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Category Archives: Mental Health

Mental Health is the Responsibility of All Healthcare Professionals

Mental health consultation
Mental health consultation

The way we treat mental health in the United States needs to change.

As many patients seek help from their primary care doctor, or more often end up in the Emergency Department (ED), it is not enough for those with mental health issues to be solely the responsibility of specialists in mental health hospitals. 

It’s therefore vital that all healthcare workers hone their skills in mental health assessment so they can begin looking at the problem from a whole human perspective – taking a holistic approach – enabling patients to access the right care at the right time no matter where that may be. 

What are the Barriers We Face?

Despite it being 2021, there is evidence that some still view those with mental health problems as “morally broken”1 rather than ill.

One plausible reason for this stigma is the perception that mental health conditions are less “real” than physical ailments. This societal stigma appears to hold true across the healthcare professional as well as within the general public.

For example, a study published in the Health Affairs journal found that doctors were less likely to follow up with their patients who have been diagnosed with depression than those with congestive heart failure, asthma, and diabetes.

This lower priority associated with mental health conditions can lead to substandard medical care2 with 44% of adults with mental illnesses reporting being discriminated against or dismissed by their physician when accessing treatment.

But stigma is not the only reason. Healthcare professionals are under enormous time pressures, frequently have a lack of adequate mental health training and, as such, often feel that mental health care is outside their scope of practice. 

Many emergency departments and general clinicians are therefore ill-equipped to meet the needs of patients with mental health issues.

Accessing Treatment

Obtaining treatment for mental health is also too difficult for patients in the US. Mental health care can be delayed by up to 23 years from first symptoms3 and it has been reported that 62% of people with mood disorders and 76% of those with anxiety do not receive treatment at all4.

According to a survey carried out by the National Council for Behavioral Health, 42% of respondents cited cost and poor insurance coverage as key barriers to accessing mental health care5 – with most insurance plans viewing mental illness and addiction as exceptions to standard care, rather than part of it.

Furthermore, Americans have reported saying they do not have the same access to mental health providers as they have for other medical providers. For example, 89.3 million Americans live in federally designated “mental health professional shortage areas”6, with 55% of US counties not having a single practicing psychiatrist7. Plus, even in states with the greatest access, more than 38% are not receiving the services they need8.

And this is only set to get worse, with the Health Resources and Services Administration reporting that by 2025, the US will be short on an estimated 250,000 mental health professionals9.

The Link Between Mental and Physical Health

Around 30% of all people with a long-term physical health condition also have a mental health problem10; Those with depression have a 40% higher risk of developing cardiovascular and metabolic disease than the general population11, and psychological stress can down-regulate various parts of the cellular immune response12.

This correlation between mental and physical health should encourage practitioners to take a holistic approach in looking after the whole human, and yet so often mental health is overlooked. 

Take a clinician in emergency care for example. If a patient attends with a broken leg and then is also noted to have a chest infection, the clinician wouldn’t just treat the initial problem – they would also look after the infection.

Why should it be any different for those with mental health problems? We need to be attuned and sensitive to those with underlying mental health issues, to identify and manage conditions alongside other healthcare problems.

Looking to train compassionate, competent healthcare professionals? Request a demo and experience OMS Mental Health Scenarios for yourself.

Why Now?

The coronavirus pandemic has had a major impact on people’s mental health. Before the pandemic, one in five US adults lived with a mental health issue13. Nine months in, 42% of people reported symptoms of anxiety or depression – an 11% increase from the previous years14.

The number of people looking for help with anxiety and depression skyrocketed between January and September 202015. It has also been reported that Covid-19 could result in a potential 50% increase in the prevalence of behavioral health conditions16.

If the country does not take action now, we will soon be dealing with another epidemic.

How Can VR Support Positive Mental Health Outcomes

Healthcare professionals do not need to be experts in mental health to have a huge impact. 

Taking a whole-person perspective, communicating sensitively, coordinating care, and encouraging self-management and peer support will all help clinicians positively impact mental health care. 

