Mental Health Related Services Research Articles

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.

Treatment Use and Costs Among Privately Insured Youths With Diagnoses of Bipolar Disorder

Recent evidence suggests that children are increasingly diagnosed as having bipolar disorder, yet no studies have quantified treatment costs for pediatric patients. The objectives of the study were to identify one-year health services utilization and treatment costs among youths newly diagnosed as having bipolar disorder. MarketScan administrative claims from 2005 to 2007 were used to construct a retrospective person-level cohort of children ages zero to 17 to identify one-year health services utilization and costs among privately insured youths with a bipolar diagnosis. Inpatient and outpatient services were categorized as mental health related or non–mental health related. Pharmacy costs were classified as psychotropic or nonpsychotropic. In the sample (4,973 youths), one-year mean reimbursements for health services were $10,372, and patient out-of-pocket spending was $1,429 per child. Mental health services accounted for 71% of all health care spending, with psychotropic medications and inpatient care contributing the largest proportions of total spending (24% and 27%, respectively) . The costs of care among privately insured children with bipolar disorder are similar to those of adults. However, spending on children is concentrated on mental health–related services. Because private insurance plans have historically limited mental health service benefits, the concentration of spending on mental health services may place a greater burden on families for out-of-pocket payments. As mental health parity is adopted by private insurers, monitoring its impact on patient utilization and costs of health services will be important, particularly for children with serious mental illness.

Normal life crises and insanity—mental illness contextualised

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city's population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one's disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client's socio-economic and psychosocial needs, rather than solely follow a medical model.

Service Utilization by Hospitalized Suicide Attempters With Schizophrenia or Depression in Montreal

The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide. This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression). Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women. The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.

The Impact of the Process of Deinstitutionalization of Mental Health Services in Canada: An Increase in Accessing of Health Professionals for Mental Health Concerns

This research evaluates accessing of community-based mental health services in relation to the ongoing process of deinstitutionalization of mental health services in Canada. From 1998/1999 to 2002/2003, the process of deinstitutionalization decreased in intensity among the provinces that implemented deinstitutionalization earlier and increased in intensity among the provinces that implemented deinstitutionalization later. By 2002/2003, average days of care per 1,000 population in psychiatric units in general hospitals exceeded days of care in psychiatric hospitals (transinstitutionalization). Accessing of community-based mental health services by individuals with higher levels of psychological distress increased in all provinces from 1998/1999 to 2002/2003.

Welcoming People with Mental Health Problems into Mainstream Market Research

As an agency-trained researcher, the two years I spent as Head of Research at a mental health charity opened my eyes to the fact that mental health problems are ‘invisible’ and widespread, and that people with mental health problems regularly face exclusion. During this time I conducted many research projects among people with mental health problems, usually about mental health-related issues and services, through which I responded to feedback and constantly amended my approach to ensure that I was providing a high-quality and inclusive research environment. My attention was also drawn to the fact that many people with mental health problems are also consumers of mainstream products and services, and therefore form a notable proportion of the population of participants involved with mainstream research projects. In this article I will discuss ‘best practice’ ways in which mental health problems should be considered when conducting mainstream qualitative research projects, and focus groups in particular.

Mental health rehabilitation services in Ireland: vision and reality.

The Irish national mental health policy document, A Vision for Change , included recommendations to develop specialist rehabilitation mental health services. This survey was conducted as part of a multicentre study to investigate current provision of mental health rehabilitation services in Ireland and factors associated with better clinical outcomes for users of these services. The aim was to carry out a detailed national survey of specialist rehabilitation services in order to describe current service provision. A structured questionnaire was sent to consultant rehabilitation psychiatrists in all mental health catchment areas of Ireland that had any rehabilitation services to gather data on various aspects of service provision. Twenty-six of the 31 mental health areas of Ireland had some form of rehabilitation service. Sixteen teams working in 15 of these areas fulfilled A Vision for Change criteria to be defined as specialist rehabilitation services and all 16 responded to the survey. The overall response rate was 73% (19/26). Most services lacked a full multidisciplinary team. Only one service had an assertive outreach team with acceptable fidelity to the assertive outreach model. Urban services were less well resourced than rural services. This is the first national survey to describe the provision of mental health rehabilitation services in Ireland. Although there has been an increase in the provision of consultant-led specialist rehabilitation services nationally, these services lack multidisciplinary input. There also appears to be a lack of planned provision of the facilities required to provide comprehensive rehabilitation services with unequal distribution of resources between urban and rural areas. This has potential cost implications for local mental health services in relation to 'out of area treatment' placements and perhaps more importantly to the overall quality of patient care.

