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This chapter explores how primary care physicians deliver mental health treatment for Medicaid patients in one county in the United States, and how treatment may have changed after HMO enrollment with a mental health carve-out. We utilize Lipsky's theory of street-level bureaucracy to better understand how primary care physicians treat Medicaid patients for depression and what types of insurance arrangements support or inhibit that treatment. Exploratory interviews with 20 physicians revealed that the patient's status as a non-voluntary client, service system barriers and physicians’ commitment to treatment caused them to bear primary responsibility for the majority of depression care. Physicians were willing to act as advocates for their clients and viewed such advocacy as ethical given the lack of mental health parity. In general, primary care physicians were not familiar with new policies dictating mental health carve-outs for Medicaid patients, nor were they concerned with how mental health care was reimbursed for their patients. However, they were willing to provide mental health care even if they were not reimbursed. Physicians rely upon medication management to treat depression, and reimbursement plays a role in the amount of time spent with patients and in the coding used for the visit. Lipsky's (1980) theory of street-level bureaucracy provides a useful framework for understanding how physicians will act as advocates for their clients in the face of structural as well as resource constraints on health care.

Educators play a vital role in supporting tertiary education students’ mental health, as they have frequent interactions with their students. However, information on the strategies and difficulties educators face in this area is scarce, particularly within the multi-ethnic Asian population. Therefore, this study aims to explore Malaysian educators’ roles and challenges in handling students with mental health issues.

Semi-structured interviews were conducted with a sample of 12 educators from tertiary education in Malaysia. All interviews were recorded, transcribed and analysed using thematic analysis.

Four themes were emerged: perceived factors contributing to mental health issues among students, educators’ strategies in supporting students’ mental health, difficulties in supporting students’ mental health and training to support students’ mental health.

To the best of the authors’ knowledge, this is the first study exploring the roles and challenges educators face in supporting tertiary education students’ mental health in Malaysia.

STEPS is a primary care mental health team that has attempted to develop a very high volume multi‐level, multi‐purpose service for those with mild to moderate problems. The service attempts to overcome many of the limitations of more traditional services. This paper describes the services contained within the six level model.

This paper aims to evaluate service user (SU) and clinician acceptability of video care, including future preferences to inform mental health practice during COVID-19, and beyond.

Structured questionnaires were co-developed with SUs and clinicians. The SU online experience questionnaire was built into video consultations (VCs) via the Attend Anywhere platform, completed between July 2020 and March 2021. A Trust-wide clinician experience survey was conducted between July and October 2020. Chi-squared test was performed for any differences in clinician VC rating by mental health difficulties, with the content analysis used for free-text data.

Of 1,275 SUs completing the questionnaire following VC, most felt supported (93.4%), and their needs were met (90%). For future appointments, 51.8% of SUs preferred video, followed by face-to-face (33%), with COVID-related and practical reasons given. Of 249 clinicians, 161 (64.7%) had used VCs. Most felt the therapeutic relationship (76.4%) and privacy (78.7%) were maintained. Clinicians felt confident about clinical assessment and management using video. However, they were less confident in assessing psychotic symptoms and initiating psychotropic medications. There were no significant differences in clinician VC rating by mental health difficulties. For future, more SUs preferred using video, with a quarter providing practical reasons.

The study provides a real-world example of video care implementation. In addition to highlighting clinician needs, support at the wider system/policy level, with a focus on addressing inequalities, can inform mental health care beyond COVID-19.

This chapter depicts the burden of suicidal behavior among African American males. It describes the public health approach to preventing suicidal behavior among African American males. This approach includes assessing and describing the problem; identifying causes or risk and protective factors; developing and evaluating programs and policies; and implementing and disseminating findings and activities. The chapter provides a review of the epidemiology of fatal and non-fatal suicidal behavior; a summary of what is known about the risk and protective factors of the problem; and a descriptive analysis of the circumstances associated with suicides among young African American males is presented. Lastly, the authors give a summary of evidenced-based prevention programs which could be applied in preventing male suicidal behavior.

The purpose of this study is to evaluate a conflict management training that used a communication competence perspective. This addresses whether the training had an impact on role conflict, conflict resolution skills, horizontal violence, burnout, turnover intention and perceptions of consumers. It also assessed staff perceptions of the training.

A mixed-method analysis was used using survey data from multiple time points along with focus group interviews.

The program decreased role conflict, horizontal violence and burnout among direct-care workers, whereas feelings of safety and perceptions of workers’ ability to protect themselves and others in aggressive situations increased. Furthermore, staff felt the training was useful and increased feelings of safety and empowerment at the study.

These findings suggest that conflict management training may need additional refresher sessions. Administrative planning is also needed to ensure training of all staff is trained in an adequate timeframe.

These results, although positive, are somewhat time bound. Therefore, the content of training and knowledge dissemination of conflict management training need additional research to ensure best practices.

This paper addresses access to formal health care among Cape Verdean immigrants in the Netherlands, and their transnational health‐seeking process in other European countries. Three barriers hindering Cape Verdeans' access to care have been identified: lack of information about the health services available, problems in the relationship with health providers and difficulties in dealing with the conditionality of help. These problems are deeply intertwined, and relate to two sets of factors. At the macro‐level these include the organisational and structural characteristics of the Dutch health care system. At the micro‐level, the problems concern the mismatch between users' and providers' expectations of health care provision.Despite the barriers encountered, Cape Verdeans strive to benefit from good health. The informants in this study employ two sorts of strategy to access good health care. On the one hand, they try to adapt their help‐seeking behaviour to the model prevalent in the Netherlands. On the other, they resort to transnational health care use in other European countries, including Portugal and France. These strategies prove Cape Verdeans' resilience in finding the care that is most appropriate to their needs.

Music therapy programs are increasingly common and necessary in mental health services. However, there is little knowledge of the key factors which influence the successful implementation of new therapeutic programs. The purpose of this paper is to explore how stakeholder input influenced the implementation and sustainability of a new music therapy program in four services within a large government funded mental health department in Melbourne, Australia.

For a period of 12 months, two cycles of assessment, action and evaluation were conducted where data were collected through interviews with staff members, feedback from consumers and attendance in sessions.

A number of influential factors were identified as important in the successful implementation and future sustainability of the music therapy program. These included: the degree of staff support received; how the program was structured and facilitated; promotion of the program within the service; evaluation of the program; and congruence with the existing therapeutic program.

Results suggest that successful implementation and future sustainability of a music therapy program is dependent on the flexibility of the program to the context and culture of the existing setting.

This is the first study to incorporate contributions from stakeholders in the implementation of a new music therapy program in a mental health service.

The purpose of this paper is to summarise the development of a recovery-oriented and socially inclusive acute care clinical psychology service in one of the NHS Trusts based in East Anglia. It demonstrates the service's compliance with relevant national policies and guidelines, and addresses some of the criticisms directed at acute mental health care in recent years. Both achievements and difficulties are reflected on.

The paper employs an organisational development case example related to applicable clinical practice model, based on national guidelines and policies, in order to demonstrate that it is possible to develop and implement a recovery-oriented clinical psychology practice in acute inpatient mental health care. This is based on the authors, experiences as a public sector clinical psychologists specialising in complex, severe, and enduring mental health needs.

Clinical psychologists may effectively contribute to the development of psychosocially informed and recovery-based multidisciplinary attitudes towards emotional difficulties of individuals admitted to psychiatric wards.

Future service development project of similar nature ought to implement standardised measures (e.g. ward atmosphere scales) to increase validity of findings.

Despite limited, and continuously decreasing, resources in the NHS it appears possible to develop and establish a successful and objectively replicable provision of recovery-based psychological services across an entire acute care mental health pathway.

Recovery-enhancing clinical psychology interventions should not be limited to those receiving care from community-based services only. Building psychologically informed understanding of mental health needs should be employed on inpatient wards too, in order to counterbalance the dominating biomedical models of mental illness.

Dissemination of examples of effective psychosocial practice in acute mental health settings appears largely underrepresented.