Social services day care and health services day care in mental health: do they differ?

BACKGROUND: The difference between the services provided by day hospitals and day centres is far from clear. The supposition that day hospitals would provide an acute service, while day centres would offer social support for a more chronic population has been contentious and there is little evidence of how they are currently used. AIMS: We aimed to ascertain the differences between day hospitals (partial hospitalisation) and social service day centres in functions and roles, as perceived by staff, service users and referrers. METHODS: The views of service users and staff at two day hospitals and four day centres were ascertained through questionnaires and interviews, along with those of staff of eight Community Mental Health Teams, who constitute the sole pathway to the two services. RESULTS: Day hospitals were perceived by both referrers and clients to offer short-term, more intensive 'treatment' to more acutely ill people in need of mental health monitoring. Day centres were perceived to offer longer-term support, particularly social support, to people more likely to have longer-term and psychotic illnesses. CONCLUSION: There is currently a clear distinction between day centres and day hospitals, in key features of their services and client groups. It would be unwise to treat them as interchangeable.     

Elderly people with alcohol-related problems: where do they go?

OBJECTIVE: To investigate how elderly people with alcohol-related problems present to medical services and examine their further management in terms of rehabilitation. DESIGN: Retrospective case-note study. SETTING: South Manchester. PATIENTS: 176 patients aged 60 and over admitted between January 1992 and April 1996 with ICD9 diagnoses of alcohol dependence or alcohol abuse. MEASURES: Medical notes of subjects aged 60 and over with an ICD9 diagnosis of alcohol dependence or abuse were reviewed. Admission episodes by age group and specialty, reason for presentation and follow-up arrangement record were noted. Frequency and specialty of admission were noted for all patients aged 20-95 with the above diagnoses for the above period from PAS (Patient Administration System). RESULTS: One hundred and seventy-six elderly patients (representing 244 episodes) were admitted with a diagnosis of alcohol dependence or abuse. Twenty-nine% of the admissions were to psychiatric services and 71% were to medicine or surgery. Of the 125 admissions where medical records were available, 50% were due to falls. Only 15% were referred on for rehabilitation. In contrast, 1441 patients (2524 episodes) aged 20-59 were admitted over the same period. Seventy-eight% were admitted to a psychiatric ward and 22% to non-psychiatric facilities. CONCLUSION: Alcohol-related problems in the elderly might present as physical problems. Most of these presented as falls and only a small proportion were referred on for rehabilitation.     

Is childhood pain associated with future mental health problems?

Background  Depression is frequently associated with pain, yet the exact nature of this relationship is still not completely understood. Increasingly it is thought that pain and depression may share a common causal pathway that may originate in childhood. Methods  A cross-sectional population-based survey recruited participants aged 18–25 years. Participants were asked about their current and childhood pain experiences. Current levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Results  A total of 858 young adults responded to the questionnaire. Depression was associated with having a family member with pain during childhood (OR 1.50; 95% CI 1.00, 2.26), having more illness than peers during secondary school (1.66; 1.03, 2.67) and having more than three relatives with pain during childhood (OR 2.48; 1.48, 4.15). Adult anxiety was associated with more illness than peers at primary school (1.73; 1.15, 2.61), more ‘emotional’ causes of pain at both primary (1.73; CI 1.13, 2.65) and secondary school (2.06; 1.41, 3.00), and having a family member with pain during childhood (1.39; 1.04, 1.86). Conclusions  This study adds further evidence of an association between pain experiences in childhood and mental health problems in adulthood. Clinicians should be aware of the importance of assessing childhood pain exposures in adult patients with common mental health problems.     

Comprehensive mental health services: who needs them?

In 1980 the agency "Psychosocial Services" was founded in Vienna, Austria to set up and to operate comprehensive outpatient services, with responsibility to the total population of the city of 1.53 millions. Vienna has been divided into eight catchment areas. 11.076 patients have been in contact with the eight outpatient departments until the end of 1984 (0.72% of the total population). Data show high numbers of alcoholic, neurotic and schizophrenic patients. Number of patients indicates a need of some minimum equipment of the city with regionalized outpatient services. 50% of all the patients have never been under inpatient precare when they contact the outpatient departments.     

