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Murphy JK, Saker S, Ananyo Chakraborty P, Chan YM(M, Michalak EE, Irrarazaval M, Withers M, Ng CH, Khan A, Greenshaw A, O’Neil J, Nguyen VC, Minas H, Ravindran A, Paric A, Chen J, Wang X, Hwang TY, Ibrahim N, Hatcher S, Evans V, Lam RW. Advancing equitable access to digital mental health in the Asia-Pacific region in the context of the COVID-19 pandemic and beyond: A modified Delphi consensus study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002661. [PMID: 38857265 PMCID: PMC11164385 DOI: 10.1371/journal.pgph.0002661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/01/2024] [Indexed: 06/12/2024]
Abstract
The COVID-19 pandemic had an unprecedented impact on global mental health and well-being, including across the Asia-Pacific. Efforts to mitigate virus spread led to far-reaching disruption in the delivery of health and social services. In response, there was a rapid shift to the use of digital mental health (DMH) approaches. Though these technologies helped to improve access to care for many, there was also substantial risk of access barriers leading to increased inequities in access to mental health care, particularly among at-risk and equity-deserving populations. The objective of this study was to conduct a needs assessment and identify priorities related to equitable DMH access among at-risk and equity-deserving populations in the Asia Pacific region during the first year of the COVID-19 pandemic. The study consisted of a modified Delphi consensus methodology including two rounds of online surveys and online consultations with stakeholders from across the region. Study participants included policy makers, clinicians and service providers, and people with lived experience of mental health conditions. Results demonstrate that vulnerabilities to negative mental health impacts and access barriers were compounded during the pandemic. Access barriers included a lack of linguistically and culturally appropriate DMH options, low mental health literacy and poor access to technological infrastructure and devices, low levels of awareness and trust of DMH options, and lack of policies and guidelines to support effective and equitable delivery of DMH. Recommendations to improve equitable access include ensuring that diverse people with lived experience are engaged in research, co-design and policy development, the development and implementation of evidence-based and equity-informed guidelines and frameworks, clear communication about DMH evidence and availability, and the integration of DMH into broader health systems. Study results can inform the development and implementation of equitable DMH as its use becomes more widespread across health systems.
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Affiliation(s)
- Jill K. Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shirley Saker
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America
| | - Promit Ananyo Chakraborty
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Erin E. Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Mellissa Withers
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, United States of America
| | - Chee H. Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Amna Khan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - John O’Neil
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, Hanoi, Vietnam
| | - Harry Minas
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Arun Ravindran
- Centre for Addiction and Mental Health/ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Angela Paric
- Centre for Addiction and Mental Health/ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jun Chen
- Shanghai Mental Health Centre, Shanghai, China
| | - Xing Wang
- Shanghai Mental Health Centre, Shanghai, China
| | - Tae-Yeon Hwang
- Korea Foundation for Suicide Prevention, Seoul, South Korea
| | - Nurashikin Ibrahim
- Mental Health, Injury and Violence Prevention and Substance Abuse Sector Section, Ministry of Health, Kuala Lumpur, Malaysia
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Vanessa Evans
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Reay RE, Maguire PA, Looi JC. A level playing field? Evaluation of the virtual Objective Structured Clinical Examination in Psychiatry and Addiction Medicine: A mixed methods study. Australas Psychiatry 2024:10398562241249567. [PMID: 38739630 DOI: 10.1177/10398562241249567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The Objective Structured Clinical Examination (OSCE) has been used for clinical assessment of a broad range of medical student competencies in Psychiatry and Addiction Medicine. However, there has been little research into online assessments. We investigated the virtual OSCE (v-OSCE) from the user perspective to better understand its acceptability, usefulness, benefits, challenges and potential improvements. METHODS At the conclusion of the v-OSCE, all participants (medical students, examiners and simulated patients) were invited to participate in a brief online survey, based on the Technology and Acceptance Model. Freeform qualitative feedback was also obtained to explore participants' experiences and attitudes. RESULTS Participants reported the v-OSCE was acceptable, efficient, convenient and easy to use. It was perceived as useful for demonstrating students' interviewing skills and interacting with the simulated patient. Benefits included greater convenience, reduced stress and travel time. Challenges were similar to those experienced in 'real world' telepsychiatry, primarily related to assessment of non-verbal cues and emotional prosody. CONCLUSIONS Our findings inform recommendations for improving online examinations. These include increased preparation, practice and professionalism, to better simulate the in-person experience. Study credibility was strengthened by the triangulation of qualitative, quantitative and psychometric data.
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Affiliation(s)
- Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, Australian National University School of Medicine and Psychology, Garran, ACT, Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, Australian National University School of Medicine and Psychology, Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, Australian National University School of Medicine and Psychology, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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Hayter CM, Allison S, Bastiampillai T, Kisely S, Looi JCL. The changing psychiatry workforce in Australia: Still lacking in rural and remote regions. Aust J Rural Health 2024; 32:332-342. [PMID: 38419201 DOI: 10.1111/ajr.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. OBJECTIVE To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. DESIGN We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. FINDINGS Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. DISCUSSION Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. CONCLUSION There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.
