Community Mental Health Journal最新文献

Pharmacists are highly accessible healthcare professionals with presence in communities, hospitals, and clinics. They are well positioned to expand their roles in supporting individuals with mental health challenges. A cross-sectional study was conducted to identify trends in how pharmacists assess, monitor, identify, and care for patients with mental health challenges. The survey was distributed to licensed pharmacists in Washington State (n = 8,082) in 2023. Questions addressed the provision of mental health supports and services provided by pharmacists, respondents' self-assessed preparedness in delivering services, and professional and personal demographics. Data were analyzed using descriptive statistics and logistic regression. A total of 856 responses were received (10.6%) and 810 were included in the final dataset. Most respondents held a PharmD degree (74%). Common practice environments included community (37%), hospital (27%), and clinic (21%) settings. Less than 1% were board-certified psychiatric pharmacists. The most common mental health services provided involved medication-related services, including talking to patients regarding psychiatric medication (51%), consulting with physicians (47%), and assessing side effects (45%). Over 60% of pharmacists reported being prepared to deliver these services. Less than 30% of pharmacists indicated they were prepared to conduct mental health screenings or make referrals, and provision of these services was low. A statistically significant association was found between preparedness and providing supports and services (p < 0.001). Overall, pharmacists indicated they were more prepared and frequently delivered services related to medication use for mental health indications, while preparedness and offerings for non-medication activities was low, highlighting opportunities for further professional development.

Young adults with early psychosis often disengage from essential early intervention services (i.e., Coordinated Specialty Care or CSC in the United States). While decision support interventions improve service engagement, their use in this population is underexplored. This study evaluated the feasibility, acceptability, fidelity, and potential impact of a decision coaching intervention for young adults with early psychosis in CSC services. Using a mixed-method, longitudinal, collective case study design, we assessed the intervention's impact on decision-making needs through the Decisional Conflict Scale and qualitative interviews. We also evaluated feasibility, fidelity, and acceptability through observations and feedback from interventionists and participants. Eight young adults from three CSC programs participated, showing variable engagement, with generally favorable fidelity and acceptability ratings. The Decisional Conflict Scale revealed mixed findings, while four themes from qualitative interviews emerged: Perspective and Information Seeking, Motivation and Prioritization, Empowerment and Confidence, and Critical Thinking and Evaluation. The findings suggest that training CSC providers-including peer specialists and clinicians-to deliver decision coaching with fidelity is feasible, well-received by young adults, and potentially impactful on decision-making. Replication in a larger controlled trial, addressing observed study limitations, is warranted. This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034) on August 28, 2020, as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis (https://clinicaltrials.gov/ct2/show/NCT04532034?term=NCT04532034&draw=2&rank=1).

Various behavioral health crisis models have been developed to advance the shared goals of improving behavioral health outcomes and increasing diversion from criminal legal systems. The effectiveness of these models is promising, yet research is needed to understand their comparative advantages. This study compares the effectiveness of three community mental health response models-co-response, mobile response, and office-based response-and law enforcement-only response in addressing key behavioral health and diversion goals. These goals include improvements to follow-ups, service linkages to community resources, crisis de-escalation, and dispositions (i.e., decreasing hospitalizations and arrests). Five partner sites in Michigan provided administrative data on crisis cases and outcomes. The sample included crisis cases from one office-based model (n = 91), two mobile response models (n = 306), and two co-response models (n = 322), along with data from the partnering law enforcement agencies at each site (n = 669). Results show that model type is associated with all key outcomes. Mobile response effectively met all examined crisis response goals, including by resolving crises informally or without hospitalization, providing links to community services, and conducting follow-ups. Co-response showed some success in meeting goals, while the law enforcement-only model showed more limited results. Additionally, law enforcement presence during a mobile crisis response produced worse disposition outcomes, while contacting a CMH during law enforcement response produced better disposition outcomes. Overall, this study contributes to SAMHSA's (2020) crisis response vision to effectively meet the behavioral health needs of those in need of service by providing "someone to respond."

