Psychiatric services最新文献

Social support improves outcomes for individuals after first-episode psychosis (FEP). Illness-related changes in social behavior (e.g., social anxiety, withdrawal, and stigma) may hinder such individuals' comfort with in-person interactions; however, online relationships may appeal to emerging adults (i.e., those ages 18-29 years) with FEP who frequently rely on and are facile with digital interactions. Despite the large footprint of the Internet in emerging adults' lives, little work has examined online social support for those with FEP. In this column, the authors suggest approaches that clinicians and researchers can take when assessing sources of social support to consider online relationships as potential alternatives to in-person interactions for emerging adults with FEP.

Objective: Involuntary civil commitment statutes codify the process of involuntary admission to a health care facility. Many statutes assign law enforcement to preside over custody and transportation during the commitment process, which can be traumatizing to people taken into custody. States and localities are seeking to develop alternative crisis response approaches that reduce law enforcement involvement. This study aimed to document variations in state laws pertaining to custody and transportation during involuntary civil commitment.

Methods: The research team analyzed statutes (in effect as of March 1, 2024) of 50 states and the District of Columbia governing custody and transportation during involuntary civil commitment.

Results: Although every state and the District of Columbia had laws pertaining to responsibility for custody and transportation during involuntary civil commitment, laws varied on the entities that were allowed to transport individuals being considered for involuntary civil commitment and when non-law enforcement transport was permissible. Only seven states barred non-law enforcement transportation under any circumstance: Alabama, Georgia, Indiana, Maryland, Missouri, Montana, and Wyoming. However, even in the 44 jurisdictions where alternative transportation was permitted, law enforcement often served as the default transporter because of a lack of available alternatives.

Conclusions: Laws specifying responsibility for transport of people being considered for involuntary civil commitment vary by state, and the statutory opportunities to implement non-law enforcement transport are plentiful. Research is needed to guide policy making and implementation regarding involuntary civil commitment.

Objective: The authors estimated associations between emergency dispatches initiated by Veterans Crisis Line (VCL) responders and use of U.S. Department of Veterans Affairs (VA) behavioral health care in the following month.

Methods: The sample included 217,541 veterans with VCL contacts between 2017 and 2019 who could be linked with medical records. Models were weighted by a propensity score and stratified by VA behavioral health care use in the year preceding contact.

Results: Of veterans with emergency dispatches, 85.9% (weighted) with and 62.2% without prior use of VA behavioral health care accessed care in the month after dispatch. Dispatch receipt was associated with higher odds of psychiatric hospitalization for veterans with and those without prior VA behavioral health care use and of in-person outpatient behavioral health care use for veterans with prior use.

Conclusions: Efforts to link dispatch recipients who had not previously used VA behavioral health care to VA care are needed.

Objective: In the context of increased uptake of flexible assertive community treatment (FACT)-despite a dearth of evidence on its outcomes-the authors aimed to compare the effectiveness of FACT with that of assertive community treatment (ACT) or intensive case management (ICM) for community-dwelling people experiencing serious mental illness.

Methods: This quasi-experimental study, using propensity score matching to minimize confounding factors, examined outcomes of acute psychiatric service use among individuals who received FACT (vs. ACT or ICM) at a large Canadian mental health hospital. Data from a period of transition to FACT and an implementation period were analyzed.

Results: The matched cohort consisted of 237 FACT and 237 ACT or ICM service users. During the transition period, no significant differences between the two groups were observed in emergency department (ED) visits, hospital admissions, or inpatient days. During the period of full FACT implementation, the FACT group had a significant increase in ED visits, compared with the group that received ACT or ICM (incidence rate ratio=1.65, 95% CI=1.02-2.67), but no significant differences were observed between the two groups in the rate of hospital admissions or inpatient days.

Conclusions: To the authors' knowledge, this study is the first of its kind in Canada. Its findings suggest generally comparable outcomes of FACT (vs. ACT or ICM) in acute mental health services use. Although the rate of ED service use increased in the FACT group after implementation, inpatient service use did not increase. The higher rate of ED service use in the FACT group warrants further study.

Objective: A cohort of certified peer specialists (CPSs) was surveyed to investigate factors affecting postcertification employment and retention.

Methods: Survey data were collected in 2020, 2021, and 2022 from 591 CPSs in four states (North Carolina, Oregon, Pennsylvania, and Texas). The data were analyzed via percentages, means, and multilevel regression models.

