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LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples. [ABSTRACT FROM AUTHOR]

This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 – May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery. [ABSTRACT FROM AUTHOR]

A Community Health Assessment (CHA) was conducted among community members in a rural Western Kentucky county in 2022–2023 identified mental health as one of the top health issues in the county. The purpose of a CHA is to identify key health needs and issues through data and develop strategies for action. One of the objectives was to identify barriers to accessing mental health care, especially among youth. Secondary data analyses were performed from survey results conducted by the local health department and local public schools. Quantitative data were analyzed using SPSS software. Qualitative data were analyzed using a two-cycle coding process. Access to mental healthcare is an area of great need in this rural Western Kentucky county. Recommendations include working with healthcare providers, especially specialists, to accept Medicaid and it is recommended to cross-train other professionals to address mental health needs in this region. [ABSTRACT FROM AUTHOR]

Though considered a best practice, there is substantial variation in how integrated behavioral health (IBH) services are structured. This study examined the impact of IBH structure on health outcomes among individuals with serious mental illness (SMI) and chronic disease receiving care in community health centers (CHCs). Data from the ADVANCE network identified 8,548 individuals with co-occurring SMI diabetes and 16,600 with an SMI and hypertension. Logistic regression tested whether IBH type impacted disease specific health outcomes among these populations. Among those with diabetes or hypertension, colocated care was associated with better health outcomes related to HbA1c, blood pressure control, and BMI compared to less coordinated and unintegrated care, though there was significant variation in this relationship across SMI diagnoses. Results reflect that colocation of primary care and behavioral health may improve outcomes for individuals with bipolar disorder or major depression and chronic disease, but that CHC-based integrated care may not be optimized for individuals with schizophrenia. [ABSTRACT FROM AUTHOR]

With the movement towards recovery-oriented mental health (MH) services, individuals with MH lived-experience are increasingly employed as peer providers (peers). Peers are unique in that they bring knowledge from experience and eye-level connection to service users that enhance the quality of services and humanize MH systems' culture. In Israel, hundreds of peers are employed in various roles and settings across the MH system. However, peer integration into MH services faces challenges. One issue involves the use of self-disclosure (SD) in MH services which varies with explicitness across roles and settings. This study sought to understand perspectives and experiences regarding peers' SD (use & sharing of knowledge from experience) among different stakeholders in MH health services. Six focus groups and 4 semi-structured interviews (N = 42) were conducted as a part of a larger international project (UPSIDES; ERC Horizon 2020, Moran et al., Trials 21:371, 2020). Data was transcribed verbatim and analyzed using thematic analysis. Four categories and 7 themes were identified regarding current perspectives and experiences with peers' SD in MH organizations: (i) Restrained or cautious organizational approach to SD; (ii) Attitudes of peers to SD approach; (iii) The influence of designated peer roles on SD; and (iv) Unwarranted SD of peers working in traditional roles. The findings reveal that peers' SD in MH services is a complex process. Organizational approaches were often controlling of non-designated peers' SD practices; participants had diverse attitudes for and against peers' SD; SD occurred according to personal preferences, specific peer role and the director's approach to peers' SD; Conflictual SD dilemmas emerged in relation to service users and staff. SD sometimes occurs unwarrantely due to ill mental health. The presence of peer-designated roles positively impacts peers' SD. We interpret the current mix of views and general conduct of peer SD practice in statutory MH services as related to three aspects: 1. The presence of a traditional therapeutic SD model vs. a peer SD model – with the former currently being dominant. 2. Insufficient proficiency and skill development in peers' SD. 3. Stigmatic notions about peer SD among service users and staff. Together, these aspects interrelate and sometimes create a negative cycle create tension and confusion. A need to develop professionalism of peer SD in statutory services is highlighted alongside enhancing staff and service user acknowledgement of the value of peer SD. Developing peer-designated roles can positively impacts peer SD in MH statutory services. Training, support, and organizational interventions are required to further support for peer-oriented SD and the enhancement of a person-centered and recovery orientation of MH services. [ABSTRACT FROM AUTHOR]

