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Presents the results of traditional and ethnographic content analyses of 23 position papers on mental health care reform debate in the United States. Identification of five concrete aspects of mental health service delivery system and eight policy issues; Measure of the quality of policy discussions.

Background: Despite disproportionate rates of mental ill-health compared with non-Indigenous populations, few programs have been tailored to the unique health, social, and cultural needs and preferences of young Aboriginal and Torres Strait Islander males. This paper describes the process of culturally adapting the US-based Young Black Men, Masculinities, and Mental Health (YBMen) Project to suit the needs, preferences, culture, and circumstances of Aboriginal and Torres Strait Islander males aged 16–25 years in the Northern Territory, Australia. YBMen is an evidence-based social media-based education and support program designed to promote mental health, expand understandings of gender and cultural identities, and enhance social support in college-aged Black men. Methods: Our adaptation followed an Extended Stages of Cultural Adaptation model. First, we established a rationale for adaptation that included assessing the appropriateness of YBMen's core components for the target population. We then investigated important and appropriate models to underpin the adapted program and conducted a non-linear, iterative process of gathering information from key sources, including young Aboriginal and Torres Strait Islander males, to inform program curriculum and delivery. Results: To maintain program fidelity, we retained the core curriculum components of mental health, healthy masculinities, and social connection and kept the small cohort, private social media group delivery but developed two models: 'online only' (the original online delivery format) and 'hybrid in-person/online' (combining online delivery with weekly in-person group sessions). Adaptations made included using an overarching Aboriginal and Torres Strait Islander social and emotional wellbeing framework and socio-cultural strengths-based approach; inclusion of modules on health and wellbeing, positive Indigenous masculinities, and respectful relationships; use of Indigenous designs and colours; and prominent placement of images of Aboriginal and Torres Strait Islander male sportspeople, musicians, activists, and local role models. Conclusions: This process resulted in a culturally responsive mental health, masculinities, and social support health promotion program for young Aboriginal and Torres Strait Islander males. Next steps will involve pilot testing to investigate the adapted program's acceptability and feasibility and inform further refinement. Keywords: Aboriginal, Torres Strait Islander, Indigenous, Australia, male, cultural adaptation, social media, mental health, masculinities, social support. [ABSTRACT FROM AUTHOR]

The author discusses Owens' paper from the point of view of a deterioration in mental health services in the US and in the UK with regard to the need in patients to establish trusting relationships as a pre-requisite to psychological stability and wellbeing. The advent of rapidly acting psychotropic drugs and a proliferation of short term psychological treatments, often addressed to very severe disturbance, sometimes with benefit to certain patients, are increasingly used to avoid fundamental needs for dependency. Owens discusses the serious fallout of this problem in the context of disturbed adolescents and bi-polar patients whose most basic developmental needs are too often not met, but the difficulty is widespread, this author suggests. The avoidance of close contact with patients who are disturbed is supported by cultural values that endorse technological and functional achievements above the need for human relatedness. [ABSTRACT FROM AUTHOR]

The article shares the author's thoughts on the review of the papers presented to the Association of Mental Deficiency in the U.S. in the past ten years. He relates that it has seemed best to present abstracts of the papers without adding special comments. He expresses his gratitude to the librarian, Hazel Catlin, for helping him prepare the abstracts.

There is a mental health crisis in the United States that shows no signs of abating. Prevalence rates of mental disorders among both adults and children are rising and there are simply not enough mental health professionals to meet the growing demand. To address this problem, digital programs are being designed to diagnose and treat mental health conditions either adjunctively to a human clinician or as stand-alone treatments. Such developments hold great promise in ameliorating the mental health professional supply shortage. However, certain limitations of digital programs may prevent many users from desiring a digital psychotherapist. This paper surveys both the promise, and limitations, of digital psychotherapies. [ABSTRACT FROM AUTHOR]

Presents the American Academy of Family Physicians' paper on the necessity of including basic mental health care services in a uniform benefits package. Need to recognize the critical role played by family physicians in its delivery; Prevalence of cost of mental health disorders; Role of primary care in mental health; Family physician training in mental health; Collaborative mental health care model.

The supply / demand issue in behavioral health care is a well-established fact, and the mental health toll of the COVID-19 pandemic continues to add challenges to an already taxed system. Existing healthcare models are not set up to adequately address the increasing mental health related needs. As such, innovative models are needed to provide patients with access to appropriate, evidence-based behavioral health care within routine clinical care. This paper introduces Precision Behavioral Health (PBH) as an example of such a model. PBH is an innovative, digital first care delivery model that provides an ecosystem of evidence-based digital mental health interventions to patients as a frontline behavioral health treatment within routine care in a large multispecialty group medical center in the United States. This paper describes the implementation of PBH within a practice research network set-up as part of an integrated behavioral health department. We will present how our team leveraged the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance; "What is RE-AIM?," n.d.) implementation science framework, which emphasizes the design, dissemination, and implementation processes at the individual, staff, and organizational levels, to prioritize key implementation constructs to enhance the successful integration of PBH within routine care. We describe how each of these constructs were operationalized to aid data gathering for rapid evaluation and lessons learned. We discuss the benefits of these types of initiatives across multiple stakeholders including patients, providers, organizations, payers, and digital intervention vendors. [ABSTRACT FROM AUTHOR]

