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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]

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]

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: Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth., Methods: Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels., Results: Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains., Conclusion: There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth., (© 2023. The Author(s).)

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]

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]

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]

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]

Background: Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector., Methods: As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked., Results: A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls., Conclusion: Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed., Trial Registration: ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.

Background: Many psychosocial interventions are disseminated and supported by organizations, termed "Intermediary/Purveyor Organizations" (IPOs). Because IPOs remain largely unstudied, we lack understanding of their scale and the strategies they utilize. The role and function of organizations that link resource systems with user systems, such as IPOs, have been identified as an important but understudied issue in implementation science. The objectives of this paper are to describe features of IPOs that disseminate evidence-based interventions (EBIs) for child behavioral health and identify the strategies they use to support their implementation., Methods: The Substance Abuse and Mental Health Services (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) listed 119 unique IPOs for the 127 child behavioral health EBIs listed on its website. Data characterizing each organization were drawn from NREPP and GuideStar profiles. From 119 unique IPOs identified, we found contact information for 108. We sent an electronic survey to capture additional organizational information and implementation strategies the IPOs employed in spreading the EBIs; response rate was 50%. Data are presented descriptively and analyzed using ordinary least squares (OLS) regression and Latent Class Analysis (LCA)., Results: Virtually all identified EBIs had an IPO. IPOs train individuals, organizations, and communities and provide supervision for the use of EBIs. About 20% of IPOs trained at large scale, some training 500-1000+ providers annually. IPOs reported using an average of 32 distinct strategies to implement their EBIs, with most using educational, planning, and quality improvement strategies. However, there was little convergence around strategy helpfulness. The only significant predictor of number of strategies used by an IPO was the NREPP-posted implementation readiness score of the intervention. LCA revealed that IPOs either used several implementation strategies or used very few., Conclusions: Findings add significantly to knowledge about IPO structure, scale, and function. They use numerous and varying implementation strategies but report little consensus in what works. The study advances methods for measuring and characterizing real-world implementation by demonstrating the feasibility of using a common nomenclature, per a published compilation and of LCA for data reduction in characterizing profiles of implementation approaches.

Background: The Evidence-Based Practice (EBP) Project has been investigating the implementation of evidence-based mental health practices (Assertive Community Treatment, Family Psychoeducation, Integrated Dual Diagnosis Treatment, Illness Management and Recovery, and Supported Employment) in state public mental health systems in the United States since 2001. To date, Project findings have yielded valuable insights into implementation strategy characteristics and effectiveness. This paper reports results of an effort to identify and classify state-level implementation activities and strategies employed across the eight states participating in the Project. Methods: Content analysis and Greenhalgh et al's (2004) definition of innovation were used to identify and classify state-level activities employed during three phases of EBP implementation: Pre-Implementation, Initial Implementation and Sustainability Planning. Activities were coded from site visit reports created from documents and notes from key informant interviews conducted during two periods, Fall 2002 - Spring 2003, and Spring 2004. Frequency counts and rank-order analyses were used to examine patterns of implementation activities and strategies employed across the three phases of implementation. Results: One hundred and six discreet implementation activities and strategies were identified as innovative and were classified into five categories: 1) state infrastructure building and commitment, 2) stakeholder relationship building and communications, 3) financing, 4) continuous quality management, and 5) service delivery practices and training. Implementation activities from different categories were employed at different phases of implementation. Conclusion: Insights into effective strategies for implementing EBPs in mental health and other health sectors require qualitative and quantitative research that seeks to: a) empirically test the effects of tools and methods used to implement EBPs, and b) establish a stronger evidence-base from which to plan, implement and sustain such efforts. This paper offers a classification scheme and list of innovative implementation activities and strategies. The classification scheme offers potential value for future studies that seek to assess the effects of various implementation processes, and helps establish widely accepted standards and criteria that can be used to assess the value of innovative activities and strategies. [ABSTRACT FROM AUTHOR]

Background: Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth. Methods: Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers. Results: Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population. Conclusions: Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services. [ABSTRACT FROM AUTHOR]

This paper presents the results of a comparative study of interorganizational networks, or systems, of mental health delivery in four U.S. cities, leading to a preliminary theory of network effectiveness. Extensive data were collected from surveys, interviews, documents, and observations. Network effectiveness was assessed by collecting and aggregating data on outcomes from samples of clients, their families, and their case managers at each site. Results of analyses of both quantitative and qualitative data collected at the individual, organizational, and network levels of analysis showed that network effectiveness could be explained by various structural and contextual factors, specifically, network integration, external control, system stability, and environmental resource munificence. Based on the findings, we develop testable propositions to guide theory development and future research on network effectiveness. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented that focuses on health issues that affect women during the postpartum period and what clinical scientist and behavioral medicine clinicians might do to fix the problem.

