Mental Health Service Recipients Research Articles

Disparities in COVID-19-Related Psychological Distress Among Recipients of a State's Public Mental Health Services.

The authors examined changes in perceived anxiety, stress, and mental health symptoms (i.e., psychological distress) reported by recipients of New York State public mental health services during the early months of the COVID-19 pandemic, as well as whether these changes varied by demographic characteristics or pandemic-related socioeconomic challenges. A statewide survey of service recipients (N=3,483) was conducted (May 8-June 22, 2020). Descriptive analyses were summarized, and logistic regression was used to evaluate associations between increases in reported psychological distress and age, gender, region of residence, race and ethnicity, socioeconomic challenges, and alcohol or drug use. Fifty-five percent of respondents (N=1,933) reported a slight or moderate increase in COVID-19-related psychological distress, and 15% (N=520) reported a substantial increase. In adjusted models, substantial elevations in psychological distress were associated with identifying as female (AOR=1.83, 95% CI=1.50-2.25), experiencing three or more pandemic-related socioeconomic challenges (AOR=2.41, 95% CI=1.91-3.03), and reporting increased use of alcohol or drugs (AOR=1.81, 95% CI=1.34-2.44). Compared with non-Hispanic/Latinx White service recipients, non-Hispanic/Latinx Black individuals had lower odds of reporting substantially increased psychological distress (AOR=0.59, 95% CI=0.45-0.76), as did non-Hispanic/Latinx Asian-descent individuals (AOR=0.28, 95% CI=0.12-0.64). In this large sample of recipients of New York State public mental health services, the COVID-19 pandemic's impact on psychological well-being was widespread and varied by gender, race and ethnicity, and socioeconomic vulnerability. These relationships must be considered in ongoing efforts to provide optimal care for this population.

Prevalence and Correlates of Four Social Determinants in a Statewide Survey of Licensed Mental Health Services.

This analysis examined the distribution of four social determinants of health among recipients of state-licensed mental health services and analyzed relationships between determinants and individuals' clinical and demographic characteristics. With data from the New York State Office of Mental Health 2017 Patient Characteristics Survey (N=103,416), prevalences of four social determinants (education, employment, housing, and criminal legal involvement) among mental health service recipients were described. Results were stratified to explore differences by diagnosis, gender, race and ethnicity, and region of residence. High proportions had low education (20.9%), unemployment (79.1%), homelessness (8.2%), and criminal legal involvement (12.2%), surpassing statistics for the general state population. Prevalences of alcohol-related, drug-related, and psychotic disorders were higher among these groups than were prevalences of other diagnoses. People of color and male recipients were overrepresented among those with adverse social determinants. Results highlight the magnitude of social adversity among those receiving mental health services, as well as potential inequities.

\u201cWith every passing day I feel like a candle, melting little by little.\u201d experiences of long-term displacement amongst Syrian refugees in Shatila, Lebanon

BackgroundLong term displacement and exposure to challenging living conditions can influence family dynamics; gender roles; violence at home and in the community and mental well-being. This qualitative study explores these issues as perceived by Syrian refugees who have been living in Shatila, a Palestinian camp in South Beirut, Lebanon, for at least 2 years.MethodsTwenty eight in-depth interviews with men and women were conducted between February and June 2018. Women were recipients of mental health services, and men were recruited from the local community. Interviews were conducted in Arabic, translated, transcribed, coded and analysed using thematic content analysis.ResultsOur results show patterns of harsh living conditions similar to those described earlier in the course of the Syrian refugee crisis. Lack of infrastructure, overcrowding, cramped rooms and violence were all reported. Participants also described a lack of social support, discrimination and harassment within the host community, as well as limited social support networks within their own Syrian refugee community. Family dynamics were affected by the increased responsibilities on men, women and children; with additional economic and employment demands on men, women assuming the roles of ‘mother and father’ and children having to work and contribute to the household. Participants discussed several types of violence, including parental violence against children and violence in the community. Violence against women was also reported. Reported mental health issues included depression, anxiety, sadness, frustration, hopelessness, self-neglect and a loss of sense of self and self-worth. Some participants expressed a wish to die.ConclusionsThis study describes experiences of changing gender roles, family dynamics, violence and mental health after long-term displacement in in Shatila camp, South Beirut as perceived by Syrian refugees. A lack of safety and security coupled with economic hardship rendered refugees even more susceptible to exploitation and harassment. Parental violence was the most commonly reported type of domestic violence.