In response to the paucity of training in therapeutic relationships and relational care for mental health clinicians, a new three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). A condensed version of this training was recently delivered to mental health service users, carers and the public during a one-day online taster session- named Dialogical And Relational Taster Training (DARTT) - to understand their perception of this training programme. 21 people took part in this taster training day and subsequently completed a survey about their impression of different elements of the training. This paper outlines the key elements of the taster training that were delivered and survey results. Overall, the response to the survey shows a positive impression of the training and the core components of it. These survey results appear to affirm the importance of relational aspects of care, especially as understood by those using services and their carers.

In the United States, a disproportionately high number of incarcerated individuals suffer from serious mental illnesses, substance use disorders, chronic medical conditions, infectious diseases, and traumatic brain injuries. Correctional facilities are often ill-equipped to address the incarcerated community's physical and mental health needs. Current laws and policies remain outdated and do not adequately address the complex health issues faced by incarcerated individuals, particularly the aging and terminally ill patients in correctional settings. We present a case of a male with schizophrenia whose ongoing psychiatric symptoms impaired his decisional capacity, leading to him to refuse medical treatment for an initially treatable medical condition, ultimately resulting in his death due to the lack of a surrogate decision-maker. This case underscores the urgent need for policy revisions to assign medical decision-making authority for individuals in custody and highlights potential interventions to bridge existing gaps in care for this population.

Studies on mental health service use among juvenile violent offenders prior to their acts of violence are sparse. Mostly, their service use seems to be short-term, although there may have been several service periods. Little is known about how they have perceived those services. Using a qualitative content analysis on data from forensic psychiatric examination statements, we studied discontinuities in the use of mental health services of 15-22-year-old violent Finnish offenders and descriptions of their perceptions of those services. There were several types of discontinuities: limited youth engagement and subsequent dropping out from services, or partial or total refusal of the proposed examinations or treatments. Most discontinuations were instigated by the youth themselves, followed by the parents and the service system. The subjects had perceived mental health services to be not beneficial for the most part, although some experienced benefits from medication. When treating children and adolescents with behavioral symptoms clinicians should identify the early signs of the process of disengagement from treatment and pay attention to the perceptions of the treatment of both the youth and their parents. Also, more research is needed on the user experience of mental health services among violent offenders, as well as factors relating to discontinuities along their mental health service path.

Community pharmacists (CPs) are vital as primary healthcare providers, particularly in the screening and management of mental health issues. This study aimed to explore CPs' views on mental health support for patients and the potential challenges in delivering mental health services. Malaysian CPs were recruited through purposive and snowballing sampling. Semi-structured interviews were recorded and transcribed verbatim. Data was thematically analyzed using NVivo 12 management software. Twenty CPs from Peninsular Malaysia were interviewed. Participants emphasized the importance of high-quality resources, comprehensive training and standardized tools to effectively provide mental healthcare services. Challenges identified were lack of knowledge and skills, absence of screening tools and social stigma and conservatism, particularly among older individuals. This study underscores the willingness of CPs taking a primary role in mental health services. However, collaboration with relevant stakeholders is crucial, aligning with national strategic plans for the program to be successful.

Peer recovery coaches utilize their lived experiences to support overdose survivors, a role gaining prominence across communities. A convergent mixed methods design, informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, was used to evaluate the Recovery Opioid Overdose Team Plus (ROOT +), through an iterative evaluation using web-based surveys and qualitative interviews. Reach: Over 27 months, ROOT + responded to 83% of suspected overdose referrals (n = 607) and engaged with 41% of survivors (n = 217) and 7% of survivors' family/friends (n = 38). Effectiveness: Among those initially engaged with ROOT +, 36% of survivors remained engaged, entered treatment, or were in recovery at 90 days post-overdose (n = 77). Adoption: First responders completed 77% of ROOT + referrals (n = 468). Implementation: Barriers included lack of awareness of ROOT + , working phones, and access to treatment from community partner interviews (n = 15). Maintenance: Adaptations to ROOT + were made to facilitate implementation. Peer-led teams are promising models to engage with overdose survivors.