Objective: Mental health readmissions are often experienced as emotionally taxing by mental healthcare workers, yet their causes and nuanced impact on workers' compassion and capacity to sustain caregiving remain underexplored. This qualitative study examines three domains of readmissions: perceived causes, impact on compassion fatigue among mental healthcare professionals, and strategies to mitigate these effects.Method: The compassion fatigue framework was used to formulate research questions used in 20 in-depth interviews with mental health professionals. A qualitative phenomenological approach within a constructivist paradigm was adopted, with data analysed using thematic analysis.Results: Ten key themes were identified across the three domains. First, three perceived causes of readmissions emerged, namely, Environmental Instability, Clinical and Discharge Barriers, and Compromised Patient Autonomy. Next, readmissions were linked to a progressive erosion of compassionate engagement of healthcare workers, expressed through Compassion Depletion, Professional Erosion, and Team Disconnect. Finally, participants articulated four strategies -Mindful Adjustment, Collaborative Resilience, Workforce Empowerment, and the adoption of Critical Intervention Pathways to sustain compassionate practice.Discussion: This research advances current understanding by highlighting the perceived emotional impact of mental health readmissions and identifying practitioner-informed, resilience-oriented strategies. These findings offer contextually grounded insights that may help inform efforts to support workforce wellbeing while enhancing continuity of care.
Objective 'Let's Talk About Voices' (LTAV) is a resource that uses a hearing voices approach to support people to manage voice hearing. This study's purpose was to evaluate its impact on voice-hearers' attitudes to and experiences with voices.Methods A pre-post design was used. Forty-nine voice-hearers completed the Voices Acceptance and Action Scale (VAAS9) and Southampton Mindfulness of Voices Questionnaire (SMVQ) before and after being introduced to LTAV. Fifteen also completed these measures at one-month follow-up. Paired t-tests were used to compare measures between times. Comparative analyses using unpaired t-test and ANOVA were performed for subgroups by gender, duration of voice hearing and level of engagement with the resources. Voice-hearers reported their perspectives about the usefulness and impact of LTAV.Results Average scores on both measures showed a numeric increase from Time 1 to Time 2 (VASS-9: mean change score 1.8, 95% confidence interval [CI] = 0.4 to 3.1; SMVQ: mean change score 1.7, 95% CI = -0.0 to 4.5) and from Time 2 to Time 3 (VASS-9: mean change score 0.7, 95% CI = -0.8 to 2.1; SMVQ: mean change score 1.5, 95% CI = -0.5 to 3.1). Change in VAAS-9 from Time 1 to Time 2 was statistically significant with a moderate effect size (t = 2.7; p = 0.010; d = 0.383). Other comparisons were not statistically significant. People experiencing voice hearing for less than 5 years reported a significantly higher improvement on the SMVQ than others (F 2,43= 3.4, p = .043). Participants indicated that they valued the resources and believed they had made a difference in their lives.Conclusion The relatively promising findings in this proof-of-concept study suggest that LTAV may be a useful resource for mental health workers to use with voice-hearers and justify further research using a controlled design.
Objective: Mental health help-seeking attitudes are shaped by multiple barriers, including stigma, attitudes towards professional care, sociodemographic characteristics, and familiarity with mental illness. Untreated mental health issues can have significant detrimental effects on individuals and society. While mental health care has progressed in Ghana, help-seeking has historically been led by traditional healers, spiritualists, and family members rather than professional providers, an approach that may be associated with poorer health outcomes. This study examined help-seeking attitudes and their relationship to demographics, health literacy, and mental health beliefs.Method: A total of 676 adults were recruited from public spaces in Accra and Tamale by a multiethnic, bilingual research team. Participants completed an anonymous Qualtrics survey available in English, Dagbani, or Twi, which included standardized measures and non-identifying demographic questions. Descriptive statistics, bivariate analyses, and a structural regression analysis were conducted using IBM SPSS and Amos.Results: The final regression model, which included gender, educational level, mental health knowledge, and self-stigma, explained 30.2% of the variance in attitudes towards professional help-seeking. Females and individuals with a greater mental health knowledge and lower self-stigma were more likely to endorse positive attitudes towards seeking professional care. In contrast, lower levels of education were associated with less favorable help-seeking attitudes.Discussion: Findings contribute to global health promotion by identifying culturally relevant factors that shape access to mental health care and informing strategies to improve health equity in low-resource settings. Implications for mental health practice, policy, and future research are discussed.
