COVID and Counseling

Due to the COVID-19 crisis, the mental health profession has shifted to online service provision, or telehealth. The aim of this chapter is to describe the COVID-19 crisis and subsequent changes that occurred to mental health service provision; the benefits and drawbacks to telehealth from practical, ethical, and cultural perspectives; and the learning opportunities that have come from this crisis. Finally, reflections on the future of the counseling profession and trends in service provision for serving an increasingly diverse population will be analyzed.

Trialogue Meetings: Engaging Citizens and Fostering Communities of Wellbeing Through Collective Dialogue

Community-based participatory approaches are widely recognized as valuable methods for improving mental health and well-being by enabling a greater sense of liberty among participants, through the development of equitable policies and practices, which accommodate a range of diverse perspectives. One such approach, “Trialogue Meetings,” has been found to encourage disclosure and dialogue surrounding mental health, facilitate the growth and development of communities in relation to people’s experience of mental health difficulties, service provider and community response. Emerging in the 1990s because of perceived and felt inequitable relations between people with lived experience of mental health difficulties, family members of people with mental health difficulties and professionals providing mental health service provision. This approach has been shown to successfully reduce stigma and discrimination and improve relations between stakeholders in community and mental health care settings. Trialogue Meetings incorporate Open Dialogue methods to allow multiple stakeholder groups to participate in conversations around a given topic and enable the creation of a common language and mutual understanding. Trialogue Meetings have added benefits of allowing individuals to express themselves better, gain a sense of relationality and community with others and address predetermined power hierarchies with prescribed responses to people’s experiences. In this perspective, we present an outline for Trialogue Meetings as a medium for enhancing wellbeing, providing a transformative empowering process for deliberate discursive practice and engaging citizens through sustained collective dialogue.

Features of Mental Health Service Provision During the COVID-19 Pandemic in Specialists Who Work with Suicide Prevention in Rural Areas

The COVID-19 pandemic can influence the situation of suicide rates and mental health in rural regions even more than in major cities. The aim of the current study was to explore the functioning of mental health service provision during the COVID-19 pandemic through interviews with mental health professionals and other specialists who work with suicide prevention in rural areas. Thirty specialists were interviewed using a semi-structured interview format. The following codes were identified during the thematic analysis: providing help during the pandemic (mental health professionals and institutions adapted to the conditions of the pandemic, remote counselling makes providing help more difficult, the help is less reachable); help-seeking during the pandemic (people seek less help because of the pandemic, seeking remote help is easier, the frequency of help seeking didn’t change); the effects and governing of the pandemic situation (the pandemic can have negative effects on mental health; after the pandemic mental health might get worse; the governing of the pandemic situation in Lithuania could be more fluent). The current study reveals positive aspects of mental health professionals’ adaptivity during the pandemic, as well as severe problems which are related to the access to the mental health services during the COVID-19 pandemic.

The development of National Safety and Quality Digital Mental Health Standards

Objective: Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm. Method: The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards. Results: The NSQDMH Standards comprise three standards—Clinical and Technical Governance, Partnering with Consumers, and Model of Care—and were launched in November 2020. Conclusions: The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.

Understanding complexity in psychological services: a modified Delphi study

Rationale, aims and objectives The concept of patient or case complexity is relevant – and widely used – at all levels and stages of mental health service provision, but there have been few methodologically robust attempts to define this term. This study aimed to establish a consensus on factors contributing to patient complexity in adult psychological services using Delphi Methodology. Method Applied psychologists in a single urban/suburban UK National Health Service setting took part in a three-round modified Delphi study. Twenty-eight respondents in round one gave qualitative data on factors they considered when assessing complexity, which was subject to thematic analysis. Twenty-five respondents in round two rated how central/peripheral each theme was to their judgement using Likert scales. In a third round, twenty respondents addressed discrepancies and possible utilities of the emerging framework. Results Thirteen factors contributing to patient/case complexity (Active Severe/Enduring Mental Health, Current Coping/Functioning, Engagement, Forensic History, Iatrogenic Factors, Interpersonal Functioning, Neuro-Cognitive Functioning, Physical Health, Problematic Substance Use, Risk, Severity/Chronicity of Presenting Problems, Systemic and Socio-Economic Factors and Trauma) were identified with a high degree of consensus. All were rated as central to complexity. Conclusions We conclude that applied psychologists do have a shared understanding of complexity and make recommendations for further research validating, developing and applying this empirically derived framework. Keywords: psychological, complexity, definition, operationalising, framework development, clinical judgement

The Intersectional Integration: Examining The Integration Experiences Of Middle Eastern LGBTQ+ Refugees In Canada And Service Providers Response

The intersectional identities of Middle Eastern LGBTQ+ (ME-LGBTQ+) refugees expose them to different forms of discrimination and persecution throughout the asylum experience, whether in their home countries, proxy countries or even in Canada, which results in increased difficulties and challenges in integration. By interviewing six ME-LGBTQ+ refugees and conducting a content analysis on 27 websites of refugee-serving organizations, this study explores how the intersectional identities of ME-LGBTQ+ refugees have shaped their integration, and examines the role of the services providers in response to their intersectional integration. The findings revealed that ME-LGBTQ+ refugees suffered intersectional forms of discrimination at the intersection of nationality with gender and sexuality, which resulted on aggravated mental stresses, in addition to gaps in access to services which ME-LGBTQ+ refugees mitigated through their personal solidarity networks. The content analysis revealed gaps in mental health service provision and representation of LGBTQ+ refugees coupled with a complex and overlapping structure of services that hindered the ability of ME-LGBTQ+ refugees to leverage these services. Recommendations include allocating more efforts to understanding the intersectional backgrounds of ME-LGBTQ+ refugees, providing tailored orientation and guidance services in their native language and creating LGBTQ+ friendly housing communities and safe spaces that would allow ME-LGBTQ+ refugees to socialize, express their identities and feel safe, and, therefore, facilitating their successful integration in Canada. Keywords LGBTQ+, Refugees, Immigrants, Canada, Toronto, Middle Eastern, Service providers, Resettlement organizations, Refugee organizations, intersectionality.