scholarly journals Determinants of timely access to Specialized Mental Health Services and maintenance of a link with primary care: a cross-sectional study

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Carlos Alberto dos Santos Treichel ◽  
Ioannis Bakolis ◽  
Rosana Teresa Onocko-Campos
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Substance Misuse ◽  
Cross Sectional Study ◽  
Psychoactive Substance ◽  
Cross Sectional ◽  
Timely Access ◽  
Specialized Mental Health

Abstract Background Although access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient’s link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. Thus, this study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients’ admission (outcome 2). Methods This is a cross-sectional study, conducted with 341 users of Specialized Mental Health Services at outpatient and community level in a medium-sized city in Brazil between August and November 2019. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators. Results Factors positively associated with timely access were the diagnosis of psychosis or psychoactive substance misuse. The inversely associated factors with this outcome were higher income, having their need for mental health care identified in an appointment for general complaints, having been referred to the current service by Primary Care, having attended the current service for up to 3 years and delay until the first appointment (in a previous service). Regarding the maintenance of a link with Primary Care, factors positively associated were being referred to the current service by Primary Care or private service and receiving visits from Community Health Agents. The inversely associated factors with this outcome were male sex, being employed, having a diagnosis of psychosis or psychoactive substance misuse, and a greater perception of social support. Conclusions In addition to individual factors, factors related to the organization of services and the referral between them stood out in influencing both the access and maintenance of the patients’ link with Primary Care. Thus, this study reinforces the idea that integration between Primary Care and Specialized Mental Health Services should be strengthened, both to reduce waiting times for between-service referrals and benefit of care continuity.

scholarly journals Determinants of timely access to Specialized Mental Health Services and maintenance of a link with Primary Care: A cross-sectional study.

2021 ◽  
Author(s):  
Carlos Alberto dos Santos Treichel ◽  
Ioannis Bakolis ◽  
Rosana Teresa Onocko-Campos
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Waiting Times ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Timely Access ◽  
Specialized Mental Health

Abstract Background: Although it is known that several factors may influence the access to specialized care, the factors related to the maintenance of a link with Primary Care by patients who accessed Specialized Mental Health Services (SMHS) remain unknown. The aim of this study was to evaluate the determinants of timely access to SMHS and maintenance of a link with Primary Care. Methods: This is a cross-sectional study, conducted with 341 users of SMHS at outpatient and community level in a medium-sized city in Brazil. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators. Results: Among the factors associated with the study outcomes, those related to the organization of services and the movement between them were noteworthy. Patients referred by Primary Care were less likely to access specialized services in a timely manner (RR: 0.61; 95% CI: 0.40, 0.93). However, the referral of cases by Primary Care (RR: 1.38; 95% CI: 1.06, 1.79) and follow-up with visits by Community Health Agents (RR: 1.26; 95% CI: 1.04, 1.53) appeared to favor maintenance of the patient-Primary Care link. Conclusion: This study reinforces the idea that integration between Primary Care and SMHS should be strengthened, both to reduce waiting times for between-service referrals and benefit continuity of care.

Distress and impaired functioning, coping mechanisms and barriers to access mental health services among Syrian refugees and Jordanian adults after eight years of Syrian crisis: a cross-sectional study (Preprint)

2021 ◽  
Author(s):  
Yousef Khader ◽  
Ahmad Bawaneh ◽  
Zaid Al-Hamdan
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
Coping Mechanisms ◽  
Syrian Refugees ◽  
Sectional Study ◽  
Cross Sectional ◽  
Barriers To Access

BACKGROUND The Syrian conflict started in 2011 and resulted ever since in a large displacement of Syrians. Conflict-related violence coupled with displacement related stressors such as poverty, poor access to health services, loss of family support and discrimination had a significant impact on the mental health and psychosocial wellbeing of Syrian refugee OBJECTIVE This study aimed to identify the perceived symptoms of severe distress and impaired functioning, identify coping mechanisms and identify the barriers to access mental health services among Syrian refugees and Jordanian adults. METHODS This cross-sectional study study took place in 14 randomly selected sites in Jordan where Syrian refugees are concentered and from Za’tari refugee camp. A toolkit for humanitarian settings was used for data collection. RESULTS Of the 1424 participants, 43.4% had distress; 38.9% among host population, 57.0% among refugees in urban communities, and 23.0% among refugees in camp (p <0.005). Overall, finding comfort in faith and spiritual beliefs was the most common coping mechanism reported by those who perceived to be experiencing distress. CONCLUSIONS A significant proportion of Syrian refugees had distress symptoms. It is recommended to incorporate mental health services into broad-based community settings, such as schools, primary prevention or case management programs.

