scholarly journals Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050036
Author(s):  
Ole Rikard Haavet ◽  
Jūratė Šaltytė Benth ◽  
Svein Gjelstad ◽  
Ketil Hanssen-Bauer ◽  
Mina Piiksi Dahli ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young People ◽  
Mental Disorders ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mental Health Disorders ◽  
Shared Care ◽  
Cluster Randomised ◽  
Health Disorders

BackgroundYoung people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions.AimTo investigate whether shared care with mental health professionals in GP offices increases the detection of youth’s mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician.Design and settingThis was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3–8 GP offices. One GP office was randomised to the intervention group and the other to the control group.MethodWe used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth.ResultsOver a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients’ regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm.ConclusionShared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient’s regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group.Trial registration numberNCT03624829; Results.

scholarly journals Cannabis tourist destinations: risk for vulnerable travellers with pre-existing mental disorders

2019 ◽  
Vol 27 (4) ◽  
Author(s):  
Hagit Bonny-Noach ◽  
Moran Sagiv-Alayoff
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Health Professionals ◽  
Mental Health Disorders ◽  
Cannabis Use ◽  
Tourist Destinations ◽  
Travel Health ◽  
Tourism Destinations ◽  
Health Disorders

In recent years, more countries have decriminalized and legalized cannabis, and have become cannabis tourism destinations. Little has been published about individuals with pre-existing mental health disorders who use cannabis during travel. Health professionals should pay greater attention to cannabis use among vulnerable travellers before, during, and after their travel.

scholarly journals Exploring the views of university students with experience of common mental health disorders about support provided within primary care community settings

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S18-S19
Author(s):  
Mikaela D'Arcy-Smith ◽  
Marta Buszewicz
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young Adults ◽  
Psychological Distress ◽  
Young People ◽  
University Students ◽  
Healthcare Professionals ◽  
Mental Health Disorders ◽  
Health Disorders ◽  
The Impact

AimsTo assess the impact of common mental health disorders (CMHDs) on university students’ function and wellbeing. To understand the barriers to receiving adequate support for CMHDs during both adolescence and at university. To provide feedback to healthcare professionals about how young people perceive the support provided when initially seeking help for psychological distress. To explore which forms of support students find the most useful.MethodA literature review was initially undertaken, identifying the lack of prior research in this area. The current study addressed the gap by considering the needs of students with CMHDs in the context of primary care services, with a retrospective exploration of their views about support received during adolescence. 15 semi-structured qualitative interviews were conducted with both current university students and recent graduates from across the UK, transcribed verbatim and subjected to thematic analysis. The study population included 7 men and 8 women, between the ages of 18–25 years.ResultFive main themes emerged from the data:The Journey to Disorder – Explored the difficulties faced by adolescents, and how these might contribute to their experience of CMHDs and their management.Attitudes Towards Help-Seeking – Many participants had little trust in healthcare professionals as adolescents. This contributed to limited trust in university support systems as young adults.Primary Care Support - Perceived effectiveness of General Practitioner (GP) support during adolescence in this cohort was highly variable. Although some participants described good experiences, others felt their views were ignored, with responsibility diverted to their caregivers. A lack of understanding from GPs about CMHDs in adolescents resulted in trust issues for them as young adults.Recommendations for Change - Participants reflected on their previous and current experiences to inform suggestions for changes to tackle issue of psychological distress in adolescents.ConclusionPrevious experiences of the care they had received when presenting with CMHDs during adolescence potentially affected the long-term wellbeing of university students and graduates; the initial support received was inconsistent with the needs of this age group. Recommendations for change included a greater emphasis on the importance of adolescent mental health education, tailoring interventions to personal growth and maturity, and ensuring primary healthcare providers are equipped with the skills required to manage psychological distress in young people.

