Effective Mental Health Services Research Articles

Implementing Evidence-Based Psychotherapies in Settings Serving Older Adults: Challenges and Solutions

This Open Forum addresses challenges--insurance limitations, staff and setting limitations, and training and sustainability issues--in the implementation of psychotherapy interventions in settings serving older adults and provides solutions for ensuring that they have access to effective mental health services. There is considerable movement toward developing the geriatric mental health workforce, and it is important that these efforts include a discussion of implementation issues with regard to evidence-based psychotherapies as they are provided in services for aging populations.

Health and Social Functioning of Adults With Intellectual Disability and Autism

AbstractThere is little information on the mental health needs of adults with intellectual disability (ID) and autism spectrum disorders (ASDs). Such evidence is much needed for the development of more effective mental health services for this group. The aim of this study is to compare adults with ID and ASD receiving specialist mental health services with participants without ASD. Data were collected from the anonymized case records of a clinic‐based population in South East London. Health and social functioning were measured using the Health of the Nation Outcome Scale for people with Learning Disability (HoNOS‐LD). A review of case records identified 371 service users in receipt of specialist mental health care who were eligible for the study. There were 117 people (32% of the sample) with a clinical diagnosis of ID and ASD. Participants with ASD were younger, more likely to be male, less likely to live independently and had more severe ID than those without ASD. Furthermore, those with ID and ASD were less likely to be diagnosed with a psychiatric disorder but had significantly higher scores on the HoNOS‐LD (indicating lower health and social functioning) than those without ASD. A significant proportion of adults with ID who are in receipt of specialist mental health services also have a clinical diagnosis of ASD. This group has different mental health needs compared with those without ASD. The authors note the need for a more personalized approach to service delivery with a focus on improving social functioning and behavioral impairments.

Symptoms of posttraumatic stress disorder and depression among bereaved and non-bereaved survivors following the 2008 Sichuan earthquake

Many studies have suggested that unexpected death of a loved one is an important risk factor of posttraumatic stress disorder (PTSD) and depression among disaster survivors, but few have examined the magnitude of psychiatric morbidities among bereaved survivors. This study examined the prevalence rates of clinically significant PTSD and depressive symptoms and their associated risk factors among Chinese adult survivors following the 2008 Sichuan earthquake. Two hundred and fifty-one bereaved adults were compared with 1474 non-bereaved adult survivors. The estimated rates of PTSD and depressive symptoms were 65.6% and 64.8% for those who lost first-degree family members, 34.1% and 45.5% for those who lost second-degree relatives, and 27.1% and 37.5% for non-bereaved survivors respectively. Loss of a child was a significant predictor of psychopathological symptoms. The results suggested that effective and sustainable mental health services were required, especially for bereaved single-child parents.

Mental health and custody: a follow on study

PurposeThe purpose of the paper is to report the findings of a small scale indicative research project. The project explores the assessment of detained persons in police custody by Forensic Physicians (FP).Design/methodology/approachA range of information was collected in every case where custody staff had identified a mental health concern and requested an FP assessment. As well as information about demographic factors, this would include questions regarding any links that the individuals had with community‐based mental health services. As well as this information, anonymous custody records and force adverse incident records for the month were examined.FindingsIn the month of the project, 59 FP assessments were requested. Only six members of this group had any contact with community‐based mental health services: two with a social worker, two with a CPN and two with a psychiatrist. Of this group, three had not been in contact with mental health services for over a month.Research limitations/implicationsThe size of the cohort and variety of arrangements for providing nursing and social care support in custody settings may limit the generalisation of the findings.Practical implicationsThis study highlights that there is a group of individuals whose mental health causes concern to the police in a custody environment. In this study, the overwhelming majority of the group have no contact with mental health services. The research supports the recommendations of the Bradley Review for wider health care provision in custody settings.Originality/valueThe paper highlights that fully effective community mental health services need to consider police custody settings as a key point for intervention.