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Affiliation(s)
- Catherine Mary Hayter
- Mental Health, Justice Health, Alcohol and Drug Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Discipline of Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Jeffrey C L Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, The Australian National University School of Medicine and Psychology, Canberra, Australian Capital Territory, Australia
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Woon LSC, Maguire PA, Reay RE, Looi JCL. Telepsychiatry in Australia: A Scoping Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237116. [PMID: 38462906 DOI: 10.1177/00469580241237116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Telepsychiatry formed part of the Australian mental health response to COVID-19, but relevant reviews pre- and post-pandemic are sparse. This scoping review aimed to map the literature on telepsychiatry in Australia and identify key research priorities. We searched databases (Medline, PubMed, PsycINFO, Scopus, Web of Science, EBSCO Psychology & Behavioral Sciences Collection, Proquest databases, and Cochrane Central Register of Controlled Trials) and reference lists from January 1990 to December 2022. Keywords included telepsychiatry, videoconferencing, telephone consultation, psychiatry, mental health, and Australia. Two reviewers independently screened titles, abstracts, and full texts. We identified 96 publications, one-third of which appeared since 2020. Extracted data included article types, service types, usage levels, outcome measures, perceptions, and research gaps. Most publications were quantitative studies (n = 43) and narrative reports of services (n = 17). Seventy-six papers reported mostly publicly established services. Videoconferencing alone was the most common mode of telepsychiatry. There was increased use over time, with the emergence of metropolitan telepsychiatry during the pandemic. Few papers used validated outcome measures (n = 5) or conducted economic evaluations (n = 4). Content analysis of the papers identified perceptions of patient (and caregiver) benefits, clinical care, service sustainability, and technology capability/capacity. Benefits such as convenience and cost-saving, clinical care issues, and implementation challenges were mentioned. Research gaps in patient perspectives, outcomes, clinical practice, health economics, usage patterns, and technological issues were identified. There is consistent interest in, and growth of, telepsychiatry in Australia. The identified perception themes might serve as a framework for future research on user perspectives and service integration. Other research areas include usage trends, outcome measures, and economic evaluation.
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Affiliation(s)
- Luke Sy-Cherng Woon
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine aAustralian National University, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
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Chuah XJ, Aw CB, Ong PN, Samsuri KB, Dhaliwal SS. Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:800-839. [PMID: 37401444 DOI: 10.1080/26408066.2023.2228791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
PURPOSE This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19. METHOD Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence. RESULTS Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners. DISCUSSION & CONCLUSION The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients' and practitioners' suitability, the need for provision of training and ongoing support to optimize practitioners' well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.
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Affiliation(s)
- Xing Jun Chuah
- Learning & Development, AMKFSC Community Services Ltd, Ang Mo Kio, Singapore
| | - Chin Bee Aw
- Family & Community Support Division, AMKFSC Community Services Ltd, Seng Kang, Singapore
| | - Pei Ni Ong
- Specialist Division, AMKFSC Community Services Ltd, Ang Mo Kio, Singapore
| | - Khalisah Binte Samsuri
- Family & Community Support Division, AMKFSC Community Services Ltd, Seng Kang, Singapore
| | - Satvinder Singh Dhaliwal
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western, Australia, Australia
- AMKFSC Community Services Ltd, Ang Mo Kio, Singapore
- Office of the Provost, University of Social Sciences, Clementi, Singapore
- DUKE-NUS Medical School, National University of Singapore, Queenstown, Singapore
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Malaysia
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Schjøtt-Pedersen O, Seierstad A, Evensen S, Horgen Evensen J, Færden A, Lunde Gjerstad C, Fadler Martinsen F, Sørgård KM, Ullevoldsæter Lystad J. Lockdown during the early phase of Covid-19 - effects on specialized mental health services and vocational activities for patients with psychotic disorders. Nord J Psychiatry 2023; 77:760-767. [PMID: 37534458 DOI: 10.1080/08039488.2023.2240301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE People with psychotic disorders may be particularly vulnerable to adverse effects from restrictions implemented to limit the COVID-19 pandemic. Mental health professionals may also be at risk of adverse effects. The aim of this study was to investigate the impact of potential changes in accessibility, quality of care and vocational activity on people with psychotic disorders and the impact on clinicians working in these conditions. MATERIALS AND METHODS Patients and clinicians in specialized mental health services for psychotic disorders answered questionnaires regarding changes in treatment, quality of treatment, vocational activity, and well-being. Data was analyzed with nonparametric tests. RESULTS Inpatients appeared more influenced by the restrictions than outpatients, however, quality of treatment was regarded relatively unaffected. Clinicians seemed satisfied working under these conditions, though a larger portion of clinicians reported changes in treatment compared to patients. The patients who reported being affected by changes in vocational activity tended to report negative effects, but the majority reported being unaffected. CONCLUSION Overall, patients and clinicians appeared to cope well with the changes they experienced in accessibility, quality of care and vocational activity during the early phases of the pandemic.
