Mental Health Related Services Research Articles

Trauma and Aging.

The aim of this paper is to present a succinct summary of the major scientific findings on trauma, posttraumatic stress disorder (PTSD), and aging over the past few years. There have been several reports from longitudinal investigations using representative samples of veterans regarding traumatic exposure and subsequent effects on health and functioning. There has also been further documentation of the significant association between PTSD and dementia as well as accelerated aging in late life. Several studies indicate that older adults with PTSD are at risk of not receiving timely and appropriate mental health treatment, indicating that targeted outreach could be helpful in increasing service use and improving care. The current knowledge base would benefit from more research on traumatized older adults from non-industrialized countries, as well as those in North America from diverse backgrounds, including ethnic and racial minorities, women, and those with cognitive impairments. Studies limited to adults aged 65 and over as well as those addressing disparities in the availability of mental health-related services within this population are warranted.

The Public Cost of Mental Health- and Addiction-Related Services for Youth (Ages 12-17) in Alberta.

To measure the provincial government cost of mental health-related activities for youth ages 12 to 17 in Alberta in 2014 to 2015. The target population was Alberta youth ages 12 to 17 (the federal justice definition) who received or were funded for mental health-related or complementary services from Alberta Health Services, Alberta Health, Alberta Human Services, Alberta Justice and Solicitor General, and Alberta Education (public schools). Data on services and expenditures were obtained from each source for the target youth population. Costs for mental health-related services for all ministries were $175 million for 27,169 youth who used mental health services as defined by Policy Wise, $6460 per youth. Public school special education supplements for youth with emotional problems was the largest group, amounting to 30% of all costs. Other prominent sources of expenditures were hospital inpatient mental health services (18%), community mental health services (11%), physician mental health services (10%), and secure services with treatment requiring judicial approval (9%). Economists in several countries have developed countrywide measures of mental health expenditures and have used these to generate national benchmarks for mental health spending. We have estimated spending for Alberta provincial mental health and addiction services for a distinct and highly vulnerable group. This measure can be used to develop measures and benchmarks for other provinces, which will be valuable policy indicators.

PMH25 - Reduced Risk of Hyperprolactinemia Among Patients Treated With Atypical Antipsychotics That Are Associated with Low or No Prolactin Elevation

To compare the risk of hyperprolactinemia among patients receiving atypical antipsychotics (AAs). METHODS Commercially insured adults aged 18 to 64 who received AAs (all AAs were considered) were identified from Truven Commercial US claims data (2006Q1–2016Q3). Two mutually exclusive cohorts were identified based on whether patients received AAs with a mechanism of action associated with no/low prolactin elevation (Low Prolactin Cohort) or moderate/high prolactin elevation (High Prolactin Cohort). For each AA treatment episode, patients were observed from start to end of treatment with the same AA. All AA treatment episodes (defined by gaps ≥180 days or AA change) were analyzed. Entropy balancing was used to reweight treatment episodes, so that the two cohorts have similar demographics, comorbidities, and mental health-related medical services. Risk of hyperprolactinemia was compared between cohorts using logistic-regression models. Analyses were replicated in Medicaid-insured patients. Among commercially insured patients, 446,673 and 77,532 AA treatment episodes were identified in the Low and High Prolactin cohorts. The mean treatment episode duration was 8 and 7 months in the Low and High Prolactin cohorts. The most commonly used AAs were quetiapine, aripiprazole, and olanzapine in the Low Prolactin Cohort, and risperidone, asenapine, and paliperidone in the High Prolactin Cohort. The prevalence of hyperprolactinemia while on treatment was 0.06% and 0.31% in the Low and High Prolactin cohorts. The odds of hyperprolactinemia in the Low Prolactin Cohort was 5 times lower than that in the High Prolactin Cohort (odds ratio=0.21; p<0.001). Similarly, the odds of hyperprolactinemia in the Low Prolactin Cohort (N=177,379) was 4 times lower than that in the High Prolactin Cohort (N=58,447) in Medicaid-insured patients (odds ratio=0.26; p<0.001). AAs associated with no/low prolactin elevation reduce the risk of hyperprolactinemia by up to 80% and may be considered in treatment decision-making to reduce the hyperprolactinemia burden in AA-treated patients.

Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study

ObjectivesMental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is...

Review: The impact of pediatric mental health care provided outpatient, primary care, community and school settings on emergency department use - a systematic review.

