The nexus between urban green space,housing type,and mental health

Introduction

Momentum for urban densification is increasing opportunities for apartment-living, but can result in reduced green space availability that negatively influences mental health. However, in contexts where apartment-living is atypical and commonly viewed as secondary to house-ownership, it may be a stressful antecedent condition (or marker of selective processes aligned with psychological distress) wherein occupants could benefit disproportionately from green space.

Method

Data were extracted from the Sax Institute’s 45 and Up Study baseline (2006–2009, n = 267,153). The focus was on subsets of 13,196 people living in apartments and 66,453 people living in households within the cities of Sydney, Newcastle and Wollongong. Multilevel models adjusted for confounders tested associations between psychological distress (Kessler 10 scale) with percentage total green space, tree canopy and open grass within 1.6 km road network buffers.

Results

Psychological distress was higher in occupants of apartments (11.3%) compared with houses (7.9%). More green space was associated with less psychological distress for house-dwellers (OR = 0.94, 95% CI = 0.91–0.98), but there was no association for apartment-dwellers. More tree canopy was associated with lower psychological distress for house-dwellers (OR = 0.88, 95% CI = 0.85–0.92) and apartment-dwellers (OR = 0.87, 95% CI = 0.79–0.96). Open grass was associated with more psychological distress among house-dwellers (OR = 1.06, 95% CI = 1.00–1.13) and also for apartment-dwellers (OR = 1.20, 95% CI = 1.07–1.35).

Conclusions

Overall, investments in tree canopy may benefit the mental health of house and apartment residents relatively equally. Urban tree canopy in densely populated areas where apartments are common needs to be protected. Further work is needed to understand factors constraining the prevention potential of open grass, to unlock its benefits for mental health.

     

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.     

Quality of housing among patients of an area mental health service

OBJECTIVES: The aims of the present study were to (i) assess the quality of housing for patients receiving treatment from an area mental health service; (ii) compare estimates of quality of housing using two different methods: housing type versus housing characteristics; (iii) determine whether either method for assessing quality is more useful that a combination; and (iv) examine the relationship between housing quality and case manager's assessment of the impact of the housing on the patient's mental disorder. METHODS: A survey was developed that included the demographics of the patient; housing type; living arrangements; housing characteristics as assessed by the patient's case manager; and an overall assessment by the case manager of the impact that the housing has on the patient's mental disorder. Case managers were asked to complete the housing survey on all patients they saw in the community during a 2 week period in 2003. The social worker for the inpatient unit completed the survey for all patients admitted to the inpatient unit over a 3 month period. RESULTS: Surveys were completed for a total of 362 patients. Just under 10% of patients were identified as homeless in that the person either had no housing or was living in a shelter or accommodation frequently associated with homeless persons. Almost half of the patients in the sample had housing that was either not affordable, not secure, not safe or not appropriate to their needs, that is, their housing met at least one of a range of criteria defining poor-quality housing. Sixty-one patients (16.9%) had housing that was considered by their case managers to have a substantial negative impact on their mental illness. CONCLUSIONS: Almost half of the patients treated by an area mental health service appeared to have poor-quality housing. Housing characteristics identified a higher proportion of people with poor-quality housing than did housing type. Case managers' assessments generally failed to identify a potential negative impact of poor quality housing on the person's mental disorder.     

Trajectories of housing affordability and mental health problems: a population-based cohort study

Purpose

With housing costs increasing faster than incomes and a limited supply of social housing options, many households face unaffordable housing. Housing affordability problems may negatively impact mental health; however, longitudinal evidence is limited. This study investigates the association between trajectories of housing affordability problems and mental health.

Methods

We used data from 30,025 households from Understanding Society, a longitudinal household survey from the UK. Participants spending 30% or more of household income on housing were categorised as facing housing affordability problems. We estimated group-based trajectories of housing affordability problems from 9 waves of data (2009–2019). We used linear regression to calculate the association between the trajectories and mental health problems, as measured by General Health Questionnaire (GHQ) score in Wave 10 (2018–2020).

Results

We found six distinct trajectories of housing affordability problems. Those in the ‘stable low’ group had a consistently low probability of affordability problems, whilst those in ‘high falling’ group had a sustained high probability in the earlier waves of the study, subsequently decreasing over time. The adjusted analysis showed that trajectory group membership over the first nine waves of data predicted GHQ score in 2018–2020 (Wave 10). Compared to the ‘stable low’ group, those in the ‘high falling’ group had a GHQ score that was 1.06 (95% CI 0.53–1.58) points higher.