scholarly journals The Substance Abuse and Mental Health Services Administration Buprenorphine Practitioner Locator Misrepresents Access to Buprenorphine

2021 ◽  
Author(s):  
Precious Anyanwu ◽  
Tyler J Varisco ◽  
Matthew A. Wanat ◽  
Shweta Bapat ◽  
Kasey Claborn ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Mental Health Services ◽  
Health Services ◽  
Poverty Line ◽  
Cross Sectional Study ◽  
The State ◽  
County Level ◽  
Cross Sectional ◽  
Health Services Administration

Abstract: Aims: To compare county-level differences in the number of buprenorphine prescribers listed in the publicly available Substance Abuse and Mental Health Services Administration (SAMHSA) Buprenorphine Practitioner Locator and in the Drug Enforcement Administration’s (DEA) Controlled Substance Act (CSA) database and to determine if disparities in access exist in poorer areas with more non-white residents. Design: Cross-sectional study Setting: TexasMeasurements: County-level counts of buprenorphine prescribers were calculated from both the publicly available SAMHSA buprenorphine practitioner locator list and the DEA CSA database. These were then used to estimate the number of providers per 100,000 residents in each county. Regional variation in access to buprenorphine was compared descriptively across the state using poverty data from the US Census and county-level demography from the Texas Demographic Center. Results: This study found 68.8% more X-waivered providers on the DEA CSA database (n=2,622) with at least one provider reported in 125 of 144 counties in the state (49.2%) compared to the SAMHSA Buprenorphine Practitioner Locator (n=1,553) with at least one provider reported in 103 counties (40.5%). This difference was magnified in Texas Public Health Region 11. This is the poorest region of the state (23.7% of residents below the federal poverty line) and contains the most non-white residents 87.4% vs 54.9% (SD: 13.6%). This region had the lowest number of buprenorphine prescribers with 3.8 providers per 100,000 on the DEA CSA database and 2.5 providers per 100,000 in the SAMHSA Buprenorphine Practitioner Locator.Conclusions: The lack of a complete, public registry of buprenorphine prescribers makes it difficult for patients to identify a convenient buprenorphine prescriber and for referring physicians to help their patients access care. This may be especially true in poorer and more diverse areas with fewer buprenorphine prescribers.

Barriers to access to mental health services among Colombia outpatients

2020 ◽  
Vol 66 (6) ◽  
pp. 600-606 ◽  
Author(s):  
Adalberto Campo-Arias ◽  
Guillermo A Ceballos-Ospino ◽  
Edwin Herazo
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Attitudinal Barriers ◽  
Barriers To Access ◽  
Care Evaluation ◽  
Associated Variables

Background: Access barriers are all situations or conditions that limit seeking, receiving or enjoying benefits offered by the health system. This set of situations translates into underutilization of the services offered. In Colombia, there is little information about barriers to accessing medical care in general, and even less in the specific field of mental health. Aim: To determine the barriers to accessing psychiatric care in outpatients in Santa Marta, Colombia. Methods: The authors designed a cross-sectional study with a non-probability sample of adult patients who consulted between August and December 2018. The barriers to access were measured with a 20-item version of the Barriers to Access to Care Evaluation (BACE) scale. Results: A total of 247 patients participated; they were between 18 and 82 years (mean ( M) = 47.5, standard deviation ( SD) = 13.9). A total of 69 (27.9%) patients classified as having major attitudinal barriers; 62 (25.1%) patients, major barriers related to stigma-discrimination; and 41 (16.6%) patients, major instrumental barriers. Concerning the associated variables, age less than 45 years was related to major attitudinal barriers (odds ratio (OR) = 2.9, 95% confidence interval (CI) 1.6-5.5), major barriers related to stigma-discrimination (OR = 3.8, 95% CI 2.0-7.2) and major instrumental barriers (OR = 2.7, 95% CI 1.3-5.3). Men reported major instrumental barriers more frequently than women (OR = 2.8, 95% CI 1.3-5.8). Conclusion: The major attitudinal, related to stigma-discrimination and instrumental barriers to access frequently delay a consultation with mental health services. Actions are necessary to reduce barriers to accessing mental health care.

