Psychiatric services最新文献

Objective: Immigrants and persons with a non-English language preference (NELP) face unique challenges in the mental health care system. This systematic scoping review aimed to evaluate the literature for disparities in psychiatric care delivery, beyond access and utilization barriers, experienced by these two populations.

Methods: The authors queried four databases: PubMed, PsycInfo, Web of Science, and CINAHL. Studies published between August 1993 and August 2023 were selected if they had a population that included immigrants to English-language countries or patients with a NELP and a mental illness, had a relevant comparison group, and included outcome measures focused on quality of psychiatric care delivery. Studies focusing solely on care access or utilization, studies without original data, case reports, and commentaries were excluded.

Results: The search identified 2,860 studies. Seventeen studies were included for full-text review (Cohen's κ=0.96). Large variability was found in the measures of quality used in the studies. Outcome variables were involuntary treatment rate, symptom management, unmet needs, medication use and monitoring, diagnosis, and psychiatric referral. Immigrants were more likely than nonimmigrants to receive involuntary treatments in all seven pertinent studies. An insufficient number of studies focused on other outcome measures, limiting analyses.

Conclusions: Many studies highlighted differences in care, especially with regard to involuntary hospitalization. Outcome measures varied and deviated from established quality metrics. Insufficient data were available to determine whether the identified differences in care represent a care delivery gap. Studies that use standardized measures would assist in evaluating the quality of care received by immigrants and patients with a NELP.

Family-based intervention approaches hold tremendous promise for improving mental health in scalable and relevant ways that address social determinants of health, yet family-focused prevention and care interventions are underused in global mental health. This article provides a brief overview of the evidence and types of programs. It then outlines five future directions for family-focused global mental health interventions: integrating implementation science into family-focused programs, expanding research on family-focused work to other populations and different modalities, encouraging transdisciplinary learning from other fields, understanding what works for whom and where, and disseminating family interventions grounded in locally derived theoretical frameworks.

Across the globe, psychiatric illnesses are common, painful, often disabling, and sometimes deadly. Although well-researched practices exist to address these disorders, most people with psychiatric illnesses do not have access to care that has been demonstrated to be effective. Practical clinical leadership experience and engagement in evidence-based practice (EBP) implementation research in Colombia and the United States have demonstrated that multisite EBP implementation is possible and that effective implementation improves outcomes for people who develop psychiatric illnesses. Implementation requires financial and policy support but is effective only if onsite operational leaders actively overcome practical, sometimes site-specific barriers. Operational leaders have the greatest impact when they focus on changing the flow of work to help clinicians offer the desired EBP in their day-to-day care. Discovery science may bring new solutions in the future, but implementing practices that have already been demonstrated to be effective can relieve patients' suffering now.

Objective: The authors utilized patient-reported outcomes from a large U.S. behavioral health care system to evaluate the strength of improvements in patients' self-perceived recovery during mental health treatment.

Methods: This was a cohort study conducted with electronic health records from 2021-2022 Discovery Behavioral Health patients. Patients were grouped according to their 41-item Recovery Assessment Scale (RAS) scores at admission. Linear regression models accounting for patient characteristics were used to estimate RAS score changes from admission to discharge and RAS score at discharge.

Results: Of 9,441 patients, those belonging to groups with lower RAS scores at admission showed substantial score improvements, although their scores at discharge were still much lower compared with those of patients with higher admission scores. Results were consistent across secondary analyses.

Conclusions: Substantial improvements in recovery were evident during treatment, especially for patients with lower RAS scores at admission. The findings underline the importance of research into enhanced personalized treatment approaches to optimize recovery.

Objective: Black adults experience depression that is more severe than that of their White counterparts, yet they are less likely to receive treatment from a mental health professional. This study aimed to examine the relationships between medical mistrust or trust and the willingness to seek mental health care.

Methods: The authors conducted an online cross-sectional survey of 1,043 Black adults in the United States. The primary variables of interest were medical mistrust (measured via the 12-item Group-Based Medical Mistrust Scale; GBMMS) and a single item, derived from the General Help-Seeking Questionnaire, that assessed willingness to seek mental health care. The authors hypothesized that mistrust would have a negative correlation with willingness to seek help from a mental health professional. To estimate the association between level of mistrust and willingness to seek care, gamma regression models were fitted with a log link, and the analyses were adjusted for age, ethnic identity or origin, education, insurance status, personal income, citizenship status, and length of time in the United States.

