Do faith-based residential care services affect the religious faith and clinical outcomes of homeless veterans?

Data on 1,271 clients in three residential care services funded by the Department of Veterans Affairs was used to examine: (1) how religious-oriented programs differ in their social environment from secular programs, (2) how religious-oriented programs affect the religiosity of clients, and (3) how client religiosity is associated with outcomes. Programs were categorized as: secular, secular now but religious in the past, and currently religiously oriented. Results showed (1) participants in programs that were currently religious reported the greatest program clarity, but secular services reported the most supportive environments; (2) participants in programs that were currently religious did not report increases in religious faith or religious participation over time; nevertheless (3) greater religious participation was associated with greater improvement in housing, mental health, substance abuse, and quality of life. These findings suggest religious-oriented programs have little influence on clients' religious faith, but more religiously oriented clients have somewhat superior outcomes.     

Racial Comparison of Therapeutic Support, Service Use, and Satisfaction Among Male Outpatients with Severe Mental Illness

This study examined racial differences among male outpatients with severe mental illness on therapeutic support, mental health service utilization, and service satisfaction. A total of 530 participants (289 White, 179 Black, and 62 of another race) across three large mental health centers (two state funded and one federally funded) in Connecticut were examined cross-sectionally. No racial differences were found in therapeutic support, and there were essentially no racial differences in service satisfaction. Black clients reported greater use of substance abuse inpatient services than White clients and clients of other racial minorities reported greater use of mental health inpatient services than White clients, but differences were small. These findings suggest there are few racial differences in the reported quality of mental health care and service utilization among male outpatients with severe mental illness. More research is needed on where and under what circumstances health disparities exist.     

Longitudinal Association of Therapeutic Alliance and Clinical Outcomes in Supported Housing for Chronically Homeless Adults

General psychotherapy research has underscored the importance of the therapeutic alliance in client outcomes. This study examined the association between therapeutic alliance and client outcomes specifically between chronically homeless clients in a supported housing program and their case managers. Using data from a federal supported housing initiative, participants were categorized into those who rated their therapeutic alliance with case managers at 3 months as relatively high (top 75th percentile; n = 123), relatively low (bottom 25th percentile; n = 128), or did not identify any primary mental health provider at 3 months (n = 205). Controlling for baseline differences, there were no group differences on any outcomes, except that participants who rated high therapeutic alliance at 3 months reported the highest subjective quality of life and perceived social support. Client outcomes in supported housing may rely more on practical assistance and access to other services than the quality of the therapeutic relationship with their primary mental health provider.     

Community-Based Mental Health Service Utilization Among Low-Income Latina Immigrants

Latina immigrants may be at increased risk for mental illnesses, but have less access to and seek mental health services less often than Black and White counterparts. Guided by the Andersen Behavioral Model of service utilization, the current study employed a medical chart review to elucidate factors associated with use of mental health services at a community health center. Of the clients referred for mental health services, only 36% followed through on the referral. Older age, use of case management services, and depressive symptomatology were predictors of attending mental health services. These findings have implications for community health and mental health providers.     

Correlates of religious service attendance and contact with religious leaders among persons with co-occurring serious mental illness and type 2 diabetes

The purpose of this study was to examine the prevalence and correlates of religious participation among persons with co-occurring serious mental illness and type 2 diabetes. Among 201 outpatients, 53% attended religious services, 36% had regular contact with a religious leader, and 15% received assistance from a religious leader. Persons with schizophrenia and African Americans were more likely to attend services and have contact with religious leaders. Both attendance at religious services and regular contact with a religious leader were linked to higher quality of life in selected domains, but not associated with global health ratings or glycosylated hemoglobin (HbA1c) levels. Results indicate that there are important diagnostic and racial differences in religious participation, and that religious participation may be a resilience factor that supports enhanced quality of life for persons with serious mental illness and diabetes.     

Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation

Background Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London. Method A two‐round Delphi process was utilised. White British and Black or Black British service users from a specialist community‐based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale. Results Twenty‐four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication. Conclusions People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.     

States' strategies for promoting supported housing for persons with psychiatric disabilities.

Survey data were used to analyze state government efforts to promote supported housing for persons with psychiatric disabilities in five states--Ohio, Oregon, Rhode Island, Washington, and Wisconsin. States worked to increase mental health service consumers' access to affordable housing by increasing the number of state staff who address housing issues, by developing housing units, and by increasing consumers' income. Legislative mandates and financial incentives were used to encourage service providers to offer more flexible support services. States promoted consumers' involvement in the mental health system by encouraging their participation in state-level decision making and by providing financial support to consumer organizations.     

The role of ethnicity in clinical psychopathology and care pathways of adults with intellectual disabilities

The objective of this study was to explore whether people with intellectual disability from ethnic minority groups have higher rates of mental health problems and access different care pathways than their White counterparts. Clinical and socio-demographic data were collected for 806 consecutive new referrals to a specialist mental health service for people with intellectual disabilities in South London. Referrals were grouped according to their ethnic origin. The analyses showed that there was an over-representation of referrals from ethnic minority groups with diagnoses of schizophrenia spectrum disorder. In addition, Black participants were more likely to have an autistic spectrum disorder. Referrals of ethnic minority groups were considerably younger than White referrals, and less likely to be in supported residences. The results are discussed in the context of cultural and familial factors in particular ethnic groups that may play an important role in accessing and using mental health services.     

