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Public outrage over police-involved deaths of people in mental health crisis has prompted governments to expand access to crisis services that partner police with social workers. Mobile Crisis Intervention Teams (MCIT) offer assessment and support for people in distress while averting escalation. Little attention has been given to the requisite competencies for social workers on MCITs. This narrative review, informed by crisis theory and the author's experience as an MCIT social worker, provides a roadmap of knowledge and skills to familiarize practitioners, educators, and students with this growing intervention model. Social workers on MCITs should have the capacity to engage complex clients, de-escalate tension, assess for risk, plan for safety, provide brief addiction counselling, diffuse interpersonal conflict, link clients with community resources, advocate for change, challenge systemic racism, build constructive relationships, and document services with awareness of relevant legislation. The role of social workers on MCITs is multifaceted and requires attention to balancing client well-being, client safety, and community safety. The practice insights discussed in this article are relevant to preventing harm and loss of life while facilitating engagement between clients and mental health services. [ABSTRACT FROM AUTHOR]

Excited delirium is a term that has been used in policing and emergency medicine to describe a condition characterized by bizarre, agitated, and aggressive behaviours. In the article 'Knowledge and skills for social workers on mobile crisis intervention teams,' I used this term in reference to people in crisis who may present with engagement barriers and aggressive behaviours. Evidence has emerged that law enforcement organizations are using it to justify the excessive use of force by officers and deaths of people during police interactions. The American Psychiatric Association and American Medical Association have released statements emphasizing that excited delirium is not an official diagnosis and denouncing its use as a justification for the use of force against people with mental health concerns. Social workers should be aware of this controversy and avoid the use of this term in crisis intervention practice and documentation. I regret the inclusion of this language in my article and recognize that excited delirium is not a valid diagnosis, nor should it be considered a legitimate rationalization for the use of force by law enforcement officers. [ABSTRACT FROM AUTHOR]

Background: Internet- and mobile-based interventions (IMIs) targeting depression have been shown to be clinically effective and are considered a cost-effective complement to established interventions. The aim of this review was to provide an overview of the evidence for the cost-effectiveness of IMIs for the treatment and prevention of depression.Methods: A systematic database search was conducted (Medline, PsychInfo, CENTRAL, PSYNDEX, OHE HEED). Relevant articles were selected according to defined eligibility criteria. IMIs were classified as cost-effective if they were below a willingness-to-pay threshold (WTP) of €22,845 (£20,000) - €34,267 (£30,000) per additional quality-adjusted life year (QALY) according to the National Institute for Health and Clinical Excellence (NICE) standard. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standard guidelines and the Cochrane Risk of Bias Tool.Results: Of 1538 studies, seven economic evaluations of IMIs for the treatment of major depression, four for the treatment of subthreshold/minor depression and one for the prevention of depression. In six studies, IMIs were classified as likely to be cost-effective with an incremental cost-utility ratio between €3088 and €22,609. All of these IMIs were guided. Overall quality of most economic evaluations was evaluated as good. All studies showed some risk of bias.Limitations: The studies used different methodologies and showed some risk of bias. These aspects as well as the classification of cost-effectiveness according to the WTP proposed by NICE should be considered when interpreting the results.Conclusions: Results indicate that guided IMIs for the treatment of (subthreshold) depression have the potential to be a cost-effective complement to established interventions, but more methodologically sound studies are needed. [ABSTRACT FROM AUTHOR]

Introduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs). Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60%) were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults), and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28%) receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health mobile teams into the primary care system. [ABSTRACT FROM AUTHOR]

Social service agencies face increasing demands for accountability, emphasizing the necessity of preparing professionals to effectively evaluate practice. University-agency collaborations incorporating service learning can build community research capacity while providing opportunities for application of student research skills. We describe a partnership model between a Master of Social Work program evaluation course and a mobile psychiatric rehabilitation program to design a formative evaluation. Course structure and tasks central to the management of the partnership are described. Agency staff benefited from access to peer-reviewed literature, introduction to standardized assessment instruments, and stimulation of staff discussion and critical thinking around service provision. Students valued the applied research experience including exposure to the agency context and a real-world impact of their work. Lessons learned and implications for university-agency collaborations are discussed. [ABSTRACT FROM AUTHOR]