Increases in emergency department (ED) visits for pediatric mental health care point to a need to understand the impact of mental health services in relation to emergency-based care. This systematic review examined the impact of mental health services delivered in outpatient, primary care, community and/or school settings on ED use and costs for ED-based mental health care. Two electronic databases and gray literature were searched. Eligible studies consisted of randomized/controlled clinical trials or cohort studies examining the effects of mental health services on ED use and costs for this care. Two reviewers independently screened the studies for relevance and study quality. Relative risks (RR), risk differences (RD), or mean differences (MD) were calculated for each study's primary outcome with 95% confidence intervals (CI). Meta-analysis was deferred due to substantial heterogeneity. Six studies were included. Overall risk of bias in the studies ranged from low, unclear, to high. The majority of programs had no effect on ED visits for mental health care. A school-based program was found to reduce the risk of ED visits for any reason during use (RD, -8.0%; 95% CI: -15.2%, -0.9%); however, these visits were not specific to mental health. Three studies examined costs. A wrap-around clinical management program was associated with higher average ED costs per patient per month ($20.07 US dollars) compared to usual outpatient care; other studies reported no cost differences. At this time, there is limited evidence to suggest outpatient, primary care, community and/or school-based mental health services impact ED use and costs for mental health care. Additional studies are needed.

Impact of homelessness and unstable housing on adolescent health

The purpose of this study was to describe service utilization and associated costs of a statewide, Medicaid-insured population of homeless adolescents (HA). This was a secondary data analysis of statewide individual service-level data. The total costs for this sample (n=5259) was $84,077,009 over the study period. Mental health related services accounted for 40% of all costs. A small subpopulation (n=65) of the sample accounted for 28% of the total costs, all of which had mental health related services. In order to reduce costs and improve health outcomes, there is a need to expand mental health services for HA.

Suicide prevention in mental health services: A qualitative analysis of coroners' reports.

Suicide is a major concern for mental health nurses because of its clear correlation with mental illness. In New Zealand, coroners investigate all deaths that appear to be a result of suicide, and provide reports to mental health services (MHS). The aim of the present study was to investigate coronial recommendations to MHS in relation to suicide prevention and to examine clinical and family responses to these. The present study was a three-phase design: (i) analysis of coroners' recommendations related to suicide in MHS; (ii) interviews with clinicians for their response to the recommendations; and (iii) interviews with individuals working with families of consumers of MHS for their responses in relation to family-related recommendations. A qualitative content analysis was conducted on the recommendations from coroners, the interviews with clinical leaders, and the focus group for family workers. Coroners recommended that MHS should implement suicide-prevention strategies that would facilitate improved communication, risk containment, service delivery, and family involvement. Clinicians agreed with most recommendations, apart from those related to risk containment. Family workers endorsed the coronial perspective that family inclusion in MHS was suboptimal. Coroners, MHS, and mental health nurses need to consider the latest clinical evidence for suicide prevention. However, given the complexity of factors that influence suicide, it is important to be realistic about MHS role in preventing suicide, but ensure that MHS provide interventions for which there is evidence, including facilitating family participation and providing access to psychotherapies.

Trajectories of Mental Health–Related Service Use Among Adolescents With Histories of Early Externalizing Problems

PurposeTo inform efforts to reduce costly service utilization, the present study examined longitudinal trajectories of mental health–related outpatient and residential service use among at-risk youth with a history of early externalizing problems. MethodsA cohort of 809 children in the Fast Track Project, a multisite longitudinal study of children at risk for conduct disorder, were followed prospectively from kindergarten through 12th grade. They resided in high-risk areas with high rates of poverty, crime, and violence. Their outpatient and residential service use was assessed annually between sixth and 12th grades through parent report. Growth mixture modeling was applied to model individual differences in trajectories of service use during this period. Teacher, parent, and observer-reported childhood predictors of those trajectories were also examined. ResultsMost youths had minimal service use during preadolescence into adolescence. However, approximately 31% had moderate probability of using outpatient counseling services, and approximately 8% had elevated probability of seeing a family doctor for mental health needs. For residential services, approximately 6% had moderate to high probability of service use that peaked during transition to high school, whereas close to 5% had service use that dramatically increased during high school. Childhood predictors of these trajectories included earlier externalizing, internalizing, and emotion regulation problems. ConclusionsThis study is the first to use person-centered analytic methods to examine longitudinal trajectories in mental health–related service use among at-risk adolescents. Timely treatment for severe externalizing problems, comorbid internalizing problems, and emotion dysregulation during childhood may be crucial for preventing chronic service use.