Results: Postcertification employment remained high: 76% (N=448 of 591) in 2020, 73% (N=329 of 448) in 2021, and 77% (N=279 of 364) in 2022. However, the proportion working in peer support positions declined significantly-from 73% (N=325 of 448) in 2020 to 63% (N=175 of 279) in 2022-despite the significantly higher job satisfaction, greater access to job benefits, and longer average job tenure reported by those working in peer support versus nonpeer jobs.

Conclusions: Although the individuals who completed certification appeared to remain employed, a significant proportion appeared to leave peer support for other work. These trends should be monitored to evaluate investments in peer certification and service capacity.

To advance diversity, equity, and inclusion (DEI) initiatives within community organizations, more attention is needed to how community-engaged research can contribute to the effectiveness of such initiatives. The authors describe their experiences of participating in an academic-community partnership to conduct a DEI evaluation of an evidence-based program implemented through the public mental health system. Elements of this successful partnership included valuing community-initiated research, building connections and learning together, including multiple perspectives, finding shared goals in different contexts, leaning into problem solving, and using feedback to move forward. The lessons learned may inform continued collaborative efforts to support DEI in mental health services contexts.

Objective: Delayed access to behavioral health services results in poor outcomes and higher costs. This brief report describes the elimination of a 702-person behavioral health waitlist through phase-based care (PBC), an innovative approach that aligns behavioral health resources with new patients with high-acuity need.

Methods: Two PBC clinics, one triage and another high-acuity treatment, were established. Comparisons of pre-post interventions analyzed nonbehavioral health medical encounters, behavioral health productivity, and no-show rates.

Results: Of 702 waitlisted persons, 614 attended triage clinics within 3.5 months, with patients needing acute care (37%) entering the treatment clinic within 2 weeks. Following evaluation, the waitlisted patients had 23% fewer medical encounters per month (p<0.001), behavioral health revenues increased 29% (p<0.001), behavioral health visits increased 165% (p<0.001), health evaluations increased 287% (p<0.001), and no-shows decreased 33% (p<0.001).

Conclusions: Reallocating resources to new patients and those needing acute care resulted in increased behavioral health evaluations and productivity and reduced nonbehavioral health services without adding staff.

A trauma-informed care interdisciplinary team within an outpatient psychiatry practice provides a framework for intentional consideration of the impact of trauma on psychopathology and patient engagement. This column highlights practical ways in which trauma-informed principles have the potential to transform clinical processes, improve patient engagement, improve provider sense of empowerment, and decrease patient emergency department visits and inpatient care utilization. Challenges with program development, implementation, and evaluation are also identified.

Objective: This study examined the impact of state medical licensure exemptions and telehealth registries on college students' access to psychiatric care.

Methods: The authors attempted to contact 901 psychiatrists who advertised online on Psychology Today by using a simulated patient, described as a student attending college in a state with a medical licensure exemption or telehealth registry.

Results: Contact was established with 282 (31%) psychiatrists across 10 states. Of the 143 contacted psychiatrists who were accepting new patients, seven (5%) were aware of state medical licensure exemptions, 43 (30%) were willing to establish care with students attending college in another state regardless of state laws, 42 (29%) were willing to learn about licensure exemptions, and 51 (36%) were unwilling to care for students in another state even when permitted by law.

Conclusions: Given psychiatrists' lack of awareness of licensure exemptions and telehealth registries, interstate access to and continuity of care may be limited.

Objective: The Clear Answers to Louisiana Mental Health (CALM) campaign's objective is to reduce the duration of untreated psychosis (DUP) of patients experiencing first-episode psychosis in the New Orleans community.

Methods: CALM used mass transit and digital marketing and local community engagement strategies to reduce DUP in referrals to the Early Psychosis Intervention Clinic-New Orleans. DUP measures were collected for clinic referrals pre- and post-CALM launch (N=116). Analytics from marketing strategies were used to evaluate campaign success.

Results: In the first 12 months of CALM, the mean DUP from onset of psychotic symptoms to clinic entry decreased from a median of 6.6 (interquartile range [IQR]=2.5-14.9) to 2.1 (IQR=1.1-10.7) months. Time from onset of psychotic symptoms to first antipsychotic treatment decreased from a median of 2.0 (IQR=0.5-8.6) to 0.2 (IQR=0.0-0.7) months.

Conclusions: The CALM campaign produced promising results for reducing DUP in referrals to a coordinated specialty care program.