Mental Health Care Program Research Articles

Push for Suicide Prevention Law Hits Senate Roadblock

Back to table of contents Previous article Next article Full AccessPush for Suicide Prevention Law Hits Senate RoadblockAaron LevinAaron LevinSearch for more papers by this authorPublished Online:24 Dec 2014https://doi.org/10.1176/appi.pn.2015.1a21AbstractVeterans and their allies—including APA—will have to wait until the next Congress convenes to push for passage of the bill.As the waning days of the 113th Congress dwindled down to a precious few, the House of Representatives passed the Clay Hunt Suicide Prevention for American Veterans Act intended to help the Veterans Health Administration (VHA) attract and retain psychiatrists.“Greater outreach, more psychiatrists, more care, and measurable outcomes are just a down payment, a start for our veterans,” says Sen. Richard Blumenthal (D-Conn.) at a news conference on Capitol Hill last month. At left is APA CEO and Medical Director Saul Levin, M.D., M.P.A.Aaron LevinHowever, that step forward went for naught as the Senate first made its way through a $1 trillion budget bill and then failed to pass the $22 million Clay Hunt Act.The bill was strongly supported through the legislative process by APA and by veterans’ service organizations such as the Iraq and Afghanistan Veterans of America, the Vietnam Veterans of America, the Wounded Warrior Project, the Veterans of Foreign Wars, and the Disabled American Veterans.The Senate vote was blocked at the end by a “hold” placed on the bill by Sen. Tom Coburn (R-Okla.), who objected to the VHA’s management capability. A hold is a parliamentary procedure permitting a single senator to block a vote on the Senate floor.“Given the extensive challenges at the VA, it is important to ensure this is not another false promise to our veterans that is not paid for or delivered upon,” said Coburn’s press secretary Elaine Joseph in an emailed response to questions from Psychiatric News. “Cost is also a concern, and the VA has proven that questions need to be asked before they are entrusted with the lives of our veterans or the money of taxpayers. Dr. Coburn wants to protect both.”Coburn, a physician known around the Senate as “Dr. No” for his frequent blockade of legislation, retired at the end of the session, raising the chances for passage of similar legislation in the next Congress.“Veterans groups have assurances from Sens. John McCain (R-Ariz.) and Richard Burr (R-N.C.) for a quick reintroduction in January,” reported Lizbet Boroughs, M.S.P.H., deputy director of APA’s Department of Government Affairs. “A bipartisan group of 20 senators currently support the bill, and Reps. Jeff Miller (R-Fla.) and Tim Walz (D-Minn.) will act quickly on the House side as well.”Among other provisions, the bill increases the options available to the VHA for hiring more psychiatrists.“The shortage of psychiatrists in the VHA is reflective of the national shortage,” said VHA psychiatrist Jenny Boyer, M.D., Ph.D., J.D., of Tulsa, Okla., and speaker of APA’s Assembly, in an interview. “It is no surprise that there are difficulties with access because we simply do not have enough psychiatrists to meet the ever-increasing demand for their services.”The Clay Hunt Act was named for a U.S. Marine veteran of the Iraq and Afghanistan wars who died by suicide in 2011.“The obstacles to care that Clay met at the VHA are not acceptable,” said Susan Selke, Clay Hunt’s mother, at a news conference three days before the vote. “Veterans need access without fighting a battle for it.”To encourage more psychiatrists to make their careers in the VHA, the act sets up a three-year demonstration program permitting the system to recruit at least 10 psychiatrists each year for full-time, permanent positions by offering a medical school loan repayment program. For their part, psychiatrists entering the program would agree to a minimum of two years of service with the VHA in return for a loan repayment of $30,000 a year.The act also included provisions for annual evaluations of the VHA’s and the Department of Defense’s mental health care and suicide prevention programs. Other sections would help veterans move from active duty to civilian life by improving access to mental health services using peer support specialists, community outreach teams, and nonprofit mental health organizations.“Veterans have given their service for our country, and now is the time to repay that service by overcoming the chronic shortage of VHA psychiatrists,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A., at the news conference. ■A summary of the Clay Hunt Suicide Prevention for American Veterans Act can be accessed here. APA’s statement of support for the legislation is available here. ISSUES NewArchived

Improving access to primary mental healthcare for Indigenous Australians.

To examine the uptake, population reach and outcomes of primary mental healthcare services provided to Indigenous Australians via the Access to Allied Psychological Services (ATAPS) program between 2003 and 2013, with particular reference to enhanced Indigenous ATAPS services introduced from 2010. Utilising ATAPS program data from a national minimum data set and comparative population data, we conducted descriptive analyses, regression analyses and t-tests to examine the uptake of ATAPS services, provider agency level predictors of service reach, and preliminary outcome data on consumer level outcomes. Between 2003 and 2013, 15,450 Indigenous client referrals were made that resulted in 55,134 ATAPS sessions. National Indigenous service volume more than doubled between 2010 and 2012, following the introduction of enhanced Indigenous ATAPS services. Non-Indigenous ATAPS service volume of primary care agencies was uniquely predictive of Indigenous service reach. Preliminary analysis of limited consumer outcome data indicated positive treatment gains and the need to enhance future outcome data collection. Concerted national efforts to enhance mainstream primary mental healthcare programs can result in significant gains in access to mental healthcare for Indigenous populations.

Population health management in integrated physical and mental health care.

Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from co-morbid physical health conditions. Integrating mental and physical health care for individuals with SMI is an emerging trend addressing the often-neglected physical health care needs of this population to better coordinate care and improve health outcomes. Population Health Management (PHM) provides a useful friamework for designing integrated care programs for individuals with SMI. This paper examines the structure and evolution of the integrated care program in Missouri in the context of PHM, highlighting particular elements of PHM that facilitate and support development of an integrated mental and physical health care program. As health care reform provides external motivation to provide integrated care, this study can be useful as other states attempt to address this important issue.

A health recreation program for u-healthcare clients: effects on mental health.

In this study, a health recreation program was implemented with elderly patients (60 years of age or older) who were receiving ubiquitous healthcare (u-healthcare) services. Furthermore, we examined the effects of health recreation on perceived stress, anxiety, and depression, by comparing survey results before and after the recreation program was conducted. Thus, the aim of this study was to develop an offline service with the ability to promote the impact of the u-healthcare service on mental healthcare. A health recreation program, consisting of a variety of weekly games, songs, and minilectures about mental health over a 10-week period, was offered at a senior citizens center in K-Gu, Seoul, Korea. This program targeted 18 elderly people currently receiving u-healthcare services. Data on the impact of the program on the mental health of the elderly were collected through surveys administered before and after the recreation program, and the results were compared with those of a control group. The control group consisted of 18 elderly people who were receiving u-healthcare services from the same district. The perceived stress and anxiety of the experimental group decreased significantly compared with those of the control group. However, the program did not result in a significant reduction in depression. This offline health recreation program offered to elderly u-healthcare service clients contributed to the promotion of their mental health. Further studies will be required to better incorporate the offline mental healthcare program into their daily lives within the u-healthcare service.

Social organizational stressors and post-disaster mental health disturbances: A longitudinal study

Social organizational stressors are well-known predictors of mental health disturbances (MHD). However, to what extent these stressors predict post-disaster MHD among employed victims hardly received scientific attention and is clearly understudied. For this purpose we examined to what extent these stressors independently predict MHD 1.5 years post-disaster over and above well-known risk factors such as disaster exposure, initial MHD and lack of general social support, life-events in the past 12 months and demographics (N=423). Exposure, social organizational stressors and support were significantly associated with almost all examined mental health disturbances on a bi-variate level. Multivariate logistic regression analyses showed that these stressors, i.e. problems with colleagues, independently predicted anxiety (Adj. OR=5.93), depression (Adj. OR=4.21), hostility (Adj. OR=2.85) and having two or more mental health disturbances (Adj. OR=3.39) in contrast to disaster exposure. Disaster exposure independently predicted symptoms of PTSD symptoms (Adj. OR=2.47) and agoraphobia (Adj. OR=2.15) in contrast to social organizational stressors. Importantly, levels of disaster exposure were not associated nor correlated with (levels of) social organizational stressors. Findings suggest that post-disaster mental health care programs aimed at employed affected residents, should target social organizational stressors besides disaster-related stressors and lack of general social support.

Disparities in mental health care provision to immigrants with severe mental illness in Italy.

