Preferred terms for users of mental health services among service providers and recipients

OBJECTIVE: The terms used to refer to recipients of psychiatric services continue to be controversial. Terms in current use include "patient," "client," "consumer," and "survivor." In this study mental health service recipients and providers were surveyed about their preferences among these terms, and responses were analyzed to identify factors associated with various preferences. METHODS: A total of 550 service providers and 427 recipients at four sites in Ontario-two provincial psychiatric hospitals, a private mental health center, and a psychiatric unit of a general hospital-participated in a brief anonymous survey. RESULTS: Among service providers, 68.4 percent preferred the term "patient," 26.5 percent preferred "client," and.5 percent preferred "consumer." Logistic regression analysis showed that service providers' preferences were associated with age and gender. Among service recipients, 54.8 percent preferred the term "patient," 28.8 percent preferred "client," 7 percent preferred "survivor," and 2.8 percent preferred "consumer." Service recipients' preferences were associated with site, self-reported diagnosis, and employment status. CONCLUSION: The study results indicate lack of universality in preferences for terms for users of mental health services and suggest the need for dialogue about preferred terms between service providers and recipients.     

Clergy as mental health service providers to older adults

Older adults tend to seek help for emotional problems from clergy at greater rates than they do from other sources. However, their help-seeking from clergy is largely understudied. We used data from the Naturally Occurring Retirement Community (NORC) Demonstration Project to examine older adults' patterns of help-seeking from clergy. We studied a sample of adults aged 65 or older (n = 317) to determine which factors were related to help-seeking from a religious leader. This study was framed within the Behavioral Model of Health Services Utilization. Results of hierarchical logistic regression analyses indicated that having less social support and greater frequency of attendance at religious services was related to help-seeking from clergy for this sample, while other predisposing, enabling, need and religiosity variables were not found to be related to help-seeking from clergy. Discussion focuses on the need for mental health workers to be aware of the important role that clergy play in service provision and to find ways to leverage knowledge and skills to enhance provider-clergy relationships in order to improve services that older adults receive.     

Work satisfaction among community-based mental health service providers: The association between work environment and work satisfaction

This is a study of work environment and work satisfaction among 601 community mental health service providers in the central United States. Aspects of the work environment may limit resources and strategies available to minimize staff burnout and maximize effective service delivery. Three human resource issues related to work satisfaction are reviewed: (a) unique constraints in rural mental health service delivery, (b) the role of paraprofessionals in service delivery, and (c) community-based services for seriously mentally ill individuals. This study demonstrates hypothesized associations between work environment and work satisfaction variables. The results suggest that staff members working with seriously mentally ill individuals are vulnerable to dissatisfaction and stress, and may require special skill and mastery enhancement.     

Health and education: service providers in partnership to improve mental health

Background

Children and adolescents from complex or disadvantaged backgrounds and multiple needs often are reluctant to seek help and this is particularly relevant in the context of mental health difficulties. Further, the complexity of the health system can be overwhelming to the family who are likely to be chaotic and less able to seek help. The current project piloted an integrated service delivery model involving a child psychiatry service and the department of education to promote access to mental health assessment and intervention to young people attending special education schools in Sydney, Australia.

Findings and conclusion

The project allowed improved access to mental health services for a group of young people who would otherwise not have sought help through traditional referral pathways. Our findings support strategies to promote the social milieu of schools as a way of achieving better mental health and learning outcomes.     

Burnout among general hospital mental health professionals and the salutogenic approach

Professionals working in mental health often exhibit high levels of strain leading to poor psychological wellbeing, emotional exhaustion and depletion of personal resources. Even under tight global economic conditions preventing burnout should be given high priority among mental health providers. This paper looks at the wide spectrum of stressors found in specialists working in the mental health area and examines, with the salutogenic approach in the background, ways to relieve professional burnout among general hospital mental health providers. Guidelines for managers and staff to alleviate their professional strain are suggested so as to improve the quality of life in the workplace.     

