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Introduction: Major depression and alcohol use disorder affect millions of individuals worldwide and cause significant disability. They often occur together, and their co-occurrence is associated with more negative outcomes than each disorder on its own. Yet, there is a lack of knowledge on how to best treat co-occurring depression and alcohol use disorder. A pilot study was conducted to investigate the feasibility, credibility, patient satisfaction, preliminary effect, and potential negative effects of an integrated treatment for depression and alcohol use disorder, which has shown promising results in an earlier pilot trial. Methods: The study was conducted at an outpatient unit in Stockholm, Sweden. Women (n=7) with current depression and alcohol use disorder were offered integrated group treatment that included evidence-based treatment for depression and alcohol use disorder. Criteria for feasibility were based on an earlier study, treatment credibility was measured using the Credibility/Expectancy Questionnaire and patient satisfaction with the Client Satisfaction Questionnaire. Results: Feasibility, credibility, and patient satisfaction were high. Depression symptom severity and alcohol consumption decreased from baseline to follow up. Negative effects were reported in terms of increased adverse emotional experiences. Discussion: The investigated integrated treatment for co-occurring depression and alcohol use disorder continues to show promise. Randomized clinical trials are needed to evaluate its effectiveness. [ABSTRACT FROM AUTHOR]

Background: In 2019, nearly one billion individuals worldwide were estimated to be living with some form of mental illness. This staggering figure underscores not only the widespread prevalence of mental health issues but also their significant negative impact. Despite the critical impact of mental health problems, there is a substantial gap in treatment at the global scale. Particularly in rural Ethiopia, there is a notable lack of data regarding the use of mental health services by community residents. This study was conducted with the aim of evaluating the utilization of mental health services and identifying factors that influence access to these services among the population of rural southern Ethiopia. Methods: A community-based cross-sectional study was conducted on randomly selected adults in southern Ethiopia. A semi-structured questionnaire assessing the sociodemographic status of the participants was used. Depression and anxiety were measured with the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorders Scale (GAD-7), respectively. The data were then analyzed using StataMP version 18. Statistical tests such as frequency, percentage, mean, bivariate logistic regression, and multivariate analysis were performed. P values and confidence intervals were used to determine statistical significance. Results: A total of 971 participants were enrolled in this study, and the mean age was 34.9 (± 11) years. A minority of the participants (152 [15.5%]) sought some form of help for mental health-related reasons. Only 24 (2.5%) of the participants used biomedical mental health services. The perceived need for any mental health service was 96 (9.9%). Thirty-three percent of the respondents with mild to moderate depression and 37.1% of those with severe depression sought care for their concerns. Similarly, 37% and 35% of individuals with mild to moderate anxiety and severe anxiety, respectively, utilized mental health services. A higher monthly income, psychoactive substance use, perceived need, and symptoms of depression and anxiety were significantly associated with mental health service utilization. Conclusion: Our study revealed a significantly low level of utilization of mental health services among the residents of rural southern Ethiopia. More efforts to address the treatment gap for mental health problems in the country are needed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to conduct an in-depth survey of psychiatric care provided for children and young people (CYP) in general hospital settings in New Zealand (NZ). Method: As part of a larger national survey of Consultation-Liaison Psychiatry (CLP) services across the lifespan, a 44-question survey was emailed to clinicians who were involved in providing psychiatric care for CYP at each of the 24 public general hospitals with specialist paediatric services. Results: Responses were obtained from all four paediatric CLP teams that cover the four specialist children's hospitals, and 16 of the 23 child and adolescent community mental health services that provide hospital inreach. These services were found to be under-resourced, utilise variable service models, and rely heavily on inreach. Conclusion: Escalating presentation rates for young people and increasingly complex paediatric presentations pose major challenges for the psychiatric care of CYP in general hospital settings. Utilising international staffing standards and service models, proposals are made to evolve more consistent and effective paediatric CLP services in NZ. [ABSTRACT FROM AUTHOR]

Aims and method: Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. Results: Recent literature proposes a Safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted. Clinical implications: Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare. [ABSTRACT FROM AUTHOR]

Background: The events of October 7, 2023, and the subsequent war have starkly exposed the shortcoming of Israel's public mental health system. This system, already strained by years of underfunding and the COVID-19 pandemic, was unprepared for the surge in mental health needs resulting from these traumatic events. This paper outlines the systemic failures and proposes a comprehensive overhaul reform towards an integrative community-based, recovery-oriented mental health service. Main body: Israel's mental health crisis is exacerbated by four converging vectors: a global diagnostic crisis in psychiatry, insufficient biological treatments, chronic underfunding, and a fragmented service model. Diagnostic practices, centered on outdated classifications, fail to address the complexity of severe mental illnesses, resulting in imprecise diagnoses and insufficient treatments. Despite the advent of psychopharmacology, significant advancements in drug efficacy are lacking, with recovery rates stagnating or declining. Financially, mental health in Israel receives only 5.2% of the health budget, far below the 10–16% seen in high-GDP Western countries. The community mental health services reform in 2015 lack effective oversight and incentives, leading to long wait times and inadequate care. Additionally, the fragmentation among funding entities—HMOs, Ministry of Health, and Ministry of Welfare—hampers coordinated care and comprehensive service delivery. Conclusion: The proposed solution involves shifting from a hospital-biomedical -based to an integrated community-based model, emphasizing recovery over symptom management, based on regional mental health centres as hubs of services. This requires significant investment in community mental health teams, crisis intervention, home treatment, and integrated services. Early intervention, technology utilization, economic incentives for community-based care, and patient and family involvement are crucial components. This transformation aims to create a holistic, efficient, and patient-centered mental health system, better equipped to handle future challenges and reduce the societal and economic burdens of mental illness in Israel. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsPeople living in supported accommodation often have complex care needs, including longer-term mental health illness and physical health comorbidities. Effective coordination between health and supported accommodation services is crucial to address these needs. However, evidence on the effectiveness of healthcare interventions in this setting remains limited. This study assesses the effectiveness of a multidisciplinary outreach intervention providing on-site healthcare for people living in supported accommodation on outcomes related to antipsychotic prescribing and physical co-morbidity.A mirror-image study was conducted to assess changes between pre- and post-service periods. Pre-index outcomes were collected as a cross-sectional measure in September 2020, and post-index outcomes were collected every six months until October 2022. People living at two supported accommodation services in the Capital Region of Denmark were included.The study included 74 people living in supported accommodation with contact to a multidisciplinary outreach team. The introduction of a multidisciplinary outreach team had no significant effect on antipsychotic prescription patterns, including antipsychotic polypharmacy, high-dose regimens, and combinations with benzodiazepines. The physical health evaluations identified a notable number of participants with untreated or dysregulated physical illness.This multidisciplinary outreach intervention for people living in supported accommodation had limited effect on antipsychotic prescribing patterns within the observation period. However, the outreach team identified and managed physical illness for a substantial portion of the study population, highlighting the importance of integrating physical health care into mental health interventions. [ABSTRACT FROM AUTHOR]