From the prehistorical to contemporary periods, prisoners' mental health has been a burgeoning issue in the United States (USA). After a decade of incarceration and a misleading penal system, prisoners' mental health has become a discussed topic for scholars not only in the correctional system but also in other disciplines. Despite having diverse initiatives for the improvement of the penal system, few initiatives have been held to take into consideration of prisoner's mental health. To fill this gap, the main purpose of this paper is to provide a brief overview of the mental health of prisoners by analyzing previous research on the mental health of prisoners along with suggesting some probable ways from management information perspectives that can be helpful to reduce a great number of prisoners and bring some positive changes in the correctional system. [ABSTRACT FROM AUTHOR]

Executive Summary: Millions of Venezuelans have fled their country in hopes for a better future outside the political and financial turmoil in their home country. This paper examines the self-reported needs of Venezuelans in the United States and Colombia. Specifically, it looks at perceived discrimination in each country and its effect on the service needs of Venezuelan immigrants. The authors used data from a larger project conducted in October to November 2017 to perform a qualitative content analysis on the specific services that participants and others like them would need following immigration. The sample consisted of 647 Venezuelan immigrant adults who had migrated to the United States (n = 342) or Colombia (n = 305). Its findings indicate statistically significant differences between the two countries. Venezuelan immigrants in the United States were more likely to identity mental health and educational service needs, while those in Colombia were more likely to list access to healthcare, help finding jobs, and food assistance. When looking at perceived discrimination, means scores for discrimination were significantly greater for participants who indicated needing housing services, who indicated needing assistance enrolling children in school and who indicated needing food assistance, compared to participants who did not list those needs. Venezuelans who had experienced greater negative context of reception were less likely to indicate needing mental health services, where 11.9 percent of those who did not perceive a negative context of reception responded that they needed mental health services. Evaluating existing service networks will be essential in working to bridge the gap between the services provided to and requested by Venezuelans. Collaboration between diverse government actors, community-based organizations (CBOs) and other stakeholders can help identify gaps in existing service networks. CBOs can also facilitate communication between Venezuelan immigrants and their new communities, on the need to invest in necessary services. [ABSTRACT FROM AUTHOR]

Purpose: Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. Methods: We conducted a cross‐sectional study to evaluate the association between patient‐level factors and a combined outcome variable encompassing multiple aspects of care engagement. Findings: Either online or on paper, 446 participants completed our survey. One‐third of the participants (33%) were from the southern United States; one‐third were women; one‐third were non‐White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. Conclusions: Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: International guidelines for trans‐and‐gender‐non‐conforming (TGNC) exists in outpatient settings.Compared to cisgender and heterosexual people, TGNC individuals are at a higher risk of mental health difficulties and have higher rates of inpatient mental health treatment. What does this paper add to existing knowledge?: An international scoping review identifying the lack of guidelines existing for TGNC individuals in inpatient mental health settings. Compared to psychiatrists and psychologists, mental health nursing has the most contact with patients admitted for inpatient psychiatric treatment. The study identifies unaddressed needs in gender affirming policies and outlines preliminary policy recommendations to assist mental health staff in improving TGNC patient quality of care within the United States. What are the implications for practice?: Reforming existing guidelines or creating new guidelines based on the identified themes and gaps to improve the well‐being and treatment outcomes of TGNC individuals in inpatient psychiatric settings within the United States. Introduction: Access to culturally sensitive care is critical for addressing known mental health disparities among trans‐and gender‐non‐conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. Aim: To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. Method: A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. Results: Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. Discussion: The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well‐being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. Implications for practice: To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings. [ABSTRACT FROM AUTHOR]

This paper discusses the impact of White supremacy, ableism, and U.S. policing on both the history and current state of psychology and sheds light on ways that psychologists can acknowledge and divest from carceral White supremacist practices in mental healthcare. Because of how oppression and intersectionality function within a White supremacist society, not all Black lives have been equally valued by non-Black Americans. Similarly, White supremacy and ableism have had lasting impacts on the public perception of disabled people. Connecting the historical origins of the U.S. policing system to the current practices of the U.S. police system, this paper argues that the police have always been about controlling "disorder." Similarly, psychology and the larger mental health field have a troubled history of controlling Black, Brown, and disabled bodies. Recommendations for ways therapists can unlearn therapy practices stemming from White supremacy cultural practices (e.g., carceral therapeutic practices and biased mental health care) are provided along with action items for mental health practitioners to maintain a commitment to undoing the harm from these historic and systemic issues. [ABSTRACT FROM AUTHOR]

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence. [ABSTRACT FROM AUTHOR]