Background: This study is a cost-effectiveness study of two implementation strategies designed to train therapists in college and university counseling centers to deliver interpersonal psychotherapy. Costs of implementing a train-the-trainer (TTT) strategy versus an expert consultation strategy were estimated, and their relative effects upon therapist outcomes were calculated and compared. Methods: Twenty four counseling centers were recruited across the United States. These centers were randomized to either a TTT (experimental) condition, in which an in-house therapist trained other center therapists, or an expert consultation condition, in which center therapists participated in a workshop and received 12 months of ongoing supervision. The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, assessed via audio recordings of therapy sessions, and analyzed using linear mixed models. Costs of each condition were quantified using time-driven activity-based costing methods, and involved a costing survey administered to center directors, follow up interviews and validation checks, and comparison of time tracking logs of trainers in the expert condition. Mean costs to produce one therapist were obtained for each condition. The costs to produce equivalent improvements in therapist-level outcomes were then compared between the two conditions. Results: Mean cost incurred by counseling centers to train one therapist using the TTT strategy was $3,407 (median = $3,077); mean cost to produce one trained therapist in the control condition was $2,055 (median = $1,932). Therapists in the TTT condition, on average, demonstrated a 0.043 higher adherence score compared to therapists in the control condition; however, this difference was not statistically significant. For the competence outcome, effect size for therapists in the TTT condition was in the large range (1.16; 95% CI: 0.85–1.46; p <.001), and therapists in this condition, on average, demonstrated a 0.073 higher competence score compared to those in the expert consultation condition (95% CI, 0.008–0.14; p =.03). Counseling centers that used the TTT model incurred $353 less in training costs to produce equivalent improvements in therapist competence. Conclusions: Despite its higher short run costs, the TTT implementation strategy produces greater increases in therapist competence when compared to expert consultation. Expanding resources to support this platform for service delivery can be an effective way to enhance the mental health care of young people seeking care in college and university counseling centers. Trial registration: ClinicalTrials.gov Identifier: NCT02079142. [ABSTRACT FROM AUTHOR]

Background: The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO)., Methods/design: In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model., Discussion: This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval for this study was granted in October 2011. The three sites were trained on MISSION-Vet and GTO in the first half of 2013. The first GTO planning meetings began after training occurred, between January 2013 and November 2013, across the three sites. The data collection-via a fidelity measure embedded into the VA Computerized Patient Record System-began as each site initiated MISSION-Vet, between April 2013 and January 2014., Trial Registration: ClinicalTrials.gov: NCT01430741.

Objective: This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP)., Methods: In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years., Results: On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days., Conclusions: This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

Nearly four decades ago, Unclaimed Children documented the gaps in the United States between mental health programs and caregivers' perspectives about those services for their children. This absence of attention to parent or caregiver perspectives, including their satisfaction with these services, was a key finding of the report, which detailed system failure in caring for youth with mental health needs. Since then, the focus on caregiver satisfaction with children's mental health services has been largely overlooked in research, and when examined has been mostly included as an indicator of the feasibility of program implementation. In striking contrast, overall healthcare system reforms have highlighted the importance of improving consumer's direct experience of care. However, caregiver satisfaction remains largely disconnected to these overall health system reforms, even as reforms focus increasingly on value-based, coordinated and integrated care. In this paper, we review literature from 2010 to 2020, revisit the measurement of caregiver satisfaction, identify how and when it is being measured, and delineate a research agenda to both realign it with health system improvements, refine its focus on expectancies and appropriateness, and root it more firmly in the principles of user experience (UX) and human-centered design (HCD). [ABSTRACT FROM AUTHOR]

This paper reports a study of the premedical student culture at a major university, based on fieldwork and interviews with 30 premedical students. The paper examines the role of stereotypes in the premedical culture; specifically, the common belief in "cut-throats" among premedical students. Cut-throats are described as excessively competitive, selfish, gradehungry students who cheat, steal books and lab reports, and sabotage lab experiments. Despite the widespread belief, our findings suggest cut-throats are a myth. We found more evidence for cooperative than cut-throat behavior. The myth emerges from the competitive and pressured situation of premedical students and the uncertainty of the medical school admission process, and is in part a manifestation of students' collective anxiety. More significantly, it provides cultural explanations for failure and success for premedical students. We discuss its connection to the general premedical stereotype and its relation to pre-medical education. [ABSTRACT FROM AUTHOR]

