Levels Of Mental Health Need Research Articles

Developing a group-based psychoeducation intervention for adoptive parents and foster carers in a specialist child and adolescent mental health service setting

Children and young people in foster and adoptive families are considered more vulnerable to a high level of mental health need when compared to peers who are not care-experienced or adopted. Acceptance of this view amongst clinical providers and policy makers has necessitated the development of specialist provision and dedicated care pathways within child and adolescent mental health services. In this provision, practitioner-initiated quality improvement projects help in appraising the effectiveness of clinical interventions in local contexts, as well as identifying areas for service learning and practice reflection. This article reports on the evaluation of a mentalisation-based psychoeducation group intervention for adoptive parents and foster carers. The evaluation activity took place in a single child and adolescent mental health service setting, starting during the COVID-19 pandemic, with the intervention being implemented online via videoconferencing. In the article, after introducing the intervention (based on the Family Minds model), an analysis of clinical data collected pre- and post-intervention is reported. Few results of the analysis regarding the two pre- and post-measures reached statistical significance, indicating only changes in the magnitude of stress in the parent/carer-child system. A series of reflections are posed that consider what this finding means in developing fit-for-purpose support for adoptive parents and foster carers in child and adolescent mental health service contexts.

Geospatial analysis of associations among mental health need, housing need, and involuntary psychiatric hospitalizations of people experiencing homelessness in Los Angeles County

The purpose of this study was to use geospatial indicators of mental health need and homelessness in Los Angeles County Service Planning Areas (SPAs) and a psychiatric sample of adults who were homeless to investigate 1) overlap between SPA level of mental health need and corresponding volume of involuntary psychiatric hospitalizations over time; 2) overlap between SPA level of unsheltered homelessness and corresponding volume of involuntary psychiatric hospitalizations over time; and 3) associations between SPA level of mental health need, SPA level of unsheltered homelessness, and initiation of a mental health conservatorship for grave disability. A sample of 373 adults who were homeless and hospitalized on an involuntary psychiatric hold from 2016 to 2018 were linked to data from the Greater Los Angeles Homeless Count on unsheltered homelessness and from the California Health Interview Survey on need for mental health services and suicidality, using admission zip codes to link variables at the SPA level. Geospatial mapping and bivariate tests were used to examine geographic overlap of SPA mental health need and unsheltered homelessness with volume of involuntary psychiatric admissions over the study period. Multiple logistic regression modeling was used to examine associations of SPA mental health need and unsheltered homelessness with conservatorship initiation. The volume of patients admitted from SPAs with higher levels of mental illness need grew from 2016 to 2018 (Tau = 0.27, P < 0.001; Tau = 0.40, P < 0.001), but there were fewer patients admitted from SPAs with higher levels of unsheltered homelessness over the same years (Tau of −0.33, P < 0.001). Being admitted from SPAs with the highest levels of unsheltered homelessness was associated with higher odds of conservatorship initiation (OR = 1.73, 95% CI = 1.82–16.74). Results suggest a need for targeted mental health and housing services to reach areas of highest need in Los Angeles County.

Parent, carer and professional views of specialist child and adolescent mental health care during the COVID-19 pandemic

Purpose The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children’s services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers’ accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children’s birth families there were more mixed and negative impressions. Originality/value Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised.

REACH-ASD: a UK randomised controlled trial of a new post-diagnostic psycho-education and acceptance and commitment therapy programme against treatment-as-usual for improving the mental health and adjustment of caregivers of children recently diagnosed with autism spectrum disorder

