How to Conceptualize Marital Conflict Within the Child’s Mind: A Psychoanalytic Perspective on Work in Public Services

This study examined the relationship of age and gender with risk of arrest among adolescents and young adults who were intensive adolescent users of public mental health services. Data were obtained from the Massachusetts Department of Mental Health (DMH) and juvenile and criminal courts. Participants were youths receiving DMH adolescent case management services sometime in 1994-1996 who were born between 1976 and 1979 (781 males and 738 females). They were cross-matched to document arrests between age seven and 25. The study examined age at first arrest, age-specific risk, and the relationship between arrest history and arrest risk by gender and age. Most males (69%) and almost half the females (46%) were arrested by age 25. First arrest was most common before age 18. As in the general population, males' arrest patterns were more concerning than those of females, although patterns were of concern in both groups. Most female arrestees had multiple arrests, many as adults. No gender differences were observed for several factors, including risk of first arrest over age 18. Risk was far greater for those arrested in the previous year than for those never arrested. Findings justify concerns of public mental health systems regarding justice system involvement of adolescent clients. Risk of first arrest was significant from early adolescence through age 24, indicating a need for arrest prevention into young adulthood. The heightened arrest risk at all ages among those who were recently arrested demarcates a population in need of immediate intervention.

Issues in Medicaid Policy and System Transformation: Recommendations From the President's Commission

What do young people and families living with an eating disorder need from a public health service system? What do clinicians and services need to provide treatment, particularly family-based treatment? How do we go about creating a public health system which provides early, equitable and quality access to evidence-based treatment for young people? The first priority of the Victorian Centre of Excellence in Eating Disorders (CEED) is supporting the provision of family-based treatment for eating disorders across public child and youth mental health services. Inspiring change for the person (child, youth and families) and for the public health treatment context is central in CEED's work towards this priority. The engagement on the ground with metropolitan and rural services across Victoria has resulted in developing initiatives in training, case consultation and service system development. This presentation aims to inform service leaders and clinicians about key aspects of implementing family-based treatment in public mental health services. It will provide an outline of CEED's approach to dissemination and implementation, and provide data about Victorian services utilization of family-based treatment as an evidence-based first-line treatment model. Key challenges and controversies will be canvassed. This abstract was presented in the Children and Youth Treatment and Service Development stream of the 2013 ANZAED Conference.

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

IntroductionAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which affects 5% of children globally. In Australia, it is estimated that 4.1% of children and adolescents have ADHD. While research...

This article examines the interplay between psychodynamic psychotherapy and other approaches to psychotherapy in mental health services in Israel, describing the history of psychotherapy approaches, education and training, current dilemmas and service examples. Israel has a system of universal healthcare, education and social care which includes mental health services for all citizens and permanent residents. Mental health services and interventions are provided by psychiatrists, clinical psychologists, educational psychologists, social workers, clinical criminologists and creative arts therapists. Despite being public, accessibility is undermined by long waiting times, inequitable geographic distributions and cultural‐linguistic barriers. The interplay between approaches is clearly visible in public mental health services. Many therapists are trained primarily in psychodynamic approaches and receive psychodynamic‐oriented supervision. However, public services often cannot provide suitable conditions for psychodynamic oriented psychotherapy, and the therapists are required to adjust their interventions to treatment plans, reimbursement and reporting. This paper describes in detail two programs that implement psychodynamic approaches in the medical and education systems respectively. The first is “Lkol Nefesh” (“for every soul”) that provides long‐term intensive psychoanalytic psychotherapy for individuals suffering from severe mental disorders. The second is the system of creative arts therapies delivered in schools that provide psychotherapy as part of special education services. The paper concludes with a discussion of the influence of the spirit of time on psychotherapy, and the opposite tendencies evident in the state of affairs of psychodynamic psychotherapy in Israel.

