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Sims-Rhodes N, Cornwell HE, Barena E, Dubre V, Elliott KS, Nabulsi EH, Yuen N, Sass SM, Miller A, Tiruneh YM, Singh KP. Perceived Barriers and Facilitators of Behavioral-Health Modality Change Adoption During the COVID-19 Pandemic: A Systematic Review. J Multidiscip Healthc 2024; 17:5695-5713. [PMID: 39649371 PMCID: PMC11624676 DOI: 10.2147/jmdh.s472060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 10/07/2024] [Indexed: 12/10/2024] Open
Abstract
Introduction During the Coronavirus Disease 2019 pandemic, there was a surge in demand for mental health services worldwide, presenting challenges for healthcare institutions as they navigated changes in policy and safety regulations. In the United States, this resulted in many behavioral health modality changes to remain in compliance with the Center for Disease Control guidelines. A growing body of literature has documented these, yet few explored barriers and facilitators affecting the adoption of these modality delivery changes. The researchers conducted a systematic review using the PRISMA method, focusing on service delivery changes across healthcare systems in the United States from March 2020 to May 2022. Objective The study objective was to identify barriers and facilitators affecting the adoption of changes to modality delivery of behavioral health services due to pandemic restrictions. Methods This was a systematic review that utilized the PRISMA method. The researchers identified 445 initial articles from eight databases using predetermined keywords and implemented a three-round screening process to select the most pertinent articles for this review. The researchers used a thematic analysis focused on user-related, program-related, technology, and environment-related constructs relevant to engagement with digital mental health interventions, and also addressed provider and administrative-related barriers and facilitators of virtual behavioral health modality changes. Barriers and facilitators were operationalized using the Borghouts Model. Results This systematic review revealed several common barriers and facilitators, including underdeveloped technology infrastructure, privacy and confidentiality concerns, poor technology literacy, availability of diverse technology options, provider technology training, and ease of integration into everyday life. Conclusion This review provides insights into barriers and facilitators of modality change adoption, which could inform the development and implementation of virtual mental healthcare services and may help optimize the application of these services by improving our understanding and ability to overcome barriers influencing their adoption.
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Affiliation(s)
- Nicholas Sims-Rhodes
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hannah E Cornwell
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Emily Barena
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Vandy Dubre
- Robert R. Muntz Library, The University of Texas at Tyler, Tyler, TX, USA
| | - Kimberly S Elliott
- Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Eman H Nabulsi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nelly Yuen
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Sarah M Sass
- Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA
| | - Anastasia Miller
- Department of Educational Leadership, Evaluation and Organizational Development, University of Louisville, Louisville, KY, USA
| | - Yordanos M Tiruneh
- Department of Preventive Medicine, University of Texas at Tyler Health Science Center, Tyler, TX, USA
| | - Karan P Singh
- Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA
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LeBeau LS, White MC, Henke RM, Hyde J, Sarpong A, Weisberg RB, Livingston NA, Mulvaney-Day N. Considerations for Opioid Use Disorder Treatment From Policy Makers' Experiences With COVID-19 Policy Flexibilities. Psychiatr Serv 2024; 75:1109-1116. [PMID: 38835255 DOI: 10.1176/appi.ps.20230260] [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: 06/06/2024]
Abstract
OBJECTIVE This qualitative study aimed to examine how states implemented COVID-19 public health emergency-related federal policy flexibilities for opioid use disorder treatment from the perspective of state-level behavioral health policy makers. Recommendations are given for applying lessons learned to improve the long-term impact of these flexibilities on opioid use disorder treatment. METHODS Eleven semistructured interviews were conducted with 13 stakeholders from six state governments, and transcripts were qualitatively coded. Data were analyzed by grouping findings according to state-, institution-, and provider-level barriers and facilitators and were then compared to identify overarching themes. RESULTS Policy makers expressed positive opinions about the opioid use disorder treatment flexibilities and described benefits regarding treatment access, continuity of care, and quality of care. No interviewees reported evidence of increased adverse events associated with the relaxed medication protocols. Challenges to state-level implementation included gaps in the federal flexibilities, competing state policies, facility and provider liability concerns, and persistent systemic stigma. CONCLUSIONS As the federal government considers permanent adoption of COVID-19-related flexibilities regarding opioid use disorder treatment policies, the lessons learned from this study are crucial to consider in order to avoid continuing challenges with policy implementation and to effectively remove opioid use disorder treatment barriers.
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Affiliation(s)
- Lavonia Smith LeBeau
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
| | - Mackenzie C White
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
| | - Rachel Mosher Henke
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
| | - Justeen Hyde
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
| | - Alexis Sarpong
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
| | - Risa B Weisberg
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
| | - Nicholas A Livingston
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
| | - Norah Mulvaney-Day
- Customer Value Partners, Washington, D.C. (Smith LeBeau); IBM Consulting, Bethesda (White); The Lewin Group, Optum Serve, Boston (Henke); Chobanian & Avedisian School of Medicine, Boston University, Boston (Hyde, Weisberg, Livingston); Center for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs (VA) Bedford Healthcare System, Bedford, Massachusetts (Hyde); Boston VA Research Institute, Boston (Sarpong); Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston (Livingston); Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts (Mulvaney-Day)
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Close J, Arshad SH, Soffer SL, Lewis J, Benton TD. Adolescent Health in the Post-Pandemic Era: Evolving Stressors, Interventions, and Prevention Strategies amid Rising Depression and Suicidality. Pediatr Clin North Am 2024; 71:583-600. [PMID: 39003003 DOI: 10.1016/j.pcl.2024.04.002] [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: 07/15/2024]
Abstract
Prior to COVID-19, there were already increasing rates of youth with mental health concerns, including an increase in youth presenting to medical emergency departments (EDs) with mental health chief complaints and limited access to treatment. This trend worsened during the pandemic, and rates of youth presenting to medical EDs with suicidal ideation and self-harm increased 50% from 2019 to 2022. This resulted in a "boarding" crisis, in part, due to a lack of inpatient psychiatric hospitalization beds, and many youth were left without access to adequate treatment. Additional study of innovations in health care delivery will be paramount in meeting this need.
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Affiliation(s)
- Jeylan Close
- National Clinician Scholars Program, Department of Psychiatry and Behavioral Sciences, Child & Family Mental Health & Community Psychiatry Division, Duke University School of Medicine, 710 West Main Street, Durham, NC 27701, USA; Duke Margolis Center for Health Policy, Duke University, 710 West Main Street, Durham, NC 27701, USA.
| | - Sarah H Arshad
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine and UC Irvine School of Medicine, The Hub for Clinical Collaboration, DCAPBS, Floor 12, 3500 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Stephen L Soffer
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
| | - Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, 4601 Market Street, 3rd Floor, Philadelphia, PA 19139, USA
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Zobi M, Abrokwa SK, Dordoye E, Phuti A. A mixed method study on the impact of COVID-19 on mental healthcare in Ghana: rethinking mental health service delivery. Int J Equity Health 2024; 23:56. [PMID: 38486258 PMCID: PMC10941419 DOI: 10.1186/s12939-024-02138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Since its emergence, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused severe health, social and economic challenges. Mental healthcare has been significantly affected globally, and even worse in developing countries. An emerging economy like Ghana in West Africa was not spared its disruptive effects. This study aimed to elucidate the impact of the coronavirus disease 2019, the COVID-19 pandemic (caused by SARS-CoV-2), on Ghana's mental healthcare system. METHODS This is a mixed-method study using an emergent sequential exploratory design. A total of 15 front-line healthcare professionals were recruited from the three psychiatric hospitals, including the mental health department of a new teaching hospital in Ghana. Purposive sampling techniques and a semi-structured interview approach were used for recruitment and data collection. Quantitative data from hospital registries were collected and analysed to triangulate qualitative findings. RESULTS Fifteen mental health workers were enrolled in the study. The mean age of participants was (34.47 ± 4.07) years, average work experience of (6.23 ± 3.64) years and the majority as males (60%). This study found an average decline of 23% in hospital attendance and a 35% decline in admissions in all four facilities compared to the previous year, 2019. The lived experiences shared by mental healthcare providers were grouped under 3 main themes: Adjustments to workplace regulations, accessibility to mental healthcare, and psychological wellbeing of mental healthcare workers. The fear of contracting SARS-CoV-2 among healthcare workers, medication shortages, and logistical challenges were also reported to affect Mental Health services during the pandemic. CONCLUSION This study highlights the challenges in mental healthcare during the COVID-19 pandemic in Ghana. The experiences encountered present an opportunity to gain insights into future pandemic preparedness and establish a framework for optimal mental healthcare delivery in Ghana.
