Predictors of mental health service utilisation in a non-treatment seeking epidemiological sample of Australian adults

This study sought to replicate Parslow and Jorm’s (Aust N Z J Psychiatry 34(6): 997–1008, 2000) research on need, enabling and predisposing factors as predictors of mental health service use, with the addition of childhood trauma as a predisposing factor. It utilised a non-treatment seeking epidemiological sample of Australian adults (N = 822) to examine 25 variables covering psychiatric disorder, socio-demographics, physical health problems, and childhood trauma as predictors of mental health visits to general practitioners (GP’s), mental health specialists and non-mental health specialists. A consistent multivariate predictor of mental health visits to all types of professionals was psychological distress. Presence of an affective disorder, age, and number of health problems were additional predictors of visiting a GP. Being female, divorced, and exposure to childhood trauma predicted use of a mental health specialist, while rural living was associated with lower use of these services. Results highlight the importance of general psychological distress and need factors in seeking help for mental health, and reinforce the lifelong disadvantage arising from adverse childhood experiences and the need to address these issues in adult mental health services.     

Service Characteristics and Counseling Outcomes: Lessons from a Cross-Site Evaluation of Crisis Counseling After Hurricanes Katrina,Rita and Wilma

The 2005 hurricane season was the worst on record, resulting in disaster declarations and the implementation of federally-funded crisis counseling programs in five states. As part of a larger cross-site evaluation of these programs, data from 2,850 participant surveys, 805 provider surveys, and 132,733 encounter logs (submitted from 3 weeks before to 3 weeks after the participant surveys) were aggregated to the county level (N = 50) and used to test hypotheses regarding factors that influence program performance. County-level outcomes (aggregate ratings of participants’ perceived benefits) improved as service intensity, service intimacy, and frequency of psychological referrals increased and as provider job stress decreased. The percent of providers with advanced degrees was indirectly related to participants’ perceived benefits by increasing service intensity and referral frequency. The results yielded recommendations for achieving excellence in disaster mental health programs.

Peer support in law enforcement: past, present, and future

Currently, the provision of mental health services to police officers referred for Posttraumatic Stress Disorder or after on-the-job trauma has been facilitated mostly by interested licensed psychologists and social workers who often have minimal experience working with the law enforcement community. Despite the heavy toll of work-related stressors on the morale and psyche of police officers, when under stress they are reluctant to seek professional psychological help as its use implies weakness, cowardice, and an inability to perform the job effectively. Peer support counseling can be used effectively whenever the target population is uniquely educated or occupationally trained. Peers offer a unique segue to groups who demonstrate resistance towards psychotherapy, possess religious or cultural characteristics which would complicate the provision of traditional mental health services, and/or believe it is not understood or misunderstood by the general population or mental health professionals. The peer support component of law enforcement and other emergency services agencies has contributed to an increase in professional mental health referrals and a decrease in on-the-job suicides, sick days, and poor work performance. Furthermore, peer participation in debriefings following a traumatic event, and peer support during a crisis facilitates the process of psychological closure and mourning and enables emergency services workers to cope more effectively with tragedy so they can continue to perform their jobs efficiently and with satisfaction.     

Expanding disaster mental health response: a conceptual training framework for public health professionals

The available research literature suggests that in disasters, individuals presenting acutely with psychologically-related complaints tend to outnumber those presenting with physical symptoms directly stemming from the injury-causing agent or event. This acute "mental health surge" can rapidly overwhelm existing community mental health resources, especially in the context of terrorism. Training professionals from outside the traditional mental health workforce in basic psychological crisis intervention may promote more efficient use of mental health services through a gatekeeper process of early intervention and appropriate referrals to mental health specialists. With their experience in patient and client services at the community level, public health professionals represent a cohort well-suited for training in and delivery of acute mental health services in disasters. In this paper, we outline a conceptual model and rationale for training public health professionals in basic crisis-oriented mental health functions (psychological first aid) in order to augment community-based mental health services for affected populations in a disaster.     