Willingness to Use Mental Health Services Among Older Residents in Assisted Living

Examining the importance of mental health care in assisted living (AL) settings, the present study examines older AL residents’ willingness to use mental health services and its predictors. Data based on face-to-face interviews with 150 older residents from 17 AL settings in Florida are used in the analyses ( Mage = 82.8, SD = 9.4). Multivariate logistic regression is used to estimate the likelihood of willingness to use mental health services in relation to predisposing (demographics and physical health), mental health needs (depressive symptoms), and enabling variables (social network, instrumental support, emotional support, informational support, satisfaction with support, and previous use of mental health services). Willingness to use mental health services is predicted by younger age, unmarried status, lower levels of emotional support, and higher levels of informational support. The relationship of informational support to higher willingness to use mental health services suggests that AL residents could benefit from educational interventions on late life depression.

Physical and Mental Health of Disaster Victims: A Comparative Study on Typhoon and Oil Spill Disasters

The purpose of this study was to compare the physical and mental health status of disaster victims according to disaster types, such as a typhoon disaster and an oil spill disaster, and to suggest adequate health care services for them. A total of 484 people who suffered disasters were selected for this study, and data were collected from July to August, 2008. The data-set for this study included 286 victims of typhoon disasters in Jeju and Jeollanamdo district in South Korea, and 198 victims of the oil spill disaster in Taean. Physical health status was measured using revised Patient Health Questionnaire and mental health status was measured using the Korean version of 'Post-traumatic Diagnostic Scale'. According to the comparative analyses of typhoon disaster victims and oil spill disaster victims, poorer physical health outcomes were shown among the oil spill disaster victims when compared to the typhoon disaster victims. Also, the oil spill disaster victims showed symptoms of depression, anxiety, and post-traumatic stress disorder, at rates higher than those found among the typhoon disaster victims. These findings suggest that there is a need to provide adequate physical and mental health-related care services for oil spill disaster victims. The seriousness of oil spill disaster should be realized and reconsidered in developing recovery strategies and disaster preparedness for physical and mental health services.

Editorial

In the United Kingdom (UK) the Government for England has recently published an updated version of its policy for people with learning disabilities: Valuing People Now (Department of Health 2009) replaces Valuing People (Department of Health 2001). It will be some time before papers about Valuing People Now reach publication (although I’d certainly welcome manuscripts that analyse this and other policy initiatives for publication in the journal). However it has been a busy time in the UK for policy in learning disabilities and I’d like to mark this in some way in the journal. It is difficult to think of a time since the early 1970s when learning disability has been such an issue in terms of policy in this country. In 2007 the Disability Rights Commission published the results of an investigation that were an indictment of health services for people with mental health problems and people with learning disabilities (Disability Rights Commission 2007). The same year Mencap (2007) published Death by Indifference which as its title suggests claimed that health services in the UK do not take into account the needs of people with learning disabilities particularly in hospitals. Six cases were detailed in which people died as a result of neglect, misunderstandings and ignorance. The Government’s response was to set up an Independent Inquiry into the health of people with learning disabilities that led to recommendations that were accepted by the Government and incorporated into Valuing People Now (Michael 2008). I appreciate that this will be old news to most British readers and it appears that there is little difference in other countries where people with learning disabilities continue to be second class citizens. There are, however, few comparative studies to demonstrate this and to discuss similarities and differences between causes and solutions. Such studies would be welcome as submissions to the journal. Those of us who rather naively thought that the changes in the 1970s would lead to a brave new world of equality for people with learning disabilities have been disappointed, at least in part. There is still, despite resettlement and the closure of the large institutions overwhelming evidence of inequality both in terms of opportunity and outcome for people with learning disabilities. As far as change is concerned parts of Valuing People Now make depressing reading. Whilst it states that progress has been made, the thrust of the document is about still having to implement the principles of Valuing People. There are no new initiatives in the policy but an emphasis on getting things done. It appears that everything is in place to promote equalities for people with learning disabilities but that the tools are not being used. The challenge is to use existing policies to improve lives and move towards the equality that people with learning disabilities deserve. I hope that this journal can make an important contribution to this challenge. Sharing good practice is an important way of helping people in learning disability services to learn and move forward. Identifying weaknesses and poor practice will help to provide evidence for change in the future. New research into methods, views and ideas will help shape our understanding of what we need to do to promote equality. This issue of the Journal contains a mix of papers that reflect some of the major issues affecting people with learning disabilities today. Some discuss concerns about health. There is an evaluation of a programme to improve knowledge and skills about access to primary healthcare and a discussion of the experiences of children with learning disabilities in an acute hospital. Two papers concentrate on the important issue of mental health services in relation to people with learning disabilities. Other papers examine different aspects of sexuality as well as training, transition, and art therapy.

Gender Differences in Veterans Health Administration Mental Health Service Use: Effects of Age and Psychiatric Diagnosis

The objective of this study was to compare gender differences in mental health disease burden and outpatient mental health utilization among veterans utilizing Veterans Health Administration (VHA) mental health services in fiscal year 1999 (FY99), after the first Gulf War and significant restructuring of VHA services. We used logistic regression to examine the relationships among gender, age, diagnostic groups, and utilization of mental health and specialty mental health services in a national sample of veterans. The sample included 782,789 veterans with at least 1 outpatient visit in the VHA in FY99 associated with a mental health or substance abuse (SA) diagnosis. Subgroup analyses were performed for 4 diagnostic categories: 1) posttraumatic stress disorder (PTSD), 2) SA disorders, 3) bipolar and psychotic disorders, and 4) mood and anxiety disorders. Younger women veterans (<35 years old) were significantly less likely and older women (> or =35) more likely to use any mental health services in comparison with their male counterparts. Similar findings were observed for younger women diagnosed with SA or mood and anxiety disorders, but not among veterans with PTSD or bipolar and psychotic disorders, among whom no there were no gender or age differences. In the case of specialized services for SA or PTSD, women younger than 55 with SA or PTSD were significantly less likely to use services than men. Women veterans underutilized specialty mental health services in relation to men but receipt of mental health care overall in FY99 varied by age and diagnosis. Examining gender differences alone, without taking other factors into account, may not provide an adequate picture of women veterans' current mental health service needs.

Exploring Patterns of Court-Ordered Mental Health Services for Juvenile Offenders

Objective assessments of the risks and needs of court-involved youth may lead to judicial processing that is less vulnerable to actual or perceived racial discrimination. Using data from a statewide assessment system on African American and Caucasian status offenders and delinquents formally processed in one Missouri circuit over a 1-year period, the authors examined the association of race and other factors on court orders for mental health—related services. Relative to their population distribution, African Americans were overrepresented in the juvenile system and underrepresented in orders for mental health services. In the logit analysis, negative attitudes and behavior problems carried strong associations with orders for mental health services. Risk and need, not bias, were mostly strongly associated with orders for mental health treatment.

The Impact of Integrating Mental and General Health Services on Mental Health's Share of Total Health Care Spending in Alberta

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Innovations in Preventive Mental Health Care Services for Adolescents

Purpose This descriptive study examined programs designed to provide mental health-related preventive services to at-risk adolescents. Methods Qualitative interviews were conducted with state and local program directors and key personnel in public health and mental health departments and academic researchers who have initiated preventive services. Results States and local communities offer varied mental health-related preventive services for high-risk adolescents in diverse settings. Services include public education, screening, early intervention for adolescents, and educational programs for primary care providers. Funding mechanisms include state general funds, foundation grants, and Medicaid and the State Children's Health Insurance Program dollars. Evaluation is essential to maintain services and to persuade funders and other stakeholders to sustain these efforts. Conclusions State and local prevention-related mental health programs have been implemented with limited funding, but significant local advocacy and community support. More extensive evaluation and cost effectiveness studies may encourage policymakers to expand services. Further data are necessary to determine how prevention-related mental health programs can best serve vulnerable youth.

My use of mental health related services

This article describes the personal experiences of a person with Asperger's syndrome who has used various services aimed at improving clients' mental health, both public and private. A number of experiences are described as summarised below.a) Post‐traumatic stress caused by experiences of school bullying, being dismissed from a job, and a period of unemployment resulted in the author's referral to a Christian counselling centre. There, specialised counselling sessions proved very beneficial.b) Difficulties in social skills resulted in the author being referred by his general practitioner to a psychiatric nurse, who in turn referred him to an excellent social skills and assertiveness course run by the Mind mental health charity. Experience of further social skills training is also described.c) Low self‐esteem and recurrent insomnia as a result of poor inter‐personal experiences and lack of career progress relative to peer group led to an extended sequence of counselling sessions with a private Christian counsellor. Guided cognitive therapy with this counsellor resulted in a substantial alleviation of both the low self‐esteem and the insomnia.d) The author also received further counselling, from a different counsellor to acquire assertiveness skills, and the ability to deal with aggressive people.In all, the author's experience of mental health intervention was mainly low‐cost Christian counselling, working through self‐help books, and the occasional social skills course. Very little use was made of medication and none of hospital‐based services.

