A formidable scholar, friend, and mentor: Celebrating the life and work of Lonnie Snowden.

AMA Calls on Licensing Boards to End Discrimination for MH Treatment

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

To assess disparities in mental health treatment in New York City (NYC) after the World Trade Center Disaster (WTCD) reported previously related to care access, we conducted analyses among a cross-sectional survey of adults who had posttraumatic stress disorder (PTSD) or major depression (N = 473) one year after the event. The dependent variables examined were use of mental health services, in general, and use of mental health services related to the WTCD. Similar dependent variables were developed for medication usage. Although a number of bivariate results were statistically significant for postdisaster mental health visits, in a multivariate logistic regression model, only WTCD exposure remained significant. For service utilization related to the WTCD, the multivariate results indicated that African Americans were less likely to have had these visits compared to Whites, while those with a regular doctor, who had greater exposure to WTCD events, and those who had a perievent panic attack were more likely to have had such visits. In terms of medication use, multivariate results suggested that African Americans were less likely to use postdisaster medications, whereas persons 45 + years old and those with a regular doctor, were more likely to use them. For WTCD-related medication use, multivariate models indicated that African Americans were less likely to use medications, relative to Whites, while those between 45 and 64 years old, those with a regular doctor, those exposed to more WTCD events, and those who had a perievent panic attack, were more likely to have taken medications related to the disaster. The primary reason respondents gave for not seeking treatment (55% of subsample) was that they did not believe that they had a problem (73%). Other reasons were that they wanted to solve the problem on their own (5%), had problems accessing services (6%), had financial problems (4%), or had a fear of treatment (4%). Despite the availability of free mental health services offered in a supportive and potentially less stigmatizing environment post disaster, there still appeared to be barriers to receiving postdisaster services among those presumably in need of care.

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Stakeholders' Perspectives on the Recommendations of the President's New Freedom Commission on Mental Health

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

This paper summarizes the findings for the European Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. The article presents a description of the region, an overview of mental health policies and legislation, a summary of relevant research in the region, a precis of community mental health services, a discussion of the key lessons learned, and some recommendations for the future.

Opportunities in mental health services research.

Health care disparities research is an exponentially growing and multi-faceted field. Our objective was to identify and analyze the top 100 cited articles in health care disparities. The authors searched the Thomas Reuters Web of Science for citations of all research papers (articles) relevant to health care disparities. After analyzing search results, the number of citations, authorship, year, journal, country of publication, institution of publication, and relevant topic were recorded for each article. The most cited article was Martin's 2002 work identifying the demography of incidence and occurrence of sepsis with specific analysis of race, sex, and disposition of US patients. The second most cited article was Kamangar's 2006 paper outlining geographic patterns in cancer incidence, mortality, and prevalence. The third most cited article was Williams' 1996 study determining the differences in US health patterns in populations of different races and socioeconomic statuses through a review of similar studies. The majority of articles originated in the USA (91). The journal with the most published articles was JAMA-The Journal of the American Medical Association (14). The second most cited journal was The New England Journal of Medicine (7). Most articles were published in the 2000s (84). In descending order, the 3 most common topics were (1) disparities in cancer incidence, screening, treatment, and mortality, (2) disparities in mental health treatment, and (3) physician concordance, cultural competency, and relationships with minority patients. Overall, the highly cited articles contain current advancements in the body of knowledge used to resolve health care disparities in race, ethnicity, socioeconomic status, gender, age, wealth, education level, mental health, and geography throughout the world.

Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color.

Rethinking India's psychiatric care

Trends in Behavioral Health Care Service Provision by Community Health Centers, 1998–2007

Disparities in mental health treatment for low-income, Black and Latinx populations have been well recognized. Beyond structural barriers, a noteworthy concern was whether attitudinal barriers played a major role in initiating and maintaining treatment. More specifically, 35- to 60-year-old Black and Latina women have been understudied regarding their attitudes and preferences for mental health treatment. The purpose of this study was to identify attitudinal enablers and barriers that have prevented midlife low-income, Black and Latina women from North Philadelphia from initiating and continuing mental health treatment. An inductive thematic analysis approach was utilized to inform the sampling, themes, and sub-themes of this study. Semi-structured interviews were conducted with predominantly 50 midlife Black and Latina women from a larger, longitudinal community-based cohort focused on health improvement in North Philadelphia, whose residents were predominantly minority and low-income. Individual semi-structured interviews, with open-ended questions were performed on our study population. This approach stimulated discussion about the participants' experiences and their feelings that both inhibited and supported accessing mental health treatment. Interviews were conducted, transcribed, and coded to identify themes by the research team. Data analysis was conducted after interviews were coded in 2 research team meetings using flow diagrams. The participants had a mean age of 50years old, and the age range was 35-60years old; most identified themselves as Black (n = 37) and reported being unemployed (n = 33). Nine overall themes were identified which included considerations of access and sustainability of mental health treatment: attitudinal and structural barriers to treatment, the need for confidentiality, the opportunity to learn coping skills, perceived helpfulness of treatment, medication considerations, therapy as an outlet, prior bad experiences with treatment, and relationships with their mental health professionals. Stigma was influential in discouraging women from seeking mental health treatment. Individual provider-related concerns impacted mental health treatment, including the relationship with the therapist. A prior bad experience with mental health treatment was associated with negative feelings about treatment. Positive feelings about mental health treatment included having an outlet, valuing the relationship with their therapist, and noticing beneficial changes because of treatment. This study provided deeper insight from the unique community of low-income, primarily Black and Latina women in North Philadelphia. Our findings suggested that efforts to decrease stigma and educate this population of women about the significance and prevalence of mental health disorders may improve the disparities in mental health treatment in this population of midlife women. Continued emphasis on strengthening the connection between the woman and her therapist/psychiatrist and improving access to community-based interventions may help address treatment disparities in midlife women in North Philadelphia.

Mental health care among marginalized populations in the United States

Back to table of contents Previous article Next article Book ReviewsFull AccessMental Health Services: A Public Health PerspectivePhyllis Solomon, Ph.D.Phyllis SolomonSearch for more papers by this author, Ph.D.Published Online:1 Apr 2006https://doi.org/10.1176/ps.49.1.118AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This edited volume represents the first attempt to provide an integrated text of the critical elements and issues of mental health policy, management, and service delivery within a public health framework. This approach requires the integration of knowledge derived from mental health epidemiology, treatment, and service system research.The editors are well suited to this challenge. Both are from Florida Mental Health Institute, a multidisciplinary research and training institute whose efforts are focused on the public mental health system. Dr. Levin is trained in public health and is noted for his writings on mental health administration and policy. Mr. Petrila is trained as a lawyer and known for his critical assessments of the impact of legislation and regulation on service delivery. The first, and strongest, of the volume's four sections covers core mental health service delivery issues including organization, legislation and regulations, economics, financial management, quality improvement, consumer and family advocacy, evaluation, and multicultural perspectives. All the contributors to this section are nationally recognized experts on their respective topics.The chapters in this section generally are good comprehensive overviews of the substantive issues covered, such as the chapters on mental health services by Elpers and Levin, on economics of mental health by Frank and McGuire, and on the impact of consumer and family advocacy on service delivery by Lefley. However, for readers well versed in mental health service delivery issues, they offer little new information. The chapters on evaluation written by Orwin and Goldman and on the impact of disability law on mental health policy and services by Petrila and Levin are strikingly innovative and do provide new insights.The following three sections are devoted to three specialized populations—children and adolescents, the elderly, and adults with substance abuse problems—with each containing three chapters on the relevant epidemiological, treatment, and policy issues. These sections are uneven in quality and comprehensiveness. For example, the chapter on epidemiology of psychiatric disorders among the elderly is too detailed, and the reader becomes impatient. On the other hand, the treatment chapters in these three sections provide rather limited coverage; in addition, they have an extremely clinical orientation, not well balanced with a service perspective. The selection of these three populations results in the omission of relevant treatment, service, and policy issues related to adults with severe mental illness, such as those who are homeless, those who are in jails and prisons, and those who need psychiatric rehabilitation.This book suffers from the typical problems of edited volumes, variable quality and redundancy of information. Given the book's significant gaps, it falls somewhat short of being a comprehensive introduction to mental health services from a public health perspective. However, many practice disciplines, such as social work, nursing, and psychiatry, need a single source that offers an overview of mental health services and related policy issues. With the use of some supplemental material, this book can serve as such an introduction, for there is no text that currently competes with it.Dr. Solomon is professor in the School of Social Work at the University of Pennsylvania in Philadelphia.Dr. Solomon is professor in the School of Social Work at the University of Pennsylvania in Philadelphia.edited by Bruce Lubotsky Levin, Dr.P.H., John Petrila, J.D., LL.M. ; New York, Oxford University Press, 1996, 430 pages, $49.95 FiguresReferencesCited byDetailsCited ByNone Volume 49Issue 1 January 1998Pages 118-118 Metrics History Published online 1 April 2006 Published in print 1 January 1998