Community mental health allies: referral behavior among Asian American immigrant Christian clergy

Asian American Christian faith leaders support and provide an array of services within their communities. However, little is known about their response to congregants’ mental health concerns. This study examined correlates of mental health referral behavior among 103 Asian American Christian clergy in California who completed an anonymous mail survey. Using multiple regression analyses, we found that clergy’s prior mental health education, knowledge of mental illness, education level, time spent providing individual counseling and referral to general practitioners were positively associated with making mental health referrals. Outreach efforts (including mental health education, and mental health referral information) to facilitate clergy’s support of congregants with mental health needs are discussed.     

Compassion fatigue following the September 11 terrorist attacks: a study of secondary trauma among New York City social workers

Experience suggests that individuals working in the caring and psychotherapeutic professions are among those to provide mental health services to disaster victims suffering from psychological trauma following catastrophic events. Yet, few studies have focused on the emotional exhaustion from working with such clients, referred to as compassion fatigue (CF) in this study, and how CF differs from other occupational hazards, such as secondary trauma (ST) and job burnout. In the present study, we used recently validated scales to predict ST and job burnout related to providing services to those affected by the World Trade Center (WTC) attacks. Our study data were based on a random survey of 236 social workers living in New York City (NYC), over 80% of which reported being involved in post-WTC disaster counseling efforts. Our analyses indicated that controlling for demographic factors, years of counseling, and personal trauma history, ST was positively associated with WTC recovery involvement (p <. 001) and negatively associated with having a supportive work environment (p < . 01). In contrast, job burnout was negatively associated with having a supportive work environment (p < .01), but not associated with WTC involvement or WTC counseling efforts. We discuss these results in light of future conceptual and empirical research needs.     

The role of ethnicity in clinical psychopathology and care pathways of adults with intellectual disabilities

The objective of this study was to explore whether people with intellectual disability from ethnic minority groups have higher rates of mental health problems and access different care pathways than their White counterparts. Clinical and socio-demographic data were collected for 806 consecutive new referrals to a specialist mental health service for people with intellectual disabilities in South London. Referrals were grouped according to their ethnic origin. The analyses showed that there was an over-representation of referrals from ethnic minority groups with diagnoses of schizophrenia spectrum disorder. In addition, Black participants were more likely to have an autistic spectrum disorder. Referrals of ethnic minority groups were considerably younger than White referrals, and less likely to be in supported residences. The results are discussed in the context of cultural and familial factors in particular ethnic groups that may play an important role in accessing and using mental health services.     

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.     

The Impact of Integrating Crisis Teams into Community Mental Health Services on Emergency Department and Inpatient Demand

This investigation focused on the impact of integrating crisis team members into community mental health services on emergency department and adult mental health inpatient unit demand within an Australian public health service. Mixed methods were used including (a) the comparison of service use data with that of two other comparable services (both of which had community-based crisis teams), (b) surveys of (i) patients and carers and (ii) staff, and (c) focus groups with staff. The numbers of emergency department presentations with mental health conditions and adult mental health inpatient separations increased 13.9 and 5.7 %, respectively, from FY2006/07 to FY2012/13. Between the three services, there were minimal differences in the percentages of presentations with mental health conditions, the distribution of mental health presentations across a 24-h period, and the triage categories assigned to these patients. Survey participants reported that patients used the emergency department due to the urgency of situations, perceptions that gaining access to mental health services would take less time, and the unavailability of mental health services when help is needed. Staff identified several issues (e.g. inappropriate referrals) that may be unnecessary in increasing emergency department demand. The integration of crisis team members into community mental health services does not seem to have produced an increase in emergency department admissions or inpatient separations beyond what might be expected from population growth. The potential may exist, however, to reduce emergency department admissions through addressing the issue of inappropriate referrals.     

Classification in Psychiatry: Does it deliver in schizophrenia and depression?

The global situation for people with mental illness – in developing and developed countries – is dire. Legislative and human rights protections are frequently lacking. Mental health budgets are inadequate. There are insufficient numbers of skilled policy makers, managers and clinicians. Communities are poorly informed about mental health and illness and not well organised for purposes of advocacy. In most of the world, mental health services are inaccessible or of poor quality. Most people who would benefit from psychiatric treatment and rehabilitation do not have affordable access to such services. Leadership – at all levels – for mental health system development needs to be greatly strengthened.     

