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In this paper we introduce the Intensive Mobile Treatment (IMT) model, which arose from a 2016 New York City initiative to engage individuals who were "falling through the cracks" of the mental health, housing, and criminal justice systems. People who are referred to IMT often have extensive histories of trauma. They experience structural racism and discrimination within systems and thus can present as distrustful of treatment teams. We detail the structure of the program as we practice it at our non-profit agency and outline the psychodynamic concepts that inform our work with challenging populations. We acknowledge IMT's role in engaging in advocacy and addressing social justice in our work. We also discuss how through this model we are able to both mitigate and tolerate risk in participants with difficult-to-manage behaviors. This is typically a long-term, non-linear process. We address how this impacts the team dynamic as a whole and explain how with long-term, trusting therapeutic relationships, participants can change and grow over time. We also explain the ways in which our non-billing model plays an integral role in the treatment we are able to provide and identify several challenges and areas for program growth. In outlining our model and its methodology, we hope to empower other practitioners to adapt IMT to other settings beyond the New York City area. [ABSTRACT FROM AUTHOR]

Deaths by overdose and suicide have been steadily rising, yet efforts to jointly address them have been limited despite shared risk and protective factors. The purpose of this study was to explore ways of jointly addressing these two significant public health issues at the community level. To accomplish this goal, we distributed an electronic survey via email to all 58 Local Mental Hygiene Directors (LMHDs) and 184 substance use and 57 suicide prevention coalition leads in New York State in March 2019 to better understand attitudes, perceptions, and practice of community-based overdose and suicide prevention. A total of 140 unique individuals completed the survey for a 47% usable response rate. Participants overwhelmingly reported that suicide and overdose are preventable and that individuals with risky substance use would benefit most from suicide prevention services compared to other populations. In addition, substance use prevention coalition leads reported less awareness of key suicide prevention programs than suicide prevention coalition leads and LMHDs; LMHDs were generally most familiar with suicide prevention programs. Finally, substance use and suicide prevention coalition leads were interested in collaborating to raise awareness, provide training, and implement community-based activities. These findings demonstrate a consensus among county leadership and substance use and suicide prevention coalition leads that suicide and overdose are prevalent in their communities and that increased collaboration to address these two public health issues is warranted. Results suggest a need for education, training, and technical assistance to support collaboration. [ABSTRACT FROM AUTHOR]

Clinical pathways are structured multidisciplinary care plans used by treatment providers to detail essential steps in the care of patients based on assessment of their current health care needs and motivation and commitment for treatment. Reducing unnecessary variations in care and streamlining treatment processes in mental health settings may promote efficiency and help support quality improvement efforts. (Rotter et al., 2019) In this article we will describe the development of clinical pathways, coined Patient Centered Clinical Tracks (PCCT) in an outpatient community mental health clinic in an academic medical center in New York City. PCCT is comprised of six different clinical pathways that include: Medication & Engagement, Supportive Therapy, Dialectal-Behavior Therapy, Cognitive-Behavioral Therapy/Acceptance Commitment-Therapy, Relational Therapy and THRIVE (a Trauma Specialty Program). We will present the six Clinical Tracks and describe the early implementation of this model. We will explore how this programmatic infrastructure can connect evidence to practice and address multiple systemic challenges faced in a community mental health setting with a strong emphasis on training. [ABSTRACT FROM AUTHOR]

Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p <.0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities. [ABSTRACT FROM AUTHOR]

This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention. [ABSTRACT FROM AUTHOR]

Mental health and suicide are serious concerns in the U.S. Though many adults report struggling with their mental health, a significant proportion do not receive care for various reasons including stigma, limited availability, long wait times, inability to pay, and a lack of culturally appropriate options. Helplines can be used to fill gaps in care and, though currently underutilized, are a significant focus of the federal government in the implementation of 988. To better understand the factors that facilitate and impede the utilization of helplines, we conducted 14 focus groups with 95 college students attending a public university and two private colleges in upstate New York between April 2019 and October 2020. Participants included undergraduates, graduate students, LGBTQIA + students, student-athletes, and international students. Participants shared several reasons for using helplines including convenience, comfort, immediate support, and privacy and anonymity. On the other hand, participants expressed hesitation as they expected ingenuine interactions with operators and a lack of continuity, they feared police involvement, and they felt that helplines are not for them, as they are marketed for those in a mental health or suicide crisis and their issues are not that severe. LGBTQIA + participants provided additional reasons as to why they use and do not use LGBTQIA+-specific helplines. Together, our findings suggest the need for improved education, marketing, and training around helplines and may be used to inform the implementation and promotion of 988 in its early stages. [ABSTRACT FROM AUTHOR]