Background: More than 20 million children in the United States lack access to primary health care. Practice Learning: Research shows that students with regular access to physical and mental health services have fewer absences, are more social, less likely to participate in risky behaviors, have improved focus and higher test scores. Implication For School Health Policy, Practice, And Equity: School‐based health centers (SBHCs) can be an important, valuable and viable health care delivery option to meet the full‐range of primary health care needs of students where they spend the majority of their wake hours, ie, in school. Children in rural and other underserved communities, as well as those underinsured, non‐insured, economically challenged, underserved, and the most vulnerable among us are especially at risk. Conclusions: This paper discusses the history, value, and importance of SBHCs from myriad perspectives, including physical and emotional wellbeing, academic and social success, and the promotion of a positive transition to adulthood. In addition, the authors' experiences that resulted in building the first SBHC in the Mid‐Hudson Valley Region of New York State are shared. These experiences form the foundation for creating an important roadmap for individuals and school leaders that are interested in bringing a SBHC to their school and district. [ABSTRACT FROM AUTHOR]

Racial and ethnic minorities like Asians in the United States are significantly less likely to receive mental health treatment than Caucasians. Using 2012 Behavioral Risk Factor Surveillance System data, we examined the underutilization of mental health treatment in the US and find that being over 65 or 35–44, being unmarried, and being insured were positively associated with mental health treatment utilization, and as mentally unhealthy days increased, the utilization of treatment also increased. The paper offers a discussion on why there is this underutilization of mental health services amongst Asians and what steps can be taken to improve utilization. [ABSTRACT FROM AUTHOR]

Mental health and drug treatment courts have a substantially positive effect on instances of recidivism in non-violent offenders in the criminal justice system. A significant portion of the prison population in the United States suffers from serious mental illness (SMI); due to the deinstitutionalization of mental health treatment, prisons often end up being the only treatment option for people with SMI or substance abuse disorders. Policy is needed to treat the issues surrounding mental illness instead of punishing them. Incarceration is not the answer for people with mental health problems. Instead of punishment, a restorative model of justice can be implemented in the form of alternative courts that reduce recidivism for non-violent offenders with mental illness. The policy which could accomplish this is the expansion of mental health and drug treatment courts. To argue this point, this policy paper will provide a brief history of mental illness deinstitutionalization and explore the basic problems of mental health and substance abuse for people in the criminal justice system. The paper will summarize the basics of mental health court (MHC) functions and examples of MHCs in action are detailed alongside evidence of their efficacy. Potential opposition and drawbacks are explored, and additional policy recommendations for supplementing MHC programs are presented. [ABSTRACT FROM AUTHOR]

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness. [ABSTRACT FROM AUTHOR]

Mental health challenges have been recognized as one of the most prevalent issues impacting children and families within the United States. Children and families of color are disproportionately affected by this due to lack of access to preventative and ongoing supports, and programs that can help address their overall well-being. These issues are even more severe for those that are at risk or interact with the child welfare system. Social workers use various clinical modalities to assess and support them. In the recent years, child welfare agencies have turned to Evidence based programs (EBPs) as a best practice to meet the needs of children and families. The Title IV-E Prevention Services Clearinghouse, established by the Administration of Children and Families is a landmark effort to review and promote such EBP's that prevents foster care placements, including mental health programs. While the Clearinghouse has reviewed 141 programs and services, out of which 71 have been rated as promising, supported, or well-supported, there is a dearth of culturally responsive programs that have met the Clearinghouse criteria. Given the overrepresentation of African American and Native American Families in the child welfare system, and the critical role of the Clearinghouse in reviewing and promoting EBPs, this paper highlights the philosophical, administrative, cultural and logistical barriers for culturally relevant programs to be accepted into the Clearinghouse. It also provides specific recommendations on how the Clearinghouse and researchers can build EBPs that account for the intersection between mental health, social location and cultural identities of the children and families that social workers serve. [ABSTRACT FROM AUTHOR]

In the wake of COVID-19, mental health providers and treatment programs are adapting rapidly to the challenges in engaging people and delivering treatment with limited guidance. This paper will explore the challenges associated with delivering treatment within coordinated specialty care (CSC) programs for people with first episode psychosis. Suggestions for treatment will take into consideration experiences with stress, changes to the pursuit of work and school, and increased time spent with families. Drawing on the experience of several CSC programs in the United States, Israel, and China, we describe the impact and modifications to the core treatment elements in CSC including medication, family interactions, supported employment and education, individual therapy, peer support and the way they are delivered. The paper includes recommendations based on experiences from CSC programs to help staff members, participants, and family members better identify, prepare, cope and respond to the unique new challenges and suggests modifications that can be made during various stages of the coronavirus pandemic. [ABSTRACT FROM AUTHOR]

In response to the rising numbers of refugees worldwide, many aid organizations suggest entrepreneurship as a preferred route to refugee economic self-reliance in a new country. Incubators have long provided assistance to nascent entrepreneurs and are utilized worldwide to offer support to entrepreneurial businesses. Yet, little research examines refugee-focused incubators or considers refugee-specific constraints. Herein, we argue that refugee status has specific implications for how refugee entrepreneurs accumulate and deploy human, social and financial capital. Thus, refugee status affects the types of services transitioning refugees require from incubators. This paper considers refugee-specific resources and uses a case study approach to investigate resource provision in a refugee-focused incubator in the United States. We find that even when an incubator follows best practices in terms of service provision, it may still miss the mark in terms of meeting key resource needs of refugees. Specifically, this paper illuminates how refugee entrepreneurs need (more) incubator support in terms of (1) addressing mental health in service provision, (2) building community within the incubator and (3) balancing financial tradeoffs associated with culturally-based businesses. Findings are novel when tied to a resource-based lens and help build theory regarding entrepreneurship among less-served populations. [ABSTRACT FROM AUTHOR]

