The use of Mobile Crisis Teams (MCTs) as a means to address behavioral health crises has demonstrated a number of positive benefits, for both individuals in crisis and health systems, but implementing these community-based responses presents challenges. Medicaid expansion grants, as part of the American Rescue Plan, afforded many states and local agencies with the opportunity to expand mobile crisis intervention services, but agency approaches and timelines widely differed both within and between states. This study investigates how service providers perceive the implementation of MCTs in Kentucky, using a multi-site approach to highlight the different challenges faced within urban and rural regions of the state. Researchers conducted semi-structured interviews and focus groups (n = 60) as a method for qualitative date collection among individuals in administration and leadership positions of four community mental health centers who were charged with coordinating regional efforts, as well as stakeholders from first response organizations and local government agencies. The results of this descriptive qualitative design offered insight into implementation barriers within three emergent themes: workforce shortages, access to services, and lack of collaboration. This study offers insight into the perceived barriers to implementing and expanding MCTs in Kentucky ranging from difficulties with workforce recruitment and retention, challenges with accessing individuals in need, and siloing of efforts between agencies. Findings suggest that diversifying staffing can offset workforce shortages, partnerships with first response agencies may provide enhanced feelings of safety, and inform targeted, context-specific investment in crisis response systems in other locales.
This study sought to examine Australian health practitioners’ knowledge, practices, and attitudes regarding lifestyle psychiatry to help elucidate factors driving an implementation gap. A convergent parallel mixed methods design was employed using an online survey with closed- and open-ended questions on eight lifestyle interventions. 212 eligible health practitioners working in or referring to mental health settings completed an online survey. Descriptive analyses were used for quantitative data, and conventional content analysis for qualitative data. Results indicated that 73.6
Although many genetic disorders known to be associated with the development of psychosis have been well-characterized, little is known about how common such diagnoses are among patients receiving care through Early Psychosis Intervention Programs in the real world, and what, if any, impact their identification has on the clinical care provided in this context. As such, this observational, retrospective study, which took place in Calgary, Alberta, Canada, sought to explore the spectrum of rare genetic variants harbored by individuals enrolled in an early psychosis program, with a particular focus on the circumstances surrounding why a genetic explanation was suspected, how a diagnosis was made, and any resultant clinical implications. Charts of 899 patients were screened. Thirteen individuals were documented to have at least one rare variant of possible or likely clinical significance. Five individuals’ variants were thought to be pathogenic and likely contributed to the development of their psychotic illness, whereas an association (direct or otherwise) was plausible but speculative in eight cases. One additional patient’s variant was thought to be non-contributory. Owing to a variety of suggestive phenotypic features, a genetic etiology was first suspected by psychiatry in seven cases, with consequent implications in five of these. The results demonstrate that a small subset of individuals supported by Early Psychosis Intervention Programs may have one or more clinically relevant genetic variants, underscoring the need for psychiatrists working in such settings to consider this possibility and, where appropriate, pursue relevant testing and/or a referral to medical genetics.
Court-Ordered Treatment (COT) is used to address treatment non-adherence and psychiatric readmission in individuals with serious mental illness (SMI), who are at risk for treatment non-adherence and recurrent psychiatric hospitalization. Evidence regarding clinical outcomes associated with COT remains mixed, partly due to differences in legal frameworks and program implementation. To compare psychiatric readmission, outpatient appointment attendance, and long-acting injectable (LAI) medication adherence during COT and during the year following COT expiration in Arizona’s public behavioral health system. This exploratory, retrospective chart review identified 94 patients placed on COT between 2020 and 2021. Paired within-subject analyses included 29 patients whose COT expired and who completed a full one-year follow-up after COT expiration. Outcomes during COT were compared with outcomes during the year after COT expiration. Among the 29 patients analyzed, psychiatric hospital admission rates rose significantly from 10.3
