Methodological Challenges in Assessing Children's Mental Health Services Utilization

This paper describes the reliability and validity of the service assessment for children and adolescents (SACA) for use among Spanish-speaking respondents. The test-retest reliability of the instrument was assessed in a randomly selected clinical sample of 146 Puerto Rican children and adolescents aged 4–17. Both parents and children were administered the SACA twice by independent interviewers over an average 12-day follow-up period. The accuracy of parental and youth self-reports was assessed by comparing these reports to information obtained from medical records. The results showed that parents and children (aged 11–17) were able to report with fair to moderate reliability any last year use of mental health services, any outpatient mental health services, and school services. Residential and hospitalization services were reported by both informants with substantial test-retest reliability. Slight or no test-retest reliability was obtained for parent and child on the use of the specific type of mental health professionals, as well as parental reports of several treatment modalities. Substantial sensitivity of the SACA was obtained when comparing medical records to parental and child reports to lifetime use of any service and outpatient mental health service. Moderate sensitivity was obtained for last year use of mental health services for both parent and child informants.     

Utilization of Public Mental Health Services by Adults with Serious Mental Illness

Public mental health (MH) services were examined for non-elderly adults with serious mental illness (SMI) using a database combining information from Medicaid, MH, and substance abuse agencies in three states. These data show that between 23% and 39% of those with SMI received MH services only through Medicaid. Relative use of community versus state hospitals for delivery of psychiatric inpatient care varied across the three states. However, state hospitals accounted for a large proportion of total inpatient days, due to high mean annual days of care. In two states, Medicaid paid for fewer psychiatric inpatient days than expected.     

Efficacy of a Community-Based Trauma Recovery Program after a Fire Disaster

As industries develop, fire disasters and their associated damage are increasing. Investigating the mental health of victims is imperative because this is an essential issue for community recovery after a disaster. This study was conducted to determine the efficacy of a program implemented by a community mental health center based on the investigation of the victims’ depression and post-traumatic stress disorder (PTSD) levels immediately after the disaster and at one-year follow-up. As a result, victims’ depression and PTSD recovered over time, and more changes were confirmed. In particular, the high-risk group for PTSD showed a high program participation rate, and there was significant recovery over time compared with the group without PTSD. Based on these results, community mental health programs are an effective way to increase community mental health after disasters. In the future, community-based recovery programs after disasters should be expanded, and administrative support for them should be developed.     

Stigmatizing Attitudes About Mental Illness and Allocation of Resources to Mental Health Services

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.     

False-Negative Reporting and Mental Health Services Utilization: Parents' Reports About Child and Adolescent Services

Parents' ability to make reliable and valid reports about health service utilization is a key research design consideration for studies about the unmet needs of children and adolescents with emotional or behavioral problems. This research report addresses the validity of parents' reports, in particular, parents' rates of false-negative reporting about their children's mental health service use. Our findings show that only a few parents of known service users fail to report that their child or adolescent has received services for an emotional or behavioral problem. However, when parents are asked to report about their child's service use with specific providers or in specific service settings, the rate of false-negative reporting tends to increase, and in some circumstances this increase is dramatic. Logistic regression results indicate that false-negative reporting is more likely to occur among parents whose children are male, less frequent service users, or service users whose use is less recent. After controlling for these factors, we did not find a significant difference in the rate of false-negative reporting for parents of Anglo and Latino children. Implications for research designs and survey instruments are discussed.     