Wellness Centre: An Evidence-Guided Approach to Delivering Culturally Relevant Community Psychogeriatric Services for Chinese Elders

Ethnic elders are commonly reluctant to access mental health services and their mental health problems are often overlooked and detected late in the course of illness. Prior studies identified major barriers to ethnic seniors accessing appropriate mental health care demonstrating that language and cultural beliefs cannot be ignored if effective mental health services are to be provided to patients from diverse cultural groups. These are particularly important when care is needed by less acculturated immigrant ethnic seniors for whom language barriers are often greatest. Differences in conceptions of mental distress affect ethnic seniors' choice of help-seeking and often discourage or divert aged persons from utilizing mainstream conventional psychiatric care. Despite the extensive need for appropriate service models for ethnic populations, there have been limited data and models to illustrate how these programs can be systematically and effectively integrated within the mainstream mental health service framework. This paper describes an innovative, mainstream, community-based psychogeriatric service delivery model developed for Chinese seniors in Toronto, Canada, aiming at improving their access to care and enhancing earlier mental health problem detection. The important concepts and strategies of designing and operating a culturally acceptable program are illustrated supported by program data and the challenges analyzed.

Factors associated with unmet needs in individuals with schizophrenia in Chile

OBJECTIVE: To evaluate the possible associations between different sociodemographic, clinical, and healthcare factors and the number of unmet needs among people being treated for schizophrenia. METHODS: The sample was made up of 141 subjects who were being treated at eight mental health service networks throughout Chile. Unmet need was assessed with the Camberwell Assessment of Need, which was specifically created for people with severe mental disorders. A multiple linear regression analysis was also applied. RESULTS: It was found a direct association with clinical variables: score in the Positive and Negative Syndrome Scale, global functioning at diagnosis, and change in global functioning at diagnosis from diagnosis to interview. However, sociodemographic (ethnicity, education level, and number of people who live with subject) and other clinical variables (age at diagnosis, and annual rate of relapse) were indirectly associated with unmet needs. CONCLUSIONS: Our results can be applied in order to coordinate and improve the effectiveness of mental health services in Chile.

Causal Beliefs and Effects upon Mental Illness Identification Among Chinese Immigrant Relatives of Individuals with Psychosis.

Identifying factors that facilitate treatment for psychotic disorders among Chinese-immigrants is crucial due to delayed treatment use. Identifying causal beliefs held by relatives that might predict identification of 'mental illness' as opposed to other 'indigenous labels' may promote more effective mental health service use. We examine what effects beliefs of 'physical causes' and other non-biomedical causal beliefs ('general social causes', and 'indigenous Chinese beliefs' or culture-specific epistemologies of illness) might have on mental illness identification. Forty-nine relatives of Chinese-immigrant consumers with psychosis were sampled. Higher endorsement of 'physical causes' was associated with mental illness labeling. However among the non-biomedical causal beliefs, 'general social causes' demonstrated no relationship with mental illness identification, while endorsement of 'indigenous Chinese beliefs' showed a negative relationship. Effective treatment- and community-based psychoeducation, in addition to emphasizing biomedical models, might integrate indigenous Chinese epistemologies of illness to facilitate rapid identification of psychotic disorders and promote treatment use.

Outcome Studies of Social, Behavioral, and Educational Interventions

This collection of articles elaborates on various aspects of outcome studies. Outcome studies feed and nurture the field of social work and other human services professions with evidence on what works. Outcome studies are designed to measure and understand the effectiveness of social, behavioral, and educational interventions. The ultimate purpose of social work action is change; that is, intended betterment of living conditions of a client, a family, or a community. Intended outcomes are often carefully considered and targeted when designing an intervention to cause betterment. However, social work interventions take place in real-life situations in which many other factors than the intervention itself are present and interfere to different degrees under different circumstances. In social work and other human services, unintended outcomes are very common and frequently complicate the processes of designing outcome studies and measuring outcomes. Thus, the main challenge of any outcome study is to determine what would have happened in the absence of a professional intervention in order to estimate the outcomes of the intervention program. As noted by Fraser and colleagues in this collection, intervention studies and outcome studies are akin but still different. Outcome studies belong to the general sphere of program evaluation. Intervention research includes phases of designing and developing an intervention program to be explicitly tested within the framework of the intervention research. Conceptualization of data-driven program theory, efficacy testing under strictly controlled conditions, and effectiveness testing in real-life situations, and on a larger scale compose the main steps of intervention research. Outcome studies and intervention research form the backbone of evidence-based practices in social, behavioral, and educational professions. In other words, outcome studies are designed to substantially contribute to the evidence base of social work and other human services. The collection of the articles offered in this special issue is the proceedings of the Stockholm Conference on Outcome Studies of Social, Behavioral, and Educational Interventions sponsored by the National Board of Health and Welfare, the Swedish Council for Working Life and Social Research, the Swedish National Board for Institutional Care, and the Swedish National Institute for Public Health in collaboration with the Hamovitch Center for Science in the Human Services at the School of Social Work, University of Southern California, held on February 7 to 8, 2011. The collection of articles begins with an introductory presentation by Mark W. Fraser and his colleagues and can be read parallel to a handy book, Intervention Research: Developing Social Programs (Fraser, Richman, Galinsky, & Day, 2009). This article describes the core features of outcome research and discusses challenges to designing and conducting robust and compelling outcome studies. As much as outcome studies are essential to evidence-based social work practice, it is equally difficult to conduct successful outcome studies—a problem often revealed during study quality appraisal processes performed by systematic review teams with the Campbell and Cochrane collaborations. Some of the issues raised by Fraser and colleagues are also addressed by Kelly and Moore, who examine the process of building an evidence base for better and more effective public health and mental health services from a British perspective. Kelly, the director of the Centre for Public Health Excellence, located in London, England, offers a special insight into national perspectives on policies of making public health interventions effective and cost-effective. Preoccupation with scientific and technical aspects of outcomes studies may at times blind researchers, decision makers, and professionals when assessing the meaning and ethics of outcome studies. In her contribution, Eileen Gambrill critically assesses ethical aspects of outcome studies, arguing that no research area is more political than the evaluation of outcome studies, and fundamentally challenges outcome researchers to serve social work clients on sound ethical grounds.