The roles and relationships of psychiatrists and other service providers in mental health services

OBJECTIVE: A number of the problems facing psychiatry are identified as having common origins in unresolved issues about teamwork. The aim is to identify the issues and to formulate recommendations for dealing with these obstacles. METHOD: The Royal Australian and New Zealand College of Psychiatrists Professional Liaison Committee (Australia) of the Board of Professional and Community Relations convened a number of meetings and discussions, with external assistance from JW and TT. RESULTS: Much of contemporary mental health care is delivered either directly or indirectly by several persons, often working in teams. Teamwork and collaboration are central to good working relationships and service delivery. Effective teamwork and collaboration is supported by key elements including agreed goals, an agreed approach, effective communication styles, established ground rules, clear team roles, and competent leadership. The obstacles to effective teamwork and collaboration are discussed in terms of the following: ambiguity and conflict over roles; conflict and confusion over leadership; differing understandings of clinical responsibility and accountability; interprofessional misperceptions; and differing rewards between the professions. CONCLUSIONS: Developing an understanding of these issues opens the way to a series of recommendations in relation to education, professional organizations, and workplaces and government, which can be considered by a number of sectors and groups.     

A randomized evaluation of consumer versus nonconsumer training of state mental health service providers

Rreliminary evidence suggests that mental health consumers can successfully serve as peer companions, case management aides, case managers, job coaches, and drop-in center staff. However, few empirical investigations have addressed the use of consumers to train mental health professionals. This project employed a randomized design to test the effects of using consumers as trainers for mental health service providers. Fifty-seven state mental health professionals participated in a two-day training designed to acquaint trainees with the attitudes and knowledge necessary for delivering assertive case management services. Participants were randomly assigned to one of two conditions: one in which they received the second day of training from a consumer and the other involving training by a nonconsumer. Analyses revealed that post-training attitudes were significantly more positive for those participants trained by the consumer. Subjective evaluations also reflected positive reactions to the use of consumers as trainers. Implications for further use of mental health consumers as trainers are explored.Funded, in part, by contract #MH19359 and #C151038092 from the Illinois Department of Mental Health and Developmental Disabilities, Springfield, Illinois. Also supported by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the U.S. Department of Education, National Institute on Disability and Rehabilitation Research (Cooperative agreement #H133B00011). The opinions expressed herein do not reflect the position or policy of any agency and no official endorsement should be inferred. The authors gratefully acknowledge Elise Brooks, Mark Gervain, Eleanor Guzzio, Karen Lee, and Mardi Solomon, as well as participants in the training, for their valuable contributions to this research project.     

Relationships between altruistic activity and positive and negative affect among low-income older adult service providers

Self-reported altruistic activity was examined as a predictor of positive and negative affective states among a sample of 115 low-income older adults who were actively providing services to others within a federally subsidized service delivery program (Foster Grandparents and Senior Companions). Results indicated that altruistic activity was predictive of positive, but not negative affect. It was found that altruistic activity was a significant predictor of positive affect after controlling for relevant demographic variables including social support and income. The theoretical and clinical implications of this research are discussed.     

Religious coping,health, and health service use among bereaved adults

OBJECTIVE: This report examined associations between religious coping, health, and health service use among a sample of 265 recently bereaved adults. METHOD: Participants were interviewed an average of 6.3 (SD = 7.4) months after their loss and again 4 months later. Multivariate regression models and repeated measures ANOVA analyses estimated the influence of religious coping on health and health service use at baseline and follow-up, controlling for significant confounding influences, such as health promoting behaviors. RESULTS: At baseline, those high on religious coping had significantly more functional disabilities than did those low on religious coping. Controlling for health status, participants with higher religious coping scores were significantly less likely to visit their doctor during the 60 days prior to the baseline interview. Despite worse health and less health service use at baseline, those high on religious coping had equivalent health status to those low on religious coping at follow-up. CONCLUSIONS: Greater use of religious coping is associated with more functional disabilities and fewer outpatient physical health care visits at baseline, but a lack of decline in health at 4-month follow-up among the bereaved, a sub-group at risk for numerous health impairments. Possible reasons for this association and its implications are discussed.     

