Showing papers in "Psychiatric Services in 2021"
TL;DR: Nearly half of the HCWs reported serious psychiatric symptoms, including suicidal ideation, during the COVID-19 pandemic, and perceived workplace culture and supports contributed to symptom severity, as did personal factors.
Abstract: Objective:The authors sought to quantify the rates of psychological distress among health care workers (HCWs) during the COVID-19 pandemic and to identify job-related and personal risk and protecti...
134 citations
TL;DR: It is suggested that COVID-19 patients with substance use disorders are at increased risk for adverse outcomes, and the attenuation of ORs in the model that matched for chronic respiratory and cardiovascular diseases associated with substance abuse suggests that the observed risks may be partially mediated by these conditions.
Abstract: Objective: The goal of this study was to examine the impact of substance use disorder on the risk of hospitalization, complications, and mortality among adult patients diagnosed as having COVID-19....
77 citations
TL;DR: Telehealth policy changes due to the COVID-19 pandemic are reviewed and what providers should consider for future delivery and implementation of their telehealth programs are highlighted.
Abstract: Because of the COVID-19 pandemic, many mental health care services have been shifted from face-to-face to virtual interactions. Several health policy changes have influenced telehealth uptake during this time, including changes in technology, Internet connectivity, prescriptions, and reimbursement for services. These changes have been implemented for the duration of the pandemic, and it is unclear if all, some, or none of these new or amended policies will be retained after the pandemic has ended. Accordingly, in the wake of changing policies, mental health care providers will need to make decisions about the future of their telehealth programs. This article briefly reviews telehealth policy changes due to the COVID-19 pandemic and highlights what providers should consider for future delivery and implementation of their telehealth programs.
67 citations
TL;DR: In this article, the authors examined the experience and attitudes of mental health care providers toward telehealth and found that the COVID-19 pandemic has forced a rapid transition to telepsychiatry.
Abstract: Objectives: The COVID-19 pandemic has forced a rapid transition to telepsychiatry. This study examined the experience and attitudes of mental health care providers toward telehealth. Methods: At 18...
57 citations
TL;DR: In this article, the authors reviewed the evidence for digital mental health treatments, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHT.
Abstract: A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs.
50 citations
TL;DR: In this paper, the authors proposed steps that can be taken to protect essential workers and other "vulnerable" populations; engage and empower communities; optimize community-led crisis response interventions; improve data collection about the intersection of COVID-19, structural racism, and mental health inequities; support school-based interventions; expand financial supports for mental health service delivery; expand health care insurance coverage to increase access and lower out-of-pocket costs; and promote workforce diversity.
Abstract: The complex interactions between the 2019 coronavirus disease (COVID-19) pandemic, structural racism, and mental health inequities have led to devastating health, economic, and social consequences. The intersection of these three conditions, which meets criteria for a syndemic (synergistic epidemics), presents numerous policy challenges-and opportunities. Addressing these issues in a unified manner, using a syndemic theory approach, can lead to significant progress and effective solutions for otherwise intransigent problems in society. This article proposes steps that can be taken to protect "essential workers" and other "vulnerable" populations; engage and empower communities; optimize community-led crisis response interventions; improve data collection about the intersection of COVID-19, structural racism, and mental health inequities; support school-based interventions; expand financial supports for mental health service delivery; expand health care insurance coverage to increase access and lower out-of-pocket costs; and promote workforce diversity. Emphasis on local, state, and federal policy interventions that prioritize equity and justice and focus on collective health and well-being will ultimately lead us on a more sustainable and equitable path.
48 citations
TL;DR: Findings suggest that the pandemic has profoundly affected care by acute mental health services.
Abstract: Objective:This study aimed to explore the effects of COVID-19 and the lockdown measures adopted in England on patients with acute mental illness.Methods:The authors analyzed referrals to the crisis...
40 citations
TL;DR: In this article, two primary compounds of the cannabis plant (Cannabis sativa), delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), differentially and dose-dependently affect mood and anxiety.
