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Edited by
Allan Young, Institute of Psychiatry, King's College London,Marsal Sanches, Baylor College of Medicine, Texas,Jair C. Soares, McGovern Medical School, The University of Texas,Mario Juruena, King's College London
Mood disorders constitute a substantial burden to patients, including a significant risk of suicide. In this chapter, the multidisciplinary components of services for mood disorders are delineated. Areas of special difficulty for service providers are recognised. Service development for mood disorders is necessary to meet existing treatment guidelines and to offer new evidence-based treatments, as they emerge. The elements of a general business case for local service development are outlined. The premise that early, correct diagnosis and effective treatment can produce savings in direct service costs and in indirect costs to society is explored briefly. The needs for co-production in partnership with service users and consultation with clinical stakeholders and managers are emphasised. Examples of service development are discussed, including a national programme to improve access to psychological treatments, a bipolar psychoeducation programme, and local specialist bipolar services. Finally, the need for rigorous planning of clinician recruitment, training and retention is highlighted.
To investigate the experiences and support needs of consultant psychiatrists following a patient-perpetrated homicide, an anonymous online survey was sent to all consultant psychiatrists registered as members of the UK's Royal College of Psychiatrists.
Results
Of the 497 psychiatrists who responded, 165 (33%) had experienced a homicide by a patient under their consultant care. Most respondents reported negative impacts on their clinical work (83%), mental and/or physical health (78%) or personal relationships (59%), and for some (9–12%) these were severe and long lasting. Formal processes such as serious incident inquiries were commonly experienced as distressing. Support was mainly provided by friends, family and colleagues rather than the employing organisation.
Clinical implications
Mental health service providers need to provide support and guidance to psychiatrists following a patient-perpetrated homicide to help them manage the personal and professional impact. Further research into the needs of other mental health professionals is needed.
The rise in assistive technology (AT) solutions to support people with an acquired brain injury (ABI) has warranted clinicians to build capability in assisting clients to select goal-centred AT. The study explored, amongst ABI clinicians, (a) capability, attitudes, and barriers with AT implementation, (b) age-related differences in technology self-efficacy and capability (c) strategies to support AT use in rehabilitation and (d) thematic analysis of AT-related experiences.
Method:
Mixed methods design. Online survey circulated to ABI clinicians across New South Wales, Australia, comprising purpose-designed items as well as the Modified Computer Self-Efficacy Scale (MCSES; range 0–100)
Results:
Clinicians (n = 123) were evenly distributed across decadal age groups. The majority were female (90%, n = 111) and one-third were occupational therapists.
Clinicians scored strongly on the MCSES (Mdn = 76, IQR = 19), with younger age groups significantly associated with higher scores (H[3] = 9.667, p = .022). Most clinicians (92%) were knowledgeable of mainstream technology for personal use, but over half (65%) reported insufficient knowledge of suitable AT for clients. Clinicians reported positive attitudes towards AT, however, time to research and develop proficiency with a range of AT was the primary barrier (81%).
Thematic analysis suggested that whilst the ideal AT experience is client-motivated requiring multidisciplinary guidance, the clinician role and experience with AT is evolving, influenced by rapid technological advancement and extrinsic opportunities to access AT.
Conclusions:
Whilst clinicians have positive attitudes towards AT, there is a gap in clinician implementation. There is need to support further resources to build clinician capability and access to AT.
Cyberscams, such as romance scams, are prevalent and costly online hazards in the general community. People with Acquired Brain Injury (ABI) may be particularly vulnerable and have greater difficulty recovering from the resultant emotional and financial hardships. In order to build capacity in the neurorehabilitation sector, it is necessary to determine whether clinicians currently encounter this issue and what prevention and intervention approaches have been found effective. This scoping study aimed to explore clinicians’ exposure to and experiences with cyberscams in their adult clients with ABI.
Method:
Participants were clinicians recruited from multidisciplinary networks across Australia and New Zealand. Eligible participants (n = 101) completed an online customised survey.
