scholarly journals Agreement between patients and mental healthcare providers on unmet care needs in child and adolescent psychiatry

2020 ◽  
Author(s):  
Richard Vijverberg ◽  
Robert Ferdinand ◽  
Aartjan Beekman ◽  
Berno van Meijel
Keyword(s):  
Mental Health ◽  
Unmet Needs ◽  
Mental Health Problems ◽  
Healthcare Providers ◽  
Unmet Need ◽  
Young Patients ◽  
Mental Healthcare ◽  
Child And Adolescent Psychiatry ◽  
Care Providers ◽  
Care Needs

Abstract Purpose In mental health care, patients and their care providers may conceptualize the nature of the disorder and appropriate action in profoundly different ways. This may lead to dropout and lack of compliance with the treatments being provided, in particular in young patients with more severe disorders. This study provides detailed information about patient–provider (dis)agreement regarding the care needs of children and adolescents. Methods We used the Camberwell Assessment of Need (CANSAS) to assess the met and unmet needs of 244 patients aged between 6 and 18 years. These needs were assessed from the perspectives of both patients and their care providers. Our primary outcome measure was agreement between the patient and care provider on unmet need. By comparing a general outpatient sample (n = 123) with a youth-ACT sample (n = 121), we were able to assess the influence of severity of psychiatric and psychosocial problems on the extent of agreement on patient’s unmet care needs. Results In general, patients reported unmet care needs less often than care providers did. Patients and care providers had the lowest extents of agreement on unmet needs with regard to “mental health problems” (k = 0.113) and “information regarding diagnosis/treatment” (k = 0.171). Comparison of the two mental healthcare settings highlighted differences for three-quarters of the unmet care needs that were examined. Agreement was lower in the youth-ACT setting. Conclusions Clarification of different views on patients’ unmet needs may help reduce nonattendance of appointments, noncompliance, or dropout. Routine assessment of patients’ and care providers’ perceptions of patients’ unmet care needs may also help provide information on areas of disagreement.

scholarly journals What if children with psychiatric problems disagree with their clinicians on the need for care? Factors explaining discordance and clinical directions.

2021 ◽  
Author(s):  
Richard Vijverberg ◽  
Robert Ferdinand ◽  
Aartjan Beekman ◽  
Berno van Meijel
Keyword(s):  
Social Context ◽  
Mental Health Problems ◽  
Young Patients ◽  
Mental Healthcare ◽  
Cross Sectional Study ◽  
Drop Out ◽  
Care Needs ◽  
Cross Sectional ◽  
Factors Associated ◽  
Psychiatric Problems

Abstract Background Children and adolescents in mental healthcare often perceive their care needs and necessary treatment differently from their clinicians. As such discordance between young patients and clinicians may obstruct treatment adherence and compromise treatment outcomes, it is important to understand the factors associated with it. We therefore investigated the factors associated with patient-clinician discordance with regard to care needs in various areas of functioning. Methods A cross-sectional study involving 244 children/adolescents aged 6-18 participating with their clinicians in treatment at a specialized mental healthcare center. As a previous study conducted by our research group had found the greatest patient-clinician discordance in three CANSAS care needs – “mental health problems,” “information regarding diagnosis and/or treatment,” and “making and/or keeping friends” – we used univariable and multivariable statistics to investigate the factors associated with discordance regarding these three care needs. Results Patient-clinician discordance on the three CANSAS items was associated with child, parent, and family/social-context factors. Three variables were significant in each of the three final multivariable models: dangerous behavior towards self (child level); severity of psychiatric problems of the parent (parent level); and growing up in a single-parent household (family/social-context level). Conclusions To deliver treatment most effectively and to prevent drop-out, it is important during diagnostic assessment and treatment planning to address the patient’s care needs at all three levels: child, parent and family/social context.