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Affiliation(s)
- Michael Zobi
- Institute of International Health, Global Health Centre, Charité Universitätsmedizin Berlin, 13353, Berlin, Germany.
| | - Seth Kofi Abrokwa
- Institute of International Health, Global Health Centre, Charité Universitätsmedizin Berlin, 13353, Berlin, Germany
| | - Eugene Dordoye
- Psychological Medicine & Mental Health Department, School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | - Angel Phuti
- Institute of International Health, Global Health Centre, Charité Universitätsmedizin Berlin, 13353, Berlin, Germany
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Sekhar DL, Schaefer EW, Hoke AM, Rosen P, Chuzie RA, Milakovic DM. Lessons Learned from an Academic Partnership to Review Pennsylvania Network for Student Assistance Services' Annual Survey. THE JOURNAL OF SCHOOL HEALTH 2024; 94:228-234. [PMID: 37553008 DOI: 10.1111/josh.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Pennsylvania's Student Assistance Program (SAP) began in the mid-1980s to address student barriers to academic success. SAP teams, groups of trained school and community professionals, review referrals, and connect students to services. State leadership conducts an annual SAP team survey, but capacity to evaluate data and affect change is limited. In 2020, leadership partnered with [institution name] to collaboratively review the survey data. METHODS Frequencies and percentages were calculated. Open responses were coded. Logistic regression models evaluated the association between SAP team size, team meeting frequency, and team maintenance. RESULTS The 2019 to 2020 survey had 1003 respondents. Median number of SAP team members was 8 (range 1-21). The majority (54%) indicated their SAP team met once per week/cycle for 30 to 90+ minutes. Larger teams met more often. Annual team maintenance occurred for 38% of teams, and was more common for larger teams. SAP team members identified mental health (68%), trauma (44%), and parent engagement (36%) as top training needs. CONCLUSIONS An academic partnership successfully provided the capacity to review SAP survey responses, and informed evidenced-based discussion of best practice guidelines and realignment of staff professional development opportunities.
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Affiliation(s)
- Deepa L Sekhar
- Department of Pediatrics, Penn State College of Medicine, 90 Hope Drive, A14, Hershey, PA
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Alicia M Hoke
- Department of Pediatrics, Penn State College of Medicine, 90 Hope Drive, A14, Hershey, PA
| | - Perri Rosen
- Pennsylvania Network of Student Assistance Services, Commonwealth of Pennsylvania, PA
| | - Roberta A Chuzie
- Pennsylvania Network of Student Assistance Services, Commonwealth of Pennsylvania, PA
| | - Dana M Milakovic
- Pennsylvania Network of Student Assistance Services, Commonwealth of Pennsylvania, PA
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Rathod S, Pallikadavath S, Graves E, Rahman MM, Brooks A, Rathod P, Bhargava R, Irfan M, Aly R, Mohammad Saleh Al Gahtani H, Salam Z, Chau SWH, Paterson TSE, Turner B, Gorbunova V, Klymchuk V, Phiri P. Effects of cumulative COVID-19 cases on mental health: Evidence from multi-country survey. World J Psychiatry 2023; 13:461-477. [PMID: 37547737 PMCID: PMC10401503 DOI: 10.5498/wjp.v13.i7.461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/27/2023] [Accepted: 04/24/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019 (COVID-19) pandemic. The pandemic affected, and in many cases threatened, the health and lives of millions of people across the globe and within the first year, global prevalence of anxiety and depression increased by 25% with the greatest influx in places highly affected by COVID-19.
AIM To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic.
METHODS A repeated, cross-sectional online international survey of adults, 16 years and above, was carried out in 10 countries (United Kingdom, India, Canada, Bangladesh, Ukraine, Hong Kong, Pakistan, Egypt, Bahrain, Saudi Arabia). The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions. Five standardised measures were included to explore levels of depression [patient health questionnaire (PHQ-9)], anxiety [generalized anxiety disorder (GAD) assessment], impact of trauma [the impact of events scale-revised (IES-R)], loneliness (a brief loneliness scale), and social support (The Multi-dimensional Scale of Perceived Social support).
RESULTS There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2. The largest number of participants recruited from the United Kingdom (112985 overall). The majority of participants reported receiving no support from mental health services throughout the pandemic. This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9, GAD-7, and IES-R scores. These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification (to control lockdown effects) confirming these results. The study findings imply that participants’ mental health worsened with high cumulative COVID-19 cases.
CONCLUSION Whist we are still living through the impact of COVID-19, this paper focuses on its impact on mental health, discusses the possible consequences and future implications. This study revealed that daily cumulative COVID-19 cases have a significant impact on depression, anxiety, and trauma. Increasing cumulative cases influenced and impacted education, employment, socialization and finances, to name but a few. Building a database of global evidence will allow for future planning of pandemics, particularly the impact on mental health of populations considering the cultural differences.
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Affiliation(s)
- Shanaya Rathod
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Saseendran Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, University of Portsmouth, Portsmouth PO1 2UP, United Kingdom
| | - Elizabeth Graves
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Mohammad M Rahman
- Salford Business School, University of Salford, Salford M5 4WT, United Kingdom
| | - Ashlea Brooks
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Pranay Rathod
- Patient and Public Involvement, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Rachna Bhargava
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry and Behavioral Sciences, Peshawar Medical College, Riphah International University, Islamabad 46000, Pakistan
| | - Reham Aly
- Department of Clinical Services, Ministry of Health, Cairo 4262114, Egypt
| | | | - Zahwa Salam
- Peshawar Dental College, Ripah International University, Islamabad 46000, Pakistan
| | - Steven Wai Ho Chau
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Theone S E Paterson
- Department of Psychology, University of Victoria, Victoria BC V8P 5C2, Canada
| | - Brianna Turner
- Department of Psychology, University of Victoria, Victoria BC V8P 5C2, Canada
| | - Viktoria Gorbunova
- Department of Social Psychology, Zhytomyr State University, Zhytomyr 10002, Ukraine
| | - Vitaly Klymchuk
- National Psychological Association, Mental Health for Ukraine Project, European Federation of Psychologists' Association, GFA, Kyiv 04071, Ukraine
| | - Peter Phiri
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
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Heflin K, Rosen BJ, Costanzo R, Ballard J, Fetter JC. Psychiatric Boarding in Emergency Departments and the COVID-19 First Wave: The New Hampshire Response. Health Secur 2023. [PMID: 37184664 DOI: 10.1089/hs.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The COVID-19 pandemic forced unprecedented challenges for emergency department operations during the spring of 2020. Before the COVID-19 pandemic, psychiatric boarding in emergency departments required a substantial amount of staffing and administrative resources. This case study describes one state's efforts to rapidly decrease psychiatric boarding by 93% in 2 weeks with a multipronged approach, and simultaneously minimal effects observed on outcome measures of psychiatric hospital readmissions and suicide rates. Lessons learned are discussed regarding workflow adaptations and leadership implications.
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Affiliation(s)
- Katherine Heflin
- Katherine Heflin, MSPH, is a Medical Student; at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Brian J Rosen
- Brian J. Rosen, MD, is a Resident Physician, at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Rosemary Costanzo
- Rosemary Costanzo, RN, MSN, PMH-BC, is Chief Nursing Officer, New Hampshire Hospital, Concord, NH
| | - Jonathan Ballard
- Jonathan Ballard, MD, is [title], at the Geisel School of Medicine at Dartmouth, Hanover, NH
- Jonathan Ballard is also Chief Medical Officer, New Hampshire Department of Health and Human Services, Concord, NH
| | - Jeffrey C Fetter
- Jeffrey C. Fetter, MD, is Assistant Professor, Department of Psychiatry; at the Geisel School of Medicine at Dartmouth, Hanover, NH
- Jeffrey C. Fetter, MD, is Chief Medical Officer, New Hampshire Hospital, Concord, NH
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Kadra-Scalzo G, Kornblum D, Stewart R, Howard LM. Adverse outcomes associated with recorded victimization in mental health electronic records during the first UK COVID-19 lockdown. Soc Psychiatry Psychiatr Epidemiol 2023; 58:431-440. [PMID: 36434299 PMCID: PMC9702612 DOI: 10.1007/s00127-022-02393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The impact of COVID-19 pandemic policies on vulnerable groups such as people with mental health problems who experience violence remains unknown. This study aimed to investigate the prevalence of victimization recorded in mental healthcare records during the first UK lockdown, and associations with subsequent adverse outcomes. METHODS Using a large mental healthcare database, we identified all adult patients receiving services between 16.12.2019 and 15.06.2020 and extracted records of victimisation between 16.03.2020 and 15.06.2020 (first UK COVID-19 lockdown). We investigated adverse outcomes including acute care, emergency department referrals and all-cause mortality in the year following the lockdown (16.06.2020- 01.11.2021). Multivariable Cox regressions models were constructed, adjusting for socio-demographic, socioeconomic, clinical, and service use factors. RESULTS Of 21,037 adults receiving mental healthcare over the observation period, 3,610 (17.2%) had victimisation mentioned between 16.03.2020 and 15.06.2020 (first UK COVID-19 lockdown). Service users with mentions of victimisation in their records had an elevated risk for all outcomes: acute care (adjusted HR: 2.1; 95%CI 1.9-2.3, p < 0.001), emergency department referrals (aHR: 2.0; 95%CI 1.8-2.2; p < 0.001), and all-cause mortality (aHR: 1.5; 95%CI 1.1-1.9; p = 0.003), when compared to service users with no recorded victimisation. We did not observe a statistically significant interaction with gender; however, after adjusting for possible confounders, men had slightly higher hazard ratios for all-cause mortality and emergency department referrals than women. CONCLUSION Patients with documented victimisation during the first UK lockdown were at increased risk for acute care, emergency department referrals and all-cause mortality. Further research is needed into mediating mechanisms.
