County mental health directors’ evaluation of a statewide intensive case management program: The New York state experience

Case management is increasingly recommended as part of an overall strategy for serving individuals with severe mental illness. The New York State Office of Mental Health developed such a program in 1988, with county mental health directors the key players in its development and operationalization. This article reports the results of a statewide survey administered by the authors to these directors 3 1/2 years after the program’s implementation to determine its degree of success. Overall, the program was viewed as effective for individual clients, particularly those most in need of services. However, with respect to overall systems change, there was more variability in results. In general, a combination of strategies to reduce fragmentation within the mental health system and increase collaboration between service providers should be considered by state mental health authorities.     

郑州市居民对精神疾病患者态度调查

目的 了解郑州市居民对精神疾病患者态度现状, 探讨影响居民态度的相关因素, 为深入开展精神卫生工作提供理论依据。方法 采用多阶段分层整群随机抽样方法抽取郑州市≥15岁居民37 201人进行个人基本信息和精神疾病态度调查。结果 郑州市居民对精神疾病态度的总得分为(37.30±4.84)分, 仅31.40%的居民持正性态度;城市居民对精神疾病态度得分为(36.68±4.72)分, 低于农村居民的(37.43±4.56)分, 差异有统计学意义(t=-100.79, P<0.01);“686”项目区居民得分为(38.14±5.03)分, 高于非“686”项目区居民的(37.47±4.63)分, 差异有统计学意义(t=46.23, P<0.01);初中及以下、高中或中专、大专或本科、研究生以上学历者分别为(37.24±5.01)、(37.36±4.67)、(37.43±4.65)、(37.02±4.84)分, 差异有统计学意义(F=3.38, P<0.05)。结论 郑州市居民对精神疾病患者持正性态度的比例较低, 并且受地区差异、受教育程度等因素影响。     

A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center

The US government funds integrated care demonstration projects to decrease health disparities for individuals with serious mental illness. Drawing on the Exploration Preparation Implementation Sustainability (EPIS) implementation framework, this case study of a community mental health clinic describes implementation barriers and sustainability challenges with grant-funded integrated care. Findings demonstrate that integrated care practices evolve during implementation and the following factors influenced sustainability: workforce rigidity, intervention clarity, policy and funding congruence between the agency and state/federal regulations, on-going support and training in practice application, and professional institutions. Implementation strategies for primary care integration within CMHCs include creating a flexible workforce, shared definition of integrated care, policy and funding congruence, and on-going support and training.

     

Coming untied? Narrative accounts of social network dynamics from first‐time mental health clients

Existing research demonstrates a relationship between mental illness and social network attrition over time – a pattern attributed to dysfunctional psychosocial and interpersonal processes and rejection. Yet, according to the social network perspective, personal network dynamics naturally accompany important biographical transitions or events, suggesting that our current understanding of mechanisms underlying network instability in mental illness may be incomplete. This research uses data from the Indianapolis Network Mental Health Study, a longitudinal study of social network dynamics spanning five years. It focuses on in‐depth interviews with 135 individuals making their first major contact with the mental health treatment system. First, levels of tie attrition and replacement in the core discussion networks of individuals with mental illness are compared to a sample with no self‐reported history of mental illness. Second, using open‐ended responses describing why specific individuals mentioned in previous waves were not listed again, respondents’ explanations of attrition are analysed qualitatively. In addition to providing support for existing perspectives, the themes suggest a need to also consider: (i) interaction strategies that maximise the supportiveness of social networks and minimise burden and (ii) changing life circumstances external to social networks that influence opportunities for social interaction.     

Vocational Peer Support: Results of a Qualitative Study

Peer-delivered services for individuals with psychiatric conditions are becoming an established part of the mental health workforce. Given the growing focus on evidence-based supported employment, peer specialists are often assisting individuals who are choosing, getting, or keeping employment. As part of a larger randomized clinical trial examining the effectiveness of an innovative intervention called vocational peer support, 13 semi-structured qualitative interviews were conducted to examine how recipients perceived peer support, and whether or how it was useful for pursuing vocational goals. A thematic analysis approach was utilized for identifying major themes and sub-themes. Results suggest that a key factor in the effectiveness of vocational peer support is the identification with another individual’s “lived experience,” which then promotes engagement and a sense of normalcy. Vocational peer support may be particularly useful for individuals with psychiatric disabilities wishing to pursue a vocational goal.

