Building a network to support people in suicide risk in Rio de Janeiro, from Primary Care to Mental Health Services

Abstract BackgroundIn Mozambique, human and financial resources for public mental health services are extremely limited. Understanding the mental health needs of those seeking healthcare can inform efficient targeting of mental health services. We examined if the frequency of mental disorders in a health facility varied based on the level of specialization of such facility, from primary care without mental health specialists (PrCMH-), to those with mental health specialists (PrCMH+) and tertiary care (TerC), where both inpatient and outpatient mental health services are available.MethodsParticipants were adults seeking health or mental health services at six facilities (2 PrCMH+, 3 PrCMH-, and 1 TerC) in the cities of Maputo and Nampula in Mozambique. Mental disorders were assessed by the MINI International Neuropsychiatric Interview (MINI) 4.0.0. We compared the sociodemographic characteristics and MINI diagnoses across the three types of health facilities. Multiple logistic regression models determined the likelihood that a person seeking services at each type of facility would have any mental disorder, common mental disorders (CMD), severe mental disorders (SMD), substance use disorders (SUD), and moderate-to-high suicide risk, adjusting for sociodemographic factors. ResultsOf the 612 total participants, 52.6% (n=322) were positive for at least one mental disorder: 37.1% were positive for CMD, 28.9% for SMD, 13.2% for SUD, and 10.5% had suicide risk. Presence of any mental disorder was highest in TerC (62.5%) and lowest in PrCMH- (48.4%). Adjusting for sociodemographic covariates, participants in PrCMH+ were significantly more likely to have SMD (OR: 1.85, 95%CI: 1.10-3.11) and SUD (OR: 2.79, 95%CI: 1.31-5.94) than participants in PrCMH-; participants in TerC were more likely to have CMD (OR: 1.70, 95%CI: 1.01-2.87) and SUD (OR: 2.57, 95%CI: 1.14-5.79) than in PrCMH-. Suicide risk was the only condition that did not differ across facility types.ConclusionsAs anticipated, people with mental disorders were more likely to be cared for at facilities with mental health specialists. However, our study suggests there is a remarkably high frequency of mental disorders across different types of facilities within the Mozambican healthcare system. These results suggest a need to increase mental health services at the primary care level.

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The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India (Preprint)

10.2196/preprints.15553 ◽

2019 ◽

Author(s):

Pallab K Maulik ◽

Siddhardha Devarapalli ◽

Sudha Kallakuri ◽

Amritendu Bhattacharya ◽

David Peiris ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Suicide Risk ◽

Health Workers ◽

Primary Care Doctor ◽

Depression And Anxiety ◽

Services Delivery ◽

Health Project

BACKGROUND Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. OBJECTIVE This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. METHODS A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. RESULTS In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. CONCLUSIONS The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial.

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The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India

Journal of Medical Internet Research ◽

10.2196/15553 ◽

2020 ◽

Vol 22 (2) ◽

pp. e15553 ◽

Cited By ~ 1

Author(s):

Pallab K Maulik ◽

Siddhardha Devarapalli ◽

Sudha Kallakuri ◽

Amritendu Bhattacharya ◽

David Peiris ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Suicide Risk ◽

Health Workers ◽

Primary Care Doctor ◽

Depression And Anxiety ◽

Services Delivery ◽

Health Project

Background Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. Objective This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. Methods A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. Results In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. Conclusions The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial.

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Assessment and Management of Suicide Risk in Primary Care

Crisis ◽

10.1027/0227-5910/a000277 ◽

2014 ◽

Vol 35 (6) ◽

pp. 415-425 ◽

Cited By ~ 8

Author(s):

Pooja Saini ◽

David While ◽

Khatidja Chantler ◽

Kirsten Windfuhr ◽

Navneet Kapur

Keyword(s):

Mental Health ◽

Risk Assessment ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Secondary Care ◽

Suicide Risk ◽

Clinical Sample ◽

Primary Care Practices ◽

Risk Assessment And Management

Background: Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aims: To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method: Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Results: Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Conclusion: Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.

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Integration of Mental Health Services in Home-Based Primary Care

PsycEXTRA Dataset ◽

10.1037/e499952008-001 ◽

2008 ◽

Author(s):

Thomas Edes ◽

Bradley E. Karlin

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Home Based Primary Care ◽

Home Based

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Making mental health services accessible in primary care settings

PsycEXTRA Dataset ◽

10.1037/e531082008-005 ◽

2008 ◽

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Primary Care Settings

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The Bridge Program: A Model for Delivering Mental Health Services to Asian Americans through Primary Care

10.36650/nexus3.1_13-29_chenetal ◽

2005 ◽

Vol 3 (1) ◽

pp. 13-29 ◽

Cited By ~ 1

Author(s):

Hongtu Chen ◽

Elizabeth Kramer ◽

Teddy Chen ◽

Jianping Chen ◽

Henry Chung

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Asian Americans ◽

Mental Health Professionals ◽

Primary Care Providers ◽

Care Providers ◽

Bridge Program ◽

Community Awareness

Compared to all other racial and ethnic groups, Asian Americans have the lowest utilization of mental health services. Contributing factors include extremely low community awareness about mental health, a lack of culturally competent Asian American mental health professionals, and severe stigma associated with mental illness. This manuscript describes an innovative program that bridges the gap between primary care and mental health services. The Bridge Program, cited in the supplement to the Surgeon’s General’s Report on Mental Health: Culture, Race, and Ethnicity as a model for delivery of mental health services through primary care; (2) to improve capacity by enhancing the skills of primary care providers to identify and treat mental disorders commonly seen in primary care; and (3) to raise community awareness by providing health education on mental health and illness. Results are presented and the potential for replication is addressed.

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Teaching Family Nurse Practitioner Students to Provide Mental Health Care to Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.034 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 10-11

Author(s):

Victoria Grando ◽

Roy Grando

Keyword(s):

Mental Health ◽

Older Adults ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Treatment Plan ◽

Primary Care Providers ◽

Neurocognitive Disorders ◽

Mental Condition ◽

Care Providers

Abstract In recent years, FNPs have been challenged to deliver mental health services in the primary care setting. Over half of mental health services are provided in primary care, and one-quarter of all primary care patients have a mental disorder. Moreover, 20% of older adults have a mental or neurological disorder often not diagnosed. Nationally, it is estimated that 17% of older adults commit suicide, 15% have a mental condition, 11% have dementia, and 5% have a serious mental condition. There is a paucity of adequately prepared primary care providers trained in geropsychiatric treatment. A didactic course was developed to instruct FNP students in the skills needed to provide mental health treatment in primary care. We discuss mental illness in the context of culture to ensure that treatment is congruent with a patient’s unique cultural background and experiences. This shapes the patients’ beliefs and behaviors that influence the way they view their condition and what they perceive as acceptable solutions. We then go into detail about the common mental conditions that older adults exhibit. Through the case study method, students learn to identify the presenting problem, protocols for analyzing the case, which includes making differential diagnoses and a treatment plan including initial medications, non-medical treatments, and referral. Students are introduced to the DMS-5 to learn the criteria for mental health diagnosis with an emphasis on suicide, depressive disorders, anxiety disorders, bipolar disorders, substance use disorders, and neurocognitive disorders. We have found that students most often misdiagnose neurocognitive disorders.

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