Chronic Mental Health Problems Research Articles

Can managed care networks improve perinatal mental healthcare for Black and minority ethnic (BME) women?

PurposePerinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer than expected women from black and minority ethnic (BME) backgrounds access care and treatment. This paper aims to address this issue.Design/methodology/approachResponding to persistent reports of patchy service provision across the UK more generally and particular concerns about potentially unmet needs among BME women, mixed‐method research was undertaken between September 2009 and March 2010. Using survey questionnaires and telephone interviews, the study sought to explore professional stakeholders' perspectives on current perinatal mental health provision and the extent to which it meets the needs of BME women. Findings from the study were intended to inform policy and plans to improve provision by establishing managed care networks (MCNs) for perinatal mental healthcare.FindingsIn total, 45 questionnaires were returned from the national survey. One‐third of respondents (n=14) consented to follow‐up telephone interviews. There was evidence of multi‐agency working among the 27 professional groups which respondents reported as being directly involved in delivering perinatal mental healthcare across the country. However, there was also evidence of disjuncture and poor communication – particularly between statutory and voluntary sectors and NHS primary and secondary care. Some respondents had difficulty defining “BME” or identifying the women to whom the acronym might be applied. They also questioned the validity of providing “BME‐specific” services. Instead, they endorsed more ethnically “inclusive models” of provision and “signposting” women to appropriate “community” services.Practical implicationsTaken together, these findings suggests that whilst there might be a theoretical argument for perinatal mental health MCNs, considerable effort is required if policy‐makers' aspirations for more “joined‐up” services capable of meeting the needs of all women are to be fully realised. Furthermore, current proposals for public sector reform coupled with reduction in voluntary sector provision is likely to disproportionately affect women from BME and other marginalised communities as they provide significant amounts of “below the radar” care and support.Originality/valueThis paper is of particular relevance to policy makers and practitioners. Findings suggest that women from BME backgrounds might be particularly vulnerable to perinatal mental illness. Contraction of voluntary sector provision increases the likelihood that the needs of BME women will remain unmet with deleterious consequences for their health and wellbeing of their families. This has potentially serious public health implications. MCNs/clinical networks have the potential to reduce inequalities by providing more “joined up” care for all women. However, the evidence base for levels of need and appropriate service response to perinatal mental illness among BME women is weak. Further research is required to bridge the evidence gap and to evaluate the impact of health and social care reform on vulnerable groups.

“My Penis Is Shrinking and People Can Tell”: A Confusing Case of Apparent Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is characterized by an intense preoccupation with a slight or imagined defect in physical appearance. Its onset, frequently in adolescence, involves an anxiety that curtails social involvement, derails a developing positive sense of self, and often predisposes those afflicted to chronic mental-health problems. Convinced their condition is genuinely physical, BDD patients seek help from internists, dermatologists, and even plastic surgeons rather than mental-health practitioners. Treatment of any kind has limited success with BDD; the disorder tends to be long term and debilitating. This article presents a case that illustrates the uncertain work of diagnosing and treating the disorder in the hope that the challenges of the case will be educative for others.

The Life Conditions of Australian Ex-Prisoners

Successful reintegration of ex-prisoners into the community is multifaceted. The life conditions of 36 adult Australian ex-prisoners (20 male and 16 female) were examined via a questionnaire administered at 1 to 4 weeks post release, and a subset of 19 of the original respondents were interviewed again at 3 to 4 months post release. Interviews focused on intrapersonal conditions (physical and psychological health and substance use), subsistence conditions (housing, employment, and finance), and support conditions (social support, support services/program participation, and criminal justice support). The majority of ex-prisoners self-reported chronic physical and mental health problems as well as a history of substance use and/or current substance use. Although the housing conditions of ex-prisoners were largely favourable and constant, the employment and financial conditions of this group were generally unfavourable. Level of social support was variable. Theoretical implications and practical applications of the present investigation for reintegration theory are discussed.