Met and unmet needs among adults with mild to moderate intellectual disability with and without mental health problems

2020 ◽  
Author(s):  
Matthias Schützwohl
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Unmet Needs ◽  
Mental Health Problems ◽  
Psychiatric Symptoms ◽  
Health Problems ◽  
Service Planning ◽  
Support Needs ◽  
Behaviour Problem ◽  
Prevalence Rates

Background: People with an intellectual disability (ID) show a great number and complex constellation of support needs. With respect to the planning of services, it is important to assess needs at the population level. ID services need to know to what extent support needs of clients with mental health problems differ from support needs of clients without any mental health problem.Aims: The aim of this study was to compare the prevalence rates of needs in relevant study groups. Methods: Data was generated from the MEMENTA-Study (“Mental health care for adults with intellectual disability and a mental disorder”). The Camberwell Assessment of Need for Adults with Intellectual Disabilities (CANDID) was used to assess met und unmet support needs. Data was available for n=248 adults with mild to moderate ID.Results: Mean total number of needs and unmet needs was associated with mental health status. However, in most particular areas under study, individuals without significant psychiatric symptoms or any behaviour problem needed as much as often help as individuals with such mental health problems. A higher rate of need for care among study participants with significant psychiatric symptoms or any behaviour problem was mainly found with regard to these specific areas (“minor mental health problems”, “major mental health problems”, “inappropriate behaviour”) or with regard to closely related areas (“safety of others”).Conclusions: Differences in prevalence rates mainly occurred in such areas of need that rather fall under the responsibility of mental health services than under the responsibility of ID services. This has implications for service planning.

Youth mental health competencies in regional general practice

2020 ◽  
pp. 103985622097005
Author(s):  
Oliver Smith ◽  
Jessica Bergmann ◽  
Ulrich Schall
Keyword(s):  
Mental Health ◽  
Young People ◽  
Mental Health Problem ◽  
Health Problem ◽  
Mental Health Problems ◽  
Young Patients ◽  
Youth Mental Health ◽  
Young Person ◽  
Health Issues ◽  
Hunter Region

Objective: General practitioners (GPs) are key health professionals for referrals to mental health specialists. Youth mental health issues are particularly challenging, requiring a competent assessment and understanding of appropriate referral pathways. We surveyed local GPs about their understanding of youth mental health problems and needs to competently look after young patients. Methods: GPs working in the Hunter region were contacted via email, fax and post over a 6-month period in 2019. Results: Seventy-five GPs participated. They reported 577 of 1698 (34%) of young people seen 2 weeks prior to being surveyed presented with a mental health problem. Predominantly, referrals were to private practice psychologists and Headspace. Almost a third (31%) reported having limited understanding of ‘at-risk mental state’ and are ‘not always comfortable’ when facing a young person with a mental health problem. Nearly all (95%) expressed interest in attending specialised training. GPs identified treatment costs, scarce access to psychiatrists and limited patient engagement as the main obstacles to help young people. Conclusions: Effective treatment of a mental health problem relies on early identification. GPs are seeing young people on a regular basis but don’t feel well equipped for this task and are keen to up-skill, which needs to be addressed by targeted training.

scholarly journals Trajectory of Food Insecurity and Its Association with Longitudinal Mental Health and Sleep Outcomes in Adolescents from Economically Disadvantaged Families

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1696
Author(s):  
Ting-Hsuan Lee ◽  
Jen-Hao Kuo ◽  
Chia-Yi Liu ◽  
Yi-Fang Yu ◽  
Carol Strong ◽  
...  
Keyword(s):  
Mental Health ◽  
Food Insecurity ◽  
Economically Disadvantaged ◽  
Mental Health Problems ◽  
Transition Period ◽  
Sleep Problems ◽  
Healthcare Providers ◽  
Estimating Equation ◽  
Health Problems ◽  
Disadvantaged Families

Background: Adolescence is a critical transition period in the course of human development. Although food insecurity (FI) has been shown to be associated with adverse mental health and sleep outcomes in US adolescents, there is a paucity of research examining the relationships between FI, mental health, and sleep outcomes in Taiwanese adolescents. Furthermore, it is unknown how the change of FI over time (i.e., the trajectory of FI) is related to health outcomes. Methods: The data come from the Taiwan Database of Children and Youth in Poverty, which is a national longitudinal project measuring FI in five survey waves (2009–2017). We employed group-based trajectory modeling to classify various FI trends over the five waves using STATA. Furthermore, a generalized estimating equation analysis was conducted with FI trajectories as the independent variable to see how FI trajectory is related to mental health and sleep outcomes. Results: In total, 1921 participants aged 12–18 years in the first wave were deemed valid for the analysis. We classified the participants into four FI trajectory groups: persistently low FI (24.8%), persistently moderate FI (64.7%), declining from high to low FI (4.1%), and food-secure groups (6.4%). As compared to food-secure adolescents, the persistently moderate FI group was more likely to have mental problems (β = 0.30, [95% confidence interval 0.21–0.38]), while the other FI groups were only marginally associated with mental health problems. Moreover, adolescents in the persistently low FI group (β = 0.13, [0.02–0.23]) and persistently moderate FI group (β = 0.39, [0.29–0.48]) were found to have more sleep problems than those in the food-secure group. Conclusions: Our study describes the FI profile of adolescents from economically disadvantaged families and the difficulties they might encounter. With this information, healthcare providers can aid adolescents in the early stages of mental health problems and provide guidance when appropriate.