Mobile mental health applications are regarded as a promising solution to meet increasing demands in mental health treatment. They are used to treat mental disorders and can only be successful if the treatment population accepts and appreciates them. This research analyses the acceptance of mobile mental health applications by young adults in Germany in order to identify inhibiting factors regarding their use. To describe people's intentions to use mobile treatment applications, an extended version of the technology acceptance model (TAM) is applied. In the past, TAM has already been used to access the acceptance and adaption of new medical applications. The findings suggest that knowledge about the existence and clinical effectiveness of mobile mental health applications are considerably low. Even though, mobile applications are considered easy to use, their effectiveness in treating mental disorders is questioned by the young adults. Furthermore, concerns that personal information can potentially be revealed arise. This can additionally inhibit the acceptance of these applications. To improve the acceptance and increase future usage, mobile mental health applications should be promoted as a supporting tool that is always available for anyone and can facilitate mental treatment. [ABSTRACT FROM AUTHOR]

People with mental illness (PMI) have increased dramatically, and these individuals are at greater risk for repeated contact with the criminal justice system. Mobile crisis units (MCUs) have been heralded as effective partners with law enforcement to provide appropriate interventions to PMI and reduce the possibilities of criminalization of this population. The purpose of this research is to examine a partnership between law enforcement and a county-wide MCU to determine (1) the nature of interactions between police-referred calls to the MCU and (2) to determine the outcomes of these calls and the factors that might influence the outcomes. Significant differences in the type of PMI calls from law enforcement–referred calls to MCUs are found; the PMI are twice as likely to be violent, intoxicated, psychotic, mood-order diagnosed, and in emergent need of care. The type of referral is no longer significant when the model includes risk factors. Policy implications of the partnership between law enforcement and MCUs are discussed. [ABSTRACT FROM PUBLISHER]

The doctors, nurses and ambulance drivers of the mobile emergency medical service ("SMUR" in French) are confronted with the death of their patients in their daily occupation (Laborie et al., 2002). In this context, the patients' death is often unforeseeable and brutal; the deaths result from forms of violence, accidents, suicides and aggressions. Thus, two dimensions emerge from the urgency department; on the one hand the unpredictability of the operations and on the other hand the confrontation with death. These two dimensions refer to the two principal psychopathological aspects concerned in the psychic traumatism: the brutality of the event and the meeting with death. Objective: The goal of our study is to describe potentially traumatic intervention by the SMUR staff and to find out about their personal experiences and also to measure the psychotraumatic repercussions. All along this research, we will rely on a qualitative and quantitative methodology, in order to confront the subjective richness of the clinical interviews with the data resulting from the questionnaire. Methodology: The study is based on 69 members of the mobile emergency medical service: doctors, nurses and ambulance drivers. Everybody has answered a semi-structured clinical interview and a questionnaire measuring the psychotraumatic disorder: posttraumatic stress disorder interview of Watson et al. (1996). From the clinical interview, we carried out a thematic analysis in order to identify the various topics emerging from each person's personal experience. We observe that the most exceptional interventions, such as catastrophes for example, are not more upsetting for the members of the SMUR. In a way, these interventions are regarded as a springboard for any professional career, a feeling of valorization is associated with it. On the contrary, it is more during their "daily" interventions that professionals express their traumatic experience. In this case, the professional is suddenly confronted with the horror, and the lack of preparation makes him more vulnerable to the "traumatic break down". Conclusions: The traumatic event is not to be understood in a psychopathological dimension, but more like an "initiatic ritual" allowing reorganization of the professional identity to cope with the following interventions. Thus, we witness the appearance of new faculties: the members of SMUR change their values, they get new competences: from now on, they can apprehend their work in a new way. Thus, the professionals seem to escape from the "traumatic curse". However, time only reveals the true nature of the event, which has been experienced, since trauma is also what we do with it afterwards. [ABSTRACT FROM AUTHOR]