Walking Psychotherapy As a Health Promotion Strategy to Improve Mental and Physical Health for Patients and Therapists: Clinical Open-Label Feasibility Trial

BackgroundPersons with mental illness are more at risk for sedentary behaviour and associated consequences. We assessed the feasibility of outdoor walking during psychotherapy sessions in an outpatient trauma therapy program to challenge sedentary behaviour.MethodsIn this pilot trial in Toronto, Canada, female therapists and patients >18 years, were encouraged to walk during 12 consecutive trauma therapy sessions. Both groups were provided wearable pedometers. We assessed protocol feasibility and desirability, and 12-week changes in patient post-traumatic stress [PTSD check-list for DSM-5 (PCL-5)], and depression, anxiety, and stress symptoms [Depression, Anxiety and Stress Scale (DASS)].Results91% (20/22) of patients approached for the study consented to participate and 17 (85%) completed follow-up questionnaires. There was walking in 132/197 (67%) of total therapy sessions (mean 7.3 out of 10.9 sessions per participant). Inclement weather was the predominant reason for in-office sessions. At 12-week follow-up, PCL-5 mean scores decreased from 38.4 [standard deviation, ((SD) 11.8) to 30.7 (SD 14.7)], [mean difference (MD) 7.7, 95% CI: 1.5 to 13.8]; 41% (7/17) participants had a clinically significant PCL-5 score reduction of >10 points. DASS-stress mean scores decreased from 19.0 to 16.0 (MD 3.0, 95% CI: 0.3 to 5.6). No changes were observed for DASS depression (MD -0.9, 95% CI: −5.1 to 3.3) nor DASS anxiety (MD -0.2, 95% CI: −3.1 to 2.7). Daily step reporting was inconsistent and not analyzed. There was high acceptability amongst patients and therapists to walk, but not to record daily steps. There were no adverse outcomes.ConclusionsIt was feasible and acceptable to incorporate outdoor walking during trauma therapy sessions for patients and therapists. Weather was the greatest barrier to implementation. Further randomized-control study to compare seated and walking psychotherapy can clarify if there are psychotherapeutic and physical benefits with walking.     

Child Mental Health Services in the New South Africa

Health departments in the new South Africa are undergoing major restructuring and, in some cases, severe financial cutbacks as new policies attempt to redress the inequities of the past. A district system is being phased in, with a shift in funding from academic hospitals to secondary and primary level care. The process is being undermined by the current recession, which also affects Welfare and Education facilities, and by widespread poverty, violence, and other adverse conditions. Child mental health services are discussed in the light of current human resources, epidemiological data, the effects of violence and cultural issues, together with some reflections on their future.     

A Survey of Mental Health Services at Post-Secondary Institutions in Alberta

Objectives:

The relatively high prevalence of mental health problems among students at post-secondary institutions in Canada is well documented; in contrast, less is known about the adequacy of mental health services available to Canadian post-secondary students on campuses. Our study sought to examine the current state of campus mental health initiatives and services in Alberta as well as the extent to which resources identified in mental health literature as being key in mental health problem prevention and promotion appear to be available.

Methods:

A 60-question, online survey was sent to staff (primarily front-line workers; n = 45) at Alberta’s 26 publicly funded post-secondary institutions. Responses were organized according to small (less than 2000 students), medium (2000 to 10 000 students), and large (10 000 or more students) institutions.

Results:

All of Alberta’s post-secondary institutions were represented in the responses. Mental health initiatives and services are available, to varying extent, at all of Alberta’s post-secondary institutions. However, many institutions do not have initiatives and (or) services aimed at identifying students with mental health problems or policies for monitoring their mental health services. Additionally, smaller institutions are less likely to offer certain services (for example, gatekeeper training and campus medical services), compared with larger ones. Finally, a systematic review or an evaluation of services appears to be infrequently conducted.

Conclusions:

These findings highlight the need for post-secondary institutions in Alberta, and by extension in Canada, to develop and institute a comprehensive strategy to evaluate and optimize the delivery of mental health initiatives and services.     

Priority Issues in Latino Mental Health Services Research

This paper identifies issues and trends affecting the quality and comprehensiveness of Latino mental health research and services. These issues include current patterns of need and services use, rapid expansion of the Latino population, extraordinary rates of uninsured, social and language barriers to care, transformation in treatment science and technology, and the sheer complexity and rapid changes in the delivery system. Progress in the field requires coordination and investments from both public and private sectors. Scientific journals should provide assistance for creating a high quality knowledge base and rapidly disseminating this information to students, practitioners, and policy makers. Vigorous activity is needed to (1) augment the supply of people entering the pipeline for researcher and practitioner training, and (2) support research in priority areas such as outcome studies for diverse treatments and different sectors of care, cultural competence, treatment models for youth and aging populations, quality of care, and barriers to mental health care.     