Use of Mobile and Computer Devices to Support Recovery in People With Serious Mental Illness: Survey Study.

BackgroundMental health recovery refers to an individual’s experience of gaining a sense of personal control, striving towards one’s life goals, and meeting one’s needs. Although people with serious mental illness own and use electronic devices for general purposes, knowledge of their current use and interest in future use for supporting mental health recovery remains limited.ObjectiveThis study aimed to identify smartphone, tablet, and computer apps that mental health service recipients use and want to use to support their recovery.MethodsIn this pilot study, we surveyed a convenience sample of 63 mental health service recipients with serious mental illness. The survey assessed current use and interest in mobile and computer devices to support recovery.ResultsListening to music (60%), accessing the internet (59%), calling (59%), and texting (54%) people were the top functions currently used by participants on their device to support their recovery. Participants expressed interest in learning how to use apps for anxiety/stress management (45%), mood management (45%), monitoring mental health symptoms (43%), cognitive behavioral therapy (40%), sleep (38%), and dialectical behavior therapy (38%) to support their recovery.ConclusionsMental health service recipients currently use general functions such as listening to music and calling friends to support recovery. Nevertheless, they reported interest in trying more specific illness-management apps.

Experiences of mental health services for 'black' men with schizophrenia and a history of disengagement: A qualitative study.

Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as 'black'. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in-depth, semi-structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) "People just keep hounding me", (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants' experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement.

Chronic care, integrated care, and mental health: Moving the needle now

ABSTRACTHealthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts.

Viewing psychopathology through a trauma lens

ABSTRACTMany symptoms and behaviors associated with a range of psychiatric disorders, including those not designated as trauma- or stressor-related, result from unprocessed and unintegrated traumatic experiences, requiring therapeutic assessments and interventions that consider the complex dynamics brought on by trauma. While the focus on symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM) may lead practitioners away from a consideration of etiology when choosing interventions, the exclusions of “disorders of extreme stress not otherwise specified” in DSM-IV and “developmental trauma disorder” from DSM-5 may further predispose practitioners to disregard traumatic etiology and symptoms when assessing, diagnosing, and treating clients. Because a majority of recipients of public mental health services suffer deleterious effects from trauma exposure, social work and other mental health professionals have an ethical responsibility to incorporate trauma-based screenings, assessments, and interventions with clients. Thus, trauma-informed evaluation and treatment approaches must be included in graduate curricula, practitioners must seek continuing education to supplement their knowledge and practice skills, and agency administrators must provide inservice training to professional staff.

Author of House Mental Health Bill Addresses APA Assembly

Author of House Mental Health Bill Addresses APA Assembly

Healthy living? By whose standards? Engaging mental health service recipients to understand their perspectives of, and barriers to, healthy living.

It is well recognized that mental health service recipients experience high rates of cardiometabolic disorders, have poorer diets, and exercise less than the general population. This study sought to explore the meaning of a healthy lifestyle for this population and the barriers they experience to healthy living. Focus groups were conducted with 23 individuals who experience serious mental health issues. The meaning of a healthy lifestyle and the barriers participants experience to living healthily were explored. Participants perceived a healthy lifestyle in broader terms than professional guidelines for exercise and diet. A broad framework including friendship, affordable safe housing, employment, spiritual, and emotional good health, as well as healthy eating and exercise, is described. Barriers identified by participants were poor mental and physical health and stigma (structural, social, and self). An unexpected result was the group problem solving that occurred during the focus groups. Health care professionals need to understand mental health service recipients' perspectives of a "healthy lifestyle." An understanding of barriers within this context is required, as only then will we be able to empathize and assist as health care professionals. This study also shows that realistic, innovative, and pragmatic solutions occur when mental health service recipients are empowered.