Psychopathology in adolescent and young adult criminal offenders (15–21 years) in Sweden

Background This study examined rates of psychopathology among adolescent and young adult serious offenders referred to pre-sentence forensic psychiatric services and compared patterns of psychiatric morbidity with adult forensic referrals and age-matched general psychiatric inpatients. Methods In Sweden, criminal offenders can be referred for an extensive court-ordered pre-sentence inpatient forensic psychiatric examination (FPE). Data on all 3,058 of these offenders (90% male, mean age = 35.3 years) during 1997–2001 were obtained from the National Board of Forensic Medicine. We compared DSM-IV psychiatric diagnoses across age bands 15–17 years (N = 60), 18–21 years (N = 300) and 22 years and older (N = 2,698). Comparative data by age bands were also obtained for inpatient diagnoses among individuals admitted to general psychiatric hospitals. Results Compared with the adult forensic psychiatric examinees, those aged 15–17 years and 18–21 years had higher rates of depression, and childhood and developmental disorders but lower rates of psychosis, bipolar disorder, and substance use disorders. Compared with general psychiatric inpatients, offenders aged 15–17 years had higher prevalences of depression and attention-deficit or disruptive disorders and lower ones of alcohol and drug misuse disorders. Conclusions There are significant differences in patterns of psychiatric morbidity in adolescent and young adult offenders that come into contact with psychiatric services compared with older offenders and adolescent psychiatric inpatients. This suggests that the development of health services addressing the psychiatric needs of younger offenders needs to draw on information on their specific mental health needs.     

Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective

  Background Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. Method: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. Results: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (β-coefficient 0.257, P=0.000), a house destroyed (β-coefficient 0.148, P=0.001), female sex (β-coefficient 0.139, P=0.001), previous mental health problems (β-coefficient 0.109, P=0.009) and illiteracy (β-coefficient 0.110, P=0.009). Those with previous mental health problems (OR=4.84; 95% CI=3.04–7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR=0.38; 95% CI=0.21–0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI=1.12–4.37) and those with previous mental health problems (OR 2.84; 95% CI=1.12–4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. Conclusion: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention. Accepted: 4 December 2000     

Experiences of Counselors Who Provided Psychological Support during COVID-19 Disaster: A Qualitative Study

Background: In crisis intervention sites such as infectious disease disasters, counselors are repeatedly exposed, directly or indirectly, to the traumatic experiences of victims. Disaster counseling has a negative effect on counselors, which can eventually interfere with the counseling process for disaster victims. Therefore, exploring and understanding the experiences of counselors is necessary to ensure that qualitative counseling for disaster victims can be continuously and efficiently conducted. Objectives: This study investigated the experiences of counselors who participated in mental health counseling as psychological support for victims of the COVID-19 disaster in Korea. Design: This is a qualitative study. Participants: The study participants comprised 18 counselors who had mental health professional qualifications of level 2 or higher and who had provided mental health counseling for COVID-19 confirmed cases and quarantined persons. Methods: Data were collected using focus group interviews from February 21 to May 29, 2021. The duration of each interview was 60–90 min, and the data were analyzed using content analysis. Results: The final theme was “Continuing to walk this road anytime, anywhere.” The participants’ experiences were identified in four sub-themes: “being deployed to unprepared counseling,” “encountering various difficulties,” “feeling full of meaning and value,” and “hoping to become a better counselor.” Conclusions: In order to continuously provide qualitative counseling in case of an infectious disease disaster such as COVID-19, it is important to develop a qualification and competency strengthening program through education and training to secure the crisis intervention expertise of counselors according to the characteristics of the disaster. In addition, a psychological support manual for each disaster should be prepared at the national level according to the type of disaster.     