Background: Individuals with serious mental illness (SMI) have disproportionately high rates of criminal legal system involvement. For many, this becomes a repeated cycle of arrest and incarceration. Treatments that address symptoms of mental illness are a critical component of the continuum of services for people with SMI in the legal system; yet on their own, psychiatric treatments have not been successful at reducing criminal legal system involvement for this population. Research suggests that criminogenic risk factors, the major drivers of criminal legal system involvement, are disproportionately prevalent among individuals with SMI. However, promising criminogenic-focused interventions have only just begun to be adapted for individuals with SMI. The proposed study will examine the capacity of Forging New Paths (FNP), a novel criminogenic-focused group intervention developed for individuals with SMI, to engage its primary and secondary outcomes when delivered in community mental health settings. Methods: The proposed pilot study will engage a small-scale clinical trial comprising three cycles of FNP delivered in a community mental health center in a Southeastern state in the U.S. The anticipated total sample size is N = 72 and will consist of community-dwelling adults with SMI who have a moderate or higher criminogenic risk level and a history of criminal legal system contact. This study will examine the extent to which FNP is able to engage its primary (aggression and community tenure) and secondary (criminal attitudes and impulsivity) treatment outcomes. Discussion: FNP provides an important new service for community-based mental health settings to reduce criminal legal system involvement (and recidivism) among the individuals they serve with SMI. Clinical Trial Registration: NCT06290648. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to evaluate, both comparatively and longitudinally, the effects of receiving services from community mental health centers on the stigma levels of patients and relatives and the burden of care for patients with severe mental illness. Methods: The study was planned to be conducted on patients with severe mental illness [schizophrenia spectrum disorders (SSDs) and bipolar disorder (BD)] and their relatives, followed by the community mental health center (CMHC group) and the outpatient clinic (outpatient group). It was planned to provide psychoeducation to relatives once a month for 2 h; meetings with the case manager at least once every 2 weeks; and psychosocial interventions (social inclusion, daily life activities studies, etc.) and psychoeducation for 2 h once a week for the patients. The Internalized Stigma of Mental Illness Scale (ISMI) was applied to the patients; the Zarit Caregiver Burden Scale (ZCBS) and the Self-Stigma Inventory for Families (SSI-F) were applied to the relatives at the beginning of the study, at the 6th and 12th month. Results: The study was completed with 53 patients from the CMHC group (number of patients with SSDs = 39, number of patients with BD = 14) and 60 patients from the outpatient group (number of patients with SSDs = 45, number of patients with BD = 15). In the CMHC group, in patients with SSD, there was a statistically significant decrease in ISMI (p < 0.001), ZCBS (p < 0.001), and SSI-F (p < 0.001) scores at the end of the 12th month. In the outpatient group, in patients with SSD, there was no statistically significant decrease in ISMI (p = 0.948), ZCBS (p = 1.000), and SSI-F (p = 1.000) scores at the end of the 12th month. In the CMHC group, in patients with BD, there was a statistically significant decrease in ISMI (p = 0.002), ZCBS (p < 0.001), and SSI-F (p < 0.001) scores at the end of the 12th month. In the outpatient group, in patients with BD, there was no statistically significant decrease in ISMI (p = 0.645), ZCBS (p = 0.166), and SSI-F (p = 0.142) scores at the end of the 12th month. Discussion: The results of our study suggest that multidimensional assessments of patients and their families, efforts to promote social participation, support for self-management in daily life, and psychoeducation may be helpful in reducing stigma and burden. [ABSTRACT FROM AUTHOR]

Introduction: Mental health disorders significantly impact global health, yet they remain a low priority in many Low-and-Middle-Income Countries (LMICs), including India. The role of Accredited Social Health Activists (ASHAs) is crucial in bridging the gaps in Mental Health Literacy (MHL) care. Aim: To assess the MHL of ASHAs and to determine any association between MHL scores and the socio-economic and socio-demographic determinants of the study participants. Materials and Methods: This mixed-method study was conducted in the Barrackpore II block of the North 24 Parganas district, West Bengal, India between July and September 2023. A cross-sectional descriptive approach was used for the quantitative segment, while two Focused Group Discussions (FGDs) were conducted for the qualitative component. The sample size was 67, selected by simple random sampling. Socio-economic and socio-demographic data were collected using a standardised validated questionnaire, and MHL data were gathered using the revised Mental Health Literacy Scale (MHLS) questionnaire. FGDs were conducted using a pretested, predesigned FGD guide. Data were analysed using Jamovi (v2.4.8). An Independent samples t-test was performed, with p-value <0.05 considered significant. Results: The mean age of participants was 37±13.5 years, with 70.1% being Hindus and 47.8% being unreserved. The MHL score ranged from 50 to 115. The Independent samples t-test revealed a statistically significant difference in means between the two age groups (less than 38 years vs. 38 years or older). There was also a statistically significant difference in MHL scores between the two caste categories (p-value=0.006) and among different years of work experience (p-value <0.001). FGDs revealed low mental health awareness among ASHAs and villagers. Conclusion: The MHL status of ASHAs was low, mainly due to a lack of training. Further research and training for healthcare workers are needed to improve MHL. [ABSTRACT FROM AUTHOR]

Purpose: Limited data exists on the relationship between sociodemographic and cultural variables and the prevalence of specific mental and substance use disorders (MSDs) among Indigenous Australians, using diagnostic prevalence data. This paper utilises data from the Queensland Urban Indigenous Mental Health Survey (QUIMHS), a population-level diagnostic mental health survey, to identify socioeconomic and cultural correlates of psychological distress and specific MSDs in an urban Indigenous Australian sample. Methods: Using a mixture of household sampling (door-knocking) and snowball sampling (promotion of the survey in the community), 406 participants aged 18 to 89 were recruited across key locations in Southeast Queensland. The study investigated various demographic, socioeconomic, and cultural factors as predictors of psychological distress (measured by the Kessler-5) and MSD diagnoses (utilising the Composite International Diagnostic Interview, CIDI 3.0) using a series of univariate logistic regressions. Results: Individuals in unstable housing (homeless, sleeping rough) and those reporting financial distress were more likely to experience an MSD in the past 12 months and throughout their lifetime. Individuals reporting lower levels of connection and belonging, limited participation in cultural events, and lower empowerment were more likely to have a lifetime mental disorder. Conclusion: This data emphasises the importance of addressing systemic and social determinants of health when designing and delivering community mental health services and underscores the need for holistic approaches when working with Indigenous communities. [ABSTRACT FROM AUTHOR]

Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color. [ABSTRACT FROM AUTHOR]

Considering the elevated cancer mortality in individuals with psychiatric conditions, possibly associated with late diagnosis, this study investigated cancer screening participation rates among patients under the care of four Trieste community mental health centers (CMHCs). We conducted a retrospective cohort study on 1252 individuals with psychiatric disorders, retrieving their electronic health records up to December 2019. The study assessed participation rates in breast, cervical, and colorectal cancer screening programs. We explored differences in demographic and clinical characteristics of participants versus non-participants in screening programs. Patients with psychiatric conditions had lower screening participation rates compared to the general population of Trieste. The rates for breast and cervical cancers were approximately one-third lower, whereas the rate for colorectal cancer was halved. Psychiatric diagnosis influenced participation in breast cancer screening, with patients having anxiety disorders more likely to participate than those suffering from schizophrenia or disorders of adult personality and behavior. Age, nationality, marital status, employment status, and living situation all affected adherence to cervical cancer screening. Individuals who participated more frequently were in the 35–54 age range, of Italian nationality, employed, and had a family of their own. Conversely, non-participants were more likely to be widowed or unmarried. Finally, among patients eligible for colorectal cancer screening, those who participated were more likely to have a family of their own and have a diagnosis of affective or anxiety disorders, while those who did not adhere to the programs were more commonly widowed and had a higher frequency of diagnosis of schizophrenia or disorders of adult personality and behavior. Mental health services should focus on increasing patients' participation in cancer screening programs in order to improve their physical health and reduce mortality. This intervention could contribute to promoting equitable access to preventative care and to bridging the gap between mental health and general medical services. • People with psychiatric disorders have lower participation rates in cancer screening programs compared to the general population. • Lowest participation rates were found in subjects suffering from schizophrenia or disorders of adult personality and behavior. • Certain sociodemographic and clinical factors are important to take into account in order to increase participation rates. [ABSTRACT FROM AUTHOR]

Background and Purpose Sexual minority individuals are at a higher risk of developing several negative health outcomes, such as substance abuse, depression, and anxiety. Meyer's minority stress theory is popularly employed to understand how social stigma and constructed sexual minority communities' unfriendly social conditions affect the health of sexual minority individuals. Based on heteronomativity, sexual minority individuals' desires or identities are silenced, ignored, denied, or labelled as abnormal. Therefore, they may develop tendencies toward self-denial or selfsuppression. These conditions lead to different types of minority stressors for sexual minorities. According to this theory, minority stressors include general, distal, and proximal stressors. However, Meyer suggested that sexual minority individuals develop resilience to buffer the influence of minority stressors. In summary, it is essential to investigate the relationships among perceived discrimination, resilience, internalized sexual stigma (ISS), rumination, and physical or psychological health among male sexual minority individuals. This study examined the joint and interactive effects of perceived discrimination and resilience on ISS, brooding rumination, and physical and psychological health among male sexual minorities in Taiwan. This study also examined the role of ISS and brooding rumination as mediators between perceived discrimination and health and resilience as a moderator of the relationship between perceived discrimination and ISS, rumination, and health. Methods This study administered a cross-sectional online survey distributed on social networking pages and sexual minority community groups between January and June 2021. The respondents were recruited through online advertisements and an online survey. This survey assessed discrimination using the Discrimination/Harassment subscale of the Daily Heterosexist Experiences Questionnaire. ISS was measured using the short version of the Measure of Internalized Sexual Stigma for Lesbians and Gay Men. Further, brooding rumination was assessed using the short version of the Ruminative Response Scale. Furthermore, resilience was measured using the Resilience Scale, and health was assessed using four questions from a questionnaire designed to determine physical and mental health problems in sexual minority communities. Pearson's correlation coefficient was used to calculate the correlations between distal and proximal minority stressors, brooding rumination, resilience, and health. We used a series of path analyses to test the relationships hypothesized in the moderated mediation model to determine the significance of the direct and indirect effects. Result A total of 242 male sexual minority individuals aged 18–70 years (M = 34.47, SD = 9.84) participated in this survey. The average Daily Heterosexist Experiences Questionnaire score was 0.78 (out of 6). The average score on the Internalized Sexual Stigma is 2.57 (out of 5). Moreover, the average score on the Brooding Ruminative Response Scale's short version was 2,49 (out of 4). The average score on the resilience Scale was 5.17 (out of 7), and the average health score was 3.32 (out of 5), respectively. Regression analyses indicated that (1) discrimination experience, internalized sexual stigma, and rumination were negatively related to physical or psychological health, (2) resilience was positively related to physical or psychological health, (3) discrimination experience was positively related to internalized sexual stigma and rumination, and (4) resilience was negatively related to internalized sexual stigma and rumination. The mediating roles of internalized sexual stigma and rumination in the relationship between discrimination and health, as well as the moderating role of resilience, were partly significant. Conclusions The findings demonstrate that relationships among discrimination, resilience, internalized sexual stigma, rumination, and physical or psychological health among male sexual minorities did exist. The findings also showed that the mediators and moderators used to evaluate the effects of minority stress on health were useful. Some issues and suggestions were discussed to help mental health practitioners provide more appropriate services to male sexual minority individuals. Furthermore, culturally sensitive research in the field of sexual minority health is required. [ABSTRACT FROM AUTHOR]

Objective: The authors aimed to examine how certified community behavioral health clinics (CCBHCs) fulfill crisis service requirements and whether clinics added crisis services after becoming a CCBHC. Methods: National survey data on CCBHC crisis services were paired with data on clinic features and the demographic and socioeconomic characteristics of the counties within a CCBHC service area. The dependent variables were whether CCBHCs provided the three categories of CCBHC crisis services (i.e., crisis call lines, mobile crisis response, and crisis stabilization) directly or through another organization and whether these services were added after becoming a CCBHC. Descriptive statistics and multivariable logistic regression analyses were performed with data about clinics and the counties they served. In total, 449 CCBHCs were surveyed in the summer of 2022, with a response rate of 56%. The final sample comprised 247 clinics. Results: The number of CCBHC employees per 1,000 people within a CCBHC service area was significantly and positively associated with clinics providing some crisis services directly (mobile crisis response: adjusted OR [AOR]=1.46, 95% CI=1.08–1.98; crisis stabilization services: AOR=1.60, 95% CI=1.17–2.19). Compared with clinics that did not receive a CCBHC Medicaid bundled payment, clinics that received this payment had higher odds of adding mobile crisis response (AOR=2.52, 95% CI=1.28–4.97) and crisis stabilization services (AOR=3.19, 95% CI=1.51–6.72) after becoming a CCBHC. Conclusions: CCBHC initiatives, particularly CCBHC Medicaid bundled payments, may provide opportunities to increase the availability of behavioral health crisis services, but the sufficiency of this increase for meeting crisis care needs remains unknown. [ABSTRACT FROM AUTHOR]