Results:
More than half (53.46%) the participants had one or more clients affected by cyberscams, predominantly romance scams. Cognitive impairments and loneliness were reportedly associated with increased vulnerability. Cyberscams impacted treatment provision and were emotionally challenging for participants. No highly effective interventions were identified.
Conclusions:
These findings indicate that cyberscams are a clinical issue relevant to neurorehabilitation providers, with prevalence studies now required. The lack of effective interventions identified underscores the need for the development of evidence-based prevention and treatment approaches to ultimately help people with ABI safely participate in online life.
The TBT-S Behavioral Agreement is a framework for action that incorporates client temperament and identified strategies (actions that detail how) to reach their intended goals with their Supports.
Entry into and exit out of TBT-S programs are similar to other transfers from one treatment level of care to another, with additional recommended phone sessions scheduled for questions and answers with clients and Supports. The more detailed the planning and passing of the baton, from a TBT-S program to ongoing ED treatment settings, the more seamless the care reducing vulnerabilities for relapse. The Behavioral Agreement, Trait Profile Checklist, and Toolbox are examples of TBT-S documents sent to ongoing treatment settings to ensure continuity of care and adult clients’ goals of who does what, when, and how for the following weeks and months.
This study aims to explore clinicians’ practices and attitudes regarding advance care planning (ACP) in mainland China.
Methods
This study was a multicenter cross-sectional survey. Clinicians from tertiary hospitals in Beijing, Guangxi, and Inner Mongolia were invited to participate in the study. A questionnaire was formulated based on related literature to obtain information including demographic characteristics, and practices and attitudes toward ACP.
Results
The total number of participants included 285 clinicians. The data response rate was 84.57%. Most of the clinicians had an inadequate understanding of ACP. Only a few clinicians had experience in participating or witnessing an ACP or related end-of-life discussions. Among 285 clinicians, 69.82% of clinicians were willing to introduce ACP to patients. Two hundred and thirty-eight (83.51%) clinicians wanted more education on ACP. Almost all clinicians believed that patients had the right to know about their diagnosis, prognosis, and available care options. Most clinicians (82.11%) regarded that ACP was partially feasible in mainland China. If clinicians had a serious illness, almost everyone was willing to find out their true health status and decide for themselves, and 81.40% wanted to institute an ACP for themselves. The biggest barriers to the use of ACP in mainland China were cultural factors. Statistical analysis revealed that some or good understanding level (P = 0.0052) and practical experience (P = 0.0127) of ACP were associated with the positive willingness.
Significance of results
ACP is still in its infancy in mainland China. Clinicians had inadequate understanding and minimal exposure to ACP. Most clinicians recognized the value and significance of ACP and had a positive attitude toward ACP. Clinicians need to be provided with education and training to promote their ACP practices. Culturally appropriate ACP processes and documents need to be developed based on Chinese culture and Chinese needs.
The Health Service Executive (HSE) Quality Improvement Division (2016) report states that young people who identify as transgender are one of the highest risk groups for suicidal ideation, self-harm, and completed suicides and may require significant input in Irish Child and Adolescent Mental Health Services (CAMHS). This research represents the first exploration of CAMHS staff’s capacity within an Irish mental health service to support transgender youth by considering their knowledge about and confidence in working with these youth.
Method:
A multi-method design was used to evaluate the knowledge and confidence levels of CAMHS clinicians in supporting transgender youth and to identify what factors would enable them to conduct this work. A questionnaire and a survey about supporting transgender youth were distributed to all clinicians in five Irish-based CAMHS services (N = 71), using an online platform. Additionally, semi-structured interviews were conducted with six clinicians. Quantitative, content, and thematic analyses were performed.
Results:
CAMHS staff reported limited knowledge and experience about supporting transgender youth. Findings indicated that both of these factors undermined their confidence in supporting these youths. Clinicians expressed a need for additional clinical education delivered through expert consultation, presentations, and learning from ‘experts by experience’.
Conclusion:
CAMHS clinicians need and want further clinical education about supporting transgender youth and their families. Recommendations are made for enhancing the knowledge, confidence, and competence of CAMHS clinicians using methods identified as acceptable by clinicians, in order to best support these youths.
