Participation In Mental Health Treatment Research Articles

Effectiveness of two systems-level interventions to address perinatal depression in obstetric settings (PRISM): an active-controlled cluster-randomised trial

Perinatal depression is a common and undertreated condition, with potential deleterious effects on maternal, obstetric, infant, and child outcomes. We aimed to compare the effectiveness of two systems-level interventions in the obstetric setting-the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms and the PRogram In Support of Moms (PRISM)-in improving depression symptoms and participation in mental health treatment among women with perinatal depression. In this cluster-randomised, active-controlled trial, obstetric practices across Massachusetts (USA) were allocated (1:1) via covariate adaptive randomisation to either continue participating in the MCPAP for Moms intervention, a state-wide, population-based programme, or to participate in the PRISM intervention, which involved MCPAP for Moms plus a proactive, multifaceted, obstetric practice-level intervention with intensive implementation support. English-speaking women (aged ≥18 years) who screened positive for depression (Edinburgh Postnatal Depression Scale [EPDS] score ≥10) were recruited from the practices. Patients were followed up at 4-25 weeks of gestation, 32-40 weeks of gestation, 0-3 months postpartum, 5-7 months postpartum, and 11-13 months postpartum via telephone interview. Participants were masked to the intervention; investigators were not masked. The primary outcome was change in depression symptoms (EPDS score) between baseline assessment and 11-13 months postpartum. Analysis was done by intention to treat, fitting generalised linear mixed models adjusting for age, insurance status, education, and race, and accounting for clustering of patients within practices. This trial is registered with ClinicalTrials.gov, NCT02760004. Between July 29, 2015, and Sept 20, 2021, ten obstetric practices were recruited and retained; five (50%) practices were randomly allocated to MCPAP for Moms and five (50%) to PRISM. 1265 participants were assessed for eligibility and 312 (24·7%) were recruited, of whom 162 (51·9%) were enrolled in MCPAP for Moms practices and 150 (48·1%) in PRISM practices. Comparing baseline to 11-13 months postpartum, EPDS scores decreased by 4·2 (SD 5·2; p<0·0001) among participants in MCPAP for Moms practices and by 4·3 (SD 4.5; p<0·0001) among those in PRISM practices (estimated difference between groups 0·1 [95% CI -1·2 to 1·4]; p=0·87). Both the MCPAP for Moms and PRISM interventions were equally effective in improving depression symptoms. This finding is important because the 4-point decrease in EPDS score is clinically significant, and MCPAP for Moms has a lower intensity and greater population-based reach than does PRISM. US Centers for Disease Control and Prevention.

Differential Use of Mental Health Services by Race and Ethnicity in Prison

Research in community settings indicates that Black persons are less likely to receive mental health treatment than White persons. Research on whether these disparities persist in prisons is limited and fails to include other racial and ethnic groups, such as Latino persons. This study examines racial and ethnic differences in the use of mental health services among incarcerated persons. Using the 2016 Survey of Prison Inmates, logistic regression assessed the effects of race/ethnicity among those receiving mental health treatment while incarcerated. Results suggest Black and Multiracial/Other incarcerated persons were 15.8% and 15.0% more likely to participate in treatment than White incarcerated persons, respectively. No significant difference between Latino incarcerated persons and White incarcerated persons was found. The differences between racial/ethnic groups and participation in mental health treatment found in this study suggest that more attention needs to be paid to diversity in the accessibility of treatment in prisons.

Parents' perspectives on user participation and shared decision‐making in adolescents' inpatient mental healthcare