Abstract: Objective:Two primary compounds of the cannabis plant (Cannabis sativa), delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), differentially and dose-dependently affect mood and anxiety In th
34 citations
TL;DR: Evidence that schools are an essential component of the system of child and adolescent care and recommendations to advance this vital care delivery system are described, describing evidence that multitiered systems of mental health support and services in schools improve academic and psychosocial functioning and reduce risk of poor outcomes.
Abstract: This review examines the history and contemporary landscape of school mental health, describing evidence that schools are an essential component of the system of child and adolescent care and providing recommendations to advance this vital care delivery system. This literature review of scientific data and shifts to policy and practice in school mental health documents the evolution of collaboration between the education and mental health systems to support student mental health. This review describes best practices and provides examples for achieving the standards of the comprehensive school mental health systems model in states and local communities. Data demonstrate that multitiered systems of mental health support and services in schools, including mental health promotion, prevention, early intervention, and treatment, improve academic and psychosocial functioning and reduce risk of poor outcomes, including mental illness and school failure. Policy and practice shifts in the field reflect a movement toward integrating mental health systems into the education sector, including preparing the education workforce to promote mental health and to support early identification of and intervention to address mental illness. To create a full continuum of mental health supports for students, states and districts can draw on national best practices and state exemplars as they install multitiered systems of mental health supports in all schools, conduct universal student mental health monitoring, and coordinate school and community mental health systems.
33 citations
TL;DR: The social determinants of mental health act as mediators and moderators of the pandemic's impacts, and like all social determinant, the effects of a pandemic are underpinned by public policies and social norms.
Abstract: Contracting COVID-19, being exposed to it, or being affected by societal containment measures can have consequences that are themselves social determinants of health. Preexisting social determinants of health also drive the disproportionately high prevalence of COVID-19 infection and deaths among minority, marginalized, and other vulnerable populations. Thus, the social determinants of mental health act as both mediators and moderators of the pandemic's impacts, and like all social determinants, the effects of the pandemic are underpinned by public policies and social norms. The major economic impacts of containment measures have had cascading effects that will affect mental health for years to come.
28 citations
TL;DR: This paper called for investment in building a pipeline of researchers with significant psychiatric disabilities and intersecting lived experiences frequently studied in public sector services research, including homelessness, incarceration, comorbid health problems, structural racism, and poverty.
Abstract: In recent years, investment in participatory research methods within mental health services research has grown. Participatory efforts are often limited in scope, however, and attention to research leadership is largely absent from discourse about stakeholder involvement in the United States. This Open Forum calls for investment in building a pipeline of researchers with significant psychiatric disabilities and intersecting lived experiences frequently studied in public sector services research, including homelessness, incarceration, comorbid health problems, structural racism, and poverty. A series of concrete steps are described that faculty and research leadership can take now.
TL;DR: Financial stress was a strong predictor of mental health outcomes, and cost was the most salient treatment barrier in the community college sample.
Abstract: Objective:This study estimated the prevalence of self-reported symptoms of mental health problems and treatment utilization in a U.S. national sample of community college students and made comparis...
TL;DR: The five action recommendations describe clear, feasible next steps that can be taken to move these systems of care forward and meaningfully improve access and quality of care for people in crisis and include a central coordinating role for Congress.
Abstract: National, state, and local actors seem ready to address the long-neglected mental health crisis system in the United States. Elements of an organized system of crisis care are in place in some states, including regional or statewide call centers, mobile crisis teams, and crisis care facilities. These necessary advances are not sufficient to address the urgent problems of increasing suicide rates, the inappropriate use of emergency departments to hold people in psychiatric distress, and the problematic reliance on inadequately trained law enforcement who frequently respond to mental health crises. This article describes the immediate challenges and opportunities that can launch nationwide reform in systems of care for individuals in psychiatric crisis. Five action recommendations describe clear, feasible next steps that can be taken to move these systems forward and meaningfully improve access and quality of care for people in crisis. The recommendations include a central coordinating role for Congress, an increase in federal authorization and appropriation of funds, enactment of a 5% Mental Health Block Grant set-aside, expanded funding for research and evaluation, and the pursuit of additional payment mechanisms by states and counties.