Results: At low levels of medical mistrust (GBMMS scores ≤3), an increase in mistrust was significantly associated with an increase in the probability of seeking mental health care (rate ratio [RR]=1.55, p<0.001). At high levels of medical mistrust (GBMMS scores >3), an increase in mistrust was associated with a decrease in care seeking (RR=0.74, p<0.001). Similar patterns were observed for medical trust.

Conclusions: At low levels of medical mistrust among Black adults, each unit increase in mistrust was counterintuitively associated with an increase in willingness to seek care from a mental health professional.

A national and global focus on expanding identification and treatment of youths who are at clinical high risk for psychosis (CHR-P) highlights an urgent need to develop clinical services for this population; however, questions remain regarding program structures and treatment approaches in CHR-P clinics. The authors of this Open Forum expand on previous recommendations and argue that a focus on enhancing developmentally informed care should serve as a central principle for structuring macrolevel service policies and programs as well as person-specific treatment approaches. The authors discuss developmental considerations in program planning and service provision and offer recommendations for providers and other stakeholders to enhance developmentally informed care for individuals at CHR-P.

Despite the effectiveness of treating substance use disorders in primary care, access to such services remains limited. In this project, quality improvement methods were used to create and evaluate a rapid-access pathway for substance use treatment services in community health clinics. A "secret shopper" test gathered information about wait times and requirements. Results informed the development of a patient-centered pathway, in which patients requesting substance use treatment services were offered an immediate telehealth appointment with a provider and then linked to ongoing care services. This treatment pathway was feasible to implement, resulted in high treatment access rates, and was minimally disruptive to clinic operations.

Objective: This study aimed to describe the characteristics of callers to a statewide mental health crisis line who were transferred to 911 (active rescue).

Methods: This retrospective cohort study examined mental health crisis line calls transferred to active rescue (N=3,538 calls; N=3,132 unique callers) from the Georgia Crisis and Access Line (2016-2018). Chi-square analyses and t tests were used to examine descriptive differences between caller characteristics and call features.

Results: Of crisis line callers with a contact that resulted in active rescue, 53% were male, and 53% were Black. Youth callers represented 11% of all rescue calls; 74% of these callers had Medicaid. Active rescue most frequently occurred because of a danger to oneself (58%). Reasons for active rescue differed by race (p<0.001).

Conclusions: Most crisis calls resulting in active rescue occurred because of concern about self-harm. Demographic differences by reason for active rescue reveal gaps in the understanding of crisis care delivery.

As the COVID-19 pandemic emerged in March 2020, the New York State Office of Mental Health received funding from the Federal Emergency Management Agency to implement the agency's Crisis Counseling Assistance and Training Program statewide. Because COVID-19 infections were disproportionately affecting minority communities of color, engagement strategies that prioritized contracting with community agencies that were already well established in the most highly affected racial-ethnic minority neighborhoods were used. This approach to outreach successfully made engagement and counseling support available to Black and Hispanic citizens, at levels significantly exceeding their proportional representation in the state population. These efforts identify an opportunity for a postpandemic paraprofessional workforce to address general medical health and mental health inequities in underresourced racial-ethnic minority communities.

Objective: The use of court-ordered mental health treatment through programs such as assisted outpatient treatment (AOT) carries substantial ramifications for the welfare of individuals with serious mental health conditions.

Methods: In this review, the authors used a narrative methodology and performed an interpretive synthesis of existing U.S.-based literature (2008-2023) on AOT implementation and outcomes.

Results: The search yielded 21 peer-reviewed articles published between 2009 and 2022 that assessed various aspects and outcomes of AOT. Although many of these studies generally supported the use of AOT, most used a limited data set (i.e., AOT program data from New York or Ohio between 1999 and 2007). Much of the latest research on AOT did not include attention to possible mechanisms to explain observed outcomes. The emerging literature suggests that increased outreach and less coercive tactics may lead to better outpatient treatment outcomes. However, more research, especially from the point of view of individuals enrolled in AOT programs, is needed.

Conclusions: The authors strongly recommend that research into these interventions be broadened and include more geographic locations. A greater emphasis should be placed on identifying potential disparities, developing a better understanding of AOT-specific mechanisms of change, and continuing efforts to identify and use high-quality comparison groups.