scholarly journals Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261921
Author(s):  
Summer Newell ◽  
Lauren Denneson ◽  
Annabelle Rynerson ◽  
Sarah Rabin ◽  
Victoria Elliott ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Suicidal Ideation ◽  
Health Staff ◽  
Veterans Health ◽  
Health Administration ◽  
Structured Interviews ◽  
Mental Health Staff ◽  
Populations At Risk ◽  
Mental Health Settings

Universal screening for suicidal ideation in primary care and mental health settings has become a key prevention tool in many healthcare systems, including the Veterans Healthcare Administration (VHA). In response to the coronavirus pandemic, healthcare providers faced a number of challenges, including how to quickly adapt screening practices. The objective of this analyses was to learn staff perspectives on how the pandemic impacted suicide risk screening in primary care and mental health settings. Forty semi-structured interviews were conducted with primary care and mental health staff between April-September 2020 across 12 VHA facilities. A multi-disciplinary team employed a qualitative thematic analysis using a hybrid inductive/deductive approach. Staff reported multiple concerns for patients during the crisis, especially regarding vulnerable populations at risk for social isolation. Lack of clear protocols at some sites on how to serve patients screening positive for suicidal ideation created confusion for staff and led some sites to temporarily stop screening. Sites had varying degrees of adaptability to virtual based care, with the biggest challenge being completion of warm hand-offs to mental health specialists. Unanticipated opportunities that emerged during this time included increased ability of patients and staff to conduct virtual care, which is expected to continue benefit post-pandemic.

Mental health care integration and primary care patient experience in the Veterans Health Administration

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 100587
Author(s):  
Lucinda B. Leung ◽  
Danielle Rose ◽  
Rong Guo ◽  
Catherine E. Brayton ◽  
Lisa V. Rubenstein ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Patient Experience ◽  
Primary Care Patient ◽  
Veterans Health Administration ◽  
Care Patient ◽  
Veterans Health ◽  
Health Administration ◽  
Care Integration

Academic Detailing to Reduce Sedative-Hypnotic Prescribing in Older Veterans

2019 ◽  
pp. 089719001987094 ◽  
Author(s):  
Addison P. Ragan ◽  
Garrett B. Aikens ◽  
Mark Bounthavong ◽  
Kevin Brittain ◽  
Anna Mirk
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Benzodiazepine Receptor ◽  
Educational Outreach ◽  
Potentially Inappropriate Medications ◽  
Veterans Health ◽  
Academic Detailing ◽  
Health Administration ◽  
Prescribing Trends ◽  
The Impact

Background: Sedative-hypnotics, including benzodiazepines (BZDs) and benzodiazepine receptor agonists (BZD-RA), are considered potentially inappropriate medications (PIMs) in older adults. Academic detailing, an educational outreach delivered by trained clinicians to other clinicians to encourage evidence-based care, can promote deprescribing of PIMs. Objective: To evaluate the impact of academic detailing on sedative-hypnotic prescribing to older veterans. Methods: A retrospective analysis was performed to evaluate the impact of academic detailing on BZD and BZD-RA prescribing to veterans aged 75 years and older. Prescribing trends for primary care and mental health prescribers in the Veterans Health Administration (VA) Southeast Network were calculated for the 18 months before and after an initial academic detailing session for each prescriber. Pre–post interrupted time series analyses (ITSAs) were conducted, and period prevalence was calculated as the number of prescriptions per 1000 older veterans. Results: A total of 155 prescribers were followed for 36 months. BZD prevalence declined by 23% (69.08-53.33 per 1000 population; P < .001) and by 15% for BZD-RA (18.07-15.38 per 1000 population; P < .001). New starts on BZD declined by 54% (2.36-1.09 per 1000 population; P < .001) and new starts on BZD-RA declined by 53% (1.02-0.48 per 1000 population; P < .001). Alternative medications for insomnia increased by 23% (39.98-49.27 per 1000 population; P < .001). Findings from the ITSA confirmed those of the pre–post analysis with sustained effects in the postintervention period. Conclusions: Academic detailing was associated with reduced sedative-hypnotic prescribing in the primary care and mental health setting.

Tackling the unseen virus at the unseen frontier

2020 ◽  
Vol 16 (2) ◽  
pp. 65-68
Author(s):  
Cholan Anandarajah ◽  
Matilda Elliott ◽  
Koravangattu Valsraj
Keyword(s):  
Mental Health ◽  
Social Care ◽  
Health Staff ◽  
Health Unit ◽  
Compassionate Care ◽  
Mental Health Staff ◽  
Health And Social Care ◽  
Healthcare Environments ◽  
Mental Health Settings ◽  
Mental Health Unit

