On-site Mental Health Services Research Articles

Mental Health Stigma Persists in the Workplace, Poll Shows

Back to table of contents Previous article Next article Professional NewsFull AccessMental Health Stigma Persists in the Workplace, Poll ShowsMark MoranMark MoranSearch for more papers by this authorPublished Online:18 Jun 2019https://doi.org/10.1176/appi.pn.2019.6b21AbstractMore work to decrease stigma is needed to make people feel comfortable about sharing their mental health issues in the workplace.Only about half of American workers said they are comfortable talking about their mental health in the workplace, and more than one-third expressed concern about job consequences if they sought out mental health care, according to the results of a survey released by APA at its 2019 Annual Meeting last month in San Francisco.While most workers with benefits said they know how to access mental health services (70%) and are at least somewhat comfortable accessing services (62%) through their employer if needed, more than 25% of workers reported uncertainty regarding how to access mental health care through their employer.The stigma of mental illness is still a major issue in the workplace, according to the survey findings. Just over half of workers said they are at least somewhat comfortable discussing mental health openly with co-workers and supervisors; however, only 20% said they are completely comfortable. Younger workers were much more likely to feel they could discuss their mental health at work—millennials were almost twice as likely as baby boomers to be comfortable (62% versus 32%).Thirty-five percent of respondents completely or somewhat agreed with the following statement: “I worry about retaliation or being fired if I seek mental health care.” Looking at age and gender, younger men were more likely to be concerned than older men or than women of any age about retaliation.Most workers said they would recognize signs of distress in co-workers and would reach out to help. Seventy-six percent of respondents said they are very likely to recognize signs of anxiety, depression, or other mental illness among co-workers; and 54% said they would reach out to fellow workers in need of mental health care. But 24% said they would not know where to guide a co-worker for mental health help.“These results show both encouraging and concerning aspects of mental health in the workplace,” said APA President Altha Stewart, M.D. “The extent to which people are willing to reach out and help colleagues is encouraging. However, the continued hesitancy among many to talk about mental health concerns in the workplace is troubling. We have work to do to get to the point where people are as comfortable talking about mental health concerns as they are about physical health concerns,” she said.The vast majority of workers said their employers offer some type of mental health resources, such as an employee assistance program, mental health days, wellness programs, or on-site mental health services. While many workers (60%) agreed their employer is providing sufficient mental health coverage, 27% said their employer does not offer sufficient coverage.These findings are from an APA-sponsored poll conducted online using ORC International’s CARAVAN Omnibus Survey. The surveys were collected from a nationally representative sample of 1,005 adults aged 18 years and older from April 4 to 7, 2019, and from similar polls of about 1,000 adults in March 2018 and April 2017. The margin of error is ±3.1 percentage points. ■More information about the poll can be accessed here. ISSUES NewArchived

Characteristic Differences Between School-Based Health Centers With and Without Mental Health Providers: A Review of National Trends

BackgroundMinority racial/ethnic pediatric populations and those living in poverty are at greater risk of exposure to trauma, development of mental health disorders, and school failure yet are less likely to have access to mental health services (MHS). School-based health centers (SBHCs) staffed with mental health providers may be one strategy for decreasing health care disparities. MethodsSecondary analysis of the cross-sectional School-Based Health Alliance Census School Year 2010–2011 Report was conducted. Descriptive statistics and chi-square analysis were used to describe differences between SBHCs with and without onsite MHS. ResultsA total of 70% of SBHCs offered MHS. SBHCs with more resources, more students, a longer history, and state funding were more likely to offer MHS, and geographic location had no impact on service availability. ConclusionReviewing SBHC characteristics that enable inclusion of MHS may help stakeholders expand this model of care to address exposure to chronic childhood trauma.

County Workforce, Reimbursement, and Organizational Factors Associated with Behavioral Health Capacity in Health Centers

This study describes on-site behavioral health treatment capacity in health centers in 2007 and examines whether capacity was associated with health center characteristics, county-level behavioral health workforce, and same-day billing restrictions. Cross-sectional data from the 2007 Area Resource File and Uniform Data System were linked with data on Medicaid same-day billing restrictions. Mental health treatment capacity was common; almost four in five health centers provided on-site mental health services. Additional services such as crisis counseling (20%), treatment from a psychiatrist (29%), and substance abuse treatment were offered by fewer health centers (51% provide on-site services and only 20% employ substance abuse specialists). In multivariate analysis, larger health centers, health centers located in counties with a larger behavioral health workforce per capita, and those located in the West and Northeast were more likely to have behavioral health capacity. Same-day billing restrictions were associated with lower odds of substance use treatment capacity and providing 24 hr crisis counseling services.

Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access

ObjectiveThis evaluation assessed the opinions and experiences of primary care providers and their support staff before and after implementation of expanded on-site mental health services and related system changes in a primary care clinic. MethodIndividual semistructured interviews, which contained a combination of open-ended questions and rating scales, were used to elicit opinions about mental health services before on-site system and resource changes occurred and repeated following changes that were intended to improve access to on-site mental health care. ResultsIn the first set of interviews, prior to expanding mental health services, primary care providers and support staff were generally dissatisfied with the availability and scheduling of on-site mental health care. Patients were often referred outside the primary care clinic for mental health treatment, to the detriment of communication and coordinated care. Follow-up interviews conducted after expansion of mental health services, scheduling refinements and other system changes revealed improved provider satisfaction in treatment access and coordination of care. Providers appreciated immediate and on-site social worker availability to triage mental health needs and help access care, and on-site treatment was viewed as important for remaining informed about patient care the primary care providers are not delivering directly. ConclusionsExpanding integrated mental health services resulted in increased staff and provider satisfaction. Our evaluation identified key components of satisfaction, including on-site collaboration and assistance triaging patient needs. The sustainability of integrated models of care requires additional study.

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

Provision of Mental Health Services in U.S. Nursing Homes, 1995–2004

This study tracked the ability of U.S. nursing homes to provide on-site mental health services after the Omnibus Budget Reconciliation Act (OBRA) of 1987 mandated the detection and treatment of mental illness among nursing home patients. The study also determined cross-sectional correlates of service availability and models of services. Retrospective analyses were done using National Nursing Home Surveys from 1995, 1997, 1999, and 2004 (the most recent survey). The surveys are periodically conducted by the Centers for Disease Control and Prevention and represent the nation's approximately 17,000 nursing homes. The longitudinal trend of mental health service provision was analyzed for all facilities and for subgroups of facilities. Multivariate regression determined facility and geographic correlates in 2004. Roughly 80% of facilities provided on-site mental health services each survey year. In 2004, 25% of facilities provided mental health services regularly or at routinely scheduled times (regular basis), 24% provided them in an on-call manner (or as needed), and 28% provided them on both a regular and on-call basis. The remaining 22% of facilities provided no on-site mental health services. Multivariate analyses found that largest facilities (> or = 200 beds) were more able than small facilities (< 100 beds) to serve persons with mental illness (odds ratio=3.80, p=.024); compared with their counterparts, facilities were more likely to provide on-site services if they had a larger proportion of residents covered by Medicare or Medicaid programs, were in the Northeast region, or were in metropolitan areas. Similar correlates were found when the types of service provision models (regular basis, on-call basis, both a regular and on-call basis) were examined. The overall availability of nursing home-based mental health services did not improve over time during the post-OBRA era. Service availability is more problematic for certain facilities, such as small or rural ones. Financial, regulatory, and system-level efforts are needed to address this issue.

On-Site Mental Health Services for PACE (Program of All-inclusive Care for the Elderly) Centers

On Lok Lifeways (On Lok), the original Program of All-inclusive Care for the Elderly (PACE), provides comprehensive health care for over a thousand community-dwelling frail seniors in San Francisco and Fremont, California. Prior to 2005, participants were referred to off-site contracted psychiatrists and psychologists for all mental health services. In 2005, On Lok introduced an on-site mental and behavioral health (MBH) team that included a psychologist, a bilingual psychiatric social worker, and a marriage and family therapist. Two part-time psychiatrists were added to the core team in 2006 and another full-time marriage and family therapist was added in 2008. We report our experience of implementing an on-site MBH program. In particular, we observed quadrupling of the number of appointments to mental health clinicians. There was a reduction in psychiatric inpatient utilization from 129.4 days/1000 patients in 2004 to 27.1 days/1000 patients in 2005. This reduction was sustained in 2006 and 2007 (41.2 and 23.6/1000 patients respectively). Inclusion of mental and behavioral health clinicians on geriatric interdisciplinary teams at On Lok appeared to improve the quality of care we provided by increasing timely access to mental health services, reduced the rate of psychiatric inpatient admissions, and reduced reported anxiety and stress of On Lok interdisciplinary teams caring for elders with mental health diagnoses.

Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use

Objective Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU. Method Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA. Results Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95% confidence interval (95% CI)=0.41–0.81] and those with IDU alone (AOR=0.64; 95% CI=0.58–0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95% CI=1.64–3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95% CI=1.13–1.55) than those with neither SMI nor IDU, SMI only or IDU only. Conclusion HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care.

Psychological services in a pediatric epilepsy clinic: Referral patterns and feasibility

Referral patterns for on-site psychological services were tracked in a pediatric epilepsy clinic at a university medical center. Results revealed that 84 children treated for seizures were referred to an on-site pediatric psychologist. Behavior problems were the overall most common reason for referral; however, boys were more likely to be referred for disruptive behaviors, and girls were more likely to be referred for internalizing symptoms. Following psychological assessment, brief cognitive-behavioral intervention services were provided on-site in the epilepsy clinic to 39% of children and families. Finally, referral rates for psychological assessment/intervention were likely far below the estimated prevalence rates for psychosocial maladjustment in children with epilepsy. Results, therefore, highlight the necessity of facilitating increased referrals to mental health providers and provide support for the feasibility of on-site mental health services.

