Psychiatric services最新文献

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.

Objective: The authors sought to quantify the proportion of U.S. postsecondary institutions that offer any on-campus mental health services to their students.

Methods: In this cross-sectional study, data about the availability and descriptions of mental health services were gathered from websites of a main sample of 200 postsecondary institutions other than community colleges and a sample of 50 community colleges. Both samples were selected through a stratified sampling process. Descriptive statistics, weighted (main sample) and unweighted percentages, and confidence intervals were calculated.

Results: In the main sample, 191 institutions (95%, 95% CI=91%-98%) offered mental health services. Among community colleges, 40 (80%, 95% CI=69%-91%) offered such services. In both the main and community college samples, most institutions (92% and 75%, respectively) used "counseling" to describe the services offered.

Conclusions: Extrapolation of these results suggests that >1,700 U.S. postsecondary institutions offer mental health services, making campus services a sizeable mental health services sector.

Objective: This study aimed to examine whether changes in mental health services use under the Patient Protection and Affordable Care Act (ACA) differed in Mental Health Professional Shortage Areas (MHPSAs) versus non-MHPSAs.

Methods: Multiple waves of data from the California Health Interview Survey (2011-2018) were analyzed. The sample (N=10,497) was restricted to adults (ages 18-64) who reported experiencing serious psychological distress (SPD) during the past 12 months. MHPSAs were identified by using scores from the Health Resources and Services Administration and were matched to respondents' zip codes. Weighted logistic regression and generalized linear models were used to identify adjusted changes in the rates of four measures of mental health services use (any primary care visit for mental health reasons, any specialty mental health care visit, any prescription psychiatric medication, and total number of outpatient visits for mental health) before and after implementation of the ACA.

Results: Rates of uninsured nonelderly adults with SPD in MHPSAs and non-MHPSAs decreased under the ACA. Changes in rates of specialty mental health services use under the ACA were statistically significant only in non-MHPSAs. Changes in mental health services use did not differ significantly between MHPSAs and non-MHPSAs for any of the four measures.

Conclusions: Changes in the four measures of mental health use under the ACA did not differ in MHPSAs versus non-MHPSAs. Future research into the ACA's long-term effects should examine systemic and structural barriers to mental health care and to having sufficient numbers of mental health professionals.

Objective: The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery.

Methods: From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy.

Results: Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth.

Conclusions: Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.

Objective: The authors evaluated the feasibility of automated depression screening and a follow-up postscreening protocol.

Methods: Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 screeners were sent to 20 specialty clinics and administered to patients who were ages ≥18 years, had not completed a PHQ-2 or PHQ-9 within the past 9 months, had no psychiatric diagnosis within the past 2 years, and had no behavioral health appointment within the previous year or an upcoming behavioral health appointment. In a two-pronged approach, patients with scores indicating moderate or moderately severe depression but with no indication of possible suicidal ideation were offered behavioral health resources (first prong), or patients with scores indicating severe depression or with possible suicidal ideation were contacted via telephone and requested to schedule a behavioral health appointment (second prong).

Results: The PHQ-2 was offered to 21,674 patients, with 38.1% (N=8,247) completing the screening; 13.1% (N=1,084) of those with completed screens had a positive depression score. Of patients who completed the PHQ-9, 44.5% (N=650) were eligible for the first prong of the intervention and 31.1% (N=455) for the second prong. Depression screening completion rates differed significantly by multiple sociodemographic factors. Mean±SD lag times from screening completion to successful contact and from contact to appointment completion were 7±6 and 5±4 days, respectively.

Conclusions: Automated depression screening with outreach based on depression severity is feasible and provides potentially efficient use of scarce resources. More research is needed on the mechanisms for automated screening and follow-up to examine factors such as patient engagement after a positive screening.

Objective: The authors aimed to increase measurement-based care in an outpatient academic psychiatry service.

Methods: The Measurement-Assisted Care program (MAC) was implemented as a clinical quality-improvement effort that included 4,665 unique patients and 176 clinicians over 12 months. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), PTSD Checklist for DSM-5, and Brief Inventory of Thriving were automatically included in the patient electronic check-in process for new visits; the PHQ-9 and GAD-7 were included for return visits. Patient responses were automatically routed to clinicians' electronic health record inboxes and documentation templates. MAC was rolled out in two phases, and clinicians were surveyed about their use of MAC data 3-6 months after the start of the program.

Results: After implementation of MAC, PHQ-9 completion rates increased from 5% to 66% of visits for phase 1 and from 5% to 60% for phase 2. Post-MAC completion rates were higher for telehealth (70%) than for in-person (40%) visits. More than 90% of clinicians reported that MAC was useful with at least one of their three most recent patients, and 51% reported that it was useful with all three of their three most recent patients. Clinician adoption was high, with 78% reporting that they use MAC data to guide care.

Conclusions: MAC increased the completion rate of patient-reported outcome measures, especially for telehealth visits. Clinicians reported that they frequently use and discuss MAC data with patients, implying that technology-supported workflows can help systems with high telehealth utilization capture and use patient-reported outcomes.