Mental Health Related Services Research Articles

Mental Health Service Use Before First Diagnosis of a Psychotic Disorder.

Characterizing mental health service use trajectories preceding diagnosis of a psychotic disorder may help identify individuals at highest risk and in which settings they are at highest risk. To examine mental health service use and diagnostic trajectories before first diagnosis of psychotic disorder and identify utilization and diagnostic patterns. This population-based, retrospective cohort study used linked provincial health administrative data. The sample included individuals aged 15 to 29 years diagnosed with a psychotic disorder in Ontario, Canada, between April 1, 2012, and March 31, 2018. These individuals were matched to individuals with a diagnosis of a mood disorder. Data were analyzed from November 2108 to November 2019. The main outcomes were rates, timing, and setting of mental health-related service use and associated diagnoses in the 3 years before the index disorder among individuals first diagnosed with a psychotic disorder compared with those first diagnosed with a mood disorder. A total of 10 501 individuals with a first diagnosis of psychotic disorder were identified (mean [SD] age, 21.55 [3.83] years; 72.1% male). A total of 72.2% of individuals had at least 1 mental health service visit during the 3 years before their first psychotic disorder diagnosis, which was significantly more than matched controls with a first mood disorder diagnosis (66.8%) (odds ratio [OR], 1.34; 95% CI, 1.26-1.42). Compared with individuals diagnosed with a mood disorder, individuals diagnosed with a psychotic disorder were significantly more likely to have had mental health-related hospital admissions (OR, 3.98; 95% CI, 3.43-4.62) and emergency department visits (OR, 2.27; 95% CI, 2.12-2.43) in the preceding 3 years. Those with psychotic disorders were more likely to have had prior diagnoses of substance use disorders (OR, 2.57; 95% CI, 2.35-2.81), other disorders (personality disorders, developmental disorders) (OR, 1.75; 95% CI, 1.61-1.90), and self-harm (OR, 1.64; 95% CI, 1.36-1.98) in the past 3 years compared with those diagnosed with mood disorders. This study found that in the 3 years prior to an index diagnosis, individuals with a first diagnosis of psychotic disorder had higher rates of mental health service use, particularly emergency department visits and hospitalizations, compared with individuals with a first diagnosis of a mood disorder. Individuals with psychotic disorders also had a greater number of premorbid diagnoses. Differences in health service utilization patterns between those with a first psychotic disorder diagnosis vs a first mood disorder diagnosis suggest distinct premorbid trajectories that could be useful for next steps in prediction and prevention research.

Mental health-related service and medicine use among a cohort of urban Aboriginal children and young people: Data linkage study.

The objective was to describe mental health service and psychotropic medicine use among a cohort of Aboriginal young people and quantify their relation to sociodemographic, family and health factors. In a prospective cohort study with data linkage, 892 Aboriginal children aged 0-17 years living in urban and regional areas of New South Wales, Australia, were included. We assessed mental health-related service use, paediatric service use and psychotropic medicine dispensing claims covered by the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme from July 2012 to June 2017. Most children (71%) did not have a record of mental health service or psychotropic medication use. 18.7% had ⩾1 mental health-related service claim; 26.7% had ⩾1 paediatric service claim; and 20.3% had ⩾1 psychotropic medicine dispensing claim. General practitioner services were the most accessed mental health-related service (17.4%) and 12.7% had been dispensed attention-deficit hyperactivity disorder medicines. Child characteristics associated with treatment included emotional and behavioural problems (prevalence ratio: 1.97, 95% confidence interval = [1.46, 2.64] for mental health services; prevalence ratio: 2.87, 95% confidence interval = [2.07, 3.96] for medicines) and risky behaviour (prevalence ratio: 1.56, 95% confidence interval = [1.12, 2.16] for mental health services; prevalence ratio: 2.28, 95% confidence interval = [1.54, 3.37] for medicines). Parent-related factors included chronic illness (prevalence ratio: 1.42, 95% confidence interval = [1.03, 1.95] for mental health services; prevalence ratio: 2.00, 95% confidence interval = [1.49, 2.69] for medicines) and functional limitations (prevalence ratio: 1.61, 95% confidence interval = [1.16, 2.24] for mental health services; prevalence ratio: 1.86, 95% confidence interval = [1.34, 2.59] for medicines). Most Aboriginal children and young people did not have claims for mental health services or medicines. Aboriginal children with emotional and behavioural problems, or parents with health problems were more likely to have mental health service or medicine claims.

