International Journal of Mental Health Systems最新文献

Background: Stepped Care 2.0 (SC2.0) and One-at-a-Time (OAAT) approaches can help address challenges related to accessing effective addiction and mental health (A&MH) services. OAAT services, available by walk-in or appointment, were implemented in New Brunswick (NB) as the first step in developing a provincial stepped care framework in alignment with NB's A&MH action plan. This study sought to evaluate the impact of online training courses in SC2.0 and OAAT service delivery on providers' knowledge, readiness, and capabilities to implement OAAT services in A&MH clinics, within the broader context of the provincial SC2.0 model.

Methods: Providers employed with A&MH services (e.g., social workers, nurses, psychologists) across NB completed asynchronous training courses in SC2.0 and OAAT services as part of a provincial implementation initiative. Over 400 providers volunteered to complete questionnaires related to this training (N = 401). Knowledge acquisition questionnaires were developed based on SC2.0 course content and administered pre- and post-training. Providers also completed a post-training knowledge acquisition questionnaire on OAAT services. Providers completed questionnaires on acceptability, appropriateness and feasibility of training courses, and self-efficacy post-training. Qualitative interviews were conducted with 28 providers to further understand their experiences with training courses in SC2.0 (n = 12) and OAAT services (n = 16).

Results: Mean percentage of correct responses at post-course for SC2.0 and OAAT services was 67.2% (SD = 15.9%) and 75.7% (SD = 15.7%), respectively. A modest, but significant, increase in knowledge of SC2.0 was observed post-training. Courses were deemed acceptable, appropriate and feasible, and resulted in favorable outcome expectancies. Moreover, providers reported modest self-efficacy to enact SC2.0 following training. Providers made recommendations to receive additional resources and training in SC2.0 and OAAT services to further enhance confidence to integrate key principles into practice.

Conclusions: Asynchronous training courses in SC2.0 and OAAT services supported the provincial practice change initiative in NB. In line with the COM-B model of behavior change, course barriers and facilitators were identified and provide insights into ways in which these courses, and related implementation projects involving training healthcare professionals, could be adapted to help create and sustain change.

Background: Over 14 million adolescents have a diagnosable mental, behavioral, or emotional disorder yet only 20% receive adequate mental health services. There is a critical need to identify accessible and effective pathways to treatment. School based mental health services (SBMHS) are an optimal setting for timely identification, effective management, and convenient delivery of evidence-based mental health care.

Methods: Using data from the 2019 National Survey on Drug Use and Health, we employed structural equation modeling to examine the relationships between utilization of SBMHS and school and academic engagement, religiosity, self-reported depressive symptoms, and parental monitoring and support.

Results: Higher levels of parental monitoring and support (ß = -0.044, p < 0.05) and religiosity (ß = -0.027, p < 0.05) along with lower levels of school and academic engagement (ß = 0.069, p < 0.001) were associated with decreased adolescent utilization of SBMHS. Adolescents reporting a higher number of depressive symptoms on a scale of 1 to 9 (ß = 0.221, p < 0.001) were more likely to utilize SBMHS compared to their counterparts. Self-reported depressive symptoms mediated the relationship between all latent variables (parental monitoring and support [ß = -0.222, p < 0.001]; religiosity [ß = -0.051, p < 0.001]; school and academic engagement [ß = -0.067, p < 0.001]) and adolescent utilization of SBMHS.

Conclusion: Findings from this study offer psychologists, teachers, counselors, school nurses, and administrators specific determinants of service use that can be used to develop strategies for adolescent mental health assessment, increase SBMHS utilization among those in need, and support overall emotional well-being.

Background: The implementation of interventions, digital tools, and policy plans in health systems research is highly complex. Proof-of-Concept (PoC) studies facilitate the development of these applications although they are rarely conducted or reported in mental health research. This paper describes the principles and processes to conduct PoC studies in mental health systems research.

Method: The Technology Readiness Level in Implementation Sciences (TRL-IS) serves as the reference framework for this study. A 'lessons learned' process was applied to refine the concepts and develop a research strategy based on previous experiences with PoC studies. This process incorporated insights gained from a scoping review, case studies and discussion with both a core group and an extended group of experts.

Results: PoC studies assess the workability of an application, formulating the basic concept and determining whether its functionality can be transformed into a real prototype to be tested as intended via a pilot study and later demonstrated in the real world. The strategy to conduct PoC studies should be part of the analysis of readiness of any application in health system's research. The first four levels of readiness in the TRL-IS scale include (1) foundational knowledge, (2) formalised prior knowledge base, (3) completion of a workable PoC, and (4) prototyping. It's design requires input from experts in all four levels. Twenty-three main elements relevant to PoC have been identified in these four phases.

