Pediatricians' pet peeves about mental health referrals

This chapter has described a number of problems encountered by pediatricians when referring their patients for mental health services; these are related to access to care, quality of providers and service, attitudes of patients and providers, and lack of adequate communication. We have discussed some of the reasons for these difficulties, provided information that may assist pediatricians in making referrals to appropriate mental health providers, and offered suggestions to facilitate the referral process. We have highlighted the utility of developing and maintaining a relationship with mental health referral sources, and noted a number of advantages of including mental health providers in pediatric practices.     

Pattern of general practitioners' referrals to a rural community mental health centre: a 3-year analysis

Community mental health centres (CMHCs) represent a major trend towards developing locally based community psychiatric services. The Beaconfield Centre described here is an example of a rural project which aims to provide comprehensive and accessible psychiatric services to the population of the town of Grantham, in south Lincolnshire. The rate and pattern of referrals to the Beaconfield Centre over a period of 3 years are examined. It was found that the bulk of the general practitioners' (GPs) referrals were directed mainly to Community Psychiatric Nurses (CPNs), 49%, followed by the Consultant Psychiatrists, 42%. GPs considered the nature of the patient's problem to be responsible for nearly 20% of the total referrals. More work is required to test the appropriateness of these referrals and assess the degree of congruence between the GPs' and the mental health team's perception. The paper also highlights the need to assess regional variations in the function of these centres and their relationship to both primary health care and traditional psychiatric services. The future composition and the policy of referrals to the Community Mental Health Team (CMHT) need to be reviewed, particularly in relation to the growing number of fund holding general practices. The future role of all mental health professionals working in community settings urgently needs to be redefined with reference to the role of the CPNs vis á vis day care nurses.     

Impact and cost of public health nurse telephone follow-up of school dental referrals.

The effect and cost of nursing follow-up services on school dental screening outcomes were investigated. Experimental and control groups were randomly assigned. A positive difference in dental visit rate occurred for all nurses, with the overall dentist visit-no visit, experimental-control odds ratio being 1.64 (95% CL = 1.15, 2.35). The service averaged 27.7 minutes and $8.92 per family contacted, suggesting that nursing follow-up increased dental care utilization after screening at low cost in this population.     

健康咨询热线中341人次心理问题分析

目的了解1997-2000年福建省健康教育促进中心健康咨询热线中咨询者的心理问题状况及其社会心理需求,为今后开展心理健康教育和行为干预提供可行性策略。方法对1997-2000年电话咨询的341个有心理问题的咨询者的咨询记录进行分析。结果341人次中,男性占54.5%,女性占45.5%。年龄以18-35岁为主（72.7%）。婚姻以未婚为主（62.2%）。主要心理问题有神经症（64.2%）、心身疾病（28.2%）、性心理障碍（2.3%）、神经分裂症（1.5%）等。结论健康咨询热线中神经症、心身疾病等心理问题在青少年中较为突出,应引起社会及卫生、教育相关部门关注。     

An equivalence analysis of provider education in youth mental health care

ObjectiveTo test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence‐based treatment.Data SourceProvider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF‐CBT) in a major metropolitan area in the United States.Study DesignWe tested for equivalence between providers (N = 182) with and without advanced degrees in treatment‐related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer‐rated competence in AF‐CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes.Data CollectionProviders completed measures prior to randomization and at 6‐month follow‐up, after completion of training and consultation in AF‐CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months.Principal FindingsProviders without advanced degrees were largely non‐inferior to those with advanced degrees in treatment‐related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non‐inferior to providers with advanced degrees in consultation attendance (B = −1.42; confidence interval (CI) = −3.01‐0.16; margin of equivalence (Δ) = 2), number of case presentations (B = 0.64; CI = −0.49‐1.76; Δ = 2), total training hours (B = −4.57; CI = −10.52‐1.37; Δ = 3), and trainer‐rated competence in AF‐CBT (B = −0.04; CI = −3.04‐2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10‐0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive.ConclusionsProvider‐level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence‐based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence‐based treatments.     

Coercive and voluntary referrals: How ethnic minority adults get into mental health treatment

Two hypotheses are typically invoked to examine the referral of adults into mental health care. The first is the clinical behavior hypothesis that suggests the psychiatric problem defines people as dangerous and risky. Accordingly, people with severe mental disorders are more likely to be coercively placed into mental health facilities. The second hypothesis suggests that people with less power are more likely than the powerful to be coercively placed in psychiatric care. We examine the extent to which these hypotheses are supported in a large urban community by investigating referrals into community mental health clinics that serve predominantly poor populations. The data set is unique because it includes four ethnic categories, whites, African Americans, Asian Americans, and Mexican Americans. The findings indicate that the clinical behavior hypothesis is applicable to whites and the stratification hypothesis is consistent with the data for African American, particularly African American men. The referral pattern for Mexican Americans and Asian Americans do not conform to the findings for whites and African Americans. It is likely that other sociocultural factors influence the referrals of these ethnic categories.     

An ecological study investigating the association between access to urban green space and mental health

Objectives

This study aims to find whether proximity to urban green spaces is associated with human mental health.

