Public Mental Health Programs Research Articles

Factor structure and measurement invariance of the Patient Health Questionnaire-4 among the Chilean population.

The PHQ-4 is an ultrabrief screening test for depression and anxiety symptoms. The psychometric properties of this test among the population in Chile are unknown. This study was aimed to determine the factor structure of the PHQ-4 in the adult population in Chile, and to assess its measurement invariance across different groups. The study considered a nationally representative sample of 10921 people aged 18 and above, in Chile in 2021. Exploratory and confirmatory factor analysis were conducted, and configural, metric, scalar, and strict measurement invariance were assessed. The two-factor structure of the PHQ-4 supported the two underlying constructs of depression and anxiety. This model explained 67% of the variance and had excellent fit (CFI: 0.9999; TLI: 0.9994; RMSEA: 0.0107; SRMR: 0.0022). Strict measurement invariance held across gender, age, area of residence, household income quintile, immigrant or host population, and indigenous or non-indigenous population (ΔCFI<0.01). The PHQ-4 can be used to assess depressive and anxiety symptoms in population studies, and as a screening test for depression and anxiety in public mental health programs in Chile.

Technologic and Nontechnologic Barriers to Implementing Behavioral Health Homes in Community Mental Health Settings During the COVID-19 Pandemic

Background Persons with serious mental illnesses (SMIs) experience disparities in health care and are more likely to die from physical health conditions than the general population. Behavioral health homes are used in public sector mental health programs to deploy collaborative care to improve physical health for those with SMIs. During the COVID-19 pandemic, these programs faced new challenges in delivering care to this vulnerable group. Purpose To describe barriers to implementing or sustaining behavioral health homes, experienced by community mental health workers during the COVID-19 pandemic, and the strategies used to address these challenges. Methods In-depth qualitative interviews were conducted among the behavioral health workforce in Maryland and Michigan community mental health programs. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR), and responses related to implementing and sustaining health homes during the pandemic were coded and themes were analyzed by using an inductive approach. Results Overall, 72 staff members across 21 sites in Maryland and Michigan were interviewed. Implementation barriers/strategies identified occurred across multiple CFIR domains (client, mental health system, physical health system). Interviewees discussed technologic and nontechnologic challenges as well as strategies to address technology issues. Strategies were more frequently discussed by providers when the barrier was viewed at the client level (eg, low technology literacy) versus the broader system (eg, canceled primary care visits). Conclusions Community mental health staff described barriers beyond technology in caring for individuals with SMIs and physical health conditions. Further research should examine how implementation strategies address both technologic and nontechnologic barriers to collaborative care.

Fatores de risco à saúde mental dos profissionais da saúde durante a pandemia de COVID-19: revisão sistemática

Abstract The aim of the present study was to map the available evidence on the mental health risk factors of frontline health professionals during the COVID-19 pandemic. This is a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was independently carried out by four researchers, following the selection criteria in the electronic databases: PubMed Central, Ovid Technologies, GALE Academic Onefile, Science Citation Index Expanded. The data processing used Zotero software, responsible for creating and importing items according to the criteria established by the research. A total of 18,733 articles were found, of which 2,722 were excluded by the Zotero software because they were in duplicate, and another 366 were manually excluded. After applying the selection criteria, 43 articles entered the final analysis of this review. It is recommended that new scientific research be carried out, especially focusing on the analysis of health workers’ mental health, aiming at providing the basis to create and implement public mental health programs and policies for workers.

Assessment of Factors Associated With Mental Well-Being Among Chinese Youths at Individual, School, and Province Levels

Although rapid urbanization in China provided improved economic prosperity and educational opportunities, it was associated with increased internalizing and externalizing problems among youths, with negative outcomes for mental well-being. Previous studies suggested that factors in individual, school, and regional levels were associated with mental well-being, and comprehensively examining these factors may provide evidence for policies for improving youth mental health. To investigate factors associated with mental well-being at individual, school, and province levels among Chinese youths. This cross-sectional study analyzed nationally representative data collected December 1, 2021, to January 1, 2022, from schools in China. Among 435 schools, 144 institutions had primary school students, 107 institutions had middle school students, 95 institutions had primary and middle school students, and 89 institutions had high school students. A total of 398 520 students were included. Characteristics at individual, school, and province levels. The main outcome was mental well-being, assessed by the Short Warwick-Edinburgh Mental Well-being Scale. Linear mixed-effects models were used to investigate individual, school, and regional disparities in mental well-being among youths. There were 398 520 participants (194 460 females [48.80%]; mean [SD; range] age, 13.78 [2.40; 9-20] years). At the school level, 352 443 students (88.44%) were in public school and 291 354 students (73.11%) were in urban schools. Drinking (coefficient = -1.08; 95% CI, -1.12 to -1.05; P < .001), smoking (coefficient = -0.89; 95% CI, -0.96 to -0.83; P < .001), and increased age (coefficient per 1-year increase in age = -0.02; 95% CI, -0.03 to -0.01; P < .001) were associated with worse mental well-being. Male sex (coefficient = 1.01; 95% CI, 0.98 to 1.04; P < .001), being in a 1-child family (coefficient = 0.17; 95% CI, 0.13 to 0.20; P < .001), being in the Han group (coefficient vs other ethnic groups = 0.20; 95% CI, 0.14 to 0.26; P < .001), a higher frequency and coverage of psychological courses (eg, ≥2/wk for all students vs none: coefficient = 1.02; 95% CI, 0.36 to 1.69; P = .003), and a higher level of self-rated popularity in school (coefficient per 1-unit increase in score = 0.89; 95% CI, 0.88 to 0.89; P < .001) were associated with improved mental well-being. However, age (eg, age and 1 courses/2 wk for all students: coefficient per 1-year increase in age = -0.047; 95% CI, -0.089 to -0.005; P = .03) and sex (eg, female sex and ≥2 courses/wk for some students: coefficient = -0.184; 95% CI, -0.323 to -0.046; P = .009) had interactions with the association between psychological courses and mental well-being. This study found that social disparities in mental well-being existed and that various factors at different levels were associated with mental well-being among Chinese youths. These findings suggest that public mental health programs may be recommended for associated improvements in regional disparities in mental health resources.

Programmatic Support for Peer Specialists that Serve Transition Age Youth Living with Serious Mental Illness: Perspectives of Program Managers from Two Southern California Counties

Peer Specialists (PS) often work in outpatient mental health programs serving transition age youth (TAY). This study examines program managers’ perspectives on efforts to strengthen PS’ professional development. In 2019, we interviewed program managers (n = 11) from two Southern California Counties employed by public outpatient mental health programs (n = 8) serving TAY and conducted thematic analyses. We present themes and illustrative quotes. PS’ roles are highly flexible; thus, PM support PS to strengthen skills to address organization-facing and client-facing responsibilities. PM addressed time management, documentation, PS integration into the organization, and workplace relationships. Trainings to better support clients included addressing cultural competency to serve LGBTQ TAY and racial/ethnic subgroups. Diverse supervision modalities address PS’ diverse needs. Supporting PS’ technical and administrative skills (e.g., planning, interpersonal communication skills) may aid their implementation of a complex role. Longitudinal research can examine the impact of organizational supports on PS’ job satisfaction, career trajectories, and TAY clients’ engagement with services.

Impact of Cofacilitated, Collaborative, Recovery-Oriented Practice Training on Clinical Mental Health Workforce Competencies.

The authors aimed to evaluate the impact of a staff development training program informed by the collaborative recovery model (CRM) on staff outcomes in the largest implementation of CRM undertaken by a public clinical mental health service. Implementation spanned community, rehabilitation, inpatient, and crisis programs for children and youths, adults, and older persons in metropolitan Melbourne, 2017-2018. The CRM staff development program was cofacilitated and coproduced by trainers with clinical and lived experience of recovery (including caregivers) and delivered to the mental health workforce (N=729, including medical, nursing, allied health, lived experience, and leadership staff). The 3-day training program was supplemented by booster training and coaching in team-based reflective practice. Pre- and posttraining measures assessed changes in self-reported CRM-related knowledge, attitudes, skills, and confidence and in the perceived importance of CRM implementation. Staff definitions of recovery were analyzed to understand changes in language related to collaborative recovery. The staff development program significantly (p<0.001) improved self-rated knowledge, attitudes, and skills in applying CRM. At booster training, improvements in attitudes and self-confidence in implementing CRM were maintained. Ratings of the importance of CRM and confidence in the organization's implementation did not change. Definitions of recovery illustrated development of shared language throughout the large mental health program. The cofacilitated CRM staff development program achieved significant changes in staff knowledge, attitudes, skills, and confidence and changes in language related to recovery. These results suggest that implementing collaborative, recovery-oriented practice in a large public mental health program is feasible and can result in broad and sustainable change.

Mental Health: Potential Bipartisan Oasis in a Partisan Congress

Mental Health: Potential Bipartisan Oasis in a Partisan Congress

Mediterranean Diet Interventions for Depressive Symptoms in Adults with Depressive Disorders: A Protocol for a Systematic Review and Meta-Analysis.

The associations between Mediterranean diet (MD) adherence and depression levels have been synthesized from observational studies. However, a systematic review with meta-analysis including randomized controlled trials (RCTs) on this relationship in adults with depressive disorders remains lacking. This protocol was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols statement. MEDLINE (PubMed), Cochrane CENTRAL, PsycINFO, Scopus, and Web of Science databases will be systematically searched to identify studies published from database inception up to 30 September 2022. The inclusion criteria will comprise RCTs reporting pre-post changes in depression status (symptoms or remission) after a MD intervention compared to a control condition in adults over 18 years with depressive disorders. Pooled effect sizes and 95% confidence intervals will be calculated using the DerSimonian random-effects model. This study protocol determines the methodological approach for the systematic review and meta-analysis that will summarize the available evidence on the efficacy of MD interventions on depressive symptoms in adults with depressive disorders. The findings from this review may have implications for public mental health programs. The results will be disseminated through peer-reviewed publication, conference presentation, and infographics. No ethical approval will be required since only published data will be used. PROSPERO registration number: CRD42022341895.

Designing the Well-Being of Romanians by Achieving Mental Health with Digital Methods and Public Health Promotion.

Taking care of mental health is a state of mind. Amid the challenges of the current context, mental health has become one of the problems with the greatest impact on citizens and the evolution of any economy. Due to the COVID-19 pandemic, people have become more anxious, solitary, preoccupied with themselves, and depressed because their entire universe has changed, by restricting their social and professional life; the increase in concern caused by a possible illness of them or those close to them made to isolate themselves. Two qualitative (group and in-depth interviews) and one survey-based quantitative research were carried out, which allowed the quantification of the opinions, perceptions, and attitudes of Romanians regarding the effectiveness of policies for the prevention and treatment of depression. Quantitative research revealed that most of the subjects had never participated in a mental health assessment, and a quarter of them had visited a mental health specialist more than two years ago. Based on the results, proposals were elaborated, which have been addressed both to the specialists from the Ministry of Health and to those from the academic environment, that may have an impact on the elaboration of some public mental health programs.

Who Would Pay Higher Taxes for Better Mental Health? Results of a Large-Sample National Choice Experiment.