Attending to physical health in mental health services in Australia: aqualitative study of service users' experiences and expectations.

Evidence is unequivocal: the premature death of people with severe mental health problems is attributable primarily to cardiovascular disease, and healthcare provided is often suboptimal. With the overarching aim of improving outcomes, policies and guidelines oblige mental health services and psychiatrists to monitor cardio-metabolic health of patients and intervene as appropriate. Practice is highly variable; however, with ongoing debate about resourcing and responsibilities dominated by clinicians who have identified disinterest among patients as influencing practice. Seeking to balance discussion, we posed the question 'what do patients experience and expect of mental health services in relation to their physical health?' To answer it, we interviewed a convenience sample of 40 service users recruited from a mental health service in Australia, early in 2015. Data were analysed using the framework approach. With few regarding themselves as healthy, participants were commonly concerned about side effects of medication, weight and fitness but rarely mentioned tobacco smoking. Participants' accounts reinforce extensive research demonstrating variability in attention to physical health in mental health services. Reports by some participants of comprehensive care are encouraging, but widespread uncertainty about reasons for various assessments and denial of requests for management of medication side effects, including weight gain, gives cause for concern. Although participants in this study wanted to improve their health and health-related quality of life, they acknowledged that their motivation and ability to do so fluctuated with mental health. They expected clinicians to work proactively, especially when symptoms compromised capacity for self-care, and mental health services to provide or enable access to health-promoting interventions. Attention should be given, as a matter of priority, to creating conditions (culture and infrastructure) needed to support sustained attention to physical health within services and, importantly, to full engagement of service users in management of their physical health.

Addressing Unmet Sexual Health Needs among Black Adolescents with Mental Illnesses.

Despite advances in HIV epidemiologic and prevention research, adolescents with mental illnesses remain a historically underserved group with respect to human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention resources. Black adolescents with mental illnesses in particular are a relatively underserved, hidden population in the field of sexual health. Strategies and guidelines are needed to account for underlying psychopathology among Black adolescents with mental illnesses in ways that current models have yet to address. In this paper, we propose several actionable mechanisms to better integrate HIV/STI and mental health related services and activities for sexual health promotion.

Mental health related contact with education professionals in the British Child and Adolescent Mental Health Survey 2004

Purpose – The purpose of this paper is to describe mental health-related contact with educational professionals amongst children in the British Child and Adolescent Mental Health Survey (BCAMHS) 2004. Design/methodology/approach – BCAMHS 2004 was a community-based survey of 5,325 children aged 5-16, with follow-up in 2007. This paper reports the percentage of children with a psychiatric disorder that had mental health-related contact with education professionals (categorised as teachers or specialist education services) and the percentage with specific types of psychiatric disorders amongst those contacting services. Findings – Two-thirds (66.1 per cent, 95 per cent CI: 62.4-69.8 per cent) of children with a psychiatric disorder had contact with a teacher regarding their mental health and 31.1 per cent (95 per cent CI: 27.5-34.7 per cent) had contact with special education either in 2004 or 2007, or both. Over half of children reporting special education contact (55.1 per cent, 95 per cent CI: 50.0-60.2 per cent) and almost a third reporting teacher contact in relation to mental health (32.1 per cent, 95 per cent CI: 29.7-34.6 per cent) met criteria for a psychiatric disorder. Practical implications – Many children in contact with education professionals regarding mental health experienced clinical levels of difficulty. Training is needed to ensure that contact leads to prompt intervention and referral if necessary. Originality/value – This is the first paper to report on mental health-related service contact with education professionals in the 2004 BCAMHS survey along with its 2007 follow-up. It identifies high levels of teacher contact which represent challenges in supporting staff with training, resources and access to mental health services.

Preferences of Young Adults With First-Episode Psychosis for Receiving Specialized Mental Health Services Using Technology: A Survey Study.