To help clinicians do this effectively, and to ensure it becomes second nature, Oxford Medical Simulation delivers immersive simulation scenarios in mental health care. These fully interactive, adaptive scenarios allow clinicians to practice interacting with artificial intelligence-controlled virtual patients as they would in real life. Learners are then given detailed feedback on performance and blended learning on one intuitive platform allowing clinicians to hone their skills to deliver optimal care in the real world. 

We have just expanded our ever-growing mental health library, which contains a range of scenarios including anxiety, self-harm, bulimia nervosa, alcohol dependence, chronic pain, dementia with difficult behavior, gender transition, and suicidal ideation.

Each scenario has been created to help learners hone their skills in assessing psychological conditions, and – as in real life – contain physical health issues too. For example, Maria is an 80-year-old patient presenting with shortness of breath. Though she has a history of heart failure, her most prevalent issue is acute anxiety. The learner must balance these two issues to manage Maria successfully.

This involves establishing rapport, elucidating a medical and mental health history, assessing acute anxiety, use of scoring systems, investigating coping mechanisms and sources of support, involving the relevant teams for further assessment, and documenting as needed.

The virtual patients are designed to look and behave like real patients, from low mood and poor eye contact to confusion and agitation.

After each scenario, detailed feedback, evidence-based blended learning, and performance analytics allow the learner to repeat and improve their performance over time, and a guided debrief allows them to reflect and document their performance.

Healthcare professionals can access flexible, immersive, engaging simulation scenarios whenever they need to, achieving first-rate educational outcomes while saving organizations time, space, and money.

Bringing Mental and Physical Health Together

Mental and physical health are inextricably linked, and it is detrimental to a person’s overall wellbeing to regard these as two separate entities.

Covid-19 has had a major impact on US citizens’ mental health and it is important that access to specialist services across the states is broadened to cope with this impending epidemic.

It is not the sole responsibility of mental health specialists. Instead, all healthcare professionals should develop their skills to be able to recognize the symptoms and engage with their patients and ultimately deliver them the care they deserve. 

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References

1 https://www.statnews.com/2017/05/31/mental-health-medicine/

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347358/#bibr50-0840470416679413

3 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/208684

4 https://www.healio.com/news/psychiatry/20190614/many-people-with-mental-health-disorders-do-not-receive-treatment

5 https://www.thenationalcouncil.org/press-releases/new-study-reveals-lack-of-access-as-root-cause-for-mental-health-crisis-in-america/

6 https://www.socialsolutions.com/blog/barriers-to-mental-healthcare-access/

7 https://www.nami.org/mhstats#:~:text=20.6%25%20of%20U.S.%20adults%20experienced,represents%201%20in%2020%20adults

8 https://www.mhanational.org/issues/state-mental-health-america

9 https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/behavioral-health-2013-2025.pdf

10 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60240-2/fulltext

11 https://www.nami.org/mhstats#:~:text=20.6%25%20of%20U.S.%20adults%20experienced,represents%201%20in%2020%20adults

12 https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(04)01597-9/fulltext

13 https://www.nimh.nih.gov/health/statistics/mental-illness#part_154785

14 https://www.census.gov/library/stories/2021/01/young-adults-living-alone-report-anxiety-depression-during-pandemic.html

15 https://www.mhanational.org/issues/state-mental-health-america

16 https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/understanding-the-hidden-costs-of-covid-19s-potential-impact-on-us-healthcare

How We’re Challenging Unconscious Bias to Progress Healthcare for Transgender Patients

Mental Health
Mental Health

It’s time to open up a dialogue with healthcare professionals around gender identity and mental health. 

Though we are becoming acutely aware of the importance of mental health, transgender patients continue to suffer significant barriers to appropriate care, including discrimination and a “lack of cultural competence”. This is especially concerning given the prevalence of mental illness amongst transgender individuals – recent research has found that the community are six times more likely than the general population to have a mood or anxiety disorder. How can we improve the care we provide transgender patients?

At OMS, we’ve created a new mental health scenario to challenge clinicians’ unconscious biases. Here, users encounter an adolescent patient, with the birth name Oscar, who has been admitted to hospital after a suicide attempt. Through a supportive and understanding dialogue, we learn that she is gender transitioning and prefers to go by the name of Ola.