     

Criminal Justice Involvement after Release from Prison following Exposure to Community Mental Health Services among People Who Use Illicit Drugs and Have Mental Illness: a Systematic Review

Illicit drug use and mental illness are common among people in prison and are associated with higher rates of reoffending and reimprisonment. We conducted a systematic review, searching MEDLINE, Embase, and PsycINFO to January 10, 2022, for studies reporting criminal justice involvement following exposure to community mental health services among people released from jail or prison who use illicit drugs and have mental illness. Our search identified 6954 studies; 13 were eligible for inclusion in this review. Studies were separated into three broad categories based on community mental health service type. Eleven of 13 studies reported a reduction in criminal justice involvement among participants exposed to community mental health services compared to a comparison group. Findings indicate a need to expand and improve integration and referral mechanisms linking people to community mental health services after jail or prison release, alongside a need for tailored programs for individuals with complex illicit drug use and mental health morbidities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-022-00635-5.     

Partnering with communities to address the mental health needs of rural veterans

Purpose: Many veterans who face mental illness and live in rural areas never obtain the mental health care they need. To address these needs, it is important to reach out to community stakeholders who are likely to have frequent interactions with veterans, particularly those returning from Operations Enduring and Iraqi Freedom (OEF/OIF). Methods: Three community stakeholder groups—clergy, postsecondary educators, and criminal justice personnel—are of particular importance for OEF/OIF veterans living in rural areas and may be more likely to come into contact with rural veterans struggling with mental illness or substance abuse than the formal health care system. This article briefly describes the conceptualization, development, initial implementation, and early evaluation of a Veterans Affairs (VA) medical center‐based program designed to improve engagement in, and access to, mental health care for veterans returning to rural areas. Findings: One year since initial funding, 90 stakeholders have attended formal training workshops (criminal justice personnel = 36; educators = 31; clergy = 23). Two training formats (a 2‐hour workshop and an intensive 2.5‐day workshop) have been developed and provided to clergy in 1 rural county with another county scheduled for training. A veteran outreach initiative, which has received 32 referrals for various student services, has been established on 4 rural college campuses. A Veterans Treatment Court also has been established with 16 referrals for eligibility assessments. Conclusions: While this pilot program is in the early stages of evaluation, its success to date has encouraged program and VA clinical leadership to expand beyond the original sites.     

高职学生自我价值感及其与心理健康的相关研究

目的探讨离职学生自我价值感的特点及其与心理健康的关系．为开展心理健康教育提供依据。方法运用青少年自我价值感量表及症状自评量表（SCL-90），对高职学生746名的自我价值感与心理健康进行测试，并进行相关分析。结果高职学生的自我价值感与其在SCL-90量表各分量表得分呈负相关，且自我价值感较高与较低组的高职学生在SCL-90量表上的得分差异有显著性。结论高职学生的自我价值感与其心理健康相关，其自我价值感水平越高，心理健康状况越好。     

Choice of health insurance by families of the mentally ill

This paper investigates whether choice of health insurance is influenced by the perceived mental and physical health of family members among a sample of policy-holders with private health insurance. A multinomial probit model of the choice among major medical coverage only, traditional full coverage, and coverage through a health maintenance organization is estimated. Results indicate that the presence of at least one family member who rates his or her general health as poor does not affect the policy-holder's choice of health insurance. However, the presence of at least one family member considered at risk of mental illness does in some instances affect the policy-holder's choice of health insurance: We observe significant effects for policy-holders who are female, black, have some college education, work for a large firm, and live in an urban area. These findings suggest that adverse selection may arise when individuals are able to choose between health insurance policies with different degrees of coverage for mental health care and that such effects are far more pronounced for those people who consider themselves at risk for mental illness than physical illness.     