Following the U.S. military's departure from Afghanistan, a significant number of Afghan refugees have resettled in the United States, presenting complex mental health challenges exacerbated by extensive traumatic exposure. This demographic is particularly affected by collective trauma due to war, genocide, and the loss of homeland. However, detailed investigations into the correlations between collective trauma and mental health outcomes among Afghan refugees are limited. This study sought to explore the relationship between collective trauma and mental health outcomes within the Afghan refugee population in the United States, paying particular attention to the influence of sociodemographic factors. Identifying subgroups at greater risk allows for the development of more targeted mental health interventions. The study surveyed 173 Afghan refugees employing snowball sampling, utilizing a cross-sectional design. Data collection was facilitated through online and in-person surveys in English, Dari, and Pashto. Key measures included the Harvard Trauma Questionnaire for individual trauma experiences, the Historical Loss Scale for collective trauma, the Historical Loss Associated Symptoms Scale for collective trauma symptoms, the Afghan Symptom Checklist-22 for mental health symptoms, and the Post-Migration Living Difficulties Scale for post-migration stressors. Statistical analyses involved Pearson's correlation for variable associations, with nonparametric Mann–Whitney U and Kruskal–Wallis tests conducted to assess sociodemographic impacts due to data's non-normal distribution. The analysis revealed significant variations in collective trauma and mental health outcomes across subgroups. Afghan women, minoritized ethnic groups, those who experienced extended displacement, and refugees with uncertain visa statuses reported higher collective trauma levels and worse mental health outcomes. Statistical significance was noted in the correlations between collective trauma and mental health symptoms (r =.53, p <.01) and between post-migration difficulties and mental health (r =.33, p <.01). The disparities in mental health outcomes based on sociodemographic characteristics were significant, with nonparametric tests showing clear distinctions across different groups (Kruskal–Wallis H = 14.76, p <.05 for trauma experience by visa status). This study emphasizes the critical need for mental health interventions that account for the complex experiences of collective trauma among Afghan refugees, especially among identified subgroups. Tailoring mental health services to address the specific needs highlighted through disaggregated data can enhance support for Afghan refugees in the United States. This research contributes to a deeper understanding of the relationship between collective trauma and refugee mental health, advocating for nuanced care strategies in resettlement environments. [ABSTRACT FROM AUTHOR]

Research shows that, in mental healthcare, empathy and active listening skills play a fundamental role in the therapeutic relationship. Despite this, clinicians receive little training in cultivating these qualities, and there is a dearth of training in therapeutic relationships and relational care in this field more generally. In response to this paucity of training, a new intensive three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). The CARE training programme has recently been delivered to a number of mental health teams in different boroughs of an NHS Trust and has undergone several rounds of redevelopment. This paper outlines the CARE training programme's objectives and mode of delivery, and subsequently presents questionnaire results from recent CARE trainees regarding their experience of the nature and utility of the training. Four main themes emerged from responses to the question of the utility of the training, these were 'A shift towards more person-centred care', 'Strengthens the therapeutic relationship', 'Facilitates more collaborative care with patients and their families' and 'Development of new skills and therapeutic techniques'. The paper concludes by discussing the potential of this training to help forge a substantial shift in the culture of mental health services in a systemic way. [ABSTRACT FROM AUTHOR]

Adolescent violence in the home is a growing public health issue and remains under reported and under-researched. The focus of the present research is to investigate factors that may contribute to adolescent violence in the home, among acohort of young people with co-occurring early psychosis. Data relates to 50 young people (16 females, 33 males, 1 nonbinary) aged from 16-25 who were clients at a youth early psychosis service in Melbourne, Australia. Results from a discriminant function analysis revealed the two major contributing factors to whether someone used violence in the home, were whether a young person had a coexisting neurodevelopmental or intellectual disability and whether they used violence outside the home. The findings provide preliminary evidence that engaging in violence outside the home and the presence of a neurodevelopmental or intellectual disability may make it more likely for young people with early psychosis to use violence in the home. [ABSTRACT FROM AUTHOR]

Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions. [ABSTRACT FROM AUTHOR]

Psychological first aid (PFA) trainings are conducted to train frontline care workers in practical and emotional support to people who have been recently affected by stressful events. The aim of this study was to describe the determinants of the implementation behavior of a PFA training strategy in Chile and to provide theoretical information on the factors that influence trainers' self-efficacy. For this purpose, the Determinants of Implementation Behavior Questionnaire, administered online to a sample of 117 PFA trainers throughout Chile, was used. The results indicate that the main facilitators for implementation originate in the intrinsic motivation of the trainers, while the barriers are mainly found in the limited institutional opportunities offered by the context. Evidence was also found on the effect of motivation and context on trainer self-efficacy. PFA trainers may need to invest a lot of psychological resources to overcome the barriers encountered during implementation. [ABSTRACT FROM AUTHOR]

Case management is a widely utilized service in both youth and adult outpatient community mental health settings. Despite its widespread use, previous findings suggest that youth case management often lacks empirically tested models or frameworks. This article presents the results of a pilot study that involved adapting the Strengths Model, an adult case management model, for the child and adolescent outpatient community mental health population. The newly adapted model, known as the Strengths Model for Youth (SM-Y), was implemented in an urban community mental health center across five different youth case management teams. To assess changes over time in youth receiving SM-Y case management, marginal maximum likelihood multilevel modeling with adaptive Gaussian quadrature methods was applied. The study focused on three domains: socialization, education, and hospitalization. Utilizing the logit link function and Bernoulli conditional distribution due to the binary nature of the outcome data, three individual trajectories were drawn for socialization, education, and hospitalization. Positive findings indicated increases in socialization and educational performance among children and adolescents. [ABSTRACT FROM AUTHOR]