Objective: Faith communities are increasingly providing services to address the mental health needs of their congregations and communities. However, many feel limited in their capacity to address serious illness and experience challenges to collaborating with the mental health sector. To inform the development of faith community–mental health sector partnerships, the authors conducted a scoping review to assess the characteristics and evidence base of partnership approaches to addressing mental health needs. Methods: A search of four databases identified peer-reviewed articles published between 2010 and 2023 on faith community–mental health sector partnerships in the United States. Results: In total, 37 articles representing 32 unique partnerships were reviewed. Most partnerships (N=19) used multicomponent approaches, particularly involving training the faith community (N=18), mental health education for the broader community (N=14), and direct counseling (N=11). Many partnerships (N=14) focused on African American communities. Partnerships that included an evaluation component (N=20) showed promising findings for improving mental health symptoms, mental health literacy, stigma, and referrals, among other outcomes. Several articles reported facilitators (e.g., support from faith leaders and reciprocal relationships and equal power) and barriers (e.g., limited time and funding and differing interests and attitudes) to developing partnerships. Conclusions: The findings highlight how faith communities can be a critical partner in providing services across the continuum of mental health care and reveal the need for more rigorous evaluations of the effectiveness, feasibility, and sustainability of these partnerships. The results also identify strategies that may facilitate the development and strengthening of future faith community–mental health partnerships. [ABSTRACT FROM AUTHOR]

Objective: Adults with serious mental illness have high rates of tobacco use disorder and underuse pharmacotherapy for tobacco cessation. In a previous randomized controlled trial, participants receiving community health worker (CHW) support and education for their primary care providers (PCPs) had higher tobacco abstinence rates at 2 years, partly because of increased initiation of tobacco-cessation pharmacotherapy. The authors aimed to determine the association between CHW-participant engagement and tobacco abstinence outcomes. Methods: The authors conducted a secondary, mixed-methods analysis of 196 participants in the trial's intervention arm. Effects of the number and duration of CHW visits, number of smoking-cessation group sessions attended, and number of CHW-attended PCP visits on initiation of tobacco-cessation pharmacotherapy and tobacco abstinence were modeled via logistic regression. Interviews with 12 CHWs, 17 patient participants, and 17 PCPs were analyzed thematically. Results: Year 2 tobacco abstinence was significantly associated with CHW visit number (OR=1.85, 95% CI=1.29–2.66), visit duration (OR=1.51, 95% CI=1.00–2.28), and number of group sessions attended (OR=1.85, 95% CI=1.33–2.58); effects on pharmacotherapy initiation were similar. One to three CHW visits per month across 2 years were optimal for achieving abstinence. Interviews identified CHW-patient engagement facilitators (i.e., trust, goal accountability, skills reinforcement, assistance in overcoming barriers to treatment access, and adherence). Training and supervision facilitated CHW effectiveness; barriers included PCPs' and care teams' limited understanding of the CHW role. Conclusions: Greater CHW-participant engagement, within feasible dose ranges, was associated with tobacco abstinence among adults with serious mental illness. Implementation of CHW interventions may benefit from further CHW training and integration within clinical teams. [ABSTRACT FROM AUTHOR]

Background: Rural older adults experience a high burden of depressive symptoms and significant barriers to accessing mental health services. The Modified Behavioral Activation Treatment (MBAT) has been verified to be effective among rural older adults in China. Due to its structured format and skill-based learning, it is well suited for digital-based delivery. However, only a few studies were from developed countries, and the evidence to support its application in rural China still needs to be provided. Thus, based on the fact that digital health technology has the potential to address the shortage of healthcare resources and the constraints of community mental health services in rural China, the effectiveness of the digital MBAT (D-MBAT) program among rural older adults is worth further evaluation. Methods: A multi-center randomized controlled trial will be conducted among 216 rural older adults from Huayuan County and Fenghuang County in Western Hunan. The intervention group will receive the D-MBAT program, while the control group will receive routine care. Depressive and anxiety symptoms, social health, quality of life, and satisfaction will be measured at baseline, one-month, and three-month follow-ups to evaluate the digital MBAT program's effectiveness. Discussion: Existing digital psychological intervention strategies seldom take into account the needs and preferences of the older adults in low-resource rural areas. Thus, this study aims to develop a D-MBAT program based on person-centered and community-engaged approach to maximize the mental health service of rural older adults with depressive symptoms.A successful D-MBAT program would be a feasible and scalable approach to the management of prevalent mental health conditions of rural older adults in resource-limited Western Hunan. Trial registration: Chinese Clinical Trial Registry ChiCTR2400091193. Registered on 23 October 2024. [ABSTRACT FROM AUTHOR]

Background: Youth involved in the legal system have disproportionately higher rates of problematic substance use than non-involved youth. Identifying and connecting legal-involved youth to substance use intervention is critical and relies on the connection between legal and behavioral health agencies, which may be facilitated by learning health systems (LHS). We analyzed the impact of an LHS intervention on youth legal and behavioral health personnel ratings of their cross-system collaboration. We also examined organizational climate toward evidence-based practice (EBP) over and above the LHS intervention. Methods: Data were derived from a type II hybrid effectiveness trial implementing an LHS intervention with youth legal and community mental health centers (CMHCs) in eight Indiana counties. Using a stepped wedge design, counties were randomly assigned to one of three cohorts and stepped in at nine-month intervals. Counties were in the treatment phase for 18 months, after which they were in the maintenance phase. Youth legal system and CMHC personnel completed five waves of data collection (n=307 total respondents, ranging from 108-178 per wave). Cross-system collaboration was measured via the Cultural Exchange Inventory, organizational EBP climate via the Implementation Climate Scale and Implementation Citizenship Behavior Scale, and intervention via a dummy-coded indicator variable. We conducted linear mixed models to examine: 1) the treatment indicator, and 2) the treatment indicator and organizational EBP climate variables on cross-system collaboration. Results: The treatment indicator was not significantly associated with cross-system collaboration. When including the organizational EBP climate variables, the treatment indicator significantly predicted cross-system collaboration. Compared to the control phase, treatment (B=0.41, standard error [SE]=0.20) and maintenance (B=0.60, SE=0.29) phases were associated with greater cross-system collaboration output. Conclusions: The analysis may have been underpowered to detect an effect; third variables may have explained variance in cross-system collaboration, and, thus, the inclusion of important covariates may have reduced residual errors and increased the estimation precision. The LHS intervention may have affected cross-system collaboration perception and offers a promising avenue of research to determine how systems work together to improve legal-involved-youth substance use outcomes. Future research is needed to replicate results among a larger sample and examine youth-level outcomes. Trial registration: Clinicaltrials.gov identifier: NCT04499079. Registered 30 July 2020. https://clinicaltrials.gov/study/NCT04499079. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction and Aim Method Results Implications for Practice This study aimed to assess the relationship between treatment adherence, internalised stigma, recovery and the mediating effect of internalised stigma on these relations in individuals diagnosed with schizophrenia.This study was conducted using a cross‐sectional design. A purposive sample of 107 individuals diagnosed with schizophrenia receiving psychiatric outpatient care at outpatient clinics and community mental health services (CMHC) affiliated with SBU Van research and education hospital was recruited for this study. The data were collected by the following tools: sociodemographic data questionnaire, the internalised stigma in mental illnesses scale, the medication adherence rating scale and recovery assessment scale.The study participants reported low levels of treatment adherence, high levels of internalised stigma and moderate levels of recovery. Furthermore, we found a weak negative correlation between internalised stigma and treatment adherence. There was a moderate negative correlation between internalised stigma and recovery. Additionally, it was found that internalised stigma has fully mediating effect on the relation between treatment adherence and recovery.The results of this study can guide mental health nurses in developing tailored interventions and support programmes to improve this population's treatment adherence, recovery and overall mental health outcomes. [ABSTRACT FROM AUTHOR]

