State Mental Health Systems Research Articles

The positive impact of women leadership in public sector settings: A case example in Virginia's state mental health system.

The role of psychology (and ergo, psychologists) within the public sector has shifted considerably over the preceding decades to include increasingly versatile and psychology-adjacent leadership positions. This publication focuses on brief leadership stories within a state mental health system, with an emphasis on the unique roles that women psychologists have advocated for over the years. The authors provide foundational knowledge of this state's mental health system in order to spotlight the ongoing need for effective leadership within this organization, identifying common ethical and public administration challenges, and ultimately using a structured questionnaire with women psychologists within this system to highlight their leadership roles. These stories expand upon the education and training they felt foundational to their growth in these roles, how they advocated for change and navigated organizational challenges, and how they hope their role can inspire junior (women) psychologists to take increasingly active roles in public service leadership. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trends in Mental Disorders in Children and Adolescents Receiving Treatment in the State Mental Health System

To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States. Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client-Level Data 2013-2021 (total number of records= 13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic, and service strata focusing on community-based programs. The analyses revealed increases in the proportion of anxiety disorders from 9.6% in 2013 to 19.2% in 2021 (adjusted odds ratio [AOR] 2.17, 95% CI 1.85-2.55, p< .001), trauma- and stressor-related disorders from 22.7% to 27.4% (AOR 1.31, 95% CI 1.09-1.57, p= .004), and depressive disorders from 13.4% to 17.0% (AOR 1.20, 95% CI 1.03-1.41, p= .04). During this same period, the proportion of bipolar disorders declined almost 8-fold from 10.0% to 1.3% (AOR 0.07, 95% CI 0.06-0.09, p< .001). The proportion of conduct disorder and oppositional defiant disorder also declined from 9.7% to 4.4% (AOR 0.42, 95% CI 0.32-0.55, p< .001) and from 11.1% to 7.8% (AOR 0.79, 95% CI 0.65-0.98, p= .03), respectively. Trends varied across sex, age, and racial/ethnic strata. The composition of childhood psychiatric diagnoses in patients within publicly funded mental health treatment settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.

The experience of launching a psychological hotline across 21 countries to support Ukrainians in wartime

PurposeThis paper aims to discuss current work and further steps of the psychological hotline launched by the National Psychological Association of Ukraine (NPA), along with a call for action to mental health professionals worldwide.Design/methodology/approachThis paper describes the training and support of the NPA’s hotline staff as well as reflections on the hotline’s work from June 2022 to April 2023.FindingsWith broad international support, the NPA’s psychological hotline currently operates in 21 countries providing psychological assistance and referrals to other service providers within Ukraine and abroad. The authors propose further steps of its work, including international collaboration.Originality/valueProviding citizens of Ukraine with broad public access to evidence-based remote psychological support through NPA’s hotlines is a high priority considering the war’s negative impact on mental health diverse and the limited capacity of the state mental health system.

California's multi‐billion plan for youth MH to include 40,000 new workers

Less than a year following the California Legislature's infusion of multibillions to support a behavioral health initiative for youth, California Gov. Gavin Newsom last week announced a master plan to overhaul the state's mental health system for children. The $4.7 billion plan will provide Californians ages 0–25 with increased access to mental health and substance use supports.

California data report shows continuing concerns on access

A new report from the California Health Care Foundation suggests that despite several initiatives to bolster the state's mental health system, too many residents with mental health needs still fail to receive necessary treatment.

Mississippi reports progress in system, as appeal of federal order looks likely

The state of Mississippi appears poised to appeal a federal judge's latest order in the long‐standing lawsuit over deficiencies in the state's mental health system. At the same time, state mental health officials suggest that the pace of improvements to community‐based care can and will continue regardless of how developments in court unfold.

Michigan governor: Federal dollars offer chance to improve MH system

The administration of Michigan Gov. Gretchen Whitmer wants a portion of federal dollars from President Joe Biden's American Rescue Plan to help close gaps in the state's mental health system. Whitmer this month proposed a $1.4 billion “MI Healthy Communities” package that includes numerous initiatives to expand the state's mental health infrastructure.

