Community Mental Health Care Delivery During the COVID-19 Pandemic: Practical Strategies for Improving Care for People with Serious Mental Illness

Roles and Dynamics within Community Mental Health Systems During the COVID-19 Pandemic: A Qualitative Systematic Review and Meta-Ethnography

Globally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare's approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users' needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries' disaster mental health response and to invest in quality care, particularly for marginalized groups.

Left Behind: Experiences of Community Mental Health Center Clients with Serious Mental Illness During the COVID-19 Pandemic

While some international qualitative research has interviewed people with serious mental illnesses (SMI) about their experiences in the initial months of the COVID-19 pandemic, few US studies have explored their experiences and perspectives as the pandemic has continued. Drawing from disability studies perspectives, this qualitative study conducted in 2022 explored the experiences of people with SMI seeking services at community mental health centers during the COVID-19 pandemic. Fifteen clients who identified as living with an SMI and were clients during March 2020 were interviewed. Using narrative analysis, we identified an overarching tenor of client experiences: feeling left behind by institutions and society. This feeling of being left behind was conceptualized as three themes. As the literature around the COVID-19 pandemic grows and we attempt to integrate it into community mental health policy and practice, it is essential to include the experiences and perspectives of clients with lived experience of SMI.

Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data

Background

Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth's impacts on SMI care outcomes is mixed, necessitating further investigation.

Objective

We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI.

Methods

We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt).

Results

Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=-4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=-4.49; P<.001; z=-3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=-3.74; P<.001), and continuity of care after a high-risk event (z=-2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=-4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized.

Conclusions

Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation-selected through a health equity lens-may improve quality of care among patients with SMI.

A two-year longitudinal evaluation of the impact of the COVID-19 pandemic on pre-existing mental health service attenders

BACKGROUND

To examine if the COVID-19 pandemic was associated with a differential effect longitudinally in relation to its psychological and functional impact on patients with bipolar disorder and Emotionally Unstable Personality Disorder (EUPD).

METHODS

Semi-structured interviews were conducted with 29 individuals attending the Galway-Roscommon Mental Health Services with an ICD-10 diagnosis of either bipolar disorder (n = 18) or EUPD (n = 11). The impact of the COVID-19 pandemic was assessed in relation to anxiety and mood symptoms, social and occupational functioning, and quality of life utilising psychometric instruments and Likert scale data, with qualitative data assessing participants' subjective experiences.

RESULTS

Individuals with EUPD exhibited significant anxiety and depressive symptoms and increased hopelessness compared to individuals with bipolar disorder. Repeated measures data demonstrated no significant change in symptomatology for either the EUPD or bipolar disorder group over time, but demonstrated an improvement in social (t = 4.40, p < 0.001) and occupational functioning (t = 3.65, p = 0.03), and in quality of life (t = 4.03, p < 0.001) for both participant groups. Themes attained from qualitative data included the positive impact of the discontinuation of COVID-19 mandated restrictions (n = 19), and difficulties experienced secondary to reductions in the provision of mental health services during the COVID-19 pandemic (n = 17).

CONCLUSION

Individuals with EUPD demonstrated increased symptomatology over a two-year period compared to those with bipolar disorder. The importance of face-to-face mental health supports for this cohort are indicated, particularly if future pandemics impact the delivery of mental health services.

The Relationship of Internet, Social Media, and Related Technology Use with Disease Severity and Functionality in Individuals with Serious Mental Disorders

Introduction

The purpose of this study was to assess internet, social media, and related technology use in patients with serious mental disorders, and to examine their relationship with disease severity and functionality and gain insight about the thoughts of patients with severe mental disorders on benefits and risks of social media.

Methods

The study included 150 patients with bipolar disorder and 150 patients with schizophrenia spectrum disorder (82 with schizophrenia, 56 with psychotic disorders not otherwise specified and 12 with schizoaffective disorder) in remission. Information about demographics, clinical features, the use of social media and related technologies, and opinions on social media use were obtained via a data form prepared by the clinicians. Severity of disease and symptoms were measured using the Hamilton Rating Scale for Depression, the Young Mania Rating Scale, the Brief Psychiatric Rating Scale and, the Clinic Global Impression Scale. The Functioning Assessment Short Test was used to evaluate psychosocial functioning.

Results

Among the patients who participated in the current study, 65.3% (n=196) reported internet use and, 59.7% (n=179) reported social media use. The Functioning Assessment Short Test total scores and the Clinic Global Impression Scale scores were significantly higher in patients who did not use social media than in those who did. The use of social media, mobile phones, smartphones, short message services (SMS), e-mail was significantly higher in patients with bipolar disorder than in patients with schizophrenia spectrum disorder.

Conclusion

The use of social media, Internet and mobile devices cannot be underestimated among patients with serious mental disorders.

A comparison of rate and methods of probable suicide for 2 years pre and post the onset of the COVID-19 pandemic

OBJECTIVES

To examine and compare rates and methods of probable suicide in a Western region of Ireland during a 24 month period since the onset of the COVID-19 pandemic compared with a similar period immediately prior to the pandemic onset.

METHODS

Post-mortem reports between March 1st 2018 and February 29th 2020 were reviewed and compared with data from March 1st 2020 to February 28th 2022. Relevant demographic data, rates and methods of probable suicide and lifetime engagement with mental health services were compared across the two time points.

RESULTS

Identical rates of probable suicide (85 individuals at both time points) were demonstrated with no difference evident in the utilisation of violent compared to non-violent methods.

CONCLUSIONS

This study demonstrates that despite previous reports of increased rates of self-harm and some evidence of increased mental distress since the onset of the COVID-19 pandemic, no change in rates of or methods employed by individuals who died by probable suicide were evident in this geographical region.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 3: study protocol to evaluate sustainment in a hybrid type 2 effectiveness-implementation cluster-randomized trial

BACKGROUND

Although research on the implementation of evidence-based psychological treatments (EBPTs) has advanced rapidly, research on the sustainment of implemented EBPTs remains limited. This is concerning, given that EBPT activities and benefits regularly decline post-implementation. To advance research on sustainment, the present protocol focuses on the third and final phase-the Sustainment Phase-of a hybrid type 2 cluster-randomized controlled trial investigating the implementation and sustainment of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for patients with serious mental illness and sleep and circadian problems in community mental health centers (CMHCs). Prior to the first two phases of the trial-the Implementation Phase and Train-the-Trainer Phase-TranS-C was adapted to fit the CMHC context. Then, 10 CMHCs were cluster-randomized to implement Standard or Adapted TranS-C via facilitation and train-the-trainer. The primary goal of the Sustainment Phase is to investigate whether adapting TranS-C to fit the CMHC context predicts improved sustainment outcomes.

METHODS

Data collection for the Sustainment Phase will commence at least three months after implementation efforts in partnering CMHCs have ended and may continue for up to one year. CMHC providers will be recruited to complete surveys (N = 154) and a semi-structured interview (N = 40) on sustainment outcomes and mechanisms. Aim 1 is to report the sustainment outcomes of TranS-C. Aim 2 is to evaluate whether manipulating EBPT fit to context (i.e., Standard versus Adapted TranS-C) predicts sustainment outcomes. Aim 3 is to test whether provider perceptions of fit mediate the relation between treatment condition (i.e., Standard versus Adapted TranS-C) and sustainment outcomes. Mixed methods will be used to analyze the data.

DISCUSSION

The present study seeks to advance our understanding of sustainment predictors, mechanisms, and outcomes by investigating (a) whether the implementation strategy of adapting an EBPT (i.e., TranS-C) to the CMHC context predicts improved sustainment outcomes and (b) whether this relation is mediated by improved provider perceptions of treatment fit. Together, the findings may help inform more precise implementation efforts that contribute to lasting change.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05956678 . Registered on July 21, 2023.

Changes in substance use and engagement in gaming/gambling in persons with severe mental illness during the COVID-19 pandemic and earthquakes: a community study in two points

Introduction

External stressors, such as COVID-19 pandemic and earthquake, can cause an increase in substance use and addictive behavior in persons with severe mental illnesses (SMI). We analyzed the changes and predictors of substance use and addictive behavior in SMI during these double disasters in Croatia.

Methods

Questionnaires exploring the presence of substance or behavior addiction disorder, mental ill health [Depression Anxiety Stress Scales-21 (DASS-21), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), Obsessive-Compulsive Inventory-Revised], coping mechanisms, and perceived social support [Multidimensional Scale of Perceived Social Support (MSPSS)] were administered among 90 participants with SMI included in the RECOVER-E study in May/June 2020 (first COVID-19 wave, Zagreb earthquake) and in December 2020/January 2021 (second COVID-19 wave, Petrinja earthquake).

Results

In both time points, a major increase was observed in tobacco smoking (25.0%; 28.6%, respectively) predicted by discontinuation of antidepressants and higher DASS-21 score. Increased sedative use was observed (24.4%; 23.8%, respectively) predicted by higher PSS and ISI scores, lower MSPSS scores, antipsychotic discontinuation and not receiving community mental health team (CMHT) service.

Discussion

In persons with SMI during a double disaster special attention needs to be given to reducing mental-ill health and stress, providing social support and continuity of psychiatric care, through medications and CMHTs.

Return to Community Mental Health Centers after the Pandemic: A Qualitative Study on Turkish Patients' Subjective Experiences

BACKGROUND

Community mental health centers (CMHCs) are important institutions for individuals with chronic mental illness. During the COVID-19 period, patients with mental health could not optimally access care in CMHCs.

AIM

To explore the experiences of patients using a CMHC after its closure due to the COVID-19 pandemic.

PATIENTS AND METHODS

This was a descriptive qualitative study that included 16 patients with mental disorders who regularly used CMHCs during the pre-pandemic period. Their data were collected between March 2022 and August 2022 using face-to-face, in-depth semi-structured interviews. All interviews were recorded and the content analysis method was used to analyze the data.

RESULTS

The age range of the 16 study participants was 29-53 years with a mean age of 40.8 ± 6.5 years. Nine (56.3%) participants were men, and 7 (43.7%) were women. Ten (62.5%) participants had schizophrenia, whereas 6 (37.5%) had bipolar disorder. According to content analysis, the five main themes that emerged based on the statements of participants were the effects of change, difficulties experienced, support needs, coping experiences, and suggestions. The results showed that although patients using CMHCs are struggling with the adverse consequences of the pandemic process, they also have difficulty managing their diseases and daily life due to their inability to access psychosocial services in the CMHCs.

CONCLUSION

The patients reported their negative experiences and need for support during the pandemic. The study highlights the need to adequately accommodate mental health services delivery during future pandemics that may impose movement restrictions.

Changes in self-reported cannabis use during the COVID-19 pandemic: a scoping review

BACKGROUND

The COVID-19 pandemic is affecting mental health and substance use (MHSU) issues worldwide. The purpose of this study was to characterize the literature on changes in cannabis use during the pandemic and the factors associated with such changes.

METHODS

We conducted a scoping review by searching peer-reviewed databases and grey literature from January 2020 to May 2022 using the Arksey and O'Malley Framework. Two independent reviewers screened a total of 4235 documents. We extracted data from 129 documents onto a data extraction form and collated results using content analytical techniques.

RESULTS

Nearly half (48%) of the studies reported an increase/initiation of cannabis use, while 36% studies reported no change, and 16% reported a decrease/cessation of cannabis use during the pandemic. Factors associated with increased cannabis use included socio-demographic factors (e.g., younger age), health related factors (e.g., increased symptom burden), MHSU factors (e.g., anxiety, depression), pandemic-specific reactions (e.g., stress, boredom, social isolation), cannabis-related factors (e.g., dependence), and policy-related factors (e.g., legalization of medical/recreational cannabis).

CONCLUSION

Public health emergencies like the COVID-19 pandemic have the potential to significantly impact cannabis use. The pandemic has placed urgency on improving coping mechanisms and supports that help populations adapt to major and sudden life changes. To better prepare health care systems for future pandemics, wide-reaching education on how pandemic-related change impacts cannabis use is needed.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 3: Study protocol to evaluate sustainment in a hybrid type 2 effectiveness-implementation cluster-randomized trial

treatments (EBPTs) has advanced rapidly, research on the sustainment of implemented EBPTs remains limited. This is concerning, given that EBPT activities and benefits regularly decline post-implementation. To advance research on sustainment, the present protocol focuses on the third and final phase - the Sustainment Phase - of a hybrid type 2 cluster-randomized controlled trial investigating the implementation and sustainment of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for patients with serious mental illness and sleep and circadian problems in community mental health centers (CMHCs). Prior to the first two phases of the trial - the Implementation Phase and Train-the-Trainer Phase - TranS-C was adapted to fit the CMHC context. Then, 10 CMHCs were cluster-randomized to implement Standard or Adapted TranS-C via facilitation and train-the-trainer. The primary goal of the Sustainment Phase is to investigate whether adapting TranS-C to fit the CMHC context predicts improved sustainment outcomes.

Methods

Data collection for the Sustainment Phase will commence at least three months after implementation efforts in partnering CMHCs have ended and may continue for up to one year. CMHC providers will be recruited to complete surveys (N = 154) and a semi-structured interview (N = 40) on sustainment outcomes and mechanisms. Aim 1 is to report the sustainment outcomes of TranS-C. Aim 2 is to evaluate whether manipulating EBPT fit to context (i.e., Standard versus Adapted TranS-C) predicts sustainment outcomes. Aim 3 is to test whether provider perceptions of fit mediate the relation between treatment condition (i.e., Standard versus Adapted TranS-C) and sustainment outcomes. Mixed methods will be used to analyze the data.

Discussion

The present study seeks to advance our understanding of sustainment predictors, mechanisms, and outcomes by investigating (a) whether the implementation strategy of adapting an EBPT (i.e., TranS-C) to the CMHC context predicts improved sustainment outcomes and (b) whether this relation is mediated by improved provider perceptions of treatment fit. Together, the findings may help inform more precise implementation efforts that contribute to lasting change.

Trial Registration

ClinicalTrials.gov identifier: NCT05956678. Registered on July 21, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT05956678?term=NCT05956678&draw=2&rank=1.

Digital health literacy and digital engagement for people with severe mental ill health across the course of the COVID-19 pandemic in England

BACKGROUND

An unprecedented acceleration in digital mental health services happened during the COVID-19 pandemic. However, people with severe mental ill health (SMI) might be at risk of digital exclusion, partly because of a lack of digital skills, such as digital health literacy. The study seeks to examine how the use of the Internet has changed during the pandemic for people with SMI, and explore digital exclusion, symptomatic/health related barriers to internet engagement, and digital health literacy.

METHODS

Over the period from July 2020 to February 2022, n = 177 people with an SMI diagnosis (psychosis-spectrum disorder or bipolar affective disorder) in England completed three surveys providing sociodemographic information and answering questions regarding their health, use of the Internet, and digital health literacy.

RESULTS

42.5% of participants reported experiences of digital exclusion. Cochrane-Q analysis showed that there was significantly more use of the Internet at the last two assessments (80.8%, and 82.2%) compared to that at the beginning of the pandemic (65.8%; ps < 0.001). Although 34.2% of participants reported that their digital skills had improved during the pandemic, 54.4% still rated their Internet knowledge as being fair or worse than fair. Concentration difficulties (62.6%) and depression (56.1%) were among the most frequently reported symptomatic barriers to use the Internet. The sample was found to have generally moderate levels of digital health literacy (M = 26.0, SD = 9.6). Multiple regression analysis showed that higher literacy was associated with having outstanding/good self-reported knowledge of the Internet (ES = 6.00; 95% CI: 3.18-8.82; p < .001), a diagnosis of bipolar disorder (compared to psychosis spectrum disorder - ES = 5.14; 95% CI: 2.47-7.81; p < .001), and being female (ES = 3.18; 95% CI: 0.59-5.76; p = .016).

CONCLUSIONS

These findings underline the need for training and support among people with SMI to increase digital skills, facilitate digital engagement, and reduce digital engagement, as well as offering non-digital engagement options to service users with SMI.

The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital

OBJECTIVES

To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset.

METHODS

Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic.

RESULTS

A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic.

CONCLUSIONS

Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.

A 2-year longitudinal evaluation of the impact of the COVID-19 pandemic on individuals with pre-existing anxiety disorders

OBJECTIVES

To examine if the COVID-19 pandemic is associated with a differential effect over a 2-year time period in relation to its psychological and social impact on patients with established anxiety disorders.

METHODS

Semi-structured interviews were conducted with 21 individuals attending the Galway-Roscommon Mental Health Services in Ireland with an ICD-10 diagnosis of an anxiety disorder. Interviews occurred at three time-points over a 2-year period to determine the impact of the COVID-19 pandemic and associated restrictions on anxiety and depressive symptoms, social and occupational functioning, and quality of life.

RESULTS

No statistical difference in symptomatology was noted between the three time-points in relation to anxiety symptoms as measured utilising psychometric rating scales (Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HARS) or Likert Scale measures). The greatest impact of COVID-19 at all time-points related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted a tentative optimism for the future in the setting of vaccination and societal re-opening. Fear of re-emerging anxiety symptoms with the removal of societal restrictions was noted.

CONCLUSIONS

No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders, however variability was demonstrated, with some individuals describing ongoing anxiety, social isolation and concern for their future. A strong theme of hope for the future and less concern regarding the COVID-19 pandemic was evident; however tailored supports including the utilisation of tele-psychiatry is suggested, particularly for those experiencing increased anxiety with the removal of societal restrictions.

Enhancing GP care of mental health disorders post-COVID-19: a scoping review of interventions and outcomes

OBJECTIVES

Considerable literature has examined the COVID-19 pandemic's negative mental health sequelae. It is recognised that most people experiencing mental health problems present to primary care and the development of interventions to support GPs in the care of patients with mental health problems is a priority. This review examines interventions to enhance GP care of mental health disorders, with a view to reviewing how mental health needs might be addressed in the post-COVID-19 era.

METHODS

Five electronic databases (PubMed, PsycINFO, Cochrane Library, Google Scholar and WHO 'Global Research on COVID-19') were searched from May - July 2021 for papers published in English following Arksey and O'Malley's six-stage scoping review process.

RESULTS

The initial search identified 148 articles and a total of 29 were included in the review. These studies adopted a range of methodologies, most commonly randomised control trials, qualitative interviews and surveys. Results from included studies were divided into themes: Interventions to improve identification of mental health disorders, Interventions to support GPs, Therapeutic interventions, Telemedicine Interventions and Barriers and Facilitators to Intervention Implementation. Outcome measures reported included the Seven-item Generalised Anxiety Disorder Scale (GAD-7), the Nine-item Patient Health Questionnaire (PHQ-9) and the 'The Patient Global Impression of Change Scale'.

CONCLUSION

With increasing recognition of the mental health sequelae of COVID-19, there is a lack of large scale trials researching the acceptability or effectiveness of general practice interventions. Furthermore there is a lack of research regarding possible biological interventions (psychiatric medications) for mental health problems arising from the pandemic.

Attitudes toward COVID-19 pandemic measures and clinical symptom severity in schizophrenia patients: a preliminary cross-sectional study

OBJECTIVES

The study aim was to compare clinical symptom severity and quality of life (QoL) among schizophrenia patients according to their attitudes toward pandemic measures and reported lockdown-related disruption.

METHODS

Patients with schizophrenia attending follow-up sessions at two community mental health centers were included in this cross-sectional study. Sociodemographic and clinical characteristics of patients were assessed using a standardized form and the following psychometric instruments: the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, State-Trait Anxiety Inventory, Heinrich-Carpenter Quality of Life Scale and Clinical Global Impressions Ratings-Severity scale. Patients were grouped according to their attitudes toward pandemic measures (positive attitudes or non-positive attitudes).

RESULTS

No significant differences were found in sociodemographic and clinical variables, clinical symptom severity or QoL between schizophrenia patients with positive attitudes and those without positive attitudes toward pandemic measures. Guilt feelings and trait anxiety levels were positively related to lockdown-related disruption.

CONCLUSIONS

Positive attitudes toward pandemic measures may be affected by factors other than the sociodemographic and clinical status of schizophrenia patients. It is important that such factors are assessed in future studies to better manage pandemic-related challenges among schizophrenia patients.

The Digital Bytes Project: Digital Storytelling as a Tool for Challenging Stigma and Making Connections in a Forensic Mental Health Setting

This article reports on the findings of a study that explores the utility of digital storytelling as a narrative practice and learning tool for social work in an Australian secure forensic mental health hospital. The short digital stories, or Digital Bytes Project, centered on capturing the lived experience, hopes and perspectives of the hospital's service users by giving voice to their experiences through digital technology. The project was collaboratively designed and co-delivered with social work students, hospital staff, and service users. It aimed to not only destigmatize people with lived experiences of mental distress and criminal justice system involvement but also to give staff and students further insights into understanding who they are working with. Through a series of 11 semi-structured, one on one interviews, this research aims to explore social work student and forensic mental health staff experiences and perceptions in relation to the utility and impact of these digital bytes, reflecting on how the prototype bytes may have impacted their learnings, or practice, including how they then interact with service users. This research investigates how these digital bytes could be used further within forensic mental health organisations and contexts. The research findings demonstrate the overall value of digital bytes in challenging different kinds of stigma, shifting power dynamics and staff perspectives; strengthening rapport and understanding through enhancing engagement and sharing power between students, staff, and consumers; as well as providing insight into the utility of digital bytes for learning and making connections between theory and practice. The preliminary findings from this research suggest the need for greater accessibility, integration, and consideration of these digital tools, with their potential to be translated across multiple human service sectors.

Experiences of nicotine users motivated to quit during the COVID-19 pandemic: a secondary qualitative analysis

OBJECTIVES

The COVID-19 pandemic has brought to light a variety of key factors that affect tobacco use, including behavioural patterns, social support and connection, and physical and mental health. What we do not know is how those motivated to quit were impacted by the pandemic. As such, understanding the unique experiences and needs of people motivated to quit smoking or vaping during the COVID-19 pandemic is critical. The aim of this study was to examine the cessation experiences of nicotine users during the COVID-19 pandemic.

DESIGN

We conducted a supplementary secondary analysis of primary qualitative data, i.e., semi-structured interviews with individuals engaged in cigarette use (smoking), e-cigarette use (vaping) and dual use.

SETTING

British Columbia, Canada.

PARTICIPANTS

Relevant data were drawn from 33 participants out of the primary study's 80-participant sample pool.

MEASURES

Interview questions explored barriers and facilitators to quitting nicotine use. We then used conventional content analysis to identify relevant and additional emergent themes and subthemes surrounding pandemic-specific barriers and facilitators to quitting, and unique needs for cessation support in the context of the COVID-19 pandemic.

RESULTS

Pandemic-specific barriers included lifestyle limitations and poor mental health due to isolation. Facilitators to quitting during the pandemic included reduced access and opportunities to use nicotine products, as well as time for personal reflection on nicotine use behaviours. Suggestions for cessation programming included a primary focus on enhancing social support features (e.g., discussion forums, support groups), followed by increasing awareness of the benefits of quitting, and enhancing visibility of resources available to support quitting.

CONCLUSIONS

The findings provide directions for how cessation supports can be tailored to better meet the needs of users motivated to quit during and beyond the COVID-19 pandemic.

Need Asseesment on Maternal Mental Health Care for Perinatal Mothers during COVID-19: A Qualitative Study

Background

During COVID-19 pandemic, the isolation, socialization, and extreme changes in daily life have some potential mental health consequences which should be recognized as a critical public health concern, especially for perinatal mothers. Therefore, it is very important to assess the needs for maternal mental health care in perinatal mothers during COVID-19 pandemic. This study aimed to explore mothers' needs for maternal mental health care in the perinatal period during COVID-19 pandemic.

Material and Methods

Realistic phenomenological approach was carried out in this qualitative study. The study was conducted at five community health centers in the city of Tangerang, Indonesia. In-depth interviews were conducted to 11 mothers who were pregnant, in labor, during puerperium and two months after giving birth with purposive sampling. Data were collected from May to August 2021. Interviews were conducted face to face, audio recorded, and transcribed verbatim. Data were analyzed by using Van Manen's phenomenological method.

Result

Initial finding revealed 254 codes, which were then reduced to 122 codes, 98 sub-categories, 22 categories, and 5 themes. There were five themes related to mothers' needs for mental health care during COVID-19, i.e., health protocol during pandemic, psychological support, health education, simple coping mechanism, and support system.

Conclusions

The needs can be fulfilled by the closest people the mothers have and healthcare system for perinatal mental health. Vaccination, health protocol, and psychological resilience should be delivered to mothers during COVID-19.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 1: study protocol for a hybrid type 2 effectiveness-implementation cluster-randomized trial

BACKGROUND

Serious mental illness (SMI) can have devastating consequences. Unfortunately, many patients with SMI do not receive evidence-based psychological treatment (EBPTs) in routine practice settings. One barrier is poor "fit" between EBPTs and contexts in which they are implemented. The present study will evaluate implementation and effectiveness outcomes of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) implemented in community mental health centers (CMHCs). TranS-C was designed to target a range of SMI diagnoses by addressing a probable mechanism and predictor of SMI: sleep and circadian problems. We will investigate whether adapting TranS-C to fit CMHC contexts improves providers' perceptions of fit and patient outcomes.

METHODS

TranS-C will be implemented in at least ten counties in California, USA (N = 96 providers; N = 576 clients), via facilitation. CMHC sites are cluster-randomized by county to Adapted TranS-C or Standard TranS-C. Within each county, patients are randomized to immediate TranS-C or usual care followed by delayed treatment with TranS-C (UC-DT). Aim 1 will compare TranS-C (combined Adapted and Standard) with UC-DT on improvements in sleep and circadian problems, functional impairment, and psychiatric symptoms. Sleep and circadian problems will also be tested as a mediator between treatment condition (combined TranS-C versus UC-DT) and functional impairment/psychiatric symptoms. Aim 2 will evaluate whether Adapted TranS-C is superior to Standard TranS-C with respect to provider perceptions of fit. Aim 3 will evaluate whether the relation between TranS-C treatment condition (Adapted versus Standard) and patient outcomes is mediated by better provider perceptions of fit in the Adapted condition. Exploratory analyses will (1) compare Adapted versus Standard TranS-C on patient perceptions of credibility/improvement and select PhenX Toolkit outcomes and (2) evaluate possible moderators.

DISCUSSION

This trial has the potential to (a) expand support for TranS-C, a promising transdiagnostic treatment delivered to patients with SMI in CMHCs; (b) take steps toward addressing challenges faced by providers in delivering EBPTs (i.e., high caseloads, complex patients, poor fit); and (c) advance evidence on causal strategies (i.e., adapting treatments to fit context) in implementation science.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04154631. Registered on 6 November 2019. https://clinicaltrials.gov/ct2/show/NCT04154631.

Challenges Experienced by Family Caregivers of Individuals With Severe Mental Illness During the COVID-19 Pandemic: An Integrative Review

Family caregivers of individuals with severe mental illness (SMI) faced increasing challenges during the coronavirus disease 2019 (COVID-19) pandemic; however, empirical evidence on the general challenges they experienced is lacking. Thus, the purpose of the current integrative review was to explore family caregivers' challenges during the COVID-19 pandemic. A total of nine relevant studies were included. Family caregivers experienced greater care burdens, physical and mental health problems, and limited access to health care services due to the pandemic. It is necessary to develop mental health policies and appropriate interventions to help individuals with mental illness and their family caregivers in the event of future crises. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Impact of COVID-19 pandemic on relapse of individuals with severe mental illness and their caregiver's burden

Background

The implementation of quarantine and social distancing measures to control the COVID-19 pandemic led to restrictions at the community level and most of in-person psychiatric services were discontinued. This situation could affect the psychopathology of the patients and the burden of their caregivers. The aim of this study was to investigate the effects of COVID-19 pandemic on people with severe mental illnesses (SMIs) and their caregivers' burden.

Method

The study sample consisted of 86 patients with severe mental illness and 86 caregivers. The mental status, relapse rate, and rehospitalization rate of the patients and the general health status and burden of caregivers were investigated in three waves, including before and 3 and 6 months after the COVID-19 pandemic.

Results

The relapse rate of the patients was 14%, 33.7%, and 43% (p = 0.000) and the rehospitalization rate was 4.7%, 7%, and 10.5% in waves 0, 1, and 2, respectively (p = 0.000). Most of the psychopathological scales increased in three waves (p = 0.000). The caregivers' burden and health condition worsened during the nine months of the study as well (p = 0.000).

Conclusion

The COVID-19 pandemic led to the exacerbation of symptoms and increased the relapse rate in people with SMIs. It also worsened the caregivers' condition. People with severe mental illnesses (SMIs) and their caregivers are one of the most vulnerable groups on which the COVID-19 pandemic had a marked negative effect.

"A breath of fresh air": mindfulness training for early-career mental health social workers in Israel during COVID-19

The present study examined the effectiveness of participation in a mindfulness group for Israeli early career social workers during the COVID-19 period. Eleven participants conducting fieldwork in a mental health rehabilitation center were interviewed. The participants described a variety of benefits from their mindfulness training, in three main areas: (1) Personal: applying mindfulness in their daily life; (2) Family: improved work-life balance and family relationships; and (3) Professional: applying mindfulness in their work with mental health clients. Mental support and self-care tools provided to early-career social workers were perceived by the participants as helping them overcome uncertainty, fatigue, and overwork.

Adapting to the COVID-19 Pandemic: A Psychological Crisis Support Call Service Within a Community Mental Health Team

To mitigate potential mental health crises within a Community Mental Health Team (CMHT) the psychology department implemented a short-term, rapid access, crisis telephone support service for clients during the COVID-19 pandemic. We aimed to evaluate the feasibility and acceptability. Data was collected on who the service was offered to and whom engaged. Demographic information, referral and crisis support call information was collected from the service's electronic database. Forty-four participants were referred to the service. Seventy seven percent of participants engaged in one or more telephone sessions. Participants rated the service as highly useful, with simply 'talking to someone' seen as the most important aspect of the calls. A number of age differences were noted regarding the content that was discussed in sessions. The psychological crisis telephone support service was feasible and acceptable to service users during the COVID-19 pandemic.

A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery

This scoping review compiled information concerning digital health technologies (DHTs) evolution to support primary health care (PHC) during COVID-19 and lessons for the future of PHC. The identified literature was published during the COVID-19 peak years (2019-2021), retrieved from PubMed, Scopus, and Google Scholar, as well as hand searched on the internet. Predefined inclusion criteria were used, thematic analysis was applied, and reporting followed the PRISMA for Scoping Reviews. A total of 46 studies were included in the final synthesis (40 articles, one book, two book chapters, one working paper, and two technical reports). These studies scrutinized various aspects of DHTs, entailing 19 types of DHTs with 20 areas of use that can be compressed into five bigger PHC functions: general PHC service delivery (teleconsultations, e-diagnosis, e-prescription, etc.); behavior promotion and digital health literacy (e.g., combating vaccine hesitancy); surveillance functions; vaccination and drugs; and enhancing system decision-making for proper follow-up of ongoing PHC interventions during COVID-19. DHTs have the potential to solve some of the problems that have plagued us even prior to COVID-19. Therefore, this study uses a forward-looking viewpoint to further stimulate the use of evidence-based DHT, making it more inclusive, educative, and satisfying to people's needs, both under normal conditions and during outbreaks. More research with narrowed research questions is needed, with a particular emphasis on quality assurance in the use of DHTs, technical aspects (standards for digital health tools, infrastructure, and platforms), and financial perspectives (payment for digital health services and adoption incentives).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12553-023-00725-7.

Social media disorder during community quarantine: A mixed methods study among rural young college students during the COVID-19 pandemic

PURPOSE

This study sought to identify determinants of social media disorder (SMD) and describe the social media engagement among rural young (18 to 24 years old) college students during long periods of community quarantine due to COVID-19.

METHODS

This mixed methods study draws from a sample of 500 students from rural Luzon, Philippines. Quantitative and qualitative data collection were done via online survey.

RESULTS

Findings reveal that 24.2 % of the respondents have SMD. Students who are from below middle-income households, and are active on Tiktok have greater odds for SMD. Qualitative analysis of narratives of students with SMD (n = 121) reveal the beneficial and negative impacts of social media.

CONCLUSIONS

Results highlight how social position, and uses and gratifications of social media can facilitate development of SMD.

A Survey of Teachers' Status in Mental Health Education Management Based on Big Data Analysis

This paper uses the theory of mental health education to conduct an in-depth study and analysis of teachers' educational management, and based on this, it designs a survey method on teachers' status and analyzes its strategic methods based on the results of the survey. Using literature analysis, questionnaires, survey interviews, and statistical analysis, the analysis of mental health of primary and secondary school teachers in the city was made. The results of the survey and analysis of the questionnaire results were used to construct a compatible mental health evaluation model. It was found that the overall level of elementary school teachers' mental health is poor at present, and different levels of mental health were presented with school sections and ages. A total of 286 questionnaires were distributed, 278 valid questionnaires were returned, and statistical analysis was conducted using EXCEL tables based on the collected data. The data analysis results show that the mental health level of teachers in middle school is significantly lower than that of teachers in primary school, and the mental health level of teachers in primary and secondary schools decreases with the increase of age. Therefore, to prevent the small and the gradual, start from the source; do a good job in the publicity of mental health education in peacetime; popularize the knowledge of mental health, so that teachers have a correct understanding of mental health education; improve the professional level of teachers; set up professional teachers in professional positions; establish sound job system and evaluation system, etc. Promote the balanced development of school psychological counseling rooms, strengthen the construction of professional teachers in mental health education, improve various systems of mental health education, comprehensively popularize teachers' mental health education and training, and mobilize teachers' enthusiasm for scientific research on mental health education. Improve the understanding of mental health education in colleges and universities, and regard mental health education as the foundation of all education.

Evaluating the Implementation of a Multi-Technology Delivery of a Mental Health and Wellbeing System of Care Within a Youth Sports Development Program During the COVID-19 Pandemic

The COVID-19 pandemic presents challenges to the provision of community programs and access to mental health services for young people. We examined the feasibility, reach, and acceptability of multi-technology delivery of an integrated system that assesses and provides feedback on youth mental health and wellbeing and connects them to care within the context of a youth sports development program. The system was delivered via computer, telephone, and teleconference with 66 adolescent boys participating in a rugby league development program in three communities in Australia. Young people completed online wellbeing and mental health measures (Assess step), parents were provided with telephone feedback on results, support, and referral options (Reflect step), and youth received teleconferenced workshops and online resources (Connect step). The multi-technology delivery was feasible to implement, and reach was high, with barriers experienced at the Assess step but minimally experienced at the Reflect and Connect steps. Delivering the system via multiple forms of technology was rated as highly beneficial and enjoyable by young people. Players improved in self-reported prosocial behaviour, gratitude, and anxiety symptoms from pre- to post-program. Strong collaboration between researchers, organisational personnel, and community members is important for achieving these outcomes.

Navigating the digital divide: providing services to people with serious mental illness in a community setting during COVID-19

Community mental healthcare around the world has been strained as people need more help and experience more barriers to access due to COVID-19. The rapid shift to telehealth services necessitated by the pandemic has made these difficulties even more pronounced. While this transition presented challenges for nearly every healthcare system, it has proven especially difficult for low resource settings such as community health centers. This article is a critical observational study of the care transformation of a state-funded safety net psychiatric system responding to the clinical needs of patients during the COVID-19 pandemic. By discussing the challenges, opportunities, and creative solutions for staff and patients, the article highlights the new importance of technology and adaptability in clinical care and outlines clear recommendations to ensure vulnerable populations do not fall into the “digital divide.”

[Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia]

Background: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia].Objectives: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021.Methods: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics.Results: In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person.Conclusions: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

The impact of COVID-19 on service delivery systems: evidence from a survey of United States refugee resettlement agencies

BACKGROUND

Key to the US refugee resettlement effort is the role of non-governmental organizations (NGOs) who receive, place, and provide transitional programs and referrals to new and recently resettled refugees. Yet only one rapid assessment study thus far examined the impact of COVID-19 on service delivery systems of US refugee resettlement agencies. This exploratory study describes the capability and preparedness of US refugee resettlement agencies to provide services and care to clients during the COVID-19 pandemic.

METHODS

Using both telephone interviews and an internet survey, we assessed the impact of COVID-19 on service delivery, agency capacity, and preparedness of 101 US refugee resettlement agencies. Descriptive statistics were used to describe the dataset, while chi-square (χ²) tests were used to examine relationships by resettlement agency size (number of employees in each agency).

RESULTS

Despite a temporary pause on refugee admissions, restrictive stay-at-home orders, and refugee travel restrictions, the majority of responding US refugee resettlement agencies continued to provide specialized services and care to resettled refugees and other immigrants. Among the more important findings was that agencies that continued to provide refugee services and care onsite in their existing facilities or office rather than moving such services offsite differed by agency size [χ² (9.494, n = 101), p < 0.05]. Almost all agencies (93.1%) strongly agreed or agreed that staff have timely access to COVID-19 information. Most of the refugee services were provided offsite (n = 72 agencies, some with multiple offices across the US).

CONCLUSIONS

US refugee resettlement agencies continued to perform admirably despite a lack of funding. Future research is underway to obtain a more balanced understanding of the impact of COVID-19 on practice or operations.

Teletherapy and hospitalizations in patients with serious mental illness during the COVID-19 pandemic: A retrospective multicenter study

BACKGROUND

Interventions with patients with Serious Mental Illness (SMI) had to adapt rapidly to the COVID-19 safety restrictive measures, leading to the widespread use of teletherapy as an alternative.

OBJECTIVES

The aims of this study were to compare the use of different intervention modalities with patients with SMI during the first wave of the pandemic and examine their association with emergency hospital visits and hospitalization rates six months later.

METHODS

Records of 270 service users of fifteen outpatient mental health services across Spain, were retrospectively assessed. We retrieved clinical data and data on the modality of intervention received (in-person, over the phone, videoconferencing) in three time points (before, during and after the first COVID-19 wave). Also, data were retrieved regarding the frequency of their emergency hospital visits and hospitalization rates, two, four and six months later.

RESULTS

During the first wave of the pandemic, teletherapy (over the phone and videoconferencing) was the modality most widely used, whilst in-person therapy sessions were significantly reduced, though they seemed to return to pre-COVID levels after the first wave had passed. Importantly, patients receiving teletherapy during the first wave seemed to have significantly fewer emergency visits and hospitalization rates four and six months later (χ2 = 13.064; p < .001). Multilevel analyses revealed that patients receiving videoconferencing interventions had fewer hospitalizations six months after the first wave (OR = 0.25; p = .012).

CONCLUSIONS

Under challenging circumstances as those created by the COVID pandemic, teletherapy is a useful tool for protection against hospitalizations and can be used as an alternative to in-person therapy, to ensure continuity of care for patients with SMI.

