Community Mental Health Treatment Research Articles

Health economic evaluation of community-based psychiatric interventions

The health economic evaluation of community mental health interventions can contribute to an optimization of the allocation of mental health care resources. Existing studies on the health economic evaluation of community mental health interventions include a wide range of treatment options from the deinstitutionalization of long-term inpatients into community-based services to specialized services for specific patient groups. The results of these studies indicate that community-based mental health care is not generally less costly in comparison to more institutionalized forms of care. Programs that are based on the ACT approach have been found to be more efficient than inpatient care. Compared to the current standard of mental health care in most western European countries, an intensification of community mental health interventions could increase the efficiency of psychiatric treatment especially for heavy users and first episode patients. However, methodological flaws and a lack of national studies limit the validity of current health economic investigations, particularly for Germany.

Erratum to: Decertification Outcomes for Bipolar Disorder in an Inpatient Community Mental Health Treatment Center: Impact on Subsequent Service Use Over Two Years

Erratum to: Decertification Outcomes for Bipolar Disorder in an Inpatient Community Mental Health Treatment Center: Impact on Subsequent Service Use Over Two Years

Decertification Outcomes for Bipolar Disorder in an Inpatient Community Mental Health Treatment Center: Impact on Subsequent Service Use Over Two Years

This study investigated differences in usage of inpatient and outpatient mental health services over a 2-year period following the index hospitalization between 50 decertified and 48 certified subjects with bipolar manic or mixed episode from an inpatient mental health treatment center. The decertified group had higher number of rehospitalization over the 2-year period compared to certified group (mean=2.26, SE=0.41 vs. mean=1.19, SE=0.24; Wald χ (2)=5.50, p=0.02). Median time to first rehospitalization was 40weeks in the certified and 17weeks in the decertified group, but the difference in time to rehospitalization failed to achieve statistical significance (p=0.18). History of prior hospitalization was associated with higher numbers of rehospitalizations and crisis room visits (both p<0.01) and with shorter time before first rehospitalization (p<0.001).

Stigma as Perceived and Experienced by People with Mental Illness who receive Compulsory Community Treatment

Objective : The purpose of this study was to explore how stigma is perceived and experienced by people with mental illness who are legally required to use mental health services while living in the community. Method : Interviews were conducted with 91 people with mental illness who were receiving compulsory community mental health treatment in British Columbia, Canada. An inductive thematic analytic framework was used to identify predominant themes and recurring patterns in the qualitative data. Results : Participants’ narratives centered around six primary themes: (a) compulsory treatment; (b) feeling/being knocked down; (c) public (mis)understanding; (d) social identity/location; (e) social disadvantage; and (f) passing-managing-overcoming. Compulsory community treatment was entangled with a myriad of other stigma-producing factors associated with the direct effects of mental illness and social disadvantage. Conclusion : Compulsory community mental health treatment is not the predominant issue that produces stigma among people with mental illness, but it may contribute to such experiences by creating situations where people are likely to feel powerless, devalued, and oppressed.

Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Who Is Paying the Price? Loss of Health Insurance Coverage Early in Psychosis

Young Offenders in Custody: An International Comparison of Mental Health Services

Over the last decade interest in the mental health of young offenders has soared. Given evidence that rates of mental disorders are remarkably high in adolescent offenders, countries have initiated efforts to improve the identification and treatment of mental illness in detained youth. Research examining current mental health screening, assessment, and treatment services has focused largely on American sites; however, there is much to be gained from an international perspective. This article discusses international findings regarding the prevalence of mental illness in detained youth, examines the extent to which countries protect incarcerated youths’ right to treatment, and compares countries’ provision of screening, assessment, and treatment services to youth in custody and the community. Considerable variability is found to exist across countries and despite some advances in practice—particularly in the area of mental health screening—significant gaps remain between best and actual practices. To ensure that young offenders with mental illness receive adequate treatment, local, in-depth reviews of the mental health services provided to young offenders must be conducted across countries. Additionally, policies and procedures for providing services to young offenders with mental illness must be improved, particularly in the areas of custodial and community mental health treatment.

Suicide Assessment and Prevention During and After Emergency Commitment

The purpose of this study was to address two primary issues within the context of emergency commitment: (a) the suicide-prevention measures implemented at receiving facilities where emergency commitments occur and (b) the perceptions of key stakeholders about access to community services post-discharge. One hundred seventy-eight respondents who worked in receiving facilities, where emergency commitments occur, responded to an online survey or were interviewed. Respondents indicated the use of suicide-prevention measures such as suicide assessment tools used at intake and discharge and strategies utilized to maintain client safety when the issue of suicidality had been determined at intake. Almost half of respondents (46.6%) described the availability of community mental health treatment at discharge from emergency commitment as being "less than adequate." Emerging themes about community service availability are discussed and include long waiting periods and funding issues.

