mental illness and disabilities were “fragmented,” the commission’s final report offered 19 recommendations within six larger goals to improve service coordination, move toward a recovery model, and help all individuals with mental illness and disability recover:

  • Americans Understand that Mental Health Is Essential to Overall Health.
    • Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
    • Address mental health with the same urgency as physical health.
  • Mental Health Care Is Consumer and Family Driven.
    • Develop an individualised plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
    • Involve consumers and families fully in orienting the mental health system toward recovery.
    • Align relevant Federal programmes to improve access and accountability for mental health services.
    • Create a Comprehensive State Mental Health Plan.
    • Protect and enhance the rights of people with mental illnesses.
  • Disparities in Mental Health Services Are Eliminated.
    • Improve access to quality care that is culturally competent.
    • Improve access to quality care in rural and geographically remote areas.
  • Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
    • Promote the mental health of young children.
    • Improve and expand school mental health programmes.
    • Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies.
    • Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports.
  • Excellent Mental Health Care Is Delivered and Research Is Accelerated.
    • Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses.
    • Advance evidence-based practices using dissemination and demonstration projects and create a public–private partnership to guide their implementation.
    • Improve and expand the workforce providing evidence-based mental health services and supports.
    • Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
  • Technology Is Used to Access Mental Health Care and Information.
    • Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.
    • Develop and implement integrated electronic health record and personal health information systems.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry’s use of front organisations and the compromise of scientific integrity under colour of authority, look askance at the irony of the commission’s ‘freedom’ descriptor, contending the commission is yet another example of the excesses of drug industry marketing, and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.

Screening Recommendations

Mad in America author Robert Whitaker criticized the commission’s screening recommendations as “fishing for customers.” A coalition of over 100 advocacy organisations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanised by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of long-time member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. “He needs a lot of help. I’ll see him for free,” said Adams.

Others, including Congressman Ron Paul (R-TX14), were more concerned by the commission’s suggestion to use schools as a site for screening. Paul’s concern led to the introduction of H.R. 181 Parental Consent Act of 2005 in the US House of Representatives on 04 January 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. Paul introduced similar bills in May 2007 (H.R. 2387), April 2009 (H.R. 2218), and August 2011 (H.R. 2769); those, likewise, died in committee.

TMAP Origin Criticism

Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public’s attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the “political/pharmaceutical alliance.” It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was “poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab.”

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/New_Freedom_Commission_on_Mental_Health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is a Mental Health Care Navigator?

Introduction

A mental health care navigator is an individual who assists patients and families to find appropriate mental health caregivers, facilities and services. Individuals who are care navigators are often also trained therapists and doctors.

Background

The need for mental health care navigators arises from the fragmentation of the mental health industry, which can often leave patients with more questions than answers. Care navigators work closely with patients and families through discussion and collaboration to provide information on best options and referrals to healthcare professionals, facilities, and organisations specialising in the patients’ needs. The difference between other mental health professionals and a care navigator is that a care navigator provides information and directs a patient to the best help rather than offering treatment. Still, care navigators may provide diagnosis and treatment planning.

Mental health care navigation is also sometimes provided by self-help books. Lloyd I. Sederer, M.D.’s The Family Guide to Mental Healthcare (W. W. Norton & Company, 2013) is a resource for patients and families searching for guidance in the mental health industry. Publishers Weekly called it a “thoughtful, compassionate, and fact-packed guide for recognizing illness and getting help.” It provides information to patients and families about recognising symptoms of mental illness, how to get diagnosis and how to choose the right therapists and treatments.

Terminology

Many mental health organisations use “navigator” and “navigation” to describe the service of providing guidance through the health care industry. Care navigators are also sometimes referred to as “system navigators.”. One type of care navigator is an “educational consultant.”

Models

Models for mental health care navigation can involve many scenarios from a brief consultation to an extended process with follow-up. They offer referrals, assistance with insurance and other financial matters and general support. A highly detailed method of care navigation with long-term follow up was developed in 2011 by San Francisco-based psychiatrist and mental health expert Eli Merritt, M.D. His model involves what he calls the “3 R’s” of mental health care: “Research, Resources, and Referrals.” It involves four steps:

  • Assessment & Needs Identification:
    • In this preliminary, exploratory phase, care navigators meet with the individual or family seeking help. Patient history and needs are identified.
    • Both the patient and the care navigator think through short- and long-term goals and levels of treatment sought.
  • Dialogue & Plan Formation:
    • Through discussion and collaboration, both the patient and care navigator brainstorm next steps, establishing a plan that is specific to the patient’s needs.
  • Care Coordination:
    • After information gathering and brainstorming, doctors, therapists, and other mental health options are provided to the patient.
    • Questions of affordability arise, and patients are advised toward the best solutions for their conditions and circumstances.
  • Continuity:
    • After guiding patients to healthcare providers, care navigators maintain communication and continuity with patients, offering assistance with any future obstacles that might arise.

What was the New Freedom Commission on Mental Health?

Introduction

The New Freedom Commission on Mental Health was established by then-US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings.

The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximise the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.

A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission’s findings as a launching point for recommending widespread reform of the nation’s mental health system.

A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed ‘atypical antipsychotic drugs’, such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behaviour issues. These drugs were later found to cause increased rates of sudden death in patients.

In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people.

Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative’s wider objectives are to foster chemical behaviour control of American citizens, contrary to civil liberties and to basic human rights.

Executive Order 13316, signed on 17 September 2003, revoked Executive Order 13263.

Reports

Interim Report

The commission issued an interim report on 01 November 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care.

Final Report

On 22 July 2003, the President’s commission returned a report containing nineteen formal recommendations, organised under six proposed national goals for mental health. The commission emphasised recovery from mental illness, calls for consumer and family-centred care, and recommendations that states develop a more comprehensive approach to mental health.

The commission reported that “despite their prevalence, mental disorders often go undiagnosed,” so it recommended comprehensive mental health screening for “consumers of all ages,” including preschool children, because “each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders.”

In contradiction, the Congressional Research Service, stated the commission did not specifically recommend a nationwide screening programme for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Recommendations

Noting the country’s services for people with mental illness and disabilities were “fragmented,” the commission’s final report offered 19 recommendations within six larger goals to improve service coordination, move toward a recovery model, and help all individuals with mental illness and disability recover:

  1. Americans Understand that Mental Health Is Essential to Overall Health.
    • Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
    • Address mental health with the same urgency as physical health.
  2. Mental Health Care Is Consumer and Family Driven.
    • Develop an individualised plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
    • Involve consumers and families fully in orienting the mental health system toward recovery.
    • Align relevant Federal programmes to improve access and accountability for mental health services.
    • Create a Comprehensive State Mental Health Plan.
    • Protect and enhance the rights of people with mental illnesses.
  3. Disparities in Mental Health Services Are Eliminated.
    • Improve access to quality care that is culturally competent.
    • Improve access to quality care in rural and geographically remote areas.
  4. Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
    • Promote the mental health of young children.
    • Improve and expand school mental health programmes.
    • Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies.
    • Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports.
  5. Excellent Mental Health Care Is Delivered and Research Is Accelerated.
    • Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses.
    • Advance evidence-based practices using dissemination and demonstration projects and create a public-private partnership to guide their implementation.
    • Improve and expand the workforce providing evidence-based mental health services and supports.
    • Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
  6. Technology Is Used to Access Mental Health Care and Information.
    • Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.
    • Develop and implement integrated electronic health record and personal health information systems.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry’s use of front organisations and the compromise of scientific integrity under colour of authority, look askance at the irony of the commission’s ‘freedom’ descriptor, contending the commission is yet another example of the excesses of drug industry marketing, and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.

Screening Recommendations

Mad in America author Robert Whitaker criticised the commission’s screening recommendations as “fishing for customers.” A coalition of over 100 advocacy organisations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanized by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of long-time member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. “He needs a lot of help. I’ll see him for free,” said Adams.

