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ObjectiveCrisis services are undergoing an unprecedented expansion in the United States, but research is lacking on crisis system design. This study describes how individuals flow through a well-established crisis system and examines factors associated with reutilization of such services.MethodsThis cross-sectional study used Medicaid claims to construct episodes describing the flow of individuals through mobile crisis, specialized crisis facility, emergency department, and inpatient services. Claims data were merged with electronic health record (EHR) data for the subset of individuals receiving care at a crisis response center. A generalized estimating equation was used to calculate adjusted odds ratios for demographic, clinical, and operational factors associated with reutilization of services within 30 days of an episode's end point.ResultsOf 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset (N=9,202 episodes) with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status.ConclusionsCrisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.

Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making. This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services. Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well. Single item on sleep disturbance used, no data on treatment adherence. These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance. • Six distinct sleep disturbance trajectories found in initial 12 treatment sessions • Improving sleep disturbance trajectories related to better endpoint outcomes • Unimproved or worsening sleep disturbance associated with worse outcomes • Unemployment, worse social function, & Asian identity linked to sleep deterioration • Being female, unemployed, medicated, or long-term conditions risks non-improvement [ABSTRACT FROM AUTHOR]

Background: Criminal legal system-involved individuals with serious mental illness (SMI) experience more challenges accessing mental health and other community services than those without a history of criminal legal system involvement. A formative qualitative study was conducted to explore feasibility and acceptability and inform the adaptation of a mental health peer navigation intervention for individuals with SMI reentering the community after jail incarceration. Methods: In-depth qualitative interviews and focus-group discussions were conducted with mental health peer navigators (i.e., certified mental health peer support specialists, peer recovery coaches) and individuals with lived experience of SMI and criminal legal system involvement (N = 20 total). Data were analyzed using applied thematic analysis. Results: Four major themes emerged: (1) Feasibility and acceptability of peer-provided services: all participants reported that peer navigation services would be feasible and acceptable for individuals with SMI reentering the community after jail incarceration; (2) roles of peer navigators in addressing barriers to care: peers can address barriers to care experienced during community reentry and contribute towards service linkage/engagement; (3) shared identity and combating stigma: having a shared identity with peer navigators may minimize the impact of stigma and make it easier for clients with multiple marginalized identities to seek support; and (4) peer navigator skills and recommendations for the planned program: essential peer navigation skills include authenticity, reliability, active listening, advocacy, trauma-informed care, motivational interviewing, and empathy. Recommendations for the planned program include initiating services while clients are in custody, emphasizing the voluntary nature of peer support, knowing the limits of a peer navigation intervention, and offering support for peer navigators while on the job. Conclusion: Participants saw peer navigation services for individuals with SMI with criminal legal system involvement as potentially feasible and acceptable. Such programs may enhance their impact by offering supportive supervision, emphasizing the voluntary nature of the service, and acknowledging recovery as a self-directed endeavor. [ABSTRACT FROM AUTHOR]

The article discusses the ethical considerations surrounding school-based mental health screening and service provision. It highlights the importance of universal mental health screening in schools as a means to identify and support students with mental health needs. The commentary emphasizes the challenges in supporting high-risk students and ensuring that referrals made after screening lead to increased student use of mental health services. The analysis calls for improved practices and research to enhance the effectiveness of mental health screening and referral processes in schools. [Extracted from the article]

Introduction Objective Design Findings Discussion Conclusion Growing the mental health peer workforce holds promise for rural communities, but we currently lack an understanding of the guidance available to support the development, implementation and sustainability of this workforce in rural settings.Study aims are to: (1) determine the extent and nature of the literature that provides guidance for growing the peer workforce in rural mental health services; and (2) identify and explore any guidance relevant to rural peer work services dedicated to First Nations communities, including those promoting social and emotional well‐being within this body of literature.A scoping review method was employed to identify relevant peer‐reviewed and grey literature published between 2013 and 2022 across PsychInfo, Medline, Embase and CINAHL, Scopus and Informit HealthInfoNet databases, as well as targeted organisation websites and Google Advanced Search.A total of 26 unique studies/projects were included from the US, UK, Canada and Australia with public mental health, non‐government/for purpose and private sector service settings represented in the literature. Grey literature, such as reports of evaluations and frameworks, formed the majority of included texts. While there is a lesser volume of rurally focused literature relative to the general peer work literature, this is a rich body of knowledge, which includes guidance concerning services dedicated to First Nations communities. Via synthesis critical considerations were identified for the development, implementation and sustainability of peer work in rural mental health services across six domains: ‘Working with community members and stakeholders’, ‘Organisational culture and governance’, Working with others and in teams, Professional expertise and experience, Being part of and working in the community and ‘Local mental health services capacity’.While there are considerations relevant across a range of settings, the domains of: ‘working with community members and stakeholders’, ‘being part of and working in the community’ and ‘local mental health services capacity’, capture additional, distinct and nuanced challenges and opportunities for growing the peer work in rural services.The literature offers insights valuable for service planning, policy development and the allocation of resources to support rural peer workforce growth. [ABSTRACT FROM AUTHOR]

Objective: This study, the first to assess the reliability and validity of the Work and Social Assessment Scale (WSAS) in Norwegian routine mental health care, examines differences in functional impairment based on sick leave status, psychiatric diagnosis, and sex. Method: Including 3573 individuals from community mental health services (n1 = 1157) and a psychiatric outpatient clinic (n2 = 2416), exploratory factor analysis (EFA) on subsample 1 and confirmatory factor analysis (CFA) on subsample 2 were utilized to replicate the identified factor structure. Results: EFA supported a one-factor model, replicated by the CFA, with high internal consistency (α =.82, ω =.81). Patients on sick leave reported greater impairments in all aspects of functioning, except for relationships, with the largest effect size observed in the reported ability to work (d =.39). Psychiatric outpatients with major depressive disorder were associated with difficulties in home management, private leisure activities, and forming close relationships. Patients with attention-deficit/hyperactivity disorder reported less impairment than those with other disorders. Patients with personality disorders reported more relationship difficulties than those with PTSD, ADHD, and anxiety. No differences were found in the perceived ability to work between diagnoses. Women had a higher impairment in private leisure activities, whereas men reported more impairment in relationships. Conclusion: The demonstrated reliability and validity suggest that WSAS is a valuable assessment tool in Norwegian routine mental health care. Variations in functional impairment across sick leave status, sex, and psychiatric diagnoses highlight the importance of integrating routine assessments of functional impairment into mental health care practices. Future research should combine WSAS with register data to allow for a broader understanding of treatment effectiveness, emphasizing improvements in functional outcomes alongside symptom alleviation. [ABSTRACT FROM AUTHOR]

AbstractWhen the family is considered as a system, individuals with a severe mental disorder can be affected by all the processes and conditions in the family. Women with a severe mental disorder are also affected by many factors such as their place in the family and society, gender roles and gender inequality. In the study, the authors aimed to determine domestic difficulties faced by women diagnosed with a severe mental disorder who were followed in a Community Mental Health Center in a province in the west of Türkiye. The study was a descriptive qualitative research design. Women who were diagnosed with a severe mental disorder, who were followed by the for mentioned Community Mental Health Center and who met the inclusion criteria were included in the study. The data collected using the one-on-one interview method were analyzed with the content analysis method. After the analysis of the data, the following four main themes related to the difficulties experienced in the family by women with a severe mental disorder identified: domestic violence, being both a sick person and a caregiver, stigma and coping strategies. It was concluded that women individuals with a diagnosis of a severe mental disorder experienced not only mental disorder-related difficulties but also difficulties of being a woman in the society brought about by their gender roles. [ABSTRACT FROM AUTHOR]