A Review of Canadian Mental Health Research on Intellectual and Developmental Disabilities

This article summarizes Canadian research in “dual diagnosis” spanning the past 20 years and places this research within a historical and policy context. Canadian researchers have made important contributions with regard to understanding inpatient and outpatient mental health services, families, autism, specific disorders and behaviors, aboriginal mental health, forensics, and emergencies. In this article, we aim to summarize several of these contributions. Following a summary of recent research findings, we offer some suggestions and directions for future research in our country.     

Routine Outcome Measurement: A Survey of UK Child and Adolescent Mental Health Services

Background:  Research suggests that the routine measurement of treatment outcomes is a neglected area of clinical practice within mental health care settings. Still it is not clear to what extent such findings apply to child and adolescent mental health services (CAMHS). A cross-sectional survey of UK CAMHS revealed that although quantitative clinical measures are commonly used within these services, there is little uniformity in the instruments utilised, and they rarely inform a system of routine outcome measurement. However, in general, respondents did not have a philosophical or scientific objection to the practice of routinely measuring outcomes, but rather felt that they lacked the necessary resources to facilitate such initiatives.     

Academic/State/Federal Collaborations and the Improvement of Practices in Disaster Mental Health Services and Evaluation

Academic, state, and federal agencies collaborated over the last 9 years to improve disaster mental health services and evaluation. This process, which included literature reviews, a number of expert panels, and case studies, is described. The products resulting from this process have included the development of a systematic cross-site evaluation of the federally funded crisis counseling program and field guides for interventions aimed at providing services to distressed individuals in the immediate aftermath of disasters and to individuals needing resilience skills training weeks or months after the event. Future improvement of disaster mental health services calls for continued research, evaluation, training, and intervention development.     

Threats to Mental Health and Well-Being Associated with Climate Change

Climate change is a contributor to extreme weather events and natural disasters. The mental health effects of climate change are multifaceted, with post-traumatic stress disorder and depression predominant. This paper aims to describe the impact of climate change on mental health conditions, including risk and protective factors related to the expression of mental health conditions post-disaster, as well as a discussion of our local experience with a devastating wildfire to our region within Canada. The risk of the development of mental health conditions post-disaster is not equally distributed; research has consistently demonstrated that specific risk factors (e.g., gender, socioeconomic status and education, pre-existing mental health symptomatology), are associated with increased vulnerability to mental health conditions following natural disasters. There are multiple strategies that must be undertaken by communities to enhance adjustment and coping post-disaster, including improved access to care, inter-agency cooperation, enhanced community resiliency, and adequate preparation.     

The Need for Mental Health Promotion and Early Intervention Services for Higher Education Students in Singapore

Student stress and depression in Singapore have a negative impact on students’ academic performance, social involvement and interpersonal relationships. In some Asian cultures, family emphasis on success places additional social and cultural pressure on students. University stressors include lack of economic resources, curriculum demands on time, examination pressure, living away from home and loss of school friends, as well as the need to uphold family respect. In university, students often become anonymous, in a new educational environment far beyond that which they have experienced in secondary school. This paper draws together information related to the demographics of depression in Singapore across education sectors. The discussion is also focused on suicide, and the need for mental health services to identify appropriate intervention and mental health promotion strategies for Singapore students, in particular university students. A number of recommendations for change are considered.     