The aim of this research was to study the views of mental health professionals on the necessity and effectiveness of mobile psychiatric care units for patients in the community. The survey method was used for the implementation of this research, the aim of which was to produce quantitative and statistical results. The research process lasted one (1) month (March - April 2010) and took place in 5 Prefectures in our country (Achaia, Thessaloniki, Lasithi (Crete), Rhodes and Serres). According to the views of mental health professionals, the results of the research showed that: i) the professional role of mental heath professionals in the Mobile Mental Health Units is very important because it is clearer, thus leading to the cohesion of the therapeutic group, ii) the inability of the existing mental health services to monitor the mentally ill patients in the community regularly was the major reason for the immediate development of Mobile Mental Health Units, iii) the most significant aim of the operation of Mobile Mental Health Units is to meet the needs of mentally ill patients residing in remote areas, and iv) the mental health professionals suggest that Mobile Mental Health Units should be made available in all prefectures of our country. [ABSTRACT FROM AUTHOR]

The care in the community of psychiatric patients according to the principles of community psychiatry is currently considered the best way of delivering mental health services. The importance of community mental health teams has been recognized worldwide and it is well known that these teams can provide effective and acceptable care. In Greece the Mobile Mental Health Unit (MMHU) constitutes an example of the provision of mental health care for patients living in remote and deprived rural areas. The basic operational principles of Greece's MMHUs are presented here and their clinical and research work and some of their important educational initiatives and promotional activities are described. The differences between the various teams in terms of operation are discussed, and the challenges they face are identified. Finally, reference is made to the outlook for such, low cost care services in the context of economic crisis, which increases the rate of certain mental disorders while reducing the resources available for mental health care. [ABSTRACT FROM AUTHOR]

This research has the following specific aim: to measure outcomes of social work emergency certificates produced by a Mobile Crises Team to determine the effectiveness of these certificates at linking clients to services. Linkage to services is a programmatic goal and is achieved by ensuring clients receive adequate crisis and follow-up services as a result of emergency certificates. In doing so, risks of homicide, suicide, and grave disability are mitigated. The data come from 233 consecutive cases of emergency certificates employed by social workers to transport clients to the local emergency department for psychiatric evaluation and treatment. Data were gathered post-hoc by reviewing copies of each specific certificate and cross-referencing those certificates with an agency risk management report and an electronic data base that stores demographic data on all clients. Descriptive, bivariate, and multivariable analysis, such as cross tabulations and binary logistic regression, are used to analyze the data in this study. Outcomes include a linkage rate of 86%, with predictors of linkage including substance abuse, police involvement, health-related disorders, and suicidality. Data were then controlled to remove the effect of police-initiated referrals and referrals from rural locales. In both cases, suicide as justification for the referral was a negative predictor of linkage. Recommendations include improving follow-up on those with health-related disorders and responding to low rates of linkage for those with police involvement. Research recommendations include developing better definitions of suicide variable and better measurements of functional status, and using control groups and larger data sets. [ABSTRACT FROM AUTHOR]

Introduction. There is a fairly widespread belief regarding the influence of the moon phases on the psychological behavior in humans. This relationship could be more pronounced among patients with mental disorders. Objective. To study the possible association between the incidence of psychiatric emergencies and moon phases and between the behaviors of psychiatric patients and moon phases. Methods. Daily series of cases seen in psychiatric emergencies were established according to the condition, typical behaviors manifested and treatments received by patients admitted to the short-term in-patient psychiatric unit, and the brightness of the moon, from 11-1-2006 to 10-31-2007. The possible association between the first two with the second was examined by making cross-correlations in the tuning fork of delays from 0 to 7 days. Results. No association appeared between moon phases and characteristics of psychiatric emergencies. In hospitalized patients, a correlation was observed between the moon phases and the bed occupancy rate, which was direct, weak but significant, decreasing until the third day after admission (0.20, 0.18, 0.16 and 0.11), while hypnotic medication in take increased with moon brightness moon until the second day after, also declining and significantly weakness (0.22, 0.19 and 0.15). Conclusions. The only empirical relation ship of the moon phases with psychiatric behavior of the mentally ill in our sample was manifested as an increase in the incidence of cases and greater disruption of sleep patterns. [ABSTRACT FROM AUTHOR]

