Mental Health Service Sectors Research Articles

The impact of COVID-19 on community mental health: lessons learned from Tasmania, Australia.

The COVID-19 pandemic had a significant impact on community mental health globally and widened pre-existing health and social inequities. Tasmania, Australia has one of the highest rates of mental ill health and socioeconomic disadvantage in the country. Whilst Tasmania experienced a delayed and reduced physical presence of COVID-19 compared to other states and territories, mental health impacts remain. It is necessary to understand such impacts to inform policy, practice, and recommendations to enhance the mental health service sector and prevent future mental health burden. This qualitative study aimed to explore expert mental health stakeholders' perspectives of the impact of COVID-19 on: (1) the mental health of people living in Tasmania, and (2) mental health services. Semi-structured interviews with 12 expert mental health stakeholders across Tasmania were conducted. This sample was well-positioned to comment on the impact of COVID-19 on community mental health and provide recommendations to enhance the sector. Interviews were thematically analysed. Three subthemes exploring the COVID-19 impact on mental health were included: (1) anxiety, distress, and isolation; (2) varying presentations across age groups; and (3) increased complexity. Four key themes capturing the COVID-19 impact on mental health services were identified: (1) transition to telehealth; (2) increased service demand; (3) spotlight on service gaps; and (4) local workforce shortages. The pandemic has highlighted existing gaps across the community mental health service sector, and exacerbated existing psychosocial/structural stressors resulting in increased presentations and complexity of mental illness among the community, particularly for youth. Existing treatment gaps and inequities in service access, engagement, and mental health outcomes will persist if not addressed. Recommendations have been provided to inform community mental health service planning, policy, design, access, and provision, and improve wellbeing.

Shaping Mental Health Reform - Key Tasks for an Incoming Government.

To describe a recent process by which mental health service sector leaders identified key elements of strategic, systemic and structural mental health reform. These elements could guide an incoming Federal government. The paper describes the process undertaken by the Sydney Mental Health Policy Forum between 2019 and 2022. This work generated principles, key domains and finally a set of actions. Five immediate actions were identified that are cost neutral or require minimal investment. Five further actions requiring realignment of existing funds and/or new funds were also identified. The task of mental health reform in Australia is both large and overdue. Continued investment in fragmented or piecemeal programmes and services will not propel desired change. Reform must facilitate new regional control of planning, funding and responding to community mental health needs. The actions identified by the Forum set out a menu of opportunities to guide reform over the life of the next Parliament, starting now.

Developing an Australian-first recovery model for parents in Victorian mental health and family services: a study protocol for a randomised controlled trial

BackgroundA considerable number of people with a mental illness are parents caring for dependent children. For those with a mental illness, parenting can provide a sense of competence, belonging, identity and hope and hence is well aligned to the concept of personal recovery. However, little research has focused on the recovery journey of those who are parents and have a mental illness. This randomised controlled trial aims to (i) evaluate the effectiveness of an intervention model of recovery for parents (Let’s Talk about Children) in three different mental health service sectors and (ii) examine the economic value of a larger roll out (longer term) of the parent recovery model.MethodsA two arm parallel randomised controlled trial will be used with participants, who are being treated for their mental illness in adult mental health, non-government community mental health or family welfare services. The study will involve 192 parents, who are considered by their treating practitioner to be sufficiently well to provide informed consent and participate in an intervention (Let’s Talk about Children) or control group (treatment as usual). Participant randomisation will occur at the level of the treating practitioner and will be based on whether the randomised practitioner is trained in the intervention. Outcomes are compared at pre, post intervention and six-month follow-up. Recovery, parenting and family functioning, and quality of life questionnaires will be used to measure parent wellbeing and the economic benefits of the intervention.DiscussionThis is the first randomised controlled trial to investigate the efficacy of a parenting intervention on recovery outcomes and the first to provide an economic evaluation of an intervention for parents with a mental illness. An implementation model is required to embed the intervention in different sectors.Trial registrationThe trial was retrospectively registered: ACTRN12616000460404 on the 8/4/2016.