Clinicians are routinely subjected to intense and stressful working environments, and the current COVID-19 crisis increases their risk of psychological distress. Mindfulness has been shown to improve life satisfaction, resilience to stress, self-compassion, compassion and general well-being in healthcare workers. Based on their clinical experience, the authors present mindfulness moments for clinicians (MMFC), a selection of short, simple and accessible mindfulness practices to promote resilience and compassion among clinicians working in this pandemic. The practices can be used on the job and are accessible to both novice and experienced meditators. Most of these practices are extracted from evidence-based mindfulness programmes. Further research is indicated to assess the effectiveness of using MMFC to support clinicians in their work and to promote resilience.
Most people get information about marijuana from friends, the Internet, newscasts and personal experience – all echo chambers filled with anecdotes, opinions, and little science. Clinicians receive little education about marijuana. From Bud to Brain provides health professionals the science of marijuana needed to offer the public objective and relevant advice about the safe and effective use of marijuana. The need is huge: 1 out of 5 US citizens can buy recreational marijuana legally and over 200 million have access to medical marijuana. Products from the cannabis plant include dried buds (marijuana), resin (hashish) and concentrates (dabs, budder) that can be smoked, vaped or fashioned into edibles. Understanding how THC produces the experience of being high requires understanding the brain’s natural THC-like chemistry and what parts of the brain are impacted by marijuana. Tracing the research discoveries leading to understanding the science of marijuana gives clinicians the scientific context to help patients make wise decisions about its use. The principles of motivational interviewing are reviewed to help clinicians communicate a science-based perspective on marijuana to recreational users, medical patients, adolescents, worried parents and heavy users.
The trend toward liberalizing medical and recreational marijuana use is increasing the obligation on clinicians to provide useful information to the public. This book summarizes the science all healthcare professionals need to know in order to provide objective and relevant information to a variety of patients, from recreational and medicinal users to those who use regularly, and to adolescents and worried parents. The author brings two and a half decades of studying cannabinoid research, and over forty years' experience in psychiatric and addiction medicine practice, to shed light on the interaction between marijuana and the brain. Topics range from how marijuana produces pleasurable sensations, relaxation and novelty (the 'high'), to emerging medical uses, effects of regular use, addiction, and policy. Principles of motivational interviewing are outlined to help clinicians engage patients in meaningful, non-judgmental conversations about their experiences with marijuana. An invaluable guide for physicians, nurses, psychologists, therapists, and counsellors.
Routine Outcome Monitoring (ROM) has become part of the treatment process in mental health care. However, studies have indicated that few clinicians in psychiatry use the outcome of ROM in their daily work. The aim of this study was to explore the degree of ROM use in clinical practice as well as the explanatory factors of this use.
Methods
In the Northern Netherlands, a ROM-protocol (ROM-Phamous) for patients with a psychotic disorder has been implemented. To establish the degree of ROM-Phamous use in clinical practice, the ROM results of patients (n = 204) were compared to the treatment goals formulated in their treatment plans. To investigate factors that might influence ROM use, clinicians (n = 32) were asked to fill out a questionnaire about ROM-Phamous.
Results
Care domains that were problematic according to the ROM-Phamous results were mentioned in the treatment plan in 28% of cases on average (range 5–45%). The use of ROM-Phamous in the treatment process varies considerably among clinicians. Most of the clinicians find ROM-Phamous both useful and important for good clinical practice. In contrast, the perceived ease-of-use is low and most clinicians report insufficient time to use ROM-Phamous.
Conclusions
More frequent ROM use should be facilitated in clinicians. This could be achieved by improving the fit with clinical routines and the ease-of-use of ROM systems. It is important for all stakeholders to invest in integrating ROM in clinical practice. Eventually, this might improve the diagnostics and treatment of patients in mental health care.