Outer-context determinants in the sustainment phase of a reimbursement-driven implementation of evidence-based practices in children\u2019s mental health services

BackgroundAlthough there is increasing investment to implement evidence-based practices (EBPs) in public systems across the USA, continued or sustained use of EBPs after initial implementation remains a challenge. The low integration of EBPs in routine practice severely limits their public health impact, highlighting the need to understand factors that affect the return on costly investments in EBP implementation. This study aims to (1) characterize trajectories of EBP delivery volume through a reimbursement-driven implementation and (2) examine impacts of system-level policy regulatory activity and state-level mental health services funding on the implementation reimbursement strategy.MethodsThis study involved secondary data analyses. Psychotherapy administrative claims and regulatory site visit data from the Los Angeles County Department of Mental Health and California state mental health expenditures were extracted from 2010 to 2017. Multilevel regression examined EBP claims volume over time with state expenditures and regulatory compliance as predictors.ResultsEBP claims volume trajectories demonstrated a rapid initial increase, followed by a period of decrease, and a small increase in the final year. State mental health expenditures increased across time reflecting increased funding availability. State mental health expenditures and system regulatory compliance were inversely related to EBP claims volume.ConclusionsThe impact of reimbursement-driven EBP implementation strategy is sensitive to multiple outer-context determinants. At the system level, commitment to fidelity of implementation regulations resulted in reduced use of the reimbursement strategy. Alternative reimbursement streams not tied to EBPs coupled with an expanded array of reimbursable services also impacted the use of the reimbursement strategy to implement EBPs.

Promoting Children's Mental, Emotional, and Behavioral (MEB) Health in All Public Systems, Post-COVID-19.

The COVID-19 pandemic exacerbates the mental, emotional, and behavioral (MEB) health problems of children and adolescents in the United States (U.S.). A collective and coordinated national economic and social reconstruction effort aimed at shoring up services to promote children's MEB, like the Marshall Plan that helped rebuild Europe post-World War II, has been proposed to buttress against the expected retrenchment. The plan prioritizes children's well-being as a social objective. We propose strategically reconstructing the public safety-net systems serving youth, including early education, maternal and child health, child welfare, corrections, and mental health. That plan called for a concentrated focus on coalition-building and contracting by state mental health systems to establish a foundation for an improved health system. This paper offers a complementary set of suggestions for the four non-mental health systems mentioned above by recommending actionable steps based on scientific evidence to support improved services for children at risk for MEB problems. For each system we describe examples of evidence-informed services, policies or programs that (1) prevent disabilities and promote health, (2) protect and preserve families and neighborhoods, and (3) provide quality care. Prioritizing the promotion of children's MEB health by all state systems can shape U.S. children's health and well-being for generations to come.

Oversight question looms in lawsuit on Mississippi mental health system

Mississippi state officials appear to be moving closer to resolving a long‐standing federal lawsuit over deficiencies in the state's mental health system, though a controversial question of who may oversee system improvements after a final agreement is reached still looms over the parties' discussions.

How Healthy Is State Mental Health System in Madhya Pradesh, India? An Assessment of Today to Plan for a Better Tomorrow.

Background Mental illness affects over one-third of the Indian population, and only a little is known about the exact situation of health systems in Madhya Pradesh, India. Therefore, the present research work provides an assessment of state mental health systems in Madhya Pradesh. Methods The present cross-sectional study was conducted as a part of National Mental Health Survey 2015-16 in 48 districts of Madhya Pradesh, to provide an overview of the status of mental health systems. Secondary data was also retrieved from the state office so as to present the situational analysis in a more comprehensive and inferential way. The proforma for the study was developed based on the experience gained from studies conducted earlier with World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) and with WHO's Mental Health Atlas as the base for thematic analysis. Results Out of 51 districts, 13.7% of the districts of the state have been covered under District Mental Health Program (DMHP) in 2015-16. Around 11.8% of district/general hospitals were involved in providing mental health services. The availability of psychiatrist was 0.05 per Lakh population. Around 0.2% of the total health budget was allocated by the state for the last financial year for mental health. The overall average score of Madhya Pradesh in the assessment of qualitative indicators was 31 out of 100 in the year 2015-16. Conclusion There is huge scope and an urgent need to increase mental healthcare facilities (with upgradation of existing one) along the availability of mental healthcare staff.