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Affiliation(s)
- Olivia Schjøtt-Pedersen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Seierstad
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Stig Evensen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Norwegian Labour and Welfare Administration, Nesodden, Norway
| | | | - Ann Færden
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Christer Lunde Gjerstad
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry Oslo, Norway
| | | | - Kari Mette Sørgård
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - June Ullevoldsæter Lystad
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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Huang R, Peng X, Yu S, Tian Y, Gao C. Attitudes and intentions toward seeking professional psychological help among Chinese healthcare workers during the COVID-19 pandemic. Front Psychiatry 2023; 14:1223895. [PMID: 37779617 PMCID: PMC10539927 DOI: 10.3389/fpsyt.2023.1223895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background It has been suggested that healthcare workers (HCWs) are experiencing massive stressors that threaten their mental health during the COVID-19 pandemic, but little is known about their attitudes and intentions toward seeking professional psychological help. This study aimed to investigate the attitudes and intentions of Chinese HCWs toward seeking professional psychological help during the COVID-19 pandemic and the associated factors. Methods A total of 1,224 Chinese HCWs working in hospitals were recruited online from 12 hospitals in Hunan province in China for a survey conducted in November 2022. The Chinese version of the attitudes toward seeking professional psychological help scale-short form (ATSPPH-SF) and the general help-seeking questionnaire (GHSQ) were separately used to assess the attitudes and intentions of the respondents toward seeking professional psychological help. Demographic and socio-psychological data were collected using a self-developed questionnaire, the perceived social support scale, the self-stigma of seeking help scale, and the patient health questionnaire-9 scale. Results The 1,208 HCWs in the final analysis showed relatively negative attitudes and low intentions toward seeking professional psychological help during the COVID-19 pandemic. Results of the multiple linear regression analysis showed that female sex (p = 0.031), experience of psychological learning (p < 0.001), and social support (p < 0.001) had a positive predictive effect on the attitudes of these HCWs toward seeking professional psychological help, whereas self-stigma of seeking help (p < 0.001) and depressive symptoms (p < 0.001) exerted negative effects. Moreover, experience of psychological learning (p = 0.004) and social support (p < 0.001) had a positive predictive effect on the intentions of these HCWs toward seeking professional psychological help, whereas divorced marital status (p = 0.011) and self-stigma of seeking help (p < 0.001) exerted negative effects. Conclusion The overall attitudes and intentions of HCWs toward seeking professional psychological help were not optimistic. Effective interventions targeted at influencing factors should be formulated to promote the professional psychological help-seeking attitudes and intentions of HCWs who are at risk of developing mental health problems.
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Affiliation(s)
- Ruirui Huang
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Xiaoyan Peng
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Shuai Yu
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Yumei Tian
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Chuanying Gao
- Department of Nursing, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, China
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Hewa Koneputugodage E. COVID-19 medicare benefits schedule telehealth for private psychiatric outpatient care in Victoria, Australia. Australas Psychiatry 2023; 31:528-534. [PMID: 37227131 PMCID: PMC10225803 DOI: 10.1177/10398562231177822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE We explore telehealth use by private psychiatrists in Victoria during the first 12 months of COVID-19, in the context of: COVID-19 case numbers and restrictions; telehealth use in Victoria compared to national use; telehealth and face-to-face consultations during the first 12 months of COVID-19 compared to face-to-face consultations in the 12 months pre-COVID-19. METHOD Outpatient psychiatric face-to-face and telehealth consultations, from March 2020 to February 2021 in Victoria, were analysed using face-to-face consultations from March 2019 to February 2020 as a comparison group, and compared to national telehealth use and trends in COVID-19 case rates. RESULTS Total psychiatric consultations increased by 16% from March 2020 to February 2021. Telehealth compromised 56% of total, peaking at 70% of consultations in August during the height of COVID-19 cases. Thirty-three percent of total consultations and 59% of telehealth consultations were via telephone. Telehealth consultations per capita in Victoria were consistently lower than the overall Australian level. CONCLUSION Telehealth usage during the first 12 months of COVID-19 in Victoria suggests it is a feasible alternative to face-to-face treatment. Telehealth-mediated increases in psychiatric consultations likely indicates an increased psychosocial need for support.
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Affiliation(s)
- Evani Hewa Koneputugodage
- Mental Health, Justice Health, Alcohol and Drug Services, Canberra Health Services, Canberra, ACT, Australia
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Yeatman T, Enticott J, Lakra V, Meadows G. Equitable psychiatry, telehealth, and the COVID-19 pandemic: Analysis of national data. Front Public Health 2023; 11:1014302. [PMID: 36935672 PMCID: PMC10014820 DOI: 10.3389/fpubh.2023.1014302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Background At the beginning of the COVID-19 pandemic, it was foreseen that the number of face-to-face psychiatry consultations would suffer a reduction. In order to compensate, the Australian Government introduced new Medicare-subsidized telephone and video-linked consultations. This study investigates how these developments affected the pre-existing inequity of psychiatry service delivery in Australia. Methods The study analyses five and a half years of national Medicare data listing all subsidized psychiatry consultation consumption aggregated to areas defined as Statistical Area level 3 (SA3s; which have population sizes of 30 k-300 k). Face-to-face, video-linked and telephone consultations are considered separately. The analysis consists of presenting rates of consumption, concentration graphs, and concentration indices to quantify inequity, using Socio Economic Indexes for Areas (SEIFA) scores to rank the SA3 areas according to socio-economic disadvantage. Results There is a 22% drop in the rate of face-to-face psychiatry consultation consumption across Australia in the final study period compared with the last study period predating the COVID-19 pandemic. However, the loss is made up by the introduction of the new subsidized telephone and video-linked consultations. Referring to the same time periods, there is a reduction in the inequity of the distribution of face-to-face consultations, where the concentration index reduces from 0.166 to 0.129. The new subsidized video-linked consultations are distributed with severe inequity in the great majority of subpopulations studied. Australia-wide, video-linked consultations are also distributed with gross inequity, with a concentration index of 0.356 in the final study period. The effect of this upon overall inequity was to cancel out the reduction of inequity resulting from the reduction of face-to face appointments. Conclusion Australian subsidized video-linked psychiatry consultations have been distributed with gross inequity and have been a significant exacerbator of the overall inequity of psychiatric service provision. Future policy decisions wishing to reduce this inequity should take care to reduce the risk posed by expanding telepsychiatry.