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Affiliation(s)
- Giouliana Kadra-Scalzo
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Nucleus, IOPPN, Mapother House, De Crespigny Park, London, UK.
| | - Daisy Kornblum
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Nucleus, IOPPN, Mapother House, De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, BRC Nucleus, IOPPN, Mapother House, De Crespigny Park, London, UK
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[Repercussions of COVID-19 on psychiatric inpatient care in Latin America and the Caribbean]. REVISTA COLOMBIANA DE PSIQUIATRIA 2023; 52:58-64. [PMID: 34226036 PMCID: PMC8251525 DOI: 10.1016/j.rcp.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/13/2021] [Accepted: 05/29/2021] [Indexed: 11/23/2022]
Abstract
Objetive To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region. Methods Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively. Results An initial decrease in the demand for hospitalisation is reported, attributed to the population's fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted. Conclusions In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.
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Telemedicine along the cascade of care for substance use disorders during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2023; 242:109711. [PMID: 36462230 PMCID: PMC9683518 DOI: 10.1016/j.drugalcdep.2022.109711] [Citation(s) in RCA: 6] [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: 09/15/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic has changed the landscape of healthcare service delivery. This review aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic. METHODS A literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services. RESULTS Soon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients' lack of access to technology and health insurance coverage, providers' capacity limits and concerns, and clinics' financial and office-space constraints. CONCLUSION The COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services.
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11
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Stone G, Witzig T, McIntosh C. The impact of COVID-19 on school-age children. PSYCHOLOGY IN THE SCHOOLS 2022; 60:PITS22831. [PMID: 36718136 PMCID: PMC9877708 DOI: 10.1002/pits.22831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 12/03/2022]
Abstract
The paper examines the impact of the coronavirus disease 2019 (COVID-19) pandemic on school-age children and their families. Changes to their daily lives were examined through the lens of their physical, mental, and emotional well-being. An analysis of current literature was conducted examining the emerging research on the pandemic's effects on families. A case example is provided to offer a narrative snapshot of the many experiences faced by children and families throughout school closures and stay at home orders. The paper concludes with implications for providers and further research with special attention paid to the emergence of telehealth and implications for treatment.
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Affiliation(s)
- Glen Stone
- Department of Social WorkBall State UniversityIndianaMuncieUSA
| | - Tyler Witzig
- Department of Social WorkBall State UniversityIndianaMuncieUSA
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12
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Janke AT, Nash KA, Goyal P, Auerbach M, Venkatesh AK. Pediatric mental health visits with prolonged length of stay in community emergency departments during COVID-19. J Am Coll Emerg Physicians Open 2022; 3:e12869. [PMID: 36570374 PMCID: PMC9767857 DOI: 10.1002/emp2.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To characterize trends in pediatric mental health visit counts, including visits for prolonged length of stay (LOS), in a sample of emergency departments (EDs) from 29 states during COVID-19. Methods We performed a secondary analysis of the Clinical Emergency Data Registry from January 2020 through December 2021. We reported trends in pediatric mental health visit counts overall and for those with prolonged ED LOS. We reported incident rate ratios (IRRs) for monthly counts compared to January 2020. Among visits with LOS >24 hours, we reported on the most common diagnostic categories. Results There were 107 EDs from 29 states with available complete data in 2020 and 2021. Pediatric mental health visit counts resulting in a LOS greater than 6, 12, and 24 hours were higher for much of 2021. At their peak, there were 604 visits with LOS >12 hours (IRR, 2.14; 95% confidence interval [CI], 1.86-2.47) and 262 visits (IRR, 2.46; 95% CI, 1.97-3.09) with LOS >24 hours in April 2021. Pediatric mental health visits with LOS >12 hours and >24 hours made up 20.9% and 7.3% of pediatric mental health visits overall, respectively. For visits with ED LOS >24 hours, the most common diagnostic categories were suicide or self-injury, depressive disorders, and mental health syndrome. Conclusions In this sample of 107 EDs in 29 states, visit counts with prolonged LOS >24 hours more than doubled in some months since the arrival of COVID-19. These findings are indicative of an increasingly strained emergency and mental health system.
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Affiliation(s)
- Alexander T. Janke
- Institute for Healthcare Policy and InnovationVA Ann Arbor/University of MichiganAnn ArborMichiganUSA
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Katherine A. Nash
- Department of PediatricsNewYork‐Presbyterian/Columbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Pawan Goyal
- American College of Emergency PhysiciansDallasTexasUSA
| | - Marc Auerbach
- Departments of Emergency Medicine and PediatricsYale University School of MedicineNew HavenConnecticutUSA
| | - Arjun K. Venkatesh
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Center for Outcomes Research and EvaluationYale School of MedicineNew HavenConnecticutUSA
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13
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Patel SR, Margolies PJ, Covell NH, Hinds M, Lopez LO, Jean-Noel P, Dixon LB. Behavioral Health Workforce Development in the era of COVID-19: Examples From a State-Funded Intermediary Organization. Community Ment Health J 2022; 58:1563-1570. [PMID: 35471752 PMCID: PMC9038991 DOI: 10.1007/s10597-022-00972-4] [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] [Received: 09/26/2021] [Accepted: 04/03/2022] [Indexed: 01/27/2023]
Abstract
Intermediary and purveyor organizations (IPOs) play a key role in disseminating and implementing behavioral health evidence-based practices. The COVID-19 pandemic created a time of crisis and disruption to behavioral health care delivery. Using the conceptual framework of basic, targeted, and intensive technical assistance (TA) from the Training and Technology Transfer Centers, case studies are used to describe how programs at The Center for Practice Innovations a state funded-intermediary organization, adapted its training and technical assistance to be delivered entirely remotely, to include content related to COVID-19 and to provide guidance on telehealth-based behavioral health care.
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Affiliation(s)
- Sapana R Patel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA. .,Associate Professor of Clinical Medical Psychology (In Psychiatry), Director of Strategic Planning and Curriculum Development, Center for Practice Innovations, Division of Behavioral Health Services and Policy Research, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA.
| | - Paul J Margolies
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Nancy H Covell
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Melissa Hinds
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Luis O Lopez
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Pascale Jean-Noel
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
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14
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Zima BT, Edgcomb JB, Rodean J, Cochran SD, Harle CA, Pathak J, Tseng CH, Bussing R. Use of Acute Mental Health Care in U.S. Children's Hospitals Before and After Statewide COVID-19 School Closure Orders. Psychiatr Serv 2022; 73:1202-1209. [PMID: 35611510 PMCID: PMC9633407 DOI: 10.1176/appi.ps.202100582] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to examine changes in child emergency department (ED) discharges and hospitalizations for primary general medical (GM) and primary psychiatric disorders; prevalence of psychiatric disorders among acute care encounters; and change in acute mental health (MH) care encounters by disorder type and, within these categories, by child sociodemographic characteristics before and after statewide COVID-19–related school closure orders. METHODS This retrospective, cross-sectional cohort study used the Pediatric Health Information System database to assess percent changes in ED discharges and hospitalizations (N=2,658,474 total encounters) among children ages 3–17 years in 44 U.S. children’s hospitals in 2020 compared with 2019, by using matched data for 36- and 12-calendar-week intervals. RESULTS Decline in MH ED discharges accounted for about half of the decline in ED discharges and hospitalizations for primary GM disorders (−24.8% vs. −49.1%), and MH hospitalizations declined 3.4 times less (−8.0% vs. −26.8%) in 2020. Suicide attempt or self-injury and depressive disorders accounted for >50% of acute MH care encounters before and after the statewide school closures. The increase in both ED discharges and hospitalizations for suicide attempt or self-injury was 5.1 percentage points (p<0.001). By fall 2020, MH hospitalizations for suicide attempt or self-injury rose by 41.7%, with a 43.8% and 49.2% rise among adolescents and girls, respectively. CONCLUSIONS Suicide or self-injury and depressive disorders drove acute MH care encounters in 44 U.S. children’s hospitals after COVID-19–related school closures. Research is needed to identify continuing risk indicators (e.g., sociodemographic characteristics, psychiatric disorder types, and social determinants of health) of acute child MH care.
