Adequate Mental Health Services Research Articles

Obstetric care providers are able to assess psychosocial risks, identify and refer high-risk pregnant women: validation of a short assessment tool - the KINDEX Greek version.

BackgroundPrenatal assessment for psychosocial risk factors and prevention and intervention is scarce and, in most cases, nonexistent in obstetrical care. In this study we aimed to evaluate if the KINDEX, a short instrument developed in Germany, is a useful tool in the hands of non-trained medical staff, in order to identify and refer women in psychosocial risk to the adequate mental health and social services. We also examined the criterion-related concurrent validity of the tool through a validation interview carried out by an expert clinical psychologist. Our final objective was to achieve the cultural adaptation of the KINDEX Greek Version and to offer a valid tool for the psychosocial risk assessment to the obstetric care providers.MethodsTwo obstetricians and five midwives carried out 93 KINDEX interviews (duration 20 minutes) with pregnant women to assess psychosocial risk factors present during pregnancy. Afterwards they referred women who they identified having two or more psychosocial risk factors to the mental health attention unit of the hospital. During the validation procedure an expert clinical psychologist carried out diagnostic interviews with a randomized subsample of 50 pregnant women based on established diagnostic instruments for stress and psychopathology, like the PSS-14, ESI, PDS, HSCL-25.ResultsSignificant correlations between the results obtained through the assessment using the KINDEX and the risk areas of stress, psychopathology and trauma load assessed in the validation interview demonstrate the criterion-related concurrent validity of the KINDEX. The referral accuracy of the medical staff is confirmed through comparisons between pregnant women who have and have not been referred to the mental health attention unit.ConclusionsPrenatal screenings for psychosocial risks like the KINDEX are feasible in public health settings in Greece. In addition, validity was confirmed in high correlations between the KINDEX results and the results of the validation interviews. The KINDEX Greek version can be considered a valid tool, which can be used by non-trained medical staff providing obstetrical care to identify high-risk women and refer them to adequate mental health and social services. These kind of assessments are indispensable for the promotion of a healthy family environment and child development.

Public mental health: the need for a broader view of the issues.

K. Wahlbeck's paper (1) provides a good overview of the field of public mental health. Right from the first paragraphs, the paper makes it explicit that public mental health deals with mental health promotion, prevention of mental disorders and of suicide, integrated and comprehensive mental health service, and the fight against stigma and human right abuses. These issues are of importance to every country or community, irrespective of their level of economic or social development. There may of course be a need for contextualizing the specific solutions to the various challenges that the issues pose, but developing those solutions should nevertheless be on the public health agenda of every country, from the low- to the high-income categories. The relevance of these issues to every country, irrespective of their developmental stage, is an important point to stress. Even though psychiatry constantly grapples with the challenge of finding the most valid ways to categorize and classify mental health problems, any notion that seeks to deny, either explicitly or implicitly, that human beings share some common biological features irrespective of their race is an absurd one. Those features make them vulnerable to develop health, including mental health, problems irrespective of where they live. It is of course also true that those health problems are influenced by where and how they live and may respond differently to various interventions, some of which may also be shaped and informed by where people live. So, while it can be said that “diagnoses” are social constructs, shaped by current understanding and consensus and reflecting the imperfect nature of the process of classifying them (2), the disorders that they seek to characterize are not. Mental disorders have consequences everywhere and, while there can be debates about the labels we ascribe to them, practicing clinicians know that the syndromes they deal with have effects on the lives of those experiencing them. A review of public mental health is in a sense a review of global mental health, and to deny the importance of one is to deny the relevance of the other. In this regard, and in addition to the points articulated in Wahlbeck's paper, the emphasis must be placed on bridging the gap in treatment for mental disorders. Global mental health is essentially the mobilization of resources to meet the challenges of population health needs and strive for equity in doing so. Given the large unmet need for mental health service in low- and middle-income countries, it is understandable that global mental health will often be seen as having a major focus on those countries. However, treatment gap for mental disorders exists everywhere across the world (3). Also, the gap is driven by essentially the same issues across the world: inadequate resources, inequity, and lack of parity with physical health. Inequity exists between countries in their ability to provide adequate mental health service for their populations, but it also exists within countries, including high-income countries. Stigma is an overarching issue and often dictates what resources are made available to provide mental health service. Addressing the challenge posed by poor policy attention to mental health service and the negative attitude to persons with mental disorders by the public requires a good understanding of the principles of public health. Unfortunately, a lack of that understanding by mental health professionals has been a major barrier to developing effective mental health service (4). Responding to the treatment gap for mental disorders is a public health imperative for which public and political support is crucial. Concerted advocacy efforts are required. The skills necessary for mounting such efforts, however, are unfortunately uncommon among mental health professionals. A broad perspective of public mental health will emphasize what is known about the burden of mental disorders, and the social determinants that underlie the burden, but will also focus on the issues that engender inequity between communities in their access to adequate mental health care, lack of parity between mental and physical conditions, and the overarching barriers that stigma and policy neglect constitute. Efforts at building leadership and advocacy skills among mental health practitioners and stakeholders and at improving access to care through appropriate capacity building for non-specialists must be of central concern to public mental health (5).