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Affiliation(s)
- Thomas Yeatman
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Psychiatry, Victorian Institute of Forensic Mental Health, Melbourne, VIC, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Southern Synergy, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- *Correspondence: Joanne Enticott
| | - Vinay Lakra
- Mental Health Services, Northern Health, Melbourne, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Graham Meadows
- Southern Synergy, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Clayton, VIC, Australia
- Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Monash Health, Dandenong, VIC, Australia
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Looi JC, Maguire PA, Bastiampillai T, Allison S. Penumbra of the pandemic workplace for psychiatrists and trainees in Australia. Australas Psychiatry 2022; 30:736-738. [PMID: 35748803 PMCID: PMC9234374 DOI: 10.1177/10398562221109742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A commentary on the workforce, infrastructure and health of psychiatrists and trainees providing psychiatric care during the COVID-19 pandemic in Australia. CONCLUSIONS The wide-ranging workplace, health system and societal changes necessitated by the SARS-CoV-2 virus have altered the practice and working lives of psychiatrists, trainees and other healthcare workers, as well as the general population. There have been workplace innovations, recalibrations and losses. There is a new baseline upon which to build better psychiatric services, as the pandemic's penumbra recedes.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Looi JCL, Allison S, Bastiampillai T, Kisely SR. The Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA): Aims, model, outputs, and implications for clinical academic advocacy. Australas Psychiatry 2022; 30:313-315. [PMID: 34839737 DOI: 10.1177/10398562211052887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We describe an independent model of clinical academic mental health services research that is able to provide synthesised views for medico-political organisations that are engaged in advocacy for national and state evidence-based policy and planning of mental healthcare. CONCLUSIONS CAPIPRA focuses on independent research and policy analysis using publicly available datasets on population mental health at national and state/territory levels, published in international and national peer-reviewed journals (>50 papers since 2019). We partner with medico-political organisations in evidence-based advocacy across a wide range of issues.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, Monash University, Wellington Road, Clayton, Victoria, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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12
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Looi JCL, Atchison M, Matias M, Viljakainen P. Sustainable operation of private psychiatric practice for pandemics. Australas Psychiatry 2022; 30:275-276. [PMID: 34839744 PMCID: PMC8990567 DOI: 10.1177/10398562211052915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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13
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Ellis LA, Meulenbroeks I, Churruca K, Pomare C, Hatem S, Harrison R, Zurynski Y, Braithwaite J. The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis. JMIR Ment Health 2021; 8:e32948. [PMID: 34666306 PMCID: PMC8651237 DOI: 10.2196/32948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the "new normal." OBJECTIVE The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. METHODS We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. RESULTS A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. CONCLUSIONS COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.
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Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarah Hatem
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Reema Harrison
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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14
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Looi JCL, Bonner D, Maguire P. Maslow's hammer: considering the perils of solutionism in mental healthcare and psychiatric practice. Australas Psychiatry 2021; 29:687-689. [PMID: 34014790 DOI: 10.1177/10398562211005438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To discuss narrow pragmatism, manifest as digital and technical solutionism, in mental healthcare and psychiatric practice. Pragmatism is a view of the field of psychiatry as an instrument or tool for the purpose of providing psychiatric care for people with a mental illness. Solutionism, as proposed by Morozov, can be considered a special case of pragmatism that valorises an approach to solving real-world problems based on computation, algorithms and digital technology,1 which we extend to discuss other technical solutions such as medication, non-invasive brain stimulation and psychotherapy. CONCLUSIONS Digital or technical solutionism may unnecessarily constrain approaches to mental healthcare and psychiatric practice. Psychiatrists can consider, and should advocate for, appropriate adaptation of technology and technical solutions toward collaborative and effective mental healthcare.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, the Australian National University Medical School, Canberra Hospital, ACT, Australia
| | - Daniel Bonner
- Academic Unit of Psychiatry and Addiction Medicine, the Australian National University Medical School, Canberra Hospital, ACT, Australia
| | - Paul Maguire
- Academic Unit of Psychiatry and Addiction Medicine, the Australian National University Medical School, Canberra Hospital, ACT, Australia
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15
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Abraham A, Jithesh A, Doraiswamy S, Al-Khawaga N, Mamtani R, Cheema S. Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping. Front Psychiatry 2021; 12:748069. [PMID: 34819885 PMCID: PMC8606591 DOI: 10.3389/fpsyt.2021.748069] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health). Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges. Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health. Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework. Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations. Systematic Review Registration: https://osf.io/4dxms/.