Dr. Carolyn Peters is a social worker and educator who currently serves as the Director of Organizational Development and Learning at New Directions for Children, Youth, Adults and Families Inc. in Winnipeg, Canada. She has experience in strategic planning, program evaluation, and change management. Dr. Peters has also established a student practicum/internship program and co-led the Indigenous Ally Strategy for the organization. She emphasizes the importance of keeping up with research, cultural understanding, and program evaluation for future human service managers and leaders. Additionally, she believes that researchers should focus on practical application and community-based research, as well as prioritize digitization in the field. [Extracted from the article]

Background Methods Findings Discussion The adolescent borderline personality disorder (BPD) diagnosis has been widely debated for many years. Strikingly, young people's experiences of both receiving a diagnosis of BPD, and of living with BPD, are largely under‐explored. The current study seeks to address these gaps in the literature in a multi‐perspectival design utilising young people–parent dyads.Young people (aged 16–18 years) with a diagnosis of BPD (n = 5) and their mothers (n = 5) were recruited from two NHS Community Mental Health Services in the West Midlands and participated in semi‐structured interviews. Data were analysed using interpretative phenomenological analysis [IPA].Analysis identified two superordinate themes with five subthemes: (1) The “ugly” reality of living with BPD (providing a stark insight into what it is like to live with the unpredictable nature of experiences labelled as BPD), and (2) The diagnosis that dare not speak its name (highlighting the complexities of how the diagnosis itself is experienced by participants as a symbol of personal and permanent defectiveness and danger).Findings highlight a clear commonality of experience centred around the intensity of the young people's emotional distress and the accompanying pressure on parents to keep young people safe, both of which services must strive to do more to contain. Ultimately, the costs of receiving a BPD diagnosis appear to outweigh the benefits, and this paper adds support to calls for change in respect to how we conceptualise difficulties labelled as BPD and how we communicate about these difficulties, in order to avoid causing harm. [ABSTRACT FROM AUTHOR]

Background: Taken together, prior publications on the association between symptoms of depression and anxiety and contact with the criminal justice system (CJS) suggest a bi‐directional relationship, but all the studies only focus on one direction in this relationship. Aims: To examine, in longitudinally collected data, period‐specific within‐individual change in anxiety and depression measures preceding arrest measurement and, separately, following arrest measurement. Methods: Data were obtained from the National Longitudinal Study of Youth 1997, a nationally representative sample of people born between 1980 and 1984 and first interviewed between ages 12–17 and a publicly accessible database. Our focus was on data for the 11 years 2000–2010. Using whole sample data, we tested for a reciprocal association between depression and anxiety during each 2‐year period and arrests during the following year, and vice versa, allowing for relatively fixed characteristics such as sex, age and socio‐economic indicators. We used period‐specific change modelling to test relationships. Results: We found that within‐individual increases in depression and anxiety scores over short periods (2‐year periods) of time was associated with an increase in the number of arrests subsequent over the following year, consistently throughout the whole of the 10 years studies. The reciprocal association was also observed, albeit the magnitude of the effects was much smaller. Conclusion: This study adds to the literature on the association between mental health and CJS contact by showing that they may be reciprocally associated. This suggests that facilitating co‐working or even formal partnerships between community mental health services and justice‐related services could be beneficial. [ABSTRACT FROM AUTHOR]

Background: Increasing attention to the early stages of psychosis and the identification of symptomatic prodromal states have led to the development of a growing number of screening tools. The 16‐item version of the Prodromal Questionnaire (PQ‐16) is a worldwide used self‐administered tool for this purpose. However, to date, fundamental psychometric properties of PQ‐16 were not thoroughly investigated. This study aimed to examine the structural validity, measurement invariance, reliability and other psychometrical properties of the Italian version of the PQ‐16 (iPQ‐16) in help‐seeking individuals and in the general population. Methods: The iPQ‐16 was administered to 449 young outpatients attending six community mental health services and to 318 control participants enrolled in educational environment. Confirmatory factor analyses (CFAs), measurement invariance (MI) between the help‐seeking group and the general population sample, convergent validity, test–retest reliability, internal consistency, and prevalence analyses were performed. Lastly, the validity of the adopted PQ‐16 cut‐offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses was also tested. Results: CFAs confirmed the single‐factor structure for the iPQ‐16 and scalar MI was reached. The iPQ‐16 showed high internal consistency, test–retest reliability, convergent validity, and acceptable diagnostic accuracy. ROC analysis suggested a score of ≥4 as best cut‐off. Conclusions: The iPQ‐16 represents a valid and reliable questionnaire for the assessment of high mental risk in both Italian outpatients and general student population. It has good psychometric properties and is easy to implement as UHR screening for clinical as well as research purposes. [ABSTRACT FROM AUTHOR]

Aim: To test the feasibility of a participatory design intervention aimed at reducing the risk of cardio-vascular disease among patients suffering from alcohol use disorder (AUD) or severe mental illness (SMI). Methods: The intervention was developed by patients from the Community Mental Health Center and the Alcohol Treatment Facility in Odense, Denmark, and consisted of eight modules (health interviews, screening and treatment, introduction, diet/alcohol, physical activity, smoking, health app, and sleep problems). The intervention was tested using pre- and post-measurements of selected variables, patients' intervention attendance, and interviews and dialogue workshops at the end of the study. Results: A total of 21 out of 42 eligible patients from the Alcohol Treatment Facility and two out of 443 eligible patients from the Community Mental Health Center accepted participation in the study. The two patients from the Community Mental Health Center were not included in the analyses due to General Data Protection Regulation (GDPR). All patients accepted being screened for risk factors at inclusion, and the majority enrolled in at least one of the subsequent modules. The study indicated that the patients followed recommendations from their GPs. Conclusions: There is a great need for focus on cardio-vascular disease in patients with SMI and those with AUD. Results indicate that the intervention is feasible for patients with AUD, but due to inclusion of too few patients with SMI, nothing can be concluded for this patient group. Patients and staff in the Alcohol Treatment Facility agreed that the intervention has future perspectives. [ABSTRACT FROM AUTHOR]

Increasingly, US community mental health settings are integrating professional near-age youth peer support providers to improve youth service engagement and outcomes. Youth peer specialists (YPS) use their lived and living experiences with a mental health diagnosis to validate, empathize, and provide individualized support, while also improving their program's overall responsiveness to young people's needs. Although promising, these roles tend to lack clarity—responsibilities vary immensely, and turnover is high. Examining near-age youth peer on-the-job experiences is needed to design effective on-the-job supports. Using community-based participatory action research methods, young adults with lived experience worked in partnership with a PhD-level qualitative researcher to design, recruit, conduct, and analyze in-depth-interviews with current and former near-age youth peer providers. Ten young adult peer mentors in Massachusetts completed interviews that revealed near-age youth peer role relational complexity. Five relational aspects were identified requiring relational practice skills and self-awareness, including relationships with (1) self, (2) clients, (3) supervisors, (4) non-peer colleagues, and (5) other near-age peer providers. Near-age peers experience relationship-related struggles with non-peer identified colleagues who do not understand nor value the near-age peer role. Findings expand on current near-age peer practice and associated on-the-job challenges. Training, supervision, and professional development activities that target these five relational areas may improve YPS on-the-job wellbeing, decrease YPS turnover, and improve youth client outcomes. [ABSTRACT FROM AUTHOR]

