Should Hospital Psychiatry Complement Community Psychiatry?

Research Paper Title

The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes?

Background

Community-based psychiatric services are essential to mental health. For decades, researchers, advocates, and policy makers have presumed that expanding the supply of these services hinges on reducing the supply of hospital-based care.

Cross-national data from the World Health Organisation call this presumption into question.

Community and hospital psychiatry appear to be complements, not substitutes.

Reference

Perera, I.M. (2020) The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes? Psychiatric Services (Washington, D.C.). doi: 10.1176/appi.ps.201900086. [Epub ahead of print].

Depression: Obstetric Mental Health Clinics & Outpatient Psychiatric Services

Research Paper Title

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination.

Background

A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression.

The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences.

Methods

A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale.

Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness.

A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service.

Results

The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit.

Patients taking three or more psychiatric medications attended more OBMHC visits.

Trend analysis indicated that women with the highest levels of depression had the best response to the intervention.

Three qualitative themes emerged:

  • Safe Place;
  • Mental/Emotional Stability; and
  • Integrated Personalised Approach.

Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care.

Conclusions

OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service.

Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms.

The longevity of this clinic’s experience serves as a role model for other centres to replicate this successful integrated model of care.

Reference

Goedde, D., Zidack, A., Li, Y.H., Arkava, D., Mullette, E., Mullowney, Y. & Brant, J.M. (2020) Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination. Journal of the American Psychiatric Nurses Association. doi: 10.1177/1078390319897311. [Epub ahead of print].

E-Therapy & Training Future Psychiatrists

Research Paper Title

Therapy and E-therapy – Preparing Future Psychiatrists in the Era of Apps and Chatbots.

Background

In both Canada and the USA, residency includes learning about psychotherapy.

The Royal College of Physicians and Surgeons of Canada mentions several psychotherapies in its training objectives and states that residents must “demonstrate proficiency in assessing suitability for and prescribing and delivering” such treatments, including cognitive behavioural therapy.

The Accreditation Council for Graduate Medical Education (ACGME) in the USA sets out competency frameworks and assessments for psychotherapy in psychiatry post-graduate education.

Yet on neither side of the 49th parallel is there mention of e-therapies in training requirements.

Read the full article using the link below.

Reference

Gratzer, D. & Goldbloom, D. (2020) Therapy and E-therapy – Preparing Future Psychiatrists in the Era of Apps and Chatbots. Academic Psychiatry. https://link.springer.com/article/10.1007%2Fs40596-019-01170-3.

Stacey Dooley: On the Psych Ward (2020)

Introduction

Every year thousands of young people are brought to mental health units across the UK to seek treatments.

Latest estimates put the number of people who suffer from a mental condition at 1 in 3 and most first experience mental health problems when they are young.

Refer to Stacey Dooley: Back on the Psych Ward (2021).

Outline

Stacey is going to work in Springfield Hospital, one of the oldest mental health units in the UK, to see what life is really like on the front line of mental health services. More than just observing, she will be working directly with staff, dealing with patients, and taking part in making incredibly tough decisions on what is best for patients.

Stacey meets Rachelle who has been diagnosed with EUPD (Emotionally Unstable Personality Disorder). Still in her 20s, she’s had a troubled life already – full of suicide attempts and self-harm. She opens up to Stacey about her struggles with her illness, and her hope that she will soon get the talking therapy that she believes could be the solution to her problems. The doctors here agree that this is not the best place for Rachelle to be, and they are hoping she will get a place at a specialist unit in Cambridge where she can make real progress in coping with her condition.

Stacey also spends time in a special acute assessment unit where patients can self-refer. She meets 19-year-old Kyle, who has come to Springfield in the midst of a severe depression and incident of self-harm. As Stacey takes part in a discussion with staff about whether to admit him to the hospital or support him in the community, Stacey experiences for herself just how difficult the decisions and the judgement calls are that the team have to make.

