Mental Health Services Research Research Articles

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

1167 T important role of general practitioners in prescribing antidepressant medications and treating depression has been documented. However, the extent to which general practitioners are prescribing other types of psychotropic medications has received less emphasis. This study used data from August 2006 to July 2007 from the National Prescription Audit (NPA) Plus database of IMS to examine this question. IMS collects transaction information each month from approximately 36,000 retail pharmacies, representing about 70% of all retail pharmacies, which when weighted represent all prescriptions filled in retail outlets in the United States. Using a separate sample of retail pharmacy transactions that includes the physician’s Drug Enforcement Administration number, IMS assigns physician specialty information to obtain an estimate of the total number of prescriptions filled in retail pharmacies by medical specialty. As shown Figure 1, of the 472 million prescriptions for psychotropic medications, 59% were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and nonphysician providers. General practitioners wrote prescriptions for 65% of the anxiolytics in the sample, 62% of the antidepressants, 52% of the stimulants, 37% of the antipsychotics, and 22% of the antimania medications. Conversely, psychiatrists and addiction specialists wrote prescriptions for 66% of the antimania medications, 49% of the antipsychotics, 34% of the stimulants, 21% of the antidepressants, and 13% of the anxiolytics. Pediatricians were included as general practitioners and wrote 25% of all stimulant prescriptions but only 3% of all other types of psychotropic medications (data not shown). Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment. However, concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment. Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

Shared Decision Making Is an Ethical Imperative

Shared Decision Making Is an Ethical Imperative

Modelo de Matriz: ferramenta para a construção de boas práticas em saúde mental comunitária

The contemporary changes produced by the new mental health policies place as main challenge the construction of substitutive services to hospital, developed in the context of care in the community. This challenge requires a complex set of conditions involving, among other factors, the development of a new ethical and technical culture able to create innovative responses to care of people with mental disorders. It is in this scenario that we must discuss the relevance and importance of the project developed by Thornicroft and Tansella, "The Matrix Model", presented in this paper. There, the authors bring fundamental contributions to underpin the new culture of services and professional training sought by the process of psychiatric reform. This model can be used in planning, evaluation and modeling of services; in addition, it can bring useful tools to the research in mental health services.

Psychiatric Symptoms Among Juveniles Incarcerated in Adult Prison

Although studies reveal substantial mental health treatment needs among youths in the juvenile justice system, far less is known about young offenders transferred to adult criminal court. This statewide study examined the mental health needs of young offenders who committed serious crimes and were transferred to adult court and subsequently incarcerated in a prison for adults. Sixty-four boys aged 16 and 17 years who were incarcerated in the Texas adult correctional system completed the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2), a mental health screening measure widely used in the juvenile justice system. Scores from the youths in adult prison were compared with those of a matched sample of youths in juvenile correctional facilities, drawn from the MAYSI-2 normative data. Youths in adult prison reported substantial symptoms of mental health problems. Most youths surveyed (51%) scored above the highest clinical cutoff (the "warning" range) on at least one MAYSI-2 subscale. For every clinical subscale except suicide ideation, the majority of youths (54% to 70%, depending on the subscale) scored above the "caution" range. Juveniles in adult prison reported higher rates of symptoms than did those in juvenile correctional facilities (effect sizes ranged from d=.18 to d=.65, depending on the subscale). Although the mental health needs of youths in the juvenile justice system are well documented, this study reveals that mental health treatment needs appear to be even more pronounced in the small subgroup of youths transferred to the adult criminal justice system and incarcerated in adult prison.

Do Noncontingent Incentives Increase Survey Response Rates among Mental Health Providers? A Randomized Trial Comparison

Surveys can be a useful tool for mental health services research. Unfortunately, clinicians typically show low response rates to surveys. To determine whether noncontingent incentives would increase responses among clinicians, we compared no incentive versus four incentives (mood magnet, $1, $2, $5) on response to a 7-page self-report survey of mental health assessment and treatment practices in a sample of 500 clinicians from the 5 largest professional guilds. Noncontingent monetary incentives significantly increased response rate compared to no incentive across all disciplines. Noncontingent monetary incentives are discussed as a cost-effective method for increasing survey response rate among mental health clinicians.

