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In an age of ever tightening state budgets, it is important to understand what factors shape decisions concerning the flow of resources from state governments into local service systems. Social movement theory examines how groups organize to affect public policy. Public policy analysis may analyze written policies and their implications or it may focus on issues of policy implementation. This research seeks to connect the pieces of the politics and policy puzzle by examining the role of advocates and service providers in shaping legislation in behavioral health and long term care services for the aging in the state of Arizona. I am interested in how the participation of advocates and providers shapes written legislation and in determining if and how this affects the implementation of public policy in service organizations. This paper is part of a larger research project that examines implementation in greater detail. The key to this piece of the project is to examine the connection between the political power of service recipients (as constituencies) and the design of the public policies that serve them. The paper that follows is a comparative legislative history and content comparison of long term care for the aging and behavioral health for the seriously mentally ill. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The broad spectrum diagnosis of depression and the practice of overdiagnosing depression has become common in North American culture over the past two decades. Depression is now a household term, and a viable market of recovery products, particularly psychopharmaceutical drugs, has thus arisen that normalizes not only the diagnosis but new self-help practices. A depression "script" shared by scientists, psychiatrists, state policy discourse and advocacy groups has been launched, informing consumers that major depression is a tangible risk, that certain groups (women, children and seniors) are more at risk, and that early detection is necessary to fend off slippage from symptom to major mental disorder. This paper addresses how consumer mental health advocacy groups participate in the promotion of depression diagnoses and the impact of this promotion. The paper analyzes how the discourses of groups including the National Alliance of the Mentally Ill (NAMI) and National Mental Health Consumer?s Self-help Clearing House (NMHCA), among others, promote depression and how these discourses intersect with and diverge from State, pharmaceutical and science discourses. The paper suggests that the consumer advocacy discourse encourages self-scrutiny and the scrutiny of other?s mundane behaviors. More, this increasing attention to our own behaviors causes individuals to self-govern, thereby encouraging a society that circumscribes and restrains potentially deviant moods or behaviors, and constrains free human behavior. [ABSTRACT FROM AUTHOR]

In this paper, we add knowledge to the sparse literature about "the long arm" of children. From an integrated life course-stress process approach, we argue that children have a long reach---strong capabilities to influence parents' mental health across the life course---years after they are actively being parented and long after negative experiences in their young lives have occurred. Using a sample of 670 African-American and white adults age 65 and older, we show that offspring's troubles in youth affect parents' current level of concern about their adult children, even controlling for negative experiences occurring in their children's adult years. Moreover, elderly parents have higher levels of anger if they had one or more teenagers who were in trouble---drank or used drugs, were disobedient, or had trouble in school---even though these events occurred when their offspring were much younger, about a quarter century prior. Effects are especially notable among African-American parents. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The prevention and treatment of mental health disorders in childhood and adolescence is one among the major public health challenges in the United States today. Prior research has suggested that neighborhood plays an important role in childhood mental health since neighborhood may reduce or induce psychological distresses for children and adolescents. Our study extends the research on neighborhood and mental health by examining the intersectionality of race, built environment in neighborhood, and children's mental health in the U.S. Using data from 2016 National Survey of Children Health (NSCH) and multivariate regression, we find that children's mental health and the neighborhood built environment vary across racial/ethnic groups, with minority groups being more likely to experience mental health disorders and disadvantaged neighborhood. Our study furthers indicates the intersectionality of race/ethnicity, neighborhood built environment and children's mental health, which suggests the need to help reduce the structural disparities in neighborhood for minority groups, particularly American Indians. [ABSTRACT FROM AUTHOR]

Emergency Medical Technicians (EMTs) and Paramedics form the backbone of the United States' Emergency Medical Service (EMS) system, providing community based emergency care for a wide range of patients. Their role as gatekeepers to treatment, particularly for patients with symptoms of mental illness, has not been fully explored and does not appear in commonly used models of pathways to care. EMS providers nonetheless play an important role in mental health care as one-third of patients seen in Emergency Departments for mental health reasons come by ambulance. Using data obtained through observations and interviews with providers at an urban EMS agency, this paper provides a preliminary analysis of the ways in which EMS providers interact with mental illness and the mental health care system. EMS providers acknowledge that they do, in fact, treat many patients for whom mental illness is the primary medical concern. They express widely-held frustrations about these calls, viewing both the calls themselves and the consequences of the calls through several common frames. Furthermore, EMS providers share fundamental concerns about whether treating certain patients should even be their job. Increasing our understanding of the role of EMS in how people get to behavioral health care will allow us to provide EMS services in ways that best meet the needs of EMS providers, patients, their families and the community. [ABSTRACT FROM AUTHOR]