Objectives: Many suicidal patients treated and released from emergency departments (ED) fail to follow through with subsequent outpatient psychiatric appointments, often presenting back for repeat ED services. Thus, the authors sought to determine whether a mobile crisis team (MCT) intervention would be more effective than standard referral to a hospital-based clinic as a means of establishing near-term clinical contact after ED discharge. This objective was based on the premise that increased attendance at the first outpatient mental health appointment would initiate an ongoing treatment course, with subsequent differential improvements in psychiatric symptoms and functioning for patients successfully linked to care. Methods: In a rater-blinded, randomized controlled trial, 120 participants who were evaluated for suicidal thoughts, plans, or behaviors, and who were subsequently discharged from an urban ED, were randomized to follow-up either in the community via a MCT or at an outpatient mental health clinic (OPC). Both MCTs and OPCs offered the same structured array of clinical services and referral options. Results: Successful first clinical contact after ED discharge (here described as “linkage” to care) occurred in 39 of 56 (69.6%) participants randomized to the MCT versus 19 of 64 (29.6%) to the OPC (relative risk = 2.35, 95% CI = 1.55–3.56, p < 0.001). However, we detected no significant differences between groups using intention-to-treat analyses in symptom or functional outcome measures, at either 2 weeks or 3 months after enrollment. We also found no significant differences in outcomes between participants who did attend their first prescribed appointment via MCT or OPC versus those who did not. However divided (MCT vs. OPC, present at first appointment vs. no show), groups showed significant improvements but maintained clinically significant levels of dysfunction and continued to rely on ED services at a similar rate in the 6 months after study enrollment. Conclusions: Community-based mobile outreach was a highly effective method of contacting suicidal patients who were discharged from the ED. However, establishing initial postdischarge contact in the community versus the clinic did not prove more effective at enhancing symptomatic or functional outcomes, nor did successful linkage with outpatient psychiatric care. Overall, participants showed some improvement shortly after ED discharge regardless of outpatient clinical contact, but nonetheless remained significantly symptomatic and at risk for repeated ED presentations. ACADEMIC EMERGENCY MEDICINE 2010; 17:36–43 © 2009 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]

Research has shown that follow-up rates with aftercare recommendations upon discharge from psychiatric emergency services are low. These patients are in need of additional wrap-around support services. This article illustrates how an innovative program has been effective in utilizing crisis intervention services and mobile crisis outreach within an emergency room (ER) setting and how these unique services can be integral in preventing psychiatric decompensation and repeated presentations to the ER. In addition, Implementing these services helps ensure better compliance with follow-up recommendations, allowing for the resolution of the crisis, enhanced diagnostic clarification, and identification of barriers to continued care in the community. Essential elements of successful application of this model include providing an immediate appointment, having close follow up, and ensuring a collaborative and interdisciplinary approach that addresses the biopsychosocial needs of patients. Further research is needed to better understand the patient characteristics and systemic factors that contribute to issues of compliance with community mental health services upon discharge from a psychiatric emergency service. [ABSTRACT FROM AUTHOR]

