Promoting mental health through multidisciplinary care: service users' experience in Ireland

Irish mental health policy identifies that mental health services should be provided in local communities by community mental health teams where several health professionals play a key role. In Ireland, recent reports indicate that the number of fully staffed multidisciplinary teams is low with potential negative consequences for the breadth and quality of care provided to service users. Limited research has been conducted from the perspective of service users. This research sought to examine service users' experiences of receiving multidisciplinary care in the community. Ten community mental health services nationally were surveyed comprising a sample of 97 service users. The results indicated that participants did not have access to the multidisciplinarity advocated in European policy and there was overreliance on the medical model of treatment. Furthermore, the results indicated that participants had little involvement in making decisions about their treatment care.     

Qualitative analysis of key informant interviews about adolescent stigma surrounding use of school mental health services

Given the increased access to mental health services that schools provide, there has been a growing consensus among mental health professionals for the delivery of services for youth in schools. Building the capacity of schools to provide evidence-based socio-emotional supports across a continuum of care has been prioritized in recent decades. However, despite policy changes to implement more mental health services in schools, these services still remain widely underutilized by adolescents experiencing mental health problems. Understanding the factors impacting students’ decisions to seek help or use resources provided in a school setting is crucial for actually increasing utilization of care. Yet, little is known about the role of stigma in students’ underutilization of school mental health services. The current study examined stigma about mental health and services in schools through a qualitative analysis of 15 school personnel and student interviews at three high schools in South Carolina. Thematic analysis of interviews indicated that students have a negative outlook of mental health services because of fear of being stereotyped or embarrassed as a result of receiving school counseling. Data from this exploratory study directly contribute to the field of education by providing a model for professionals to implement strategies to eliminate the stigma that causes underutilization of school mental health services.     

Coordinating mental health care across primary care and schools: ADHD as a case example

Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between health care and educational professionals, role restrictions among professionals, and privacy laws. Strategies for overcoming these barriers, which can be applied in both primary care and school settings, are described in this paper. This paper has a primary focus on children with attention-deficit/hyperactivity disorder, but the principles and strategies described are applicable to children with a range of mental health and health conditions.     

Culturally competent health care for sex workers: an examination of myths that stigmatize sex work and hinder access to care

Abstract

Sex workers are individuals who offer sexual services in exchange for compensation (i.e. money, goods, or other services). Within the United States, the full-service sex work (FSSW) industry generates 14 billion dollars annually there are estimated to be 1–2 million FSSWers, though experts believe this number to be an underestimate. Many FSSWers face the possibility of violence, legal involvement, and social stigmatization. As a result, this population experiences increased risk for mental health disorders. Given these risks and vulnerabilities, FSSWers stand to benefit from receiving mental health care however a constellation of individual, organizational, and systemic barriers limit care utilization. Destigmatization of FSSW and offering of culturally competent mental health care can help empower this traditionally marginalized population. The objective of the current review is to (1) educate clinicians on sex work and describe the unique struggles faced by FSSW and vulnerability factors clinicians must consider, (2) address five common myths about FSSW that perpetuate stigma, and (3) advance a research and culturally competent clinical training agenda that can optimize mental health care engagement and utilization within the sex work community.     

Transitioning from child and adolescent mental health services with attention‐deficit hyperactivity disorder in Ireland: Case note review

In a context of international concern about early adult mental health service provision, this study identifies characteristics and service outcomes of young people with attention‐deficit hyperactivity disorder (ADHD) reaching the child and adolescent mental health service (CAMHS) transition boundary (TB) in Ireland. The iTRACK study invited all 60 CAMHS teams in Ireland to participate; 8 teams retrospectively identified clinical case files for 62 eligible young people reaching the CAMHS TB in all 4 Health Service Executive Regions. A secondary case note analysis identified characteristics, co‐morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). Two‐thirds of young people with ADHD were on psychotropic medication and half had mental health co‐morbidities, yet none was directly transferred to public adult mental health services (AMHS) at the TB. Nearly half were retained in CAMHS, for an average of over a year; most either disengaged from services (40%) and/or actively refused transfer to AMHS (35%) at or after the TB. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. Despite high rates of medication use and co‐morbid mental health difficulties, there appears to be a complete absence of referral to publicly available AMHS for ADHD youth transitioning from CAMHS in Ireland. More understanding of obstacles and optimum service configuration is essential to ensure that care is both available and accessible to young people with ADHD.     

