Open Dialogue compared to treatment as usual for adults experiencing a mental health crisis: Protocol for the ODDESSI multi-site cluster randomised controlled trial

Aims and method Community forensic mental health services (CFMHS) in England were developed to reduce reliance on hospital care for this population, but provision varies. It is unclear whether standard setting work has increased consistency. Freedom of information requests were therefore sent to 50 National Health Service Trusts in England, to examine the population, staffing, treatment provision and organisation of CFMHS. Results Data were provided for 32 CFMHS, of which 59% were part of secure hospital-based services and 41% were standalone services working in parallel with general services. There was variation in aspects including professional composition, functions, the settings from where CFMHS accept referrals and long-term approach to patients subject to special restrictions under the Mental Health Act 1983. Clinical implications CFMHS continue to vary, especially in their interface with services other than forensic hospitals. This may impede standard setting and empirical evaluation. Different approaches to centralising oversight may be needed for standardisation.

BackgroundSince the economic recession began in 2008 anecdotal reports suggest that mental health services in England have experienced disinvestment, but published data to test this proposition are few.MethodThis paper presents information from a wider range of official, research and grey literature sources aiming to: (1) assess whether governmental investment in publically funded mental health services has declined since the start of the economic recession in 2008; (2) to assess whether relative changes in mental health service investment over this period were or were not similar to trends in national investment in services for people with physical disorders, and (3) to interpret these findings in terms of met and unmet population levels needs for mental health care.ResultsThe key findings are that: across England social service expenditure reductions have led to a decrease of 48 % in the number of people with mental illness who receive such care, while direct NHS expenditure was reduced in some local areas by up to 32 %.ConclusionsThe results of this overview suggest that there have been substantial reductions in the resources dedicated to mental health treatment and care in England since 2008, that such reductions seem not to have been applied to physical health services, and that these findings appear to run counter to the government policy of ‘parity of esteem; for mental and physical healthcare.

Social Network Influences on Service Use Among Urban, African American Youth with Mental Health Problems

Purpose Despite government and national health service demands for equality within mental health (MH) services, racial inequalities remain. South Asian (SA) women underutilise MH services, yet research regarding their experiences and the cultural sensitivity (CS) of services is sparse. The purpose of this study was to explore the experiences of SA women who have used MH services and the cultural sensitivity of the latter. Design/methodology/approach Thematic analysis was used for data analysis of semi-structured interviews carried out with 16 SA women. Findings Analysis yielded an overarching theme of “degree of understanding” and three main themes: “shared background and understanding” “humanity” and “cultural factors” and their subsequent subthemes. Results demonstrated mixed experiences, illustrating varied levels of CS and the impacts of this upon experiences. Cultural understanding underpins CS: participants’ experiences demonstrated the benefit of significant understanding and the detriment of limited understanding. Research limitations/implications All participants were well educated, English-speaking and from psychology, health or research backgrounds. SA culture is nuanced; thus, the demographic of “South Asian” could be too broad. However, because current understanding is limited, this research provides fundamental empirical knowledge. Practical implications Clear recommendations were co-produced with participants, highlighting strong impacts for service development and best practice. Social implications The research provides valuable insight into SA women’s experiences of MH services and wider understanding of CS. This raises cultural awareness in a field lacking understanding. Findings and recommendations can, therefore, provide foundational knowledge for broader societal issues experienced by people from this demographic and challenge preconceptions. Originality/value This research offers unique recommendations for more culturally sensitive practice, co-produced with participants.

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

Effects of the COVID-19 pandemic on self-harm

Anxiety problems are common in children, yet few affected children access evidence-based treatment. Digitally augmented psychological therapies bring potential to increase availability of effective help for children with mental health problems. This study aimed to establish whether therapist-supported, digitally augmented, parent-led cognitive behavioural therapy (CBT) could increase the efficiency of treatment without compromising clinical effectiveness and acceptability. We conducted a pragmatic, unblinded, two-arm, multisite, randomised controlled non-inferiority trial to evaluate the clinical effectiveness and cost-effectiveness of therapist-supported, parent-led CBT using the Online Support and Intervention (OSI) for child anxiety platform compared with treatment as usual for child (aged 5-12 years) anxiety problems in 34 Child and Adolescent Mental Health Services in England and Northern Ireland. We examined acceptability of OSI plus therapist support via qualitative interviews. Participants were randomly assigned (1:1) to OSI plus therapist support or treatment as usual, minimised by child age, gender, service type, and baseline child anxiety interference. Outcomes were assessed at week 14 and week 26 after randomisation. The primary clinical outcome was parent-reported interference caused by child anxiety at week 26 assessment, using the Child Anxiety Impact Scale-parent report (CAIS-P). The primary measure of health economic effect was quality-adjusted life-years (QALYs). Outcome analyses were conducted blind in the intention-to-treat (ITT) population with a standardised non-inferiority margin of 0·33 for clinical analyses. The trial was registered with ISRCTN, 12890382. Between Dec 5, 2020, and Aug 3, 2022, 706 families (706 children and their parents or carers) were referred to the study information. 444 families were enrolled. Parents reported 255 (58%) child participants' gender to be female, 184 (41%) male, three (<1%) other, and one (<1%) preferred not to report their child's gender. 400 (90%) children were White and the mean age was 9·20 years (SD 1·79). 85% of families for whom clinicians provided information in the treatment as usual group received CBT. OSI plus therapist support was non-inferior for parent-reported anxiety interference on the CAIS-P (SMD 0·01, 95% CI -0·15 to 0·17; p<0·0001) and all secondary outcomes. The mean difference in QALYs across trial arms approximated to zero, and OSI plus therapist support was associated with lower costs than treatment as usual. OSI plus therapist support was likely to be cost effective under certain scenarios, but uncertainty was high. OSI plus therapist support acceptability was good. No serious adverse events were reported. Digitally augmented intervention brought promising savings without compromising outcomes and as such presents a valuable tool for increasing access to psychological therapies and meeting the demand for treatment of child anxiety problems. Department for Health and Social Care and United Kingdom Research and Innovation Research Grant, National Institute for Health and Care (NIHR) Research Policy Research Programme, Oxford and Thames Valley NIHR Applied Research Collaboration, Oxford Health NIHR Biomedical Research Centre.

