Collaboration and integrated services for perinatal mental health: an integrative review

Background: An integrative review was undertaken to synthesise the research related to professionals’ perceptions and experiences of working in collaborative and integrated models of perinatal care for women with mental health problems. Method: A search of the databases CINAHL, Medline, PubMed, Psychinfo and Scopus was conducted. Studies were limited to English language papers published from 2000 to 2010. Fourteen papers were included in the review. Results: The overarching theme identified in the review related to the process of ‘making it happen’. Eight key elements were identified as central components of this process: funding and resources for collaboration; shared vision, aims and goals; pathways and guidelines; continuity of care; building relationships and trust; role clarity; training and education of staff and support to work in new ways. Conclusion: Perinatal mental health is an emerging field that is particularly challenging as it requires professionals to work across disciplines and timeframes, where there is a risk of dichotomising care, compounding existing barriers to service uptake. Professionals need resources and to feel supported to change clinical practice and work in more collaborative ways. The voices of women and families are missing in the literature.     

Parental Combat Injury and Early Child Development: A Conceptual Model for Differentiating Effects of Visible and Invisible Injuries

The injuries (physical and emotional) sustained by service members during combat influence all members of a family system. This review used a systemic framework to conceptualize the direct and indirect effects of a service member’s injury on family functioning, with a specific focus on young children. Using a meta-ethnographic approach to synthesize the health research literature from a variety of disciplines, this review makes relevant linkages to health care professionals working with injured veterans. Studies were included that examined how family functioning (psychological and physical) is impacted by parental illness; parental injury; and posttraumatic stress disorder. The synthesis of literature led to the development of a heuristic model that illustrates both direct and indirect effects of parental injury on family functioning and the development of young children. It further illustrates the contextual factors or moderating variables that buffer detrimental effects and promote family resilience. This model can be a foundation for future research, intervention, and policy.     

A project to change the attitudes,beliefs and practices of health professionals concerning hypnosis

This study describes an educational project designed to change the beliefs, attitudes and practices of health care professionals concerning hypnosis and hypnotherapy. The purpose of the study was to investigate whether an educational offering that dispelled myths and misconceptions of hypnosis, offered a historical perspective, discussed how hypnosis works therapeutically, and elucidated the many medical uses of hypnosis, could change the attitudes, practices and beliefs of health care providers. Workshops were given to health care professionals at a variety of venues. Three questionnaires were used to collect data from study subjects before, immediately after and three months following the educational intervention. The results indicated that it is possible with a 90 to 180 minute lecture on hypnosis to create changes in beliefs, attitudes and practices. When health professionals have accurate information on hypnosis that is substantiated by scientific research, they are more likely to believe that hypnosis has a place in traditional mainstream medicine and to suggest self-regulatory strategies and hypnosis to their patients. An educational presentation on hypnosis can encourage health care professionals to learn more about this modality and to seek training in hypnosis.     

Promoting mental health through multidisciplinary care: Experience of health professionals working in community mental health teams in Ireland

International mental health policy recommends that community-based mental health care is the optimal service provision marking a distinct departure from institutions. In Ireland, it is envisioned that this care be provided by Community Mental Health Teams (CMHTs), where multidisciplinary health professionals all play a key role in promoting client mental wellbeing. However, recent reports indicate that implementation of the community-based care approach has been less than optimal. This research explored CMHTs' perspectives and experience of community-based care; it also examined their awareness of specific key performance indicators (KPIs) that can monitor their provision of care. A total of 738 health professionals working in 70 CMHTs across the nation were surveyed. The results indicated little multidisciplinary input from CMHTs in the provision of mental health care. In addition, the findings indicated that having clear KPIs did not represent a priority for a large number of respondents.     