It is now widely accepted that there is a growing discrepancy between demand and access to adequate treatment for behavioral or mental health conditions in the United States. This results in immense personal, societal, and economic costs. One rapidly growing method of addressing this discrepancy is to integrate mental health services into the primary care setting, which has become the de facto service provider for these conditions. In this paper, we describe the development and implementation of a novel integrated care program in a large mid-western university-based healthcare system, drawn from the collaborative care model, and describe the benefits in terms of both health care utilization and depression outcomes. Limitations and proposed future directions are discussed. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the “active ingredients” of integrated behavioral health care (IBHC) from the perspective of Karen refugee participants in an IBHC intervention.Design/methodology/approach This paper is based on in-depth, semi-structured interviews with participants (n=40) who have received an IBHC intervention for one year. These qualitative data are supplemented by descriptive quantitative data from those same participants.Findings This research suggested that IBHC increased awareness and access to behavioral health services, and that IBHC may be especially amenable to treating complex health conditions. The research also found that IBHC provided a point of regular contact for patients who had limited time with their primary care providers, which helped to enhance access to and engagement with health care.Practical implications IBHC has the potential to meet the complex needs of Karen resettled refugees living in an urban setting in the USA.Originality/value IBHC is a promising approach to help meet the mental health needs of refugees in the USA. There are, however, gaps in knowledge about the “active ingredients” of IBHC. This paper helps fill these gaps by studying how IBHC works from the perspective of a group of Karen refugees; these are critical perspectives, missing in the literature, which must be heard in order to better address the complex conditions and needs of resettled refugees. [ABSTRACT FROM AUTHOR]

This article is a reaction paper to the article in this journal issue entitled Human Service Cartels: The Soft Repression of the Mediocracy by David Stoesz. As such, it addresses two significant questions about the Stoesz article. One question is as follows: Are we really talking about a cartel? The other question is as follows: Isn't it the power elite that promotes societal control and repression? [ABSTRACT FROM AUTHOR]

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]

BACKGROUND Socioeconomically disadvantaged groups disproportionately reported experiencing adverse circumstances resulting from the COVID-19 pandemic's socioeconomic impacts. Overarching factors associated with differentiated risks in the United States include race and ethnicity. OBJECTIVE We aim to examine: (1) the differentiated risk of experiencing adverse circumstances by race and ethnicity in the United States and (2) the trend in adverse outcomes and racial/ethnic differences in the past two years. METHODS The study utilized 49 data cycles from the Household Pulse Survey from April 2020 to September 2022. The outcomes are adverse experiences, including loss of employment income, food scarcity, housing insecurity, and unmet needs for mental health services. The racial and ethnic groups are non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, non-Hispanic other minorities, and Hispanic. We compared weighted percentages of the total population and racial and ethnic groups reporting having experienced adverse circumstances during every data collection period. RESULTS We found that except for non-Hispanic Asians, racial and ethnic minorities were more likely to report loss of employment income, food scarcity, housing insecurity, and unmet needs for mental health services. Prevalence estimates by race/ethnicity for each cycle illustrated the persistent racial/ethnic disparities from April 2020 to the present. CONCLUSIONS The adverse socioeconomic impacts of the COVID-19 pandemic tended to be disproportionately higher for most racial and ethnic minorities compared to non-Hispanic Whites, and this trend continues. CONTRIBUTION This paper analyzes real time population survey data to demonstrate the extent of unequal and adverse socioeconomic impacts of the COVID-19 pandemic on minority groups and highlights the persistence of these trends in adverse socioeconomic outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe and discuss both the early implementation of a US mental health intervention for young children in the context of its introduction to a pilot site in a London borough and the progress made in establishing a randomised controlled trial (RCT). Design/methodology/approach: This paper describes an evaluation of a new intervention and the learning that followed in terms of its implementation and future evaluation. Qualitative data were collected from a range of stakeholders and practitioners through interviews and small group discussions. These interviews focussed on both of these issues, with particular reference to the proposal to conduct an RCT. Findings: The findings of this evaluation add to the evidence on how best to support new initiatives that have been introduced from other settings and countries to embed in a receiving site and the optimal timing and feasibility of conducting an RCT. At the end of the feasibility study, which took place within the year of the service being introduced and which was only open to clients for six months of this year the conclusion was that an RCT at that point was neither possible nor desirable. Over the following years, the commitment of the judiciary to examine if there was a way to make an RCT study in respect of this intervention meant that a template was established that may well have broader application. Research limitations/implications: At a time when there is an increasing demand for evidence on effective interventions this paper makes a valuable contribution to the development of RCTs in general and specifically in the family court arena. It also recommends that attention must also be paid to the time, which is needed to implement and establish interventions and then to test them. Practical implications: This paper highlights the need to establish realistic timescales not only around the implementation of initiatives but also for their evaluation. Originality/value: This study breaks new ground in considering implementation challenges in the court and children's services' context. It brings to the fore the important role of the judiciary in approving new processes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to address the barrier to care experienced by LGBTQIA+ populations by binary language for gender, sexual orientation and relationship status. Design/methodology/approach: The authors review the research that shows linguistic barriers are a significant obstacle to healthcare for LGBTQIA+ communities. The authors describe both a process and revisions for addressing language bias in psychiatric intake/research research materials as well as quantify its impact in an adult psychotherapy clinic in a public hospital. Findings: Patients self-identified their gender, sexual orientation and relationship status in a variety of ways when not presented with binaries and/or pre-established response choices. In addition, the non-response rate to questions decreased and the authors received positive qualitative feedback. The authors also present the revisions to the intake/research materials. Practical implications: Other healthcare settings/clinicians can revise language in order to remove significant barriers to treatment and in doing so, be welcoming, non-pathologizing and empowering for LGBTQIA+ consumers of mental health services (as well as for non-LGBTQIA+ consumers who are in non-traditional relationships). Social implications: This work is one step in improving healthcare and the healthcare experience for LGBTQIA+ communities and for those in non-traditional relationships. Originality/value: This work is set in a public safety-net hospital providing care for underserved and diverse populations. This paper describes the process of revising psychiatric materials to be more inclusive of the range of self-identity are: gender, sexual orientation and relationship status. [ABSTRACT FROM AUTHOR]

