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Who Is Calling: A Change in the Profile of the Callers of a Crisis Phone Line During the First Three Waves of the COVID-19 Pandemic
- David Gutnisky, Licenciate Maria Soledad Ortega, Horacio Rodriguez O'Connor, Licenciate Sandra Garcia Taboada, Licenciate Victoria Kugler, Florencia Alul
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S50
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Aims
‘Mental Health Answers’ [Salud Mental Responde] is a Crisis Telephone Line that was developed during the first months of the COVID-19 pandemic in the Autonomous City of Buenos Aires, Argentina. It is also a Point of Entry to Mental Health services, providing assisted referrals to the appropriate level of care. The aim of this paper is to evaluate the profile of the callers to the line during the first three waves of COVID-19.
MethodsRetrospective case analysis of calls made to the telephone line throughout the different COVID-19 waves under study. For this analysis, the time frame for the first three waves was as follows. First wave: from 1 August to 30 of November 2020; second wave: 15 of March to 30 of July 2021; third wave: from 20 of December 2021 to 25 January 2022.
ResultsThe first wave lasted 122 days. 4,601 calls were recorded, 27 calls were discarded for missing data. Women's mean age 51.79, SD 17.3, n = 3355. Men's mean age 43.29, SD 15.52, n = 1219. Significant differences were found in age, being men younger (T=−15.764, p < 0.000). Women made the majority of calls (72.9%). Fear and anxiety represented 45.1% of calls, depression 27.3% and psychosis 9%.
The second wave lasted 138 days and there were 4051 calls. Again, most of calls were made by women (71.5%). There were significant differences in age, being men younger (T = 14.450, p < 0.000). Women's mean age 46.68, SD = 18.72, n = 2872; men's mean age 38.05, SD = 16.34, n = 1138. The three most common detected problems were fear and anxiety 53.3%, depression 14.9% and psychosis 18.3%.
The third wave lasted 36 days; it had 1117 calls. Most calls made by women, 70.5%. Men were younger and this difference was significant (women's mean age 46.09, men's mean age 42.54; T = 3.233, p = 0.001). Problems detected, fear and anxiety 37.6%, depression 4.5% and psychosis 32.7%.
ConclusionThere was a change in the caller profile throughout the studied period, the callers from the first wave were older than the ones from the second and third waves. There was a change in the motivation to call, the most noticeable changes the drop in the number of calls related to depression (from 27.3% to 4.5%) and the increase in calls related to psychotic problems (from 9% to 32.7%). This last change might be related to the shift in the use of the Phoneline, from a Crisis Line to a Point of Entry to Mental Health Services.
Keeping the Door Open: The Function of the Supported Employment Programme During the First Year of COVID-19 Pandemic
- David Gutnisky, Licenciate Maria Soledad Ortega, Horacio Rodriguez O'Connor, Licenciate Sandra Garcia Taboada
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S134-S135
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Aims
The Supported Employment Programme of the General Directorate of Mental Health of the Autonomous City of Buenos Aires has been running for the last five years. Its purpose is to help adults with severe mental illness obtain and maintain competitive work in the community and provide the support necessary throughout the entire process and follow-up after successful inclusion. The aim of this paper is to evaluate the impact of the COVID-19 pandemic has had upon the Programme and to analyse the main causes of clients’ drop-off despite the fact the modifications were put in order to keep running the service during the lockdown.
MethodsRetrospective analysis of case records of the Supported Employment Programme from 1 January 2020 to 31 December of 2020.
Different variables were analysed to identify the main causes of dropout. Between them, variables related to the digital divide, fear of COVID-19, and increased economic vulnerability.
ResultsAt the beginning of 2020, the programme had 51 users and received 11 referrals throughout the year, of whom 8 users were finally admitted. Therefore, 59 users entered this sample, 40.7% were women (n=24) and 59.3% were men (n=35). Mean age 40.4, ranging from 18 to 65 years of age (sd = 11.6). No significant differences were found in sex, age, or level of instruction between participants. The dropout rate after the lockdown was introduced reached 50.3% (n = 30), and there were no significant differences between those who left the programme and those who continued, with respect to sex, age, or level of instruction. Significant differences were found between these two groups in access to Technology (T= –6.158 p<0.000); Digital illiteracy (T–3.247 p<0.003); fear of getting COVID-19 (–7.616 p<0.000). However, having obtained a job through the programme was a protective factor against leaving, and only one user out of nine who got a job through the programme dropped out. This difference was at the significant level (T=2.671 p<0.05).
ConclusionEven though, in an attempt to keep the Programme running during the strict lockdown that was imposed during the first year of the COVID-19 pandemic, moving the face-to-face interviews to remote ones through digital platforms did no guarantee the access to service. The digital divide was one of the main causes of dropout of users. It is important to point out the protective value that had to have obtained a job through the programme against leaving.
Change of Focus: Interventions of Occupational Therapy From a Psychodynamic Perspective
- David Gutnisky, Licenciate Maria Soledad Ortega
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S123
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Aims
Strictly speaking, occupational therapy interventions in mental health help clients through different activities to improve and develop skills that allow them to become increasingly independent and self-sufficient. Occupational therapy evaluation includes areas such as activities of daily life, play/leisure, productivity, study, work, and social participation. Occupational therapy also considers the impact of the context on the areas mentioned, but usually does not include the psychodynamic aspects of the client.
MethodsMale patient in his early thirties who was suffering an acute psychotic episode. He was experiencing a mystical delusion, with grandiose ideas of personal significance and delusions of reference. His mood was elevated, in consonance with the content of his thoughts. He was disorganised and needed help to maintain his daily routine. He said that he was experiencing a Maslow's Peak-Experience not a psychotic episode although he acceded to take medication. In an attempt to avoid involuntary admission to a mental health clinic (he refused to be admitted, as did his family), we tailored a home approach, with the inclusion of an occupational therapist on the team. Our first approach was unfruitful. Our attempts to help him to organize himself and his daily routine did not work. He was so fixated with his delusional project that any other idea or plan was rapidly discarded. So, we decided to change our approach and took his delusional project as the activity to organise and plan about. We agreed with him that we were going to help him with his project, but that there were no guarantees of success. Occupational therapy interventions helped him organise his project step by step and accept the frustration that his plan was impossible to achieve. Eventually, the episode ended with no need of admission.
ResultsChanging the focus of the occupational therapy interventions, paused the interventions that were aimed at activities of the daily life, and taking the delusional project as the main and the most important activity of the client at this point allowed us to build a stronger therapeutic alliance and helped the client deal with the psychotic process and tolerate the constraints of reality.
ConclusionThe introduction of a psychodynamic point of view in the planning of occupational therapy interventions enriches the realm of occupational therapy and allowed, in this case, a flexible and creative approach that opened the path to a home treatment plan avoiding involuntary admission.