Measurement-based care (MBC), which collects session-by-session symptom data from patients and provides clinicians with feedback on treatment response, is a highly generalizable evidence-based practice with significant potential to improve the outcomes of mental health treatment in youth when implemented with fidelity; however, it is rarely used in community settings. This study tested whether an implementation strategy targeting organizational leadership and organizational implementation climate could improve MBC fidelity and clinical outcomes for youth in outpatient mental health clinics. In a cluster randomized trial, 21 clinics were assigned to the Leadership and Organizational Change for Implementation strategy plus training and technical assistance in MBC (k = 11, n = 117) or training and technical assistance only (k = 10, n = 117). Primary outcomes of MBC fidelity (assessed via electronic metadata) and youth symptom improvement (assessed via caregiver-reported change on the Shortform Assessment for Children Total Problem Score) were collected for consecutively enrolled youths (ages 4-18 years) who initiated treatment in the 12 months following MBC training. Outcomes of each youth were assessed for 6 months following baseline. A total of 234 youths were enrolled and included in intent-to-treat analyses. At baseline, there were no significant differences by condition in clinic, clinician, or youth characteristics. Youths in clinics using the Leadership and Organizational Change for Implementation strategy experienced significantly higher MBC fidelity compared with youths in control clinics (23.1% vs 3.4%, p =.014), and exhibited significantly greater reductions in symptoms from baseline to 6 months (d = 0.31, 95% CI: 0.04-0.58, p =.023). Implementation strategies targeting organizational leadership and focused implementation climate can improve fidelity to evidence-based practices and clinical outcomes of youth mental health services. Measurement-based care is an evidence-based intervention that has been shown to improve the outcomes of mental health services in dozens of randomized trials; however, it is not widely used in routine practice. In this randomized controlled trial of 21 outpatient mental health clinics and 234 youth, the authors found an organizational intervention which trained clinic leaders in skills to support the use of measurement-based care increased the extent to which patients received measurement-based care compared to control clinics where clinic leaders did not receive this training (23% vs. 3%). Youth receiving services in the clinics that received the organizational intervention also had greater reductions in mental health symptoms. Working to Implement and Sustain Digital Outcome Measures (WISDOM); https://clinicaltrials.gov/ ; NCT04096274. [ABSTRACT FROM AUTHOR]

Accessible summary: What Is Known on the Subject?: Mental health care can be delivered remotely through video and telephone consultations.Remote consultations may be cheaper and more efficient than in person consultations. What the Paper Adds to Existing Knowledge: Accessing community mental health care through remote consultations is perceived as not possible or beneficial for all service users.Delivering remote consultations may not be practical or appropriate for all clinicians or community mental health teams. What are the Implications for Practice?: Remote consultation cannot be a 'one‐size‐fits‐all' model of community mental health care.A flexible approach is needed to offering remote consultation that considers its suitability for the service‐user, service and clinician. Introduction: Responding to COVID‐19, community mental health teams in the UK NHS abruptly adopted remote consultations. Whilst they have demonstrable effectiveness, efficiency, and economic benefits, questions remain around the acceptability, feasibility and medicolegal implications of delivering community mental health care remotely. Aim: To explore perceived advantages, challenges, and practice adaptations of delivering community mental health care remotely. Methods: Ten community mental health teams in an NHS trust participated in a service evaluation about remote consultation. Fifty team discussions about remote consultation were recorded April–December 2020. Data analysis used a framework approach with themes being coded within a matrix. Results: Three major horizontal themes of operations and team functioning, clinical pathways, and impact on staff were generated, with vertical themes of advantages, challenges, equity and adaptations. Discussion: Remote consultation is an attractive model of community mental healthcare. Clinical staff note benefits at individual (staff and service‐user), team, and service levels. However, it is not perceived as a universally beneficial or practical approach, and there are concerns relating to access equality. Implications for Practice: The suitability of remote consultation needs to be considered for each service‐user, clinical population and clinical role. This requires a flexible and hybrid approach, attuned to safeguarding equality. [ABSTRACT FROM AUTHOR]

This article provides an overview of the primary care approach to first-episode psychosis, emphasizing the importance of early detection and treatment. It acknowledges the cultural barriers and stigma associated with seeking mental health treatment in Singapore. The article offers guidance for general practitioners on identifying and managing first-episode psychosis, including the use of antipsychotic medications and the importance of a shared care and recovery-based model. It highlights the need for integrated care between specialist mental health services and general practitioners, as well as the importance of psychosocial support, family engagement, and community mental health services. The article concludes with key messages on reducing the duration of untreated psychosis, the role of GPs in early recognition and treatment, the significance of family and community support, and the effectiveness of lower doses of antipsychotic medication. [Extracted from the article]

ABSTRACT Aims Design Methods Findings Conclusion Clinical Evidence The aim of this study is to explore in‐depth the experiences of patients enrolled in Community Mental Health Centers regarding the illness process.This study employed interpretative phenomenological analysis (IPA), one of the phenomenological design approaches within qualitative research methods.The study was conducted between 24 May 2023 and 23 December 2023, at two different Community Mental Health Centers located in the eastern and western regions of Turkey. Maximum variation sampling was employed in the selection of the sample, which consisted of 12 patients registered at the Community Mental Health Centers. Data were collected using a semi‐structured interview form. The interviews were conducted face‐to‐face and audio‐recorded. Content analysis was performed using the MAXQDA 2022 software package. The study was written following the COREQ checklist.Based on the expressions of the patients, themes, subthemes and codes were identified. Accordingly, three themes were determined: ‘emotions felt after diagnosis’, ‘changes in life with the illness process’ and ‘coping methods with the process’.This study highlights that patients from diverse geographical backgrounds, served by Community Mental Health Centers, share similar cultural and emotional experiences during their illness. These findings underscore the need for tailored interventions that address universal challenges faced by patients across different regions.This research emphasises the necessity of comprehensive efforts to improve societal understanding, support mechanisms and employment prospects for individuals dealing with mental health issues in Community Mental Health Centers. [ABSTRACT FROM AUTHOR]

Background: Instruments to assess the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals' practices related to substitute decision-making and coercion are either missing or lack evaluation of their validity and reliability. Aim: The aim of this study is to evaluate the validity and reliability of three instruments developed to fill this gap in the literature, the World Health Organization's QualityRights (WHO QR) Knowledge questionnaire, the WHO QR Attitudes questionnaire, and the WHO QR Practices questionnaire. Methods: A sample of participants was recruited and completed an online survey. Content validity and face validity were assessed for the three questionnaires. Based on the characteristics of the questionnaires, different approaches were used to assess their construct validity (confirmatory factor analysis, known group validity, and convergent and divergent validity). Internal consistency was evaluated using Cronbach's alpha and test re-test reliability using Pearson's and Spearman's r coefficients. Results: The analyses conducted indicate that the three questionnaires are valid and reliable instruments to evaluate the knowledge about the rights of persons with mental health conditions and psychosocial disabilities, the attitudes toward their role as rights holders, and mental health professionals' practices related to substitute decision-making and coercion. Conclusion: This finding lends support to the use of these instruments both within mental health services and in the general population for a better understanding of current knowledge, attitudes, and practices related to a human rights-based approach to mental health in mental health services and the community. [ABSTRACT FROM AUTHOR]

