Issues In Mental Health Care Research Articles

What Social Work Educators and Practitioners Need to Know on Immigrants’ Health Care: a Systematic Review

Introduction: 47 million immigrants are living in the United States and they constitute 14.4 percent of the total population in the United States. As the immigrant population grows rapidly, their health care needs require ongoing and additional attention from social workers and health care practitioners. Methods: This study systematically reviewed content on immigrants and healthcare in social work literature and discussed implications for social services for immigrant populations. Systematic review and content analysis were employed. Research methods, topics, and samples of included studies were screened and coded. Results: 47 studies met eligibility for inclusion in this review. The majority of included studies were cross-sectional analysis (60%), focusing on mental health care issues (51%), health care utilization (51%) and adult immigrant samples (49%). Discussion: Encouraging diversity of social work research can directly promote social work services and health care practices for the underrepresented populations. Our findings suggest that more input from the social work profession on evidence-based practice for diverse immigrants are required. Social workers and health care practitioners must continually be reminded of the health care needs of immigrants.

Postpsychiatry and postmodern psychotherapy: Theoretical and ethical issues in mental health care in a Polish context

The article reconstructs postpsychiatry’s core propositions and briefly describes its theoretical background and assumptions. It also presents chosen aspects of postmodern psychotherapy, which seem to be in many ways similar to postpsychiatry’s ideas. Although they are drawn from different inspiration, postpsychiatry and postmodern psychotherapy seem to come to similar conclusions, especially regarding the role of the patient in the therapeutic process, the meaning of psychiatric diagnosis, and the importance of the institutional, cultural, and social contexts in mental health practice and research. The paper also aims to place postpsychiatry and postmodern psychotherapy in a Polish context, focusing on the ethical challenges faced by psychiatry and showing that some of postpsychiatry’s ideas and solutions to contemporary problems were already present in the Polish psychiatric literature of the 20th century. It also contains a brief description of the Polish social and historical context of psychiatry, as well as key aspects of the Polish legal system that relate to mental health and seem to reflect the nature of biomedical explanations of mental distress. It concludes that the model of psychiatric care postulated by “postmodern” approaches seems more ethical and scientifically and philosophically grounded and promises better treatment results than the “traditional” biomedical model.

Outcomes of untreated attention deficit hyperactivity disorder and the mental health nurse

Attention deficit hyperactivity disorder (ADHD) has long been a contentious and polarising issue in mental health care. Mental health nurses are regularly responsible for the care, treatment and care coordination of individuals with a diagnosis of ADHD. This means that mental health nurses are in one of the best positions to have a positive impact on the lives of people with ADHD. This article aims to be a refresher to mental health nurses of the lifetime health outcomes and risks associated with ADHD. This article discusses a multitude of factors, such as increased rates of substance abuse and addiction, higher instances of self-harm and suicide, reduced life expectancy, increased driving risk, poorer educational outcomes, and reduced professional outcomes. The role of the mental health nurse is central in supporting service users to seek appropriate, evidence-based treatment. Improving mental health nurses' understanding and information will enable practitioners to make informed decisions regarding the care and treatment of service users.

Prevalence of depressive symptoms in older nursing home residents with intact cognitive function in Taiwan

The investigators aimed to explore the prevalence of depressive symptoms and associated factors among older residents with intact cognitive function in nursing homes in Taiwan. A cross-sectional descriptive and correlational research design was used. A convenience sample of 178 older residents without cognitive impairment was recruited from 36 nursing homes in Southern Taiwan. The questionnaires included demographic data; the Barthel Index, which assesses the ability to perform activities of daily living; and the Geriatric Depression Scale Short Form. Among older residents in nursing homes with intact cognitive function, 39.3% had depressive symptoms. Age, religion, previous living status, previous working status, being totally dependent in physical function, and being severely dependent in physical function were significant predictors of depressive symptoms among cognitively intact older residents. The findings highlight the critical mental healthcare issues among older residents with intact cognitive function in nursing homes. Practical strategies for preventing the occurrence of depressive symptoms and caring for those who have depressive symptoms should be developed, especially for younger or dependent older residents or residents who have never been employed, have no religious beliefs, or have lived alone before they moved into an institution.