Mapping interventions that promote mental health in the general population: A scoping review of reviews

Health policies and programs promoting mental health or preventing mental illness in the general public are under-recognized facets of primary prevention. Increasing awareness and adoption of such strategies could reduce the burden of mental illness in individuals, families, communities, and society as whole. We conducted a scoping review of reviews of interventions to promote mental health or prevent mental illness. We searched PubMed, PsycINFO, Scopus, Cochrane CENTRAL, CINAHL and ERIC from 2004 to 2014. Reviews were included if the authors indicated a systematic approach in their literature searches, and if they comprised interventions in Westernized countries targeting the general population. We identified 39 reviews that met the inclusion criteria. Mental health intervention approaches and outcomes varied across age groups and settings, and included functional, social, and cognitive measures. Most interventions aimed to prevent a specific mental illness or symptoms (depression, anxiety, burnout, or stress). Cognitive-behavioral therapy and educational components were common. School-based programs focused on outcomes involving social and academic development. Interventions for families, especially for young or disadvantaged parents, taught parenting skills to help improve the well-being of children and their care-givers. In the workplace, the focus was on managing stress, while programs for the elderly emphasized quality of life determinants. This review summarizes a wide variety of interventions to promote mental health or prevent mental illness, but the literature is primarily focused on the individual or family unit. More information is required about interventions at the community and societal levels.     

Access to care among disabled adults on Medicaid

Although disabled individuals account for a disproportionate share of Medicaid expenditures, little is known about their health care needs and experiences. This article explores differences in access and use among key disability subgroups--adults with physical disabilities, mental illness, and mental retardation/development disabilities (MR/DD). We find that disabled Medicaid beneficiaries with mental illness and those with greater health and functional limitations face more difficulties in obtaining care. This suggests a need for changes in the system of care under Medicaid, including targeting efforts to improve access to individuals with specific types of disabilities.     

社会支持模式对重性精神疾病患者家属心理状况的影响

目的调查深圳市福田区在社区康复的重性精神疾病患者家属的心理健康状况,探讨福田区社会支持模式对改善重性精神疾病患者家属心理状况的效果。方法采用症状自评量表(SCL-90)在模式开展前对深圳市福田区174例重性精神疾病患者的家属进行测评;建立给予重性精神疾病患者家属以心理干预和健康教育为主的社会支持模式,为期一年;项目实施一年后再次对深圳市福田区174例重性精神疾病患者的家属进行第二次症状自评量表(SCL-90)测评。结果通过对患者家属给予以心理干预和健康教育为主的社会支持后,患者家属的SCL-90躯体化、抑郁、焦虑因子的评分较干预前有显著性降低(P<0.05)。结论重性精神疾病患者家属心理状况不容乐观,对在社区进行康复的重性精神疾病患者进行社会支持的同时,要重视对家属的社会支持,对家属实施以心理干预和健康教育为主的社会支持非常有必要,可有效改善患者家属的心理状况。     

Associations of physical symptoms with perceived need for and use of mental health services among Latino and Asian Americans

Although many believe that low rates of perceived mental health need and service use among racial/ethnic minorities are due, in part, to somatization, data supporting this notion are lacking. This study examined two hypotheses: (1) increased physical symptoms are associated with lower perceived need for mental health services and actual service use; and (2) physical symptoms are most strongly associated with perceived mental health need and service use among first-generation individuals. Data come from the National Latino and Asian-American Study, a nationally-representative household survey in the United States conducted from 2002 to 2003. Participants reported on the presence of fourteen physical symptoms within the past year. Perceived mental health need was present for individuals who endorsed having an emotional or substance use problem or thinking they needed treatment for such a problem within the past year. After adjusting for sociodemographic and clinical covariates, the number of physical symptoms was positively associated with perceived mental health need and service, an effect that differed by generation. Among first-generation individuals, physical symptoms were associated with increased perceived need and service use. Physical symptoms were not significantly associated with perceived need or service use among third-generation Latinos, but were associated with service use among third-generation Asian-Americans. Physical symptoms do not appear to interfere with mental health problem recognition or service use. In contrast, individuals, especially of the first-generation, with more physical symptoms were more likely to perceive need for and utilize mental health services. Our findings do not support the notion that physical symptoms account for low rates of perceived mental health need and service use among Latino and Asian-Americans.     

