Mental Hygiene in Industry†

Objective: Approximately 30 million Americans present to acute care medical settings annually after incurring traumatic injuries. Posttraumatic stress disorder (PTSD) and depressive symptoms are endemic among injury survivors. Our article is a replication and extension of a previous report documenting a pattern of multiple traumatic life events across patients admitted to Level I trauma centers for an alcohol-related injury. Method: This study is a secondary analysis of a nationwide 20-site randomized trial of an alcohol brief intervention with 660 traumatically injured inpatients. Pre-injury trauma history was assessed using the National Comorbidity Survey trauma history screen at the six-month time point. Results: Most common traumatic events experienced by our population of alcohol-positive trauma survivors were having had someone close unexpectedly die, followed by having seen someone badly beaten or injured. Of particular note, there is high reported prevalence of rape/sexual assault, and childhood abuse and neglect among physically injured trauma survivors. Additional trauma histories are increasingly common among alcohol-positive patients admitted for a traumatic injury. Conclusions: Due to the high rate of experienced multiple traumatic events among acutely injured inpatients, the trauma history screen could be productively integrated into screening and brief intervention procedures developed for acute care settings.     

Do Current Measures of Polygenic Risk for Mental Disorders Contribute to Population Variance in Mental Health?

The polygenic risk score (PRS) allows for quantification of the relative contributions of genes and environment in population-based studies of mental health. We analyzed the impact of transdiagnostic schizophrenia PRS and measures of familial and environmental risk on the level of and change in general mental health (Short-Form-36 mental health) in the Netherlands Mental Health Survey and Incidence Study-2 general population sample, interviewed 4 times over a period of 9 years, yielding 8901 observations in 2380 individuals. Schizophrenia PRS, family history, somatic pain, and a range of environmental risks and social circumstances were included in the regression model of level of and change in mental health. We calculated the relative contribution of each (group of) risk factor(s) to the variance in (change in) mental health. In the combined model, familial and environmental factors explained around 17% of the variance in mental health, of which around 5% was explained by age and sex, 30% by social circumstances, 16% by pain, 22% by environmental risk factors, 24% by family history, and 3% by PRS for schizophrenia (PRS-SZ). Results were similar, but attenuated, for the model of mental health change over time. Childhood trauma and gap between actual and desired social status explained most of the variance. PRS for bipolar disorder, cross-disorder, and depression explained less variance in mental health than PRS-SZ. Polygenic risk for mental suffering, derived from significance-testing in massive samples, lacks impact in analyses focusing on prediction in a general population epidemiological setting. Social-environmental circumstances, particularly childhood trauma and perceived status gap, drive most of the attributable variation in population mental health.     

What is a Mental Health Clinic? How to ask Parents about Help-seeking Contacts Within the Mental Health System

We compared parents' endorsement of having contacted a "mental health clinic or agency" when seeking help for their child, with parents' recognition of having contacted specific, named mental health agencies in their geographic region. Data were from two studies involving parents of children and adolescents seeking mental health services. Across the two studies, only 28 and 41% of parents reported having contacted a "mental health agency," but 100% reported contact when asked about specific agencies by name. Incorporating this simple modification in future studies could provide more accurate documentation of help-seeking for, and utilization of, children's mental health services.     

Juvenile Probation Officers’ Mental Health Decision Making

We reviewed case records for 583 juvenile delinquency intakes in four county juvenile probation offices; 14.4% were receiving mental health or substance use services at case opening, and 24.9% were newly identified during probation contact. Youths were significantly more likely to be newly identified if they were repeat offenders, if their probation officer knew more about mental health and if they resided in a county without a shortage of available mental health professionals. Probation officers were especially likely to underidentify internalizing disorders. Policy implications for promoting identification of mental health needs and improving linkage to community service providers are discussed.     

Mental health practice: can philosophy help?

Traditionally, philosophy has been regarded as operating at a level above practical application. However, the discipline can offer mental health policy and practice some valuable aid. First, its logical rigour can help to clarify concepts and expose inconsistency and prejudice; second, its wealth of theory about morality can enrich the concepts that guide mental health practice. By avoiding simplistic solutions (such as reliance on the 'four principles' of biomedical ethics) those who turn to the discipline of philosophy may learn how to be more critical of accepted policies and practices.     

Modernizing Mental Health Services: Mission Impossible?

Managing complex change initiatives can be a risky and controversial task. Hargrove and Glidew's (1990) model of impossible jobs defines typical obstacles: constituency conflict, perceptions of client legitimacy, respect for professional authority, and the strength of the agency myth. The author uses this model to describe his experiences while implementing major changes within British Columbia's community mental health system and provincial psychiatric hospital. Coping strategies include coalition building, public education, meaningful stakeholder participation, systemic feedback, mutual aid, and staff development.     

Community Mental Health Center Visits and Community Mobility of People with Serious Mental Illnesses: A Facilitator or Constraint?