To determine whether disparities exist in mental health care provision to immigrants and Italian citizens with severe mental illness in Bologna, Italy. Records of prevalent cases on 31/12/2010 with severe mental illness and ≥1 contact with Community Mental Health Centers in 2011 were extracted from the mental health information system. Logistic and Poisson regressions were carried out to estimate the probability of receiving rehabilitation, residential or inpatient care, the intensity of outpatient treatments and the duration of hospitalisations and residential care for immigrant patients compared to Italians, adjusting for demographic and clinical covariates. The study population included 8602 Italian and 388 immigrant patients. Immigrants were significantly younger, more likely to be married and living with people other than their original family and had a shorter duration of contact with mental health services. The percentages of patients receiving psychosocial rehabilitation, admitted to hospital wards or to residential facilities were similar between Italians and immigrants. The number of interventions was higher for Italians. Admissions to acute wards or residential facilities were significantly longer for Italians. Moreover, immigrants received significantly more group rehabilitation interventions, while more social support individual interventions were provided to Italians. The probability of receiving any mental health intervention is similar between immigrants and Italians, but the number of interventions and the duration of admissions are lower for immigrants. Data from mental health information system should be integrated with qualitative data on unmet needs from the immigrants' perspective to inform mental health care programmes and policies.

Leveraging Integrated Care Principles in Community Mental Health Centers

Leveraging Integrated Care Principles in Community Mental Health Centers

Revisiting Balint's innovation: enhancing capacity in collaborative mental health care

Interprofessional collaboration is increasingly recognized as a key response to the challenges associated with complex mental health issues in community primary-care settings. Relatively few practice models, however, provide an orientation and a structure that combines quality patient care, professional development, and the building of community capacity. A psychodynamic tradition of supervision and collaboration, an approach known as the Balint model, holds considerable potential to bring this orientation to collaborative primary care and mental health teams. As a consultation group, the Balint approach brings participants' attention to subtle emotional–interpersonal phenomena such as the provider–patient relationship, the presentation of illness, and the experiences of patients and team members. We introduce and provide an overview of the Balint group model, including several concepts proposed by Balint to illuminate the emotional and relational complexities of providing mental health care in a collaborative primary-care setting. The context of our discussion is the implementation of a modified Balint group approach within a Canadian collaborative mental health Care (CMHC) program. We also discuss how an interprofessional application of this approach can enhance patient care, contribute to care providers' professional development, and build community capacity.

Advantages of the Net Benefit Regression Framework for Economic Evaluations of Interventions in the Workplace

Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not well known. To illustrate regression-based economic evaluation, we present a case study investigating the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. We implement net benefit regression to illustrate its strengths and limitations. Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges. Economic evaluations of person-level data (eg, from a clinical trial) should use net benefit regression to facilitate analysis and enhance results.

Uptake of a national primary mental health program by young people in Australia

BackgroundThe purpose of this study was to examine the uptake of an Australian primary mental health care program (Access to Allied Psychological Services) by young people aged 12 to 25 years and the characteristics of consumers and the treatments received. Data were sourced from a national web-based minimum dataset.ResultsBetween 1 July 2003 and 30 June 2012, 51 716 young consumers received 245 704 sessions via the primary mental health program. Around two thirds were female and the average age was 19 years. The majority had depressive and/or anxiety disorders.Most services were delivered to individuals (including just the young person and/or the young person with one or both parents), in a face-to-face context and free of charge. Cognitive and behavioral strategies were the most common interventions delivered.ConclusionsThe primary mental health care program has been well utilized by people aged 12 to 25 years. Similar programs in other developed countries may improve access to primary mental health care for young people.

The multiplier role of psychiatrists in low income settings

Mental health care is receiving increased attention in low-income countries with the availability of a wide range of effective evidence-based treatments for acute and chronic mental disorders amidst scarce resources. Availability of these treatments and competent human resources enables the use of a variety of interventions at several levels of care for persons with mental illness and makes it feasible to ensure observance of quality in the treatment approaches that go beyond institutionalisation. However, unlike developed countries which are endowed with many and relatively well-paid mental health specialists, low-income countries face a dire shortage of highly trained mental health professionals in addition to several other challenges. In light of this, there is need to re-assess the role of the few available psychiatrists, with a shift to new core tasks such as designing mental health care programmes that can be delivered by non-specialists, building their health system's capacity for delivering care, including supporting front-line health workers through support supervision, raising awareness on mental health and patients' rights in addition to promoting essential research. This requires a fundamental paradigm shift from the current training for mental health specialists to a public health oriented approach and providing incentives for community engagement.

Mental health and Victorian Aboriginal people: what can data mining tell us?

