Psychiatric services最新文献

Access to evidence-based programs that address early psychosis is a substantial public health concern. The authors describe the community-engaged, data-driven process that informed the development of the Massachusetts Strategic Plan for Early Psychosis, an effort to identify actionable priorities to build a system of prevention and care that responds to the needs of individuals who experience psychosis and their caregivers. A multiphase, mixed-methods approach was used to gather knowledge from young adults experiencing early psychosis and their caregivers, including two symposia with diverse stakeholders. Six overarching goals were identified, each with possible action steps and stigma reduction strategies: connecting and supporting individuals who experience psychosis and their families, promoting early identification of and intervention for psychosis through community education, providing specialized support to key community members, providing specialized support to medical and behavioral health care professionals, supporting specialized treatment teams in the delivery of evidence-based care, and developing a statewide system of psychosis services. Next steps for and operationalization of the statewide strategic plan for psychosis in Massachusetts will require a population health approach that engages the community through intersectoral and multisectoral strategies.

Objective: Patients' experiences of inpatient psychiatry have received limited empirical scrutiny. The authors examined patients' likelihood of experiencing institutional betrayal (harmful actions or inactions toward patients) at facilities with for-profit, nonprofit, or government ownership; patient-level characteristics associated with experiencing institutional betrayal; associations between betrayal and patients' trust in mental health providers; and associations between betrayal and patients' willingness to engage in care postdischarge.

Methods: Former psychiatric inpatients (N=814 adults) responded to an online survey. Data were collected on patients' demographic characteristics; experiences of institutional betrayal; and the impact of psychiatric hospitalization on patients' trust in providers, willingness to engage in care, and attendance at 30-day follow-up visits. Participants' responses were linked to secondary data on facility ownership type.

Results: Experiencing institutional betrayal was associated with less trust in mental health providers (25-percentage-point increase in reporting less trust, 95% CI=17-32), reduced willingness (by 45 percentage points, 95% CI=39-52) voluntarily undergo hospitalization, reduced willingness (by 30 percentage points, 95% CI=23-37) to report distressing thoughts to mental health providers, and lower probability of reporting attendance at a 30-day follow-up visit (11-percentage-point decrease, 95% CI=5-18). Participants treated at a for-profit facility were significantly more likely (by 14 percentage points) to report experiencing institutional betrayal than were those treated at a nonprofit facility (p=0.01).

Conclusions: Institutional betrayal is one mechanism through which inpatient psychiatric facilities may cause iatrogenic harm, and the potential for betrayal was larger at for-profit facilities. Further research is needed to identify the determinants of institutional betrayal and strategies to support improvement in care quality.

Climate change poses substantial challenges to mental health, with increased frequency of extreme weather events and environmental degradation exacerbating stress, anxiety, trauma, and existential concerns. Digital innovations, particularly artificial intelligence and digital phenotyping, offer promising avenues to mitigate climate-related mental health burdens. The integration of digital tools into climate-related mental health care necessitates careful consideration of issues of access to and adoption of solutions. Future research should evaluate the effectiveness and scalability of digital interventions to address the mental health impacts of climate change through collaborative efforts involving clinicians, environmental health specialists, bioethicists, policy makers, and technology developers.

Objective: Expanded funding to support care across the crisis continuum is intended to improve behavioral health outcomes. A greater understanding of how to effectively implement and integrate local crisis care systems has been identified as a research and policy priority. The aim of this study was to explore provider perceptions of the barriers and facilitators associated with implementing effective behavioral health crisis services.

Methods: The authors conducted semistructured qualitative interviews with personnel from 15 behavioral health crisis care programs across California. Purposive sampling was used to ensure adequate representation of peer specialists, clinicians, mental health workers, and program leaders. Interview transcripts were analyzed via an inductive approach to thematic analysis. On the basis of patterns identified in the data, initial codes were developed, reviewed, and combined into overarching preliminary themes and subthemes.

Results: Twenty-nine crisis care personnel participated. Facilitators of effective crisis care included an optimal crisis service structure, a client-centered approach, engagement with clients' support systems, and collaboration with community partners to link clients to services and enable safe delivery of crisis care. Barriers at the client, program, and system levels were identified, with solutions proposed for each.