Software Measurement by Using Artificial Intelligence

Artificial intelligence (AI) is a subfield of computer science concerned with developing intelligent machines capable of performing tasks similar to those performed by humans. This human-created intelligence began more than 60 years ago. The goal of previous generations of applications was to demonstrate generic human-like behaviour. The goal has expanded with the advancement and increased compliance of this technology. It includes areas such as healthcare, gaming, and smart devices. The COVID-19 epidemic has posed a significant barrier to maintaining a sustainable strategy for mental health support clients with major mental illnesses and clinicians who have had to shift delivery modes quickly. In this study, we have conducted a systematic literature review (SLR) to provide an overview of the current state of the literature related to software measurement of healthcare using artificial intelligence. The study followed a secondary research strategy. The systematic literature review aim was to analyze software measurement of mental health illness in terms of previous literature. This study screened out of 28 research papers out of 1076 initial searches. We used Science Direct, IEEE Xplore, Springer Link, ACM, and Hindawi as database search engines. The research objective was to explore the needs of software applications and automation in the healthcare sector to bring efficiency to the systems. The research concluded that the healthcare setting crucially requires the implementation of software automation.

The Impact of Using mHealth Apps on Improving Public Health Satisfaction during the COVID-19 Pandemic: A Digital Content Value Chain Perspective

The use of mobile technology and equipment has been found to be successful in the governance of public health. In the context of the coronavirus disease 2019 (COVID-19) pandemic, mobile health (mhealth) apps are expected to play an important role in the governance of public health. This study establishes a structural equation model based on the digital content value chain framework, identifies the main values created by mhealth apps in the prevention and control of COVID-19, and surveys 500 citizens of China. The data were analyzed using an independent t-test and partial least squares structural equations (PLS-SEM). The results showed that people who use mhealth apps are more satisfied with public health governance than those who do not; the healthcare assurance value of mhealth apps and healthcare confidence positively influence the interaction between users and mhealth app functions, the interaction with information, and the interaction with doctors to improve users’ satisfaction with public health governance; and the parasocial relationships between doctors and users of mhealth apps positively affect the interactions between users and doctors to improve users’ satisfaction with public health governance. This study confirms the potential of mhealth apps toward improving public health governance during the COVID-19 pandemic from a new perspective and provides a new theoretical basis whereby mobile technology can contribute toward improving public health governance.

Strengthening the Trialability for the Intention to Use of mHealth Apps Amidst Pandemic: A Cross-Sectional Study

Recent advancements in mHealth apps and services have played a vital role in strengthening healthcare services and enabling their accessibility to marginalized people. With the alarming rise in COVID-19 infection rates around the world, there appears to be an urgent call to modernize traditional medical practices to combat the pandemic. This study aims to investigate the key factors influencing the trialability of mHealth apps/services and behavioral intention to adopt mobile health applications. The study also examines the moderating effects of self-discipline motivation, knowledge, and attitude on the relationship between trialability and behavioral intention to use. The deductive reasoning approach was followed in a positivism paradigm. The study used convenience sampling and collected responses from 280 Generation Y participants in Bangladesh. Partial least square-based structural equation modeling was employed. The results revealed that relative advantage (β = 0.229, p < 0.05), compatibility (β = 0.232, p < 0.05), complexity (β = −0.411, p < 0.05), and observability (β = 0.235, p < 0.05) of mHealth apps influence the trialability of mHealth apps and services among users. Trialability compatibility (β = 0.425, p < 0.05) of mHealth was positively related to the behavioral intention to use these mobile apps. The study found no moderating effects of attitude (β = 0.043, p > 0.05) or self-discipline motivation (β = −0.007, p > 0.05) on the hypothesized relationships. The empirical findings of this study may facilitate the development, design process, and implementation of mHealth applications with improved features that can lead to high user acceptance among Generation Y during future health crises.

Collecting Data During the COVID-19 Pandemic: Lessons From an In-Person Survey of People Who Use Opioids

OBJECTIVES

In response to the COVID-19 pandemic, much in-person data collection has been suspended or become tele-remote. However, tele-remote methods often exclude marginalized groups, including people who use drugs, many of whom lack the technology to participate. To inform future surveillance and research during the pandemic and other public health disasters, we report methods and lessons learned from an in-person survey of people who use opioids conducted by the New York City Department of Health and Mental Hygiene (DOHMH) during the COVID-19 pandemic.

MATERIALS AND METHODS

This public health surveillance was a component of the Centers for Disease Control and Prevention Overdose Data to Action initiative and aimed to inform overdose prevention efforts. Survey domains inquired about participants' drug use patterns, risk behaviors, overdose history, and service use.

RESULTS

From June 16 through September 9, 2020, DOHMH staff members conducted 329 surveys with participants from 4 syringe service programs (n = 148, 44.9%) and via street intercept (n = 81, 55.1%). To survey participants safely and effectively, it was important to build rapport upfront so that requests to maintain distance were not perceived as stigmatizing. DOHMH staff members offered all participants, regardless of survey eligibility, Narcan and hygiene products, including face masks and soap.

PRACTICE IMPLICATIONS

Surveys administered outdoors during the COVID-19 pandemic should be limited to 30 minutes. Although conducting in-person surveys poses unique challenges, this method should be considered so marginalized populations are included in data collection and public health responses.

Psychiatric Rehabilitation During COVID-19 Pandemic: Richmond Fellowship Society (I), Bangalore Branch Experience

Richmond Fellowship Society (India) [RFS(I)] is a "Not for Profit" Non-Governmental Organization working for the psychosocial rehabilitation of persons with chronic mental illness. The RFS(I) Bangalore branch runs a daycare, half-way home, and long-stay facility. This paper describes the RFS(I) Bangalore branch's experience running psychiatric rehabilitation facilities during the first two waves of the COVID-19 pandemic, including managing a COVID-19 outbreak in the residential facilities.

Redesign of a brief PTSD treatment in safety net integrated primary care: Supporting implementation in the context of the COVID-19 pandemic

OBJECTIVE

We conducted a formative evaluation to understand the impact of the COVID-19 pandemic on the safety net integrated primary care setting and to identify (and respond to) new implementation barriers prior to a hybrid type I effectiveness-implementation trial of a posttraumatic stress disorder (PTSD) treatment.

METHOD

We used surveys and qualitative interviews with employee stakeholders (N = 27) to (1) understand pandemic-related factors that may influence implementation, including changes in patient needs, provider experiences, and the practice, and (2) assess the need for augmentation to study design, implementation plan, or intervention.