Nationally, Aboriginal people experience high levels of psychological distress, primarily due to trauma from colonisation. In Victoria, Aboriginal Community Controlled Health Organisations (ACCHOs) provide many services to support mental health. The aim of the present study was to improve understanding about Victorian Aboriginal people and mental health service patterns. We located four mental health administrative datasets to analyse descriptively, including Practice Health Atlas, Alcohol and Other Drug Treatment Service (AODTS), Kids Helpline and Close The Gap Pharmaceutical Scheme data. A large proportion of the local Aboriginal population (70%) were regular ACCHO clients; of these, 21% had a mental health diagnosis and, of these, 23% had a Medicare Mental Health Care Plan (MHCP). There were higher rates of Medicare MHCP completion rates where general practitioners (GPs) had mental health training and the local Area Mental Health Service had a Koori Mental Health Liaison Officer. There was an over-representation of AODTS episodes, and referrals for these episodes were more likely to come through community, corrections and justice services than for non-Aboriginal people. Aboriginal episodes were less likely to have been referred by a GP or police and less likely to have been referrals to community-based or home-based treatment. There was an over-representation of Victorian Aboriginal calls to Kids Helpline, and these were frequently for suicide and self-harm reasons. We recommend primary care mental health programs include quality audits, GP training, non-pharmaceutical options and partnerships. Access to appropriate AODTS is needed, particularly given links to high incarcerations rates. To ensure access to mental health services, improved understanding of mental health service participation and outcomes, including suicide prevention services for young people, is needed.

Mental health care training for practitioners in remote and rural areas

Rural and island health care staff in Scotland are required to manage patients experiencing mental health crises. To ensure practitioners in remote and rural areas have the necessary skills, the Remote and Rural Healthcare Educational Alliance (RRHEAL) were asked to develop a pre-hospital mental health care course. Several mental health care experts were asked to express an opinion on the essential content of such a course. Stakeholder review informed the development of a survey to identify the priority areas for training. The first round of the survey process involved an expert group of 16; the second round used a survey of over 300 remote and rural practitioners involved with the British Association for Immediate Care, Scotland (BASICS). The stakeholder review identified key content, summarised under the following topics: risk assessment; patient assessment; crisis management; handling difficult situations; engagement skills; mental health law; management of retrieval; pharmacology; theory and classification of mental illness; and understanding your network. This article shares how the needs within a national pre-hospital mental health care programme were identified, and demonstrates how consensus over the content of a national course was achieved through the use of a modified Delphi approach. The Clinical Skills Managed Educational Network (CSMEN), Self-Harm Mitigation Training (STORM®) and BASICS, alongside RRHEAL, contributed to this development. Using blended learning techniques the resulting course encourages a contextual approach to user needs, specifically teaching generic mental health care skills to staff who are often working single-handed, and are required to respond appropriately, locally and safely as they work towards achieving National Mental Health crisis standards.

Predictors of treatment satisfaction among older adults with anxiety in a primary care psychology program

Increasing numbers of patients are treated in integrated primary care mental health programs. The current study examined predictors of satisfaction with treatment in patients from a randomized clinical trial of late-life generalized anxiety disorder (GAD) in primary care. Higher treatment satisfaction was associated with receiving CBT rather than enhanced usual care. Treatment credibility, treatment expectancies, social support, and improvements in depression and anxiety symptoms predicted higher treatment satisfaction in the total sample. In the CBT group, only credibility and adherence with treatment predicted satisfaction. This suggests that older patients receiving CBT who believe more strongly in the treatment rationale and follow the therapist's recommendations more closely are likely to report satisfaction at the end of treatment. In addition, this study found that adherence mediated the relationship between treatment credibility and treatment satisfaction. In other words, patients’ perceptions that the treatment made sense for them led to greater treatment adherence which then increased their satisfaction with treatment.

Substance Screening and Referral for Substance Abuse Treatment in an Integrated Mental Health Care Program

This study examined rates of substance screening and referral for substance abuse treatment as part of an integrated care program providing mental health services to low-income patients in primary care. Adults (N=11,150) who were enrolled in the program between 2008 and 2010 were included. Primary outcomes included substance screening rates, treatment referral rates, and correlates of accessing recommended treatment. A total of 7,513 (67%) participants were screened for substance abuse. Among the 2,856 (38%) participants with a positive screen, 1,344 (47%) were referred for treatment. After adjustment for covariates, accessing recommended treatment was associated with past substance abuse treatment history, alcohol use, heavy drug use, posttraumatic stress disorder, and number of follow-up contacts with a care manager. This study of a vulnerable population highlights missed opportunities for identifying and referring patients in primary care to substance abuse treatment.

