Quality Of Mental Health Services Research Articles

Researching the mental health needs of hard-to-reach groups: managing multiple sources of evidence

BackgroundCommon mental health problems impose substantial challenges to patients, carers, and health care systems. A range of interventions have demonstrable efficacy in improving the lives of people experiencing such problems. However many people are disadvantaged, either because they are unable to access primary care, or because access does not lead to adequate help. New methods are needed to understand the problems of access and generate solutions. In this paper we describe our methodological approach to managing multiple and diverse sources of evidence, within a research programme to increase equity of access to high quality mental health services in primary care.MethodsWe began with a scoping review to identify the range and extent of relevant published material, and establish key concepts related to access. We then devised a strategy to collect - in parallel - evidence from six separate sources: a systematic review of published quantitative data on access-related studies; a meta-synthesis of published qualitative data on patient perspectives; dialogues with local stakeholders; a review of grey literature from statutory and voluntary service providers; secondary analysis of patient transcripts from previous qualitative studies; and primary data from interviews with service users and carers.We synthesised the findings from these diverse sources, made judgements on key emerging issues in relation to needs and services, and proposed a range of potential interventions. These proposals were debated and refined using iterative electronic and focus group consultation procedures involving international experts, local stakeholders and service users.ConclusionsOur methods break new ground by generating and synthesising multiple sources of evidence, connecting scientific understanding with the perspectives of users, in order to develop innovative ways to meet the mental health needs of under-served groups.

Mental health quality and outcome measurement and improvement in Australia

This study outlines the broad approach taken in Australia to improve the quality of mental health services, including the use of performance and outcome measures along with a range of other linked quality initiatives. The investment of Australia in a strategic national approach to mental health reform with a range of nationally coordinated quality initiatives has provided a firm foundation for continuing to engage governments, healthcare organizations and clinicians in the ongoing quest for quality and outcome measurement and improvement. Australia has adopted a strategic national approach to quality and outcome measurement and improvement of mental health services despite having a federated health system involving nine governments and tiered care across public and private sectors. A range of interconnected initiatives including national plans, standards and guidelines, performance indicators and outcomes measures and benchmarking and reporting processes are the key components of this nationally coordinated system.

Part II: Multisystemic Therapy: Addressing Racial Disparity and Its Effectiveness With Families From Diverse Racial and Ethnic Backgrounds

Disparities in health and mental health care delivered to racial and ethnic minorities became a focus of national policy following reports of the Institute of Medicine (IOM, 2002) and the Surgeon General (USDHHS, 2001). The Surgeon General (USDHHS, 2001) reported racial and ethnic minorities experience disparities in availability and quality of mental health services compared to whites. Two challenges that intersect and compound each other are the disproportionately high numbers of African American children in child welfare with unmet mental health needs remaining in their homes or placed in relative's homes after a substantiation of child maltreatment (USDHHS, 2002) and the lack of culturally appropriate, effective home-based treatments available to them. This study compared outcomes for the youth who received Multisystemic Therapy (MST) controlling for the impact of race and ethnicity. The findings provide further evidence for child welfare practitioners to consider when working with children and families from diverse populations in decision-making.

Lives in isolation: stories and struggles of low-income African American women with panic disorder.

Research evidence points to the existence of racial-ethnic disparities in both access to and quality of mental health services for African Americans with panic disorder. Current panic disorder evaluation and treatment paradigms are not responsive to the needs of many African Americans. The primary individual, social, and health-care system factors that limit African Americans' access to care and response to treatment are not well understood. Low-income African American women with panic disorder participated in a series of focus-group sessions designed to elicit (1) their perspectives regarding access and treatment barriers and (2) their recommendations for designing a culturally consistent panic treatment program. Fear of confiding to others about panic symptoms, fear of social stigma, and lack of information about panic disorder were major individual barriers. Within their social networks, stigmatizing attitudes toward mental illness and the mentally ill, discouragement about the use of psychiatric medication, and perceptions that symptoms were the result of personal or spiritual weakness had all interfered with the participants' treatment seeking efforts and contributed to a common experience of severe social isolation. None of the focus-group members had developed fully effective therapeutic relationships with either medical or mental health providers. They described an unmet need for more interactive and culturally authentic relationships with treatment providers. Although the focus-group sessions were not intended to be therapeutic, the women reported that participation in the meetings had been an emotionally powerful and beneficial experience. They expressed a strong preference for the utilization of female-only, panic disorder peer-support groups as an initial step in the treatment/recovery process. Peer-support groups for low-income African American women with panic disorder could address many of the identified access and treatment barriers.

Community-Level Correlates of Hospitalizations for Persons With Schizophrenia

Community-Level Correlates of Hospitalizations for Persons With Schizophrenia

Mental health in the tropics

Although problems in mental health constitute 14% of the global burden of disease, mental health has been largely missing from the international health agenda. The burden from mental illness is largely attributable to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. The last decade has seen some progress in addressing this gap. In 2001, the World Health Report, Mental Health: New Understanding, New Hope, drew attention to the situation, with an appeal from the World Health Organization's Director General that 'mental health - neglected for far too long - is crucial to the overall well-being of individuals, societies and countries and must be universally regarded in a new light.' In September 2007, the journal Lancet launched the global mental health series, which highlighted the public-health dimension of mental health, identified barriers to receiving treatment, and gave a call for action to the nations of the world, to make a major commitment to upgrade the quality of mental-health services, to develop evidence-based treatment and preventive measures, to provide support for research in mental health, and to develop indicators to monitor progress. In October 2008, the World Health Organization launched the Mental Health Gap Action Programme, with the aim of scaling up the services for mental, neurological and substance-use disorders in all countries but especially those with low and middle incomes. The programme aims to develop evidence-based packages of care, psycho-social interventions and pharmacotherapy for tens of millions who could be treated for depression, schizophrenia and epilepsy, prevented from suicide, and begin to lead normal lives - even in very poor countries. While there is cause for optimism, much remains to be done. Most of all, there needs to be awareness amongst health providers and planners that mental health is an integral part of general health concerns, and that there can be no health without mental health.

Training, Treatment Access, and Research on Trauma Intervention in the Armed Services

Since 2001, the wars in Iraq and Afghanistan have caused considerable strain on military medicine to effectively manage the growing mental health demand from deployed personnel. This article examines the ability of the U.S. Department of Defense to provide quality mental health services based on the availability of (a) clinical training, (b) mental health interventions, and (c) funded research of treatments for posttraumatic stress disorder. While notable progress has been made in cognitive-behavioral treatment access and research, eye movement desensitization and reprocessing is far less available—perhaps attributable to ongoing controversy over the technique. We suggest that underserved veterans would benefit from increased availability of evidence-based behavioral treatments, perhaps through continuation of a recent regional training program.

Avaliação de serviços de saúde mental: adaptação transcultural de uma medida da percepção dos usuários sobre os resultados do tratamento

INTRODUÇÃO: Para avaliar a qualidade dos serviços de saúde mental, medidas de resultados relatados pelos próprios usuários têm sido destacadas e, mais recentemente, a percepção de mudanças. O objetivo desta pesquisa foi realizar a adaptação transcultural para o Brasil da escala canadense Questionnaire of Perceived Change, obtendo-se a Escala de Mudança Percebida (EMP), em duas versões: a dos pacientes e a dos familiares. MÉTODO: Participaram da pesquisa 20 familiares e 23 pacientes psiquiátricos de um serviço de saúde mental de uma cidade de porte médio de Minas Gerais. A escala foi submetida aos procedimentos de adaptação transcultural: tradução, retradução, análise por comissão de especialistas, estudo piloto. A escala original possui 20 itens que avaliam a mudança percebida em quatro dimensões da vida dos pacientes. As alternativas de resposta estão dispostas em escala tipo Likert de 4 pontos. RESULTADOS: Foram feitas modificações, incluindo: uma nova forma de aplicação por um entrevistador, número balanceado de alternativas de resposta resultando em três opções, redação dos itens em linguagem simples, eliminação de um item, uso de exemplos e inclusão de duas perguntas abertas. A escala mostrou-se de fácil compreensão pelos usuários. CONCLUSÃO: As duas versões da escala EMP estão adaptadas ao contexto brasileiro e apresentam equivalência semântica com a escala original. Elas servirão para avaliar os resultados do tratamento, na percepção dos seus usuários.

Integrating Behavioral Health Care and Primary Care: Application of a Clinical and Economic Model in Culturally Diverse Communities

Although mental illness treatment protocols exist, the organization and financing of screening and treatment services inhibit access. These challenges are compounded for refugees, immigrants, and other groups vulnerable due to their ethnicity, race, or culture. By creating a system-wide, collaborative, integrated model that recognizes and addresses critical clinical and economic aspects in the delivery of services, high quality, evidence-based care can be made available to groups susceptible to the burdens of mental illness. Clinically and financially aligning primary and specialty care offers a viable alternative for improving access and quality of mental health services to vulnerable populations.

The psychological impact of rape victims.

This review article examines rape victims' experiences seeking postassault assistance from the legal, medical, and mental health systems and how those interactions impact their psychological well-being. This literature suggests that although some rape victims have positive, helpful experiences with social system personnel, for many victims, postassault help seeking becomes a "second rape," a secondary victimization to the initial trauma. Most reported rapes are not prosecuted, victims treated in hospital emergency departments do not receive comprehensive medical care, and many victims do not have access to quality mental health services. In response to growing concerns about the community response to rape, new interventions and programs have emerged that seek to improve services and prevent secondary victimization. The contributions of rape crisis centers, restorative justice programs, and sexual assault nurse examiner programs are examined. Strategies for creating more visible and impactful roles for psychologists and allied professionals are also discussed.

School Mental Health and Foster Care: A Logical Partnership

School mental health is increasingly recognized as an effective framework of care for enhancing access to high quality mental health services for school age youth. This article discusses the potential role that school mental health can play in helping to address the mental health needs of children and adolescents in foster care, a group with elevated risk for mental health and educational problems when compared to other children and adolescents living in high risk environments. A full continuum of school mental health services, from prevention to intervention, offers opportunities to reach these youth before academic and emotional-behavioral problems escalate. Benefits and challenges to providing services to youth in foster care through school mental health are discussed and next steps toward developing a training curriculum that addresses core competencies needed for effective school-mental health-foster care integration are addressed.

Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research.

The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: (1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; (2) distinguishing among key components of the diffusion process-including contextual factors, adoption, implementation, and sustainment of interventions-showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; (3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and (4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies.

Jail Diversion

The primary purpose of this research is to illuminate three critical components related to the success of jail diversion programs. First, prior to diversion there is the need to identify those offenders most open to therapeutic services. Second, for those offenders diverted, there must be a proper match between the offender and the mental health professional who provides therapeutic services. Third, quality mental health services must have therapists that are routinely involved in the offender's clinical progress from intake to program completion. Suggestions are offered which may serve to forward the evolution of jail diversion implementation and enhance success rates.

State Prison Mental Heath Services Recipients Perception of Care Survey

Studies have demonstrated the importance of patient perceptions' of mental health service quality. No studies, however, could be found that surveyed recipients in prison, despite the rapid growth of patients, and litigation in these settings. Patients were asked to complete an anonymous survey in private, and sealed it in an envelope. Of 613 respondents, most were satisfied (79%), agreed they had sufficient access to therapists (78%), were involved with treatment decisions (84%), and thought the MH services they had received would help them better deal with a crisis and emotional stress (75%). There were differences among mental health programs/housing units. Several of perception questions were significantly correlated with medication compliance, admission to crisis observation cells, and receiving disciplinary infractions. Random samples were requested, but likely only a convenience sample was obtained. However, the positive results suggest the need to strive to enhance patient quality of care ratings.

Collective inquiry: understanding the essence of best practice construction in mental health

Delivering quality services has become a committed aspiration of mental health services over the past decade. Service planners look to validated care models to give guidance on what constitutes best practice. While there are many different views of what is 'best', there is a growing acknowledgement that services need to listen to the experiences of a network of frontline stakeholders in order to create quality mental health services. This paper describes an exploratory study within a regional mental health service that aimed to understand the meaning and enactment of best practice from the perspectives of a representative sample of service users and providers. A number of themes emerged as important and include the inherent value placed on consistent familial style relationships between service user and provider. This was deemed pivotal to the provision of expertise, good clinical decision-making, choice and collaboration. The study also highlighted stakeholder preference for autonomy and openness to inquiry into developing practice. In deconstructing the meaning of best practice, the study prompts a closer consideration of how best practice is created and suggests a view of best practice as a fluid dialogic process that is co-constructed by its participants in ongoing dialogic communication and reflection.

Minority-Oriented Programs Awarded for Achievements

Back to table of contents Previous article Next article Association NewsFull AccessMinority-Oriented Programs Awarded for AchievementsKen HausmanKen HausmanSearch for more papers by this authorPublished Online:6 Jul 2007https://doi.org/10.1176/pn.42.13.0008The American Psychiatric Foundation's (APF) annual gala, held on May 19 in San Diego, accomplished two key goals—it set a fundraising record for the foundation and honored several initiatives that have advanced minority mental health, one of the program areas in which APF has provided considerable funding. It also provided contributors with great food, wine, and music.APF President Altha Stewart, M.D., noted at the gala that it was on track to raise about $230,000, an increase of $40,000 over the amount raised at the 2006 gala in Toronto.One popular fund-raising feature of recent foundation galas is a silent auction at which attendees bid on trips, gift baskets, and art work.Dennis Hunt, Ph.D., executive director of the Center for Multicultural Human Services, receives an award on behalf of the program from American Psychiatric Foundation President Altha Stewart, M.D. The award recognizes the program's efforts to serve the “complex mental health needs of vulnerable, low-income immigrants, refugees, and survivors of war and trauma.”Credit: David HathcoxA major part of the evening, which was held at the San Diego Wine and Culinary Center, was presentation of the APF's annual Awards for Advancing Minority Mental Health. The following individual and programs were cited this year:♦ Henry Acosta, M.S.W., was recognized for his work at the New Jersey Mental Health Institute, where he has been instrumental in a major increase“ in access to and provision of quality mental health services for Hispanics through training, educational materials, public-service campaigns, and policy-development initiatives.”♦ Mt. Sinai Hospital Assertive Community Treatment Team in Toronto was acknowledged for its “ethno-specific program serving marginalized, severely, and persistently mentally ill ethnic minority populations.” The program relies on a “cultural-competency” model and matches patients with clinicians who have similar backgrounds.♦ Center for Multicultural Human Services in Falls Church, Va., was honored for developing a program that addresses “the complex mental health needs of vulnerable, low-income immigrants, refugees, and survivors of war and other trauma.”♦ Family Health Centers of San Diego was awarded for its extensive individual and group treatment programs and case management that address the mental health needs of “uninsured and medically underserved individuals.” The program has 24 service sites and serves more than 100,000 persons annually.The foundation also inducted Clarence Chou, M.D., of Milwaukee into its Benjamin Rush Circle, which honors donors who have given at least $10,000 over their lifetime to the APF. ▪ ISSUES NewArchived

How do patients expect the mental health service system to act? Testing the WHO responsiveness concept for its appropriateness in mental health care

The World Health Organisation (WHO) concept of r esponsiveness has been defined as a measure of how well the health system responds to the population's legitimate expectations of non-health aspects of health care provision. It comprises eight domains: dignity, prompt attention, autonomy, choice of health care provider, clear communication, confidentiality, quality of basic amenities, and access to social support networks. The concept is of particular relevance to mental health care systems because of the specific dependency and vulnerability of their users. We tested its applicability to mental health care with five focus groups of experienced mental health care users in Hannover, Germany. The focus groups revealed 492 statements about users’ expectations in mental health care. Most concerned attention (115), dignity (108) and autonomy (86). The quotations were assigned to the eight responsiveness domains. In addition, the domain of prompt attention was extended and renamed attention, and the new domain continuity was created. The findings correspond with the literature on health care expectations of non-mental health patients, but differ slightly from the results of a WHO study on overall health care responsiveness. The need for widening the concept of continuity and extending the attention domain reflects the nature of mental health care of providing predominately long-term care. Our analysis indicates the feasibility of the responsiveness concept (if altered as proposed) as a tool for assessing the quality of mental health service from the users’ point of view. It should also be further developed to quantitatively evaluate mental health care systems and to benchmark system performance.

