Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly acknowledged as critical tools for enhancing patient-centred, value-based care. However, research is lacking on the impact of using standardized patient-reported indicators in acute psychiatric care. The aim of this study was to explore whether subjective well-being indicators (generic PROMs) are relevant for evaluating the quality of hospital care, distinct from measures of symptom improvement (disease-specific PROMs) and from PREMs.

Two hundred and forty-eight inpatients admitted to a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardized generic PROMs on well-being, symptom improvement was assessed using standardized disease-specific PROMs, and experience of care using PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of providing treatment using adapted PREMs items.

Change in subjective well-being (PROMs) at discharge was significantly (p < 0.001), but moderately (r2 = 28.5%), correlated to improvement in symptom outcomes, and weakly correlated to experience of care (PREMs) (r2 = 11.0%), the latter being weakly explained by symptom changes (r2 = 6.9%). Patients and clinicians assessed the experience of care differently.

This study supports the case for routinely measuring patients’ subjective well-being to better capture the unmet needs of patients undergoing psychiatric hospital treatment, and the use of standardized patient-reported measures as key indicators of high quality of care across mental health services.

Research indicates that greater exposure to Hurricane Sandy is associated with increased mental health difficulties. This study examined whether Project Restoration, a program that linked adults into mental health care (L2C), was effective in reducing post-Sandy mental health difficulties as compared to a cohort of adults matched on mental health difficulties that were not linked into post-Sandy mental health care.

Project Restoration participants (n = 52) with elevated self-reported mental health difficulties had the option to enroll into L2C. Project LIGHT (n = 63) used similar methodologies but did not have a L2C component and served as the matched control group.

Multivariable modeling showed significant decreases in all mental health difficulties except for depression in the Project Restoration group, whereas there were no significant decreases in LIGHT. The decrease in anxiety from baseline to follow-up was significantly greater for Project Restoration as compared to LIGHT.

Findings confirm the powerful impact community outreach and treatment have on reducing mental health difficulties after a disaster.

Personal Health Budget (PHB) has been provided to consumers with severe mental illness within a policy shift toward a person-tailored mental healthcare treatment based on individual unmet needs. PHB is an amount of money to support patient’s health and wellbeing needs, which is planned and agreed between patients and their local NHS team. It is not new money, but it may mean spending money differently so that patients can get the care that they need. However, evidence of beneficial effects of PHB is still scarce.

The aim of this study was to provide preliminary data on clinical and social benefits of adding PHB to a standard pharmacotherapy in patients with severe mental illness across a 24-month follow-up period.

137 individuals with severe mental illness (aged 18–50 years) were recruited in one of the adult mental health services of an Italian Department of Mental Health. They completed the Global Assessment of Functioning scale, the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale. Friedman’s test for repeated measure was used to assess the longitudinal stability of functioning and clinical parameters. A linear regression analysis was also performed.

A significant decrease in all GAF scale, HoNOS and BPRS scores along the 24 months of follow-up was observed. Regression analysis results specifically showed a relevant association between a PHB multiaxial intervention and the longitudinal reduction in BPRS ‘Negative Symptoms’ and HoNOS ‘Social Problems’ subscores.

Our findings support the useful implementation of a PHB approach for severe mental illness patients within the Italian mental health service network.

No significant relationships.

Mental health interventions for Italian (and European) prisoners with mental disorders remain a problematic issue, despite radical changes in general psychiatric care and a 2008 major government reform transferring mental health care in prison to the National Health Service. Indeed, according to the American Psychological Association, 64% of incarcerated individuals report mental health concerns.

The aim of this study is to describe the mental health intervention model implemented since January 2020 for prisoners allocated in the Parma Penitentiary Institutes (PPI). This approach is specifically based on specialized, “person-centered” and “person-tailored” therapeutic-rehabilitation plans in line with psychiatric treatments usually provided in community mental health-care centers of the Parma Department of Mental Health.