Conclusion

This study provides evidence that sustained exposure to housing affordability problems is associated with long-term worse mental health, even in the absence of more recent problems.

     

Housing needs of consumers of mental health services in rural New South Wales, Australia

A survey of the housing needs of 101 people with mentally illness treated by the Central Western Area Mental Health Service were compared with data from the 1994 Australian Housing Study (Australian Bureau of Statistics). The results indicate that people with mental illness want housing similar to Australians in general. However, unemployment or very low incomes may affect their ability to realise their housing choices. Despite very low incomes most in the survey felt their rent was affordable. Preferences for housing types and factors relating to housing choice are described. The results are discussed in relation to the importance of housing in maintaining mental health.     

Geographic location and mental health services utilization among the chronically mentally Ill

This study examined the relationship between geographic location and use of mental health services using data collected on 1053 Community Support Program (CSP) clients. Multiple regression analyses revealed that geographic location (i.e., urban, suburban, rural) influences mental health services utilization even when service availability and accessibility, socio-demographic and need factors are controlled. The results do not support the assumption that rural residence has uniformly negative effects on service use. Rural CSP clients, for example, were more likely to use crisis and supportive housing services than their urban counterparts. The findings suggest that models of service utilization must be carefully specified with regard to residential location.Work on this paper was supported in part by a NIMH grant: # 5 T32 MH17120-04. A special thanks to Rick Tessler for his insightful comments on an earlier draft.     

Problem type and referral to HMO mental health treatment

The present study examined the cases of 353 patients seen in the outpatient department of psychiatry at a large west coast HMO. Comparisons were made between self-referred and physician-referred patients in the types of problems presented for treatment. Patients with relationship problems were self-referred more than those with adjustment, anxiety, and mood disorders who were more likely to be physician-referred. HMO patients with a self-referral option appear to enter mental health treatment because of relationship problems at a higher rate than their physician-referred counterparts.     

Knowledge of mental health benefits and preferences for type of mental health providers among the general public

OBJECTIVE: The study explored knowledge of mental health benefits and preferences for providers among the general public. METHODS: Analysis was based on a telephone survey of 1,358 adults randomly sampled throughout Michigan in 1997-1998. RESULTS: A large proportion of the respondents were uninformed about their mental health benefits. One-quarter of the sample were unsure if their health plan even included mental health services. Forty-three percent of the sample believed that mental health benefits were equal to benefits provided for general medical services. In answer to a survey question that summarized payment restrictions for psychiatric services and counseling under Medicare, nearly a quarter of older respondents indicated that they would not seek care even when needed. In the overall sample, the majority of respondents said they would initially seek care from their primary care physician for a mental health problem, although responses varied by age. Persons over age 65 were significantly more likely to seek assistance from their primary care doctor than were younger persons. CONCLUSIONS: The general public lacks information about important mental health benefits, and this lack of information may represent a barrier in their seeking care when needed. Given the overriding preference for primary care providers to treat mental health problems, particularly among older adults, mental health issues should be given more attention at all levels of primary care education.     

An exploratory investigation into the housing preferences of consumers of mental health services

In the present qualitative study, 10 mental health consumers living in the community were interviewed in relation to their housing situations. Three themes emerged from the interview data: 'The place', 'Other consumers' and 'A normal life'. Consumers rejected congregated housing because it enables the larger community to more easily identify them as former psychiatric patients. The views of participants consistently indicate a desire to live a normal life. Results of this study highlight the need for greater consumer participation with mental health nurses and policy makers, in relation to the development of housing services.     

Collaboration among the education, mental health, and public health systems to promote youth mental health

The authors discuss the growing movement in the United States to develop expanded school mental health programs. These programs represent partnerships between schools and community mental health agencies to expand the range of mental health services provided by schools. Such programs emphasize effective prevention, assessment, and intervention. The authors describe efforts that have been undertaken to improve the fragmented and incomplete nature of children's services and to proactively identify and address children's emotional and behavioral problems. They also discuss a strategy to improve youth mental health programs, which includes needs assessments and an analysis of existing programs in a community. They describe the augmenting roles played by the mental health and public health systems in expanding and improving school-based mental health services. The authors outline steps to minimize or avoid the turfism and negative attitudes that may arise among professionals from different disciplines when they collaborate to expand and improve school-based programs.     