Others, including Congressman Ron Paul (R-TX14), were more concerned by the commission’s suggestion to use schools as a site for screening. Paul’s concern led to the introduction of H.R. 181 Parental Consent Act of 2005 in the US House of Representatives on 04 January 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. Paul introduced similar bills in May 2007 (H.R. 2387), April 2009 (H.R. 2218), and August 2011 (H.R. 2769); those, likewise, died in committee.

TMAP Origin Criticism

Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public’s attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the “political/pharmaceutical alliance.” It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was “poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab.”

Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing

Research Paper Title

Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing.

Background

Kovner (2020) has importantly highlighted the role that health care workers play in the 21st century to fight pandemics, such as the recent COVID-19 outbreak, in Canada and around the world. The heroic actions, determination, selflessness, and compassion of nurses and many health care providers worldwide have become the highlighted story of COVID-19 pandemic (Kovner, 2020). This is particularly significant, as 2020 has been called the Year of the Nurse and the Midwife by the World Health Organization and the International Council of Nurses to celebrate the birth of renowned nurse Florence Nightingale on her 200th anniversary. While this year has already signified the critical position of nurses in primary care, policy, and clinical practice, the role of psychiatric nurses and their contributions to primary care have often been overlooked by society, government policy makers, and many academics.

This is particularly true, as most provinces/states do not have dedicated bachelors’ degrees in psychiatric nursing, except for British Columbia (BC), Alberta, Saskatchewan, and Manitoba in Canada. Additionally, BC remains the only province/State in North America that has a fellowship program in Addiction nursing (Jozaghi & Dadakhah-Chimeh, 2018). Momentously, it was also the first province/state in North America to enact a provincial ministry dedicated to mental health and addiction (BC Gov News, 2017). This is remarkably significant in the current pandemic as many North American are asked to work from home, have been laid off, ordered to self-isolate, or practice social distancing. The cumulative effects of financial strain and self-isolation have already been reflected in a higher frequency of police calls for mental health and domestic assault cases in many provinces, territories, and states (Hong, 2020; Seebruch, 2020). The latest research also highlights a projected increase in suicide cases in North America linked to the COVID-19 pandemic (McIntyre & Lee, 2020). Self-isolation measures and the ongoing opioid crisis have also caused sharp increases in mortalities linked to synthetic opioids to their highest levels (Johnston, 2020). Finally, some researchers have warned about the potential misuse of alcohol during the current pandemic (Clay & Parker, 2020).

Therefore, the rise in mental health and domestic abuse calls, potential suicides, overdose deaths, and alcohol abuse serves as a reminder that COVID-19 is not our only health crisis. We must tackle and plan for the potential tsunami of mental health and addiction cases. While the Federal government in Canada has promised investment to improve long-term care, Kovner (2020) rightly pointed out that COVID-19 pandemic is about politics and policy and we similarly urge the governments and municipalities to invest to improve public health. More importantly, dedicated mental health care and training in psychiatric and addiction nursing is long overdue. We also recommend that cities, states, and federal housing agencies to increase funding for dedicated mental health and harm reduction programs during the current pandemic for people who have mental health or substance use disorders.

Reference

Dadakhah-Chimeh, Z. & Jozaghi, E. (2020) Mental Health Care, Policy, and COVID-19: The Renewed Role for Psychiatric and Addiction Nursing. Policy, Politics& Nursing Practice. doi: 10.1177/1527154420957305. Online ahead of print.

PLA Navy Personnel in Relation to Attitudes & Barriers to Mental Healthcare

Research Paper Title

Attitudes and perceived barriers to mental healthcare in the People’s Liberation Army Navy: study from a navy base.

Background

The People’s Liberation Army (PLA, China) Navy is increasingly conducting military operations other than war overseas. Factors such as confrontations with pirates, special environments and long sailing times have resulted in mental health problems. However, the navy’s actual utilisation of mental health services is low.

This study examined members’ rate of willingness to seek help and the factors that act as barriers to willingness to seek mental health services in the PLA Navy.