Evaluation of a community-based brief intervention service for youth in crisis with suicidal ideation or self-harm.

To evaluate the implementation of a mixed virtual and in-person brief intervention for young people, aged 12-25 years, presenting to a large urban mental health service in crisis with suicidal ideation and/or self-harm. A pragmatic, real-world evaluation was conducted on the Youth Brief Intervention Service between June 2021 (inception) and October 2022. Service users were offered four sessions over an approximate one-month period. Sessions focused on distress tolerance, safety plans and support systems. Implementation outcomes related to service uptake, retention, fidelity of the model and service user experience. Effectiveness outcomes were measured pre-post and included mental health-related hospital service utilization (primary outcome), functioning, mental health status, self-harm, suicidal ideation and quality of life. Of the 136 young people referred to the Youth Brief Intervention Service, 99 were accepted with 17 disengaging before the first session. Eighty percent of people who commenced, completed the package of care. Young persons' and parent/carers experience of service was high (97% and 88%, respectively). Mental health-related emergency department presentations and inpatient days decreased from 3 months pre-intake to 3 months post-intake (42 vs. 7 presentations, X2 = 25.3, p < .001; 11 vs. 0 inpatient days, X2 = 9.1, p = .01). There were significant improvements in mental health status, days engaging in self-harm, general health and functioning and quality of life. The Youth Brief Intervention Service is feasible, acceptable, subjectively beneficial and coincided with less mental health-related emergency department presentations and inpatient days, and improved mental health status and behaviour.

Tackling poor mental health and self-harming tendencies among students: Indicative evidence of the effectiveness of a novel partnership-based approach to intervention

Poor mental health and self-harm are becoming increasingly common in student populations. Strategic partnerships between universities and NHS mental health services can ensure that students have access to appropriate support. The current paper reports on a pilot service evaluation of a brief therapy service for students who have recently self-harmed, namely University-Community Outpatient Psychotherapy Engagement (U-COPE) service. The aim of the pilot evaluation was to ascertain the efficacy of the U-COPE service as well as offer insights around partnership working between university and NHS mental health services in relation to the design, implementation, and delivery of the U-COPE service. Students completed measures of psychological distress before and after the intervention, as well as across the four therapy sessions. There was a reduction in psychological distress between assessment and discharge. Psychological distress also reduced significantly between the first and final therapy session. Most students (93%) continued their programme of study from the year in which they had accessed the U-COPE service to their next year of study. The provision of brief, relational psychotherapy to students presenting with self-harm related difficulties is a novel approach to intervention. The success of this approach illustrates how multiple organisations play a role in supporting student mental health, bringing a blend of diverse skills and expertise together. Although the U-COPE service shows promise as a brief intervention for students who self-harm, these findings should be treated with caution due to the small sample size. Further investigation of this brief intervention is warranted to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours.

Telemedicine Trends and Lessons Learned During the COVID-19 Pandemic-World Trade Center Health Program, 2020-2021.

The World Trade Center (WTC) Health Program, a limited federal health care program for eligible people exposed to the terrorist attacks on September 11, 2001, expanded telemedicine services during the COVID-19 pandemic (2020-2021). We analyzed service use trends from January 2020 through December 2021 to describe how the program implemented telemedicine services. About three-quarters (75%) of telemedicine visits were for mental health-related services. In the second quarter of 2020 (April-June), the number of telemedicine visits per 1000 members (n = 367) increased, exceeding in-person visits (n = 152) by 1.4-fold. The number of telemedicine visits per 1000 members decreased gradually during the rest of the study period but still represented 38% of total visits by the end of 2021. Changes in telemedicine visits were offset by comparable changes for in-person visits, such that the rate of total visits was essentially constant during the study period. Multivariate logistic regression models showed differences in telemedicine visit rates by member type and by demographic characteristics. Survivor members (vs responder members), those self-identified as non-Hispanic Other races (vs non-Hispanic White), those with preferred language not English (vs preferred language English), and those not living in the New York metropolitan area (vs living in the New York metropolitan area) were less likely to use telemedicine. Implementing telemedicine services in the WTC Health Program during the COVID-19 pandemic underscored the importance of extensive collaboration among partners, the capacity to rapidly develop necessary technical guidance, and the flexibility to address frequent regulatory guidance updates in a timely fashion. These lessons learned may guide similar health care providers posed with time-sensitive disruptions of in-person services.

