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Dahiya P, Riano NS, Dilley JW, Olfson M, Cournos F, Mangurian C, Arnold EA. Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2024; 24:690. [PMID: 38822307 PMCID: PMC11143645 DOI: 10.1186/s12913-024-11146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare-as well as co-located sites providing both-sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic. METHODS We interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis. RESULTS Commonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices. CONCLUSIONS Though COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.
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Affiliation(s)
- Priya Dahiya
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Nicholas S Riano
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Psychological Science, School of Social Ecology, University of California Irvine. 4220 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - James W Dilley
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Mark Olfson
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, 2789 25th Street, Suite 350, San Francisco, CA, 94110, USA
| | - Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, Box 0886, San Francisco, CA, 94143, USA.
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Brunette MF, Erlich MD, Edwards ML, Adler DA, Berlant J, Dixon L, First MB, Oslin DW, Siris SG, Talley RM. Addressing the Increasing Mental Health Distress and Mental Illness Among Young Adults in the United States. J Nerv Ment Dis 2023; 211:961-967. [PMID: 38015186 DOI: 10.1097/nmd.0000000000001734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Recent surveys show rising numbers of young people who report anxiety and depression. Although much attention has focused on mental health of adolescent youth, less attention has been paid to young people as they transition into adulthood. Multiple factors may have contributed to this steady increase: greater exposure to social media, information, and distressing news via personal electronic devices; increased concerns regarding social determinants of health and climate change; and changing social norms due to increased mental health literacy and reduced stigma. The COVID-19 pandemic may have temporarily exacerbated symptoms and impacted treatment availability. Strategies to mitigate causal factors for depression and anxiety in young adults may include education and skills training for cognitive, behavioral, and social coping strategies, as well as healthier use of technology and social media. Policies must support the availability of health insurance and treatment, and clinicians can adapt interventions to encompass the specific concerns and needs of young adults.
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Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Matthew D Erlich
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - Matthew L Edwards
- Department of Psychiatry, Stanford University, Palo Alto, California
| | - David A Adler
- Department of Psychiatry, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Jeffrey Berlant
- Canyon Manor Mental Health Rehabilitation, Novato, California
| | - Lisa Dixon
- Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - Michael B First
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian, New York, New York
| | - David W Oslin
- Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, Pennsylvania
| | - Samuel G Siris
- Department of Psychiatry, Donna and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Rachel M Talley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Riley EN, Cordell KD, Shimshock SM, Perez Figueroa RE, Lyons JS, Vsevolozhskaya OA. Evaluation of Telehealth in Child Behavioral Health Services Delivery During the COVID-19 Pandemic. Psychiatr Serv 2023; 74:237-243. [PMID: 36097723 DOI: 10.1176/appi.ps.20220141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors quantified the impact of the use of telehealth services on patient-level clinical outcomes among children with complex behavioral and emotional needs in Idaho during the COVID-19 pandemic by comparing data collected in 2020 with data for the same months in 2019. METHODS Longitudinal statewide data of Child and Adolescent Needs and Strengths (CANS) assessments were extracted from Idaho's mental and behavioral health system. Prepandemic assessments were matched to midpandemic assessments. A linear mixed-effect model was used to explore four child-level outcomes: psychosocial strengths-building rate, rate of need resolution within a life-functioning domain, rate of need resolution within a behavior-emotional domain, and rate of need resolution within a high-risk behaviors domain. RESULTS The number of new patients admitted to Idaho's state-funded mental and behavioral health program decreased almost twofold from April-December 2019 to April-December 2020 (N=4,458 vs. 2,794). For most children with complex needs, the use of telehealth was as effective in terms of strengths building and needs resolution as in-person services; for children whose caregivers had issues with access to transportation, availability of telehealth services improved outcomes for the children. CONCLUSIONS The COVID-19 pandemic in 2020 was associated with a dramatic drop in the number of children served by Idaho's mental health program. Telehealth may effectively bridge mental health service delivery while patients and providers work toward the resolution of transportation issues or may serve as a more acceptable permanent format of service delivery for some populations.
