Journey into Genes: Cultural Values and the (Near) Future of Genetic Counselling in Mental Health

AbstractThrough a case narrative set in the near future, this chapter explores some of the cultural and values issues that are raised by recent advances in genetics and associated personalised medicine. On first inspection, these advances might be thought to resolve or at any rate ameliorate the values issues that arise in the context of shared clinical decision-making as the basis of personalised mental health practice in genetic counselling. On the contrary, however, as the case narrative illustrates, the values issues are considerably amplified. This is an instance of the ‘Science Driven’ principle of values-based practice: that the practical impact of advances in medical science and technology is to widen patients’ choices and with choices go values. The result is that advances in medical science and technology drive the need for enhanced values-based as well as evidence-based practice in responding to the challenges presented by personalised clinical care. The emerging resources for responding to these challenges in the context of psychiatric genetic counselling are described.

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Vectors of Best Practice: An Introduction to Part III, Practice

International Perspectives in Values-Based Mental Health Practice ◽

10.1007/978-3-030-47852-0_15 ◽

2020 ◽

pp. 129-138

Author(s):

Bill Fulford

Keyword(s):

Mental Health ◽

Decision Making ◽

Cultural Values ◽

Multidisciplinary Team ◽

Best Practice ◽

Clinical Decision Making ◽

Personal Narratives ◽

Clinical Decision ◽

Bottom Line

AbstractThis chapter introduces Part III of the book. Contributing chapters illustrate the role of a culturally enriched form of values-based practice in building best practice in the design and delivery of contemporary mental health services. Topics covered from the model of values-based practice set out in chapter ‘Surprised by Values: An Introduction to Values-Based Practice and the Use of Personal Narratives in this Book’ include, person-values-centred care, the extended multidisciplinary team, shared clinical decision-making supported by dissensus within frameworks of shared values, and recovery practice. The bottom-line message is that incorporated into values-based practice, cultural values cease to operate as barriers to, and instead become effective vectors of, best practice in mental health.

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A Mobile Sensing App to Monitor Youth Mental Health: A Feasibility Study (Preprint)

10.2196/preprints.20638 ◽

2020 ◽

Author(s):

Banuchitra Suruliraj ◽

Dominik Gall ◽

Lucy MacLeod ◽

Kitti Bessenyei ◽

Alexa Bagnell ◽

...

Keyword(s):

Mental Health ◽

Clinical Decision Making ◽

Clinical Care ◽

Active Role ◽

Clinical Decision ◽

Mobile Sensing ◽

Clinical Monitoring ◽

Health States ◽

Clinical Symptomatology ◽

Prediction Tools

BACKGROUND Current methods of predicting mental health crises usually rely on subjective symptom ratings obtained at discrete time points during routine clinical care. But clinical decision-making based on such subjective information is challenging, as changes in symptoms might be sub-threshold, context dependent, or variable over time. Therefore, novel prediction tools need to be developed meeting the highest standards of reliability, feasibility, scalability, and affordability. Smartphones might configure such prediction tools, as they are ubiquitous and afford a wide variety of types of behavioural data that can be automatically recorded by their built-in sensors. OBJECTIVE To facilitate the collection of high-quality, passive mobile sensing data, we built the Predicting Risk and Outcomes of Social InTeractions (PROSIT) tool, a mobile sensing app that runs on both Android and iOS operating systems. In addition we aimed to ensure the acceptability and usability of this tool in youth. METHODS The PROSIT tool captures multiple indices of a youth’s daily life behaviors via their naturalistic use of a smartphone. These indices include physical activity, geolocation, sleep, phone use, typed text, music choice, and acoustic vocal quality. Importantly, the PROSIT tool records most of these data passively with only minimal burden to youth. All the time-intensive, detail-rich data streams that the tool captures to make inferences about youth’s mental health states are encrypted and uploaded to a secure server at our clinic. Although other mobile data collection tools exist, the PROSIT tool places a unique emphasis on the designing the tool for youth. RESULTS In a pilot study (N=61), participants tolerated the PROSIT tool well, reporting only minimal burden. Over 85% of youth were using the tool for the whole study period, although they were suffering from severe clinical symptomatology. But not only youth accepted the PROSIT tool well, for youth under the age of 15 we requested consent of parents, which 80% of parents provided. CONCLUSIONS The PROSIT tool offers novel way for clinical monitoring in youth with mental disorder. The high acceptability rates indicate that mobile sensing technologies can successfully be used even in youth with severe clinical symptomatology. We built the PROSIT tool to assist in clinical monitoring, with the ultimate goal of leveraging individual big data to empower youth patients to take on a more active role in the management of their clinical symptomatology.

