Child psychiatry in Bombay: the school mental health clinic

The school mental health clinic is an unusual amalgamation of the mental health and education sectors in Bombay. It aims to detect emotional problems in schoolchildren, increase mental health awareness in teachers and other professionals and determine any risk or causal factors in schoolchildren suffering from mental health problems. It also offers cross-cultural research opportunities.     

Clinical mental health training within a multidisciplinary school-based health clinic

A model is presented to illustrate a clinical mental health training program within a multidisciplinary School-Based Health Clinic (SBHC). In collaboration with schools of education, medicine, nursing, and social work, a multidisciplinary training and treatment program was established that provided unique opportunities for clinical training. An ecological/public health model was utilized as the conceptual framework for clinical mental health training, treatment, and research. Preliminary clinical outcome data suggest that out of a sample of 381 patients, 15% of those utilizing the SBHC's mental health services were being treated for substance abuse disorders. This finding supports current research that has demonstrated that the SBHCs are providing access to students who are in the most serious need to mental health services. Process data suggest that the SBHC is an effective site for multidisciplinary clinical mental health training.     

Reduced list costings: Examination of an informed short cut in mental health research

The demands for cost information in health services are many and various but the supply of such information is less than might be expected and is compounded by the expense of undertaking costs research. This paper examines a short cut to mental health research which, if certain rules and conventions are obeyed, can still produce valid costs data. By distilling evidence from previous research a reduced list of services is identified which accounts for the greater part of the total costs of care packages. By concentrating on these key services, 94 per cent of the total costs of care were predicted for discharged long-stay patients and no less than 91 per cent for people supported by community psychiatric nurses. The results suggest that this reduced list method can work well where the aim is to obtain broad orders of magnitude for the costs of care. By reducing the resources required for research, the approach could expand the current costs information base and move towards meeting the pressing practice demands for costs data.     

Inequalities in mental health in the working population.

Objectives: To analyze inequalities in mental health in the working population by gender and professional qualifications and to identify psychosocial risk factors and employment conditions related to the mental health of this population. Methods: We performed a cross-sectional study using data from the Barcelona Health Survey 2000. The working population aged 16-64 years (2322 men and 1836 women) was included. Mental health was measured with the General Health Questionnaire (GHQ-12). Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated by means of multivariate logistic regression models separated by job qualifications and gender. Results: The prevalence of poor mental health ranged from 8% among men working in non-manual occupations to 19% in women working in manual jobs. Women were more likely to report poor mental health status than men, although sex differences were greater among manual workers (aOR = 2.26; 95%CI, 1.68-3.05 for women compared to men in the same group). Differences according to qualifications were found among women only (aOR = 1.58 [95%CI, 1.22-2.05] for women working in manual jobs compared to those working in non-manual jobs), while no differences were found among men according to qualifications. Psychosocial risk factors were associated with mental health: demand was associated in all groups, autonomy only in non-manual occupations, and social support only in the most highly qualified working women. Employment conditions such as working a split shift (working day with a long lunch break) or having a temporary contract were associated with mental health in manual occupations only. Conclusions: Mental health among the working population is related to professional qualifications and gender. Women are at greater risk than men, especially those working in manual occupations. Psychosocial occupational factors are related to mental health status, showing different patterns depending on gender and professional qualifications.     

A population health framework for inner-city mental health

Dealing with mental health problems in the inner city presents a major challenge to planners and service providers. Traditional mental health service-oriented interventions often prove ineffective due to the complexity of individual's needs. This article argues that a population health framework can be used to identify critical risk and protective factors and facilitate more effective, upstream, population-based interventions for mental health problems in the inner city. A community report card is seen as a useful measure of key indicators at any point in time and of changes over time at the community or neighborhood level. A number of issues with regard to report card development are identified and discussed, as is the process of creating a report card, including key domains and the organization of findings.     

Adherence to mental health treatment in a primary care clinic

BACKGROUND: Patient nonadherence is common for the standard mental health treatments in primary care: antidepressants and referrals to specialty mental health treatment. This is one of few studies to prospectively identify predictors of nonadherence. METHODS: We observed 95 veterans attending an internal medicine clinic prescribed antidepressant medication or referred to mental health treatment. We collected information on sociodemographic factors, health beliefs, preferences about treatment, past experiences, and treatment knowledge. RESULTS: At 1 month, medication adherence was greater when patients experienced previous pharmacy trouble and traveled for less than 30 minutes to reach the clinic. Appointment attendance improved when patients were ready for treatment, perceived benefits, and saw their physician as collaborative. At 6 months, medication adherence was greater when patients reported a preference for medicine treatment, traveled for less than 30 minutes, and perceived greater benefits. Fewer negative effects from previous mental health treatment improved adherence to appointments. In multivariate analyses examining adherence to all treatments, greater readiness for treatment predicted 1-month adherence, whereas being unmarried and seeing the physician as more collaborative improved 6-month adherence. CONCLUSIONS: Adherence to antidepressant medications and to mental health referrals should be examined separately. A brief initial assessment for nonadherence risk factors may identify persons for targeted adherence promoting interventions.