Conclusions: The participants identified features of crisis care that could improve program implementation and effectiveness or could help mitigate identified barriers. As states and local municipalities work to implement an integrated system of care across the crisis care continuum, input from frontline providers can be used to support the development of new programs, refine existing services, and inform future directions for research.

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: To improve understanding of the application process for temporary involuntary hospitalization (Section 12 of the Massachusetts General Laws) in Boston, the authors focused on cases involving the Boston Police Department (PD) and the information shared about the individuals involved.

Methods: A retrospective analysis was conducted on all Section 12 applications submitted to the Boston PD by external clinicians from July 14, 2021, to June 30, 2022. The authors analyzed 488 applications processed by the Boston PD's Street Outreach Unit, examining demographic information, reasons for requests, information provided by petitioners, and the status of the applications (completed vs. not).

Results: The analysis revealed racial disparities: 41% of involuntary hospitalization applications were for individuals identified as Black or African American, but this racial group represents only 23% of Boston's population. Racial-ethnic data were based on police perceptions, and 21% of cases lacked race-ethnicity data. Seventy-six percent of applications were submitted without a direct clinical examination by petitioners, who did not justify the omission. The Boston PD completed 70% of the requested involuntary hospitalization orders.

Conclusions: This study identified substantial racial disparities in Section 12 applications, which disproportionately involved Black or African American individuals. The frequent absence of direct clinical examinations before application submissions and the lack of justification indicated a need for regulatory oversight and enhanced petitioner training. Incomplete demographic data underscored the need for improved data collection and reporting practices. These findings highlight the need for reforms to ensure equitable, transparent, and best practice-aligned involuntary hospitalization processes.

Objective: This study aimed to describe the demand for, supply of, and clinic processes associated with behavioral health care delivery in the Military Health System and to examine the clinic-level factors associated with receipt of a minimally adequate dosage of psychotherapy.

Methods: This retrospective study used administrative behavioral health data from eight military treatment facilities (N=25,433 patients; N=241,028 encounters) that were participating in a larger implementation study of evidence-based psychotherapy for posttraumatic stress disorder. Minimally adequate dosage of psychotherapy was defined in two ways: at least three sessions within a 90-day period and at least six sessions within a 90-day period. The authors then used a path model to examine clinic-level factors hypothesized to predict psychotherapy dosage, including care demand, supply, and processes.

Results: Patients had an average of 2.5 psychotherapy appointments per quarter. Wait times for intake, between intake and the first psychotherapy session, and between follow-up sessions all averaged 17 days or longer. Path modeling showed that a higher patient-to-encounter ratio was associated with a longer wait time between follow-up psychotherapy appointments. In turn, a longer wait time between appointments was associated with a lower probability of receiving an adequate dosage of psychotherapy. However, a greater proportion of care delivered in groups was associated with a greater probability of receiving at least six sessions of psychotherapy.

Conclusions: Receipt of a minimally adequate dosage of psychotherapy in the Military Health System is hindered by clinic staffing and workflows that increase wait times between follow-up psychotherapy appointments.

Objective: Wellness has been associated with various general medical and mental health outcomes; however, few empirically supported measures capture the breadth of the wellness construct. The first author had previously developed the Wellness Inventory through an iterative process with key stakeholders to establish face and content validity and examined the psychometric properties of the Wellness Inventory as a tool for assessing wellness across eight dimensions.

Methods: The authors assessed the Wellness Inventory by using data from self-report online surveys in three samples of data collected from two groups of respondents: students and faculty members in a public university and behavioral health providers (N=3,446; 50% White and 43% female). Exploratory and confirmatory factor analyses and data from samples 1 and 2 were used to examine the factor structure and fit of the inventory. Data from sample 3 were used to assess test-retest reliability and convergent and discriminant validity.

Results: Factor analyses yielded a one-factor model comprising 54 items. A revised instrument based on this model revealed good fit to the data, internal consistency, and test-retest reliability and reasonable construct validity.

Conclusions: The Wellness Inventory is a comprehensive and psychometrically valid tool for assessing wellness. The findings support a single dimension of wellness, suggesting wellness as a holistic, general construct. This inventory has implications for research on health promotion and prevention and clinical outcomes in both research and treatment.

Objective: The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA).

Methods: The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition).

Results: Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses.

Conclusions: Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT.