Impact of COVID-19 on Primary Care Mental Health Services: A Descriptive, Cross-Sectional Timeseries of Electronic Healthcare Records

Introduction. There are growing concerns about the impact of the COVID-19 pandemic on mental health. With government-imposed restrictions as well as a general burden on healthcare systems, the pandemic has the potential to disrupt the access to, and delivery of, mental healthcare. Ultimately, this could potentially lead to unmet needs of individuals requiring mental health support. Methods. Electronic healthcare records from primary care psychological therapy services (Improving Access to Psychological Therapy) in England were used to examine changes in access to mental health services and service delivery during early stages of the COVID-19 pandemic. A cross-sectional, descriptive timeseries was conducted using data from 1st January 2019 to 24th May 2020 across five NHS trusts to examine patterns in referrals to services (n = 171,823) and appointments taking place (n = 865,902). Results. The number of patients accessing mental health services dropped by an average of 55% in the 9 weeks after lockdown was announced, reaching a maximum reduction of 74% in the initial 3 weeks after lockdown in the UK. As referrals began to increase again, there was a relatively faster increase in referrals from Black, Asian, and ethnic minority groups as well an increase in referrals from more densely populated areas. Despite a reduction in access, service providers adapted to infection control guidance by rapidly shifting to remote delivery of care. Interpretation. Services were able to rapidly adapt to provide continuity of care in mental healthcare. However, patients accessing services reduced dramatically, potentially placing a future burden on service providers to treat a likely backlog of patients in addition to a possible excess of patients as the long-term consequences of the pandemic become more apparent. Despite the observational nature of the data, which should be noted, the present study can inform the planning of service provision and policy.

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Consultation liaison to support efficient delivery of mental health care

BJPsych Open ◽

10.1192/bjo.2021.835 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S317-S317

Author(s):

Emma Davies ◽

Mihaela Bucur

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Secondary Care ◽

Waiting Times ◽

Individual Treatment ◽

Efficient Treatment ◽

Number Of Patients ◽

The Impact

AimsTo study the impact of collaborative working, via consultation liaison, between Mental Health Liaison Practitioners (MHLPs) and Doctors within a secondary care mental health service. We hypothesise that this model of working may avoid unnecessary clinic appointments and waiting times, whilst providing patients with more efficient treatment.BackgroundMental health services are stretched, understaffed and under-resourced. It is estimated that 75% of people with mental health problems in England may not get access to the treatment they need. We therefore need efficient and innovative ways for people who seek help to receive support. Good practice consultation liaison involves face to face contact between clinicians; treatment can be delivered by supporting primary care whilst reducing the burden of secondary care mental health services.MethodRegular 30-minute sessions within an Assessment and Treatment Service, between MHLPs and Doctors, at both Consultant and Trainee level, were coordinated. Patients assessed by MHLPs were discussed by opening a dialogue whereby further management was discussed across a multi-professional team. A record was created of all patients discussed and the outcome.ResultNumber of MHLP/Doctor sessions: 10 across a six-month period.Number of patients discussed: 17.Medication advice provided for 16 patients. One patient required a referral for a clinic appointment.For several patients, integrated working procured alternative care pathways and resources to be considered, to incorporate into individual treatment plans.ConclusionRegular consultation liaison with MHLPs and Doctors is a model of working across the interface between primary care and specialist mental health services. It may provide patients with more efficient care, whilst avoiding unnecessary waiting times for clinic appointments. The consultation liaison working supported the development of an educative relationship between clinicians, with interprofessional learning. This is an example of an integrated and collaborative care model, whereby multi-professional working can provide efficient and effective treatment, whilst the support for the patient can remain in the primary care setting.

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Evaluating models of working at the interface between mental health services and primary care

The British Journal of Psychiatry ◽

10.1192/bjp.170.1.6 ◽

1997 ◽

Vol 170 (1) ◽

pp. 6-11 ◽

Cited By ~ 101

Author(s):

Linda Gask ◽

Bonnie Sibbald ◽

Francis Creed

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Health Care Services ◽

Service Providers ◽

Psychiatric Nurses ◽

Local Health ◽

Care Services ◽

Secondary Health Care

BackgroundThis paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.MethodMethodological problems relevant to evaluation of innovative models of working at the interface are discussed.ResultsAlthough there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the ‘shifted out-patient’ model have eased this problem. By contrast the ‘consultation-liaison’ (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred.ConclusionStudies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

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Beyond the barriers: South Asian women’s experience of accessing and receiving psychological therapy in primary care

Journal of Public Mental Health ◽

10.1108/jpmh-06-2020-0058 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Saimah Yasmin-Qureshi ◽