BackgroundDespite the potential and interest of using technology for delivering specialized psychiatric services to young adults, surprisingly limited attention has been paid to systematically assess their perspectives in this regard. For example, limited knowledge exists on the extent to which young people receiving specialized services for a first-episode psychosis (FEP) are receptive to using new technologies as part of mental health care, and to which types of technology-enabled mental health interventions they are amenable to.ObjectiveThe purpose of this study is to assess the interest of young adults with FEP in using technology to receive mental health information, services, and supports.MethodsThis study uses a cross-sectional, descriptive survey design. A convenience sample of 67 participants between the ages of 18 and 35 were recruited from two specialized early intervention programs for psychosis. Interviewer-administered surveys were conducted between December 2013 and October 2014. Descriptive statistics are reported.ResultsAmong the 67 respondents who completed the survey, the majority (85%, 57/67) agreed or strongly agreed with YouTube as a platform for mental health-related services and supports. The top five technology-enabled services that participants were amenable to were (1) information on medication (96%, 64/67); (2) information on education, career, and employment (93%, 62/67); (3) decision-making tools pertaining to treatment and recovery (93%, 62/67); (4) reminders for appointments via text messaging (93%, 62/67); and (5) information about mental health, psychosis, and recovery in general (91%, 61/67). The top self-reported barriers to seeking mental health information online were lack of knowledge on how to perform an Internet search (31%, 21/67) and the way information is presented online (27%, 18/67). Two thirds (67%; 45/67) reported being comfortable in online settings, and almost half (48%; 32/67) reported a preference for mixed formats when viewing mental health information online (eg, text, video, visual graphics).ConclusionsYoung people diagnosed with FEP express interest in using the Internet, social media, and mobile technologies for receiving mental health-related services. Increasing the awareness of young people in relation to various forms of technology-enabled mental health care warrants further attention. A consideration for future research is to obtain more in-depth knowledge on young people’s perspectives, which can help improve the design, development, and implementation of integrated technological health innovations within the delivery of specialized mental health care.

Motherhood and mental distress: Personal stories of mothers who have been admitted for mental health treatment

There is a need for qualitative studies on motherhood and mental distress. Many mothers have a diagnosis of mental illness, and their motherhood exists in constant tension with their distress. This paper focuses on 10 mothers’ stories about motherhood in relation to being admitted as mental health service users in three different Norwegian community mental health centers. The study has a narrative approach, and through a thematic analysis of personal stories, we emphasize how the 10 women make sense of their experiences of admittance to mental health services in relation to dominant Discourses of good motherhood. Themes identified were: (1) being able to put oneself in the child’s shoes; (2) the emotional impact of being admitted; (3) being open with the children about the admission; and (4) being an emotionally available and present mother. Based on the results of our analysis, we suggest the mothers experienced their distress as a natural reaction to life strains over time, and that they relate to the admissions as interruptions. This underlines the necessity of a more holistic approach, with a support system that focuses on both personal and social aspects of motherhood and mental distress.

Trajectories of Psychopathology in Relation to Mental Health Related Service Contacts over Three Years in the British Child and Adolescent Mental Health Survey 2004

Introduction Previously, a number of observational studies have found no association between contact with services and improved outcomes in children with psychopathology, despite the existence of effective interventions. The British Child and Adolescent Mental Health Survey (BCAMHS) 2004 is a study of 5,325 children aged 5-16, with data on parent-reported mental health-related public sector service contacts and psychopathology over three years, allowing exploration of the association in a large community-based dataset. Aims • Describe the trajectories of children in contact and not in contact with services over three years from 2004-2007 • Explore the association between mental health-related service contact over the study period and outcomes in terms of parent-rated psychopathology Methods This study is a secondary analysis of children's trajectories by service contact status (no contact, contact 2004 only, contact 2007 only, contact 2004 & 2007). The main measure of psychopathology over time was the well-validated Strengths and Difficulties Questionnaire. Multivariable linear regression was used to examine the association between contact and outcomes in children with a psychiatric disorder at baseline in 2004. Results Children in contact with services demonstrated the highest levels of psychopathology over time, and the 2007-only contact group displayed a trajectory of increasing difficulties. Overall, contact with services was not associated with improvement in outcomes, following adjustment for measured confounders. Conclusions The effectiveness of contact alone with services was not demonstrated in our findings. Despite methodological limitations, this underlines the need for continuing development and consistent implementation of effective interventions, alongside initiatives evaluating outcomes within services.

Comorbid antisocial and substance misuse proclivity and mental health service utilization by female inmates: testing the worst of both worlds hypothesis with the PAI.