Loss,stress, and mental health

1. The loss of an attachment to a loved person or of some other significant attachment leads to a prolonged period of distress and disability. 2. The upset feelings are usually associated with reduction in cognitive effectiveness and problem-solving capacity, the magnitude of which is dependent on the intensity and duration of emotional arousal. There is a reduced capacity for collecting and processing information and for access to relevant memories that associate significant meaning to perceptions. There is also a deterioration in the clarity of the person's self-concept and in his capacity to assess his ability to persevere in the face of discomfort, which weakens his will to struggle. 3. The disability following loss of an attachment is the product of three interlocking factors: (a) the pain of the rupture in the bond and the agony of coming to terms with this reality, (b) the handicapping privation of the missing assets previously derived from the lost person or resource, and (c) the cognitive erosion and reduction in problem-solving capacities and of the will to persevere. 4. These factors may lead to poor mental health in the form of an acute adjustment disorder, or else of chronic psychopathology if the individual uses maladaptive ways of trying to escape his burdens through alienation from reality or through the irrational mechanisms of psychoneurotic symptoms, or if prolonged emotional tension leads to malfunctioning of a bodily system. On the other hand, if the individual masters his problems by working out ways of effective coping, he may emerge from the experience with increased competence and resilience. 5. Eventual mastery of the burdensome experience involves reorganization of the individual's "assumptive world," namely of his intrapsychic maps of external reality and his internal system for guiding and motivating his behavior, which have been disorganized by the loss of their anchorage in the ruptured attachment. 6. This reorganization is helped by the following: a. The maintenance of hope of eventual personal mastery that provides a basis for continued striving. b. Regular activity through adhering to a daily schedule of work and social interaction, even though this initially provides little emotional satisfaction and seems empty and meaningless. c. Seeking support from other people in compensating for current deficits and in helping lower the intensity of emotional arousal. d. Repeatedly remembering the values and guidance the person used to derive from the old attachments.(ABSTRACT TRUNCATED AT 400 WORDS)     

Neuronal excitability and calcium/calmodulin-dependent protein kinase type II: location, location, location

Calcium/calmodulin-dependent protein kinase type II (CaMKII) is a highly abundant serine/threonine kinase comprising a significant fraction of total protein in mammalian forebrain and forming a major component of the postsynaptic density. CaMKII is essential for certain forms of synaptic plasticity and memory consolidation and this is mediated through substrate binding and intramolecular phosphorylation of holoenzyme subunits. CaMKII is multifunctional; it targets a variety of cellular substrates, and this diversity depends on holoenzyme subunit composition. CaMKII comprises homooligomeric and heterooligomeric complexes generated from four subunits (α, β, δ, and γ) encoded by separate genes that are further expanded by extensive alternative splicing to more than 30 different isoforms. Much attention has been paid to understanding the regulation of CaMKII function through its structural diversity and/or substrate specificity. However, given the importance of subunit composition to holoenzyme activity, it is likely that specificity of cellular expression of CaMKII isoforms also plays a major role in regulation of enzyme function. Herein we review the cellular colocalization of CaMKII isoforms with special regard to the cell-type specificity of isoform expression in brain. In addition, we highlight the remarkable specificity of subcellular localization by the CaMKIIα isoform. In addition, we discuss the role that this cellular specificity of expression might play in propagating the type of recurrent neuronal activity associated with disorders such as temporal lobe epilepsy.     

Women, catastrophe and mental health

This paper examines the concept of catastrophic experience, its relationship to the range of acute and prolonged stressors to which women may be exposed and the broad impacts on their mental health and well-being. It identifies catastrophe in terms of multiple accumulated stresses including death, loss, victimization, demoralization, shame, stigmatization, helplessness and identity. Catastrophic experiences include personal violence in domestic circumstances of intimate partner abuse, sexual assault and child physical and sexual abuse. Women's experiences of loss through the violent deaths of children and loved ones may also have such enduring impacts. Terrorism victimizes men and women in this way, with the enduring impacts for women in terms of threat of ongoing attacks as well as acute effects and their aftermath. The catastrophes of war, conflict, genocide, sexual exploitation and refugee status differentially affect large numbers of women, directly and through their concerns for the care of their children and loved ones. Ultimate catastrophes such as Hiroshima and the Holocaust are discussed but with recognition of the very large numbers of women currently experiencing catastrophe in ongoing ways that may be silent and unrecognized. This is significant for clinical care and population impacts, and in the losses for women across such contexts.