Background. Comprehensive programs that address the complex needs of survivors of human trafficking (HT) remain rare nationwide despite demonstrable remaining need. Non-profit clinics have proliferated to fill this gulf and provide care, services, and resources to this population. No existing research has explored success and challenges of such clinics. Objectives. To outline operational characteristics and provider experiences of several nonprofit medical clinics serving survivors of human trafficking (HT) that proliferated due to a lack of comprehensive integrated care serving this population. Methodology. We interviewed eight nonprofit medical clinics caring for survivors of HT across the U.S. Clinics were identified using a network sampling snowball approach. Semi-structured, conversational Zoom interviews were performed from May-August 2021 using SCORE analysis; subsequent thematic analysis established an interview codebook. Results. All clinics incorporated trauma-informed care and patient advocates, many offered primary care, and fewer offered partnerships with multidisciplinary services that provided mental health, pregnancy, or substance use treatments. Most clinics expressed challenges with funding, patient continuity due to mistrust or unstable circumstances, and patient identification due to legislative heterogeneity around HT. Conclusions. Nationwide efforts to standardize medical care for survivors of HT should learn from care models such as those demonstrated in this study. More healthcare systems with should provide comprehensive, integrated health care for trafficking survivors supported by line-item funding that sustains vital components such as patient advocates, mental health services, and substance use treatment support. [ABSTRACT FROM AUTHOR]

Medical professionals face high stress due to the type of work they do and the prolonged working hours. Frequent burnout results due to the challenging nature of their work. Added to the stress of work, malpractice lawsuits add to their burden. In India, most doctors work in compromised settings with poor infrastructure and manpower but are expected to follow the best practices. In court, they are judged with the Bolam and Bolitho tests being essential considerations. Several tragic incidents have been reported, including depression, anger issues, and even suicide deaths of healthcare professionals (HCPs) after accusations of negligence and subsequent inquiry. Such incidents demonstrate the multitude of challenges an HCP faces in day-to-day practice. It is crucial to find ways to tackle these problems and enhance the capacity of HCP to handle such demanding circumstances. Malpractice litigation can significantly impact the mental health of HCPs. It is common to experience emotional turmoil when faced with a lawsuit. Second victim syndrome (SVS) is a term used to describe a set of symptoms experienced by HCPs who make an error leading to injury to a patient. However, it also happens if he is traumatized by the consequences of violence during healthcare services or a lawsuit or defamation article in newspaper/social media. Following a litigation crisis in their career, many HCPs go through various stages of grief, including shock, denial, anger, bargaining, depression, and acceptance. At times, death by suicide of the HCPs is well known. SVS is known to profoundly affect the personal, family, economic, professional (defensive practice), and social life of HCPs. HCPs should accept the allegations of negligence as an occupational hazard and prepare for the eventual litigation at least once in a lifetime by knowing about the medical laws, HCP's rights, becoming aware of the emotional turmoil of the lawsuit, preparing to cope with the lawsuit, and seeking help from colleagues and indemnity insurance. Frequent training of the HCPs is strongly recommended to know about the changing laws and also to undergo periodic professional competence enhancement to reduce the incidents of errors amounting to medical negligence. Medical and hospital administration should debrief after any incident and conduct internal investigations to identify systemic flaws and prevent future recurrence, resolve issues within their control at their level, and manage media (mainstream and social media) appropriately. If established, a reporting system with online and offline services will ease the internal administrative investigation process and take appropriate, timely actions. During the crisis, HCPs should have adequate and appropriate insurance or indemnity coverage and mental health support systems. [ABSTRACT FROM AUTHOR]

Background: Institutional Graduate Medical Education (GME) Well-being Director (WBD) roles have recently emerged in the United States to support resident and fellow well-being. However, with a standard position description lacking, the current scope and responsibilities of such roles is unknown. This study describes the scope of work, salary support, and opportunities for role definition for those holding institutional leadership positions for GME well-being. Methods: In November 2021, 43 members of a national network of GME WBDs in the United States were invited to complete a cross-sectional survey that included questions about job responsibilities, percent effort, and dedicated budget, and a free text response question about unique leadership challenges for GME WBDs. The survey was analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data. Results: 26 members (60%) responded. Most were physicians, and the majority identified as female and White. Median percent effort salary support was 40%. A small minority reported overseeing an allocated budget. Most respondents worked to improve access to mental health services, oversaw institution-wide well-being programs, designed or delivered well-being content, provided consultations to individual programs, met with trainees, and partnered with diversity, equity, and inclusion (DEI) efforts. GME WBDs described unique challenges that had implications for perceived effectiveness related to resources, culture, institutional structure, and regulatory requirements in GME. Discussion: There was high concordance for several key responsibilities, which may represent a set of core priorities for this role. Other reported responsibilities may reflect institution-specific needs or opportunities for role definition. A wide scope of responsibilities, coupled with limited defined budgetary support described by many GME Well-being Directors, could limit effective role execution. Future efforts to better define the role, optimize organizational reporting structures and provide funding commensurate with the scope of work may allow the GME Well-being Director to more effectively develop and execute strategic interventions. [ABSTRACT FROM AUTHOR]