Although they comprise 12.5% of the population in the United States, Latinos' share of mental health service use is low. Explanations for lower use include cultural identities, self-reliant attitudes, socioeconomic status, place of residence, health insurance, employment opportunities, and linguistic barriers. In this paper, we examine the role of language barriers, immigrant status, and medical self-reliance. Previous research finds that ethnicity specific barriers (limited English language proficient and immigrant status) are associated with decreased use of medical care for physical and mental health problems among Latinos. Medical self-reliance has been posited as a mediator of lower usage patterns, but is rarely tested empirically. In the present study we use nationally representative data from the 2002-2003 Medical Expenditure Panel Survey to examine specialty mental health care service utilization by Mexicans, Cubans, and Puerto Ricans in the United States. Of the three Latino subgroups, Mexicans were the only group with statistically significant differences in service use. We find that controlling for foreign born status and completing the interview in Spanish resulted in partial mediation of the gap in service use between Mexicans and non-Latino whites. Cubans and Puerto Ricans did not differ from non-Latino whites. Medical self-reliance was directly associated with specialty mental health service utilization but did not mediate any of the Mexican gap in service use. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Previous studies have found that primary care resources have associations with various health outcomes. The primary purpose of the study was to test for the effect of psychiatric care, social disintegration, and suicides in U.S. counties. Data utilized were from the 2002 Area Resource File on U.S. counties (n=3080). Suicide rates were averaged over three years covering 1990, 1991, and 1992. Negative binomial regression models were used to assess the impact of psychiatric care on suicide rate ratios. Psychiatric care was significantly associated with suicide rates. Counties with greater availability of psychiatric resources experienced a reduction in suicide mortality (β= -0.0003, IDR=0.999, CI=0.999,0.999). Divorce strongly elevated suicides (β=0.0729, IDR=1.076, CI=1.067,1.084). An increase in the White population between 1980 and 1990 increased suicide rates. Immigration significantly reduced suicides, while counties located in the West had much higher suicide rates than those elsewhere. Counties with low median household income had elevated suicide rates, and those with high median household incomes experienced lower suicides. Increases in psychiatric care availability reduce suicide rates. Psychiatric care may also partially reduce the effects of social disintegration at the county level. Greater mental health promotion might reduce area inequalities in suicide rates.Keywords: suicide, psychiatric care, social disintegration, ecological analysis. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Conditional release program services as a method of addressing juvenile recidivism has received limited evaluation. Using data from the Florida Department of Juvenile Justice, the influence of participation in different types of conditional release programs on recidivism is examined. Specifically, this study analyzes the effect of participating in conditional release programs that offer on-site services on recidivism. Additionally, this study examines the influence of participation in juvenile conditional release programs in which youth are required to take part in on-site educational, vocational, or substance abuse services on recidivism. Recidivism is defined as re-arrest and includes two measures of re-arrest: whether a re-arrest occurred during the follow-up period and the length of time between exiting the conditional release program and the first re-arrest. Logistic regression and survival analysis are used to analyze recidivism. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The Level of Service Inventory-Revised (LSI-R) is a broad based risk/needs assessment instrument that has been utilized and studied extensively by scholars in Canada. Although the instrument is widely used in the United States, very little research on the LSI-R has been published among US samples. The LSI-R is unique because it is a predictive instrument that assesses risk and need through considering those static and dynamic factors that influence outcome, specifically criminal history, education/employment, financial, family/marital, accommodations, leisure/recreation, companions, alcohol/drug problems, emotional/personal, and attitudes/orientation. The LSI-R is theoretically grounded in the notion that risk is invariant; that is, it exists equally across person (gender), place (geographic location), and crime (crime type). There is, however, a lack of research on this issues. The present research examined 516 male offenders from a Northeastern state placed in three halfway houses and one day reporting center in an effort to assess differences in ethnicity (primarily African Americans and Hispanics) and crime type with regards to LSI-R scores. Results indicate that no differences in ethnicity or crime type exist in a primarily minority offender sample (88%) who was administered the LSI-R. Policy implications are discussed. [ABSTRACT FROM AUTHOR]