We spoke to Dana Plank, RN – a nurse in New Hampshire – and Dr Bex Thompson – a physician in the UK –  to get a better understanding of its significance. Both are clinical authors at OMS and have been instrumental in the scenario’s development.

A screenshot of the patient from OMS mental health scenario for transitioning youth
Our new scenario features a gender transitioning adolescent who prefers to be called Ola.
A screenshot of the patient from our new scenario, who is gender transitioning and prefers to be called Ola
Ola, whose preferred pronouns are she/her, has been admitted to hospital after a suicide attempt.

We know how important mental health is, and how impactful these scenarios can be. In fact, mental healthcare and health inequalities are areas OMS actively works to improve. But this one resonates with so many people – we’d love to hear how it got started.

Bex: One of our authoring team (Kelly) had a great background in mental healthcare and was very passionate about making scenarios that aren’t just out of a textbook, but really bringing them to life and making them a bit more real-world. Kelly had worked with transgender people before and had first-hand knowledge and recognized how important the topic was. It’s one that’s not talked about enough in healthcare, and we saw an opportunity to change that.

What had been your experience of training on transgender awareness before working on this scenario?

Bex: Certainly when I went through med school (UK) we didn’t receive any formal training about how to approach topics around gender identity.

Dana: It’s the same here (US). LGBTQ issues aren’t something that we’re very good at—we’re not very good at using the right terminology and consistently demonstrating compassion towards these issues. But it’s just because we haven’t had the practice. The idea behind this scenario was to give people the opportunity to learn how to interact compassionately, and to ask the right questions so that you don’t alienate your patient.

You received input from people with first-hand experience of transgender issues to help develop the scenario. How did their expertise influence the finished product?

Dana: We mainly asked for our subject matter expert’s input to ensure we were representing the patient sensitively, and to find out whether we’d overlooked any issues they’d faced in the patient’s care. They have experience with transgender patients and mental health care as an RN, but they also identify as non-binary, which meant that they were able to offer both professional and personal insight. They certainly helped us with some background that we would’ve never thought of. For example, how the parents refer to this gender transitioning adolescent. If you’re calling the parents, it gives you an idea of how they feel. They might either be accepting of the situation that the patient is going through, or they might still refer to them as Oscar.

Bex: I also consulted with a colleague of mine who is training to be a psychiatrist. She helped us to narrow down the scenario and remove any unnecessary elements that could distract users from focusing on the patient’s mental health.

You mentioned taking out unnecessary elements. Can you tell us more about how the scenario developed to focus on the patient’s mental health?

Dana: Originally the patient had ligature marks – they weren’t gruesome, just a minor abrasion or burn. But Bex mentioned that from a doctor’s perspective, any kind of mark like that would suggest a more serious suicide attempt, needing a more serious physical examination. We didn’t want to go down that path – we wanted it to be mental health-focused – and our authoring approach got us there.

Bex: The patient was also originally drinking and using drugs, but we had to pare it back or it would’ve ended up being a child safety issue. It’s difficult because in real life, people do present with lots of things, but we have to be mindful that this is only a 20-minute scenario. At the end of the day, it’s a mental health scenario, so all the objectives are about understanding your patient and what led them to feel the way they do.

Looking to train competent, compassionate healthcare professionals? Discover how OMS can make it happen.

Even after it was stripped back, the scenario still sounds uniquely complex – a juvenile patient who is transitioning and has also attempted suicide. Was that a conscious choice?

Dana: This particular scenario is in an ED setting, so we needed something that would bring a patient there. It might look like a physical problem but in reality, it’s a mental health issue.

Bex: Absolutely. Our first few mental health scenarios were more simplistic, like an anxiety attack. It was a conscious decision, we were focusing on learning outcomes. But people don’t tend to come with just one problem. People are complicated, and this scenario reflects that. A gender transitioning patient is new for our scenarios but we should ideally be asking everyone their preferred pronouns and treating everyone with that consideration.

Why do you think that patient-focused care is so crucial for mental health scenarios like this one?

Bex: With anything you do in medicine, it should be about patient care and compassion, but with mental health in particular it’s so important. If you’re treating somebody’s heart attack and you don’t get on well, they might not like you, but you can still treat the problem quite successfully. That’s not the case with mental health – if you don’t connect with your patient, you’re really going to struggle.