ObjectiveHormonal fluctuations during menopause can exacerbate symptoms of Attention Deficit Hyperactivity Disorder (ADHD). The present study aimed to understand women's actual lived experiences and the impact on their daily lives.MethodEight women experiencing symptoms associated with perimenopause or menopause were recruited from a UK social media platform for people with ADHD. They participated in semi-structured interviews and data were subject to reflexive thematic analysis.ResultsTwo themes were identified: (1) Revelations, comprising two subthemes: collapse of coping strategies, and unmasking. Participants reported how exacerbation of ADHD symptoms and disruption of established coping mechanisms led to diagnosis seeking. New coping strategies were developed and identity re-evaluated. Theme 2 reflected the need for greater understanding and support from personal and professional networks, underscoring the necessity for increased awareness among healthcare professionals, but also a lack of understanding from family and friends. Participants emphasised the value of peer support and shared experience with other women.DiscussionThis study contributes to the limited literature on ADHD in midlife women. It highlights the gendered nature of their experience, the specific challenges women face in navigating everyday life, and the importance of tailored neurodiversity-informed interventions to improve quality of life during this period.
Objective:One in twenty adults in the U.S. experiences a mental illness, and research suggests that diagnoses are on the rise. Furthermore, the leading causes of morbidity and mortality in the U.S. are primarily attributable to health behaviours. Therefore, preparing future medical providers to address behavioural health issues is increasingly important. However, research has not explored whether clinical training leaves providers confident in their ability to do so. The aim of this study was to evaluate medical and nursing students' perceived preparedness and intentions regarding their future patients' behavioural health.Methods:Data were collected via an online survey from medical and nursing students. Participants answered questions about their behavioural health education and training, as well as how well it prepares them to discuss these issues.Results:Nearly half the students expressed confidence in their ability to discuss behavioural health, but a similar proportion believed that their preparation was inadequate. Despite lower perceived preparedness, a majority of students expressed the intention to discuss behavioural health issues. There was no difference between medical and nursing students in their responses regarding perceived competence and willingness to discuss behavioural health.Discussion:Results highlight a potential gap between students' willingness to discuss behavioural health and their perceived preparedness, underscoring the potential need to reassess the training provided to future healthcare providers.
Background: Young Australians experiencing homelessness are at elevated risk of suicidal thoughts and behaviors. LivingWorks' safeTALK training teaches people the necessary skills for responding to someone thinking of suicide, including how to connect them with further support.Aims: To evaluate the feasibility of delivering safeTALK training to young people with experience of homelessness.Method: Eleven young people aged 16-25 participated in the safeTALK training. Participants completed questionnaires immediately pre- and post-training, and 3-months post-training. Four participants completed the questionnaires at all three timepoints and five completed a follow-up telephone interview.Results: All participants felt more confident helping someone at risk of suicide after completing the safeTALK training. However, ethical and procedural requirements meant that we were unable to organise more than one training session.Limitations: Ethical requirements around suicide risk, as well as LivingWorks requiring a minimum group size, were significant limitations when attempting to organise training sessions with this population.Conclusion: While there is a demand for peer-based, gatekeeper suicide interventions, as well as preliminary evidence that safeTALK improves confidence, safeTALK as it is currently delivered was not a feasible training program for this population. Tailored training for young people experiencing homelessness should be considered as an alternative.