Stress,burnout, and job dissatisfaction in mental health workers

As the industrial world has transformed toward a service economy, a particular interest has developed in mental health problems at the workplace. The risk for burnout is significantly increased in certain occupations, notably for health care workers. Beyond the effects of an extensive workload, many working hours, or long night shifts, the medical field has specific stressors. Physicians work in emotionally demanding environments with patients, families, or other medical staff. They must make quick decisions while faced with a quite frequent information overload. All of these stressors have to be weighed against a rapidly changing organizational context within medicine. Today, economics objectives have priority over medical values in health care. In principal, mental health workers should experience similar work stressors and the same contextual factors as health professionals from other medical disciplines. However, several studies have identified stressors that are unique to the psychiatric profession. These challenges range from the stigma of this profession, to particularly demanding relationships with patients and difficult interactions with other mental health professionals as part of multidisciplinary teams to personal threats from violent patients. Other sources of stress are a lack of positive feedback, low pay, and a poor work environment. Finally, patient suicide is a major stressor, upon which a majority of mental health workers report post-traumatic stress symptoms.

     

The roles of behavioral health professionals in class action litigation

Class action suits frequently have been used as a strategy for improving the quality of mental health care. Psychiatrists, psychologists, and professionals from related disciplines have been involved in these suits in different roles. This article presents and discusses case examples of these roles, which include the expert witness, court-appointed expert, consulting expert, monitor, special master, receiver, advocate, amicus curiae, plaintiff, and defendant. The authors caution against assuming dual roles and argue that professionals, before beginning to participate in this complex arena, should clarify their functional responsibilities, the legal basis of their involvement, and the ethics principles that will guide their actions.     

Role of mental health professionals in the management of functional somatic symptoms in primary care

Functional somatic symptoms associated with persistent frequent attendance is emotionally demanding, costly and intractable to treat. Such patients are hard to engage in practice and research by mental health professionals, whose main role may be indirect training, supporting and advising primary care professionals rather than direct patient care.     

Coping with everyday reality: mental health professionals' reflections on the care provided in an acute psychiatric ward

There is little research evidence about how the mental health professionals are coping with the complexity of everyday practice in psychiatric acute care. The aim of this study was to explore mental health professionals' reflections on their work on an acute psychiatric ward. Data were collected using participant observation and interview methods. Three core themes were identified from a qualitative hermeneutic analysis. The first core theme, coping with uncertainty, uncovered a dialectical pattern of the factors contributing to thriving and strain in the working situation. The second core theme, caring for the patient, included the caring process, patients' pathway to acute psychiatric care, as well as the patients' needs and roles on the ward. The third core theme, coping strategies, included five different methods the primary nursing system, concealing versus integrating, milieu therapy, seclusion and the medical orientated model. It was concluded that good mental health care is a result of collaboration between health professionals and the health services. This study highlights the need for support to professionals and for establishing structures that will enable collaboration to take place. Taken together, this may contribute to enhancing the care of the patient and their families.     

How good are we at diagnosing seizures based on semiology?

The accuracy of visual diagnosis of seizures based on semiologic features among different health care professionals is largely unknown. We evaluated the ability of health care professionals to correctly diagnose epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) from a random selection of 10 ES and 10 PNES videos. The 20 videos (without accompanying electroencephalography) were shown only once, in a random mix to different groups of health care professionals. These individuals, blinded to the diagnosis, were asked to classify the seizure as ES or PNES. We used summary receiver operating characteristic (SROC) curves to determine the accuracy for each group. Next we calculated the difference between the area under the curve (AUC) of SROC between neurologists (as the reference) and the other groups of health care professionals. Neurologists achieved significantly higher AUC results compared to other health care professionals. These results indicate a wide range of diagnostic accuracy among different health care professionals and have practical implications for the evaluation of patients with seizure disorders in acute settings.     

Shame and acute psychiatric inpatient care: healthcare professionals

This qualitative research study convened focus groups to learn about situations that might provoke shame in people receiving mental health services and mental health professionals alike. The focus groups convened for mental health professionals were made up of psychiatrists, social workers, occupational therapists and mental health nurses – six men and eight women in total. Age ranges spanned from early 20 to 55; all had different lengths of service and experience. Ten people with experience of using mental health services also volunteered to take part in the focus groups – five men and five women with an age range of 30–63 years. Varied clinical diagnoses included schizophrenia, bipolar affective disorder, depression and personality disorder. Internationally, there are concerns for the quality of treatment and care offered to people with mental health problems and requiring hospital admission. There is also evidence to suggest that healthcare professionals can experience stigma and shame because of the complexities of their work. Information gained from the focus groups suggests that a better understanding of difficulties encountered by people in need of mental health services is possible. The study also permitted glimpses of the problems and distress faced by mental healthcare professionals because of moral dilemmas and challenges concerned with the overall nature of their chosen work. Although moderate in scope, this research study might help inform health and social policy research agendas along with professional education and training programmes. An awareness of the complexities in relation to ways in which shame is aroused in individuals and groups of people could contribute to improving the quality of care provided to communities.     