TL;DR: The APA evaluation framework has emerged as an adaptable tool for those seeking to navigate the ever-growing space of mental health apps as mentioned in this paper. But it is not suitable for mobile applications.
Abstract: The app evaluation framework of the American Psychiatric Association (APA) has emerged as an adaptable tool for those seeking to navigate the ever-growing space of mental health apps. The authors d...
TL;DR: The mental health field must take these actions collectively so that history does not continue to repeat itself as mentioned in this paper, and mental health professionals can take several antiracist actions, including acknowledging individual and structural racism through an examination of racist policies.
Abstract: With a growing understanding of how racism negatively affects the mental health of patients, mental health professionals are as anxious to act as they are uncertain about the best path forward. This uncertainty persists even though thoughtful, actionable antiracist recommendations in psychiatry were made 50 years ago. Mental health professionals can take several antiracist actions, including acknowledging individual and structural racism through an examination of racist policies, to achieve mental health equity. The mental health field must take these actions collectively so that history does not continue to repeat itself.
TL;DR: For smokers with schizophrenia, varenicline led to significantly higher abstinence rates, and NNT was comparable to the control group, and no treatment significantly increased NPSAE prevalence.
Abstract: Objective:This study aimed to evaluate the efficacy and safety of varenicline, bupropion, and nicotine replacement therapy (NRT) among smokers with schizophrenia spectrum disorders in post hoc anal...
TL;DR: In this article, the authors presented a reconceptualization of shared decision making as a process of shared risk taking that often occurs during different phases of illness management and recovery, and the concepts of intersubjectivity, meaning making, and metacognition were offered to inform clinical interventions needed to address risk in SDM.
Abstract: Shared decision making (SDM) is an interpersonal health communication model that is underutilized with people with serious mental illness Although research has emphasized the role of patient capacity-, clinician-, and system-related barriers in SDM underutilization, the risk taking that affects SDM with people with mental illness is less often discussed This Open Forum presents a reconceptualization of SDM as a process of shared risk taking that often occurs during different phases of illness management and recovery The concepts of intersubjectivity, meaning making, and metacognition are offered to inform clinical interventions needed to address risk in SDM
TL;DR: Enabling and need factors seemed to be the most predictive of disengagement from early psychosis services, and substantial between-study variation in identified predictors of disengagements may be addressed by developing and applying a consensus definition of diseng engagement in future research.
Abstract: Objective:Therapeutic benefits associated with early services for psychosis are influenced by the degree to which participants engage in treatment. The main objective of this review was to analyze ...
TL;DR: Findings demonstrate the feasibility of incorporating suicide assessment procedures into depression screening in pediatric primary care and highlight avenues for maximizing preventive care for adolescents at increased risk for suicide.
Abstract: Objective:The authors evaluated suicide risk rates detected via a depression screener administered within a large pediatric primary care system and examined 1-year follow-up care after adolescents’...
TL;DR: Since the beginning of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights movement, LGBTQ community centers have been on the front lines of mental health care for sexual a...
Abstract: Objective: Since the beginning of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights movement, LGBTQ community centers have been on the front lines of mental health care for sexual a...
TL;DR: In this paper, the acceptability and feasibility of telehealth services in a community behavioral health agency was examined, after their rapid introduction into a community health agency as part of the response to the 2011 Boston Marathon bombing.
Abstract: Objective: The authors examined the acceptability and feasibility of telehealth services shortly after their rapid introduction into a community behavioral health agency as part of the response to ...
TL;DR: Nonsuicidal self-injury is a common and serious concern because of its association with multiple psychiatric difficulties and illnesses as well as its robust association with suicidal thinking and thinking.
Abstract: Nonsuicidal self-injury is a common and serious concern because of its association with multiple psychiatric difficulties and illnesses as well as its robust association with suicidal thinking and ...
TL;DR: In this paper, the authors evaluated whether implementation of perinatal collaborative care is associated with improvements in screening and treatment recommendations for per-inatal depression by obstetrieval.
