scholarly journals Screening and Referral is Not Enough: A Qualitative Exploration of Barriers to Access and Uptake of Mental Health Services in Patients With Cardiovascular Diseases

2020 ◽  
Author(s):  
Catherine M Collopy ◽  
Suzanne M Cosh ◽  
Phillip J Tully
Keyword(s):  
Mental Health ◽  
Cardiovascular Diseases ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Service Use ◽  
Information Provision ◽  
Cardiac Events ◽  
Structured Interviews

Abstract Background: Cardiovascular diseases (CVD) are commonly comorbid with mental health disorders, portending poorer cardiac prognosis. Despite the high prevalence of depression and anxiety, and guidelines recommending routine depression screening and referral, uptake of mental healthcare in CVD populations remains low. Reasons for the underutilisation of mental health and psychological services for this population remain largely unknown.Methods: Thirteen CVD patients with clinically significant psychological symptoms (depression, anxiety and/or stress) participated in one-on-one in-depth semi-structured interviews. Data were analysed using inductive thematic analysis.Results: Barriers to uptake included the timing of referral and screening, with patients reporting a need for longer term follow-up. A lack of information provision and understanding around mental health and services, especially following cardiac-events were further barriers. A reluctance to report mental health or engage in services was also identified, with patients indicating a preference for informal peer support networks. A range of practical barriers such as mobility, transport and cost were also reported. Conclusions: Longer term follow-up and routine mental health assessment may be beneficial to facilitate use of mental health services. Upskilling of practitioners around mental health may be a further avenue to promote information provision and enhance service use. Further focus on enhancing informal peer support may be a valuable initial approach for the CVD population. The implications for improving services and enhancing service use are discussed.

scholarly journals Screening and referral is not enough: a qualitative exploration of barriers to access and uptake of mental health services in patients with cardiovascular diseases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
C. M. Collopy ◽  
S. M. Cosh ◽  
P. J. Tully
Keyword(s):  
Mental Health ◽  
Cardiovascular Diseases ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Service Use ◽  
Information Provision ◽  
Cardiac Events ◽  
Structured Interviews

Abstract Background Cardiovascular diseases (CVD) are commonly comorbid with mental health disorders, portending poorer cardiac prognosis. Despite the high prevalence of depression and anxiety, and guidelines recommending routine depression screening and referral, uptake of mental healthcare in CVD populations remains low. Reasons for the underutilisation of mental health and psychological services for this population remain largely unknown. Methods Thirteen CVD patients with clinically significant psychological symptoms (depression, anxiety and/or stress) participated in one-on-one in-depth semi-structured interviews. Data were analysed using inductive thematic analysis. Results Barriers to uptake included the timing of referral and screening, with patients reporting a need for longer term follow-up. A lack of information provision and understanding around mental health and services, especially following cardiac-events were further barriers. A reluctance to report mental health or engage in services was also identified, with patients indicating a preference for informal peer support networks. A range of practical barriers such as mobility, transport and cost were also reported. Conclusions Longer term follow-up and routine mental health assessment may be beneficial to facilitate use of mental health services. Upskilling of practitioners around mental health may be a further avenue to promote information provision and enhance service use. Further focus on enhancing informal peer support may be a valuable initial approach for the CVD population. The implications for improving services and enhancing service use are discussed.

scholarly journals The effectiveness of one-to-one peer support in mental health services: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah White ◽  
Rhiannon Foster ◽  
Jacqueline Marks ◽  
Rosaleen Morshead ◽  
Lucy Goldsmith ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Service Use ◽  
Positive Impact ◽  
Evidence Base ◽  
Risk Of Bias ◽  
One To One ◽  
Meta Analyses

Abstract Background Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. Method We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. Results Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. Conclusions One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. Trial registration Prospero identifier: CRD42015025621.

Utilisation and costs of community mental health services

1998 ◽  
Vol 173 (5) ◽  
pp. 391-398 ◽  
Author(s):  
Paul McCrone ◽  
Graham Thornicroft ◽  
Michael Phelan ◽  
Frank Holloway ◽  
Til Wykes ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Service Use ◽  
Community Mental Health Services ◽  
Supported Accommodation ◽  
Health Services Need ◽  
Time Periods ◽  
The Cost

BackgroundThe costs and the effectiveness of mental health services need to be evaluated if provision is to be efficient. Service use and costs are described for two geographical areas in south London.MethodService use was measured comprehensively for clients in both sectors for two six-month time periods using the Client Service Receipt Interview This information was combined with unit costs to calculate service costs. The ‘hidden’ costs of informal care and unsupported accommodation were also calculated.ResultsAt baseline significantly more intensive sector clients had in-patient stays but by the follow-up this difference had disappeared. There was significantly more use of supported accommodation in the intensive sector during both time periods. Baseline and follow-up total service costs were significantly higher for the intensive sector. Costs were spread disproportionately and a small number of services accounted for a large proportion of cost.ConclusionsWhile the cost at Time 2 was significantly greater in the intensive sector, this was largely due to the high use of supported accommodation. There was some convergence in cost between the sectors over time.

scholarly journals Health System-Level Evaluation of Tele-Mental Health Services Among Children and Adolescents in Ontario, Canada