Impact of Program Services on Treatment Outcomes of Patients With Comorbid Mental and Substance Use Disorders

This study examined the outcomes of individuals with co-occurring disorders who received drug treatment in programs that varied in their integration of mental health services. Patients treated in programs that provided more on-site mental health services and had staff with specialized training were expected to report less substance use and better psychological outcomes at follow-up.Participants with co-occurring disorders were sampled from 11 residential drug abuse treatment programs for adults in Los Angeles County. In-depth assessments of 351 patients were conducted at treatment entry and at follow-up six months later. Surveys conducted with program administrators provided information on program characteristics. Latent variable structural equation models revealed relationships of patient characteristics and program services with drug use and psychological functioning at follow-up.Individuals treated in programs that provided specific dual diagnosis services subsequently had higher rates of utilizing mental health services over six months and, in turn, showed significantly greater improvements in psychological functioning (as measured by the Brief Symptom Inventory and the RAND Health Survey 36-item short form) at follow-up. More use of psychological services was also associated with less heroin use at follow-up. African Americans reported poorer levels of psychological functioning than others at both time points and were less likely to be treated in programs that provided mental health services.Study findings support continued efforts to provide specialized services for individuals with co-occurring disorders within substance abuse treatment programs as well as the need to address additional barriers to obtaining these services among African Americans.

Impact of Program Services on Treatment Outcomes of Patients With Comorbid Mental and Substance Use Disorders

This study examined the outcomes of individuals with co-occurring disorders who received drug treatment in programs that varied in their integration of mental health services. Patients treated in programs that provided more on-site mental health services and had staff with specialized training were expected to report less substance use and better psychological outcomes at follow-up. Participants with co-occurring disorders were sampled from 11 residential drug abuse treatment programs for adults in Los Angeles County. In-depth assessments of 351 patients were conducted at treatment entry and at follow-up six months later. Surveys conducted with program administrators provided information on program characteristics. Latent variable structural equation models revealed relationships of patient characteristics and program services with drug use and psychological functioning at follow-up. Individuals treated in programs that provided specific dual diagnosis services subsequently had higher rates of utilizing mental health services over six months and, in turn, showed significantly greater improvements in psychological functioning (as measured by the Brief Symptom Inventory and the RAND Health Survey 36-item short form) at follow-up. More use of psychological services was also associated with less heroin use at follow-up. African Americans reported poorer levels of psychological functioning than others at both time points and were less likely to be treated in programs that provided mental health services. Study findings support continued efforts to provide specialized services for individuals with co-occurring disorders within substance abuse treatment programs as well as the need to address additional barriers to obtaining these services among African Americans.

On-site primary care and mental health services in outpatient drug abuse treatment units.

Providing health services to drug abuse treatment clients improves their outcomes. Using data from a 1995 national survey of 597 outpatient drug abuse treatment units, this article examines the relationship between these units' organizational features and the degree to which they provided onsite primary care and mental health services. In two-stage models, Joint Commission on Accreditation of Healthcare Organizations-certified and methadone programs delivered more on-site primary care services. Units affiliated with mental health centers provided more on-site mental health services but less direct medical care. Units with more dual-diagnosis clients provided more on-site mental health but fewer on-site HIV/AIDS treatment services. Organizational features appear to influence the degree to which health services are incorporated into drug abuse treatment. Fully integrated care might be an unattainable ideal for many such organizations, but quality improvement across the treatment system might increase the reliability of clients' access to health services.

Behavioral health services in primary care: A new perspective for treating depression.

This article attempts to provide information, inspiration, and practical guidelines for mental health professionals who want to work with primary care providers. Depression is an ideal initial focus in starting primary care behavioral services because (1) the majority of currently available efficacy studies on primary care behavioral hearth interventions concern depression and (2) depression is highly prevalent in the primary care setting. Several large clinical trials indicate that on-site mental health services help primary care providers improve quality of care to depressed primary care patients. This article examines five key questions and suggests two service delivery models to help mental health providers plan initiatives that Integrate medical and behavioral health care in the primary care setting.

School-based mental health services in the United States: history, current models and needs.

Children's mental health needs continue to be largely unmet, even when community services are provided. On-site mental health services in schools address unmet needs by improving access to, and relevance of services. As schools have increasingly been mandated to serve the needs of all children (including those who are emotionally disturbed) general health and mental health services have been increasingly placed in them. Although the provision of basic health care in schools began in the early part of the century, the concept of providing comprehensive services, in which mental health services are integrated into primary medical care, has only been implemented recently. We review the background of school-based mental health services, compare various models of service delivery, and highlight issues important to the future development and advancement of these services.