Enhancing mental health service delivery to ethnically diverse populations: Introduction to the special series.

Mental health care among marginalized populations in the United States

Opportunities in mental health services research.

Initiation and Use of Public Mental Health Services by Persons With Severe Mental Illness and Limited English Proficiency

Back to table of contents Previous article Next article ArticleFull AccessCommentary: Devising Prevention and Treatment Strategies for the Nation's Diverse Populations With Mental IllnessThomas R. Insel M.D.Thomas R. Insel M.D.Search for more papers by this authorPublished Online:1 Mar 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The mission of the National Institute of Mental Health (NIMH) is to reduce the public health burden of mental and behavioral disorders through research. As the Surgeon General reported in 1999, the public health burden of mental illness is not shared equally—mostly because of disparities in access to services and variations in the quality of care. Recent epidemiological studies have documented many of these disparities, demonstrating that mental disorders, unlike other medical illnesses, remain largely outside of the nation's health care system. Clearly, the success of NIMH depends on identifying where the public health burden is greatest and on devising prevention and treatment strategies that will be most effective for those populations. The NIMH recently convened a meeting of experts to consider how best to improve research directly relevant to better serving Latinos with persistent mental disorders. A summary of this meeting, published in this issue, highlights key areas of research that will help inform future research efforts in this important area ( 1 ). How can research have the greatest impact on those with the greatest need? First, we need to document the needs. Epidemiological studies, including studies in Latino populations, have tracked not only the prevalence of psychiatric disorders but also the use of services in various facets of our society. More recently, NIMH funded a large, regionally diverse, six-site collaborative study to examine the effects of ethnicity on clinical diagnosis and treatment assignment among African-American, Latino, and Caucasian patients with mood disorders. In addition to epidemiological studies, a critical part of the NIMH strategy includes large-scale, practical treatment trials in real-world health care settings to study treatment of such disorders as schizophrenia, depression, and bipolar disorder. Studies such as the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) for schizophrenia and Alzheimer's disease, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) for treatment-resistant depression, and the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) represent the first and largest studies of their kind.In order for clinical research to provide results that address the needs of the American public, the research needs to include diverse populations. Recently, NIMH issued a new policy to monitor the recruitment of participants in NIMH-sponsored clinical research studies that expect to enroll 150 or more human participants. The purpose of this policy is to ensure the establishment of realistic recruitment targets from the outset of a project and achievement of these targets throughout the course of the research—particularly the recruitment and retention of underrepresented racial and ethnic minority participants.The results of recent clinical research demonstrate that current treatments, although helpful for many, are not sufficient for all patients with serious mental illness. Research is essential to develop new treatments and to identify which people will benefit most from the various treatments available. Research can also inform policy, including ways to optimize the dissemination and implementation of scientifically based treatments. The severe fragmentation of our present treatment system, as noted in the report from the President's New Freedom Commission on Mental Health, is an urgent national problem. Finding ways to restructure this system may open the door for creating a more equitable and responsive network for individuals who have unique linguistic needs or who come from cultural backgrounds with a very different understanding of mental illnesses or their management.In short, NIMH research must offer pragmatic solutions to improve access to mental health care and to find effective interventions that can be implemented in diverse settings and populations within our nation.Dr. Insel is director of the National Institute of Mental Health, Room 8235, MSC 9669, 6001 Executive Boulevard, Bethesda, MD 20892 (e-mail: [email protected]).Reference1. Vega WA, Karno M, Alegria M, et al: Research issues for improving treatment of US Hispanics with persistent mental disorders. Psychiatric Services 58:385–394, 2007Google Scholar FiguresReferencesCited byDetailsCited byA randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic stress disorder1 August 2013 | Implementation Science, Vol. 8, No. 1Administration and Policy in Mental Health and Mental Health Services Research, Vol. 36, No. 1Neuropsychopharmacology, Vol. 34, No. 1 Volume 58Issue 3 March, 2007Pages 395-395PSYCHIATRIC SERVICES March 2007 Volume 58 Number 3 Metrics PDF download History Published online 1 March 2007 Published in print 1 March 2007

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.