Adolescents referred to specialty mental health care from local services and adolescents who remain in local treatment: what differs?

Background

The study investigates whether adolescents referred to specialty mental health services from local services differ from adolescents who only have received help for psychiatric problems locally. If so, which factors associate strongest with referral?

Method

Adolescents (n = 76) from an adolescent population sample (N = 2,538) who had received help during the last year for mental problems from local services were compared to a clinical sample of adolescents (N = 129) referred to specialty mental health services from such local services. Comparisons were made according to scores on the Youth Self-Report (YSR); depressive symptoms; family functioning; attachment to parents; self-concept; coping styles; response styles; dysfunctional attitudes; negative life events; daily hassles; socio-demographics.

Results

As compared to adolescents receiving help locally, adolescents in specialty mental health care scored higher on YSR internalising syndrome; YSR attention problems; YSR thought problems; suicidality; psychosocial stressors; knowing someone who had attempted suicide; parental divorce; substance use; recent moves; living in lodgings; lost a pal or boy/girlfriend; and lower on attachment to parents. Multivariate logistic regression analysis identified four factors associated with receiving specialty mental health care: low family functioning; moved previous year; knowing someone who had attempted suicide; own suicidality.

Conclusions

Family functioning as reported by the adolescents, and not mental health problems except for suicidality, was found to be the strongest associated with referral to specialty mental health services. Contrary to findings from many other studies, referral was associated with internalising problems, not externalising ones.     

What do children and young people want from mental health services?

PURPOSE OF REVIEW: The purpose of this paper is to review the literature reporting on children and young people's views on child and adolescent mental health services. RECENT FINDINGS: The review demonstrates that there is limited research exploring the views of children and young people regarding mental health services. Despite its limitations, the research available shows that young people, their parents and healthcare providers often have different expectations of services. Young people want accessible services staffed by those they are able to trust and who demonstrate an ability to listen; above all, young people want to be involved in the decisions made about them. SUMMARY: To date, children and young people have not been actively engaged or involved in service development. This is an evolving field and we need to ensure that existing evidence is taken into account as well as investigating further the views of young people. Child and adolescent mental health services need to consider how we serve young people, particularly children, whose perspectives may differ from those of their parents.     

Meeting the millennium development goals in Sub-saharan Africa: what about mental health?

Mental health is a crucial public health and development issue in sub-Saharan Africa (SSA), a region where little progress has been made towards achieving the Millennium Development Goals (MDGs). In this paper we argue that not only will limited progress in achieving these targets have a significant impact on mental health, but it will be impossible to achieve some of these aspirations in the absence of addressing mental health concerns. We consider the strong relationship of mental health with dimensions of human development represented in the MDGs, including reducing poverty, achieving universal primary education, decreasing child mortality rates, improving maternal health, HIV, environmental factors and improving the lives of those living in informal settlements. With these links in mind, we examine the mental health context in SSA settings and provide some specific examples of best practice for addressing mental health and the MDGs. It is recommended that the role of mental health interventions in accelerating the realization of the MDGs is investigated; further efforts are dedicated to probing the impact of different development projects upon mental health outcomes, and that mental health is declared a global development priority for the remainder of the MDG period and beyond.     

The mental health benefits of work: do they apply to poor single mothers?

Background  

The relationship between employment and improved mental health is well documented. However, no research has examined whether this relationship applies to poor single mothers. Given recent changes in the labor market where poor women are disproportionately employed in unstable jobs, the competing demands of work and childcare may operate to prevent poor women from reaping the mental health benefits of employment. Understanding these connections has become more salient not just for mental health epidemiology but for policies targeting employment and poverty.     

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.     

Progressive changes in schizophrenia: do they exist and what do they mean?