Over the past 30 years there have been numerous large-scale and longitudinal psychiatric research efforts to improve our understanding and treatment of mental health conditions. However, despite the huge effort by the research community and considerable funding, we still lack a causal understanding of most mental health disorders. Consequently, the majority of psychiatric diagnosis and treatment still operates at the level of symptomatic experience, rather than measuring or addressing root causes. This results in a trial-and-error approach that is a poor fit to underlying causality with poor clinical outcomes. Here we discuss how a research framework that originates from exploration of causal factors, rather than symptom groupings, applied to large scale multidimensional data can help address some of the current challenges facing mental health research and, in turn, clinical outcomes. Firstly, we describe some of the challenges and complexities underpinning the search for causal drivers of mental health conditions, focusing on current approaches to the assessment and diagnosis of psychiatric disorders, the many-to-many mappings between symptoms and causes, the search for biomarkers of heterogeneous symptom groups, and the multiple, dynamically interacting variables that influence our psychology. Secondly, we put forward a causal-orientated framework in the context of two large-scale datasets arising from the Adolescent Brain Cognitive Development (ABCD) study, the largest long-term study of brain development and child health in the United States, and the Global Mind Project which is the largest database in the world of mental health profiles along with life context information from 1.4 million people across the globe. Finally, we describe how analytical and machine learning approaches such as clustering and causal inference can be used on datasets such as these to help elucidate a more causal understanding of mental health conditions to enable diagnostic approaches and preventative solutions that tackle mental health challenges at their root cause. [ABSTRACT FROM AUTHOR]

The article reports on the two new titles from the series of overview papers released by the United States Substance Abuse and Mental Health Services Administration (SAMSHA). The papers discuss the treatment and proper understanding of co-occurring mental and substance use disorders. They aim to inform professionals and policy makers on what to do when they encounter a patient with the disorder. People with the type of disorder are said to be the ones who rarely receive substance abuse and mental health treatment.

Objective: Collaborative chronic care models (CCMs) were established with implementation support in nine mental health clinics. This study sought to determine whether their clinical impact was maintained after implementation support ceased.Methods: Posttrial data were analyzed from a randomized stepped-wedge CCM implementation trial in general mental health clinics in nine Department of Veterans Affairs medical centers. Sites received 1 year of implementation support, which was associated with reduced mental health hospitalization rates compared with non-CCM clinics in the same medical centers. Hospitalization rates for the year after implementation support were analyzed by using repeated measures logistic regression comparing the same clinics.Results: Hospitalization rates for the postsupport year did not differ from comparison clinics either in the population that initially showed the difference or the population active in the clinics at the end of the year of implementation support.Conclusions: Clinical effects of the CCM may wane after cessation of active implementation support. [ABSTRACT FROM AUTHOR]

Objective: This article reviews how mental health services can best prevent and treat HIV infection among women with serious mental illness. Methods: This is a selective narrative review of the recent literature on mental health services and HIV. The author used the terms "HIV," "serious mental illness," and "women" to search Google Scholar. Results: Out of 500 relevant papers retrieved, 82 were included, based on their state-of-the-art findings. Women with serious mental illness at risk of HIV were found to be an especially vulnerable group. The evidence suggests that discussion of the modes of viral transmission reduces the risk of infection in this population, as do psychoeducation; long-term antipsychotic medication; adherence therapy; community treatment orders; prevention of domestic violence and homelessness; disbursement of financial entitlements; provision of psychotherapy and social support; cognitive rehabilitation; promotion of abstinence, monogamy, or reduction in the number of sexual partners; access to and training in the use of condoms; prophylaxis with vaginal microbicides and oral antiretroviral drugs; prompt diagnosis and treatment of sexually transmitted diseases; across-the-board offers of HIV testing; and preservation and monitoring of reproductive health. For HIV-positive individuals, comprehensive treatment measures have included prompt HIV treatment; long-term retention in care; supervision of medication adherence and drug interactions; rapid management of substance use disorders and all other comorbidities as well as drug side effects; and preclusion of professional stigmatization. Conclusions: There is now sufficient evidence to recommend effective combinations of strategies to prevent and treat HIV within mental health services. [ABSTRACT FROM AUTHOR]

