Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy

Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self‐perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at‐risk service users, yet feel less prepared for dealing with suicidality.     

Family-Centered Care to Promote Successful Community Reintegration After War: It Takes a Nation

The papers in this section focus on public health responses and implementation considerations in addressing the challenges military families confront when parents go to war. While many military families show resilience, the challenges resulting from a decade of war with multiple deployments are detailed, as are innovative military and civilian programs designed to help service members and their families reintegrate successfully into the community. As more and more service members leave active duty, the burden of meeting military families’ psychological needs will transition from the Department of Defense (DoD) and into the Veterans Administration (VA) and civilian arenas. While many strategies to support successful readjustment are offered, in this time of dwindling mental health resources and competing needs, it is unclear what priority the broader society places on meeting the needs of returning service members and their families. A growing emphasis on family-centered care in the Veterans Administration may help meet this gap.     

Psychiatry and religion circa 1978: Analysis of a decade,part II

Prior tensions between science and religion have dissolved and coalesced into new alliances based on ideology and philosophy. This general cultural pattern is reflected in the realignment of interests and interactions between paychiatry and religion. There are increasing numbers of mental health professionals with devout religious commitments and involvement in religiously oriented mental health activities; while clergy have developed new organizational structures to reflect many diverse mental health interests, including pastoral counseling, community mental health chaplains, hospitals chaplains, and expanded parish ministries. Clinical and research literature has continued to rapidly proliferate, while a unique genre of pastoral care and counseling literature has emerged. A decade ago there was hope for an amicable alliance between specialists in psychiatry and in religion. That irenic quest has shifted into overlapping goals and roles, with tensions between those engaged in universalistic norms and those seeking to develop particularistic norms.Dr. Pattison is Director of Training, Orange County Department of Mental Health and Professor and Acting Chairman of the Department of Psychiatry and Human Behavior, University of California Irvine Medical Center, 101 City Drive South, Orange, California 92668. Part I of his article appeared in the Fall, 1978 issue ofPastoral Psychology.     

Psychiatry and religion circa 1978: Analysis of a decade,part I

Prior tensions between science and religion have dissolved and coalesced into new alliances based on ideology and philosophy. This general cultural pattern is reflected in the realignment of interests and interactions between psychiatry and religion. There are increasing numbers of mental health professionals with devout religious commitments and involvement in religiously oriented mental health activities; while clergy have developed new organizational structures to reflect many diverse mental health interests, including pastoral counseling, community mental health chaplains, hospital chaplains, and expanded parish ministries. Clinical and research literature has continued to rapidly proliferate, while a unique genre of pastoral care and counseling literature has emerged. A decade ago there was hope for an amicable alliance between specialists in psychiatry and in religion. That irenic quest has shifted into overlapping goals and roles, with tensions between those engaged in universalistic norms and those seeking to develop particularistic norms.Dr. Pattison is Professor of Psychiatry and Human Behavior, Social Science, Social Ecology; Acting Chairman, Department of Psychiatry and Human Behavior, University of California, Irvine; Deputy Director, Training, Consultation, Education Division, Orange County Department of Mental Health. His address is UCI Medical Center, 101 So. The City Dr., Orange, Ca. 92668. Part II of this article will be published inPastoral Psychology, Volume 27, No. 2.     

Online mental health treatment: concerns and considerations.

Concerns and considerations have emerged as mental health professionals contemplate the provision of mental health treatment over the Internet. This paper identifies perceptions of online mental health treatment among a national sample of 2,098 social workers, psychologists, and other professionals. These professionals were unlikely to provide online mental health treatment, although some used the Internet as an adjunct to clinical practice. They noted specific concerns related to the provision of mental health treatment online, including confidentiality of client information and liability issues. We explore these issues and discuss implications for professionals who provide mental health treatment.     

Ethical Considerations for Assessing Parent Mental Health during Child Assessment Services

Parents play an integral role in the mental health service provision of children and adolescents, and they can have significant effects on the outcomes of youth. A growing body of research has linked parents’ own mental health status to numerous outcomes for their children, and recent guidelines have emerged recommending the assessment of parent psychopathology when treating child patients. However, these recommendations present a range of ethical considerations. Mental health professionals must determine if the assessment of a parent is empirically supported and that an assessment procedure appropriate for parents can be feasibly implemented. They must also respect the autonomy and confidentiality of parents while ensuring that assessment findings can be translated to meaningful benefits for child patients. This article details and discusses each of these concerns within the context of the relevant principles and standards of the 2016 American Psychological Association’s Code of Ethics. Further, it provides guidelines, relevant clinical examples, and an applied model for mental health professionals to consider the ethical implications of assessing parent mental health when serving child patients.     

Collaborative Communication Between Psychologists and Primary Care Providers

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient’s primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient’s confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan.     