Views of Mental Health Care Consumers on Public Reporting of Information on Provider Performance

Views of Mental Health Care Consumers on Public Reporting of Information on Provider Performance

Revisiting practice-based research networks as a platform for mental health services research.

Practice-based research networks (PBRNs)-collaborations of practice settings that work together to generate research knowledge-are underused in mental health services research. This article proposes an agenda for mental health services research that uses a variety of PBRN structures and that focuses on what really happens in practice, the effectiveness of practice innovations in real world care, the challenges of implementing evidence supported interventions, modification of clinician behavior, and assessment of the effect of mental health policy changes on practice. The challenges of conducting research within PBRNs are substantial, including difficulties in maintaining positive member relations, securing ongoing funding, sustaining productivity, overcoming IRB entanglements and achieving both scientific excellence in recruitment and measurement validity and utility for practitioner members. However, the awareness of these challenges allows researchers and practitioners to build networks that creatively overcome them and that infuse mental health services research with heavy doses of the realities of everyday clinical practice.

Economic evaluations in evidence based healthcare

Economic evaluations are increasingly carried out alongside clinical evaluations so that the clinician is presented with information on both the effectiveness and cost-effectiveness of alternative treatments to inform their evidence...

Journal Digest

Journal Digest

Public-Academic Partnerships: The Thresholds-Dartmouth Partnership and Research on Shared Decision Making

Public-Academic Partnerships: The Thresholds-Dartmouth Partnership and Research on Shared Decision Making

Initial Evaluation of the Peer-to-Peer Program

Peer-to-Peer, sponsored by the National Alliance on Mental Illness (NAMI), is a structured, experiential, self-empowerment, relapse prevention and wellness program led by trained peer mentors for people with mental illnesses. The authors conducted the first empirical evaluation of the program by using a pre-post survey design. Approximately 550 participants who were enrolled in Peer-to-Peer during the data collection period (2005-2006) were invited to complete a brief, anonymous survey before participating in the program and immediately after. Analyses of responses from 138 participants indicated that they gained significant benefits, especially in areas central to the Peer-to-Peer curriculum--specifically, knowledge and management of their illness, feelings of being less powerless and more confident, connection with others, and completion of an advance directive. Qualitative analysis of responses to an open-ended postintervention question supported the quantitative findings. Peer-to-Peer is a promising self-help modality that warrants additional evaluation with more rigorous methodology.

Antipsychotic medications do not differ substantially in ability to reduce violent behaviour in people with schizophrenia

ED FROM Swanson JW, Swartz NS, Van Dorn RA, et al. Comparison of antipsychotic effects on reducing violence in people with schizophrenia. Br J Psychiatry 2008;193:37–43. Correspondence to: Professor Jeffrey...

P02-88 Pathways to psychiatric care in child and adolescent mental health - Tirana

There has been almost no mental health service research in Albania. A pathway study provides a quantitative description of the filters in the help-seeking and investigate the relative contributions of child, parents, pediatrics, GP etc. in determining service use.Aims:To investigate the process of help seeking for child and adolescent psychopathology at Child and Adolescent Mental Health Service (CAMHS) in UHC “Mother Teresa”, Tirana.Method:Participants were 5-18years old, newly referred children/adolescents in CAMHS during 2006. Measures: Strengths and Difficulties Questionnaire for parents/children, Pathways Encounter Form. Pathway diagram was drawn showing the main routes of care seeking. Patterns of care seeking, durations and previous treatments for diagnosis within ICD-10 groups were prescribed. Analysis: Comparisons between groups, diagnosis and predictive factors influencing help seeking care.Results:The main pathway of seeking care resulted to be from hospital doctors or to be direct access. General practitioners have a limited role as ‘gatekeeper’ for patients. 72% of individuals resulted with conduct, hyperactivity, depressive and some anxiety disorders, but fewer than 30% of individuals with specific phobias, separation anxiety and eating disorders.Conclusions:A clear picture of pathway of seeking care in mental health for children/adolescents coming in CAMHS is provided. Findings highlight areas that require further attention if aspirations for community-oriented mental health care are to be realized in Tirana and Albania. Declaration of interest: None.