Patient and Caregiver Perspectives on Ethical Issues in Mental Health Care: an Exploratory Study from India

Ethical viewpoints about the correct course of action in a clinical situation can vary across individuals. The views of patients and their caregivers are also important considerations while exploring solutions to ethical dilemmas. This study aimed to ascertain the perspectives of patients and caregivers on ethical issues in mental health care. This vignette-based study included patients with psychiatric disorders and their caregivers. Patients were included if they were in clinical remission determined by psychiatric rating scales. Caregivers were included if they resided with the patient for the last 1 year. Both patients and caregivers were in the adult age group. The vignettes pertained to confidentiality and coercive care and elicited a yes or no type of responses. Ten short vignettes were presented to the patient caregiver dyad. The types of responses and agreement between the patients and their caregivers were assessed. Responses were available from 160 dyads of patients and their caregivers. The mean age of the patients was 35.6 years while that of the caregivers was 40.5 years. A slight majority of the patients and caregivers were males and were educated above high school. There was considerable variation in the views about correct course in a particular clinical situation. The responses from patients and caregivers endorsing disclosure of confidential information or coercive treatment varied from about 50% to more than 90% depending upon the clinical situation. The responses of patients generally had a fair agreement with responses of the caregivers (kappa values largely between 0.21 and 0.40). Viewpoints of patients and their caregivers provide an important stakeholder insight in approach to resolving ethical dilemmas. In the present cultural context, patients and caregivers were amenable to disclosure of confidential information in for a variety of clinical situations.

Improving Mental Health: Four Secrets in Plain Sight

Back to table of contents Previous article Next article Book ForumFull AccessImproving Mental Health: Four Secrets in Plain SightNoa Heiman, Ph.D.Noa HeimanSearch for more papers by this author, Ph.D.Published Online:1 May 2017https://doi.org/10.1176/appi.ajp.2017.17030260AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Lloyd I. Sederer, M.D. Washington, D.C., American Psychiatric Association Publishing, 2017, 129 pp., $29.00 (hardcover).In Improving Mental Health: Four Secrets in Plain Sight, Dr. Sederer addresses the costly and alarming state of affairs of mental health by describing four “secrets” that reveal a way to close the science-to-practice gap. These secrets are fundamental ways in which everyday practices can be improved to reduce the discrepancy between what we know and what we do. Dr. Sederer notes that his audiences are mental health practitioners, clinical leaders, graduate students, and patients and their families. The book succeeds in addressing such a wide scope of audience with Dr. Sederer’s clear, down-to-earth, approachable writing.Not to be a plot spoiler, but the four secrets are:1.Behavior serves a purpose.2.The power of attachment.3.Less is more.4.Chronic stress is the enemy.The first secret stresses an often-overlooked insight that behavior that may seem perplexing to a lay observer may actually bear a lot of meaning for a patient. Dr. Sederer encourages anyone interacting with people with mental illness to consider the adaptive function or purpose the illness may have or have had historically. This is a welcome point because so often mental health practitioners, leaders, and patients themselves or their families tend to pathologize without putting themselves in the patient’s shoes or reflecting on the implicit meaning of the illness.The second secret discusses the power of attachment. Dr. Sederer reviews the attachment research and literature and highlights an issue often underestimated by providers and caregivers: the patient’s need for a secure attachment. Providers may ignore how much their care, tone of voice, body language, and other mannerisms can affect a patient’s sense of safety.The third secret is “less is more.” This secret is a true gem offering Dr. Sederer’s humanistic approach. Less is more as a rule is too often overlooked in health care, where providers and caregivers often tend to take an aggressive approach in terms of medication and hospitalizations as a first choice of care. Less reliance on medication, less neglect, less distancing from family, and less clinic- and hospital-based care are what Dr. Sederer prescribes. To Dr. Sederer, less can be replaced by a more comprehensive set of services delivered at homes and in the community with a recovery-oriented view of the future. Less medication and monitoring is more when comprehensive treatment aligns with what the patient is seeking, and less is more when prevention and early intervention are emphasized. According to Dr. Sederer, comprehensive programs will not cost more if hospital and emergency services are reduced. In time, this may also translate to reductions on the criminal justice, shelter, and welfare systems. This secret addresses more the systemic issues of mental health care and its current costly state.The fourth secret is “chronic stress is the enemy.” Dr. Sederer reviews the effects of chronic stress on our physical and emotional health. This is probably the secret/chapter with the most resources and practical advice for the reader.It seems that Dr. Sederer has undertaken two tasks in his book and through his public service:1.To make mental health issues more accessible to the public through his writings in the Huffington Post. In the book, secrets 1 and 2 pertain to this task by offering more of a psychological-formulation insight that is often overlooked in mental health practices.2.Secrets 3 and 4 offer more systemic insights as to how to reduce the science-to-practice gap on a system-wide level, which fit with Dr. Sederer’s role as medical director for the New York state mental health system.While the book does not offer insights or literature that were not already known, Dr. Sederer’s neat, clear, and succinct packaging of this knowledge into a short 100-page book makes these issues very approachable and practical to lay readers and practitioners alike.From the Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byNone Volume 174Issue 5 May 01, 2017Pages 489-489 Metrics KeywordsChronic Psychiatric IllnessCommunity Mental HealthEconomic IssuesStressPDF download History Accepted 1 March 2017 Published online 1 May 2017 Published in print 1 May 2017