scholarly journals Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis (Preprint)

2020 ◽  
Author(s):  
Adam Atherly ◽  
Eline Van Den Broek-Altenburg ◽  
Victoria Hart ◽  
Kelsey Gleason ◽  
Jan Carney
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Effects ◽  
Care Delivery ◽  
Preventive Services ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

BACKGROUND The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative. OBJECTIVE This study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine. METHODS We conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown. RESULTS Deferred care was widespread—48% (n=812) of respondents deferred care—but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care. CONCLUSIONS Temporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services.

scholarly journals Investigating geographical variation in the use of mental health services by area of England: a cross-sectional ecological study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lucy Maconick ◽  
Luke Sheridan Rains ◽  
Rebecca Jones ◽  
Brynmor Lloyd-Evans ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Geographical Variation ◽  
Ecological Study ◽  
Cross Sectional ◽  
Psychological Therapies ◽  
Access To Primary Care

Abstract Background There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. Methods This is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI. Results The populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies. Conclusions There is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder.

scholarly journals Suicidal ideation in patients with mental illness and concurrent substance use: analyses of national census data in Norway

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Helle Wessel Andersson ◽  
Solfrid E. Lilleeng ◽  
Torleif Ruud ◽  
Solveig Osborg Ose
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Substance Use ◽  
Suicidal Ideation ◽  
Mental Health Services ◽  
Health Services ◽  
Census Data ◽  
Current Treatment ◽  
Cross Sectional ◽  
Specialized Mental Health

Abstract Background Suicidal ideation may signal potential risk for future suicidal behaviors and death. We examined the prevalence of recent suicidal ideation in patients with mental illness and concurrent substance use and explored the clinical and sociodemographic factors associated with suicidal ideation in this patient subgroup, which represents a particular risk group for adverse psychiatric outcomes. Methods We used national cross-sectional census data in Norway collected from 25,525 patients in specialized mental health services. The analytic sample comprised 3,842 patients with concurrent substance use, defined as having a co-morbid substance use disorder or who reported recent regular alcohol use/occasional illicit drug use. Data included suicidal ideation measured in relation to the current treatment episode, sociodemographic characteristics and ICD-10 diagnoses. Bivariate and multivariate analyses were used to examine differential characteristics between patients with and without suicidal ideation. Results The prevalence of suicidal ideation was 25.8%. The suicidal ideation rates were particularly high for those with personality disorders, posttraumatic stress disorder, and depression, and for alcohol and sedatives compared with other substances. Patients with suicidal ideation were characterized by being younger, having single marital status, and having poorly perceived social relationships with family and friends. Conclusion Suicidal ideation in patients with mental illness and concurrent substance use was associated with a number of distinct characteristics. These results might help contribute to an increased focus on a subgroup of individuals at particular risk for suicidality and support suicide prevention efforts in specialized mental health services.

scholarly journals What is the prevalence, and what are the clinical correlates, of insulin resistance in young people presenting for mental health care? A cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025674 ◽  
Author(s):  
Elizabeth M Scott ◽  
Joanne S Carpenter ◽  
Frank Iorfino ◽  
Shane P M Cross ◽  
Daniel F Hermens ◽  
...  
Keyword(s):  
Mental Health ◽  
Insulin Resistance ◽  
Primary Care ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Self Report ◽  
Model Assessment ◽  
Cross Sectional ◽  
Younger Age

ObjectivesTo report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services.DesignCross-sectional.SettingHeadspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney.Participants768 young people (66% female, mean age 19.7±3.5, range 12–30 years).Main outcome measuresIR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI).ResultsFor BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, <1% had an abnormally high fasting blood glucose (>6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score >2.0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p<0.001). Participants in the upper third of HOMA2-IR scores are characterised by younger age, higher BMIs and depression as a primary diagnosis. HOMA2-IR was predicted by younger age (β=0.19, p<0.001) and higher BMI (β=0.49, p<0.001), together explaining 22% of the variance (F(2,361)=52.1, p<0.001).ConclusionsEmerging IR is evident in a significant subgroup of young people presenting to primary care-based mental health services. While the major modifiable risk factor is BMI, a large proportion of the variance is not accounted for by other demographic, clinical or treatment factors. Given the early emergence of IR, secondary prevention interventions may need to commence prior to the development of full-threshold or major mood or psychotic disorders.

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