Search

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states ([Formula: see text]=-0.038, SE = 0.005, p < 0.0001) than in expansion states ([Formula: see text]=-0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population.

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This report describes a domestic violence program in an urban Indian health center. The failure of office-based interventions and the importance of developing interventions that are sensitive to the needs of this population are discussed. Successful interventions including home visits and a domestic violence group that incorporated American Indian traditions and values are presented.

The article reports that The original version of this article unfortunately contained an error in describing one of the programs discussed in the article. This paper inaccurately conflated the two Recovery After an Initial Schizophrenia Episode (RAISE) studies: Early Treatment Program (ETP) and Implementation and Evaluation Study (IES).

The US South is disproportionately impacted by HIV. Social, cultural, economic, and political characteristics of the South shape access to mental health services leaving adverse impacts on health and wellness outcomes among People Living with HIV. The aim of this paper was to: (a) identify meso factors (at individual, organizational and community-level manifestations) which impact mental health services among People living with HIV in the South of those factors and (b) pose community-articulated recommendation and strategies. Through qualitative interviews with People Living with HIV and service providers, this study found that the meso factors of restricted funding and compounding stigma shaped mental health services in the South. Given the disproportionate rate of HIV, lack of mental health care, and landscape of socio-political factors unique to the region, attention to intervenable meso factors and community-based strategies are needed to enhance mental health services and respond to the HIV epidemic in the US South. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has presented a formidable challenge to care continuity for community mental health clients with serious mental illness and for providers who have had to quickly pivot the modes of delivering critical services. Despite these challenges, many of the changes implemented during the pandemic can and should be maintained. These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions. This paper represents the authors' collaborative attempt to both reflect the changes to clinical practice we have observed in CMHCs across the US during this pandemic and to suggest how these changes can align with best practices identified in the empirical literature. [ABSTRACT FROM AUTHOR]

The evidence-based practice demonstration for services to adults with serious mental illness has ended its pilot stage. This paper presents the approaches states employed to combine traditional policy levers with more strategic/institutional efforts (e.g., leadership) to facilitate implementation of these practices. Two rounds of site visits were completed and extensive interview data collected. The data were analyzed to find trends that were consistent across states and across practices. Two themes emerged for understanding implementation of evidence-based practices: the support and influence of the state mental health authority matters and so does the structure of the mental health systems.

The role of state mental health authorities (SMHA) is critical to implementing and sustaining evidence-based practices. This paper describes the seven major tasks of SMHA's that comprise that role and provides examples from states which have been actively pursuing evidence-based practices.

This paper is a description of qualitative interviews with homeless mothers participating in an outdoor camp program designed as time out from the stressful conditions of shelter living. In addition to evaluation of family satisfaction with camp, the individual interviews and parental discussion groups offered at camp enabled the women to share stories about some of the obstacles they encounter in moving toward self-sufficiency and in parenting their children. Gaps in services to help overcome these obstacles ranged from learning to read to treatment of childhood sexual abuse and more comprehensive substance abuse treatment. Suggestions for expansion of the program to better meet needs of families included support groups and referrals to community mental health services.

Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify. [ABSTRACT FROM AUTHOR]

This paper reviews issues in planning and delivering mental health services to rural dwelling elderly. First, comparative data on the prevalence of mental illness among rural elderly, and the availability and accessibility of mental health services in rural areas are presented to provide a basis for subsequent discussion. Next, several strategies for improving the development and delivery of geriatric mental health services to rural areas are discussed. These include: increasing the number and quality of rural mental health providers; adapting or developing diagnostic techniques to improve case identification among rural elderly; providing culturally sensitive mental health services; strengthening informal and formal care linkages in rural communities; developing innovative service delivery models building upon the strengths of rural settings; and emphasizing fluidity as well as continuity in treatment models.

This paper reviews some of the issues that affect the rural mental health professional who wishes to maintain an ethical position with respect to non-sexual dual relationships. Although the ethical codes of professional regulating bodies provide general guidelines for professional conduct, they do not offer specific guidance for practical decision-making. Furthermore, there appear to be some contrasting opinions between the various ethical codes with respect to what would be considered unethical behavior in a non-sexual dual relationship. Alternative decision making models that may be of help to a rural practitioner for assessing the ethics of such a relationship are reviewed.

The public treatment of seriously mental ill patients continues to be frustrated by the lack of administrative and financial integration of state and community mental health services. Several states have initiated attempts to improve the cost-effectiveness of public mental health services through mechanisms that create financial incentives fostering community-based alternatives to psychiatric hospitalization. Examples of such mechanisms include capitation financing systems, performance contracts, regional mental health authorities, utilization review, and bed-targets. This paper reviews evidence supporting the need for and success of these efforts, and also addresses their limitations.