Background Method Results Conclusion Policy changes in Australia mean that psychedelic‐assisted therapy (PAT) is now available to consumers outside of clinical trials. Yet, the regulatory frameworks guiding the practice of PAT are underdeveloped, and the evidence base for guiding clinical practice is diverse and emerging, resulting in anticipated challenges in translation to community practice. Mental health clinicians who have experience delivering PAT in clinical trials are likely to be at the forefront of community practice and training, and influential in discussions about implementation. Yet little is known of their perspectives, preferences, and practices associated with the implementation of PAT.Interviews with 11 clinicians working on clinical trials of PAT were thematically analysed.Four themes were identified, describing the therapeutic frames that interviewees used to understand PAT and shaped their views on its interface with the mental health system: (1) therapeutic eclecticism, (2) enhanced reflexivity for PAT providers, (3) legitimisation of extra‐medical perspectives in mental health, and (4) what might be lost in translation?We argue that clinicians' perspectives on PAT are reflective of existing tensions between a medical model of mental health care and other psychosocial, relational models. Therapists' ideals for the delivery of PAT can be conceptualised as a sort of ‘enhanced care’ approach, but workforce development and economic constraints are likely to challenge the accessible and impactful translation of this vision. [ABSTRACT FROM AUTHOR]

Anxiety disorders is ranked as the most common class of mental illness disorders globally, affecting hundreds of millions of people and significantly impacting daily life. Developing reliable predictive models for anxiety treatment outcomes holds immense potential to help guide the development of personalised care, optimise resource allocation and improve patient outcomes. This research investigates whether community mental health treatment for anxiety disorder is associated with reliable changes in Kessler psychological distress scale (K10) scores and whether pre-treatment K10 scores and past health service interactions can accurately predict reliable change (improvement). The K10 assessment was administered to 46,938 public patients in a community setting within the Western Australia dataset in 2005–2022; of whom 3794 in 4067 episodes of care were reassessed at least twice for anxiety disorders, obsessive–compulsive disorder, or reaction to severe stress and adjustment disorders (ICD-10 codes F40–F43). Reliable change on the K10 was calculated and used with the post-treatment score as the outcome variables. Machine learning models were developed using features from a large health service administrative linked dataset that includes the pre-treatment K10 assessment as well as community mental health episodes of care, emergency department presentations, and inpatient admissions for prediction. The classification model achieved an area under the receiver operating characteristic curve of 0.76 as well as an F1 score, precision and recall of 0.69, and the regression model achieved an R2 of 0.37 with mean absolute error of 5.58 on the test dataset. While the prediction models achieved moderate performance, they also underscore the necessity for regular patient monitoring and the collection of more clinically relevant and contextual patient data to further improve prediction of treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: A dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, was co-designed with rural and remote communities in the Greater Whitsunday Region of Central Queensland in Australia. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to design and guide multiple aspects of a multisite study, The Bridging Study, to evaluate the implementation of Navicare in Australia. Methods: A community-engaged hybrid effectiveness-implementation study design will focus on the tailored implementation of Navicare at three new sites as well as monitoring implementation at an existing site established since 2021. Study outcomes assessed will include sustained access as the co-primary outcome (measured using access to Navicare mental health referral services) and Proctor's Implementation Outcomes of feasibility, acceptability, appropriateness, adoption, fidelity, implementation cost, and sustainability. Data collection for the implementation evaluation will include service usage data, community consultations, interviews, and workshops; analysed using mixed methods and guided by EPIS and other implementation frameworks. Pre-post effectiveness and cost-consequence study components are embedded in the implementation and sustainment phases, with comparison to pre-implementation data and value assessed for each EPIS phase using hospital, service, and resource allocation data. A scaling up strategy will be co-developed using a national roundtable forum in the final year of the study. Qualitative exploration of other aspects of the study (e.g., mechanisms of action and stakeholder engagement) will be conducted. Discussion: Our study will use tailoring to local sites and a community-engaged approach to drive implementation of a mental health care navigation service in rural and remote Australia, with expected benefits to mental healthcare access. This approach is consistent with policy recommendations nationally and internationally as building blocks for rural health including the World Health Organization Framework for Action on Strengthening Health Systems to Improve Health Outcomes. Trial registration: Prospectively registered on April 2, 2024, on the Australian New Zealand Clinical Trials Registry, no. ACTRN12624000382572. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386665&isReview=true. [ABSTRACT FROM AUTHOR]

As the frequency of mental illness diagnoses rises in the U.S. there has also been an increase in physical distress related to mental health symptoms, especially among members of underrepresented populations. This study examined the extent self-reported feelings of hope and depression predict somatic symptoms in a sample of predominantly Hispanic adults (N = 73) in a local community mental health center. Multiple Regression analyses showed that the overall model significantly predicted somatic symptoms (R2 =.35, F [2, 72] = 18.48, p <.001). While feelings of depression significantly predicted somatic symptoms, hope was not a significant predictor in the model. [ABSTRACT FROM AUTHOR]

Objective: There is growing utilization and acknowledgement of the benefits of community-based participatory action research (CBPAR) in advancing health practices and equity. However, the sustainability and full impact of CBPAR in health care settings faces many obstacles and limitations. The present article examines the synergies between CBPAR and Clubhouse programs, presents the demonstration and ongoing implementation of sustainable CBPAR practices at Fountain House in New York City, and offers lessons learned for other Clubhouses and similar programs seeking to integrate CBPAR. Methods: Alignment in practice and principles between CBPAR and Clubhouse programs are presented. The innovation and ongoing sustainable CBPAR practices in the Fountain House Clubhouse program are examined with a contribution of practice guidance for other Clubhouse and similar programs in further adopting and learning CBPAR into participatory health practices. Results: Clubhouse psychosocial rehabilitation programs present structurally conducive settings for the success and sustainability of CBPAR activities and projects. The Fountain House examination and demonstration of integrating CBPAR sustainably into core Clubhouse programming presents opportunities for further integration, research, and practice guidance in uniquely leveraging features of the Clubhouse model to advance health equity and rehabilitative outcomes through CBPAR. Conclusions and Implications for Practice: The opportunity for incorporating structural CBPAR activities within Clubhouse programs can be informed by the experience, processes, and lessons applied in the Fountain House example. Further research into the rehabilitation, program, and equity benefits of Clubhouse and CBPAR integration could uniquely contribute to the advancement of sustainable participatory research practices across the mental health field generally. Impact and Implications: The article provides an examination of the synergies between community-based participatory action research and Clubhouse programming through an examination of the sustainable integration of community-based participatory action research activities within a particular Clubhouse program that can serve as a guide and resource for replication. [ABSTRACT FROM AUTHOR]