Objective: This study offers a first-hand qualitative examination of how on-the-ground delivery processes shape the effectiveness of contact-based education interventions for reducing mental health stigma. We aimed to identify the delivery features, facilitators, and barriers influencing implementation and engagement, addressing a gap in stigma research that has largely prioritised outcomes over delivery processes.Method: We explored the perspectives of 18 intervention delivery staff using semi-structured focus groups. Data were analysed using reflexive thematic analysis to examine experiential accounts of delivery alongside broader contextual and structural influences on implementation.Results: Participants identified lived experience storytelling, peer-led delivery, relatable framing, and strategic pacing as central to effective delivery. Facilitators included supportive physical and temporal conditions, strong stakeholder alignment, optimal audience dynamics, and delivery team cohesion. Barriers included environmental and logistical disruptions, insufficient contextual audience information, stakeholder disengagement, systemic inequities, and team fatigue. Importantly, delivery tone, energy, authenticity, and relational engagement were viewed as equally, if not more, important than content in promoting meaningful engagement and stigma reduction.Discussion: Findings highlight delivery as a central mechanism of impact and inform the development of responsive, context-sensitive initiatives that are evidence-based in both content and delivery, grounded in lived experience, and adaptable to real-world settings.
Objective:Integrated medical and behavioural health care promotes timely access to mental health services and warrants evidence-based brief therapy for optimal early intervention. Solution-focused brief therapy (SFBT) has shown benefits in integrated care, but additional insight is needed regarding best practices for SFBT implementation.Method:The present study reports findings from a cluster randomised evaluation of SFBT implementation in 12 integrated care agencies across a midwestern U.S. state. Half of the agencies were randomly assigned to a local champion component involving additional training of designated champions who provided consultation and implementation support at their agency. The evaluation assessed implementation outcomes of the initiative and potential benefits of local champions using mixed methods analysis of provider surveys and focus groups.Results:Quantitative analysis showed benefits of local champions for higher implementation ratings but similar improvements in adoption, fidelity, and feasibility at both champion and non-champion agencies. Qualitative analysis explored facilitators and barriers to SFBT implementation, with mixed methods analysis highlighting improved efficiency and a point person for ongoing support as key factors in SFBT implementation.Conclusion:The study provides helpful insights into factors influencing SFBT implementation in integrated care with further research needed on the best approaches for providing implementation support.
Objective: Racism is increasingly recognised as a determinant of poor health, including mental health. Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that has historically been under-diagnosed in women, particularly women from racially minoritised groups. This study aimed to explore the lived experiences of Black women in the United Kingdom (UK) who were formally diagnosed with ADHD in adulthood. Method: Seventeen Black women aged 23 to 54 years participated in qualitative interviews using an interpretivist intersectional paradigm focused on multiple ways of 'being in the world'. Data were analysed using Reflexive Thematic Analysis. Results: Three main themes were generated: (1) Cultural narratives of mental health and neurodivergence, (2) Being a Black woman with ADHD and (3) Navigating healthcare as a Black woman with ADHD. Participants reported stigma, mistrust, and negative or uninformed attitudes towards ADHD. They also encountered misogynoir, stereotyping, and a sense of invisibility as Black women with ADHD. These factors created significant barriers to accessing and navigating healthcare.Discussion: The experiences of Black women with ADHD are shaped by intersecting racial, gendered, and neurodivergence-related discrimination. Addressing inequalities in ADHD care and treatment will also require more equitable recognition, assessment, and support for this group.