Background: Racial and ethnic disparities in the United States exist along the entire continuum of mental health care, from access and use of services to the quality and outcomes of care. Efforts to address these inequities in mental health care have focused on adapting evidence-based treatments to clients' diverse cultural backgrounds. Yet, like many evidence-based treatments, culturally adapted interventions remain largely unused in usual care settings. We propose that a viable avenue to address this critical question is to create a dialogue between the fields of implementation science and cultural adaptation. In this paper, we discuss how integrating these two fields can make significant contributions to reducing racial and ethnic disparities in mental health care., Discussion: The use of cultural adaptation models in implementation science can deepen the explicit attention to culture, particularly at the client and provider levels, in implementation studies making evidence-based treatments more responsive to the needs and preferences of diverse populations. The integration of both fields can help clarify and specify what to adapt in order to achieve optimal balance between adaptation and fidelity, and address important implementation outcomes (e.g., acceptability, appropriateness). A dialogue between both fields can help clarify the knowledge, skills and roles of who should facilitate the process of implementation, particularly when cultural adaptations are needed. The ecological perspective of implementation science provides an expanded lens to examine how contextual factors impact how treatments (adapted or not) are ultimately used and sustained in usual care settings. Integrating both fields can also help specify when in the implementation process adaptations may be considered in order to enhance the adoption and sustainability of evidence-based treatments., Summary: Implementation science and cultural adaptation bring valuable insights and methods to how and to what extent treatments and/or context should be customized to enhance the implementation of evidence-based treatments across settings and populations. Developing a two-way street between these two fields can provide a better avenue for moving the best available treatments into practice and for helping to reduce racial and ethnic disparities in mental health care.

This paper provides an overview of the rapidly evolving paradigm of "Integrative Mental Health (IMH)." The paradigm of contemporary biomedical psychiatry and its contrast to non-allopathic systems of medicine is initially reviewed, followed by an exploration of the emerging paradigm of IMH, which aims to reconcile the bio-psycho-socio-spiritual model with evidence-based methods from traditional healing practices. IMH is rapidly transforming conventional understandings of mental illness and has significant positive implications for the day-to-day practice of mental health care. IMH incorporates mainstream interventions such as pharmacologic treatments, psychotherapy, and psychosocial interventions, as well as alternative therapies such as acupuncture, herbal and nutritional medicine, dietary modification, meditation, etc. Two recent international conferences in Europe and the United States show that interest in integrative mental health care is growing rapidly. In response, the International Network of Integrative Mental Health (INIMH: www.INIMH.org) was established in 2010 with the objective of creating an international network of clinicians, researchers, and public health advocates to advance a global agenda for research, education, and clinical practice of evidence-based integrative mental health care. The paper concludes with a discussion of emerging opportunities for research in IMH, and an exploration of potential clinical applications of integrative mental health care., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Introduction: The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used. Methods: To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review. Results: Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail. Discussion: Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals. [ABSTRACT FROM AUTHOR]

Background: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials' samples consisted of predominantly non-Hispanic, White individuals. Objective: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. Methods: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. Results: Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). Conclusions: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention. [ABSTRACT FROM AUTHOR]

Background: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using Χ2 tests. We analyzed interview data using thematic analysis. Results: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA's Collect-Share-Act model of MBC. [ABSTRACT FROM AUTHOR]

This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models. [ABSTRACT FROM AUTHOR]

The U.S. Department of Veterans Affairs (VA) has been undergoing tremendous transformation in the past 15 years with regard to the delivery of health care. This special issue describes one aspect of this transformation of the largest health system in the U.S.; the system-wide efforts to integrate mental health treatment into the primary care setting in VA. This primary care-mental health integration (PC-MHI) is being accomplished through the central VA system support and implementation of three primary models developed in the field: the White River Colocated models, the Behavioral Health Laboratory, and TIDES (Translating Initiatives in Depression into Effective Solutions). The papers in this special issue describe the development of these models, local and regional efforts to prepare medical centers to adapt and implement PC-MHI, and the impact of the integration on mental health care in these settings. These efforts could represent a national model of PC-MHI implementation for health care systems throughout the U.S., (PsycINFO Database Record (c) 2010 APA, all rights reserved.)