Background Although national policies in China are comprehensive and instructive, a wide disparity exists between different cities. The current status of public mental health services by region in China remains unclear. This study aimed to investigate policies related to public mental health services, the contact coverage of public mental health services and outcomes of service users.MethodsA cross-sectional study was carried out in Southern China, between April 2021 and March 2022. Considering the geographical location, socioeconomic development levels, and prevalence of severe mental illness, four cities including Wuhan, Changsha, Guangzhou, and Shenzhen were selected. Relevant service providers were asked to report data on mental health policies and facility-related information, including mental health resources, registration rates of patients, management rates of patients, and medication rates of patients. Eligible patients were invited to report service user-related data, including contact coverage of public mental health services and their outcomes. SPSS 26.0 was used for data analysis.ResultsThe four cities in Southern China have made different efforts to develop public mental health services, primarily focusing on socio-economically disadvantaged individuals. Community health centers in Guangzhou and Shenzhen reported having more professional human resources on mental health and higher mental health budgets for patients. The contact coverage rates of most public mental services were higher than 80%. Patients in Changsha (B = 0.3; 95%CI: 0.1–0.5), Guangzhou (B = 0.2; 95%CI: 0.1–0.3), and Shenzhen (B = 0.3; 95%CI: 0.1–0.4) who received social medical assistance services reported higher levels of medication adherence. Patients in Wuhan (B = -6.5; 95%CI: -12.9--0.1), Guangzhou (B = -2.8; 95%CI: -5.5--0.1), and Shenzhen who received community-based rehabilitation services reported lower levels of disability (B = -2.6; 95%CI: -4.6--0.5).ConclusionsThere have been advances in public mental health services in the four Southern cities. The contact coverage rates of most public mental health services were higher than 80%. Patients’ utilization of public mental services was associated with better health outcomes. To improve the quality of public mental health services, the government should try to engage service users, their family members, and supporters in the design, delivery, operationalization, and evaluation of these public mental health services in the future.

By providing affordable healthcare to many Americans for the first time, the Affordable Care Act increases demand for public mental health services. It is, however, unclear if states’ provision standards for supply of mental health services will be able to accommodate this demand increase. Both the demand and supply of public mental health services vary within states; it is necessary to measure both locally. In this paper, we estimate the prevalence of mental illness within 30 geographical regions in the state of Virginia, a representative example of how many states organize their public mental health systems and how mental illness prevalence can be measured locally. Our methodology extends the analysis in Stern (Health Serv. Outcomes Res. Methods 14:109–155, 2014) by covering an entire state and accounting for peoples’ insurance status. The latter allows us to compare estimates of demand for public mental health services among those 30 geographical regions. We find that over 66,000 uninsured and Medicaid-insured individuals in Virginia are not provided with public mental health services. The deficit varies locally, with several regions having no deficit and others having 5000 or more untreated people. We also estimate that a large portion of the unserved people with mental illness are uninsured but would be insured for mental health services through Medicaid if Virginia were to accept the Medicaid expansion associated with the Affordable Care Act. These results provide evidence that there is significant variation in the demand for and public health systems’ ability to supply mental health services within states. This implies states can better serve populations relying on mental health care by allocating scarce public mental health dollars to localities reflecting their need.

BackgroundThere is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes.MethodsAn in-depth policy and document analysis was conducted using Carol Bacchi’s ‘What is the problem represented to be?’ approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves.ResultsTwo dominant representations of the ‘problem’ were identified: 1) the ‘problem’ of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the ‘problem’ of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the ‘problem’ of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision.ConclusionsThis critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.

In this paper I examine the possible role of public sector child and youth mental health services in prevention and treatment of childhood and adolescent aggression. The problem of juvenile antisocial behaviour in Australian society is discussed. The review details the extent, concern and costs of juvenile antisocial behaviour. The most efficacious prevention and treatment programs for aggressive and antisocial behaviour are reviewed within the context of reforms to public sector mental health services. The place of evidence-based mental health programs within child and youth mental health services is discussed. Recommendations are made on the adoption of selective programs demonstrated to be efficacious in the prevention and treatment of aggression and antisocial behaviour. Child and youth mental health services can make a specific contribution to crime prevention.

To describe the population characteristics of people with intellectual disability in New South Wales; to quantify and compare public mental health service use and costs for people with and without intellectual disability in NSW during 2014-15. Retrospective cohort data linkage analysis. People using publicly funded in- or outpatient (admitted or non-admitted) mental health services in NSW, 2014-15. Numbers of bed days (inpatient mental health services), and treatment days (ambulatory mental health); costs of publicly funded mental health services. People with intellectual disability comprised 1.1% of the NSW population, but 6.3% of people who used public mental health services; 12% of public mental health costs during 2014-15 were for people with intellectual disability. Compared with metropolitan local health districts (LHDs), overall public mental health service costs were lower for rural and regional LHDs (adjusted incidence rate ratio [aIRR], 0.8; 95% CI, 0.8-0.9) and higher for specialty networks (aIRR, 1.2; 95% CI, 1.1-1.3). Per person costs for people with intellectual disability were higher than for those without intellectual disability (aIRR, 2.6; 95% CI, 2.2-3.0). People with intellectual disability use public mental health services to a greater degree than other people. They should be explicitly considered by all tiers of mental health policy and service planning in Australia. Population health planning for the needs of people with disabilities would be assisted by including disability identifiers in all health administrative data sets.

