Lessons Learned From the Implementation of an Integrated Prenatal Opioid Use Disorder Program

ObjectiveTo evaluate key lessons learned from efforts at increasing engagement in integrated prenatal and opioid use disorder services.DesignAn interdisciplinary team consisting of a board-certified obstetrician and registered nurse led the implementation of this multipronged approach driven by several plan–do–study–act cycles to develop an integrated prenatal and opioid use disorder program.Setting/Local ProblemAn urban community health center in Chicago, Illinois, where mental health issues, including substance use, are the leading cause of death for pregnant people.ParticipantsConnections were made with local harm reduction agencies, substance use treatment facilities, and community outreach programs to develop partnerships with organizations providing existing addiction and maternal–child services in the community.Intervention/MeasuresPartnership building was achieved through organization needs assessments, dissemination of information about integrated services, and sustained communication. Referral workflow guides and patient education cards were created and distributed to community partners. Incoming referrals were tracked at the clinic site. Use of the referral materials was evaluated via online surveys distributed to community partners.ResultsIn the 18 weeks of enhanced integration, three patients engaged in services and were initiated on medication for opioid use disorder, two of whom had been referred from agencies targeted in the outreach efforts. Surveys showed that community partners believe the referral guides were easy to use and that the harm reduction information on the patient cards was useful.ConclusionAn urban community health center was equipped to provide comprehensive, integrated services to pregnant people with opioid use disorder, but barriers such as community unawareness and stigma impeded engagement. Sustained collaboration with community partners serving pregnant people with opioid use disorder supports program development and linkage to care. Integrated prenatal and opioid use disorder care is feasible, is destigmatizing in nature, and can lead to improved maternal and fetal outcomes.     

The Gut Microbiome,Mental Health,and Cognitive and Neurodevelopmental Disorders: A Scoping Review

BackgroundNurse practitioners encounter many patients with concerns related to mental health, cognitive disorders, or neurodevelopmental disorders. Marketing of supplements and foods geared toward the gut microbiome and mental health has increased, despite limited evidence of efficacy.MethodsA scoping review of the literature published through November 2021 was conducted using the Arksey and O’Malley framework to map the findings. Thirty-two articles ultimately met inclusion criteria.ResultsFindings were mapped to summarize the current state of knowledge regarding the gut microbiome, mental health, and cognitive and neurodevelopmental disorders as well as clinical implications for the nurse practitioner. The relationship between the gut microbiome and mental health appears bidirectional. Currently, there is limited evidence for probiotic supplements for mental or cognitive health. Of the 32 articles surveyed, 12 related to probiotic interventions, with 9 demonstrating benefit to mental or cognitive health related outcomes, and 5 specifically demonstrating benefit in depression. There is evidence to support interventions such as diet changes, physical activity, and stress management as ways to support a healthy gut microbiome, which may in turn benefit mental or cognitive health.ConclusionResearch on the gut microbiome, mental health, and cognitive and neurodevelopmental disorders continues to evolve. At present, nurse practitioners can provide evidence-based counsel regarding lifestyle factors to improve physical and mental health, which may also influence the gut microbiome.     

The personal cost of repetitive mental health inquiries that fail to result in change

BackgroundNurses and other professionals working in mental health care, and those utilising it, will likely be aware that the sector has been the subject of scrutiny through numerous public inquiries and Royal Commissions over the years.AimThe aim of this paper is to understand the total number of high-profile public inquiries undertaken in relation to mental health in Australia over the last 30 years. Importantly, we then seek to quantify the likely contributions by the community, including by people with experience of mental illness and their supporters, to those inquiries and to consider the personal impacts and outcomes of those contributions.MethodsInformation available in the public domain (online) on Royal Commissions, parliamentary inquiries, and federal Commission inquiries held in Australia between 1991 and August 2021, relating to mental health, is drawn on, collated, and compared.FindingsNo less than 55 high-profile public inquiries relevant to mental health have been held over the last 30 years, involving more than 55,000 public submissions and 9,000 witnesses, among other contributions made by the community. A significant proportion of these include contributions made by people who use mental health services, who share their personal stories in a process that is acknowledged as being potentially traumatic.DiscussionDespite this enormous effort by the community generally, and by people with experience of mental health care specifically, to effect change in the mental health sector through formal inquiry processes, analysis shows that key recommendation themes identified for mental health care 30 years ago remain current issues today.ConclusionWe see a role for mental health nurses together – to call on the Federal and State Governments to fund and implement the meaningful change required to improve the mental health system, as identified in the long-line of inquiries to date. With major budget announcements for mental health care recently made in Australia, now is the time to influence policy direction and implementation into the future.     