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

There is limited empirical evidence on the extent to which perceived public stigma prevents individuals from using mental health services, despite substantial recent policy interest in this issue. This study investigated associations between perceived public stigma and mental health care seeking. This study used cross-sectional survey data from a representative sample of undergraduate and graduate students (N=2,782) at one university. A five-item scale was used to assess perceived public stigma toward mental health service use. Perceived need for help in the past 12 months and current presence of depressive and anxiety disorders were also assessed. Perceived stigma was higher among males, older students, Asian and Pacific Islanders, international students, students with lower socioeconomic status backgrounds, and students with current mental health problems. Perceived stigma was also higher among those without any family members or friends who had used mental health services and among those who believed that therapy or medication is not very helpful. Perceived stigma was negatively associated with the likelihood of perceiving a need for mental health services, but only among younger students. Among those with probable depressive or anxiety disorders, there was no evidence that perceived stigma was associated with service use. These results suggest that, at least in this population, perceived stigma may not be as important a barrier to mental health care as the mental health policy discourse currently assumes.

British Journal of School NursingVol. 6, No. 7 CommentDeveloping empathy in school staff through emotional first aidPaul JettenPaul JettenSearch for more papers by this authorPaul JettenPublished Online:16 Aug 2013https://doi.org/10.12968/bjsn.2011.6.7.353AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department for Education (2011) Productive Children's Services: A New Model. http://media.education.gov.uk/assets/files/productive%20chil-drens%20services%20a%20new%20model.pdf (accessed 20 May 2011) Google ScholarDepartment of Health (2011) No Health without Mental Health: A cross-government mental health outcome strategy for people of all ages. www.dh.gov.uk/mentalhealthstrategy (accessed on 13 May 2011) Google ScholarGemmell S, Kelly J, Smith D (2009) Here's Your Primary Emotional First Aid Course Handbook. Grishart, Southampton Google ScholarMoreton H, Tutte R, Board W, Simpson F, Floyd P, Harris E (2008) Me & U (My Emotions Understood). A real insight into the emotional experience of a young person today. Grishart, Southampton Google ScholarNHS Confederation (2007) Maintaining the Momentum: towards excellent services for children & young people's mental health. www.nhsconfed.org/Publications/reports/Pages/Maintainingthemomentum.aspx (accessed 20 May 2011) Google ScholarWistow R, Barnes D (2007) A Profile of Child & Adolescent Mental Health Services in England 2007/8. www.childrensmapping.org.uk/results/publications/CAMHS_Atlas_2007_08.pdf (accessed 2 September 2011) Google Scholar FiguresReferencesRelatedDetailsCited byExploring the Effectiveness of Mental Health First Aid Program for Young People in South Africa16 November 2022Interventions for Better Mental Health LiteracySupporting positive mental health development in adolescents with a group cognitive intervention23 May 2014 | British Journal of School Nursing, Vol. 9, No. 1 1 September 2011Volume 6Issue 7ISSN (print): 1752-2803ISSN (online): 2052-2827 Metrics History Published online 16 August 2013 Published in print 1 September 2011 Information© MA Healthcare LimitedPDF download

Medicaid Enrollment and Mental Health Service Use Following Release of Jail Detainees With Severe Mental Illness

The case of a teenage girl with mental health problems who was kept in a police cell for almost two days has again highlighted the strain on mental health services...

10.1176/appi.ps.59.1.105

BackgroundThe Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic.MethodsThe design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method.ResultsParticipants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations.ConclusionsMental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.

In August 2006, a year after Hurricane Katrina, the first acute inpatient public psychiatric unit for adults was opened in New Orleans to serve patients referred from local emergency departments. This article describes the clinical and administrative experiences of providing inpatient care in post-Katrina New Orleans, including the increased demand for programs to treat patients with co-occurring disorders, the expanded scope of practice for psychiatrists to include primary care, and ongoing staff shortages in a traumatized and displaced workforce. Lessons learned in regard to disaster planning and recovery are also discussed.