Literature Collection

BACKGROUND: Individuals with mental illnesses are disproportionately incarcerated in jails, which have become de facto mental health institutions across the US. Yet there is limited research describing mental healthcare practices from entry to release among multiple jails and states. METHODS: We conducted 34 semi-structured interviews with jail healthcare personnel across five Southeastern states and used the Framework Method to guide analyses. RESULTS: We report results on challenges and practices related to mental health staffing, screening, additional evaluations and services, and discharge planning in jails. Initial mental health screenings were often restricted to the detection of suicidality and history of treatment and medications as opposed to current mental health symptoms. Use of validated mental health screening forms was uncommon. We found delays in care between the initial health screening and being evaluated by a mental health professional. Most jails reported primary responsibilities for mental healthcare as preventing suicides and managing psychiatric medications. Jails reported mental healthcare as challenging to manage, with high volumes of individuals with mental health needs, yet limited resources, especially regarding staffing. Discharge planning was limited despite reports of poor continuity of mental health services. CONCLUSIONS: Jails have a constitutional duty to provide adequate healthcare to individuals with mental illnesses, yet practices are insufficient and resources are limited across jails. Based on our findings, we recommend 1) greater adoption and revisions of jail health standards 2) system improvement that expands identification of mental illnesses and quicker, less variable follow-up mental health evaluations, 3) improved linkages and supports for community resources that prevent incarceration of this population.

BACKGROUND: Mental illness poses a large and growing disease burden worldwide. Its management is increasingly provided by primary care. The prescribing of psychotropic drugs in general practice has risen in recent decades, and variation in prescribing rates has been identified by a number of studies. It is unclear which factors lead to this variation. AIM: To describe the variables that cause variation in prescribing rates for psychotropic drugs between general practices. METHODS: A narrative review was conducted in January 2018 by searching electronic databases using the PRISMA statement. Studies investigating causal factors for variation in psychotropic prescribing between at least two general practice sites were eligible for inclusion. RESULTS: Ten studies met the inclusion criteria. Prescribing rates varied considerably between practices. Positive associations were found for many variables, including social deprivation, ethnicity, patient age and gender, urban location, co-morbidities, chronic diseases and GP demographics. However studies show conflicting findings, and no single regression model explained more than 57% of the variation in prescribing rates. DISCUSSION: There is no consensus on the factors that most predict prescribing rates. Most research was conducted in countries with central electronic databases, such as the United Kingdom; it is unclear whether these findings apply in other healthcare systems. More research is needed to determine the variables that explain prescribing rates for psychotropic medications.

The mental status examination relies on the physician's clinical judgment for observation and interpretation. When concerns about a patient's cognitive functioning arise in a clinical encounter, further evaluation is indicated. This can include evaluation of a targeted cognitive domain or the use of a brief cognitive screening tool that evaluates multiple domains. To avoid affecting the examination results, it is best practice to ensure that the patient has a comfortable, nonjudgmental environment without any family member input or other distractions. An abnormal response in a domain may suggest a possible diagnosis, but neither the mental status examination nor any cognitive screening tool alone is diagnostic for any condition. Validated cognitive screening tools, such as the Mini-Mental State Examination or the St. Louis University Mental Status Examination, can be used; the tools vary in sensitivity and specificity for detecting mild cognitive impairment and dementia. There is emerging evidence for the validity of cognitive screening performed during telemedicine visits, but it should not replace in-person evaluation of patients who have comorbidities that would preclude reliable testing via telephone or video. The workup after abnormal results of a mental status examination or cognitive screening tool is based on clinical judgment and primarily focuses on ruling out reversible causes of impairment and considering the need for further neuropsychiatric evaluation.

While the benefits of mentorship programs are well established, their effective design, implementation, and sustainability remain complex and challenging. This perspective paper contributes to the mentorship literature by presenting key lessons learned from the implementation of a mentorship program in the emerging field of integrated health and social care. We suggest that prioritizing thoughtful mentor-mentee matching, promoting flexible and adaptable mentoring meeting formats, offering clear guidance for structured mentoring meetings, and acknowledging the reciprocal value of mentoring relationships can inform strategic approaches to strengthening mentorship programs in integrated care and beyond.

Background: Currently, the capacity to provide buprenorphine treatment (BT) is not sufficient to treat the growing number of people in the United States with opioid use disorder (OUD). We sought to examine participant retention in care rates of primary care delivered BT programs and to describe factors associated with retention/attrition for participants receiving BT in this setting.Objectives: A PRISMA-guided search of various databases was performed to identify the articles focusing on efficacy of BT treatment and OUD.Method: A systematic literature search identified 15 studies examining retention in care in the primary care setting between 2002 and 2020. Random effects meta-regression were used to identify retention rates across studies.Results: Retention rates decreased across time with a mean 0.52 rate at one year. Several factors were found to be related to retention, including: race, use of other drugs, receipt of counseling, and previous treatment with buprenorphine.Conclusions: While we only investigate BT through primary care, our findings indicate retention rates are equivalent to the rates reported in the specialty care literature. More work is needed to examine factors that may impact primary care delivered BT specifically and differentiate participants that may benefit from care delivered in specialty over primary care as well as the converse.

BACKGROUND: Rates of suicide following discharge from psychiatric hospitals are extraordinarily high in the first week post-discharge and then decline steeply over time. The aim of this meta-analysis is to evaluate the strength of risk factors for suicide after psychiatric discharge and to investigate the association between the strength of risk factors and duration of study follow-up. METHODS: A PROSPERO-registered meta-analysis of observational studies was performed in accordance with PRISMA guidelines. Post-discharge suicide risk factors reported five or more times were synthesised using a random-effects model. Mixed-effects meta-regression was used to examine whether the strength of suicide risk factors could be explained by duration of study follow-up. RESULTS: Searches located 83 primary studies. From this, 63 risk estimates were meta-analysed. The strongest risk factors were previous self-harm (odds ratio = 2.75, 95% confidence interval = [2.37, 3.19]), suicidal ideation (odds ratio = 2.15, 95% confidence interval = [1.73, 2.68]), depressive symptoms (odds ratio = 1.84, 95% confidence interval = [1.48, 2.30]), and high-risk categorisation (odds ratio = 7.65, 95% confidence interval = [5.48, 10.67]). Significantly protective factors included age ⩽30, age ⩾65, post-traumatic stress disorder, and dementia. The effect sizes for the strongest post-discharge suicide risk factors did not decline over longer periods of follow-up. CONCLUSION: The effect sizes of post-discharge suicide risk factors were generally modest, suggesting that clinical risk factors may have limited value in distinguishing between high-risk and low-risk groups. The highly elevated rates of suicide immediately after discharge and their subsequent decline remain unexplained.