All the processes and procedures included in the PPI intervention model were first carefully described, paying special attention to the service for newly admitted prisoners and each typology of specialized therapeutic-rehabilitation treatment potentially provided. Additionally, a preliminary descriptive process analysis of the first six months of clinical activity was also performed.

Since January 2020, 178 individuals entered the PPI service for newly admitted prisoners. In total, 83 (46.7%) of them were engaged in the services of the PPI mental health-care team (35 with pathological addiction and 48 with mental disorders): 56 prisoners were offered an integrated mental health intervention and 27 exclusively an individual psychological or psychiatric treatment.

The results support the potential applicability of an integrated mental health intervention in prison, planning a person-tailored rehabilitation in close collaboration with the prisoners, their families and the local mental health/social services.

No significant relationships.

Decision Support Systems (DSS) are appropriate tools for guiding policymaking processes in Mental Health (MH) management, especially where a balanced and integrated care provision is required.

To assess the performance of a MH ecosystem for identifying benchmark and target-for-improvement catchment areas according to the Balanced Care model.

The MH provision, distinguishing inpatient, day and outpatient main types of care, has been assessed in the Mental Health Network of Gipuzkoa (Basque Country, Spain) using a DSS, integrating Data Envelopment Analysis, Monte-Carlo Simulation and Artificial Intelligence. 13 catchment areas, defined by a reference MH centre, are the units (universe) for the analysis. The indicators for MH ecosystem performance were: relative technical efficiency, stability and entropy, for identifying both benchmarking and target-for-improvement areas. The analysis of the differences between the two groups can be used to design organizational interventions.

The Mental Health Network of Gipuzkoa showed high global efficiency scores, but it can be considered statistically unstable (small changes in variable values can have relevant impacts on its performance). For a global performance improvement, it is recommended to reduce admissions and readmissions in inpatient care, increase workforce capacity and utilization of day care services and, finally, increase the availability of outpatient care services.

This research offers a guide for evidence-informed policy-making to improve MH care provision in the main types of care and provide aftercare. The characteristics of the area to be improved are critical to design interventions and assess their potential impact on the MH ecosystem.

No significant relationships.

There is limited existing research about patient safety issues in mental healthcare. A lack of evidence is particularly pronounced in relation to safety in community-based mental health services, where the majority of care is provided. To date, reviews of mental health patient safety literature have focused primarily on inpatient care settings.

This systematic scoping review will aim to identify and synthesise literature about the types of patient safety problems in adult community-based mental health settings, the causes of these problems, and evaluated safety interventions in this care context.

A systematic search was conducted on 19th June 2020 and refreshed on 23rd October 2021, across five databases: Medline, Embase, PsycINFO, Health Management Information Consortium, and Cumulative Index to Nursing and Allied Health Literature. The search strategy focused on three key elements: ‘mental health’, ‘patient safety’ and ‘community-based mental health services’. Retrieved articles were screened at title, abstract and subject heading level, followed by full-text screen of longlisted articles.

In this presentation, the findings of this systematic scoping review will be described, based on synthesised literature about safety incidents, broader care delivery problems, their causes, and evaluated patient safety interventions to address these issues.

This study will offer learning opportunities about the safety problems, contributory factors, and safety interventions in adult community-based mental health services, as described in the evidence base. Review findings will also help to ascertain gaps in existing research, which should be addressed in future studies.

NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

How do medical students, who have self-criticism of being procrastinators of their study obligations, deal psychologically with daily tasks? The experience of procrastination by those who are considered high-performance students involves resources of mental health to cope with guilt, exhaustion, or even self-sabotage. According to MeSH used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’.

To explore the psychological meanings that medical students attribute to procrastination phenomena to better understand how they handle the usual curriculum overload.

Clinical-qualitative design. Sample of 13 participants closed by information saturation with 2nd, 3rd, 4th-year students. Semi-directed interviews with open-ended questions in-depth. Clinical-qualitative content analysis, free-floating readings with psychodynamic concepts. Results were validated by peers at the Laboratory of Clinical-Qualitative Research.