Preventing Risk and Promoting Young Children’s Mental, Emotional, and Behavioral Health in State Mental Health Systems

Early neural development and maternal health have critical long-term effects on children's mental health and outcomes later in life. As child mental disorders continue to rise nationwide, a number of states are considering new ways of investing in the critical early childhood period to prevent later poor outcomes and reduce the burden on the mental health system. Because most state mental health authorities (SMHAs) have no dedicated mental health dollars to devote to this early, crucial period of child development, building coalitions is key to implementing prevention and promotion programming. The authors describe two issues-coalition building and contractual considerations-that should be considered as SMHAs develop these types of policies or plan new prevention and promotion initiatives. Coalition building includes establishing the structural conditions for implementing a prevention or promotion initiative, resolving workforce issues (i.e., who will carry the program out), and engaging communities and families in the effort. Contractual considerations include establishing agreed-upon measures and metrics to monitor outcomes, assigning accountability for those outcomes, and delineating realistic time frames for these investments before expecting improved outcomes. The promise of moving services upstream to support early childhood development, to prevent mental health issues from derailing children's development, and to promote children's well-being are goals that are within reach.

Oregon audit finds its MH system is failing children, staff

The Oregon Secretary of State Audits Division revealed this month that the state's mental health system is failing children and families at a time when they need it most, Willamette Week reported Sept. 21. An audit report listed failings that ranged from a chronic workforce shortage to lack of performance measurements, which prevents the Oregon Health Authority (OHA) from catching shortcomings in its own work. Auditors discovered high turnover among mental health staff, which sometimes retraumatizes patients. The report says employees leave because of low pay and a high‐stress work environment — and the high turnover puts a strain on the staff members who stay. (Staff also reported not getting support from management who have made it clear they are replaceable.) In‐depth training is required to efficiently improve children's mental health issues, but various OHA mental health staff told auditors that new hires are not receiving the proper training to help high‐risk children. This puts staff at risk from traumatized children who can become aggressive and violent in an instant. OHA responded by agreeing to all 22 recommendations made by the auditors and set a target date for implementing each one.

Framework and approach for measuring performance and progress of mental health systems and services in India: National Mental Health Survey 2015\u20132016

BackgroundPrevious attempts of Mental Health Systems Assessment in India were restricted in scope and scale. Information on all aspects of mental health systems (leadership/governance, legislation, financing, service delivery, workforce, access to essential medicines, information systems, intersectoral activities, and monitoring and evaluation) was scarcely available. The National Mental Health Survey-Mental Health Systems Assessment (NMHS-MHSA), a unique endeavor, assessed the performance of mental health systems and services through health systems assessment framework. The present paper discusses the design and methodology adopted under NMHS-MHSA along with emphasizing its implication for India and other LMICs.MethodsNMHS-MHSA was undertaken in 12 Indian states by contextually adapting WHO-AIMS instrument. Data was collated from several secondary sources including interviews of key stakeholders. Utilizing the data a set of 15-quantitative, 5-morbidity and 10-qualitative indicators were developed to summarize the functional status of mental health systems in the surveyed states. This information was authenticated through state level stakeholder’s consultation and consensus building workshops following which a state mental health systems report card with indicators was developed.ConclusionThe process and robust method of data compilation enabled NMHS-MHSA to be a reliable and comprehensive method for assessing mental health systems at the state level. It’s envisaged that the assessment provides requisite impetus for strengthening mental health program and mental health systems in India. Being less resource intensive, low -and middle- income countries can adopt NMHS-MHSA tool and methodology to assess their mental health systems with contextual modifications.