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Affiliation(s)
- Amit Abraham
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Anupama Jithesh
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | | | | | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
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16
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Maguire PA, Looi JC. COVID-19 telehealth challenges for patients with schizophrenia and other psychoses. Aust N Z J Psychiatry 2021; 55:923. [PMID: 33092391 DOI: 10.1177/0004867420968887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, ACT, Australia
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17
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Hopkins L, Pedwell G. The COVID PIVOT - Re-orienting Child and Youth Mental Health Care in the Light of Pandemic Restrictions. Psychiatr Q 2021; 92:1259-1270. [PMID: 33754240 PMCID: PMC7983966 DOI: 10.1007/s11126-021-09909-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 12/05/2022]
Abstract
The COVID pandemic required significant changes in the provision of youth mental health services during the period of lockdown/stay at home orders. Things which were identified as changing significantly during this period included: service via telehealth; working from home, split teams (to reduce infection risk), and social (physical) distancing. An online survey of clinicians was conducted involving both closed and open ended questions. Service staff identified significant benefits from the changes to the way services were delivered as well as some impediments and challenges. Advantages in the new way of working revolved around the flexibility of the virtual service, with appointments online enabling families to more easily overcome issues of transport, work commitments, childcare and disruption to routines and timing. The online platforms also enabled some family members to participate who otherwise might not have been able to come to appointments in person. Disadvantages included where there were issues with availability and access to appropriate technology or private spaces, or when the young person was very young, very unwell, unstable, isolated or at higher risk. This study suggests that telehealth and flexible working arrangements have become an essential new element in the clinicians' toolkit to be offered either alone or as a supplement to in person interventions.
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Affiliation(s)
- Liza Hopkins
- Alfred Health, Child and Youth Mental Health Service, 999 Nepean Hwy, Moorabbin, VIC, 3189, Australia.
| | - Glenda Pedwell
- Alfred Health, Child and Youth Mental Health Service, 999 Nepean Hwy, Moorabbin, VIC, 3189, Australia
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18
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Marcelin LH, Cela T, Dembo R, Jean‐Gilles M, Page B, Demezier D, Clement R, Waldman R. Remote delivery of a therapeutic intervention to court-mandated youths of Haitian descent during COVID-19. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2938-2958. [PMID: 33734451 PMCID: PMC8251117 DOI: 10.1002/jcop.22559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/19/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
The threat generated by the COVID-19 pandemic has triggered sudden institutional changes in an effort to reduce viral spread. Restrictions on group gatherings and in-person engagement have increased the demand for remote service delivery. These restrictions have also affected the delivery of court-mandated interventions. However, much of the literature has focused on populations that voluntarily seek out face-to-face medical care or mental health services, whereas insufficient attention has been paid to telehealth engagement of court-mandated populations. This article draws on data gathered on an NIH/NIDA-funded study intervention implemented with juvenile justice-involved youths of Haitian heritage in Miami-Dade County, Florida, during the COVID-19 public health crisis. We explore the process of obtaining consent, technological access issues, managing privacy, and other challenges associated with remote delivery of family-based therapy to juvenile justice-involved youth. Our aim is to provide some insights for consideration by therapists, healthcare workers, advocates, researchers, and policymakers tasked with finding alternative and safer ways to engage nontraditional populations in health services. The clinical trial registration number is NCT03876171.
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Affiliation(s)
- Louis Herns Marcelin
- Department of AnthropologyUniversity of MiamiCoral GablesFloridaUSA
- Department of Public Health SciencesUniversity of MiamiMiamiFloridaUSA
- Laboratory on Health, Family and MigrationInteruniversity Institute for Research and Development (INURED)Port‐au‐PrinceHaiti
| | - Toni Cela
- Department of AnthropologyUniversity of MiamiCoral GablesFloridaUSA
- Laboratory on Health, Family and MigrationInteruniversity Institute for Research and Development (INURED)Port‐au‐PrinceHaiti
| | - Richard Dembo
- Department of CriminologyUniversity of South FloridaTampaFloridaUSA
| | - Michèle Jean‐Gilles
- Robert Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFloridaUSA
| | - Bryan Page
- Department of AnthropologyUniversity of MiamiCoral GablesFloridaUSA
| | - Danna Demezier
- Department of AnthropologyUniversity of MiamiCoral GablesFloridaUSA
| | - Roy Clement
- Department of AnthropologyUniversity of MiamiCoral GablesFloridaUSA
| | - Rachel Waldman
- Department of AnthropologyUniversity of MiamiCoral GablesFloridaUSA
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19
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Looi JC, Atchison M, Pring W. Private psychiatry in Australia: reflections on career opportunities, benefits, and challenges. Australas Psychiatry 2021; 29:442-445. [PMID: 33434046 DOI: 10.1177/1039856220978856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide reflection on career opportunities, benefits and challenges, with regard to commencing private practice psychiatry in Australia. CONCLUSIONS There are varied opportunities for a career in private practice psychiatry. Private practice has benefits and challenges, distinct from public sector psychiatry; with moderately greater professional autonomy, facilitating the provision of expert mental healthcare for the community.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia.,Private Psychiatry, Canberra, ACT, Australia.,Bi-National Committee, Section of Private Practice Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia
| | - Michelle Atchison
- Bi-National Committee, Section of Private Practice Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia.,Private Psychiatry, Hawthorn, SA, Australia
| | - William Pring
- Bi-National Committee, Section of Private Practice Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia.,Monash University, and Centre for Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia.,Private Psychiatry, Melbourne, VIC, Australia
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20
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Mazziotti R, Rutigliano G. Tele-Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction. JMIR Ment Health 2021; 8:e26187. [PMID: 34114956 PMCID: PMC8323764 DOI: 10.2196/26187] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/13/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele-mental health was rapidly implemented to deliver health care services. OBJECTIVE The aims of this study were (1) to present state-of-the-art tele-mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele-mental health. METHODS Document clustering was applied to map research topics within tele-mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele-mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. RESULTS Evidence on tele-mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele-mental health delivery of care. However, respondents held skeptical views about tele-mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele-mental health as they are with face-to-face interventions (Hedges g=-0.001, 95% CI -0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. CONCLUSIONS Mental health services equipped with tele-mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations.
