The influence of state mental health perceptions and spending on an individual’s use of mental health services

Purpose

To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health treatment on an individual’s use of mental health services, independent of the individual’s own perceptions.

Methods

Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from 35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to estimate the effects of individual-level characteristics and three state-level factors—per capita spending on community mental health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness—on the individual’s current use of mental health services.

Results

Adjusting for the individual’s perceptions and characteristics, state-level perception of treatment effectiveness was positively associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08; 95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1–4 days of mental distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services was also positively associated with an individual’s use of mental health services (OR for a $40 increase in spending = 1.09; 95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.

Conclusions

Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending on community mental health services on the use of mental health services.     

Relationships Between Youth and Caregiver Strengths and Mental Health Outcomes in Community Based Public Mental Health Services

To examine relationships between youth and caregiver strengths and behavioral health outcomes for youth in community service settings. Strengths and behavioral health needs of youth (N = 793) receiving Home and Community Based Services Waiver from 2002–2008 were characterized using the child and adolescent needs and strengths mental health assessment. Comparisons of assessment scores at admission and program completion were conducted using Chi-square, repeated measures ANOVA and Cohen’s d effect size. Associations between strengths at admission and having behavioral health needs met were examined using multivariable logistic regression. Youth had high levels of needs on mental health, risk and functioning dimensions at admission. All needs improved significantly over the course of the service episode. Youth and caregiver strengths at admission were associated with significant improvements in youth behavioral needs areas at discharge. The findings support the importance of assessing and incorporating youth and caregiver strengths in planning and delivering public mental health services.     

Perceptions of mental health and utilization of mental health services among new immigrants in Canada: A qualitative study

The impact of immigration on individuals’ overall health, including mental health, is complex. New immigrants’ concepts of mental health, mental healthcare utilization, and their knowledge of existing services in Regina, Canada were explored using a hermeneutic phenomenological approach. Three focus groups were conducted with 37 participants recruited from English language classes provided by a non-governmental organization in the city. Irrespective of country of origin, participants recognized the impact of mental health on general wellbeing. Access to existing mental healthcare was hindered by language barriers, inadequate information about existing healthcare services, and individuals’ perceptions about what and when services should be accessed. Despite challenges, participants viewed relocation positively and exhibited resilience when dealing with daily stress. Participants had knowledge gaps surrounding the role of family physicians in managing mental health conditions. Information on ways to access existing healthcare services should be delivered in collaboration with community organizations serving new immigrants.

     

What Family Support Specialists Do: Examining Service Delivery

This study describes services provided by family support specialists (FSS), peer advocates in programs for children with serious psychiatric conditions, to delineate differences between recommended components of FSS services and services actually provided. An analysis of qualitative interview and observational data and quantitative survey data from 63 staff at 21 mental health programs in New York identified that FSS and other staff have generally similar ideas about FSS services, and that these perceptions of activities are generally congruent with what FSS actually did. Implications of findings are discussed in the context of developing competencies and quality indicators for FSS.     

The Eye of the Beholder: Youths and Parents Differ on What Matters in Mental Health Services

The goal of this study was to examine the degree to which youths and caregivers attend to different factors in evaluating their experiences with mental health programs. Youth (n = 251) receiving mental health services at community agencies and their caregivers (n = 275) were asked open-ended questions regarding the positive and negative aspects of the services. Qualitative analyses revealed some agreement but also divergence between youth and caregivers regarding the criteria by which services were evaluated and aspects of services that were valued most highly. Youths’ positive comments primarily focused on treatment outcomes while caregivers focused more on characteristics of the program and provider. Youths’ negative comments reflected dissatisfaction with the program, provider, and types of services offered while caregivers expressed dissatisfaction mainly with program characteristics. Results support the importance of assessing both youth and caregivers in attempts to understand the factors used by consumers to evaluate youth mental health services.     

Social Support and Religion: Mental Health Service Use and Treatment of Schizophrenia

The perceptions and religious beliefs held by family members, mental health and health care professionals, and the community may affect the treatment of individuals with schizophrenia. To better identify and understand the influence of families, professionals and community members on individual’s treatment for schizophrenia, this review paper examines: (1) the religious perceptions of families, professionals, and the public towards schizophrenia; (2) religious perceptions of the etiology of schizophrenia; (3) how others perceive religion as a coping mechanism; and (4) how religion influences treatment engagement and help-seeking behaviors. MEDLINE and PsycInfo databases were systematically searched from 1980 to 2010 using the terms schizophrenia, schizoaffective, schizophreniform, psychotic disorder not otherwise specified and religion, religiosity, spirituality, and faith. Forty-three (n = 43) original research studies met the inclusion criteria. This study found that religious beliefs influence the treatment of schizophrenia in the following ways: Religious themes were positively associated with coping, treatment engagement and help-seeking behavior. Evidence of religious underpinnings was found in perceptions of etiology. The findings also indicate that there is often both a preference among family members and caregivers to utilize religious-based professionals and caution toward mental health professionals. Researchers and professionals may find avenues for improving treatment through examining the interaction of religious and schizophrenia at the social support level.     