Improving the health of African Americans in the USA: an overdue opportunity for social justice.

Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber legacy of years of racial and social injustice and a formidable challenge to equitable health care for all. Systemic causes of suboptimal black health require equally systemic solutions; positive trends in black health indicators seem to be driven by social development programs, economic investment in education, participation of African Americans in policy, and decision-making and expansion of access to health care.

Clinical and Social Contexts of Ethical Issues in Mental Health Care

Clinical and Social Contexts of Ethical Issues in Mental Health Care

Prisoners, pups, and PTSD: the grass roots response to veterans with PTSD

As the human–animal bond is increasingly recognized as therapeutic, the role of animals, most frequently canines, grows. A contemporary pairing of animals and humans can be found inside prisons. While the dogs trained by inmates are most frequently adopted out to the community, today dogs are being trained to assist veterans with post-traumatic stress disorder (PTSD) as part of a grass roots effort to fulfill the mental health needs of veterans. The growing number of veterans with PTSD and concomitant issues including addiction, unemployment, homelessness, and crime, makes the mental healthcare issues of veterans a social problem. The civilian-led effort to provide veterans with dogs is a continuation of the public’s involvement with the proliferation of prison-based animal programs. While this next generation of animal programs has overwhelming community support, it also suffers from similar limitations as its predecessors. With no universal agreement as to the training methods or level of skills needed by the dogs, their efficacy at lessening the symptoms of veterans’ PTSD remains largely unknown.

Development of the Treatment Inventory of Costs in Psychiatric Patients: TIC-P Mini and Midi

BackgroundMedical costs of (psychiatric) illness can be validly measured with patient report questionnaires. These questionnaires comprise many detailed items resulting in lengthy administrations. ObjectivesWe set out to find the minimal number of items needed to retrieve 80% and 90% of the costs as measured by the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). MethodsThe TIC-P is a validated patient-reported outcome measure concerning the utilization of medical care and productivity losses. The present study focused on direct medical costs. We applied data of 7756 TIC-P administrations from three studies in patients with mental health care issues. Items that contribute least to the total cost were eliminated, providing that 80% and 90% of the total cost was retained. ResultsAverage medical costs per patient were €658 over the last 4 weeks. The distribution of cost was highly skewed, and 5 of the 14 items of the TIC-P accounted for less than 10% of the total costs. The 80% Mini version of the TIC-P required five items: ambulatory services, private practice, day care, general hospital, and psychiatric clinic. The TIC-P Midi 90% inventory required eight items. Both had variance between the three samples in the optimal choice of the items. ConclusionsThe number of items of the TIC-P can be reduced considerably while maintaining 80% and 90% of the medical costs estimated by the complete TIC-P. The reduced length makes the questionnaire more suitable for routine outcome monitoring.

