Formal Mental Health Services Research Articles

Medical Returnees: Somali Canadians Seeking Psychosocial and Spiritual Care in East Africa.

The refugee experience has been associated with increased rates of psychosocial challenges. At the same time, evidence suggests that those who resettled in Western countries including Canada underutilize the formal mental health services in these countries. The low uptake has been attributed to barriers such as language, complexity of the health systems, and differing explanatory models of illness. The same is true for Somali refugees in the West. Studies suggest that Somali refugees prefer spiritual healing for psychosocial illness and that some return to East Africa for such healing. However, little is known about Somali Canadian's experiences with the Canadian mental health services and transnational health seeking. The study aimed to understand psychosocial challenges faced by Somali Canadians, their health seeking behaviors, and service utilization. Because some sought psychosocial services outside the country, fieldwork was conducted in Kenya to provide new evidence on transnational healing services. Ethnographic fieldwork and in-depth interviews were utilized. Thirty-seven interviews of about an hour each were undertaken. Fieldwork in Nairobi focused on spiritual healing centers and medical clinic. The findings reveal important findings regarding psychosocial challenges experienced by participants. It discusses psychosocial illnesses as variedly experienced, challenges with accessing Canadian healthcare services, and seeking culturally appropriate services in East Africa. The study highlights participants and their families struggle with psychosocial distress, the challenges of accessing culturally appropriate services within Canada, the role of spiritual healers and the existence of transnational health seeking practices.

Examining recovery and mental health service satisfaction among young immigrant Muslim women with mental distress in Quebec

ObjectiveThe overall aim of this study was to understand the experiences and perspectives of immigrant Muslim women in Quebec living with mental illness, who have recently used formal mental health services such as an accredited therapist, psychologist, or clinician. Specific objectives included (i) eliciting and examining their self-identified barriers and facilitators to recovery; (ii) exploring links between religion and mental health; and (iii) self-reported satisfaction with mental health services received.MethodsWe adopted a qualitative approach, facilitating the prioritization of participant perspectives. This involved semi-structured interviews with 20 women who (i) identified as Muslim; (ii) had used mental health services in the last three years; and (iii) were 18 + years of age. Interviews were transcribed and analyzed using thematic analysis techniques.ResultsThree prominent themes emerged from the analysis. These themes were (i) stigma and misunderstandings in families (especially parents) and sometimes in the ethno-religious community, both acting as barriers to health service utilization and recovery; (ii) frustrating clinical experiences within formal mental health care settings, in particular a perceived lack of cultural and religious competence, which negatively affected service utilization and the development of a therapeutic alliance; and (iii) deeply-held religious beliefs, practices and trust in God imparting a rhythm, purpose and meaning, which were strong facilitators to recovery.Conclusions and implications for practiceThese findings suggest that recovery from mental illness can be advanced by a three-pronged approach in this population. First, anti-stigma mental health literacy interventions could be held in collaboration with Muslim community groups. Second, there is a need for further religious and cultural competence interventions, resources and trainings for mental health professionals working with Muslims. Third, self-care resources should be developed that harness aspects of religious practices that can give structure, meaning, purpose and hope. All this could ultimately foster recovery in this population.

A qualitative investigation into care-leavers' experiences of accessing mental health support.

People who grew up under the care of children's social services are a highly vulnerable group, with 50% of this population meeting the criteria for a mental health problem at any one time. Emerging evidence suggests that there is a disparity between the number of people who require support, and those that receive it, and that they face several barriers to accessing timely and effective mental health support. We have a limited understanding of how to support the mental health of this group as they 'age out' of children's social services, and the transition to independence, which occurs around the age of 18. We aimed to explore how care-leavers understand their experiences of help-seeking from formal mental health services. We used qualitative interviews, and Interpretative Phenomenological Analysis with 9 care-experienced young people aged between 18 and 25 years old. This work was co-produced by a team of care-experienced adults, from the conception of the study to write-up. Qualitative analysis revealed several themes which centred around: (1) taking reluctant steps towards recovery, (2) challenges with being understood and the importance of gaining an understanding of yourself, (3) navigating trust and (4) the legacy of not having your mental health needs met. We identified several important implications for health and social care practice, across primary and secondary health care settings. This work highlights ways to better support this highly vulnerable group in accessing evidence-based mental health support, and how to maintain engagement.