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Spiritual, Religious and Ethical Values in a Suicidal Individual

International Perspectives in Values-Based Mental Health Practice ◽

10.1007/978-3-030-47852-0_13 ◽

2020 ◽

pp. 109-115

Author(s):

Ana Cristina Lopes ◽

Diogo Telles Correia

Keyword(s):

Mental Health ◽

Decision Making ◽

Cultural Values ◽

Clinical Decision Making ◽

Religious Faith ◽

Clinical Decision ◽

Spiritual Experiences ◽

Mental Health Practice ◽

Spiritual Dimension ◽

Spiritual Perspectives

AbstractReligious and spiritual experiences can appear in mental health practice as far as they often structure what aspects of psychopathological phenomena are present, sometimes making it difficult to determine whether some experiences should be classified as symptoms of a psychiatric disorder or crises within spiritual life.We present a clinical vignette of a 62-year-old sacristan who was admitted to the Psychiatric Emergency Room for suicidal thoughts in the context of physical sequelae of a cardiac episode. He confessed that, in the process of coping with his illness, he had a distressing experience of guilt and of losing his religious faith and shared the intention to take his own life by hanging himself.Themes that emerge in the discussion include issues related to the boundaries of psychiatric diagnosis, the spiritual dimension of mental health and the values that underlie clinical decision-making regarding a suicidal individual.Incorporating religious and spiritual perspectives in the clinical assessment of patients is essential to understand individual’s framework of cultural values and social attitudes on disease.

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A values-based phenomenology for substance use disorder: a new approach for clinical decision-making

Estudos de Psicologia (Campinas) ◽

10.1590/1982-0275202138e200102 ◽

2021 ◽

Vol 38 ◽

Author(s):

Guilherme MESSAS ◽

Kenneth FULFORD

Keyword(s):

Decision Making ◽

Substance Use ◽

Cultural Values ◽

Substance Use Disorders ◽

Clinical Decision Making ◽

Clinical Care ◽

Clinical Decision ◽

New Approach ◽

Mental Health Treatments ◽

Phenomenological Psychopathology

Abstract Phenomenological psychopathology has been defined as a human science that is concerned with the object on which clinical psychology and psychiatry act. How psychopathological experiences are understood is an important factor determining decision-making in clinical care. An accurate understanding of psychopathology is fundamental to the effectiveness of mental health treatments. This is even more important in a field such as substance use disorders in which social and cultural values influence both diagnosis and decision-making. In this article, we offer a contribution to clinical decision-making in substance use disorders by suggesting the association of Phenomenological Psychopathology and Values-Based Practice, constituting a Values-based Phenomenology We present a fictitious clinical case (to preserve confidentiality), illustrating a three-step practical application of Values-based Phenomenology. We conclude that although still a nascent discipline, Values-based Phenomenology offers a promising approach to reducing the gap between services and patients’ needs in clinical decision-making, and thus to improving clinical care in substance use disorders.

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Artificial Intelligence: An Interprofessional Perspective on Implications for Geriatric Mental Health Research and Care

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.734909 ◽

2021 ◽

Vol 12 ◽

Author(s):

Brenna N. Renn ◽

Matthew Schurr ◽

Oleg Zaslavsky ◽

Abhishek Pratap

Keyword(s):

Mental Health ◽

Artificial Intelligence ◽

Clinical Practice ◽

Data Science ◽

Clinical Decision Making ◽

Clinical Care ◽

Clinical Status ◽

Clinical Decision ◽

Mental Health Research ◽

Geriatric Mental Health

Artificial intelligence (AI) in healthcare aims to learn patterns in large multimodal datasets within and across individuals. These patterns may either improve understanding of current clinical status or predict a future outcome. AI holds the potential to revolutionize geriatric mental health care and research by supporting diagnosis, treatment, and clinical decision-making. However, much of this momentum is driven by data and computer scientists and engineers and runs the risk of being disconnected from pragmatic issues in clinical practice. This interprofessional perspective bridges the experiences of clinical scientists and data science. We provide a brief overview of AI with the main focus on possible applications and challenges of using AI-based approaches for research and clinical care in geriatric mental health. We suggest future AI applications in geriatric mental health consider pragmatic considerations of clinical practice, methodological differences between data and clinical science, and address issues of ethics, privacy, and trust.

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Transitioning towards official clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: current state and future directions.