Discussion: PoC is generally omitted (or not reported) in mental health systems research. Researchers should be actively encouraged to overcome this omission. A common language, classification and vocabulary is needed for implementation science which incorporate this domain. The description of the specific activities conducive to PoC and prototyping should be provided. Training on the use of the TRL-IS framework including expert knowledge should also be promoted in mental health system research.

Background: Care coordination is commonly employed to assist individuals with mental health challenges [MHCs]. However, its implementation in mental health contexts is inconsistent. The term, 'care coordination' is also used interchangeably with integrated care and case management. This review aims to (1) consolidate the literature on how, and in what contexts, care coordination has been used to help adults with MHCs access care from more than one service and (2) describe the challenges and benefits of implementing care coordination for adults with MHCs from the perspective of service providers, care coordinators and service users.

Methods: This is a scoping review that adopted methodological aspects of Arksey and O'Malley and those proposed by the Joanna Briggs Institute.

Results: Care coordination has been employed in a range of clinical and non-clinical settings. Eligibility for care coordination was predominantly restricted to individuals at high risk of deterioration or those unable to access multiple services independently. Care coordinators worked individually or as part of a team and were mostly mental health nurses or social workers. Care coordination was reported to include both clinical and non-clinical tasks. Clinical tasks included medication management, preparing coordinated treatment plans and implementing crisis triage. Non-clinical tasks included acceptance of referrals, identification of service user needs, developing a plan for service involvement, implementation of the said plan, and monitoring of outcomes. Benefits of care coordination included improved access to services, reduced consumer distress, and self-harming behaviour, a team approach to care, decrease in psychiatric hospitalisations, emergency room visits and arrests, and better interservice collaboration. Challenges to care coordination included continuing unmet needs, lack of service availability and health insurance, unclear processes causing confusion, difficulties in engaging with some service users, administrative complications, large consumer load and staff shortages, incompatibility of technology between systems, insufficient funding and limited community support agencies.

Conclusion: A better understanding of care coordination is needed that includes indications, eligibility criteria, coordination tasks, expected outcomes, as well as organizational and service system requirements.

Background: Digital technologies can facilitate comprehensive mental health assessment of an individual's treatment needs, while also enabling data aggregation and analysis at the population or service level. The Service Needs Index (made up of clinical, psychosocial, and comorbidity components) collectively expresses a concise metric for the type, range, and complexity of young people's treatment needs. This study aimed to examine variation in the Service Needs Index across service settings and assess its potential to inform population-level mental health planning.

Methods: Using data from 1611 young people, we examined the Service Needs Index (made up of Clinical, Psychosocial, and Comorbidity subscores) across four mental health service populations (headspace Camperdown, urban headspaces, regional headspaces, and Mind Plasticity [a private practice in Sydney, Australia]). ANCOVA and pairwise comparisons were conducted controlling for age and sex. Bayesian logistic regression was used to examine the association between index scores and the odds of exceeding the Kessler-10 threshold for moderate psychological distress (K-10 ≥ 25).

Results: There was significant variability in Service Needs Index scores (and subscores) between the four service populations. The private practice (Mind Plasticity) and regional headspaces had greater complexity than urban headspace services and headspace Camperdown. Complexity was driven by different patterns: Mind Plasticity had relatively higher clinical and comorbidity needs, while regional headspace services had higher clinical and psychosocial needs. Higher index scores were associated with increased odds of scoring in the moderate psychological distress range, with the Service Needs Index requiring the smallest score increase (6.1 units) to double the odds of scoring 25 or above on the K-10 (OR = 2.0).

Conclusions: The differences across service groups provide examples on how indices may shape policy and system-level decision-making in headspace services and other Primary Health Networks. The Service Needs Index measures complexity and could inform system-level decision-making by providing insights into trends, resource allocation, and the efficacy of interventions across broader groups.

Background: Undiagnosed depressive and anxiety disorders may be widespread. The study aimed to assess the prevalence and associated factors of undiagnosed depressive and/or anxiety disorders (DAD) among women in two low-resource countries, Bangladesh and Nepal.

Methods: Data were analyzed from 19,987 women (aged 15-49 years) in the 2022 Bangladesh Demographic and Health Survey and 7,442 women (aged 15-49 years) in the 2022 Nepal Demographic and Health Survey who completed the interview-administered nationally representative sub-survey component on mental health. DAD was categorized as either 'undiagnosed DAD' (meeting symptom criteria on the PHQ-9 and/or GAD-7 but without a prior diagnosis or treatment) or 'diagnosed DAD' (having a prior diagnosis and/or current treatment). Relative to diagnosed DAD, associations with undiagnosed DAD were estimated using logistic regression.