Emergent categories: 1) between procrastination and despair: the process of stress in procrastination; 2) a proving mechanism: procrastination as an emotional defense; 3) a very delicate rumination: between procrastination and mere delay, an emotional dilemma; 4) this conflict is painful: the confrontation between the desire to comply with tasks with excellence and the enjoyment of life.

Procrastination is reported by students as a source of great tension generated by opposing forces and desires, in which exhaustion is eventually reached. There are emotional contradictions related to guilt for leaving tasks to the last moment and the need to live other things besides doing academic tasks. Procrastination is a message-metaphor. It is important that institutions listen to students to understand what procrastination is saying about them.

No significant relationships.

Refugees have been shown to be a vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care. By establishing cooperations between psychosocial centers and psychiatric clinics the state funded project refuKey by NTFN e.V. and DGPPN aims to improve access to and quality of mental health care for traumatized refugees pursuing a stepped-care model.

As part of a larger project evaluation study four focus-groups among experts were conducted to explore the impact of refuKey on refugees’ mental health care.

Data analysis was conducted using Mayring qualitative content analysis as well as an additional quantitative survey with state refugee reception centers’ employees.

The results indicate that refuKey faciliated the access to mental health care for refugees in terms of systematic identification of mental disorders, eased transitions and increased networking between the mental health care institutions and sectors. Planning and implementation of treatment is described as being more coordinated, solution oriented and sustainable due to multiprofessional collaboration and regular use of qualified interpreters. Reduced distress as well as increased transcultural expertise was found for professionals.

The persisting barriers for refugees in access to mental health care, especially to psychotherapeutic treatment and the emotional burden for professionals underlines the need for further support and research. The experts highly endorse the continuance of refuKey. Furthermore, they call for expansion of the project in terms of staff and new sites and changes of health policies to guarantee the access to adequate health care for traumatized refugees.

No significant relationships.

Health Psychology is a scientific branch that studies interpersonal relationships in the field of emotions and behavior in clinical settings. Violence against women is a gender-based action that alarmingly affects the population, with sexual violence (SV) being one of its main phenomena. The complexity of the care offered to SV patients by clinical professionals impacts themselves, affecting their personal lives and the quality of their work.

To explore symbolic emotional meanings attributed by health professionals to care and follow-up of women victims of SV in state service of reference of the Unified Health System.

Clinical-Qualitative design was used to guide semi-directed interviews with open-ended questions in-depth. Clinical-Qualitative Content Analysis was employed to treat data. Five participants make up the multi-professional team at the Hospital of the Woman of the State University of Campinas. Theoretical framework chosen to interpret categories was Balintian Medical Psychology.

Three categories were selected for this presentation: The human anguishes as the main challenge and handling of working with sexual violence; “To see things progressing”: to the patient and together with the team, a facilitator of the work; and “I try to leave it on the three’s leaves”: the difficult attempt to separate work from personal life.

Taking care of SV is a very emotionally demanding task. Working with the team and see expected outcomes help clinical professionals deal with negative feelings, avoiding, for example, compensatory traumas. New research about social-cultural impacts of working with SV is important to develop institutional approaches of coping for health teams.

No significant relationships.

About 3% of the general population suffers from Severe Mental Illness (SMI), including schizophrenia spectrum, bipolar and major depressive disorders. In this group, the rates of cardiovascular disease, diabetes mellitus and metabolic syndrome are approximately twice as high as the general population and the life expectancy is 13-30 years inferior compared to age and sex matched controls, greatly due to medical comorbidities. Low levels of physical activity (PA) and low fitness are likely to play a role.

To review the evidence about the effects of PA on physical health markers and psychiatric clinical symptoms of SMI patients.

We performed a literature review on the impact of exercise programs in physical and mental health of SMI patients using the PubMed and Google Scholar databases.