Tools for the job: why relying on risk assessment tools is still a risky business

This theoretical review paper examines the applicability of assessment tools, guidelines and protocols in mental health and substance use care on the basis of the construction of such tools and their reliance on aggregate and actuarial methodologies. Evidence-based practice leads clinicians to increasing reliance on tools for assessment of health status, risk and prediction for a range of clinical needs for individual clients. In the longer-term management of people with enduring and chronic mental health and substance misuse problems, clinicians are often dealing with complex and unstable health needs. The tools available, however, are developed on the basis of majority population evidence and on presumptions of similarity and stability over time. This paper provides explanation of the basis for the development of such tools and argues that clinicians need to be able to evaluate the applicability of tools used for their clients and not just evaluate the internal validity of the tools used to make individual and contextual decisions about individual clients.

Introduction to the Special Section: Rural Health Issues in Pediatric Psychology

The difficulties of meeting the medical and psychological needs of individuals living in rural areas have long been recognized. In Pre-Colonial days, a network of native healers attempted to meet the needs of rural populations, and when the Colonists arrived from England, the first formally trained physicians arrived in America as well. As the colonists moved westward, physicians followed, facing difficulties and hardships they had not encountered previously. In 1910, the Flexner report was released, which suggested revamping medical education and moving toward a formalized 4-year medical education system. Less than 20 years after this report was implemented, publications started to appear in the literature discussing the lack of healthcare providers in rural areas—an unintended consequence of the Flexner report. Recognizing this problem, in the 1960s and 1970s, the federal government established Area Health Education Centers (AHECs) primarily to directly serve the medical and behavioral needs of rural individuals. Although the office of Rural Health Policy at the U.S. Department of Health and Human Services was not formally established until 1987, it was seen as a final major step forward in improving the health of rural Americans. Data indicate, however, that even with all of these impressive steps forward, the health of rural populations is still lacking when compared to urban populations. Recent data released by the National Center for Health Statistics (2010) indicate that 14.8% of individuals in urban areas ‘‘did not get medical care due to cost,’’ and yet this rate is even higher (17.1%) among rural residents. The same is true for the items querying ‘‘did not get prescription drugs due to cost’’ (10.8% urban, 13.6% rural) and ‘‘did not get dental care due to cost’’ (16.4% urban, 19.2% rural). Specific to children, 10.2% of the children aged <18 years who live in urban areas had no visit to a physician in the past 12 months; the rate for rural children was higher at 12.0%. Finally, the percentage of children aged 18 years with one or more visits to an emergency room was higher for rural children (24.2%) than for urban children (20.2%). Though these differences may seem small, they equate to tens of thousands of rural children not receiving adequate medical care. Looking at specific diseases, data from the National Survey of Children’s Health (U.S. Department of Health and Human Services, 2005) indicate that rural children are more likely to be overweight (17.1% large rural, 17.4% small rural) than urban children (14.2%). Unintentional injury rates are also higher among rural children (9.4% large rural, 10.0% small rural) compared to urban children (9.3%). Chronic physical or mental health problems are also more prevalent among rural children (9.0% large rural, 8.1% small rural) than among urban children (7.7%). Our nation has long recognized the problems faced in meeting the medical and behavioral needs of rural populations, and has taken dramatic and positive steps to ameliorate these differences. Despite this, taken together, data overwhelmingly indicate that children and adults living in rural areas still experience greater medical and behavioral issues and are less likely to receive treatment for these issues relative to their nonrural counterparts.