Strategies to Improve Access to Mental Health and Psychosocial Support Among Displaced Populations in Ethiopia

Background: In 2021, more than 23 million people were in need of humanitarian assistance in Ethiopia, including four million internally displaced persons and returnees. Displaced populations face an elevated risk of mental health and psychosocial problems, yet they often have limited access to mental health and psychosocial support. Objective: This study aimed to assess: 1) the mental health and psychosocial needs and resources among displaced persons in Ethiopia; and 2) examine barriers, and facilitators, and identify strategies to improve access to culturally appropriate mental health and psychosocial support in this population and context. Methods: We conducted a sequential mixed-methods assessment of mental health and psychosocial needs and resources. First, we conducted 16 key informant interviews with those who had experience and knowledge regarding the mental health situation of displaced persons in Ethiopia, including mental health providers and humanitarian practitioners. Second, we conducted an assessment of available mental health services in 15 internally displaced persons (IDP) sites in Ethiopia along with 28 key informant interviews in this context to explore some of the challenges and strategies to improving access to mental health and psychosocial support. Results: Access to mental health services was limited in IDP sites. Participants identified numerous barriers to accessing services that ranged from limited supply and fragmentation of existing mental health services to an incongruence between formal mental health services and explanatory models of mental illness. Strategies to address these barriers included engagement of community members and key stakeholders (e.g., traditional and religious healers), improving mental health literacy, strengthening referral systems and mental health capacity, and improving coordination and integration of mental health within the national health system. Conclusion: This study highlights several challenges and opportunities for improving access to mental health and psychosocial support among displaced persons in Ethiopia. Efforts to bridge gaps in access to mental health and psychosocial support must consider both systems-level factors that influence availability as well as community factors influencing perceptions and acceptability of services within this context.

Parent-Child Interaction Therapy for Muslim-American Parents and Young Children

There are limited data available regarding early childhood mental health in the Muslim American population. Nevertheless, the literature has shown that American Muslims are more likely to experience mental health disorders, including being twice as likely to report a history of suicide attempt1 compared to other religious communities.2 Despite these challenges, Muslims in America are often underserved and tend to underutilize mental health services, compared to other minority groups.2-5 The combination of Muslim children with significant mental health challenges and caregivers who underutilize mental health services reduces the likelihood that effective treatments will be used and increases risk of long-term harm for Muslim American children. Research has shown that Muslim American populations may be hesitant in seeking mental health treatment for a variety of reasons, including associated stigma behind mental illness within the community, fears related to past experiences of racism and discrimination in a post-9/11 world, differing way of conceptualizing mental illness and psychological distress that may lead to seeking alternative supports within family and community instead of mental health providers, and lack of knowledge about how to access formal mental health services.6,7 Another plausible reason for the underutilization of mental health services in this population is the concern that mental health treatment may not align with religious or cultural values.3

Depression and help-seeking behaviors among college students: Findings from the Healthy Minds Study 2018-2019

Objective To determine the likelihood of using formal and informal mental health services among college students according to prior history of depression diagnosis and presence of depression symptoms. Participants College students from 79 universities in the U.S. and Canada who participated in the Healthy Minds Study, 2018-2019. Methods Odds ratios and 95% confidence intervals via logistic regression were estimated for the likelihood of using informal and formal mental health services stratified by depression diagnosis and severity of depression symptoms and further stratified by race/ethnicity. Results We report increased odds of using formal mental health services with increasing depression severity symptoms and increased odds of using formal mental health services among students without a clinical depression diagnosis. The odds of service utilization varied by race/ethnicity. Conclusions The likelihood of seeking mental health services differs depending on the history of formal depression diagnosis, current symptoms, and race/ethnicity among college students.

A theory of change for one-on-one peer support for older adolescents and young adults

Peer support has become increasingly available as a formal mental health service. However, high quality research and implementation of peer support has been hampered over the years by the lack of theory that clarifies peer support roles and explains exactly how these roles foster positive outcomes for peer support users. Observers have noted that theory is particularly sparse in regard to peer support for older adolescents and young adults, and they have called for theory that not only clarifies roles and mechanisms of impact, but also identifies how peer support for young people might differ from peer support for older adults This qualitative study brought young people with experience providing and using peer support together in small group discussions focused on understanding the activities and outcomes of peer support. This information was used to develop a theory of change that outlines key activities that constitute a one-on-one peer support role for young people, and describes how and why carrying out these activities should lead to positive outcomes. The theory highlights the characteristics of a successful “peerness-based relationship,” and proposes that the development of this kind of relationship mediates other positive outcomes from peer support. The article concludes with a discussion of how this theory can usefully inform the development and specification of peer support roles, training and supervision, and other organizational supports.