Advances in scientific knowledge must begin to address the significant health disparities that persist among ethnic and racial minority groups in the United States (Pinn, 2000; Ruffin, 2000). Exceedingly low participation rates of older ethnic minorities and women in health research have been well documented (Gavaghan, 1995). Policies encouraging involvement of underrepresented groups in health research have been in place at the National Institutes of Health (NIH) since the mid 1980s (Roth, Pinn, Hartmuller, Bates, & Fanning, 2000), and, in 1994, NIH issued Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research mandating such inclusion. The NIH, and the Office of Research on Women’s Health (ORWH) in particular, have stressed the importance of recruiting women as research volunteers, especially those from diverse cultures and minority populations (Becker et al., 1992; NIH, ORWH, 1997). Policy and research efforts such as the Women’s Health Initiative are anticipated to address past discrepancies in many scientific areas (Hall, 1999). A recent Government Accounting Office (GAO) evaluation reported that NIH has made significant progress in increasing representation of women in clinical research (GAO, 2000). Nevertheless, the science of recruitment and retention of ethnic minorities is in its early stages, with models only recently being developed and evaluated (Ory, Lipman, Barr, Harden, & Stahl, 2000; Swanson & Ward, 1995). Although there are a few practical guides to assist investigators (for example, LaRosa, Seto, Caban, & Hayunga, 1995; NIH, ORWH, 1994), current information about effective approaches is quite limited. Barriers and facilitators to research participation among ethnic minorities of all ages are just beginning to be examined, with much of the literature focusing on cancer prevention (Giuliano et al., 2000; Underwood, 2000). Research on older adults has primarily addressed recruitment and retention in clinical trials for cancer (Moinpour et al., 2000; Zhu et al., 2000), osteoporosis (Unson, Dunbar, Curry, Kenyon, & Prestwood, 2001), Alzheimer’s disease (Gauthier & Clarke, 1999), mental health services (Arean & Gallagher-Thompson, 1996) and primary prevention studies such as dietary interventions and exercise trials (Coleman et al., 1997; Dennis & Neese, 2000; Lewis et al., 1998; Prohaska, Walcott-McQuigg, & Peters, 2000). Several themes emerge from this growing body of literature: (a) trust and connection with the community is central, (b) involvement of ethnic and racial minority researchers at all levels (lead investigator to data collector) is essential, and (c) barriers to recruitment can stem from research institutions as well as the minority community of interest (Levkoff, Levy, & Weitzmann, 2000). Despite recent progress, the need persists for development of theory-based, population-specific models of recruitment and retention, coupled with systematic evaluation of impact and cost-effectiveness (Ory et al., 2000). Against this backdrop, the National Institute on Aging (NIA) sponsored a preconference to The Gerontological Society of America’s 1999 Annual meeting, ‘‘Involving Older Ethnic Minorities in Health-Related Research.’’ The workshop faculty examined recruitment and retention of research Address correspondence to Leslie Curry, Braceland Center for Mental Health and Aging, The Institute of Living, Hartford Hospital Mental Health Network, 200 Retreat Avenue, Hartford, CT 06106. Email: lcurry@harthosp.org Braceland Center for Mental Health and Aging and University of Connecticut School of Medicine, Hartford. Institute for Social Research, University of Michigan, Ann Arbor.

LGBTQ youth mental health during COVID-19: unmet needs in public health and policy

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.

Mental health care for Latinos: introduction to the special section.

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

The Role of Providers in Mental Health Services Offered to American-Indian Youths

Lessons learned in developing community mental health care in Australasia and the South Pacific

The Robert Wood Johnson Foundation (RWJF) Program on Chronic Mental Illness has come to an end. Launched in December 1986, it was the foundation’s first multisite national venture into mental health care. The program sought to establish improved systems of care for persons with serious and long-term mental disorders in nine major cities across the country. Now, almost six years later, the grant period has ended, and it is time to take stock. The nine demonstration programs are still intact, with more than 250 staff in place at the sites. Throughout the program’s lifetime it received $22.5 million in RWJF grant funds, $9 million in foundation loan funds to stimulate housing development, and 1,200 Section 8 housing certificates, issued by the U.S. Department of Housing and Urban Development (HUD). One view of the impact of this program is offered by Howard Goldman and his colleagues, based on a formal evaluation funded by RWJF and a consortium of federal agencies.’ But there is another view of the program’s impact: the subjective impressions of the national program office staff and the staff at the nine demonstration sites. This perspective has been enriched by RWJF’s style of grant management, which is to fund a partnership between the national program office (typically in a university) and the demonstration sites. Instead of awarding the grant and coming back later to assess the results, RWJF requires that each demonstration site develop its program in collaboration with the national program staff. The national office maintains constant contact with the sites to monitor progress and solve immediate problems and carries out numerous site visits, with special conferences among the sites and other direct contact as needed. This management style affords the national program staff an intimate view of the demonstration sites and an opportunity to compare them as they face common situations.

A Prospective Examination of Service Use by Abused and Neglected Children Followed Up Into Adulthood

Mental Health in the Context of Health Disparities