This study explored the enablers and obstacles to the integration of traditional medicine and mainstream medicine in mental health services in West Africa. This study is a systematic review conducted in accordance with the relevant parts of the Preferred Reporting Items for Systematic reviews and Meta-analyses. Keywords searches were done in databases, and other reference lists were also searched. The Rainbow model of integrated care and a thematic analysis framework were used to account for the factors influencing the integration of traditional medicine and mainstream medicine in mental health services in West Africa. A total of 12 studies met the eligibility criteria after the evaluation of 6413 articles from databases and reference lists. The themes of: policy and implementation; different conceptualisation of mental health/referrals; trust issues, and education and training, were enablers or obstacles of integration depending on how they worked to facilitate or hinder integration. There was an indication of little integration of TM and MM at the macro, meso and micro levels in mental health services in West Africa. Though the study does cover all the West African states evenly, it is recommended that policy-makers and stakeholders interested in integration should ensure integration activities, especially policies, cut across all the levels of the rainbow model of integrated care and are planned and aligned at the macro, meso and micro levels instead of using ad hoc measures, informal initiatives or placing TM services in MM mental health services, which do not amount to integration. [ABSTRACT FROM AUTHOR]

Model adherence is a key indicator of mental health care quality. This study investigates the degree of model adherence, as well as content and staging of care, among the first Youth Flexible Assertive Community Treatment (ACT) teams in the Netherlands. Model fidelity was assessed in sixteen teams with the Youth Flexile ACT model fidelity scale (2014 version). Mental health workers completed a 'content of care questionnaire' to map the interventions applied in the teams. Model fidelity scores revealed that twelve teams adhered to the Youth Flexible ACT standard with 'optimal implementation' (≥ 4.1 on a 5 point scale) and four teams with 'adequate implementation'. Most disciplines were well integrated within the teams; however, several items regarding the involvement of specific disciplines and the availability of treatment interventions (peer support worker, employment and education specialist and programs, family interventions, integrated dual disorder treatment) scored below the optimum. Frequency of contact during ACT and the use of Routine Outcome Monitoring instruments scored below the optimum as well. The 'content of care' data showed that most clients received an individual psychological intervention, and nearly half of the client sample received scaled-up / intensified ACT care. The findings indicate a predominantly successful translation of care from the theoretical Flexible ACT framework into practice, covering both ACT and non-ACT functions. Further room for improvement lies in the incorporation of specialized disciplines in the personal and social recovery domains, including the peer support worker and employment and education specialist, as well as in specific protocolled interventions. [ABSTRACT FROM AUTHOR]

In 2021, national leaders in the United States declared a "national youth mental health crisis." Still, only 1-in-4 children receive adequate mental healthcare access. Patient Navigator Programs (PNPs) can improve children's referral-to-connection to mental health services. We examined patient- and community-level factors associated with pediatric mental healthcare access. Pediatric Support Services (PSS) is a PNP that triages mental and behavioral health referrals within a large health system in a southeastern state. This study analyzes PSS data from September 2017-March 2023 and Child Opportunity Index 2.0 state-normed zip-code level data to assess social drivers of health estimates. Structural equation modeling was conducted between patient- and community-level factors and connection to mental health services. Overall, 62.7% of children connected to mental health services since PSS' inception. Regardless of SDOH, as children get older, they are more likely to connect with mental health services (β =.053, SE =.010, p <.001). Children with greater number of referral needs are more likely to connect with mental health services (β =.034, SE =.011, p =.002). Further, children who live in communities with higher opportunity levels are more likely to connect with mental health services (β =.016, SE =.008, p =.040), suggesting that children who live in low-income communities experience more barriers to mental healthcare. Social drivers may inform referral practices and tiered navigation support for optimal mental healthcare access among children. Further research should demonstrate the effectiveness of PNPs integrated within healthcare and community-based settings. [ABSTRACT FROM AUTHOR]

This study examined mental health service utilization and disparities during the first year of COVID. We analyzed data from all adult respondents with any mental illness in the past year (n = 6967) in the 2020 National Survey on Drug Use and Health to evaluate if mental health service utilization differed by geographic areas, race/ethnicity, and age groups. Only 46% of individuals with any mental illness had received mental health treatment. Compared to non-Hispanic Whites, Asian and Hispanics were less likely to receive outpatient services and prescription medicine. Rural residents received less outpatient treatment compared to large metropolitan residents. No difference was found in telemedicine utilization across area types and race/ethnicity groups. Older individuals were less likely to utilize telemedicine services. Our findings highlighted continued mental health treatment disparities among race/ethnic minorities and other sub-populations during COVID. Targeted strategies are warranted to allow older populations to benefit from telemedicine.

