Online mental health treatment: Concerns and considerations

Concerns and considerations have emerged as mental health professionals contemplate the provision of mental health treatment over the Internet. This paper identifies perceptions of online mental health treatment among a national sample of 2,098 social workers, psychologists, and other professionals. These professionals were unlikely to provide online mental health treatment, although some used the Internet as an adjunct to clinical practice. They noted specific concerns related to the provision of mental health treatment online, including confidentiality of client information and liability issues. We explore these issues and discuss implications for professionals who provide mental health treatment

Research governance in children's services: the scope for new advice (Research report DFE-RR072)

"In 2009, following a period of informal consultation with key stakeholders, the former DCSF commissioned the work reported here, with the following overarching aims: to identify and evaluate existing arrangements for research governance and ethics review in children’s services in England; and to make recommendations for the future development of those governance arrangements, with the overall goal of ensuring a more coherent and transparent system, that is proportionate to the governance needs and ethical risks in research with users of children’s services." - Page iii

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health. Objectives To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision. Design Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study. Setting Global (systematic reviews); England and Wales (mapping exercise and case study). Participants (case study) Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites. Main outcome measures (meta-analysis) A measure of CYP’s mental health symptomatology. Data sources (literature reviews) MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC). Review methods Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review. Results Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support. Conclusions Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes. Future work Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness

IT and the NHS: Investigating different perspectives of IT using soft systems methodology

The UK NHS National Programme for IT has been criticized for a lack of clinical engagement. This paper uses a soft systems methodology (SSM) analysis of a case study from the use of electronic systems within a National Health Service (NHS) Mental Health Trust in the United Kingdom (UK) to explore the legal and ethical implications of the failure to develop clinical systems which are fit for purpose. Soft systems methodology (SSM) was used as a theoretical model both to derive deeper insights into the survey data and suggest how communication between those producing information and those using it, could be improved. Multiple methods were employed which included a postal survey and participant interviews to triangulate the data The use of SSM reinforced the concept that the national IT programme is based on a 'hard' systems view and does not take local factors (which are related to 'soft systems' thinking) into account. The study found administrative staff to be a crucial link between clinicians and information departments and highlighted the need for a joint-up information strategy and integrated systems. The article concludes with a discussion of the legal and ethical implications of the findings and the lessons for the broader UK national programme. It argues that the failure to deliver systems that are fit for purpose is not value neutral but an ethical issue

Opportunities for information sharing: case studies

Personal information provided to government and non-government service providers is highly sensitive. Appropriate collection, management and storage of personal information are critical elements to citizen trust in the public sector. However, misconceptions about the frameworks governing sharing personal information can impact on the coordination of services, case management and policy development.   The NSW Department of Premier & Cabinet engaged the Social Policy Research Centre to develop three case studies that identified the challenges to sharing information appropriately, and the opportunities for better personal information sharing between government agencies and non-government organisations. Improved sharing of personal information in these areas can support more effective policy development, leading to improved service delivery performance and coordination.   The Social Policy Research Centre identified the legislative and policy framework for each case study, conducted qualitative research on the interpretation of this framework, and developed three case study reports

The Right to Mental Health in the Digital Era

People with mental illness usually experience higher rates of disability and mortality. Often, health care systems do not adequately respond to the burden of mental disorders worldwide. The number of health care providers dealing with mental health care is insufficient in many countries. Equal access to necessary health services should be granted to mentally ill people without any discrimination. E-mental health is expected to enhance the quality of care as well as accessibility, availability and affordability of services. This paper examines under what conditions e-mental health can contribute to realising the right to health by using the avail- ability, accessibility, acceptability and quality (AAAQ) framework that is developed by the Committee on Economic, Social and Cultural Rights. Research shows e-mental health facilitates dissemination of information, remote consultation and patient monitoring and might increase access to mental health care. Furthermore, patient participation might increase, and stigma and discrimination might be reduced by the use of e-mental health. However, e-mental health 146 might not increase the access to health care for everyone, such as the digitally illiterate or those who do not have access to the Internet. The affordability of this service, when it is not covered by insurance, can be a barrier to access to this service. In addition, not all e-mental health services are acceptable and of good quality. Policy makers should adopt new legal policies to respond to the present and future developments of modern technologies in health, as well as e-Mental health. To analyse the impact of e-mental health on the right to health, additional research is necessary

How do school counselling and therapy services undertake participation activities in a way that meets the ethical requirements of therapeutic practice?