Determinants of mental health service use among depressed adolescents

Objective

Evaluate determinants of mental health service use among depressed adolescents.

Method

We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥ 11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use.

Results

Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77–16.35), parental history of depression/anxiety (OR 4.12, CI 1.36–12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use.

Conclusion

Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.     

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.     

The property of the Japanese version of the Recovery Knowledge Inventory (RKI) among mental health service providers: a cross sectional study

Background

The Recovery Knowledge Inventory (RKI) is one of the influential scales to assess knowledge and attitude toward recovery-oriented practices among mental health service providers. In the present study, we aimed to develop a Japanese version of RKI and examine the validity and reliability.

Methods

We translated RKI into Japanese by reference to the guidelines for translating and adapting psychometric scales. A cross-sectional questionnaire survey was conducted with mental health service providers. Of a total of 475 eligible professionals, we used data from the 299 participants without missing value for the analyses (valid response rate = 62.9%). The questionnaire included Japanese RKI, Recovery Attitudes Questionnaire, The positive attitudes scale, and Japanese-language version of the Social Distance Scale. To examine the factorial validity of RKI, explanatory factor analysis and confirmatory factor analysis was employed. Convergent validity was assessed by calculating Pearson’s correlation coefficients between the total RKI score and the scores for the other three scales. We also calculated Cronbach’s α coefficients for the total score and for each domain of RKI to assess internal consistency reliability.

Results

The participants’ mean age was 40.4 years and 30.4% were men. 20-item RKI did not provide any adequate or interpretable factor solutions at any number of factors by EFAs. Thus four items (#1, 4, 5, and 13) were subsequently eliminated in stages, then 16-item RKI was employed as a consequence for further analyses. EFA with four factor structures yielded marginally interpretable constitution. Each factor represented the knowledge regarding psychiatric symptoms and recovery; knowledge about the recovery process; the understanding of what is important for recovery; and the understanding of the challenges and responsibility in recovery, respectively. Subsequent CFA suggested good fit to the data. Good convergent validity and understandable internal consistency reliability were also observed.

Conclusions

The Japanese 16-item RKI revealed reasonable factorial validity, good convergent validity, and understandable internal consistency reliability among mental health professionals. Japanese cultural settings seemed to influence the four-factor structure in the present study. It can be used for future study in Japan, while future large-scale research is required to ensure robust verification.

     

Survey of consumer and non-consumer mental health service providers on assertive community treatment teams in Ontario

Reflecting the increasing trend of consumers as providers in mental health services, the standards for Assertive Community Treatment (ACT) teams in Ontario, Canada require the hiring of at least 0.5 full-time equivalent consumer as a service provider. Through a mail-out survey, we explored how the consumer position has been integrated into these ACT teams. It was found that despite some variation in the roles and degree of integration of the consumers on these teams, consumers were generally well-incorporated team members with equal or better job satisfaction as compared to other employees.     

Factors associated with mental health service utilization among bipolar youth

OBJECTIVES: This study aims to characterize patterns of mental health service utilization within a sample of bipolar youth. Demographic variables, youth bipolar characteristics, youth comorbid conditions, and parental psychopathology were examined as predictors of treatment utilization across different levels of care. METHODS: A total of 293 bipolar youth (aged 7-17 years) and their parents completed a diagnostic interview, family psychiatric history measures, and an assessment of mental health service utilization. Demographic and clinical variables were measured at baseline and mental health service use was measured at the six-month follow-up. RESULTS: Approximately 80% of bipolar youth attended psychosocial treatment services over the span of 6 months. Of those who attended treatment, 67% attended only outpatient services, 22% received inpatient/partial hospitalization, and 12% received residential/therapeutic school-based services. Using multinomial logistic regression, older age, female gender, and bipolar characteristics, including greater symptom severity and rapid cycling, were found to predict higher levels of care. Youth suicidal and non-suicidal self-injurious behavior, comorbid conduct disorder, and parental substance use disorders also predicted use of more restrictive treatment settings. CONCLUSIONS: Results underscore the importance of assessing for and addressing suicidality, comorbid conduct disorder, and parental substance use disorders early in the treatment of bipolar youth to potentially reduce the need for more restrictive levels of care.     

Trauma-related mental health needs and service utilization among female veterans

Women constitute a growing segment of the military veteran population and researchers have begun to examine the extent to which their mental health needs are appropriately addressed within the Veterans Affairs (VA) healthcare system. Existing research documents high rates of both military and non-military trauma among female veterans; however, little has been done to examine the extent to which female veterans exposed to trauma receive treatment for trauma-related problems such as posttraumatic stress disorder (PTSD) and substance abuse within the VA system. This article reviews the literature documenting a high rate of trauma exposure among female veterans and examines evidence that trauma-related mental health problems, such as PTSD and substance-use problems, are under-diagnosed and under-treated among female veterans in VA healthcare settings. The few available studies examining general service utilization among female veterans are also reviewed, and implications for future research and clinical practice in the area of female veterans' trauma-related mental health needs and service use patterns are discussed. In order to provide more accurate assessments of female veterans' trauma-related mental health needs, researchers are encouraged to implement comprehensive trauma assessments as well as clinically valid PTSD and substance abuse diagnostic assessments. Researchers are also encouraged to examine the availability and efficacy of both VA and non-VA mental health services to determine the appropriateness of women's VA service use patterns. Clinicians providing VA mental health services for women are encouraged to include comprehensive, behaviorally-specific trauma interviews and diagnostic evaluations for PTSD and substance-related problems in their standard assessment protocols.     

Knowledge of ECT among staff of a mental health service

Electroconvulsive therapy (ECT) is frequently projected as a controversial treatment to the general public. In England and Wales, user groups have reported an insufficient provision of information on which to base a decision regarding consent to ECT. In view of these findings, a study was carried out to assess the knowledge of ECT among mental health staff in a general hospital setting, as they are frequently the source of information for patients and caregivers. All staff in the mental health unit were invited to complete a semistructured questionnaire that consisted of questions about ECT including their knowledge of the laws about informed consent. Seventy-five staff members, representing about two thirds of the staff population, returned the questionnaires. Seventy of them responded that they knew the indications for ECT, of which the most frequently quoted were depression, mania, and schizophrenia. Only 24 (36.9%) staff members knew of the guidance with respect to informed consent and ECT. The finding in this study led to a revision of the local ECT training program for patients, caregivers, and staff. A review of the impact of the changes made will take place in the future. The Royal College of Psychiatrists itself has decided to implement changes by setting up a commission to assess and accredit various ECT units in England and Wales.     

Disparity in location of urban mental service providers

This article investigates geographic disparities in the location of mental health providers in relation to population demographics. Associations between provider-to-population ratios and demographics were examined with density calculations and map algebra. This disparity in geospatial availability of specialists may constitute an important barrier for persons seeking mental health care.     

Changes in service delivery following HIV/AIDS education of medical and mental health service providers: results of a one-year follow-up

This study examined changes in service delivery patterns of health and mental health service providers one year after a training on the fundamentals of HIV/AIDS and mental health. Paired t-tests for 424 training recipients showed significant increases in delivery of HIV-related services, and these remained significant while controlling for additional training, job changes, region (urban, rural, suburban), and provider discipline. Multiple logistic regression analysis revealed a significantly greater likelihood of providing direct services to HIV+ individuals among male providers, those with more years of HIV experience, those in counseling disciplines, and those working in a new job since the training.