Youth mental health first aid training with diverse educators.

Schools are the most likely place for students to receive formal or informal mental health services and support. Classroom educators often provide informal mental health support to students and referrals to school-based services. Despite their key role, educators often feel underprepared in recognizing concerning symptoms in youth and supporting student mental health. This mixed-methods study explored the effectiveness of in-person Youth Mental Health First Aid (YMHFA) training on a diverse sample of 106 educators (Mage = 22, SD = 1.9 years, 96% ethnic minorities): City Year AmeriCorps members who work in diverse low-income schools in Florida. We culturally adapted the program to better meet the needs of the participants and the students they serve as over 95% of the students they served were people of color. Quantitative survey data were collected at three time points (pre, post, and 3 months after the training) to examine whether YMHFA training better equipped classroom educators to support students' mental health. Overall, training was associated with improvements in mental health literacy, knowledge of school-based mental health providers, confidence, and intentions to engage in mental health first aid (MHFA) behaviors. Notably, educators reported greater engagement in mental health first aid behaviors at the 3-month follow-up than before training. No improvement in mental health stigma was observed. Some improvements (i.e., mental health literacy, intentions to help) were not sustained at the follow-up. Qualitative data generally supported quantitative findings and suggested that the YMHFA program with cultural consideration is suitable for this diverse sample of classroom educators. Educators' suggestions to improve the training to support culturally and linguistically diverse students' mental health are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Why are African immigrants in Montreal reluctant to use mental health services?: a systematic inventory of reasons.

Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada. The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis. An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics. Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.

Coping with the long-term impact of civil strife: A grief-centered analysis of Tamil Sri Lankan communities affected by ethnopolitical conflict.

Limited research has examined coping mechanisms in response to chronic war-related stressors, as opposed to war-exposure trauma. The current study sought to investigate the types of losses experienced by communities affected by the Sri Lankan conflict, how participants responded to their losses, and what coping mechanisms they employed. Data consisted of interviews from two independent investigations conducted following the end of the conflict in Northern Sri Lanka (total N = 103). Interview transcripts were analyzed using a directed content analysis approach. Participants most frequently described experiencing material loss and loss of loved ones. Relatedly, participants commonly reported experiencing ambiguous loss, that is, living with the uncertainty of their loved one's death. These losses were particularly pronounced by gender, with women experiencing higher rates of loss. Common coping strategies included support-seeking, including informal support from social networks and religion, and formal mental health services. Additionally, participants described a range of longer term coping strategies from establishing a future-oriented cognitive style to a sense of helplessness and resignation. The findings shed light on how conflict-affected groups cope with profound loss. We provide recommendations for how such findings can inform grief-related clinical interventions.

Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study.

The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems. To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary. Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary. The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary. Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.

Training Male Sexual Abuse Survivors as Peer Leaders to Deliver Motivational Interviewing and Trauma-Informed Affirmative Care

ABSTRACT This paper provides a description and evaluation of training male sexual abuse survivors to deliver Motivational Interviewing (MI) and Motivational Interviewing with Trauma-Informed Affirmative Care (MI-AC) online to sexual and gender minority (SGM) men with sexual assault histories and depression. After a search and selection process, 26 men with lived experience of sexual abuse received MI training that included the use of role-playing, video demonstrations, and practice followed by weekly supervision while co-leading groups. Peer leaders completed several measures pre and post training, including beliefs about MI and self-reported learning of MI and satisfaction with the training. A sample of MI and MI-AC audio sessions were independently rated for adherence and competence. Peer leaders’ beliefs about MI changed over time, while self-rated skill level stayed consistent. Peer leaders demonstrated good adherence to the MI and MI-AC conditions. Results suggest that men with lived experience of sexual trauma effectively learned to deliver MI and/or MI-AC to SGM male survivors in online groups. These interventions have the potential to expand the reach of limited services for this population as well as reduce their depression and assist in SGM men with histories of sexual abuse entering into formal mental health services.

