The Next Step in Integrated Care: Universal Primary Mental Health Providers

Breaking the Stigma in Mental Health Nursing through High-Fidelity Simulation Training

The social stigma toward individuals with mental health problems is habitual among nursing students, which can lead to poor quality of health care services for patients with mental illnesses. The purpose of the present study was to learn about nursing students' perceptions of providing care to patients with severe mental disorders before and after participating in a simulated student clinical case. A descriptive qualitative study was conducted through 39 interviews. The difficulties expected by the students and their perceptions about patients were explored before the simulation training. Their perceptions about the use of clinical simulation for learning about the adequate management of these patients were analyzed afterwards. Results: Before the simulation training, the students assessed the case as being complicated, expressed their lack of specific training, and felt fear and insecurity, thus reproducing the stigma towards mental health patients. After this training, they positively valued the usefulness of the clinical simulation for gaining confidence and overcoming the stigma. Discussion: The use of high-fidelity simulation offers nursing students the opportunity to approach patients with mental health conditions, overcoming their fears and normalizing mental disorders. Simulation training allows nursing students to analyze the reasoning of clinical judgment and to detect the influence of previous prejudices about mental illness in their clinical decision. This study was not registered.

Patient and healthcare professionals' perceived barriers and facilitators to the implementation of psychosocial screening in cardiac practice: A Delphi study

BACKGROUND

Psychosocial risk factors contribute to the incidence and progression of coronary heart disease (CHD). Psychosocial screening may identify individuals who are at risk and aid them with getting appropriate care. To successfully implement psychosocial screening in the cardiology practice, the current study aims to identify key barriers and facilitators to its implementation and evaluate their perceived importance among health care professionals (HCPs) and patients.

METHODS

We took a modified 3-round Delphi study approach to gain insight into key determinants that could either impede or ease implementation. Round 1 gathered data from HCPs (n = 9; cardiologists, medical psychologists, cardiac nurses) and CHD patients (n = 21), which we transcribed verbatim, coded, and processed into unique determinants. In rounds 2 and 3, participants were asked to select the most relevant determinants and rank them based on importance. Subsequently, determinants were classified by implementation level.

RESULTS

Patients were generally more positive towards screening. HCP barriers included time-constraints, disruption of primary activities, and limited knowledge on psychosocial risk and screening, while patient barriers were commonly related to accessibility and patient characteristics (e.g., health literacy, motivation). Facilitators of both groups mainly pertained to the use of the screener and follow-up care, such as increasing the accessibility and the benefits of the screener.

CONCLUSION

Barriers may be targeted by enhancing the effects of the facilitators. Increasing the accessibility to the screener and interventions, improving information provision, and appointing a contact person to oversee the screening process may ease the screening and care process for both patients and HCPs.

Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety

OBJECTIVE

Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals.

METHODS

We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews.

RESULTS

Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization.

CONCLUSIONS

Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.

Strong Mind, Strong Body: The Promise of Mind-Body Interventions to Address Growing Mental Health Needs Among Youth

As the prevalence of childhood and adolescent anxiety, depression, and other mental health concerns continues to rise, there has been an unprecedented increase in support of mind-body practices like yoga, dance, meditation, mindfulness, aerobic exercise, and more-in part driven by the mental health burden imposed by the COVID-19 pandemic. While a growing body of evidence supports the safety and effectiveness of mind-body approaches, gaps in funding for and empirical research on mechanistic underpinnings, methodology development to assess multi-component therapeutic practices, dissemination and implementation, and diversity in researchers, practitioners, and recipients remain. As a consequence, the neurobiological impacts of mind-body techniques are not well understood nor broadly accepted as standard forms of care by clinicians and insurers-often being considered as 'alternative' rather than 'complementary' or 'integrative'. In this commentary, we summarize work from our labs and others highlighting the promise of mind-body approaches for improving mental health in youth, in line with the National Institute of Mental Health's strategic plan to address health disparities. We offer a potential framework for implementation and research-the Expressive Therapies Continuum. We also propose solutions to key research and policy gaps, that by could have positive public health impacts for those who are struggling and to prevent emergence of psychiatric illness, especially in developing youth.

