Training CAMHS Professionals in Developing Countries: An Indian Case Study

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links.     

Child Mental Health is Everybody's Business: The Prevalence of Contact with Public Sector Services by Type of Disorder Among British School Children in a Three-Year Period

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed-up over 3 years. Parents provided summary information on service contacts in relation to mental health; selected subgroups provided more detailed information by telephone interview.
Results:  Common overlaps in service use were between health services, between teachers and educational specialists, and between the latter and CAMHS or social services. Services other than primary health care saw more children with externalising disorders, while children with anxiety disorders were less likely than children with other psychiatric disorders to be in contact with any service.
Conclusions:  Child mental health is everybody's business, and professionals need to be alert(ed) to the types of disorders that children using their service may have.     

Child Mental Health Services in the New South Africa

Health departments in the new South Africa are undergoing major restructuring and, in some cases, severe financial cutbacks as new policies attempt to redress the inequities of the past. A district system is being phased in, with a shift in funding from academic hospitals to secondary and primary level care. The process is being undermined by the current recession, which also affects Welfare and Education facilities, and by widespread poverty, violence, and other adverse conditions. Child mental health services are discussed in the light of current human resources, epidemiological data, the effects of violence and cultural issues, together with some reflections on their future.     

Stigmatizing Attitudes About Mental Illness and Allocation of Resources to Mental Health Services

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.     

A Call for a Mental Health Services Research Agenda for Youth with Serious Emotional Disturbance

This paper proposes a research agenda on clinical interventions for youth with serious emotional disturbances (SED). A National Institute of Mental Health (NIMH) National Advisory Mental Health Council report on adults with severe mental disorders issued in 1991, led to a research plan and a significant expansion of services research for this adult population. A similar strategy is proposed for children, based on three assumptions: (1) there is a real need for effective treatment; (2) the timing is right; and (3) a small cadre of child clinical and clinical services researchers is prepared to pursue such research. Four topics provide the rationale for NIMH or another agency to commission an expert panel to: (1) conduct an evidence-based review of promising interventions; (2) assess quality indicators; (3) evaluate outcome measures; and (4) reach consensus on a research phase model. A research plan for youth with SED could be endorsed before the new millennium.     

Psychiatric Emergency Services: A Review of the Literature and a Proposed Research Agenda

To gain a better understanding of the scope of previous research on psychiatric emergency services (PES) and to identify areas of focus for future studies, the author reviews PES literature published between 1983 and 2003. PES literature was identified by performing a MEDLINE search. The author was interested in studies or reviews of all types of PES. The refereed research, consisting of 85 articles, is a representation of the existing literature as multiple studies were found to be similar in topic and methodology. This review is organized using Donabedians structure, process, outcome framework to describe research that has examined 1) providers, clients, and services; 2) variations in access, utilization, evaluation, treatment, and continuity of care; and 3) outcomes of these services. The resulting report reveals methodological limitations that are pervasive throughout the PES literature, dimensions of psychiatric emergency services that remain unexplored, and a PES research agenda.     

Challenges in Establishing Adolescent Forensic Mental Health Services Within Australian Youth Detention Centres

Young people in custody rank amongst the most marginalized in Australia, and have high rates of mental health disorders. However, the knowledge base to support the emerging field of adolescent forensic psychiatry is limited. Following an appraisal of Australia's state-based youth justice systems, it is proposed that three key challenges need to be addressed: the challenge of advocating for change, the challenge of building an evidence base, and the challenge of developing integrated transitional models of service delivery. Adolescent forensic mental health services that view their role as existing solely within the walls of youth detention centres or community juvenile justice services have too narrow a vision. While not seeking to trivialize their patients’ criminal behaviour, psychiatrists need to drive the delivery of innovative mental health services within youth detention centres and collaborate with those in the political, legal, youth justice, education and child safety sectors to inform debate of the challenges faced by young people in custody.     

Urgent Psychiatric Services: A Scoping Review

Objective:

Urgent psychiatric services can provide timely access to ambulatory psychiatric assessment and short-term treatment for patients experiencing a mental health crisis or risk of rapid deterioration requiring hospitalization, yet little is known about how best to organize mental health service delivery for this population. Our scoping review was conducted to identify knowledge gaps and inform program development and quality improvement.

