Mental Health Review Journal

Publisher:: Emerald Group Publishing Limited
Publication date:: 2021-02-01

ISBN:: 1361-9322

Issue Number

No. 25-1, March 2020

Latest documents

Evaluation of a diagnostic ADHD pathway in a community child mental health service in South London
Purpose: Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people. Design/methodology/approach: Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline. Findings: Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis. Research limitations/implications: Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence. Practical implications: The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families. Originality/value: This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.
Depressive symptoms associations with online and in person networks in an online gaming community: a pilot study
Purpose: Increases in video game use have led to mental health concerns, citing greater risk for depressive symptoms (DS) and reduced “in-real-life” (IRL) social involvement. However, recent studies have uncovered potential social benefits for online gaming. Many games provide avenues to extend real life relationships and make new online friendships. The purpose of this pilot study is to use social network analysis to determine associations between connections and DS in a gaming community. Design/methodology/approach: As a pilot study, members of an online gaming site were asked to report demographic characteristics, DS, IRL social support, online social support and IRL people and members of the online community with whom they spoke to about important life matters. Multi-level modeling was used to parse variance described by demographic characteristics, IRL measures and online measures. Linear network autocorrelation modeling (LNAM) was used to determine relationships between network connections and DS. Findings: Members (n = 37; µ = 24.76 years old, SD = 6.55; 100% male; 89.2% white) on average felt DS’ “not at all” to “several days” over the past two weeks. Multi-level modeling including online network measures explained 50% of variance (R2 = 0.50, F (9,27) = 2.98, p = 0.01); online connections were associated with DS (ß = 0.46). LNAM indicated DS were associated with IRL support (ß = −2.66), IRL connections (ß = 1.81), online support (ß = 2.40) and network effects (ß = 0.06), which indicates that a gamer’s DS were similar to those of their online connections. Originality/value: Members with more DS may be seeking help via online channels. This may be important for future research to consider alternative forms of help-seeking behavior.
Service user experience of the Norfolk youth service
Purpose: There is an international drive to improve mental health services for young people. This study aims to investigate service user experience of a youth mental health service in Norfolk, UK. In addition to suggesting improvements to this service, recommendations are made for the development of youth mental health services in general. Design/methodology/approach: A mixed-methods approach was used. Quantitative data from satisfaction questionnaires were analysed using descriptive statistics and compared between two time points. A semi-structured interview was used to generate qualitative data. Thematic analysis was used to identify themes in the interview transcripts and triangulation was used to synthesise quantitative and qualitative data. Findings: Service users appeared satisfied with the service. Significant improvements in satisfaction were found between two time points. Qualitative analysis identified three main themes that were important to service users, including support, information and personhood. Practical implications: Recommendations for the development of youth mental health services are provided. Although these are based on findings from the Norfolk youth service, they are likely to apply to other mental health services for young people. Originality/value: Mental health care for young people requires significant improvement. The Norfolk youth service is one of the first services of its kind in the UK. The findings from this study might be helpful to consider in the development of youth mental health services across the world.
Public awareness of psychological problems in Pakistan
Purpose: Awareness of psychological problems is essential to address the problems adequately. It also contributes positively in the overall psychosocial well-being of a society. The rates of mental health literacy have been investigated in many countries and have been found to be lower than expected. The purpose of this study was to explore public awareness of psychological problems and psychological treatment in Pakistan. Design/methodology/approach: The current study explored the latest levels of public awareness of psychological problems in the country by involving 3,500 respondents from five major cities. The sample of the study was sufficiently rich to represent Pakistanis based on gender, age, education, profession and income. Data were gathered from 3,500 respondents through interviews and a self-respondent questionnaire. Findings: The study revealed that the awareness of psychological problems in Pakistan was 36 per cent. Several significant variations were also found based on different demographic factors. The study also revealed that 42.17 per cent of the respondents were aware of psychotherapy as a possible way of treating psychological problems followed by their awareness of social support (17.29 per cent), medicine (16.74 per cent), supernatural practices (6.29 per cent), religious practices (5.60 per cent) and self-help (3.57 per cent). Practical implications: As a result of the findings of unsatisfactory levels of public awareness of psychological problems, this paper has implications for mental health practitioners and policymakers to play their active part in improving the situation. Originality/value: The current study is the first large-scale study in the country.
