Social Identities of Clients and Therapists During the Mental Health Intake Predict Diagnostic Accuracy

Across countries, common mental disorders are often more prevalent and/or more persistent among disadvantaged members (e.g., ethnic minorities) compared with advantaged group members. Although these disparities constitute a heavy challenge to national health organizations, there is little empirical evidence to help account for the mechanism underlying them. In this study, conducted in clinics across Israel, we investigated processes, rooted in the clinical encounter that may contribute to mental health disparities. We focused on the accuracy of diagnostic decisions, which are likely to substantially impact the client’s prognosis. Therapists’ diagnostic decisions following the initial intake with their client were compared with independent structured diagnostic interview of the client. Results revealed that therapists were twice as likely to misdiagnose mental illness when their client was a member of a disadvantaged (relative to advantaged) group. Implications for the quality of mental health services that members of disadvantaged groups receive are discussed

Examination of the Role of Implicit Clinical Judgments During the Mental Health Intake

We examined the characteristics of therapists\u27 implicit clinical judgments during the mental health intake. Following the intake sessions with new clients, we conducted 129 semistructured interviews with 47 therapists. We found that 82% of therapists and 75% of interviews included reference to implicit clinical judgments. Therapists referred to these judgments as a cognitive process that relied on knowledge acquired through past clinical experiences and was primarily based on nonverbal cues and affective communication. Therapists used implicit processes when evaluating how to facilitate a good working alliance, what diagnostic information to collect, and how to decide on a diagnosis. The majority of therapists described elements of good rapport, such as being listened to, as central for a positive outcome of the intake. We concluded that implicit clinical judgments were vital to allow therapists to integrate the plethora of information from different channels of communication they collect during the intake

Oncology Healthcare Professionals’ Mental Health During the Covid-19 Pandemic

The paper begins by reviewing the literature on oncology healthcare professionals’ (HCP) mental health. We summarize and present the current data on HCP mental health in order to understand the baseline state of oncology HCPs’ mental health status prior to the COVID-19 pandemic. At each juncture, we will discuss the implications of these mental health variables on the personal lives of HCPs, the healthcare system, and patient care. We follow by reviewing the literature on these parameters during the COVID-19 pandemic in order to better understand the impact of COVID-19 on the overall mental health of HCPs working in oncology. By reviewing and summarizing the data before and after the start of the pandemic, we will get a fuller picture of the pre-existing stressors facing oncology HCPs and the added burden caused by pandemic-related stresses. The second part of this review paper will discuss the implications for the oncology workforce and offer recommendations based on the research literature in order to improve the lives of HCPs, and in the process, improve patient care

Lesbian, Gay, and Bisexual Adults Have Higher Prevalence of Illicit Opioid Use than Heterosexual Adults: Evidence from the National Survey on Drug Use and Health, 2015-2017

Purpose: We estimated illicit opioid use prevalence among LGB and heterosexual adults. Methods: Cross-sectional National Survey on Drug Use and Health data (2015-2017) were used to estimate illicit opioid use prevalence by sexual identity, age, and gender. Results: An estimated 1.1 million LGB adults used illicit opioids in the preceding 12 months (LGB adults: 9.8%; heterosexual adults: 4.24%). Prevalence of illicit opioid use was significantly higher among LGB women aged /bisexual men (18-25 and 50 +) compared with their heterosexual counterparts. Conclusions: Interventions targeting LGB illicit opioid use should account for possible differential minority stress associated with age and gender

Primary Mental Health Prevention Themes in Published Research and Academic Programs in Israel