Youth suicide and mental health are important issues of global concern that require timely and evidence-based interventions to increase quality of life and prevent deaths. Findings report that young people have lower mental health help-seeking rates, and there is a lack of qualitative research examining why. The aim of this research study was to further understanding on young people's core needs in mental healthcare based on actual experiences (PLE) of help-seeking with providers of mental health services. Constructivist Grounded Theory methods (Charmaz, 2014) informed this study design, and in-depth interviews and a focus group were conducted with 18 young people. The findings were presented across four sub-categories, which together describe the common factors, that are regarded as essential in youth mental healthcare provision. These include: 1. The services; 2. The helper; 3. The interventions, and 4. The impact of development. Critical discussion into young people's needs in mental healthcare was provided including the key service factors, approach and rapport with helpers, types of intervention and alignment with typical developmental capacity. This article provides guidance on how to improve, design, or reform service provision, and can be a useful resource for policy makers, service providers and practitioners. This study concluded that youth participation in the co-design of service provision is important as it can reduce health disparities and ensure that services provide relevant, respectful and suitable care that reflects the way in which young people experience mental health problems as well as the ways in which they want to be helped. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, transgender, queer, or similarly identified (LGBTQ+) people experience substantial mental health disparities compared to heterosexuals. The "Let's Connect" intervention was designed to improve mental health outcomes for LGBTQ+ people. This impact evaluation aimed to assess effectiveness of this intervention during its pilot phase, using a single arm pilot trial. Respondents completed baseline surveys at intervention start, a post survey on the last day of the intervention (at 6 weeks), then a follow-up survey 6 weeks after the intervention ended (at 12 weeks). Pre-post differences in outcomes were analyzed using paired t-tests, chi-square tests, and generalized estimating equations to evaluate impact on mental health outcomes at 6 and 12 weeks, and identify characteristics associated with loss to follow-up. The average value of all three outcome measures decreased substantially between the baseline and post surveys; all of these differences were highly statistically significant, and further decreased between the end of the intervention at 6 weeks and the 12 week follow-up survey. Let's Connect participants did experience substantial improvements in mental health outcomes, on average, between the start and end of this intervention. Further study of this intervention using a randomized design and control group is warranted. [ABSTRACT FROM AUTHOR]

Transitional age youth experiencing homelessness (TAY-EH) represent an underserved and understudied population. While an increasing number of empirical interventions have sought to address the high burden of psychopathology in this population, findings remain mixed regarding intervention effectiveness. In this systematic review of behavioral health interventions for TAY-EH, we sought to examine the structural framework in which these interventions take place and how these structures include or exclude certain populations of youth. We also examined implementation practices to identify how interventions involving youth and community stakeholders effectively engage these populations. Based on PRISMA guidelines, searches of Medline, PsycInfo, Embase, Cochrane Central, Web of Science, and ClinicalTrials.gov databases were conducted, including English language literature published before October 2022. Eligible studies reported on interventions for adolescent or young adult populations ages 13–25 years experiencing homelessness. The initial search yielded 3850 citations; 353 underwent full text review and 48 met inclusion criteria, of which there were 33 unique studies. Studies revealed a need for greater geographic distribution of empirically based interventions, as well as interventions targeting TAY-EH in rural settings. Studies varied greatly regarding their operationalizations of homelessness and their method of intervention implementation, but generally indicated a need for increased direct-street outreach in participant recruitment and improved incorporation of youth feedback into intervention design. To our knowledge, this is the first systematic review to examine the representation of various groups of TAY-EH in the literature on substance use and mental health interventions. Further intervention research engaging youth from various geographic locations and youth experiencing different forms of homelessness is needed to better address the behavioral health needs of a variety of TAY-EH. [ABSTRACT FROM AUTHOR]

Managing waitlists for outpatient mental health services particularly in community health settings is difficult to standardize, poses an administrative burden, and are barriers rather than gateways to access to care particularly for low-income communities. While telehealth has initially expanded access to mental healthcare at the onset of the COVID-19 pandemic, it has not resolved the challenges associated with the increasing demand for services and the shortage of available providers. This commentary explores the intricate interconnections between wait times, readiness for and appropriateness of therapy, and engagement in treatment. Drawing on insights from waiting line theory to question the attachment to and utility of waitlists for non-emergency, outpatient mental healthcare, this commentary questions the utility and efficacy of waitlists. Alternative solutions that capitalize on community resources and collaboration and harness patients' agency for change are discussed. [ABSTRACT FROM AUTHOR]

This scoping review critically assessed evidence regarding mental disorders among mothers involved with the criminal justice system (CJS) and provided pooled prevalence rates of mental disorders. In total, 27 studies were included in the review, with 23 studies from the United States of America and 26 focused on incarcerated mothers. The findings supported the evidence on substantial burden of mental disorders, among CJS-involved mothers. Several factors contributing to mental disorders were identified, including history of abuse/incarceration/mental illness, a greater number of pregnancies, child-rearing responsibilities, less contact with children, and poor social support, which were organised using a socioecological model. However, significant gaps in the current evidence base were apparent, including inconsistencies in methodologies and outcomes assessed and a lack of large, longitudinal studies. The study highlights the importance of high-quality longitudinal research to extend knowledge around causal pathways between different risk or protective factors and mental disorders among CJS-involved mothers. [ABSTRACT FROM AUTHOR]

This study examined the intersectional effects of gender, race, and socioeconomic status (SES) on mental health service utilization (MHSU) employing the intersectionality framework. Data was extracted from Canadian Community Health Survey 2015–2016 with a total of 85,619 sample. Covariate adjusted prevalence ratio (aPR) and the predicted probability of MHSU from intersectional analyses were estimated using Poisson regression with robust variance. The prevalence of MHSU was 15.04% overall, 19.61% among women, 10.27% among men, 21.56% among white women and 11.12% among white men. The study observed overall significant intersectional effect of SES by gender and race on MHSU. For instance, white men with the lowest income were more likely to have MHSU compared to their counterparts. Similarly, the predicted probability of MHSU decreased with the increase of SES that varied by gender and race. Two-way and three-way interactions also confirmed statistical significance (p-interaction < 0.05) of intersectional effect of gender, race, and SES. The observed socioeconomic differences in MHSU across gender and racial groups can be explained by intersectionality. [ABSTRACT FROM AUTHOR]