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Affiliation(s)
- Elizabeth N Riley
- Center for Innovation in Population Health (Riley, Cordell, Shimshock, Lyons, Vsevolozhskaya), Department of Health Management and Policy (Riley, Lyons), and Department of Biostatistics (Shimshock, Vsevolozhskaya), University of Kentucky, Lexington; Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, New Jersey (Figueroa)
| | - Kate D Cordell
- Center for Innovation in Population Health (Riley, Cordell, Shimshock, Lyons, Vsevolozhskaya), Department of Health Management and Policy (Riley, Lyons), and Department of Biostatistics (Shimshock, Vsevolozhskaya), University of Kentucky, Lexington; Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, New Jersey (Figueroa)
| | - Stephen M Shimshock
- Center for Innovation in Population Health (Riley, Cordell, Shimshock, Lyons, Vsevolozhskaya), Department of Health Management and Policy (Riley, Lyons), and Department of Biostatistics (Shimshock, Vsevolozhskaya), University of Kentucky, Lexington; Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, New Jersey (Figueroa)
| | - Rafael E Perez Figueroa
- Center for Innovation in Population Health (Riley, Cordell, Shimshock, Lyons, Vsevolozhskaya), Department of Health Management and Policy (Riley, Lyons), and Department of Biostatistics (Shimshock, Vsevolozhskaya), University of Kentucky, Lexington; Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, New Jersey (Figueroa)
| | - John S Lyons
- Center for Innovation in Population Health (Riley, Cordell, Shimshock, Lyons, Vsevolozhskaya), Department of Health Management and Policy (Riley, Lyons), and Department of Biostatistics (Shimshock, Vsevolozhskaya), University of Kentucky, Lexington; Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, New Jersey (Figueroa)
| | - Olga A Vsevolozhskaya
- Center for Innovation in Population Health (Riley, Cordell, Shimshock, Lyons, Vsevolozhskaya), Department of Health Management and Policy (Riley, Lyons), and Department of Biostatistics (Shimshock, Vsevolozhskaya), University of Kentucky, Lexington; Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, New Jersey (Figueroa)
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Agrest M, Kankan T, Fernández M, Rosales M, Matkovich A, Velzi-Díaz A, Ardila-Gómez S. COVID-19 impact on the provision of psychosocial rehabilitation services in Latin America and the Caribbean. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2154562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Martín Agrest
- Research Unit, Proyecto Suma, Buenos Aires, Argentina
- Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Tanvi Kankan
- Teachers College, Columbia University, New York, NY, USA
| | - Marina Fernández
- Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Melina Rosales
- Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Andrés Matkovich
- Facultad de Psicología, Universidad Nacional de Rosario, Rosario, Argentina
| | - Alberto Velzi-Díaz
- Facultad de Psicología, Universidad Nacional de Rosario, Rosario, Argentina
| | - Sara Ardila-Gómez
- Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
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Gately ME, Waller D, Metcalf EE, Moo LR. Occupational Therapy Practitioner Perspectives of the Role of Caregivers in Video Telehealth. J Gerontol Nurs 2022; 48:15-20. [PMID: 36169296 PMCID: PMC9577539 DOI: 10.3928/00989134-20220908-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current article examines the role of caregivers to support patient participation in video telehealth, using data from interviews with occupational therapy practitioners at Veterans Health Administration. We found that caregiver participation allowed patients who might otherwise not be able to access video telehealth to do so, with patient factors, such as low technical literacy, contributing to caregiver involvement. In addition, caregiver participation varied by type of task performed. There were also benefits and barriers to caregiver participation. This study enhances our understanding of caregivers' role enabling patients to access video telehealth, which has implications for nursing professionals. [Journal of Gerontological Nursing, 48(10), 15-20.].
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Savill M, Nguyen T, Shim RS, Loewy RL. Online Psychosis Screening: Characterizing an Underexamined Population to Improve Access and Equity. Psychiatr Serv 2022; 73:1005-1012. [PMID: 35172594 DOI: 10.1176/appi.ps.202100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Online resources represent an important avenue to identify and support individuals who may be experiencing symptoms of psychosis but have yet to engage in care. Understanding the experiences and needs of this group is critical to inform outreach for early psychosis and improve outcomes by addressing barriers to early treatment. METHODS The authors conducted a retrospective, explorative, cross-sectional analysis by using data collected by Mental Health America as part of their online psychosis screening and support program. Data included scores from the Prodromal Questionnaire-Brief, basic demographic information, and respondents' plans for next steps. RESULTS Of 120,937 respondents, most (82.1%) reported distressing psychosis-like experiences at levels sufficient to merit a referral to specialty care for additional evaluation. However, only 17.1% planned to seek treatment as a next step, with most (53.6%) wanting instead more information. Higher distress was only weakly associated with the plan to seek treatment. In the multivariable analysis, respondents who were younger; lesbian, gay, bisexual, transgender, or queer; or Native American or who had lower income reported the greatest symptom-related distress. Younger and higher-income respondents were less likely to plan to seek treatment next. Across race-ethnicity, African Americans were most likely to plan to seek treatment. CONCLUSIONS Most respondents reported that psychosis-like experiences caused significant distress, but they did not plan to seek treatment next. Addressing this treatment gap requires careful consideration regarding what services individuals want, how services should be presented, and what barriers may limit help seeking. These steps are critical to improve access to early intervention for individuals with psychosis spectrum disorders.