Background: We investigated the relationship between neighbourhood income quintile and mental health service use by immigration experience among youth and explored changes during the COVID-19 pandemic. Method: We used administrative data to examine mental health service use among youth aged 10 to 24 in British Columbia, Canada, between April 1, 2019, and March 31, 2022. We compared rates of community-based mental health service use, emergency department visits, and hospitalizations and the proportion of involuntary admissions by neighbourhood income quintile and immigration. We used models stratified by immigration to estimate the relationship with income. Results: Non-immigrant youth used substantially more services than immigrant youth. Service use increased following the pandemic's start and peaked between January and March 2021. We observed a clear income gradient for community-based service use among both immigrant and non-immigrant youth, but the direction of the gradient was reversed. Service use was highest among non-immigrant youth in lower-income neighbourhoods and lowest for immigrant youth in lower-income neighbourhoods. We observed similar patterns of income gradient for non-immigrant youth for emergency department visits and hospitalization. The proportion of involuntary admissions was higher for immigrant youth. Conclusions: Mental health service use was substantially lower among immigrant youth than non-immigrant youth, but higher proportions of immigrant youth were hospitalized involuntarily. The reverse income gradient patterns observed for community-mental health service use are noteworthy and suggest significant barriers to accessing preventable care among immigrant youth, particularly those living in lower-income neighbourhoods. [ABSTRACT FROM AUTHOR]

Patient and Public Involvement (PPI) is considered good practice in all health research including literature reviews. Reporting of involvement practice in realist reviews has been inconsistent leaving gaps in understanding of best practice. Realist reviews are theory driven and explain how interventions work, for whom and in which circumstances. PPI in realist reviews provides a link between programme theory and real-world experiences and can be achieved through a 'stakeholder group' bringing lived and professional experience together. This paper discusses experiences of a stakeholder group with seven members with lived experience and eight members with professional experience in a realist review focused on how community mental health crisis services work. A mental health crisis is a time of distress when people need urgent support. Many different agencies can respond to mental health crises, but despite this, people often find it hard to navigate to the right help at the right time. Reflections on involvement in four stakeholder meetings alongside practical examples of involvement activities used during the realist review are discussed. Having two researchers co-lead the stakeholder group from both lived and professional experience perspectives provided a bridge between the different expertise within the stakeholder group. Engagement with a voluntary organisation provided support to lived experience stakeholders, which sustained their involvement over time. Social connectedness was needed to establish trust between stakeholders. This required informal social contact between stakeholders that needed to be planned, especially for online meetings. To maintain the emotional wellbeing of the stakeholders during their involvement, safe spaces for discussion are needed and these are best planned in partnership with the stakeholders. We concluded that consideration of ways to provide opportunity for informal contact in online meetings may improve the experience of the stakeholders. Careful consideration of ways to sustain stakeholders' contribution over time are needed. The emotional impact of involvement should be considered when planning realist reviews. This may include built in flexibility in the involvement to include small expertise specific breakout groups, individual meetings, and should be planned in partnership with the stakeholders. Plain English Summary: Involving people with experience of accessing mental health services (PPI) in literature reviews is good practice. We know less about how to do this in 'realist' literature reviews. Realist reviews explain how things work, who they work for, and in what situations. PPI can help researchers to link theory with people's real-life experience. Researchers do this in a 'stakeholder group' that brings people with experience of accessing services together with professionals. This paper shares experiences of a stakeholder group with seven PPI members and eight professional members. Stakeholders supported a realist review about how community mental health crisis services work. A mental health crisis is a time of distress when people need urgent support. Many different services can help, but people still find it hard to get the right help at the right time. The researchers thought carefully about the stakeholder group membership to make sure everyone felt able to join in. We have written about how the stakeholders learned together about doing realist reviews and the activities the stakeholders took part in. Due to Covid-19, the stakeholder meetings moved online. Although online meetings worked well, being in a room together was better for the stakeholders to get to know each other. Support from voluntary organisations as well as informal contact with stakeholders between meetings helped people to stay involved over time. Planning safe spaces to talk, could help avoid stakeholders being upset by being involved in realist reviews. [ABSTRACT FROM AUTHOR]

The abstract from the Journal of Psychopharmacology discusses the evaluation of polypharmacy and constipation management for individuals with learning disabilities. The study aimed to review prescribing practices and completed medication reviews for this population, focusing on polypharmacy and constipation risk. Results showed areas of concern such as unclear documentation, high-risk prescribing, and variable involvement of lived experience. Recommendations included implementing constipation care planning, reviewing medications causing constipation, and improving collaboration across care settings. The study emphasized the importance of including lived experience perspectives in healthcare decision-making. [Extracted from the article]

Objective: In response to high demand and prolonged wait times for cognitive behavioural therapy (CBT) in Ontario, Canada, we developed predictive models to stratify patients into high- or low-intensity treatment, aiming to optimize limited healthcare resources. Method: Using client records (n = 953) from Ontario Shores Centre for Mental Health Sciences (January 2017–2021), we estimated four binary outcome models to assign patients into complex and standard cases based on the probability of reliable improvement in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. We evaluated two choices of cut-offs for patient complexity assignment: models at an ROC (receiver operating characteristic)-derived cut-off and a 0.5 probability cut-off. Final model effectiveness was assessed by assigning treatment intensity (high-intensity or low-intensity CBT) based on the combined performance of both GAD-7 and PHQ-9 models. We compared the treatment assignment recommendations provided by the models to those assigned by clinical assessors. Results: The predictive models demonstrated higher accuracy in selecting treatment modality compared to provider-assigned treatment selection. The ROC cut-off achieved the highest prediction accuracy of case complexity (0.749). The predictive models exhibited large sensitivity and specificity trade-offs (which influence the rates of patient assignment to high-intensity CBT) despite having similar accuracy statistics (ROC cut-off = 0.749, 0.5 cut-off = 0.690), emphasizing the impact of cut-off choices when implementing predictive models. Conclusions: Overall, our findings suggest that the predictive model has the potential to improve the allocation of CBT services by shifting incoming clients with milder symptoms of depression to low-intensity CBT, with those at highest risk of not improving beginning in high-intensity CBT. We have demonstrated that models can have significant sensitivity and specificity trade-offs depending on the chosen acceptable threshold for the model to make positive predictions of case complexity. Further research could assess the use of the predictive model in real-world clinical settings. Plain Language Summary Title: Stratified Care in Cognitive Behavioural Therapy: A Comparative Evaluation of Predictive Modeling Approaches for Individualized Treatment Plain Language Summary: In response to high demand and prolonged wait times for cognitive behavioral therapy (CBT) in Ontario, Canada, we developed predictive models to stratify patients into high- or low-intensity treatment, aiming to optimize limited healthcare resources. We used client records from Ontario Shores Centre for Mental Health Sciences (January 2017–2021). The final model's effectiveness was assessed by assigning treatment intensity (high-intensity or low-intensity CBT) based on treatment success. Treatment success was determined using validated symptom scales. We compared the treatment assignment recommendations provided by the predictive model to those assigned by clinical assessors. Overall, our findings suggest that the predictive model has the potential to improve the allocation of CBT services by shifting incoming clients with milder symptoms of depression to low-intensity CBT, with those at highest risk of not improving beginning in high-intensity CBT. [ABSTRACT FROM AUTHOR]