This paper presents qualitative data collected from 996 licensed social workers in the United States who reported mental health and/or alcohol and other drug problems and indicated the types of services they used to address these issues. Outpatient therapy was the most commonly accessed modality to treat mental health issues. Regarding problems with alcohol and other drugs, self-help groups were the most frequently utilized intervention. Qualitative findings suggest that behavioral health service use has influenced respondents' work with clients, personal and professional development, and career trajectories. Barriers to service use, such as stigma and limited access to care, were also identified. Implications for social work education and professional practice are discussed. [ABSTRACT FROM AUTHOR]

Histories of psychiatry in the United States can shed light on current areas of need in mental health research and treatment. Often, however, these histories fail to represent accurately the distinct trajectories of psychiatric care among black and white populations, not only homogenizing the historical narrative but failing to account for current disparities in mental health care among these populations. The current paper explores two parallel histories of psychiatry in the United States and the way that these have come to influence current mental health practices. Juxtaposing the development of psychiatric care and understanding as it was provided for, and applied to, black and white populations, a picture of the theoretic foundations of mental health emerges, revealing the separate history that led to the current uneven state of psychiatric care. [ABSTRACT FROM AUTHOR]

Background: The Implementation Research Institute (IRI) provides two years of training in mental health implementation science for 10 new fellows each year. The IRI is supported by a National Institute of Mental Health (NIMH) R25 grant and the Department of Veterans Affairs (VA). Fellows attend two annual week-long trainings at Washington University in St. Louis. Training is provided through a rigorous curriculum, local and national mentoring, a 'learning site visit' to a federally funded implementation research project, pilot research, and grant writing. Methods: This paper describes the rationale, components, outcomes to date, and participant experiences with IRI. Results: IRI outcomes include 31 newly trained implementation researchers, their new grant proposals, contributions to other national dissemination and implementation research training, and publications in implementation science authored by the Core Faculty and fellows. Former fellows have obtained independent research funding in implementation science and are beginning to serve as mentors for more junior investigators. Conclusions: Based on the number of implementation research grant proposals and papers produced by fellows to date, the IRI is proving successful in preparing new researchers who can inform the process of making evidencebased mental healthcare more available through real-world settings of care and who are advancing the field of implementation science. [ABSTRACT FROM AUTHOR]

• Digital Mental Health Services (DMHS) can greatly increase access to care. • Training is needed so providers can effectively integrate DMHS into their treatments. • More research on DMHS is needed, along with regulatory standards. • DMHS may help reduce health disparities but questions remain about cultural tailoring. The papers in this special series make a compelling case for the value of digital mental health services (DMHS; including technology-based interventions, assessments, and prevention programs) to help address some of the currently unmet needs in mental health care. At the same time, the papers highlight the work that needs to be accomplished for DMHS to fulfill their promise. We review the papers' contributions in terms of (a) the imperative to increase access to evidence-informed, high-quality care, especially for underserved populations, both in the United States and globally; (b) ways to use DMHS to improve the ways that clinical care is provided to make treatment provision more effective and efficient; and (c) the current state of the research on DMHS for emotional disorders. We then consider lessons learned and recommendations to move the field forward, such as increasing (and making transparent) the research base on DMHS, adopting regulatory standards for DMHS, attending carefully to training issues for DMHS and best practices for dissemination and implementation, designing specifically for digital platforms, and being intentional about efforts to reduce disparities regarding who benefits from DMHS. [ABSTRACT FROM AUTHOR]