The Association Between Disaster-Related Experiences and Mental Health Outcomes Among Drug Using African American Hurricane Katrina Evacuees

This article provides a detailed examination of the relationship between disaster-related experiences and mental health outcomes among a sample of drug using African American Hurricane Katrina evacuees. Face-to-face structured interviews were administered to Hurricane Katrina evacuees (n = 350) residing in voucher assisted apartment complexes in Houston, Texas (2006–2007). We use Ordinary Least Squares and logistic regression models to examine both the relevance of disaster-related experiences and the interactive relationships between disaster-related experiences and post-disaster mental health outcomes including psychological distress, severe depression, somatic symptoms, and posttraumatic stress disorder. Results indicate that disaster-related experiences including negative life changes, disaster exposure, post-disaster stressors, and resource loss, have unique, inverse relationships with mental health. While resource loss has the strongest inverse relationship with mental health, disaster exposure has a negative interactive effect on psychological distress and anxiety. Although highly vulnerable populations report low levels of mental health nearly 2 years following a disaster experience, there is a convergence in mental health outcomes with high levels of disaster experiences and disaster exposure that suggests mental resiliency.     

Mental health services for children in the first two years after the 1995 Oklahoma City terrorist bombing.

Nineteen infants and children were killed in the 1995 terrorist bombing in Oklahoma City, and many were injured. More than 200 children lost one or both parents. These casualties focused attention on children in the disaster response efforts. This paper describes the development and implementation of a school-based mental health program that provided accessible services to children affected by the bombing, with an emphasis on normalization. A clinical needs assessment of all children in the Oklahoma City public school system was carried out, and clinicians provided emergency and crisis services, counseling, and support groups.     

The use of mental health services among young adults with emotional and behavioural problems: equal use for equal needs?

Objective  Mental health problems are highly prevalent in young adults. Despite possibilities for effective treatment, only about one-third of young adults with mental health problems seek professional help. Little knowledge exists of which groups of young adults are underusing mental health services and for what reasons. The present study examined socio-demographic inequalities in the use of mental health services by young adults, and examined whether such inequalities were attributable to differences in objective need, subjective need, predisposing or enabling factors. Design  Cross-sectional study among the general population aged 19–32 years (2,258 respondents). A postal survey was administered including questions on socio-demographic factors and mental health service use. Data were analyzed with logistic regression analysis. Setting  South–West Netherlands. Participants  All respondents with serious internalizing and externalizing problems (n = 367). Main outcome measure  Twelve-month primary and specialty mental health services use. Results  Only 34.6% of young adults with psychopathology had used any mental health services: 16.2% had used only primary mental health services and 18.4% had used specialty mental health services. No socio-demographic differences were found in the use of only primary mental health services. However, recipients of specialty mental health services were more often female (OR = 2.12, 95% CI = 1.14–3.96), economically inactive (OR = 3.12, 95% CI = 1.59–6.09) or students (OR = 2.38, 95% CI = 1.05–5.42) and they were less often higher educated (OR = 0.49, 95% CI = 0.25–0.97). The higher odds ratio for specialty service use among young adults who were female or economically inactive attenuated when adjusting for need for care. The other socio-demographic disparities in specialty service use did not attenuate when adjusting for need, enabling or predisposing factors. Conclusion  Among young adults, equal use of specialty mental health services for equal needs has not been achieved. The underserved groups of young adults oppose the traditionally underserved groups in the general population, and may inform interventions aimed at improving young people’s help-seeking behaviours.     

Rates of Occurrence and Influence of Trauma Exposure on Posttraumatic Stress Disorder Symptoms Among Survivors of Terrorist Attacks in Northeast Nigeria