Summary: Gender disappointment can be defined as subjective feelings of sadness when discovering that the sex/gender of a child is the opposite of what the parent had hoped or expected. Wanting a boy (or 'son preference') has long been noted in many cultures, particularly in South and East Asian communities, but it is now becoming more recognised in the UK, Europe and North America. This article aims to improve understanding of gender disappointment by exploring medical and social sciences research; it also discusses the clinical and risk implications of assessing and managing gender disappointment (or not doing so) when individuals present to perinatal and/or community mental health services. [ABSTRACT FROM AUTHOR]

The Province of Nova Scotia has a broad range of responsibilities during provincial emergencies. Hurricane Fiona had significant impacts on citizens and government services for a considerable time due to widespread telecommunication and power outages. The spring wildfires caused widespread destruction, presented coordination and logistical problems, and resulted in mental health impacts for affected communities and responders. This paper describes the challenges faced by provincial emergency management and business continuity response teams: 1) mental health matters — the next evolution in business continuity requires building confidence in people executing the plan under stressful and uncertain conditions for extended periods; 2) senior leadership support is vital to balance business continuity priorities with ongoing operational business demands; and 3) the best plans are as effective as the relationships that make them work. The importance and value of individual and team relationships during planning, preparedness and response, therefore, cannot be underestimated. [ABSTRACT FROM AUTHOR]

Objective: Certified community behavioral health clinics (CCBHCs) are designed to provide comprehensive care for individuals with co-occurring mental and substance use disorders. The authors classified outpatient mental health treatment facilities on the basis of provision of services for clients with co-occurring disorders and assessed whether CCBHCs differed from other outpatient mental health facilities in services provided. Methods: The authors used latent class analysis to identify distinct services for clients with co-occurring disorders in 5,692 outpatient mental health facilities in the 2021 National Substance Use and Mental Health Services Survey. Nine indicators were included: treatment for clients with substance or alcohol use disorder co-occurring with serious mental illness or serious emotional disturbance, specialized programs or groups for such clients, medication-assisted treatment (MAT) for alcohol use disorder, MAT for opioid use disorder, detoxification, individual counseling, group counseling, case management, and 12-step groups. A multinomial logistic regression was used to estimate whether CCBHCs were associated with any identified classes after analyses controlled for facility characteristics. Results: A four-class solution provided a model with the best fit, comprising comprehensive services (23.4%), case management services (17.7%), counseling and self-help services (58.6%), and professional services (4.3%). Regressing class membership on facility type and covariates, the authors found that compared with community mental health clinics (CMHCs), CCBHCs were more likely to belong to the comprehensive services class than to the case management services, counseling and self-help services, and professional services classes. Conclusions: CCBHCs were more likely than other outpatient programs to offer comprehensive care, and CCBHC status of a CMHC facilitated enhanced service provisions. [ABSTRACT FROM AUTHOR]

Excess mortality in mentally ill is largely due to high rates of physical illnesses that lead to worse health outcomes. This study examines the intake of added sugar from sugar-sweetened beverages (SSBs) and factors associated with poor mental and physical health in people with severe mental illness. Methods: Data were collected as part of the standard care of consumers attending the Collaborative Centre for Cardiometabolic Health in Psychosis clinics where a diet history is taken by a dietitian. SSBs and tea/coffee with added sugars consumed in the past seven days were collected. Results: Overall, 1648 occasions of service comprising 1142 consumers (mean age 45.0 ± 12.5 years, 63.5% males) were seen. Of these, 1234 (74.9%) occasions of service were provided by a dietitian. Two-thirds (n = 840) self-reported to have consumed one or more SSBs or tea/coffee with sugar. Over half 697 (56.5%) consumed one or more SSBs and 437 (35.4%) tea/coffee with sugar. The mean daily consumption of added sugar from SSBs and tea/coffee was 86.2 g/day. On multivariable analysis, males, those diagnosed with schizophrenia, being on Olanzapine ± other antipsychotics and lower socio-economic status were statistically associated with consumption of added sugar. Conclusion: Consumption of added sugars from SSBs in consumers of community mental health services is four times higher than the general population. This is an underestimation of the total intake of added sugars without other contributors from discretionary foods. Measuring consumption of SSBs may be an easy-to-use proxy for assessing dietary risk when dietitians are not available. [ABSTRACT FROM AUTHOR]

ObjectiveCrisis services are undergoing an unprecedented expansion in the United States, but research is lacking on crisis system design. This study describes how individuals flow through a well-established crisis system and examines factors associated with reutilization of such services.MethodsThis cross-sectional study used Medicaid claims to construct episodes describing the flow of individuals through mobile crisis, specialized crisis facility, emergency department, and inpatient services. Claims data were merged with electronic health record (EHR) data for the subset of individuals receiving care at a crisis response center. A generalized estimating equation was used to calculate adjusted odds ratios for demographic, clinical, and operational factors associated with reutilization of services within 30 days of an episode's end point.ResultsOf 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset (N=9,202 episodes) with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status.ConclusionsCrisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.