Psychosocial screening in a pediatric diabetes clinic: Adolescents' and mothers' perspectives

OBJECTIVE

Adolescents with type 1 diabetes (T1D) frequently experience psychosocial concerns, and mental health screening is becoming increasingly common in routine diabetes care. However, little is known about what adolescents or their caregivers think about the role of mental health screening and intervention within the context of comprehensive diabetes care, or how their diabetes care providers should be involved in navigating mental health concerns. This study used qualitative methods to obtain the perspectives of adolescents with T1D and their caregivers regarding these issues.

METHODS

Participants were 13 adolescents with T1D (ages 12-19 years; M = 15.1 years; 53.8% female; 61.5% Hispanic/Latinx White) and 13 mothers, recruited from an outpatient pediatric endocrinology clinic in South Florida, who participated in semi-structured interviews via video teleconference. Thematic content analysis was used to evaluate participants' responses.

RESULTS

Adolescents and their mothers reported positive experiences with the clinic's psychosocial screening procedures and appreciated meeting with the psychology team during visits. They wanted the clinic to offer more opportunities for peer support. Mothers highlighted barriers to seeking mental health care outside of the clinic and the importance of mental health professionals understanding diabetes. Mothers also wanted the clinic to offer more on-site therapeutic services.

DISCUSSION

Study participants valued psychosocial screening and supported addressing mental health as a routine part of diabetes comprehensive care.

Mental health outcomes and help-seeking behaviours among Egyptian medical students: A cross-sectional study

AIM

Approximately half of the population in Egypt is under the age of 25. Globally, mental illness represents the highest burden of disease in this age group. Yet in Egypt, there is still no youth-specific mental health system in place and the vast majority of young people do not have access to any professional mental health support. The objective of this study was to describe the mental health needs of Egyptian youth and the resources they use when seeking help.

METHODS

An online cross-sectional survey was distributed among medical students at Tanta University in Egypt. Of the 707 individuals who completed the survey (90.9% response rate), 60.5% were female, 62.0% lived in urban and suburban areas, and the mean age of the sample was 20.5 (±1.8) years old.

RESULTS

More than half (54%) of the students reported that they had been affected by mental health problems at some point in their lives. Anxiety and depression were the most common problems. Regarding help-seeking behaviours, participants mainly searched the web or spoke to peers and relatives; few reported approaching medical professionals. The majority of participants (59.7%) reported being disappointed with the current mental health care system in Egypt.

CONCLUSIONS

There is a high prevalence of mental challenges among Egyptian youth and the health care system is not adequately prepared to respond to their needs. E-Mental Health and online interventions seem to be a promising solution that could increase access to mental health services for Egyptian youth.

Novel Approach to Integrating Mental Health Care into a Primary Care Setting: Development, Implementation, and Outcomes

It is now widely accepted that there is a growing discrepancy between demand and access to adequate treatment for behavioral or mental health conditions in the United States. This results in immense personal, societal, and economic costs. One rapidly growing method of addressing this discrepancy is to integrate mental health services into the primary care setting, which has become the de facto service provider for these conditions. In this paper, we describe the development and implementation of a novel integrated care program in a large mid-western university-based healthcare system, drawn from the collaborative care model, and describe the benefits in terms of both health care utilization and depression outcomes. Limitations and proposed future directions are discussed.

Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center

Guidelines recommend routinely screening adults with diabetes for psychological concerns, but few diabetes clinics have adopted screening procedures. This study assessed patient and provider perspectives regarding the role of mental health in diabetes care, psychosocial screening procedures, and patients’ support needs. Patients with diabetes (n = 15; 73.3% type 2) and their medical providers (n = 11) participated in qualitative interviews. Thematic content analysis was used to categorize results. Participants believed that mental health was important to address within comprehensive diabetes care. Patients expressed positive or neutral opinions about psychosocial screening. Providers had mixed reactions; many thought that screening would be too time-consuming. Both groups emphasized that screening must include referral procedures to direct patients to mental health services. Patients and providers interviewed in this study viewed psychosocial screening as compatible with diabetes care. Including a mental health professional on the treatment team could reduce potential burden on other team members.

Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care

BACKGROUND

Mental health care must improve in this country. With the worsening shortage of psychiatrists and other mental health professionals, the next generation of physicians in primary care will need to be better trained in mental health care.

OBJECTIVES

We estimate the direct cost of implementing an evidence-based Train-the-Trainer (3T) program to disseminate mental health training to allopathic medical school faculty; once trained, faculty can teach a much-enhanced curriculum of mental health care to medical students and residents.

METHODS

A combination of published standardized unit costs and an activity-based costing approach is used to estimate the direct costs (labor and nonlabor) for implementing the 3T program.

RESULTS

The estimated direct cost of implementing the 3T program at one prototypical school, including the 12-month start-up period (1.1 million) and 18-month rollout period (8.6 million), is ∼9.7 million dollars.

CONCLUSIONS

Successfully adopted in all US allopathic medical schools, the 3T program will provide over 3800 attitudinally competent and mental health skills-qualified primary care faculty members. They would then be available to train nearly 100,000 medical students per year and 55,000 primary care residents to be as competent in basic mental health care as in medical care. This 3T program will begin to meet the needs each year for the millions of adults with major mental disorders that now are largely unrecognized and untreated.

Reducing the Impacts of Mental Health Stigma Through Integrated Primary Care: An Examination of the Evidence

The reduction of mental health stigma (MHS) was an expected benefit of integrating behavioral health in primary care (IPC). However, unlike other barriers discussed in agency reports on IPC, discussions of MHS lack research support. To fill this gap, the authors conducted a literature review identifying seven studies. Given the dearth of research, we also examine general IPC research on probable indicators of MHS reduction in IPC, as well as, facets of IPC potentially influencing MHS related factors negatively associated with help-seeking. Using the data from these three types of research, the evidence suggests the potential of IPC to reduce MHS impact on care utilization, but indicates it is premature to draw firm conclusions. Given the possible benefits of primary care and the known benefits of decreased MHS, this review highlights the importance of further research examining this question and provides specific research and program development recommendations.

Examining Caretaker Attitudes Towards Primary Prevention of Pediatric Behavioral Health Problems in Integrated Care

Understanding caretaker attitudes towards the prevention of pediatric behavioral disorders is important for the effective delivery of prevention services. Caretakers of children ages 0-18 (N = 385) read a description of pediatric prevention services in an integrated primary care setting. Attitudes towards these services were assessed. The majority of participants (80%) agreed that prevention is important, 87% reported interest in learning their child's risk for a behavioral disorder, 84% were interested in learning the results of a screen for behavioral disorders, and 88% were interested in learning parenting strategies. Participants endorsed similarly positive attitudes towards prevention in integrated care. Perceived risks outweighing perceived benefits, younger caregiver age, and identifying as non-Hispanic White predicted less favorable attitudes towards prevention. Other socio-demographic characteristics (e.g., caretaker education) were associated with disorder-specific beliefs about the importance of prevention, but not general attitudes. Findings suggest generally positive attitudes towards preventing behavioral disorders in an integrated care setting.

A Primary Care Prevention System for Behavioral Health: The Behavioral Health Annual Wellness Checkup

Behavioral health problems are involved in the majority of primary care visits. These behavior disorders (e.g., depression, anxiety, smoking, insomnia, etc.) are costly, burdensome to both the patient and the healthcare system, and result in greater medical utilization/cost and poorer future health outcomes. Integrated behavioral healthcare has been proposed as a model for more efficiently addressing the burden of behavioral health problems. While this model has demonstrated some promise in the treatment of behavioral health problems, as well as in the reduction in costs and improvement in healthcare outcomes, the primary prevention of behavioral health problems in this delivery model has been relatively neglected. The present paper discusses the potential value of incorporating the prevention of behavioral health problems into the annual physical/wellness checkup and proposes a detailed system for how this might be accomplished. Limitations, future research, and costs associated with increased prevention in a primary care context are discussed.