Results: The analytic sample included 2,388 women in Bangladesh and 960 women in Nepal with undiagnosed DAD and diagnosed with DAD. The prevalence of undiagnosed DAD was 44.8% in Bangladesh and 60.0% in Nepal. In Bangladesh, in adjusted logistic regression analysis, having a big problem with permission to go to a health facility (Adjusted Odds Ratio-AOR: 1.53, 95% Confidence Interval (CI): 1.21-1.93, p < 0.001), being widowed (AOR: 2.04, 95% CI: 1.40-2.99, p < 0.001) and being divorced or separated (AOR: 2.30, 95% CI:1.40-3.77, p < 0.001) were significantly positively associated with undiagnosed DAD. Having secondary or higher education (AOR: 0.75, 95% CI: 0.58-0.97, p = 0.028) was significantly negatively associated with undiagnosed DAD. In Nepal, compared to the rich or richest wealth status, poor or poorest wealth status (AOR: 1.55, 95% CI: 1.09 to 2.21), compared to Bramin/Chhetri ethnicity, being Dalit (AOR: 1.77, 95% CI: 1.08-2.89) and being Janajati (AOR: 1.72, 95% CI: 1.17-2.54) were positively associated with undiagnosed DAD. Increasing age (AOR: 0.97, 95% CI: 0.96-0.99) was negatively associated and history of cervical cancer screening (AOR: 0.57, 95% CI 0.32-1.02) was marginally negatively associated with undiagnosed DAD.

Conclusion: Nearly half of the women in Bangladesh and three in five women in Nepal had undiagnosed DAD. Targeted interventions addressing these factors are needed to improve mental health screening and access to care for women in Bangladesh and Nepal.

Background: Low- and middle-income countries (LMICs) allocate a disproportionately small fraction of their healthcare budgets to mental health, leading to a treatment gap exceeding 75%. To address this disparity, the World Health Organization (WHO) introduced the Mental Health Gap Action Programme (mhGAP), aiming to integrate mental healthcare into primary and community care settings. Central to this initiative is task-sharing: empowering non-specialist healthcare providers to detect and treat mental disorders. Adaptation and modification of mhGAP to the national and local contexts is an integral aspect of the guidelines.

Methods: This systematic review of reviews employs the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to document and characterize modifications to mhGAP implementation in LMICs. The databases searched included Embase, PubMed, PsycINFO, CINAHL, Google Scholar, Cochrane, and Web of Science. Reviews selected in stage 1 were used to find empirical studies from which relevant data was extracted.

Results: Narrative synthesis suggests that modifications primarily focus on content, delivery, and training methods, with limited attention to scaling up. Modifications adopt top down, yet consultative and participatory approaches. There is a notable lack of reporting on challenges, processes, and outcomes. Recommendations have been made to expand FRAME, namely, sources of knowledge, financial and temporal resources employed during the process of modification.

Conclusion: Modifications are essential for adapting interventions to diverse settings, yet they are often researcher-led with limited stakeholder involvement. Better documentation-particularly on challenges and outcomes-is needed. Strengthening frameworks like FRAME can improve reporting, optimize resources, and enhance implementation and scale-up in similar contexts.

Background: Length of stay (LoS) is a critical parameter of inpatient forensic treatment functioning. Inpatient forensic LoS in Czechia varies across hospitals with the number of patients per 100,000 inhabitants and the treatment duration. We aimed to analyse these inter-hospital differences and provide relevant sociodemographic and treatment-related data.

Methods: We collected descriptive parameters from 841 forensic inpatients from 13 hospitals in Czechia, with follow-up data collection after 6 months (N = 800). Data from eight hospitals with > 50 patients (N = 765) were entered into linear regression analyses with subsequent resampling to identify differences in LoS associated with index offence, diagnosis, and treatment type, thereby highlighting interhospital variations.

Results: The cohort comprised predominantly males (mean age, 41.84 years; standard deviation [SD] 3.63) with extended mental health histories; the mean main diagnosis length was 13.2 years (SD 12.18). Most inmates committed violent offences, with psychotic, substance use, or paraphilic disorders predominating. Family contact remained common despite the patients' poor socioeconomic status. The mean LoS was 1,327.58 (SD 1642.41) days. We observed significant differences in LoS among patients from the same diagnostic group. Within the whole system, patients with substance abuse disorders, psychotic disorders, and intellectual disabilities stayed for 760, 1490, and 2441 days, respectively. Violent index offences increased LoS in most hospitals, as did sexual offences, but "other" minor criminal offences (non-violent, non-sexual) were associated with increased LoS only in some hospitals. Sex offender treatment significantly affected LoS in some hospitals, while enrolment into substance use programmes shortened it.

Conclusions: Our study revealed significant inter-hospital variations in LoS associated with index offences, diagnoses, or treatment programs, which could be related to previously unrecognised institutional factors. Regular evaluation of treatment outcomes and implementation of standardised guidelines across the entire system is necessary to balance these differences. The insights provided into inpatient treatment in Czechia can be used to guide policy and practice improvements, enhancing the quality of forensic psychiatric care and ensuring the rights and well-being of the patients. The study addressed the knowledge gap existing in the available literature regarding previously unrecognised factors influencing the LoS at the system "mezzo" level.