A framework for evidence-based mental health care and policy

OBJECTIVE: Care planning integrates a growing number of disciplines, research fields and analysis techniques. A framework of the main areas of interest with regard to evidence-based health care in mental health is provided here. METHOD: The framework is based on the experience of working with data analysts and health and social decision makers at the PSICOST/RIRAG network, a Spanish research association which includes psychiatrists, health economists and health policy experts, as well as on a review of the literature. RESULTS: Three main areas have been identified and described here: outcomes management, knowledge discovery from data, and decision support systems. Their use in mental health care is reviewed. CONCLUSION: It is important to promote bridging strategies among these new fields in order to enhance communication and information transfer between the different parts involved in mental health decision making: i) clinicians and epidemiologists, ii) data analysts, iii) care policy makers and other end-users.     

The role of music therapy in paediatric rehabilitation

Meeting the needs of the child in rehabilitation requires an interdisciplinary approach, whereby a variety of health care professionals are called upon to work together in planning and coordinating each patient's programme. The Registered music therapist is one of the allied health professionals who plays an integral role in this team approach. Music therapy is a recognized allied health profession, which is becoming acknowledged in the expanding world of health care as a therapy able to meet the expansive needs of the patient in rehabilitation. This article will present a literature review which advocates the role of music therapy in rehabilitation, with particular focus on the needs of the paediatric patient. Case vignettes will be used as further evidence to support the role of music therapy in this context, together with considerations for future research.     

Kathleen Mears Memorial Lecture: innovative research for the END allied healthcare professional

Electroneurodiagnostic technologists play a key role in health care. It is time for these allied health professionals to make a commitment and contribution, using scientific methodology, to the body of medical research and publication. Research methods, quantitative, qualitative, and mixed research design will be reviewed. Introduced is an innovative research approach that is applicable to END practice; it is called, action research.     

Political strategy 101: how to make health policy and influence political people.

Many health policy decisions that affect how health care professionals care for their patients are made by the federal government or state and local governments. For most health care professionals, the policy-making process is a mystery. Health policy decisions made by elected and appointed officials in various branches of government are influenced by political factors often unfamiliar to the decision-making process of health care professionals. With some guidance on how to think critically about politics, health care professionals can influence the development, passage, and implementation of government-sponsored health policies that affect their patients. Based on insights gleaned from experience, accounts of the policy-making process, and political science literature, this article describes a process of gathering and analyzing political information that can aid physicians in developing a strategy that will help them influence the political agenda and their patients' care.     

The Norwegian Multiple Sclerosis National Competence Centre and National Multiple Sclerosis registry – a resource for clinical practice and research

The Norwegian Multiple Sclerosis National Competence Centre was established at the Department of Neurology, Haukeland University Hospital, Bergen in 1996. Promotion of research, supervision and education of doctors and other health care professionals in Norway are the main responsibilities of the Centre. The centre has established national networks for MS care and research and has provided supervision and education of doctors and other health care professionals in Norway. Guidelines for diagnosis and treatment of MS have been established. The National Multiple Sclerosis Registry was established in 1998 and includes by January 2006 50–60% of all MS patients in Norway. Through a national collaboration, the registry aims for inclusion of a biobank unit for collection of cerebrospinal fluid and serum, DNA, and tissue samples.     