Background: Personal recovery is a persisting concern for people with psychotic disorders. Accordingly, mental health services have adopted frameworks of personal recovery, prioritizing adaptation to psychosis alongside symptom remission. Group acceptance and commitment therapy (ACT) for psychosis aims to promote personal recovery alongside improved mood and quality of life. Aims: The objectives of this uncontrolled, prospective pilot study were to determine whether 'Recovery ACT' groups for adults are a feasible, acceptable and safe program within public mental health services, and assess effectiveness through measuring changes in personal recovery, wellbeing, and psychological flexibility. Method: Program feasibility, acceptability and safety indicators were collected from referred consumers (n =105). Adults (n =80) diagnosed with psychotic disorders participated in an evaluation of 'Recovery ACT' groups in Australian community public mental health services. Participants completed pre- and post-group measures assessing personal recovery, wellbeing, and psychological flexibility. Results: Of 101 group enrollees, 78.2% attended at least one group session (n =79); 73.8% attended three or more, suggesting feasibility. Eighty of 91 first-time attendees participated in the evaluation. Based on completer analyses (n =39), participants' personal recovery and wellbeing increased post-group. Outcome changes correlated with the linear combination of psychological flexibility measures. Conclusions: 'Recovery ACT' groups are feasible, acceptable and safe in Australian public mental health services. 'Recovery ACT' may improve personal recovery, wellbeing, and psychological flexibility. Uncontrolled study design, completer analyses, and program discontinuation rates limit conclusions. [ABSTRACT FROM AUTHOR]

Background: Non-adherence to medication leading to a break in continuity of care poses significant challenges in severe mental illness (SMI), leading to poor outcomes. In India, proxy consultation, wherein caregivers consult on behalf of patients, is a commonly adopted but insufficiently researched area to address these challenges. Aims: To explore the extent of proxy consultation in outpatient care of persons with SMI and investigate its sociodemographic and clinical correlates. Methodology: In a tertiary care psychiatry outpatient setting, we conducted a cross-sectional study involving 374 caregivers of persons with SMI (Schizophrenia, Bipolar and related disorders). Descriptive statistics and univariate logistic regression were performed to examine correlates' relationships with proxy consultation. Results: Proxy consultation prevalence was 43% in the past 1 year. Compared with 18 to 30 years, middle-aged patients aged 31 to 40, 41 to 50 and 51 to 60 years had twofold, threefold and sixfold increased chances of proxy consultation, respectively. Being illiterate had six times higher odds than graduates, three times and two times if they studied till primary and secondary education. Early age of onset was associated with three times higher chances of proxy consultation compared to the onset of illness in adulthood. On the contrary, male gender and upper and middle socioeconomic status decreased the chances of proxy consultation by 40%. Financial difficulties (n = 72, 45%) and patients' unwillingness to visit outpatients (n = 44, 27.5%) were the most commonly cited reasons for proxy consultation. Conclusion: Proxy consultations are relatively common, driven by many social, economic, patient-related, pragmatic and practical factors. In formulating community care policies for persons with SMI, the primary imperative should be to conduct additional research, deepening our understanding of proxy consultations. Additionally, it is essential to be mindful of the diverse issues associated with proxy consultations during the formulation process. [ABSTRACT FROM AUTHOR]

The article discusses the critical importance of the first years of a child's life for brain development, emphasizing that healthy relationships and early learning experiences significantly influence lifelong health and learning. Topics include the impact of parental education on brain development, the role of public libraries in supporting families, and the disparities faced by underserved communities in accessing resources for early childhood development.

In recent years, athlete mental health has received increased attention from researchers; however, coaches also experience stressors that can impact their mental health. This study addressed a gap in the sport coaching literature by using a phenomenological approach to explore the experiences of community sport coaches in Canada—an understudied population that makes up a large portion of the coaching workforce. Nineteen coaches from Atlantic Canada discussed stressors, coping strategies, and mental health in one-on-one semistructured interviews. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Results are presented in three higher order themes: mental health culture in sport, influences on coach mental health, and coping strategies and supports. Our findings suggest that community coaches experience a variety of stressors (e.g., interpersonal, personal, organizational) similar to elite coaches, but that the origin of stressors may be different in the community sport context. The impact of stressors can be mitigated by coaches' coping strategies, access to training and resources, and aspects of the role that support their mental health (e.g., rewarding work). Finally, these results suggest that training should address gaps in mental health literacy for coaches to support their own mental health needs as well as their athletes' needs. [ABSTRACT FROM AUTHOR]

Background: This analysis aimed to examine the factors predictive of service utilization among patients with anxiety and/or depression. Quick and appropriate treatment for anxiety and depression can reduce disease burden and improve social functioning. Currently, less than half of the population with comorbid anxiety and depression receives the recommended treatment. Aims: This analysis aims to identify factors predictive of utilizing mental health treatment for those with anxiety and/or depression by analyzing intrinsic, patient-centered factors. Methods: This study is a cross-sectional cohort analysis using National Health Interview Survey (NHIS) 2019 data. The sample size is 7,156 adults aged 18 to 64 with family incomes ≤100% of the federal poverty level. We used multivariate logistic regression analysis to identify factors predictive of care utilization in this population. Variables of interest include scores on Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7), service utilization, level of social functioning, having a usual source for care, and previous mental health care utilization. Additional covariates were age, gender, race, country of origin, education, marital status, and insurance coverage. Results: Twenty-one percent of respondents reported using mental health services. Factors predictive of care utilization were older age, female gender, limited social functioning, having a usual source of care, and insurance coverage. Conclusion: There are significant barriers to receiving quick and appropriate care for anxiety and/or depression. Strategies should focus on reducing barriers for young adults, men, and the uninsured/underinsured. Strategies for integrating mental health services into primary care could increase the percentage of people with anxiety and/or depression who receive services. [ABSTRACT FROM AUTHOR]

Regular exercise is reported to improve depressive symptoms and quality of life for people experiencing mental illness. For older adults, including strength and balance can also decrease falls. Mental health services seldom include funding for Accredited Exercise Physiologist programs. A 9-week Accredited Exercise Physiologist-led program for older adults receiving mental health treatment with a community Older People's Mental Health Service was trialed in regional Australia. This clinician-conceived small-scale feasibility study utilized a two-phase concurrent triangulation mixed-method design to evaluate physical and psychological program outcomes and identify factors related to engaging in physical activity. This tailored exercise program led to improvements in measures of psychological distress and physical and psychological function. These changes corresponded with participants identifying benefits of exercising as a group of adults living with mental illness. Such findings suggest a supervised, individualized program for older mental health consumers confers physical and psychological benefits; however, further research evaluating exercise interventions with this population is required. [ABSTRACT FROM AUTHOR]

Informal caregivers of persons with mental disorders encounter various challenges in their role of caregiving. As such, they require support to enable them to cope with the demands of their caregiving. There is comprehensive evidence on the experiences of burden among informal caregivers in mental health; however, there is a limited number of studies that report on the mental health services aimed specifically at supporting informal caregivers in their role. To address this gap, this study aimed to explore the perspectives of the service providers regarding the challenges encountered by informal caregivers and the mental health services available to support these caregivers. Semi-structured interviews were conducted with mental health coordinators at provincial, district, and sub-district level and mental health professionals from a district hospital. Focus group discussions were conducted with primary healthcare supervisors and community health workers in Bushbuckridge municipality, South Africa at participants' workplaces and sub-district offices. Semi-structured interviews and focus group guides with semi-structured questions were used to direct data collection in August 2022–January 2023. All interviews were audio recorded and transcribed verbatim. Reflexive thematic inductive analysis was conducted using NVivo 12 software. Three themes were identified, namely perceived caregiving consequences and related factors, current state of mental health services, and factors affecting delivery of informal caregiver mental health services. The service providers acknowledged the negative consequences faced by informal caregivers. This includes the experience of caregiver burden which was attributed to the uncooperative and violent behaviours exhibited by the mental health care users. The current state of formal and informal community mental health services was described and considered inadequate to meet informal caregivers' needs. Various personal, health system, and contextual factors influencing the provision of caregiver-orientated services were identified. The findings revealed the need for intersectoral collaborations between hospital-based and community-based mental health service providers, and community stakeholders to ensure provision of user-friendly and accessible mental health services for informal caregivers. [ABSTRACT FROM AUTHOR]

Background: Depersonalisation-Derealisation Disorder (DDD) is a distressing mental health condition which causes individuals to have a sense of 'unreality' or detachment about themselves and/or the world around them. DDD is chronically under-researched, and as a result, under-diagnosed, with a population prevalence of about 1%. In systematic reviews, Cognitive Behavioural Therapy (CBT) has been found to be the only intervention with significant clinical impact on alleviating the symptoms of DDD. However, previous studies have suffered from small sample sizes, reliance on expert clinicians to provide therapy and narrow population demographics. This feasibility randomised controlled trial aims to provide more robust evidence for the treatment efficacy of CBT in DDD. Methods: The study aims to recruit 40 participants from two NHS trusts, 20 per arm from two community Mental Health NHS services in London. The intervention group will receive 12–24 individual CBT sessions over a 6-month period from CBT therapists following specialist training for DDD. The control group will receive Treatment as Usual. We will assess the feasibility of a future RCT through measuring the acceptability of the intervention, and assessing our ability to recruit, retain and randomise participants. We will calculate the correlation of scores on the Cambridge Depersonalisation Scale, its baseline standard deviation, assess the magnitude/direction of change and characterise the uncertainty in the outcome scores and the probability that the results have been obtained by chance. Discussion: The outputs of this trial will guide whether a definite RCT is feasible and acceptable, for both the clinician and participant. Trial registration: The ISRCTN registration number is ISRCTN97686121(https://doi.org/10.1186/ISRCTN97686121). [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONObjectives: Digital interventions can offer accessible and scalable treatment for chronic conditions, though often focus separately on physical or mental health. People accessing digital health services may live with multiple conditions or experience overlapping symptoms. This study aimed to describe the breadth and characteristics of chronic health conditions and self-reported disability among routine users of a digital mental health service, and to examine related motivations to engage with digital mental health interventions.Methods: A cross-sectional survey of adults registered with a digital mental health service in the Australian community (THIS WAY UP) was conducted. Participant demography, chronic health conditions, self-reported disability and motivations for accessing digital treatment were collected and analyzed descriptively.Results: 366 participants responded (77% female, mean age 50 ± 15 years). 71.6% of participants (242/338) reported ≥1 chronic health condition and one-third reported multimorbidity (112/338, 33.1%). Chronic pain, musculoskeletal and connective tissue disorders were most common. 26.9% of respondents (90/334) reported a disability, most commonly physical disabilities. 95% of those with chronic conditions reported negative mental health effects and 46% reported heightened interest in digital mental health treatments because of their condition. Primary motivations for digital service use were receiving a recommendation from a health professional and service accessibility.Discussion: People who access digital mental health services in routine care report high rates of heterogenous chronic illness and related disability. There is interest in accessible digital treatments to support mental health at scale among people who live with varied chronic conditions and disabilities.Heterogenous chronic health conditions and disability are prevalent among people who engage with digital mental health interventions in the community.Approximately three-quarters of people (72%) who access digital mental health interventions have at least one chronic condition, and approx. one quarter (27%) have a disability.The accessibility of digital mental health treatments appealed to people with chronic conditions and/or disabilities.Digital mental health services may have a role to play in supporting mental health and wellbeing at scale among people with varied, disabling chronic conditions.Heterogenous chronic health conditions and disability are prevalent among people who engage with digital mental health interventions in the community.Approximately three-quarters of people (72%) who access digital mental health interventions have at least one chronic condition, and approx. one quarter (27%) have a disability.The accessibility of digital mental health treatments appealed to people with chronic conditions and/or disabilities.Digital mental health services may have a role to play in supporting mental health and wellbeing at scale among people with varied, disabling chronic conditions. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? What this paper adds to existing knowledge? What are the implications for practice? Mental health nurses in the UK play a critical role in providing care, advocating for patients and navigating the complexities associated with mental health challenges. Acknowledging and supporting the efforts of mental health nurses is essential for advancing mental health care, promoting inclusivity and fostering community resilience amidst ongoing challenges within existing health care organisations. Highlights the integral role of mental health nurses in the UK's health system as both care providers and advocates, underpinning the importance of addressing the growing demand for mental health services Introduces innovative digital tools like the ‘Hub of Hope’ and the potential of social prescribing as effective strategies for improving access to mental health care and support. Emphasises the need for enhanced support and recognition of mental health nurses to ensure the sustainable advancement of mental health services and the well‐being of communities. Mental health nurses should integrate innovative digital tools like the ‘Hub of Hope’ into their practice to improve signposting and access to mental health resources for individuals in need. There is a critical need for ongoing education and support for mental health nurses within practice settings to maintain their well‐being and enhance their ability to provide holistic care despite increasing clinical demands. Advocacy for increased investment in mental health resources and support for research activities lead by mental health nurses is essential to address current service gaps and promote the development of more effective interventions. [ABSTRACT FROM AUTHOR]

This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population. Methods: A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings. Results: Significant correlations were found between patients' control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes. Conclusion:  The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients' control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles. Plain Language Summary: In today's fast-paced world, understanding how we can better cater to the needs of psychiatric patients is more important than ever. This study, conducted in Tenerife, Spain, with 151 participants, shines a light on the intricate relationship between a patient's psychological mindset and their involvement in psychiatric care. Researchers explored how patients' beliefs about health control, their resistance or openness to psychiatric advice, and their preferences in treatment decisions intertwine to affect their approach to psychiatric treatment. The core findings reveal a fascinating tapestry of patient attitudes and behaviors. For example, patients who prefer a joint approach with their psychiatrists toward managing their treatment tend to have a more positive outlook on medication and a deeper trust in their doctors. This suggests that when patients feel they are part of the decision-making process, they are more likely to follow through with treatment plans, leading to better outcomes. What does this mean in everyday terms? Essentially, the study highlights the power of listening and integrating patients' viewpoints into their care plans. When patients see their insights and preferences reflected in their treatment, their engagement and adherence to medication improve. This not only fosters a more supportive environment for healing but also paves the way for more personalized, effective psychiatric care. In essence, this research is a call to action for healthcare providers to delve deeper into understanding each patient's unique psychological makeup. By doing so, they can tailor treatments that resonate more closely with the patient's own beliefs and preferences, ultimately leading to a more positive healthcare experience for everyone involved. [ABSTRACT FROM AUTHOR]

Routine quantitative outcome measures are commonly used within mental health services to provide an overview of change made by service users from the beginning to end of therapy. Whilst this is useful, these measures do not provide insight into why any changes may, or may not, have occurred. This article explores the results of a qualitative service evaluation conducted in an NHS community mental health team (CMHT). The questionnaire asked service users about aspects of therapy that they found helpful or unhelpful. Crucially, the questionnaire gave voice to service users who did not complete therapy and thus did not complete the final quantitative outcome measure. Analysis of data using a thematic analysis approach identified several themes, 1) whether it was the right time to access therapy, 2) challenges in maintaining progress outside of therapy, 3) meeting service user expectations of therapy, 4) whether service users can be vulnerable, 5) impact of therapy on the service users understanding of themselves and their emotions, and 6) flexibility within the service structure. Overall, service users found therapy to be challenging, yet the support and flexibility offered by their therapist was valued. The team used the results to reflect on their practice and to implement changes moving forward. [ABSTRACT FROM AUTHOR]