P02-76 - Risk factors for criminal behavior in persons with schizophrenia in rural community

ObjectivesThe risk factors of criminal behavior in patients with schizophrenia are not well explored. This study is to explore the risk factors for criminal behavior in patients with schizophrenia in rural China.MethodsWe used data from a 14-year prospective follow-up study (1994-2008) of criminal behavior among a cohort (n=510) of patients with schizophrenia in Xinjin County, Chengdu, China.ResultsThere were 489 patients (95.9%) who were followed up from 1994 to 2008. The rate of criminal behavior was 13.5% among these patients with schizophrenia during the follow-up period. Compared with female subjects (6 cases, 20.0%), male patients had significantly higher rate of violent criminal behavior (e.g., arson, sexual assault, physical assault, and murder) (24 cases, 80.0%) (p&lt; 0.001). Bivariate analyses showed that the risk of criminal behavior was significantly associated with being unmarried, of younger age, previous violent behavior, homelessness, lower family economic status, no family caregivers, and higher scores on measures (PANSS) of positive, negative, and total symptoms of illness. In multiple logistic regression analyses being unmarried and previous violent behavior were identified as independent predictors of increased criminal behavior in persons with schizophrenia.ConclusionsThe risk factors for criminal behavior among patients with schizophrenia should be understood within a particular social context. Criminal behavior may be predicted by specific characteristics of patients with schizophrenia in rural community. The findings of risk factors for criminal behavior should be considered in planning community mental health care and interventions for high-risk patients and their families.

New Models of Collaboration Between Criminal Justice and Mental Health Systems

New Models of Collaboration Between Criminal Justice and Mental Health Systems

Addicted to Incarceration: Corrections Policy and the Politics of Misinformation in the United States

Back to table of contents Previous article Next article Book ReviewFull AccessAddicted to Incarceration: Corrections Policy and the Politics of Misinformation in the United StatesH. Richard Lamb M.D.H. Richard Lamb M.D.Search for more papers by this authorPublished Online:1 Nov 2009https://doi.org/10.1176/ps.2009.60.11.1562aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail With at least 350,000 persons with severe mental illness in our jails and prisons, the mental health field is very much in need of the knowledge and perspective of criminologists. Their perspective can only help us in our efforts to deal with criminalization of persons with severe mental illness, one of the most important social issues of our time. Thus this slender volume by an expert on crime and delinquency and the criminal justice system focuses on an area that is one of our greatest challenges.The author's main thesis is that society's emphasis on social support is inversely related to its emphasis on social control. As the State has placed increasing emphasis on its social control function by increasing the power and scope of the criminal justice system, the State has deemphasized its public responsibilities in providing social support in areas such as community mental health and inpatient treatment. Another issue emphasized by the author is the war on drugs, in which the criminal justice system plays a leading role. Given that such a large percentage of persons with severe mental illness have severe substance abuse and dependence problems, many tens of thousands have found their way into our jails and prisons via their problems with drugs and alcohol.The author points out that the State's shift in emphasis from social service to social control has resulted in responsibilities, in addition to punishment, beyond the capabilities of the correctional system. For instance, prisons are simply ill equipped to effectively treat persons with severe mental illness. Society needs to be reminded of this fact, and the author forcefully does that. This statement needs to be qualified, however; if the person has committed a serious crime, such as murder or armed robbery, there is no alternative but to incarcerate that person, no matter how severe the mental illness.In addition to the struggle in society between those who would stress social control and those who would stress social support is the issue of cost. In the case of persons with severe mental illness, there has been an attempt to show, as an argument for decriminalization, that treatment in the mental health system would cost less than incarcerating these persons in jails and prisons. The argument considers all the costs associated with the criminal justice system, such as the courts, law enforcement, public defenders, and so on. However, this is difficult to prove, and, in fact, high-quality mental health care, including therapeutic psychiatric hospitalization, is expensive.An additional issue is the belief on the part of many persons, both in and outside of the mental health system, that hospitals and involuntary mental health treatment often are not necessary. Ironically, this belief often leaves jail and prison as the only alternative for those who need involuntary, structured care.Clearly, the main points of this book are valid. Society has a public responsibility to provide treatment to persons with severe mental illness, and this should be done in facilities designed not for punishment but for treatment.The reviewer reports no competing interests.Dr. Lamb is professor of psychiatry, University of Southern California Keck School of Medicine, Los Angeles. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 11 November, 2009Pages 1562-1563PSYCHIATRIC SERVICES November 2009 Volume 60 Number 11 Metrics PDF download History Published online 1 November 2009 Published in print 1 November 2009