Public Policy and Limits of Diversion Programs for Reducing Jail Exposure of Persons With Serious Mental Illness

Diverting potential arrestees with serious mental illnesses from the criminal justice system to mental health services has become a mainstay of public policy. Federal funding for local diversion and mental health court programs mandates that recipients of funds focus on "nonviolent misdemeanants," allowing more serious offenders to proceed through the justice system. This study explored the potential effects of applying such exclusions to a group of arrestees with serious psychiatric illnesses. Data on charges in a cohort of mental health service recipients (N=13,816) were analyzed. Episodes of felony arrest, including some involving violence toward others, outnumbered misdemeanors. Under federal funding policies, many such cases would be processed through the justice system. Expanding inclusion criteria is necessary if diversion is to significantly affect incarceration rates among persons with mental illnesses. Policy makers should heed the accumulating evidence in this area in determining priorities for funding.

P01-577 - Project “social point”: Partnership of sociality activities of mental health service recipients

The project “Social Point” deals in promoting integration of Mental Health Service recipients within contexts of social relationship, voluntary work and community activism. The project is still taking place in the district of Modena.AimsAssessment of the effectiveness of the project SP: production of a change in quality of life; development of purposeful relationships out of families and health services; development of Mental Health Service recipients’ awareness of being not only a user of the health service but also a resourceful person; change of method and approach within relationship between Mental Health and community and public services.MethodsAt the beginning and at the end of the integration courses (autumn/winter 2010 and after 6–8 months), both individuals and collectives, every Mental Health Service recipient was asked to fill in a form with socio-demographic characteristics and the WHOQOL-bref. A social network diagram was subsequently drawn.Expected resultsAt the end of the research (September 2010) joining courses directed to the development of social relationship is forecast to improve the quality of life of the recipients, to increment purposeful relationships and to strengthen empowerment of persons with mental disease by promoting a different project of life no more illness-based but resource-based.ConclusionThe study will provide evidences about the performance of the project with regard to the promotion of the social integration of citizens with mental disease in contexts, to the empowerment and to the promotion of processes of social.

Risk of Arrest Among Public Mental Health Services Recipients and the General Public

Objective: This study compared arrest rates on a broad range of offenses in a cohort of public mental health service recipients and in the general population. Methods: Administrative data from a state mental health agency were merged with data capturing arrests over a 9.5-year period in a cohort of persons with severe and persistent mental illness who used public mental health services and were aged 18–54 (N=10,742). The cohort's arrest rates for eight offense categories were compared with those of the general population for persons in the same age group over the same period (N=3,318,269). The data for the cohort that received mental health services were weighted by age and gender to align the cohort's demographic characteristics with those of the general population. Results: The service use cohort members' odds of experiencing at least one arrest in any charge category were significantly higher than those of the general population (odds ratio [OR]=1.62, 95% confidence interval=1.52–1.72); odds were higher across all charge categories, with ORs ranging from 1.84 for drug-related offenses to 5.96 for assault and battery on a police officer. Aside from the crime of assault and battery on a police officer, the largest ORs were associated with misdemeanor crimes against persons and property and with crimes against public decency. ORs associated with felony charges, while significant, tended to be slightly smaller in magnitude. Conclusions: The offenses for which persons with serious mental illness are at greatest risk of arrest are many of those targeted by current diversion programs. These findings suggest the need for additional research addressing the ways in which individual psychopathology and socioenvironmental factors affect risk of offending in this population. (Psychiatric Services 62:67–72, 2011)