Mass murder, especially involving a firearm, has been a subject of increasing interest among criminologists over the past decade. Lacking an existing and reliable data resource for studying these crimes, several organizations have launched their own database initiatives with, unfortunately, little consensus on definition. As a result, there is confusion regarding the nature and trends of such events. In this paper, we rely on the Associated Press/USA Today/Northeastern University Mass Killing Database, which provides the widest coverage of incidents in the U.S. with four or more victim fatalities, regardless of location, situation, or weapon. First, we present trends in incidents and victimization of mass killings from 2006 through 2020, followed by an examination of various incident, offender, and victim characteristics, distinguishing among the major subtypes. Next, we detail a motivational typology of mass murder and identify the common contributing factors. Finally, we consider the potential effects of certain policy responses related to media coverage, mental health services, and gun restrictions on the prevalence of mass killing. [ABSTRACT FROM AUTHOR]

As the field of psychology continues to make efforts to diversify the field, training programs must adapt to include the needs of diverse students. Universities in the United States mirror middle-class norms and values, which implies that students are expected to separate from familial roles and focus on their personal growth. This conflicts with core values and intentions of students from collectivist cultures. Although psychology trainees are obligated to adhere to professional ethical standards, a growing number of psychology trainees from collectivistic cultures need support to manage role conflict within potentially ambiguous standards regarding how to care for family and community members. This need is further complicated when training programs consider the lack of equitable access to mental health care resources in communities where their psychology trainees come from. In this paper, we engage in ethical decision making to address two scenarios representing role conflict between training program expectations and collectivist community and familial obligations. Through this exercise we develop and propose a Decision-Making Model for Addressing Role Conflict for Psychology Trainees. This conceptual model details a novel framework to assist psychology trainees when addressing the mental health of family and community while also providing guidance to help graduate training programs proactively equip their students with the skills and ethical framework they need to balance role conflicts such as when family and community members desire and need mental health support. [ABSTRACT FROM AUTHOR]

Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs' different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidence-based practices for historically marginalized communities within the U.S. [ABSTRACT FROM AUTHOR]

School-based mental health services are a promising context for evidence-based interventions to promote early socio-emotional development, yet implementation presents significant challenges. This paper describes the rationale, content and format of a school-based intervention, Starting Strong in Kindergarten (Starting Strong). Starting Strong is a 10 week, indicated prevention programme aimed at promoting positive student–teacher relationships and behavioural adjustment during the transition to kindergarten. This parent- and teacher-focused indicated prevention programme targets children with or at risk for disruptive behaviour problems. The paper describes feasibility results of a pilot study of Starting Strong’s parent programme. Twenty-five families participated; rates of enrolment, attendance, retention, session engagement, homework completion, treatment fidelity and participant satisfaction suggest promising feasibility. School-based efforts targeting the transition to kindergarten may be helpful in improving behavioural and relational adjustment, especially for children who begin school with behavioural or relational risk. [ABSTRACT FROM AUTHOR]

Purpose Inclusion of members of the target population in research is an increasing priority in the social sciences; however, relatively few studies employ approaches that involve persons with lived experience of the mental health system in mental health services research, particularly in the USA. The purpose of this paper is to describe one such approach, the employment of peer interviewers in the evaluation of a peer respite program.Design/methodology/approach The paper describes how peer interviewers were recruited, hired, trained, and supervised. The authors discuss some benefits and challenges associated with the approach.Findings Peer interviewer benefits and challenges: the shared lived experience between the peer interviewers and study participants contributed to increased comfort and a high response rate overall. The study opened up professional opportunities for peers, but inconsistent work hours were a challenge and resulted in turnover and difficulty filling vacant positions. The lead evaluator and supervisors worked closely with peer interviewers to ensure conflict of interest was mitigated to reduce bias.Originality/value This paper adds to the limited literature describing peer representation in research, outlining one avenue for partnering with peers to align research with the values of the intervention under study without compromising – and perhaps increasing – scientific rigor. The authors expect that even more peer involvement in the oversight, analysis, and interpretation of results would have improved the overall quality of the evaluation. Future efforts should build upon and incorporate the approach alongside more comprehensive efforts to partner with service users. [ABSTRACT FROM AUTHOR]

Perinatal mental health is a complex and multifaceted area influenced by various psychosocial risk factors that impact the well-being of individuals during pregnancy and the postpartum period. This article provides insight into the intricacies of perinatal mental health challenges, emphasizing the importance of comprehensive support systems. It highlights prominent risk factors, including exposure to stressful life events, strained marital relationships, inadequate social support, lower socioeconomic status, single marital status, unwanted pregnancies, obstetrical stressors, and infant temperament. The article discusses various psychosocial interventions, including psychoeducation, cognitive restructuring, problem-solving techniques, behavioral activation, and befriending. It also emphasizes the importance of specialized care for women experiencing postpartum psychosis. The National Institute of Mental Health and Neurosciences-Mother-Baby Unit Model, a multidisciplinary approach to perinatal mental health care, is explored, highlighting its comprehensive psychosocial assessment and tailored interventions. The article emphasizes the need to focus on psychosocial risk factors and culturally sensitive interventions in perinatal mental health care. [ABSTRACT FROM AUTHOR]

