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Concept: Mental health professional


Depression is often co-morbid with chronic conditions, and when combined with HIV it can increase progression and reduce survival. A brief and accurate screening tool for depression among children living with HIV is necessary to increase access to mental health care and improve HIV-related outcomes in the long-term.

Concepts: Health care, Psychology, Medicine, Health, Mental health, Illness, Mental disorder, Mental health professional


The experience of burnout has been the focus of much research during the past few decades. Measures have been developed, as have various theoretical models, and research studies from many countries have contributed to a better understanding of the causes and consequences of this occupationally-specific dysphoria. The majority of this work has focused on human service occupations, and particularly health care. Research on the burnout experience for psychiatrists mirrors much of the broader literature, in terms of both sources and outcomes of burnout. But it has also identified some of the unique stressors that mental health professionals face when they are dealing with especially difficult or violent clients. Current issues of particular relevance for psychiatry include the links between burnout and mental illness, the attempts to redefine burnout as simply exhaustion, and the relative dearth of evaluative research on potential interventions to treat and/or prevent burnout. Given that the treatment goal for burnout is usually to enable people to return to their job, and to be successful in their work, psychiatry could make an important contribution by identifying the treatment strategies that would be most effective in achieving that goal.

Concepts: Health care, Psychology, Medicine, Mental health, Mental disorder, Psychiatry, Mental health professional, Psychiatrist


IMPORTANCE There have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance. OBJECTIVE To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties. DESIGN, SETTING, AND PARTICIPANTS We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not. MAIN OUTCOMES AND MEASURES Our main outcome variables were physician acceptance of new patients with private noncapitated insurance, Medicare, or Medicaid. Our main independent variables were physician specialty and year groupings (2005-2006, 2007-2008, and 2009-2010). RESULTS The percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% [95% CI, 46.7%-63.8%] vs 88.7% [86.4%-90.7%]; P < .001) and had declined by 17.0% since 2005-2006. Similarly, the percentage of psychiatrists who accepted Medicare in 2009-2010 was significantly lower than that for other physicians (54.8% [95% CI, 46.6%-62.7%] vs 86.1% [84.4%-87.7%]; P < .001) and had declined by 19.5% since 2005-2006. Psychiatrists' Medicaid acceptance rates in 2009-2010 were also lower than those for other physicians (43.1% [95% CI, 34.9%-51.7%] vs 73.0% [70.3%-75.5%]; P < .001) but had not declined significantly from 2005-2006. Psychiatrists in the Midwest were more likely to accept private noncapitated insurance (85.1%) than those in the Northeast (48.5%), South (43.0%), or West (57.8%) (P = .02). CONCLUSIONS AND RELEVANCE Acceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.

Concepts: Health care, Medicine, Health insurance, Mental health, Physician, Psychiatry, Mental health professional, Psychiatrist


Perhaps because gastroenterology, immunology, toxicology, and the nutrition and agricultural sciences are outside of their competence and responsibility, psychologists and psychiatrists typically fail to appreciate the impact that food can have on their patients' condition. Here we attempt to help correct this situation by reviewing, in non-technical, plain English, how cereal grains-the world’s most abundant food source-can affect human behavior and mental health. We present the implications for the psychological sciences of the findings that, in all of us, bread (1) makes the gut more permeable and can thus encourage the migration of food particles to sites where they are not expected, prompting the immune system to attack both these particles and brain-relevant substances that resemble them, and (2) releases opioid-like compounds, capable of causing mental derangement if they make it to the brain. A grain-free diet, although difficult to maintain (especially for those that need it the most), could improve the mental health of many and be a complete cure for others.

Concepts: Immune system, Psychology, Medicine, Nutrition, Immunology, Human behavior, Psychiatry, Mental health professional


Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes.

Concepts: Health care, Health care provider, Psychology, Clinical trial, Illness, Clinical psychology, Psychiatry, Mental health professional