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Affiliation(s)
- Bonnie T Zima
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
| | - Juliet Beni Edgcomb
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
| | - Jonathan Rodean
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
| | - Susan D Cochran
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
| | - Christopher A Harle
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
| | - Jyotishman Pathak
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
| | - Chi-Hong Tseng
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
| | - Regina Bussing
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles (Zima, Edgcomb); Children's Hospital Association, Lenexa, Kansas (Rodean); Fielding School of Public Health, UCLA, Los Angeles (Cochran); Department of Psychiatry, University of Florida, Gainesville (Harle, Bussing); Department of Healthcare Policy and Research, Weill Cornell Medicine, New York City (Pathak); Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles (Tseng)
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15
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Agrest M, Rosales M, Fernández M, Kankan T, Matkovich A, Velzi-Díaz A, Ardila-Gómez S. “About Navigating Chaos”: Latin American and Caribbean Mental Health Workers’ Personal Impact Due to SARS-CoV-2 in the First Hundred Days. Int J Public Health 2022; 67:1604359. [PMID: 36147883 PMCID: PMC9485453 DOI: 10.3389/ijph.2022.1604359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/04/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives: The personal impact of COVID-19 on mental health care workers (MHWs) has received scarce attention despite their work addressing the emotional wellbeing of those affected by the pandemic. This study aims to analyze Latin American and Caribbean’s MHWs’ subjective impact in connection to working during the initial times of the pandemic. Methods: One hundred and fifty-five persons (n = 155) from seventeen countries were contacted in May–June 2020 through a snowball approach. Complementary methodological strategies of analysis used for data triangulation included content analysis, thematic analysis, and interpretative phenomenological analysis. Results: Participants reported feelings of fear, anxiety, anguish, and fatigue. Milder negative impacts (e.g., uncertainty, concern), and complex feelings (e.g., ambivalence) were also frequent. One third of participants acknowledged their capacity to learn from this situation and/or experience satisfaction. Conclusion: Mental health of MHWs in Latin America and the Caribbean were under severe strain and the ongoing mental health reforms at risk during the pandemic’s beginning. More research and additional care may be needed to offer support to those involved in caring for the wellbeing of others.
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Affiliation(s)
- Martin Agrest
- Proyecto Suma, Asistencia y Rehabilitación en Salud Mental, Buenos Aires, Argentina
- *Correspondence: Martin Agrest,
| | - Melina Rosales
- Instituto de Investigaciones, Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marina Fernández
- Instituto de Investigaciones, Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Tanvi Kankan
- Teachers College, Columbia University, New York, NY, United States
| | - Andrés Matkovich
- Facultad de Psicología, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Alberto Velzi-Díaz
- Facultad de Psicología, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Sara Ardila-Gómez
- Instituto de Investigaciones, Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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16
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Beogo I, Bationo NJC, Sia D, Collin S, Kinkumba Ramazani B, Létourneau AA, Ramdé J, Gagnon MP, Tchouaket EN. COVID-19 pandemic or chaos time management: first-line worker shortage - a qualitative study in three Canadian Provinces. BMC Geriatr 2022; 22:727. [PMID: 36057549 PMCID: PMC9440325 DOI: 10.1186/s12877-022-03419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Over the successive waves of the COVID-19 pandemic, front-line care workers (FLCWs) —in this case, at long-term care facilities (LTCFs)— have been the backbone of the fight. The COVID-19 pandemic has disproportionately affected LTCFs in terms of the number of cases, deaths, and other morbidities, requiring managers to make rapid and profound shifts. The purpose of this study is to describe the effects of the pandemic on LTCF services offered and LTCFs staff dedicated to linguistic minorities in three Canadian provinces. Methods This qualitative descriptive study involved eleven managers and fourteen FLCWs, from six LTCFs of three Canadian provinces (New-Brunswick, Manitoba and Quebec). A qualitative content analysis was performed to identify key themes describing the effects of the COVID-19 pandemic on the services offered and the management of LTCFs staff. Results Based on participants’ experiences, we identified three main categories of themes. These macro-themes are as follows: (i) organization and management of staff, (ii) communication and decision-making method, and (iii) staff support. Conclusion The study highlighted the tremendous impact of COVID-19 on direct care staff in terms of the high risks associated with caring for LTCFs residents, which are exacerbated by absences and resignations (sometimes up to 50% of staff), resulting in higher resident to FLCWs ratios. Team members had to support each other, they also received accolades and appreciation from the residents.. Finally, the pandemic led to the rethinking of management procedures centred on a coordinated, inclusive and more hands-on management approach.
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Affiliation(s)
- Idrissa Beogo
- École des sciences infirmières, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. .,College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | | | - Drissa Sia
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Gatineau, Québec, Canada.,Département de médecine sociale et préventive, École de santé publique Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Collin
- École des hautes études publiques (HEP), Université de Moncton, New Brunswick, Moncton, Canada
| | | | - Aurée-Anne Létourneau
- English Language and Cultural Communities Planning, Programming and Research Officer, Jeffery Hale - Saint Brigid's, CIUSSSCN, Québec, Canada
| | - Jean Ramdé
- Faculté des sciences de l'éducation, Université Laval, Québec, Québec, Canada
| | | | - Eric Nguemeleu Tchouaket
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, Gatineau, Québec, Canada.,Département de Gestion, d'évaluation Et de Politique de Santé, École de santé publique, Université de Montréal, Montréal, Québec, Canada
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17
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Presentation of Patients with Eating Disorders to a Pediatric Quaternary-Level Care Emergency Department During the COVID-19 Pandemic. Psychiatr Q 2022; 93:935-946. [PMID: 36044107 PMCID: PMC9428383 DOI: 10.1007/s11126-022-09999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 10/28/2022]
Abstract
Despite an overall decrease in utilization of emergency departments during COVID-19 (Hartnett et al. in MMWR Morb Mortal Wkly Rep. 69(23):699-704, 2020), US pediatric emergency departments experienced an increase in mental health visits for children and adolescents (Leeb et al. in MMWR Morb Mortal Wkly Rep. 69(45):1675-80, 2020). Simultaneously, individuals with eating disorders reported increasing symptomology (Termorshuizen et al. in Int J Eat Disord. 53(11):1780-90, 2020). This study compares Emergency Department utilization at a pediatric quaternary-level care center by patients with eating disorders during the pandemic (March-Dec 2020) vs March-Dec 2019. We hypothesize that there was an increase in presentation of patients with eating disorders. An Informatics for Integrating Biology and the Bedside query of the electronic medical record system identified patients with eating disorder diagnoses per ICD9/ICD10 codes aged 6-23 who presented to the Emergency Department between March 1st and December 31st of 2020 and 2019. Subsequent retrospective chart review was carried out. Patients were excluded from analysis if the presenting problem was not directly related to the eating disorder. During March-Dec 2019, 0.581% percent of all patients presented to the Emergency Department due to an eating disorder. During the same time frame in 2020, however, that percentage increased to 1.265%. Statistical significance was corrected using a Benjamini-Hochberg analysis. Despite a 66.5% decline in overall visits to the Emergency Department, the percentage of patients presenting with eating disorders doubled during the pandemic. During the pandemic, the total time spent awaiting placement significantly increased, and the number of patients identifying as transgender and/or nonbinary increased. Our data support the hypothesis that eating disorder presentation increased during the pandemic.
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18
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Palitsky R, Kaplan DM, Brodt MA, Anderson MR, Athey A, Coffino JA, Egbert A, Hallowell ES, Han GT, Hartmann MA, Herbitter C, Herrera Legon M, Hughes CD, Jao NC, Kassel MT, Le TAP, Levin-Aspenson HF, López G, Maroney MR, Medrano M, Reznik SJ, Rogers ML, Stevenson BL. Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders. Clin Psychol Sci 2022; 10:819-845. [PMID: 36465892 PMCID: PMC9718483 DOI: 10.1177/21677026211072232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.
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Affiliation(s)
- R Palitsky
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - D M Kaplan
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
- 12. Brown University, Center for Alcohol and Addiction Studies
| | - M A Brodt
- 2. Oklahoma State University, Counseling and Counseling Psychology Department, College of Education and Human Sciences
| | - M R Anderson
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - A Athey
- 3. Johns Hopkins University School of Public Health
| | - J A Coffino
- 4. Department of Population Health, New York University School of Medicine
| | - A Egbert
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
- 5. The Miriam Hospital, Providence, RI
| | - E S Hallowell
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - G T Han
- 6. Yale Child Study Center, Yale School of Medicine
| | | | - C Herbitter
- 8. VA Boston Healthcare System
- 18. Boston University Medical School
| | | | - C D Hughes
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - N C Jao
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
- 5. The Miriam Hospital, Providence, RI
| | | | - T-A P Le
- 11. Capital OCD and Anxiety Practice
| | - H F Levin-Aspenson
- 1. Warren Alpert Medical School at Brown University, Department of Psychiatry and Human Behavior
| | - G López
- 12. Brown University, Center for Alcohol and Addiction Studies
| | - M R Maroney
- 13. Werklund School of Education, University of Calgary
| | | | - S J Reznik
- 15. Texas Institute for Excellence in Mental Health, University of Texas at Austin
| | - M L Rogers
- 16. Icahn School of Medicine, Mount Sinai Beth Israel
| | - B L Stevenson
- 17. University of Minnesota Department of Psychiatry
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19
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Powell KG, Chaple MJ, Henry M, Morton C, Becker SJ, Gotham HJ, Hagle HN, Helle AC, Krom LJ, Martin R, Molfenter TD, Roget N, Rutkowski BA, Velez-Echevarria II, Yanez R. Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions. BMC MEDICAL EDUCATION 2022; 22:575. [PMID: 35897014 PMCID: PMC9326150 DOI: 10.1186/s12909-022-03598-y] [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: 02/03/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. METHOD Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. RESULTS Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. CONCLUSIONS Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.