Therapeutic Interventions in Perinatal and Infant Mental Health Services: A Mixed Methods Inquiry

Perinatal mental health disorders potentially have long-term negative sequelae for women, their infants and their families. Multidisciplinary perinatal and infant mental health (PIMH) services are an emerging specialty in mental health designed to improve mother-infant outcomes. This mixed methods study explored the characteristics of women referred to a specialist PIMH service and the therapeutic interventions that PIMH clinicians use. Women referred to the service were identified with multiple and complex risk factors. Perinatal and infant mental health clinicians use a range of interventions, dependent upon their training, such as family of origin work/genograms, non-directive counseling, and strategies to manage anxiety and depression. Clinicians also emphasized the therapeutic relationship and the interventions they use within an attachment-based framework, which warrants further research.     

Evaluation of a new mental health liaison role in a rural health centre in Rocky Mountain House,Alberta: A Canadian story

This paper describes the evaluation of a mental health liaison (MHL) role in a rural community in Alberta, Canada. The role provides advocacy, education, indirect and direct client intervention, and follow up. It was developed to eliminate gaps in mental health care and build collaborative cultures between the local hospital, physicians' offices, mental health clinics, and community agencies. Obtaining stakeholder feedback was an important step in assessing initial service impact while providing directions for role refinement and future programme development. A total of 116 questionnaires were distributed to physicians, hospital staff, and community mental health assessing stakeholder perception relating to various functions of the MHL. A 50% (n = 58) response rate was achieved with broad representation from different partners, including 75% of local physicians. The majority of respondents positively perceived the roles, functions, and impact of the MHL, including relationship development across the hospital community, improved access to services, and perceived improved client outcomes. The results reinforced that the MHL service meets a previously unmet need in this rural setting. Findings are being used to refine roles, provide local learning and resource development, understand issues relating to programme development in other areas, and develop client level outcomes relating to the services delivered.     

Emergency department utilization for mental health conditions before and after the COVID-19 outbreak

IntroductionThe outbreak of COVID-19 disrupted lives across the United States. Evidence shows that such a climate is deleterious to mental health and may increase demand for mental health services in emergency departments. The purpose of this study was to determine the difference in emergency department utilization for mental health diagnoses before and after the COVID-19 surge.MethodsWe conducted a cross-sectional study between January–August 2019 and January–August 2020 with emergency department encounter as the sampling unit. The primary outcome was the proportion of all emergency department encounters attributed to mental health. We performed chi-square analyses to evaluate the differences between 2019 and 2020.ResultsWe found that overall emergency department volume declined between 2019 and 2020, while the proportion attributable to mental health conditions increased (p < 0.01). Substance abuse, anxiety, and mood disorders accounted for nearly 90% of mental health diagnoses during both periods. When stratified by sex, substance abuse was the leading mental health diagnosis for males and anxiety and substance abuse disorders combined accounted for the largest proportion for females.DiscussionThe emergency department is an important community resource for the identification and triage of mental health emergencies. This role is even more important during disasters and extended crises, making it imperative that emergency departments employ experienced mental health staff. This study provides a comparison of emergency department utilization for mental health diagnoses before the pandemic and during the spring 2020 surge and may serve as a useful guide for hospitals, health systems and communities in future planning.     

The impact of the COVID-19 pandemic and its related restrictions on people with pre-existent mental health conditions: A scoping review

ContextGlobally, governments have introduced a variety of public health measures including restrictions and reducing face-to-face contact, to control the spread of COVID-19. This has implications for mental health services in terms of support and treatment for vulnerable groups such as people with pre-existent mental health conditions. However, there is limited evidence of the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions.ObjectivesTo identify the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions.MethodsA scoping review of the literature was employed. Eight electronic databases (PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, Academic Search Complete) were searched and 2566 papers identified. 30 papers met the criteria for this review and findings were summarised under three key review questions.ResultsCOVID-19 and its related restrictions have had a notable effect on people with pre-existent mental health conditions. Public health restrictions have contributed to increased levels of social isolation, loneliness, and reduced opportunities for people to connect with others. Reduced access to health services and treatments has compounded matters for those seeking support. Exacerbation and deterioration of symptoms are commonly reported and can lead to greater susceptibility to COVID-19 infection.ImplicationsThe importance of proactive planning, alternative accessible healthcare services and supports for vulnerable and at-risk groups is illuminated. Increased monitoring, early intervention and individually tailored care strategies are advocated. Recommendations revolve around the need for enhanced provision of remote support strategies facilitated using technology enhanced resources.Accessible summary

