Receipt Of Mental Health Services Research Articles

The cost-utility of an intervention for children and adolescents with a parent having a mental illness in the framework of the German health and social care system: a health economic evaluation of a randomized controlled trial

BackgroundChildren of families with a parent with a mental illness have an increased risk of developing social and mental health problems resulting in decreased quality of life. Therefore, children and adolescents living in families with a parent with mental illness are regarded as a target group for preventive interventions. To date, only a few economic evaluation studies for interventions directed at preventing the intergenerational transmission of mental health problems exist. In this investigation we estimated the cost utility of an intervention for the support of children and adolescents with a parent having a mental illness from the perspective of the German health and social care system.MethodsWe randomly assigned a total of 214 families with 337 children and adolescents to the intervention (INT) group (108/170) or the control (TAU) group (106/167). Families in the intervention group received on average eight intervention sessions (50–90 min) over 6 months. We estimated total cost of illness by means of the Children and Adolescent Mental Health Service Receipt Inventory (CAMHSRI) over 24 months. For the estimation of Quality-Adjusted Live Years (QALYs) we applied the KIDSCREEN-10. For estimating the incremental cost-utility of the intervention compared to treatment as usual we used the net-benefit approach.ResultsWe estimated the annual cost of illness amounting to € 3784.59 (SD € 8581.11) in the TAU group and € 3264.44 (SD € 9431.89) in the INT group. The annual cost difference between INT and TAU was € − 516.14 (SE 1124.95) which was not significant (p ≤ 0.05). We estimated the average QALY to be 0.759 (SD 0.073) in the TAU group and 0.763 (SD 0.072). The QALY difference between INT and TAU was 0.0037 (SE 0.0092) which was not significant (p ≤ 0.05). The incremental cost utility ratio (ICUR) indicated that the gain of one additional year in full health by means of the intervention was associated with the saving of € 139.49. However, the stochastic insecurity of the ICUR did not allow a unique decision about the cost-utility of the intervention.ConclusionsMore information on the economic value of the intervention for families with a parent with mental illness in comparison to treatment as usual in Germany is needed.Trial registration: ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

Predictors of suicide coping self-efficacy among youth presenting to a psychiatric emergency department.

Low levels of youth-reported self-efficacy to cope with suicidal urges have been shown to prospectively predict repeat emergency department (ED) visits and suicide attempts, yet little is known about how self-efficacy may change following receipt of crisis services or about factors that may strengthen self-efficacy. Protective factors (e.g., parent-reported youth competence, parent-family connectedness, and receipt of mental health services) were examined in relation to self-efficacy at the time of a psychiatric ED visit and 2 weeks later. Participants were 205 youth (ages 10-17), presenting to a psychiatric ED due to a suicide-related concern. Youth primarily identified as biological female (63%) and White (87%). Multivariate hierarchical linear regressions were used to examine candidate protective factors in relation to initial and follow-up suicide coping self-efficacy. Self-efficacy significantly improved in the 2 weeks following the ED visit. Parent-family connectedness was positively related to suicide coping self-efficacy at the time of the ED visit. Parent-family connectedness and receipt of inpatient psychiatric care following the ED visit were associated with higher follow-up suicide coping self-efficacy. During the adolescent developmental period when suicidal thoughts and behaviors notably increase, study findings highlight potential malleable intervention targets, including parent-family connectedness, that may strengthen suicide coping self-efficacy.

Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children’s Mental Health Systems: A Case Study of the Gateway CALL Demonstration

The mental health needs of children and youth involved in the child welfare system remain largely unmet. Service cascades are an emerging approach to systematizing mental health screening, assessment, and treatment referral processes. However, evidence is minimal and inconsistent regarding the effectiveness of such approaches for improving mental health service access and outcomes. In an effort to address this gap, this study presents a case-study of the implementation fidelity and treatment outcomes of the Gateway CALL service cascade. Study analyses involved longitudinal data collected as part of a larger evaluation of Gateway CALL. Specifically, descriptive and linear mixed model analyses were conducted to assess the implementation of service cascade components, and changes in mental health outcomes (behavior problems) among 175 children placed out-of-home during the study. Study analyses found that although fidelity was strong early in the service cascade, implementation began to break down once components involved more than one service system (child welfare, mental health). However, results also indicated that parent-reported child behavior problems decreased significantly over time, despite later cascade components being implemented with poor fidelity to the Gateway CALL service model. For children and youth involved in child welfare systems, service cascades like Gateway CALL have the potential to significantly improve both mental health service receipt and outcomes. To maximize the effectiveness of such approaches, later phases of implementation may require increased attention and support, particularly regarding processes and outcomes that cross child welfare and mental health service systems.

Among Children Placed in Kinship Care: Exit to Reunification, Adoption, or Foster Care

This study examined factors related to children’s exit from kinship care to reunification, adoption, and foster care. Data describing 498 parents of children placed in kinship care were extracted from a national survey. Results showed that the likelihood of reunification was increased with other maltreatment type, parent receipt of mental health services, number of alcoholic drinks consumed, having other health insurance, and family income; such likelihood was reduced by parent nonmedical use of medication, receipt of health-care services, and education. Number of alcoholic drinks consumed, number of IPV episodes reported, receipt of domestic-violence services, caseworker turnover, and family income increased the likelihood of exit to adoption; receipt of legal services, having other health insurance, parent of other minority race/ethnicity, and being employed diminished such likelihood. Likelihood of exit to foster care was reduced by other maltreatment, nonmedical use of medication, mental health, receipt of employment services, receipt of health-care services, having other health insurance, parent–caseworker shared race/ethnicity, Hispanic parent, other non-Black minority parent, and education. Such likelihood was increased with physical maltreatment, receipt of financial assistance, difficulty in accessing services, perceived caseworker engagement, and caseworker turnover. Implications and future research for facilitating unification, case plans, and working alliance are discussed.

Trajectories of mental health services for youth in foster care with attention deficit hyperactivity disorder

Youth in foster care with Attention Deficit Hyperactivity Disorder (ADHD) often have significant needs for mental health services. The degree to which youth taking medication for ADHD use mental health services in relation to sibling co-placement and their level of need over time is unclear. To examine these issues, caregivers (N = 54) provided information on youth mental health service use across an 18-month study period. Results show that siblings living apart had a higher probability of mental health service use. For youth with higher CBCL scores, probability of mental health service use was both high and stable over time. However, youth with lower CBCL scores showed a decrease in probability of mental health service use over time. The sustained commitment to receipt of mental health services among youth with ADHD is something all behavioral health providers who work with foster care involved youth can benefit from, as well as the youth themselves.

Disparities in psychological distress and access to mental health services among immigrants with rheumatologic disease.

Patients with rheumatologic disease experience higher rates of comorbid mental health diseases than those without. Although mental health services (MHS) can improve musculoskeletal functional outcomes, access to MHS has been limited among vulnerable populations in the United States (US). The purpose of this study was to investigate contemporary patterns of severe psychological distress and receipt of MHS among immigrant populations with rheumatologic disease in the US. The National Health Interview Survey was queried for patients with rheumatologic disease from 2009 to 2018. Patient demographics, severe psychological distress, and receipt of MHS were collected and/or calculated. Multivariable logistic regressions assessed for factors associated with decreased receipt of MHS and severe psychological distress. Immigrant patients with rheumatologic disease had higher rates of severe psychological distress than US-born patients (7.7% vs. 6.5%, p < 0.001), but were less likely to access MHS (8.3% vs. 11.0%, p < 0.001). Among immigrant patients, factors associated with lower MHS receipt included being Black (AOR 0.50, 95% CI 0.32-0.77, p = 0.002), Hispanic (AOR 0.80, 95% CI 0.30-1.00, p = 0.050), Asian (AOR 0.44, 95% CI 0.31-0.63, p < 0.001), older (p < 0.001), uninsured (p < 0.001), and having self-reported poor health (p < 0.001). Immigrant patients with rheumatologic disease in the US had higher rates of severe psychological distress yet were less likely to receive MHS compared to US-born patients. Immigrants with rheumatologic illness were less likely to receive MHS if they were male, Black, Hispanic, Asian, older, lower income, or uninsured. This lack of MHS receipt may contribute to disparities in functional outcomes seen in immigrant minorities with musculoskeletal disease. Key Points • Immigrant patients with rheumatologic disease in the US had higher rates of severe psychological distress yet were less likely to receive MHS compared to US-born patients between 2009 and 2018 • Immigrants with rheumatologic illness were less likely to receive MHS if they were Black, Hispanic, Asian, older, lower income, or uninsured • Future efforts to carefully screen for mental health diseases in these vulnerable patient populations should be made while exploring patient-specific cultural considerations of MHS receipt.

Does mental health screening and assessment in child welfare improve mental health service receipt, child safety, and permanence for children in out-of-home care? An evaluation of the Gateway CALL demonstration

BackgroundUnmet mental health service needs among children in out-of-home care are sometimes attributed to poor assessments and referrals in child welfare. The Gateway CALL project implemented mental health screening, diagnostic assessment, and referral to treatment practices. ObjectiveWe examined the effectiveness of Gateway CALL for improving children's mental health service receipt, safety, and permanency outcomes. Participants and settingParticipants included 538 children (birth to 18 years) in out-of-home placements through a county-based child welfare agency over a 17-month period. MethodsWe compared the mental health service receipt, safety, and permanency outcomes for 175 children who received Gateway CALL with 175 children who received “services as usual” identified through propensity score matching. Participant demographics, safety, and permanency outcomes were drawn from child welfare administrative records, and mental health service visits and diagnoses were drawn from Medicaid billing records. ResultsGateway CALL appeared to increase the number of mental health service visits children received (z = 2.14, p = 0.032), although not the likelihood of receiving services. In terms of child safety, children in Gateway CALL had a greater number of screened-in calls after the intervention than those in the comparison group [t(348) = −1.92, p = 0.03]; there were no differences in substantiations. There were also no observed effects on permanency. ConclusionsDespite systematic efforts to identify, assess, and refer children to mental health services through the Gateway CALL intervention, substantial unmet mental health service needs among children persisted. Results have implications for designing interventions that promote cross-system service access.

The CRISIS Survey: The Catholic Church's Work with Immigrants in a Period of Crisis

The CRISIS Survey: The Catholic Church's Work with Immigrants in a Period of Crisis

11.2 CHILDREN’S MENTAL AND BEHAVIORAL HEALTH BEFORE, DURING, AND AFTER THE COVID-19 PANDEMIC

Public health crises, such as the ongoing COVID-19 pandemic, can cause emotional distress in children without mental disorders and worsen existing mental disorders. Since the beginning of the COVID-19 pandemic in the United States in 2020, reports of children’s mental health concerns have increased. Access to services before, during, and after public health crises is essential for promoting children’s emotional well-being. The unique combination of the COVID-19 public health crisis, social isolation, and other social and economic factors may create new barriers to mental health service receipt and exacerbate existing barriers. This presentation will highlight 3 areas of research: 1) support from primary care providers for adolescents with mental, behavioral, and developmental disorders during the transition from the pediatric to the adult healthcare system prior to the COVID-19 pandemic; 2) children’s mental health–related emergency department visits during the COVID-19 pandemic; and 3) a systematic review of policies about access to children’s mental health care. The utility of public health surveillance data, including data from the National Survey of Children’s Health and the National Syndromic Surveillance Program, to identify mental/behavioral health service needs and use will be discussed, and policy levers that may improve services will be presented. Gaps, methodological challenges, and areas for future research will be described. Nearly 1 in 5 children (age <18 years) in the United States have a mental, emotional, or behavioral disorder, such as anxiety, depression, ADHD, and disruptive behavior disorder. The findings of the studies to be presented suggest that continued monitoring of children’s mental health and ensuring that mental health services are accessible by families are essential before, during, and after public health crises.

A Reduction in Health Care Expenditures Linked to Mental Health Service Use Among Adults With Chronic Physical Conditions.

The aim was to examine the impact of receipt of mental health services on health care expenditures for U.S. adults with major chronic physical conditions. Medical Expenditure Panel Survey data for 2004-2014 were analyzed for adults ages ≥18 with at least one of six chronic physical conditions (cardiovascular diseases, cancer, diabetes, emphysema, asthma, and arthritis) who were followed up for 2 years (N=33,419). Outcomes included overall health care spending and expenditure by service type (inpatient services, outpatient services, emergency department visits, office-based physician visits, and prescribed medication). A difference-in-differences model compared a change in health care costs in the subsequent year for those who did and did not receive mental health services in the preceding year. On average, the increase in overall health care expenditure in the subsequent year among adults receiving mental health services in the preceding year was smaller by 12.6 percentage points (p<0.05) than for those who did not receive such services. The difference was equivalent to $1,146 in 2014 constant U.S. dollars (p=0.05). Medication treatment alone did not have a meaningful effect on overall costs. The combination of psychotherapy and medication was associated with a per-capita reduction in overall health care expenditure of 21.7 percentage points, or $2,690 (p<0.01). The combination was also associated with reduced costs for office-based visits (p<0.05) and medication (p<0.05). Receipt of mental health services was associated with a reduction in overall health care costs, particularly for office-based visits and prescribed medication, among adults with chronic physical conditions.

Costs of health and social services use in children of parents with mental illness

BackgroundChildren of parents with mental illness have a higher risk of developing mental health problems when compared with the general population. Therefore, families with parents with mental illness are a suitable target group for selective prevention. In order to plan and evaluate the health economic consequences of preventive interventions for this target group, data on the societal costs related to parenthood under the condition of mental disorders are needed. To date, within Germany there has been a lack of research evaluating the costs of mental health treatment and use of social services by children and adolescents with parents with mental illness.MethodsAs part of a multicentre randomised controlled trial, use and costs of health and social services were assessed for a sample of 332 children and adolescents with parents with mental illness in six regions of Germany. Service use at baseline was assessed by the German version of the Children and Adolescent Mental Health Service Receipt Inventory. Costs were calculated for 12 months based on diagnosis and service user status and described separately. Cost drivers were identified by means of a two-part regression model.ResultsTotal mean costs for 12 months for the total sample amount of € 3736.35 (95% CI: € 2816.84–4813.83) per person. Children with a psychiatric diagnosis generated a total of € 5691.93 (95% CI: € 4146.27–7451.38) of costs per person, compared to € 1245.01 (95% CI: € 657.44–1871.49) for children without a psychiatric diagnosis. The logit part indicates significant odds ratios for individual functioning and diagnosis of the child as well as for family functioning. The linear part reveals that increasing individual functioning in the child is related to decreasing costs.ConclusionsChildren of families with parents with mental illness use a broad spectrum of mental health care, school-based support and youth welfare services even if they are not yet diagnosed as having a mental disorder. Further research should examine whether these institutions are sufficiently qualified and interlinked to meet the support needs of this vulnerable group.Trial registration The study was registered at the 07/10/2014 before the start of data collection (04/11/2014) at the German clinical trials register (Deutsches Register Klinischer Studien, DRKS, nr: DRKS00006806, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006806).

Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study

BackgroundTo characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation.MethodsWe performed a cross-sectional cohort study of children 12–17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017–9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children’s Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality.ResultsOf the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99–1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82–0.98]; p < 0.02).ConclusionsSuicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.

“We Are Our Own Counselor”: Resilience, Risk Behaviors, and Mental Health Service Utilization among Young African American Men

Despite risk for trauma, subsequent mental health concerns, and poor health outcomes, young Black/African American men (YBM) are less likely to receive mental health services than other racial/ethnic groups. Despite the growing literature on resilience, there is less information on relationships between resilience, risk behaviors, and use of mental health services. This study sought to examine resilience, trauma-related risk behaviors, and receipt of mental health services among a sample of YBM who experienced trauma. Focus groups and a brief survey were conducted with YBM (N = 55) who had been exposed to at least one traumatic event (e.g., witnessing violence, experienced serious injury or illness) and were recruited from urban community settings (e.g., colleges/universities, barbershops, churches). Participants were an average age of 23 years (SD = 3.9; range 18–30) and experienced an average of 2 to 3 traumatic events (SD = 2.2). Trauma exposure was a significant predictor of risk factors (β = .513, p < .01). However, resilience did not significantly moderate this relationship. Resilience also did not predict receipt of mental health services. Culturally relevant qualitative themes found to be related to resilience included maintaining resilience autonomously, preferred coping methods (e.g., friends, music), and habituating to adversity. This study has potential to inform the development of culturally tailored, relevant interventions to promote engagement in mental health services among YBM who’ve experienced trauma.

Mental distress and mental health services receipt in foreign-born survivors of cancer: A national health interview survey analysis.

e19001 Background: There is a greater burden of mental illness, in survivors of cancer compared with the general population. Though mental health interventions may reduce mental distress and improve subsequent oncological outcomes, there are disparities in mental health service (MHS) receipt in immigrant populations. Therefore, we examined contemporary patterns of mental distress and mental health service receipt by immigrant status in cancer survivors in the United States. Methods: Data are collected in non-institutionalized civilian adults by the US National Health Interview Survey. For this study, harmonized data of participants reporting a cancer diagnosis were extracted from the Integrated Health Interview Series from 2009-2018. Sample weight-adjusted estimates of mental distress were defined by the validated Kessler 6 (K6). MHS receipt in the past 12 months was estimated, stratified by K6 status. Multivariable logistic regression defined adjusted odds ratios (AOR) and 95% confidence intervals (95CI) for the odds of MHS receipt, with birth status (US vs. non-US) as the primary independent variable of interest. Results: Among 14,653 adult survivors of cancer and 207,018 adults without cancer, 4.16% vs. 3.01% had K6 &gt;13, respectively (AOR 0.96, 95CI 0.87-1.07, P = 0.504). Among survivors of cancer, younger age, female sex, and white race were associated with K6&gt;13, while factors associated with lower MHS receipt included non-US born status, non-white race, and older age. The distribution of severe mental illness (K6&gt;13) did not differ by place of birth. However, non-US birth status was associated with lower MHS receipt among survivors of cancer with K6 &lt; 13 (5.61% vs 8.15%, AOR 0.67, 95CI 0.49-0.92, P = 0.013), and there was a greater disparity among those with K6&gt;13 (9.43% vs 37.8%, AOR 0.19, 95CI 0.08-0.45, P &lt; 0.001) (Pinteraction= 0.002). Conclusions: In this large contemporary cross-sectional survey, though there was a similar distribution of mental distress in survivors of cancer based on birth status, non-US born adults with severe mental distress (K613) were 81% less likely to receive MHS relative to US born adults. These data suggest that immigrant survivors of cancer who suffer from severe mental distress may be a greater risk not receiving appropriate MHS, which could lead to subsequent adverse outcome. Given the demonstrated gap in use of MHS in non-US born adults with cancer and severe mental distress, increased efforts are needed to screen for mental illness and the need for MHS in immigrant populations.

Associations of Sociodemographic Factors and Psychiatric Disorders With Type of School-Based Mental Health Services Received by Youth

PurposeSchools provide access to mental health services for traditionally underserved youth. However, there is variability in the types of school-based services students receive (e.g., school counseling, services in separate classrooms, or schools serving students with psychiatric disorders). Prior research has typically not distinguished among these different types of school-based services. The present study examines sociodemographic characteristics and disorders associated with the types of services received in schools. MethodsData were analyzed from a sample of adolescent–parent pairs in the U.S. National Comorbidity Survey Adolescent Supplement who received school mental health services (N = 1,204). DSM-IV diagnoses were based on the Composite International Diagnostic Interview administered to adolescents and questionnaires self-administered to parents. Adolescents (aged 13–18 years) and parents also responded to questions about lifetime school-based mental health service receipt. ResultsAmong those receiving school-based mental health services, almost one-third (29.7%) received services in a separate classroom and almost one-fourth (22.3%) in a separate school. Increased likelihood of lifetime placement in a separate classroom or school was detected among older youth, males, blacks, Latinos, youth with learning disabilities, those whose parents had fewer years of education, and those who received community-based mental health services. Oppositional defiant disorder was associated with increased lifetime placement in a separate school. ConclusionsThe results advance the evidence base by indicating that racial/ethnic minority youth and those whose parents have fewer years of education were more likely to receive school-based mental health services in separate settings. These results provide more context to studies of school-based mental health service receipt.

Mental health services receipt among caregivers in the child welfare system: A longitudinal analysis

This study intended to identify factors associated with receipt of mental health services by caregivers substantiated for maltreatment. Longitudinal records for 1445 substantiated caregivers were extracted from a national data set. Generalized estimating equations yielded positive associations between receipt of the services by caregivers and 3 explanatory factors: need for mental health services, inclusion of mental health services in case plan, and second interview wave. The analysis results also yielded negative associations between receipt of the services and 11 explanatory factors: mental health, number of IPV episodes, refusal of services, number of caseworkers worked with, African American, Hispanic, physical maltreatment, sexual maltreatment, neglect, kinship care placement, and out-of-home placement. Mental health services receipt was not associated with substance use, caseworker engagement perceived by caregiver, socioeconomic factors, or other demographic factors. Implications for child welfare efforts include the need to identify mental health problems among caregivers; to ensure case plans state any need for mental health services; to address refusal of services by caregivers; and to ensure cultural competence within agencies serving caregivers of minority ethnicity.

Is screening for psychosocial risk factors associated with mental health care in older adults with cancer undergoing surgery?

Surgery is a notable stressor for older adults with cancer, who often are medically and psychosocially complex. The current study examined rates of preoperative psychosocial risk factors in older adults with cancer who were undergoing elective surgery and the relationship between these risk factors and the provision of mental health services during the postoperative hospitalization. A total of 1211 patients aged ≥75years who were referred to the geriatrics service at a comprehensive cancer center were enrolled. Patients underwent elective surgery with a length of stay of ≥3days and were followed for at least 30days after surgery. A comprehensive geriatric assessment was administered as part of routine preoperative care. Bivariate relationships between demographic and surgical characteristics and the preoperative comprehensive geriatric assessment and the receipt of mental health services during the postoperative hospitalization period were examined. Characteristics with bivariate relationships that were significant at the level of P<.10 were entered into a multivariable regression predicting postoperative mental health service use. Approximately one-fifth of the total sample (20.6%) received postoperative mental health services. In multivariable analyses, high distress (P=.007) and poor social support (P=.02) were found to be associated with a greater likelihood of the receipt of mental health services. Of those patients with high distress and poor social support, only approximately one-quarter (24.6%-25.5%) received mental health care. Distressed older adults and those with low levels of support preoperatively were found to be more likely to receive mental health services after surgery. Nevertheless, less than one-third of these patients received inpatient postoperative mental health care, indicating that barriers to translating screening into the provision of psychosocial services remain.