ForWhen is an Australia-based national navigation service aimed at helping parents and carers navigate the perinatal mental health service landscape and connect them with appropriate support and clinical services. The current study forms part of a mixed-methods evaluation of the ForWhen program. Semi-structured interviews were conducted with ForWhen navigators during the early design and implementation phases of the service. Results were used to characterise the ForWhen navigator activities and responsibilities, identify navigator core competencies, and examine facilitators and barriers to successful implementation of a large-scale navigation program for perinatal and infant mental health. Further research will be crucial for evidencing the utility and potential of navigation models in addressing identified issues with access to treatment for perinatal and infant mental health issues. [ABSTRACT FROM AUTHOR]

Behavioral Health Rehabilitation Service (BHRS) is a comprehensive service for Pennsylvania's Medicaid-enrolled youth and their families. In 2021, BHRS transitioned to Intensive Behavioral Health Service (IBHS) through state-wide policy change. To assess impact, the largest behavioral health managed care organization in the state compared service utilization in BHRS in 2019 versus IBHS in 2021. Results show that significantly more youth received non-Applied Behavior Analysis (non-ABA) services in BHRS (n = 13,795) than IBHS (n = 10,083) and more youth were discharged during the measurement period for BHRS versus IBHS (47% vs. 44%). Significantly more youth received ABA through IBHS versus BHRS (n = 4,385 vs. n = 2,690). The number of youth served in therapeutic service in IBHS did not indicate improved access during this first year of transition; however, more youth received evidence based treatments through IBHS indicating higher quality care for some youth and families. [ABSTRACT FROM AUTHOR]

Federally funded medical and behavioral healthcare programs often have substantial evaluation outcome tracking and reporting requirements, which can become burdensome to program staff resulting in decreased buy-in, increased chance of staff burnout and turnover, and less rigorous and consistent data collection efforts. To address this issue, a novel data collection approach, "exception reporting," was implemented to supplement and support the required data collection for a federally funded Assertive Outpatient Treatment (AOT) program. This work details the process and outcomes related to exception reporting for this comprehensive behavioral health treatment program that serves justice involved clients with serious mental illness (SMI). Results indicate that exception reporting was easily integrated into clinician's normal workflows and resulted in a number of benefits. Specifically, results indicated that exception reporting decreased the data collection burden for program staff while allowing them to efficiently track program outcomes required by the funder. Additional research into which practice settings exception reporting can most easily be integrated into, and which client outcomes may be best tracked using this methodology, is indicated. [ABSTRACT FROM AUTHOR]

Patients with serious mental illness are reported to have a 10–25 year reduction in life expectancy. Medical mistrust may influence their willingness to seek care (Bynum, S. A., Davis, J. L., Green, B. L., & Katz, R. V. (2012). Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. American Journal of Health Promotion : Ajhp, 26(5), 295–300. https://doi.org/10.4278/ajhp.110113-QUAN-20). This cross-sectional study used baseline data from a SAMHSA funded demonstration project to describe the prevalence and of medical mistrust among a sample of African American adults with serious mental illness. Medical mistrust was identified using the Medical Mistrust Scale. One hundred and fifty-four participants completed the medical mistrust scale. Approximately, a third (34.4%) reported medical mistrust. After adjusting for financial stability, those endorsing medical mistrust reported nearly 3 times the odds of lacking support (AOR [95% CI]: 2.84 [1.01–7.97]) compared to those not endorsing medical mistrust. The study is among the first to describe elevated rates of medical mistrust among a sample of African Americans people with serious mental illness. An association between medical mistrust and lack of social support was demonstrated. [ABSTRACT FROM AUTHOR]

To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed. [ABSTRACT FROM AUTHOR]

