scholarly journals Alternatives to mental health admissions for children and adolescents experiencing mental health crises: a systematic review of the literature

2021 ◽  
Author(s):  
Denisa Clisu ◽  
Imogen Layther ◽  
Deborah Dover ◽  
Russell M Viner ◽  
Tina Read ◽  
...  
Keyword(s):  
Mental Health ◽  
Web Of Science ◽  
Community Services ◽  
Multisystemic Therapy ◽  
Future Research ◽  
Inpatient Stay ◽  
Review Of The Literature ◽  
Children And Young People ◽  
Randomised Controlled

Background: Increasingly more children and young people (CYP) present in mental health crises, many being hospitalised due to concerns around illness severity and lack of community services. To release the burden of admission, we systematically reviewed the literature on the effects of proposed alternatives to CYP in crises. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The best evidence came from in-home interventions, in particular multisystemic therapy (MST), which proved to be promising alternatives by improving psychological outcomes and decreasing length of inpatient stay. The quality of included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. Conclusions: We could not recommend a particular intervention as an alternative to inpatient admission, however our review describes benefits across a range of types of inteventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.

scholarly journals Alternatives to mental health admissions for children and adolescents experiencing mental health crises: A systematic review of the literature

2021 ◽  
pp. 135910452110447
Author(s):  
Denisa A Clisu ◽  
Imogen Layther ◽  
Deborah Dover ◽  
Russell M Viner ◽  
Tina Read ◽  
...  
Keyword(s):  
Mental Health ◽  
Web Of Science ◽  
Multisystemic Therapy ◽  
Risk Of Bias ◽  
Future Research ◽  
Inpatient Setting ◽  
Review Of The Literature ◽  
Children And Young People ◽  
Randomised Controlled

Background: Many children and young people (CYP) presenting with mental health crises are admitted to hospital due to concerns around illness severity and risk. Whilst inpatient admissions have an important role for such children, there are a number of burdens associated with them, and safe avoidance of admissions is favourable. We systematically reviewed the literature for studies of interventions reported as alternatives to a hospital admission in CYP presenting with mental health crises, in any inpatient setting. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The quality of most included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. The best quality studies and greatest evidence for efficacy came from in-home interventions, in particular multisystemic therapy, which improved psychological outcomes, and though a large number of CYP still ended up being admitted, there appeared to be decreased length of stay. Conclusions: Overall, we could not recommend a particular intervention as an alternative to inpatient admission; however, our review describes benefits across a range of types of interventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.

scholarly journals North West London New Model of Care Project (NMOC) – improving inpatient mental health care for children and young people

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S199-S199
Author(s):  
Jovanka Tolmac ◽  
Alun Lewis ◽  
Azer Mohammed ◽  
Elizabeth Fellow-Smith ◽  
Johan Redelinghuys ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Community Support ◽  
Community Services ◽  
Clinical Group ◽  
Inpatient Stay ◽  
Psychiatric Admission ◽  
Children And Young People ◽  
Effective Discharge ◽  
Inpatient Mental Health

AimsSpecialised inpatient mental health services for children and young people are commissioned and managed by NHS England (NHSE) and provided by NHS as well as independent sector. The access to beds has been managed nationally with young people admitted far from home. There were capacity issues identified in London. To address these concerns, NHSE invited organisations to work in partnership to co-design and establish new models of care. This is one of the first of such projects, set up to manage the budget for children and young people's beds on behalf of NHSE and change the way of managing and monitoring admissions.Our aims:To reduce length of inpatient stayTo enable admission of young people as close to home as possibleTo improve resource efficiency, capacity and capability of managing young people in crisis in the community.MethodA number of changes were introduced, including engagement of community and inpatient clinical staff, repatriation to units closer to home and introduction of CRAFT meetings (early review meetings in inpatient units to enable timely and effective discharge planning and support back to local services). The implementation has been closely monitored by the project manager and clinical group, which included representatives from all organisations involved.ResultAfter four years, young people are admitted to hospitals closer to home and the length of inpatient stay has decreased by 18%. The number of admissions has decreased by 28%. Out of area occupied beds days have been decreased by 66%.Significant recurrent budget savings have been achieved. Over the past three years, these savings have been reinvested in developing crisis community support and more specialist community services within CNWL and West London Trust.ConclusionThere have been considerable benefits of multiple organisations working in partnership to improve patients care. The success of the project has created further opportunities for the development of services which provide safe and effective alternatives to admission (such as crisis services, home treatment teams and specialized community services). In summary, this collaborative model has improved the quality of care and experience for young people and reduced the need for psychiatric admission.