Use of an integrated Atlas of Mental Health Care for evidence informed policy in Catalonia (Spain)

This paper aims to present the Integrated Atlas of Mental Health of Catalonia (2010) focusing on: (a) the importance of using a taxonomy-based coding and standard system of data collection when assessing health services; and (b) its relevance as a tool for evidence-informed policy. This study maps all the care-related services for people with mental disorders available in Catalonia in 2010, using the 'Description and Evaluation of Services and Directories in Europe for long-term care' (DESDE-LTC). The unit of analysis is the Basic Stable Input of Care (BSIC), which is the minimal organisation unit composed by a set of inputs with temporal stability. We presented data on: (a) availability of BSICs and their capacity; (b) the adequacy of the provision of care, taking into account availability and accessibility; (c) the evolution of BSCIs from 2002 to 2010; and (d) the perceived relevance of Atlas of Mental Health as a tool for evidence-informed policy. We identified a total of 639 BSICs. A lack of Health services was detected in highly rural areas, although there was moderate availability of Social Services. Overall, more than 80% of the small mental health areas in Catalonia had an adequate core mental health service. Since 2002 the availability of mental health services has increased. Decision makers found the Atlas a useful and relevant tool for evidence informed policy. Policy makers can use Atlases to detect gaps and inequities in the provision of care for people with mental health needs.

MUTANT MOUSE MODELS TO EXPLORE D1-GLUTAMATE INTERACTIONS AND CORTICAL VS SUBCORTICAL D1 DOPAMINE RECEPTOR FUNCTION: SCHIZOPHRENIA-RELATED PHENOTYPIC EFFECTS

Individuals with severe mental illness frequently have difficulties in obtaining and maintaining adequate accommodation. If they are not willing or able to adapt to requirements of traditional supported housing institutions they may live in sheltered and emergency accommodation. Adequate mental health services are rarely available in these facilities. The aim of the present study was to evaluate mental health, functional and social status of individuals living in community sheltered housing facilities. A cross-sectional survey of n=338 individuals in sheltered housing compared to a sample of patients at intake in acute inpatient psychiatry (n=619) concerning clinical and social variables was carried out in the catchment area of Zurich. Matched subsamples of individuals with schizophrenia (n=168) were compared concerning functioning and impairments on the Health of the Nation Outcome Scales (HoNOS). Individuals with schizophrenia in sheltered housing (25% of the residents) have significantly more problems concerning substance use, physical illness, psychopathological symptoms other than psychosis and depression, and relationships, daily activities and occupation than patients with schizophrenia at intake on an acute psychiatric ward. Community sheltered accommodation although conceptualized to prevent homelessness in the general population de facto serve as housing facilities for individuals with schizophrenia and other severe mental illness.

Perspectives of People Who Are Deaf and Hard of Hearing on Mental Health, Recovery, and Peer Support

This qualitative study sought to better understand the experiences of deaf and hard of hearing individuals with accessing recovery-oriented mental health services and peer support via a focus group and interviews. Cultural brokers were used to facilitate culturally-sensitive communication with study participants. Findings indicate that access to adequate mental health services, not just recovery-oriented and peer support services, is not widely available for this population, largely due to communication barriers. Feelings of isolation and stigma are high among this population. Public mental health systems need to adapt and expand services for various cultural groups to insure recovery.

