Impact of the COVID-19 pandemic on mental health: potentially vulnerable groups and comorbidities

The coronavirus 2019 (COVID-19) pandemic is an unprecedented emergency situation with significant stressors causing adverse impacts on mental health across the globe. Certain individuals are potentially more vulnerable during the outbreak, in particular those with medical vulnerabilities to COVID-19, eg, elderly, living with chronic illnesses, as well as individuals with pre-existing mental health issues such as anxiety disorders, depression, suicidality, and loss/grief. Additionally, individuals with persistent post-acute COVID-19 symptoms, eg, long haulers, are also a vulnerable population. During this international crisis, pandemic-related stressors, such as isolation/quarantine, lockdown, social distancing, homeschooling, loss of income or employment, and/or loss of loved ones could negatively affect these vulnerable subgroups and their overall life functioning. This paper aims to aid in the management of this international emergency by identifying potentially vulnerable subgroups because of the COVID-19 pandemic and by providing recommendations related to appropriate mental health referrals/interventions. This paper also aspires to enhance the knowledge of first responders and lay persons about vulnerability factors to readily help individuals struggling with mental health issues during the pandemic.

Pathways to mental health consultations: A study from a tertiary care setting in India

Background: Research indicates that help seeking for mental health is low and often delayed. Understanding pathways to care is crucial to facilitate mental health referrals and reduce the time to consultation. Methods: In the present study, 63 individuals were assessed on illness severity, attitudes towards help-seeking and pathways-to-care. Results: Multiple pathways for therapy were noted, a delayed-pathway, two-step referral pathway and a direct-pathway. Most prominent pathway was the delayed-pathway. The direct-pathway had least treatment delay, contributed by timely recognition of symptoms by the patient. As first point of contact, patients preferred psychiatrists and popularly sought information about treatment via media. Conclusions: There are multiple pathways to consultations, often leading to treatment delay in care received. Timely recognition of symptoms was associated a direct pathway and the least delay. These findings have implications for strengthening routes to mental health specialists at early stages and increasing awareness about treatment available.

Crisis Intervention Team Training in a Correctional Setting: Examining Compliance, Mental Health Referrals, and Use of Force

The Crisis Intervention Team (CIT) model was developed as a specialized police-based program in which officers are trained to safely interact with individuals with mental illnesses. In 2011, the Minnesota Department of Corrections adapted this program for corrections. This study compares prison incidents involving CIT officers to a comparison sample of non-CIT incidents on a number of outcomes, including gaining compliance from people in custody (either immediately or as an incident unfolds), making mental health referrals, and using force against people in custody. We conducted a content analysis of reports describing 500 incidents in an all-male, maximum security prison and estimated multivariate binary logistic models to control for characteristics of situations, incarcerated people, and employees. The findings provide some support for implementing CIT training in a correctional setting, but some less encouraging results show that improvements to the program are still needed.

Patterning in Patient Referral to and Uptake of a National Exercise Referral Scheme (NERS) in Wales from 2008 to 2017: A Data Linkage Study

Exercise referral schemes have shown small but positive impacts in randomized controlled trials (RCTs). Less is known about the long-term reach of scaled up schemes following a RCT. A RCT of the National Exercise Referral Scheme (NERS) in Wales was completed in 2010, and the scheme scaled up across Wales. In this study, using a retrospective data linkage design, anonymized NERS data were linked to routine health records for referrals between 2008 and 2017. Rates of referral and uptake were modelled across years and a multilevel logistic regression model examined predictors of uptake. In total, 83,598 patients have been referred to the scheme and 67.31% of eligible patients took up NERS. Older adults and referrals for a musculoskeletal or level four condition were more likely to take up NERS. Males, mental health referrals, non-GP referrals and those in the most deprived groupings were less likely to take up NERS. Trends revealed an overall decrease over time in referrals and uptake rates among the most deprived grouping relative to those in the least deprived group. Findings indicate a widening of inequality in referral and uptake following positive RCT findings, both in terms of patient socioeconomic status and referrals for mental health.

Mental illness evaluation and referrals in medical care

The current study seeks to better understand the process by which medical professionals assess mental illness and their subsequent steps when mental illness is suspected or diagnosed (e.g., psychiatric or psychological referral, prescribing medication, etc.). Participants included 36 licensed medical professionals (80% physicians, 20% non-physicians) who are currently practicing in the United States. All participants completed an online survey that included questions about 1) participant demographics, 2) participant’s medical practice and training, 3) prevalence of mental illness in their patient population, 4) how they assess mental illness symptoms, and 5) steps they generally take if they recognize these symptoms in their patients. Additional questions asked about the specific referral processes for patients for whom the physician suspected low, moderate, and severe psychopathology. More than half (56.7%) of participants indicated they have not received training about mental health. Although nearly two-thirds (65.7%) of participants reported using routine screening measures, more than one third (35.3%) reported that non-medical professionals conduct these screenings. Results suggest that regardless of the severity of the patients’ mental illness the majority of participants referred the patient to a mental health professional; around three-quarters referred to specific providers. The second most common referral step was prescribing medications. This study highlights the importance of leveraging medical professionals’ interactions with their patients to improve mental health referrals for patients who may benefit from further mental health evaluation or treatment.