Are mental health services for children distributed according to needs?

OBJECTIVES: The purpose of this study was twofold: 1) to determine whether publicly funded mental health services and resources available in 4 large regions in the province of Quebec were distributed according to the mental health needs of children aged 6 to 14 years and 2) to assess whether the variations in mental health services and resources across the 4 regions had changed over a 5-year period. METHODS: Indicators of need according to the child's parent (presence of mental disorder, measure of adaptation, and perception of need for help) from an epidemiologic survey of 2400 noninstitutionalized children were compared with both in-school and community professional resources and with physician and hospital services in 1992-1993. Resource and service data were also collected for 1997-1998. Resource and service data came from professional colleges and government administrative databases. RESULTS: No significant regional differences were found for need indicators, but there were large discrepancies in mental health resources and services in 1992-1993. Differences in professional resources were largest for special education teachers in the school system and for psychiatrists in the community. The regional differences in resources and services were as large in 1997-1998 as they were in 1992-1993. CONCLUSIONS: Despite universal health care in Quebec and a government mental health policy stressing equity of access, the available mental health resources for children aged 6 to 14 years are not distributed across regions according to needs. More evidence-based planning is required, specifically using epidemiologic survey data, to match resources to needs and to monitor changes over time.     

Searching for new directions in mental health services...for new times

The mental health system as we know it today is essentially a linear extension of the system in place thirty years ago. "System lethargy" results from planning which has relied excessively on past models and has emphasized "facts" over principles rather than taking advantage of changing values and societal trends. This paper identifies major environmental changes likely to influence the health field, including changes in technology, scale of organization, and leadership style. Vibrant mental health services of the future are likely to be less exclusively based in the health care system, with greater emphasis on initiatives in the workplace, more use of electronic media, development of new professional roles and more intensive client-focused programming.     

A guide to knowledge and skills necessary for employment within a mental health service

This document "A Guide to Knowledge and Skills Necessary for Employment Within a Mental Health Service" was developed over the course of a number of meetings by the Provincial and Territorial Directors of Mental Health Divisions. It arose from a concern expressed from all parts of the country that the graduates of some professional schools were not necessarily equipped by their training to assume roles in mental health services. The document has no mandatory aspect and is intended only as an advisory guideline, to be helpful to employers and to those planning to work in direct mental health services.     

The relationship of community mental health centers to the professional standards review organizations program

Given the realities of the professional standards review organization (PSRO) program and the necessity for accountability on the part of all health service providers, community mental health centers (CMHCs) should begin now to take an active role in planning their involvement in the PSRO program. The author points out the need for both psychiatrists and nonphysician professionals to become involved. There are many types of mental health services delivered in a given area, and the active involvement of CMHCs can be a major determinant of the shape and direction of this impact.     

Narrating uncertainties about treatment of mental health conditions

Background  

Integration of patient views in mental health service planning is in its infancy despite service provision being clearly dominated by narratives from professional consultations and medical records. We wished to clarify perceptions of uncertainty about mental health conditions from a range of provider and user perspectives (patients, carers, parents, mental health service providers) and understand the role of narratives in mental health research.     

The marketing approach as a model for mental health needs assessment

This article compares the marketing approach of private business to the mental health planning process as it relates to needs assessment. It is the authors' assumption that the future of mental health programs will depend on careful planning designed to exhibit fiscal responsibility and program accountability. It is concluded that private business is an appropriate resource for planning strategies in mental health, and one that mental health administrators can readily turn to, especially in time of shrinking revenues for human service programs.     

Comprehensive planning for community mental health services: The Commonwealth of Pennsylvania

Comprehensive Mental Health Planning required the involvement of the professional and lay communities. These program areas were selected for study: Mentally Ill Adults, Mentally Ill Children, Problem Areas, and Mental Retardation. The planning effort coordinated mental health and mental retardation programs. 450 professionals worked on 42 Task Forces; 2500 volunteers participated in the 8 regional committees producing an inventory of resources and a survey of need as well as current statements of philosophy of treatment modalities. These data are being treated for presentation as Comprehensive Mental Health and Comprehensive Mental Retardation Plans. The use of volunteer citizens to produce respectable substantive reports is probably unique on this mammothscaled effort.     