• ￭COVID-19 is a serious public health threat to people across the globe.
• ￭COVID-19 related factors have negatively impacted on the health outcomes of people with pre-existent mental health conditions.
• ￭The rapidly changing environment, risk of infection, increasing isolation and reduced access to support services has led to an increase in psychological distress.
• ￭People with pre-existent mental health conditions are vulnerable and at greater risk of relapse and deterioration in their condition.

     

POSITIVE MENTAL HEALTH: A TURN OF THE CENTURY PERSPECTIVE

Within the last decade, a national prevention research, training, and practice agenda on mental health has been established to address the epidemiological increases in mental disorders and associated emotional and financial costs to individuals, families, and communities. In this article, the author reviews theoretical, empirical, and public policy support in favor of prevention science that inherently includes a broad positive mental health orientation with an emphasis on mental health promotion processes. Prevention within the mental health field needs to include not only minimizing mental disorders, but also enhancing positive qualities of daily functioning. The socioeconomic and cultural context of positive mental health is emphasized with particular attention given to the interrelatedness of individual, family, and community "collective sense of well being." Nursing and interdisciplinary contributions are reviewed, noting implications for future public policy and service system changes. Innovative ways to enhance mental health will require study of system integration across primary and mental health services as well as incorporating services within societal institutions such as schools and the workplace.     

Positive mental health: a turn of the century perspective

Within the last decade, a national prevention research, training, and practice agenda on mental health has been established to address the epidemiological increases in mental disorders and associated emotional and financial costs to individuals, families, and communities. In this article, the author reviews theoretical, empirical, and public policy support in favor of prevention science that inherently includes a broad positive mental health orientation with an emphasis on mental health promotion processes. Prevention within the mental health field needs to include not only minimizing mental disorders, but also enhancing positive qualities of daily functioning. The socioeconomic and cultural context of positive mental health is emphasized with particular attention given to the interrelatedness of individual, family, and community "collective sense of well being." Nursing and interdisciplinary contributions are reviewed, noting implications for future public policy and service system changes. Innovative ways to enhance mental health will require study of system integration across primary and mental health services as well as incorporating services within societal institutions such as schools and the workplace.     

FACTORS AFFECTING USE OF THE MENTAL HEALTH SYSTEM BY RURAL CHILDREN

As many as 20% of children between the ages of 0 and 18 meet the criteria for one or more mental disorders at some point in their lives, with about one half of these being described as being seriously disturbed. Only about one-third of these children and adolescents receive help from the mental health system. Negative outcome expectations toward the mental health system can prevent use of services. This study examined rural parents' expectations about outcomes related to mental health treatment, the provider-client-parent relationships, social and cultural factors, and accessibility to mental health services. The parents' knowledge of the prevalence of mental health disorders in children and adolescents was also examined. Bandura's Social Cognitive Theory served as the conceptual framework for this study. Stigma toward the use of the mental health system was evident. More than half the parents were concerned that mental health professionals would not care for their child. Although negative relationship outcome expectations were revealed, positive treatment outcome expectations also emerged. Structural outcome expectations were not shown to be a major deterrent in receiving care. The belief and hope is that positive outcome expectations toward the mental health system will encourage use of services.     

Substance abuse in older adults: policy issues

By 2020, it is projected that the number of older adults needing treatment for drug and alcohol addictions will increase dramatically. Although Medicare covers treatment for mental health issues, copayments can be prohibitive for those with lower incomes. The Positive Aging Act, an amendment to the Public Health Service Act, is a policy alternative that could address substance abuse in the older adult population by (a) demonstrating ways of integrating mental health services for older adults into primary care settings, and (b) supporting the establishment and maintenance of interdisciplinary geriatric mental health outreach teams in community settings where older adults reside or receive social services. Increasing funding to states to emphasize primary care provider education on the detection, evaluation, and treatment of substance abuse problems of older adults has the potential to better meet the substance abuse needs of this population. Educating primary care providers, including gerontological nurses, to recognize signs of substance abuse in this population and providing age-appropriate treatment options is critically important but will require funding beyond what is currently available.     

