Implementing a digital mental health intervention for individuals with psychosis - a multi-country qualitative study

Using implementation science to operate as a learning health system to improve outcomes in early psychosis

AIM

Early interventions are well understood to improve psychosis outcomes, but their successful implementation remains limited. This article introduces a three-step roadmap for advancing the implementation of evidence-based practices to operate as a learning health system, which can be applied to early interventions for psychosis and is intended for an audience that is relatively new to systematic approaches to implementation.

METHODS

The roadmap is grounded in implementation science, which specializes in methods to promote routine use of evidence-based innovations. The roadmap draws on learning health system principles that call for commitment of leadership, application of evidence, examination of care experiences, and study of health outcomes. Examples are discussed for each roadmap step, emphasizing both data- and stakeholder-related considerations applicable throughout the roadmap.

CONCLUSIONS

Early psychosis care is a promising topic through which to discuss the critical need to move evidence into practice. Despite remarkable advances in early psychosis interventions, population-level impact of those interventions is yet to be realized. By providing an introduction to how implementation science principles can be operationalized in a learning health system and sharing examples from early psychosis care, this article prompts inclusion of a wider audience in essential discourse on the role that implementation science can play for moving evidence into practice for other realms of psychiatric care as well. To this end, the proposed roadmap can serve as a conceptual guiding template and framework through which various psychiatric services can methodically pursue timely implementation of evidence-based interventions for higher quality care and improved outcomes.

Understanding and Fostering Mental Health and Well-Being among University Faculty: A Narrative Review

In recent years, there has been increasing recognition of mental health concerns in academia, with stress, burnout, anxiety, and depression being reported among faculty members. The demanding work environment, the need to balance personal and professional duties, and the constant pressure of productivity while navigating multiple tasks of teaching, research, mentorship, professional development, and service all impact the mental health and overall well-being of faculty. Higher education institutions have structurally changed as has the research landscape. These changes as well as faculty-specific and student-specific factors coupled to the effect of the COVID-19 pandemic have led to profound effects on the mental health of academics. This paper is a narrative review of the pertinent literature describing faculty mental health and well-being. It summarizes the available evidence on factors influencing faculty mental health and shows the prevalence of anxiety, depression, stress, and burnout among faculty from various academic fields and along the whole academic ladder. Using a suggested framework that collates the efforts of leaders and faculty, the paper concludes by exploring strategies that promote work-life balance among academics and suggesting effective interventions to improve their mental health outcomes.

Systematic Review on End-Users' Perception of Facilitators and Barriers in Accessing Tele-Rehabilitation Services

Psychiatric rehabilitation is a therapeutic approach that encourages people with mental illness and intellectual disabilities to develop their inherent capacities through learning and environmental support. Psychiatric treatment (pharmacological and psychological) controls psychiatric symptoms; psychiatric rehabilitation focuses on functioning and role outcomes. The review aimed to explore the end-user's perception of facilitators and barriers in accessing psychiatric tele-rehabilitation services. Various electronic databases like Web of Science, Scopus, PubMed, Research Gate, Science Direct, ProQuest, Springer, Wolters-Taylors, Elsevier, PsycINFO, and Wiley online library were searched using Google scholar. Inclusion criteria were studies including psychiatric rehabilitation, web-based interventions, and facilitators and barriers in accessing psychiatric tele-rehabilitation services. A systematic search identified 13 studies, including quantitative, qualitative, and mixed-method approaches. The results identified were based on the facilitators and barriers in accessing telerehabilitation. The common themes identified in this review are (1) facilitators of telerehabilitation, (2) barriers of tele-rehabilitation, and (3) expectations in tele-rehabilitation. The facilitating factors include an internet-enabled device, cost/financial benefits, ehealthcare knowledge, technology as a valuable and accessible tool, motivational factors, satisfaction and willingness. The barriers include affordability to the internetenabled device, network connectivity, lack of technical skills, and digital literacy. Expectations include some modifications needed to carry out effective practices of psychiatric tele-rehabilitation. Effective tele-rehabilitation helps people with mental illness and intellectual developmental disorders for their optimal functioning/quality of life.

Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe

BACKGROUND

DIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians' personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders.

AIMS

To investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project.

METHOD

Three months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis.

RESULTS

Clinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention.

CONCLUSIONS

Participants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.

Implementing psychosocial interventions within low and middle-income countries to improve community-based care for people with psychosis-A situation analysis

BACKGROUND

Globally, a treatment gap exists for individuals with severe mental illness, with 75% of people with psychosis failing to receive appropriate care. This is most pronounced in low and middle-income countries, where there are neither the financial nor human resources to provide high-quality community-based care. Low-cost, evidence-based interventions are urgently needed to address this treatment gap.

AIM

To conduct a situation analysis to (i) describe the provision of psychosocial interventions within the context of existing care in two LMICs-India and Pakistan, and (ii) understand the barriers and facilitators of delivering a new psychosocial intervention.

METHOD

A situation analysis including a quantitative survey and individual interviews with clinicians, patients and caregivers was conducted. Quantitative survey data was collected from staff members at 11 sites (private and government run hospitals) to assess organizational readiness to implement a new psychosocial intervention. To obtain in-depth information, 24 stakeholders including clinicians and service managers were interviewed about the typical care they provide and/or receive, and their experience of either accessing or delivering psychosocial interventions. This was triangulated by six interviews with carer and patient representatives.

RESULTS AND DISCUSSION

The results highlight the positive views toward psychosocial interventions within routine care and the enthusiasm for multidisciplinary working. However, barriers to implementation such as clinician time, individual attitudes toward psychosocial interventions and organizational concerns including the lack of space within the facility were highlighted. Such barriers need to be taken into consideration when designing how best to implement and sustain new psychosocial interventions for the community treatment of psychosis within LMICs.