Norms for mental health services in South Africa

Background In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy. Methods A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level). Results The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care. Conclusions The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.     

Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries

Purpose

While there has been systematic research on the experiences of immigrant patients in mental health services within certain European countries, little research has explored the experiences of mental health professionals in the delivery of services to immigrants across Europe. This study sought to explore professionals’ experiences of delivering care to immigrants in districts densely populated with immigrants across Europe.

Methods

Forty-eight semi-structured interviews were conducted with mental health care professionals working in 16 European countries. Professionals in each country were recruited from three areas with the highest proportion of immigrants. For the purpose of this study, immigrants were defined as first-generation immigrants born outside the country of current residence, including regular immigrants, irregular immigrants, asylum seekers, refugees and victims of human trafficking. Interviews were transcribed and analysed using thematic analysis.

Results

The interviews highlighted specific challenges to treating immigrants in mental health services across all 16 countries including complications with diagnosis, difficulty in developing trust and increased risk of marginalisation.

Conclusions

Although mental health service delivery varies between and within European countries, consistent challenges exist in the experiences of mental health professionals delivering services in communities with high proportions of immigrants. Improvements to practice should include training in reaching appropriate diagnoses, a focus on building trusting relationships and measures to counter marginalisation.     

Inner-City Child Mental Health Service Use: The Real Question Is Why Youth and Families Do Not Use Services

OBJECTIVE: This study examines pathways to urban child mental health care as well as explores reasons why care was not received. METHODS: A single group longitudinal design was used to study initial attendance rates at an outpatient child mental health clinic and identify factors associated with initial service use for urban children and their families. RESULTS: Approximately one-third of families (n = 82) do not follow up with care despite their child being referred and an initial appointment scheduled. Yet, three-quarters of those who did not attend a first session still wanted services when interviewed. Factors most significantly related to service use were social support and parental skill efficacy. Miscommunication between adult caregiver and provider was the most often cited reason for non-attendance. CONCLUSIONS: There is a significant unmet need for care along with identification of significant barriers to access. Empirical findings can serve as the basis for modifying urban child mental health service delivery systems.     

Change in Mental Health Service Delivery Among Blacks, Whites, and Hispanics in the Department of Veterans Affairs

The authors analyzed changes in access to and use of mental health services by minorities in the Veterans Health Administration during a period of major system change (1995–2001). Blacks had poorer outpatient access than Whites during this period of change, but were not further disadvantaged over time, and their access to care improved relative to Whites on some measures. For Hispanics, there was a trend toward greater inequality in the delivery of outpatient mental health care. These results suggest a need to monitor and address the differential impact on minorities of changes in mental health service delivery.     

Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation

Background Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London. Method A two‐round Delphi process was utilised. White British and Black or Black British service users from a specialist community‐based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale. Results Twenty‐four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication. Conclusions People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.     

Health professionals' attitudes and emotions towards working with adults with intellectual disability (ID) and mental ill health

Objectives Mainstream mental health services are providing more care for individuals with an intellectual disability (ID); this has implications for staff and service users. Attitudes of staff towards people with ID in mental health services may be negative and negative staff attitudes may have a detrimental impact on service provision. Design A cross‐sectional design was used. Methods A questionnaire designed to investigate the attitudes and emotions of staff towards delivering mental health care to adults with ID was completed by 84 staff from mainstream and specialist ID services. Results Staff in both services experienced more positive emotions when working with clients whom they are currently employed to work with. When the frequency of contact with adults with ID, the number of individuals worked with and the amount of formal ID training received were considered, there was no significant difference between the attitudes of staff in both services. Positive correlations were found between attitude scores and positive emotional experiences in both services. Conclusions The research suggests that numerous factors, including the role of emotional experience and a number of environmental aspects, need to be considered in the context of providing mental health services to adults with ID to ensure the highest quality. Research limitations and clinical implications of the study are also considered.     

