Mental health professionals' perspectives of telemental health with remote and rural First Nations communities

We conducted an online survey and interviews amongst mental health workers in Canada who reported experience in working with rural and remote First Nations (although not necessarily telemental health). Sixty-three respondents (of the 164) to the online survey reported experience in working with clients in remote and rural First Nations. Only 16 of the online survey respondents with remote and rural First Nations experience reported having received training in videoconferencing use. When asked how frequently they used videoconferencing with clients, 51% reported never using it, 19% used it once every few months and 10% reported using it a few times a month. Approximately 50% of participants reported finding it useful. Approximately 38% found the technology easy or very easy to use, and 15% found it very difficult. Individual in-depth interviews were also conducted with professionals who had First Nations telemental health experience specifically (n = 5). A quantitative data analysis was used to explore their perceptions of usefulness and ease of use of telemental health, as well as the relationships among these constructs. Advantages, disadvantages and challenges in using the technology were identified from the qualitative data. Promising ways forward include incorporating traditional practices and the Seven Teachings into telemental health services.     

Mental health services for children and youth: a survey of physicians' knowledge, attitudes and use of telehealth services

Rural physicians in Ontario, whose practice included children, were surveyed on their awareness, attitudes and use of telemental health services for children and young people in their region. Of 95 rural physicians, 70 completed and returned the telehealth section of the survey (74% response rate). The survey comprised 14 questions. Only 27% of responders were aware of the available videoconferencing services. The proportion of physicians who reported having referred patients for the various mental health services through videoconferencing was 0-24%. The proportion of physicians who reported that they would refer patients through videoconferencing was 55-92%. Reduced travel time and care provided closer to home were seen as the primary benefits of referring patients to mental health services through videoconferencing. Unclear referral patterns and technology compromises were seen as limitations of referring patients to videoconferencing. Access to rural populations and improved access to patients were seen as benefits to practice, and undeveloped remuneration procedures as the primary limitation. Promotion may be important to successful implementation of telemental health services for children and young people.     

Use of videoconferencing in Norwegian psychiatry

We conducted a national survey about access to and use of videoconferencing in Norwegian mental health care. A questionnaire was mailed to 300 institutions, with 113 returned (38%). Attitudes towards videoconferencing were positive. 58 of the respondents had access to videoconferencing equipment. 51 institutions had used videoconferencing in the previous year. Geographical and climatic factors and travel-related strain were predictors of access. Videoconferencing was mostly used for meetings, supervision and lectures, and to a lesser degree was used clinically, with the patient present. 90% of the institutions had experienced videoconferencing as useful. Lack of videoconferencing equipment in collaborating institutions was an inhibiting factor for use. There is a gap between the potential of videoconferencing and its actual utilization in Norway's mental health sector.     

杭州市精神卫生服务资源现状调查

目的：掌握杭州市精神卫生服务资源现状,为杭州市精神卫生服务规划和精神卫生政策制定提供科学依据。方法：采用自编的问卷对杭州市精神卫生专科医院和设有精神科的综合医院进行调查。结果：截至2010年末,杭州市共有16家医疗机构提供精神卫生服务,每10万人拥有精神科医师和护士数分别为4．29、7．07。医生和护士主要集中在市属医疗机构（分别占47．5％、56．3％）和专科医院（分别占61．7％、60．7％）。医生、护士和医技人员以30～39岁组所占的比重最大（分别占42．1％、44．1％、35．4％）。医生中中级职称者最多,占36．7％,护士和医技人员都是初级职称者占多数（分别占56．9％、66．7％）。医生和护士的学历都以本科为多数（分别占53．4％和44．8％）,而医技人员的学历以大专为最多（37．4％）。实际开放床位2445张,床位密度为2．81／万人。结论：杭州市精神卫生服务资源数量不足,地理分布不合理,社区精神卫生服务需加大投入,人力资源结构尚待优化。     

Disseminating information about healthcare effectiveness: a survey of consumer health information services.