BackgroundAutism is a neurodevelopmental disability affecting over 1% of UK children. The period following a child’s autism diagnosis can present real challenges in adaptation for families. Twenty to 50% of caregivers show clinically significant levels of mental health need within the post-diagnostic period and on an ongoing basis. Best practice guidelines recommend timely post-diagnostic family support. Current provision is patchy, largely unevidenced, and a source of dissatisfaction for both families and professionals. There is a pressing need for an evidenced programme of post-diagnostic support focusing on caregiver mental health and adjustment, alongside autism psycho-education. This trial tests the clinical and cost-effectiveness of a new brief manualised psychosocial intervention designed to address this gap.MethodsThis is a multi-centre two-parallel-group single (researcher)-blinded randomised controlled trial of the Empower-Autism programme plus treatment-as-usual versus usual local post-diagnostic offer plus treatment-as-usual. Caregivers of children aged 2–15 years with a recent autism diagnosis will be recruited from North West England NHS or local authority centres. Randomisation is individually by child, with one “index” caregiver per child, stratified by centre, using 2:1 randomisation ratio to assist recruitment and timely intervention. Empower-Autism is a group-based, manualised, post-diagnostic programme that combines autism psycho-education and psychotherapeutic components based on Acceptance and Commitment Therapy to support caregiver mental health, stress management and adjustment to their child’s diagnosis. The comparator is any usual local group-based post-diagnostic psycho-education offer. Receipt of services will be specified through health economic data. Primary outcome: caregiver mental health (General Health Questionnaire-30) at 52-week follow-up. Secondary outcomes: key caregiver measures (wellbeing, self-efficacy, adjustment, autism knowledge) at 12-, 26- and 52-week follow-up and family and child outcomes (wellbeing and functioning) at 52-week endpoint. Sample: N=380 (approximately 253 intervention/127 treatment-as-usual). Primary analysis will follow intention-to-treat principles using linear mixed models with random intercepts for group membership and repeated measures. Cost-effectiveness acceptability analyses will be over 52 weeks, with decision modelling to extrapolate to longer time periods.DiscussionIf effective, this new approach will fill a key gap in the provision of evidence-based care pathways for autistic children and their families.Trial registrationISRCTN 45412843. Prospectively registered on 11 September 2019.

Mental health recovery for survivors of modern slavery: grounded theory study protocol

IntroductionSlavery and human trafficking are crimes involving the violation of human rights and refer to exploitative situations where an individual cannot refuse or leave due to threats, coercion or abuse...

Do Racial and Ethnic Disparities in Mental Health Treatment Vary With Underlying Mental Health?

A long line of studies document substantial and persistent racial and ethnic disparities in the use of mental health services. Many recent studies follow the Institute of Medicine's definition of disparities, adjusting only for differences in health and mental health status across groups. However, controlling for mental health may mask important changes in the magnitudes of disparities at different levels of mental health need. We extend the previous literature by explicitly estimating how differences in treatment use across groups change at different levels of psychological distress. We used detailed data on sociodemographic characteristics, health insurance coverage, treatment, and the K6 psychological distress scale from the 2010 to 2015 Medical Expenditure Panel Survey to estimate nonlinear models of ambulatory and prescription drug mental health treatment. We find that in contrast to physical health treatment, Black-White and Hispanic-White disparities in any mental health treatment use widen with higher levels of psychological distress.

An updated picture of the mental health needs of male and female prisoners in the UK: prevalence, comorbidity, and gender differences

PurposeEpidemiological data on the mental health needs of prisoners are essential for the organisation, planning, and delivery of services for this population as well as for informing policy and practice. Recent reports by the National Audit Office and NICE call for new research to provide an updated picture of the mental health needs of men and women in prison in the UK. This study aimed to measure the prevalence and comorbidity of mental health needs across a representative sample of both men and women across 13 prisons in one UK region.MethodParticipants completed a standardised battery of psychometric assessments which screened for a range of mental health difficulties including: mental disorders, personality disorder, and substance misuse.Results469 participants were included in the final sample (338 males, 131 females). A high number of participants reported having had previous contact with mental health services and/or a pre-existing diagnosis of a mental disorder. High rates of current mental disorder were detected across the range of disorders screened for. Levels of comorbidity were also high, with nearly half of participants screening positive for two or more types of mental disorder. Gender differences were noted in terms of previous contact with mental health services, having a pre-existing diagnosis, prevalence of current mental disorder, and levels of comorbidity; with women reporting higher rates than men.ConclusionsRates of pre-existing and current mental illness continue to be high amongst prisoners. Women report significantly higher levels of mental health need compared to men.

Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff, and mental health providers.

Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs. We completed semi-structured interviews and focus group discussions with adolescents (n=191), parents (n=9), teachers (n=78), school counsellors (n=15), clinical psychologists/psychiatrists (n=7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers. All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents. SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.

Validation of the Massachusetts Youth Screening Instrument with a looked after population.

The Massachusetts Youth Screening Instrument-version 2 (MAYSI-2) was developed to help identify mental health needs of young people admitted to youth detention centres. Only one study has applied the tool to a UK population and none have looked at young people who live in residential and secure care in Scotland. This study aimed to assess the validity of the MAYSI-2 in Scotland with a looked after and accommodated population. Boys and girls in a large education and care centre were asked to complete the MAYSI-2 within 72 hours of being accommodated. A total of 168 males and 69 females with a mean age of 15 completed the tool. Substantial levels of mental health need were identified. Girls appeared to have higher needs on all areas, bar alcohol and substance misuse. The MAYSI-2 had good internal consistency and exploratory factor analysis showed good overlap with the tool's original factor model. As a result, there can be more confidence in the validity and consistency of the tool with this population. This is also further evidence of the high need of this population, particularly girls.

Patterns of family service needs and caregiver–child relationships among families at risk of child welfare involvement

AbstractCaregivers at risk of involvement in the child welfare system report high levels of need for multiple types of services, and their children have high levels of mental health need. Caregivers from families with more service needs, as well as unmet needs, are less likely to be engaged with child welfare services and may have diminished capacity to care for their child. This study takes a family‐centered approach by using latent class analysis to identify patterns of both caregiver and child service needs among families at risk of child welfare involvement. Using data from the LONGSCAN consortium (N = 957), we identified 4 classes of service needs among child welfare‐involved families. We then examined differences between the 4 classes based on demographics, maltreatment histories, unmet service needs, and caregiver–child relationship. The caregivers were split fairly evenly among the 4 classes: low needs, medical needs, poverty support, and high needs. There were significant differences between classes on assessed variables, with higher levels of needs associated with diminished caregiver–child relationships.

Mental health needs and services in the West Bank, Palestine.

BackgroundPalestine is a low income country with scarce resources, which is seeking independence. This paper discusses the high levels of mental health need found amongst Palestinian people, and examines services, education and research in this area with particular attention paid to the West Bank.MethodsCINAHL, PubMed, and Science Direct were used to search for materials.Results and conclusionEvidence from this review is that there is a necessity to increase the availability and quality of mental health care. Mental health policy and services in Palestine need development in order to better meet the needs of service users and professionals. It is essential to raise awareness of mental health and increase the integration of mental health services with other areas of health care. Civilians need their basic human needs met, including having freedom of movement and seeing an end to the occupation. There is a need to enhance the resilience and capacity of community mental health teams. There is a need to increase resources and offer more support, up-to-date training and supervision to mental health teams.

Understanding systemic problems in providing mental health services to people with an intellectual disability and co-morbid mental disorders in Victoria

This paper explores the difficulties the services system in Victoria has in responding to people with intellectual disability (ID) and mental health problems and identifies the underlying assumptions that have led to these. These issues are discussed and where possible put into a Victorian context with the intention of informing service development in the area of Dual Disability (co-morbid mental disorders in people with intellectual disability). People with ID have high levels of mental health need. Generic services have difficulty responding to these needs due to a range of patient, professional and service system factors as well as some of the conceptual issues underpinning policy and legislation.

Mental Health Service Contacts Among Sexual Minority and Heterosexual Girls in Boston Public High Schools

Although sexual minority (SM) adolescent girls are at high risk for suicidal behavior, little is known about their use of mental health services (MHS). Therefore, we examined survey data from a sample of Boston high school students to compare the prevalence of MHS use among SM and heterosexual girls.We used chi-square tests to assess the statistical significance of group differences. To test whether SM status moderated the association between MHS use and mental health need (i.e., whether the student reported self-harm, suicidal ideation, or a suicide attempt in the past year), we entered mental health need, SM status, and the interaction term of the two into a regression model that predicted past 12-month MHS use.SM girls (n = 89) were significantly more likely than heterosexual girls (n = 800) to report suicidal ideation, suicide attempts, and self-harm. SM girls were also more likely to have reported a past 12-month MHS contact (54% vs. 26%, p < 0.0001); this finding held for those with and without a high level of mental health need. The interaction term was not statistically significant, indicating that SM status does not moderate the effect of mental health need on MHS use. These results indicate that SM girls, particularly those experiencing suicidality, are likely to report a MHS contact. Future research is needed to elucidate when/how SM girls come to use MHS and what types of services they are receiving.

Perception of need and barriers to access: the mental health needs of young people attending a Youth Offending Team in the UK

This study used a mixed methodology with young offenders attending a Youth Offending Service to identify, with regard to mental health problems, perceptions of level of need, experiences of and views on support and perceptions of barriers in accessing services. Between May and September 2008, 44 young offenders completed a questionnaire about their self-reported levels of mental health need, and their behaviour, preferences and evaluation regarding different sources of support and advice for mental health issues. Six young people were interviewed about their experiences and these data were analysed using thematic analysis. Findings showed that these vulnerable young people had a high level of mental health need, and were most likely to seek support from people with whom they had a confiding and long-standing relationship (parents and friends). For these young people, low levels of service use were not the result of a lack of provision, but because there were psychological, social, structural and cultural barriers to accessing those services including issues of understanding, stigma and confidentiality.

Embracing the notion that context is crucial in prison mental health care

This paper focuses on the mental health of adult male prisoners and the mental health care provided within Her Majesty's Prison Service (HMPS), United Kingdom (UK). Currently, the level of mental health need within this population is high, and prison mental health services require additional positive developments. The prison milieu is not always conducive to good mental health, and is not often a useful catalyst for mental health care. Arguably, prison mental health services ought to be increasingly fashioned (commissioned, provided, managed and practised) in direct accordance with the prison social environment, institutional set‐up and specific mental health requirements of prisoners/patients. In this paper, therefore, attention is devoted to social and institutional structures which permeate the prison setting. The proposition is that situation‐specific and culturally responsive mental health care is a must; context is crucial.

Social deprivation and the outcomes of crisis resolution and home treatment for people with mental health problems: a historical cohort study

The development of crisis resolution and home treatment (CRHT) teams has been central to the UK Government's objective of reducing reliance on hospital-based care and is supported by a growing body of evidence. However, there has been no research specifically exploring the relationship between social deprivation and CRHT teams, in spite of evidence of an association between social deprivation and increased pressure on inpatient services. This article reports a study which tested the hypothesis that social deprivation is associated with the outcome of CRHT interventions. Using a historical cohort study design, we examined a total of 260 accepted referrals to a CRHT. Social deprivation was measured by the Index of Multiple Deprivation (Office of the Deputy Prime Minister 2004) as a predictor of CRHT interventions outcomes. CRHT outcomes were dichotomised into successful and unsuccessful and were defined with reference to the CRHT operational policy. Univariate analysis found that people who lived in more socially deprived areas had a poorer outcome, as did older people and those referred from the enhanced community mental health team (CMHT). Logistic regression analysis found that age and referral source were independently associated with outcome. Analysis of the demographic data also suggested a non-significant trend towards men having less successful outcomes. Further analysis exploring the characteristics of the different referral sources to the CRHT found that those referred from the enhanced CMHT were significantly more likely to be from the most deprived area. This suggested a relationship between an enhanced level of mental health need, social deprivation and poor outcome of CRHT intervention.