Posttraumatic stress and depression symptoms as correlates of deliberate self-harm among community women experiencing intimate partnerviolence

Deliberate self-harm (DSH) among women in the general population is correlated separately with posttraumatic stress, depression, and abuse during childhood and adulthood. The prevalence of these DSH correlates is particularly high among women exposed to intimate partner violence (IPV), yet few studies have examined DSH among this high-risk population and none have examined these correlates simultaneously. Two hundred and twelve IPV-victimized women in the community participated in a 2-h retrospective interview. One-third reported current or past DSH. Discriminant analysis was used to examine which posttraumatic stress and depression symptoms and types of current IPV and childhood abuse were uniquely associated with current DSH. Findings show that women who currently use DSH reported greater severity of posttraumatic stress numbing symptoms and more severe sexual IPV compared to women who used DSH only in the past. Examining factors that are associated with women's current DSH in this population is critical so that a focus on DSH can be integrated into the treatment plans of women who are receiving mental health care, but also so that women who are not receiving such care can be referred to adequate mental health services.

The Counseling Profession in Russia: Historical Roots, Current Trends, and Future Perspectives

Psychology was established in Russia before the Communist era. The social work profession was created in 1991 for a society in turmoil after the collapse of the Soviet Union. In 2011, the counseling profession officially emerged as a branch of social work called social psychological help. Professional counseling associations are in the formative stage. Concern about mental health issues, particularly substance abuse, suggests that the counseling profession could continue to grow in Russia.

Lessons learned in developing community mental health care in Europe.

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.

Poor Access to MH Care Cited in High Court's Prison Ruling

Back to table of contents Previous article Next article Professional NewsFull AccessPoor Access to MH Care Cited in High Court's Prison RulingMark MoranMark MoranSearch for more papers by this authorPublished Online:1 Jul 2011https://doi.org/10.1176/pn.46.13.psychnews_46_13_1_2AbstractThe Supreme Court ruled that the state of California must reduce its prison population by some 33,000 inmates in the next two years, declaring that the extremely overcrowded conditions in California prisons and the resulting substandard state of general and mental health care violate the Eighth Amendment's prohibition against cruel and unusual punishment. In the justices' majority opinion, Justice Anthony Kennedy noted that "prisoners in California with serious mental illness do not receive minimal, adequate care," and that "inmates awaiting care may be held for months in administrative segregation, where they endure harsh and isolated conditions and receive only limited mental health services. Wait times for mental health care range as high as 12 months." The decision requires the state to reduce its prison population to 110,000, approximately 137.5 percent of the system's capacity. Although the decision technically applies only to California's prison system, its impact may be felt more broadly. Late last year, APA submitted, along with several other mental health organizations, an amicus brief in support of the inmates' suit, which claimed that the conditions in which they were housed meant that they had inadequate access to mental health and general medical care. "In the wake of deinstitutionalization and closure of state hospitals, a growing number of persons with severe mental illnesses have been incarcerated in U.S. jails and prisons, where mental health care is often deficient or lacking altogether," said APA President John Oldham, M.D., in response to the ruling. "By upholding the lower court's ruling in this case, the Supreme Court is signaling that it takes the mental health and other medical needs of prisoners seriously—a matter of constitutional law. APA also believes that creating constitutionally adequate medical and mental health services as ordered in this case is in the interests of all people in the state of California." Howard Zonana, M.D., an expert in forensic psychiatry, told Psychiatric News that the Supreme Court was attentive to concerns about public safety, emphasizing that the court-ordered reduction in the prison population could be achieved by means that did not require the release of violent criminals into the community. "The state has a variety of options, but it has to do something," he said. "It can pay to transfer people out of state to other facilities or it can move them into county jails and prisons." The decision comes after a decades-long fight over the state of health care in California prisons, and Zonana noted that the state has the highest rate of incarceration of any in the country. He added that the prison population, being a literally captive population with no options for receiving general health or mental health care outside of the prison, is the only group that has a constitutional right to state-provided care. The Court's 5-4 ruling states that "For years the medical and mental health care provided by California's prisons has fallen short of minimum constitutional requirements and has failed to meet prisoners' basic health needs. Needless suffering and death have been the well-documented result. Over the whole course of years during which this litigation has been pending, no other remedies have been found to be sufficient." ISSUES NewArchived

Racial variations in major depressive disorder onset among immigrant populations in the United States

Background and Aims. Considering the heterogeneity within the immigrant population, this study aimed to examine racial variations in major depressive disorder (MDD) onset and the factors associated with it among immigrants in the United States.Methods. Data from the Collaborative Psychiatric Epidemiology Surveys were analyzed. The Kaplan–Meier method was employed to estimate survival functions by race. The Cox proportional hazards model was employed to explore the factors associated with MDD onset after controlling for socio-demographic and immigration-related sample characteristics.Results. Asians showed the highest survival function, followed by African Americans. A Cox proportional hazards model indicated that those who were younger, female, and non-Asian were more likely to experience an MDD onset than were their older, male, and Asian counterparts. None of the immigration-related characteristics were found to be significantly associated with MDD onset among foreign-born individuals.Conclusions. Findings from this study reveal that different racial groups experience different patterns of MDD onset over time. Exploring the factors associated with MDD onset will help mental health providers identify vulnerable subgroups among immigrant populations and, in turn, promote adequate mental health services for them.