The Veterans Health Affairs is in the process of implementing a new model for the delivery of primary care: The Patient-Centered Medical Home (PCMH). One critical challenge of any PCMH model will be the integration of basic mental health treatment into primary care. Such a mental health integration program must be flexible enough to incorporate new evidence-based treatments as patient demographics and health care needs evolve over time. This paper summarizes the Behavioral Health Laboratory (BHL) care management model, a program already in place in more than 20 Veterans Affairs facilities along with private sector insurance providers, as ideally suited to fill this role in the PCMH. The BHL uses a platform of standardized, software-aided mental health assessments and clinical care managers to deliver evidence-based treatments for depression, anxiety, and substance abuse in primary care settings. The authors review this comprehensive program of screening, assessment, treatment, and referral to specialty care when needed. The BHL program is consistent with the guiding principles of the Patient-Centered Medical Home: applying chronic illness disease management principles to provide more continuous, coordinated, and efficient primary care services to patients with diverse needs. Just as importantly, the authors review how this standardized platform for delivering integrated mental health services provides the flexibility to incorporate novel interventions for a changing population., (PsycINFO Database Record (c) 2010 APA, all rights reserved.)

Forensic psychiatrists serve as expert witnesses in litigation involving the impact of conditions of confinement, including mental health care delivery, on the emotional well-being of institutionalized persons. Experts review volumes of data before formulating opinions and preparing reports. The author has developed PRAMS, a method for systematically reviewing and presenting data during mental health litigation involving detention and corrections facilities. The PRAMS method divides the examination process into five stages: paper review, real-world view, aggravating circumstances, mitigating circumstances, and supplemental information. PRAMS provides the scaffolding on which a compelling picture of an institution's system of care may be constructed and disseminated in reports and during courtroom testimony. Also, PRAMS enhances the organization, analysis, publication, and presentation of salient findings, thereby coordinating the forensic psychiatrist's efforts to provide expert opinions regarding complex systems of mental health care.

Youth crime is a serious social problem, as is the high proportion of young offenders in the juvenile justice system who have mental disorders. A recent policy innovation applies the theory of therapeutic jurisprudence and diverts youth with mental disorders to treatment in lieu of further court processing. The expansion of mental health diversion programs reflects an increasingly popular view that there is a causal relationship between youth mental disorders and crime. Policymakers who share this view place greater emphasis on rehabilitation and treatment as a way to reduce crime, rather than on stricter punishment. This paper considers the policy issues around youth mental health diversion programs. In addition, it evaluates the effect of a mental health diversion program for youth that was implemented in Texas. The paper finds that mental health diversion can be used effectively to delay or prevent youth recidivism.

Objective: In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care., Data Sources: Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use., Study Design: Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities., Principal Findings: Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach., Conclusions: A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

Today's researchers are obligated to conduct their studies ethically. However, it often seems a daunting task to become familiar with the important ethical codes required to do so. The purpose of this article is to examine the content of those ethical documents most relevant to the biomedical researcher. Documents examined include the Nuremberg Code, the Declaration of Helsinki, Henry Beecher's landmark paper, the Belmont Report, the U.S. Common Rule, the Guideline for Good Clinical Practice, and the National Bioethics Advisory Commission's report on research protections for the mentally ill.

This paper is based on a report commissioned by the Subcommittee on Mental Health Interface With General Medicine of the Presidents New Freedom Commission on Mental Health. Although mental and medical conditions are highly interconnected, medical and mental health care systems are separated in many ways that inhibit effective care. Treatable mental or medical illnesses are often not detected or diagnosed properly, and effective services are often not provided. Improved mental health care at the interface of general medicine and mental health requires educated consumers and providers; effective detection, diagnosis, and monitoring of common mental disorders; valid performance criteria for care at the interface of general medicine and mental health; care management protocols that match treatment intensity to clinical outcomes; effective specialty mental health support for general medical providers; and financing mechanisms for evidence-based models of care. Successful models exist for improving the collaboration between medical and mental health providers. Recommendations are presented for achieving high-quality care for common mental disorders at the interface of general medicine and mental health and for overcoming barriers and facilitating use of evidence-based quality improvement models.