APA Needs More Input From District Branches

Back to table of contents Previous article Next article From the SpeakerFull AccessAPA Needs More Input From District BranchesMichael Blumenfield, M.D.Michael BlumenfieldSearch for more papers by this author, M.D.Published Online:4 May 2007https://doi.org/10.1176/pn.42.9.0009At the conclusion of the annual meeting in May, I will complete my term as speaker of the Assembly. I have had the opportunity to visit all the Area meetings, most of them at least three times, over the past three years and have sat on the Board of Trustees and the Finance Committee. I have come to appreciate more than ever the vibrancy of APA, mainly through the dedicated members who spend a great deal of time throughout the year serving APA in various capacities and the great staff under the direction of our medical director.We have so many outstanding psychiatrists who, in addition to treating their patients and working for their local mental health institutions, have chosen to collaborate on the national and local levels to serve our patients and our profession. Nowhere is that more clearly demonstrated than in the Assembly, where we come together representing every district branch plus MITs, ECPs, minority groups, and allied organizations. Not only are creative solutions offered here, but also there is passion in an open, democratic process. The Assembly representatives are an essential connection between local psychiatrists throughout the United States and Canada and the national efforts that originate at APA headquarters.Based on my observations as an Assembly officer, I have concluded that the district branches can take on an even more important role in providing input to our APA and influencing the delivery and quality of mental health services. Most health care decisions that occur on a national level have implications on the state and local level. Similarly, observations, experiences, and data from district branches have significance for APA and the mental health movement in this country.As the result of a joint meeting arranged by APA's president, Dr. Pedro Ruiz, between the APA Board of Trustees and the Board of Trustees of the National Alliance on Mental Illness (NAMI), I set up a program in which a district branch member will serve as a liaison with a local NAMI member. I suggested that there be discussion about the same agenda on which the two boards were dialoguing on the national level. This included the adequacy of mental health care for returning veterans, parity on both the national and state levels, problems with access to care, and other subjects. I also encouraged district branches to hold town-hall meetings to discuss these and other important mental health topics. I suggested that they invite the public and professionals in the community to “testify” before a panel of psychiatrists from the district branch. I believe that this is a method by which we can gain valuable information and data. We can demonstrate to our government leaders and the media that American psychiatry at all levels is involved and active. Several district branches are already planning to undertake this project.This type of action can produce government response and public support as well as action papers in our Assembly. I would hope that someday this would be a hallmark of how APA functions.We expect to see many important actions papers debated in our Assembly later this month in San Diego, with topics including increased access to treating veterans with PTSD, protection of children who testify in criminal procedures, information systems and technology in psychiatry, and the reoccurring question of the relationship between the Assembly and Board of Trustees. We have invited the president of Mental Health America, one of our coalition partners, to speak to us. We also will hear from the president of the Britain's Royal College of Psychiatrists about the pros and cons of the British system of mental health coverage. The discussion and debate on all subjects will be lively, passionate, heartfelt, and always in the best interest of our patients.I want to thank all of the Assembly members for their support and the collegial atmosphere that they always provide. I also appreciate the work of Drs. Jeff Akaka and Ron Burd, my co-officers in the Assembly; Dr. Michael Pearce, my parliamentarian; and of course Lori Klinedinst, Margaret Dewar, Ardell Lockerman, and the other APA staff who work behind the scenes to make our Assembly and all of APA function as well as they do.I know that the Assembly and APA will continue to be responsive to changing events, but we will always be a shining light in the support for mental health care. ▪ ISSUES NewArchived

The stigma of schizophrenia from patients' and relatives' view: A pilot study in an Italian rehabilitation residential care unit

ObjectiveTo identify the constituent elements of the stigma from the perspective of those having first-hand experiences of it.MethodsSubjective experiences of stigma were explored in six focus groups: three with people suffering from schizophrenia and three with patients' relatives. Focus group sessions were tape-recorded, transcribed and analyzed by means of an inductive method, forming categories from the texts, as a basis for coding. Analysis aimed at establishing a typology of stigmatization experiences from the spoken words of the focus group participants.ResultsFour dimensions of stigma were identified: access to social roles; internalization of stigma; quality of mental health services, public image of mental illness.ConclusionThe most frequently found topics concerned experiences of marginalization and discrimination that people with schizophrenia experience in their daily life. These results mirror the findings of similar studies obtained in other cultural contexts.

A new self-report questionnaire called "ABC" to evaluate in a clinical practice the aid perceived from services by relatives, needs and family burden of severe mental illness.

ObjectiveTo describe: a) a self-report questionnaire of 34 item, developed by a Family Association of Psychiatric Patients in collaboration with two psychiatrists to evaluate by key-relative in a clinical practice the perceived quality of mental health services, the needs and family burden; b) the methodology of validation.MethodsIt has been studied (a) the Face Validity by two focus groups of 10 relatives for each group, (b) the concurrent validity of family burden items comparing the ABC with QPF, a widely used questionnaire, in 6 Italian mental health centres on a sample of key-relatives, (c) the discriminant validity comparing three different samples of key-relatives of patients with psychiatric illness, Alzheimer or cancer. The internal consistency of items for assessing relatives' opinions on the quality of care has been evaluated by Chronbach' s α. The test-retest has been evaluated on a sample of 20 key-relatives.ResultsThe results indicate a fairly good performance of the questionnaire in this preliminary but almost complete phase of validation. The time to fill in it has been estimated in a 7 minutes average.ConclusionIt is possible by this self-report questionnaire to evaluate in a clinical routine setting and in a very short time three important problems for relatives and professionals: opinions and needs of relatives, and objective and subjective family burden of severe mental illness.