BackgroundParents are a resource that can be of considerable importance in supporting their adolescents' recovery and shared decision‐making processes. However, involving both adolescents and their parents in treatment creates challenges. Understanding the roles of all decision stakeholders is vital to the implementation of shared decision‐making and delivery of high‐quality healthcare services.ObjectiveThe aim of this study is to explore parents' experiences with adolescents' participation in mental health treatment and how parents perceive being involved in decision‐making processes.DesignThis was a qualitative study with a phenomenological, inductive design. Content analysis of data from qualitative interviews was performed.Setting and ParticipantsThis study took place in a Norwegian public healthcare setting. Twelve parents of adolescents who received treatment for severe mental illness participated.ResultsFour themes were identified: (1) self‐determined treatment, but within limits; (2) the essential roles of parents; (3) the need for information and support; and (4) the fight for individualized treatment and service coordination.ConclusionUser participation is vital in adolescent mental healthcare and parents play essential roles regarding the shared decision‐making process. However, user participation and shared decision‐making pose several dilemmas. Parental involvement in treatment decisions may be necessary when adolescents are mentally ill, but could simultaneously hinder those adolescents' empowerment and recovery. Cooperation among parents, adolescents and healthcare professionals can improve treatment engagement and adherence, but may be challenged by divergent interests. Health services should provide family‐oriented services to utilize the potential of parents as a resource and minimize conflicting interests.Patient or Public ContributionTwo adolescent user representatives participated in designing the study.

Predictors and Barriers to Mental Health Treatment Utilization Among Older Veterans Living With HIV.

To identify key mood, social, and functional correlates of current participation in mental health treatment and barriers to participation in mental health treatment among older HIV infected (HIV+) veterans. HIV+ veterans (N = 150) aged ≥ 50 years receiving HIV-related medical care at the VA San Diego Healthcare System, San Diego, California, anonymously completed a survey assessing current self-reported mood, social support, daily functioning problems, mental health service utilization, and barriers to participating in mental health services. Veterans also completed the 2-item Patient Health Questionnaire (PHQ-2), a validated depression screening instrument frequently used in primary care settings. Data were collected from February 2014 to May 2014. Overall, 44% of participants screened positive for depressive symptomatology on the PHQ-2; 55% of those who screened positive were participating in mental health treatment. Of the 45% of veterans who screened positive on the PHQ-2 and were not in treatment, two-thirds (66%) stated they had been offered services; however, they were not engaging in or accepting the services. Regardless of PHQ-2 status, current self-reported depressive symptoms emerged as an independent, significant positive predictor of participation in mental health treatment (odds ratio = 5.98; 95% CI, 1.16-30.72; P = .03), whereas anxiety, HIV-related stigma, sufficiency of social support, and daily functioning problems were not associated with mental health treatment utilization. Primary reported barriers to mental health treatment included scheduling/availability, travel time and transportation, and discomfort with group settings. Results of this study suggest there may be a need to better engage older HIV+ veterans in depression-related treatment. The use of telehealth technology, such as teletherapy, electronic devices, and cell phone-based programs, may be beneficial in helping older HIV+ veterans overcome many barriers that restrict their participation in mental health treatment.

Innovations in Practice: Supporting parent and teen communication during outpatient psychotropic medication appointments

Encouragement of youth participation in mental health treatment is relatively new and there have been few specific interventions to improve engagement, particularly as it relates to medication management. This article describes the development of a tool to support engagement during medication appointments by identifying areas of agreement/disagreement between parents and teens. Data were analyzed from 240 parent/teen dyads visiting an outpatient community mental health center for medication management. Frequencies and percentages were calculated for all items. Kappa scores were used to assess agreement between parent and teen dyads. The level of agreement between parents and teens was low. Overall, teens expressed preference for discussion of 'positive' aspects of treatment such as what is going well, whereas parents preferred to focus on 'negative' aspects of treatment such as problematic symptoms. The lowest level of agreement was found for the item: 'My teen seems to be having problems with energy levels' (Kappa = .19; 95% CI=.05-.34). The strongest level of agreement was for the question 'How has your teen been using the medication since the last appointment?' (Kappa=.56; 95% CI=.44-.69). The findings support the utility of the tool for illustrating the variation in needs of teens and parents during medication appointments. Knowledge of these differences can be used by providers to encourage teen participation and may enhance overall communication.