Police have brought Laura to the 136 unit, so called because it is the local designated place of safety as defined under section 136 of the Mental Health Act. She has been sectioned after being found on a motorway bridge, threatening to jump. She opens up to Stacey as they talk, trying to explain her thinking and her ongoing struggles with depression and her eating disorder – all stemming from traumas earlier in her short life.

Production & Filming Details

What Psychiatric Inpatients Needs when Approaching Discharge?

Research Paper Title

Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis.

Background

Understanding the needs of individuals transitioning to the community following a psychiatric hospitalisation can inform community service planning.

This study is among the first to examine the needs of a sample of psychiatric inpatients approaching discharge in a large urban area in the USA.

Methods

Representative data were drawn from 1129 acutely hospitalised psychiatric inpatients from eight New York City hospitals.

Descriptive statistics were used to estimate patient needs at discharge across nine domains: housing, employment, income, transportation, education, time use, social support, and help accessing medical and mental health care.

Latent class analysis (LCA) was applied to identify subgroups of patients based on needs profiles.

Multinomial logistic regression was used to investigate socio-demographic associations with class membership.

Results

Respondents were most likely to have needs related to income (50.7%), housing (49.2%), and employment (48.7%).

Results from the LCA suggested a five class solution of patient needs:

  • Three domain-specific classes whose members endorsed needs for ‘housing and employment’ (22.5%), ‘social support and time use’ (15.0%) and ‘access to care’ (6.4%); and
  • Two classes where overall member needs were high (‘high needs,’18.4%) or low (‘low needs,’ 37.7%) across all needs.

Compared to the ‘low needs’ class, members of the ‘high needs’ class had significantly greater odds of being black or Latino, male, uninsured, and parents of a child under 18 years.

Conclusions

Patients have unique profiles of need that are significantly associated with the socio-demographic characteristics.

These findings may help practitioners and policymakers improve mental health services.

Reference

McDonald, K.L., Hoenig, J.M. & Norman, C.C. (2020) Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis. Social Psychiatry and Psychiatric Epidemiology. doi: 10.1007/s00127-019-01817-4. [Epub ahead of print].

Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders

Research Paper Title

Taking the Pain out of Somatisation: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Paediatric Somatic Symptom and Related Disorders.

Background

The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care.

Little literature exists to address SSRDs in the inpatient paediatric setting.

The purpose of the study was to characterise current SSRD practice, identify problem areas in workflow, and develop a standardised approach to inpatient evaluation and management at a tertiary care academic children’s hospital.

Methods

A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014.

A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice.

Lean methodology was used to define current state practice and future state intervention.

These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development.

Results

Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review.

Most patients presented with either neurological or pain-related complaints.

The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalisation.

Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis.

Half of patients had co-morbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up.

Conclusions

In this study, the researchers describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of paediatric SSRDs.

This study may serve as a model for similar standardisation of SSRD care in other inpatient paediatric medical settings.

Reference

Kullgren, K.A., Shefler, A., Malas, N., Monroe, K., Leber, S.M., Sroufe, N., El Sakr, A., Pomeranz, E., O’Brien, E. & Mychaliska, K.P. (2020) Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hospital Paediatrics. 10(2), pp.105-113. doi: 10.1542/hpeds.2019-0141. Epub 2020 Jan 2.

Are Community-Based Psychiatric Services Essential to Mental Health?

Research Paper Title

The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes?

Background

Community-based psychiatric services are essential to mental health.

For decades, researchers, advocates, and policy makers have presumed that expanding the supply of these services hinges on reducing the supply of hospital-based care.

Cross-national data from the World Health Organisation call this presumption into question.

Community and hospital psychiatry appear to be complements, not substitutes.

Reference

Perera, I.M. (2020) The Relationship Between Hospital and Community Psychiatry: Complements, Not Substitutes? Psychiatric Services (Washington, D.C.). doi: 10.1176/appi.ps.201900086. [Epub ahead of print].