scholarly journals Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e054131
Author(s):  
Huiming Liu ◽  
Guanjie Chen ◽  
Jinghua Li ◽  
Chun Hao ◽  
Bin Zhang ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Suicide Risk ◽  
Psychiatric Patients ◽  
Randomised Trial ◽  
Intervention Strategy ◽  
Suicide Intervention ◽  
Multiple Assignment ◽  
Community Team ◽  
To Receive

IntroductionThe postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework.Methods and analysisThis study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team.Ethics/disseminationThis study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention.Trial registration numberNCT04907669.

scholarly journals Suicide rates among patients subject to community treatment orders in England during 2009–2018

BJPsych Open ◽  
2021 ◽  
Vol 7 (6) ◽  
Author(s):  
Isabelle M. Hunt ◽  
Roger T. Webb ◽  
Pauline Turnbull ◽  
Jane Graney ◽  
Saied Ibrahim ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicide Risk ◽  
Psychiatric Patients ◽  
Case Series ◽  
Population Based ◽  
Time Dependent ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Suicide Rates ◽  
Discharged Patients

Background Community treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce. Aims To compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients). Method From a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients. Results Suicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges). Conclusions CTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.

Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder

2020 ◽  
pp. 1-11
Author(s):  
Daniel Vigo ◽  
Josep Maria Haro ◽  
Irving Hwang ◽  
Sergio Aguilar-Gaxiola ◽  
Jordi Alonso ◽  
...  
Keyword(s):  
Mental Health ◽  
Major Depressive Disorder ◽  
Mental Health Service ◽  
Effective Treatment ◽  
Health Service Utilization ◽  
Mental Health Service Utilization ◽  
Major Depressive ◽  
Treatment Coverage ◽  
Point Reduction ◽  
To Receive

Abstract Background Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks. Methods Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both. Results MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination. Conclusions Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.

Suicide in recently discharged psychiatric patients: a case-control study

2008 ◽  
Vol 39 (3) ◽  
pp. 443-449 ◽  
Author(s):  
I. M. Hunt ◽  
N. Kapur ◽  
R. Webb ◽  
J. Robinson ◽  
J. Burns ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Suicide Risk ◽  
Case Control Study ◽  
Clinical Symptoms ◽  
Risk Measures ◽  
Psychiatric Patients ◽  
Case Control ◽  
Control Study

BackgroundFew controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge.MethodWe conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls.ResultsForty-three per cent of suicides occurred within a month of discharge, 47% of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide.ConclusionsThe weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention under the Mental Health Act and current use of enhanced levels of aftercare may be protective.

Mental Health Service Needs in the Prison Boom: The Case of Children of Incarcerated Mothers

2015 ◽  
Vol 28 (5) ◽  
pp. 415-436 ◽  
Author(s):  
Jillian J. Turanovic ◽  
Nancy Rodriguez
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Health Needs ◽  
Mental Health Service Use ◽  
Incarcerated Mothers ◽  
Mental Health Needs ◽  
To Receive

This study identifies the factors related to mental health service use among children of incarcerated mothers. Data on 700 children collected from a diverse sample of mothers in Arizona are used, and a two-stage probit model with sample selection is estimated to assess the various child, mother, and caregiver characteristics associated with children’s use of mental health services. Results indicate that children involved in child protective services (CPS) and children cared for by grandparents are more likely to receive mental health services, whereas children of Native American mothers and children who have been exposed to violence are less likely to receive services for their mental health needs. These findings have important implications for correctional policy regarding the intake screening of female inmates and suggest that criminal justice agencies communicate more closely with CPS and community-based services to ensure children’s mental health needs are addressed while their mothers are in prison.

Zero suicide southwest UK initiative – Steps to mitigate suicide risk in local populations using quality improvement methodology and a whole life approach

2017 ◽  
Vol 41 (S1) ◽  
pp. S402-S402 ◽  
Author(s):  
R. Shankar ◽  
E. Wilkinson ◽  
S. Roberts ◽  
O. Rebecca
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Suicide Risk ◽  
Psychiatric Patients ◽  
Regional Strategy ◽  
Suicide Survivors ◽  
Radio Stations ◽  
The Usa ◽  
Competing Interest ◽  
To Come