2021 ◽  
pp. 070674372110433
Author(s):  
Alene Toulany ◽  
Paul Kurdyak ◽  
Sima Gandhi ◽  
Longdi Fu ◽  
Seena Grewal ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Children And Adolescents ◽  
Service Use ◽  
System Level ◽  
Test Statistic ◽  
Post Test

Objective To describe the characteristics of children and adolescents receiving tele-mental health services in Ontario, Canada and examine access to a psychiatrist, in-person or via tele-mental health services, following a mental health and addictions (MHA)-related emergency department (ED) visit or hospitalization. Method Using linked health and administrative data, we described two cohorts: (1) children and adolescents (1–18 years) who used a provincial tele-mental health programme from January 1, 2013 to March 31, 2017, comparing their MHA-related service use (outpatient, ED, hospitalization) in the 1 year prior to and the 1 year following initial consultation; (2) children and adolescents with high mental health service needs, defined as those with an incident MHA-related ED visit or hospitalization between January 1, 2013 and December 31, 2016, examining their 1-year follow-up with telemedicine and other health care utilization. Results In the first cohort, 7,216 children and adolescents (mean age 11.8 [±3.8] years) received tele-mental health services. The proportion of MHA-related ED visits [15.1% pre vs. 12.6% post (test statistic 23.57, P < 0.001)] or hospitalizations [10.2% pre vs. 8.7% post (test statistic 11.96, P < 0.001)] declined in the year following tele-mental health consultation, while local psychiatry visits increased [8.4% pre vs. 17.0% post (test statistic 298.69, P < 0.001)]. In the second cohort ( n = 84,033), only 1.5% received tele-mental health services, 40.7% saw a psychiatrist in-person, and 32.5% received no MHA-related outpatient care in follow-up. Conclusions Tele-mental health services were rarely used in Ontario, even among high-needs children and adolescents, despite their association with increased access to care and less need for acute mental health care.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

scholarly journals Higher Rates of Untreated Distress in Older Versus Younger Adults With Indolent Lymphoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 466-466
Author(s):  
Kelly Trevino ◽  
Peter Martin ◽  
John Leonard
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Service Use ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Younger Adults

Abstract Indolent lymphomas are incurable but slow-growing cancers, resulting in a large number of older adults living with these diseases. Patients typically live with their illness for years with the knowledge that disease progression is likely. Yet, little is known about psychological distress in this population. This study examined rates of and the relationship between distress and mental health service use in older and younger adults with indolent lymphomas. Adult patients diagnosed with an indolent lymphoma (e.g., follicular lymphoma, marginal zone lymphoma) within the past six months completed self-report surveys of distress (Hospital Anxiety and Depression Scale; HADS) and mental health service use since the cancer diagnosis (yes/no). Descriptive statistics, t-tests, and chi-square analyses were used to examine study questions. The sample (n=84) included 35 patients 65 years or older. Across the entire sample, 21.4% screened positive for distress on the HADS; 58.8% of these patients did not receive mental health services. Older adults reported lower distress levels than younger adults (17.1% v. 24.5%; p=.038). Among younger adults, 50% of distressed patients received mental health services; only 20% of distressed older adults received mental health services. Distress was associated with mental health service use in younger adults (p=.004) but not in older adults (p=.17). Older adults with indolent lymphomas have higher levels of untreated distress than younger adults. Research on the mechanisms underlying these age differences (e.g., stigma toward mental health services, ageism) would inform interventions to increase rates of mental health service use and reduce care disparities due to age.

The Influence of Social Support, Help-Seeking Attitudes and Help-Seeking Intentions on Older Australians’ use of Mental Health Services for Depression and Anxiety Symptoms

2021 ◽  
pp. 009141502110508
Author(s):  
Susan Jane Bretherton
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Mental Health Services ◽  
Health Services ◽  
Help Seeking ◽  
Service Use ◽  
Anxiety Symptoms ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Help Seeking Attitudes

This study investigated the influence of predisposing factors (social support, help-seeking attitudes and help-seeking intentions) on older Australian adults’ use of mental health services for depression and/or anxiety symptoms. Participants were 214 older Australian adults (61% female; aged between 60 and 96 years; M  =  75.15 years, SD  =  8.40 years) who completed a self-report questionnaire that measured predisposing factors and lifetime mental health service use for depression and/or anxiety symptoms. Higher levels of social support predicted non-use of mental health services. When this relationship was serially mediated by help-seeking attitudes and help-seeking intentions, it predicted mental health service use for depression and/or anxiety. Older adults are less likely to seek help for depression and/or anxiety symptoms unless members of their social support network encourage positive help-seeking attitudes, which lead to positive help-seeking intentions and the subsequent use of mental health services.

A day in the life of a peer support worker: re-entry

2016 ◽  
Vol 20 (3) ◽  
pp. 149-152
Author(s):  
Emma Watson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Design Methodology ◽  
Narrative Approach ◽  
Personal Recovery ◽  
Support Worker ◽  
Content Type ◽  
Returning To Work

Purpose – The purpose of this paper is to share the experiences and reflections of a peer support worker over the course of a day working in mental health services. Design/methodology/approach – A narrative approach has been taken to structure reflections based on the experience of returning to work after taking sick leave. Findings – Reflections are offered based on the process of returning to work and the way that this experience sheds light on personal recovery. Originality/value – This paper adds to the small number of accounts of the experiences of peer support working in mental health services and as such is highly original.

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