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Mental health considerations

MENTAL HEALTH CONSIDERATIONS FOR RESEARCHERS

DECEMBER 2023

EXPLANATION OF RISKS:

  • Be clear in application and ICD about risks associated with mental health assessments (cognitive status assessments, IQ screens, mental health assessments, exploitation/abuse/violence assessments, and drug testing).
  • Describe how and by who mental health assessments and outcomes are reviewed and reported.
  • Remember to report psychiatric adverse events, including serious adverse events, appropriately.

SELF-REPORT MEASURES:

  • Protocols using subject self-reports that ask about depression, worthlessness/guilt, and quality of life, should include a process of review by personnel with plan to notify investigator of pertinent positives.
  • Protocols using subject self-report reports with items specifically addressing self-harm or suicidal ideation, or related items indicating a subject may be at risk, should have a mechanism for responses to be reviewed in REAL TIME so action can be taken as appropriate.
  • Protocols using remote self-reports (Ipad, EMA device, web-based, etc.) should include a mechanism for notification of the investigator or designated member of the study team when threshold responses are received so that REAL TIME management can occur.

INVESTIGATOR-ADMINISTERED MEASURES:

  • Investigator-administered measures of psychiatric symptoms should be completed by those with appropriate training.
  • If the study team does not have the specific expertise, consider consultation with psychiatry or psychology colleagues.

PHQ-9:

  • PHQ-9: Suggestion to align with Suicide Risk BPA’s used by NM PCMH clinics rooming staff starting 8/8/2022:
    • if >14 and + response to question 9 = refer for emergency eval
    • if >14 and – response to question 9 = refer for mental health consult
    • if <14 and + response to question 9 = further assessment needed; refer as appropriate
    • if <14 and – response to question 9 = no further specific intervention

The Columbia Suicide Severity Rating Scale-Revised (CSSRS-R):

  • Baseline (“lifetime”) and “since last visit” versions available on-line.
  • Validated and available in Spanish.
  • Use of this scale should include training for non-mental health providers as it explores suicidality in a very thorough manner:

RESOURCES:

  • CURRENT – include 988 for the suicide hotline, don’t give numbers to agencies now closed (911 is still ok to use).
  • ACCURATE—know the policy for referral to the Department of Psychiatry, procedures for accessing ER, the Psychiatric Emergency Service (PES). Consider age- and/or diagnosis-appropriate services (e.g. Nebraska Family Help Line [1-888-866-8660]; Professional Partners-Region specific).
  • LOCAL—while resources are limited in some areas of the state, please make sure you list the ones close to the subject’s home.

UNMC/NE MEDICINE PSYCHIATRY SERVICES:

  • Psychiatry (ADULT) accepts referrals from PCP’s within the system.
  • C/A psychiatry not limited to UNMC/NE Med providers.
  • Behavioral Health Connections team (402-552-6007) facilitates referrals to community agencies.
  • When referring to the “PES” (Psychiatric Emergency Service), understand that patients still must go through the regular NE Med ER or Bellevue Medical Center ER first.

PSYCHIATRY SERVICES FOR CHILDREN

  • Immanuel (CHI) ER is primary location for inpatient triage for children/teens; other ER’s may transfer there if hospitalization is needed.
  • Bryan LGH (Lincoln) has inpatient care for children/teens as well as emergency shelter placement.
  • Boys Town (Grand Island) has emergency shelter placement.
  • Mercy (Council Bluffs) will accept NE youth (even Medicaid if no NE beds available).
  • Boys Town has an inpatient unit—triage through Methodist ER’s.

PSYCHIATRY SERVICES FOR STUDENTS:

  • For UNMC students: call UNO Health Center, 402-554-2374 (select option 2 to leave message for the nurse for scheduling).
  • For UNO students: Call CAPS 402-559-7276 (initial appointments are covered by student fees).
  • Gender and Sexuality Resource Center (GSRC): Confidential and free, Student Life Center 2031. Call 402-559-7276.

KEARNEY COMMUNITY RESOURCES

  • S.A.F.E. Center: 24/7 hotline 1-877-237-2513

LINCOLN COMMUNITY RESOURCES

  • Voices of Hope: Crisis hotline 402-475-7273 (non-emergencies, 402-476-2110)

NORFOLK COMMUNITY RESOURCES

  • Bright Horizons: call 877-379-3798 or text 402-370-8817

SCOTTSBLUFF COMMUNITY RESOURCES

  • Doves Program: call 308-436-4357 or 866-953-6837; text 515-599-6620

NATIONAL RESOURCES

  • National Domestic Violence Hotline: 1-800-799-7233, TTY 1-800-787-3224
  • National Suicide Prevention Lifeline: Text or Call 988
  • Trans Lifeline: 1-877-565-8860
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