Unequal and inadequate involvement possibilities in mental health care networks

Background/Objectives: Nowadays, involvement and participation of mental health service users are considered to be ethical practices and health care systems around the world are increasingly emphasising the value of participatory approaches. However, in Belgian mental health care, involvement is scarcely out of the egg. A positive change happened in 2007, when the Belgian Federal Government initiated experimental care networks for persons with complex and chronic mental health problems. These networks were aimed at providing needs-based care, at promoting rehabilitation in society and at ensuring continuity of care. The Katholieke Universiteit Leuven and the Interregional Association for Guidance and Health (AIGS) were asked to conduct a study about involvement possibilities in these networks. The research was based on a whole-systems view on the complex concept of involvement. The main question of the study was: to what extent can service users and carers be involved in treatment decisions? Furthermore, we investigated the fulfilment of determinants for involvement such as communication and information provision, support and training, and procedures for involvement.

Response to Intervention and Interdisciplinary Collaboration: Joining Hands to Support Children's Healthy Development

School psychologists often are involved with the provision of services to students with chronic physical health conditions and mental health problems. However, collaborative efforts between school psychologists and the medical professionals who treat these youth often are lacking despite the benefits that may result from interdisciplinary collaboration. To address this disconnect, the authors discuss various ways school psychologists and medical professionals can collaborate to enhance the provision of services to youth with health and mental health problems in a response-to-intervention framework. Specifically, the authors discuss ways in which school psychologists can improve interdisciplinary collaboration across multiple tiers of service provision. In addition, the authors provide a case example to illustrate the benefits of interdisciplinary collaboration among school psychologists, allied health professionals, and physicians.

Holism in nursing and health promotion: distinct or related perspectives? – A literature review

The concept of holism is central in health promotion as well as in nursing. Holism or a holistic view on health was identified as one of the key principles of the Ottawa Charter for Health Promotion and is linked to social ecology and the determinants of health. To explore how the term holism was defined and/or described in Nordic articles with a health-promotion approach, and how holism aspects were related to nursing and health promotion, and to the other key principles of the Ottawa Charter. Abstracts were first identified by the search word 'health promotion' as a keyword. The search was limited to 1986-2008 and abstracts written in English by authors with a Nordic affiliation. Abstracts/articles for this study were subsequently selected from these abstracts using the search words 'holism' and 'holistic' and analysed by quantitative and manifest qualitative content analysis. The sample included 23 articles: one theoretical, two reviews and 20 empirical studies. Sixteen articles included a hospital setting or nursing perspective. A holistic perspective could be extracted from most articles. No larger but several minor differences were identified in the way holism aspects were related to nursing and health promotion respectively. There is a risk that the individual patient perspective of holism in nursing may result in less chance of reaching larger groups of patients with chronic diseases and mental health problems, not least the most vulnerable ones.

How Acceptable Are One-Off Consultations for Consumers? Further Information On Item 291

The aim of this paper is to evaluate consumer and carer views of one-off psychiatric assessments, Item 291 in the Australian Medicare system. Following general practitioner referral to a psychiatrist, consumers were invited to enroll in this study and provide: demographic data; a one-off face-to-face recorded interview 6-8 weeks following psychiatric assessment; and longitudinal assessment of their mental health, using the DASS, K10 and WHOQoL (prior to psychiatric assessment, 6-8 weeks after assessment and 3-4 months later). Consumer and carer enrollment were very difficult to obtain. Sufficient consumers (8) enrolled to provide meaningful qualitative data. Most had good mental health literacy, had severe and chronic mental health problems, and appreciated the opportunity to access a mental health expert and receive a management plan. Overall, GPs had appropriately informed consumers of the process. Following assessment, the GP and consumer were implementing the suggested management plan. Negative statements included instances of failure to improve, insufficient appointments with the psychiatrist, and concern with GP follow-up. One-off psychiatric assessments using Item 291 appear highly acceptable to referred consumers. Qualitative outcomes showed trends towards an improvement in mental health, in an appropriate target group.