Help-Seeking and Barriers to Service Use amongst Men with Past-Year Suicidal Ideation and not in Contact with Mental Health Services

Objective Men are less likely than women to engage with formal mental health services for suicidality. We describe the sources of support, barriers to service use, and coping strategies of men with past-year suicidal ideation who are not receiving formal mental health services. Method Australian men experiencing past-year suicidal ideation who also did not receive formal mental health services within the past year (n = 176) completed a survey that assessed help-seeking behaviors, coping strategies and styles, use of general services, barriers to service use, and individual-level characteristics. Analyses included descriptive statistics and bivariate analyses. Results The most common type of support was self-help resources, and self-reliance was the most common barrier to formal mental health service use. Most participants had seen a GP for non-mental-health-related reasons in the past year. Men who did not seek any help for their suicidality experienced lower instrumental barriers and perceived need for support, and lower levels of certain coping styles. Limitations included a cross-sectional design and small sample size. Conclusion The current study provides insight into the help-seeking experiences of men with past-year suicidality and not receiving formal mental health services. The findings suggest it may be helpful to improve the linkage between online and informal sources of support and evidence-based interventions. HIGHLIGHTS Online self-help, friends, and partners were the most commonly used sources of help. A subset of men (42%) with lower perceived need for help did not seek any support. Despite no past-year formal mental health service use, 80% of the men had seen a GP.

Mental Health Services Use and Social Support Among Latinx Families with Adolescents Who Engage in Suicidal Behavior

ABSTRACT Latinx communities experience a significant child mental health disparity. Research is needed to examine mental health services use and social support in Latinx adolescents, with particular attention to acculturative factors and youth who have high levels of clinical severity. The current study examined whether acculturation and enculturation, and related proxies, are associated with prior history of services use and social support in Latinx families with adolescents who had a recent suicidal crisis. Participants were 110 youths, recently admitted to psychiatric hospitalization, ages 12–17 years and their caregivers. Results indicated that approximately 20% of the overall sample did not access any formal mental health services (e.g. outpatient mental health care, primary care support, school staff support) before high acuity hospital care. First-generation status and higher caregiver enculturation were associated with a lower likelihood of formal mental health services use, even when controlling for clinical covariates. Adolescent preference for Spanish was associated with lower social support. Findings suggest that families with higher enculturation and first-generation immigrant families (both caregivers and youth born outside of the U.S.), in the context of severe clinical impairment, experience systemic and sociocultural barriers conducive to limited engagement with mental health support. Implications for improving the accessibility of mental health supports are reviewed.

Program logic of a mental health outreach service for socially anxious youth

Youth mental health is a major concern both in Australia and internationally. Identifying at-risk young people is a core service priority. This report describes a “Youth Social Inclusion Program” developed in Australia to assist young people identified as having social difficulties that prevent them linking into formal mental health services. This report describes the Australian service context and uses the “program explication” methodology to document: the program activities, therapeutic processes, and underpinning evidence for the benefits of this service. Program explication is a consulting method designed to assist services to identify and review implicit program logic assumptions against evaluation literature. We demonstrate the application of this method in exploring the assumptions and evidence for the Youth Social Inclusion Program, targeting outreach to socially anxious young people in Australia. The Youth Social Inclusion Program involved seven logically consistent activities. Our literature search revealed moderate evidence for the expected benefits of the activities. This practice-based design drew on several theoretical perspectives. Given that the program logic has been established, we outline a proposal for further evaluation.

Stigma as a barrier to suicide prevention efforts in Iran.

Suicide and suicide attempt affect a considerable part of the general population, and in spite of their prevalence, the stigma associated with suicide remains an unsolved problem surrounding this important public health problem, especially in lower-income countries such as Iran. Evidence shows that help-seeking from formal mental health services for suicidal people is low in countries like Iran. Previous studies on Iranian survivors of suicide attempts have shown that these people experience fear of stigma due to labels such as loss of faith in God, having forms of severe mental illnesses ("madness"), and being involved in unaccepted sexual relationships. The associated stigma prevents them from seeking appropriate health and social services. Although both self-stigma and public stigma contribute to an unwillingness to seek mental health care and suicide prevention efforts in Iran, public stigma may be of greater consequence, significantly impeding an individual's likelihood of accessing care for their suicidal thoughts or attempts. In such circumstances, many people with suicidal thoughts miss out on social and formal support programs offered by social and healthcare providers. In this perspective article, focusing on the public stigma regarding suicide in Iranian society, we address the challenges and barriers to seeking suicide prevention efforts in Iran and discuss culturally appropriate strategies to improve the current situation.