Introduction to the Special Section on Practice Contexts: A Glimpse into the Nether World of Public Mental Health Services for Children and Families

If scientific trends about strengthening knowledge on installation of evidence-based practices are to ever gain a foothold, then a necessary complement—if not precursor— to these studies will be knowledge about the practice contexts that surround new services. It is difficult and perhaps foolhardy to try to improve what you do not understand. Implementation of effective services in the absence of knowledge about the contexts of their delivery is likely to be impractical, inefficient, and costly. The three papers in this issue are firmly ensconced in what is fondly called ‘‘real world.’’ Each comes at the challenge of evidence-based installation in a different way. The first paper by Kolko et al. describes a national survey of four hundred therapists participating in an EBP training on Trauma-focused CBT for children and adolescents. The second paper also by Kolko et al. describes findings from interviews conducted with a sample of 89 child welfare administrators across the country about agency and system issues that impede or facilitate delivery of mental health services. The third paper by Herschell et al. describes different methods for improving knowledge about and skills for delivering a specific evidencebased practice—parent–child interaction therapy—among community based mental health therapists. All three of these papers describe from different vantage points—i.e., therapists, administrative managers, and program evaluators–core elements of real world practice that are likely to impact uptake and delivery of evidence-based practices. The elements that are described include provider attitudes, beliefs, and expectations as well as agency structures, financing methods, linkages and supervisory practices. Each of these elements, if not acknowledged and understood, can pose enormous obstacles to the introduction of new practices. There are several reasons why a glimpse into the nether world of service practices is needed. First, the databases that are available to describe the public mental health system for children and families are severely limited in their scope, availability and content about both services and about the workforce that delivers these services. Basic descriptive data about agency or program operations, staffing patterns, supervisory practices, and electronic technologies for tracking service visits, much less the content of services, are simply not available to either the public or to researchers. Consequently, program implementers or services researchers wanting to embed new practices in routine care settings are unable to anticipate the many challenges ahead because the context of delivery has not been elucidated, operationalized, or deconstructed. If a more thorough understanding about real world practices existed, then factors that mediate or moderate implementation could be identified and potentially manipulated. In the absence of such knowledge, implementation studies are often launched in a vacuum. Second, these papers set the stage for an important next generation of studies that can take advantage of the robust basic science on behavior change and the emerging cognitive neurosciences to apply innovative approaches to change the practices of providers, organizations and potentially even communities. For example, drawing on theory of reasoned action (Fishbein 1980) theory of planned behavior (Ajzen 1991), and more recently the unified theory of behavior change (Jaccard et al. 2002), new K. Hoagwood (&) Division of Mental Health Policy & Services Research, Columbia University, New York, NY, USA e-mail: hoagwood@childpsych.columbia.edu

Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges

One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.

Advancing Mental Health Research: Washington University's Center for Mental Health Services Research

Research centers have become a key component of the research infrastructure in schools of social work, including the George Warren Brown School of Social Work at Washington University. In 1993, that school's Center for Mental Health Services Research (CMHSR) received funding from the National Institute of Mental Health (NIMH) as a Social Work Research Development Center (R24 MH50857), with a renewal in 1999 for five more years of support. After the program announcement for the social work research development center mechanism expired, the center applied under an advanced mechanism and in 2004 was awarded five years of funding as an NIMH Advanced Center for Interventions and Services Research (P30 MH068579).This article describes the background for developing the center, the center's aims and research agenda, its structure and functioning, and outcomes of CMHSR from 1993 to the present. KEY WORDS: faculty mentoring; mental health services; National Institute of Mental Health; research center; research infrastructure ********** In 1993, the George Warren Brown School of Social Work at Washington University, St. Louis, Center for Mental Health Services Research (CMHSR) received funding from the National Institute of Mental Health (NIMH) as a Social Work Research Development Center (R24 MH50857), with a renewal in 1999 for five more years of support. After the program announcement (PA) for the social work research development center mechanism expired, the center applied under an advanced mechanism and in 2004 was awarded five years of funding as an NIMH Advanced Center for Interventions and Services Research (P30 MH068579). BACKGROUND, PURPOSE, AND FUNDING FOR THE CMHSR Although social work has long been recognized as one of the dominant professions providing mental health services, it has lacked a commensurate level of research activity in mental health. In the late 1980s, a national Task Force on Social Work Research (1991) challenged the profession to increase its research activity in mental health, so that the services provided by social workers might be informed by research conducted by social work researchers and thus shaped by social work perspectives. The task force also called for the National Institute of Mental Health (NIMH) to launch new initiatives aimed at advancing social work's research capacity. NIMH responded through several activities targeted to social work, including a PA for Social Work Research Development Centers (SWRDCs).The announcement was widely disseminated within the social work community, and NIMH convened meetings to inform interested deans and doctoral program directors about the PA and application requisites. These national events triggered extensive discussion within the Brown School about interest in and capacity for mental health research. Mental health was one of the schools' largest curriculum concentrations in the MSW, and several faculty members identified mental health as one of their research interests. The school's strong research culture and publication record notwithstanding, it had received very few external research or training grants in the area of mental health. The dean of the Brown School (Shanti K. Khinduka, 1974-2004) asked Enola K. Proctor to lead a planning process to develop an application in response to the NIMH SWRDC announcement. Planning meetings were open to all interested faculty and included leadership of the Missouri Department of Mental Health, researchers at the University's Department of Psychiatry, and staff from local mental health organizations and agencies. An application resulted; after two submissions, the Center was established as the nation's first SWRDC in September 1993. Its mental health services research agenda reflected the interests of faculty members who developed pilot projects for the grant application. NIMH staff members, Drs. Juan Ramos and the late Kenneth G. Lutterman, were instrumental in the formation of this NIMH program announcement. …