Risk of Arrest Among Public Mental Health Services Recipients and the General Public

This study compared arrest rates on a broad range of offenses in a cohort of public mental health service recipients and in the general population. Administrative data from a state mental health agency were merged with data capturing arrests over a 9.5-year period in a cohort of persons with severe and persistent mental illness who used public mental health services and were aged 18-54 (N=10,742). The cohort's arrest rates for eight offense categories were compared with those of the general population for persons in the same age group over the same period (N=3,318,269). The data for the cohort that received mental health services were weighted by age and gender to align the cohort's demographic characteristics with those of the general population. The service use cohort members' odds of experiencing at least one arrest in any charge category were significantly higher than those of the general population (odds ratio [OR]=1.62, 95% confidence interval=1.52-1.72); odds were higher across all charge categories, with ORs ranging from 1.84 for drug-related offenses to 5.96 for assault and battery on a police officer. Aside from the crime of assault and battery on a police officer, the largest ORs were associated with misdemeanor crimes against persons and property and with crimes against public decency. ORs associated with felony charges, while significant, tended to be slightly smaller in magnitude. The offenses for which persons with serious mental illness are at greatest risk of arrest are many of those targeted by current diversion programs. These findings suggest the need for additional research addressing the ways in which individual psychopathology and socioenvironmental factors affect risk of offending in this population.

The Incremental Value of Self-Reported Mental Health Measures in Predicting Functional Outcomes of Veterans

Research on patient-centered care supports use of patient/consumer self-report measures in monitoring health outcomes. This study examined the incremental value of self-report mental health measures relative to a clinician-rated measure in predicting functional outcomes among mental health service recipients. Participants (n = 446) completed the Behavior and Symptom Identification Scale, the Brief Symptom Inventory, and the Veterans/Rand Short Form-36 at enrollment in the study (T1) and 3 months later (T2). Global Assessment of Functioning (GAF) ratings, mental health service utilization, and psychiatric diagnoses were obtained from administrative data files. Controlling for demographic and clinical variables, results indicated that improvement based on the self-report measures significantly predicted one or more functional outcomes (i.e., decreased likelihood of post-enrollment psychiatric hospitalization and increased likelihood of paid employment), above and beyond the predictive value of the GAF. Inclusion of self-report measures may be a useful addition to performance measurement efforts.

Why Current and Former Recipients of Foster Care Need High Quality Mental Health Services

This commentary presents data about the emotional, behavioral, and substance abuse disorders of youth in foster care and former recipients of foster care ("alumni") in the United States to underscore the reasons why high quality mental health services are essential.

Service user, patient, client, user or survivor: describing recipients of mental health services

Aims and methodTo determine which terms receivers of mental health services wish to be known by (service user, patient, client, user, survivor) according to the professional consulted (psychiatrist, nurse, psychologist, social worker, occupational therapist). We conducted a questionnaire study to assess terms by like or dislike and by rank order. There were 336 participants from local catchment area secondary care community and in-patient settings in east Hertfordshire.ResultsPatient is the preferred term when consulted by psychiatrists and nurses, but it is equally preferable to client for social workers and occupational therapists. Service user is disliked more than liked overall, particularly by those who consulted a health professional, but not by those who consulted a social worker. A significant minority wish to be regarded as a survivor or user.Clinical implicationsNational and local mental health services should adopt evidence-based terminology in referring to ‘patient’ or, in some groups, ‘patient or client’ in preference to ‘service user’.

Categorizing temporal patterns of arrest in a cohort of adults with serious mental illness.