Background Reflective practice groups have been recommended for improving staff wellbeing and team functioning in inpatient psychiatric services, and clinical psychologists have been identified as potential leaders in this type of work. Research is limited with little information about reflective practice group guidelines, prevalence and effectiveness. Aims The aims of this study were to describe clinical psychologists' practice in reflective groups for staff in inpatient psychiatric services and to explore how such groups are conceptualized and implemented. Methods Online questionnaires and follow-up interviews were used to gain broad descriptions of practice and in-depth information about participants' experiences. The sample consisted of 73 clinical psychologists working in the UK, six of whom were interviewed. Data were analysed using descriptive statistics, content analysis and thematic analysis. Results Clinical psychologists regularly facilitate reflective staff groups in inpatient psychiatric settings in the UK. Common outcomes related to staff wellbeing, service culture and teamwork. Engagement, group dynamics and lack of management support were common challenges. Group experiences were influenced by the organizational context. Conclusions Clinical psychologists' practices regarding reflective staff groups were in line with recent professional developments. Several difficulties were described, which may be indicative of both a difficulty inherent to the task and a training gap in reflective staff group process. The study had methodological limitations but offers a useful contribution to the literature, and enables practice and training implications to be drawn. The need for further research exploring facilitator characteristics, views of group participants and the impact of reflective staff groups on patients is indicated. Copyright © 2013 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: The term ‘reflective practice group’ encompasses a range of practices, but a typical group structure was found with common aims, outcomes and challenges. Reflective staff groups are regularly facilitated by clinical psychologists in inpatient psychiatric settings in the UK and are influenced by practitioner experience as well as psychodynamic, systemic and group process theories. The safety required for reflective groups to function is influenced by the organizational context, and groups can contribute to shifts in culture toward including psychosocial perspectives. Reflective staff groups represent one type of contribution to an inpatient psychiatric service and team relationships; other processes to encourage alternative professional perspectives and values might also support change. More research is recommended to explore facilitator characteristics, the views of staff teams on reflective staff groups and the impact of these groups on patients.

Concepts: Psychology, Clinical psychology, Psychiatry, Psychotherapy, Mental health professional, Social psychology, Facilitator, Group dynamics


The current study explored differences in acceptance of telehealth interventions amongst currently licensed and future clinicians with a focus on web camera-based intervention. The influence of theoretical orientation was also assessed.

Concepts: Psychology, Clinical psychology, Psychiatry, Psychotherapy, Mental health professional, Family therapy, Clinical neuropsychology, Applied psychology


We aimed to investigate the association of psychopathology with tattooing and body piercing among adolescents in Istanbul by means of self-report questionnaires. Tenth, eleventh and twelfth grade students from 2 high schools in Istanbul with a total number of 607 participated in the study. The Youth Self Report, Children’s Depression Inventory and a detailed semi-structured inquiry assessing tattooing, body piercing and some psychiatric and psychosocial variables were administered to the students. The prevalence of tattooing and body piercing were 4.8 and 7 %, respectively. The adolescents with tattooing and body piercing were found to have a higher frequency of alcohol and drug use, smoking, going to bars/night clubs and lower school grades when compared to those without tattooing and body piercing. Externalizing problems, mainly delinquent and aggressive behaviours were more prominent in the adolescents with tattooing and body piercing. Tattooing and body piercing in adolescents may be indicative of mental health risks.

Concepts: HIV, Psychology, Drug addiction, High school, Psychiatry, Mental health professional, Body modification, Body art


ABSTRACT Background: The provision of mental health care for older people will become increasingly important with rising demand related to global demographic changes. This project aimed to identify changes in work patterns of UK consultant old age psychiatrists between 1993 and 2012. Method: A link to an online questionnaire was circulated to consultant old age psychiatrists through the Faculty of Old Age Psychiatry, Royal College of Psychiatrists. Results: In all 210 usable responses were received. On the survey day 71% of old age psychiatrists arrived at work before 9 am, and 40% left work after 6 pm. Over one-third (35%) worked for another hour or more at home. The range of activities was broader than previously reported. Administrative activity was undertaken by over 60% and acute ward work by only 26%. Few consultants reported time in long-stay care or day hospitals. Outpatient activity included Memory Clinics and Health Center Clinics. The main stressors reported by consultants were lack of resources and pressures from management-imposed, financially driven service changes. Relationships with people at work (including patients and their families) and outside work were the main identified support. Conclusions: Consultants' working hours have changed little since 1997, but the range and emphases of activities have changed. Changes in service organization are stressful and consultants are supported by relationships with colleagues and patients. Work patterns are changing in response to demands and constraints on the specialty. Research is needed into service design and work patterns, which can provide humane care in the current economic climate.

Concepts: Middle age, Gerontology, Old age, Ageing, Change, Psychiatry, Mental health professional


Recent literature has raised an important ethical concern relating to the way in which surgeons approach people with gender dysphoria (GD): it has been suggested that referring transsexual patients to mental assessment can constitute a form of unjust discrimination. The aim of this paper is to examine some of the ethical issues concerning the role of the mental health professional in gender reassignment surgeries (GRS).

Concepts: Health care, Mental health, Gender, Philosophy, Ethics, Mental health professional, Transgender, Sex reassignment surgery