Mental Health Promotion Among the Chronic Disabled Population in the Community

Societal ageing and the rising prevalence of chronic disease are important causes that underlie the growth in the number of disabled individuals. The disease-induced psychological distress experienced by this population not only decreases quality of life but also increases demand for healthcare. The healthcare policy for the disabled population currently focuses on community healthcare. Therefore, developing appropriate programs to promote mental health among the disabled population in community settings is a critical issue. The present paper reviews current mental health promotion initiatives that target the disabled population in the community and addresses mental healthcare issues that are prevalent among the chronically disabled; strategies of mental health promotion that use music therapy, reminiscence therapy, and horticultural therapy; and the roles and responsibilities of community professionals in mental healthcare. We offer these perspectives as a reference to promote mental health and to establish holistic community healthcare for chronically disabled individuals.

Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications.

Transgender individuals report pervasive discrimination, microaggressions, and victimization across the life span, contributing to disparate rates of suicide, anxiety, and depression. Clinical interventions must be empirically supported and affirming, competently and sensitively attending to the effect of transphobic discrimination on the lives and experiences of transgender people. Transgender affirmative clinical practice acknowledges and counters the oppressive contexts in which transgender clients often experience health and mental health care. The primary aim of this article is to introduce a transgender-affirming adaptation of a cognitive behavior therapy intervention (TA-CBT) for use with transgender individuals suffering from depression, anxiety, and/or suicidality. Clinical considerations such as the historical context of transgender issues in mental health care, the minority stress framework, current mental health disparities, and resilience will be explored. Transgender-affirming practice applications focused on psychoeducation, modifying problematic thinking styles, enhancing social support, and preventing suicidality will be provided.

P.1.k.009 Epidemiology of involuntary hospitalization of schizophrenic patients attended at home

Introduction: The involuntary placement and involuntary treatment of mentally ill patients are central issues in mental health care. Their massive impact upon the liberty and freedom of the persons concerned have made them a topic of controversial legal and ethical debates for more than 100 years. Coercive treatment in psychiatry, including the admission to a psychiatric hospital, remains an understudied issue [1]. The only replicated finding in this highly sensitive area is the significant cross-national variation concerning aspects such as provisions in mental health legislations and rates of involuntary admissions to psychiatric hospitals [2]. Objectives: The purpose of this study is to examine the impact of clinical and contextual characteristics on the decision to perform compulsory admission in psychiatric units in patients with diagnostic of schizophrenia who were attended and treated by a mobile home-care unit in the area of Barcelona (Multidisciplinary Team Support Specialist, EMSE in its Spanish acronym). Methods: We performed a cross-sectional retrospective study of the medical records of 362 patients with diagnosis of schizophrenia according to DSM-IV criteria who were attended at home by a mobile home-care unit in Barcelona. We collected the following data; age, number of visits done by EMSE at home, presence of violent behavior (evaluated with AVAT scale), awareness of disease (evaluated with SUMD scale), functionality of the patient (evaluated with WHO scale), global severity of disease (evaluated with GEP scale), clinical impression (evaluated with CGI scale), score in GAF scale, score in Positive PANSS scale, score in Negative PANSS scale and score in General PANSS scale. The sample was divided in two groups according to if patients were compulsory hospitalized or not. Results: We found more aggressiveness in the group of patients in which we decide to do compulsory hospitalization (mean AVAT score 4.87 Vs 2.99, p = 0.033). We also observed in patients compulsorily admitted to hospital worse awareness of disease (mean SUMD score 12.9 Vs 10.6, p = 0.008), major global severity of disease (mean GEP score 16.55 Vs 12.51, p = 0.047), worse clinical impression (mean CGI score 5.34 Vs 4.41, p< 0.001) and lower score in GAF scale (30.63 Vs 43.36, p< 0.001). Regarding to psychopathology we found higher score in positive PANSS scale in patients compulsorily admitted (29.44 Vs 22.54, p = 0.002), but we haven’t found statistically significant differences in negative PANSS score nor general PANSS score. Conclusions: As previously seen in the literature [3], in our study we observed that the decision to perform an involuntary admission is related with a worse awareness of disease, lower score at GAF scale and more aggressiveness in schizophrenic patients. In our sample we also observed that the decision to perform an involuntary admission is related with major severity of disease, a worse clinical impression and with higher positive psychotic symptoms.

