THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT

