If not now, when? COVID-19, lived experience, and a moment for real change

Mental health service user organizations in times of crises: adaptions, challenges and opportunities experienced by local associations during COVID-19

PURPOSE

This study examines how local user associations of mental health service-user organizations were affected by the pandemic, in order to provide guidance to user organizations and surrounding actors on future advancements. The pandemic is used as a case to explore organizational resilience and digitalization during crisis.

METHODS

Data from focus group interviews and individual interviews with representatives of ten local associations were analysed using qualitative content analysis. A theoretical framework combining governance theory and organizational theory was applied.

RESULTS

Typically, associations swiftly restructured activities to support members to meet the urgent needs that arose, not least in relation to the digital transition. Simultaneously, face-to-face interactions was valued and some members became isolated. Public sector actors often did not prioritize collaboration, and the associations had limited agency and influence in advocacy activities.

CONCLUSIONS

User organizations can play an important role in times of crisis. Surrounding social systems should provide resources to counteract resource dependencies and allow organizations to develop operating reserves. They should value collaboration and establish collaborative practices to ensure a readiness to utilize the organizations' capacities when needed. User organizations should have control over future developments, both to harness the potential of digital connectivity and to prevent a digital divide.

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.

Destigmatizing Borderline Personality Disorder: A Call to Action for Psychological Science

Despite recognition that borderline personality disorder (BPD) is one of the most stigmatized psychological disorders, destigmatization efforts have thus far focused on the views and actions of clinicians and the general public, neglecting the critical role that psychological science plays in perpetuating or mitigating stigma. This article was catalyzed by recent concerns about how research and editorial processes propagate stigma and thereby fail people with BPD and the scientists who study BPD. We provide a brief overview of the BPD diagnosis and its history. We then review how BPD has been stigmatized in psychological science, the gendered nature of BPD stigma, and the consequences of this stigmatization. Finally, we offer specific recommendations for researchers, reviewers, and editors who wish to use science to advance our understanding of BPD without perpetuating pejorative views of the disorder. These recommendations constitute a call to action to use psychological science in the service of the public good.

Design and Application of Sports-Oriented Public Health Big Data Analysis Platform

People's pursuit of public health continues to improve with the rapid economic development. Physical activity is an important way to achieve public health. Excessive physical activity intensity and uncomfortable forms of physical activity can affect people's physical and mental health. Reasonable physical activity intensity and reasonable physical activity form will be beneficial to public health. People need to choose the corresponding sports mode according to physical function parameters and mental health parameters. However, it is difficult to understand the relationship between physical activity patterns and public health-related parameters, which limits people to establish reasonable exercise patterns. This research uses big data technology to design an intelligent sports-oriented public health data analysis scheme. It mainly uses MLCNN method and LSTM method to extract physical function parameter features, mental health parameter features, and sports parameter features. The research results show that the MLCNN method and LSTM can accurately extract and predict the parametric features related to sports and public health. The largest relative mean error is only 2.52%, which is the predicted value of the physical performance parameter characteristics. The smallest prediction error is also 2.27%, and this part of the relative error comes from the prediction of sports parameters.

Methodologies to Advance a "Science of How": Identifying and Engaging Intervention Targets and Outcomes

OBJECTIVE

Although implementation science has taken hold in many areas of psychiatric services research, a need remains for developing effective, low-cost interventions for specific subpopulations with mental health conditions. The experimental therapeutics approach has gained momentum as a framework for developing effective interventions. However, few studies have taken steps to rigorously apply experimental therapeutics. This article provides a blueprint for applying this approach.

METHODS

A focused literature review was conducted to document the frequency of the application of experimental therapeutics among articles published between 2011 and 2021 in some of the American Psychiatric Association's journals. Independently of the review, the authors delineated a four-component approach for applying experimental therapeutics in research and present practical, innovative strategies to advance psychiatric services research.

RESULTS

The four-component approach includes outlining prerequisites, identifying target mechanisms, proposing intervention strategies to address target mechanisms, and using advanced analytic methods. The strategies described for each component are not exhaustive; rather, they suggest promising avenues for research that can lead to more effective interventions and deeper understanding of how, and for whom, an intervention works.

CONCLUSIONS

The application of experimental therapeutics in psychiatric services research can lead to increased development, refinement, and implementation of effective interventions for specific populations or conditions.

Healing in Health Care: Mental Health Promotion, Advocacy, and Voluntarism in Response to COVID-19

The COVID-19 pandemic increased many known risk factors for mental health problems. In the context of overwhelmed health systems and resource and staffing shortages, the mental health needs of frontline health care workers (HCWs) gained attention as a major public health concern and a threat to high-quality care delivery. In response, mental health promotion initiatives were quickly developed to meet the demands of the public health crisis. Two years later, the context for psychotherapy has changed, especially as it pertains to the health care workforce. Particularly salient experiences-grief, burnout, moral injury, compassion fatigue, and racial trauma-have become routinely discussed as part of everyday clinical practice. Service programs have become more responsive to the needs, schedules, and identities of HCWs. In addition, mental health and other HCWs have contributed to advocacy and volunteer initiatives promoting health equity, culturally responsive care, and access to care across a range of settings. In this article, the authors review the benefits of these activities to individuals, organizations, and communities and summarize example programs. Many of these initiatives began in response to the acute public health crisis; however, engaging in these ways and spaces holds promise for increasing connection and prioritizing equity and structural change over the long term.

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.

Scaling up public mental health care in Sub-Saharan Africa: insights from infectious disease

INTRODUCTION

Models estimate that the disability burden from mental disorders in Sub-Saharan Africa (SSA) will more than double in the next 40 years. Similar to HIV, mental disorders are stigmatized in many SSA settings and addressing them requires community engagement and long-term treatment. Yet, in contrast to HIV, the public mental healthcare cascade has not been sustained, despite robust data on scalable strategies. We draw on findings from our International AIDS Society (IAS) 2020 virtual workshop and make recommendations for next steps in the scale up of the SSA public mental healthcare continuum.

DISCUSSION

Early HIV surveillance and care cascade targets are discussed as important strategies for HIV response in SSA that should be adopted for mental health. Advocacy, including engagement with civil society, and targeted economic arguments to policymakers, are reviewed in the context of HIV success in SSA. Parallel opportunities for mental disorders are identified. Learning from HIV, communication of strategies that advance mental health care needs in SSA must be prioritized for broad global audiences.

CONCLUSIONS

The COVID-19 pandemic is setting off a colossal escalation of global mental health care needs, well-publicized across scientific, media, policymaker, and civil society domains. The pandemic highlights disparities in healthcare access and reinvigorates the push for universal coverage. Learning from HIV strategies, we must seize this historical moment to improve the public mental health care cascade in SSA and capitalize on the powerful alliances ready to be forged. As noted by Ambassador Goosby in our AIDS 2020 workshop, 'The time is now'.