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Affiliation(s)
- Raffaele Mazziotti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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21
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Adarmouch L, Tourari S, Sebbani M, Amine M. Impact of the COVID-19 pandemic on the activity of private medical practices in Morocco. Int J Clin Pract 2021; 75:e14127. [PMID: 33638904 PMCID: PMC7995031 DOI: 10.1111/ijcp.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess the impact of the COVID-19 pandemic on the activity of private medical practices in Morocco. METHODS An online survey was carried out in June 2020. The study population consisted of physicians (General practitioners and specialists) who run private practices in different regions of Morocco. The questionnaire comprised three sections: demographic and professional data, the impact noticed by the physicians and the strategies they adopted to tackle this impact. RESULTS We analysed 225 responses. Specialists represented 71.6% of the respondents. The majority (94.2%) of the private practices were located in urban areas. Almost all respondents have noticed a change in the demand for medical services, mainly a decrease (96.4%). There was an increase in urgent consultations (30.7%) and consultations for acute motives (39.1%). Respondents also reported less (69.3%) or no (23.1%) regular follow-up visits for patients with chronic diseases. Decreased incomes concerned 97.3% of the practices. Practitioners reacted by working less hours (87.6%), delaying some procedures (78.2%) and applying recommended safety measures (100%). Telemedicine was used in an informal way to facilitate the communication with patients. DISCUSSION AND CONCLUSION During this pandemic, private practices were challenged to contribute to the continuity of healthcare services while ensuring the safety of the staff and the patients. Several strategies were adopted to cope with the new situation and to survive its many challenges.
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Affiliation(s)
- Latifa Adarmouch
- Clinical Research DepartmentMohammed VI University HospitalMarrakeshMorocco
- Community Medicine and Public Health DepartmentBioscience et Santé research labSchool of Medicine CadiAyyad UniversityMarrakeshMorocco
| | - Samya Tourari
- Clinical Research DepartmentMohammed VI University HospitalMarrakeshMorocco
| | - Majda Sebbani
- Clinical Research DepartmentMohammed VI University HospitalMarrakeshMorocco
- Community Medicine and Public Health DepartmentBioscience et Santé research labSchool of Medicine CadiAyyad UniversityMarrakeshMorocco
| | - Mohamed Amine
- Clinical Research DepartmentMohammed VI University HospitalMarrakeshMorocco
- Community Medicine and Public Health DepartmentBioscience et Santé research labSchool of Medicine CadiAyyad UniversityMarrakeshMorocco
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22
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Lakeman R, Crighton J. The Impact of Social Distancing on People with Borderline Personality Disorder: The Views of Dialectical Behavioural Therapists. Issues Ment Health Nurs 2021; 42:410-416. [PMID: 32931341 DOI: 10.1080/01612840.2020.1817208] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dialectical Behavioural Therapy (DBT) is an evidence-based treatment for borderline personality disorder and other problems associated with emotional dysregulation. It has traditionally been deployed as a face-to-face programme comprised of attendance at group skills training, individual therapy and phone coaching. Social distancing measures arising from the COVID-19 pandemic led to a cessation of therapeutic programmes in many places. This survey of DBT clinicians in a regional State mental health service in Australia explored the impact of the cessation of DBT programmes in the region and obstacles to engaging with people via online platforms. Clinicians have been able to engage in DBT informed care, but it was perceived that many people have experienced a clinical deterioration or have increased their use of crisis services, which is entirely appropriate, as group skills programmes have ceased. Movement to online platforms of delivery poses problems, as some people do not have the access to internet or privacy in their home environments to engage in online therapy. Ideally, clinicians need to be supported through education, supervision and coaching in the use of telehealth interventions. Social distancing requirements has enabled an opportunity to carefully consider how programmes can be adapted to enable the extension of these programmes to those who have traditionally been unable to access them.