The mental health needs of the severely physically disabled

Severely physically disabled individuals, advocates for the disabled, and rehabilitation and mental health professionals were surveyed to determine their perceptions of the need for services for 12 mental health problems encountered by persons with physical disability and the kinds of services needed. All groups surveyed agreed that vocational, social-interpersonal, personal-emotional, self-concept, and marital-family problems were in greatest need of services, but their perceptions of the extent of service need for each of the 12 problems differed significantly. The groups unanimously perceived rehabilitation counseling as the most needed service but differed significantly in their perception of the extent of service need for other services that were also highly rated, such as family, group, and individual therapy; peer counseling; respite care; and social skills training. The groups unanimously agreed that services designed to treat major mental illness were the least needed.     

Unmet needs for services for older adults with mental illness: comparison of views of different stakeholder groups.

OBJECTIVE: The authors assessed the need for mental health services among older adults in San Diego County, California, by determining what needs were not being addressed by existing services, what services were necessary to address these needs, and how much consensus there was among different stakeholders with respect to the problems and solutions related to service delivery. METHODS: Semistructured interviews were conducted with 23 health care and social service providers and administrators, 16 services consumers and other older adults (55 years of age and older), and 19 caregivers/family members and patient/client advocates. This was followed by four focus groups comprised of 18 providers and administrators, six focus groups comprised of 50 consumers and other older adults, and five focus groups comprised of 39 caregivers (family members and advocates). RESULTS: The unmet needs fell into three categories: mental health services, physical health services, and social services. Two interrelated themes were identified by participants: 1) the need for age-appropriate and culturally appropriate services to overcome barriers to mental health services access, use, and quality; and 2) the interrelations between unmet needs that address prevention as well as treatment of mental illness, including socialization and social support, transportation, housing, and physical health care. Differences in stakeholder assessment of unmet needs were associated with respective roles in delivery and use of mental health services. CONCLUSION: Age-appropriate and culturally appropriate solutions that address both prevention and treatment may represent the best strategies for addressing the challenges of mental illness and are most likely to be endorsed by all three groups of stakeholders.     

The effect of financial risk arrangements on service access and satisfaction among medicaid beneficiaries

OBJECTIVE: The relationship between financial risk arrangements, access to services, and consumer satisfaction with services was assessed in a sample of Medicaid beneficiaries who were enrolled under three different financial risk arrangements for health care and mental health care. METHODS: A survey was mailed to a stratified random sample of 9,449 recipients of Supplemental Security Income. Respondents reported their health and mental health service needs, service use, and satisfaction with services. Access was measured in terms of service needs that were met. RESULTS: Access to services was related to the type of risk arrangement. Respondents who were enrolled in plans that assumed the risk for the cost of services had poorer access to services than respondents who were enrolled in plans that did not assume the risk for the cost of these services. Satisfaction with medical services was negatively related to the plan's assuming the risk for medical expenditures. CONCLUSIONS: Financial risk arrangements may have important implications for service use patterns among persons who have disabilities. Health and mental health policy makers should carefully consider risk arrangements when designing health plans for vulnerable populations.     

Depression symptoms in adolescents with autism spectrum disorder: A contextual approach to mental health comorbidities

IntroductionAlthough research on mental health comorbidities in autism spectrum disorder (ASD) has increased in recent years, little has been done to evaluate potential individual × environment interactions associated with these comorbidities. The current study explored whether ASD-related characteristics (social-communication impairment) and environmental factors (peer and family contexts) had additive or interactive effects on the depression symptoms of youth with ASD.MethodIn a cross-sectional sample of adolescents with ASD (N = 176; 13–17 years old; 72.7% male), primary caregivers and adolescents responded to a series of surveys online pertaining to adolescents' mental health (Revised Child Anxiety and Depression Scale), family functioning (Self-Report of Family Inventory), and experiences of peer victimization (Peer Experiences Questionnaire-Revised).ResultsThere were statistically significant interactions between social-communication skills and the environment in both family (△R² = 0.02) and peer (△R² = 0.02) contexts. For youth with better social-communication skills, there was a positive association between peer victimization and depression symptoms and a negative association between family competence and depression symptoms.ConclusionFindings support social-push interactive models in which better social-communication skills are associated with fewer depression symptoms in the context of less-stressful peer and family environments, highlight the utility of ecologically informed approaches to the mental health of youth with ASD, and suggest several areas for future study.     

