Structures to improve the implementation of mental health practices in adult trauma centers: A Canadian nationwide practice survey.

Abstract

Up to one third of trauma patients experience mental disorders, placing them at greater risk of morbidity and healthcare utilization. However, few studies have examined knowledge-to-practice gaps when it comes to improving their mental health. This study aims to assess how trauma program leaders perceive the implementation of structures to facilitate the adoption of recommendations aimed at improving mental health outcomes in trauma patients. We conducted a cross-sectional practice survey across Levels I to III Canadian trauma centers (n = 69). The survey focused on empirically supported structures for optimizing mental health practices. Responses were analyzed using descriptive statistics and content analysis. The overall response rate was 62%, with 75% in Level I trauma centers, 91% in Level II centers, and 47% in Level III centers. The structures most frequently perceived as having been implemented were: referral mechanisms to a rehabilitation program to improve psychological outcomes in severely injured patients (58%), referral mechanisms to mental health resources for patients with a psychological condition that contributed to the injury (56%), protocols for screening suicidal ideation (56%) and substance use disorders (51%), protocols for the pharmacological treatment of aggression in patients with traumatic brain injury (TBI) (51%), and follow-up programs to manage behavioral disorders in TBI patients (51%). These were more widely reported as being implemented in Level I trauma centers. The importance of integrating mental health services throughout the continuum of care was also emphasized. Our survey results revealed that Canadian trauma centers could improve the implementation of structures to facilitate the uptake of evidence-based recommendations in mental health.