The current study examined predictors of mental health treatment among Black men while incarcerated. Participants were 76 individuals who identified as Black Americans and were recruited from a correctional setting. Using secondary data analysis (Shaw, L. B., & Morgan, R. D. (2011). Inmate attitudes toward treatment: Mental health service utilization and treatment effects. Law and Human Behavior, 35(4), 249–261. https://doi.org/10.1007/s10979-010-9233-5.), results indicated that Black men with a mental health diagnosis were more likely than those without a diagnosis to report receiving mental health treatment while incarcerated. Additionally, linear regression analyses indicated that only expectations about treatment (i.e., personal commitment; not therapy fears or history of mental health diagnosis) significantly predicted the current use of mental health treatment. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Arab immigrants constitute a sizable portion of the US population, and their adjustment and relocation challenges might escalate mental health issues. Nevertheless, mental health care accessibility among such populations is not recognized as policy issue. Hence, it is crucial to explore the political tools that might be employed to improve immigrants' access to mental health treatment. The Public Arenas Model (Hilgartner and Bosk, American Journal of Sociology 94:53–78, 1988) provides better understanding of how access to mental health care is defined in the public sphere, why mental health inaccessibility among Arabs has not received attention, and how stakeholders worked to raise the public's attention to such issue (Smith, Policy, Politics & Nursing Practice 10:134–142, 2009). Ultimately, several policy options are proposed to address Arab immigrants' access to mental health care issue, including increasing mental health service providers' language proficiency and cultural competency, integration of behavioral health and primary care services for immigrant populations, and considering novel modes of mental health delivery. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus (DM) is more common among individuals with severe mental illness (SMI). We aimed to assess quality-of-care-indicators in individuals with SMI following the 2015 Israel's Mental-Health-reform. We analyzed yearly changes in 2015–2019 of quality-of-care-measures and intermediate-DM-outcomes, with adjustment for gender, age-group, and socioeconomic status (SES) and compared individuals with SMI to the general adult population. Adults with SMI had higher prevalences of DM (odds ratio (OR) = 1.64; 95% confidence intervals (CI): 1.61–1.67) and obesity (OR = 2.11; 95% CI: 2.08–2.13), compared to the general population. DM prevalence, DM control, and obesity rates increased over the years in this population. In 2019, HbA1c testing was marginally lower (OR = 0.88; 95% CI: 0.83–0.94) and uncontrolled DM (HbA1c > 9%) slightly more common among patients with SMI (OR = 1.22; 95% CI: 1.14–1.30), control worsened by decreasing SES. After adjustment, uncontrolled DM (adj. OR = 1.02; 95% CI: 0.96–1.09) was not associated with SMI. Cardio-metabolic morbidity among patients with SMI may be related to high prevalences of obesity and DM rather than poor DM control. Effective screening for metabolic diseases in this population and social reforms are required. [ABSTRACT FROM AUTHOR]

In India, where institutional-based mental health care is common, gender and other intersecting marginalized identities along with absent familial support contribute to women's admission and prolonged confinement to psychiatric institutions. However, an intersectional analysis of factors that prevent women with limited familial support from returning to their communities is lacking. This article is based on narratives of eleven women residing at a halfway home in an urban city in India, awaiting return to their communities. We include descriptions and an intersectional analysis of women's pathways to psychiatric institutions, their experiences receiving institutional-based mental health care, and the challenges they face as they contemplate returning to their communities. This study adds to the minimal research examining women's gendered pathways to psychiatric institutions in India. Women's narratives highlight that gender and illness-related disadvantages coupled with economic adversity that led to the initial admission also serve as deterrents to reentering the community. [ABSTRACT FROM AUTHOR]

Although shared decision making (SDM) has become the most preferable way in doctor–patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care. [ABSTRACT FROM AUTHOR]

The integration of multiple ancillary services into mental health treatment settings may improve outcomes, but there are no national studies addressing whether comprehensive services are distributed equitably. We investigated whether the availability of a wide range of service types differs based on the facility's racial/ethnic composition. We used the 2020 National Mental Health Services Survey to identify twelve services offered in outpatient mental health treatment facilities (N = 1,074 facilities). We used logistic regression to model each of the twelve services, predicted by the percentage of a facility's clientele that was White, Black, and Hispanic, adjusted for covariates. Facilities with the highest proportions of Black and Hispanic clientele demonstrated the lowest predicted probabilities of offering comprehensive and integrated services. Our findings offer context around upstream factors that may, in part, drive treatment disparities. We orient our findings around frameworks of structural racism and inequities in mental healthcare. [ABSTRACT FROM AUTHOR]

This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better individual psychosocial conditions were positively associated with higher QoL. As well, living in PSH located in good neighborhoods for at least 5 years, higher self-esteem and community integration were positively associated with greater QoL. Met needs, satisfaction with housing support services, and no use of acute care were also linked with positive QoL. Comprehensive efforts to improve treatment for mental health disabilities responsive to the needs of PSH residents, and sustained long-term housing may reinforce QoL. Encouraging active participation in community-based activities, incorporating biophilic design into the neighborhoods around PSH, and promoting satisfaction with care may also enhance QoL. [ABSTRACT FROM AUTHOR]

The present study examined whether there were ethnoracial differences in the use of formal and informal resources by family members of individuals in the early stages of psychosis. A sample of 154 family member respondents participated in an online cross-sectional survey. Ethnoracially minoritized family members disproportionately made early contact with informal resources (e.g., religious/spiritual leaders, friends, online support groups) on the pathway to care compared to non-Hispanic white family members who tended to contact formal resources (primary care doctors/nurses or school counselors). A description of early contact among Black and Hispanic family members are also described. Study findings highlight that ethnoracially minoritized families seek out support and/or resources from informal resources embedded within their community. Our findings suggest the need for targeted strategies that leverage the reach of informal settings to capture family members as well as general community members. [ABSTRACT FROM AUTHOR]