Shame and acute psychiatric inpatient care: healthcare professionals

This qualitative research study convened focus groups to learn about situations that might provoke shame in people receiving mental health services and mental health professionals alike. The focus groups convened for mental health professionals were made up of psychiatrists, social workers, occupational therapists and mental health nurses – six men and eight women in total. Age ranges spanned from early 20 to 55; all had different lengths of service and experience. Ten people with experience of using mental health services also volunteered to take part in the focus groups – five men and five women with an age range of 30–63 years. Varied clinical diagnoses included schizophrenia, bipolar affective disorder, depression and personality disorder. Internationally, there are concerns for the quality of treatment and care offered to people with mental health problems and requiring hospital admission. There is also evidence to suggest that healthcare professionals can experience stigma and shame because of the complexities of their work. Information gained from the focus groups suggests that a better understanding of difficulties encountered by people in need of mental health services is possible. The study also permitted glimpses of the problems and distress faced by mental healthcare professionals because of moral dilemmas and challenges concerned with the overall nature of their chosen work. Although moderate in scope, this research study might help inform health and social policy research agendas along with professional education and training programmes. An awareness of the complexities in relation to ways in which shame is aroused in individuals and groups of people could contribute to improving the quality of care provided to communities.     

Consumer and Family Views on Evidence-Based Practices and Adult Mental Health Services

Evidence-based practice (EBP) is an important construct in mental health services. Though much has been written about them, there is little in the literature that fully explores consumers’ and family members’ views regarding EBPs. Using a focus group methodology, this study asked the question “What are consumers’ and family member’s views of EBPs within the larger context of their mental health service needs and their experiences with the mental health service system?” Results indicate that consumers and families have limited knowledge of EBPs, are generally supportive of EBPs, but have questions and concerns that are grounded in systemic and contextual considerations.     

Child Mental Health is Everybody's Business: The Prevalence of Contact with Public Sector Services by Type of Disorder Among British School Children in a Three-Year Period

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed-up over 3 years. Parents provided summary information on service contacts in relation to mental health; selected subgroups provided more detailed information by telephone interview.
Results:  Common overlaps in service use were between health services, between teachers and educational specialists, and between the latter and CAMHS or social services. Services other than primary health care saw more children with externalising disorders, while children with anxiety disorders were less likely than children with other psychiatric disorders to be in contact with any service.
Conclusions:  Child mental health is everybody's business, and professionals need to be alert(ed) to the types of disorders that children using their service may have.     

Does neuroticism explain variations in care service use for mental health problems in the general population?

AbstractBackground Little is known about the role of personality characteristics in service utilisation for mental health problems. We investigate whether neuroticism: 1) predicts the use of primary and specialised care services for mental health problems, independently of whether a person has an emotional disorder; and 2) modifies any association between emotional disorder and service use.Methods Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) a prospective cohort study in the general population aged 18–64. Neuroticism was recorded at baseline, and emotional disorder and service use at 12-month follow-up, in a representative sample (N=7076), using the Composite International Diagnostic Interview.Results People with high neuroticism were more likely to receive care in the specialised mental health sector, and after entry to care they made more visits to the services, whether or not they had an emotional disorder. If they had an emotional disorder, their likelihood of receiving specialised mental health care showed an additional increase. Neuroticism also predicted the use of primary care for mental health problems, but greater numbers of visits were made only by clients with both high neuroticism and an emotional disorder.Conclusions It would be useful to incorporate personality characteristics into models to understand variations in service utilisation for mental health problems. The findings suggest that professionals would be wise to focus not just on their clients’ emotional problems and disorders, but also on strengthening their problem-solving abilities through approaches like cognitive behavioural therapy.     

Building mental health promotion capacity in health care: results from Phase I of a workforce development project

The development of mental-health-promoting health care systems is dependent on having a skilled and informed workforce to effectively integrate mental health promotion (MHP) into programme and service delivery. This paper describes Phase I (September 2009-July 2010) of Health Compass, an innovative, multi-phased project that aims to transform health care practice and shift organizational culture by enhancing the capacity of health care providers to further promote patient, client and family mental well-being. Phase I of Health Compass examined the current state of MHP within British Columbia's Provincial Health Service Authority health care services. The findings, based on group discussions and key informant interviews, examined health care providers' current understanding and knowledge of MHP; identified existing strategies, facilitators and barriers that help or hinder the incorporation of MHP into health care practice and services; and identified preferred learning modalities for development and piloting of future MHP resources in Phases II and III.     