Objective: People with mental health conditions have high rates of chronic physical diseases, partially attributable to lifestyle risks factors. This study examined risk prevalence among community mental health service clients, their readiness and confidence to change, and associations with participant characteristics. Methods: Cross-sectional survey of adult clients from 12 community mental health services across 3 local health districts in New South Wales, Australia, collected from 2021 to 2022. Participants (n = 486) completed a telephone interview determining five risk factors, and readiness and confidence to change these. Multiple binary logistic regression models determined associations between readiness and confidence (for each risk), and participant characteristics (demographics and diagnosis). Results: Participants most commonly reported a diagnosis of schizophrenia (36.7%) or depression (21.1%). Risk factors were prevalent: ranging from 26% (harmful alcohol use) to 97% (poor nutrition). High readiness was greatest for smoking (68%), weight (66%) and physical inactivity (63%), while confidence was highest for changing alcohol use (67%). Two significant associations were identified; females were more likely than males to have high readiness to change nutrition (odds ratio = 1.14, confidence interval = [1.13, 2.34], p = 0.0092), with males more likely to have high confidence to change physical activity (odds ratio = 0.91, confidence interval = [0.45, 0.99], p = 0.0109). Conclusions: Many participants were ready and confident to change risk factors. Gender influenced readiness to change nutrition and physical activity confidence. Training to upskill mental health clinicians in provision of preventive care that builds confidence and readiness levels may aid in supporting positive behaviour change. [ABSTRACT FROM AUTHOR]

The 1960s and 1970s saw the overt "politicization" of the American Psychological Association as an organization. Politics in this context carried a dual meaning referring to both political lobbying to promote the interests of psychology as a health profession and grassroots political action to advance social justice causes. In the years between the passage of the Community Mental Health Act (1963) and the Vail Conference on levels and patterns of professional training in psychology (1973), these two forms of politics were intertwined. The first significant political mobilization of professional psychologists in the postwar era occurred over the staffing of community mental health centers in the mid-1960s. These creations of the Great Society social welfare programs provided a platform for pursuing bold experiments in structural interventions to improve the lives and mental health of minoritized Americans and came to serve as hubs for the Black psychology movement of the early 1970s. This alternative model for the profession received careful consideration at the Vail Conference. However, a different relationship between politics and the profession crystalized by 1980. The politics of professionalism in psychology took the form lobby on behalf of practitioners working independent practices to receive reimbursement from third-party health insurance providers. This shift in the political economy of mental health has obscured this earlier, communitarian moment in American psychology. The racial economy of psychology's professionalization was structural, but not inevitable. It resulted from a series of historical choices. [ABSTRACT FROM AUTHOR]

The way parents report their child's emotional and behavioral difficulties is important both for identifying the child's needs, diagnosis, and prevention. This study examined to what extent parents' internal processes predict the way in which parents report their child's emotional and behavioral difficulties on the SDQ, as mediated by parental feelings. Parents of children who were referred to a community mental health clinic completed a self-report questionnaire including the following scales: adulthood attachment style, self-regulation difficulty, personal well-being, self-compassion parental feelings, and their child's emotional-behavioral difficulties. Study findings indicated that parents' internal processes do not directly predict parents' report of their children's mental difficulties on the SDQ, only when mediated by parental feelings. These findings highlight the significance of parental feelings in reporting children's behavioral and emotional difficulties. It also contributes to the body of knowledge concerning the importance of caring for parents' needs and feelings and overall parenthood. [ABSTRACT FROM AUTHOR]

Objective: This study compared mental health treatment engagement among people with serious mental illness after release from jails that had either a for-profit (N=3 jails) or a nonprofit mental health provider (N=7 jails). Methods: Across the 10 jails, data were collected in 2019 for 1,238 individuals with serious mental illness. Data included demographic characteristics (age, race-ethnicity, gender, geography, and jail type) and behavioral health variables (previous mental health treatment, psychotropic medication use, substance use, and receipt of jail-based mental health services). Logistic regression was used to predict treatment engagement during the year after release, stratified by type of jail-based mental health provider, in analyses controlled for demographic and behavioral health variables. Results: Almost half (46%, N=573) of the individuals had stayed in jails with a for-profit mental health provider; the other half (54%, N=665) had stayed in jails with a nonprofit provider. In the year after release, 37% (N=458) of all individuals engaged in mental health treatment, and 63% (N=780) did not. Those who had stayed in a jail with a for-profit provider were significantly less likely to engage in mental health treatment during the year after release (AOR=0.59, 95% CI=0.42–0.83, p<0.01), compared with those in jails having a nonprofit provider. Conclusions: Staying in a jail with a for-profit mental health provider was associated with reduced postrelease engagement with community service providers. Less engagement with services during a pivotal time after release may increase behavioral health crises that erode individuals' well-being and may raise downstream costs due to further criminal legal involvement and emergency care use. [ABSTRACT FROM AUTHOR]

In the context of the current youth mental health crisis, it is prudent to reconsider how resources are allocated to facilitate the delivery of effective and comprehensive supports and services to children and adolescents. Schools are the main delivery sites for youth mental health services. Many districts have adopted comprehensive school mental health systems (CSMHS) to provide a multitiered approach comprising mental health promotion, prevention, and intervention to students via partnerships between school and community health and behavioral health providers. COVID-19 relief funding and other new federal and state investments in school mental health have led to expansions of school mental health programming in most states. An impending federal funding cliff necessitates an examination of how to wisely invest now to achieve the greatest positive future impact on youth mental health. To capitalize on opportunities to sustain effective school mental health and maximize return on investment, states may consider four strategies: leverage cross-sector partnerships to advance school mental health policies and funding, strengthen and expand Medicaid coverage of CSMHS, establish and enhance data systems, and create state technical assistance and professional development support for CSMHS implementation through local education agencies. [ABSTRACT FROM AUTHOR]

Objective: Churches in socioeconomically disadvantaged neighborhoods serve as safe havens in many Black communities. Churches provide faith and charitable services but often have limited resources to address the mental health needs of their communities. This article reports on a collaborative effort, driven by members of a Black church, to understand mental health needs, coping strategies, and resilience factors in a community of socioeconomically disadvantaged Black Americans. Methods: A community-based participatory research effort was established among a church, a community mental health organization, clinicians, and researchers to interview and survey individuals residing near the church. Results: The sample consisted of 59 adults, most of whom were ages 46–65 years, men (N=34, 58%), and unemployed (N=46, 78%). Mean scores on the Patient Health Questionnaire–9 (9.2±7.7) and Generalized Anxiety Disorder–7 scale (9.4±6.7) were almost three times higher than those reported by studies of other Black populations in the United States. Five themes emerged: prolonged poverty and daily exposure to violence trigger emotional distress, mental health stigma affects help seeking, spirituality promotes mental relief and personal recovery, spirituality helps in coping with poverty and unsafe neighborhoods, and church-based programs are needed. Conclusions: Uptake of traditional mental health services was low, and reliance on faith and resource distribution by the church was high. Church-led interventions are needed to promote mental health at the individual and community levels. Mental health stigma, and negative attitudes toward mental health promotion in the community, may be addressed by integrating traditional mental health services in church-based recreational and leisure activities. [ABSTRACT FROM AUTHOR]