Women with substance use disorders (SUDs) who are homeless or near homeless have high rates of mental health, behavioral health, and SUD treatment needs. To effectively respond to these needs, it is critical to understand the population-specific trauma experiences of these women. This descriptive study examined the extent and nature of trauma experience among women who have an SUD and are homeless or near homeless. Results (n = 851 women) indicated high rates of trauma experience. All participants (100%) reported at least one type of trauma experience in their lifetime, with the majority (75.3%) having experienced five to seven of the seven types of trauma experiences assessed. Participants reported high levels of emotional severity related to the majority of traumatic events experienced. The pervasiveness of the trauma experiences and the related emotional impact among women with SUDs who are homeless or near homeless reinforce the necessity for trauma-informed care in treatment settings. [ABSTRACT FROM AUTHOR]

Translating research to behavioral healthcare practice is vital for improving treatment impact but can be challenging. Current and lifetime histories of trauma need to be considered in behavioral healthcare provision as they can significantly affect an individual's treatment experience. This article provides guidance on how to utilize research findings regarding trauma prevalence and experiences of women who have substance use disorder and who are homeless or near homeless to help guide responsive healthcare and treatment in practice. [ABSTRACT FROM AUTHOR]

Federally qualified health centers (FQHCs) that provide comprehensive health services, including integrated behavioral health (IBH), transitioned to deliver care via telehealth during the COVID-19 pandemic. This study explored how FQHCs adapted IBH services using telehealth. A mixed-method design was used, pairing a survey disseminated to FQHC administrators with a structured interview. Of the 46 administrators who participated in the survey, 14 (30.4%) reported delivering IBH using telecommunication prior to the pandemic. Since COVID-19, almost all of the FQHCs surveyed used telecommunication to deliver IBH (n = 44, 95.7%). Nine interviews with FQHC administrators resulted in the four themes: telehealth was essential; core components of IBH were impacted; payment parity and reimbursement were a concern; and telehealth addressed workforce issues. Findings confirm the necessity of telehealth for FQHCs during COVID-19. However due to the lack of co-location, warm-handoffs and other core components of IBH were limited. [ABSTRACT FROM AUTHOR]

The outburst of the COVID-19 pandemic challenged vulnerable populations such as individuals with significant mental illness. In this fresh focus, we describe the innovative development of the UPSIDES mental health peer support intervention, in face of the COVID-19 pandemic in Israel. While the research program is still ongoing, in this paper we focus on the processes and lessons learned from dealing with the rapidly changing circumstances of the pandemic. We portray additional activities conducted above and beyond the UPSIDES protocol in order to maintain continuation and prevent dropout. We learned that an essential combination of keeping a close adherence with the core peer principles and UPSIDES' systematic program and the use of flexible telecommunication means, helped to maintain social connection and service users' participation throughout these times. The sudden pandemic challenges appeared to level out power imbalances and accelerated the formation of reciprocal and supportive relational interactions within the intervention. These processes highlight experiential knowledge as a unique asset, and peer support services as useful in supporting individuals with significant mental illness throughout COVID-19. [ABSTRACT FROM AUTHOR]

This study was conducted to examine the construction of social identity among mental health experts by experience working in Finnish municipal mental healthcare services. The construction of social identity is approached as an ongoing lifelong process that is significantly affected by lived experiences with mental health problems and recovery from them. The research data consist of focus group discussions, and the analysis is based on a thematic design that is initially material-driven. As a result, four categories are formed to describe the effect of acting as an expert by experience on social identity and the importance of the issue. Experts by experience have to consider profound questions about their identity and future in their new life situation. The individual meanings of acting as an expert by experience are considered particularly important. The support provided by group members builds confidence in one's chances of success and thereby supports the development of social identity. Social identities of experts by experience are partially built in encounters with professionals representing the mental health care system. This creates opportunities for new roles for those who act as experts by experience. [ABSTRACT FROM AUTHOR]

Recovery-orientated practice is crucial to mental health care services—consistently identified in policy, service delivery guidelines and national mental health action plans. An essential component to systems reform and the adoption of recovery-orientated practice is the inclusion of peer support workers as practice leaders to support shifting culture in mental health service delivery. Designated peer support roles operate as healthcare professionals who utilise their lived and living experience of mental health difficulty to support those on their recovery journey through mutual understanding of shared experience. This research sought to explore the experiences of peer support workers integrating into mental health teams and identify organisational actions to facilitate successful recognition, integration and acceptance by colleagues; therefore, promoting sustainability of the peer support role. Qualitative interviews were undertaken with 18 peer support workers employed across four Australian states within 12 different government and non-government organisations. Study findings reveal three key areas for organisational change with seven main themes to assist organisations to better facilitate the successful integration of peer support workers into mental health service teams. These included robust induction, training for existing staff, clear referral pathways into the service, consistent supervision and debriefing, leadership support, professional development pathways and involving peer workers through change processes. These themes were grouped into three key areas for change including preparation, process and structural changes, and cultural change actions for sustainability. This article makes recommendations for organisations to consider when implementing peer support roles into mental health services. [ABSTRACT FROM AUTHOR]

