Follow‐up with Callers to the National Suicide Prevention Lifeline: Evaluation of Callers’ Perceptions of Care

Continuity of care for suicidal individuals engaged with a variety of health and mental health care systems has become a national priority, and crisis hotlines are increasingly playing a part in the risk management and continuum of care for these individuals. The current study evaluated a national initiative to have crisis centers in the National Suicide Prevention Lifeline network provide follow‐up care to suicidal callers. Data were obtained from 550 callers followed by 41 crisis counselors from 6 centers. Two main data sources provided the information for the current study: a self‐report counselor questionnaire on the follow‐up activities completed on each clinical follow‐up call and a telephone interview with follow‐up clients, providing data on their perceptions of the follow‐up intervention's effectiveness. The majority of interviewed follow‐up clients reported that the intervention stopped them from killing themselves (79.6%) and kept them safe (90.6%). Counselor activities, such as discussing distractors, social contacts to call for help, and reasons for dying, and individual factors, such as baseline suicide risk, were associated with callers’ perceptions of the impact of the intervention on their suicide risk. Our findings provide evidence that follow‐up calls to suicidal individuals can reduce the perceived risk of future suicidal behavior.     

The Psychology of Respite Care for People with Dementia in Australia

Australian health professional bodies promote the use of respite to ease carer burden, following well‐established findings that carers often face physical, mental, social, and financial strain while providing informal care. This narrative review examined the use and impacts of respite for older clients, with a particular focus on Australian research and on dementia respite. It was found that despite reports of high satisfaction from caregivers with respite use, barriers, such as caregiver concerns for the well‐being and safety of the care recipient during respite, limited flexibility for short‐notice respite booking, and low provision of support and education post respite, impacted on the accessibility and efficacy of respite care. It was concluded that respite care needs to move away from a custodial model to a more psychological model of care, and that more natural and flexible models (e.g., host family respite), integrated with increased post‐respite support and psychosocial education, are likely to be beneficial and need further evaluation.     

The Treatment of Substance‐Abusing Clients in Multiservice Mental Health Agencies: A Practice Analysis

This article examines the work behaviors related to counseling substance‐abusing clients by mental health service providers in multiservice mental health agencies. The results support the need for specialized knowledge and skills in working with substance‐abusing clients.     

Stress in Clinical Psychology Trainees: Current Research Status and Future Directions

The purpose of this article is to present the current status of the literature related to stress in clinical psychology trainees (CPTs), and to offer research directions for investigating stress in this population and ways to enhance self‐care in these individuals. The following conclusions emerge from the review: (1) CPTs are vulnerable to elevated stress; (2) undue stress can negatively impact CPTs' personal and professional functioning and, in turn, result in less than optimal standards of care for clients; (3) there is a dearth of studies on stress in this population and no published intervention studies; (4) incorporating self‐care strategies into clinical psychology training is recommended; and (5) “third‐wave” cognitive behaviour therapy stress management interventions have been efficacious in comparable populations. In view of the potential costs of elevated stress to trainees themselves and their clients, research on stress and stress management in this population is of a high priority. Broad research agendas are proposed for these two domains. Modifications to clinical training programmes to reduce trainee stress are required and should be evidence‐based and systematically revaluated.     

When Being “Essential” Illuminates Disparities: Counseling Clients Affected by COVID‐19

The 2019 novel coronavirus (COVID‐19) has highlighted social disparities in the United States. This article examines how preexisting racial and ethnic disparities, exacerbated by COVID‐19, have negatively affected communities of color that tend to be overrepresented in lower socioeconomic groups, have limited access to health care and education, have an undocumented status, and work in jobs considered “essential.” Counselors are encouraged to use creative strategies to design and facilitate telecounseling and reduced‐ or no‐cost workshops in which attendees can participate safely. Specific cultural considerations, aspects of crisis management, and creative interventions that can be used with clients of color at an appropriate social distance are discussed. Counselors can also instill hope in their clients by promoting sociopolitical development. As the impact of COVID‐19 will be felt for years, it is crucial that counselors be prepared to address the needs of those disproportionately affected.     

