scholarly journals Baby Steps to a Learning Mental Health Care System: Can we do the Work?

2020 ◽  
Author(s):  
Brian Shiner ◽  
Bradley V Watts
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Mental Health Care ◽  
Health Care System ◽  
Health Care Systems ◽  
Electronic Health Record Data ◽  
Mental Health Care System ◽  
Care System

Abstract There are an infinite number of small decisions to be made in routine clinical practice, and most will never be the subject of prospective research studies. Rather than making these decisions arbitrarily, learning health care systems leverage experience represented by electronic health record data and other sources to inform decision making and improve clinical practice. While this approach has been elusive in mental health, Coulombe et al. (AJE-00362-2020.R3) use British National Health Service data to evaluate a decision rule for antidepressant choice created using dynamic weighted survival modeling. Though the results are equivocal in this use case, the work suggests a path forward for data-driven decision making in routine mental health care. Such approaches will be required to set the stage for a learning mental health care system.

scholarly journals Coping with Criticism and Embracing Change—Further Reflexions on the Debate on a Mental Health Care System without Coercion

Laws ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 22
Author(s):  
Sebastian von Peter ◽  
Martin Zinkler
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care System ◽  
Police Custody ◽  
Judicial Control ◽  
Mental Health Care System ◽  
The Will ◽  
Alternative Scenarios ◽  
Care System

In August 2019, a manuscript was published in this journal that aimed at imagining a mental health care system that renounces the judicial control to better focus on the will and preferences of those who require support. Alternative scenarios for dealing with risk, inpatient care, and police custody were presented that elicited strong and emotionally laden reactions. This article adds further reflections to this debate, aiming at contributing explanations for this unsettlement. A productive notion of criticism is discussed, and ways to achieve change toward a more human rights-oriented psychiatric practice are outlined.

Mental health services for individuals at risk of suicide in Peru: Attitudes and perspectives of mental health professionals

2020 ◽  
pp. 002076402094678
Author(s):  
Dana Alonzo ◽  
Dafne Aida Zapata Pratto
Keyword(s):  
Mental Health ◽  
Health Care ◽  
At Risk ◽  
Mental Health Care ◽  
Health Care System ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Specialized Training ◽  
Mental Health Care System ◽  
Care System

Background: Mental Health professionals often have to deal with at-risk individuals in crises and lack specialized training on suicide risk assessment and intervention. This study examined mental health professionals’ attitudes toward at-risk individuals and their perceptions of the quality of training and treatment available for assessing and intervening with this population. Methods: A total of 32 mental health professionals (13 psychiatrists, 16 psychologists, 2 psychiatric nurses; 1 social assistant) from highly vulnerable communities in Lima, Peru discussed their perceptions in four focus groups conducted by the authors. Results: Participants reported glaring deficiencies in all areas explored including training, knowledge and skills regarding suicide assessment and management. In addition, using ground theory analysis, three domains of findings emerged representing barriers and facilitators of treatment engagement, risk and protective factors of suicide and pros and cons of the current mental health care system including micro-, mezzo- and macro-level factors. The most frequently identified barrier was the perception that suicide is illegal; facilitator was family involvement; risk factor was poor parenting; protective factor was religious beliefs; pro of mental health care system was establishment of community-based services and con of mental health care system was lack of access to psychiatrists. Conclusion: The lack of specialized training available in the institutions that are designed to prepare mental health professionals for working with at-risk individuals is notable and has a direct and known impact self-identified by helping professionals. The need and desire for targeted training is palpable and essential to address growing rates of suicide, particularly among youth, in Peru.

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