Designing Attitudinal Environments to Address Stigma: Virtual Film Screenings and Panel Discussions on Dementia in a Health Promotion Program

AbstractBackgroundIntersectoral partnerships are critical for effective and sustainable health promotion programs. Yet stigma and misperception continue to interfere with public engagement in dementia prevention programs, outreach, and willingness to access to dementia and‐or mental health related services for persons living with Alzheimer’s and‐or related disorders and personal carers. The aim of our Public Health Agency of Canada Dementia Community Investment project, What Connects Us∼Ce Qui Nous Lie (2020‐2023), was to collaboratively cultivate sociocultural environments worth living in using shared activities and events to address stigma at the intersection of dementia, aging and mental health. In this paper, we present initial results on the effectiveness of using on‐line, community screenings of short films featuring stories about living with dementia, followed by curated panel discussions with the film directors, arts/culture partners, policy makers and other stakeholders.MethodWe employed a mixed methods ethnographic approach to describe and measure the impact of six film screenings with pre/post‐film and then later post‐discussion measures of semantic sentiment. All discussions were simultaneously interpreted, and based on open‐ended qualitative questions that had been developed with panelists prior to the screening. The qualitative questions asked for one word/phrase responses to generate word clouds in French and English. Three researchers then assessed the words/phrases until agreement on positive or negative value was reached. French words were back‐translated into English prior to analysis using suzy‐net, a natural language processor, to confirm positive/negative valence and to measure changes within each film screening and across all film screenings.ResultThere was a significant change in sentiment from negative (e.g., frustration, lies, loss, confusion) to positive sentiment (e.g., humanity, empathy, compassion, understanding) across all waves within and across the six screenings, with the most change occurring post‐discussion. In addition, partners and project‐related team members were removed from the analysis to test for partner participation confounding with the overall shift in valence remaining the same.ConclusionFilms about living with dementia, and curated questions developed in collaboration with panelists and directors of 1st person experiences can positively impact changes in sentiment about dementia.

The Relationship Between Entrapment and Attitude Towards Seeking Mental Health Services Among Young Adults: A Pilot Study

Background: Many studies have been carried out in the past that discovered a link between different types of mental health conditions and help-seeking attitudes, but the link between entrapment and attitude towards seeking mental health services remains unknown. Objective: The study is pilot research that aims to fill the research gap by investigating the existence of association between feelings of entrapment and young adults' attitudes toward accessing mental health care. Method: A random sample of young individuals (n=90) in the age range of 18-30 years living in the Delhi NCR area of India were invited to complete the questionnaires to determine their level of entrapment and attitude towards seeking mental health care. Result: It was discovered that the two variables (feelings of entrapment and attitude towards seeking mental health services) have a significant negative relationship (r = -.855). Conclusion: Based on the findings, it is concluded that a high level of entrapment is associated with unfavourable attitudes regarding getting mental health-related services. Based on the findings, recommendations for a broader, more thorough investigation can be conducted.

Mental health services for Muslim communities in England and Wales: developing a more collaborative model

ABSTRACT The landscape of mental health services for Muslim communities in England and Wales remains fragmented with many Muslims unsure how to access services that accommodate their religious beliefs and practices. This article reports findings from a pilot study of mental health services and Muslim communities in England and Wales. It explores the role of Muslim mental health organisations, charities, therapists, counsellors, faith leaders and community groups in supporting the communities they serve. The study’s aim was to establish a larger project to identify and amplify best practice across mainstream and non-mainstream mental health services in relation to improving provision for Muslim communities. Focus group data from key informants was analysed using grounded theory. Four analytical themes emerged from the analysis: “Knowledge gaps”, “Policy gaps”, “Working together” and “Moving forward”. Based on this, the authors argue for an asset-based approach to building collaborative partnerships between Muslim communities and mental health providers.

Chronic Psychotic Disorders and Correctional Involvement: A Population-Based Matched Case-Control Study in Ontario, Canada.

Individuals with chronic psychotic disorders are overrepresented in correctional facilities, but little is known about factors that increase the risk of correctional involvement. The objective of this study was to compare individuals with chronic psychotic disorders who were released from correctional facilities in Ontario to individuals with chronic psychotic disorders but no correctional involvement on sociodemographic, clinical, and prior mental health-related health service utilization characteristics. All individuals with chronic psychotic disorders who were released from a provincial correctional facility in Ontario in 2010 were matched (1:2) by age and sex to Ontario residents with chronic psychotic disorders and no correctional involvement. Covariates included sociodemographic (rural residence, marginalization such as residential instability quintile, material deprivation quintile, dependency quintile, and ethnic concentration quintile) and clinical (duration of chronic psychotic disorder and comorbidities) characteristics, and mental health-related health service utilization characteristics (primary care physician, psychiatrist and emergency department visits, and hospitalizations) 1 and 3 years prior to correctional involvement. The association between correctional involvement and prior health service utilization was measured by estimating incidence rate ratios using Poisson and negative-binomial regressions. Individuals with correctional involvement (N = 3,197) lived in neighbourhoods with higher material deprivation and residential instability, and had a shorter duration of illness, and more psychosocial comorbidities (e.g., behavioural issues and depression) than individuals without correctional involvement (N = 6,393). Adjusting for sociodemographic and clinical variables, individuals with correctional involvement had a higher rate of mental health-related primary care physician visits, emergency department visits, and hospitalizations but a lower rate of psychiatrist visits prior to correctional involvement, compared to individuals without correctional involvement. Despite higher mental health-related comorbidities and higher rates of accessing acute mental health services among individuals with chronic psychotic disorders and correctional involvement, visits to psychiatrists prior to involvement were low.

Utilization of mental health services in relation to the intention to reduce chemsex behavior among clients from an integrated sexual health services center in Taiwan

IntroductionThe intention of chemsex-practicing gay and bisexual men and other men who have sex with men (GBMSM) to reduce their drug use is an important factor for the utilization of harm reduction services. This study aimed to examine data from an integrated sexual health services center to understand the relationship between the intention to reduce chemsex behavior and chemsex-related utilization of mental health services among GBMSM who engage in chemsex.MethodWe used data collected from Healing, Empowerment, Recovery of Chemsex (HERO), an integrated health center in Taiwan, between November 2017 and December 2021. As the baseline, clients were asked to rate the current and ideal proportions of their sexual activities that involved the use of MDMA, ketamine, methamphetamine, GHB/GBL, or mephedrone. Having the intention to reduce chemsex was defined as having a lower proportion of ideal engagement compared to actual engagement. The data on the use of the services provided at HERO were linked to the survey responses and compared to information gathered during regular follow-up visits. Univariable and multivariable logistic regression analyses and a Poisson regression analysis were performed on the data.ResultsA total of 152 GBMSM reported engaging in chemsex, of whom 105 (69.1%) expressed the intention to reduce their chemsex behavior. Service utilization ranged from 23.0% for participating in meetings of a chemsex recovery group, 17.1% for visiting a mental health clinic, and 10.5% for using both of these services. The intention to reduce chemsex behavior significantly associated with visiting a mental health clinic (aOR = 4.68, p < 0.05), but its association with attending meetings of a chemsex recovery group was only marginally significant (aOR = 2.96, p < 0.1). Other factors that remained significantly associated with service use were a high frequency of substance use and living with HIV.ConclusionComprehensive harm reduction strategies, which touch on mental health, drug use management and recovery, are needed for those who want to reduce their chemsex behavior. Public health practitioners should endeavor to raise awareness of resources that are available for people who engage in chemsex and to minimize the barriers blocking their access to the appropriate services.

Sexually Transmitted Infection/Human Immunodeficiency Virus, Pregnancy, and Mental Health-Related Services Provided During Visits With Sexual Assault and Abuse Diagnosis for US Medicaid Beneficiaries, 2019.