Collaboration Between Mental Health Professionals and Family Physicians: A Survey of New Jersey Family Physicians

Background: Mental health problems are frequent in primary care, and there are many barriers to their detection and treatment. Clinical research protocols that include close collaboration between mental health professionals and primary care physicians have been found to be beneficial. This study explores the opinions of community family physicians regarding mental health professionals working directly in the primary care office.Method: Members of the New Jersey Academy of Family Physicians (N = 709) were sent a 25-item questionnaire about collaboration with mental health professionals. Three mailings were sent, with a 62% response rate. The surveys were mailed between May and July 1999.Results: Of family physicians included in the analysis, 13.5% reported having an in-office mental health professional. Of those who did not, 60.2% responded that they would consider having one. Compared with physicians who would not consider having an in-office mental health professional, physicians with a mental health professional and those without an in-office mental health professional but who would consider one were statistically more likely (p < .01) to respond that an in-office mental health professional would result in increased use of mental health services, improved acceptance of referrals to mental health professionals, and improved detection and treatment of mental health problems.Conclusion: Although few family physicians have an in-office mental health professional, many more would consider this arrangement and recognize the potential benefits of such collaboration.     

Perspectives on Training Needs for Geriatric Mental Health Providers: Preparing to Serve a Diverse Older Adult Population

An increasingly diverse population of older adults requires a diverse workforce trained to address the problem of differential healthcare access and quality of care. This article describes specific areas of training focused on addressing health disparities based on ethnic differences. Culturally competent care by mental health providers, innovative models of mental health service delivery such as collaborative care, and expansion of the mental health workforce through integration of lay health workers into professional healthcare teams, offer potential solutions and require training. Cultural competency, defined as respect and responsiveness to diverse older adults' health beliefs, should be an integral part of clinical training in mental health. Clinicians can be trained in avoidance of stereotyping, communication and development of attitudes that convey cultural humility when caring for diverse older adults. Additionally, mental health clinicians can benefit from inter-professional education that moves beyond professional silos to facilitate learning about working collaboratively in interdisciplinary, team-based models of mental health care. Finally, familiarity with how lay health workers can be integrated into professional teams, and training to work and supervise them are needed. A growing and diversifying population of older adults and the emergence of innovative models of healthcare delivery present opportunities to alleviate mental health disparities that will require relevant training for the mental health workforce.     

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

Purpose

Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels.

Methods

A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically.

Results

The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention.

Conclusions

Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.

     

Dual relationships in mental health practice: issues for clinicians in rural settings

OBJECTIVE: This paper aims to provide an overview of the literature on non-sexual dual relationships, and to discuss these in the context of rural mental health practice in Australia. METHOD: An internet-driven literature search was undertaken using OVID databases, which include MEDLINE, PsycINFO, CINAHL, and EMBASE: Psychiatry. Ethical codes of practice for the mental health professions of psychiatry, psychology, occupational therapy, social work and nursing were referred to. Searches were not limited by year of publication. Other unpublished material or information was included where relevant. RESULTS: Dual relationships are common in rural mental health practice. However, research on non-sexual dual relationship boundary issues in rural mental health is limited. Ethical codes of practice of mental health professional bodies provide little guidance regarding non-sexual dual relationships. Decision-making models addressing the ethics of dual relationships are restricted to considerations of whether to enter a dual relationship rather than how to manage such a relationship. CONCLUSIONS: Everyday' dual relationships are a predictable part of rural mental health practice. Further research is required to identify the benefits and/or problems in clinical practice resulting from non-sexual dual relationships. Responsibility for identifying and implementing ways of appropriately managing such relationships should be shared by the patient, the clinician, mental health services and professional organizations.     

Individualized network planning for chronic psychiatric patients

Conclusions While most individuals naturally develop networks in the course of social and vocational activities, chronic mental patients may require the assistance of a mental health professional to develop viable networks. Such assistance, which is most needed at the time of placement out of the hospital and into the community, may range from facilitating or consulting to more active network organizing.In order to determine the level of assistance required by individual patients, clinicians must make a thorough assessment of patients' existing network resources as well as an evaluation of their interpersonal strengths, needs and deficits. Such variables as need for interpersonal distance, tolerance of stress and desire for autonomy should be considered. Attention to these variables, which differ from and must be considered in conjunction with the traditional focus on symptomatology, is essential in network planning.An individualized approach to network development allows program planners to match different types of patients to different types of networks. In this paper we have described three varieties of social networks to accommodate the needs of a diverse patient population. Such a range of network possibilities affords mental health professionals added flexibility in providing treatment and support to chronic mental patients.     

An educational model for teaching living skills to long-term patients.

Establishing rehabilitation programs for long-term mental patients outside mental health settings can save mental health funds and further the patients' integration into the community, the author declares. He describes an approach that uses an educational model to teach patients the basic skills of everyday living. As "students," they enroll in a course taught by a credentialed teacher and sponsored by the adult education department of the local high school. Mental health professionals are used only for consultation, and the cost to the local mental health program is minimal. A key element in the course is having the students participate in planning the curriculum.     

