The Contribution of the Mental Health Strategy for Canada to Changing Perceptions of Mental Health and Mental Illness

Chodos, Howard

doi:10.1037/e506852013-117

Cited by 6 publications

(7 citation statements)

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“…The evidence for these interventions also included reviews rated as a high (CBT) or medium (CBT and behavioral therapy) strength of evidence based on GRADE. The studies that examined CBT and BT were often conducted in the short term, and only one SR + MA examined the effect of online versus in-person CBT, which is an important question for future research given the cost of and difficulties accessing in-person CBT [88].…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews

et al. 2019

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BackgroundThis review aimed to assess the existing evidence regarding the clinical effectiveness and safety of pharmacological and non-pharmacological interventions in adults with insomnia and identify where research or policy development is needed.MethodsMEDLINE, Embase, PsycINFO, The Cochrane Library, and PubMed were searched from inception until June 14, 2017, along with relevant gray literature sites. Two reviewers independently screened titles/abstracts and full-text articles, and a single reviewer with an independent verifier completed charting, data abstraction, and quality appraisal.ResultsA total of 64 systematic reviews (35 with meta-analysis) were included after screening 5024 titles and abstracts and 525 full-text articles. Eight of the included reviews were rated as high quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool, and over half of the included articles (n = 40) were rated as low or critically low quality. Consistent evidence of effectiveness across multiple outcomes based on more than one high- or moderate quality review with meta-analysis was found for zolpidem, suvorexant, doxepin, melatonin, and cognitive behavioral therapy (CBT), and evidence of effectiveness across multiple outcomes based on one high-quality review with meta-analysis was found for temazepam, triazolam, zopiclone, trazodone, and behavioral interventions. These interventions were mostly evaluated in the short term (< 16 weeks), and there was very little harms data available for the pharmacological interventions making it difficult to evaluate their risk-benefit ratio.ConclusionsAssuming non-pharmacological interventions are preferable from a safety perspective CBT can be considered an effective first-line therapy for adults with insomnia followed by other behavioral interventions. Short courses of pharmacological interventions can be supplements to CBT or behavioral therapy; however, no evidence regarding the appropriate duration of pharmacological therapy is available from these reviews.Systematic review registrationPROSPERO CRD42017072527.

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Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews

et al. 2019

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“…Furthermore, recovery is considered to occur in the context of one's lifespan, from admission to discharge from inpatient psychiatric settings. 13,14 While this model of care has been incorporated widely in community and outpatient mental health settings, its integration into inpatient psychiatric settings remains limited. 15,16 Reconceptualizing overarching aims of inpatient psychiatric care through the lens of the recovery-oriented practice model can be beneficial in this case and similar cases in which questions of safety and risk are being evaluated.…”

Section: Recovery-oriented Practice Modelmentioning

confidence: 99%

“…In the case of LH, Dr Psych's application of a recovery-oriented lens would affirm her autonomy and build her capacity for vigilance for her own safety and well-being; such an approach has been shown to reduce patients' feeling of being "imprisoned." 13,14 Promoting LH's personal efficacy and responsibility might involve Dr Psych supporting activities-such as access to the garden-that include some element of risk but enhance her well-being and give her an opportunity to work toward maintaining her own safety during her inpatient stay. While supporting LH's access to the garden does have potential for risk, Dr Psych's taking a recovery-oriented approach to practice within a broader safety paradigm would reorient the goal of a psychiatric inpatient stay from risk elimination to collaboratively supporting the patient's skills and capacity for maintaining safety and well-being during and following hospitalization.…”

Section: Recovery-oriented Practice Modelmentioning

confidence: 99%

When Should Inpatient Psychiatric Care Include Access to the Outdoors, Despite Elopement or Other Risks?

2024

AMA Journal of Ethics

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This commentary on a case considers consequences of a so-called "zerorisk" paradigm now common in psychiatric inpatient decision making. Iatrogenic harms of this approach must be balanced against promoting patients' safety and well-being. This article suggests how to collaboratively assess risk and draw on recovery-oriented goals of care.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case LH is a 29-year-old woman hospitalized, so far for 11 days, for a severe episode of depression. Dr Psych estimates she will be hospitalized for another week and is working with risk managers to find a way to allow LH to leave the unit with a staff member to walk in the hospital's garden, which LH can see from the unit's windows. LH feels distressed about not having access to fresh air. Dr Psych makes a case to a risk manager for LH's accompanied access to the garden: it will make her feel better, probably diminish her length of stay, and remove LH's feeling "imprisoned" as an obstacle to trust and healing in their patient-physician relationship. The risk manager, however, states: "I'm sorry; we just can't. Two years ago, a patient eloped after being allowed to walk in that garden." Dr Psych considers how to respond. CommentaryHealth care systems, particularly psychiatric care settings, are currently dominated by a zero-risk paradigm: an approach to ethical decision making that upholds elimination of risk as a shared goal and moral imperative. 1,2 The widespread adoption of the zero-risk approach has given rise to dedicated roles for risk managers and a range of interventions and technologies, including, in inpatient psychiatric settings, the use of surveillance, locked doors, and seclusion rooms, all aiming to eliminate risks associated with people experiencing mental health challenges. 3,4 Yet growing empirical evidence demonstrates that the zero-risk paradigm and its associated strategies fail to effectively eliminate or even reduce risks associated with self-harm, interpersonal violence, or absconding and instead threaten therapeutic relationships between health care professionals and patients. 5,6 Furthermore, zero-risk approaches introduce iatrogenic

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“…Counselling literature consistently shows that the willingness to seek and utilize services is dependent on how accessible and appropriate they are to the person’s needs (Chodos, 2017; Mental Health America, 2021; Pahwa et al, 2012; Williamson, 2014). Accessibility and appropriateness of services have many factors that go beyond what is immediately visible, including culturally held attitudes, institutional racism, and other barriers.…”

Section: Institutional and Social Organization Of Cultural Competencementioning

confidence: 99%

Preparing student therapists to work with Black mental health: Attending to the social and institutional organization of “culture” in Canadian counsellor education.

Smith¹,

Doyle²

2022

Canadian Psychology / Psychologie canadienne

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The current mental health needs of Black populations are significantly heightened, as more public occurrences of racial discrimination, systematic oppression, and violence have shed light on the adversities Black people experience in their everyday life. Despite this, many Canadian Black people are underutilizing psychological resources. The dominant approaches to research and practice have historically focused on identifying and addressing barriers to clients seeking care, rather than accessibility and appropriateness of the services offered. There is currently a dearth of information considering how the current focus impacts racialized students in their counselling programmes, and consequently their work as student therapists. In this article, we extend the invitation to further consider, from the standpoint of a racialized student, an example of how “culture” is both taught and performed in the fields of counsellor education, with implications for supervised student therapeutic practices and beyond.

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The Contribution of the Mental Health Strategy for Canada to Changing Perceptions of Mental Health and Mental Illness

Cited by 6 publications

References 0 publications

Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews

Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews

When Should Inpatient Psychiatric Care Include Access to the Outdoors, Despite Elopement or Other Risks?

Preparing student therapists to work with Black mental health: Attending to the social and institutional organization of “culture” in Canadian counsellor education.

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