Suicide postvention in the oil industry: innovation in mental health and care with life in the world of work

Background Within the oil industry work process, risk, technology, confinement and changes in sociability are implied, variables for mental health actions, complexed in the psychosocial coping of the COVID-19 pandemic, involving workers and their families. Attempts or death by suicide, challenge mental health actions, require specialized practices within organizations. This study aims to describe an innovative initiative in occupational health in the oil industry in Brazil, addressing Suicide Postvention in the Workplace. Methods Using an epistemological basis of ‘working with groups’; ‘psychology in emergencies and disasters’; ‘mourning elaboration’, an attempt was made to systematize the specialized intervention in mental health within suicide assistance, workplace adapted. It relates an intervention-action in 5 occurrences during the year 2020, with the participation of an interdisciplinary health team including social workers, psychologists, physicians and nurses. Individual care, group approaches, leaders’ advice and family members’ support, was provided. Results An average of 20 individual consultations were carried out for each occurrence, 7 interventions with groups. In 4 of the cases, direct approaches from the interdisciplinary team with family members were necessary. The implantation allowed to structure the intervention in suicide emergencies; methodological legitimation; ensuring innovation in emergency mental health practice; prevention of contagious suicide; monitoring of critical cases; and continuity of support in mental health through internal and external network. Conclusions The results of the study will serve as input for the construction of a specialized intervention protocol for suicide postvention, constituting an innovation in the care and prevention of mental health problems for oil workers and their families.

Predictors of Stepping Up to Higher Level of Care Among Eating Disorder Patients in a Partial Hospitalization Program

Partial hospitalization programming (PHP) is a treatment option available for individuals with eating disorders (ED) who have made insufficient progress in outpatient settings or are behaviorally or medically unstable. Research demonstrates that this level of care yields efficacy for the majority of patients. However, not all patients achieve recovery in PHP and later admit to a higher level of care (HLOC) including residential treatment or inpatient hospitalization. Although PHP is an increasingly common treatment choice for ED, research concerning outcome predictors in outpatient, stepped levels of care remains limited. Thus, the current study sought to identify the predictors of patients first admitted to PHP that later enter residential or inpatient treatment. Participants were 788 patients (after exclusions) enrolled in adolescent or adult partial hospitalization programs in a specialized ED clinic. When compared to patients who maintained treatment in PHP, a significantly greater proportion of patients who discharged to a HLOC had previously received ED residential treatment. Moreover, patients who discharged to a HLOC were diagnosed with a comorbid anxiety disorder and reported greater anxious and depressive symptomatology. A logistic regression model predicting discharge from PHP to a HLOC was significant, and lower body mass index (BMI) was a significant predictor of necessitating a HLOC. Supplemental programming in partial hospitalization settings might benefit individuals with previous ED residential treatment experience, higher levels of anxiety and depression, and lower BMIs. Specialized intervention for these cases is both practically and economically advantageous, as it might reduce the risk of rehospitalization and at-risk patients needing to step up to a HLOC.

Wicked Problems: An Exploration of Elder Mistreatment Complexity

Elder mistreatment (EM) complexity, while described anecdotally, lacks an empirical foundation for measurement. Improved knowledge on the range and nature of concurrent issues that complicate EM intervention would inform the development of more effective solutions and enable greater precision of evaluation research. The purpose of this qualitative study was to explore factors contributing to complexity in a sample of EM cases that was selected based on difficulty reaching resolution. The sample was drawn from those reviewed by an experienced EM Multidisciplinary team (MDT) and determined to require long-term case management (n=39) beyond the capacity of the MDT’s usual response. Case manager narrative documentation of ongoing assessment and social service records were qualitatively coded by two researchers. Inductive content analysis, with iterative code reconciliation, was used to identify issues and problems both related and concurrent to EM. Eighteen themes and 74 sub-themes emerged, with 93% initial coding agreement between researchers. The most frequent themes were problems with Caregiving (80%), Cognition (80%), Physical Health (80%), Behavioral Health (69%), Socialization (64%), and Finances (62%). Refusal of formal services was common (90%), yet all accepted visitation by the case manager, suggesting informal support may be effective. Diversity, interconnectedness, and emergence of issues along the duration of case management indicates a system approach to intervention design and evaluation is warranted. This research underscores the need for holistic intervention for highly complex EM, and lays the foundation for objective measure of complexity to standardize selection for specialized intervention.

Pediatric Psychology in Emergency Services: a Clinical Practice to Follow in Hospital Context

SiSince the beginning of 2016, the team of the Emergency Service (SU) of the Pediatric Department of the Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (HSM-CHULN), counts with another valence in its intervention plan. Traditionally specialized in an approach of organic pathology, the service is now composed of a specialized intervention of Pediatric Psychology. This paper has the purpose of review, deepen and disclose (i) the psychological intervention model that is used in the SU, focused on babies, children and adolescents, as well as on direct/indirect support to families, at a Physical and Mental Health levels, (ii) the developed work in stress management of the emergency team and (iii) the performance of psychologists in the emergency context, as a way to update the intervention protocols within this practice according to international guidelines. The intervention carried in this SU, in situations of emergency, urgency or crisis, resort from strategies that mitigate and treat the intense cognitive, behavioral and emotional malaise of the pediatric patient and families/caregivers, in a interprofessional perspective and always as a first line resource. Given the increase and clinical relevance of the psychological variables, the inclusion of this specialized area presents itself as a sustainable and important intervention for a practice that we wish to be implemented transversally, contributing to the reduction of outpatient visits, therapeutic prescriptions, number of consultations and frequency of hospitalizations. A pre- and postgraduate training that privilege this type of knowledge and enables the implementation of these intervention models in a larger number of institutions presents itself as a sustained practice of health services.

SOCIAL RESPONSIBILITY AND INDIVIDUAL SECURITY

This paper aims to analyze social responsibility in relation to individual security. Social responsibility contains the mechanisms by which individuals and groups contribute to a collective security when the state institutions specialized intervention is not required. In this context, we will analyze the importance of responsibility for building social protection. The study is a qualitative one. The results highlight that the social responsibility of citizens can be a factor of stability, generator of security and human development. The conclusions highlight, among others, the fact that people interested in their own security are trying to find solutions for preserving the standard of living on the basis of social responsibility.

Urinary catheterization 2: technique and managing failure

Urinary catheterization is an important procedure that is regularly performed in hospital. All clinicians should have a good working knowledge of urinary catheters and the competence to manage them effectively. This topic is discussed over two articles: the first article focused on indications, and this second discusses techniques and managing failure. Good technique is essential to prevent complications and if problems do occur, these must be managed efficiently to prevent long-term consequences. In some situations, this may require referral to the urology team for more specialized intervention. This article discusses this in more detail to help guide clinicians involved in urethral catheterization.

Does Engagement Build Empathy for Shared Water Resources? Results from the Use of the Interpersonal Reactivity Index during a Mobile Water Allocation Experimental Decision Laboratory

Currently, there are no tools that measure improvements in levels of empathy among diverse water stakeholders participating in transboundary decision-making. In this study, we used an existing empathy scale from clinical psychology during an Experimental Decision Laboratory (EDL) where participants allocated water across a transboundary basin during minor and major drought conditions. We measured changes in empathy using a pre-test/post-test design and triangulated quantitative results with open-ended survey questions. Results were counter-intuitive. For most participants, levels of the four components of empathy decreased after participating in the EDL; however, significant demographically-driven differences emerged. Qualitative results confounded the problem through the capture of participant perceptions of increased overall empathy and perspective taking specifically. Implications for methodological tool development, as well as practice for water managers and researchers are discussed. Water empathy is a particularly sensitive construct that requires specialized intervention and measurement.