Women's Past-Year Prostitution Status and Receipt of Substance Abuse Treatment Services

The study compared services received in substance abuse treatment programs by women who reported involvement in prostitution and by those who did not. Women (N=1,604) in a national study of substance abuse programs completed a structured interview assessing substance abuse, demographic characteristics, and past-year prostitution at program entry. At discharge, information was gathered on treatment modality (residential including inpatient, or outpatient), duration, and amounts of medical, mental health, and psychosocial services received during treatment. Analyses compared women involved in prostitution and those not involved. Women involved in prostitution were more likely to enter residential treatment. No differences between involvement groups were found in residential treatment duration, services received in residential treatment, or length of outpatient enrollment. In outpatient programs, women involved in prostitution received more psychosocial services. Substance abuse treatment programs appear responsive to the greater needs of women involved in prostitution. However, more research is needed on outcomes.

Trends in Use of Antipsychotics and Mood Stabilizers Among Medicaid Beneficiaries With Bipolar Disorder, 2001-2004

Trends in Use of Antipsychotics and Mood Stabilizers Among Medicaid Beneficiaries With Bipolar Disorder, 2001-2004

Outcome Among Community Dwelling Older Adults with Schizophrenia: Results Using Five Conceptual Models

There have been few studies examining the outcome of schizophrenia in later life. Using five conceptual models, we test two hypotheses with respect to range of outcomes among older schizophrenia outpatients and how they compare to their age peers in the community. We operationalized five outcome measures from the following conceptual models: Remission, adapting criteria of Andreasen et al. (The American Journal of Psychiatry, 162:441-449, 2005); Recovery, adapting the criteria by Liberman et al. (International Review of Psychiatry, 14:256-272, 2002); Community Integration using the model of Wong and Solomon (Mental Health Services Research, 4:13-28, 2002); Subjective and Objective Successful Aging using the model of Rowe and Kahn (Science, 237:143-149, 1987). The schizophrenia (S) group consisted of 198 community-dwelling persons aged 55 and over who developed schizophrenia before age 45 and a community comparison (CC) group (N = 113). Remission and recovery criteria were met by 49 and 17% of the S group, respectively. There were significant differences between the S and CC groups in the distribution of community integration and successful aging scales: 41% of the CC group met at least 10 of 12 criteria versus 23% of the S group on the Community Integration Scale; 19% of the CC group met all six criteria vs. 2% of the S group on the Objective Successful Aging Scale; 27% of the CC group vs. 13% of the S group met all six criteria on the Subjective Successful Aging Scale. Correlations among the five outcome measures ranged from r = .19 to .48 (median value: r = .26 or 7% shared variance). There is wide variability in outcome in later life depending on which measure is used. Rather than one universal indicator, each measure offers a different perspective that can provide useful guidelines for researchers, clinicians, and policy makers.