Susan Ledwith

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

South Asian ◽

Psychological Therapy ◽

Easy Access ◽

Asian Women ◽

South Asian Women ◽

Content Type

Purpose A number of initiatives have been developed to ensure easy access to mental health services for Black and Asian Minority Ethnic (BAME) communities. Improving Access to Psychological Therapies (IAPT) is a service that delivers first line interventions for South Asian women; however, little is known about what makes IAPT accessible for this population. This paper aims to explore South Asian women’s experiences of accessing psychological therapy and whether therapy within IAPT helps individuals to re-frame their experiences within their own cultural context. Design/methodology/approach A qualitative approach was used. Semi-structured interviews were carried out with South Asian women who accessed an IAPT service. Ten participants took part in the study and interviews were analysed using thematic analysis. Findings Six themes were identified; access, experience, cultural framework, therapist characteristics, expectations and “sticking with it”. Having a good therapeutic relationship with the therapist was key. While cognitive behavioural therapy (CBT) enabled clients to manage their symptoms, manualised CBT led to a sense of dissatisfaction for some. Clients spoke of having to make a forced choice to either deny their culture or leave their culture at the door to access therapy. Cultural and religious exclusion had a negative impact on therapy particularly for those whose difficulties were related to their cultural or religious context. Practical implications Culture and religion continues to be excluded from psychological therapy for South Asian Women. A cultural shift is required from within IAPT services to maintain engagement for this group. Further clinical implications are discussed. Originality/value While the experiences of Black and Asian ethnic minority groups accessing secondary mental health services has been explored, this study explores and highlights the experiences of South Asian Women accessing therapy in primary care, and uniquely identifies the processes that enable women to engage in therapy.

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Availability of mental health services at the primary care level in northern part of Nigeria: Service providers' and users' perspectives

Indian Journal of Social Psychiatry ◽

10.4103/ijsp.ijsp_52_19 ◽

2020 ◽

Vol 36 (2) ◽

pp. 157

Author(s):

EmmanuelEjembi Anyebe ◽

VictorO Olisah ◽

SalehNgaski Garba ◽

HassanHassan Murtala ◽

Fatima Balarabe

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Service Providers ◽

Care Level ◽

Primary Care Level

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COVID and early intervention: the impact of COVID-19 on referrals to an early intervention service

BJPsych Open ◽

10.1192/bjo.2021.329 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S112-S112

Author(s):

Adam Whyte ◽

Alastair Reid

Keyword(s):

Mental Health ◽

Early Intervention ◽

Mental Health Services ◽

Health Services ◽

First Episode Psychosis ◽

First Episode ◽

Intervention Service ◽

Number Of Patients ◽

Episode Psychosis ◽

The Impact

AimsCOVID-19 has a demonstratable impact on the population's mental health and is associated with an increased incidence of psychiatric disorders, including patients experiencing psychotic presentations. The aim of this study was to explore whether referral rates within a county-wide Early Intervention (EI) service changed in response to the COVID-19 pandemic. The EI service provides NICE approved treatments and support for patients experiencing a First Episode Psychosis (FEP).MethodData were collected from all referrals to the EI service between March–December 2019 and March–December 2020. Clinical notes were reviewed to ascertain whether the referred patient was assessed and if they were subsequently accepted on to the team's caseload.ResultDuring the March–December 2019 period 147 referrals were made to the EI service, with 66 patients being accepted for treatment by the service (44.9% of referrals). In March–December 2020, 127 referrals were made, a 13.6% reduction compared to the same period in 2019, however 70 referrals were accepted (55.1% of referrals).Whilst the overall referrals declined during the COVID-19 period, there were notable increases in both April and August 2020, by 25.0% and 70.0% respectively.ConclusionAlthough overall referrals to the EI service reduced during the COVID-19 pandemic compared similarly to the previous year, there was a noteworthy increase in the proportion of patients accepted onto the team's caseload.Potential explanations for this finding include the possibility of an increased incidence of first episode psychosis during this period, or that restrictions in accessing primary care and secondary mental health services during the COVID-19 pandemic reduced the number of patients being referred whose symptoms were not representative of First Episode Psychosis (FEP).This study highlights that mental health services, such as EI teams, have experienced a persistent level of need over the past year and that ongoing investment in psychiatric services is warranted to meet this sustained requirement for support and interventions.

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Readiness to Deliver Person-Focused Care in A Fragile Situation: The Case of Mental Health Services in Lebanon

10.21203/rs.3.rs-103550/v1 ◽

2020 ◽

Author(s):

Aya Noubani ◽

Karin Diaconu ◽

Giulia Loffreda ◽

Shadi Saleh

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Health Services ◽

Health Services ◽

Health System ◽

Health Care Providers ◽

Mental Healthcare ◽

Care Providers ◽

Health Seeking

Abstract Background: Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support (MHPSS) service provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.Methods: A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. Results: Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care.Conclusion: Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to 1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and 2) promote the implementation of integrated person focused care for addressing mental health.