Abstract: Objective: The study evaluated whether implementation of perinatal collaborative care is associated with improvements in screening and treatment recommendations for perinatal depression by obstetri...
TL;DR: The use of Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder; yet, its use is confined to < 1% of individuals with this disorder.
Abstract: Objective: Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder; yet, its use is confined to <1% of individuals with this disorder. The authors aimed to examine b...
TL;DR: In this article, the authors explore the challenges of reducing risks of viral contagion while maintaining high-quality mental health care in a correctional setting, and describe the modification of mental health services in SQSP during the early stages of the COVID-19 pandemic.
Abstract: Pandemics pose unique risks to people in correctional facilities. Among other vulnerabilities, incarcerated populations often have high rates of mental disorders and substance use disorders, which may increase risks for morbidity and mortality during a pandemic. California's San Quentin State Prison (SQSP) experienced multiple outbreaks during the 1918 influenza pandemic, and, a century later, the prison faces a new pandemic. This Open Forum describes the modification of mental health services in SQSP during the early stages of the COVID-19 pandemic. The authors explore the challenges of reducing risks of viral contagion while maintaining high-quality mental health care in a correctional setting.
TL;DR: In this article, the authors provide a roadmap for extending the World Health Organization's eastern Mediterranean region's SMHP to address the mental health consequences of COVID-19 among children globally.
Abstract: Children are likely to struggle with mental health consequences relating to the COVID-19 pandemic. School closures and home confinement increase the risk for emotional distress, domestic violence and abuse, and social isolation, as well as for disruption of sleep-wake and meal cycles, physical exercise routines, and health care access. As schools reopen, school mental health programs (SMHPs) incorporating universal approaches will be important for all children, and targeted approaches will be necessary for those more severely affected. Using their experience in Pakistan, the authors provide a roadmap for extending the World Health Organization's eastern Mediterranean region's SMHP to address the mental health consequences of COVID-19 among children globally.
TL;DR: Incidences of involuntary psychiatric detentions between 2011 and 2018 varied 33-fold across 25 states, and the mean state rate increased by three times themean state population increase.
Abstract: Objective:Characterizing commitment as an involuntary psychiatric emergency detention that possibly extends into a longer-term detention, the authors aimed to calculate population rates of detentio...
TL;DR: The null findings indicate that PGLB was not superior to usual care in helping participants achieve clinically significant changes in weight, CRF, and CVD risk reduction at 12 and 18 months.
Abstract: Objective: The effectiveness of the Peer-led Group Lifestyle Balance (PGLB) intervention, a 12-month manualized healthy lifestyle intervention delivered by peer specialists, was investigated in a s...
TL;DR: In this paper, the authors proposed the adoption of staged care as a population health-oriented service delivery model for packages of specialized services delivered largely in ambulatory care settings for individuals with common affective disorders.
Abstract: An ongoing need exists for innovation in service delivery to ensure that mental health services deliver high-quality treatment and prevention in the population. This Special Article proposes the adoption of "staged care" as a population health-oriented service delivery model for packages of specialized services delivered largely in ambulatory care settings for individuals with common affective disorders. Staged care integrates measures of clinical need alongside clinical stage and personal choice to select hierarchically arranged service packages for individuals. Packages then vary according to the intensity, duration, and mix of treatment options. This Special Article describes five levels of care in staged care: self- or family-directed monitoring and management, low-intensity services, moderate-intensity services, high-intensity services, and acute and specialist community mental health services. The care environment, treatment team, and length of treatment are also described, and provisional criteria are specified for assigning individuals to different care levels on the basis of current clinical need and clinical stage. Staged care is presented as a model that guides treatment selection and health service delivery to ensure that the high-quality care aims of "right care first time" and prevention are achieved and optimal use of available resources is considered.
TL;DR: In this article, the authors used a retrospective sample to determine whether Black patients with first-episode psychosis were at higher risk for coercive referral and coercive treatment, and they found that black patients with FEP were more likely to be referred for coercive treatment.
Abstract: Objective: Using a retrospective sample, the authors sought to determine whether Black patients with first-episode psychosis (FEP) in Canada were at a higher risk for coercive referral and coercive...