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Affiliation(s)
- Kristen G Powell
- Rutgers University School of Social Work, New Brunswick, NJ, USA.
| | | | - Maxine Henry
- National Latino Behavioral Health Association, Peña Blanca, NM, USA
| | - Cory Morton
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Sara J Becker
- Brown University School of Public Health, Providence, RI, USA
| | - Heather J Gotham
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Holly N Hagle
- University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | - Ashley C Helle
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Laurie J Krom
- University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | | | | | - Nancy Roget
- University of Nevada, Reno, Reno, Nevada, USA
| | - Beth A Rutkowski
- UCLA Integrated Substance Abuse Programs, Los Angeles, California, USA
| | | | - Ruth Yanez
- National Latino Behavioral Health Association, Peña Blanca, NM, USA
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Garagiola ER, Lam Q, Wachsmuth LS, Tan TY, Ghali S, Asafo S, Swarna M. Adolescent Resilience during the COVID-19 Pandemic: A Review of the Impact of the Pandemic on Developmental Milestones. Behav Sci (Basel) 2022; 12:220. [PMID: 35877290 PMCID: PMC9311591 DOI: 10.3390/bs12070220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
This review explores the literature regarding the ways in which the COVID-19 pandemic has affected the navigation of developmental milestones among adolescents, specifically those in late adolescence, across several domains of their lives. The exploration is contextualized globally, focusing on five key areas: mental health, physical health, education, peer relationships, and family relationships. Implications for practice and interventions are explored in each key area to provide recommendations for those working with adolescents, as well as future research. The changes brought about by the pandemic and the readjustment to what some have referred to as the "new normalcy" will undoubtedly have lasting effects on all areas of life for this cohort of adolescents, who have shown remarkable resilience navigating this new and unfamiliar world. These changes are synthesized, with the aim to highlight differences and similarities of the shared experiences of the pandemic globally. After exploring the current realities, this chapter goes on to outline the ways in which the experience of such a significant developmental period of one's life during the COVID-19 pandemic will have an impact on adolescents for years to come. Although it is still impossible to comprehend the long-term effects, in examining proximal effects, we can postulate distal implications and potential future effects, as well as possible ways to mitigate these implications as we transition back to more of what was experienced pre-pandemic life, from a post-pandemic experience.
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Affiliation(s)
- Erica R. Garagiola
- Department of Psychology, Rutgers University, New Brunswick, NJ 08901, USA; (S.G.); (M.S.)
| | - Queenie Lam
- Department of Psychology, Long Island University Brooklyn, Brooklyn, NY 11201, USA;
| | - Louise S. Wachsmuth
- Counseling and Clinical Psychology, Teacher’s College, Columbia University, New York, NY 10027, USA;
| | - Tse Yen Tan
- Yale Center for Emotional Intelligence, New Haven, CT 06511, USA;
| | - Samara Ghali
- Department of Psychology, Rutgers University, New Brunswick, NJ 08901, USA; (S.G.); (M.S.)
| | - Seth Asafo
- Department of Psychiatry, University of Ghana, Korle Bu, Accra P.O. Box GP 4236, Ghana;
| | - Manjari Swarna
- Department of Psychology, Rutgers University, New Brunswick, NJ 08901, USA; (S.G.); (M.S.)
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Purtle J, Nelson KL, Horwitz SM, Palinkas LA, McKay MM, Hoagwood KE. Impacts of COVID-19 on Mental Health Safety Net Services for Youths: A National Survey of Agency Officials. Psychiatr Serv 2022; 73:381-387. [PMID: 34320821 PMCID: PMC8799776 DOI: 10.1176/appi.ps.202100176] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mental health agencies provide critical safety net services for youths. No research has assessed impacts of the COVID-19 pandemic on services these agencies provide or youths they serve. This study sought to characterize agency officials' perceptions of the pandemic's impacts on youths and challenges to providing youth services during the pandemic and to examine associations between these challenges and impacts. METHODS Surveys were completed in September-October 2020 by 159 state or county mental health agency officials from 46 states. Respondents used 7-point scales (higher rating indicated more severe impact or challenge) to rate the pandemic's impact on youth mental health issues, general service challenges, and telepsychiatry service challenges across patient, provider, and financing domains. Multiple linear regression models estimated associations between service challenges (independent variables) and pandemic impacts (dependent variables). RESULTS Most agency officials perceived the pandemic as having disproportionately negative mental health impacts on socially disadvantaged youths (serious impact, 72%; mean rating=5.85). Only 15% (mean=4.29) perceived the pandemic as having a seriously negative impact on receipt of needed youth services. Serious service challenges were related to youths' lack of reliable equipment or Internet access for telepsychiatry services (serious challenge, 59%; mean=5.47) and the inability to provide some services remotely (serious challenge, 42%, mean=4.72). In regression models, the inability to provide some services remotely was significantly (p≤0.01) associated with three of five pandemic impacts. CONCLUSIONS Officials perceived the COVID-19 pandemic as exacerbating youth mental health disparities but as not having a dramatic impact on receipt of needed services.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); Brown School, Washington University in St. Louis, St. Louis (McKay)
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); Brown School, Washington University in St. Louis, St. Louis (McKay)
| | - Sarah McCue Horwitz
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); Brown School, Washington University in St. Louis, St. Louis (McKay)
| | - Lawrence A Palinkas
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); Brown School, Washington University in St. Louis, St. Louis (McKay)
| | - Mary M McKay
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); Brown School, Washington University in St. Louis, St. Louis (McKay)
| | - Kimberly E Hoagwood
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City (Horwitz, Hoagwood); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Palinkas); Brown School, Washington University in St. Louis, St. Louis (McKay)
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22
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Royster J, McCall TC, Dekker D, Brees K. Untapped Potential: Local Health Departments' Involvement in Behavioral Health Preparedness Planning and Recovery Through a Population Behavioral Health Framework. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:210-213. [PMID: 35100221 PMCID: PMC8852818 DOI: 10.1097/phh.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Due to the COVID-19 pandemic, there is an increased demand for behavioral health services in an already strained public health system. Thus, there is a critical need to shift to a population behavioral health framework to address the scope and magnitude of the behavioral health crisis. Local health departments (LHDs) are positioned and purposed to assist in this work by implementing behavioral health surveillance, prevention, and early intervention strategies. Two surveys conducted by the National Association of County and City Health Officials (NACCHO) were used for this analysis, the 2018 Preparedness Profile survey and the 2020 Forces of Change survey. In 2018, a little over half of LHDs involved behavioral health groups in their planning coalitions, and three-quarters of LHDs addressed behavioral health in preparedness planning. However, in 2020, LHDs implementing a behavioral health response during COVID-19 was substantially lower than the planning phases: strategy to support the public health system, including behavioral health (20%); specific initiative for individuals with behavioral health needs (48%); or targeted messaging for people with behavioral health needs (25%). The findings of this analysis indicate that as of 2020, LHDs’ involvement in behavioral health is still minimal and the potential for LHDs to reduce burden on the public health system is not being maximized. For LHDs to provide more behavioral health services they will require support in the form of funds, technical assistance, education on best practices, and the support and authority to expand services in behavioral health.
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Affiliation(s)
- Jordan Royster
- National Association of County and City Health Officials, Washington, District of Columbia
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23
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Abstract
The American pediatric mental health system is in crisis; the COVID-19 pandemic highlighted and exacerbated existing gaps. All youth were affected by the pandemic, an impact medicated by mental illness, the closing of schools, reduced access to mental health services, loss and bereavement, and financial and emotional stress on families. The pandemic's fallout is likely to be felt for years to come as today's youth move through successive developmental stages. Improvements in health care systems for youth, innovations in how care is delivered, and ongoing community support for recovery and resilience are needed moving forward.
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24
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COVID 19 and Implementing E-Mental Health using the VRIO Strategic Planning Framework. INTERNATIONAL JOURNAL OF E-COLLABORATION 2022. [DOI: 10.4018/ijec.299005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronavirus has disrupted normalcy for communities and businesses across the globe. With massive shutdowns across the world, organizations were forced to assess their business operations and determine how to sustain in such turbulent times. Mental health clinics faced equivalent barriers as the structure of engaging with clients in a face to face setting was similarly disrupted. The implementation of e-mental health structures were clear targets of change as clinics needed to continue to serve the mentally fragile. Strategic planning calls for thoughtful collaboration, collection, and consideration of the necessary adaptations to meet the mission and vision of the organization. Strategic frameworks like the Value, Rarity, Imitability, and Organization are useful tools for mental health clinics to plan on shifting their operations from an in-person to a virtual environment.