Physical health among patients with common mental health disorders in primary care in Europe: a scoping review

2020 ◽  
pp. 1-17
Author(s):  
F. Fogarty ◽  
G. McCombe ◽  
K. Brown ◽  
T. Van Amelsvoort ◽  
M. Clarke ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Scoping Review ◽  
Common Mental Disorder ◽  
Research Question ◽  
Mental Health Disorders ◽  
Hand Search ◽  
Health Disorders

Introduction: Mental disorders are increasingly common among adults in both the developed and developing world and are predicted by the WHO to be the leading cause of disease burden by 2030. Many common physical conditions are more common among people who also have a common mental disorder. This scoping review aims to examine the current literature about the prevention, identification and treatment of physical problems among people with pre-existing mental health disorders in primary care in Europe. Methods: The scoping review framework comprised a five-stage process developed by Arksey & O’Malley (2005). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Both quantitative and qualitative studies were included, with no restriction on study design. Results: The initial search identified 299 studies, with a further 28 added from the hand-search (total n = 327) of which 19 were considered relevant to the review research question and included for full analysis. Depression was the mental health condition most commonly studied (nine studies), followed by depression and anxiety (seven studies), with three studies examining any mental disorder. Eleven studies examined the effects of various interventions to address physical and mental comorbidity, with the most commonly studied intervention being collaborative care. Conclusions: With just 19 studies meeting our criteria for inclusion, there is clearly a paucity of research in this area. Further research is essential in order to understand the pathophysiological mechanisms underlying the association between mental disorders and chronic conditions.

scholarly journals Efficacy of an Intervention to Reduce Stigma Beliefs and Attitudes among Primary Care and Mental Health Professionals: Two Cluster Randomised-Controlled Trials

2021 ◽  
Vol 18 (3) ◽  
pp. 1214
Author(s):  
Francisco José Eiroa-Orosa ◽  
María Lomascolo ◽  
Anaïs Tosas-Fernández
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Cluster Randomised ◽  
Awareness Raising ◽  
Randomised Controlled ◽  
Beliefs And Attitudes ◽  
Health Diagnosis

Although it may seem paradoxical, primary care and mental health professionals develop prejudices and discriminatory attitudes towards people with mental health problems in a very similar way to the rest of the population. The main objective of this project was to design, implement and evaluate two awareness-raising interventions respectively tailored to reduce stigmatising beliefs and attitudes towards persons with a mental health diagnosis among primary care (PC) and mental health (MH) professionals. These interventions were developed by Obertament, the Catalan alliance against stigma and discrimination in mental health. Activists from this organisation with lived experience of mental health diagnosis carried out awareness-raising interventions in PC and MH health centres. The Targeted, Local, Credible, Continuous Contact (TLC3) methodology was adapted to the Catalan healthcare context. The efficacy of these interventions was evaluated using two prospective double-blind cluster-randomised-controlled trials. Stigmatizing beliefs and behaviours were measured with the Opening Minds Stigma Scale for Health Care Providers in PC centres and with the Beliefs and Attitudes towards Mental Health Service users’ rights in MH centres. Reductions in both PC and MH professionals’ stigmatising beliefs and attitudes were found in the 1-month follow-up, although a ‘rebound effect’ at the 3-month follow up was detected. This emphasizes the importance of the continuity of the presence of anti-stigma activities and messages. Attrition rates were high, which can hamper the reliability of the results. Further follow-up studies should enquiry effects of long-term interventions aimed at reducing stigmatising beliefs and attitudes among primary care and mental health professionals using assessment systems that include the measurement of knowledge acquired and actual behavioural change.

scholarly journals Language in Mental Health Disorders

Linguistics ◽  
2019 ◽  
Author(s):  
Dennis Tay
Keyword(s):  
Mental Health ◽  
Discourse Analysis ◽  
Critical Discourse Analysis ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mental Health Disorders ◽  
World Health ◽  
Traumatic Experiences ◽  
Trauma Patients ◽  
Health Disorders