How would you respond to those who would say mental health should only be treated by those within the specialty?

Bex: I think that’s wrong. As we have said, mental health often goes with physical problems and we have to take that holistic approach. Some problems you do need to separate, so you wouldn’t want a surgeon looking at a cardiology problem, but mental health filters into every part of medicine. It’s really important to understand mental health presentations because if someone’s having an anxiety attack and they’re short of breathing and having palpitations, I need to take a good history to make sure they’re not actually having a heart attack. They’re not just ‘patients’, we want to treat them as people.

Dana: We talk about “holism” in treating a patient. People are multifaceted beings, and everything that is affecting them physically, mentally, socially – everything comes into play. This holistic approach is emphasized in nurse training. You would be doing a disservice to a patient to not consider a whole person.

Bex: And even though this scenario is set in the ED, it could just as easily be used for other situations, such as for someone who is on a ward or even the community. The mental health scenarios help users to take the patient’s history and to recognize what’s going on, and that’s an important part of a clinician’s work. Whether you’re on a ward or in an outpatient community, you’re going to come across mental health.

Finally, why do you feel that this scenario is so important to furthering the understanding of transgender patients’ struggles?

Dana: I had an experience a little while back where I was describing this scenario to someone I knew, and saying that we can be better equipped by using the right pronouns, things like that. And he said, “What, just so they can be special?”. But you have to think about it from their perspective. Transgender individuals have been marginalized and treated unfairly their whole life. It’s not giving them special treatment – it’s giving them the same respect that we give everyone else. We are up against that lack of understanding and that’s why this scenario is so important.

Bex: Even if you understand why we need to be aware, a lot of people are uncomfortable because they haven’t come across the situation before. You might never come across it again. There are so many things going on for a clinician and it can be hard to remember things like asking patients’ pronouns, which is why normalizing it in this way is so important. It might feel a bit uncomfortable at first but that’s okay, you’re trying, and that’s key.

Dana: Absolutely. The fact that you’re acknowledging it and trying your best for the patient really speaks volumes.

 

Learn more about mental health simulation from the educational experts at OMS.

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About the Clinical Authors

Dana Plank MS, RN, CHSE 

Dana is a Registered Nurse with a Masters in Nursing Education. Dana is also a Certified Healthcare Simulation Educator. Gaining extensive experience in OR Nursing, homecare, and public health, Dana then transitioned her career to simulation education. Since 2019, she’s been using her expertise to develop immersive sim scenarios as a Clinical Author at OMS.

Dr. Rebecca (Bex) Thompson BSc, MBBS

Bex is a Physician and Simulation Educator with a PGCert in Clinical Education. While working as a hospital physician she began delivering innovative simulation training, and developed specialist knowledge of clinical teaching. Bex continues to practice clinically alongside her work at OMS, and uses this real-world experience to help create engaging scenarios for learners as a specialist clinical author.

Holistic Simulation: Mental and Physical Health in a Pandemic

COVID-19 mental health impact

“If I go to see someone about my eyes, my eyes are what I am, and the rest of me doesn’t matter. It’s the same with mental health. If I go to see someone for a mental health problem, I AM a mental health problem”

Mental health focus group participant  ¹


If you work in healthcare or have ever been a patient with multiple conditions, you may relate to the statement above. You may have been that clinician or that patient.

Why is this? Why do we, as healthcare professionals, tend to see one issue at a time?

Part of it is the time pressures we are under – we need to prioritize and focus on the most urgent issue first. Part of it is about competence – the skills and confidence to work outside our conventional role boundaries. Part of it is about attitudes – there is a tendency to treat physical health ahead of mental health.

And part, unfortunately, is our education. In classes, in clinicals and in simulation, we are taught to think of issues as discrete. A mental health simulation involves a mental health issue, and cardiac scenario is about chest pain, and so on.

Yet we know in the real world people aren’t that simple. We know that mental and physical health are inextricably linked, and it is detrimental to a person’s overall wellbeing to regard these as two separate entities. As such, shouldn’t we be designing simulation to teach just that?