This column shares lessons learned from a 1-year pilot implementation of a crisis response program deploying crisis professionals to rural parts of Albany County, New York. The data (325 crisis interventions for 191 unique individuals, 57% of cases resolved on the scene) suggest that the program helps fill the crisis services gap in these communities. Police were present on 80% of cases. Educating police to build confidence in the program and providing clearer guidelines on the triage process for dispatchers may be important strategies to continue shifting crisis response duties from traditional first responders to crisis professionals. [ABSTRACT FROM AUTHOR]

Objective: Suicide is a significant public health concern. About 48,000 individuals died by suicide in 2021 in the United States, and approximately one in 100 deaths globally are due to suicide. Continuing efforts in program development and evaluation are vital to preventing suicide. Multiple frameworks have been developed to reduce suicide rates, but they have not been compared to assess their comprehensiveness, nor have their components been classified. Methods: In 2019, the authors conducted a narrative review of the literature and identified four major frameworks for suicide prevention: the U.S. Department of Veterans Affairs (VA) Suicide Prevention Program, the Defense Suicide Prevention Program of the U.S. Department of Defense, Zero Suicide in Health and Behavioral Health Care, and the technical package developed by the Centers for Disease Control and Prevention. Program components for these frameworks were identified and classified by using two prevention strategy classification systems: the National Academy of Medicine's (NAM's) continuum-of-care model and the Substance Abuse and Mental Health Services Administration's (SAMHSA's) prevention model. Results: The cross-program comparison revealed that no single program included all components of suicide prevention programs. However, the VA program was the most comprehensive in terms of the number of components and their spread across prevention strategy classifications. The programs used few components categorized under NAM's promotion or selective prevention strategy classifications. The SAMHSA prevention strategy classifications of information dissemination, community-based processes, and positive alternatives were also used infrequently. Conclusions: Organizations, health care systems, and policy makers may use these findings as they develop, improve, and implement suicide prevention programs. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Young adults with serious mental illness (SMI) have poor physical health and high Emergency Department (ED) and hospital utilization. Integrating primary care into community mental health care may be an important form of early intervention.Adjusted multivariable regressions assessed changes in self‐reported annual primary care, ED and hospital utilization for 83 young adults with SMI enrolled in integrated care.Participants' mean annual per person utilization changed significantly as follows: primary care visits, from 1.8 to 3.6, p < .001; medical ED visits, from 1.0 to 0.6, p < .01; psychiatric ED visits from 0.6 to 0.2, p < .001; medical inpatient days, from 1.2 to 0.1, p < .001 and psychiatric inpatient days, from 6.3 to 2.6, p < .001.Young adults with SMI receiving integrated care increased primary care and reduced ED and inpatient utilization. Future controlled research is warranted to further assess integrated care for young adults with SMI. [ABSTRACT FROM AUTHOR]

This document explores the legacy of Emil Kraepelin, a prominent figure in psychiatry, and the challenges to his ideas within the field. It delves into the social and historical contexts of psychiatry, including the rise of psychiatric institutions and the influence of financial factors. The authors argue for a reevaluation of psychiatry, drawing on the philosophy of Walter Benjamin and emphasizing the importance of understanding the social and cultural context in which psychiatric practices take place. They propose that psychiatrists critically examine the narrative of history and consider the potential for radical change in the field. The document discusses the relevance of history to psychiatry, highlighting the work and ideas of Emil Kraepelin and Walter Benjamin. It emphasizes the significance of viewing history as a series of tense episodes rather than a linear progression. The document suggests that psychiatrists can benefit from incorporating Benjamin's non-linear thinking into their practice to better comprehend the complexities of mental suffering. It concludes by highlighting the potential for Benjamin's work to enrich the field of mental health science. [Extracted from the article]

ObjectiveMethodResultsConclusionsThe current observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. The aims of the study were to (1) Identify therapist and client factors associated with increased SDM within EBP sessions and (2) Examine the association between SDM and therapeutic alliance between community therapists and Latinx caregivers.The Observing Patient Involvement in Decision-Making (OPTION) instrument measured SDM in 210 audio-recorded therapy sessions with 62 community therapists (91.94% female; 69.35% Latinx) and 109 Latinx caregivers (91.43% female) of youth who were an average age of 8.26 years (SD = 3.59). We used the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale to measure the caregiver-therapist alliance observationally. Multilevel linear regressions were conducted to examine research questions.Greater SDM was observed within sessions where therapists targeted conduct problems versus trauma (B = −8.79, 95% CI[−14.09, −3.49], p = .001). There was a trend that SDM was higher in English-language sessions compared to Spanish. We found that the global measurement of SDM (B = .04, 95% CI[.01, .08], p = .03) and the OPTION item Integrate Preferences (B = .69, 95% CI[.07, 1.32], p = .03) were positively associated with alliance.SDM may help foster Latinx caregiver engagement within EBP delivery. Provider training in SDM may be warranted with consideration of the specific clinical contexts (e.g., by presenting problem) that are appropriate for collaborative treatment planning. More research is needed to further establish the benefits of SDM in youth psychotherapy. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionStepped care models are frameworks for mental health care systems in several countries. According to Norwegian guidelines, individuals with mental health problems of mild severity should be treated in community mental health services, moderate severity in specialist mental health services, while complex/severe problems are often a shared responsibility. This study investigated whether patients are allocated as intended.In a cross-sectional study, 4061 outpatients recruited from community- and specialist mental health services reported demographic variables, symptoms of anxiety/depression, functional impairment, health status, and sick leave status. The community sample consisted of two subsamples: mild/moderate problems and complex problems.There was substantial overlap (80%–99%) of symptoms, impairment, and health between community- and specialist mental health services. More impairment, worse health, lower age, and being male were associated with treatment at specialist level compared to community mild/moderate. Better health, being in a relationship, and lower age were associated with specialized treatment compared to community complex group.The limited association between treatment level and symptoms and functional impairment reveals inconsistencies between treatment guidelines and clinical practice. How the existing organization affects patient outcomes and satisfaction should be investigated further. [ABSTRACT FROM AUTHOR]

AbstractGlobally, people with mental illness are more likely to present poor social, health and economic outcomes than the general population. While formal mental health services have been integral to the wellbeing of these vulnerable individuals, the relevance of kinship support in their lives cannot be overemphasized. Mental health practitioners play a crucial role in navigating the complex dynamics inherent in family relationships when mental illness is present. As such, their perspectives could shed light on the intricate dynamics of kinship care and emphasize the need for tailored interventions that address the diverse issues within familial contexts. In this qualitative study, the perspectives of twenty mental health professionals on kinship care for persons with severe and persistent mental illness in Ghana were explored. Data were gathered through in-depth interviews and were analyzed via content analysis. The mental health professionals mainly understood kinship care as nuclear and extended family members providing support to their ill relative, albeit mostly with reference to nuclear family support. While kinship was deemed relevant due to the bonds that tie family members, some drawbacks were noted. When working with patients and their families, mental health professionals are expected to assess the availability of kinship support from the patient’s perspective in collaboration with the family members before deciding whether to integrate kinship into their support services. [ABSTRACT FROM AUTHOR]