Background: Willingness to pay is a valuation technique that has rarely been applied in mental health economics. First used in environmental economics to measure the intangible value of environmental improvements, WTP has increasingly been used in health care economics. The technique may be useful in mental health policy research where it can be critical to include the intangible impact of mental health treatment on individuals other than the person with illness, such as family members, in cost-benefit analyses., Aims of the Study: The goal of the study was to test the application of WTP in a sample of individuals who have family members with serious mental illness. This paper describes the survey development process and the feasibility analysis that was conducted as part of the study., Methods: A mail survey was designed by the author in two phases and utilized cognitive pretests and focus group pretests in the process of development. Qualitative analysis of this process resulted in a revised survey instrument that was then distributed to a random sample of 2000 individuals who have family members with mental illness. Feasibility was evaluated based upon the study response rate, the willingness to pay item response rate and an outlier response analysis., Results: Qualitative analysis during the survey development process found that it was critical to consider two areas of concern in the application of WTP with this population in the mental health field. Some respondents experienced a highly emotional response to the initial versions of the survey, and complex probabilities were difficult for the respondents to answer. These findings resulted in significant modifications in the survey design. The analysis of response rate, WTP item non-response rate, and outlier responses found no significant concerns regarding overall feasibility of WTP with this population., Discussion: Based upon the results from this study, WTP is a potentially useful tool for further research in the mental health policy and economics field. However, significant accommodations must be made in survey design to account for a possibility of a high level of emotional distress for those dealing with the illness of a family member. Some of these modifications may be in contrast to the recommendations currently being followed in health care economics. Face-to-face surveys may be preferred in some cases, such as with elderly respondents. Limitations of this study include the lack of targeted follow-up due to the anonymous study design and the fact that there are so few models for WTP studies in mental health. IMPLICATIONS FOR MENTAL HEALTH POLICY: Given that effective mental health programs can be matched with additional expenditures, it is important to explore comprehensive measures of value for treatment in cost-benefit analysis. The values of persons whose family members have serious mental illness are important to consider in setting policy. The success of this study suggests that WTP could be used in other settings, e.g., to understand community preferences for mental health treatment programs, to understand differences in preferences across multiple stakeholder groups.

Background: Several studies postulate that psychological conditions may contribute to the link between low relative income and poor health, but no one has directly tested the relationship between relative deprivation and mental health disorders. In this paper, we investigate whether low income relative to a reference group is associated with a higher probability of depressive disorders or anxiety disorders. Reference groups are defined using groups of individuals with similar demographic and geographic characteristics. We hypothesize that perceptions of low social status relative to one's reference group might lead to worse health outcomes., Aims: We attempt to determine whether an individual's income status relative to a reference group affects mental health outcomes. Our contributions to the literature include (i) defining reference groups using demographic characteristics in addition to geographic area, (ii) looking at an individual's relative income status rather than low income or aggregate-level income inequality, and (iii) focusing specifically on mental-health related outcomes., Methods: Our primary data source is the national household survey component of HealthCare for Communities (HCC), funded by the Robert Wood Johnson Foundation to track the effects of the changing health care system on individuals at risk for alcohol, drug abuse, or mental health disorders. HCC is a complement to the Community Tracking Survey (CTS) and reinterviews participants of the main study. To construct relative deprivation measures, we used data from the 5% Public Use Micro Data Sample of the 2000 Census. Our measure of relative deprivation is defined using Yitzhaki's index, a term that measures the expected income difference between an individual and others in his or her reference group that are more affluent. We evaluate the relationship between relative deprivation and mental health using conditional logit models with reference group random effects., Results: Even after controlling for an individual's absolute income status, those with low relative income are at higher risk of experiencing a mental health disorder. Our findings hold for both depressive disorders and anxiety/panic disorders., Discussion and Limitations: Our findings suggest that relative deprivation is associated with an increased likelihood of probable depression and anxiety or panic disorders. Simulations suggest that a 25 percent decrease in relative deprivation could decrease the probability of any likely mental health disorder by as much as 9.5 percent. Limitations of this study include the fact that we only have one measure of relative deprivation, and that reference groups are defined using relatively large geographic areas., Implications for Health Policy: Low relative income may contribute to socioeconomic disparities in mental health. Efforts to eradicate socioeconomic differentials should take into account psychological perceptions and self-esteem in addition to absolute material resources., Implications for Future Research: Future work should explore whether mental health disorders explain the link between relative deprivation and poor physical health.