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25
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Zima BT, Devaskar SU, Patel M, Raphael J, Pursley D, Keller D, Cheng T, Javier J, Lee L. Imperative to accelerate research aligning real-time clinical demand with mental health supply. Pediatr Res 2022; 92:917-920. [PMID: 36104514 PMCID: PMC9472179 DOI: 10.1038/s41390-022-02246-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Bonnie T. Zima
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA USA ,Pediatric Policy Council, Washington, DC USA
| | - Sherin U. Devaskar
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA USA ,Pediatric Policy Council, Washington, DC USA
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Gifford L, Johnson CC, Haque N, Passalacqua KD, Swiderek J, Kalkanis S. COVID-19 in the hotspot of Metropolitan Detroit: A multi-faceted health system experience. Int J Health Plann Manage 2021; 37:657-672. [PMID: 34859491 PMCID: PMC9015618 DOI: 10.1002/hpm.3392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/02/2021] [Accepted: 11/14/2021] [Indexed: 12/02/2022] Open
Abstract
Health systems were abruptly plunged into a crisis as SARS‐CoV‐2 exploded into a pandemic in spring 2020. In March‐April 2020, Metropolitan Detroit was a US “hotspot.” As a large health system with five hospitals and two behavioural health inpatient facilities, a health insurance company, a medical group and physician network, and 41 ambulatory clinics normally hosting over 10,000 daily patient encounters, the Henry Ford Health System deployed numerous strategies in the management of this upheaval. As hospitals and Emergency Departments were inundated with COVID‐19 patients, other services and activities needed to shut down as state‐mandated policies were promulgated, new internal and external communication networks established, and management of employees and resources such as ventilators, ICU beds, personal protective equipment, and laboratory supplies became critical challenges. We describe herein the system‐wide strategies implemented and lessons learned in the operation of a health system in the initial throes of a global pandemic.
A pandemic rapid response requires coordination of multiple facets of a health system, best led by a highly centralised incident command model. Regular and frequent (at least daily) communication with a wide range of leaders is paramount. Early and constant attention to IT infrastructure for data and communications is essential. Frequent coordination and communication with the local community and local and regional health care organisations and government agencies are critical. Establishment of a pandemic‐specific structure for education and research activities is crucial, including a system for ongoing monitoring of public data and pandemic‐related literature on topics ranging from epidemiology to infection control to treatment. Continuing attention needs to be paid to acknowledging and mitigating the psychological impacts of a pandemic on patients, families and staff.
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Affiliation(s)
- Linda Gifford
- Henry Ford Medical Group AdministrationHenry Ford Health SystemDetroitMIUSA
| | | | - Nadia Haque
- Department of NeurosurgeryHenry Ford Health SystemDetroitMIUSA
| | | | - Jennifer Swiderek
- Department of Internal Medicine, Division of Pulmonary & Critical Care MedicineHenry Ford Health SystemDetroitMIUSA
| | - Steven Kalkanis
- Henry Ford Medical Group AdministrationHenry Ford Health SystemDetroitMIUSA
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27
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Purcell N, Sells J, McGrath S, Mehlman H, Bertenthal D, Seal KH. “Then COVID happened…”: Veterans’ Health, Wellbeing, and Engagement in Whole Health Care During the COVID-19 Pandemic. Glob Adv Health Med 2021; 10:21649561211053828. [PMID: 35174002 PMCID: PMC8842446 DOI: 10.1177/21649561211053828] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Little is known about the COVID-19 pandemic’s impact on US military veterans’ health, wellbeing, and care engagement. Healthcare systems like VA need additional information about the pandemic’s biopsychosocial impacts and how a Whole Health approach may help to address them. Objective To examine how the pandemic has affected veterans’ health, wellbeing, and engagement in the VA Whole Health System of Care. Method We conducted qualitative interviews with 40 veterans at a large multicampus VA healthcare system during the pandemic. Informed by a Whole Health approach, interviews used open-ended questions to holistically explore pandemic impacts on mental and physical health, healthcare access and engagement, social support, coping strategies, and use of VA healthcare and wellness services. Interviews were conducted by telephone, audio-recorded, and analyzed using a matrix-based technique. Interviews were supplemented by an original survey assessing pandemic impacts; descriptive frequencies were calculated to describe and characterize the interviewed sample. Interview Results Nearly, all participating veterans described significant pandemic impacts on their wellbeing, especially loneliness and sorrow stemming from isolation and disruptions to ordinary routines. These emotional impacts—sometimes combined with new constraints on care access and personal mobility—disrupted veterans’ health plans and sometimes deterred engagement in both routine and wellness care. Veterans already struggling with chronic mental and physical health conditions and those who experienced transitions or losses during the pandemic described the most severe impacts on their wellbeing. Virtual VA wellness services, especially health coaching and mind-body wellness groups, were a key source of support and connection for those who engaged in them. Conclusion We discuss the implications of our findings for care systems attempting to implement a Whole Health System of Care, including how they can address postpandemic barriers to engagement in healthcare and wellness programs, and how wellness programs can be leveraged to support those most at risk after the COVID-19 pandemic and in future crises.
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Affiliation(s)
- Natalie Purcell
- San Francisco VA Health Care System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Joanna Sells
- San Francisco VA Health Care System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Sarah McGrath
- San Francisco VA Health Care System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Haley Mehlman
- San Francisco VA Health Care System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | | | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
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28
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Schneider KE, Dayton L, Wilson D, Nestadt PS, Latkin CA. Distress in the time of COVID-19: Understanding the distinction between COVID-19 specific mental distress and depression among United States adults. J Affect Disord 2021; 294:949-956. [PMID: 34375223 PMCID: PMC8321623 DOI: 10.1016/j.jad.2021.07.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, many Americans have experienced mental distress, which may be partially characterized by a rise in mental illnesses. However, COVID-19 specific psychological distress may also be separate from diagnosable conditions, a distinction that has not been well established in the context of the pandemic. METHODS Data came from an online survey of US adults collected in March 2020. We used factor analysis to assess the relationship between COVID-19 related mental distress and depressive symptoms. Using four questions on psychological distress modified for COVID-19 and eight depressive symptoms, we conducted an exploratory factor analysis (EFA) to identify the factor structure and then estimated a confirmatory factor analysis (CFA). RESULTS The EFA model indicated a two-factor solution, where the COVID-19 distress items loaded onto the first factor and depression items loaded onto the second. Only two items cross-loaded between factors: feeling fearful and being bothered by things that do not usually bother the participant. The CFA indicated that this factor structure fit the data adequately (RMSEA=0.106, SRMR=0.046, CFI=0.915, TLI=0.890). LIMITATIONS It is possible that there are additional important symptoms of COVID-19 distress that were not included. Depression symptoms were measured via the CES-D-10, which while validated is not equivalent to a clinician diagnosis. CONCLUSIONS As COVID-19 related mental distress appears to be distinct from, though related to, depression, public health responses must consider what aspects of depression treatment may apply to this phenomenon. For COVID-related distress, it may be more appropriate to treat symptomatically and with supportive psychotherapy.
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Affiliation(s)
- Kristin E. Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, 624 N. Broadway, Baltimore, MD 21205, USA,Corresponding author
| | - Lauren Dayton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Deborah Wilson
- School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD 21205, USA
| | - Paul S. Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, 624 N. Broadway, Baltimore, MD 21205, USA,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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29
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Druss BG, Cohen AN, Brister T, Cotes RO, Hendry P, Rolin D, Torous J, Ventura J, Gorrindo T. Supporting the Mental Health Workforce During and After COVID-19. Psychiatr Serv 2021; 72:1222-1224. [PMID: 33882690 DOI: 10.1176/appi.ps.202000509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.
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Affiliation(s)
- Benjamin G Druss
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Amy N Cohen
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Teri Brister
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Robert O Cotes
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Patrick Hendry
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Donna Rolin
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - John Torous
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Joseph Ventura
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Tristan Gorrindo
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
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Janoczkin A, Kiers S, Edara N, He P, Li Y. Impact of COVID-19 pandemic on emergency psychiatry-Millcreek community hospital, Erie, PA. Compr Psychiatry 2021; 110:152255. [PMID: 34461390 DOI: 10.1016/j.comppsych.2021.152255] [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] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Evidence suggested that traumatic events, including pandemics, can be associated with psychiatric symptoms like increased anxiety and depression. However, there were many unknowns concerning the emergent global coronavirus-19 (COVID-19), including its impact on psychiatric health within the United States. Our study aimed to track trends of mental health problems in individuals who presented with psychiatric complaints in an emergent setting. METHODS A total of 1776 patients and 1610 patients presented to Emergency Department (ED) with psychiatric complaints between January 1 - July 9 of the years of 2019 and 2020, respectively, in Millcreek Community Hospital (MCH) Erie, PA. This study was an electronic medical record review (EMR), therefore the data were collected exclusively from EMR over the two-year span. ED prevalence was calculated as the number of total psychiatric MCH ED cases divided by the total number of all MCH ED patients, and prevalence ratio (PR) between 2019 and 2020 was used to reflect change of overall ED psychiatric prevalence. RESULTS Clinical notes revealed increased ED psychiatric chief complaint prevalence, as indicated by a PR greater than one, in multiple categories in comparison to before the COVID-19 outbreak. Concerning primary psychiatric disorders, there was increased ED prevalence in chief complaint of total mood disorders (PR = 1.21) with major depressive disorder (PR = 1.23) and bipolar disorder (PR = 1.47), neurodevelopment disorders (PR = 1.25) with attention deficit hyperactivity disorder (ADHD) (PR = 1.19) and intellectual disability (PR = 1.52), trauma- and stressor-related disorders (PR = 1.56) with post-traumatic stress disorder (PTSD) (PR = 1.39) and adjustment disorder (PR = 1.73), substance abuse and addiction disorders (PR = 1.29), and personality disorders (PR = 1.56). CONCLUSIONS The pandemic outbreak dramatically impacted mental health in an ER setting. Further research on mental health disparities in conjunction with the COVID-19 pandemic is critical to help predict and address risk for chronic symptoms and sequela to help anticipate and improve psychiatric patient care and well-being during potential future pandemics.