Addressing the Needs of Problem Gamblers With Co-Morbid Issues: Policy and Service Delivery Approaches

Most people with gambling problems have at least one co-occurring condition and many experience multiple co-occurring conditions simultaneously. In many Western jurisdictions, a specialist service response has developed, with separate agencies and workforces established to respond to gambling problems. Despite the number of co-occurring issues that occur alongside gambling, research is limited on the prevalence of problem gambling across some service systems, such as mental health and family service sectors. However, it is reasonable to conclude that significant numbers of people with gambling problems are currently engaged in other health and welfare service sectors. Partnership work with other service sectors is therefore vital to respond to the needs of these people. In Victoria, Australia, a partnership program was established in gambling help services to improve integration and co-ordination between gambling, alcohol and drug, family support, and mental health service sectors. From the experience acquired in developing the program, we seek in this article to outline the benefits and challenges of implementing a cross-sector approach in gambling treatment service systems and to recommend effective strategies to develop a cross-sector approach, including creating an authorising environment at the government policy level.

Poverty and mental health in Indonesia

Community and facility studies in developing countries have generally demonstrated an inverse relationship between poverty and mental health. However, recent population-based studies contradict this. In India and Indonesia the poor and non-poor show no difference in mental health. We revisit the relationship between poverty and mental health using a validated measure of depressive symptoms (CES-D) and a new national sample from Indonesia – a country where widespread poverty and deep inequality meet with a neglected mental health service sector. Results from three-level overdispersed Poisson models show that a 1% decrease in per capita household expenditure was associated with a 0.05% increase in CES-D score (depressive symptoms), while using a different indicator (living on less than $2 a day) it was estimated that the poor had a 5% higher CES-D score than the better off. Individual social capital and religiosity were found to be positively associated with mental health while adverse events were negatively associated. These findings provide support for the established view regarding the deleterious association between poverty and mental health in developed and developing countries.

Culture and the Anxiety Disorders: Recommendations for DSM-V

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over-specification” of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal...

Differences in Mental Health Service Sector Utilization among African American and Caucasian Youth Entering Systems of Care Programs

Differences in unmet need and access to services between African American and Caucasian youth have been established; less is known about differences in specific mental health service sectors. This study examined differences in past year outpatient, school-based, day treatment and residential/inpatient service utilization among African American and Caucasian youth (n = 3,649) entering a federally funded system of care program. Random effect logistic regression models were implemented to examine the relationship between race and past year service utilization. Analyses revealed that African American youth were less likely than Caucasian youth to have utilized school-based and residential/inpatient mental health services in the past year. Findings suggest that racial disparities exist in service use for certain types of service sectors and highlight the importance of understanding and identifying individual, family, and community factors that contribute to disparities in service utilization.

MY OTHER, MY SELF

Click to increase image sizeClick to decrease image size Notes 1. For work that begins to explore the relationship between feminism and popular culture, see also Gamman Gamman , Lorraine , and Margaret Marshment 1988 . The female gaze . London : Women's Press . [Google Scholar] and Marshment's edited collection The Female Gaze (1988). 2. Disturbingly, perhaps, Hermes entertains the possibility that the way magazines are read in the unfocused flurry of everyday life renders them ‘virtually meaningless’. That potentially nihilistic insight for media and cultural studies’ concern with the reception of popular texts has been left hanging on the page. 3. There is no archive of Cleo letters beyond those that were published. Popular magazines rarely consider their own future historical value in the immediacy of deadlines and the continual present of magazine publishing. Nor would the publishing company, Australian Consolidated Press, allow me access to whatever documents may have been kept relating to Cleo. This lack of co-operation with researchers is one that Bridget Griffin-Foley also met when writing The House of Packer: The Making of a Media Empire (1999). 4. Issues of authenticity, selection and editing letters in magazines demand an article in their own right. Given the popular mythology that readers’ letters to magazines are invented by staff writers, it is probably worth stressing here that this is simply not the case with Cleo and with many (if not all) magazines. I have yet to interview Ita Buttrose and other staff formally, but informal conversation indicates a respect for the editorial function of the letters page to create a public forum, to increase magazine loyalty and ‘brand’ identification, and to allow readers to feel ownership and inclusion in ‘their’ magazine. There is a principle of trust involved with publishing readers’ letters, and it is one that women's magazines like Cleo took seriously. If readers’ letters were written in-house, and if that practice leaked into the public domain, the trust between readers and their magazine would be broken. 5. Here I use the broader definition of consciousness-raising as defined by Meryl Altman: ‘… a belief in the liberating potential of speaking openly about women's lives, starting with one's own and moving outward to connect with others’ (Altman 2003 Altman , Meryl. 2003 . Beyond trashiness: The sexual language of 1970s feminist fiction . Journal of International Women's Studies 4 ( 2 ): 1 – 19 . Available from http://www.bridgew.edu/SoAS/jiws/April03/Altman.pdf [cited 10 February 2007] . [Google Scholar], 2). 6. The Australian Women's Weekly was the most-read magazine, reaching 34.1 per cent of Australians. Cosmopolitan, Cleo's most direct niche competitor, and at that point a little over a year old in Australia, was read by 4.9 per cent. 7. Dr Beverly Raphael was Associate Professor in Psychiatry at the University of Sydney in 1975. After an illustrious career in the mental health service sector, she now holds many professorial appointments at a number of Australian universities. 8. Edna Ryan was involved at this time in the Industrial Action group of WEL. It was her submission to the Arbitration Commission in 1974 that succeeded in removing the legal concept of the male family wage, replacing it with the adult minimum wage. 9. By 1976, 36 per cent of the Australian workforce was female and, of that number, 64 per cent were married women (Matthews 1984 Matthews , Jill Julius. 1984 . Good and mad women. The historical construction of femininity in twentieth century Australia . North Sydney : Allen & Unwin . [Google Scholar], 54). 10. It is pointed that Dasey does not identify as a feminist in her editorial letter, but as part of ‘the women's movement’, a by-word in Cleo for the less militant, more ‘respectably’ mainstream manifestation of women's liberation. 11. There is no space here to explore the mainstreaming of sexual liberation in Cleo and its contentious relationship to second-wave feminism, but that too is part of the meaning of popular feminism and part of its trajectory into the present.