Patients' Supportive Care Needs Beyond the End of Cancer Treatment: A Prospective, Longitudinal Survey

2009 ◽  
Vol 27 (36) ◽  
pp. 6172-6179 ◽  
Author(s):  
Jo Armes ◽  
Maggie Crowe ◽  
Lynne Colbourne ◽  
Helen Morgan ◽  
Trevor Murrells ◽  
...  
Keyword(s):  
Negative Affect ◽  
Supportive Care ◽  
Unmet Needs ◽  
Unmet Need ◽  
Hormone Treatment ◽  
Longitudinal Survey ◽  
Supportive Care Needs ◽  
Fear Of Recurrence ◽  
Care Needs ◽  
Prospective Longitudinal

Purpose To estimate prevalence and severity of patients' self-perceived supportive care needs in the immediate post-treatment phase and identify predictors of unmet need. Patients and Methods A multicenter, prospective, longitudinal survey was conducted. Sixty-six centers recruited patients for 12 weeks. Patients receiving treatment for the following cancers were recruited: breast, prostate, colorectal, and gynecologic cancer and non-Hodgkin's lymphoma. Measures of supportive care needs, anxiety and depression, fear of recurrence, and positive and negative affect were completed at the end of treatment (T0) and 6 months later (T1). Results Of 1,850 patients given questionnaire packs, 1,425 (79%) returned questionnaires at T0, and 1,152 (62%) returned questionnaires at T1. Mean age was 61 years; and most respondents were female (69%) and had breast cancer (57%). Most patients had no or few moderate or severe unmet supportive care needs. However, 30% reported more than five unmet needs at baseline, and for 60% of these patients, the situation did not improve. At both assessments, the most frequently endorsed unmet needs were psychological needs and fear of recurrence. Logistic regression revealed several statistically significant predictors of unmet need, including receipt of hormone treatment, negative affect, and experiencing an unrelated significant event between assessments. Conclusion Most patients do not express unmet needs for supportive care after treatment. Thirty percent reported more than five moderate or severe unmet needs at both assessments. Unmet needs were predicted by hormone treatment, negative mood, and experiencing a significant event. Our results suggest that there is a proportion of survivors with unmet needs who might benefit from the targeted application of psychosocial resources.

scholarly journals Impact of mental health and addiction NIMHANS ECHO on primary care physicians: study from a rural state of India

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S157-S157
Author(s):  
Shabinabegam A M Sheth ◽  
Bhavya Bairy ◽  
Aurobind Ganesh ◽  
Sumi Jain ◽  
Prabhat Chand ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Health Problems ◽  
Care Providers ◽  
Primary Health ◽  
Secondary Outcomes

AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health problems do not have access to care in India. Further, primary health care providers (PCPs) have not been adequately trained in the screening, diagnosis, and initial management of common mental health conditions. There is thus a need to train health care providers at the State level to incorporate mental health into primary health care. In this paper, we report the findings of a collaborative project between the National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore India, and the state of Chhattisgarh incorporating mental health into primary care and addressing urban-rural disparities through tele-mentoring.MethodWe assessed the impact of the NIMHANS Extended Community Health Care Outcome (ECHO), an online, blended training program on participants' knowledge and competence (primary outcome) and commitment, satisfaction, and performance (Secondary outcomes) using Moore's evaluation framework. Primary and secondary outcomes were determined through a pre-post evaluation, assessment of trainee participation in the quarterly tele ECHO clinic as well as periodic assignments, respectively.ResultOver ten months of the NIMHANS ECHO program, there was a significant improvement in the participants' knowledge post-ECHO (p < 0.05, t = −3.52). Self-efficacy in diagnosis and management of mental health problems approached significance; p < 0.001. Increased engagement in tele-ECHO sessions was associated with better performance for declarative and procedural knowledge. The attrition rate was low (5 out of 30 dropped out), and satisfaction ratings of the course were high across all fields. The participants reported a 10- fold increase in the number of patients with mental health problems they had seen, following the training. A statistically significant increase in the number of psychotropic drugs prescribed post ECHO with t = −3.295, p = 0.01.ConclusionThe outcomes indicate that the NIMHANS ECHO with high participant commitment is a model with capacity building potential in mental health and addiction for remote and rural areas by leveraging technology. This model has the potential to be expanded to other states in the country in providing mental health care to persons in need of care.

scholarly journals Depressive Symptoms, Help-Seeking, and Barriers to Mental Healthcare Among Healthcare Professionals in Lithuania

2021 ◽  
Vol 28 (1) ◽  
pp. 3
Author(s):  
Daniel Rogoža ◽  
Robertas Strumila ◽  
Eglė Klivickaitė ◽  
Edgaras Diržius ◽  
Neringa Čėnaitė
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Help Seeking ◽  
Healthcare Professionals ◽  
Mental Health Problems ◽  
Mental Healthcare ◽  
Health Problems ◽  
Poor Mental Health ◽  
Work Related ◽  
Patient Health

Background: Previous research suggests that healthcare professionals (HCPs) experience high levels of work-related psychological distress, including depressive symptoms. Due to the stigma of mental health problems and other barriers, HCPs are likely to be hesitant to seek appropriate mental healthcare. We aimed to explore these phenomena among HCPs in Lithuania.Methods: A web survey inquiring about depressive symptoms, help-seeking, and barriers to mental healthcare was conducted. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). 601 complete questionnaires were included in the analyses. The barriers to help-seeking were identified using the inductive content analysis approach. Descriptive, non-parametric, and robust statistical analysis was performed using SPSS software.Results: Most of the respondents have reported depression-like symptoms over the lifetime, although only about a third of them sought professional help. Of those, roughly half preferred a private specialist. The stigma and neglect of mental health problems were the most common barriers to help-seeking. Around half of the HCPs believed that seeking mental healthcare can imperil their occupational license. About a quarter of the HCPs screened positive for clinically relevant depressive symptoms. Statistically significant differences in the PHQ-9 score were found between categories of healthcare specialty, marital status, religious beliefs, workplace, and years of work as a HCP. Fewer years of work and younger age were associated with the higher PHQ-9 score.Conclusions: Our findings suggest that HCPs in Lithuania may be inclined not to seek appropriate mental healthcare and experience poor mental health, although stronger evidence is needed to verify these findings. 

scholarly journals Improving access to mental healthcare for displaced Syrians: case studies from Syria, Iraq and Turkey

2016 ◽  
Vol 13 (4) ◽  
pp. 84-86 ◽  
Author(s):  
P. Hughes ◽  
Z. Hijazi ◽  
K. Saeed
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Primary Healthcare ◽  
Unmet Need ◽  
Mental Healthcare ◽  
Integrated Approach ◽  
World Health ◽  
Case Examples ◽  
Displaced People

The conflict in Syria has led to an unprecedented humanitarian crisis that extends across multiple countries in the area. Mental health services were undeveloped before and now face huge strain and unmet need. The World Health Organization and others have developed a programme to build capacity in the delivery of mental health services in an integrated healthcare package to refugees and displaced people. The tool used for this is the mhGAP Intervention Guide and complementary materials. In this paper we refer to training in Turkey, Iraq and Syria where health professionals were trained to roll out this community-based integrated approach through primary healthcare. We describe field case examples that show the complexity of situations that face refugees, displaced people and those caught in active conflict. Training improved the knowledge and skills for managing mental health disorders in primary healthcare. Further work needs to be done to demonstrate greater access to and utilisation of services, client outcomes and organisational change with this approach.