Evaluation of an Australian primary care telephone cognitive behavioural therapy pilot

A telephone-based cognitive behavioural therapy pilot project was trialled from July 2008 to June 2010, via an Australian Government-funded primary mental health care program. A web-based minimum dataset was used to examine level of uptake, sociodemographic and clinical profile of consumers, precise nature of services delivered, and consumer outcomes. Key informant interviews with 22 project officers and 10 mental health professionals elicited lessons learnt from the implementation of the pilot. Overall, 548 general practitioners referred 908 consumers, who received 6607 sessions (33% via telephone). The sessions were delivered by 180 mental health professionals. Consumers were mainly females with an average age of 37 years and had a diagnosis of depressive and/or anxiety disorders. A combination of telephone and face-to-face sessions of 1h in duration were conducted, delivering behavioural and cognitive interventions, usually with no cost to consumers. Several implementation issues were identified by project officers and mental health professionals. Although face-to-face treatment is preferred by providers and consumers, the option of the telephone modality is valued, particularly for consumers who would not otherwise access psychological services. Evidence in the form of positive consumer outcomes supports the practice of multimodal service delivery.

The Place of Autochthonous Disease Aetiology in Mental Health-Seeking Behaviors in a Globalizing Nigerian Community

This study aimed at ascertaining the connection between disease aetiology of the autochthonous psychiatric health system and the current mental health-seeking behaviors of the Nsukka people. Structured participant observation was the principal method of collecting data. In-depth interview sessions were also held with elders in the communities. It was found that although there has been social contact and change among the Nsukka, the personalistic elements in the aetiology of their traditional psychiatric system still largely determined their mental health-seeking behaviors. Thus, they were found to be more at home with traditional healers and syncretic churches than orthodox mental healthcare. To be successful, any mental healthcare program in Nsukka ought to consider how orthodox mental health practitioners, traditional healers, and those who run prayer houses could be incorporated in a comprehensive community mental healthcare program.

The psychometric properties of the Illness Management and Recovery scale in a large American public mental health system

The Illness Management and Recovery (IMR) scale was created to measure recovery outcomes produced by the IMR program. However, many other mental health care programs are now designed to impact recovery-oriented outcomes, and the IMR has been identified as a potentially valuable measure of recovery-oriented mental health outcomes. The purpose of this study was to examine the psychometric properties and structural validity of the IMR clinician scale within a variety of therapeutic modalities other than IMR in a large multiethnic sample (N=10,659) of clients with mental illness from a large U.S. county mental health system. Clients completed the IMR on a single occasion. Our estimates of internal consistency were stronger than those found in previous studies (α=0.82). The scale also related to other measures of theoretically similar constructs, supporting construct and criterion validity claims. Additionally, confirmatory factor analyses supported the multidimensional representation of the IMR clinician scale. The three-factor model of illness self-management and recovery was represented by dimensions of recovery, management, and substance use. These reliable psychometric properties support the use of both the original one-factor and revised three-factor models to assess illness self-management and recovery among a broad spectrum of clients with mental illness.

Cultural Lens on Mental Illness: Four Clients Share Their Perspectives

People served by mental health providers represent diverse cultural groups. In-depth qualitative interviews were used to collect data to examine: “How do people, diagnosed with a mental illness, perceive their experience in a partial care mental health program from the perspective of their cultural context?” Four participants described cultural identities that included ethnic, health status, and sexual orientation identities. The participants' way of participating in the world was often in conflict with cultural values and expectations of the family and counselors. Cultural competence must include understanding how complex, multiple cultural contexts interact and influence a person's participation in the therapeutic process.

Ergonomics in the psychiatric ward towards workers or patients?

Patient's aggressive behavior is one of the major problem in the psychiatric ward. Here we present the preliminary results of a psychiatric ward case-study, of a public hospital in the Chieti province, in order to plan ergonomic improvement. We applied the Method of Organizational Congruencies in the psychiatric ward in order to study the relationship between organized hospital work and nurses wellbeing in a 24 hour shifts. We observed 58 main phases in the three work shifts. The technical actions are mainly those of any hospital wards (shift briefing, preparing and administering drugs, recording data on clinical charts, etc.). We found important differences mainly due to the nurses overcontrol activities on the patients behavior (preventing suicides or self destructive behavior), the occurrence of restraint procedure towards patients, the pollution due to patient's cigarette smoke. The fear of patient's self destructive behavior or other aggressive behaviour are the main cognitive and social aspects of this hospital ward. Nurses working in this psychiatric ward have to accept: locked doors, poor and polluted environment, restraint procedure with high risk of aggression and no availability of mental health care programs. A new interdisciplinary concept for ergonomics in psychiatry setting may represent a challenge for both nurses and patients and the community.