Background: The World Health Organization Comprehensive Mental Health Action Plan (CMHAP) 2013-2020 proposes the implementation of primary prevention strategies to reduce the mental health burden of disease. The extent to which Israeli academic programs and published research adhere to the principles spelled out by the CMHAP is unknown. Objective: To investigate the presence of mental health primary prevention themes in published research and academic programs in Israel. Methods: We searched for mental health primary prevention themes in: (1) three major journals of psychiatry and social sciences during the years 2001-2012; (2) university graduate programs in psychology, social work and medicine in leading universities for the academic year of 2011-2012; and (3) doctoral and master\u27s theses approved in psychology and social work departments in five universities between the years 2007-2012. Results: Of the 934 articles published in the three journals, 7.2%, n=67, addressed primary prevention. Of the 899 courses in the 19 graduate programs 5.2%, n=47, elective courses addressed primary prevention. Of the 1960 approved doctoral and master\u27s theses 6.2%, n=123, addressed primary prevention. Only 11 (4.7%) articles, 5 (0.6%) courses, and 5 (0.3%) doctoral and master\u27s theses addressed primary prevention directly. Conclusions: The psychiatric reform currently implemented in Israel and WHO CMHAP call for novel policies and course of action in all levels of prevention, including primary prevention. Yet, the latter is rarely a component of mental health education and research activities. The baseline we drew could serve to evaluate future progress in the field

Uncovering the Intricacies of the Clinical Intake Assessment: How Clinicians Prioritize Information in Complex Contexts

Objective: Based on a single intake interview, mental health clinicians must distill their assessment to brief statements reflecting essential information. We explored how clinicians organize and prioritize the clinical information they collect during the initial assessment of their clients. Method: We conducted in-depth semistructured interviews with a convenience sample of 38 clinicians in four community-and hospital-based mental health clinics in Israel. Clinicians were interviewed immediately following an intake session with 117 clients and were asked about the client’s main problem, evaluation process, rapport with the client, and role of sociocultural factors in assessment. We identified primary themes across interviews. Results: Clinicians prioritized a psychiatric diagnosis based on DSM-5 categories, followed by psychological processes and family and social relationships. Less than a third of clinicians (29.1%) viewed sociocultural and socioeconomic factors as important in discerning expressions of distress. Conclusions: Our findings raise questions about how the structured expectation of diagnosis may influence how clinicians gather and prioritize information

Primary Mental Health Prevention Themes in Published Research and Academic Programs in Israel

Background: The World Health Organization Comprehensive Mental Health Action Plan (CMHAP) 2013-2020 proposes the implementation of primary prevention strategies to reduce the mental health burden of disease. The extent to which Israeli academic programs and published research adhere to the principles spelled out by the CMHAP is unknown. Objective: To investigate the presence of mental health primary prevention themes in published research and academic programs in Israel. Methods: We searched for mental health primary prevention themes in: (1) three major journals of psychiatry and social sciences during the years 2001-2012; (2) university graduate programs in psychology, social work and medicine in leading universities for the academic year of 2011-2012; and (3) doctoral and master\u27s theses approved in psychology and social work departments in five universities between the years 2007-2012. Results: Of the 934 articles published in the three journals, 7.2%, n=67, addressed primary prevention. Of the 899 courses in the 19 graduate programs 5.2%, n=47, elective courses addressed primary prevention. Of the 1960 approved doctoral and master\u27s theses 6.2%, n=123, addressed primary prevention. Only 11 (4.7%) articles, 5 (0.6%) courses, and 5 (0.3%) doctoral and master\u27s theses addressed primary prevention directly. Conclusions: The psychiatric reform currently implemented in Israel and WHO CMHAP call for novel policies and course of action in all levels of prevention, including primary prevention. Yet, the latter is rarely a component of mental health education and research activities. The baseline we drew could serve to evaluate future progress in the field

Presenting Problems and Treatment Expectations Among Service Users Accessing Psychiatric Outpatient Care: Are There Gender Differences?

Background: Community-based studies have documented gender differences in mental health problems and service utilization. This mixed methods study explored gender differences in severity of emotional distress, referral paths, presenting problems and care expectations among service users upon accessing outpatient psychiatric care. Methods: Consecutive service users (N=284, 64% women) who presented for a new or repeated episode of care in adult outpatient clinics completed questionnaires on a measure of emotional distress, treatment history and referral path. These variables were quantitatively analyzed. Also, users completed two open-ended questionnaires on reasons for seeking care and expectations from the services. These variables were qualitatively analyzed using thematic analyses. Results: No significant gender differences emerged on any of the variables examined among new and repeated users. The main reasons for seeking care were psychiatric symptoms as well as non-specific psychopathology. The most frequent expectations from the services were receiving psychotherapy and specific tools to better manage life problems. Limitations: The sample of new male service users was relatively small. Conclusions: Once care is initiated, men and women showed similar clinical presentation and care expectations