BACKGROUND: In 1997 a research based information leaflet designed for men considering being screened for prostate cancer was distributed to general practitioners (GPs) and consumer health information services. OBJECTIVES: To investigate consumer health information service staff opinions of the leaflet and the use they made of it. To find out whether such staff would find similar leaflets on other topics useful. DESIGN: A postal questionnaire survey sent to United Kingdom consumer health information services. RESULTS: Consumer health information service staff were enthusiastic about the content and presentation of the leaflet and gave it to many enquirers, including some who had not been given information by their GPs. Respondents were keen to be supplied with similar leaflets about different topics. Some respondents were reluctant to give the leaflet to people enquiring about screening for prostate cancer, for example, because they thought that the leaflet would cause anxiety, or because prostate cancer screening was not freely available locally. CONCLUSION: Consumer health information services can complement information provided by health professionals and make good use of research based information for consumers. However, they may withhold information from some people who might benefit from it and are not well placed to advise people about healthcare options. Strategic thinking is needed to encourage a more integrated approach to giving information and support for patients in making decisions.     

Factors associated with variations in older people's use of community-based continence services

Many people who have urinary incontinence and who may benefit from healthcare and professional advice do not currently access UK National Health Service services, even though effective treatments are available in the community. Older people have an increased prevalence of incontinence and a correspondingly increased need for continence services. Therefore, increasing older people's access to continence services has the potential to reduce inequalities and improve quality of life. The present study aimed to identify older people with urinary incontinence living in the community, to describe and compare the characteristics of users and non-users of continence services, and to identify factors which prevent older people seeking help. A cross-sectional postal survey of patients aged over 65 years registered with four general practices in an urban area found an overall prevalence of 39% of older people with urinary incontinence, only 15% of whom had accessed services. Two-thirds of respondents who reported that they experienced urinary leakage several times per week to all the time, and up to two-thirds of those reporting leakage of moderate or large volumes of leakage had not accessed services. The majority of older people are in regular contact with health professionals, and the greatest single influence on use of services was that of being asked whether there were continence problems by a health professional. Being married or having a partner, experiencing less pain generally, and suffering relatively high frequency and volumes of urinary leakage also appeared to be associated independently with continence service use. In conclusion, there appears to be considerable unmet need for continence services. Health professionals should be aware that incontinence is an important health problem for older people, and by asking older people specifically about urinary leakage, they could reduce inequalities in use of services.     

A community-based approach to evaluation of health outcomes and costs for telepsychiatry in a rural population: preliminary results

A pilot trial was established to support visiting psychiatric services and local public and private practitioners through the use of videoconferencing. The purpose of the trial was to determine whether people in the community received better health-care with telemedicine. A community-based approach was used to evaluate health outcomes, costs, utilization, accessibility, quality and needs for such services in a rural community in Queensland. Over a two-year period data were collected from 124 subjects who met the criteria of having a mental health problem or mental disorder. Nine further subjects refused to participate in the study. Only 32 subjects used videoconferencing to receive mental health services. Preliminary results did not show any significant improvements in wellbeing or quality of life, although the time span was relatively short. However, the results confirmed that the people were no worse off from a consumer or a practitioner perspective from using videoconferencing. Most consumers found that videoconferencing with a psychiatrist moderately or greatly helped them in managing their treatment, with 98% of them preferring to be offered videoconferencing in combination with local services. Overall, videoconferencing is a crucial part of enhancing psychiatry services in rural areas. However, it is not necessarily cost-effective for all consumers, general practitioners, psychiatrists, or the public mental health service.     

Child advocacy outreach: using telehealth to expand child sexual abuse services in rural Kentucky

We evaluated the use of videoconferencing as an educational and consultative tool for physicians and mental health staff providing services for child victims of sexual abuse in rural Kentucky. The number of counties with access to sexual abuse examinations by a qualified physician increased from 16 to 23 in the first year and to 54 in the second. The number of cases increased from 77 to 83 in the first year and to 339 in the second year. The number of consultations increased from zero to eight in the first year and to 74 in the second year. A user survey showed that the equipment supported clinical decision making, was useful and was easy to use. However, it was not as effective for case conferencing as for one-to-one interactions. Rural health professionals knowledge of child sexual abuse increased.     

Barriers to meeting the mental health needs of the Chinese community.

BACKGROUND:This study aimed to identify the barriers encountered by Chinese people with mental health needs in England which hindered their obtaining appropriate help from the National Health Service (NHS). METHODS: Attenders at Chinese community centres in health authority districts with resident Chinese population in excess of 2000 were invited to fill in a 12-item Chinese Health Questionnaire (12-CHQ). Individuals who scored two or above, indicating a high probability of a mental health problem, were invited to undertake a semi-structured interview. RESULTS: A total of 401 completed the 12-CHQ. Eighty-six (21.4 per cent) screened positive and 71 (82.6 per cent) agreed to be interviewed. Although 70 (98.6 per cent) were registered with a general practitioner (GP), there were long delays before they made contact with health professionals, and the GP was the first port of call for help in only 27 (38.6 per cent) interviewees. Fifty-two (74.3 per cent) had encountered difficulties when they sought professional help. The main barriers were language, interviewees' perceptions of symptoms as somatic rather than psychiatric in origin, lack of knowledge about statutory services, and lack of access to bilingual health professionals. Doctors, particularly GPs, were pivotal in the management of their conditions. The majority were prescribed psychiatric medication with only a small number in contact with community psychiatric services. Unemployment and social exclusion were common. Stigma associated with mental illness and limited knowledge in the community were identified as the causes for the widespread discrimination experienced by the interviewees. CONCLUSION: The mental health needs of these Chinese people were not adequately met by statutory services, nor could they rely on family and friends for care and support. Training for health service staff and access to health advocates are essential to maximize the effectiveness of health professional-patient contacts. The promotion of better understanding of mental illness by the Chinese community is important, and greater flexibility within the NHS is required to ensure those professionals with bilingual skills are used to the best effect.     

Breast self-examination and mammography among university staff and faculty

Women faculty and staff (N = 201) answered a series of questions about breast self-examination (BSE) and mammography. Although all subjects indicated familiarity with BSE, and two-thirds of them knew it should be practiced monthly, only 31% actually did so. Women who learned BSE from physicians or other health professionals reported more frequent BSE than those who learned from other sources. About one-third of respondents indicated that they would like to learn more about BSE; women health professionals were the most preferred learning source. Respondents indicated that they fail to do BSE because they do not remember to do it and reported that reminders would increase their likelihood of compliance. Of subjects age 40 and older, about four-fifths had had a mammogram. Those who had not had one reported that the cost of mammography was a significant barrier for them. These results are discussed and recommendations for practice and for future research are made.     

Breast Self-Examination and Mammography Among University Staff and Faculty

Women faculty and staff (N = 201) answered a series of questions about breast self-examination (BSE) and mammography. Although all subjects indicated familiarity with BSE, and two-thirds of them knew it should be practiced monthly, only 31% actually did so. Women who learned BSE from physicians or other health professionals reported more frequent BSE than those who learned from other sources. About one-third of respondents indicated that they would like to learn more about BSE; women health professionals were the most preferred learning source. Respondents indicated that they fail to do BSE because they do not remember to do it and reported that reminders would increase their likelihood of compliance. Of subjects age 40 and older, about four-fifths had had a mammogram. Those who had not had one reported that the cost of mammography was a significant barrier for them. These results are discussed and recommendations for practice and for future research are made.     

Community attitudes to the sexual behaviour of young people in an urban area with high rates of sexual ill-health

CONTEXT: Adults in any community are a potentially important source of sexual health information for young people. Open discussion of sexual health issues is associated with low rates of sexual ill-health. Adults who disapprove of teenage sexual behaviour are poor sources of advice. The study of adult attitudes to the sexual behaviour of young people is relevant to work on improving access to sexual health services. SETTING: Adults' attitudes to the sexual behaviour of young people in an urban area with high indices of sexual ill-health were documented. DESIGN: Data were collected via questionnaires administered in popular shopping areas by local people after training. RESULTS: A total of 283 interviews were completed. Eighty-eight percent of respondents thought that the likely age of first sex among young people was under the age of consent but only 8% thought that the acceptable age of first intercourse was under 16 years. Knowledge of local services was suboptimal. Twenty percent of respondents did not know where young people could get contraception or advice on sexual health issues. Less than half (42%) suggested a general practitioner with a similar proportion suggesting a family planning clinic (FPC) or Brook clinic. When asked what services FPCs provide, only 40% mentioned contraception and 32% did not know. Despite their lack of knowledge, the majority (84%) of respondents would tell a young person where they could obtain contraception or sexual health advice. Seventy-six percent thought parents and 56% thought schools are the key sources of sexual health information for young people.CONCLUSIONS: Adults resident in this area have negative attitudes to the sexual behaviour of local young people and suboptimal knowledge of local contraceptive services. They do, however, identify themselves as potentially important sources of sexual health advice and may therefore benefit from more information and an opportunity to discuss their attitudes.     