Measuring consumer participation in mental health services: are attitudes related to professional orientation?

This study describes the development of the Consumer Participation Questionnaire to measure consumer involvement in the planning, management and evaluation of mental health services, and the attitudes of mental health workers towards consumer participation. Results indicate that while most professionals view the concept positively, progress may be occurring faster at the level of individual treatment than at the organisational level. Professionals with a more biological (as opposed to psychosocial) orientation were less likely to predict that services would improve if consumers were involved in the planning of services or were employed therein. Recommendations to facilitate more effective consumer participation are made, including the need for the value of a collaborative approach to be emphasised in professional training programmes.     

Problems for paraprofessionals in mental health services

Issues of changing positions and roles for paraprofessionals are considered in the context of the hierarchical structure and process of mental health organizations. A brief history of paraprofessionals in mental health is presented, showing their function as low-status staff who control a troublesome patient population. The mental health organization is examined as a social system with a functional division of labor and a professional caste system. Discussion focuses on problems arising when paraprofessionals are promoted in the functional hierarchy while continuing to occupy the lowest level in the professional caste system, and from the organization's continuing need for low-level staff to serve on the boundary between professional staff and difficult clients.Marjorie Bayes is a member of the Department of Psychiatry, Yale University School of Medicine. T. Kerby Neill is Coordinator of the Children's Service Program, Bluegrass East Comprehensive Care Center, Lexington, Kentucky.     

Planning for mental health

This report is based on a study of comprehensive mental health state plans submitted to the National Institute of Mental Health in 1965, interviews with mental health planners in selected states, discussions with professionals and citizens involved in the planning, and a review of the pertinent literature. This study was made to bring together observations about the outcome of this massive planning effort, to comment on the current status of mental health planning, and to develop some directions for facilitating planning at the state level.At the time this article was written, the authors were staff members at the National Institute of Mental Health.     

A Service System Planning Model for Individuals With Serious Mental Illness

An institutional-based care system in mental health has been replaced by a network of community-based services with different levels of structure and support. This poses both an opportunity and a challenge to provide appropriate and effective care to persons with serious mental illnesses. This paper describes a simulation-based approach for mental health system planning, focused on hospital and residential service components that can be used as a decision support tool. A key feature of this approach is the ability to represent the current service configuration of psychiatric care and the client flow pattern within that framework. The strength of the simulation model is to help mental health service managers and planners visualize the interconnected nature of client flow in their mental health system and understand possible impacts of changes in arrival rates, service times, and bed capacity on overall system performance. The planning model will assist state mental health agencies to respond to requirements of the Olmstead decision to ensure that individuals with serious mental illness receive care in the least restrictive setting. Future plans for refining the model and its application to other service systems is discussed.     

The Effect of Organizational Conditions (Role Conflict, Role Ambiguity, Opportunities for Professional Development, and Social Support) on Job Satisfaction and Intention to Leave Among Social Workers in Mental Health Care

This study examined the relationships between the organizational conditions of social workers practicing in mental health agencies and their job satisfaction and intention to leave. A sample of 259 social workers, practicing in sixteen mental health agencies in New York State completed a questionnaire that included several measures: role conflict, role ambiguity, social support, extent of opportunities for professional development, type of work activities, job satisfaction and intention to leave. Results showed that the organizational conditions are strong predictors for job satisfaction and intention to leave. The author suggests that it is possible to find an appropriate balance between the professional expectations of social workers and the business-driven aspect of the mental health care environment.     

Opportunities for community mental health training within the residential college campus context

The utilization of college campuses as a setting for providing training in community mental health offers an exciting prospect. If the possibilities available are to be realized, however, training programs within the mental health professions will need to be geared to provide course work which both precedes and accompanies student practicum experiences in the campus settings. In addition, postgraduate training opportunities in community mental health for all of the mental health professions will need to be greatly increased. This becomes vital in order that mental health professionals who work in college settings enlarge their own professional identifications to include community mental health concepts.presented this paper at the American Psychological Association's annual convention at Los Angeles in September, 1964.     

Chronic mentally ill women: emergence and legitimation of program issues

Program development for chronic mentally ill women is emerging in a climate where more general concerns relating to women's health and mental health are increasingly being examined. Although in the past the special needs of chronic mentally ill women have received scant attention in the professional literature, there is evidence today of a growing commitment to serving this population. The author traces the emergence and legitimation of three specific issues--homelessness, skills training, and family planning--that reflect the complexity of program development for this population. As specific issues in service delivery to chronic mentally ill women come to the fore and move toward relevant solutions, we may anticipate a sharpening of planning concepts. Both male and female chronic mental patients stand to benefit from these developments.