An evaluation of counselling and rehabilitation courses for Chronic Fatigue Syndrome

The aim of the current study was to evaluate the services offered by Action for ME to sufferers of Chronic Fatigue Syndrome using measures developed and validated in previous research. Preliminary studies had suggested that clients attending rehabilitation residential courses were benefiting from the service. A further, more in‐depth evaluation process with a greater number of health‐related outcome measures was warranted. In addition, assessment was widened to include other services offered to sufferers of the illness. Data relating to the usefulness and success of the services (rated by the clients) were also collected. Data from client volunteers were collected at baseline (that is, before intervention) and approximately six months later. Quantitative comparative analyses were conducted using within‐group comparisons to assess any improvements in scores at six‐month follow‐up from baseline. Fifty‐six participants completed wide‐ranging questionnaires assessing illness history, psychopathology, psychosocial factors and health and well‐being. Data relating to improvements in illness status and acceptability of treatment were also collected by means of global outcome measures. Both the counselling and residential groups showed improvements in many areas assessed at follow‐up. Most importantly, improvements were indicated in areas such as fatigue and the levels of disability suffered by patients. In addition, there were significant improvements in ratings of mood, anxiety, depression and physical symptoms. Overall, clients reported satisfaction with the care received and most found the services useful. All of the participants who completed the evaluation stated that they would recommend Action for ME services to fellow sufferers. The outcome of the current study is encouraging. The data presented provides evidence of the high level of support and advice Action for ME offers to sufferers of this illness. Furthermore, measurable improvements in scores relating to illness status were accompanied by improvements in mental health and psychosocial variables in the patient group.     

Limitations of Mental Health Case Management: A Rational Emotive and Cognitive Therapy Perspective

Since the closure of many psychiatric hospitals, case management has come to be accepted worldwide as a method of community care for the seriously mentally ill. Although case management has many commendable values, it falls short of providing a comprehensive treatment. It focuses almost exclusively on environmental interventions and largely ignores psychological elements of an individual's functioning. In particular, case management rarely provides clients with evidence-based therapy techniques, such as those developed from a cognitive-behavioral perspective. Consequently, clients with mental illness are not being provided with skills which could help them systematically reduce their emotional disturbance. It is hypothesized that the effectiveness of mental health case management may be enhanced by incorporating evidence-based psychological therapies within a community care model.     

The Practice of Suicide Assessment and Management by Marriage and Family Therapists

Abstract

Over 90% of mental health providers encounter suicidal clients. However, the majority of marriage and family therapists (MFTs) are not exposed to suicide-specific trainings within their clinical coursework. Due to the lack of consistent training protocols for suicide assessment and management among MFTs, this qualitative study identified common MFT responses to suicidal clients, including assessment of risk severity and intervention modalities. Responses were then compared to best practices for suicidal clients. Participants inconsistently adhered to best practices identified in the larger field of mental health, revealing the need for increased MFT training on suicide to ensure appropriate and effective care.     

“Like Drawing Into Sand”: Acceptability,Feasibility, and Appropriateness of a New e‐Mental Health Resource for Service Providers Working With Aboriginal and Torres Strait Islander People

Cross‐cultural considerations and difficulties recruiting and retaining skilled workers in rural and remote regions may contribute to poorer service use for Aboriginal and Torres Strait Islander people. However, electronic resources may provide the opportunity for remote workforces to deliver structured, evidence‐based, culturally appropriate treatments with limited training burden. The aim was to develop and determine the acceptability, feasibility, and appropriateness of a new e‐mental health resource (the Australian Integrated Mental Health Initiative [AIMhi] Stay Strong App) for service providers working with Aboriginal and Torres Strait Islander people in the Northern Territory. Eleven semi‐structured interviews were conducted with 15 service providers and managers from a range of rural and remote primary health care service settings in the Northern Territory. All participants were given the resource to trial for at least 1 month before being interviewed about perceived barriers and enablers, acceptability, and feasibility. Thematic analysis revealed support for the acceptability, feasibility, and appropriateness of the resource among service providers. Major themes identified included acceptability, building relationships, broad applicability, training recommendations, integration with existing systems, and constraints to implementation. This is one of the first studies to explore the acceptability of e‐mental health approaches for Aboriginal people among the remote health workforce. It is likely that e‐mental health interventions, such as the AIMhi Stay Strong App will assist services to deliver evidence‐based, structured interventions to improve well‐being for Aboriginal and Torres Strait Islander clients.     

A five‐year evaluation of the effectiveness of person‐centred counselling in routine clinical practice in primary care

Counselling is the recommended treatment for individuals with mild to moderate mental health problems of recent onset. In this evaluation of a primary care counselling service offering person‐centred counselling, the Core Outcome Measure (CORE‐OM) was administered at referral and at the beginning and end of therapy. A pre‐post therapy effect size for 697 individuals over a 5 year period was 1.2. This compares with a waitlist (between referral and pre therapy) effect size of 0.24 for 382 individuals over a three year period. The results indicate that person‐centred counselling is effective for clients with common mental health problems, such as anxiety and depression. Effectiveness is not limited to individuals with mild to moderate symptoms of recent onset, but extends to people with moderate to severe symptoms of longer duration.     

Counselors and Physicians Providing Mental Health Services: An Integrated Approach

The authors argue that there is a clear link between mental and physical health issues. A wellness‐based approach to integrated health care, such as the one described in this article, may allow older clients to be empowered to make lifestyle changes that can improve the quality of their lives and reduce physical illness.     

Self-Esteem, Self-Efficacy, and the Balance of Peer Support Among Persons With Chronic Mental Health Problems

Despite several suggestions that peer support is empowering for persons with mental health problems because of its mutual nature, few studies have empirically studied the role of its reciprocity and the effects on subjective well-being of clients from mainstream mental health care settings. Using data of 628 users of vocational and psychiatric rehabilitation centers ( N  = 51) in Flanders, the effects of the reciprocity of peer support on self-esteem and self-efficacy are explored by testing hypotheses derived from the theories of exchange, social capital, equity, and self-esteem enhancement. Results show that providing peer support is more beneficial than receiving it. One conclusion is that the net beneficial effects of receiving support from peers are overestimated.     

Predictors of Diabetes Self‐care,Metabolic Control,and Mental Health in Youth with Type 1 Diabetes

The purpose of this study was to explore the psychosocial predictors of diabetes self‐care (adherence to care regimes), metabolic control (glycated haemoglobin), and mental health among rural‐ and urban‐dwelling youth with type 1 diabetes. One hundred and twenty three adolescents/young adults (aged 13?25 years, mean = 16 years, standard deviation = 3.8 years) with type 1 diabetes, 50 males and 73 females, completed questionnaires reporting on diabetes self‐care, metabolic control, mental health (negative affect, quality of life), risk‐taking behaviours and attitudes, diabetes self‐efficacy, community engagement, and perceived social support. No rural/urban differences were detected on key predictors or outcome variables. Structural equation modelling revealed that high diabetes self‐efficacy, lower risk behaviour, and more conservative attitudes to risk taking predicted better diabetes self‐care, which in turn predicted better metabolic control and mental health. Social support and engagement in community activities did not influence diabetes self‐care. The study has significance because both diabetes self‐efficacy and propensity towards risk behaviour are potential targets for educational and counselling interventions designed to improve diabetes self‐care regimes and resultant metabolic and mental health outcomes.     

Psychological Care Provided by the Church: Perceptions of Christian Church Members

Spirituality and religion are integral parts of a person's belief system and support network. Although there are many avenues a person can take when seeking mental health care, conservative Protestant clients have a tendency to seek assistance through their church. There is a paucity of literature about conservative Protestant church members’ perceptions of mental health care. The authors used phenomenology to understand participants’ perceptions of mental health care provided by the church. Themes found within participants’ stories included the importance of the relationship when seeking care, the use of knowledgeable practitioners, and the use of religious practices in counseling.     

Quantitative and qualitative analysis of a set of goal attainment forms in primary care mental health services

Aims: The aim of this paper is to present an attempt to collate the results of the client‐completed Goal Attainment Form (GAF) and to explore the usefulness of analysing the data in this way. The GAF is used primarily to add qualitative idiosyncratic data to the quantitative data collected by the CORE‐OM (Clinical Outcomes for Routine Evaluation Outcome Measure) questionnaire. Method: A sample of 477 completed GAF were used during short‐term therapy through primary care mental health services to investigate potential correlations in various different aspects between the GAF and the CORE outcome measure (CORE‐OM). The themes from these forms were qualitatively analysed to compare how clients describe their experience of therapy with clinical perspectives. Results: The results reveal several significant correlations. Themes used by clients to describe their problems and benefits of therapy were different from clinicians' perspectives. Discussion and recommendations: Several suggestions and recommendations are offered regarding evaluation, therapy and primary care short‐term therapy services.     

Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study

Primary objective: This is the first qualitative study that elicited the perceptions of both psychological therapists and their clients in the use of Clinical Outcomes in Routine Evaluation with computer software (CORE‐Net), where instant visual feedback for session tracking was given on a computer screen in the therapy room at each therapy session. The study also examined how therapists viewed its potential value in supervision and provides suggestions for improving training. Research design: The study adopted a convenience sample of four therapists in a primary care counselling setting (PCC – General Practitioner referrals) who were experienced in using CORE‐Net, and five therapists in an NHS employee/occupational support counselling service (OH) who had just begun to use CORE‐Net for session tracking with 10 of their clients. Method: A qualitative methodology was used and interview data were collected from the therapists via focus groups; the clients were interviewed individually face to face. All data was analysed inductively. Findings: The study identified six overarching themes: (i) therapists were initially anxious and resistant; (ii) therapists adapt ‘creatively’; (iii) outcome measures help the client/therapist relationship; (iv) clients perceive visual measures as helpful; (v) CORE scores inform supervision; and (vi) proper and ongoing training/support of therapists is necessary. The main limitations are comparability of data and the generalisabilty of results. Conclusions: The implementation of routine outcome measurement (ROM) is a challenge but can be made easier with proper training and supervision. Clients appear happier than their therapists when routine outcome measurement is used.     

Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.