Parental involvement in minors' abortion decisions.

In a 1991 study based on a nationally representative sample of more than 1,500 unmarried minors having an abortion, 61% of the respondents said that one or both of their parents (usually the mother) knew about the abortion. Only 26% of the respondents said their father knew about the abortion; furthermore, 57% of the mothers who knew about their daughter's pregnancy did not tell her father. In this study, which was conducted in states without parental involvement laws in effect, about 75% of the parents who knew about the pregnancy had been told by the daughter herself, and the great majority supported their daughter's decision to have an abortion. Among the minors whose parents found out without being told by the minor, 18% said their parents were forcing them to have an abortion and 6% reported physical violence, being forced to leave home or damage to their parents' health. Minors who did not tell their parents were disproportionately older (aged 16 or 17), white and employed. The minors' most common reasons for not telling their parents were wanting to preserve their relationship with their parents and wanting to protect the parents from stress and conflict. Of those who did not tell their parents, 30% had experienced violence in their family, feared that violence would occur or were afraid of being forced to leave home. Among minors whose parents were unaware of the pregnancy, all consulted someone other than clinic staff about the abortion; most frequently, they consulted their boyfriend (89%), an adult (52%) or a professional (22%).     

Access to health care among Australian adolescents young people's perspectives and their sociodemographic distribution.

PURPOSE: To identify the health concerns for which adolescent residents in New South Wales, Australia, do not receive health care, and the associated factors, including their sociodemographic distribution. METHODS: Purposive sampling was used to recruit school students who were stratified by gender and age (12-14, 14-16 and 16-17 years), from schools stratified by socioeconomic status and urban/rural location. Out-of-school young people were recruited through youth health services. Qualitative methods were used to collect and analyze data. RESULTS: Eighty-one focus groups were conducted. Most young people defined health solely in terms of their physical well-being, but still identified a broad range of situations, conditions, or behaviors which they believed might affect their health. One-third of females and two-thirds of males said they would not seek help for their health concerns, and when they did, were most likely to seek help from family, friends, or others they trusted. When professional help was sought, young people again preferred someone they knew and trusted. The three groups of barriers to accessing health care were: concerns about confidentiality, knowledge of services and discomfort in disclosing health concerns, and accessibility and characteristics of services. Factors related to use of health care services were associated with age, gender, and location, but rarely with socioeconomic status. CONCLUSIONS: The majority of these young people in New South Wales (particularly males) do not seek health care despite identifying a broad range of issues that affect their health.     

Mental health services in Sydney nursing homes

Abstract: Senior nursing staff of the 58 nursing homes in one health area of Sydney were interviewed concerning mental health services and staff education. One or more psychiatrically trained staff were employed in 45 per cent of the nursing homes. Most nursing homes received services from a psychiatrist or another mental health professional, but the average time per month provided by them to see residents was less than one hour in 18 (31 per cent), one to two hours in 16 (28 per cent), and three hours or more in only 11 (19 per cent). Forty-four (76 per cent) wanted more mental health services to be provided, especially for advice on management of disturbed behaviour. A substantial number of the nursing homes (at least 28 per cent) provided no ongoing education to their staff about dementia or other psychiatric problems. There is good reason to encourage greater use of mental health professionals in Sydney nursing homes; enhanced funding of area psychiatric services for elderly people is desirable to allow these services to be more readily available.     