Method:

We searched MEDLINE, PsycINFO, CINAHL, Embase, and EBM Reviews for English-language articles, published from January 1993 to June 2014, using relevant key words and subject headings. Reverse and forward citations were manually searched using reference lists and Google Scholar. Articles were included if they described programs providing ambulatory psychiatric assessment (with or without treatment) within 2 weeks of referral.

Results:

We identified 10 programs providing urgent psychiatric services. Programs targeted a diagnostically heterogeneous population with acute risks and intensive needs. Most programs included a structured process for triage, strategies to improve accessibility and attendance, interprofessional staffing, short-term treatment, and efforts to improve continuity of care. Despite substantial methodological limitations, studies reported improvements in symptom severity, distress, psychosocial functioning, mental health–related quality of life, subjective well-being, and satisfaction with care, as well as decreased wait times for post-emergency department (ED) ambulatory care, and averted ED visits and admissions.

Conclusions:

Urgent psychiatric services may be an important part of the continuum of mental health services. Further work is needed to clarify the role of urgent psychiatric services, develop standards or best practices, and evaluate outcomes using rigorous methodologies.     

Piloting a New Model of Crisis Counseling: Specialized Crisis Counseling Services in Mississippi After Hurricane Katrina

During January–April 2007, Project Recovery, a federally funded crisis counseling program implemented by Mississippi’s Department of Mental Health, piloted a new model of Specialized Crisis Counseling Services (SCCS) on the Mississippi Gulf Coast. In this team-based approach, a masters-level counselor trained in a variety of intervention techniques and a resource coordinator worked together with persons whose needs were relatively intense. Compared to regular program (RCCS) participants over the same interval (n = 29,522), SCCS participants (n = 281) were more likely to be female, middle-aged, and at greater risk for severe distress. In a participant survey conducted in both programs over the same week, SCCS participants reported significantly greater benefit than did RCCS participants. A subset of 129 SCCS participants provided pre- and post-participation assessments and showed large improvements in disaster-related distress.     

Community management of intellectual disabilities in Pakistan: a mixed methods study

Background   Pakistan has one of the highest reported rates of childhood intellectual disabilities (ID) in the world. Prevalence estimates vary from 19.1/1000 for serious ID to 65/1000 for mild ID.
Methods   We surveyed carers of persons with ID ( n  = 100) using quantitative and qualitative instruments. We conducted in-depth interviews of carers ( n  = 16) and key primary health providers ( n  = 10). We also carried out focus groups ( n  = 7). Data were triangulated and interpreted in light of peer reviewed literature.
Results   There was a delay of 2.92 (95% CI 1.9 to 3.94) to 4.17 (95% CI 2.34 to 6.01) years between detection and seeking of care. Parental stress associated with caring for these children was high (mean Self-Reporting Questionnaire score 8.4; 95% CI 6.80 to 9.91). Home management consisted mainly of physical containment. Stigma associated with ID contributed to decreased opportunity for these children and families to participate in community activities. There was a lack of knowledge about causation and effective interventions for ID.
Conclusions   Our findings suggest that there is significant delay in detection of ID especially in rural setting where more than 70% of population of Pakistan resides. This missed opportunity for rehabilitation in early formative years is a cause of significant distress for the caregivers who rarely receive valid information about course, prognosis and what remedial action to take. There is a need to develop feasible, cost-effective, community level interventions, which can be integrated into existing healthcare systems.     

Developing a Model Psychiatric Treatment Program for Patients with Intellectual Disability in a Community Mental Health Center

The Special Needs Clinic of the Johns Hopkins Bayview Medical Center in Baltimore, Maryland provides comprehensive treatment for patients with developmental or intellectual disability and psychiatric illness. This report describes the clinical characteristics and service utilization of patients attending this clinic. Factors that support quality mental health services that are both cost-effective and accessible are identified.Florence Hackerman, Chester W. Schmidt, Charles Donald Dyson, Lisa Hovermale, and Gerard Gallucci are affiliated with Department of Psychiatry, The Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA.     

