Bisexual People’s Experiences with Mental Health Services: A Qualitative Investigation

Bisexual people experience minority stress and social isolation as a result of their marginalized sexual identities, and likely due to this stigmatization, previous research has identified high rates of psychological distress, anxiety, depression, suicidality, alcohol misuse, and self-harming behaviour among bisexual populations. It is therefore important that mental health service providers are able to provide culturally competent care to bisexual people. This study used focus groups and interviews with 55 bisexual participants across the province of Ontario, Canada, to investigate their experiences with mental health care. Results suggest that bisexual people have both positive and negative experiences with mental health service providers. Specific provider practices which contribute to the perception of positive and negative experiences with mental heath services are described, and the implications for clinical practice discussed.     

The Influence of Childhood Adversity on Rural Black Men’s Sexual Risk Behavior

Background

Young Black men living in resource-poor rural environments are disproportionately affected by both adverse childhood experiences and HIV/STIs. The influence of childhood adversity on sexual risk behavior remains to be examined among this vulnerable population.

Purpose

In this study, we investigated the influence of overall adversity as well as three subcomponents, abusive parenting, parental neglect, and witnessing family violence, on men’s engagement in sexual risk behavior. We hypothesized that adverse experiences would predict engagement in sexual risk behaviors including multiple sexual partnerships, inconsistent condom use, frequent sexual activity, and concurrent substance abuse and sexual activity. We tested formally the extent to which defensive relational schemas mediated these associations.

Methods

Hypotheses were tested with data from 505 rural Black men (M age?=?20.29, SD?=?1.10) participating in the African American Men’s Health Project. Participants were recruited using respondent-driven sampling. Self-report data were gathered from participants via audio computer-assisted self-interviews.

Results

Bi-factor analyses revealed that, in addition to a common adversity factor, neglect independently predicted sexual risk behavior. Men’s defensive relational schemas partially mediated the influence of the common adversity factor as well as the neglect subcomponent on sexual risk behavior.

Conclusions

The present research identified a potential risk factor for sexual risk behavior in an understudied and vulnerable population. Adverse childhood experiences in general, and neglect in particular, may place many young Black men at risk for engaging in sexual risk behavior due in part to the influence of these experiences on men’s development of relational schemas characterized by defensiveness and mistrust.

     

Mental health and the timing of Men’s retirement

BACKGROUND: Analysis of the Psychiatric Morbidity Survey of Great Britain showed that the prevalence of common mental disorders was lower amongst men at or above Britain's state pension age of 65, relative to younger men. Retirees below this age had consistently higher rates of mental disorders than working men. In contrast, the low prevalence of mental disorders amongst retirees aged 65 and older was similar to that of their working peers. The aim of this analysis was to investigate this pattern of results in a national sample of Australian men, and the mediating role of socio-demographic factors. METHOD: Data were from the Household, Income and Labour Dynamics (HILDA) in Australia survey (2003). The analyses included men aged 45-74 years who were active in the labour force (n = 1309), or retired (n = 635). Mental health was assessed using the mental health scale from the Short-Form 36 Health Questionnaire. RESULTS: Retirees were more likely to have mental health problems than their working peers, however this difference was progressively smaller across age groups. For retirees above, though not below, the age of 55 this difference was explained by poorer physical functioning. When age at retirement was considered it was found that early retirees who were now at or approaching the conventional retirement age did not display the substantially elevated rates of mental health problems seen in their younger counterparts. Further, men who had retired at age 60 or older did not display an initially elevated rate of mental health problems. CONCLUSIONS: The association between retirement and mental health varies across older adulthood. Retired British and Australian men below the conventional retirement age of 65 are more likely to have mental health problems relative to their working peers, and retirees above this age. However, poor mental health appears to be linked to being retired below this age rather than an enduring characteristic of those who retire early.     

High prevalence of mental disorders and comorbidity in the Geneva Gay Men’s Health Study

Background Several large surveys have suggested high prevalence of psychiatric disorders among gay men and other men who have sex with men. Methods In 2002, a comprehensive health survey was conducted among 571 gay men in Geneva, Switzerland, using probability-based time-space sampling. The Composite International Diagnostic Interview Short-Form (CIDI-SF) was used to assess 12-month prevalence of major depression, specific phobia, social phobia, alcohol dependence, and drug dependence. Results Nearly half (43.7%, 95% CI=39.0–48.4) of the sample fulfilled the criteria for at least one of the five DSM-IV disorders: 19.2% had major depression, 21.9% had specific and/or social phobia, and 16.7% had an alcohol and/or drug dependence disorder in the past 12 months. Over one quarter of the cases were comorbid with another kind of disorder, and 35.7% of cases consulted a health care professional in the past 12 months for mental health. Like cases, screen-positives for mood and/or anxiety disorders (24.7%) also reported significantly greater disability and lower quality of life. Conclusions Nearly two-thirds of this community sample of gay men was affected by psychiatric morbidity with new evidence for comorbidity, subthreshold disorders, and low levels of awareness of psychiatric disorders and their treatment. This population needs to be a priority in psychiatric epidemiology and mental public health.     