From posts to protection: Ethical considerations regarding forensic psychiatrists and a duty to warn based on social media

Increasing use of social media in forensic mental health evaluations will lead to new challenges that must be resolved by forensic practitioners and the legal system. One such dilemma is the discovery of information that would typically trigger a legal duty and professional ethics obligation for mental health professionals to breach doctor-patient confidentiality to promote public safety and prevent harm to vulnerable third parties. Although the law and professional organizations offer clear guidance for practitioners in the treatment role, there is currently no clarity from the law or instruction from professional organizations on what mental health professionals should do if they discover such information during a confidential forensic evaluation. For example, a forensic evaluator may find evidence on social media of an evaluee’s threats to seriously harm others, abuse of children and the elderly, or severely impaired driving. There are no clear guidelines for how a forensic psychiatrist should respond in these complicated situations. We review the legal concepts and historical evolution of confidentiality, privilege, and mandated reporter duties that forensic practitioners should consider in these legally ambiguous situations. Finally, we discuss ethics frameworks practitioners can implement to determine their most ethical course of action when faced with such dilemmas.     

Implementing a Primary Mental Health Service for Children: Administrator and Provider Perspectives

The Child Mental Health Service (CMHS) is an Australian primary care program introduced in July 2010 to provide mental healthcare to children who have, or are at risk of, developing psychological disorders. The Australian Government provided supports (e.g., training for mental health professionals), resources (e.g., funding for positions devoted to fostering inter-agency linkages or partnerships) and various flexibilities in service delivery. This study aimed to explore the processes used in the implementation of the CMHS in order to achieve its objectives of delivering a high quality standard of service, and forging linkages and support networks with other relevant health and non-health agencies. Structured interviews were conducted with 20 program administrators, six referring professionals and eight mental health professionals. Interviews were recorded, transcribed and analysed for themes using NVivo. The CMHS appears to have made good progress towards achieving its objectives by implementing processes that facilitated the delivery of a high quality service (e.g., engaging appropriately qualified, and encouraging additional training and clinical support for, mental health professionals; employing quality assurance mechanisms and clinical governance arrangements) and establishment of inter-agency linkages (e.g., devoting a professional role—Coordination and Liaison—to this purpose). Provider perspectives suggest that the CMHS has had a positive impact on children and their families. Comparable countries implementing primary mental health programs for children may benefit from considering similar additional supports (e.g., training for mental health professionals), resources (e.g., funding positions devoted to fostering service inter-agency linkages) and service delivery flexibilities as those available in the CMHS.     

Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners,Adolescents and Their Parents

The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.     

Mental health and well-being of black women: Toward strategies of empowerment

This review of the literature on Black women's mental health has three goals: 1) to describe the mental health issues, needs, and adaptive behaviors of Black women; 2) to discuss the research, intervention, and public policy efforts of mental health professionals and Black women's groups to address the multiple needs of this population; and 3) to identify effective strategies by which community psychologists can improve the mental health status of Black women through efforts to reduce their environmental stressors, to increase their resources and access to services, and to facilitate their empowerment in American society. The authors propose a number of recommendations to improve Black women's mental health, including changes in research paradigms, changes in education and training programs, and the development of culturally competent service delivery systems.     

What Low-Income,Depressed Mothers Need From Mental Health Care: Overcoming Treatment Barriers From Their Perspective

Maternal depression is a major public health concern, as children of depressed mothers have a substantially increased risk for psychiatric problems into adulthood. Low-income mothers have high rates of depression, yet few receive mental health care. Barriers have been identified, but solutions have been based on what mental health professionals believe is helpful rather than mothers’ own perspectives, or require participation in an existing treatment. The purpose of our study was to learn what low-income, depressed mothers believe they need from mental health care to overcome barriers to mental health care. Twelve mothers with at least one child between the ages of 2 and 17 participated in individual interviews. Using qualitative grounded theory methodology, data were organized into six theoretical constructs. These included: (1) attitudes, expectations, and emotions impact the intention to enter treatment, (2) identifying as self-sufficient inhibits the intention to enter treatment, (3) providing knowledge, skills and environmental resources facilitate treatment entry, (4) habits and life circumstances that make treatment seem unimportant inhibit treatment entry, (5) balancing acceptance, change, and the therapeutic relationship facilitates treatment retention, and (6) sharing similarities with people involved in treatment often, but does not always facilitate treatment retention. A 3-step theory was developed regarding variables that influence mothers’ (a) intentions to enter treatment, (b) treatment entry, and (c) treatment retention. Offering what low-income, depressed mothers believe they need could better engage and retain them in mental health treatment.     

Client or patient? Contrasts between medical and counselling models of confidentiality

Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability.     

Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.     