CORC's Survey of Routine Outcome Monitoring and National CAMHS Dataset Developments: A Response to Johnston and Gower

Background:  The CAMHS Outcome Research Consortium has 44 members across Great Britain who are collaborating to introduce routine outcome monitoring into clinical practice.
Methods:  Members were surveyed in 2004, in order to establish a baseline against which we could measure progress.
Results:  Like Johnston and Gowers, we discovered a wide range of measures were being used, while a third of CORC members were sharing information with clinicians and commissioners, and were using it to develop clinical practice or services.
Discussion:  We discuss the constraints brought up by our members and by Johnston and Gowers, as well as recent work in relation to the development of a national CAMHS dataset.     

Academic/State/Federal Collaborations and the Improvement of Practices in Disaster Mental Health Services and Evaluation

Academic, state, and federal agencies collaborated over the last 9 years to improve disaster mental health services and evaluation. This process, which included literature reviews, a number of expert panels, and case studies, is described. The products resulting from this process have included the development of a systematic cross-site evaluation of the federally funded crisis counseling program and field guides for interventions aimed at providing services to distressed individuals in the immediate aftermath of disasters and to individuals needing resilience skills training weeks or months after the event. Future improvement of disaster mental health services calls for continued research, evaluation, training, and intervention development.     

Priority Issues in Latino Mental Health Services Research

This paper identifies issues and trends affecting the quality and comprehensiveness of Latino mental health research and services. These issues include current patterns of need and services use, rapid expansion of the Latino population, extraordinary rates of uninsured, social and language barriers to care, transformation in treatment science and technology, and the sheer complexity and rapid changes in the delivery system. Progress in the field requires coordination and investments from both public and private sectors. Scientific journals should provide assistance for creating a high quality knowledge base and rapidly disseminating this information to students, practitioners, and policy makers. Vigorous activity is needed to (1) augment the supply of people entering the pipeline for researcher and practitioner training, and (2) support research in priority areas such as outcome studies for diverse treatments and different sectors of care, cultural competence, treatment models for youth and aging populations, quality of care, and barriers to mental health care.     

Beneficence vs. Obligation: Challenges of the Americans with Disabilities Act for Consumer Employment in Mental Health Services

Involvement of mental health service consumers in the provision of mental health services is a growing model in community mental health. It is, however, a complicated issue, made ever more so by the passage of the Americans with Disabilities Act. In this ethnographic case study, we seek to explore the changes one social services agency has made to adjust to the requirements of the ADA and the impact of these changes on their consumer employees. Our results indicate potential for positive progress as a result of the ADA, but also unexpected pitfalls as organizational cultures change as well.     

Correlates of Adolescents' Satisfaction with Mental Health Services

While there has been increased attention to consumers' satisfaction with mental health services as an indicator of quality of care, little is known about the construct of consumer satisfaction, especially for youth. The goal of this study was to examine potential correlates of adolescents' satisfaction with mental health services. One hundred eighty adolescents who had received out-patient mental health services completed a multidimensional satisfaction scale and measures of behavior problems, attitudes and expectations about treatment, perceived choice/motivation in seeking treatment, and service use history. Results indicate that the strongest unique correlates of satisfaction are severity of behavior problems, positive expectations about services, and perceived choice in seeking services. Satisfaction with services was also associated with service site, length of time in treatment, and reason for entering treatment. Demographic variables were not related to satisfaction. A discussion of the appropriateness of using satisfaction as an indicator of quality of care is included.     

Making progress in mental health policy in conservative times: one step at a time

Progress in mental health services has been made incrementally in a sequence of policy steps. In recent years, in spite of political conservatism, progressive changes have advanced new principles of service delivery. Reports from the surgeon general and the President's New Freedom Commission on Mental Health advanced these principles, including recovery and evidence-based practices. Both of these high-level reports were influenced by the findings of the Schizophrenia Patient Outcomes Research Team (PORT). The Schizophrenia PORT established the effectiveness of mental health treatments and supports, which provided a scientific foundation for the optimistic focus on recovery and its expectation of improved outcomes for individuals with severe mental disorders. The PORT study also established the gap between treatment recommendations and actual services. Concern about this gap has motivated efforts to transform services by implementing evidence-based practices. Advances in broad mental health and social policy, coupled with continued advances in science, have the potential to improve the care of individuals who experience severe mental disorders, such as schizophrenia.