Background: Research in the pre-hospital phase of emergencies involves certain ethical and practical challenges. Severely ill or injured patients are not able to give informed consent in the immediate stressful situation. The aim of this pilot study was to find an ethically acceptable method to carry out research in acutely ill or injured patients before any treatment was given in order to be able to study the acute and unmodified systemic inflammatory response to trauma. Methods: Younger physicians were assigned to the mobile emergency care unit (MECU) on a volunteer basis. They drew blood samples ‘at the scene’ from patients exposed to accidental injury or from patients with acute medical emergencies. The ethical committee accepted that informed consent to blood analyses could be postponed until later or given by relatives. Pro- and anti-inflammatory cytokines, catecholamines and cortisol were measured. Results: During 6 months, the study group accompanied the MECU on approximately 500 call-outs. Blood samples were drawn from 42 patients. Consent to the analysis of blood samples was obtained in 30 cases. In 20 cases, it was not possible to draw the blood sample before medication. Conclusion: This pilot study showed that it was possible to conduct blood sampling from acutely ill patients ‘at the scene’. However, the present legislation on informed consent makes this type of research very time consuming. When patients die in hospital and no relatives can be found, consent cannot be obtained, and information from these severely affected patients is lost. [ABSTRACT FROM AUTHOR]

Purpose: To describe cases seen by two Mobile Crisis Programs (MCPs) for individuals with severe mental illnesses. Focus is on client characteristics, mental health status, interventions, referrals, and immediate outcomes. Methods: Data were collected retrospectively through a chart review of clinical record forms and accompanying progress notes for cases seen by the MCPs over a one-year period. A total of 981 cases were included in the study. Data were analyzed using descriptive and bivariate statistics. Results: Most cases involved clients who were female (60.2%), single (55.8%), living at home (56.8%), unemployed (85.6%), and between 20 and 44 years of age (44.5%). The two programs varied on a number of factors related to the demographic profile and mental health needs of the different geographical regions in which they are located. Conclusions: Findings highlight the need for further research into how MCPs can be integrated with related mental health services in offering clients the least intrusive and most efficient services. [ABSTRACT FROM AUTHOR]

The article presents the findings of a study that examined the impact of community-based mobile crisis services on post crisis community-based mental health service use and user characteristics related to likelihood of post crisis service use. The Cox regression analytic procedure was applied to matched samples to examine the impact of the community-based mobile crisis intervention on the receipt of community aftercare services. In this design, the approach was to make the pre-intervention and post-intervention groups as similar as possible through the use of the matching procedure on key variables. This approach avoids the limitation imposed by using regression, which only controls for the linearity of the relationships of the variables. Several factors such as the availability of services were investigated and found to be unlikely to have influenced the results. Other factors, however, such as changes in key administrative personnel within agencies or changes in training provided for staff could not be examined.

Data collected on calls made to a telephone counseling service over a 22-month period were examined. It was found that (a) calls concerning alcohol problems, dating and social skills, information and referral, loneliness and depression, pranks and obscenities, and problem pregnancy differed significantly across four two-hour intervals extending from 6 p.m. to 2 a.m.; (b) males made significantly more prank and obscene calls than females, more calls concerning dating and social skills; and (c) males made significantly more calls between 12 a.m. and 2 a.m. [ABSTRACT FROM AUTHOR]

Project Outreach was a specially designed crisis intervention program funded by the National Institute of Mental Health following the devastating 1972 Agnes flood disaster in the Wyoming Valley of northeastern Pennsylvania. The project was in operation for 32 months and employed 60 individuals primarily specially trained, indigenous nonprofessionals. Utilizing a neighborhood canvassing effort, Human Service Counselors encountered individuals with a wide range of problems ranging in severity and difficulty from those requiring limited assistance from community resources to those involving the need for direct mental health services. Over 25,000 client contacts were made. The project demonstrated that a cadre of local residents can be recruited, selected, and trained within a very short period of time to provide crisis intervention services to disaster victims. Further, Project Outreach has shown that an active, community-based, outreach/case-finding effort can be a highly effective approach in dealing with the problems of disaster victims. [ABSTRACT FROM AUTHOR]