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Affiliation(s)
- R Lakeman
- School of Health & Human Sciences, Southern Cross University, Bilinga, QLD, Australia
| | - J Crighton
- Northern NSW Local Health District, Lismore, Australia
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23
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Jonnagaddala J, Godinho MA, Liaw ST. From telehealth to virtual primary care in Australia? A Rapid scoping review. Int J Med Inform 2021; 151:104470. [PMID: 34000481 DOI: 10.1016/j.ijmedinf.2021.104470] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The COVID-19 pandemic and its socio-economic impacts have disrupted our health systems and society. We sought to examine informatics and digital health strategies that supported the primary care response to COVID-19 in Australia. Specifically, the review aims to answer: how Australian primary health care responded and adapted to COVID-19, the facilitators and inhibitors of the Primary care informatics and digital health enabled COVID-19 response and virtual models of care observed in Australia. METHODS We conducted a rapid scoping review complying with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews guidelines. Two reviewers independently performed the literature search, data extraction, and synthesis of the included studies. Any disagreement in the eligibility screening, data extraction or synthesis was resolved through consensus meeting and if required. was referred to a third reviewer. Evidence was synthesised, summarised, and mapped to several themes that answer the research question s of this review. RESULTS We identified 377 papers from PubMed, Scopus, Web of Science and Embase. Following title, abstract and full-text screening, 29 eligible papers were included. The majority were "perspectives" papers. The dearth of original research into digital health and COVID-19 in primary care meant limited evidence on effectiveness, access, equity, utility, safety, and quality. Data extraction and evidence synthesis identified 14 themes corresponding to 3 research questions. Telehealth was the key digital health response in primary care, together with mobile applications and national hotlines, to enable the delivery of virtual primary care and support public health. Enablers and barriers such as workforce training, digital resources, patient experience and ethical issues, and business model and management issues were identified as important in the evolution of virtual primary care. CONCLUSIONS COVID-19 has transformed Australian primary care with the rapid adaptation of digital technologies to complement "in-person" primary care with telehealth and virtual models of care. The pandemic has also highlighted several literacy, maturity/readiness, and micro, meso and macro-organisational challenges with adopting and adapting telehealth to support integrated person-centred health care. There is a need for more research into how telehealth and virtual models of care can improve the access, integration, safety, and quality of virtual primary care.
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Affiliation(s)
- Jitendra Jonnagaddala
- WHO Collaborating Centre on eHealth, School of Population Health, UNSW Sydney, Australia.
| | - Myron Anthony Godinho
- WHO Collaborating Centre on eHealth, School of Population Health, UNSW Sydney, Australia
| | - Siaw-Teng Liaw
- WHO Collaborating Centre on eHealth, School of Population Health, UNSW Sydney, Australia.
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24
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Looi JC, Allison S, Bastiampillai T, Pring W, Reay R. Australian private practice metropolitan telepsychiatry during the COVID-19 pandemic: analysis of Quarter-2, 2020 usage of new MBS-telehealth item psychiatrist services. Australas Psychiatry 2021; 29:183-188. [PMID: 33280401 PMCID: PMC7723735 DOI: 10.1177/1039856220975294] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Australian Commonwealth Government introduced new psychiatrist Medicare-Benefits-Schedule (MBS)-telehealth items in the first wave of the COVID-19 pandemic to assist with previously office-based psychiatric practice. We investigate private psychiatrists' uptake of (1) video- and telephone-telehealth consultations for Quarter-2 (April-June) of 2020 and (2) total telehealth and face-to-face consultations in Quarter-2, 2020 in comparison to Quarter-2, 2019 for Australia. METHODS MBS item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with a baseline of the Quarter-2, 2019 (April-June 2019) of face-to-face consultations for the whole of Australia. RESULTS Combined telehealth and face-to-face psychiatry consultations rose during the first wave of the pandemic in Quarter-2, 2020 by 14% compared to Quarter-2, 2019 and telehealth was approximately half of this total. Face-to-face consultations in 2020 comprised only 56% of the comparative Quarter-2, 2019 consultations. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations comprised 38% of the total telehealth provision (for new patient assessments and longer consultations). CONCLUSIONS There has been a flexible, rapid response to patient demand by private psychiatrists using the new COVID-19-MBS-telehealth items for Quarter-2, 2020, and in the context of decreased face-to-face consultations, ongoing telehealth is essential.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, ACT, Australia.,Private Psychiatry, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, SA, Australia.,Department of Psychiatry, Monash University, VIC, Australia
| | - William Pring
- Monash University, and Centre for Mental Health Education and Research at Delmont Private Hospital, VIC, Australia.,Private Psychiatry, VIC, Australia
| | - Rebecca Reay
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, ACT, Australia.,Private Practice, ACT, Australia
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Sheek-Hussein M, Abu-Zidan FM, Stip E. Disaster management of the psychological impact of the COVID-19 pandemic. Int J Emerg Med 2021; 14:19. [PMID: 33761863 PMCID: PMC7988636 DOI: 10.1186/s12245-021-00342-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/12/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has exposed a suboptimal response to this threatening global disaster, including the response to the psychological impact. Both the economic hardship and the continuous media coverage of alarming news have exacerbated this effect which also includes increased domestic violence. AIM To address this important aspect of disaster management and provide recommendations on how to mitigate these effects. METHODS This is a narrative review written by three experts in community medicine, disaster medicine and psychiatry reflecting the interdisciplinary approach in managing disasters. Selected important papers, personal published papers, PUBMED articles and media news related to the disaster management of the psychological effects of COVID-19 pandemic were collected over the last year, critically appraised and used in writing this manuscript. RESULTS The COVID-19 pandemic causes major emotional distress. Lack of effective treatments and availability of the current vaccines for this virus increases the fear of being infected and infecting others. Negative emotions are common and are related to adjustment but may progress in the long term to anxiety, depression, and post-traumatic stress syndrome. The COVID-19 pandemic has a major impact on mental health. The most common distress reactions include anxiety, insomnia, perception of insecurity, anger, fear of illness, and risky behaviors. Patients having mental disorders are vulnerable during the pandemic because of (1) somatic vulnerability, (2) cognitive and behavioral vulnerability, (3) psychosocial vulnerability, and (4) disruption to psychiatric care. Psychiatric wards, which are commonly separate from main hospitals, should be included in the disaster management plans. Acute care physicians carry the psychological and ethical impact of difficult triage decisions when ending the support of some patients to save others. A combination of fear and guilt may overcome normal human tolerance levels in vulnerable health workers. The moral injuries can be carried for a long time. CONCLUSIONS Addressing the psychological effects is an essential component of disaster management of infectious pandemics. This should be implemented through the whole spectrum of disaster management including preparedness, mitigation, response, and recovery.
