Help For Mental Health Issues Research Articles

Views of Young People in Rural Australia on SPARX, a Fantasy World Developed for New Zealand Youth With Depression.

BackgroundA randomized control trial demonstrated that a computerized cognitive behavioral therapy (cCBT) program (Smart, Positive, Active, Realistic, X-factor thoughts [SPARX]) was an appealing and efficacious treatment for depression for adolescents in New Zealand. Little is known about the acceptability of computerized therapy programs for rural Australians and the suitability of computerized programs developed in one cultural context when used in another country. Issues such as accents and local differences in health care access might mean adjustments to programs are required.ObjectiveThis study sought to explore the acceptability of SPARX by youth in rural Australia and to explore whether and how young people would wish to access such a program.MethodsFocus groups and semistructured interviews were conducted with 16 young people attending two youth-focused community services in a small, rural Tasmanian town. An inductive data-driven approach was used to identify themes using the interview transcripts as the primary data source. Interpretation was supported by demographic data, observer notes, and content analysis.ResultsParticipants reported that young people want help for mental health issues but they have an even stronger need for controlling how they access services. In particular, they considered protecting their privacy in their small community to be paramount. Participants thought computerized therapy was a promising way to increase access to treatment for youth in rural and remote areas if offered with or without therapist support and via settings other than school. The design features of SPARX that were perceived to be useful, included the narrative structure of the program, the use of different characters, the personalization of an avatar, “socialization” with the Guide character, optional journaling, and the use of encouraging feedback. Participants did not consider (New Zealand) accents off-putting. Young people believed the SPARX program would appeal to those who play computer games generally, but may be less appealing for those who do not.ConclusionsThe findings suggest that computerized therapy offered in ways that support privacy and choice can improve access to treatment for rural youth. Foreign accents and style may not be off-putting to teenage users when the program uses a playful fantasy genre, as it is consistent with their expectation of fantasy worlds, and it is in a medium with which they already have a level of competence. Rather, issues of engaging design and confidential access appeared to be more important. These findings suggest a proven tool once formally assessed at a local level can be adopted cross-nationally.

Patients’ experience of being triaged directly to a psychologist in primary care: a qualitative study

In a primary health-care centre (PHCC) situated in a segregated area with low socio-economic status, 'primary care triage' has increased efficiency and accessibility. In the primary-care triage, the nurse sorts the patient to the appropriate PHCC profession according to described symptoms. Aim The aim of this study was to examine the patients' experience of being triaged directly to a psychologist for assessment. Interviews were conducted with 20 patients and then analysed using qualitative content analysis. The results show that patients contacting the PHCC for mental health issues often are active agents with their own intent to see a psychologist, not a doctor, as a first-hand choice when contacting the PHCC. Seeking help for mental health issues is described as a sensitive issue that demands building up strength before contacting. The quick access to the preferred health-care professional is appreciated. The nurse was perceived as a caring facilitator rather than a decision maker. It is the patient's wish rather than the symptoms that directs the sorting. The patients' expectations when meeting the psychologist were wide and diverse. The structured assessment sometimes collided and sometimes united with these expectations, yielding different outcome satisfaction. The results could be seen in line with the present goal to increase patients' choice in the health-care system. The improved accessibility to the psychologist seems to meet community expectations. The results also indicate a need for providing more prior information about the assessment and potential outcomes.

The effectiveness of a preferred intensity exercise programme on the mental health outcomes of young people with depression: a sequential mixed methods evaluation