Getting Them Through the Door: a Survey of Men’s Facilitators for Seeking Mental Health Treatment

International Journal of Mental Health and Addiction -     

Modeling the Decision of Mental Health Providers to Implement Evidence-Based Children’s Mental Health Services: A Discrete Choice Conjoint Experiment

Using an online, cross sectional discrete choice experiment, we modeled the influence of 14 implementation attributes on the intention of 563 providers to adopt hypothetical evidence-based children’s mental health practices (EBPs). Latent class analysis identified two segments. Segment 1 (12%) would complete 100% of initial training online, devote more time to training, make greater changes to their practices, and introduce only minor modifications to EBPs. Segment 2 (88%) preferred fewer changes, more modifications, less training, but more follow-up. Simulations suggest that enhanced supervisor support would increase the percentage of participants choosing the intensive training required to implement EBPs. The dissemination of EBPs needs to consider the views of segments of service providers with differing preferences regarding EBPs and implementation process design.     

Continuity of Care in Children’s Mental Health: Development of a Measure

A new measure, Continuity of Care in Children’s Mental Health (C3MH), is presented. The study involved item generation, pre-testing, pilot testing, and validation. The C3MH was administered to 364 parents recruited from 13 children’s mental health agencies in Ontario, Canada. The measure includes five scales supported by confirmatory factor analysis. Scale validity was supported through analyses of relationships with established measures of satisfaction, problem severity, and therapeutic alliance, as well as through known-group differences. The results of a pilot youth-report version (N = 57) are presented. The C3MH will be a useful tool for assessing improvements in system integration.     

Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children’s Mental Health System: A Pilot Study

Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices. However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements.     

Family Advocacy, Support and Education in Children’s Mental Health: Results of a National Survey

In conjunction with the national survey of mental health service organizations (Schoenwald et al. this issue), a separate but complementary national survey was conducted of family advocacy, support and education organizations (FASEOs). Directors of FASEOs within the same localities as the mental health agencies responded to a survey and provided information in four areas: (1) structure and funding; (2) factors influencing advocacy decisions about children’s mental health; (3) types of services provided by FASEOs and factors perceived as related to improved outcomes; and (4) the types of working relationships between FASEOs and local mental health clinics. Findings from a total of 226 (82% response rate) portray a network of family advocacy, support and education organizations that are strategically poised to effect substantive change and characterized by significant fiscal instability. Results from this survey and implications for delivery of family-based services are provided. The Research Network on Youth Mental Health is a collaborative network funded by the John D. and Catherine T. MacArthur Foundation. Network Members at the time this work was performed included: John Weisz, Ph.D. (Network Director), Bruce Chorpita, Ph.D., Robert Gibbons, Ph.D., Charles Glisson, Ph.D., Evelyn Polk Green, M.A., Kimberly Hoagwood, Ph.D., Peter S. Jensen, M.D., Kelly Kelleher, M.D., John Landsverk, Ph.D., Stephen Mayberg, Ph.D., Jeanne Miranda, Ph.D., Lawrence Palinkas, Ph.D., Sonja Schoenwald, Ph.D.     

Closing the Research to Practice Gap in Children’s Mental Health: Structures, Solutions, and Strategies

Failure to apply research on effective interventions spans all areas of medicine, including children’s mental health services. This article examines the policy, structural, and economic problems in which this gap originates. We identify four steps to close this gap. First, the field should develop scientific measures of the research-practice gap. Second, payors should link incentives to outcomes-based performance measures. Third, providers and others should develop improved understanding and application of effective dissemination and business models. Fourth, efforts to link EBP to clinical practice should span patient/consumers, providers, practices, plans, and purchasers. The paper discusses each of these in turn and relates them to fundamental problems of service delivery.     

Culturally Competent Systems of Care for Children’s Mental Health: Advances and Challenges

There has been a remarkable growth in cultural diversity in the United States over the past 20 years. The population of minority groups has increased at a much faster rate than the European-background population in America, and faster even among children and youth. At the same time, minority youth face increasing disparities in their mental health and in access to mental health services. These are related to the multiple challenges they already face in socioeconomic status, but are aggravated by the lack of culturally competent services that can address their specific mental health needs within the context of their culture, family, and community. This paper reviews the current knowledge about the mental health of culturally diverse youth in the United States, and provides guidance on approaches to address the disparities they face.     

Community Mental Health in the People’s Republic of China: A Critical Analysis

Community mental health has long been the crucial modality in service delivery of mental health services. This paper is an attempt to evaluate community mental health services in the People’s Republic of China. The writer critically argues that community mental health services in the People’s Republic of China still have faced a lot of difficulties such as huge demand but scarce resources, withdrawal of governmental funding in related services, inaccessibility of services to deprived and remote rural areas, political control, high mental health illiteracy and problems in formation of multidisciplinary team. An articulation of community mental health in the China context is also discussed.     

School-Based Screening: A Population-Based Approach to Inform and Monitor Children’s Mental Health Needs

School-based mental health professionals often conduct assessments and provide interventions on an individual basis to students with significant needs. However, due to increasingly limited resources and continuing high levels of need, a shift in service delivery is warranted. Efforts to move school psychological services from reactive and individual, to preventive and universal are ongoing. To further service delivery change, school-based mental health professionals can engage in systematic periodic mental health screening of all children. This article will (a) discuss screening for risk of emotional and behavior problems from a population-based approach, (b) describe how screening data can identify and monitor the needs of students, schools, and communities, and (c) provide future directions for screening practices. As continued changes to service delivery are imminent, information on how to utilize school-based screening data will be particularly valuable to mental health professionals working with or within schools.