Improving medical residents’ utilisation of integrated mental health in primary care

BackgroundIntegration of mental health services allows for improved prevention and management of chronic conditions within the primary care setting. This quality improvement project aimed to increase adherence to and functioning of an integrated care model within a patient-centred medical home. Specifically, the project focused on improving collaboration between Primary Care Mental Health Integration (PC-MHI) and the medical resident Patient Aligned Care Teams (PACT) at a Veterans Affairs Medical Center in Northport,New York (VAMC Northport).MethodThe project used increased education, training and relationship building among the medical resident PACTs, and the establishment of regularly occurring integrated team meetings for medical and mental health providers. Education of residents was measured with a self-assessment pre-training and post-training, while utilisation was measured by the percentage of patients currently on a PACT’s panel with at least one PC-MHI encounter in the last 12 months (known in VAMC Northport as PACT-15 metric).ResultsTwo resident PACTs that received both training and weekly integrated meetings increased their utilisation of integrated mental health services by 3.8% and 4.5%, respectively. PACTs that participated in training only, with no regular meetings, showed an initial improvement in utilisation that declined over time.ConclusionsTraining alone appeared beneficial but insufficient for increased integration over time. The addition of a regularly occurring integrated weekly meeting may be a critical component of facilitating sustained mental health integration in a primary care medical home model.

Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran

Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presented Method: This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed. Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed. Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

RMIT together: An integrated mental health promotion campaign designed to build wellbeing and connection during the COVID-19 pandemic.

With the unfolding COVID-19 pandemic, physical distancing requirements and new psychosocial risks, the RMIT Wellbeing team andleaders in the community focussedon responding to the changing needs of students and staff. Communication of reliable, timely and evidence-based information through the lens of mental health and wellbeing was a top priority. The ‘RMIT Together’ campaign was designed to bring the whole community together, creating new online groups to foster peer connection and coping skills development. This case study demonstrates the various functions and wellbeing benefits that mental health and wellbeing promotion, prevention and education can play during periods of unforeseen life-changing global stress. It also demonstrates the sustainability of such interventions to build community resilience and mental wellbeing.

Mental health interventions in an Italian prison: the Parma integrated approach

Purpose Mental health interventions for Italian prisoners with mental disorders remain a problematic issue, despite radical changes in general psychiatric care and a 2008 major government reform transferring mental health care in prison to the National Health Service. The aim of this study is to describe the mental health intervention model implemented since January 2020 for prisoners allocated in the Parma Penitentiary Institutes (PPI). This approach is specifically based on specialized, “person-centered” and “person-tailored” therapeutic-rehabilitation plans in line with psychiatric treatments usually provided in community mental health-care centers of the Parma Department of Mental Health. Design/methodology/approach All the processes and procedures included in the PPI intervention model were first carefully illustrated, paying special attention to the service for newly admitted prisoners and each typology of specialized therapeutic-rehabilitation treatment potentially provided. Additionally, a preliminary descriptive process analysis of the first six months of clinical activity was also performed. Findings Since January 2020, 178 individuals entered the PPI service for newly admitted prisoners. In total, 83 (46.7%) of them were engaged in the services of the PPI mental health-care team (35 with pathological addiction and 48 with mental disorders): 56 prisoners were offered an integrated mental health intervention and 27 exclusively an individual psychological or psychiatric treatment. Originality/value The results support the potential applicability of an integrated mental health intervention in prison, planning a person-tailored rehabilitation in close collaboration with the prisoners, their families and the local mental health/social services.

Suicide behavior among patient with mental disorder

Suicide is an act consciously taken by a person to end his life. The phenomenon of suicide in Indonesia is increasingly worrying. Indonesia, as a country that adheres to a culture of collectivity, also has a high suicide rate. WHO estimates that in 2020 the suicide rate in Indonesia could reach 2.4 percent of 100,000 people if it does not get serious attention from various parties.Suicide is one of the effects of mental disorders that are in the global spotlight today. This study aims to describe suicidal behavior in patients with mental disorders. This is a descriptive study. The research subjects were schizophrenic they were treated in the Installation of Integrated Mental Health Service in Banyumas Hospital. The data were collected using the Self Harm Behavior questionnaire. Result of the study is suicidal behavior are the desire to die, trying with sharp objects, hitting selves, hitting glass and drinking poisonous substance, and jumping from high building.