Methods

This cross-sectional study was conducted at the Zhoushan Base, operated by the East Sea Fleet, between March 2019 and April 2019.

The researchers distributed a 12-item questionnaire to examine participants’ attitudes and perceived barriers to mental healthcare. They recruited 676 navy personnel. Participants’ willingness to seek help if they had mental health problems was also assessed.

Results

The response rate was 99%. A total of 88.44% of the sample reported being willing to seek help. Univariate analysis suggested that those not willing to seek help were more likely to agree with the items, ‘Mental healthcare does not work’ and ‘My unit leadership might treat me differently’ and all organisational barriers, and they were more likely to have concerns about ’embarrassment’ and ‘being weak’ than those willing to seek help.

After controlling for demographic characteristics, binary logistic regression analyses confirmed that a lack of knowledge regarding the location of mental health clinics and being perceived as weak were the main factors preventing participants’ willingness from seeking help.

Conclusions

Extensive efforts to decrease organisational barriers and stigma towards mental healthcare should be a priority for researchers and policymakers to improve the usage of mental health services.

Psychoeducation aimed at de-stigmatising mental health problems should be delivered and the accessibility and availability of mental health services should be increased.

Reference

Gu, R-P., Liu, X.R> & Ye, X.F. (2020) Attitudes and perceived barriers to mental healthcare in the People’s Liberation Army Navy: study from a navy base. BMJ Military Health. doi: 10.1136/bmjmilitary-2019-001396. Online ahead of print.

Pragmatism & Empathy in Mental Health Nurses

Research Paper Title

Mental health nurses’ understandings and experiences of providing care for the spiritual needs of service users: A qualitative study.

Background

Mental health nurses have a professional obligation to attend to service users’ spiritual needs, but little is known about specific issues related to provision of care for spiritual need faced by mental health nurses or how nurses understand this aspect of care and deliver it in practice.

To explore mental health nurses’ ́understandings of spiritual need and their experiences of delivering this care for service users.

Methods

A qualitative study was conducted in one NHS mental health service. Interviews were undertaken with seventeen mental health nurses practising in a variety of areas.

Results

Four themes were generated from thematic analysis of data in the template style:

  1. Expressing personal perspectives on spirituality;
  2. Expressing perspectives on spirituality as a nursing professional;
  3. Nursing spiritually; and
  4. Permeating anxiety (integrative).

Conclusions

Participants had complex understandings of spiritual need and evident anxieties in relation to this area of care.

Two different approaches to nursing spiritually are characterised as:

  • Pragmatic (concerned with procedural aspects of care); and
  • Spiritually empathetic.

Mental health nurses were uncertain about the acceptability of attention to spiritual issues as part of care and anxious about distinguishing between symptoms of mental ill health and spiritual needs.

Educational experiences need to emphasise both pragmatic and empathetic approaches, and work needs to be organised to support good practice.

Reference

Elliot, R., Wattis, J., Chirema, K. & Brooks, J. (2020) Mental health nurses’ understandings and experiences of providing care for the spiritual needs of service users: A qualitative study. Journal of Psychiatric and Mental Health Nursing. 27(2), pp.162-171. doi: 10.1111/jpm.12560. Epub 2019 Sep 16.

Advancing E-Mental Health in Canada

Research Paper Title

Advancing E-Mental Health in Canada: Report From a Multistakeholder Meeting.

Background

The need for e-mental health (electronic mental health) services in Canada is significant.

The current mental health care delivery models primarily require people to access services in person with a health professional.

Given the large number of people requiring mental health care in Canada, this model of care delivery is not sufficient in its current form. E-mental health technologies may offer an important solution to the problem.

This topic was discussed in greater depth at the 9th Annual Canadian E-Mental Health Conference held in Toronto, Canada.

Themes that emerged from the discussions at the conference include:

  1. The importance of trust, transparency, human centredness, and compassion in the development and delivery of digital mental health technologies;
  2. An emphasis on equity, diversity, inclusion, and access when implementing e-mental health services;
  3. The need to ensure that the mental health workforce is able to engage in a digital way of working; and
  4. Co-production of e-mental health services among a diverse stakeholder group becoming the standard way of working.