Centers for Disease Control recommends that the decision to provide sexually transmitted infection (STI)/human immunodeficiency virus (HIV) testing and presumptive treatment to patients who report sexual assault and abuse (SAA) be made on an individual basis. The 2019 Centers for Medicare & Medicaid Services national Medicaid data set was used. The SAA visits were identified by International Classification of Diseases 10th Revision Clinical Modification (O9A4 for pregnancy-related sexual abuse, T74.2 for confirmed sexual abuse, and Z04.4 for alleged rape). The initial SAA visit was defined as the patient's first SAA-related visit. Medical services were identified by International Classification of Diseases 10th Revision Clinical Modification codes, Current Procedural Terminology codes, and National Drug Code codes. Of 55,113 patients at their initial SAA visits, 86.2% were female; 63.4% aged ≥13 years; 59.2% visited emergency department (ED); all STI/HIV tests were provided in ≤20% of visits; presumptive gonorrhea and chlamydia treatment was provided in 9.7% and 3.4% of visits, respectively; pregnancy test was provided in 15.7% of visits and contraception services was provided in 9.4% of visits; and diagnosed anxiety was provided in 6.4% of visits. Patients who visited ED were less likely to have STI testing and anxiety than those visited non-ED facilities, but more likely to receive presumptive treatment for gonorrhea, testing for pregnancy, and contraceptive services. About 14.2% of patients had follow-up SAA visits within 60 days after the initial SAA visit. Of 7821 patients with the follow-up SAA visits within 60 days, most medical services provided were chlamydia testing (13.8%), gonorrhea testing (13.5%), syphilis testing (12.8%), HIV testing (14.0%); diagnosed anxiety (15.0%), and posttraumatic stress disorder (9.8%). Current medical services during SAA visits for Medicaid patients are described in this evaluation. More collaboration with staff who handle SAA will improve SAA-related medical services.

The Effectiveness of Peer Support in Personal and Clinical Recovery: Systematic Review and Meta-Analysis.

Peer support has been shown to support personal recovery from mental illness. It is unclear whether the effects of peer support across different mental illnesses depend on the organizational setting. The authors reviewed the effectiveness of peer support for both personal recovery and clinical recovery of adults with any mental illness and evaluated the effectiveness of peer support in different settings. A systematic review of randomized controlled trials (RCTs) was conducted in PubMed, PsycInfo, CINAHL, Cochrane Library, and Web of Science. A meta-analysis of outcomes of personal and clinical recoveries at the end of interventions was conducted. In total, 49 RCTs with 12,477 participants with any mental illness were included. Most of the trials had a high risk for bias. Results of the meta-analysis indicated that peer support in general had a small positive effect on personal recovery (standard mean difference [SMD]=0.20; 95% CI=0.11-0.29) and decreased anxiety symptoms (SMD=-0.21; 95% CI=-0.40 to -0.02), with most trials evaluating peers added to mental health-related hospital services. No data for peers in established service roles were available for the meta-analysis. Peer-designed interventions developed to be provided independently of hospital services and delivered in community settings had a modest effect on self-advocacy. A small nonsignificant effect on personal recovery for peer support delivered online was also observed. The effect on personal recovery from mental illness was most evident in peer support added to hospital services. High-quality RCTs with comparable cocreated interventions and clear descriptions of mechanisms of change are needed to further investigate peer support efficacy.

Mental health-related healthcare service utilisation and psychotropic drug dispensation trends in British Columbia during COVID-19 pandemic: a population-based study

BackgroundThe impact of the COVID-19 pandemic on the population’s mental health is vital for informing public health policy and decision-making. However, information on mental health-related healthcare service utilisation trends beyond...