Regular exercise is reported to improve depressive symptoms and quality of life for people experiencing mental illness. For older adults, including strength and balance can also decrease falls. Mental health services seldom include funding for Accredited Exercise Physiologist programs. A 9-week Accredited Exercise Physiologist-led program for older adults receiving mental health treatment with a community Older People's Mental Health Service was trialed in regional Australia. This clinician-conceived small-scale feasibility study utilized a two-phase concurrent triangulation mixed-method design to evaluate physical and psychological program outcomes and identify factors related to engaging in physical activity. This tailored exercise program led to improvements in measures of psychological distress and physical and psychological function. These changes corresponded with participants identifying benefits of exercising as a group of adults living with mental illness. Such findings suggest a supervised, individualized program for older mental health consumers confers physical and psychological benefits; however, further research evaluating exercise interventions with this population is required. [ABSTRACT FROM AUTHOR]

Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making. This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services. Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well. Single item on sleep disturbance used, no data on treatment adherence. These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance. • Six distinct sleep disturbance trajectories found in initial 12 treatment sessions • Improving sleep disturbance trajectories related to better endpoint outcomes • Unimproved or worsening sleep disturbance associated with worse outcomes • Unemployment, worse social function, & Asian identity linked to sleep deterioration • Being female, unemployed, medicated, or long-term conditions risks non-improvement [ABSTRACT FROM AUTHOR]

High rates of cardiometabolic disease and poor physical health outcomes contribute to significant premature mortality in people living with severe mental illness (PLWSMI). Lifestyle interventions such as exercise are known to improve both physical and mental health outcomes, however the best way to deliver exercise programs for PLWSMI remains a challenge. This paper uses a pragmatic program evaluation of a co-delivered low-cost community-based exercise program implemented over a 6-month period. Of 46 referrals in the first half of 2023 to the SLHD Gym and Swim program, 13 gave consent to participate in standardised measures and qualitative interviews. Findings revealed an increase in average hours of sport/exercise, improvements in confidence to exercise independently and within group settings, as well as achievement of individualised goals. The success of the program was in part due to the co-facilitation between peer support workers and exercise physiologists, community connection and the established partnership between the public health service and the local government council. Results offer evidence to adopt and implement accessible and low-cost exercise opportunities in the community external to health services to address barriers of attendance for PLWSMI. [ABSTRACT FROM AUTHOR]

Introduction Method Results Positive psychology and virtue ethics traditions suggest that virtue development is a pathway to well‐being, but few studies have examined how psychotherapy in naturalistic settings contributes to clients' virtue engagement.This study was conducted at a community mental health clinic specialising in contemporary relational psychotherapy (CRP) in the northeast United States. The embedded, explanatory mixed method design included (a) longitudinal mixture‐modelling to identify clients showing gains in relational virtue engagement over time, and (b) interviewing a subsample (N = 15) of these clients.Our findings suggest that virtue engagement in CRP emerges (a) within the dynamic conditions of the alliance and (b) through holistic attunement to clients' identities, experiences, mental health and growth in capacities that promote wisdom and flourishing. Clinical and research implications and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To investigate provider and administrators' perspectives about the impact of the Department of Veterans Affairs' (VA) Community Care program on acute and residential mental health treatment of rural Veterans.Primary data were collected from participants via interviews. Participants were employees of VA Healthcare Systems located in Northern New England, or employees of non‐VA mental health treatment settings affiliated with VA in Northern New England.This study was informed by the Consolidated Framework for Implementation Research (CFIR), with Community Care as the implemented program. Individual, semi‐structured interviews were conducted.Individual interviews were transcribed, coded deductively using the CFIR, and inductively coded by locating themes.Twenty‐one people completed interviews. Commonly reported challenges included community programs not focused on Veterans' needs, poor coordination of care, communication challenges, and problems tracking Veteran care. Facilitators included increased access to care and strengthening coordination of care.The VA's Community Care program can address the acute or residential mental health needs of Veterans in rural settings in some circumstances, however there are challenges to successful implementation. [ABSTRACT FROM AUTHOR]

Studies have shown a high prevalence of trauma and PTSD among patients with severe mental illness, but relatively few studies have examined the outcomes of PTSD treatment for this patient group. The aim of this case-series was to assess the feasibility of a Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) intervention for PTSD in people with psychosis. The study examined the possibilities and obstacles when treating this population within clinical settings. Patients were selected from four community mental health centers and were screened for traumatic experiences and symptoms of PTSD. A small group of eligible participants (n=7) received manualized TF-CBT adapted for patients with psychosis. Experienced therapists received training and supervision in the intervention. Symptoms of PTSD and psychosis were assessed at baseline and post-treatment along with quality of life, level of functioning, alliance, life events, engagement, suicidal ideation and adverse events. Treatment fidelity and the different combinations of treatment modules were monitored in regard to implementation. Three cases were selected as illustrative of the different treatment courses when implementing the TF-CBT intervention within this population. Detailed case descriptions were based on quantitative ratings and the therapists' experiences with the therapy. Results from the case series highlighted issues regarding toleration of treatment, large variation in psychopathology and the task of matching treatment needs with appropriate therapeutic techniques. The complexity of the patient group may affect treatment and clinical research studies. Lessons learned from this case series can contribute to the future development implementation and evaluation of trauma treatment for patients with psychosis. [ABSTRACT FROM AUTHOR]

This paper presents a pioneering pilot implementation of group dialectical behaviour therapy (DBT) for adolescents with maladaptive coping in Qatar's child and adolescent mental health services. The project highlights the positive effect on patient satisfaction and the potential for early intervention with adolescents displaying emotional dysregulation. This pioneering initiative was consistent with local cultural values, stressing the importance of interconnectedness in mental health interventions. The impact of the initiative stresses its significance in diverse cultural contexts, urging further adoption regionally for improved mental health outcomes, particularly among adolescents displaying features of an emerging emotionally unstable personality disorder. [ABSTRACT FROM AUTHOR]

The document discusses the life and career of Dr. Sebastiano Gaetano Santostefano, a renowned clinical child psychologist and researcher. Dr. Santostefano's work focused on merging developmental and clinical psychology, leading to significant contributions in the field of child psychopathology. His presidency in the 1960s coincided with a time of increased attention to civil rights, diversity, equity, and inclusion in the broader clinical psychology field. Dr. Santostefano's legacy emphasizes the importance of integrating clinical psychology and developmental science, as well as the use of integrative therapies in working with youth and families. [Extracted from the article]

Aim: Young adults with serious mental illness (SMI) have poor physical health and high Emergency Department (ED) and hospital utilization. Integrating primary care into community mental health care may be an important form of early intervention. Methods: Adjusted multivariable regressions assessed changes in self‐reported annual primary care, ED and hospital utilization for 83 young adults with SMI enrolled in integrated care. Results: Participants' mean annual per person utilization changed significantly as follows: primary care visits, from 1.8 to 3.6, p <.001; medical ED visits, from 1.0 to 0.6, p <.01; psychiatric ED visits from 0.6 to 0.2, p <.001; medical inpatient days, from 1.2 to 0.1, p <.001 and psychiatric inpatient days, from 6.3 to 2.6, p <.001. Conclusions: Young adults with SMI receiving integrated care increased primary care and reduced ED and inpatient utilization. Future controlled research is warranted to further assess integrated care for young adults with SMI. [ABSTRACT FROM AUTHOR]

The last decades, in an effort to transform the mental health system, the adoption of social psychiatry principles and the development of Community Mental Health Services (CMHS) over inpatient hospitalization have gradually highlighted the need to evaluate the outcome of therapeutic interventions, as well as the effectiveness-efficiency of the services provided. Quality of life and satisfaction are now projected as an equally important indicator of an evaluation process, as is clinical outcome. The purpose of this article is to present the basic principles of the organization and the evaluation of mental health services and to highlight the need for a redesign of the mental health system in order to address the challenges of providing services and to ensure their high quality. [ABSTRACT FROM AUTHOR]