The primary purpose of this study was to establish whether female inmates with comorbid proclivity for antisocial behavior and substance misuse, as measured by the Personality Assessment Inventory (PAI; Morey, 2007), use more mental health-related services than female inmates with either antisocial or substance misuse proclivity alone. A second purpose was to determine whether the effect of comorbid antisocial and substance misuse proclivity on mental health service utilization is cumulative or interactive. In a survey of 421 female federal prison inmates, it was noted that proclivity for both antisocial behavior and substance misuse was associated with significantly greater subsequent use of mental health services in female inmates than either proclivity alone, even after preexisting mental health diagnoses and treatment were controlled. In addition, the effect was additive rather than interactive. These findings provide further support for the "worst of both worlds" hypothesis, which holds that comorbid antisocial and substance involvement/proclivity portend poorer future outcomes than either antisocial or substance involvement/proclivity alone. The implications of these results for development of a comprehensive training model that provides mental health professionals with the skills to properly screen and effectively treat female inmates are discussed, along with the need to clarify the theory behind the "worst of both worlds" hypothesis.

NCAA Athletic Administrators’ Preferred Characteristics for Sport Psychology Positions: A Consumer Market Analysis

This study used a consumer marketing approach to investigate the market for sport psychology positions in National Collegiate Athletic Association (NCAA) institutions. Athletic administrators’ (AA) preferences for various sport psychology positions were compared based on time commitment, affiliation, payment, services, and clients. Results indicated that AAs were most attracted to positions that included (a) part-time commitment, (b) athletic department employment, (c) payment via annual salary, (d) both performance and mental health related services, and (d) work with athletes, teams, and athletics staff members. Over two thirds of the 478 AAs sampled were interested in hiring a sport psychology professional to fill that position. It was concluded that the field of sport psychology collaborate across disciplines and emphasize multiple options for meeting the perceived needs of NCAA athletic departments.

Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission.

A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status, electroconvulsive therapy, problems with activities of daily living and community contacts.

Homelessness in a National Sample of Incarcerated Veterans in State and Federal Prisons

The Veterans Health Administration (VHA) has been increasing efforts to reach out to assist incarcerated veterans. While previous studies have shown strong associations between incarceration and homelessness, few studies have examined distinctive characteristics of incarcerated homeless and non-homeless veterans. National administrative data on 30,348 incarcerated veterans served by the Health Care for Re-entry Veterans (HCRV) program were analyzed. Incarcerated veterans were classified into four groups based on their history of past homelessness: not homeless, transiently homeless, episodically homeless, and chronically homeless. Multinomial logistic regression was used to compare groups on sociodemographic characteristics, criminal justice status, clinical status, and their interest in using VHA services. Of the sample, 70 % were classified as not homeless, 8 % as transiently homeless, 11 % as episodically homeless, and 11 % as chronically homeless. Thus, 30 % of the sample had a homeless history, which is five times the 6 % rate of past homelessness among adult men in the general population. Compared to non-homeless incarcerated veterans, all three homeless groups reported significantly more mental health problems, more substance abuse, more times arrested in their lifetime, more likely to be incarcerated for a non-violent offense, and were more interested in receiving VHA services after release from prison. Together, these findings suggest re-entry programs, like HCRV, can address relevant mental health-related service needs, especially among formerly homeless veterans and veterans in need of services are receptive to the offer of assistance.

Family of people with a mental disorder and needs in psychiatric care

We aimed to learn about the needs of the family which provides care to a person with a mental disorder in the current model of health care. This is a qualitative study conducted in the municipalities of three regional health units in the state of Paraná, using data collection with thirty-two families. Data were analyzed by means of indicators. The results show gaps in the mental health services in relation to the care provided to people with a mental illness and their families with regard to the need for: adaptation after diagnosis of the pathology, family counseling, treatment compliance, hospitalization, financial assistance, transportation assistance, reintegration into society, inclusion in outpatient services after hospitalization, and the bond between professionals and people assisted. We conclude that these requirements need to be explored by mental health network professionals as to the possibility and implementation of deinstitutionalized, integral and decisive assistance to the person with a mental illness and his/her family.

Prevalence study of head shop drug usage in mental health services

Aims and methodTo examine the prevalence of head shop drug usage in individuals attending a range of adult mental health services. We examined the effect of head shop drug usage on the mental state of individuals with a range of mental health disorders. Clinical data were obtained from 608 consecutively reviewed individuals attending adult mental health services in relation to their use of head shop and psychoactive drugs and the putative effects of head shop drugs on their mental state.ResultsThe prevalence of head shop drug use was 13% (n= 78), with a higher prevalence of usage noted in individuals younger than 35 years of age (25%). A large proportion of individuals (n= 41, 54%) reported adverse effects of these agents on their mental state, with psychotic symptoms being the most prevalent.Clinical implicationsHead shop drug usage was associated with a reported deleterious effect on mental state, which was particularly evident for individuals with a history of psychosis.