Barriers and Challenges in Mental Healthcare Utilization among Pregnant Women in Rural India -A Narrative Review

Mental disorders during pregnancy affect the health of both mother and child and are considered a significant public health problem. It was found that household-related barriers, health facility-related challenges, lack of resources at primary health centres, poor screening facilities, stigma and discrimination, and poor knowledge and awareness are the most critical barriers to accessing mental health-related services in rural India. As stated by the World Health Organisation, four hundred fifty million people suffer from mental disorders globally. The prevalence of lifetime mental morbidity, as per NMHS 2016, is 13.9%. A significant public health issue is that approximately 150 million people in our nation need active mental health intervention, according to the 2016 National Mental Health Survey of India. Women are more susceptible to problems with their mental health. The review aims to identify and recognize barriers and challenges in receiving mental health services among rural pregnant women in India to assess and prioritize the most prevalent barriers and challenges within this population. Changes in the current policies and strategies related to poverty and health programs strengthening knowledge, awareness, and economy are a few suggested strategies in this article. This review article discusses how mental health issues affect pregnant women and their children. It's a significant problem in rural India due to household issues, lack of knowledge, stigma, limited healthcare facilities, etc. Around 150 million people in India need mental health help. This article suggests ways to improve this situation, through better healthcare facilities, awareness, and policy changes. It also emphasizes the need to focus on mental health during pregnancy to ensure the well-being of both the mother and the child: Mental health, Rural Health, Pregnant Women.

Identifying Resource Needs and Experiences of the Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning+ Community during the Coronavirus Disease-2019 Pandemic

Introduction Lesbian, gay, bisexual, transgender, queer, and questioning+ (LGBTQ+) people have historically faced disproportionate economic and health-related challenges, which have likely been further exacerbated by coronavirus disease-2019 (COVID-19). To provide support and equitable resources for this community, it is critical to identify resource needs and challenges and understand the experiences of this community during the COVID-19 pandemic. Materials and Methods We administered an online survey to examine the experiences and needs of minority LGBTQ+ people, ages 18-35, who resided in an Ending the Human Immunodeficiency Virus (HIV) Epidemic (EHE) metropolitan jurisdiction in the Southeastern United States (U.S.). Results Since the onset of COVID-19, the majority of survey respondents reported increases in mental health symptomology and substance use, and decreases in economic stability, food security, and medical care access. Conclusion The findings support the need for extended reach of substance use and mental health-related services, linkage to medical/sexual healthcare, and financial assistance.

Social Disparities in Mental Health Service Use Among Children and Youth in Ontario: Evidence From a General, Population-Based Survey.

To examine differences in mental health-related service contacts between immigrant, refugee, racial and ethnic minoritized children and youth, and the extent to which social, and economic characteristics account for group differences. The sample for analyses includes 10,441 children and youth aged 4-17 years participating in the 2014 Ontario Child Health Study. The primary caregiver completed assessments of their child's mental health symptoms, perceptions of need for professional help, mental health-related service contacts, experiences of discrimination and sociodemographic and economic characteristics. Adjusting for mental health symptoms and perceptions of need for professional help, children and youth from immigrant, refugee and racial and ethnic minoritized backgrounds were less likely to have mental health-related service contacts (adjusted odds ratios ranged from 0.54 to 0.79), compared to their non-immigrant peers and those who identified as White. Group differences generally remained the same or widened after adjusting for social and economic characteristics. Large differences in levels of perceived need were evident across non-migrant and migrant children and youth. Lower estimates of mental health-related service contacts among immigrant, refugee and racial and ethnic minoritized children and youth underscore the importance and urgency of addressing barriers to recognition and treatment of mental ill-health among children and youth from minoritized backgrounds.

Excess healthcare costs of psychological distress in young women: Evidence from linked national Medicare claims data.

The prevalence of mental health disorders in young adults is increasing, yet there is limited empirical evidence on its economic consequences. We contribute to the literature by estimating the healthcare costs of psychological distress using panel data of young women (aged 18-23years with a 5-year follow-up) from the Australian Longitudinal Study on Women's Health and linked administrative data from Medicare Australia. Our empirical strategy is based on the classical two-part model of healthcare costs with individual specific fixed-effects. We complement our analysis with a test for selection on unobservables to address potential concerns of endogeneity. We find that young women with psychological distress have 15% higher annual healthcare costs (excluding hospital costs) than women with no psychological distress. A large proportion of these costs is driven by the use of antidepressants and the services of psychiatrists and psychologists. We further find that women with psychological distress have higher out-of-pocket costs on these mental health related services compared to non-mental health specific services. Additionally, we show that the effect of psychological distress on healthcare costs is highest during the first 6months of onset, which gradually decreases afterwards. The findings justify the importance of policy initiatives towards early prevention and treatment of psychological distress, especially among young women.

