Mental Health Screening in Clinical Practice- Tools and Recommendations for Diverse Populations

Mental Health Screening in Clinical Practice- Tools and Recommendations for Diverse Populations

My clinical practicum setting is a primary care center, and I typically see people of all ages, including adolescents, women, and older adults.

Mental Health Screening Tools

            There are different mental health screening tools used in my clinical site. One screening tool is the Patient Health Questionnaire (PHQ-9). It is a nine-item questionnaire that asks patients to rate, on a four-point scale ranging from “most days” to “not at all,” the number of times they have gotten specific depression symptoms (Beswick et al., 2022). The questionnaire can be a patient self-report or administered by the doctor and is used in medical settings like primary care and others. The entire score is a simple addition of item scores. 20,15,10 and 5 represent thresholds for severe, moderately severe, moderate, and mild depressive signs, respectively. The questionnaire contains eight items that assess depressive symptoms, while the ninth item screens for suicidal ideation (Beswick et al., 2022).

The second screening tool is the Kessler Psychological Distress Scale. The tool has 10-item and 6-item versions, both of which were developed initially to evaluate the severity of psychological distress. The 10-item (K10) version measures nonspecific psychological distress, while the 6-item version (K6) is used in the identification of persons with severe psychological distress (Puac‐Polanco et al., 2023). The scales measure physiological, emotional, cognitive, and behavioral aspects of nonspecific psychological distress in line with diagnostic criteria for generalized anxiety disorder and major depressive episodes. The scale uses a 30-day reference period where patients rate how many times they feel hopeless, nervous, and unfortunate that nothing can cheer them, restless, and feeling worthless (Puac‐Polanco et al., 2023).

The third screening tool is the Generalized Anxiety Disorder Scale-7 (GAD-7). It is a seven-item tool that is used in both general population and primary care settings. The tool reports scores between 0 to 3 on all the questions (Sapra et al., 2020). It assesses how many times the patient has been troubled by seven different anxiety symptoms in the last two weeks. The patient answers the questions using responses like “nearly daily,” “more than half the days,” “several days”, and “not at all” which are scored as 3, 2, 1, and 0 respectively (Sapra et al., 2020). The scores of 15, 10, and 5 are taken as severe, moderate, and mild anxiety, respectively. This tool is efficient and potent for screening generalized anxiety disorder and works moderately well in the detection of three other anxiety disorders: post-traumatic stress disorder, social anxiety, and panic disorder (Sapra et al., 2020).

Disparities or Biases in Care Provided

           The quality of mental health services I have observed is overall good. Healthcare workers do a commendable job by showing cultural sensitivity, empathy, and patient-tailored care to all patients they serve. However, there exist biases or disparities in the care offered to different population groups. One disparity is age-related disparity, where older adults may get less focus on mental health issues during follow-up visits, resulting in underdiagnosis and underreporting of disorders like depression and anxiety. Secondly, I noted gender biases whereby mental health diagnosis was based on gender stereotypes affecting the identification and treatment of conditions like mood disorders (Halliburton & Allison‐Jones, 2023).

Recommendations

            Two changes I would recommend in my practice setting and community to increase the frequency of mental health screenings within vulnerable populations are the integration of mental health services and encouraging community education and outreach. Integrations of mental health services are achieved by closely working together with mental health professionals like psychiatric nurse practitioners or psychologists, who will provide integrated care within the primary care setting. It can be done by including a routine mental health screening in the annual wellness visits. For patients showing positive risk factors and symptoms, they are immediately referred for further management.

Secondly, community outreach can be developed and implemented to educate the population on mental health. The target vulnerable populations include low-income families, seniors, and communities that are culturally diverse. Also, free mental health screenings can be offered to senior living facilities, community centers, and local events to encourage early diagnosis and intervention. Partnerships with local leaders and organizations may promote outreach engagement and effectiveness.

References

Beswick, E., Quigley, S., Macdonald, P., Patrick, S., Colville, S., Chandran, S., & Connick, P. (2022). The Patient Health Questionnaire (PHQ-9) as a tool to screen for depression in people with multiple sclerosis: a cross-sectional validation study. BMC Psychology, 10(281), 281. https://doi.org/10.1186/s40359-022-00949-8

Halliburton, A., & Allison‐Jones, L. (2023). Mental health bias in physical care: An integrative review of the literature. Journal of Psychiatric and Mental Health Nursing, 30(4). https://doi.org/10.1111/jpm.12911

Puac‐Polanco, V., Ziobrowski, H. N., Nur Hani Zainal, Sampson, N. A., & Kessler, R. C. (2023). K10 and K6 Scales. Springer EBooks, 1–30. https://doi.org/10.1007/978-3-030-89738-3_49-1

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Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.
Mental health care is often initiated in the primary care setting. Screenings are a critical part of identifying clients who may require psychiatric care. Carefully read the questions below and address each in your initial post.

Mental Health Screening in Clinical Practice- Tools and Recommendations for Diverse Populations

CLINICAL PRACTICUM: PRIMARY CARE CENTER
POPULATION: ALL AGES (INCLUDES ADOLESCENTS, WOMEN, AND OLDER ADULTS

I. Application  of  Course  Knowledge
a. Identify your clinical practicum setting (primary care office, urgent care, etc.) and a population that you typically see (i.e., adolescents, women, older adults).
b. Discuss mental health screening tools used at your clinical site. If no screening tools are currently used, which ones would you recommend?
c. Describe the quality of the mental health care you have observed. Discuss disparities or biases, if any, in the care provided to different members of the population.
d. Screening opportunities are often missed in vulnerable populations and those with limited access to care. Describe at least TWO changes you recommend in your practice setting and community to increase the frequency of mental health screenings within vulnerable populations.
II. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations.Links to an external site.
a. Cite a scholarly source in the initial post.
b. Cite a scholarly source in one faculty response post.
c. Cite a scholarly source in one peer post.
d. Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
e. Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
III. Engagement in Meaningful Dialogue: Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.
a. Peer Response: Respond to at least one peer.
b. Faculty Response: Respond to at least one faculty post.
c. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
IV. Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
V. Reference Citation: Use current APA format to format citations and references and is free of errors.
VI. Wednesday Participation Requirement: Provide a substantive response to the graded discussion topic (not a response to a peer or faculty), by Wednesday, 11:59 p.m. MT of each week.
VII. Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.