Feasibility and acceptability of web-based enhanced relapse prevention for bipolar disorder (ERPonline): Trial protocol

BackgroundRelapse prevention interventions for Bipolar Disorder are effective but implementation in routine clinical services is poor. Web-based approaches offer a way to offer easily accessible access to evidence based interventions at low cost, and have been shown to be effective for other mood disorders.Methods/designThis protocol describes the development and feasibility testing of the ERPonline web-based intervention using a single blind randomised controlled trial. Data will include the extent to which the site was used, detailed feedback from users about their experiences of the site, reported benefits and costs to mental health and wellbeing of users, and costs and savings to health services. We will gain an estimate of the likely effect size of ERPonline on a range of important outcomes including mood, functioning, quality of life and recovery. We will explore potential mechanisms of change, giving us a greater understanding of the underlying processes of change, and consequently how the site could be made more effective. We will be able to determine rates of recruitment and retention, and identify what factors could improve these rates.DiscussionThe findings will be used to improve the site in accordance with user needs, and inform the design of a large scale evaluation of the clinical and cost effectiveness of ERPonline. They will further contribute to the growing evidence base for web-based interventions designed to support people with mental health problems.     

‘Violence is Not Part of Our Job’: A Thematic Analysis of Psychiatric Mental Health Nurses’ Experiences of Patient Assaults from a New Zealand Perspective

This paper describes psychiatric mental health nurses’ (PMHN) experiences of patient assaults within mental healthcare settings using a thematic analytical approach. The aim of the study was to explore and describe psychiatric mental health nurses’ experiences of patient assaults. The major findings of the study related to the nature and impact of assaults and supportive strategies associated with violence perpetrated by patients against psychiatric mental health nurses. Perpetrator risk factors for patients include mental health disorders, alcohol and drug use and the inability to deal with situational crises. The injuries sustained by nurses in the context of the study include lacerations, head injuries, dislocations and bruises. Psychological harm has also occurred, including quite severe mental health problems, such as post-traumatic stress disorder. Protective strategies for combating negative consequences of workplace violence include practice of self-defence, social support and a supportive and consultative workplace culture with access to counselling services and assistance in all aspects, including finances. The paper concludes that while healthcare employers need to provide better support services to the healthcare professionals who are assaulted, the legal system also needs to acknowledge that assaults against nurses are a violation of human rights and violence should not to be tolerated as part of working in mental healthcare settings.     

Healthy babies for mothers with serious mental illness: A case management framework for mental health clinicians

Women with a serious mental illness (SMI), notably schizophrenia, bipolar disorder, and personality disorders are considered high risk for adverse pregnancy and birth outcomes, which in turn, are associated with poor neurodevelopment in the child. Failure to access antenatal care, poor adherence with folate supplementation, an unhealthy lifestyle, and inappropriate health decisions can contribute to poor outcomes. Many women with SMI continue contact with mental health services while pregnant. This primary prevention project aimed to develop a framework for community mental health clinicians to improve the reproductive health outcomes for women with SMI. The consultation process involved discussions with key stakeholders, an environmental scan to determine current service delivery issues, a literature review, and individual and group interviews with community mental health clinicians, consumers, general practitioners, and midwives. Three key elements underpin the framework: early detection and monitoring of pregnancy, providing reproductive choices, and implementing a ‘small known team approach’ in the management of the pregnant client. Specific modules within the framework focus upon establishing a professional support network, assessing the risk of pregnancy, the early detection of pregnancy, monitoring during pregnancy, preparing for birth, and planning for the postnatal period. Implementation of the framework has the potential to significantly improve obstetric and neonatal outcomes for this high‐risk group.     

The Characteristics of Consumers Receiving Case Management in the Community: A Review of Literature

Mental health nurses increasingly provide care for consumers in the community who once would have received treatment in psychiatric inpatient units. The purpose of this review is to determine the characteristics of these consumers. We searched electronic databases and obtained information on some of the characteristics of community mental health consumers. For some nurses, over half of their caseloads are consumers with schizophrenia. Up to about one-third of consumers may be involuntary, but this proportion varies considerably. Impairments of health and social functioning appear common among consumers of community mental health services. This study identifies the need for greater interrogation of national databases to enhance understanding of community caseloads.