Reference

Strudwick, G., Impey, D., Torous, J., Krausz, R.M. & Wiljer, D. (2020) Advancing E-Mental Health in Canada: Report From a Multistakeholder Meeting. JMIR Mental Health. 7(4), pp.e19360. doi: 10.2196/19360.

Proposing Principles for Designing the Built Environment of Mental Health Services

Research Paper Title

Principles for designing the built environment of mental health services.

Background

Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area.

To help address this gap, the authors present evidence that highlights the pivotal role of evidence-based architectural design in service users’ experience of mental health services.

They propose six important design principles to enhance the care of mental health service users.

Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, they outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience.

In this Personal View, they argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels.

Reference

Liddicoat, S., Badcock, P. & Killackey, E. (2020) Principles for designing the built environment of mental health services. Lancet Psychiatry. doi: 10.1016/S2215-0366(20)30038-9. Online ahead of print.

Outlining Tele-Mental Health & In-Person Care

Research Paper Title

Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models.

Background

Although use of tele-mental health services is growing, there is limited research on how tele-mental health is deployed.

This project aimed to describe how health centres use tele-mental health in conjunction with in-person care.

Methods

The 2018 Substance Abuse and Mental Health Services Administration Behavioural Health Treatment Services Locator database was used to identify community mental health centres and federally qualified health centres with telehealth capabilities.

Maximum diversity sampling was applied to recruit health centre leaders to participate in semi-structured interviews.

Inductive and deductive approaches were used to develop site summaries, and a matrix analysis was conducted to identify and refine themes.

Results

Twenty health centres in 14 states participated. All health centres used telepsychiatry for diagnostic assessment and medication prescribing, and 10 also offered therapy via telehealth.

Some health centres used their own staff to provide tele-mental health services, whereas others contracted with external providers. In most health centres, tele-mental health was used as an adjunct to in-person care.

In choosing between tele-mental health and in-person care, health centres often considered patient preference, patient acuity, and insurance status or payer.

Although most health centres planned to continue offering tele-mental health, participants noted drawbacks, including less patient engagement, challenges sharing information within the care team, and greater inefficiency.

Conclusions

Tele-mental health is generally used as an adjunct to in-person care.

The results of this study can inform policy makers and clinicians regarding the various delivery models that incorporate tele-mental health.

Reference

Uscher-Pines, L., Raja, P., Qureshi, N., Huskamp, H.A., Busch, A.B. & Mehrotra, A. (2020) Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models. Psychiatric Services (Washington, D.C.). 71(5), pp.419-426. doi: 10.1176/appi.ps.201900386. Epub 2020 Jan 30.

Examining National Trends in the Care of Different Mental Health Problems & in Different Treatment Settings among Adolescents

National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.

Research Paper Title

National Trends in Mental Health Care for US Adolescents.

Background

The prevalence of adolescent depression and other internalising mental health problems has increased in recent years, whereas the prevalence of externalising behaviours has decreased. The association of these changes with the use of mental health services has not been previously examined.

Therefore, the purpose of this study was to examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Methods

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analysed from July 20 to December 1, 2019.

Time trends in 12-month prevalence of any mental health treatment or counselling in a wide range of settings were examined overall and for different:

  • Sociodemographic groups;
  • Types of mental health problems (internalising, externalising, relationship, and school related); and
  • Treatment settings (inpatient mental health, outpatient mental health, general medical, and school counselling).

Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47,090 of the 230,070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years.

The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002).

Internalising problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalising problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions.

During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counselling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001).

Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions

This study’s findings suggest that the growing number of adolescents who receive care for internalising mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Reference

Mojtabai, R. & Olfson, M. (2020) National Trends in Mental Health Care for US Adolescents. JAMA Psychiatry. 77(7), pp.1-12. doi: 10.1001/jamapsychiatry.2020.0279. Online ahead of print.