Public's View of Mental Health Services for the Elderly: Responses to Dear Abby

The need for adequate mental health services for older adults is an increasingly urgent issue as the life expectancy of Americans continues to extend; yet there are unresolved questions regarding the public's perception of service needs. The Group for the Advancement of Psychiatry collaborated with advice columnist Jeannie Phillips of "Dear Abby" to invite public feedback on mental health services for the elderly. Feedback was invited on access to services as well as perceived need for improvement in the quality or quantity of those services. The effort resulted in 800 responses that identified three primary issues: problems in accessing care, inadequate detection of mental health conditions by general practitioners, and a need for more psychotherapy services. It is hoped that this Open Forum will stimulate discussion throughout the country for the benefit of older persons with mental health needs as the country grapples with changes to come after the passage of health care reform.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

Women with mental disorders and motherhood

Mothers' ability to deliver care and tend to the needs of their children is considered to generate an adequate preventive environment for infant psychological development. This study describes the phenomenon of motherhood from the perspective of users of a mental health outpatient clinic in Ribeirão Preto, SP, Brazil, through Symbolic Interactionism theoretical framework. Ten women under treatment for at least one year and with at least one child between 7 and 12 years old were interviewed. Grounded Theory was used for data analysis, which enabled the development of a theory to explain the phenomenon: 'of perceiving oneself in such a way as to keep fighting'. The conclusion is that these women need to deal with, recognize and perceive themselves in their maternal role so as to keep on fighting limitations imposed by the disease. That these women come and see beyond their condition of mental disorder patients is another step towards the delivery of more adequate mental health services to meet this demand.

R. Slate, W. W. Johnson, Criminalization of Mental Illness: Crisis and Opportunity for the Justice System

It was with great enthusiasm that we read the book Criminalization of Mental Illness: Crisis and Opportunity for the Justice System, by Risdon Slate and W. Wesley Johnson. Amidst this monograph, several chapters were contributed by legal expert, Ronald Honberg, and psychiatric experts, Anand Pandya, Richard Lamb, and Suzanne Vogel-Scibilia. It is an invaluable contribution to both the criminal justice and mental health fields, as well as society at large. Designed primarily as a textbook for academic use, the book is clear and interesting enough to be engaging and accessible to the general public. Not only does the book seek to explain and discuss the difficulties with this population receiving adequate mental health services in America, it does what many are not able to do: It provides solutions to the problem, with the hope of “inform[ing] decisions, motivat[ing] policymakers and citizens, and provid[ing] an opportunity for positive, collaborative change” (Slate and Johnson 2008, p. 347). Chapter One briefly introduces the reader to the topic of the criminalization of mental illness. The authors begin with the notion that jails have long served as the place to house less desirable members of society and explain that individuals with mental illness frequently fall into this category due to their inability to conform their behavior to social norms. Slate and Johnson discuss that the closing of many state-run mental hospitals sparked a trans-institutionalization movement in which the U.S. prison system has become the de facto mental health treatment system. They expose the reader to the startling fact that more people with mental illness currently are receiving treatment from the correctional system than from the mental health system. In Chapter Two, the authors present a quick overview of the history of treatments for mental illness. From spiritual remedies, demonology, and exorcisms, the reader can see that from the beginning persons with mental illness were highly stigmatized. Over time, the model of mental illness shifted from the idea of possession to an understanding that mental illness is instead a disease of the mind that necessitates treatment. Despite this recognition, stigma continued to surround mental illness. States built psychiatric hospitals (i.e., state hospitals), but these institutions fell out of favor in the 1950’s and 1960’s due to inhumane conditions in the asylums and an inclination toward community treatment. Slate and Johnson undertake a variety of topics that have contributed to the criminalization of mental illness in Chapter Three. They propose that deinstitutionalization, anti-psychotic medication, negative publicity of asylums, managed care, media sensationalization, lack of funding for community mental health centers, and lack of long-term treatment have combined to create an environment that is not conducive to mental health. In this environment the mentally ill are further stigmatized and denied necessary treatment. As a result, individuals with mental illness may commit a minor crime that leads to their arrest and placement in jail. Although jails are beginning to improve the services available to inmates, when an individual with mental illness is released with no connections to community treatment they quickly decompensate and are frequently arrested again. J Police Crim Psych (2009) 24:134–136 DOI 10.1007/s11896-009-9041-3

Providing Mental Health Services to Older People Living in Rural Communities

Summary Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional well-being and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.