The economic benefits of supported employment for persons with mental illness

BACKGROUND: Policies and programs that emphasize employment for persons with mental illness are often promoted with the goals of improving economic self-sufficiency and reducing dependence on public welfare programs. At present, there is little empirical evidence about the actual effect of vocational interventions on economic self-sufficiency or on use of public benefits by persons with mental illness. STUDY AIMS: This study provides a preliminary look at how participating in supported employment, a form of vocational rehabilitation emphasizing ongoing support in competitive jobs, affects the amount that participants earn from work and the total amount of income they receive from all sources. Further, we examine the extent to which receiving public benefits affects the amount earned from private employment, taking into consideration other factors that might be associated with benefit status. METHODS: Data are from a randomized trial of supported employment interventions. This analysis followed 137 of those study participants with severe mental illness for 18 months after they enrolled in either of two supported employment programs. Income from various sources was estimated based on interviews with study participants upon study entry and at six-month intervals thereafter. Changes in income from work, government and other sources were analyzed using paired Wilcoxon matched-pairs signed-ranks tests and t-tests. Using ordinary least-squares regression, we analyzed the effect of benefit status on changes in earnings, taking into account diagnosis, work history, education, program type, site of program, psychiatric symptoms, global functioning and previous earnings. RESULTS: Estimated total income increased by an average of $134 (US) per month after enrolling in supported employment. More than three-quarters of this increase was from government sources, such as Social Security and educational grants. The increase in government income was largely due to participants applying for and getting cash benefits for the first time. Social Security payments for those receiving benefits before enrollment did not change significantly. A small group of persons (n = 22) who did not receive Social Security benefits before or after enrolment earned significantly more from competitive employment after enrolling than did those who received benefits. This finding persisted after taking into acount differences in work history, clinical and functional variables and education. LIMITATIONS: Because of the relatively small sample size and the lack of continuous measures of income these results should be considered preliminary. CONCLUSIONS: Supported employment, one of the more effective forms of vocational rehabilitation for persons with mental illness, did not reduce dependence on government support. Receiving government benefits was associated with lower earnings from work. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: These findings suggest that most persons in treatment for severe mental illness need continued public financial support even after enrolling in vocational rehabilitation programs. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Undoubtedly increased labor force participation can benefit persons with mental illness in a number of ways. However, policy makers should be careful about justifying increased access to vocational programs on the basis of reduced spending for income support. Further, targeting such programs only to persons receiving income support may overlook the clients who can benefit most: those who are not currently receiving benefits. IMPLICATIONS FOR FURTHER RESEARCH: Policy makers need a better understanding of how vocational interventions and income support programs affect the income and well-being of persons with mental illness. Studies similar to this one should be repeated with larger, more diverse samples that will allow use of instrumental variables statistical techniques.     

Profile of Community Mental Health Service Needs in the Moretele District (North-West Province) in South Africa