ObjectivePrimary care is the largest platform for continuous, person-centred, relationship-based care in the United States of America. Integrating mental and behavioural health into primary care may help meet demand for clients needing this care and relies on interdisciplinary primary care team members functioning well.MethodThis qualitative evaluation of an integrated behavioural health program in seven family medicine clinics gathered in-depth, semi-structured interviews from 46 practice members - physician medical directors, practice administrators, psychologists, and psychiatrists. The 'Big Five' of teams framework from Salas, et al. provided an analytical framework to deeply examine components of effective teamwork: team leadership, mutual performance monitoring, backup behaviour, adaptability, and team orientation. A team-based analysis approach used grounded theory techniques for coding with a priori segmenting codes and deductive coding.ResultsPractice teams benefitted from visible and supportive team leadership, capable mutual performance monitoring, skilful backup behaviours, adaptability, and strong and cooperative team orientation. Teams further benefited from supporting mechanisms: a shared overall mental model of integrated behavioural health, mutual trust among team members, and effective closed-loop communications.DiscussionThe 'Big Five' in teams framework illuminated areas of team functioning useful for this evaluation and may be useful when examining other interprofessional healthcare teams.
ObjectiveThis study examined the effectiveness of the Learn Mental Health (LMH) modules, delivered through Bachelor and Master of Education courses, in improving educators' mental health literacy (MHL), reducing stigma and enhancing their ability to identify student mental health needs.MethodEmploying a longitudinal two-wave pre/post treatment design with active and passive control groups, the study involved Bachelor of Education and Master of Education students at Saint Francis Xavier University during the 2022-2023 academic year. Participants (N = 296) were assigned to a treatment group (LMH modules), an active control group (alternative mental health content) or a passive control group (no content). Pre- and post-intervention measures assessed MHL, stigma and the Vignette-based Student Evaluation Scale (VSES).ResultsANCOVA and mixed two-way ANOVA revealed significantly greater gains in overall MHL for the LMH group compared to both control groups. Improvements were observed across most MHL domains, except knowledge of effective treatments. No significant differences emerged for stigma or VSES scores between groups.DiscussionLMH modules appear effective in enhancing educators' MHL when embedded in coursework. However, further strategies may be needed to reduce stigma and improve recognition of student mental health concerns.
Objective: Supervision in mental health nursing varies in quality and accessibility between workplaces. Influencing factors are complex, multifactorial and not without challenges. This study explores key enablers of Clinical Supervision, how we anchor them in public sector mental healthcare and overcoming key barriers to Clinical Supervision sustainability. Method: A Community of Practice joined nine clinical supervision mental health nursing experts from Australia and New Zealand to qualitatively explore the questions based on their shared experience. Online discussions were recorded and transcribed verbatim, thematically analysed using NVivo, and coding was summarised into themes. Iterative analysis brought coding to each meeting for analysis by all authors. Results: Individual knowledge and confidence, leadership and workplace champions, and strong professional identity were identified as influences on rates and quality of clinical supervision. Additional themes of culture, responsibility and interprofessional differences were identified as influencing the uptake of clinical supervision in public mental health settings. Recommendations to improve clinical supervision uptake and quality include workplace sustainability, local level leadership and education. Discussion: Clear and widely accepted definitions and understanding across tertiary education institutions and the mental health workforce are needed to facilitate widespread uptake of good quality clinical supervision.
ObjectiveGiven the significant extent of mental health conditions like anxiety and depression, effective prevention and treatment offers are imperative. Prompt Mental Health Care (PMHC) is a service model offering low-threshold treatment for individuals with mild to moderate anxiety or depression, initial substance use, or sleep difficulties. While external implementation support can enhance the adoption and sustainability of such models, its role in PMHC remains underexplored. This study investigates the experiences of PMHC providers with external implementation support.MethodA qualitative exploratory design was employed. Twenty-two managers and team members from nineteen PMHC teams across Norway participated in focus group interviews. Data were analysed using reflexive thematic analysis.ResultsThree main themes emerged: (1) Cultural and relational implementation support, fostering team cohesion and a shared identity. (2) Organisational implementation support, facilitating integration into municipal structures, the navigation of administrative challenges, and supporting model fidelity. (3) Operational implementation support, promoting treatment quality and efficiency.DiscussionOverall, the results highlight that external implementation support is highly valued and perceived as critical for the successful and sustainable implementation of PMHC, underscoring the need for comprehensive support strategies to integrate evidence-based mental health models in primary healthcare effectively.