Maternal Mental Health after a Wildfire: Effects of Social Support in the Fort McMurray Wood Buffalo Study

Objective:Following disasters, perinatal women are vulnerable to developing post-traumatic stress disorder (PTSD)-like symptoms. Little is known about protective factors. We hypothesized that peritraumatic stress would predict PTSD-like symptoms in pregnant and postpartum women and would be moderated by social support and resilience.Method:Women (n = 200) who experienced the 2016 Fort McMurray Wood Buffalo wildfire during or shortly before pregnancy completed the Peritraumatic Distress Inventory (PDI), Peritraumatic Dissociative Experiences Questionnaire, and the Impact of Event Scale-Revised for current PTSD-like symptoms. They also completed scales of social support (Social Support Questionnaire-Short Form) and resilience (Connor-Davidson Resilience Scale).Results:Greater peritraumatic distress (r = 0.56) and dissociative experiences (r = 0.56) correlated with more severe PTSD-like symptoms. Greater social support satisfaction was associated with less severe post-traumatic stress symptoms but only when peritraumatic distress was below average; at more severe levels of PDI, this psychosocial variable was not protective.Conclusions:Maternal PTSD-like symptoms after a wildfire depend on peritraumatic distress and dissociation. Higher social support satisfaction buffers the association with peritraumatic distress, although not when peritraumatic reactions are severe. Early psychosocial interventions may protect perinatal women from PTSD-like symptoms after a wildfire.     

Correlates of Adolescents' Satisfaction with Mental Health Services

While there has been increased attention to consumers' satisfaction with mental health services as an indicator of quality of care, little is known about the construct of consumer satisfaction, especially for youth. The goal of this study was to examine potential correlates of adolescents' satisfaction with mental health services. One hundred eighty adolescents who had received out-patient mental health services completed a multidimensional satisfaction scale and measures of behavior problems, attitudes and expectations about treatment, perceived choice/motivation in seeking treatment, and service use history. Results indicate that the strongest unique correlates of satisfaction are severity of behavior problems, positive expectations about services, and perceived choice in seeking services. Satisfaction with services was also associated with service site, length of time in treatment, and reason for entering treatment. Demographic variables were not related to satisfaction. A discussion of the appropriateness of using satisfaction as an indicator of quality of care is included.     

Reasons and Determinants for Perceiving Unmet Needs for Mental Health in Primary Care in Quebec

Objective:

To evaluate the mental health care needs perceived as unmet by adults in Quebec who had experienced depressive and (or) anxious symptomatology (DAS) in the previous 2 years and who used primary care services, and to identify the reasons associated with different types of unmet needs for care (UNCs) and the determinants of reporting UNCs.

Method:

Longitudinal data from the Dialogue Project were used. The sample consisted of 1288 adults who presented a common mental disorder and who consulted a general practitioner. The Hospital Anxiety and Depression Scale was used to measure DAS, and the Perceived Need for Care Questionnaire facilitated the assessment of the different types of UNCs and their motives.

Results:

About 40% of the participants perceived UNCs. Psychotherapy, help to improve ability to work, as well as general information on mental health and services were the most mentioned UNCs. The main reasons associated with reporting UNCs for psychotherapy and psychosocial interventions are “couldn’t afford to pay” and “didn’t know how or where to get help,” respectively. The factors associated with mentioning UNCs (compared with met needs) are to present a high DAS or a DAS that increased during the past 12 months, to perceive oneself as poor or to not have private health insurance.

Conclusions:

To reduce the UNCs and, further, to reduce DAS, it is necessary to improve the availability and affordability of psychotherapy and psychosocial intervention services, and to inform users on the types of services available and how to access them.     

Incorporating Community Mental Health into Local Bioterrorism Response Planning: Experiences from the DeKalb County Board of Health

Following a brief introduction to response planning for terrorism and other disasters, the authors present their experiences in developing a grassroots, interdisciplinary group charged with incorporating a mental health response component into the bioterrorism response plan for the metropolitan Atlanta area. This group was organized and supported by the Center for Public Health Preparedness at the DeKalb County Board of Health. Various viewpoints of key participating agencies are presented. Recommendations are provided for other localities and stakeholders who plan to incorporate a community mental health component into local disaster response plans.