Research has shown that trauma exposure is associated with increased symptoms of posttraumatic stress disorder (PTSD). However, knowledge is sparse on whether there are differential predictions of specific clusters of PTSD symptoms by trauma exposure. We investigated the rate of trauma exposure and prevalence of PTSD as well as the contributions of trauma exposure to severity of four PTSD symptoms clusters among persons who were displaced due to terrorist attacks. Participants were Nigerian internally displaced persons (IDPs, N?=?1059, 54.8% males; mean age?=?34.30 years, SD?=?13.69) who completed Hausa language versions of the Harvard Trauma Questionnaire – Part 1 for measuring trauma exposure and the Posttraumatic Stress Disorder Checklist for DSM-5 for assessing PTSD symptoms. The most frequently reported traumatic stressors were lack of basic needs, losses, maltreatment/torture, and violent deaths. Prevalence of PTSD was high (65.72%). Trauma exposure uniquely and strongly predicted increased PTSD symptoms severity across all the PTSD symptoms clusters by adding more variances above and beyond the demographic factors. Regular provision of relief materials is necessary in IDPs’ camps. Psychological interventions and mental healthcare services should be prioritized in comprehensive management of the displacement crisis resulting from terrorist attacks.

     

Principles and practical procedures for acute psychological first aid training for personnel without mental health experience

Most authorities agree that mass disasters leave in their wake a need for some form of acute mental health services. However, a review of current literature on crisis intervention and disaster mental health reveals differing points of view on the methods that should be employed (Raphael, 1986; NIMH, 2002). Nevertheless, there appears to be virtual universal endorsement, by relevant authorities, of the value of acute "psychological first aid" (American Psychiatric Association, 1954; USDHHS, 2004; Raphael, 1986; NIMH, 2002; Institute of Medicine, 2003; WHO, 2003; DoD/VAPTSD, 2004; Ritchie, et al., 2004; Friedman, Hamblin, Foa, & Charney, 2004). Psychological first aid (PFA), as an acute mental health intervention, seems uniquely applicable to public health settings, the workplace, the military, mass disaster venues, and even the demands of more well circumscribed critical incidents, e.g., dealing with the psychological aftermath of accidents, robberies, suicide, homicide, or community violence. In this document, we shall introduce the notion of psychological first aid (PFA) as one aspect of a psychological continuum of care, offer a rudimentary definition of PFA, and provide the reader with a practicalframework for its implementation utilizing the individual psychological first aid (iPFA)format. The goal of this paper is to better prepare public health, public safety, and other disaster response personnel who do not possess formal clinical mental health degrees or specialized training to provide iPFA services to primary and secondary disaster victims.     

Threshold 3: the feasibility of the Threshold Assessment Grid (TAG) for routine assessment of the severity of mental health problems

Background Evidence-based practice requires the development of measures which are suitable for everyday clinical use (‘feasible’). There is no consensus as to how to establish feasibility. Method The feasibility of a new assessment – the Threshold Assessment Grid (TAG) – for use when making referrals to mental health services was tested by training mental health teams in using the TAG and other standardised assessments, asking referrers to ten mental health services in London also to complete a TAG, surveying TAG users, and evaluating a feedback meeting at which TAG data were presented. Results One hundred and one (61 %) mental health staff received training, and 445 (74 %) referrers of 600 patients completed TAGs. Sixty-five (65 %) questionnaires from TAG users were completed, and 24 (80 %) people attending feedback meetings evaluated the TAG. These allowed the extent to which the TAG is brief, simple, relevant, acceptable, available and valuable to be investigated. Conclusion The TAG exhibited good feasibility when used by mental health staff, and moderate feasibility when used by referrers. This approach can be used to investigate the feasibility of other standardised assessments. Accepted: 5 July 2001     

An Analysis of Relationships Among Peer Support,Psychiatric Hospitalization,and Crisis Stabilization

This study’s objective was to investigate how peer support relates to psychiatric hospitalization and crisis stabilization utilization outcomes. The likelihood of experiencing a psychiatric hospitalization or a crisis stabilization was modeled for consumers using peer support services and a control group of consumers using community mental health services but not peer support with 2003 and 2004 Georgia Medicaid claims data; 2003 and 2004 Mental Health, Developmental Disability, and Addictive Diseases (MHDDAD) Community Information System data; and 2003 and 2004 MHDDAD Hospital Information System data. Peer support was associated with an increased likelihood (odds = 1.345) of crisis stabilization, a decreased but statistically insignificant likelihood (odds = 0.871) of psychiatric hospitalization overall, and a decreased and statistically significant (odds = .766) likelihood of psychiatric hospitalization for those who did not have a crisis stabilization episode.