APA Mental Health Campaigns Win Advertising Awards

APA leaders emphasize that the Association will continue to seek out creative avenues for addressing key issues in mental health care.

The development of psychiatric and mental health nursing in Taiwan

Psychiatric mental health is critical to ensuring the health and wellbeing of individuals, families, and communities. While psychiatric mental health work continues to become increasingly complex and challenging, the demand for psychiatric nurses with evidence-based skills continues to grow. Psychiatric mental health nurses (PMHNs) are the primary providers of professional psychiatric mental health care services. PMFNs emphasize humanistic values and focus on servicing patient and family needs. In Taiwan, the Psychiatric Mental Health Nursing Association constructs the competence-credentialing model for psychiatric mental health nursing that underpins the values, attitudes, and beliefs of PMHNs and ensures that the mental health nursing practice promotes public health and wellbeing. In addition, this association promotes advanced psychiatric nursing education, research, and practice, influences the national health agenda, and discusses and disseminates information on psychiatric mental health care issues in order to influence the direction, nature, and quality of psychiatric and mental health care.

Centenary of Karl Jaspers's general psychopathology: implications for molecular psychiatry.

Modern molecular psychiatry benefits immensely from the scientific and technological advances of general neuroscience (including genetics, epigenetics, and proteomics). This “progress” of molecular psychiatry, however, will be to a degree “unbalanced” and “epiphytic” should the development of the corresponding theoretical frameworks and conceptualization tools that allow contextualization of the individual neuroscientific findings within the specific perspective of mental health care issues be neglected. The General Psychopathology, published by Karl Jaspers in 1913, is considered a groundbreaking work in psychiatric literature, having established psychopathology as a space of critical methodological self-reflection, and delineating a scientific methodology specific to psychiatry. With the advance of neurobiology and molecular neuroscience and its adoption in psychiatric research, however, a growing alienation between current research-oriented neuropsychiatry and the classical psychopathological literature is evident. Further, consensus-based international classification criteria, although useful for providing an internationally accepted system of reliable psychiatric diagnostic categories, further contribute to a neglect of genuinely autonomous thought on psychopathology. Nevertheless, many of the unsolved theoretical problems of psychiatry, including those in the areas of nosology, anthropology, ethics, epistemology and methodology, might be fruitfully addressed by a re-examination of classic texts, such as Jaspers’s General Psychopathology, and their further development and adaptation for 21st century psychiatry.

The South African Society of Psychiatrists is speaking up for good reasons

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Mental health care issues in America: an encyclopedia