APA’s Psychiatric Services Has Filled Critical Niche for Seven Decades

APA’s <i>Psychiatric Services</i> Has Filled Critical Niche for Seven Decades

Medicaid Waiver Adoption for Youth With Complex Behavioral Health Care Needs: An Analysis of State Decision-Making

Many states have enacted Home- and Community-Based Services (HCBS) Medicaid waivers, which waive or expand Medicaid means tests to increase access to community-based public mental health services for youth with Serious Emotional Disturbance (SED). This study sought to understand key factors in State Mental Health Authorities and Medicaid Agency decision-making in adopting Medicaid waivers for youth with SED. Using purposive sampling to collect data through semi-structured interviews with officials from 37 state mental health systems, interviews focused on fiscal, historical, and political reasons for states’ adoption or rejection of Medicaid waivers to serve youth with SED. Results suggest that decisions around waiver adoption relate to the size and flexibility of state budgets, the sufficiency of existing public HCBS funding and services, political prioritization of children and families, states’ desire to move away from a reliance on residential care, and ideology related to the role of the state in providing for the welfare of children and families. Advocacy efforts promoting state waiver adoption can address apprehensions about budget constraints and providing financial assistance to non-poor families by emphasizing potential cost savings from residential diversion and ethical imperatives to keep children in their homes and communities.

Improving Cardiometabolic Monitoring of Children on Antipsychotics.

This study evaluated changes in cardiometabolic monitoring for children and adolescents who were prescribed an antipsychotic medication in a state mental health system before and after a quality improvement intervention. The intervention included education for prescribers, auditing on metabolic monitoring, and feedback to mental health center leaders regarding their monitoring. Research staff extracted yearly data on cardiometabolic monitoring from randomly selected community mental health center records before and after the intervention. Pre- and postintervention changes in monitoring were assessed with chi-squared tests. Evidence of past year monitoring increased: for glucose 18.9%-42.1% (χ2 = 6.75, p < 0.001), for triglycerides 13.5%-31.0% (χ2 = 4.54, p = 0.033), for cholesterol 13.5%-33.1% (χ2 = 5.48, p = 0.019), and for weight 67.6%-84.1% (χ2 = 5.21, p = 0.022). Rates of monitoring for blood pressure and waist circumference increased but not significantly. In both years studied, weight was obtained most frequently and waist circumference was obtained least frequently. Monitoring rates significantly improved for four out of six parameters evaluated, but overall monitoring rates remained low at the end of the study period. Prescriber education with audit and feedback may improve cardiometabolic monitoring rates, but research is needed to evaluate barriers to monitoring in children.

Access to Care for Youth in a State Mental Health System: A Simulated Patient Approach

To examine access to psychiatric care for adolescents with depression in outpatient specialty clinics within a state mental health system, using a simulated patient approach. Trained callers posed as the mother of a 14-year-old girl with depression, following a script. A stratified random sample (n= 264) of 340 state-licensed outpatient mental health clinics that serve youth was selected. Clinics were randomly assigned to season and insurance condition. We examined whether access varied by season, clinic characteristics, and caller insurance type. Weighted logistic and linear mixed effects regression models were fitted to examine associations with appointment availability and wait times. Among clinics at which a treatment appointment could be scheduled, appointment availability differed by season. Clinics that had participated in state-sponsored trainings targeting access were more available. Wait times for treatment appointments varied by season and region. Wait times in New York City were shorter than in some other regions. Although callers were 4.1 times more likely to be able to schedule a psychiatry appointment in the spring, wait times for psychiatry appointments were significantly longer in the spring than in the summer (49.9 vs. 36.7 days). Wait times for therapy appointments were significantly shorter in community than in hospital clinics (19.1 days vs. 35.3 days). Access to psychiatric care for youth with depression was found to be variable in a state system. State-sponsored trainings on strategies to reduce wait times appear to improve care access. The simulated patient approach has promise for monitoring the impact of health care policy reforms on care quality measures.

Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience.

Psychiatric mental health nurse practitioners (PMHNPs) are assuming increasing clinical responsibilities in the treatment of individuals with mental illness as the shortage of psychiatrists and their maldistribution continues to persist in the United States. States vary widely in their statutes and administrative rules delineating PMHNP's scope of practice. This column describes the legislative process of incremental changes in New Hampshire statute and rules changes over the past 15 years that have significantly expanded PMHNP's ability to treat individuals with mental illnesses in the state mental health system. PMHNPs have worked closely with physician leaders and policy makers to allow this to occur.

Pilot Project in NY State Reduces Use of Seclusion, Restraint in Facilities Serving Children

Pilot Project in NY State Reduces Use of Seclusion, Restraint in Facilities Serving Children