Parents' use and views of the national standard Personal Child Health Record: a survey in two primary care trusts

BACKGROUND: The Personal Child Health Record (PCHR) is a booklet given to parents in the UK, following the birth of a child, to be used as the main record of their growth, development and uptake of preventative health services. The national standard PCHR has been available since April 2004. The aim of this survey was to explore parental views of the 'new' PCHR, their experiences in receiving it, and its subsequent use, focusing on specific issues of current debate among health professionals. METHODS: A parental questionnaire (n = 89) was administered in July 2004, in 10 child health clinics located in two primary care trusts; one in central London and the other in Buckinghamshire. RESULTS: Nearly all parents (98%) reported that they used the PCHR as a record of their child's health and development and 92% reported that they 'always' took it with them when seeing healthcare staff about their child. Some parents (22%) indicated that they had not been given a satisfactory explanation as to how to use the PCHR, at the time it was issued to them. Parents reported that health visitors were more likely than other health professionals to use the PCHR both to obtain information about their child and to record information. The majority of respondents (78%) were happy for the level of maternal education to be documented in their child's PCHR. CONCLUSIONS: Parents used, appreciated and liked the design of the national standard PCHR. Health visitors and primary care staff used the PCHR more than secondary care staff. The potential benefits of the PCHR will only be maximized if other healthcare professionals respond by using it.     

From policy to practice: physicians' views on OBRA and mental health resources in long-term care

OBJECTIVES: The purpose of this national survey was to seek to clarify physician beliefs about nursing home mental health needs, understand the perceived effectiveness of OBRA legislation, determine physician exposure to OBRA PASARR Level II assessments, and understand the current role of community mental health interventions in the nursing home. DESIGN: A self-administered questionnaire. SETTING: Surveyed physicians were nursing home medical directors and/or attending physicians. PARTICIPANTS: The overall response rate for the 1000 physicians surveyed nationally, was 62% (n = 620). Fifty-nine percent (n = 361) of all responders were family physicians, and 41% (n = 250) were general internists. MEASUREMENTS/RESULTS: Only 48% (n = 291) of all respondents ever saw the recommendations from their patient's OBRA PASARR Level II assessment screening. Approximately one-third of all respondents viewed each discipline's recommendations as "very" or "somewhat" helpful. Thirty-seven percent (n = 228) of respondents viewed OBRA's psychotropic guidelines as only somewhat helpful. More than two-thirds (n = 412) believed OBRA regulations had not improved access to mental health care for their nursing home patients. CONCLUSIONS: This survey demonstrated that OBRA PASARR Level II assessments are not being viewed or valued by many physicians. In nursing homes, limited access to community mental health staff and psychiatric input may leave primary care physicians treating difficult behavioral problems themselves. Collaborating on helpful mental health interventions for nursing home patients is an ongoing critical issue in long-term care.     

Rural generalist nurses' perceptions of the effectiveness of their therapeutic interventions for patients with mental illness

OBJECTIVE: To explore generalist nurses' perceptions of their efficacy in caring for mentally ill clients in rural and remote settings, and their educational needs in the area of mental health care. DESIGN: A self-administered questionnaire adapted from the Mental Health Problems Perception Questionnaire; a Likert scale used to rate the perceptions of nursing staff of their own ability to adequately treat and care for patients experiencing mental illness. Setting: The Roma and Charleville Health Service Districts, Queensland, Australia. SUBJECTS: Nurses (Registered Nurses, Assistants in Nursing and Enrolled Nurses) in the Roma and Charleville health service districts (n = 163). MAIN OUTCOME MEASURES: Generalist nurses' perceptions regarding their therapeutic commitment, role competency and role support. Results: Seventy per cent of respondents indicated that limited knowledge of mental health problems was an issue preventing nursing staff in rural and remote settings from providing optimum care to patients with mental illness. Twenty-nine per cent of respondents indicated that they had never received or undertaken training or education in relation to the care, treatment or assessment of patients with mental illness. CONCLUSION: Rural nurses do not feel competent, nor adequately supported, to deal with patients with mental health problems. In addition, the nurses' education and ongoing training do not adequately prepare them for this sphere.     

ACCESS TO A QUEENSLAND COMMUNITY HEALTH SERVICES CENTRE THROUGH COMMUNITY CARETAKERS

When persons needing health and welfare services do not know about available resources, their access to such services depends in part upon the people they have contact with in the community being knowledgeable and making appropriate referrals. Groups of community “caretakers” were surveyed to find their level of awareness of a community health services centre in their city. Most respondents were aware of the community health services centre but did not have a clear understanding of its objectives and functions. The community caretakers thought the centre could increase their knowledge of its functions by more personal contact by staff members with individuals and professional groups in the community and through increased press publicity, the issuing of brochures, cards and pamphlets.