BACKGROUND: The emergence of democracy in South Africa led to a need to transform all public structures, including the health care system. The aim has been to transform these structures in order to bring them in line with the new culture of human rights. Transformation of the whole health care system is motivated by a number of key objectives, which include achieving equity in resource allocation and health service delivery, developing primary health care infrastructure and decentralising services to promote community participation. AIMS OF THE STUDY: In the context of de-institutionalising mental health services in South Africa, this study aimed to investigate community mental health service needs of mental health service users and that of their families in the Moretele district, North-West province, South Africa. METHODS: The study was conducted in three clinics situated in three different communities in the Moretele district. Data collection consisted of : 147 clinical record reviews, 105 interviews with patients followed by a joint interview with a family member, 83 interviews with caregivers and eight interviews with community key informants (traditional healers, a civic leader, a councillor, a retired teacher, and a physician). RESULTS: The majority of service users were males (54%). The mean age was 41 years and 63% had completed primary schooling.Patients were recorded as having only one of two primary diagnoses, namely schizophrenia (57%) or epilepsy (41%). However, a review of prescribed drugs and caregiver interviews showed that there was a presence of mood disorders among service users. The local hospital was service users primary entry point into the mental health care system, followed by traditional healers (30%). Interviews with service users, service providers and caregivers reveal limited knowledge of patient illness. Nevertheless, service users who had epilepsy were more likely to provide details of their illness than those with mental illness. Above half of service users had basic social skills such as bathing, eating, washing and using public transportation independently. Feelings of loneliness and isolation were common among service users in the community; seventy nine percent (79%), for example spent their days entirely in their homes. Only 7% reported contact with friends. Experiences of community discrimination and exploitation of people with mental illness were reported in key informant interviews and by service users themselves. DISCUSSION: The main community mental health service needs identified in this study were: (i) Improved quality of mental health services at clinics. (ii) Better co-ordination of services (clinic, hospital, social work and traditional healers) and removal of barriers to health service utilisation. (iii) Alleviation of the social isolation of mental health service users by building on existing community structures and individuals willing to engage in partnerships with service providers. The authors indentify a need to train primary health care providers in mental health in order to promote the adequate diagnosis and detection of common psychiatric illnesses.They also point out the need for social support interventions to enable people with mental illness to deal with loneliness and isolation and a need for psycho-educational programmes to make patients and caregivers better informed about mental illness.     

Total smoking bans in psychiatric inpatient services: a survey of perceived benefits,barriers and support among staff

Background  

The introduction of total smoking bans represents an important step in addressing the smoking and physical health of people with mental illness. Despite evidence indicating the importance of staff support in the successful implementation of smoking bans, limited research has examined levels of staff support prior to the implementation of a ban in psychiatric settings, or factors that are associated with such support. This study aimed to examine the views of psychiatric inpatient hospital staff regarding the perceived benefits of and barriers to implementation of a successful total smoking ban in mental health services. Secondly, to examine the level of support among clinical and non-clinical staff for a total smoking ban. Thirdly, to examine the association between the benefits and barriers perceived by clinicians and their support for a total smoking ban in their unit.     

Continuity of care: Validation of a new self-report measure for individuals using mental health services

Continuity of care is a concern for individuals with persistent mental illness who need diverse services over time in response to multiple and changing needs. Efforts to study continuity have been hampered by lack of appropriate instruments. The Alberta Continuity of Services Scale — Mental Health is a newly developed, self-report scale that assesses continuity of care across settings and providers. This study examined the structure, reliability, and validity of the measure among users of community mental health programs. Findings were positive. Scores captured both positive and negative perceptions of care. Factor analyses elucidated 3 components of continuity—system access, interpersonal aspects, and care team function. Associations between the continuity scores and selected client and service use measures supported its validity. The tool holds promise for system monitoring, but would need refinements to create a shorter, conceptually clearer version. Also, performance among individuals with mild and very severe levels of mental illness needs to be evaluated.     

The social-environmental context of violent behavior in persons treated for severe mental illness

OBJECTIVES: This study examined the prevalence and correlates of violent behavior by individuals with severe mental illness. METHODS: Participants (N = 802) were adults with psychotic or major mood disorders receiving inpatient or outpatient services in public mental health systems in 4 states. RESULTS: The 1-year prevalence of serious assaultive behavior was 13%. Three variables-past violent victimization, violence in the surrounding environment, and substance abuse-showed a cumulative association with risk of violent behavior. CONCLUSIONS: Violence among individuals with severe mental illness is related to multiple variables with compounded effects over the life span. Interventions to reduce the risk of violence need to be targeted to specific subgroups with different clusters of problems related to violent behavior.