Hispanic client-case manager matching: differences in outcomes and service use in a program for homeless persons with severe mental illness

Mental health professionals have responded to ethnic and racial disparities in mental health care by advocating increasing cultural relevancy in treatment. A central component of cultural relevancy is ethnic and racial pairing of clients and providers. This study examined the effects of client-case manager ethnic and racial matching among white and Hispanic clients who received assertive community treatment in the Access to Community Care and Effective Services and Supports Program. Twelve-month outcomes and service use were examined among 242 Hispanic and 2333 white clients seen in the first 3 years of the program. Analysis of covariance was used to evaluate the association of client-case manager ethnic and racial matching with changes in health status and service use from baseline to 12 months after program entry. At baseline, Hispanics had more serious problems than whites on several measures of psychiatric and substance abuse domains, and they also showed less improvement than whites over the next year on several measures of psychiatric status and service use. One significant association with ethnic matching was found: when treated by a Hispanic clinician, Hispanic clients showed less improvement in symptoms of psychosis. These results do not support the hypothesis that ethnic and racial matching improves outcomes or service use. Several explanations are offered for the results.     

Brief reports: Unequal treatment: mental health care for sexual and gender minority groups in a rural state

OBJECTIVE: This qualitative study examined the social dynamics of communities and clinic settings that impede the delivery of culturally relevant services to lesbian, gay, bisexual, and transgender (LGBT) people living in rural areas. METHODS: Ethnographic interviews were conducted with 20 providers in rural areas to document their perceptions of LGBT mental health care. RESULTS: A majority of rural providers claimed that there is no difference between working with LGBT clients and non-LGBT clients. This neutral therapeutic posture may be insufficient when working with rural LGBT clients. Despite providers' claims of acceptance, lack of education about LGBT mental health issues, and homophobia influenced services for rural LGBT people. LGBT clients had been denied services, discouraged from broaching sexuality and gender issues by providers, and secluded within residential treatment settings. CONCLUSIONS: The challenges of ensuring access to quality care for this population are magnified by provider discourses of "therapeutic neutrality."     

Landlords as partners for promoting success in supported housing: "it takes more than a lease and a key"

This paper examines the potential value of working with landlords and property managers to promote success in supported housing for people with psychiatric and addictive disabilities. The authors argue that relationships with landlords can promote tenants' housing stability, rehabilitation, social integration, and success in community living. A case history of the program is used to describe efforts to develop working relationships with landlords. It concludes presenting a model for how tenants, housing programs, and service providers can collaborate with landlords.     

Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009–2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.     

A randomized controlled trial of integrated versus parallel housing services for homeless adults with severe mental illness

This study compared two contemporary approaches to linking housing and mental health services. In the integrated housing program, case management and housing services were provided by teams within a single agency and were closely coordinated. In the parallel housing condition, case management services were provided by mobile assertive community treatment teams and housing by routine community-based landlords. Adults with severe mental illness who were at high risk for homelessness (n = 121; 72.7% schizophrenia spectrum) were assigned randomly to integrated or parallel housing services and followed for 18 months. Integrated housing services led to more days of stable housing and greater life satisfaction than parallel housing services, especially for male participants. Integrated housing services were also associated with greater reductions in psychiatric symptoms. Closer integration between clinical and housing services, and greater use of supervised living settings, led to more time in stable housing for participants in the integrated housing services condition and was associated with greater gains in several outcome domains.     

Collaborative mental health care for the homeless: the role of psychiatry in positive housing and mental health outcomes.

OBJECTIVE: Factors associated with positive outcomes for homeless men referred to a shelter-based collaborative mental health care team were examined. METHOD: A chart review of 73 clients referred over 12 months was completed. Two outcome measures were examined, clinical status and housing status, 6 months after their referral to the program. RESULT: Among the referred clients, the prevalence of severe and persistent mental illness and substance use disorders was 76.5% and 48.5%, respectively. At 6 months, 24 clients (35.3%) had improved clinically, and 33 (48.5%) were housed. Logistic regression identified 2 factors associated with clinical improvement: the number of visits with a psychiatrist and treatment adherence. The same 2 factors were associated with higher odds of housing, and presence of substance use disorder was associated with lower odds of housing at 6-month follow-up. CONCLUSION: Care by a mental health specialist is positively associated with improved outcomes. Strategies to improve treatment adherence, access to mental health specialists, and innovative approaches to treatment of substance use disorders should be considered for this population. Having a psychiatrist as a member of a shelter-based collaborative care team is one possible way of addressing the complex physical and mental health needs of homeless individuals.     

Religious participation as a predictor of mental health status and treatment outcomes in older persons

OBJECTIVES: This study focuses on examining the relations of religious participation and affiliation to mental health status among older primary care patients, and to the use and clinical outcomes of mental health services. METHODS: A sample of older adults participating in a clinical study (PRISM-E) to treat their depression with or without co-morbid anxiety (n = 1610) were queried about their religious affiliation and the frequency of their participation in religious activities. The diagnoses of depressive and anxiety disorders were made based on the MINI-International Neuropsychiatric Interview. Severity of depressive disorders was assessed by emotional distress using the CES-D. RESULTS: Those attending religious activities on a weekly, monthly, or occasional basis were significantly less likely to have suicidal ideation (p < 0.02) and emotional distress (p < 0.0001) than those who never participated or participated on a less frequent basis. Frequency of religious participation was not associated with mental health service utilization (p = 0.16), but it was predictive of a lower CES-D score at the end of the study intervention (p < 0.001). CONCLUSIONS: Religious participation is positively associated with older adults' mental health status and treatment effects, but results regarding mental health service utilization were inconclusive.     

The effects of culture-compatible intervention on the utilization of mental health services by minority clients

This study examined the relationship between a culture-compatible approach to mental health service and utilization as measured by dropout and total number of outpatient visits. The sample (N=300) was 23.5% Mexican, 22.8% White, 18.1% Black, 17.1% Vietnamese, 16.8% Pilipino, and 1.7% Other ethnic group. A culture-compatible approach was found to be effective in increasing utilization. Three culture-compatibility components were the best predictors of dropout status: language match of therapists and clients, ethinic/racial match of therapists and clients, and agency location in the ethnic/racial community. Pharmacotherapy, education, previous treatment and a diagnosis of psychosis were significantly related to remaining in therapy.     

A Comparison of Treatment Outcomes Among Chronically Homelessness Adults Receiving Comprehensive Housing and Health Care Services Versus Usual Local Care

Service use and 2-year treatment outcomes were compared between chronically homelessness clients receiving comprehensive housing and healthcare services through the federal Collaborative Initiative on Chronic Homelessness (CICH) program (n = 281) a sample of similarly chronically homeless individuals receiving usual care (n = 104) in the same 5 communities. CICH clients were housed an average of 23 of 90 days (52%) more than comparison group subjects averaging over all assessments over a 2-year follow-up period. CICH clients were significantly more likely to report having a usual mental health/substance abuse treater (55% vs. 23%) or a primary case manager (26% vs. 9%) and to receive community case management visits (64% vs. 14%). They reported receiving more outpatient visits for medical (2.3 vs. 1.7), mental health (2.8 vs. 1.0), substance abuse treatment (6.4 vs. 3.6), and all healthcare services (11.6 vs. 6.1) than comparison subjects. Total quarterly healthcare costs were significantly higher for CICH clients than comparison subjects (4,544 vs.4,544 vs. 3,326) due to increased use of outpatient mental health and substance abuse services. Although CICH clients were also more likely to receive public assistance income (80% vs. 75%), and to have a mental health/substance provider at all, they expressed slightly less satisfaction with their primary mental health/substance abuse provider (satisfaction score of 5.0 vs. 5.4). No significant differences were found between the groups on measures of substance use, community adjustment, or health status. These findings suggest that access to a well funded, comprehensive array of permanent housing, intensive case management, and healthcare services is associated with improved housing outcomes, but not substance use, health status or community adjustment outcomes, among chronically homeless adults.     

The Therapeutics of Counselling Religious Clients: Intake and Assessment

This is the first of a series of articles exploring the unique interface between religion and psychotherapy. At issue is the paucity of clinical research and therapeutic application exploring not only effective methodologies for counselling clients of diverse religious backgrounds, but how to integrate religious beliefs with best practices. It is the premise of this author that religion has become a pariah, avoided by many mental health providers hiding behind “value neutrality,” unexplored transferential dynamics with religion as well as the belief that religious values are mutually exclusive with psychological principles. These misconceptions are especially present in the case of clients who present in counselling with extremely dogmatic and exclusive theological views that make the requisite quality of self-exploration necessary for progress difficult. This article will introduce an assessment tool geared toward not only collecting pertinent information regarding a client’s religious beliefs, but will help the therapist build a therapeutic alliance during the initial phases of therapy with devoutly religious clients through the use of specific catchment areas designed to integrate faith values with therapeutic outcomes.     

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.

     

Mental health care providers' perception of giving culturally responsive care to American Indians

PROBLEM: To determine if mental health care providers delivering culturally responsive care to American Indians experiencing severe and persistent mental illness. METHODS: This qualitative study used grounded theory. Eleven mental health care providers and two administrators participated on two American Indian reservations with two different tribal affiliations. FINDINGS: Preliminary findings indicate the ability of providers to be culturally responsive varied based on an awareness of their personal culture and of the diversity within the American Indian culture. CONCLUSIONS: Mental health providers need to develop a higher level of awareness of diversity within their culture, which is possible through greater connection to their own culture. Future research should ask clients what mental health services would be culturally responsive.