Intercultural dialogues in times of global pandemics: The Confucian ethics of relations and social organization in Sinic societies

Since COVID-19 is a global-scale pandemic, it can only be solved on the global level. In this context, intercultural dialogues are of utmost importance. Indeed, different models of traditional ethics might be of assistance in constructing a new, global ethics that could help us confront the present predicament and prepare for other possible global crises that might await us in the future. The explosive, pandemic spread of COVID-19 in 2020 clearly demonstrated that in general, one of the most effective tools for containment of the epidemics is precisely human and interpersonal solidarity, which must also be accompanied by a certain degree of autonomous self-discipline. The present paper follows the presumption that these types of personal and interpersonal attitudes are—inter alia— culturally conditioned and hence influenced by different traditional models of social ethics. In light of the fact that East-Asian or Sinic societies were more successful and effective in the process of containing and eliminating the virus compared to the strategies of the Euro-American regions, I will first question the widespread assumption that this effectiveness is linked to the authoritarian political traditions of the Sinic East and Southeast Asian areas. Then, I will critically introduce the Confucian ethics of relations, which in various ways has influenced the social structures of these regions, and clarify the question of whether and in which way the relics of this ethics had an actual effect on the crisis resolution measurements. The crucial aim of this paper is to contribute to the construction of theoretical groundworks for a new, transculturally grounded global ethics, which is more needed today than ever before.

Features and prospects of resolving the political crisis in Venezuela

The purpose of the research is to identify opportunities and prospects for resolving the political crisis in Venezuela proceeding from the current situation in the country. The specifics of the crisis processes in the socio-economic and political spheres, as well as the causes contributing to their deepening are considered. The authors analyze the conflict between the ruling regime and the opposition and the factors impeding the implementation of the political and economic measures pursued by the government to remove the country from the crisis. The authors research the actions performed by the authorities of the Chavist regime in promoting dialogue and seeking compromise both with the political opposition and other immediate parties to the conflict, including secret negotiations, and with the help of mediators. Particular attention is paid to the scenarios of crisis resolution in Venezuela developed by the author of the paper, named "negative", "positive", and "neutral". Each of the scenarios traces the actions of the main opposing forces, their capabilities to resolve the conflict in one or another direction, the involvement of regional and major world states and the possibilities of their implementation to date.

Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study

Background For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams. Objectives To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units. Design Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout. Setting and participants Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England. Results Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15). Limitations In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data. Conclusions Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.

Intrusiveness and Social Media in Mental Health Research: A Reflection. Comment on "Twitter Users’ Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis" (Preprint)

UNSTRUCTURED not applicable

Twitter Users’ Views on Mental Health Crisis Resolution Team Care Compared With Stakeholder Interviews and Focus Groups: Qualitative Analysis

Background Analyzing Twitter posts enables rapid access to how issues and experiences are socially shared and constructed among communities of health service users and providers, in ways that traditional qualitative methods may not. Objective To enrich the understanding of mental health crisis care in the United Kingdom, this study explores views on crisis resolution teams (CRTs) expressed on Twitter. We aim to identify the similarities and differences among views expressed on Twitter compared with interviews and focus groups. Methods We used Twitter’s advanced search function to retrieve public tweets on CRTs. A thematic analysis was conducted on 500 randomly selected tweets. The principles of refutational synthesis were applied to compare themes with those identified in a multicenter qualitative interview study. Results The most popular hashtag identified was #CrisisTeamFail, where posts were principally related to poor quality of care and access, particularly for people given a personality disorder diagnosis. Posts about CRTs giving unhelpful self-management advice were common, as were tweets about resource strains on mental health services. This was not identified in the research interviews. Although each source yielded unique themes, there were some overlaps with themes identified via interviews and focus groups, including the importance of rapid access to care. Views expressed on Twitter were generally more critical than those obtained via face-to-face methods. Conclusions Traditional qualitative studies may underrepresent the views of more critical stakeholders by collecting data from participants accessed via mental health services. Research on social media content can complement traditional or face-to-face methods and ensure that a broad spectrum of viewpoints can inform service development and policy.

Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)

AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.

A narrative literature review of the typology of psychiatric emergency services in the UK

AimsThis study aims to provide a detailed literature review of the different forms of Psychiatric Emergency Services currently available within the UK.Background1 in 6 individuals have one form of mental health disorders. Mental health crisis resulting in an individual requiring access to Psychiatric Emergency Service (PES) can occur at any time. Psychiatric Emergency Service (PES) is described as one that provides an immediate response to an individual in crisis within the first 24 hours. Presently, several PESs are available in the UK with the aim of providing prompt and effective assessment, management and in some cases treatment and/or referral. Over the years, economic and political influences have greatly determined the service delivery models of PES. Indeed, these services vary in name, accessibility, structure, professionals involved, outcomes and many more.MethodElectronic search of five key databases (MEDLINE, PsychINFO, EMBASE, AMED and PUBMED) was carried out to identify various models of PES in the UK. Various combinations of search terms were used and studies which met the inclusion criteria were selected. Studies were included if they were written in English, conducted within the United Kingdom, and described a form of PES. Search was not limited by years and this is to help have a comprehensive overview as well as show changes over time of the various models of psychiatric emergency services. Studies which did not meet any of the criteria detailed above were excluded.ResultIn total, 59 relevant studies were found which identified nine type of PES-Crisis resolution home treatment, police officer intervention, street triage, mental health liaison services in the Emergency Department, psychiatric assessment unit, integrated services, voluntary services and crisis house. There were more papers describing Crisis resolution home treatment services than the others. Furthermore, majority of the papers reported services within England than other countries within the UK.ConclusionAll forms of PES are beneficial, particularly to mental health service users, but not without some shortcomings. There is a need to continue carrying out methodological research that evaluate impact, cost-effectiveness as well as identify methods of optimising the beneficial outcomes of all models of PES. This will inform researchers, educationist, policy makers and commissioners, service users and carers, service providers and many more on how to ensure current and future PES meet the needs as well as aid recovery of mental health service users.

The organization of a mental health phoneline in Buenos Aires City: its role to minimize the impact of mental health services disruption amidst COVID-19 pandemic

AimsThe main concern of this research is to evaluate the performance of a new Mental Health Phoneline Programme, developed to facilitate access to Mental Health Services and to lower the impact of Mental Health Services disruption due to COVID-19 lockdown. Crisis resolution, new referrals, and patients’ reconnection with their former Mental Health Teams were recorded.MethodThe data obtained from 11,406 calls made to the Mental Health Phone Line from April 14th, 2020 to March 1st, 2021 were analysed. Crisis resolutions, new referrals, and patients’ reconnection with their former Mental Health Teams were calculated.ResultOf the 11,406 calls registered, 72.2% of them were made by women. Mean age was 50.13 years, SD 18.51; median: 50. There was a significant difference between gender regarding age (males: mean 43.91 years, SD 18.88; females: mean 52.48 years, SD: 15.9), being the males who used the phoneline younger (t:23.75; p <0.000). 54.2 % of the users lived with a significant other. Crisis resolution represented 12.6 % of the sample, request for information 34.4%, psychosocial interventions 47.6% and, reconnection with former Mental Health Team 4.3%. New referrals for treatment were 2.9% of the total calls. Two main negative affects the74.2% of the total affect reported. Anxiety-Fear accounts for 49.3% of reported feelings and depression a 24.9 %.Conclusion