At Oxford Medical Simulation we think so…

Holistic Simulation

We deliver clinical experiences on-demand, helping educators provide fully interactive and immersive simulation on-screen and in virtual reality. Our virtual patients reflect what we see in the real world, taking a holistic approach to managing mental and physical health.

Angry virtual patient

Each scenario of the OMS mental health library has been created to help learners hone their skills in mental health assessment, and – as in real life – contain physical health issues as well.

For example, Maria is an 80-year-old patient presenting with shortness of breath. Though she has a history of heart failure, her most prevalent issue is acute anxiety. The learner must balance these two issues to manage Maria successfully. This involves establishing rapport, elucidating a medical and mental health history, assessing acute anxiety, use of scoring systems, investigating coping mechanisms and sources of support, involving the relevant teams for further assessment, and documenting as needed.

As with all the OMS scenarios, all elements of care are possible: communication, examination, investigations, EMR, charting, and team interaction – just like in the real world. This breadth of possibilities, combined with adaptive scenarios that change depending on learner behaviors, ensures scenarios feel real, whilst scaffolded learning ensures they are appropriate for a wide range of learners.

The virtual patients are designed to look and behave like real patients, from low mood and poor eye contact to confusion and agitation.

After each scenario, detailed feedback, evidence-based blended learning and performance analytics allow the learner to repeat and improve their performance over time, and guided debrief allows them to reflect and document their performance.

Scenarios are objective and standardized and can run with or without faculty input. This allows instructors to focus on debriefing, synchronously or asynchronously, with OMS providing the clinical experience. Running on learners’ own computers, ensuring accessibility, or virtual reality, OMS scenarios are built to deliver simulation at scale for maximal immersion.

The mental health library contains a range of scenarios to cover the mental health syllabus. The growing OMS mental health library consists of scenarios that challenge learners across multiple areas: anxiety, self-harm, bulimia nervosa, alcohol dependence, chronic pain, dementia with difficult behavior, gender transition and suicidal ideation.

There is a lot to learn within each scenario. Our approach reflects the understanding that healthcare professionals don’t need to be experts in mental health to have a huge impact. Getting the basics right is the most important element in mental health care.2 Taking a ‘whole person’ perspective, focusing on communication and consultation skills, ensuring coordination of care, and encouraging self-management and peer support are common across all scenarios.

Mental Health in Context

Physical health problems significantly increase the risk of poor mental health, and vice versa.

Around 30% of all people with a long-term physical health condition also have a mental health problem,3 and mental health problems can seriously exacerbate physical illness, affecting outcomes and the cost of treatment.4

COVID-19 mental health impact

This is compounded as many of those with diagnosable mental health problems receive no formal treatment. As such, a presentation for medical care may be the first presentation with an underlying mental health issue.5

To appreciate just how important and timely these issues are, before COVID-19, one in five U.S. adults lived with a mental health issue.6 In 2020 this skyrocketed. Nine months into the pandemic, 42% of people surveyed by the US Census Bureau reported symptoms of anxiety or depression – an increase from 11% the previous year.

This is not surprising. Fear of contracting the virus, working from home, temporary unemployment, home-schooling, and lack of physical contact contribute. “I don’t think this is going to go back to baseline anytime soon,” says clinical psychologist Luana Marques, at Harvard Medical School in Boston, Massachusetts, who is monitoring the mental-health impacts of the crisis.7

COVID-19 anxiety and depression impact

And amongst the mental health casualties are healthcare workers. It was known from the SARS outbreak that clinicians were at high risk of developing anxiety, depression, stress during outbreaks.8 Sadly, this has been reflected across the healthcare spectrum during COVID-19, with nurses seeming to be most impacted by the consequences of the pandemic.9 Without healthcare workers, there is no healthcare system, so whilst we continue to strive to improve the care we provide our patients, we mustn’t forget about ourselves, and each other.

All this to say that as the urgency of the pandemic begins to recede, the focus will rightly turn to the mental health epidemic. We should be designing scenarios that reflect this. Blending learning objectives across mental health and physical health through simulation is one way to help us deliver the complex care required for our patients, and scenarios such as those we design are part of that picture.

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