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Affiliation(s)
- Mark Savill
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
| | - Theresa Nguyen
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
| | - Ruth S Shim
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
| | - Rachel L Loewy
- Department of Psychiatry and Behavioral Sciences, University of California, Davis (Savill, Shim); Mental Health America, Alexandria, Virginia (Nguyen); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Loewy)
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Wang B, Huskamp HA, Rose S, Busch AB, Uscher-Pines L, Raja P, Mehrotra A. Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness. JAMA Netw Open 2022; 5:e2218730. [PMID: 35759264 PMCID: PMC9237790 DOI: 10.1001/jamanetworkopen.2022.18730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Access to specialty mental health care remains challenging for people with serious mental illnesses, such as schizophrenia and bipolar disorder. Whether expansion of telemedicine is associated with improved access and quality of care for these patients is unclear. OBJECTIVE To assess whether greater telemedicine use in a nonmetropolitan county is associated with quality measures, including use of specialty mental health care and medication adherence. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the variable uptake of telemental health visits was examined across a national sample of fee-for-service claims from Medicare beneficiaries in 2916 nonmetropolitan counties between January 1, 2010, and December 31, 2018. Beneficiaries with schizophrenia and related psychotic disorders and/or bipolar I disorder during the study period were included. For each year of the study, each county was categorized based on per capita telemental health service use (none, low, moderate, and high). The association between telemental health service use in the county and quality measures was tested using a multivariate model controlling for both patient characteristics and county fixed effects. Analyses were conducted from January 1 to April 11, 2022. Before the COVID-19 pandemic, telemedicine reimbursement was limited to nonmetropolitan beneficiaries. MAIN OUTCOMES AND MEASURES Receipt of a minimum of 2 specialty mental health service visits (telemedicine or in-person) in the year, number of months per year with medication, hospitalization rate, and outpatient follow-up visits after a mental health hospitalization in a year. RESULTS In 2018, there were 2916 counties with 118 170 patients (77 068 [65.2%] men; mean [SD] age, 58.3 [15.6] years) in the sample. The fraction of counties that had high telemental health service use increased from 2% in 2010 to 17% in 2018. In 2018 there were 1.08 telemental health service visits per patient in the high telemental health counties. Compared with no telemental health care in the county, patients in high-use counties were 1.2 percentage points (95% CI, 0.81-1.60 percentage points) (8.0% relative increase) more likely to have a minimum number of specialty mental health service visits, 13.7 percentage points (95% CI, 5.1-22.3 percentage points) (6.5% relative increase) more likely to have outpatient follow-up within 7 days of a mental health hospitalization, and 0.47 percentage points (95% CI, 0.25-0.69 percentage points) (7.6% relative increase) more likely to be hospitalized in a year. Telemental health service use was not associated with changes in medication adherence. CONCLUSIONS AND RELEVANCE The findings of this study suggest that greater use of telemental health visits in a county was associated with modest increases in contact with outpatient specialty mental health care professionals and greater likelihood of follow-up after hospitalization. No substantive changes in medication adherence were noted and an increase in mental health hospitalizations occurred.
