Mental health and substance abuse services in HMOs

Managed Care, in health services in general and in mental health in particular, is the latest building block presented as necessary for the development of an organized human services system. HMOs represent the fastest growing element in such systems. This paper attempts to collate the latest information available as to how mental health and substance abuse care is being designed and provided in HMOs.Portions of this article have been taken from Managed Health Care Handbook, ed.: P.R. Kongstvedt, Aspen Publishers, Inc., 1988.     

Behavior problems in sons and daughters of substance abusing parents

Information to address the question of whether sex specific features exist in behavioral characteristics of children of substance abusing parents was gathered from the records of a large number of hospital treated youth. There was a trend for sons of substance abusing parents to have more conduct disorder diagnoses in association with severe aggressive/destructive behavior than sons of non substance abusing parents. Girls of substance abusing parents generally were more likely to have attention deficit/hyperactive, aggressive and conduct disorder problems than girls of non substance abusing parents.     

Mental health and substance abuse services for adolescents: Clinical and service system issues

This paper addresses changes in the prevalence, type, and severity of problems being presented by adolescents, and the familial, social, and cultural supports and context for adolescent behavior. Also described are the types of clinical training, financing, service system, and research supports that must be addressed if the field is to adequately meet the needs of adolescents with serious and persistent problems.This paper seeks to identify critical clinical and service system issues needing to be addressed if mental health and substance abuse services are to effectively meet the needs of adolescents and their families. It is one of four papers commissioned by the Task Force on Mental Health and Substance Abuse Services for Adolescents of the American College of Mental Health Administrators.The paper will not only identify important issues but, in a concluding section, will offer some general recommendations for addressing them. The paper is not intended to be a thorough and scholarly review of the current state of knowledge in the field but rather a selective highlighting of topics in order to provoke further discussion.The issues identified are based on the projection of developments with regard to professional practice. They also take into consideration general social and demographic trends, and the impact that these trends are likely to have both on the type of clinical needs and prevalence of problems in the future.The paper will focus both on clinical and service system issues because of their close interrelationship. It will also address the public, private not-for-profit, and private for-profit sectors, and the relationship between them in the belief that each sector has a vital role to play in meeting the mental health and substance abuse needs of adolescents.     

Mental health services in the health accounts: the Czech Republic

Background  

Policy makers as well as health services researchers lack information on financial flows within national mental health systems. The studies that are available use different methodologies and hence it is difficult to make any comparisons. The aim of this study was to modify the existing health accounting framework and apply it to describe and analyse the financial flows within a national mental health system.     

Mental health and use of health care services in opioid-exposed school-aged children compared to foster children

Given the concerns raised regarding the effects of prenatal exposure to methadone and buprenorphine on the developmental outcomes of the children, this study assessed mental health and use of services in a national sample of school-aged children (N = 78) born to women enrolled in opioid maintenance treatment during pregnancy, compared with a group of foster children (N = 140). The majority of the opioid-exposed children lived with their birth parent(s) at the time of assessment (N = 62), while 16 lived in foster homes. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and the Reactive Attachment Disorder scale. Teachers completed the SDQ. Three kinds of services were included in measuring service use: school-based education services, child mental health services, and hospital-based habilitation services. The main finding of the study is that children prenatally exposed to methadone or buprenorphine living with their family of origin had significantly better mental health status than their foster-placed counterparts and that of the comparison group of foster children. In addition, the exposed children living at home had less child welfare involvement, and only half of them were using any of the three services measured. The odds for using services increased significantly in accordance with increasing mental health problems, independent of group affiliation, indicating a need-based access to services. In line with other studies, we found that the odds for using one or more services was 2.3 times greater for boys than for girls. Our results contribute to a more-nuanced understanding of the developmental outcomes of prenatal exposure to methadone and buprenorphine, and factors associated with increased service use in groups of at-risk children.

     

Two-year predictors of runaway and homeless episodes following shelter services among substance abusing adolescents

Given high levels of health and psychological costs associated with the family disruption of homelessness, identifying predictors of runaway and homeless episodes is an important goal. The current study followed 179 substance abusing, shelter-recruited adolescents who participated in a randomized clinical trial. Predictors of runaway and homeless episodes were examined over a two year period. Results from the hierarchical linear modeling analysis showed that family cohesion and substance use, but not family conflict or depressive symptoms, delinquency, or school enrollment predicted future runaway and homeless episodes. Findings suggest that increasing family support, care and connection and reducing substance use are important targets of intervention efforts in preventing future runaway and homeless episodes amongst a high risk sample of adolescents.     

