Is trauma informed care possible in the current public mental health system?

Objectives: As mental health services move towards implementing ‘Trauma-informed care’, there is a need to consider the challenges posed within services and systems. This paper raises some of the challenges associated with integrating TIC into the current public mental health system. . Conclusion: The lack of clarity about expectations of trauma-informed approaches causes difficulties for its integration into services, but the wider political context of mental health services is also of relevance. Transparent and ongoing debate is required about approaches to mental health care, to ensure the system meets the needs of those who require it, while questioning what other purposes it may be serving at social and political levels.

Criminal and financial penalties for clinicians in the ACT Mental Health Act weigh more heavily on senior doctors

Objective: We sought to assess the attitudes of ACT public psychiatry doctors towards the financial and criminal penalties in the ACT Mental Health Act 2015. Method: Baseline attitude was surveyed with an 11-item 5-point Likert scale. Education was then provided about the offences outlined in the Act and the associated penalties. The same initial survey was then repeated. Primary outcomes were changes in attitude pre- and post- information, and secondarily data was explored for differences related to gender and seniority. Results Forty-nine percent of 89 eligible public mental health system doctors responded. The majority of the survey respondents were female (59%). Provision of information resulted in a significant improvement in understanding of liabilities (2.80 (SD 1.14) versus 3.58 (SD 0.93), t(39) = 4.06, p < 0.001). Gender had no significant impact on scores. Senior staff were less legally secure and less satisfied with the Mental Health Act pre-information being provided. With regards to notification penalties, with education, junior staff became more secure and seniors less so. Conclusions: Information provision improves understanding of the penalties under the Mental Health Act 2015. Having a senior role predicts lower satisfaction with the penalties in the Act.

Regulatory oversight, mental health and human rights

Regulatory oversight is crucial to ensure human rights are protected in closed environments. In Victoria, evidence continues to surface that suggests oversight of the public mental health system is failing consumers. There are, however, several lessons for regulators on how to ensure consumers enjoy equal protection of the law.

Doing More With Less: A Survey of Economic Precarity, Financial Strain, Burnout, and Secondary Traumatic Stress in Philadelphia’s Public Mental Health System

Background: Efforts to increase the implementation of evidence-based interventions come at a time of rising inequality and cuts to public mental health funding. Clinicians in publicly funded mental health clinics face increased demands, work long hours, experience financial stress, and treat clinically severe, under-resourced patients. A detailed understanding of clinicians' economic precarity, financial strain, and job-related stressors, and an understanding of how these factors relate to treatment delivery, is needed. Methods: In July 2020, we surveyed 49 clinicians working in Philadelphia’s public mental health system who participated in a large-scale trauma-focused cognitive behavioral therapy (TF-CBT) training initiative. Respondents reported on professional burnout, economic precarity, financial strain, secondary traumatic stress, and self-reported use of TF-CBT. We examined associations between clinicians’ economic precarity, job-related stressors, and their TF-CBT use with mixed models. We used content coding to organize open-ended responses into themes.Results: Economic precarity, financial strain, burnout, and secondary traumatic stress among respondents was high. Thirty-seven percent of clinicians were independent contractors, and of those, 44% reported desiring a salaried position. Most clinicians (76%) had outstanding education loans, and of those, 38% reported over $100,000 in education debt. In the last year, 29% of clinicians went without personal mental healthcare due to cost. Most clinicians (73%) endorsed at least one symptom of secondary traumatic stress, with 22% scoring above the clinical cutoff. Education debt was negatively associated with TF-CBT use (p&lt;0.001). Secondary traumatic stress, measured continuously and categorically, was associated with burnout (ps&lt;0.05).Discussion: Clinicians in Philadelphia’s public mental health system experience burnout, economic precarity, financial strain, and secondary traumatic stress, which were associated with TF-CBT use. The economic strain and stress of providing care in under-resourced clinical settings may interfere with ongoing efforts to integrate scientific evidence into mental health services. Financial investment in the mental health workforce is essential.

Editorial reprint: Call for a Canadian Public Mental Health System: Transformative change amid a global pandemic

This Editorial was previously published in the Journal of Concurrent Disorders, https://concurrentdisorders.ca/and is reprinted here with permission of the editor. Original source: Khanlou N. (2020). Editorial: Call for a Canadian Public Mental Health System: Transformative change amid a global pandemic. Journal of Concurrent Disorders, 2(1), 1-2. Available url: https://concurrentdisorders.ca/2020/03/31/call-for-a-canadian-public-mental-health-system/