10.31234/osf.io/8hsmy ◽

2017 ◽

Author(s):

Alexandra-Raluca Gatej ◽

Audri Lamers ◽

Robert Vermeiren ◽

Lieke van Domburgh

Keyword(s):

Mental Health ◽

Clinical Guidelines ◽

Clinical Decision Making ◽

Daily Practice ◽

Clinical Decision ◽

European Guidelines ◽

Current State ◽

Assessment And Treatment ◽

Evidence Based Treatments ◽

Multifactorial Approach

Severe behaviour problems (SBPs) in early childhood include oppositional and aggressive behaviours and predict negative mental health outcomes later in life. Although effective treatments for this group are available and numerous clinical practice guidelines have been developed to facilitate the incorporation of evidence-based treatments in clinical decision-making (NICE, 2013), many children with SBPs remain unresponsive to treatment (Lahey & Waldman, 2012). At present, it is unknown how many countries in Europe possess official clinical guidelines for SBPs diagnosis and treatment and what is their perceived utility. The aim was to create an inventory of clinical guidelines (and associated critical needs) for the diagnostics and treatment of SBPs in youth mental health across Europe according to academic experts and mental health clinicians’ opinions. To investigate the aim, two separate online semi-structured questionnaires were used, one directed at academics (N=28 academic experts; 23 countries), and the other at clinicians (N=124 clinicians; 24 countries). Three key results were highlighted. First, guidelines for SBPs are perceived as beneficial by both experts and clinicians. However, their implementation needs to be reinforced and content better adapted to daily practice. Improvements may include taking a multifactorial approach to assessment and treatment, involving the systems around the child, and multidisciplinary collaboration. Second, academic experts and clinicians support the need for further developing national / European guidelines. Finally, future guidelines should address current challenges identified by clinicians to be more applicable to daily practice.

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Cultural Values Influence Mental-Health Help-Seeking in Asian and Latinx College Students

10.31234/osf.io/674h9 ◽

2019 ◽

Author(s):

Elayne Zhou ◽

Yena Kyeong ◽

Cecilia Cheung ◽

Kalina Michalska;Michalska

Keyword(s):

Mental Health ◽

College Students ◽

Cultural Values ◽

Mental Health Treatment ◽

Help Seeking ◽

Online Survey ◽

Negative Attitudes ◽

Help Seeking Behaviors ◽

Seeking Behavior ◽

Ethnic Group Membership

The current study examined the influence of cultural values on mental health attitudes and help-seeking behaviors in college students of diverse ethnic backgrounds. Asian and Latinx college students (N = 159) completed an online survey in which they reported their adherence to cultural values and general attitudes towards mental health and help-seeking behavior. Factor analysis revealed two common factors of cultural values irrespective of ethnic background: Interdependent Orientation (IO) and Cultural Obligation (CO). Regardless of ethnicity, the more students endorsed IO values, the less likely they were to perceive a need for mental health treatment. IO value adherence also predicted more negative attitudes towards mental health. CO values were not predictive of perceived need or help-seeking behaviors. Findings highlight the importance of assessing certain cultural values independently from ethnicity and considering how the multidimensionality of culture may help explain shared mental health behaviors across ethnic group membership.

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Individualized Intervention to Support Mental Health Recovery Through Implementation of Digital Tools into Clinical Care: Feasibility Study

Community Mental Health Journal ◽

10.1007/s10597-021-00798-6 ◽

2021 ◽

Author(s):

Elizabeth Carpenter-Song ◽

Stephanie C. Acquilano ◽

Valerie Noel ◽

Monirah Al-Abdulmunem ◽

John Torous ◽

...

Keyword(s):

Mental Health ◽

Feasibility Study ◽

Clinical Care ◽

Digital Tools ◽

Mental Health Recovery ◽

Individualized Intervention

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Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-041371 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041371

Author(s):

Alyssa Howren ◽

J Antonio Aviña-Zubieta ◽

Deborah Da Costa ◽

Joseph H Puyat ◽

Hui Xie ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Mental Disorder ◽

Clinical Care ◽

Mental Healthcare ◽

Cluster Sampling ◽

Cross Sectional ◽

Perceived Need ◽

Mental Health Support ◽

Health Support

ObjectiveTo evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.DesignA cross-sectional analysis using data from Canadian Community Health Survey—Mental Health (2012).SettingThe survey was administered across Canada’s 10 provinces using multistage cluster sampling.ParticipantsThe study sample consisted of individuals reporting depression, anxiety or bipolar disorder.Study variables and analysisThe explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region.ResultsAmong 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support.ConclusionComorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care.

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