There has been widespread coverage, attention and discussion regarding the anxieties of COVID-19 pandemic in health and social care settings; however, compared to other healthcare environments, mental health care settings have not received a similar level of attention and concern. Interestingly there are unique challenges in mental health units and at the height of the pandemic there has been a significant impact on staff, patients and carers. Mental health staff have had to adapt their ways of working, focusing more on the physical health of patients and caring for COVID positive patients in a mental health unit. Anxiety about the infection spreading to other patients and to staff who interact very closely with patients were significant concerns, with the additional difficulties of accessing the appropriate PPE during the early stages of the outbreak. Some challenges are unique to mental health settings and become even more intense within a psychiatric intensive care unit (PICU). These include difficulties with isolation, social distancing and the reluctance of patients to wear masks. The lessons learnt caring for the most challenging patients in a PICU are explored. The adaptability, flexibility and commitment to providing kind, compassionate care at the height of the COVID pandemic is remarkable.

scholarly journals Development of a training programme for primary care mental health staff to support management of depression and anxiety in long-term conditions

2018 ◽  
Vol 20 ◽  
Author(s):  
Kate Hamilton-Westa ◽  
Amanda Batesb ◽  
Sarah Hothamc ◽  
Patricia Wilsond
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Physical Health ◽  
Online Training ◽  
Training Programme ◽  
Health Staff ◽  
Mental Health Staff ◽  
Evaluation Questionnaire ◽  
Primary Care Mental Health

AbstractAimWe aimed to develop, deliver and evaluate a brief training programme for primary care mental health staff in NW London focussing on long-term physical health conditions (LTCs). The objective was to improve participants’ knowledge, understanding and confidence (self-efficacy) in providing effective support to people with LTCs. The second objective was to develop an online version to be made available more widely.BackgroundThe project was commissioned by NW London Collaboration of Clinical Commissioning Groups as part of a strategy to develop more joined up care and support for people with mental health needs. Training was developed by a team of experts, with input from commissioners, service users, clinicians and service managers.MethodsTraining was delivered via two-day interactive workshops providing: (i) key facts (informed by a review of published research and publically available health information); (ii) opportunity to engage with the ‘lived experience’ of people with LTCs (via videos, role plays, case studies and group discussion); (iii) skills-based training (in specific assessment and intervention methods). Knowledge, understanding and confidence (with respect to supporting people with LTCs) were assessed at the start and end of the training. An online training programme (with embedded evaluation questionnaire) was also developed, covering the same themes as the workshop.FindingsMental health staff (n=60) reported limited knowledge, understanding and confidence before the workshop, underlining the need for training. Knowledge of LTCs improved significantly following training (P<0.0001), along with awareness of the impact of poor psychological wellbeing on physical health (P<0.05) and the role of psychological therapies in supporting people with LTCs (P<0.0001). Self-efficacy also improved (P<0.001). Online training was accessed by 894 participants in the first six months and 187 provided feedback via the evaluation questionnaire. Responses indicated that participants found the training useful (88%), interesting (91%) and easy to understand (97%).

Process mapping appointments to identify improvements in care delivered to patients who screen positive for depression

2016 ◽  
Vol 4 (3) ◽  
pp. 433
Author(s):  
Bo Kim ◽  
Stephanie Rodrigues ◽  
Natalie S Dell ◽  
Rani Elwy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Treatment ◽  
Veterans Health ◽  
Health Administration ◽  
Depression Care ◽  
Positive Screen ◽  
Novel Approach ◽  
Using Data

Rationale, aims and objectives  After screening positive for depression, many patients do not receive effective medication or maintain optimal contact with practitioners.  Our objective was to examine how appointments that patients have after screening positive may affect the delivery of evidence-based and guideline-concordant depression care. Methods  We reviewed treatment records for 271 patients who screened positive for depression in primary care across three United States Veterans Health Administration medical facilities.  For each patient, we mapped the process of appointments that took place following the positive screen, noting the number of appointments, the service line in which each appointment was held, as well as whether guideline-concordant depression care was in turn received over four months. Results  We found that (i) approximately half of the patients who screened positive had no follow-up appointments, (ii) all patients who had two or more follow-up appointments received some – but not necessarily guideline-concordant – mental health treatment, and (iii) there were distinct patterns across the three facilities regarding which service lines’ appointments most often resulted in treatment. Conclusions  Our work offers a novel approach of using data on appointments that patients have after screening positive for depression to shed light on current care practices.  The number of post-screening appointments can be an informative process measure for improving depression care to become more guideline-concordant.  Facilities vary substantially in terms of which service lines they use to attain guideline-concordance, likely due to notable differences in how their primary care, integrated primary care behavioral health, and mental health services are organized.

scholarly journals Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access

2019 ◽  
Vol 38 (8) ◽  
pp. 1281-1288 ◽  
Author(s):  
Lucinda B. Leung ◽  
Lisa V. Rubenstein ◽  
Jean Yoon ◽  
Edward P. Post ◽  
Erin Jaske ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Care Access ◽  
Mental Health Integration
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