Policy Points Public funding for mental health programs must compete with other funding priorities in limited state budgets. Valuing state‐funded mental health programs in a policy‐relevant context requires consideration of how much benefit from other programs the public is willing to forgo to increase mental health program benefits and how much the public is willing to be taxed for such program benefits. Taxpayer resistance to increased taxes to pay for publicly funded mental health programs and perceived benefits of such programs vary with state population size. In all states, taxpayers seem to support increased public funding for mental health programs such as state Medicaid services, suggesting such programs are underfunded from the perspective of the average taxpayer. ContextThe direct and indirect impacts of serious mental illness (SMI) on health care systems and communities represents a significant burden. However, the value that community members place on alleviating this burden is not known, and SMI treatment must compete with a long list of other publicly funded priorities. This study defines the value of public mental health interventions as what the public would accept, either in the form of higher taxes or in reductions in nonhealth programs, in return for increases in the number of mental health program beneficiaries.MethodsWe developed and fielded a best‐practice discrete‐choice experiment survey to quantify respondents’ willingness to be taxed for increased spending among several competing programs, including a program for treating severe mental health conditions. A realistic decision frame was used to elicit respondents’ willingness to support expanded state budgets for mental health programs if that expansion required either cuts in the competing publicly financed programs or tax increases. The survey was administered to a general population national sample of 10,000 respondents.FindingsNearly half the respondents in our sample either chose “no budget increase” for all budget scenarios or had preferences that were too disordered to estimate trade‐off values. Including zero values for those respondents, we found that the mean (median) amount that all respondents were willing to be taxed annually for public mental health programs ranged between $156 ($99) per year for large‐population states and $343 ($181) per year for small‐population states. Respondents would accept reductions of between 1.6 and 3.4 beneficiaries in other programs in return for 1 additional mental health program beneficiary.ConclusionsOur results are consistent with findings that a substantial portion of the US public is unwilling to pay higher taxes. Nevertheless, even including the substantial number of respondents who opposed any tax increase, the willingness of both the mean and median respondent to be taxed for mental health program expansions implies that programs providing mental health services such as state Medicaid are underfunded.

Roles of peer specialists and use of mental health services among youth with serious mental illness.

To examine whether roles of peer specialists affect service use among Black, Latinx and White youth ages 16-24 with serious mental illness (SMI) in Los Angeles and San Diego Counties. Administrative data from 2015 to 2018 was used to summarize service use among 6329 transition age youth age 16-24 with SMI who received services from 76 outpatient public mental health programs with peer specialists on staff. Roles of peer specialists were assessed via a program survey. Generalized linear models were used to assess the relationship between peer specialist characteristics and service use outcomes (ie, outpatient and inpatient). Having a transition age youth peer specialist on staff (vs older peer specialists) and having peer specialists that provide four or more services (vs fewer services) was associated with an increase in annual outpatient visits in both counties (P=<.001 each). In Los Angeles County, having three or more peer specialist trainings (vs fewer trainings) was associated with lower use of inpatient services (P < .001). In San Diego County, having a transition age youth peer specialist and peer specialists that provide four or more services was associated with lower use of inpatient services (P < .001 each). Types of peer support and number of types of peer services were associated with mental health service utilization. Detailed examination of the roles of peer specialists is merited to identify the specific pathways that improve outcomes.

HIV and Sexual Health Services Available to Sexual and Gender Minority Youth Seeking Care at Outpatient Public Mental Health Programs in Two California Counties.