scholarly journals Effect of a physical activity and sleep m-health intervention on a composite activity-sleep behaviour score and mental health: a mediation analysis of two randomised controlled trials

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Mitch J. Duncan ◽  
Anna T. Rayward ◽  
Elizabeth G. Holliday ◽  
Wendy J. Brown ◽  
Corneel Vandelanotte ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Trial Registration ◽  
Poor Sleep ◽  
Poor Sleep Quality ◽  
Sleep Health ◽  
Intervention Effects ◽  
Symptoms Of Depression ◽  
Randomised Controlled

Abstract Background To examine if a composite activity-sleep behaviour index (ASI) mediates the effects of a combined physical activity and sleep intervention on symptoms of depression, anxiety, or stress, quality of life (QOL), energy and fatigue in adults. Methods This analysis used data pooled from two studies: Synergy and Refresh. Synergy: Physically inactive adults (18–65 years) who reported poor sleep quality were recruited for a two-arm Randomised Controlled Trial (RCT) (Physical Activity and Sleep Health (PAS; n = 80), or Wait-list Control (CON; n = 80) groups). Refresh: Physically inactive adults (40–65 years) who reported poor sleep quality were recruited for a three-arm RCT (PAS (n = 110), Sleep Health-Only (SO; n = 110) or CON (n = 55) groups). The SO group was omitted from this study. The PAS groups received a pedometer, and accessed a smartphone/tablet “app” using behaviour change strategies (e.g., self-monitoring, goal setting, action planning), with additional email/SMS support. The ASI score comprised self-reported moderate-to-vigorous-intensity physical activity, resistance training, sitting time, sleep duration, efficiency, quality and timing. Outcomes were assessed using DASS-21 (depression, anxiety, stress), SF-12 (QOL-physical, QOL-mental) and SF-36 (Energy & Fatigue). Assessments were conducted at baseline, 3 months (primary time-point), and 6 months. Mediation effects were examined using Structural Equation Modelling and the product of coefficients approach (AB), with significance set at 0.05. Results At 3 months there were no direct intervention effects on mental health, QOL or energy and fatigue (all p > 0.05), and the intervention significantly improved the ASI (all p < 0.05). A more favourable ASI score was associated with improved symptoms of depression, anxiety, stress, QOL-mental and of energy and fatigue (all p < 0.05). The intervention effects on symptoms of depression ([AB; 95%CI] -0.31; − 0.60,-0.11), anxiety (− 0.11; − 0.27,-0.01), stress (− 0.37; − 0.65,-0.174), QOL-mental (0.53; 0.22, 1.01) and ratings of energy and fatigue (0.85; 0.33, 1.63) were mediated by ASI. At 6 months the magnitude of association was larger although the overall pattern of results remained similar. Conclusions Improvements in the overall physical activity and sleep behaviours of adults partially mediated the intervention effects on mental health and quality of life outcomes. This highlights the potential benefit of improving the overall pattern of physical activity and sleep on these outcomes. Trial registration Australian New Zealand Clinical Trial Registry: ACTRN12617000680369; ACTRN12617000376347. Universal Trial number: U1111–1194-2680; U1111–1186-6588. Human Research Ethics Committee Approval: H-2016-0267; H-2016–0181.

scholarly journals M.I.C.E—Mental Health Intervention for Children with Epilepsy: a randomised controlled, multi-centre clinical trial evaluating the clinical and cost-effectiveness of MATCH-ADTC in addition to usual care compared to usual care alone for children and young people with common mental health disorders and epilepsy—study protocol

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sophie D. Bennett ◽  
◽  
J. Helen Cross ◽  
Anna E. Coughtrey ◽  
Isobel Heyman ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Usual Care ◽  
Psychological Intervention ◽  
Mental Health Disorders ◽  
Long Term Conditions ◽  
Children And Young People ◽  
Health Disorders ◽  
Randomised Controlled