Experiences of engaging in therapeutic storytelling
Purpose: The purpose of this study is to seek answer to the following question: Does participating in storytelling changes participants’ life experiences in their journey of recovery? The study explores participants’ experiences of engaging in a storytelling programme in a community mental health team in a large New Zealand city. The programme aims to provide a safe environment to support and increase participants’ engagement with services and the community. Currently, there is limited literature on consumer’s experiences of engaging in therapeutic storytelling programmes in the international or New Zealand context. Design/methodology/approach: Following ethical approval, eight adult participants were recruited to the study. Data were collected through semi-structured interviews and analysed using the six-phase process of thematic analysis, developed by Braun and Clarke. Findings: Three main themes emerged from the data. The first theme, breaking barriers, was described by participants as to how they overcame barriers. The second theme, creating positive memories, uncovered the positive experiences that participants gained from the programme. The final theme, becoming a new person, described some of the transformative experiences that emerged through participation in the programme. Originality/value: This is the first qualitative study in the New Zealand context that has explored the value of a storytelling programme from a consumer’s perspective. The findings suggest that participating in a storytelling programme can contribute to a participant’s journey of recovery; the use of myths, legends and group work is fundamental to those from collective cultures with oral traditions. The ongoing value of storytelling as a therapeutic tool requires further research and the development of a clearer evidence base to inform practice.
Self-determination theory and the collaborative assessment and management of suicidality
Purpose: The collaborative assessment and management of suicidality (CAMS) is a first-encounter suicide-specific brief intervention that motivates suicidal individuals for voluntary treatment engagement and choosing life. How the intervention works, however, has not been theoretically explained. The purpose of this paper is to explain the effectiveness using self-determination theory (SDT). Design/methodology/approach: The paper focuses the theoretical examination on the philosophy of care and the clinical procedures of the CAMS suicide intervention. SDT is used as the theoretical lens of the examination. Findings: The underlying philosophy of care and the clinical procedures of CAMS enhance the autonomy, relatedness and competence of the client in the first encounter. The paper proposes that fulfilling these basic human needs results in the intervention outcomes of treatment engagement and choosing life for the time being. Research limitations/implications: The research is limited to the examination of the documented clinical procedures and philosophy of care. Further research applying SDT to the design and empirical testing of therapeutic interventions for suicide prevention is warranted. Practical implications: Clinicians working with suicidal clients need to empathically address suicidal individuals’ motivation to engage in voluntary treatment and reduce controlling and autonomy-thwarting approaches. Social implications: Suicidal behaviour is conventionally considered the manifestation of a mental disorder characterized by limited informed decision-making. The success of CAMS points to the contrary. Despite their suffering, many suicidal individuals make informed decisions about treatment with the support of an empathetic clinician. Originality/value: CAMS has not previously been theoretically explained. This paper explains the effectiveness of the intervention in engaging suicidal clients in further treatment through SDT.
Mental health literacy in Pakistan: a narrative review
Purpose: The term “Mental health literacy” is defined as knowledge and beliefs about mental disorders which aid their recognition, management or prevention. The importance of health literacy for physical health is widely studied; however, the area of mental health literacy in Pakistan has been comparatively neglected. The purpose of this paper is to address the knowledge about mental health in people living in Pakistan. Design/methodology/approach: Relevant literature relating to mental health literacy was identified through various database searches. The databases searched included: PubMed, Cochrane database of Systemic Reviews, PsycINFO using the terms mental health, mental health literacy, mental health education, Pakistan. Findings: Literature suggests that there is dearth of knowledge about mental illnesses and their treatment among public. This review also highlights the importance of mental health literacy among professionals working in the field of health care. In Pakistan, due to low literacy rate, a high percentage of poverty and dearth of trained professionals warrants an emendation in approaches established for attaining the goal of public health and psychiatric care. Practical implications: Findings have implications for practitioners in the field of mental health care as well as designing targeted interventions for enhancing mental health literacy and help-seeking behavior in the future. Originality/value: A limited understanding and lack of improvement in mental health literacy may interfere with society’s acceptance of evidence-based mental health care which may hamper the delivery of adequate mental health services to the needy.