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Affiliation(s)
- Bill Wang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Alisa B. Busch
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- McLean Hospital, Belmont, Massachusetts
| | | | - Pushpa Raja
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Smali E, Talley RM, Goldman ML, Pincus HA, Woodlock D, Chung H. A Continuum-Based Framework as a Practice Assessment Tool for Integration of General Health in Behavioral Health Care. Psychiatr Serv 2022; 73:636-641. [PMID: 34555921 DOI: 10.1176/appi.ps.202000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE General medical conditions among patients with mental and substance use disorders are often not adequately detected and managed in behavioral health settings. The project described in this study sought to investigate how behavioral health clinics used a new general health integration (GHI) framework to assess integration efforts. METHODS Eleven community behavioral health clinics were introduced to a new continuum-based framework for use in GHI assessment. A multidisciplinary team in each clinic was tasked with identifying current GHI interventions according to several framework stages (preliminary, intermediate 1, intermediate 2, and advanced) among eight domains and 15 related subdomains. The clinics provided feedback on the framework's utility for GHI planning and advancement. RESULTS The clinics could readily identify distinct integration interventions within each domain and subdomain. Clinics reported strengths in the domains of trauma-informed care, self-management support, social service linkages, and quality improvement. Opportunities for future advancement in integration of general health services were identified in the major domains of screening and referral, evidence-based treatments, care teams, and sustainability. The clinics also described potential benefits of the framework to further advance and implement GHI best practices. CONCLUSIONS The clinics could use the framework as a practice assessment of integration efforts with minimal guidance and identify several evidence-based integration interventions. Some GHI interventions were seen as strengths and as opportunities for further advancement. Longitudinal evaluation among a larger number of and more geographically diverse behavioral health clinics seeking to advance their GHI practices will improve the GHI framework's generalizability and potential for dissemination.
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Affiliation(s)
- Ekaterina Smali
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Rachel M Talley
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Matthew L Goldman
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Harold Alan Pincus
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - David Woodlock
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
| | - Henry Chung
- Montefiore Health System, Inc., New York City (Smali); Department of Psychiatry, University of Pennsylvania, Philadelphia (Talley); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Goldman); Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, and New York State Psychiatric Institute, New York City (Pincus); Institute for Community Living, New York City (Woodlock); Department of Psychiatry, Albert Einstein College of Medicine and Montefiore Health System, New York City (Chung)
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Ainslie M, Brunette MF, Capozzoli M. Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis. JMIR Ment Health 2022; 9:e33092. [PMID: 35311673 PMCID: PMC8981005 DOI: 10.2196/33092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. OBJECTIVE We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. METHODS We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. RESULTS A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. CONCLUSIONS The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness.
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Affiliation(s)
- Marcy Ainslie
- Department of Nursing, University of New Hampshire, Durham, NH, United States
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Michelle Capozzoli
- Department of Mathematics & Statistics, University of New Hampshire, Durham, NH, United States
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Baker AL, Forbes E, Pohlman S, McCarter K. Behavioral Interventions to Reduce Cardiovascular Risk Among People with Severe Mental Disorder. Annu Rev Clin Psychol 2022; 18:99-124. [PMID: 35175861 DOI: 10.1146/annurev-clinpsy-072720-012042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among people with severe mental disorder (SMD). CVD risk factors occur at the individual, health system, and socio-environmental levels and contribute not only to high rates of CVD but also to worsening mental health. While acknowledging this wider context, this review focuses on behavioral interventions for seven CVD risk behaviors-smoking, physical inactivity, excessive alcohol consumption, low fruit and vegetable intake, inadequate sleep, poor social participation, and poor medication adherence-that are common among people with SMD. We survey recent meta-reviews of the literature and then review additional key studies to provide clinical recommendations for behavioral interventions to reduce CVD risk among people with SMD. A transdiagnostic psychological approach from the start of mental health treatment, drawing upon multidisciplinary expertise to address multiple risk behaviors, is recommended. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia;
| | - Erin Forbes
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia;
| | - Sonja Pohlman
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kristen McCarter
- School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
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11
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Erlich MD, Casoy F, Berezin J, Hernandez Y, Smith TE. Building and Landing the Plane While Flying: How New York State Addressed the Needs of People With Serious Mental Illness During the COVID-19 Pandemic. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac035. [PMID: 36348646 PMCID: PMC9620771 DOI: 10.1093/schizbullopen/sgac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
New York State was the epicenter for COVID-19 in Spring 2020 when little was known about the pandemic. Dire circumstances necessitated New York State’s (NYS) public mental health system to rapidly pivot, adapt, and innovate its policies and procedures to ensure continuous high-level care to individuals with serious mental illness (SMI), a population especially vulnerable to both the physical and psychosocial sequelae of COVID-19. NYS rapidly adopted emergency measures to support community providers, expanded the capacity of its State-Operated facilities, created policies to promote improved infection control access, collaborated to enhance the public–private continuum of service to support people with SMI, and broadened the use of new technologies to ensure continued engagement of care.