BackgroundOnly 25% of people who die by suicide see mental health services. Suicide is not just a health issue. Its causation and consequences lie within all of society. Many erroneously believe that suicide is inevitable and not preventable, because its causation is too complex. Underlying associations with suicide are largely social. There are programmes in the USA, which have combined interventions to reduce suicides. The 2014 UK suicide rate per 100,000 was 10.8 but 11.1 in South West (SW) England (pop: 5 million). A whole system approach is necessary. Zero Suicides SW is a project to address this.Aim(1) To develop a regional strategy to reduce and prevent suicide. (2) To make whole populations suicide risk aware. (3) Reduce regional suicide rates.MethodA collaborative involving national and local 60 organisations including charities and voluntary sector was formed. Five collaborative meetings used narratives of suicide survivors, national experts led themed workshops, etc. to come up with a regional strategy. Quality Improvement (QI) Methodology was used to develop and examine the success of all projects.OutputsInitiatives such as using local radio stations for mental health promotion, collaboration via a poster campaign with local breweries and pubs to make men more self-aware of risk, suicide risk counselling for relatives/carers of patients admitted to psychiatric care, improving scrutiny to access to medication for recently discharged psychiatric patients have developed from the project. The QI model demonstrated how localised changes at person and organisation level could combine and have a powerful role in suicide prevention.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Factors Increasing Noncompliance of Psychiatric Patients Undergoing for Psychotropic Therapy

2021 ◽  
pp. 51-54
Author(s):  
A. R. Bharathi
Keyword(s):  
Mental Health ◽  
Informed Consent ◽  
Mental Health Service ◽  
Health Service ◽  
Positive Result ◽  
Mental Hospital ◽  
Psychiatric Patients ◽  
Drug Regimen ◽  
Sampling Procedure ◽  
Adherence To Treatment

Introduction: The positive result of the treatment regimen mainly depends on the adherence of the patients towards the instruction given by the physician and termed as the noncompliance or incomplete adherence to treatment. Methods: The present study aimed to descriptively analyze and identify the reasons that increasing the incomplete adherence for psychotropic therapy based on information retrieved from the patient and their relatives in Institute of Mental Hospital (IMH), Chennai.90 participants were interrogated using a structured questioner by purposive-sampling procedure after receiving their informed consent. Results: The present study showed the involvement of different factors such as pre – mature stopping the drug regimen (28.8%), buying lesser quantity of the drugs than prescribed by physicians (24.4%), and irregular drug consuming (23.3%). The present study importance of creating the awareness regarding the optimal follow- ups and emphasized the advices regarding the changing the mental health service regimes.  The patients and relatives should be given the psychological based awareness for reducing the noncompliance on the psychotropic regimes.

scholarly journals Mental health service user and worker experience of psychosocial support via telehealth through the COVID­19 pandemic: A qualitative study (Preprint)

2021 ◽  
Author(s):  
Annie Venville ◽  
Sarah O'Connor ◽  
Hannah Roeschlein ◽  
Priscilla Ennals ◽  
Grace McLoughlan ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Service Delivery ◽  
Service User ◽  
Psychosocial Support ◽  
Service Users ◽  
Worker Experience ◽  
To Receive ◽  
The Relationship

BACKGROUND The Covid-19 pandemic saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known pre-pandemic for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding is needed about its capacity to provide psychosocial support for people with complex and enduring mental health conditions. OBJECTIVE Focusing on an Australian community-managed provider of psychosocial intervention and support, this qualitative study aimed to understand the service user and worker experience of psychosocial support via telehealth through the COVID­19 pandemic. METHODS This research was jointly developed, and conducted by people with lived experience of mental ill health and/or distress, mental health service providers, and university-based researchers. Semi structured interviews conducted between August and November 2020 explored participant experiences of receiving or providing psychosocial support via telehealth platforms including telephone, text, and video conferencing. Qualitative data was analysed thematically, quantitative data was collated and analysed using descriptive statistics. RESULTS Twenty service users and eight workers completed individual interviews via telephone or video conferencing platform. Sixty percent (n=12) of service users received psychosocial support services by telephone, 30% (n=6) by videoconferencing, and 10% (n=2) through a blend of telephone and videoconferencing. Of note, 55% (n=11) of service user participants stated a future preference for in-person psychosocial support services, 30% (n=6) preferred to receive a mixture of in-person and telehealth, and 15% (n=3) elected telehealth only. Two meta- themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort, and (2) a whole new way of working. The first meta-theme comprises sub-themes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship, and having and exercising choice and control. The second meta-theme contains sub-themes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth. CONCLUSIONS Overall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. Whilst access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in person psychosocial support, or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Notably, challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood.

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