Schizophrenia is a disorder characterized by multiple symptoms, with a varied course and outcome. The etiology is yet unknown, but multiple pathological processes or, equally likely, a unique pathophysiological process, may be involved. Here, we review evidence for progressive changes in schizophrenia in order to understand further the pathophysiology of this disorder. We first present evidence for clinical and psycho-social changes over time, followed by evidence from structural brain studies that suggests that schizophrenia is a brain disorder. We then review findings from the small number of longitudinal studies that have evaluated structural brain changes in schizophrenia, followed by a review of the evidence for neurophysiological changes, both cross-sectional and longitudinal. This is followed by a discussion of possible cellular mechanisms, including NMDA receptor abnormalities, that might account for structural and functional brain changes (temporal and frontal), and we discuss how these abnormalities might be related to not only the specific signs and symptoms of schizophrenia but also to the onset and course of the illness. Finally, we discuss neurodevelopment (static and perhaps non-static alterations) and neurodegenerative theories of schizophrenia. We propose that the two are not mutually exclusive, but instead likely reflect a "two-hit" model for some subtypes of schizophrenia.     

Improved investment in mental health services: value for money?

BACKGROUND: This paper examines what has been achieved in the specialist mental health services by the vastly increased health expenditures that the National Health Service (NHS) has enjoyed in the past 5 years. AIMS: To describe the way money has been spent in specialist mental health services and examine why problems remain after such admirable changes to already available resources. METHOD: Changes in staff employed by mental health services, where the extra staff are deployed, and patterns of expenditure within the whole service and within community mental health teams are examined. RESULTS: Some of the new expenditure has been well spent, and has produced improvements in the service. However, one must also take account of the costs of the greatly increased numbers of managers, who impose two sorts of costs: that of their own salaries, and the opportunity costs of front-line staff having to attend meetings and write reports rather than seeing patients. Throughout the rest of the NHS, money has been wasted on needless reorganisations, on consultant and general practitioner contracts, and on information technology that has so far failed to deliver tangible advantages. CONCLUSIONS: The emphasis on central control undermines local initiatives and wastes resources. Some central control is inevitable, but policies need to be developed in collaboration with clinicians. At local level, expenditure by primary care trusts and mental health trusts also needs to be scrutinised by committees that should include representatives of front-line mental health staff.     

Sexuality and mental health: Issues and what next?

Abstract

Human sexuality plays a major role in an individual's existence and functioning. In addition, rightly or wrongly sexuality often defines people and also affects social attitudes. These attitudes, if negative, can contribute to stigma and prevent people from help seeking if they are suffering from mental health problems. Recent changes in policy towards same-sex relationships have been positive in many countries including the UK and the USA, whereas in others such as Russia and Uganda attitudes have become more negative and punitive. Sexual activity is seen as having both pleasurable and procreational functions which contribute to society's attitudes to homosexual behaviour. Inevitably, individual responses to their own sexuality and sexual behaviour will be influenced by social attitudes. To ensure that those with various sexual variations can access psychiatric services without discrimination, various levels of interventions are needed. Here we discuss different levels of intervention and organizational change that may make it possible. Social organization and institutional organization of services need to be sensitive, especially as rates of many mental disorders are high in individuals who may be sexually variant. Those providing services need to understand their own negative attitudes as well as prejudices to ensure that services are emotionally accessible.     

Adolescents initiating cannabis use: cultural opposition or poor mental health?

In Norway, the use of cannabis was introduced by a resourceful group of oppositional middle-class adolescents in the late 1960s. At the beginning of the 1970s there were, however, signs of a change in the recruitment of the users: youths in trouble from lower social levels gradually started to use the drug. In a prospective longitudinal study of 1311 Norwegian pupils aged 13-19, the possible links between normative and political opposition, mental health and the use of cannabis were investigated. The findings indicate that the group that experiments with cannabis, and use the drugs a few times, is still mainly characterized by a political and normative "oppositional" engagement. Heavy users of cannabis, however, also have family problems and suffer from poor mental health. Thus, the study draws attention to the importance of distinguishing between two different clusters of longitudinal predictors for adolescent cannabis use: the first consists of subcultural opposition and certain personality traits, and seems to predict the earlier stages of use. The second consists of psychosocial problems and poor mental health. From this study one may not conclude that this second cluster predicts heavy cannabis involvement. We have, however, shown that it correlates with heavy involvement, cross-sectionally.