BackgroundPeople with mental illness are more likely to suffer physical health problems than comparable populations who do not have mental illness. There is evidence to suggest that exercise, as well has having obvious physical benefits, also has positive effects on mental health. There is a distinct paucity of research testing its effects on young people seeking help for mental health issues. Additionally, it is generally found that compliance with prescribed exercise programmes is low. As such, encouraging young people to exercise at levels recommended by national guidelines may be unrealistic considering their struggle with mental health difficulties. It is proposed that an exercise intervention tailored to young people's preferred intensity may improve mental health outcomes, overall quality of life, and reduce exercise attrition rates.Methods/DesignA sequential mixed methods design will be utilised to assess the effectiveness of an individually tailored exercise programme on the mental health outcomes of young people with depression. The mixed methods design incorporates a Randomised Controlled Trial (RCT), focus groups and interviews and an economic evaluation. Participants: 158 young people (14-17 years) recruited from primary care and voluntary services randomly allocated to either the intervention group or control group. Intervention group: Participants will undertake a 12 week exercise programme of 12 × 60 minutes of preferred intensity aerobic exercise receiving motivational coaching and support throughout. Participants will also be invited to attend focus groups and 1-1 interviews following completion of the exercise programme to illicit potential barriers facilitators to participation. Control group: Participants will receive treatment as usual. Primary Outcome measure: Depression using the Children's Depression Inventory 2 (CDI-2). Secondary Outcome measures: Quality of Life (EQ-5D), physical fitness (Borg RPE scale, heart rate), incidents of self-harm, treatment received and compliance with treatment, and the cost effectiveness of the intervention. Outcome measures will be taken at baseline, post intervention and 6 month follow up.DiscussionThe results of this study will inform policy makers of the effectiveness of preferred intensity exercise on the mental health outcomes of young people with depression, the acceptability of such an intervention to this population and its cost effectiveness.Trial RegistrationClinicalTrials.gov: NCT01474837

Memory for Patient Information as a Function of Experience in Mental Health

Mental health clinicians are tasked to diagnose and treat the millions of people worldwide seeking help for mental health issues. This paper investigates the memory clinicians have for patient information. We hypothesize that clinicians encapsulate mental health knowledge through experience into more abstract concepts, as in other domains changing what clinicians remember about patients compared with non-professionals. We tested memory for realistic patient-therapist interactions in experienced clinicians, intermediately trained graduate students, and laypeople. Clinicians recalled fewer facts than intermediate trainees and as many as laypeople. Furthermore, clinicians reported more abstracted information than all other participants, providing the first empirical demonstration of knowledge encapsulation in the memory of mental health clinicians. We discuss how our results fit into the existing literature on clinical expertise in mental health and the implications of our findings for future research relevant to mental health care.

Patient perspectives on health, health needs, and health care services in a rural Irish community: a qualitative study