Employment After Prison: A Longitudinal Study of Former Prisoners

Finding sustained employment is an important component of the transition from prison to the community for exiting prisoners. Anecdotal reports from former prisoners indicate that most individuals experience great difficulties finding jobs after their release. However, little systematic information is available about the employment experiences of individuals released from prison or the characteristics of former prisoners who are successful in locating employment. Using a causal framework, this paper examines the employment experiences of a multi-state sample of former prisoners, and identifies the individual factors influencing the likelihood of employment after release from prison, using data gathered from interviews with prisoners before and at multiple times after release. Findings indicate that consistent work experience before incarceration, connection to employers before release, and conventional family relationships improve employment outcomes after release. Individuals who relapse to drug use quickly after release, have chronic physical or mental health problems, and are older or nonwhite are employed fewer months after a period of incarceration.

Fetal alcohol spectrum disorders - an Irish perspective.

The impact of prenatal alcohol exposure is far reaching and transgenerational but is largely under diagnosed. This has been a major public health concern but remains an area that has lacked attention with regards service development and research in Ireland. There is a need for mental health professionals to have a good working knowledge of the range of deficits associated with prenatal alcohol exposure. Knowledge of these deficits will facilitate identification of affected children for early diagnosis and intervention. This paper reviews available literature on this topic using broad search criteria. The aim of this article is to create greater awareness among professionals working with children in Ireland considering the high rates of alcohol consumption and the fact that most cases of FASD present with chronic undiagnosed mental health problems.

Structural Determinants of Boredom Among the Clients of Psychosocial and Vocational Rehabilitation Centers

In psychosocial rehabilitation programs, clients are encouraged to counter boredom by occupying their time in more structured, meaningful, and enjoyable ways. Several means by which the structure of service organizations reduces feelings of boredom were explored. Hypotheses were tested using data from a sample of clients of Flemish rehabilitation centers for people with chronic mental health problems. Results show that in larger, more heterogeneous centers, boredom is reduced by offering clients a wider range of more routinized activities; in small homogeneous centers, the same effect is obtained by enhancing the intrinsic value of the tasks and by providing more opportunities for task communication. Rehabilitation centers seem to adapt their rehabilitation technology according to their organizational structure.

‘‘Some Light at the End of the Tunnel’’: Exploring Users’ Evidence for the Effectiveness of Music Therapy in Adult Mental Health Settings

This study responds to the current demand for evidence of the effectiveness of music therapy in adult psychiatric care and rehabilitation. The qualitative, idiographic, and user-based perspective of the study also responds to the growing requirement that ‘‘evidence-based practice’’ take into account patients’ needs, experiences, and evaluations of services. The study is based on verbal data from 19 patients with chronic mental health problems who completed at least 10 individual sessions of professional music therapy in a London mental health unit. In-depth analysis of semistructured interviews using interpretive phenomenological anal- ysis elicits patients’ experiences of the process of music therapy and its varied benefits for them in relation to their symptoms, coping strategies, and overall quality of life. The data suggest how the approach to music therapy taken in this situation often works in relation to users’ long-standing relationship to music, as expressed through their ‘‘music-health-illness narratives.’’ Participation in music therapy has benefits in itself but can also help reestablish patients’ ongoing use of music as a health- promoting resource and coping strategy in their lives. Keywords music therapy, music improvisation, adult psychiatry, rehabilitation, evidence

Self-reported chronic mental health problems and mental health service use in Spain

To determine the prevalence of self-reported chronic mental health problems (MHPs) and mental health service use and their determinants, among the Spanish population over 14 years of age. Data from the 1999 Spanish Survey on Disabilities, Deficiencies, and State of Health were used. The survey is a cross-sectional study based on a multi-stage stratified sample of all the non-institutionalized Spanish population aged over 14 years (n=59,101, 11% non-responders). Multivariate logistic regression analysis were used. 10.7% of the Spanish population suffer from an MHP. The highest prevalences were found in women, divorced/separated persons, those with a lower level of education and income, and those suffering from a chronic somatic problem. The number of days of daily activity lost was 2-fold greater among those with an MHP than among those with a chronic somatic problem. Greater use of mental health services was associated with loss of daily activity, having a higher level of education, invalidity or disability. The probability of MHP being referred from primary to mental healthcare is reduced if somatic comorbidity is present. MHPs have a high prevalence and a significant repercussion on the patient's life. An inverse relationship was found between certain risk factors for MHPs and the use of services, which suggests inequality. Problems of accessibility are identified.

Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services

Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services

Sharing clinical information across care settings: the birth of an integrated assessment system

BackgroundPopulation ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific.MethodsFrom 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system.ResultsThe rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations.ConclusionThis comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.

Complementary medicines in mental health

The use of complementary medicines for mental health problems generates wide public interest. Patients, particularly when suffering from chronic mental health problems such as anxiety and depression, may use complementary...

Coming Home From Jail: The Social and Health Consequences of Community Reentry for Women, Male Adolescents, and Their Families and Communities

Each year, more than 10 million people enter US jails, most returning home within a few weeks. Because jails concentrate people with infectious and chronic diseases, substance abuse, and mental health problems, and reentry policies often exacerbate these problems, the experiences of people leaving jail may contribute to health inequities in the low-income communities to which they return. Our study of the experiences in the year after release of 491 adolescent males and 476 adult women returning home from New York City jails shows that both populations have low employment rates and incomes and high rearrest rates. Few received services in jail. However, overall drug use and illegal activity declined significantly in the year after release. Postrelease employment and health insurance were associated with lower rearrest rates and drug use. Public policies on employment, drug treatment, housing, and health care often blocked successful reentry into society from jail, suggesting the need for new policies that support successful reentry into society.

Users and non-users of web-based health advice service among Finnish university students – chronic conditions and self-reported health status (a cross-sectional study)

BackgroundThe Internet is increasingly used by citizens as source of health information. Young, highly educated adults use the Internet frequently to search for health-related information. Our study explores whether reported chronic conditions or self-reported health status differed among Finnish university students using the Finnish Student Health Services web-based health advice service compared with those not using the service.MethodsCross-sectional study performed by a national postal survey in 2004. Material: A random sample (n = 5 030) of a population of 101 805 undergraduate Finnish university students aged 19–35. The response rate: 63% (n = 3 153). Main outcome measures: Proportion of university students reporting use a of web-based health advice service, diagnosed chronic conditions, and self-reported health status of users and non-users of a web-based health advice service. Statistical methods: Data were presented with frequency distributions and cross-tabulations and the χ2 test was used.Results12% (n = 370) of Finnish undergraduate students had used the web-based health advice service and were identified as 'users'. The proportion of male students reporting allergic rhinitis or conjunctivitis was greater among users than non-users (24%, n = 22 vs. 15%, n = 154, χ2, P = .03). The proportion of female students reporting chronic mental health problems was greater among users than non-users (12%, n = 34 vs. 8%, n = 140, χ2, P = .03). There was no statistical significance between the group differences of male or female users and non-users in self-reported health status (good or fairly good, average, rather poor or poor).ConclusionAmong young, highly educated adults the use of a web-based health advice service is not associated with self-reported health status. However, a web-based health advice service could offer support for managing several specific chronic conditions. More research data is needed to evaluate the role of web-based health advice services that supplement traditional forms of health services.

Self‐Esteem, Self‐Efficacy, and the Balance of Peer Support Among Persons With Chronic Mental Health Problems

Despite several suggestions that peer support is empowering for persons with mental health problems because of its mutual nature, few studies have empirically studied the role of its reciprocity and the effects on subjective well‐being of clients from mainstream mental health care settings. Using data of 628 users of vocational and psychiatric rehabilitation centers (N = 51) in Flanders, the effects of the reciprocity of peer support on self‐esteem and self‐efficacy are explored by testing hypotheses derived from the theories of exchange, social capital, equity, and self‐esteem enhancement. Results show that providing peer support is more beneficial than receiving it. One conclusion is that the net beneficial effects of receiving support from peers are overestimated.