Older adults access to mental health and social care services during COVID-19 restrictions in Western Australia

ABSTRACT Objective This study aimed to understand the impact of COVID-19 on access to mental health and social services among older adults in Western Australia. Method A cross-sectional study was conducted with 194 adults aged ≥70 years or ≥60 years with chronic conditions. A questionnaire co-developed by a consumer reference group was used to collect data on social networks and service access. Frequency analyses were used to assess quantitative data. Qualitative data were assessed using thematic analyses. Results 62.7% of participants reported being not at all/slightly affected by COVID-19; 40.7% reported having three/four people to chat with. 76.3% of participants did not access mental health or social services during the 2020 COVID-19 restrictions. The remaining 23.7% mostly accessed mental health-related services, with GPs the most common source of support. 18.0% of the total sample reported choosing not to access services even though they would have liked to. Conclusions Most older adults in this sample did not access mental health or social care services. 18.0% of all participants felt they needed services but did not access them. This suggests there were some unmet needs within the community. Strengthening social networks may help protect older adults against psychosocial declines during and post-COVID-19.

Role of Mosque Communities in Supporting Muslims with Mental Illness: Results of CBPR-oriented Focus Groups in the Bay Area, California.

Objective The purpose of this study was to explore perspectives of Muslims residing in the Bay Area, California on the role of the mosque community in supporting community members' mental health needs and barriers to mental health care for members who experience mental health challenges. Methods This study employed a CBPR-focused qualitative approach in the form of content analysis of three focus group discussions organized and conducted with the help of a Community Advisory Board made up of members of the Muslim Community Association. Results Two major themes were identified upon examination of the data: services needed in the mosque community and barriers to addressing mental health issues in the mosque community. Specifically, participants reported wanting support groups within the mosque space, mosque-based activities, virtual support, community social workers, and family-oriented services. Barriers reported included community stigma, lack of cultural awareness of race-ethnic minorities within the community, attribution of mental illness to lack of faith or supernatural causes, and specific barriers unique to vulnerable/special subgroups within the community. Conclusion These findings highlight the need for developing mental health-related services and social support initiatives within the mosque space, specifically for those Muslim Americans living in the Bay Area in California. Furthermore, special attention needs to be placed on the barriers to accessing these services as identified by the community members.

Utilisation and costs of mental health-related service use among adolescents.

The high level of care needs for adolescents with mental health conditions represents a challenge to the public sector, especially in low and middle-income countries. We estimated the costs to the public purse of health, education, criminal justice and social care service use associated with psychiatric conditions among adolescents in Brazil; and examined whether the trajectory of psychopathology and its impact on daily life, and parental stigma towards mental illness, was associated with service utilisation and costs. Data on reported service use among adolescents from a prospective community cohort (n = 1,400) were combined with Brazilian unit costs. Logistic regression and generalised linear models were used to examine factors associated with service use and associated costs, respectively. Twenty-two percent of those who presented with a psychiatric disorder used some type of service for their mental health in the previous twelve months. Higher odds of service use were associated with having a diagnosed mental disorder (either incident, [OR = 2.49, 95%CI = 1.44-4.30, p = 0.001], remittent [OR = 2.16, 95%CI = 1.27-3.69, p = 0.005] or persistent [OR = 3.01, 95%CI = 1.69-5.36, p<0.001]), higher impact of symptoms on adolescent's life (OR = 1.32, 95%CI = 1.19-1.47, p<0.001) and lower parental stigma toward mental illness (OR = 1.12, 95%CI = 1.05-1.20, p = 0.001). Average annual cost of service use was 527.14 USD (s.d. = 908.10). Higher cost was associated with higher disorder impact (β = 0.25, 95%CI = 0.12-0.39, p<0.001), lower parental stigma (β = 0.12, 95%CI = 0.02-0.23, p = 0.020) and white ethnicity (β = 0.55, 95%CI = 0.04-1.07, p = 0.036). The impact of mental health problems on adolescents' daily lives and parental stigmatising attitudes toward mental illness were the main predictors of both service use and costs.