There is evidence that living in a rural environment confers certain health advantages in terms of health and wellbeing. However, there is limited knowledge of patients' perspectives on determinants of health in rural areas. The aim of the present study was to explore determinants of health, health needs, and healthcare services in a rural community in the west of Ireland. Semi-structured interviews were carried out on a purposeful sample of 12 participants who presented to a community medical centre during a designated 14 day period in May 2010. The often interwoven conceptual themes identified during analysis of the data included 'community', 'environment', 'familiarity', 'accessibility', and 'expectations'. The advantages of living in a rural environment included the strong sense of community, the benefits of the natural environment, familiarity, and a general sense of satisfaction in life. Issues of geographical inaccessibility and availability of affordable food were highlighted as disadvantages. In addition, hesitation was expressed about confiding mental health issues to medical professionals. The rural environment and sense of community with its associated strong social networks were identified as key determinants of good mental and physical health. However, the inaccessibility to mental health care and reluctance to seek help for mental health issues remain a significant problem in rural areas. In considering priorities for health, greater effort and resources are required to increase public awareness and change attitudes to mental health issues.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterCathleen E. Willging Ph.D.Melina Salvador M.A.Miria Kano M.A.Cathleen E. Willging Ph.D.Search for more papers by this authorMelina Salvador M.A.Search for more papers by this authorMiria Kano M.A.Search for more papers by this authorPublished Online:1 Aug 2006https://doi.org/10.1176/ps.2006.57.8.1217aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We agree with Dr. Hellman's assertion that the problem of disparities in mental health services for lesbian, gay, bisexual, and transgender (LGBT) people is widespread. We are also frustrated that as federal and state governments increasingly mandate culturally relevant care, political efforts have sought to limit services for and research regarding the health and mental health of sexual and gender minorities—a move which can only intensify existing inequities. We find that conducting in-depth research among segments of the LGBT population offers concrete examples of how LGBT individuals are subjected to disparities. This concentrated view can challenge dominant notions of the "LGBT experience" and help determine the compounding factors that prevent LGBT individuals from obtaining high-quality mental health care. Similarly, Hellman ( 1 , 2 ) and Lucksted ( 3 ) have cast critical attention upon the unique needs of individuals with serious mental illness, who constitute a stigmatized, underserved, and neglected segment of the broader LGBT population. Our research involving 38 rural and 38 urban New Mexicans points to important commonalities in their help-seeking narratives, such as lack of insurance and financial resources, limited access to LGBT-friendly services, and homophobic-transphobic encounters in treatment settings. Nevertheless, our ongoing analysis of these narratives suggests that disparities associated with rural life in New Mexico make it even harder for rural LGBT individuals to access mental health care either from specialty providers or in informal settings. The most obvious example is that some 80 percent of psychiatrists, 70 percent of psychologists, 47 percent of social workers, and 53 percent of mental health counselors are based in New Mexico's two largest urban centers ( 4 ). Rural LGBT people are thus greatly restricted in both access to basic services and the ability to choose their providers. Another difference worth noting is the isolation that rural LGBT people feel from informal mental health resources. Compared with their urban counterparts, rural LGBT people have substantially less access to LGBT-friendly environments, including religion-based social networks, other community support systems, and LGBT-specific support groups, organizations, and help-lines. This isolation is exacerbated by conditions of poverty and complicates the already difficult living situations of many LGBT people who seek help for mental health issues. Such difficulties were tackled in the seminal article on mental health care for rural LGBT people almost two decades ago ( 5 ), and we find that they continue to occur unabated. We advocate for research and reform that attends to all LGBT people but that also considers the context-specific reality of rural LGBT individuals who, much like people with serious mental illness, experience extensive stigmatization and are an underserved and neglected segment of a larger population. Voices of rural LGBT people—and of rural residents in general—are not typically represented in mainstream mental health literature. The narratives of our rural LGBT participants reinforce the efforts of other researchers and demonstrate that the barriers to culturally relevant services discussed by Dr. Hellman in his 1996 Psychiatric Services article ( 2 ) remain salient today. And, as he concluded in that article, "A change in attitudes and practice is overdue." We might add that such a change now is disturbingly long overdue.

Psychiatry in the News

<p>Psychiatry in the News summarizes consumer-oriented media reports on psychiatry and topics related to psychiatry. Our purpose is to help keep you informed about subjects that your patients might read or hear and question you about.</p> <p>Please note that publication of the reports in this department does not imply endorsement of the methods or systems described.</p> <p>We hope you find this department both informative and entertaining. As always, we welcome your comments and contributions.</p> <H4>Hurricane Victims Still Lack Mental Health Treatment</H4> <P>Victims of Hurricane Katrina continue to have difficulties finding help for mental health issues. [see more news...]</P>

Single parent mothers and mental health care service use.

This paper examines the use of mental health care services by single mothers and married mothers in Canada. We employ a secondary data analysis of the 1994-95 National Population Health Survey. Single mothers are significantly more likely to have seen a professional regarding their mental health in the previous 12 months and to use such services more frequently than married mothers. Multivariate analyses show that higher use among single mothers is independent of depression and sociodemographic factors. Further analysis revealed that single mothers have a higher rate of contact with professionals than married mothers and that the relationship between single parent status and frequency of contact is moderated by depression. Single mothers are more likely to seek professional help for mental health issues. While qualifying for a diagnosis has some important conditional effects on the frequency of use among single mothers, neither major depression nor controlling for sociodemographic factors accounts for their higher use of services.