Use of social network analysis to describe service links for farmers' mental health

The primary mental health care needs of farmers require that service innovations incorporate rural support workers into a local service network. This component of the FarmLink pilot sought to develop a social network analysis method that would describe local mental health-related human service networks. The purpose is to inform improvements in this network and to serve as a baseline against which such improvements can be evaluated. A pilot survey of rural human service providers who deal with mental health-related issues among farmers about their self-reported links between each other. Service delivery agencies associated with a small rural town in New South Wales. Twenty-five agents from a range of human services involved in rural human support services to farmers, such as from agricultural and drought support, welfare, primary health care and education. Telephone interview prior to the conduct of a Mental Health First Aid seminar and a Farmers Mental Health and Wellbeing workshop. Agent self-reported service links over the past three months for information exchange, client referrals and working together in relation to helping farmers for mental health, emotional health or stress-related problems. Analysis trialled on the 'made referrals' link shows the network influence, prominence and intermediary status of the rural financial counsellor. Within the limitations of recalled self-report data, social network analysis provides a useful network description for informing and evaluating service network improvements.

Moving beyond the mental health care system: An exploration of the interfaces between health and non-health sectors

Background: Many interventions both to promote good mental health and to tackle the consequences of poor mental health may be funded and/or delivered outside the health care sector.Aims: To describe the interfaces between health and other sectors, particularly social care, in 17 European countries, and to look at potential ways in which challenges to the efficient and fair delivery of services across sectors may be overcome.Methods: A structured questionnaire was completed by partners in the Mental Health Economics European Network (MHEEN) to review the extent to which mental health related services are funded and delivered outside the health care sector, with a particular emphasis on social care services. This was augmented by a review of the literature.Results: The boundaries between health and other sectors differ across and within countries. The provision and funding of services may be highly fragmented and poorly coordinated, with little incentive for funding to follow individuals along the care pathway. Out-of-pocket payments for non-health sector services can be substantial and much responsibility may fall to families. Conclusions: Differing rules of entitlement, as well as fragmentation and poor coordination between health and non-health services can act as barriers to a truly holistic approach to mental health across Europe. Useful insights on how to overcome some of these barriers may be drawn from experiences of joint working and innovative financing arrangements in respect of older people and those with physical disabilities. However as yet there have been comparatively few attempts to smooth the sector interfaces that confront those with mental health needs.Declaration of interest: The Mental Health Economics European Network Phase I was supported by a grant (SPC.2002397) from the European Commission, Health and Consumer Protection Directorate.

Use of Mental Health–Related Services Among Immigrant and US-Born Asian Americans: Results From the National Latino and Asian American Study

We examined rates of mental health-related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors. Data were derived from the National Latino and Asian American Study (2002-2003). About 8.6% of the total sample (n=2095) sought any mental health-related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health-related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months. Asian Americans demonstrated lower rates of any type of mental health-related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans.

Incidence of suicide ideation and attempts in adults: the 13-year follow-up of a community sample in Baltimore, Maryland

Utilizing a prospectively designed community sample, we set out to estimate the rate of newly-incident suicidal ideation and attempts (non-fatal suicide behaviour) in a community sample, to evaluate antecedent sociodemographic characteristics and psychiatric disorders, and to assess use of mental health services in relation to non-fatal suicide behaviour. Prospectively-gathered data was utilized from 3481 continuing participants in the 13-year follow-up of the Baltimore sample of the NIMH Epidemiologic Catchment Area survey interviewed in 1981, 1982 and 1993/6. The incidence of suicide attempts was estimated at 148.8 per 100,000 person-years and ideation at 419.9 per 100,000 person-years. Persons in the youngest age group, in the lowest socioeconomic status, and previously married persons were at increased risk for non-fatal suicide behaviour during the follow-up interval. Persons who reported suicidal ideation at baseline were more likely to report having attempted suicide at follow-up (RR = 6.09, 95% CI 2.58-14.36). Psychiatric disorders, especially depression and substance abuse, were associated with new-onset of non-fatal suicidal behaviour. While persons who reported newly-incident suicidal behaviour were more likely to report use of mental health services, few said that suicidal ideation or attempts were the reason for the visits. Suicidal ideation is a common and important antecedent to suicide attempts and deserves more attention in community and general medical settings.

Serious emotional disturbance in children and adolescents: Current status and future directions

Research indicates low rates of identification, poor school performance and completion, and high rates of restrictive placements, despite federal mandates requiring appropriate educational and mental health-related services for children with serious emotional disturbance (SED). The present paper examines the current status of assessment and treatment needs of children with SED. A synthesis of child characteristics, diagnostic criteria, placement rates, and outcomes is presented. Challenges to appropriate and effective care for children with SED are outlined. Five empirically validated behavioral prevention and intervention models are described as examples of “programs that work” with this population. New frameworks are provided to stimulate future thinking on behavioral assessment and therapy for children with SED. Finally, priorities for professional development and research are described.