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Mental healthcare and service user impact of the COVID-19 pandemic: results of a UK survey of staff working with people with intellectual disability and developmental disorders

10.1101/2020.09.01.20178848 ◽

2020 ◽

Author(s):

Rory Sheehan ◽

Christian Dalton-Locke ◽

Afia Ali ◽

Vasiliki Totsika ◽

Norha Vera San Juan ◽

...

Keyword(s):

Mental Health ◽

Developmental Disabilities ◽

Mental Health Services ◽

Health Services ◽

Service User ◽

Mental Healthcare ◽

Free Text ◽

Intellectual And Developmental Disabilities ◽

Health And Social Care ◽

The Impact

Background Very little is known about the impact of previous epidemics on the care of people with intellectual and developmental disabilities, particularly in terms of mental health services. The COVID-19 pandemic has the potential to exacerbate existing health inequalities as well as expose gaps in service provision for this vulnerable population group. Methods We investigated the responses of 648 staff working in mental healthcare with people with intellectual disabilities and/or developmental disabilities. Participants contributed to a UK-wide online survey undertaken by the National Institute for Health Research Mental Health Policy Research Unit between 22nd April and 12th May 2020. Recruitment was via professional networks, social media and third sector organisations. Quantitative data describing staff experience over three domains (challenges at work, service user and carer problems, sources of help at work) were summarised and differences between groups explored using Chi square tests. Content analysis was used to organise qualitative data focusing on service changes in response to the pandemic. Results The majority of survey respondents worked in the NHS and in community mental health services. One third had managerial responsibility. Major concerns expressed by mental healthcare staff were: difficulties for service users due to lack of access to usual support networks and health and social care services during the pandemic; and difficulties maintaining adequate levels of support secondary to increased service user need. Staff reported having to quickly adopt new digital ways of working was challenging; nevertheless, free text responses identified remote working as the innovation that staff would most like to retain after the pandemic subsides. Conclusions Understanding the experiences of staff working across different settings in mental healthcare for people with intellectual and developmental disabilities during the COVID-19 pandemic is essential in guiding contingency planning and fostering service developments to ensure the health of this vulnerable group is protected in any future disease outbreaks.

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Primary care clinical management following self-harm during the first wave of COVID-19 in the UK

10.1101/2021.03.19.21253969 ◽

2021 ◽

Author(s):

Sarah Steeg ◽

Matthew J Carr ◽

Laszlo Trefan ◽

Darren M Ashcroft ◽

Nav Kapur ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Psychotropic Medication ◽

Clinical Management ◽

Practice Nurse ◽

Self Harm ◽

The Uk ◽

The Impact

AbstractBackgroundA substantial reduction in GP-recorded self-harm occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown.AimTo examine the impact of COVID-19 on clinical management within three months of an episode of self-harm.Design and settingProspective cohort study using data from the UK Clinical Practice Research Datalink.MethodWe compared cohorts of patients with an index self-harm episode recorded during a pre-pandemic period (10th March-10th June, 2010-2019) versus the COVID-19 first-wave period (10th March-10th June 2020). Patients were followed up for three months to capture psychotropic medication prescribing, GP/practice nurse consultation and referral to mental health services.Results48,739 episodes of self-harm were recorded during the pre-pandemic period and 4,238 during the first-wave COVID-19 period. Similar proportions were prescribed psychotropic medication within 3 months in the pre-pandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs. 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (3.4%) was around half of that in the pre-pandemic cohort (6.5%).ConclusionDespite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to pre-pandemic levels. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.

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Readiness to deliver person‐focused care in a fragile situation: the case of Mental Health Services in Lebanon

International Journal of Mental Health Systems ◽

10.1186/s13033-021-00446-2 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Aya Noubani ◽

Karin Diaconu ◽

Giulia Loffreda ◽

Shadi Saleh

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Health Services ◽

Health Services ◽

Health System ◽

Health Care Providers ◽

Mental Healthcare ◽

Care Providers ◽

Health Seeking

Abstract Background Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model. Methods A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. Results Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care. Conclusions Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to (1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and (2) promote the implementation of integrated person focused care for addressing mental health.

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Carers and co-production: enabling expertise through experience?

Mental Health Review Journal ◽

10.1108/mhrj-05-2014-0016 ◽

2015 ◽

Vol 20 (4) ◽

pp. 232-241 ◽

Cited By ~ 15

Author(s):

Eleanor Bradley

Keyword(s):

Mental Health ◽

Decision Making ◽

Mental Health Services ◽

Health Services ◽

Mental Health Professionals ◽

Family Members ◽

Mental Healthcare ◽

Service Users ◽

Content Type ◽

The Impact

Purpose – The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design/methodology/approach – The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings – Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research limitations/implications – Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical implications – Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social implications – The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise. Originality/value – This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.

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