Mental health services and interventions have increasingly focused on the importance of community participation and mobility for people with serious mental illnesses (SMI). This study examined the role that visits to community mental health centers (CMHCs) may play in increasing community mobility of people with SMI. Eighty-nine adults with SMI receiving services at three CMHCS were tracked with GPS-enabled phones over a 13-day period. Findings revealed that participants visited more destinations on days they went to a CMHC compared to days they did not. They also spent more time out of the home and traveled greater distances. Results suggest that the benefits of visiting a mental health center appear to go beyond treatment outcomes, but also point to the possibility that obligations, whether to a clinic appointment or possibly vocational, educational, leisure, faith, or social commitments, may be an important stepping stone to more mobility and intentional, sustained community participation.

     

Attitudes and Perceived Barriers to Working with Families of Persons with Severe Mental Illness: Mental Health Professionals’ Perspectives

A state-wide survey of 453 clinicians serving people with severe mental illness in community mental health centers evaluated the degree to which they provide services to families and their perceptions of barriers to developing such services. Most clinicians did not provide many services to families and reported barriers related to the family or client (e.g., family’s lack of interest) and their own work environment (e.g., heavy workload). Clinicians who had received prior training on working with families provided more services, had more positive attitudes toward family, and felt more competent about their knowledge, confirming the importance of staff training.     

Antonovsky Revisited – Implications for Mental Health Promotion Practice

The paper assesses the validity of Antonovsky's (1996) assertion that health promotion should use the salutogenic model of health to guide practice, by drawing on the results of an evaluation of a supported further education programme for people with long-term mental health needs. Three consecutive cohorts of further education (FE) students with a long-term mental health diagnosis were assessed before and after participation, using Antonovsky's (1987) short form Sense of Coherence questionnaire (SOC-13). Students with SOC13 scores 52 and above at entry showed no significant change. However, students with entry SOC13 scores below 52 made statistically significant positive gains in their exit scores. A causation model was developed from qualitative evidence from students’ accounts of participation in the programme. The results of short questionnaires provided numerical data for building a model of the relationships between the themes and SOC13 scores. The model suggests that peer support is an important factor in the success of the programme and that the activity of learning reduced symptoms and raised positive affect. The results of this study support the value of Antonovsky's salutogenic health perspective for mental health promotion staff and allied professionals, and highlight the need for mental health professionals to pay attention to the pathogenic and salutogenic paradigms for understanding the health needs of people with long-term mental health needs.     

Mental Health Consultation Among Ontario’s Immigrant Populations

To determine the prevalence rates and characteristics of past-year mental health consultation for Ontario’s adult (18?+?years old) immigrant populations. The Canadian Community Health Survey (CCHS) 2012 was used to calculate the prevalence rates of past-year mental health consultation by service provider type. Characteristics associated with mental health consultation were determined by carrying out multivariable logistic regression analysis on merged CCHS 2008–2012 data. Adult immigrant populations in Ontario (n?=?3995) had lower estimated prevalence rates of past-year mental health consultation across all service provider types compared to Canadian-born populations (n?=?14,644). Amongst those who reported past-year mental health consultation, 57.89% of Ontario immigrants contacted their primary care physician, which was significantly higher than the proportion who consulted their family doctor from Canadian-born populations (45.31%). The factors of gender, age, racial/ethnic background, education level, working status, food insecurity status, self-perceived health status, smoking status, alcohol drinking status, years since immigration, and age at time of immigration were significantly associated with past-year mental health consultation for immigrant populations. Ontario’s adult immigrant populations most commonly consult their family doctor for mental health care. Potential exists for expanding the mental health care role of primary care physicians as well as efforts to increase accessibility of specialized mental health services. Integrated, coordinated care where primary care physicians, specialized mental health professionals, social workers, and community educators, etc. working together in a sort of “one-stop-shop” may be the most effective way to mitigate gaps in the mental health care system. In order to effectively tailor mental health policy, programming, and promotion to suit the needs of immigrant populations initiatives that focus on the connection between physical and mental health and migration variables such as length of stay in Canada, years since immigration, and other important migration variables (beyond the scope of the CCHS which require further study) need to be developed. Examination of the social determinants of mental health is critical to understand how we can best serve the mental health needs of Ontario’s immigrant populations.     

Laypersons’ Choices and Deliberations for Mental Health Coverage

Insurance coverage for mental health services has historically lagged behind other types of health services. We used a simulation exercise in which groups of laypersons deliberate about healthcare tradeoffs. Groups deciding for their “community” were more likely to select mental health coverage than individuals. Individual prioritization of mental health coverage, however, increased after group discussion. Participants discussed: value, cost and perceived need for mental health coverage, moral hazard and community benefit. A deliberative exercise in priority-setting led a significant proportion of persons to reconsider decisions about coverage for mental health services. Deliberations illustrated public-spiritedness, stigma and significant polarity of views.     

Why Is Better Mental Health Care So Elusive?

PURPOSE. There are numerous barriers to improving healthcare delivery. This article summarizes contemporary theories and research evidence to focus on ways to motivate change within the hospital system to provide better health care. CONCLUSIONS. Understanding multidisciplinary team processes, recognizing hospitals as systems, and ascertaining the unit culture is a prerequisite for leaders and policy makers to improve mental health practices. PRACTICE IMPLICATIONS. Finding ways to deliver better health care to people with a mental illness is a high priority, and nurses have a central role to play in this pursuit of excellence.