Racial and Ethnic Differences in Utilization of Mental Health Services Among High-Risk Youths

Racial and ethnic disparities in mental health service use have been identified as a major public health problem. However, the extent to which these disparities may be accounted for by other confounding sociodemographic or clinical predictors of service use (e.g., family income, functional impairment, caregiver strain) is relatively unexplored, especially for youth services. The goal of this study was to test for racial/ethnic disparities in use of a variety of outpatient, inpatient, and informal mental health services among high-risk youths, with the effects of other predictive factors controlled. Participants were 1,256 youths ages 6-18 years who received services in a large, publicly funded system of care (including the child welfare, juvenile justice, special education, alcohol and drug abuse, and mental health service sectors). Youths and caregivers were interviewed with established measures of mental health service use, psychiatric diagnoses, functional impairment, caregiver strain, and parental depression. Significant racial/ethnic group differences in likelihood of receiving any mental health service and, specifically, formal outpatient services were found after the effects of potentially confounding variables were controlled. Race/ethnicity did not exert a significant effect on the use of informal or 24-hour-care services. Racial/ethnic disparities in service use remain a public health problem.

Assessment, intervention, and research with infants in out‐of‐home placement

AbstractInfants constitute a large and increasing proportion of youth in out‐of‐home placement. These infants have very high rates of medical illnesses, developmental delays, and substantial risks for psychopathology. They receive varying amounts of services from a complex and poorly integrated service system that includes four principal service sectors: the child welfare, medical, early intervention, and mental health service sectors. These service systems are currently undergoing major changes in their policies, organization, and financing, such as the introduction of managed care into the child welfare system. In this article, we provide an overview of what is known about infants in out‐of‐home placement. We then summarize approaches to infant mental health assessment and intervention from a comprehensive perspective that addresses the infants' multiple problems and acknowledges that they need to receive services from multiple systems that are undergoing rapid change. We conclude by highlighting a number of critical areas in need of research. ©2002 Michigan Association for Infant Mental Health.

Caseload Segregation/Integration: A Measure of Shared Responsibility for Children and Adolescents

In this article, we introduce a child-focused measure of the degree to which local systems of care share responsibility for children and adolescents (the Caseload Segregation/Integration Ratio) and apply this measure to three service sectors in each of Vermont's 10 mental health service areas. The analysis focuses on caseload overlap among three service sectors: community mental health programs, the state child protection agency, and special education for an emotional or behavioral disability. Because the three service sectors do not share unique person identifiers, probabilistic population estimation was used to derive unduplicated counts of the number of children and adolescents served. Caseload integration was found to be positively related to the size of the mental health service sector, negatively related to the size of the child protection service sector, and unrelated to the size of the special education emotional behavioral service sector.