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Key Points: Question: Can an antistigma campaign and a mobile technology–based electronic decision support system result in reduced stigma and improved mental health for adults at high risk of common mental disorders at the primary health care level? Findings: This cluster randomized clinical trial included 44 primary health center clusters with 9928 eligible participants (3365 in the high-risk cohort). There was a significant difference in mean depression scores between intervention vs control groups at 12 months, with lower scores in high-risk cohort. Meaning: A multifaceted primary health center intervention with high implementation fidelity may be effective in reducing depression risk. This cluster randomized clinical trial evaluates the use of a digital mental health intervention and community-based antistigma campaign in reducing risk of depression and mental health–related stigma. Importance: More than 150 million people in India need mental health care but few have access to affordable care, especially in rural areas. Objective: To determine whether a multifaceted intervention involving a digital health care model along with a community-based antistigma campaign leads to reduced depression risk and lower mental health–related stigma among adults residing in rural India. Design, Setting, and Participants: This parallel, cluster randomized, usual care–controlled trial was conducted from September 2020 to December 2021 with blinded follow-up assessments at 3, 6, and 12 months at 44 rural primary health centers across 3 districts in Haryana and Andhra Pradesh states in India. Adults aged 18 years and older at high risk of depression or self-harm defined by either a Patient Health Questionnaire–9 item (PHQ-9) score of 10 or greater, a Generalized Anxiety Disorder–7 item (GAD-7) score of 10 or greater, or a score of 2 or greater on the self-harm/suicide risk question on the PHQ-9. A second cohort of adults not at high risk were selected randomly from the remaining screened population. Data were cleaned and analyzed from April 2022 to February 2023. Interventions: The 12-month intervention included a community-based antistigma campaign involving all participants and a digital mental health intervention involving only participants at high risk. Primary health care workers were trained to identify and manage participants at high risk using the Mental Health Gap Action Programme guidelines from the World Health Organization. Main Outcomes and Measures: The 2 coprimary outcomes assessed at 12 months were mean PHQ-9 scores in the high-risk cohort and mean behavior scores in the combined high-risk and non–high-risk cohorts using the Mental Health Knowledge, Attitude, and Behavior scale. Results: Altogether, 9928 participants were recruited (3365 at high risk and 6563 not at high risk; 5638 [57%] female and 4290 [43%] male; mean [SD] age, 43 [16] years) with 9057 (91.2%) followed up at 12 months. Mean PHQ-9 scores at 12 months for the high-risk cohort were lower in the intervention vs control groups (2.77 vs 4.48; mean difference, −1.71; 95% CI, −2.53 to −0.89; P <.001). The remission rate in the high-risk cohort (PHQ-9 and GAD-7 scores <5 and no risk of self-harm) was higher in the intervention vs control group (74.7% vs 50.6%; odds ratio [OR], 2.88; 95% CI, 1.53 to 5.42; P =.001). Across both cohorts, there was no difference in 12-month behavior scores in the intervention vs control group (17.39 vs 17.74; mean difference, −0.35; 95% CI, −1.11 to 0.41; P =.36). Conclusions and Relevance: A multifaceted intervention was effective in reducing depression risk but did not improve intended help-seeking behaviors for mental illness. Trial Registration: Clinical Trial Registry India: CTRI/2018/08/015355. [ABSTRACT FROM AUTHOR]

Objective: Police officers are often the first responders when individuals experience a mental health crisis and typically remain responsible for transport to a psychiatric emergency department. In 2014, a psychiatric ambulance (PA) was introduced in the city of Amsterdam to take over the transport of individuals in a mental health crisis. The purpose of the PA was to use fewer restrictive measures while guaranteeing safety for both patients and personnel. Methods: A preimplementation-postimplementation design was used to assess the feasibility and utility of a single-vehicle PA service compared with police transport. Data on 498 rides were collected in the 4 months before implementation of the PA (pre-PA cohort) and on 655 rides in the 6 months after implementation (PA cohort). Results: After PA implementation, most patients were transported by the PA (82%), and rides by police vehicle were very rare (1%). Individuals in the PA cohort had a greater transportation delay, compared with those in the pre-PA cohort, but the PA reduced use of coercive measures with no increase in the incidence of patient aggression. Among individuals in the PA cohort, hospitalization was more often voluntary than among those in the pre-PA cohort. Conclusions: Transporting emergency psychiatric patients by a special PA rather than by the police reduced the use of coercive measures during transport, kept the occurrence of aggressive incidents stable, and was associated with fewer coercive hospital admissions. [ABSTRACT FROM AUTHOR]

Research shows that guests experience peer-run respites as empowering and safe places where they feel more seen, heard, and respected than they do in conventional settings. This column describes the successful and unique processes of peer-run respites that support guests in emotional crisis and facilitate healing. In a discussion informed by their experiences and the literature, the authors examine how peer-run respites differ from conventional psychiatric crisis response services in their basic philosophy: how emotional crisis is understood, the goal of crisis response, how trauma is viewed, the importance of self-determination, power dynamics, and relationality. [ABSTRACT FROM AUTHOR]

Background: Criminal legal system-involved individuals with serious mental illness (SMI) experience more challenges accessing mental health and other community services than those without a history of criminal legal system involvement. A formative qualitative study was conducted to explore feasibility and acceptability and inform the adaptation of a mental health peer navigation intervention for individuals with SMI reentering the community after jail incarceration. Methods: In-depth qualitative interviews and focus-group discussions were conducted with mental health peer navigators (i.e., certified mental health peer support specialists, peer recovery coaches) and individuals with lived experience of SMI and criminal legal system involvement (N = 20 total). Data were analyzed using applied thematic analysis. Results: Four major themes emerged: (1) Feasibility and acceptability of peer-provided services: all participants reported that peer navigation services would be feasible and acceptable for individuals with SMI reentering the community after jail incarceration; (2) roles of peer navigators in addressing barriers to care: peers can address barriers to care experienced during community reentry and contribute towards service linkage/engagement; (3) shared identity and combating stigma: having a shared identity with peer navigators may minimize the impact of stigma and make it easier for clients with multiple marginalized identities to seek support; and (4) peer navigator skills and recommendations for the planned program: essential peer navigation skills include authenticity, reliability, active listening, advocacy, trauma-informed care, motivational interviewing, and empathy. Recommendations for the planned program include initiating services while clients are in custody, emphasizing the voluntary nature of peer support, knowing the limits of a peer navigation intervention, and offering support for peer navigators while on the job. Conclusion: Participants saw peer navigation services for individuals with SMI with criminal legal system involvement as potentially feasible and acceptable. Such programs may enhance their impact by offering supportive supervision, emphasizing the voluntary nature of the service, and acknowledging recovery as a self-directed endeavor. [ABSTRACT FROM AUTHOR]