Abstract Background Mental health disorders in the context of long-term conditions in children and young people are currently overlooked and undertreated. Evidence-based psychological treatments for common childhood mental health disorders (anxiety, depression and disruptive behaviour disorders) have not been systematically evaluated in young people with epilepsy despite their high prevalence in this population. The aim of this multi-site randomised controlled trial is to determine the clinical and cost-effectiveness of adding a modular psychological intervention to usual care for the mental health disorders in comparison to assessment-enhanced usual care alone. Methods In total, 334 participants aged 3–18 years attending epilepsy services will be screened for mental health disorders with the Strengths and Difficulties Questionnaire (SDQ) and the diagnostic Development and Wellbeing Assessment (DAWBA). Those identified as having a mental health disorder and consenting to the trial will be randomised to either receive up to 22 sessions of the modular psychological intervention (MATCH-ADTC) delivered over the telephone over 6 months by non-mental health professionals in addition to usual care or to assessment-enhanced usual care alone. Outcomes will be measured at baseline, 6 months and 12 months post-randomisation. It is hypothesised that MATCH-ADTC plus usual care will be superior to assessment-enhanced usual care in improving emotional and behavioural symptoms. The primary outcome is the SDQ reported by parents at 6 months. Secondary outcomes include parent-reported mental health measures such as the Revised Children’s Anxiety and Depression Scale, quality of life measures such as the Paediatric Quality of Life Inventory and physical health measures such as the Hague Seizure Severity Scale. Outcome assessors will be blinded to group assignment. Qualitative process evaluations and a health economic evaluation will also be completed. Discussion This trial aims to determine whether a systematic and integrated approach to the identification and treatment of mental health disorders in children and young people with epilepsy is clinically and cost-effective. The findings will contribute to policies and practice with regard to addressing mental health needs in children and young people with other long-term conditions. Trial registration ISRCTN ISRCTN57823197. Registered on 25 February 2019.

scholarly journals Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study

2017 ◽  
Vol 19 (5) ◽  
pp. 225-231 ◽  
Author(s):  
Rachel M. Gilbertson ◽  
Maryanna D. Klatt
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Multiple Sclerosis ◽  
Mindfulness Meditation ◽  
Short Form ◽  
Physical Symptoms ◽  
Future Research ◽  
Five Facet Mindfulness Questionnaire ◽  
Anxiety Depression

Background: Mindfulness in Motion is an 8-week mindfulness-based intervention that uses yoga movement, mindfulness meditation, and relaxing music. This study examined the feasibility of using Mindfulness in Motion in people with multiple sclerosis (MS) and the effect of this program on stress, anxiety, depression, fatigue, and quality of life in people with MS. Methods: Twenty-two people with MS completed the 8-week mindfulness program as well as assessments 1 week before and after the intervention. Results: Pre/post comparison of four self-reported questionnaires—the Mental Health Inventory, 36-item Short Form Health Status Survey, Modified Fatigue Impact Scale, and Five Facet Mindfulness Questionnaire—showed significant improvement in physical functioning, vitality, and mental health. Specifically, improvements were seen in anxiety, depression, and positive affect; cognitive, psychosocial, and overall functioning regarding fatigue; and mindfulness in the areas of observing, acting with awareness, nonjudgment, and nonreactivity. Conclusions: Due to the uncertainty in disease progression associated with MS, and the multiplicity of mental and physical symptoms associated with it, programming that addresses anxiety, depression, and fatigue is a key area of future research in MS disease management. Mindfulness in Motion proved to be a feasible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS.

scholarly journals Economia solidária, saúde mental e inclusão: uma revisão de literatura / Solidarity economy, mental health and inclusion: a literature review

2020 ◽  
Vol 4 (4) ◽  
pp. 674-687
Author(s):  
Ioneide De Oliveira Campos ◽  
Rafael Moraes Reis
Keyword(s):  
Mental Health ◽  
Web Of Science ◽  
Case Reports ◽  
Self Management ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Solidarity Economy ◽  
Collective Work ◽  
Qualitative Approaches ◽  
Salud Mental