Temporal patterns of arrest among mental health systems' clientele have not been well explored. This study uses "trajectory analysis," a methodology widely employed by criminologists exploring patterns of desistence in offending, to examine patterns of criminal justice involvement in a cohort of mental health service recipients. Data for this study are from a statewide cohort of individuals who received services from the Massachusetts Department of Mental Health in 1991 (N = 13,876) and whose arrests were followed for roughly 10years. Zero-inflated Poisson trajectory analysis applied to cohort members having two or more arrests identified five trajectories with widely varying arrest patterns. Analysis of differences in the composition of the five trajectory-based groups revealed few between-group differences in members' demographic and service use characteristics, while certain offense types were disproportionately prevalent among particular trajectory-based groups. The implications of these findings for understanding criminal justice involvement in this population and the utility of the trajectory model for system planning are discussed.

Characteristics of Traumatic Experience and Survivor Perceptions of Mental Health Services: The 2004–2005 Erie County Community Trauma Survey

Trauma is associated with severe mental illness and substance abuse problems, yet it typically is not addressed sufficiently in treatment. This article reports on an assessment of mental health service recipients and their experience of traumatic events and perceptions of service providers' sensitivity, helpfulness, and knowledge regarding their trauma and service needs using a community-based participatory research model. Demographic characteristics and status of co-occurring disorders were measured. Participants perceived that individual therapists and peer service providers were sensitive to and knowledgeable about their trauma. Group treatment and peer programs were seen as being most helpful. Psychiatric services were seen as being the least sensitive to trauma issues. Implications for practice and research are discussed.

The use of mental health services among young adults with emotional and behavioural problems: equal use for equal needs?

Mental health problems are highly prevalent in young adults. Despite possibilities for effective treatment, only about one-third of young adults with mental health problems seek professional help. Little knowledge exists of which groups of young adults are underusing mental health services and for what reasons. The present study examined socio-demographic inequalities in the use of mental health services by young adults, and examined whether such inequalities were attributable to differences in objective need, subjective need, predisposing or enabling factors. Cross-sectional study among the general population aged 19-32 years (2,258 respondents). A postal survey was administered including questions on socio-demographic factors and mental health service use. Data were analyzed with logistic regression analysis. South-West Netherlands. All respondents with serious internalizing and externalizing problems (n = 367). Twelve-month primary and specialty mental health services use. Only 34.6% of young adults with psychopathology had used any mental health services: 16.2% had used only primary mental health services and 18.4% had used specialty mental health services. No socio-demographic differences were found in the use of only primary mental health services. However, recipients of specialty mental health services were more often female (OR = 2.12, 95% CI = 1.14-3.96), economically inactive (OR = 3.12, 95% CI = 1.59-6.09) or students (OR = 2.38, 95% CI = 1.05-5.42) and they were less often higher educated (OR = 0.49, 95% CI = 0.25-0.97). The higher odds ratio for specialty service use among young adults who were female or economically inactive attenuated when adjusting for need for care. The other socio-demographic disparities in specialty service use did not attenuate when adjusting for need, enabling or predisposing factors. Among young adults, equal use of specialty mental health services for equal needs has not been achieved. The underserved groups of young adults oppose the traditionally underserved groups in the general population, and may inform interventions aimed at improving young people's help-seeking behaviours.

‘Youth-friendly’ characteristics of professionals in mental health settings

Adolescents have a unique developmental vulnerability to suicide, with youth presenting as the second most vulnerable group to suicide across the lifespan. Youth have been recognized as underserved mental health service recipients, with only one in six of those in need receiving care. Calls for innovative mental health services to better serve youth have been articulated for over a decade and the adolescent health and mental health communities have responded. However, to date there has been little empirical discussion of the caregiver characteristics that would increase the likelihood of youth feeling comfortable discussing their mental health concerns. Objectives of this study were twofold: (1) to ask a large sample of Canadian youth [n = 11 171: 5146 males, 6001 females (n = 24 participants did not indicate their sex )] to identify characteristics of mental health professionals they would define as ‘youth-friendly’, and (2) to test which youth-friendly characteristics are deemed important to youth based on their circumstances, including those experiencing recent suicidality. Gender differences are also tested and explored. The absence of youth-friendly mental health service provision is proposed to be a modifiable barrier to help seeking in at-risk youth.