Mental health services for children and youth in the child welfare system: A focus on caregivers as gatekeepers

Caregivers serve as gatekeepers for children while in the child welfare system, but few studies have focused on the caregiver and the factors that influence the use of mental health services for the children under their care. The purpose of this study was to examine the child's mental health need, the caregiver's level of stress, depression, and social support, and the utilization of mental health services by children using the three most common types of caregivers in the child welfare system (i.e., birth parent, relative caregiver, and foster parent). Data comes from the Patterns of Care (POC) study of five public sectors of care. The present study examined parents/caregivers and youth from the child welfare sector. Findings suggest that while birth parents were more likely to endorse more risk factors for themselves, and the children under their care had a higher level of mental health need, they were the least likely to utilize mental health services for the children under their care. Implications for the child welfare and mental health systems are discussed.

Young adult outcomes and mental health problems among transition age youth investigated for maltreatment during adolescence

This study examines the young adult outcomes of a nationally representative cohort of transition age youth who were involved with the Child Welfare System (CWS) during adolescence. We report on the demographic and psychosocial characteristics, risk of mental health problems, and developmental milestones related to young adult outcome among these transition age youth. We also examined the effect of risk for mental health problems on young adult outcomes, over and above other psychosocial risk factors. Many youth were living in poverty, getting married early and already parenting, involved with the criminal justice system and had high levels of mental health need. Being at risk for a mental health problem increased the likelihood of criminal justice system involvement for these youth. Youth transitioning to adulthood with a history of CWS involvement appear to be at risk for negative developmental outcomes. Our findings are consistent with previous findings and highlight the risks associated with the transition to adulthood for youth who were involved with the CWS in adolescence.

Sociological Theories Relating to Mental Disabilities in Racial and Ethnic Minority Populations

Research has demonstrated that mental disorders are one of the leading causes of disability in the United States. The level of mental health need is particularly high for members of racial and ethnic minority groups who, despite similar to higher mental disorder and disability prevalence rates, use fewer mental health services in comparison to whites and tend to receive poorer quality care when they do use services. Though the existence of mental health disparities is well established, solid explanations for their causes are less so. This literature review examines major theories in the discipline of sociology with the aim of elucidating reasons for the preponderance of differential mental health impacts across racial lines. Specifically, it discusses the theories of social causation or fundamental causes, social stress theory, social capital theory, political economy of health, and ecosocial theory. The relevance of each of these general sociological theories to the specific topics of mental health, disorder, and disability is emphasized, and a special lens is turned toward the differential disability exposures and impacts of minority individuals within their social systems.

The challenges of purpose in the face of chaos: commentary paper by Professor Beverley Raphael

This paper addresses the issues and purposes of psychiatric research into disaster. Purposes include those that are focused on basic scientific questions, such as the role of disaster stressors in contributing to the development of psychiatric morbidity, and research attempting to identify the level of mental health need. There is also intervention research but this is limited in the acute emergency and longer term. These questions and the methodologies to address them, overlap significantly. Many studies use different measures of exposure, disorder and other disaster variables. There is also a wide range of population groups studied, making comparison of findings difficult. Thus, for these large scale events affecting populations, studies may not readily meet either the purposes of affected populations or government funders. Nor are interventions systematically operationalized to promoted replication. Challenges lie in the diversity of researchers, the pluralistic nature of Western society and the rapid development of the field. It is suggested that a set of disaster mental health research standards, based on core principles and data, would facilitate national and international collaboration and the interests of individual researcher. This could lead to comparable studies that could progress the field, while at the same time fostering innovations which could link to these research programmes. Strategic partnerships with government and other funders, as well as affected communities, could strengthen advocacy and commitment for disaster mental health research.