Background: Schizophrenia is a costly and complicated disorder to treat. A variety of schizophrenia treatment guidelines have been developed to provide valuable expert advice to practicing psychiatrists on various treatment options that are presumed to result in the best outcomes. However, examination of antipsychotic medication use patterns has suggested that current prescribing practices do not mirror recommended treatment guidelines and may have adverse economic consequences., Aim of the Study: This study seeks to describe antipsychotic medication treatment patterns and estimate the total costs of care associated with treatment patterns for individuals diagnosed with schizophrenia in usual care settings., Methods: Use of outpatient antipsychotic medications and other health services during 1997 was obtained for 2,082 individuals with a diagnosis of schizophrenia in the IMS Health LifeLink employer claims database. We describe outpatient antipsychotic treatment patterns, estimated the costs of schizophrenia care by treatment pattern, and compared costs by treatment pattern using regression models., Results: During 1997, 26% (n=536) of individuals diagnosed with schizophrenia received no antipsychotic medication in the outpatient setting, while 52% (n=1,088) were treated with only one antipsychotic (Monotherapy). For individuals who received more than one antipsychotic medication during 1997 (n=458), 13% (n=262) switched antipsychotic medications (Switch), 7% (n=154) augmented their original antipsychotic therapy with an additional antipsychotic (Augment), and 2% (n=42) of individuals were on more than one antipsychotic therapy at the start of the year. After adjusting for covariates, Switch and Augment patterns were associated with significant increases in total costs (an increase of 4,706 dollars (p<0.0001) and 4,244 dollars (p=0.0002), respectively) relative to Monotherapy., Discussion: These results indicate that a substantial proportion of individuals with a diagnosis of schizophrenia were not treated with or had low exposure to antipsychotic therapy. Individuals treated with antipsychotic monotherapy experienced nearly half the annual costs as individuals who were treated with antipsychotic polytherapy or who switched antipsychotic medications. These observations should be interpreted in the context of the study limitations., Implications for Health Care Provision and Use: This analysis indicates that there may be considerable room for improvement in the treatment for individuals diagnosed with schizophrenia., Implications for Health Policies: Though schizophrenia affects a very small portion of the population, the individual and societal burden associated with the disorder is quite high. This paper suggests that antipsychotic monotherapy and continuous therapy, commonly recommended by published treatment guidelines, may be associated with economic savings., Implications for Further Research: Future research should evaluate the impact of newer antipsychotic medications on patterns of care and economic outcomes. More information is also needed on which individual patient characteristics are likely to predict success or failure on specific treatments. Finally, more detailed information on the reasons or rationale for switching or augmenting original pharmacotherapy would be valuable in improving medication management in these complex and often difficult to treat patients.

Background: Alcohol consumption has been identified as one of the most important risk factors for youth suicide. Previous research has shown a strong, empirical link between alcohol use and suicide. If alcohol use is a contributing factor in determining suicidal behaviors, then policies designed to reduce the alcohol consumption may succeed in reducing youth suicides as well., Aims of the Study: This paper looks at the role of alcohol-related policies in reducing completed suicides by American youths and young adults. This hypothesis comes from two well established relationships: i) the observed correlation between alcohol consumption and incidents of suicide, and ii) the negative relationship between the full price of alcohol and consumption. The alcohol policies examined are excise taxes on beer, measures of alcohol availability, and drunk driving laws., Methods: Data on completed suicides for each state in the United States are analyzed for the period 1976-1999. Negative binomial regressions are used to estimate a reduced form model of youth suicide. Suicides are analyzed by gender and age groups (ages 10-14, 15-19 and 20-24)., Results: The results indicate that increases in the excise tax on beer are associated with a reduced number of male suicides. This tax, however, has no impact on female suicides. Suicides by males ages 20-24 are positively related to the availability of alcohol, and negatively related to the presence of a 0.08 BAC (blood alcohol concentration) law and a zero tolerance law for drunk driving. Female suicides are not impacted by the availability of alcohol, although the drunk driving laws may impact suicides by teenage females., Implications for Health Policies: Policies designed to reduce alcohol consumption may have the unintended benefit of reducing suicides, particularly among young males., Implications for Further Research: While this research shows that alcohol policies may be successful in reducing male suicides, such policies have little impact on female suicides. Future research should explore other potential types of policies and programs to reduce female suicides. Also, illegal drug use has been linked to suicides in a similar manner as alcohol consumption. Future research should consider the role of illegal drug consumption and related policies in determining youth suicides.

The article discusses the steady increase of U.S. suicide rates since 2000 as of 2024. Topics covered include the multifactorial and complicated reasons like suicide method behind them, understanding such suicide causes as trauma, isolation and loneliness, and solutions like telepsychiatry and screening to address the increase of rates. Also noted is the importance of acknowledging how a patient's suicide affects the clinician.

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Little is known about ex-serving military personnel who access secondary mental health care. This narrative review focuses on studies that quantitatively measure secondary mental health care utilisation in ex-serving personnel from the United States. The review aimed to identify rates of mental health care utilisation, as well as the factors associated with it. The electronic bibliographic databases OVID Medline, PsycInfo, PsycArticles, and Embase were searched for studies published between January 2001 and September 2018. Papers were retained if they included ex-serving personnel, where the majority of the sample had deployed to the recent conflicts in Iraq or Afghanistan. Fifteen studies were included. Modest rates of secondary mental health care utilisation were found in former military members—for mean percentage prevalence rates, values ranged from 12.5% for at least one psychiatric inpatient episode, to 63.2% for at least one outpatient mental health appointment. Individuals engaged in outpatient care visits most often, most likely because these appointments are the most commonly offered source of support. Post-traumatic stress disorder, particularly re-experiencing symptoms, and comorbid mental health problems were most consistently associated with higher mental health care utilisation. Easily accessible interventions aimed at facilitating higher rates of help seeking in ex-serving personnel are recommended. [ABSTRACT FROM AUTHOR]