A more promising architecture? Commissioners’ perspectives on the reconfiguration of personality disorder services under the Offender Personality Disorder (OPD) pathway
Purpose: The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty’s Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway. Design/methodology/approach: A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted. Findings: Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness. Research limitations/implications: The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway. Practical implications: While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation. Originality/value: There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway.
Effectiveness of Mental Health First Aid: a meta-analysis
Purpose: The purpose of this paper, a meta-analysis and systematic review of Mental Health First Aid (MHFA), is to focus on studies that reported trainees’ mental health literacy, attitudes and helping-related behaviors, as well as the impact of the program for the people who came into contact with trainees (i.e. recipients). Design/methodology/approach: A systematic search included several online databases of published studies, dissertations or theses, and journals commonly publishing research in this area. Studies were randomized or non-randomized control trials using an intervention based upon the adult or youth MHFA curriculum. Findings: Of the 8,257 initial articles, 16 met inclusion criteria. Small-to-moderate effect sizes (Hedges’ g=0.18–0.53) were found for the primary outcomes for the trainees with effects appearing to be maintained at follow-up. Study quality was inversely associated with effect size. No evidence of investigator allegiance was detected. Few studies examined the effects for those who received aid from a MHFA trainee. Preliminary quantitative evidence appeared lacking (Hedges’ g=−0.04 to 0.12); furthermore, a qualitative review found limited positive effects. Research limitations/implications: MHFA trainees appear to benefit from MHFA; however, objective behavioral changes are in need of greater emphasis. Additionally, considerably greater attention and effort in testing effects on distressed recipients is needed with future empirical investigations. Originality/value: This is the first known review that includes preliminary findings on the effects of MHFA on the distressed recipients of the aid. It is anticipated that this will prompt further investigation into the impact of MHFA.
Wounds and mental health care: system thinking
Purpose: This paper considers how the quality of wound care delivered to people experiencing mental ill health can be improved at the system level in line with the global focus on improving population health. The purpose of this paper is to identify how the quality of wound care delivered to mental health care service users can be improved at a population level through system thinking informed by boundary theory. Design/methodology/approach: This paper is a critical analysis of practice underpinned by systems thinking and boundary theory. Findings: Tissue viability care and mental health care have different professional cultures and identities that are manifest in the way that they are organised and deliver care. If improvements in wound care-related outcomes at a population level are to be achieved, then it is important that the wound care needs of people experiencing mental ill health are addressed. Systems thinking and boundary theory provide a useful conceptual framework for informing quality improvement for people experiencing mental ill health at a population level. Integrated care plans are a useful mechanism for delivering comprehensive care that brings about wound healing and recovery from mental ill health. Social implications: Integrated wound and mental health care plans transcend the professional boundaries that exist between tissue viability and mental health care services. Improvements in the quality and safety of care delivered to people with wounds who also utilise mental health services can be achieved through the use of integrated care plans. Health care policy and organisation need to meet the wound-related needs of people using mental health services. Originality/value: There has been a focus on improving many aspects of wound care in line with the global focus on grand convergence in population health, but there has been very little emphasis on improving the wound-related outcomes of people that use mental health services. Systems thinking and boundary theory provide a useful framework for understanding how wound care for people experiencing mental ill health can be improved at a population level. Integrated care plans are a useful way of ensuring that safe high-quality wound care is consistently delivered to people experiencing mental ill health.