Mental health care issues in America: an encyclopedia

APA Holds Press Conference on Key Mental Health Issues

Back to table of contents Previous article Next article Government NewsFull AccessAPA Holds Press Conference on Key Mental Health IssuesJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:25 Jun 2013https://doi.org/10.1176/appi.pn.2013.7a5AbstractTwo continuing struggles—to combat stigma and get federal officials to issue a rule implementing the parity law—dominate the agenda.On June 3, President Obama and Vice-President Biden hosted a White House conference on mental health to which several APA leaders were invited.They included Jeffrey Lieberman, M.D., president of APA and chair of psychiatry at Columbia University; Paul Summergrad, M.D., APA president-elect and chair of psychiatry at Tufts University; and Jeffrey Borenstein, M.D., editor in chief of Psychiatric News, host of the television series “Healthy Minds,” and president and CEO of the Brain & Behavior Research Foundation. Also attending was Patrick Kennedy, a former member of Congress who cosponsored the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in the House of Representatives and worked hard to ensure its passage. Today he serves as a senior strategic advisor for APA.Former member of Congress Patrick Kennedy addresses the media at the National Press Club in Washington, D.C., after a White House conference on mental health last month. Kennedy is leading the charge for issuance of a long-overdue final rule implementing the Mental Health Parity and Addiction Equity Act of 2008. At left is APA President Jeffrey Lieberman, M.D.David HathcoxAfter the conference, these participants, along with APA Medical Director and CEO James H. Scully Jr., M.D., held a press conference at the National Press Club in Washington, D.C., to discuss some of the key issues in mental health care and how mental illness is perceived by the public.One of those issues concerns the federal parity law that was passed five years ago but still does not have a final rule to ensure that insurance companies follow the law’s provisions as the law was intended. “We want a rule to be released by the White House” that says that treatment for illnesses of the brain as well as the body should be covered by insurance policies, Kennedy declared, and disclosure of the names of insurance companies that do not “comply with parity” should be part of the final rule. Summergrad concurred, emphasizing that it has been five years since the parity act was signed and that a final rule is critical.Another critical issue is how to dissuade the American public from believing that all people who commit violence are mentally ill. “Gun control and violence have been conflated with mental illness,” Lieberman said. Yet only 4 percent of violent crimes are committed by mentally ill individuals, he emphasized.Yet a third pressing issue is how to combat the stigma often attached to mental illness and its treatment. The speakers agreed that the best solution is to change how the media portray mental illness. An example of how reporters propagate stigma is when they write, “A politician has a schizophrenic attitude,” Borenstein noted. Reporters would certainly never write, “A politician has a diabetic attitude.” An example of how popular films foster stigma can be found in the new psychological thriller “Side Effects,” Lieberman pointed out. The film is entertaining, but it undermines the psychiatric profession by reinforcing myths that have often been promulgated about this field, he said.The increasing integration of mental health care with primary care is also high on the national mental health agenda. Scully reported that APA is working with private insurance companies and Medicare officials to ensure that they provide equitable payment for care provided through such initiatives.Finally, the health insurance exchanges that are being set up under the Affordable Care Act will influence how mental illness is covered. “We need a voice in these health exchanges…and APA needs to convene that discussion,” Kennedy asserted. ■To watch a video of APA’s press conference following the White House Conference on Mental Health, go to http://vimeo.com/67656759. ISSUES NewArchived

Voluntary versus involuntary hospital admission in child and adolescent psychiatry: a German sample

Involuntary psychiatric admission is a central issue in mental health care, especially in the treatment of children and adolescents. Its legal regulations do not only differ between European countries, but also on a federal level. Only few studies so far dealt with rates of involuntary admission (RIA), mainly focusing on adults, rather than children and adolescents. None of the studies analyzed this topic in a large cohort. The aim of this regional cross-sectional study was to compare voluntary and involuntary admissions in child and adolescent psychiatry (CAP) regarding personal and admission characteristics. Furthermore, risk factors and predictors of involuntary admission should be identified. A retrospective analysis of hospital admission registers from three major German CAP hospitals over a period of 6 years (2004-2009) was conducted (N = 10,547 inpatients). Group comparisons between involuntarily and voluntarily treated minors and a logistic regression to determine predictors of legal status were performed. Information on harm to self or others prior to the admission, medication and clinical outcome was not available due to data structure. 70.8 % of patients were voluntarily and 29.2 % involuntarily admitted. Both subsamples comprised more males. The RIA decreased consistently over the years, ranging from 25.7 to 32.4 %. The strongest predictor of being admitted involuntarily was suffering from mental retardation (OR = 15.74). Adolescence, substance abuse, psychotic disorders and admission on duty time were also strongly associated (OR > 3). In this first large cohort study on involuntary treatment of children and adolescents in Germany, about every fourth patient was treated involuntarily. Certain personal and disease-related factors increased the risk. Commitment laws and other legal instruments for regulating involuntary placements are inconsistent and a standardized description or systematic analysis is needed. The influence of demographic, institutional variables and care and health services aspects should also be investigated.