In our collective memory of the 1950s, Frederic Wertham often appears as the spearhead of the conservative anti–comic book campaign. Yet in recent historiography, scholars have championed him as an antiracist who made mental health care more available to African Americans at Harlem’s Lafargue Mental Hygiene Clinic. Named for Karl Marx’s son-in-law, its volunteers provided low-cost care regardless of race from 1946 to 1959. How did someone who might otherwise have been branded a Communist attract white conservative allies at the repressive outset of the Cold War? This paper contends that this leftist was able to keep his subversive clinic open for thirteen years because that white public was unaware its patients and staff were black. The Lafargue Clinic relied on mass media to generate donations. In the 1950s, the clinic’s public image was linked to the anticomics movement. Because Wertham represented the work he did there with children and comics in a race-neutral fashion, white parents thought the clinic was white, flooding it with donations and requests for speakers. Ironically, this radical clinic was forced to close once the anticomics crusade ended, eroding its conservative base. The history of the Lafargue Clinic’s public image highlights the ironies of a postwar United States united by mass media. A carefully crafted public image enabled some subversive institutions to avoid the blacklist and pursue their missions. By generating allies ignorant of their actual activities and ideology, places such as the Lafargue Clinic managed to survive the 1950s—hidden in plain sight. [ABSTRACT FROM AUTHOR]

This paper discusses methodological issues that emerged during the design and implementation of a large-scale survey of licensed social workers in the USA. Benefits and challenges of survey research are identified. The paper provides recommendations for future workforce studies and surveys that assess behavioral health problems. [ABSTRACT FROM AUTHOR]

This article discusses individual and systemic barriers to accessing behavioral healthcare, tailoring the examination to the specific needs of Asian Americans (AAs). Some barriers include language barriers, lack of access to behavioral health care, and providers that may not be culturally sensitive to patients' needs. These barriers lead to the underuse of health services and worse mental health outcomes. AAs are said to be the "model minority," a term most often to describe Chinese Americans, East Asians or South-eastern Asians. This is a myth; AAs with behavioral health needs encounter numerous barriers. Among the barriers are health insurance coverage, especially Medicaid expansion, which is not available in every state. Also, healthcare workers and providers are not always prepared to treat behavioral health needs in their primary care practice. This paper highlights the need to further investigate these topics in order to help eliminate the disparities that still exist in our growing populations of racial and ethnic minorities from the standpoint of healthcare practitioners in their practices. Asian Americans now comprise the largest growing minority group in the United States (US). Asian Americans include all those that may be born in any Asian countries, or born in the US to parents who are not native English speakers. However, there remains insufficient comprehensive discussion and action to reduce the barriers to behavioral healthcare they face. It is important to tailor an all-inclusive agenda with the purpose of eliminating racial and ethnic disparities in behavioral healthcare for AAs in the US. [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 COVID-19 pandemic has been stressful for many, increasing levels of anxiety, depression and other mental health concerns worldwide. With the spread of the virus, many youth found themselves physically isolated from their peers and confined to their homes, and medical and mental health services previously provided in person had to adapt by providing virtual sessions. The transition to virtual care created many new challenges for clinicians and patients, including some specific to transgender youth and their families. Pre-pandemic, transgender youth comprised a marginalized and vulnerable population, with elevated risk for adverse mental health outcomes. However, community support, strong group identification and family affirmation can serve as important mitigating factors. In this paper, we will discuss unique challenges encountered in working with the parents and caregivers of transgender youth during virtual visits that have the potential to interfere with development of a therapeutic alliance and the movement toward increased family acceptance. We will provide clinical case examples and propose methods through which to address difficulties and improve care. [ABSTRACT FROM AUTHOR]

For people experiencing chronic homelessness, supportive housing with intensive social, health, and behavioral health services reduces the likelihood of re-entering homelessness and the public costs of associated acute medical care, shelter use, and incarceration. Due to a limited supply of supportive housing, it must be allocated to those most in need. This paper examines findings from a unique, region-wide method for prioritizing individuals for supportive housing based on utilization of high-cost public services and vulnerability if left on the street. A sample of 196 individuals were prioritized for housing based on this method, while a comparison group of 102 were housed not using the method. Results showed that those housed under the prioritization method achieved greater reductions in utilization of high-cost public services, but were also less likely to have positive dispositions when exiting the housing programs, suggesting the need for a greater intensity of supports and/or multiple “doses” of supportive housing before stability can be expected. The method described in the paper can provide a starting point for developing regional, comprehensive systems of coordinated, prioritized entry into supportive housing, such as those now required by US Department of Housing and Urban Development. [ABSTRACT FROM PUBLISHER]