Book Review: Mental Health Care in the College Community

Kay, J., & Schwartz, V. (20 1 0). Mento/ Health Care in the College Community. Hoboken, NJ:Wiley-Blackwell. 396 pp. $64.95 (hardcover). ISBN 978-0-47074-618-9.Mental Health Care in the College Community edited by Jerald Kay and Victor Schwartz, provides a broad and yet detailed introduction to counseling services at American colleges and universities. The editors have produced a book that focuses on the nuts and bolts of counseling, and it will be a welcome addition to the limited literature on the topic. For readers unfamiliar with mental health care at higher education institutions, the book is an effective guide to better understanding how counseling services are provided in these settings. The book may also serve as a textbook in graduate counseling and higher education courses that examine the delivery of counseling services at various colleges and universities. The book includes 17 chapters written by notable and experienced professionals in the field. These authors include practicing psychologists, psychiatrists, and attorneys.The first two chapters provide a helpful foundation for later ones. The first chapter emphasizes the importance of research by highlighting findings from a number of studies examining mental health issues on campus. Chapter 2 focuses on the history of counseling and mental health services and explains how the community mental health model has been integrated into higher education settings.Subsequent chapters examine the structural and functional components of effective college mental health services in addition to the importance of the counseling center team, which should be an integral part of the college community. Of particular interest is chapter 7 in which legal and ethical issues are discussed in detail. Other chapters highlight a number of specific topics related to college counseling, including managing crises and crisis intervention; counseling parents and families of young adults; the value of psychiatry residency training when it includes campus placements; psychology and social work training; counseling members of special populations; using a public approach when counseling some students; and providing counseling services to address student alcohol and drug misuse. The penultimate chapter, chapter 16, revisits a major theme that extends throughout the work: Improvement in the delivery of mental health and counseling services will in all likelihood be tied to research focused on the work of college counseling centers. This chapter is especially helpful in reminding readers about the necessary components of excellent research.When readers take a closer look at each chapter, they will find a thoughtful and helpful organization to the subject matter in each case. More specifically, the authors provide introductions to the primary topics of each chapter. These introductions are followed by an in-depth examination of the primary topic and included subtopics. Readers interested in further study will appreciate the robust reference list at the end of each chapter and, when appropriate, appendices that offer additional valuable information for the reader such as a triage form and helpful hints for supervisors. Attentive reading of individual chapters is facilitated through the use of informative charts and graphs that help the reader understand the most important information presented.The strengths of this text are numerous, beginning with the focus on a comprehensive examination of college counseling. The individual chapters develop discussion points that could easily be adopted for in-class or online class interaction to help develop the major themes and problems articulated by authors. …

Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China

This study examined the estimated prevalence rate of posttraumatic stress disorder (PTSD) symptoms and associated risk factors among Chinese adult survivors 7 to 8 months after the 2008 Sichuan earthquake. The sample was recruited from 2 areas close to the epicenter but of different distances. The estimated rate of PTSD symptoms was 55.6% and 26.4% respectively in the two areas. Loss of a child was a strong predictive factor for PTSD symptoms for the parents. Other predictive factors included female gender, loss of a parent, loss of friends or neighbors, residential house damage or collapse, and proximity to the epicenter. Effective and sustainable mental health services are needed and should be directed particularly to bereaved survivors.