Several studies demonstrate that PA improves a variety of physical health markers in SMI patients, such as body weight, body mass index, waist circumference, body fat percentage, cardiorespiratory fitness, systolic blood pressure and HDL cholesterol. In parallel, there is evidence to support the benefit of PA in mental health, especially due to its effect on mood. Furthermore, PA promotes cognitive functioning, sleep quality, quality of life, self-esteem and fosters social interaction. Moreover, in patients with schizophrenia, exercise seems to decrease negative symptoms.

Implementation of regular physical activities in psychiatric wards should be considered whenever possible, due to its positive effects on physical and mental health. The adoption of structured exercise programs in psychiatric wards is feasible, safe, and well-received by patients.

No significant relationships.

According to the Medical Subject Headings, the vocabulary used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’. Studies on procrastination are increasing, especially among university students, gaining prominence in academic literature. However, studies on the procrastination phenomenon have been mainly quantitative, correlating such experiences with clinical and behavioral manifestations. Specific research with occupational therapy students is lacking in the literature.

To interpret symbolic meanings related to life experiences of the procrastination phenomenon of school tasks as reported by occupational therapy undergraduate students, self-referred as procrastinators.

Clinical-qualitative design. Data collected through semi-directed interviews with open-ended questions in-depth. Clinical-Qualitative Content Analysis generated categories discussed in the light of the psychodynamic theoretical framework. This study was carried out in a private Brazilian university. The sample was closed by the information saturation criterion.

Seven students were interviewed. Procrastination comes associated with anxiety as productivity, but not reported as an “executive drive”, that would imprison the individual in a vicious cycle. There are defense mechanisms referred to as self-preservation for not assume responsibilities for tasks. Ineffective strategies seem to be experienced by the students to avoid procrastination, but without resolving possible psychodynamic conflicts related to the task.

Students’ procrastination ambivalently affects their daily lives, although they can report the phenomenon as negative. It is suggested further qualitative studies that explore specifically meanings of procrastinating personal activities, in general, considering these individuals will work precisely in a therapeutic approach in the field of occupations of the people.

No significant relationships.

Individual placement and support (IPS) has a considerable body of evidence for its effectiveness in helping people with mental disorder to obtain and maintain competitive jobs in the labour market. IPS closely follows 8 main principles (such as it aims to get people into competitive employment, it is open to all those who want to work, it tries to find jobs consistent with people’s preferences, it works quickly, it brings employment specialists into clinical teams, it provides time unlimited, individualised support, benefits counselling is included). However, little data in young adults are currently available, especially in Europe.

Aim of this study was to evaluate the beneficial effect of IPS in Italian young adults with severe mental illness, examining the main competitive employment outcomes and drop out rates during a 3-year follow-up period.

54 participants were recruited from patients receiving psychiatric treatment in adult Community Mental Health Centers of an Italian Department of Mental Health. Together with drop out rates, we examined job acquisition, job duration (total number of days worked), total hours per week worked and job tenure (weeks worked on the longest-held competitive job).

A crude competitive employment rate of 40.7% and a crude drop out rate of 22.2% over the 3-year follow-up period were found. However, 66% of 42 clients who remained in the program over 3 years gained competitive employment at some time during the 3-year period.

This research shows the feasibility of an IPS intervention model in the public mental health care system in Italy, especially for a young adult target population.

No significant relationships.

The increase of mental health issues globally has been well documented and now reflected in the United Nations' Sustainable Development Goals as a matter of global health significance. At the same time, studies show the mental health situations in conflict and post-conflict settings much higher than the rest of the world, lack the financial, health services and human resource capacity to address the challenges.

The study used a descriptive literature review and collected data from public domain, mostly mental health data from WHO's Global Health Observatory. Since there is no primary database for Somalia's public health research, the bibliographic databases used for mental health in this study included Medline, PubMed, CINAHL, PsycINFO, and Google Scholar.

The review of the mental health literature shows one of the biggest casualties of the civil war was loss of essential human resources in healthcare as most either fled the country or were part of the victims of the war.