The travails of Martin Orne: On privacy,public disclosure,and confidentiality in psychotherapy

The experiences of one psychotherapist have brought to the fore the entire issue of privacy and confidentiality and the responsibilities of mental health professionals. In a computer driven culture, where data about patients become subject to public scrutiny, how does the mental health professional practice, guided by the concept of confidentiality? Where does confidentiality begin and end? What about the patient's right to self-disclose? What about patient autonomy? In this paper, illustrated by one particular case where the rule of absolute confidentiality, an intrinsic part of the practice of psychotherapy, was questioned, our current confusion comes to the surface. The reader is urged to re-think the concept of confidentiality and patient self-disclosure.     

Spiritual advisors and old age psychiatry in the United Kingdom

This survey investigates the role and views of NHS spiritual advisors across the United Kingdom on the provision of pastoral care for elderly people with mental health needs. The College of Health Care Chaplains provided a database, and questionnaires were sent to 405 registered NHS chaplains/spiritual advisors. The response rate was 59%. Quantitative and qualitative analyses were carried out. Spiritual advisors describe their working patterns and understanding of their roles within the modern NHS, and their observations of the level of NHS staff awareness of the importance of spiritual issues in the mental health care of older adults. They provide insights into possible negative and positive perceptions of their roles at a service level, and contribute suggestions of topics relevant to shared education between pastoral care and clinical services. This survey further highlights ethical and operational dimensions at the point of integration of the work of spiritual advisors and multidisciplinary teams.     

VA telemental health: suicide assessment

The Department of Veterans Affairs (VA) encompasses one of the largest telemental health networks in the world, with over 45,000 videoconferencing and over 5,000 home telemental health encounters annually. Recently, the VA designated suicide prevention as a major priority, with telehealth modalities providing opportunities for remote interventions. Suicide risk assessments, using videoconferencing, are now documented in the literature, as are current studies that find telemental health to be equivalent to face-to-face treatment. Remote assessment of suicidality, however, involves complex legal issues: licensing requirements for remote delivery of care, legal procedures for involuntary detainment and commitment of potentially harmful patients, and liability questions related to the remote nature of the mental health service. VA best practices for remote suicide risk assessment include paradigms for establishing procedures in the context of legal challenges (licensing and involuntary detainment/commitment), for utilizing clinical assessment and triage decision protocols, and for contingency planning to optimize patient care and reduce liability.     

Generalizability of Evidence-Based PTSD Psychotherapies to Suicidal Individuals: A Review of the Veterans Administration and Department of Defense Clinical Practice Guidelines

Posttraumatic stress disorder (PTSD) is strongly associated with suicide. The 2010 Department of Veterans Affairs/Department of Defense Clinical Practice Guidelines for PTSD (VA/DoD CPG) endorse cognitive therapy and its variants as empirically supported PTSD treatments. However, we lack an understanding about whether these treatments are generalizable to patients with suicidal ideation and/or behaviors. Randomized controlled trials (RCTs) cited in the VA/DoD CPGs were systematically reviewed for methodology, suicide-related content, and adverse event reporting. Thirty-eight RCTs were reviewed. Twenty-three reported suicide-related exclusion criteria, 15 made no mention of suicide-related inclusion/exclusion criteria. Thirty-six RCTs included depression assessments containing suicide-related items, but no suicide-relevant data were reported. Two RCTs outlined suicide risk monitoring procedures. Suicidal PTSD participants are underrepresented in PTSD RCTs and suicide risk assessment procedures were inconsistently reported. Standardized reporting of RCT methods pertaining to suicide risk to determine generalizability and safety of empirically supported PTSD treatments to this clinical population is needed.     

What members of Alcoholics Anonymous really believe

Many mental health professionals work with people who are members of Alcoholics Anonymous (AA) or may benefit from AA attendance. This article provides practical information about AA that professionals can use to understand and work with people in AA. It is a summary of a survey of 187 members of AA as well as synthesising the literature on AA. Specifically, it describes what AA is, the twelve steps and principles that underlie them, common AA expressions and how they can be used in therapy, common concerns about AA, and how to get more information about AA. Implications of how AA's steps and language can be incorporated into therapy, how therapy can facilitate working the steps of AA, and how to address consumers’ (or professionals’) concerns about AA are addressed.     

Service users’ perceptions of shared agency in mental health services

Objective: The concept of shared agency is used in examining the collaboration between the service user and the professionals. The study aims to find out what kind of experiences on shared agency mental health service users have.

Method: The study was based on interviews of 19 service users. The data set was formed of those parts of the interviews that dealt with shared aims, being heard, collaboration and joint planning and decision-making. Typical methods of inductive content analysis were applied.

Results: Three domains of shared agency were found: emotional, communicative and supportive ones. The emotional domain included elements of becoming heard and building confidence. In the communicative one, the main features were mutual information sharing, finding words to describe the chaos and reconstructing harmony. The supportive domain included encouragement and giving support. Experiences on non-shared agency were also found.

Conclusion: Many experiences on shared agency were found. Joint planning and working with life goals were, however, seldom reported. This result, together with experiences of non-shared agency, sets a challenge for mental health services.