Need for and use of mental health services among parents of children in the head start program

This study examined the prevalence of psychosocial difficulties and use of mental health services among 290 parents of children in the Head Start program. Data on demographic characteristics, child behavior problems, parents' difficulties, home environment, child behavior, and use of health services were collected. A total of 161 parents (56 percent) had identifiable psychosocial difficulties, and 41 (14 percent) reported use of mental health services in the previous 12 months. Child behavior problems, unmet need for mental and physical health services, and less optimal home environments were associated with parents' psychosocial difficulties. Parents who had an unmet need for mental health services were more likely to report behavior problems among their children.     

Mental health services for children in public care and other vulnerable groups: implications for international collaboration

Children in public care and other vulnerable young groups (homeless, adopted, refugees) are increasingly becoming the focus of policy and service planning. There is strong evidence that all these client populations have high rates of mental health problems which are closely associated with other needs. We also have good knowledge on the factors that predispose individuals to and maintain mental health problems, as well as on the reasons for their not easily accessing and engaging with services. There is less evidence on the effectiveness of interventions or service models, although some interesting patterns are beginning to emerge. These include the need for inter-agency commissioning, clear care pathways, designated provision, applied therapeutic interventions, training for carers and frontline practitioners, and multi modal programmes. This paper discusses these issues, as well as ways forward, both for systems with relatively well developed child mental health services and for low-income countries. Service quality can be greatly strengthened by international collaboration on policy, practice and research networks, training and research.     

Mental health services for rural elderly: Innovative service strategies

This paper reviews issues in planning and delivering mental health services to rural dwelling elderly. First, comparative data on the prevalence of mental illness among rural elderly, and the availability and accessibility of mental health services in rural areas are presented to provide a basis for subsequent discussion. Next, several strategies for improving the development and delivery of geriatric mental health services to rural areas are discussed. These include: increasing the number and quality of rural mental health providers; adapting or developing diagnostic techniques to improve case identification among rural elderly; providing culturally sensitive mental health services; strengthening informal and formal care linkages in rural communities; developing innovative service delivery models building upon the strengths of rural settings; and emphasizing fluidity as well as continuity in treatment models.     

Mental health services for American Indians and Eskimos

Past and present mental health services for American Indians and Eskimos are surveyed and found to be inadequate. A plan is outlined for the development of such services based upon a cooperative rather than a paternalistic venture with these minority groups. The plan is based upon the use of indigenous therapists for individual and group psychotherapy, the modification of etiological beliefs, and an emphasis upon primary prevention. The Alaskan Eskimo is used to illustrate how these principles could be put into effect. The outcome would be a system of mental health services specifically adapted to the culture, realistically commensurate with available manpower, and compatible with dignity for the group.     

Mental health services in the Solomon Islands

The Solomon Islands comprise an archipelago of nearly 1,000 islands and coral atolls and have an estimated population of 549,574 people. Formal mental health services date back to 1950 when an asylum was established. Since then the process of mental health service development has been largely one of incremental change, with a major boost to community services in the last two decades. During the 1990s a mental health outpatient clinic was established in Honiara, together with attempts to recruit nursing staff as psychiatric coordinators in the provinces. In 1996, the Ministry commenced sending registered nurses for psychiatric training in Papua New Guinea. By 2010, there were 13 psychiatric nurses and one psychiatrist, with a second psychiatrist in training. A National Mental Health Policy was drafted in 2009 but is yet to be endorsed by Cabinet. A significant portion of the population still turns to traditional healers or church leaders for purposes of healing, seeking help from Western medicine only after all other alternatives in the community have been exhausted. There is still a long way to go before mental health services are available, affordable and accessible to the whole population, including people living in geographically remote areas. Realization of this vision requires increased resourcing for mental health services; improved communication and collaboration between the centrally‐based, national mental health services and the provincial health services; and closer, ongoing relationships between all stakeholders and partners, both locally and internationally.