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Affiliation(s)
- Alexis Janoczkin
- Department of Pre-Clinical medicine, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Spencer Kiers
- Department of Pre-Clinical medicine, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Naga Edara
- Department of Pre-Clinical medicine, Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Ping He
- Department of Pre-Clinical medicine, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
| | - Yueling Li
- Department of Psychiatry, Millcreek Community Hospital, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.
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Sharma A, Feuer V, Stuart BK, Folk JB, Doan BT, Kulkarni CA, Ramtekkar U, Fortuna L, Myers K. Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool. J Child Adolesc Psychopharmacol 2021; 31:464-474. [PMID: 34543079 DOI: 10.1089/cap.2021.0020] [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: 11/13/2022]
Abstract
Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.
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Affiliation(s)
- Aditi Sharma
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Vera Feuer
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Barbara Krishna Stuart
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Johanna B Folk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Bridget T Doan
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Hospital for Sick Children (SickKids), Toronto, Canada
| | - Chetana A Kulkarni
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Hospital for Sick Children (SickKids), Toronto, Canada
| | - Ujjwal Ramtekkar
- Department of Psychiatry and Behavioral Health, The Ohio State University School of Medicine, Columbus, Ohio, USA.,Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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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: 21] [Impact Index Per Article: 5.3] [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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Martin R, Kang AW, DeBritz AA, Walton MR, Hoadley A, DelaCuesta C, Hurley L. Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6163. [PMID: 34200312 PMCID: PMC8201197 DOI: 10.3390/ijerph18116163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022]
Abstract
Using quantitative and qualitative evidence, this study triangulates counselors' perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors' experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients' anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.
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Affiliation(s)
- Rosemarie Martin
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (A.W.K.); (A.A.D.); (C.D.)
| | - Augustine W. Kang
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (A.W.K.); (A.A.D.); (C.D.)
| | - Audrey A. DeBritz
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (A.W.K.); (A.A.D.); (C.D.)
| | - Mary R. Walton
- CODAC Behavioral Healthcare Inc., Cranston, RI 02910, USA; (M.R.W.); (L.H.)
| | - Ariel Hoadley
- College of Public Health, Temple University, Philadelphia, PA 19122, USA;
| | - Courtney DelaCuesta
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI 02903, USA; (A.W.K.); (A.A.D.); (C.D.)
| | - Linda Hurley
- CODAC Behavioral Healthcare Inc., Cranston, RI 02910, USA; (M.R.W.); (L.H.)
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Legrand G, Boisgard C, Canac B, Cardinaud Z, Gorla MG, Gregoire E, Jamon C, Oussal T, Vaury P. Organisation and timeline of measures in French psychiatric establishments during the first wave of the COVID-19 epidemic: EvOlu'Psy study. BMC Psychiatry 2021; 21:284. [PMID: 34074271 PMCID: PMC8169419 DOI: 10.1186/s12888-021-03293-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/11/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The onset of COVID-19 required rapid organisational changes in the mental health domain. Most mental health-care departments appear to have set up infection control measures and also organised planning, coordination and measures that enabled them to provide psychiatric care in a restrictive environment. Our objective was to assess the organisation by psychiatric facilities in France of their response to COVID-19, during the first wave. METHODS In June 2020, a cross-sectional study was performed by an audit with 48 items which was proposed to 331 hospitals in metropolitan France with a capacity for full-time, that is, inpatient psychiatric hospitalisation of adults. RESULTS Of the 331 establishments contacted, 94 (28.4%) agreed to respond to the survey questionnaire. Full-time inpatient hospitalisation was completely or partially maintained by 94.7% (n = 89) of facilities. Specific measures concerning respect for patients' rights were reported by 58% (n = 55) of establishments. Overall, 74.5% (n = 70) had set up a dedicated channel of care for patients at risk of severe COVID-19, and 52.1% (n = 49) a system for routine screening at admission for these risk factors. Nearly half the establishments (48.9%, n = 46) reported they had set up specific training programmes for patients about barrier measures and social distancing. CONCLUSIONS French psychiatric establishments on the whole were able to provide a necessary reorganisation of their management of patients and their families, regardless of facility status. Patients' rights nonetheless seem to have not received the attention they merited during the early pandemic period. Somatic management of patients with mental illness must absolutely be improved.
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Affiliation(s)
- Guillaume Legrand
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Clermont-Ferrand, 33 Rue Gabriel Péri, 63000, Clermont-Ferrand, France.
| | - Catherine Boisgard
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Clermont-Ferrand, 33 Rue Gabriel Péri, 63000, Clermont-Ferrand, France
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Rodez, Cayssiols, 12510, Rodez, France
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Nice, 87 Avenue Joseph Raybaud, 06100, Nice, France
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie du Puy-en-Velay, 50 Route de Montredon, 43009, Le Puy-en-Velay, France
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Rodez, 19 Cours du Temple, 07000, Privas, France
| | - Bernard Canac
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Rodez, Cayssiols, 12510, Rodez, France
| | - Zuzana Cardinaud
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Clermont-Ferrand, 33 Rue Gabriel Péri, 63000, Clermont-Ferrand, France
| | - Michela Giugiario Gorla
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Nice, 87 Avenue Joseph Raybaud, 06100, Nice, France
| | - Elisabeth Gregoire
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Clermont-Ferrand, 33 Rue Gabriel Péri, 63000, Clermont-Ferrand, France
| | - Caroline Jamon
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie du Puy-en-Velay, 50 Route de Montredon, 43009, Le Puy-en-Velay, France
| | - Tarik Oussal
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Rodez, 19 Cours du Temple, 07000, Privas, France
| | - Pascal Vaury
- Association Hospitalière Sainte-Marie, Centre Hospitalier Sainte-Marie de Clermont-Ferrand, 33 Rue Gabriel Péri, 63000, Clermont-Ferrand, France
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Mental Health and Service Impacts During COVID-19 for Individuals with Serious Mental Illnesses Recently Released from Prison and Jail. J Behav Health Serv Res 2021; 48:610-616. [PMID: 33987798 PMCID: PMC8118368 DOI: 10.1007/s11414-021-09759-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
Individuals recently released from jail or prison with serious mental illnesses may be vulnerable to the coronavirus pandemic. This study aims to understand how they experienced the pandemic during initial stay-at-home orders in New York City. Structured surveys and in-depth semi-structured interviews examined the impact of the pandemic on participants. Survey responses are presented as percentages. Thematic analysis was used to code and analyze in-depth interviews. All participants (N = 5) knew about the coronavirus pandemic, and most took steps to minimize risk. Participants experienced changes to their services, including suspensions of some supportive services. They also reported an increase in psychiatric symptoms but utilized a variety of coping mechanisms in response. Community reintegration was essentially on hold as supportive services were suspended. Comprehensive reentry services may need to be adapted during the pandemic to address the multiple needs of individuals and to facilitate community reintegration.
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36
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Swenson I, Gates TG, Dentato MP, Kelly BL. Strengths-based behavioral telehealth with sexual and gender diverse clients at Center on Halsted. SOCIAL WORK IN HEALTH CARE 2021; 60:78-92. [PMID: 33563143 DOI: 10.1080/00981389.2021.1885561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/05/2021] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic necessitated an immediate response and rapid transition from traditional face-to-face behavioral health services to behavioral telehealth at an organization serving sexual and gender diverse (SGD) individuals in Chicago. In this practice innovations article, we explore the unfolding public health crisis and the impact on service delivery for SGD individuals. Using a large multi-service organization as a case study, this paper describes how key members of the staff and leadership team shifted services online as a means of responding to isolation, loneliness, and disparities in access to healthcare for Chicago SGD communities. Lessons learned and practice recommendations are presented.