Service Priority and Standard Performance of Community Mental Health Centers in South Korea: A Delphi Approach

Objective

The role of community mental health centers (CMHCs) in Korea is quite different than that of these centers in Western countries due to nation-specific health care system characteristics. For example, CMHCs of Korea are expected to provide services for serious mental illness in addition to other services in response to community needs, such as internet addiction of adolescents. Consequently, it is important to determine service priorities of CMHCs and to define standard service performances in order to maximize their effectiveness with limited resources. The present study aimed to generate expert consensus on service priorities and to identify standard service performances of CMHCs in South Korea.

Methods

Forty-five mental health professionals participated as experts in a Delphi survey. We made a survey questionnaire based on Korean and international data and guidelines of some countries such as the UK and Australia. Experts answered the first and second round questionnaires and their answers were analyzed using frequency analysis.

Results

For the question about future directions of CMHCs, twenty-two experts (49%) answered that the growth of services for serious mental illness should be preferred to other areas. The service for chronic mental illness was thought to be the most important service area (27.1%) and, early psychosis (10.5%) is included, the services for serious mental illness should be regarded as the most important service area of Korean CMHCs. It is followed by child and adolescent services (13.2%) and mental health promotion services (10.8%). The relative importance of service performances on each service domain were given by answers of experts.

Conclusion

CMHCs in Korea should focus their priority on the management of serious mental illness. Service standardization by the relative importance of service performances on each service domain is needed.     

Making progress in mental health policy in conservative times: one step at a time

Progress in mental health services has been made incrementally in a sequence of policy steps. In recent years, in spite of political conservatism, progressive changes have advanced new principles of service delivery. Reports from the surgeon general and the President's New Freedom Commission on Mental Health advanced these principles, including recovery and evidence-based practices. Both of these high-level reports were influenced by the findings of the Schizophrenia Patient Outcomes Research Team (PORT). The Schizophrenia PORT established the effectiveness of mental health treatments and supports, which provided a scientific foundation for the optimistic focus on recovery and its expectation of improved outcomes for individuals with severe mental disorders. The PORT study also established the gap between treatment recommendations and actual services. Concern about this gap has motivated efforts to transform services by implementing evidence-based practices. Advances in broad mental health and social policy, coupled with continued advances in science, have the potential to improve the care of individuals who experience severe mental disorders, such as schizophrenia.     

The prediction of mental health service use in residential care

The purpose of this study was to characterize the clinical and psychosocial factors of residents living in psychiatric nursing homes, assess residents' levels of mental health service utilization, and examine the factors that predict the utilization of mental health services. Data were collected from 200 randomly selected residents with schizophrenia living in four intermediate care facilities. Fewer than 60% of residents received mental health services beyond medication and nearly one-half of the residents were readmitted to the hospital in the course of a year. Family contact and involvement in activities were associated with mental health service utilization. Hospital readmission was predicted, not by substance use, but rather by not using substances. There is a growing need among service providers to better identify relevant factors that are important in treatment planning and service delivery. Attention to these issues may impact treatment provision and outcomes for persons with schizophrenia and their families.     

Assessing mental health services in a rural setting: Service providers’ perspective

Addressing the inadequate and poor provision of mental health services in rural areas is a world-wide challenge. Most people with mental illness in these areas do not have access to mental health services. Using eight attributes of good mental health service as criteria, the purpose of this study was to assess mental health services at Mashashane, a rural area in the Limpopo Province, South Africa. A survey was conducted with a purposively selected sample of health care professionals from four health establishments serving Mashashane. Data was collected using a questionnaire with closed and open-ended questions. Quantitative and qualitative data analyses were used. The results show that out of eight attributes assessed only comprehensiveness was positively perceived. This is an indication of the inadequacy of mental health services, hence their inability to improve the well-being of people with mental illness and their families. Lack of resources was identified as the major hindrance to the delivery of appropriate mental health services. The findings highlighted aspects that contributed to the development of a framework for a community-based program to improve the well-being of people with mental illness and their families in a rural setting.