Science and Recovery in Schizophrenia

Mental health advocates and policy makers are increasingly attuned to the importance of the recovery concept, and psychiatrists and neuroscientists increasingly emphasize the medical model and neurobiological mechanisms in relation to schizophrenia. Studies have shown that people with schizophrenia are tremendously heterogeneous in each domain of recovery, and the various domains of recovery are themselves relatively independent from one another. Studies have also shown that current interventions are effective for specific dimensions of the illness and functions, are usually ameliorative rather than curative, and are effective only for a proportion of patients. Hence, the authors suggest defining recovery in terms of improvements in specific domains rather than globally -- for example, "recovery of cognitive functioning" or "recovery of vocational functioning" -- to signify improvements in specific areas. This definition realistically emphasizes states of relative and partial recovery that patients can achieve in response to treatment. The emphasis on a range of improvements in specific areas should allow clinicians to communicate more clearly regarding the current findings and goals of treatment. The article also examines current research on various aspects of recovery, including the effects of treatment on pathophysiology, symptoms, cognitive impairments, quality of life, and self-agency. An operational definition of recovery allows for bridging hope and recovery with important advances in the science of the brain. Future clinical and neuroscience research and service development should emphasize measures of recovery as outcomes for people with schizophrenia.

Does Compensation Status Influence Treatment Participation and Course of Recovery from Post-Traumatic Stress Disorder?

We reviewed the empirical literature to examine how seeking compensation and/or being awarded compensation for posttraumatic stress disorder-related disability are associated with participation in mental health treatment and course of recovery. The search for relevant literature was conducted using the PubMed, PsycINFO, Medline, and PILOTS databases and yielded seven studies on veterans and five on motor vehicle accident survivors. The literature indicates that veterans who are seeking or have been awarded compensation participate in treatment at similar or higher rates than do their non-compensation-seeking counterparts. Veteran treatment outcome studies produced either null or mixed findings, with no consistent evidence that compensation-seeking predicts worse outcomes. Studies of motor vehicle accident survivors found no association between compensation status and course of recovery. Recommendations to strengthen future research in this area are provided, including using clear and consistent definitions of compensation status that differentiate compensation-seeking status from award status.

Decoupling the Relation Between Risk Factors for Conduct Problems and the Receipt of Intervention Services: Participation Across Multiple Components of a Prevention Program

This study examined whether the link between risk factors for conduct problems and low rates of participation in mental health treatment could be decoupled through the provision of integrated prevention services in multiple easily-accessible contexts. It included 445 families of first-grade children (55% minority), living in four diverse communities, and selected for early signs of conduct problems. Results indicated that, under the right circumstances, these children and families could be enticed to participate at high rates in school-based services, therapeutic groups, and home visits. Because different sets of risk factors were related to different profiles of participation across the components of the prevention program, findings highlight the need to offer services in multiple contexts to reach all children and families who might benefit from them.

Predicting Incarceration of Clients of a Psychiatric Probation and Parole Service

This study assessed the extent to which clinical characteristics, psychiatric status, and use of mental health services explain incarceration for technical violations of probation or parole rather than incarceration for new offenses. A total of 250 clients of an urban psychiatric probation and parole service were screened for psychiatric diagnoses and monitored with a 12-month data collection protocol. Longitudinal analysis was used to explain incarceration on new charges, incarceration on technical violations of probation and parole, or absence of incarceration. Eighty-five individuals (34 percent) were incarcerated during the follow-up period. Forty-four (18 percent) were incarcerated for a new offense, and 41 (16 percent) were incarcerated for a technical violation. Participation in mental health treatment was associated with a lower risk of incarceration for a technical violation. Intensive monitoring by mental health providers, such as through case management and medication management, were significant risk factors for incarceration for a technical violation. Clients who were incarcerated for a technical violation were more than six times as likely to have received intensive case management services. The role of mental health services in reducing the risk of incarceration remains mixed. Providing services that emphasize monitoring tends to increase the risk of incarceration for technical violations of criminal justice sanctions. However, any participation in treatment and motivation to participate in treatment appears to reduce the risk of incarceration.

Using the Therapeutic Relationship to Promote an Internal Locus of Control in Elderly Mental Health Clients

Seniors who feel powerless to effect change on their environment or who feel that their lives are controlled by external circumstances are said to have an external locus of control. This may adversely affect commitment to and participation in mental health treatment. This article presents the conce t of using the therapeutic relationship to encourage internal contro f' beliefs in elderly mental health clients, with the goal of promoting personal empowerment and improving the efficacy of therapy. Included is a review of litera- ture relevant to aging and locus of control. The develoament of an external locus of conbol is explained by the theories of self psychol- ogy and the social breakdown syndrome.