The Age of Anxiety: Stones, Feathers and Re-institutionalization

Although the value of the Italian psychiatric reform is widely acknowledged and hotly contested, a meticulous comment on its roots and progress is required. This paper attempts to examine the current state of mental health services in Italy and emphasizes Franco Basaglia's writings. The aim of the paper is to: (1) respond to the challenge of providing adequate and human rights-based mental health services, (2) contrast the new Italian tendency of medicalization, which is supported by a law proposal to re-institutionalize the mental health care system. The analysis is based on both current and historical library work and literature review. Since the present policy seems to be proceeding backwards, the direct study of Basaglia's writings assumes significance in not forgetting the past as well as in re-interpreting the present risk of re-institutionalization. The paper then emphasizes the veracity of Basaglia's thought and suggests a re-reading of his work.

Psychiatrist Finds Stigma Education Desperately Needed on Hill

Psychiatrist Finds Stigma Education Desperately Needed on Hill

Depressive Symptomatology of Black College Men

Black Americans have poorer health than the rest of the nation and are exposed to a wider range of social and environmental factors that adversely impact their health. Although it may be presumed that men who acquire a college education will also attain middle-class status, middle-class status does not provide Black men with the anticipated reductions for at least some health risks. This study presents preliminary findings from a study designed to assess the prevalence of depressive symptoms among Black college men (n=115) at a predominately white institution and a historically Black institution. Results suggest that although depressive symptoms for the Black college men in the sample were relatively low, participants from the predominately white institution reported slightly higher on individual depression items and had a higher total depression score than participants from the historically Black institution. Findings from this study have implications for the provision of adequate mental health services for Black college men as well as future research conducted with this population regarding their health and health behaviors.

Mental health consultations in a prison population: a descriptive study.

BackgroundThe psychiatric morbidity among prison inmates is substantially higher than in the general population. We do, however, have insufficient knowledge about the extent of psychiatric treatment provided in our prisons. The aim of the present study was to give a comprehensive description of all non-pharmacological interventions provided by the psychiatric health services to a stratified sample of prison inmates.MethodsSix medium/large prisons (n = 928) representing 1/3 of the Norwegian prison population and with female and preventive detention inmates over-sampled, were investigated cross-sectionally. All non-pharmacological psychiatric interventions, excluding pure correctional programs, were recorded. Those receiving interventions were investigated further and compared to the remaining prison population.ResultsA total of 230 of the 928 inmates (25 %) had some form of psychiatric intervention: 184 (20 %) were in individual psychotherapy, in addition 40 (4 %) received ad hoc interventions during the registration week. Group therapy was infrequent (1 %). The psychotherapies were most often of a supportive (62 %) or behavioural-cognitive (26 %) nature. Dynamic, insight-oriented psychotherapies were infrequent (8 %). Concurrent psychopharmacological treatment was prevalent (52 %). Gender and age did not correlate with psychiatric interventions, whereas prisoner category (remanded, sentenced, or preventive detention) did (p < 0.001). Most inmates had a number of defined problem areas, with substance use, depression, anxiety, and personality disorders most prevalent. Three percent of all inmates were treated for a psychotic disorder. Remand prisoners averaged 14 sessions per week per 100 inmates, while sentenced inmates and those on preventive detention averaged 22 and 25 sessions per week per 100 inmates, respectively. Five out of six psychiatric health services estimated the inmates' psychiatric therapy needs as adequately met, both overall and in the majority of individual cases.ConclusionOur results pertain only to prisons with adequate primary and mental health services and effective diversion from prison of individuals with serious mental disorders. Given these important limitations, we do propose that the service estimates found may serve as a rough guideline to the minimum number of sessions a prison's psychiatric health services should be able to fulfil in order to serve the inmates psychiatric needs. The results rely on the specialist services' own estimates only. Future studies should take other important informants, including the inmates themselves, into consideration.