Does distress screening lead to mental health care in older adult surgical patients?

11543 Background: Surgery is a notable stressor for older adults with cancer who are often medically complex and frail. The American College of Surgeons Commission on Cancer requires distress screening in accredited cancer care settings. The degree to which distress screening leads to mental health use is unclear. This study examined rates and predictors of post-surgical mental health care in older adults referred for a preoperative evaluation. Methods: Patients aged 75 years or older (n = 1,008) referred to the Geriatrics Service at a comprehensive cancer center were enrolled. Patients underwent elective surgery with a length of stay of 3 days or longer and were followed for at least 30 days after surgery. A comprehensive geriatric assessment (CGA) was administered as part of routine care. Surgical characteristics and post-surgical encounters with social work, psychology, and psychiatry were abstracted from the electronic medical record. Bivariate relationships between demographic and surgical characteristics and the CGA and post-operative receipt of mental health services were examined. Characteristics with significant (p &lt; .01) bivariate relationships were entered into a multivariable regression predicting post-operative mental health service use. Results: One-quarter of the total sample (n = 246, 24.4%) received post-operative mental health services. In multivariable analyses, high distress (Distress Thermometer score≥4; p = .01), poor social support (p = .01), iADL dependence (p = .04), and longer length of stay (p &lt; .001) were associated with receipt of mental health services after controlling for significant sociodemographic and surgical characteristics and CGA variables. Of patients with high distress, poor social support, or iADL dependence, only one-third (29-33%) received mental health care. Conclusions: Distressed older adults and those with low levels of support pre-operatively were more likely to receive mental health services after surgery, controlling for sociodemographic and surgical characteristics. Yet, only one-third of these patients received mental health care. These findings suggest that barriers to translating distress screening into provision of mental health services remain.

Assessing Acceptability of the Term: "Psychopathology" Among Youth Aged 18-25.

A prevailing model for mental health care for youth and families is to provide services within a "psychopathology" focused framework. This approach can compound problems for youth by imparting negative labels on them, and may be associated with iatrogenic impacts of interventions (e.g., stigmatization, lowered self-efficacy, dependency). This study assessed perceptions of the term "psychopathology" among 486 youth aged 18-25, with 39% of these youth receiving prior mental health services. Results indicated statistically significant differences in perception of the term, with youth who had received mental health services perceiving it more negatively than youth who had not. Findings suggest receipt of mental health services among young people may sensitize them to negative aspects of the term psychopathology, indicating the need for caution in using this term and other terms that may have negative impacts on mental health service use among youth.

Mental health service users\u2019 experiences of psychiatric re-hospitalisation - an explorative focus group study in six European countries

BackgroundPsychiatric re-hospitalisation is considered costly and disruptive to individuals. The perspective of the mental health service user is largely unexplored in literature.The purpose of our study was to explore service users’ experiences of psychiatric re-hospitalisation across six countries in Europe.MethodEight focus groups were conducted in Romania, Slovenia, Finland, Italy, Austria and Norway.ResultsA total of 55 service users participated in the study. All participants had been in receipt of mental health services for at least 1 year, and had experienced more than one psychiatric hospitalisation. The experience of re-hospitalisation was considered: (1) less traumatising than the first hospitalisation, (2) to be necessary, and a relief, (3) occurring by default and without progress, (4) part of the recovery process.ConclusionsPsychiatric re-hospitalisation was considered inevitable by the study participants, in both positive and negative terms. Striking similarities in service user experiences were found across all of the six countries, the first experience of psychiatric hospitalisation emerging as especially significant. Findings indicate the need for further action in order to develop more recovery and person-centred approaches within hospital care. For psychiatric inpatient care to be a positive part of the recovery process, further knowledge on what therapeutic action during the hospital stay would be beneficial, such as therapy, activities and integration with other services.