Mental health disorders are conditions that disturb thought, mood, behaviors, or combinations of all three. Familiar examples include depression, bipolar disorder, posttraumatic stress disorder, and schizophrenia. Although symptoms range from mild to severe, they generally affect an individual’s ability to function in daily life and are more common in the 2010s than popularly assumed, according to reporting by the World Health Organization. Language in mental health disorders has been researched in two broad strands. First, many of them are treated by the verbal activity of psychological counseling (or psychotherapy), sometimes called the “talking cure.” Therapists apply clinical methods and interact with clients over multiple sessions to understand and modify their behaviors, cognitions, and emotions. On the one hand, this type of interaction provides rich data for linguists working in sociolinguistics, conversation analysis, (critical) discourse analysis, and pragmatics to investigate the linguistic nature of a socially important activity. On the other hand, a growing number of mental health professionals acknowledge the relevance of linguistic research and offer similar analyses from more clinically oriented perspectives. Both groups of researchers employ diverse methodologies, including discourse analysis, corpus, survey, and (quasi)-experimental techniques on different levels of linguistic phenomena, from words to rhetorical devices such as metaphor. While research into the language of psychotherapy generally assumes that clients have intact language and communication skills that support the treatment process, the second research strand examines the relationships between specific mental health diagnoses and language-related symptoms. Trauma patients, for instance, suffer a loss of ability to produce coherent narratives of their traumatic experiences. Whether language is seen as a treatment resource or target of affliction, one can identify fairly distinct descriptive or prescriptive/interventionist foci in the literature. Descriptively oriented studies are more common in linguistics research and have the fundamental aim of documenting characteristics of language in the underexplored context of mental health. The general assumption of such studies is that all social contexts of language use are of inherent interest. Therefore, research is not primarily aimed at improving how the activities underlying these contexts are conducted; that is, better treatment outcomes. In contrast, prescriptive or interventionist studies are more common in psychological and mental health research. The emphasis is not on understanding linguistic properties, but on the relationship between language variables and treatment processes or outcomes. A survey of both literatures, however, reveals an encouraging movement toward some meeting point in between, and closer collaborative work among linguists and mental health professionals. The growing number of synergistic research resources and publication outlets also reflects this.

scholarly journals Clergy as a frontline mental health service: a UK survey of medical practitioners and clergy

2020 ◽  
Vol 33 (6) ◽  
pp. e100229
Author(s):  
William Heseltine-Carp ◽  
Mathew Hoskins
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mental Health Disorders ◽  
Medical Professionals ◽  
Collaborative Relationship ◽  
Medical Practitioners ◽  
Health Disorders

BackgroundChristian clergy have often been identified as ‘frontline mental health workers’ and gatekeepers to mental health services. However, despite this, collaboration between clergy and mental health services remains poor, with some US clergy referring on as little as 10% of cases.AimsIn this study, we aimed to evaluate the collaborative relationship between UK clergy and medical practitioners, with the purpose of identifying key issues that should be addressed to improve such collaboration between the two services.MethodsWe surveyed 124 clergy, 48 general practitioners and 13 psychiatrists in Wales. Part 1 of the survey covered four main themes: demographics; types of mental health cases seen by clergy and practitioners; referral rates between clergy and mental health services; attitude and relationship between clergy and mental health services. Part 2 was directed at clergy only and assessed how sensitive clergy were in identifying and referring on mental health disorders by using seven virtual case vignettes.ResultsClergy frequently encountered mental health cases and around 60%–80% regularly referred on to a healthcare professional. Clergy appeared very effective at identifying and referring on high risk scenarios, such as psychosis, suicidal ideation and substance misuse, however were less effective at identifying and referring on clinical depression and anxiety. Clergy rarely received referrals from medical professionals. Both medical professionals and clergy felt they needed to engage in a more collaborative relationship, and around of one-third of practitioners were prepared to offer training to clergy.ConclusionMost clergy in Wales regularly encounter mental health cases and appear effective at recognising and referring on mental health disorders; however, a large minority do not (20%–40%). Clergy generally do not receive referrals from mental health professionals, despite the proven benefits. Therefore, improving collaboration, developing spiritual training for mental health professionals, and mental health training for clergy is likely useful, a notion that many clergy and medical professionals deem important and are prepared to support.

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 VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression

2019 ◽  
Vol 12 (2) ◽  
pp. 71 ◽  
Author(s):  
Madhukar Trivedi ◽  
Manish Jha ◽  
Farra Kahalnik ◽  
Ronny Pipes ◽  
Sara Levinson ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Universal Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Similar Treatment ◽  
Measurement Based Care

Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.

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