Correlates of non-receipt of formal mental health services among Australian men experiencing thoughts of suicide

Correlates of non-receipt of formal mental health services among Australian men experiencing thoughts of suicide

S90 An Assessment of Mental Health Needs in Pediatric Patients With Inflammatory Bowel Disease (IBD) During the COVID-19 Pandemic

Background: Inflammatory bowel disease (IBD) is a disorder characterized by chronic inflammation and a dysregulated response to microbiota in the gastrointestinal tract. The severity of the disease can vary and often consists of alternating periods of remission and relapse. While IBD can present at any age, approximately 25% of patients are diagnosed before 20 years of age. Additionally, many studies have indicated that adolescent and pediatric patients with IBD have a poorer quality of life and increased prevalence of psychiatric disorders requiring medications. For example, a significantly greater usage of antidepressants was noted among adolescents with IBD in a nation-wide Finnish study. The aim of this project was to assess the burden and the kind of mental health issues facing our pediatric IBD population during the COVID-19 pandemic. Methods: A retrospective chart review was conducted on pediatric IBD patients (N = 140) seen at the University of Rochester Medical Center (URMC) from 2020 to 2021. Seven individuals were excluded because they did not have an established IBD diagnosis. Patient information, including sex, IBD type, symptoms at diagnosis, and age at diagnosis, was gathered from the medical record. Patient charts were reviewed for psychotropic medications. Medications used to treat ADHD, ADD, and chronic migraines were excluded. Mental health visits within the psychiatry, behavioral health, pediatric psychology, adolescent medicine, and social work departments were reviewed and recorded. Results: Of the pediatric IBD population sampled 56% were male, 44% were female, and the mean age of diagnosis was 11.2 years (SD: 3.74). Most individuals were diagnosed with Crohn’s disease (81%), and a smaller percentage were classified as having ulcerative colitis (19%). Approximately 43% of the pediatric IBD population had at least 1 mental health concern over this time period, and the most common psychiatric diagnoses were depression alone (67%), anxiety alone (3%), or both depression and anxiety (30%). About 36% of patients were prescribed a psychotropic medication and hydroxyzine (53%), sertraline (33%), and fluoxetine (25%) were the most prescribed therapeutics. 24% of patients utilized some form of mental health service but 49% of patients taking psychotropic medications did not appear to receive any formal mental health services. Patients who developed a psychiatric disorder reported more IBD-related symptoms at the time of their diagnosis compared to those without any history of psychiatric diagnoses (t(136)=1.99, P=.02). Conclusion(s): Our results suggest there are high levels of depression and/or anxiety in children with IBD seen at URMC during the time of the COVID-19 pandemic. Additionally, increased IBD symptoms at the time of diagnosis were associated with increased rates of psychopathology. Taken together, these findings suggest that more anxiety and depression screening is needed for pediatric IBD patients and that mental health services may be underutilized in the pediatric IBD population. Future directions include combining and comparing this data set with a previous pre-pandemic study performed at our institution to determine the full impact of COVID-19 on this population.

Depression rates and health-seeking behavior in primary care: Andersen model of health- care utilization

ABSTRACT Depression imposes a tremendous burden on the health-care systems. Many patients prefer informal (family & friends) over formal mental health services (MHS) provided by professionals. We aimed to investigate the prevalence of depression among primary care patients and to examine the factors predicting seeking MHS using the Andersen Health Care Utilization Model. We interviewed 300 primary care patients in Jordan. The mean age was 39.85 ± 14.45, and 80% were women. 35.7% had depression, and 28.7% had significant depression impairing daily function. The most commonly reported source of help was family members and less than one-third had the intention to seek formal MHS. The predisposing-factors domain was the only predictive of seeking MHS in depression and suicide, whereas the ‘enabling’ and ‘need’ domains were not. Knowledge, stigma and life satisfaction were predictive of seeking formal MHS. Raising awareness and empowering doctors to screen for depression is needed as less than a third would seek formal MHS.

Systematic Review of Religiosity's Relationship with Suicidality, Suicide Related Stigma, and Formal Mental Health Service Utilization among Black Americans.

Rates of suicide have increased among Black Americans. Suicide is now the 3rd leading cause of death for Black Americans between the ages of 1-19 and the 4th leading cause of death for Black Americans aged 20-44. Due to the increasing need in the community, a marked increase in literature focusing on suicide in the Black community has been published since 2018. To build a better understanding of the current state of the literature on suicidality among Black Americans and to offer suggestions for further areas of research, a systematic review was conducted. Spirituality and religious beliefs are often an important cultural focus in the Black community. Some religious beliefs pose potential unintended regarding the sanctity of life among Black Americans. The focus of this systematic review was religiosity's effect on suicidality among Black Americans. Religiosity was found to have a protective effect against suicidality among Black Americans while discouraging formal mental health services utilization. This systematic review also reveals a dearth of research on the relationship between religiosity and suicide related stigma. Areas for further research are mentioned, and religious institutions as mental health intervention centers are encouraged.