This study adapted Andersen’s Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services. [ABSTRACT FROM AUTHOR]

President Kennedy's "bold new approach" remains compelling 15 years after it was first announced. Mental health services at the community level have come a long way since the community mental health center program's establishment in 1963. Mental health manpower, advances in treatment technology, and volumes of service all have grown remarkably; but much still remains to be done to integrate community mental health services into the communities they serve in the planning of human services generally, and particularly in emphasis on preventive care. The National Council of Community Mental Health Centers Environmental Assessment Task Force has two closely related charges in these latter areas. First, to inquire into the "environmental" aspects of mental health at the community level; and, second, to explore environmental perspectives for the establishment of prevention initiatives in the delivery of services. This paper explores that charge by seeking a perspective on environment that traces the intersection of the built environment and social-interpersonal behavior with special attention to the implications for mental well-being. Implications of this perspective for community mental health center roles in community planning are considered, with reference to the establishment of preventive services.

Psychiatric crisis care in the U.S. exemplifies the "more is less paradox" of U.S. health care. We spend more for health care than any other high-income country, yet our outcomes are typically poor compared to these other countries (OECD in OECD health statistics. Retrieved from https://www.oced.org/health/health-data.html, 2020). We do this, in part, by emphasizing medical treatments for problems that are inherently social, rather than addressing social determinants of health. Medical interventions for socio-economic problems are usually expensive and ineffective. For mental health crisis care, adding unfunded, untested, medical interventions to the current mélange of poorly funded, disorganized arrangements will not help. Instead, the U.S. should address social determinants, emphasize research-based interventions, and emphasize prevention—proven strategies that decrease costs and improve outcomes. [ABSTRACT FROM AUTHOR]

Parent engagement is a well-documented challenge when delivering child and adolescent mental health treatments. Therapists’ internal experiences, and how they respond to parents, may create a barrier to the parent engagement process. The current study developed the 13-item Therapist Barriers to Engaging Parents measure (TBEP) to assess providers’ internal and external experiences that operate as barriers to parent engagement. The TBEP was completed by 148 child and family therapists across the United States. The TBEP demonstrated strong internal reliability (Cronbach α = .86), and was negatively correlated with counselor efficacy, and significantly positively correlated with burnout, indicating convergent validity. Incremental validity of the subscales of the TBEP was also demonstrated. The TBEP appears to be a psychometrically sound measure of the internal barriers mental health providers experience when trying to engage parents. [ABSTRACT FROM AUTHOR]

This article describes the development and initial psychometric testing of the Mental Health Provider Self-Assessment of Stigma Scale (MHPSASS), a 20-item instrument crafted in reflection of Charles' (Social Work in Mental Health 11:360-375, 2013) empirically derived, experience-based, five-themed model of provider stigmatization. Following model and item review by construct experts, 220 mental health service providers in Virginia's public mental health centers and in-patient facilities completed the survey package. Results indicate the refined MHPSASS is a reliable measure of provider-based stigma with promising face and content validity. However, rather than they hypothesized five-factors, analysis indicates a four-factor solution, a key finding signaling a discrepancy between what providers endorse and what clients' experience. Notably absent from the MHPSASS' were items related to blame and shame, in contrast to the experience of clients and families. Further refinement is indicated, particularly reconsideration of blame and shame items due to their practical and theoretical significance. [ABSTRACT FROM AUTHOR]

Using data from a nationally representative study of the community-dwelling U.S. population, we estimated the percentage of male veterans who visited a mental health professional in the past year, compared it to an estimate from non-veteran males, and examined factors associated with visiting a mental health professional. We found that 10.5% of male veterans visited a mental health professional in the past year, compared to only 5.6% of male non-veterans. In the regression models, veteran status, sociodemographic factors, and healthcare utilization were independently associated with visiting a mental health professional. These findings demonstrate the importance of using nationally representative data to assess the mental healthcare needs of veterans. [ABSTRACT FROM AUTHOR]

This study analyzed the National Epidemiological Survey on Alcohol and Related Conditions data, 2001-2002, to compare the prevalence and odds of DSM-IV mood, anxiety, and substance use disorders and mental health service use across Asian American subethnic groups (648 East Asians, 485 Southeast Asians, 298 South Asians). Asian American subethnic groups varied in lifetime prevalence of psychiatric disorders ( p = 0.004), mainly due to differences in the presence of any substance use disorder ( p = 0.06), and specifically, drug use disorders ( p = 0.02). While Southeast Asians had the highest prevalence of substance use disorders (16.7 %), fewer Southeast Asians with substance use disorders used mental health services (11.1 %) compared to South Asians with substance use disorders (24.2 %). East Asians compared to South Asians had significantly lower odds of mental health service use for substance use disorders (confidence interval = 0.08-0.84). Asian American subethnic groups vary in the prevalence of mental disorders and in mental health service use, especially for substance use disorders. [ABSTRACT FROM AUTHOR]

Literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans. This study adapted the behavioral model of health service use to examine factors associated with MHS use among Latino and Asian Americans. The model consists of predisposing, enabling, and need factors. This study used the National Latino and Asian American Study data, including six ethnic groups. The outcome measure for this study was the use of MHS in the past 12 months. Age, sex, and education predicted higher odds of MHS use among Latinos, none of which were significant among Asians. Needs factors were strongly associated with higher odds of MHS use among Latinos and Asians. [ABSTRACT FROM AUTHOR]

We assess the satisfaction of mental health providers using four dimensions from the medical practice literature—degree of autonomy, relationship with patients, compensation, and administrative burden—and extend current work on professional satisfaction to include frontline service providers rather than only psychiatrists or other physicians. In contrast to results reported for primary care settings, we find that the impact of managed care on satisfaction is minimal for the mental health providers in our study of a Medicaid capitation demonstration in the southeastern US. Instead, variables relevant to everyday working conditions have an important effect on job satisfaction. [ABSTRACT FROM AUTHOR]

Integrated dual disorders treatment programs for people with severe mental illness and co-occurring substance use disorder have been implemented in a variety of community mental health center sites across the U.S. and in several other countries over the past 15 years. Consumers who receive services from programs that offer integrated dual diagnosis treatments that are faithful to evidence-based principles achieve significant improvements in their outcomes. Unfortunately, not all programs that attempt implementation are successful, and the quality of high-fidelity programs sometimes erodes over time. This article outlines implementation strategies that have been used by successful programs. As a general rule, success is achieved by involving all major participants (consumers, family members, clinicians, program leaders, and state or country mental health authorities) in the process and attending to the three phases of change: motivating, enacting, and sustaining implementation. [ABSTRACT FROM AUTHOR]

Assesses the method of identifying consumer satisfaction on mental health services in Delaware. Categories of service needs; Administrative issue of mental health; Use of consumer concerns and opinions in modifying services.

Focuses on the involvement of mental health service consumers in the provision of mental health services in New York. Relationship between consumer and non-consumer staff; Nature of mental illness; Advantages of peer service delivery.

Examines the use of Connections, a peer-based hospital diversion program as an innovation in the mental health services in Philadelphia, Pennsylvania. Services offered by the program; Reduction in the costs for mental services; Provision of options for addressing acute crises.

Investigates mental health service providers' knowledge, attitudes and service provision patterns to Bosnian refugees with Post Traumatic Stress Disorder (PTSD) in urban centers in Chicago, Illinois. Trauma mental health services for refugees; Education for refugee families; Implications for trauma-related mental health services.

Describes the telepsychiatry program of the Medical College of Georgia in Augusta aimed at providing mental health services via telecommunication systems. Background for the development of the telepsychiatry program; Availment and cost of the program; Mental health services offered by the program.

Presents a survey on school administrators from midatlantic and northeastern locations in the United States to assess school-based mental health programs. Identification of trends in problems and resources by school level and geographic location; Evaluation of stressful conditions and behavioral problems; Prevalence of substance abuse.

This study examines the predictors of mental health service use among patients in an ethnically diverse public-care women's clinic. While waiting for their clinic appointments, 187 Latina, African American, and White women were interviewed about their attitudes towards mental illness and mental health services. White women were much more likely to have made a mental health visit in the past than the ethnic minority women. Having a substance use problem, use of mental health services by family or friends, and beliefs about causes of mental illness were all predictors of making a mental health visit. [ABSTRACT FROM AUTHOR]

Contrasts the financial experiences of the capitated Community Mental Health Centers (CMHC) in Utah and five noncontracting Centers. Patterns of financial management; Contractual relationships between the CMHCs and the state; Implications of the findings for CMHCs in other states where Medicaid is exploring managed care alternatives for mental health care.

Highlights the results of a survey of mental health consumers' and family members' involvement in advocacy in the United States. Importance of consumers' and family members' involvement in mental health policy-making; Barriers to involvement; Knowledge about changes in the mental health system.

Reports on the analysis of the service utilization data of a study on multi-ethnic adolescents, regarding their mental health services utilization within the United States. Details on the participants used in the study; Examination of the impact of the service availability; Evaluation of the impact of symptomatology; What was demonstrated by multiple regression analyses; Discussion on the results of the study.