In an attempt to address the human resource gap, there are calls to task-shift so that available human resource can be utilized efficiently and effectively. This policy paper discusses the case of Somalia, the impact of decade-long civil conflict on mental health and health services, the significant gap in mental health service delivery and how to strategically and evidently task-shift in closing the mental health gap in service delivery.

The Kennedy Krieger Institute Network for Early Childhood Tele-Education (KKI-NECT) is a federally funded ECHO project. Its hub consists of a child psychiatrist, developmental pediatricians and a behavioral psychologist. Its community partners are primary care providers(PCPs) in underserved areas. Its goal is to create local experts in early childhood behavioral, emotional and developmental disorders.

After attendance at this session, the learner will be able to: 1. report the rates of co-occurring developmental, behavioral and emotional disorders presented by primary care participants 2. explain the efficacy of case based learning and a structured curriculum as a mechanism for expanding the workforce. The goal of this presentation is to build awareness of and interest in ECHOs specifically targeted to child behavioral, emotional and developmental issues.

Dr. Leppert will discuss KKI-NECT, particularly the process of procuring funding, setting up an ECHO, and getting institutional “buy-in". She will describe the use of case based learning and a structured curriculum in a longitudinal CME program, report the comorbidities in cases that participants present for discussion, and demonstrate the impact on participants’ practice.

Data from four cohorts demonstrate that PCPs showed increased comfort levels, improved knowledge of behavioral, emotional and developmental disorders. PCPs expanded the scope issues they could address in their practice as a result of participation in KKI-NECT.

KKI-NECT is a viable response to the workforce shortage of child psychiatrists by confidently increasing the role of the PCP in treating childhood developmental and mental health disorders.

No significant relationships.

It is well-known that university students experience high levels of mental health problems (1). University life presents changes and challenges that can be stressful and may affect the mental health of its community (2,3). More than 20 years ago, the Social Affairs Service (SAS) of the University of Salamanca started a program that ensured the mental health care in their community. The Psychiatric Care Unit is part of this program and its objectives are: 1) to detect serious mental disorders; 2) treat mild mental disorders; 3) give information to prevent illness and promote mental health; 4) serve as support in patients with previous follow-up that has been discontinued due to the beginning of their studies; 5) liaise with referral psychiatrists.

To make known a Psychiatric Care Unit targeted in the university community

18 people between 19 and 52 years old (22% male, 78% female) were evaluated between November and December of 2020 in the Psychiatric Care Unit of the Social Affairs Service (PCU-SAS, University of Salamanca). The assessment consisted in an interview carried out by a psychiatrist, in the presence of a medical graduate. Every patient belong to the university community (students/ staff).

The most frequent diagnosis in the sample is Adjustment Disorder (F43.2). Substance use, eating disorders, low-self-concept, perfectionism and emotional dysregulation are very prevalent symptoms along our sample.

Universities should invest in creating environments that promote student and staff mental wellbeing. However, the current body of evidence is scarce and more research is needed to recommend what are the best strategies(4).

No significant relationships.

After attendance at this session, the learner will be able to: 1. describe the history and expansion of the ECHO model worldwide, 2.name the components and structure of ECHO sessions, 3. discuss ECHO as a force multiplier.

Dr. Harrison will briefly present the history and expansion of ECHO. She will then describe the program, which consists of a “hub and spokes” model with “tele-clinics” consisting of a “hub” of specialists and “spokes” of clinicians in rural, underserved areas who present cases for discussion, generating treatment recommendations.

The ECHO model has been replicated in a variety of disciplines across the United States and internationally. Its success has been well documented. There are currently 920 active ECHO programs worldwide.

Project ECHO is a viable model to address the workforce shortage of child psychiatrists worldwide.

No significant relationships.

Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services.

We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15–49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15–49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression.

In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5–52.9) for patients followed-up in private care, 96.5% (95% CI 95.0–97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5–85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06–0.07), 50 (aRR 0.02, 95% CI 0.01–0.03) and 2.6 (aRR 0.39, 95% CI 0.35–0.43) times lower in public primary care programmes than in the private sector programmes.

There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.