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Affiliation(s)
| | - Flavio Casoy
- New York State Office of Mental Health , New York, NY , USA
| | - Joshua Berezin
- New York State Office of Mental Health , New York, NY , USA
| | | | - Thomas E Smith
- New York State Office of Mental Health , New York, NY , USA
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12
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Szmulewicz AG, Benson NM, Hsu J, Hernán MA, Öngür D. Effects of COVID-19 pandemic on mental health outcomes in a cohort of early psychosis patients. Early Interv Psychiatry 2021; 15:1799-1802. [PMID: 33432786 PMCID: PMC8013468 DOI: 10.1111/eip.13113] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/13/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the impact of the COVID-19 pandemic on clinical outcomes, we used data from Electronic Health Records from 128 patients receiving care at a First Episode Psychosis clinic. METHODS Rates of admission or emergency room (ER) visits from January 2020 to July 2020 were analysed using difference-in-difference regression. We used the same weeks in 2019 to control for seasonality. RESULTS We found 17 hospitalizations or ER visits between 1 January 2020 and 13 March 2020 (incidence rate: 71.4 events/1000 person-weeks) and 6 between 14 March 2020 and 20 June 2020 (incidence rate: 18.5 events/1000 person-weeks) for an incidence rate ratio of 0.26. The severity of presentation worsened after transition to telemedicine. No signs of significant interruptions of care were found. CONCLUSIONS We report that patients have avoided accessing higher levels of care, except in extreme cases. We argue that this is not a sustainable trajectory and that public health actions are required.
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Affiliation(s)
- Alejandro G Szmulewicz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nicole M Benson
- McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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13
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Benjenk I, Saliba Z, Duggal N, Albaroudi A, Posada J, Chen J. Impact of COVID-19 Mitigation Efforts on Adults With Serious Mental Illness: A Patient-Centered Perspective. J Nerv Ment Dis 2021; 209:892-898. [PMID: 34846356 PMCID: PMC8614196 DOI: 10.1097/nmd.0000000000001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
ABSTRACT In response to COVID-19 mitigation policies, mental health and social service agencies have had to rapidly change their operations, creating challenges for patients with serious mental illness (SMI). This study aimed to explore the experiences of adults with SMI navigating these altered systems during the pandemic. In-depth interviews were conducted with 20 hospitalized adults with SMI in the fall of 2020; they were coded using thematic analysis. Most participants found the new systems effective at meeting their essential needs. However, several reported significant unmet needs, including inability to access mental health care and public benefits. These participants lacked identification documents, housing, and/or a personal device. Although none of the participants used telemedicine before COVID-19, most reported no or minimal problems with telemental health. Those reporting difficulties did not have personal devices, were receiving audio-only services, or viewed telemedicine as less personal or too distracting.
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Affiliation(s)
| | | | - Neel Duggal
- School of Medicine, George Washington University, Washington, DC
| | - Asmaa Albaroudi
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | | | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
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14
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Further Adaptations and Reflections by an Assertive Community Treatment Team to Serve Clients with Severe Mental Illness During COVID-19. Community Ment Health J 2021; 57:1217-1226. [PMID: 34146189 PMCID: PMC8214380 DOI: 10.1007/s10597-021-00860-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
In September of 2020, Guan and colleagues wrote about their experience of an Assertive Community Psychiatry Program responding to the COVID-19 pandemic. We describe our own experience as an Assertive Community Treatment team in Minnesota responding to challenges of effectively and safely delivering service to clients. As the pandemic has progressed since last year, so has the literature, and updated references are highlighted. Common threads are woven between our experience, the experience of Guan and colleagues, and others to suggest the beginnings of a template to adapt services to a new post-pandemic world.
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15
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Abstract
PURPOSE OF REVIEW The aim of this study is to review the recent literature on disasters' impact on the course of psychotic spectrum disorders (PSDs) and how people with PSD fare during a disaster, including the effects of COVID-19. RECENT FINDINGS Several, but not all, studies examining disasters including earthquake-affected communities and refugee populations have found increased incidence of PSDs. Studies have been inconsistent regarding psychosis incidence in COVID-19 patients. Meanwhile, patients with PSD have been found to cope poorly in recent disasters including flooding and a nuclear accident. Patients with schizophrenia appear to be at particular risk during COVID-19 due to such issues as poor awareness of health precautions and the psychiatric impact of lockdown. However, novel methods including telepsychiatry have allowed care of this population to remain consistent during COVID-19. SUMMARY There is conflicting evidence as to the association between disasters and onset of PSD, and further study is needed to elucidate this link. Patients with PSDs are more likely to fare worse during disasters. Novel approaches to delivery of care have helped offset the psychiatric risks to PSD patients during the COVID-19 pandemic. These approaches may be applicable to other disaster scenarios or to general outpatient care.
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