Funding Cultural Adaptations to Promote Effective and Efficient Mental Health Service Provision

· Given the changing demographics of the U.S. and documented racial and ethnic health disparities, behavioral health service providers must look at adapting their services to better meet the needs of their diverse client populations.

The relationship between deinstitutionalization, expenditure and quality of care

Background/Objectives: Individuals with a diagnosis of schizophrenia or schizoaffective disorder may require longer term care in psychiatric or social care facilities based in hospital or the community. Due to the complexities of caring for this population and the high financial and resource cost of care, it is important to ensure that efficient and effective mental health services are being provided. This investigation aims to examine international differences in quality of care and service user experience when compared to national mental health expenditure and the degree of deinstitutionalisation in 10 countries.

A Community Mental Health Service Delivery Model: Integrating the Evidence Base Within Existing Clinical Models

A model of care for community mental health services was developed by reviewing the available literature, surveying ?best practice? and evaluating the performance of existing services in a metropolitan area mental health service servicing a population of approximately 1.1 million people. A review of relevant academic literature and recognized ?good practice? service delivery models was undertaken in conjunction with a review of local activity data and consultation with key stakeholders (not addressed in this paper). A model was developed identifying the core functions of community mental health service delivery. The components of a comprehensive, integrated model of community mental health service (CMHS) are outlined. The essential components of a comprehensive, integrated model of CMHSs include: acute and emergency response, community continuing care services, assertive rehabilitation teams, partnerships with general practitioners and other human services agencies. We propose a comprehensive integrated model of community mental health service. Clarity of role, required outputs and expected outcomes will assist the development of effective and appropriate community mental health services. Outreach to the community is a key success factor for these services and their associated inpatient services. Gap analysis can assist in the planning and costing of community mental health services.

Learning by Teaching: Reflections on Developing a Curriculum for School Mental Health Collaboration

Interdisciplinary collaboration is identified as best practice in delivering effective school mental health services. Pre-service training, however, often uses discipline-specific curriculum, limiting students' access to other disciplines and development of competency in interdisciplinary collaboration. Graduate students and faculty in this study worked collaboratively to develop a problem-based learning curriculum for promoting interdisciplinary collaboration in school mental health. Qualitative methods were used to evaluate the curriculum development process and its impact on the developers' own competency in interdisciplinary collaboration. Five curriculum developers provided narrative responses to questions developed by the authors. Using content analysis coding, several categories emerged from the data. Key categories include participants learning more about their own and others' disciplinary perspectives, training methods for interdisciplinary collaboration, and challenges and positive outcomes asso...

Use of Outcomes Information in Child Mental Health Treatment: Results From a Pilot Study

Use of Outcomes Information in Child Mental Health Treatment: Results From a Pilot Study

Limited English proficient Asian Americans: Threshold language policy and access to mental health treatment

The importance of providing timely, effective mental health services is increasingly recognized worldwide, and language barriers are a formidable obstacle to achieving this objective. Threshold language policy is one response implemented by California and other states within the U.S., in accordance with Title VI of the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color, and national origin in programs receiving federal funding. This policy mandates language assistance services for Medicaid enrollees whose primary language is other than English once their population size reaches a designated level. Medicaid is the federal-state-funded health insurance program for specific classifications of low-income Americans. This study evaluated the impact of threshold language policy on Vietnamese, Cantonese, Hmong, and Cambodian limited English proficiency persons' use of public mental health services in California. Using random-effects regression on 247 observations, we regressed aggregate Vietnamese, Cantonese, Hmong, and Cambodian Medicaid mental health service penetration rates on an indicator of the threshold language policy's implementation, while controlling for a linear time trend and the effects of non-threshold language assistance programming. Immediately after implementation, threshold language policy requirements were associated with a penetration rate increase among this population. The penetration rate increase became greater after accounting for the impact of concurrent language assistance. However, this increase diminished over time. The findings indicate that, at least in the short run, language assistance measures requiring reasonable accommodations once populations of LEP persons reach a specified size have detectable effects on their mental health service use. These requirements increase the number of mental health consumers, but appear to provide declining benefit over time. California's threshold language policy provides one example of how public or national health systems worldwide may attempt to address the issue of equity of mental health service access for burgeoning immigrant/migrant populations with language assistance needs.