This article presents a review and assessment of a community Mobile Crisis Intervention Team working on the Lower East Side of Manhattan. Of special importance, a trend is noted involving a changing philosophy and modus operand!. Some reasons are offered to explain the trend and questions are raised about the future of the delivery of mental health services in large urban areas. [ABSTRACT FROM AUTHOR]

Abstract: During the 2 years of the mobile mental-health unit''s operation in Northwestern Greece, the referrals increased rapidly with 29.4% of patients never having received mental-health care before, while hospitalizations and relapses reduced significantly, indicating that community-oriented programs can contribute greatly to successfully addressing the needs of patients in remote rural areas. [Copyright &y& Elsevier]

The article offers information on several products including the heated shell GTx lamp from GE and the MobileDefender Model S mobile emergency pendant from SecuraTrac.

Background The most radical form of community treatment involves attempts to develop a community-treatment alternative to mental hospital. One interesting and effective community oriented model is the development of services such as Mobile Psychiatric Units in rural areas, which contributes considerably to the establishment of an organized net of psychiatric care that covers the broad needs of the remote areas. This study presents the development of the recently established Mobile Psychiatric Unit of the prefectures of Ioannina and Thesprotia (M.P.U. I-T), Greece, as well as the results of its operation during the first six-month period of its establishment. Materials and methods The M.P.U. is a specialized multidisciplinary team which provides psychiatric services and promotes mental health in the rural areas of the prefectures of Ioannina and Thesprotia, for a population of about 100.000 people. The M.P.U. visits 8 Health Centers of the Primary Health Care once a week, and has the potential to examine patients at home, while a close cooperation with almost all Home Care Programs within the catchment area has been also established. Patients were examined by the MPU staff and medical data were also collected in order to better identify the needs of the patients living in these remote areas. Results 344 therapeutic actions have been recorded within this first six months period of the MPU development. 106 (30.8%) were visits at the patients' homes. During this period, the number of the patients was gradually increased, reaching currently a total of 132 patients, whereas 42 patients are permanently followed-up by the MPU. 19 patients had psychotic disorders and 17 had affective disorders. Emphasis is also given in supporting the patients to the management of their practical needs and the attendance of their compliance. Since one of the main goals is the undertaking of activities that promote mental health and implement educational programs in the community, 58 promotion activities, 55 meetings with members of Primary care services, 9 meetings with members of the local authorities, and 18 meetings with other corporations, such as rehabilitation centers, social support organizations, hospital administrations and the church have been developed within the same period. Conclusions It has been mentioned that the basic principles in managing a psychotic patient should be that he gets what he needs, when he needs it and where best possible. Although the present findings are only preliminary, they provide initial evidence about the increased needs of the rural areas for the development of community-based mental health services and that a community-oriented programme based on Mobile Psychiatric Units offers quite satisfactory results in this direction. [ABSTRACT FROM AUTHOR]

Objectives: The study of the correlation between the insight of the patients attended by a Regional Mobile Psychiatric Unit, and various clinical and sociodemographic variables. The evaluation of the insight included the compliance of the patient to the treatment, his awareness regarding his illness as well as to the therapist notion concerning the way the patient was coming in terms with his disease. Methods: 45 psychotic patients aged 17-67 were studied. Spearman rank correlation, x2 statistical test and stepwise multiple regression analysis were used in order to determine the relation between the variables at the beginning as well as at the end of the 5-year study. Results-conclusions: [•] The subjects who had no insight of their disease prior to research were not prescribed. During the intervention, the patients’ insight as well as their compliance to the prescription was improved. However, this correlation did not remain significant at the end of the study. [•] The diagnosis of the patients as well as the family history of a mental disease was related to the degree of their insight before the intervention. [•] The more socialized a patient was before the intervention, the more insightful he was not only before, but also after the intervention. [•] The more motivated a patient was regarding his leisures on his free time after the intervention the more insightful he was before the intervention. [•] The patients’ insight was positively correlated to the duration and the number of the previous admissions prior and after the intervention respectively. [Copyright &y& Elsevier]