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

Smoking rates have decreased in the general population but remain high among people with severe mental illness (SMI). An individualized smoking cessation program was tested with 99 adults with SMI. The program showed it is possible to help people with SMI smoke fewer cigarettes and reduce nicotine addiction. Customized smoking cessation programs are essential for those with high nicotine dependence and mental health challenges. Mental health services should offer tailored tobacco cessation programs because these programs can improve the health of people with mental illness who smoke. It is important for mental health services to follow government guidelines and provide evidence-based support. INTRODUCTION: Despite significant reductions in smoking rates in the general population over recent decades, smoking rates remain relatively unchanged among people with SMI. To evaluate the feasibility and preliminary effectiveness of the Keep Quitting in Mind pilot program, an individualized smoking cessation program for people experiencing SMI. In total, 99 adult participants with SMI and engaged with a community mental health service, participated in the intervention. The intervention included motivational interviewing and goal setting, in addition to provision of pharmaceutical aids (including nicotine replacement therapy). Analysis determined that the Keep Quitting in Mind pilot program was feasible in a public adult mental health service and participation in the program was associated with reductions in the number of cigarettes smoked daily and level of nicotine addiction. This real-world pilot program demonstrated feasibility and potential effectiveness in reducing smoking among adults with mental illness. Aligning with government guidelines, tailored smoking cessation programs are crucial due to high nicotine dependence and mental health complexities. Given the high rates of cigarette smoking by people with mental illness and the cardiometabolic health risks associated with this, mental health services should consider adding evidence-based and bespoke tobacco cessation programs as part of core business.

To derive planning estimates for the provision of public mental health services in Queensland 2007-2017. We used a five-step approach that involved: (i) estimating the prevalence and severity of mental disorders in Queensland, and the number of people at each level of severity treated by health services; (ii) benchmarking the level and mix of specialised mental health services in Queensland against national data; (iii) examining 5-year trends in Queensland public sector mental health service utilisation; (iv) reviewing Australian and international planning benchmarks; and (v) setting resource targets based on the results of the preceding four steps. Best available evidence was used where possible, supplemented by value judgements as required. Recommended resource targets for inpatient service were: 20 acute beds per 100,000 population, consistent with national average service provision but 13% above Queensland provision in 2005; and 10 non-acute beds per 100,000, 65% below Queensland levels in 2005. Growth in service provision was recommended for all other components. Adult residential rehabilitation service targets were 10 clinical 24-hour staffed beds per 100,000, and 18 non-clinical beds per 100,000. Supported accommodation targets were 35 beds per 100,000 in supervised hostels and 35 places per 100,000 in supported public housing. A direct care clinical workforce of 70 FTE per 100,000 for ambulatory care services was recommended. Fifteen per cent of total mental health funding was recommended for community support services provided by non-government organisations. The recommended targets pointed to specific areas for priority in Queensland, notably the need for additional acute inpatient services for older persons and expansion of clinical ambulatory care, residential rehabilitation and supported accommodation services. The development of nationally agreed planning targets for public mental health services and the mental health community support sector were identified as priorities.

Background: Consumer consultants are people who have suffered from a mental illness requiring treatment in a public facility, and who are employed in public mental health services to put forward a consumer perspective. Aims: The aim of this study was to investigate the experience of consumer consultants in the Victorian public mental health program. Method: The paper traces the development of the consumer consultant program in Victoria, Australia and examines the literature on barriers to consumer participation in mental health services. The paper then outlines a qualitative study of the experiences of consumer consultants, focussing on their perceived areas of influence, areas of difficulty and their suggestions for improvement. Results: Organizational influences that affect the work of the consumer consultants are discussed and two "ideal types" of services outlined. Service red has institutional barriers that hinder the work of consumer consultants, whereas service green has institutional features that facilitate their work. Conclusions: Consumer consultants have made real gains in providing effective representation of the consumer perspective, resulting in service improvement, but the results have been uneven, and many significant barriers persist. Declaration of interest: The first and third author work in public mental health services. This study was carried out in part fulfilment of a Master of Social Work.