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

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

The Effect of Services and Stigma on Quality of Life for Persons With Serious Mental Illnesses

This study examined the effects of mental health services and stigma on self-concept and quality of life among individuals with serious and persistent mental illnesses. A broad array of inpatient and outpatient services, as well as perceptions of stigma, was assessed among 188 individuals who had been diagnosed as having serious mental illnesses. Quality of life and self-concept (that is, self-esteem and mastery) were also assessed at baseline and follow-up (approximately six months). Receiving mental health services had an effect on changes in quality of life over time. Specifically, receiving counseling services had a positive influence on quality of life, whereas receiving inpatient services decreased quality of life. Stigma was not significantly associated with changes in quality of life over the study period. Self-esteem and mastery influenced the association between stigma and quality of life but did not influence the relationship between services and quality of life. Finally, although services had little effect on changes in self-concept, perceived stigma significantly reduced both self-esteem and mastery. The extent to which services influenced quality of life was dependent on the type of service examined. Moreover, although the effects of services were more pronounced with respect to quality of life than self-concept, the opposite was true with respect to the effects of stigma. Efforts should be made to increase access to specific types of services, such as counseling, as well as to reduce negative perceptions of stigma that erode self-image among individuals with serious mental illnesses.

Characteristics and Experiences of Adults With a Serious Mental Illness Who Were Involved in the Criminal Justice System

This study identified characteristics and experiences of arrestees and jail inmates with a serious mental illness that were associated with misdemeanor and felony arrests and additional days in jail. County and statewide criminal justice records and health and social service archival data sets were used to identify inmates with serious mental illness who were in the Pinellas County, Florida, jail between July 1, 2003, and June 30, 2004, and their health and social service contacts from July 1, 2002, to June 10, 2006. Criminal justice and mental health services were recorded longitudinally across 16 quarters, or 90-day periods. Generalized estimating equations for count data were used to describe the associations between individual characteristics and experiences and the risks of misdemeanor and felony arrests and additional days in jail. A total of 3,769 jail inmates (10.1% of all jail inmates) were diagnosed as having a serious mental illness. Participants experienced a mean+/-SD of .90+/-.60 arrest for every three quarters and 10.9+/-23.6 days in jail per quarter that they resided in the county. Being male, being homeless, not having outpatient mental health treatment, and having an involuntary psychiatric evaluation in the previous quarter were independently associated with significantly increased odds of misdemeanor arrests and additional days in jail. On the other hand, being black, being younger than 21 years, having a nonpsychotic diagnosis, and a co-occurring substance use disorder diagnosis were all independently associated with significantly increased odds of felony arrests, and with the exception of having a nonpsychotic diagnosis, they were also significantly associated with additional days in jail. Findings suggest that there are subgroups of individuals with a serious mental illness in the criminal justice system that may require different policy and programmatic responses.

Psychiatric Disorders in Detained Male Adolescents: A Systematic Literature Review

To provide a best estimate of the prevalence of psychiatric disorders among detained male adolescents, with particular emphasis on impairment, multi-informant assessment, and race or ethnicity. Computer-assisted searches were executed to identify relevant studies. Fifteen studies using adolescents as informants met inclusion criteria (n = 3401), of which only 2 reported within a subsample on parent-derived diagnoses. The mean prevalence of any disorder was 69.9% (95% CI 69.5% to 70.3%); with conduct disorder occurring most frequently (46.4%, 95% CI 45.6% to 47.3%), followed by substance use disorder (45.1%, 95% CI 44.6% to 45.5%), oppositional defiant disorder (19.8%, 95% CI 19.2% to 20.3%), and attention-deficit hyperactivity disorder (13.5%, 95% CI 13.2% to 13.9%). Although lower, rates for internalizing disorders were still substantial, with any anxiety disorder found in 15.9% (95% CI 15.6% to 16.1%), major depression in 12.0% (95% CI 11.7% to 12.2%), and posttraumatic stress disorder in 9.6% (95% CI 9.2% to 10.0%). Three studies reported on psychotic disorders, finding low rates (1.35%, 95% CI 1.32% to 1.39%). Estimates of prevalence were only marginally different when impairment was not required, while consistency between adolescents and parents was poor. Findings on the relations between race or ethnicity were too scarce and inconsistent to interpret. Detained male adolescents bear substantial mental health needs, emphasizing the need to organize effective mental health services for this troubled group. However, our knowledge on mental disorders in detained youth should be enhanced, in particular regarding the reliability of adolescents, compared with parent report, and whether clinically relevant differences exist by race or ethnicity.