Predictors of Major Depression Six Months After Admission for Outpatient Treatment

This study examined the rate and predictors of major depression six months after outpatient mental health admission. Assessments were conducted at admission and three and six months later among 166 participants. Antidepressant treatment adequacy and depression outcomes were assessed at follow-ups. Predictors of major depression at six months included nonremission status at three months (odds ratio [OR]=3.56, p=.003), inadequacy of early pharmacotherapy (OR=2.73, p=.009), worse physical functioning measured by the 36-Item Short-Form Health Survey (OR=.975, p<.001), and being unmarried (OR=2.54, p=.031). The findings support the effects of baseline physical disability, marital status, early treatment adequacy, and early remission on the course of major depression. The identification of individuals who do not receive intensive pharmacotherapy or who have not recovered by three months may provide opportunities for interventions to optimize six-month outcomes and to prevent the development of a persistent depression.

The Relationship Between Maternal and Child Symptom Change in Community Mental Health

The mental health of mothers and children are closely linked. This study examined the relationship between child and maternal symptom change during a period in which children participated in community mental health treatment. Symptom change was measured using the Child Behavior Checklist for children and the Beck Depression Inventory for Mothers. Results indicate that mothers whose children improve in community mental health treatment are significantly more likely to report a reduction in maternal depressive symptoms than mothers whose children do not improve. Implications of these findings for mental health service settings are discussed.

Have Broad‐Based Community and Professional Education Programs Influenced Mental Health Literacy and Treatment Seeking of those with Major Depression and Suicidal Ideation?

Mental health literacy is the knowledge and beliefs about mental disorders that aid in their recognition, management, or prevention; it is also a determinant of help seeking. As such, it is presumed to be important in community suicide prevention programs. In Australia there have been a number of government, professional, and charitable organizations as well as pharmaceutical company suicide prevention initiatives which have been designed to enhance public and professional knowledge about mental disorders, particularly depression. This naturalistic study conducted between 1998 and 2004 in a random and representative population sample examined the changes in mental health literacy and treatment seeking of those with major depression, both with and without suicidal ideation, and those who were neither depressed nor suicidal. Results indicated that there was marked improvement in mental health literacy for all three groups, although there was less change for those most in need of intervention (i.e., those with major depression and suicidal ideation). Furthermore, there were fewer changes in appropriate treatment seeking in those with major depression and suicidal ideation. These findings are consistent with literature reporting limited problem solving and decision making in those who are suicidal, and indicate that there are limits to broadbased community education programs. More focused suicide prevention initiatives are required, specifically for those who are depressed and suicidal.

Adults traumatized by child abuse: What survivors need from community-based mental health professionals

Aims: To understand, from the “insider” perspectives of adults abused as children, the aspects of community mental health interventions that are experienced as helpful and less helpful after discharge from inpatient trauma treatment.Method: In-depth interviews were conducted with 30 child abuse survivors, six months after discharge from a specialized trauma treatment program.Results: Participants reported difficulties managing intense feelings that surfaced after inpatient treatment, which became more problematic when they could not talk about them honestly with their community-based therapists. Therapists who were patient, understanding, and respectful of survivors' needs for a sense of control in working toward their own solutions were most helpful. Participants emphasized the need for accessible trauma-based treatment from clinicians.Conclusions: Many communities in Canada, due to lack of resources, are not providing trauma-specific services. This study indicates that community-based therapists need to become more knowledgeable about trauma issues, to increase their ability to work collaboratively with adults abused as children in assessing their therapeutic needs, and to ensure that survivors have some control in the treatment process.Declaration of interest: The Social Sciences and Humanities Research Council of Canada, Grant # 410‐98‐0092 and the Homewood Foundation, Guelph, Ontario, provided funding for this study.

IPS in Europe: The EQOLISE trial.