A Economia Solidária é uma alternativa para inserção laboral de pessoas com transtornos mentais. Realizou-se uma revisão da literatura, com o propósito de conhecer o que tem sido publicado sobre Economia Solidária, inclusão e Saúde Mental, quais os objetivos e métodos de pesquisa, quem são os profissionais e populações-alvo e quais os resultados obtidos nos estudos. Foram considerados os seguintes critérios para a realização desse estudo: a importância da temática para o contexto da Saúde Mental e a identificação de pesquisas e relatos de experiência que informassem práticas em Saúde Mental e Economia Solidária. A revisão foi realizada nas bases: Web of Science, DOAJ, PubMed, SciElo e LILACS, sem restrições de ano. Os descritores utilizados foram “economia solidária”, “saúde mental” e “inclusão”. Vinte e nove (n=29) artigos foram encontrados e, após a aplicação dos critérios de inclusão, dez foram analisados na íntegra. Trinta e quatro (n=34) profissionais estiveram envolvidos nas pesquisas, sendo a Terapia Ocupacional, Enfermagem e Psicologia, as profissões que apareceram mais frequentemente.  Todos os estudos encontrados eram qualitativos e foram conduzidos no Brasil. A entrevista foi o método mais adotado. Os resultados dos estudos sinalizaram ganhos para aspectos intrínsecos dos usuários no que se refere a autogestão, expressão, empoderamento, e também extrínsecos, como a questão familiar e do trabalho coletivo. A revisão agregou conhecimento que permitem refletir sobre a importância da interdisciplinaridade, do trabalho colaborativo em rede, e sobre a necessidade de documentação das experiências em Economia Solidária no país. AbstractThe Solidarity Economy is an alternative for the labour inclusion of people with mental health. A review of the literature was conducted in order to know what has been published on the issue of Solidarity Economy, Inclusion and Mental Health, what are the objectives and research methods, who are the professionals and populations’ target, and the results identified in the research. We considered the following criteria: the importance of the issue in the mental health context and identification of studies and case reports which informed practice in Mental Health and Solidarity Economy. The search was done at the databases: Web of Science, DOAJ, PubMed, Scielo and LILACS, with no year restrictions. The descriptors used were "solidarity economy", "mental health" and "inclusion". Twenty-nine (n=29) were found and after the inclusion criteria filter, ten articles were analysed. Thirty-four (n=34) professionals were involved in the studies and the most were Occupational Therapy, Nursing and Psychology. All the studies found used qualitative approaches and were conducted in Brazil. The interview was the most adopted method for data collection. The results indicate outcomes for users' intrinsic aspects such as self-management, expression, empowerment, and also extrinsic, such as family and collective work. The review added knowledge to reflect about the interdisciplinary and collaborative network, and also on the documentation of experiences in Solidarity Economy in the country.Keywords: Mental health; Solidarity economy; Public policies; Inclusion; Research.ResumenLa Economía Solidaria es una alternativa para la inserción laboral de personas con trastornos mentales. Se realizó una revisión de la literatura, con el fin de conocer qué se ha publicado sobre Economía Solidaria, inclusión y Salud Mental, cuáles son los objetivos y métodos de investigación, quiénes son los profesionales y las poblaciones objetivo y cuáles son los resultados obtenidos. Se consideraron los siguientes criterios para realizar este estudio: la importancia del tema para el contexto de la salud mental y la identificación de informes de investigación y experiencia que informarían las prácticas con la Salud Mental y la Economía Solidaria. La revisión se realizó en las bases de datos: Web of Science, DOAJ, PubMed, Scielo y LILACS, sin restricciones de año. Los descriptores utilizados fueron "economía solidaria", "salud mental" e "inclusión". Veintinueve (n = 29) artículos fueron encontrados y, después de aplicar los criterios de inclusión, diez fueron analizados en su totalidad. Treinta y cuatro (n = 34) profesionales participaron en las investigaciones, siendo la Terapia Ocupacional, Enfermería y Psicología las profesiones que aparecieron con más frecuencia. Todos los estudios encontrados fueron cualitativos y se realizaron en Brasil. La entrevista fue el método más adoptado. Los resultados de los estudios señalaron ganancias para los aspectos intrínsecos de los usuarios, como la autogestión, la expresión, el empoderamiento y también los aspectos extrínsecos, como el tema del trabajo familiar y colectivo. La revisión agregó conocimiento que nos permite reflexionar sobre la importancia de la interdisciplinariedad, así como el trabajo en red colaborativo, y sobre la necesidad de documentar experiencias en Economía Solidaria en el país.Palabras clave: Salud mental; Economía solidaria; Políticas públicas; Inclusión; Investigación.      

