Rapprochement and Reform: Overcoming Factionalism in Policy Making for Serious Mental Illness

The Ethics of Risk Prediction for Psychosis and Suicide Attempt in Youth Mental Health

OBJECTIVE

To identify potential clinical utility of polygenic risk scores (PRS) and exposomic risk scores (ERS) for psychosis and suicide attempt in youth and assess the ethical implications of these tools.

STUDY DESIGN

We conducted a narrative literature review of emerging findings on PRS and ERS for suicide and psychosis as well as a literature review on the ethics of PRS. We discuss the ethical implications of the emerging findings for the clinical potential of PRS and ERS.

RESULTS

Emerging evidence suggests that PRS and ERS may offer clinical utility in the relatively near future but that this utility will be limited to specific, narrow clinical questions, in contrast to the suggestion that population-level screening will have sweeping impact. Combining PRS and ERS might optimize prediction. This clinical utility would change the risk-benefit balance of PRS, and further empirical assessment of proposed risks would be necessary. Some concerns for PRS, such as those about counseling, privacy, and inequities, apply to ERS. ERS raise distinct ethical challenges as well, including some that involve informed consent and direct-to-consumer advertising. Both raise questions about the ethics of machine-learning/artificial intelligence approaches.

CONCLUSIONS

Predictive analytics using PRS and ERS may soon play a role in youth mental health settings. Our findings help educate clinicians about potential capabilities, limitations, and ethical implications of these tools. We suggest that a broader discussion with the public is needed to avoid overenthusiasm and determine regulations and guidelines for use of predictive scores.

The Future of the Psychiatric Mental Health Nursing Workforce: Using Our Skill Set to Address Incongruities in Mental Health Care Delivery

The USA is dealing with well-documented issues around mental health and its treatment. The Psychiatric Mental Health (PMH) workforce is growing and practicing in a variety of roles within the mental health system. How will PMH nurses address instances when the structure of services does not meet the mental health needs of the population? In this piece, I argue that to some degree the future of the PMH workforce will be determined by how well we use our capacity and capabilities to address incongruities in service structure and population needs. Five areas of concern with mental health services are outlined; they all involve factors that can be addressed with innovative approaches and optimum utilization of the PMH workforce. Included are suggestions on how PMH nurses might direct efforts toward these service issues, particularly by using their skill set and presence in the mental health system. Strategies include forging a tighter connection between the work of advanced practice and registered nurses in delivering care. Broadly, these efforts should be directed at building models of patient-centered care that address the needs of populations, reducing disparities, and demonstrating how engagement is a critical lever of effective inpatient and community-based care.

Beyond Binary Narratives of Mental Health Advocacy: Latent Profiles of Mental Health Activists and Advocates With Lived Experience

OBJECTIVE

In this article, the authors used data from a national survey of mental health activists and advocates (MHAAs) with lived experience of psychiatric disabilities to investigate attitudes toward psychiatric care.

METHODS

The authors distributed a survey, developed by a team led by researchers who were also service users, to both mainstream and more critical advocacy groups and networks (N=547 participants), and they analyzed the data by using latent class analysis (LCA). Four survey variables regarding beliefs about involuntary hospitalization, assisted outpatient treatment, medication, and diagnosis were used to generate latent subgroups. The authors explored associations between key survey variables and latent classes with chi-square tests and analysis of variance.

RESULTS

LCA indicated an optimal six-class solution. The classes existed on a spectrum of positions, ranging from highly favorable views of traditional psychiatric practices to highly critical views, with classes in the middle representing distinct profiles of attitudes toward treatment and diagnosis. Significant between-group differences were found for participants' psychiatric treatment histories, motivations to engage in activism and advocacy, and views about mental health care and advocacy priorities.

CONCLUSIONS

Findings reveal considerable heterogeneity among MHAAs and challenge binary narratives of mental health advocacy.

The Correlates of Government Expenditure on Mental Health Services: An Analysis of Data From 78 Countries and Regions

Background

Governmental investment in mental health is of vital importance for the implementation and maintenance of educational, preventive, and therapeutic services related to mental illness, particularly in low- and middle-income countries (LMICs). However, mental health expenditures represent only a small portion of total health spending in many countries. Little is known about the economic, social, or health-related factors that may influence variations in governmental spending in this sector.

Methods

Data on government expenditure on mental health as a percentage of total healthcare expenditure, collected by the WHO from 78 countries and regions in the period 2013-2014, was available for study. These data were analyzed in relation to key economic, social, and health-related indicators. The selection of these indicators was based on prior national and regional research and expert opinion as reported in the existing literature.

Results

Government spending on mental health was below 1% of health expenditure in 24.4% of the countries studied. A number of economic, social, and health-related indicators were significantly associated with variations in spending on mental health. Based on the partial correlation, sub-group, and multivariate linear regression analyses, the variables most significantly associated with low government spending on mental health were the burden of communicable diseases (β = −.47, p = .001) and cultural collectivism (β = −.37, p = .008).

Conclusions

These results suggest that low government investment in mental health may be associated not only with economic or political factors but also with variations in disease burden and in cultural attitudes across countries. Though no direct assumption regarding causation can be made, such findings may be of value when advocating for greater public investment in mental health, particularly in non-Western cultures with a high competing burden of infectious diseases.