Development of public stigma toward people with mental health problems in Czechia 2013–2019

BackgroundWe aimed to assess the changes in public stigma towards people with mental health problems in Czechia; and to investigate the association between these and the exposure to the ongoing mental health care reform and one of its implementation projects focused on reducing stigma.MethodsWe analyzed data from three cross-sectional surveys representative of the Czech adult population. We used linear regression models to compare population attitudes and desire for future contact with people with mental health problems between the 2013/2014 baseline and the 2019 follow-up. In our 2019 sample, we employed linear regression models to assess the relationship between exposure to mental health care reform and nation-wide anti-stigma campaign, and population stigmatizing attitudes and intended behavior. We utilized a propensity score matching procedure to mitigate potential bias.ResultsThe 2013, 2014, and 2019 datasets consisted of 1797, 1810, and 1077 participants, respectively. Population attitudes improved significantly between 2014 and 2019 (B = 0.99, 95% CI = 0.06; 1.93), but we did not detect a change in population desire for future contact with people with mental health problems. Exposure to the nationwide anti-stigma campaign or mental health care reform was associated with more favorable attitudes (B = 4.25, 95% CI = 2.07; 6.42 and B = 7.66, 95% CI = 3.91; 11.42), but not with higher desire for future contact with people with mental health problems.ConclusionsMental health care reform and its nation-wide anti-stigma project seems to have a positive impact on population attitudes, but not on desire for future contact with people with mental health problems.     

The Nordic Comparative Study on Sectorized Psychiatry: patients who use only psychiatric in-patient care in comprehensive community-based services — a 1-year follow-up study

In the present paper a sample of patients using psychiatric in-patient care only is characterized and analysed with regard to characteristics of the psychiatric services. This paper forms part of the Nordic Comparative Study on Sectorized Psychiatry, designed to investigate contact rates and use of psychiatric care by new patients in 7 catchment areas in 4 Nordic countries during a 1-year follow-up. One-year treated incidence cohorts were used. The logistic regression analysis revealed that the variable ‘psychiatric service’ was one of the statistically significant determinants of using only in-patient care during the follow-up. The diagnostic groups with the highest probability of using only in-patient care were dependencies and functional psychoses. The following factors were associated with a high risk of using only in-patient care: older age, being referred by another psychiatrist, having received previous psychiatric in-patient care, male sex, being retired, and not living with one's parents or a partner. Patients who used only inpatient care had fewer admissions and days in in-patient care than others during the 1-year follow-up period. Lack of 24-hour emergency services in out-patient care correlated positively with the use of only in-patient care.     

Innovations in Practice: Child and adolescent psychiatrists and primary care – innovative models of consultation in the United States

Background: There is a severe shortage of child and adolescent psychiatrists (CAPs) in the United States, an increasingly recognized high prevalence of mental disorders in young people, and widely supported goals to provide more mental health services in the primary care setting. Method: A number of innovative, state‐wide or more local, publically funded programs have been developed in the United States over the last several years to respond to these challenges and to provide CAP consultation to primary care physicians (PCPs) who wish to address the mental health disorders of their patients in the primary care setting. Results: A number of these programs and their approaches to consultation are described. An example of a clinical scenario that might be addressed using this model of CAP/PCP collaboration is offered. Conclusions: An innovative model of consultation to PCPs from CAPs appears able to facilitate the treatment of many young people with mental health disorders in the primary care setting.     

Changing patterns of mental health care in Greece (1984–1996)

Greece joined the European Community in 1981 and, three years later, the Commission of the European Communities provided financial and technical assistance under EEC Regulation 815/84 for the modernisation of the traditional psychiatric care system, with the emphasis on decentralisation of mental health services and the development of community-based services, as well as on deinstutionalization of long-stay patients and improvement of conditions in public mental hospitals. Over the last 11 years, the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards extramural care and rehabilitation. The role of the large mental hospitals has gradually been diminished and a large number of long-stay patients have been deinstitutionalised. It is commonly accepted that the EEC-funded psychiatric reform programme, despite inadequacies and constraints, had an impact on the changing mental health scene in Greece.     

The role of local inpatient psychiatric units and general practitioner on continuity of care in Northern Norway: A case‐register study

ObjectivesThe general practitioners'' (GP) role in the care of mental health patients has received increased attention. The literature underlines the need for integration of primary and specialist services, but cross‐boundary continuity for patients with severe conditions may be particularly poor. The aim of this study was to analyze the collaboration between primary care and different models of specialized psychiatric services for patients with severe conditions.MethodsWe compared a local and a centralized model of mental health care. Service utilization over a 5‐year period was studied.ResultsFindings suggest that a local institution‐based model of services positively affects the use of both GP and specialist outpatient care, with most inpatients utilizing both GP and specialist outpatient consultations. In the centralized model, a substantial proportion of inpatients only used GP outpatient care. Furthermore, inpatients that used both GP and specialist outpatient services received more of both services compared to those who did not enter specialist outpatient care at all.ConclusionLocal inpatient units may positively affect continuity of care and collaboration between general practitioners and specialist psychiatric services compared to more traditional hospital units, probably because better functional integration of services, better facilitation of clinical alliances/relationships, or a more network‐oriented treatment philosophy.     

“One Degree of Separation”: A Mixed-Methods Evaluation of Canadian Mental Health Care User and Provider Experiences With Remote Care During COVID-19

ObjectivesThe COVID-19 pandemic has contributed to a shift from in-person to remote mental health care. While remote care methods have long existed, their widespread use is unprecedented. There is little research about mental health care user and provider experiences with this transition, and no published studies to date have compared satisfaction between these groups.MethodsCanadian mental health care users (n = 332) and providers (n = 107) completed an online self-report survey from October 2020 to February 2021 hosted by the Canadian Biomarker Integration Network in Depression. Using a mixed-methods approach, participants were asked about their use of remote care, including satisfaction, barriers to use, helpful and unhelpful factors, and suggestions for improvement.ResultsOverall, 59% to 63% of health care users and 59% of health care providers were satisfied with remote care. Users reported the greatest satisfaction with the convenience of remote care, while providers were most satisfied with the speed of provision of care; all groups were least satisfied with therapeutic rapport. Health care providers were less satisfied with the user-friendliness of remote care (P < 0.001) than users, while health care users were less satisfied than providers with continuity of care (P < 0.001). The use of a video-based platform was associated with remote care satisfaction among health care users (P < 0.02), and qualitative responses support the importance of visual cues in maintaining therapeutic rapport remotely. The majority of users (55%) and providers (87%) reported a likelihood of using remote care after the pandemic.ConclusionsRemote mental health care is generally accepted by both users and providers, and the majority would consider using remote care following the pandemic. Suggestions for improvement include greater use of video, increased attention to body language and eye contact, consistency with in-person care, as well as increased provider training and administrative support.