There is little research on the effectiveness of autistic peer-delivered services. This study examines early outcomes associated with the Community Autism Peer Specialist program (CAPS), which was created in partnership with autistic individuals and is delivered by autistic adults who have received training in the delivery of peer support services to enhance the community functioning of autistic youth and adults. A single group pre-test/post-test design was used to examine early outcomes in the areas of independent living needs, social functioning, service engagement, and quality of life. A total of 23 individuals with autism aged 14–41 years were included in the study. Reductions were found in social functioning impairments and unmet needs after three months in the program. Participants also reported greater engagement in mental health services and activities that promote wellness compared with before the program. This study suggests that peer support services delivered by autistic peers may be an effective intervention approach for autistic youth and adults. Future studies with a more rigorous study design (e.g., randomized controlled trials), a larger sample size, and longer-term outcome measurements are needed to further investigate the effectiveness of CAPS and similar autistic-delivered services. [ABSTRACT FROM AUTHOR]

Telehealth dramatically expanded during the COVID-19 pandemic, but there remains a dearth of literature examining how this service modality is utilized by individuals who use substances. This study examined patterns of telehealth use and individual level sources of variation among clients receiving counseling in an outpatient substance use clinic in early 2021 (n = 370). Univariate statistics described the percentage of counseling visits delivered via telehealth. OLS regression explored individual level demographic and clinical characteristics that predicted greater telehealth utilization. Overall, more than two thirds (86%) of counseling visits were conducted via telehealth. Individuals with unstable housing or with a co-occurring serious mental illness used less telehealth. Findings suggest that while telehealth appears to be an acceptable way to deliver substance use counseling, patterns varied among vulnerable subgroups. As telehealth becomes further integrated into behavioral health services delivery, it is critical to uncover sources of this variation and identify potential solutions. [ABSTRACT FROM AUTHOR]

COVID-19 has had a disproportionate impact on the most disadvantaged members of society, including minorities and those with disabling chronic illnesses such as schizophrenia. We examined the pandemic's impacts among New York State's Medicaid beneficiaries with schizophrenia in the immediate post-pandemic surge period, with a focus on equity of access to critical healthcare. We compared changes in utilization of key behavioral health outpatient services and inpatient services for life-threatening conditions between the pre-pandemic and surge periods for White and non-White beneficiaries. We found racial and ethnic differences across all outcomes, with most differences stable over time. The exception was pneumonia admissions—while no differences existed in the pre-pandemic period, Black and Latinx beneficiaries were less likely than Whites to be hospitalized in the surge period despite minorities' heavier COVID-19 disease burden. The emergence of racial and ethnic differences in access to scarce life-preserving healthcare may hold lessons for future crises. [ABSTRACT FROM AUTHOR]

Black, Indigenous, and People of Color (BIPOC) communities have weathered centuries of racism, causing transgenerational mental health consequences and hindering access to quality treatment. In this commentary, we describe the systemic challenges of engaging BIPOC to promote mental health equity during the COVID-19 pandemic. We then describe an initiative that illustrates these strategies, provide recommendations and further readings for academic institutions seeking to partner with community organizations to provide equitable mental health services to populations that have been traditionally overlooked. [ABSTRACT FROM AUTHOR]

This manuscript reviews the unique challenges, barriers, and ethical implications of providing mental health services in rural and underserved areas. Community mental health centers in rural areas are often underserved due to shortages of mental health providers and limited resources. Individuals living in rural areas are at increased risk of developing mental health condition with limited access to mental health clinicians and healthcare facilities. These access to care issues are often exacerbated by geographical barriers as well as social, cultural, and economic challenges. A rural mental health professional may encounter several barriers to providing adequate care to individuals living in rural areas. For example, limited services and resources, geographic barriers, conflict between professional guidelines and community values, managing dual relationships, and challenges pertaining to confidentiality and privacy are several barriers to providing adequate care in rural areas. We will briefly summarize the primary ethical domains that are especially influenced by rural culture and the complex responsibilities of mental health providers in rural areas including barriers to care, crisis intervention, confidentiality, multiple relationships/dual roles, limits of competency, and rural mental healthcare practice implications. [ABSTRACT FROM AUTHOR]

Vocational recovery is frequently identified as a primary goal of specialized early intervention in psychosis services (EIS). However, few studies have investigated the multi-level impacts of psychosis and its social sequelae on emerging vocational identities and mechanisms by which EIS may contribute to longer-term career development. The goal of this study was to deepen our understanding of the experiences of young adults with early psychosis during and following discharge from EIS as they relate to vocational derailment, identity and career development. We conducted in-depth interviews with 25 former EIS recipients and five family members (N = 30). Interviews were analyzed using modified grounded theory, with an orientation to generating a rich, theory informed understanding young people's experiences. Approximately half of the participants in our sample were not in employment, education, or training (NEET) and had applied for or were receiving disability benefits (SSI/SSDI). Among those participants who were working, the majority reported short-term, low-wage work. Thematic findings elucidate factors underlying the erosion of vocational identity, as well as ways in which both participant-reported vocational service characteristics and socioeconomic background shape different pathways to college, work and/or disability benefits both during and following discharge from EIS. Findings underscore the need for additional research on vocational identity among youth and young adults with early psychosis and the development and evaluation of interventions designed to support career development, address social and structural barriers to education and training, and foster long-term socioeconomic mobility. [ABSTRACT FROM AUTHOR]