scholarly journals How the Pilates Method Can Influence Sports Performance in Different Modalities

2020 ◽  
Vol 25 (264) ◽  
pp. 139-152
Author(s):  
Manoela Abreu ◽  
Franciele Carvalho Santos ◽  
Ana Laura Nogueira ◽  
Matheus Lima Zampieri ◽  
Dernival Bertoncello
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Web Of Science ◽  
Sports Performance ◽  
Review Of The Literature ◽  
Control Groups ◽  
Future Studies ◽  
Pilates Method

The aim of this study was to perform a systematic review of the literature in order to investigate the effects of the Pilates Method on athletes of different sports. Methods: Researches were carried out in databases (SciELO, LILACS, PubMed, Web of Science and SCOPUS) and to evaluate the methodological quality of the studies, the PEDro scale was used. Results: Of the 87 studies found, only four were included. Meta-analyzes to assess flexibility using the Wells Bank's Sit and Reach test and a fleximeter indicated improvement after Pilates application, although there were no statistically significant differences compared to the control groups (Wells Bank's Sit and Reach test: 2 , 83 95% CI: -0.73 to 6.38, I² = 99%; Fleximeter: -0.78, 95% CI: -1.84 to 0.27, I² = 0%). Conclusion: There is evidence of benefits after Pilates intervention. Future studies with standardized protocols, according to the chosen sport, are necessary to determine how the Pilates Method can improve athletes' performance.

The Imposter Phenomenon in the Medical Profession

2020 ◽  
pp. 148-166
Author(s):  
Rebecca C. Grossman
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Coping Strategies ◽  
Ethnic Minorities ◽  
Medical Profession ◽  
Future Research ◽  
Review Of The Literature ◽  
Imposter Phenomenon ◽  
Internal Experience ◽  
The Impact

The imposter phenomenon, or imposter syndrome, is defined as an internal experience of feeling like an intellectual fraud, despite external evidence of an individual's accomplishments, and results in an inability to internalise a sense of success. It is common among high-achieving people, and appears to be more common in women and ethnic minorities. In this chapter, a systematic review of the literature will be presented on imposter syndrome in the medical profession. Topics covered include purported aetiology, implications (including the impact on mental health and career progression), limitations of research, potential coping strategies, and avenues for future research.

scholarly journals A Critical Review of the Impact of Sarcoma on Psychosocial Wellbeing

Sarcoma ◽  
2019 ◽  
Vol 2019 ◽  
pp. 1-18 ◽  
Author(s):  
Lesley Storey ◽  
Lorna A. Fern ◽  
Ana Martins ◽  
Mary Wells ◽  
Lindsey Bennister ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Psychosocial Impact ◽  
Diagnosis And Treatment ◽  
Future Research ◽  
Clear Understanding ◽  
Psychosocial Wellbeing ◽  
Patient Reported ◽  
The Impact

Background. Previous reviews of outcomes in specific sarcoma populations suggest patients have poor quality of life. In most of these reviews, there is a predominant focus on physical function rather than psychosocial outcome. The aim of this review was to describe the psychosocial impact of diagnosis and treatment on patients with all types of sarcoma. Methods. Searches were conducted through six electronic databases for publications of any study design using a validated patient-reported outcome measure reporting the psychosocial impact in this population. Results. Eighty-two studies fulfilled the inclusion criteria. Most (65%) were assessed of being of reasonable quality. The most common aspect of psychosocial wellbeing measured was quality of life (80%). Due to the heterogeneity of methods, outcomes, and populations, it was not possible to make definitive conclusions. It seems there is an improvement in the physical aspects of quality of life over time but not in psychosocial function or mental health. There was no change in mental health scores, but patients reported an improvement in adjusting to normal life. There are no differences according to the type of surgery patients receive, and psychosocial outcomes tend to be poorer than the general population. There is no consistency in identifying the factors that predict/influence psychosocial wellbeing. Conclusion. The published literature does not provide a clear understanding of the impact of sarcoma diagnosis and treatment on psychosocial wellbeing. Instead, the review demonstrates a need for well-designed studies in this area and a more consistent approach to the measurement of patient-reported outcomes, which include psychosocial domains. Recommendations for future research have been proposed.

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