Purpose: Sexual and gender minority youth (SGMY, ages 16–24 years) face disparities in sexually transmitted infections (STIs) and HIV, in part, due to exposure to settings and behaviors that may harm youth's physical and mental health. This study examines the scope of sexual health and HIV services available to youth living with serious mental illness (SMI), including SGMY, seeking care at publicly funded outpatient mental health programs.Methods: Between 2018 and 2019, we surveyed 183 managers of mental health programs serving youth living with SMI of ages 16–24 years, including SGMY, in San Diego and Los Angeles counties. Participants reported on programs' target populations, sexual health/HIV service provision, and the use of peer providers. Descriptive statistics and Pearson chi-square tests were used to describe sexual health/HIV services and identify programmatic characteristics associated with providing these services.Results: Overall, 46% of all programs surveyed provided sexual health/HIV services. Of these, 62% provided HIV education, 81% provided sexual/reproductive health education, and 69% provided sexual/reproductive health education tailored for lesbian, gay, bisexual, queer, intersex (LGBQI) youth. Peers often provided these services. Chi-squared tests showed that programs employing peer specialists (p=0.009) and targeting LGBQI youth (p=0.045) were significantly more likely to provide sexual health/HIV services.Conclusion: The use of peer providers may reduce stigma around sexual/HIV service utilization and promote SGMY's trust. Publicly funded outpatient mental health programs serving youth and especially those actively engaging SGMY may consider also offering onsite HIV, STI, and sexual health services, creating a one-stop-shop approach.

The Availability of Peer Support and Disparities in Outpatient Mental Health Service Use Among Minority Youth with Serious Mental Illness

We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16–24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015–2018 was used to summarize service use among 13,363 transition age youth age 16–24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤ .05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P < .001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P < .05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes.

Implementación de un programa público de salud mental escolar en Chile en el contexto de la nueva gestión pública

This research aimed to characterize the implementation of a public school mental health program through the practices and perspectives of those who execute it under the prism of the New Public Management in Chile. Through qualitative content analysis of nine focus groups and four interviews, the results showed that the implementation is characterized by implementers whose practices are strongly influenced by their years of experience, and for an execution that requires high levels of adaptability and goes beyond what is indicated in the technical guidelines. Its implications are discussed given the way decentralization has taken in Latin America and its consequences for public policies.

Oral Health-Related Quality of Life Among Publicly Insured Mental Health Service Outpatients With Serious Mental Illness.

The study investigated factors associated with unmet need for dental care and oral health-related quality of life (OHQoL) among individuals with serious mental illness receiving outpatient care in a public mental health program serving a largely low-income population, mostly from racial-ethnic minority groups. Cross-sectional interview data were collected from a convenience sample (N=150) of outpatients. Adjusted risk ratios (ARRs) and adjusted risk differences (ARDs) were estimated by logistic regression models to examine the independent contribution of sociodemographic and clinical factors to low OHQoL and past-year unmet dental need, defined as inability to obtain all needed dental care. More than half of participants reported low OHQoL (54%) and a past-year dental visit (61%). Over one-third (39%) had past-year unmet dental need. Financial barriers (ARR=3.16) and nonfinancial barriers (ARR=2.18) were associated with greater risk for past-year unmet dental need after control for age, gender, high dental anxiety, and limited English proficiency. ARDs for financial and nonfinancial barriers indicated absolute differences of 40 and 27 percentage points, respectively. Unmet dental need (ARR=1.31), xerostomia severity (ARR=1.20), and a schizophrenia spectrum diagnosis (ARR=1.33) were associated with low OHQoL, after control for age and current smoking, with ARDs ranging from 11 to 15 percentage points. Improving oral health promotion, oral health service access, and the integration of the mental and oral health systems may help reduce the high prevalence of low OHQoL in this population, given that low OHQoL is partly driven by unmet dental need.

Construction and validation of a classroom climate scale: a mixed methods approach

Students’ perceptions of their classroom climate have been found to relate significantly to students’ learning outcomes. The purpose of the present study was to construct an instrument for assessing elementary-school students’ perceptions of classroom climate, based on a previous instrument that was being used in Chile by a public national school mental health program as a tool for aiding teachers in improving classroom management, but which showed poor psychometric properties. We used a six-staged mixed-methods approach to construct relevant items and dimensions based on this measure and by adapting previously-existing scales. Item development included participatory construction of items involving program officials, focus groups with students, and a pilot study. The final version was administered to a sample of 6813 elementary-school students. Results showed adequate reliability and construct validity, convergent validity with school climate, and divergent validity with peer victimisation. When consequential validity was explored through semi-structured interviews with program officials and school administrators, we found that the instrument was being used as a tool for helping teachers to improve their school climate and management skills. We discuss the importance of constructing instruments using a mixed-methods approach.

Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland.

We use discrete-time survival regression to study two empirical issues relating to take-up of individual placement and support (IPS) supported employment (SE) services for persons with serious mental illness: (1) the influence of client characteristics on take-up probability, and (2) the possible impacts of a major recent initiative in one state (Maryland) to overcome barriers to IPS-SE expansion. Our longitudinal analysis of population-based Medicaid cohorts, during 2002-2010, provides tentative evidence of positive state initiative impacts on SE take-up rates, and evidence of effects on take-up for clients' diagnoses, prior work-history, health and demographic characteristics, and geographic accessibility to SE providers.

Prevalence of suicidal ideation and attempt: associations with psychiatric disorders and HIV/AIDS in post-conflict Northern Uganda.

Research on the prevalence of suicidal ideation, attempt, and cormorbid psychiatric disorders in post-conflict areas is still limited. We explored the prevalence of suicidal ideation, attempt, associated psychiatric disorders and HIV/AIDS in post-conflict Northern Uganda, an area that experienced civil strife for over two decades. A total of 2400 respondents (aged 18 and above) and randomly selected in three districts (Gulu, Amuru and Nwoya), were interviewed. Multivariable logistic regression was used to assess for associations between suicidality (suicidal ideation and attempt) and psychiatric cormorbidities. The prevalence of suicidal ideation and attempt were 12.1 % and 6.2 % respectively. Suicidality was significantly (P<0.001) higher among respondents with major depressive disorder (adjusted Odds Ratio (OR) = 9.5; 95%CI= 7.4, 12.1) and post-traumatic stress disorder (adjusted OR =2.4; 95%CI= 1.6, 3.6). Men had lower odds of ideating or attempting suicide compared to women (adjusted OR = 0.55; 95%CI: 0.38, 0.82). The prevalence rate of suicide ideation and attempt indicate a major public health problem in post-conflict Northern Uganda. Effective public mental health programs that that target both suicidality and psychiatric co-morbodities will be vital. Special attention should be given to women in post conflict Northern Uganda.

Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland

Access to evidence-based supported employment (SE) services for persons with serious mental illness is limited in the U.S., despite evidence such services are effective and could benefit more persons. Major barriers to SE expansion are overlapping and limited funding streams, and interagency coordination problems. An important recent initiative in one state (Maryland) addressed both types of barriers. This longitudinal analysis of SE take-up probabilities for population-based cohorts of Medicaid recipients, during 2002-2010, provided tentative evidence of initiative impacts (particularly during the recession downturn), and evidence of effects for a schizophrenia diagnosis, prior work-history, health and demographic characteristics, and geographic accessibility.

Governance and mental health: contributions for public policy approach.

ABSTRACTOBJECTIVE To analyze the conceptualization of the term governance on public mental health programs.METHODS In this systematic review, we analyzed the scientific literature published in the international scenario during 15 years (from 2000 to 2015). The databases analyzed were: Medline, CINAHL, PsycINFO and PubMed. Governance and mental health were the descriptors. We included relevant articles according to our subject of study and levels of analysis: (i) the concept of governance in mental health; (ii) process and decision spaces; (iii) strategic and pertinent actors who operate in the functioning of the health system, and (iv) social regulations. We excluded letters to the editor, news articles, comments and case reports, incomplete articles and articles whose approach did not include the object of study of this review.RESULTS We have found five conceptualizations of the term governance on mental health in the area of provision policies and service organization. The agents were both those who offer and those who receive the services: we identified several social norms.CONCLUSIONS The concept of governance in mental health includes standards of quality and attention centered on the patient, and incorporates the consumers of mental healthcare in the decision-making process.