Little is known about clinicians’ experiences in rehabilitation for people with traumatic brain injury (TBI). This survey study aimed to investigate clinicians’ scope of practice, perceived barriers to practice, factors influencing confidence levels and professional development preferences. Participants included 305 clinicians (88% female, 97% aged 20–60 years) from psychology (28%), occupational therapy (27%), speech pathology (15%), physiotherapy (11%), social work (6%), rehabilitation medicine (3%) and nursing (3%) disciplines. Survey results indicated that goal setting, client or family education, and assessment for rehabilitation, were the most common activities across all disciplines (>90%). Client-related barriers, family-related barriers and client–therapist relationship barriers were more frequently selected than workplace context and professional skill barriers (p < .05). Clinicians working with clients with mild TBI reported significantly fewer barriers (p < .05); yet, they were less confident in overcoming barriers than clinicians working with clients with more severe TBI (p < .001). Clinicians with fewer years of experience (<2 years) reported significantly lower confidence in overcoming barriers than clinicians with 2–10 years and >10 years of experience (p < .01). The most commonly selected professional development areas included new interventions and therapies, translating rehabilitation research into everyday practice and client specific topics. These findings provide a unique multidisciplinary perspective on clinicians working in TBI rehabilitation in Australia. Understanding of the perceived barriers to practice and professional development needs may guide training and support initiatives for clinicians which, in turn, may enhance the quality of brain injury rehabilitation.
The Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) programme emphasizes the meaningful contribution session-by-session routine outcome monitoring (ROM) can make to clinical practice and its importance in highlighting services’ effectiveness. Two studies on issues related to the implementation of ROM in children's services were conducted. Study 1 was qualitative; 12 Child and Adolescent Mental Health Services (CAMHS) professionals participated in focus groups. Themes identified included the idea that ROM could provide objectivity, could be collaborative and empowering. Concerns included how measures may adversely influence therapeutic sessions and how the information may be used by the service. These themes were used to develop a questionnaire about professionals’ experience of and views on session-by-session ROM. In Study 2, 59 professionals from four CAMHS teams completed the questionnaire. It was found that only 6.8% reported ‘almost always’ utilizing session-by-session ROM. Detailed analysis of questionnaire responses suggested two subscales reflecting the perceived negative and positive impact of session-by-session ROM. It was found that clinicians who currently use session-by-session ROM hold stronger positive and negative beliefs than clinicians who do not. This study suggests that session-by-session ROM is not currently routine practice within CAMHS and highlights the importance of considering how this practice can be best implemented within this setting with reference to clinician attitudes.
The purpose of the present study was to investigate drug and alcohol work-force issues related to the treatment of cannabis use and related problems in Australia. Method: A postal or online questionnaire of randomly selected drug and alcohol clinicians (n = 179) across Australia. Results: A total of 53 clinicians (30%) completed surveys. Results indicated that staff in metropolitan services tended to have higher qualifications than rural and regional agencies. Access to ongoing training and clinical supervision could be improved, with approximately one third of staff having not received training in the last five years, and nearly one in five agencies not offering regular clinical supervision. Preferred options for the further development of cannabis treatments included support for medications and specific cannabis outpatient clinics. Discussion: To adequately assist with the consequences of cannabis use frontline workers need to be adequately supported to deliver evidenced based interventions.
Background: Research has begun to examine the effectiveness of computerized cognitive behaviour therapy (cCBT) with children and adolescents. Although cCBT appears promising, the attitudes of clinicians towards this type of intervention with children and young people have not been assessed, yet these are important in determining when and if cCBT will be offered. Aims: To survey clinicians’ attitudes towards cCBT with children and adolescents. Method: A self-report questionnaire was completed by 43 mental health professionals attending a conference. Results: Clinicians were cautious but generally positive about the use of cCBT with children and adolescents, particularly for the delivery of prevention programmes and in the treatment of mild/moderate problems. Few felt that cCBT should be available freely online without any professional support. Indeed, the lack of a therapeutic relationship and professional support were identified as the biggest problems, whilst the potential to use cCBT at home was the greatest advantage identified. Conclusions: This survey suggests that clinicians are generally positive about the use of cCBT with children and adolescents for the prevention and treatment of mild/moderate problems. Further research is required to address clinicians’ concerns about the effectiveness of cCBT for more substantial problems and the level of therapeutic support required.