Collaboration Between Mental Health Professionals and Family Physicians: A Survey of New Jersey Family Physicians

Background: Mental health problems are frequent in primary care, and there are many barriers to their detection and treatment. Clinical research protocols that include close collaboration between mental health professionals and primary care physicians have been found to be beneficial. This study explores the opinions of community family physicians regarding mental health professionals working directly in the primary care office.Method: Members of the New Jersey Academy of Family Physicians (N = 709) were sent a 25-item questionnaire about collaboration with mental health professionals. Three mailings were sent, with a 62% response rate. The surveys were mailed between May and July 1999.Results: Of family physicians included in the analysis, 13.5% reported having an in-office mental health professional. Of those who did not, 60.2% responded that they would consider having one. Compared with physicians who would not consider having an in-office mental health professional, physicians with a mental health professional and those without an in-office mental health professional but who would consider one were statistically more likely (p < .01) to respond that an in-office mental health professional would result in increased use of mental health services, improved acceptance of referrals to mental health professionals, and improved detection and treatment of mental health problems.Conclusion: Although few family physicians have an in-office mental health professional, many more would consider this arrangement and recognize the potential benefits of such collaboration.     

首都医科大学附属北京天坛医院2017-2019年脑血管病专业与非重点学科专业医学人才发展调查

目的 对首都医科大学附属北京天坛医院脑血管病专业与非重点学科专业人才梯度及发展现状进 行调查,为不同专业的人才管理策略提供依据。 方法 选取北京天坛医院重点学科脑血管病专业和非重点学科专业（内科、外科、妇科、儿科）在 职医师为研究对象,对比医师的人才梯队及科研产出的差异。 结果 脑血管病专业组共103人,非重点学科组共308人。脑血管病专业组平均年龄高于非重点学 科组（43.3±7.9岁 vs 41.3±8.7岁,P =0.036）;两组的专业技术职称（P =0.005）、教学职称（P＜0.001） 和学历（P =0.001）分布差异具有统计学意义,脑血管病专业组的高级专业技术职称、高级教学职称 和博士学历的比例更高。2016-2017年度、2017-2018年度及2018-2019年度脑血管病专业承担的国 家级（6项 vs 1项、7项 vs 0项、8项 vs 4项）和省部级课题（7项 vs 4项、9项 vs 3项、6项 vs 3项）均多于 非重点学科组。 结论 与非重点学科专业相比,天坛医院脑血管病专业人才学历和专业技术职称更高,科研产出 也显著高于非重点学科专业。应借鉴脑血管病专业人才管理策略,加强人才引进,激励科技创新,提 高医院人力资源发展和管理水平,以促进医院各科室医学人才全面发展。     

R4P – Un réseau régional de professionnels dédié à l’enfant en situation de handicap

A regional health network for children and teenagers with disabilities (R4P) was created in Rhône-Alpes region (France) in 2007 with the aim to improve the quality of care provided to those patients. The main projects of the R4P concern training, harmonization of care and communication. R4P is a very special regional health network in France because of two particularities. First, it concerns all types of disabilities; secondly, it includes each kind of professionals concerned by children with disabilities: health care professionals of hospital and ambulatory care, social workers, administrations and education professionals. Decompartmentalization and collaboration between all kinds of professionals is necessary to improve global care of children and teenagers with disabilities. Today, 750 professionals are participating in the R4P network.     

Capacity building in global mental health: professional training

We suggest that the optimal approach to building capacity in global mental health care will require partnerships between professional resources in high-income countries and promising health-related institutions in low- and middle-income countries. The result of these partnerships will be sustainable academic relationships that can educate a new generation of in-country primary care physicians and, eventually, specialized health professionals. Research capabilities will be an essential educational component to inform policy and practice, and to ensure careful outcome measurements of training and of intervention, prevention, and promotion strategies. The goal of these academic centers of excellence will be to develop quality, in-country clinical and research professionals, and to build a productive environment for these professionals to advance their careers locally. In sum, this article discusses human capacity building in global mental health, provides recommendations for training, and offers examples of recent initiatives.     

Factitious Disorder By Proxy: The Role of Child Mental Health Professionals

Factitious Disorder By Proxy (FDBP) has been gaining increasing amounts of media attention and is being diagnosed more commonly. Here we propose a wider definition to include seven other, related clinical presentations. We then go on to review 'classic' FDBP and the role of mental health professionals. FDBP often has grave consequences both physically and psychologically, and may result in extensive misuse of health care resources. The literature concerning FDBP has largely been written by paediatricians, but this review pays particular attention to aspects of FDBP that concern child mental health professionals. The presentation, investigation, diagnosis, and management of FDBP are discussed with reference to the role of child mental health professionals, particularly psychiatrists. What little is known of the prognostic factors is reviewed and suggestions are made for further research.