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Affiliation(s)
- Ing Swenson
- Behavioral Health Department, Center on Halsted, Chicago, Illinois, USA
| | - Trevor G Gates
- School of Law and Society,University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Michael P Dentato
- School of Social Work, Loyola University Chicago, Chicago, Illinois, USA
| | - Brian L Kelly
- School of Social Work, Loyola University Chicago, Chicago, Illinois, USA
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38
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Almeda N, García-Alonso C, Salvador-Carulla L. Mental health planning at a very early stage of the COVID-19 crisis: a systematic review of online international strategies and recommendations. BMC Psychiatry 2021; 21:43. [PMID: 33451305 PMCID: PMC7809644 DOI: 10.1186/s12888-020-03015-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/14/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mental health care systems have been dramatically affected by COVID-19. Containment measures have been imposed, with negative consequences on population mental health. Therefore, an increase in both symptomatology and mental disorder incidence is expected. This research aims to identify, describe and assess the empirical background on online strategies and recommendations developed by international organizations and governments to cope with the psychological impact of COVID-19 at a very early stage of the pandemic. METHODS The PRISMA guidelines were adapted to review online documents. A new questionnaire was developed to identify the existence of common patterns in the selected documents. Questions were classified into three domains: COVID-19 information, mental health strategies and mental health recommendations. A two-step cluster analysis was carried out to highlight underlying behaviours in the data (patterns). The results are shown as spider graphs (pattern profiles) and conceptual maps (multidimensional links between questions). RESULTS Twenty-six documents were included in the review. The questionnaire analysed document complexity and identified their common key mental health characteristics (i.e., does the respondent have the tools for dealing with stress, depression and anxiety?). Cluster analysis highlighted patterns from the questionnaire domains. Strong relationships between questions were identified, such as psychological tips for maintaining good mental health and coping with COVID-19 (question n° 4), describing some psychological skills to help people cope with anxiety and worry about COVID-19 (question n° 6) and promoting social connection at home (question n° 8). CONCLUSIONS When fast results are needed to develop health strategies and policies, rapid reviews associated with statistical and graphical methods are essential. The results obtained from the proposed analytical procedure can be relevant to a) classify documents according to their complexity in structuring the information provided on how to cope with the psychological impact of COVID-19, b) develop new documents according to specific objectives matching population needs, c) improve document design to face unforeseen events, and d) adapt new documents to local situations. In this framework, the relevance of adapting e-mental health procedures to community mental health care model principles was highlighted, although some problems related to the digital gap must be considered.
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Affiliation(s)
- Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain.
| | - Carlos García-Alonso
- grid.449008.10000 0004 1795 4150Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Spain
| | - Luis Salvador-Carulla
- grid.1001.00000 0001 2180 7477Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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Abstract
PURPOSE OF REVIEW We report evidence on the negative psychological effects of pandemics in people with personality disorders (PDs) and on the role of personality pathology in compliance with mitigation-related behaviors. Considering the paucity of studies, after a description of the main features of PDs, on the basis of the current literature on pandemic and quarantine mental health impact, we trace some clinical hypotheses. RECENT FINDINGS Paranoid traits and detachment (cluster A) might lead to worse psychological outcomes. Cluster B patients may show more intense stress-related reactions and react strongly to social distancing, especially considering borderline personality disorder. Cluster C patients might be particularly prone to anxiety and stress due to fear of contagion and may be less flexible in adaptation to new routines. Evidence on compliance with mitigation measures is mixed, with lower compliance in cluster B patients and higher in cluster C ones. We suggest that PD patients might be particularly affected by pandemics. Furthermore, they might react differently, according to their main diagnosis. Similarly, compliance with mitigation measures may differ according to specific PDs. Our results should be considered as a starting point to reflect on therapeutic strategies to be adopted in the post-COVID-19 situation.
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Affiliation(s)
- Emanuele Preti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
| | - Rossella Di Pierro
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Erika Fanti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
- Department of Adult Psychiatry, Nîmes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nîmes, France
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Aamir A, Awan S, de Filippis R, Diwan MN, Ullah I. Effect of COVID-19 on Mental Health Rehabilitation Centers. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2020; 8:97-100. [PMID: 33106766 PMCID: PMC7577361 DOI: 10.1007/s40737-020-00203-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/03/2020] [Indexed: 01/13/2023]
Abstract
The SARS-CoV-2 outbreak is an unprecedented event in modern history worldwide. To facilitate speedy and smooth recovery during this time period, an added responsibility is placed upon rehabilitation center counselors, staff and management. In this paper we expose the role that psychiatric rehabilitation plays during the COVID-19 crisis. Since COVID-19 pandemic has remarkably raised mental health concerns, one of the high risks and possibly neglected groups includes individuals undergoing mental health rehabilitation, the impact on which can be significant as compared to the rest of the population. In order to ensure that individuals on the road to recovery are not alone and forgotten during the times of coronavirus crisis they should be provided with adequate resources, such as online meetings and group therapy sessions, assessment, treatment and support by telephone and video consultation and getting the medications they need to recover. This article highlights how the coronavirus pandemic, that has hit hard the health care and all categories of patients affected by mental disorders, is likely to be particularly dramatic for mental health rehabilitation centers. Indeed, the COVID-19 crisis has severely tested the health systems worldwide, reducing sometimes the quality and quantity of care offered to psychiatric patients both hospitalized and not in rehabilitation centers. The main goal of this paper is to raise awareness of the importance, often underestimated, of mental health rehabilitation centers, on which one should invest for the both future of psychological and psychiatric rehabilitation and the current crisis as well.
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Affiliation(s)
- Alifiya Aamir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Sana Awan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Renato de Filippis
- Department of Health Sciences, Psychiatric Unit, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
- Undergraduate Research Organization, Dhaka, Bangladesh
- Naseer Teaching Hospital, Peshawar, Pakistan
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Khanna R, Murnane T, Kumar S, Rolfe T, Dimitrieski S, McKeown M, Ejareh Dar M, Gavson L, Gandhi C. Making working from home work: reflections on adapting to change. Australas Psychiatry 2020; 28:504-507. [PMID: 32910690 DOI: 10.1177/1039856220953701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES During the COVID-19 pandemic, our mental health service experimented with working from home. The flexibility of this practice can enable improved efficiency, staff well-being and expanded operating hours in the longer term. This paper shares our experiences and makes recommendations for being a part of and leading distributed clinical teams. CONCLUSIONS We saw a 3% increase in total appointment bookings and a 7% reduction in cancellations/non-attendance compared to the same period in 2019. Based on our experience and the literature, effective distributed teams have leaders that connect via video at least weekly; focus on transparency and output over micromanagement; prioritise staff relationships and err towards overcommunication.
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Affiliation(s)
- Rahul Khanna
- Mental Health Division, Austin Health, Australia.,Department of Psychiatry, University of Melbourne, Australia
| | - Tess Murnane
- Mental Health Division, Austin Health, Australia
| | | | | | | | | | - Maryam Ejareh Dar
- Mental Health Division, Austin Health, Australia.,Department of Psychiatry, University of Melbourne, Australia
| | - Laura Gavson
- Mental Health Division, Austin Health, Australia
| | - Charu Gandhi
- Mental Health Division, Austin Health, Australia
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Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, Cannon M, Correll CU, Byrne L, Carr S, Chen EYH, Gorwood P, Johnson S, Kärkkäinen H, Krystal JH, Lee J, Lieberman J, López-Jaramillo C, Männikkö M, Phillips MR, Uchida H, Vieta E, Vita A, Arango C. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020; 7:813-824. [PMID: 32682460 PMCID: PMC7365642 DOI: 10.1016/s2215-0366(20)30307-2] [Citation(s) in RCA: 918] [Impact Index Per Article: 183.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
Abstract
The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.
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Affiliation(s)
- Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Merete Nordentoft
- CORE-Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region, Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Crossley
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nev Jones
- Department of Psychiatry, University of South Florida, Tampa, FL, USA
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Louise Byrne
- School of Management, College of Business, RMIT University, Melbourne, VIC, Australia; Program for Recovery and Community Health, School of Medicine, Yale, New Haven, CT, USA; School of Medicine, Yale, New Haven, CT, USA
| | - Sarah Carr
- School of Social Policy and Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Eric Y H Chen
- Department of Psychiatry and State Key Laboratory on Cognitive and Brain Sciences, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris, University of Paris, INSERM U1266, Paris, France; GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, Paris, France
| | - Sonia Johnson
- Division of Psychiatry (National Insitute for Health Research Mental Health Policy Research Unit), University College London, London, UK
| | - Hilkka Kärkkäinen
- Global Alliance of Mental Illness Advocacy Networks-Europe, Brussels, Belgium
| | - John H Krystal
- Department of Psychiatry, School of Medicine, Yale, New Haven, CT, USA; Yale New Haven Hospital, New Haven, CT, USA
| | - Jimmy Lee
- North Region and Department of Psychosis, Institute of Mental Health, Singapore; Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jeffrey Lieberman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, NY, USA
| | - Carlos López-Jaramillo
- Department of Psychiatry, School of Medicine, University of Antioquia, Medellín, Colombia
| | | | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
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