This study explores how organisations providing counselling and therapy services within schools undertake participation activities, and the ways in which ethical considerations might have affected the choice of methods. It primarily focuses on the participation of children and young people in improving the quality of services. The research aimed to gather potential models of involving children and young people in the development of services. Two semi-structured interviews and one focus group took place, gathering data from five services providing therapeutic services in schools in London or the South East. The research found that while participative practice is inherent in the day-to-day delivery of therapy and counselling, it is still in development at an organisational level. The need for standardisation of approach at an organisational level clashed with the therapist and counsellors’ need to consider an ethical approach and the individual needs of clients. Specific challenges related to collecting the views of young children were noted in the interviews.The study concludes that devising a prescriptive approach that is delivered identically in every case is not appropriate. Every method used must be differentiated for different ages and developmental stages, and a level of flexibility in its implementation must be allowed. This flexibility will allow the therapist or counsellor to adapt the approach in situations where its delivery may conflict with ethical principles

Professional issues in maternal mental health scale (PIMMHS): The development and initial validation of a brief and valid measure

Introduction:The life-threatening consequences of perinatal mental health problems (PMHP) are well documented. Midwives are ideally placed to effectively identify women at risk and facilitate early intervention. However, a multitude of factors contribute to failure in recognition and treatment. It would be of value for service providers to be able to identify key professional issues in their own context. The present study sought to develop and evaluate a ‘professional issues in maternal mental health’ scale (PIMMHS), explore its psychometric properties and potential application.Methods:A cross-sectional design and instrument evaluation approach was taken to investigate the psychometric properties of the PIMMHS. A total of 266 student midwives from 10 UK institutions completed the PIMMHS via Survey Monkey.Results:PIMMHS comprises two sub-scales of emotion/communication (PIMMHSEmotion sub-scale) and training (PIMMHS-Training sub-scale). Both PIMMHS subscales demonstrate adequate divergent and convergent validity. Sub-optimal internal consistency was observed for the training sub-scale, however, the PIMMHS-Training had a more impressive effect size in terms of known-groups discriminant validity compared to PIMMHS-Emotion.Conclusions:The PIMMHS appears to be a sound psychometric instrument for assessing professional issues that influence the practice of student midwives in PMH. The PIMMHS could support education providers to identify areas for curriculum development, as well as maternity services in proactive assessment of service provision, to identify training and service development opportunities

Practice-based conundrums and existentialist quandaries of a professional code of ethics

Ethical codes have long been considered indispensable tools in defining the proper conduct of counseling professionals. Revisions reflect the ideals of the industry to accommodate the evolving needs of clients and trends in treatment models, but the essence of the code is to convert principles befitting of the profession into concrete actions or considerations that abet professional decision-making. Acculturation into the profession involves ethics training intended to improve professionals’ ability to apply the code to situations that might arise in their practices, resulting in the most ethically appropriate action. However, such assumptions may be problematic. The idea of ethical competency and improvement in the code itself should be qualified to reflect the uncertainty of moral truths, including counselor training tailored to test competency, both before and during professional practice. In this article, the consideration that morals and ethics are distinct is spelled out and then challenged by drawing on Jean Paul Sartre’s existentialist critique of moral decision-making reality. In light of this critique and John Stuart Mill’s argument regarding the value of vigorous debate over philosophical ideas, suggestions are made regarding a potential approach to ethics competency education