BACKGROUND Mental health services in the United States public schools are an important component of the academic success of a student. Not all schools, however, have the necessary personnel and funding to offer such services. METHODS: In this paper, we provide an analysis of data collected from schools in 3 geographic locations. Comparisons were made of the availability of personnel to assess and treat mental health disorders in students enrolled in city, urban, and suburban schools, with over 10,000 schools represented. The data were part of the 2015 to 2016 School Survey on Crime and Safety. RESULTS: Accessibility of mental health practitioners and reasons that limited efforts of a school to provide the services were assessed. Statistically significant differences were identified by school location, demonstrating that those in rural communities were most challenged providing diagnostic assessment and treatment for students by school mental health professionals, for several reasons. CONCLUSIONS: Increased state and county funding to support mental health practitioners in public high schools is one suggestion to address mental health disorders in students. Other strategies are offered for timely and appropriate diagnoses and treatment for mental health disorders that may impact the quality of life of a student for a lifetime. [ABSTRACT FROM AUTHOR]

Purpose – Research and experience following a variety of recent disasters has fostered the development of a range of disaster behavioral health interventions that can be used post-disaster. Consensus documents recommend that five guiding principles be used to inform intervention efforts. These five essential elements, a sense of safety, calming, efficacy, connectedness, and hope, appear critical to the fostering of adaptation and resilience in affected communities. This paper aims to examine the use of these principles in practice. Design/methodology/approach – Translating these five evidence-informed principles into practice requires dissemination, delivery and prioritizing and validation of the elements. Scholars identify actions for dissemination, delivery, and prioritization and validation, and this paper expands on the literature to identify processes that actualize the research into a framework for practice. Findings – This article describes how disaster behavioral health professionals in Colorado have advanced these five principles into practice. Originality/value – While literature clearly dictates the importance of addressing the impacts of extreme stress on individuals and communities, there remains a gap to explain how to bridge the research and practice. These strategies included in this paper begin to bridge this gap and can be used by others charged with disaster planning and response to inform their practices. [ABSTRACT FROM AUTHOR]

Youth in the United States are experiencing mental health concerns at alarming rates. Considering the nation's legacy of racism and growing recognition of the impact of social determinants of health on educational and mental health inequities, it is imperative to re-envision how we approach mental health screening in schools to center equity. A focus on mental health screening for the sole purpose of identifying individual at-risk students ignores key contextual considerations, is ineffective in addressing health and educational inequities, and has the potential to perpetuate oppressive practices in schools. Equity-focused mental health screening requires a shift from individual- and deficit-focused approaches to systems- and holistic-focused approaches that (a) identify strengths and stressors among individuals, groups, and communities; (b) dismantle structural forms of oppression; and (c) promote positive mental health outcomes for minoritized youth. Integrating recommendations from the educational equity literature and critical school mental health frameworks, this paper identifies core considerations for equitable school mental health screening and provides guiding principles for each phase of the screening process, from screening readiness to execution to follow up. To implement these recommendations and transform school-based mental health care, schools should (a) incorporate multiple perspectives; (b) prioritize student, family, and community voices; and (c) build collaborative partnerships to co-construct a vision for equitable school mental health. [ABSTRACT FROM AUTHOR]

Mental health recovery is emerging as a central philosophy in every institution providing mental health services across the world. However, in order to implement effective and efficient programs and policies that focus on recovery, it is important to understand how recovery happens. This understanding involves more than outcomes monitoring; it requires that the indicators be used in a way that will increase our understanding and do not lead us in unexpected directions. Therefore, it is important that mental health stakeholders recognize the impact that outcomes monitoring can have on programs and be aware of their unwanted influence. In this paper we describe the measurement tools, methodological techniques (quantitative and qualitative), and outcome reporting systems currently used at the Mental Health Center of Denver in the United States, that are helping us to investigate critical research questions about what drives recovery. The article concludes by discussing how we are using the information we have gathered to develop programs and policies that help people recover, as well as use resources more efficiently. [ABSTRACT FROM AUTHOR]

In this paper the author provides a case illustration of home-based systemic therapy performed in the U.S., with a female survivor from a war-affected region of West Africa. Providing clinical services in a person's home has been shown to be an effective way to engage those who are otherwise unlikely to seek out mental health services. In this paper, first-person narrative vignettes about the therapy endeavor illustrate how working in the context of the client's home assisted the clinician in eliciting rich information about the resourcefulness of the client in constructing a new life for herself in her host country. Such information tends to be overlooked in literature about work with refugee survivors of war. [ABSTRACT FROM AUTHOR]

The United States spends more money on mental health services than any other country, yet access to effective psychological services remains strikingly low. The need-to-access gap is especially wide among children and adolescents, with up to 80% of youths with mental health needs going without services, and the remainder often receiving insufficient or untested care. Single-session interventions (SSIs) may offer a promising path toward improving accessibility, cost-effectiveness, and completion rates for youth mental health services. SSIs are structured programs that intentionally involve only one visit or encounter with a clinic, provider, or program; they may serve as stand-alone or adjunctive clinical services. A growing body of evidence supports the capacity of SSIs to reduce and prevent youth psychopathology of multiple types. Here, we provide a working definition of SSIs for use in future research and practice; summarize the literature to date on SSIs for child and adolescent mental health; and propose recommendations for the future design, evaluation, and implementation of SSIs across a variety of settings and contexts. We hope that this paper will serve as an actionable research agenda for gauging the full potential of SSIs as a force for youth mental health. [ABSTRACT FROM AUTHOR]