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Affiliation(s)
- Mohamud Sheek-Hussein
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Emmanuel Stip
- Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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26
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Strudwick G, Sockalingam S, Kassam I, Sequeira L, Bonato S, Youssef A, Mehta R, Green N, Agic B, Soklaridis S, Impey D, Wiljer D, Crawford A. Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review. JMIR Ment Health 2021; 8:e26550. [PMID: 33650985 PMCID: PMC7927953 DOI: 10.2196/26550] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/18/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. OBJECTIVE The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. METHODS This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada's guidance on app assessment and selection. RESULTS A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. CONCLUSIONS A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area.
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Affiliation(s)
- Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Iman Kassam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lydia Sequeira
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Sarah Bonato
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alaa Youssef
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Rohan Mehta
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Branka Agic
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - David Wiljer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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27
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Finlay AJ, Looi JC. Public and private mental healthcare for the population mental health effects of COVID-19 measures. Aust N Z J Psychiatry 2020; 54:1138. [PMID: 32746608 DOI: 10.1177/0004867420946846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Angus Jf Finlay
- Academic Unit of Psychiatry & Addiction Medicine, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia.,Consultation-Liaison Psychiatry, Canberra Hospital, Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry & Addiction Medicine, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia.,Older Persons Mental Health Service, Canberra Health Services, Canberra, ACT, Australia
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28
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Kisely S, Looi JC. The Productivity Commission's Draft Report illustrates the benefits and risks of economic perspectives on mental healthcare. Aust N Z J Psychiatry 2020; 54:1072-1077. [PMID: 32847374 DOI: 10.1177/0004867420951255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2018, the Australian Government instructed the Productivity Commission to examine the social and economic effects of poor mental health, as well as make recommendations on how they might be addressed. The resulting Draft Report demonstrates both the benefits and risks of an economic approach to these issues. Some of the broader systemic recommendations have merit such as the need for stepped care, coordinated crisis management and the important role of welfare, housing and the workplace in improving mental health. However, there are areas of concern, particularly for mental health services in the public sector. One is a disproportionate emphasis on prevention and intervention in the early years of life for strategies where evidence for effectiveness is limited. Another is the introduction of market-based approaches such as shadow billing or a commissioner/provider split to the funding of mental health services across Australia. Among the numerous problems of such market-driven approaches are the increased costs of additional bureaucracy and the lack of commissioner expertise in planning services or evidence-based practice. As a result, similar arrangements have been abandoned in other jurisdictions. The Commission's final recommendations and the Australian Government's response are awaited and the resulting changes to the mental health system, and beyond, may well be influenced by the COVID-19 pandemic. However, reform should be based on evidence and achieved without increasing administrative complexity.
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Affiliation(s)
- Steve Kisely
- Metro South Health, Woolloongabba, QLD, Australia.,Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry & Addiction Medicine, ANU Medical School, Canberra Hospital, Canberra, ACT, Australia
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29
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Sasangohar F, Bradshaw MR, Carlson MM, Flack JN, Fowler JC, Freeland D, Head J, Marder K, Orme W, Weinstein B, Kolman JM, Kash B, Madan A. Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective. J Med Internet Res 2020; 22:e22523. [PMID: 32936768 PMCID: PMC7546859 DOI: 10.2196/22523] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 01/05/2023] Open
Abstract
As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.
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Affiliation(s)
- Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Major R Bradshaw
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | | | - James N Flack
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - James C Fowler
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Diana Freeland
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - John Head
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Kate Marder
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - William Orme
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Benjamin Weinstein
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
| | - Jacob M Kolman
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
| | - Alok Madan
- Behavioral Health Clinic, Houston Methodist Hospital, Houston, TX, United States
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30
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Abstract
OBJECTIVE To provide a rapid clinical update on the evidence for telehealth in mental healthcare in the context of the COVID-19 pandemic public health measures. CONCLUSIONS Telehealth has been rapidly implemented in metropolitan and rural settings and the existing evidence base demonstrates that it represents an effective mode of service delivery.
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Affiliation(s)
- Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School; and ACT Health, Australia
| | - Jeffrey CL Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School; and ACT Health, Australia
| | - Philip Keightley
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School; and ACT Health, Australia
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31
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Looi JC, Pring W. To tele- or not to telehealth? Ongoing COVID-19 challenges for private psychiatry in Australia. Australas Psychiatry 2020; 28:511-513. [PMID: 32847378 PMCID: PMC7453156 DOI: 10.1177/1039856220950081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate. CONCLUSIONS Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, Australia.,Private Psychiatry, Australia
| | - William Pring
- Monash University, and Centre for Mental Health Education and Research at Delmont Private Hospital, Australia.,Private Psychiatry, Australia
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