Study design

A cross-sectional examination of the relationship between access to urban green spaces and counts of anxiety/mood disorder treatments amongst residents (aged 15 years and over) in Auckland City, New Zealand.

Methods

Anxiety/mood disorder treatment counts by three age groups were aggregated to 3149 small area units in Auckland. Six measures of green space access were derived using GIS techniques involving total green spaces and useable green spaces. Negative binomial regression models have been fitted to test the relationship between access to green space and area-level anxiety/mood disorder treatment counts, adjusted for age and area-level deprivation.

Results

Anxiety/mood disorder treatment counts were associated with three green space measures. The proportion of both total and useable green space within 3 km and distance to nearest useable green space all indicated a protective effect of increased access to green space against anxiety/mood disorder treatment counts. Access to total and useable green space within 300 m did not exhibit significant associations.

Conclusion

This study found that decreased distance to useable green space and increased proportion of green space within the larger neighbourhood were associated with decreased anxiety/mood disorder treatment counts in an urban environment. This suggests the benefits of green space on mental health may relate both to active participation in useable green spaces near to the home and observable green space in the neighbourhood environment.     

Denial and its association with mental health care use

In clinical practice, denial has long been thought to be a determinant of treatment initiation and retention; however, little empirical research has focused on denial as a mechanism. For example, denial has not been standardized or operationalized in epidemiological studies for mental health services research and, thus, the magnitude of the effects of denial on mental health care use are unknown. This study makes use of the "Mental Health Care among Puerto Ricans" study, a 3-wave island-based probability epidemiological study conducted from 1992 to 1998. For all the 3 waves, 2928 individuals participated (81.5% response). The analyses were limited to only those participants who were objectively determined to have a severe need for mental health care (n = 742). The findings from this study show that admitting to a mental health problem is related to the increased odds of using any mental health care, any specialty care, psychotropic drugs, and retention in mental health care, after adjusting for potential confounding. Similar patterns were observed even after the data were limited to those participants who did not previously seek mental health care, and the trends persisted when determining changes from denial to admitting a mental health problem. The study confirms that denial is a significant factor for treatment initiation and retention, particularly for Puerto Ricans, and denial should be considered an important mechanism in planning interventions to eliminate mental health care disparities.     

青春期女性心理健康状况2523例调查分析

目的 :了解青春期女性心理需求及健康状况。方法 :采用自制问卷调查表对 2 5 2 3例青春期女性进行心理健康状况及其影响因素以及对青春期保健需求等情况的调查。结果 :青春期女性的心理健康状况表现为对月经的焦虑和恐惧 ,造成的主要因素依次为痛经、月经不规律、经期综合征 ,与年龄呈正相关 (P<0 .0 1) ,青春期女性对保健需求及青春期生理心理知识的了解亦与年龄呈正相关 (P<0 .0 1)。结论 :青春期女性的心理健康状况随年龄不同而有差异 ,青春期健康教育尚存在问题 ,需要我们有针对性地实施保健指导     

Medical versus nonmedical mental health referral: Clinical decision-making by telephone access center staff

A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist. Care managers sent 56% of callers already taking psychotropic medications to nonpsychiatrists, 51% of whom were then cross-referred to psychiatrists. Predictive algorithms showed no potential to enhance efficiency of decisions about referral to a psychiatrist versus a nonpsychiatrist. Efforts to enhance such efficiency may not be cost-effective. It may be more fiscally efficient to assign less-experienced personnel as telephone care managers.The work described in this article was jointly performed by The Delegated Care Management Project, an enterprise of the Department of Psychiatry of UMDNJ-New Jersey Medical School, Newark NJ 07103-3000; and the UMDNJ-University Behavioral HealthCare Access Center, Edison, NJ 08817-2600. UMDNJ is the University of Medicine and Dentistry of New Jersey, and operates medical schools and other facilities throughout the state.This article was presented in part as a New Research poster at the Annual Meeting of the American Psychiatric Association, Toronto, Canada, May 30–June 4, 1998.     

An audit of NHS Trust alcohol policy referrals to an occupational health service

An exploratory review of 33 referrals to an Occupational Health Service of employees with alcohol problems provided information on age and sex, job category, mode of referral, medical and social problems and outcome. Case records were examined providing information on clinical assessment and the treatment options. The high rates of relapse, drop-out and refusal of help, supported the view that this population had serious alcohol problems. Clinical recording by occupational physicians showed a marked variability. No doctors were included in the sample although this group is known to be vulnerable. Blood testing was used infrequently. Occupational health clinical practice could be enhanced by the use of clinical protocols, systems of morbidity recording and co-operative studies with other agencies. Further prospective studies are needed.     

沉浸体验与青少年心理健康关联的研究进展

电子设备的流行让沉浸体验越来越广泛,沉浸体验的二重性给青少年带来多方面的影响。为了更好地发挥沉浸体验的积极作用,促进青少年学生心理健康,研究综述了不同情境下的沉浸体验与青少年心理健康。在学习情境下,沉浸体验能增强学生自信、学习体验、学校积极情绪、积极取向、自尊和自我效能等,同时有利于缓解学习压力与学习拖延;在娱乐情境下,沉浸体验对成瘾有直接影响,也会通过影响自我控制、认知偏差间接影响网络游戏成瘾。