IPS has been demonstrated to increase return to open employment significantly in individuals with mental health problems in the US. Previous experience (e.g. with ACT) has demonstrated the sensitivity of complex community mental health interventions to local social and healthcare cultures. Europe has conditions of generally greater employment security than the US and varying (generally higher) unemployment rates and welfare benefits. Evidence of the effectiveness of IPS in these conditions, and its potential variation across them, would guide local policy and provide possible insights into its mechanism. We conducted an RCT of IPS versus high-quality train-and-place vocational rehabilitation in six European centers with very different labor market and health and social care conditions. A sample of 312 individuals with psychotic illness was randomly allocated (50 per site). Inclusion criteria were a minimum of two years' illness duration, with at least one year of continuous unemployment and six months contact with their current mental health services. Follow-up was 18 months. The primary outcome was any open employment, and secondary outcomes included time to employment, duration of employment and hospital admission. IPS was more effective than the Vocational Services for all vocational outcomes. 85 IPS patients (54.5%) worked for at least one day compared to 43 Vocational Service patients (27.6). They were significantly less likely to be rehospitalized. Local unemployment rates explained a significant amount of the variation in IPS effectiveness and both national economic growth and welfare systems influenced overall employment rates in both services. IPS doubles the access to work of people with psychotic illnesses, without any evidence of increased relapse. Its effectiveness is not independent of external circumstances, particularly local unemployment rates.

MAKING THE CONNECTION: LEGAL ADVOCACY AND MENTAL HEALTH SERVICES

Recent research documenting the magnitude of mental health needs among juveniles has intensified calls for interventions that both address clinical needs and decrease recidivism. This article first examines research supporting the movement toward community mental health treatment for juveniles and argues that effective legal advocacy requires interdisciplinary coordination to identify and address mental health needs. Next, we present one jurisdiction's model for increasing access to community‐based mental health services and discuss how attorneys can apply the model to achieve this end.

Effect of Maternal Mental Health Problems on Child Treatment Response in Community-Based Services

Many mothers bringing children for community mental health treatment need mental health services themselves. Moreover, children of mothers with mental health problems enter treatment with more severe symptomatology than do other children. However, little is known about how maternal mental health problems affect children's response to treatment. This study examined the impact of maternal mental health status on the child's treatment response. The mental health of 272 mother-child pairs was assessed twice, when children entered treatment at three community mental health clinics and again three months later. Analysis of variance was used to examine the impact of maternal mental health status on children's rate of improvement. Children of mothers with mental health problems had significantly greater behavior problems (F=34.54, p<.001) and demonstrated less improvement over time (F=4.44, p=.04) than children of mentally healthy mothers. These findings suggest that treatment for mothers as well as children could be beneficial for this population.

Clinical Mental Health Outreach to Older Adults: Serving the Hard-to-Serve

ABSTRACT Older adults with severe and persistent psychological difficulties can have trouble taking care of their basic needs, protecting themselves, and maintaining adequate housing. Traditional community mental health interventions, as well as almost all supportive services, are refused by this subgroup of elders. The project described in this article expands mental health services to older adults who, because of the severe nature of their psychological difficulties, are at risk of eviction, homelessness, premature institutionalization, premature guardianship, elder abuse including self-neglect, and decreased quality of life. The project utilizes psychological skills in personalized, flexible, time-intensive interventions that are delivered in community settings. Foundational to the interventions are careful clinician recruitment and established working relationships with community gatekeepers. Initial contacts include informal needs assessment and often require several hours per week. Ongoing clinical interventions are stepwise and may expand to include case management and traditional psychotherapy. Community consultation supports sustained interdisciplinary assistance to hard-to-serve elders. Outcomes included 508 persons served, of which 304 received long-term assistance. Positive changes included elders receiving services previously refused, decreasing isolation, avoiding eviction, reducing need for emergent services, decreasing delusional material, and setting limits in relationships. Ongoing issues such as burnout prevention and informed consent are addressed.

Limitations of System Integration in Providing Employment Services for Persons with Mental Illness

This study assessed the influence of service systems integration on employment outcomes for persons with mental illness. A survey was sent to all 125 key program staff that worked for community mental health treatment agencies or vocational rehabilitation agencies. The survey found that referral and employment rates were low; but that these rates were related to characteristics of the interagency systems integration. Community mental health staff referred 448 individuals for employment services. Staff from vocational rehabilitation agencies accepted only 26% of these referrals and found work for just 11%; 7% were employed six months later. Also, 39% of respondents reported that the linkage agreement between their agencies was never established. This study suggests the need for more effective strategies for integrating mental health treatment and vocational rehabilitation systems.

Trauma and Disaster: Response and Management • Terrorism and Disaster: Individual and Community Mental Health Interventions

Trauma and Disaster: Response and Management • Terrorism and Disaster: Individual and Community Mental Health Interventions