Perceptions of emergency medicine and acute care among a cohort of non-emergency medicine health providers in Myanmar

2019 ◽  
Author(s):  
Corey B. Bills ◽  
Peter Acker ◽  
Tina McGovern ◽  
Rebecca Walker ◽  
Htoo Ohn ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Acute Care ◽  
Emergency Care ◽  
Healthcare Providers ◽  
Unmet Need ◽  
Health Providers ◽  
Care Providers ◽  
Convenience Sample ◽  
Care Services ◽  
Acute Care Services

Abstract Background Currently, Myanmar does not have a nationalized emergency care or emergency medical services (EMS) system. The provision of emergency medicine (EM) education to physicians without such training is essential to address this unmet need for high quality emergency care. We queried a group of healthcare providers in Myanmar about their experience, understanding and perceptions regarding the current and future needs for EM training in their country. Methods A 34-question survey was administered to a convenience sample of healthcare workers from two primary metropolitan areas in Myanmar to assess exposure to and understanding of emergency and pre-hospital care in the country. Results 236 of 290 (81% response rate) individuals attending one of two full-day symposia on emergency medicine completed the survey. The majority of respondents were female (n=138, 59%), physicians (n=171, 74%), and working in private practice (n=148, 64%). A majority of respondents (n=133, 57%) spent some to all of their clinical time providing acute and emergency care however 83.5% (n=192) of all surveyed reported little or no past training in emergency care; and those who have received prior emergency medicine training were more likely to care for emergencies (>2 weeks training; p=.052). 81% (n= 184) thought the development of emergency and acute care services should be a public health priority. Conclusions Although this subset of surveyed health practitioners commonly provides acute care, providers in Myanmar may not have adequate training in emergency medicine. Continued efforts to train Myanmar’s existing healthcare workforce in emergency and acute care should be emphasized.

scholarly journals Young Patients With Persistent and Complex Care Needs Require an Integrated Care Approach: Baseline Findings From the Multicenter Youth Flexible ACT Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Marieke Broersen ◽  
Nynke Frieswijk ◽  
Hans Kroon ◽  
Ad A. Vermulst ◽  
Daan H. M. Creemers
Keyword(s):  
Mental Health ◽  
Integrated Care ◽  
Substance Misuse ◽  
Mental Healthcare ◽  
Target Group ◽  
Complex Care ◽  
Care Needs ◽  
Specific Patient ◽  
Care Approach ◽  
Complex Care Needs

Background: The Multicenter Youth Flexible ACT Study is an ongoing observational prospective cohort study that examines the effects of Youth Flexible ACT (Assertive Community Treatment) on young people with complex care needs who are difficult to engage in traditional (office-based) mental health services. However, a clear and detailed description of this patient group is lacking. In the current paper, we present baseline characteristics and psychosocial outcomes of the Youth Flexible ACT target group and explore the existence of underlying specific patient subgroups.Methods: Sixteen Youth Flexible ACT teams from seven mental healthcare institutes in the Netherlands participated in the study. Research participants were monitored for 18 months and administered questionnaires measuring psychiatric- and social functioning every 6 months, yielding four measurements. Baseline data were obtained from 199 adolescents, their mental health workers, and parents/carers. Latent Class Analysis based on HoNOSCA scores (measuring psychosocial and daily functioning) was conducted to identify underlying subgroups.Results: The target group of Youth Flexible ACT mainly consisted of patients older than 15 years of age with a history of (specialized) mental healthcare. They face many complex problems, including trauma; developmental, mood, and anxiety disorders; and problems with school attendance, family life, and peer relationships. Other frequently reported difficulties were substance misuse, the involvement of the legal system or police, problems with intellectual functioning, and personal finance. Patients were classified into four distinct classes: the “internalizing,” “externalizing,” “non-specific,” and the “overly impulsive” subgroup. Each subgroup had its unique pattern of difficulties and focus, respectively, high levels of depression and anxiety, disruptive behavior, unspecific difficulties, and substance misuse.Conclusions: As expected, patients in Youth Flexible ACT experienced many severe problems, rendering them vulnerable to fragmented and, thus, ineffective care. Our findings underscore the need for an integrated care approach with a multidisciplinary team of skilled professionals that can bridge these wide-ranging psychosocial problems, as each class of participants experienced a different set of difficulties. Youth Flexible ACT teams need to adjust their care services accordingly.

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