RESULTS

Conventional content analysis and survey findings suggest that patient acuity and volume increased provider burden, leading to high burnout. Although the shift to telehealth improved behavioral health access, issues with technology access and literacy were common. Changes to the study design and implementation plan, based on findings, included the provision of multi-modality treatments (in person, telehealth, web-administered), technology and administrative support, and other strategies for reducing provider burnout.

CONCLUSIONS

This study describes how an ongoing research study adapted to major changes to the implementation setting during the pandemic. Changes to study design and implementation plan were responsive to the shift to telehealth and therapist burden (and burnout) concerns.

Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey

OBJECTIVE

Peer support specialists (PSS) are an integral part of the mental health workforce. The purpose of this study was to better understand how the COVID-19 pandemic affected their employment status and day-to-day work.

METHODS

A cross-sectional, online survey was conducted (May-June 2020). Recruitment occurred through the National Association of Peer Specialists and additional snowball sampling. Closed- and open-ended questions sought information about employment status, work tasks, challenges faced by PSS and by individuals they supported, and positive impacts they experienced.

RESULTS

A total of 1,280 surveys were analyzed. Nine percent of respondents reported having lost their job as a result of COVID-19. Of these, 65% reported a length of employment of 2 or more years, and 61% reported working 35 hours or less per week. Job tasks changed dramatically, with 73% reporting engagement in new tasks, including increased reliance on technology (N=717), increased coordination of resources (N=123), and COVID-19-related tasks (N=142). Engagement in some support tasks decreased significantly from prepandemic levels, including individual support provision (p<0.001) and group facilitation (p<0.001). Respondents reported significant challenges among individuals they supported, including increased isolation (92%), substance use (67%), housing instability (38%), and food insecurity (64%). Although respondents also reported challenges, satisfaction with organizational and supervisory support was high. Most respondents (73%) reported positive impacts or benefits from the pandemic.

CONCLUSIONS

The changing roles and tasks identified in this study have implications for hiring, training, supervising, and supporting peer staff. The peer workforce demonstrated flexibility and commitment to meeting increasing needs.

Mental Health and Quality & Safety of Care in Czech Residential Institutions during the COVID-19 Pandemic: A Mixed-Methods Study

Long-stay institutions have been considerably affected by the COVID-19 pandemic. We aimed to assess the mental health of clients and staff as well as quality and safety of care in long-stay institutions during the state-of-emergency in the Czech Republic in response to COVID-19 pandemic. We found a high prevalence of poor mental health outcomes in clients (46% poor well-being, 58% depression, 45% anxiety) and staff (17% poor well-being, 22% depression, 14% anxiety). In clients, COVID-19 health-related and economic worries were associated with depression (1.79, 95% CI = 1.14; 2.8 and 2.28, 95% CI = 1.27; 4.08 respectively) and anxiety (1.63, 95% CI = 1.11; 2.4 and 1.85, 95% CI = 1.2; 2.85 respectively) and in staff with any mental health outcome (1.92, 95% CI = 1.33; 2.77 and 1.75, 95% CI = 1.15; 2.66 respectively). Lack of information and communication from authorities, lack of protective equipment and logistic difficulties were reported as challenges. Delivery of care was mostly disrupted as well as admission and discharge processes. Other reported issues included lack of staff, lack of activities for patients or an increase in usage of restrictive measures. Best practices and key future measures were identified by each institution, a summary of which is presented in the article.

"How can I hug someone now [over the phone]?": Impacts of COVID-19 on peer recovery specialists and clients in substance use treatment

Introduction

The COVID-19 pandemic has disproportionately affected underserved, low-income, ethnoracial minority communities, as well as those with substance use disorders (SUDs). The workforce of peer recovery specialists (PRSs), individuals with lived substance use and recovery experience, has rapidly expanded in response to a shortage of access to substance use treatment, particularly for those from underserved communities. As PRSs are likely serving individuals disproportionately affected by the pandemic, it is important to understand how COVID-19 has affected the PRS role and the individuals with SUD who they are supporting.

Method

This study aimed to examine: (1) the impact of COVID-19 on the PRS role and experience, (2) the impact of COVID-19 on clients in or seeking SUD treatment, (3) facilitators for clients engaging in treatment and adapting to new changes, and (4) sustainability of new treatment methods post-pandemic.

Results

Findings suggest that PRSs have had to adapt their role and responsibilities to meet changing client needs; however, PRS strengths, such as their shared experience and expertise navigating treatment barriers, make them uniquely suited to assist clients during the pandemic. The study identified various barriers and facilitators to clients seeking treatment or living with SUD, such as the loss of interpersonal connection. PRSs also identified some drawbacks to utilizing telehealth, but identified this as a potentially sustainable approach to delivering care after the pandemic.

Conclusion

Future research could explore how challenges to fulfilling the PRS role, as well as adaptations to overcome these challenges, have changed over time.

Further Adaptations and Reflections by an Assertive Community Treatment Team to Serve Clients with Severe Mental Illness During COVID-19

In September of 2020, Guan and colleagues wrote about their experience of an Assertive Community Psychiatry Program responding to the COVID-19 pandemic. We describe our own experience as an Assertive Community Treatment team in Minnesota responding to challenges of effectively and safely delivering service to clients. As the pandemic has progressed since last year, so has the literature, and updated references are highlighted. Common threads are woven between our experience, the experience of Guan and colleagues, and others to suggest the beginnings of a template to adapt services to a new post-pandemic world.

mHealth for Young Adults with Early Psychosis: User Preferences and Their Relationship to Attitudes About Treatment-Seeking

A long duration of untreated psychosis reduces benefits of early intervention for early psychosis. Digital technologies have potential to encourage help-seeking and reduce barriers to care. Because of high rates of smartphone ownership, mobile health (mHealth) interventions may be particularly well-suited to increase access. There is a lack of available information on the specific features that may be most appealing to young adults with early psychosis. The present study remotely recruited 77 young adults with psychosis and surveyed their interest in mHealth features, delivery modalities, and attitudes toward treatment. Overall, respondents reported high utilization of digital health and high interest in psychosis-specific mHealth. They expressed the highest interest (ordered by mean score by item) in information about medications and side effects (n = 69, 89.6% reporting being “interested” or “very interested”), managing stress and improving mood (n = 67, 89.3%) and symptoms of psychosis (n = 66, 88%), as well as in tracking changes in symptoms (n = 70, 90.9%), and goals (n = 66, 86.9%). They also reported high interest in content being delivered as text (n = 69, 89.6%) and also in communicating directly with providers. Respondents were less interested in social features, and those with most negative attitudes toward help-seeking had particularly low interest in features related to disclosing symptoms to others. These results suggest mHealth may have potential to engage individuals with early psychosis, and that the most effective strategies may be those that are most straightforward, including direct psychoeducational information.