Development and Psychometric Evaluation of the Youth and Caregiver Service Satisfaction Scale

There is widespread need for the inclusion of service satisfaction measures in mental health services evaluation. The current paper introduces the Service Satisfaction Scale (SSS), a practical and freely available measure of global youth and adult caregiver service satisfaction. The development process, as well as results from a comprehensive psychometric evaluation in a large sample of clinically referred youth (N = 490) receiving home-based care, and their caregivers (N = 383), are presented. Multiple models for psychometric analyses were used including classical test theory, item response theory, and confirmatory factor analysis. As expected, SSS total scores were negatively skewed but the measure displayed otherwise adequate scale characteristics for both the youth and caregiver versions. Thus, the SSS is a brief and psychometrically sound instrument for measuring global satisfaction in home-based mental health service settings. It has several advantages compared to existing measures including brevity, parallel youth and caregiver forms, availability at no cost, and its development on a large sample of youth and caregivers with rigorous psychometric methodology.     

Factors associated with psychiatric symptoms and psychiatric disorders in ethnic minority youth

While ethnic diversity is increasing in many countries, ethnic minority youth is less likely to be reached, effectively treated and retained by youth mental health care compared to majority youth. Improving understanding of factors associated with mental health problems within socially disadvantaged ethnic minority youth is important to tailor current preventive and treatment interventions to the needs of these youth. The aim of this study was to explore factors at child, family, school, peer, neighbourhood and ethnic minority group level associated with mental health problems in Moroccan-Dutch youth (n = 152, mean age 13.6 ± 1.9 years). Self-reported and teacher-reported questionnaire data on psychiatric symptoms and self-report interview data on psychiatric disorders were used to divide children into three levels of mental health problems: no symptoms, only psychiatric symptoms and psychiatric disorders. Psychiatric symptoms and/or disorders were associated with more psychopathic traits, a higher number of experienced trauma and children in the family, and more conflicts with parents, affiliation with delinquent peers, perceived discrimination and cultural mistrust. Psychiatric symptoms and/or disorders were also associated with less self-esteem, parental monitoring, affiliation with religion and orientation to Dutch or Moroccan culture, and a weaker ethnic identity. For youth growing up in a disadvantaged ethnic minority position, the most important factors were found at family (parent–child relationship and parenting practices) and ethnic minority group level (marginalization, discrimination and cultural mistrust). Preventive and treatment interventions for socially disadvantaged ethnic minority youth should be aimed at dealing with social disadvantage and discrimination, improving the parent–child relationship and parenting practices, and developing a positive (cultural) identity.     

Public vs. private insurance: Cost, use, accessibility, and outcomes of services for children with autism spectrum disorders

Very little research has been conducted on insurance type (private vs. public funded) and costs, accessibility, and use of services of children with autism. Analysis of five parent reported outcomes: (a) out-of-pocket expenditures, (b) variety of services used, (c) access to services, (d) child and family service outcomes, and (e) satisfaction with payer of services against private and public insurance was completed. Parents/caregivers completed a survey regarding recent usage of nine specific services—inpatient care, medication management, counseling or training, individual therapy, in-home behavior therapy, speech and language therapy, occupational therapy, case management, and respite care. Across all respondents (n = 107), 73.5% were privately insured; 21.2% were publicly insured. Based on insurance type, no statistically significant differences in outcome variables were found, findings that were not consistent with previous research. However, an indirect association was found between out-of-pocket expense and parent satisfaction with the payer of services, access to care, and family outcomes. Further, a significantly higher percentage of total out-of-pocket expenditures were allocated to speech language therapy among publicly insured children than among privately insured children (p = .03) and parent stress was a moderating variable between access to care and variety of services used.     

Perceptions of rural school mental health services: a focus group study

The presence of emotional or behavioural disorders has an impact on academic achievement. Access to behavioural health services is a challenge, particularly in rural communities. School-based mental health services have been recognised as an effective means of addressing the needs of students with emotional or behavioural disorders. This qualitative focus group study explored the service needs, gaps, and barriers to mental health services. Themes related to time, space, family engagement, and education for teachers and caregivers emerged from the focus groups.     

Caregiver causal attributions in youth psychosis

Aim: Caregiver causal attributions influence patient and caregiver reactions to psychosis. The current study describes common caregiver causal attributions about psychosis onset in youth, including a subset of first‐episode psychosis patients, and the patient and caregiver characteristics that influence these attributions. It also examines if caregiver views are affected by contact with youth mental health services. Methods: Fifty‐one caregivers of 50 youth patients with a diagnosed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) psychotic disorder were interviewed about their causal attributions. Patient and caregiver demographic and clinical predictors were also collected. Results: Caregivers most highly endorsed substance use, genetics, negative peer influences and school stress as individual causes. These findings were consistent across the total sample. Principal components analysis derived three causal categories. Caregivers most frequently endorsed a biological and substance use lifestyle causal category, followed by psychological vulnerability and stress‐reactivity causal categories. There was evidence that caregiver and patient factors, as well as contact with youth mental health services, influenced the causal attributions caregivers made about the onset of psychosis. Conclusion: Caregivers of youth with psychosis are making causal attributions that are consistent with current aetiological theories of psychosis in youth. The study showed that caregivers are particularly cognizant of genetic and substance use factors in the development and maintenance of psychosis. However, youth mental health services may need to particularly focus on increasing caregiver understanding of the dynamics of stress factors as symptoms, and not causes, of psychosis early in the illness course.     

Feelings of burden and health-related quality of life among family caregivers looking after the impaired elderly

The aim of the present study was to examine the relationship between feelings of burden and health-related quality of life (HRQOL) among family caregivers looking after the impaired elderly residing in a community located in southern Japan. Subjects were 85 pairs comprising elderly individuals requiring care and their respective family caregivers. Questionnaire items for the family caregivers related to demographic variables, caregivers' burden, HRQOL, use of public services, hours spent caregiving, duration of caregiving, and satisfaction with verbal communication with family. Questionnaire items for the elderly recipients of care concerned demographic variables, activities of daily living, and cognitive status. According to bivariate analysis, caregivers' burden was significantly related to cognitive status, hours spent caregiving, and each HRQOL subscore except physical function. From multiple regression analysis, subscore of HRQOL with respect to mental health and satisfaction with verbal communication were extracted as influential factors. Final regression coefficient was 0.72 (P<0.01) and coefficient of determination was 0.53. These results suggest that satisfactory mental health status plays an important role in limiting family caregivers' burden.     

Outcomes of a Family Peer Education Program for Families of Youth and Adults with Mental Illness

Abstract:

Family members of consumers with mental illness often play important roles in initiating and supporting treatment. Self-help programs such as the National Alliance on Mental Illness (NAMI) Family-to-Family Education Program (FTF) have been shown to provide a variety of benefits for family members. Despite recognizing the benefits of FTF, little is known about who may benefit most, and in what ways they might benefit. One group of interest is family members of younger consumers, a group shown to report more negative caregiving experiences and more depression and anxiety than caregivers of older consumers. The current study assesses whether relatives of youth (ages 8–18) differ in their response to FTF as opposed to relatives of adults (19 years and older). Results suggest that all members benefit from FTF. Family members of youth in FTF, however, reported gains more pronounced on their depressive symptoms, and negative perceptions and experiences, relative to family members of adults. The importance of peer support programs is discussed, as well as the specific usefulness of these programs to effectively address concerns of relatives of youth with serious mental health concerns.     

Adverse Impact of Coercive Treatments on Psychiatric Inpatients’ Satisfaction with Care

Consumers’ satisfaction with inpatient mental health care is recognized as a key quality indicator that prospectively predicts functional and clinical outcomes. Coercive treatment experience is a frequently cited source of dissatisfaction with inpatient care, yet more research is needed to understand the factors that influence consumers’ perceptions of coercion and its effects on satisfaction, including potential “downstream” effects of past coercive events on current treatment satisfaction. The current study examined associations between objective and subjective indices of coercive treatments and patients’ satisfaction with care in a psychiatric inpatient sample (N = 240). Lower satisfaction ratings were independently associated with three coercive treatment variables: current involuntary admission, perceived coercion during current admission, and self-reported history of being refused a requested medication. Albeit preliminary, these results document associations between patients’ satisfaction ratings and their subjective experiences of coercion during both current and prior hospitalizations.     

Consumer-directed supports: economic, health, and social outcomes for families

The impact of a consumer-directed support program on family caregivers of adults with developmental disabilities was explored. Economic, health, and social outcomes were compared between families in the program and families on the waiting list for the program. Caregivers of adults in the program reported fewer out-of-pocket disability expenses, greater access to health care, engagement in more social activities, and greater leisure satisfaction. There also appeared to be greater impacts on lower income families; these caregivers reported better mental health and access to health care than did similar caregivers on the waiting list.     

Suicide Prevention Gatekeeper Training: Can They Advance Prevention in Indian Country?

American Indian youth have the highest suicide rates in the United States; however, many do not use services and access barriers exist. This study was a cross-sectional evaluation of 6 gatekeeper trainings conducted on 1 reservation with N = 84 individuals. Analyses examined participant characteristics, impact on training objectives, and satisfaction. The majority of participants were American Indian and female (89.3%). Significant increases in knowledge (p < 0.001) and self-efficacy (p < 0.001) were observed post-test, as well as high satisfaction (3.53/5) and intent to use skills daily (36.4%) or monthly (66.3%). Lowest rated was how the training addressed cultural differences (2.93). While results support the promise of gatekeeper training, they identify a clear need for adaptation; specific implementation and research recommendations are discussed.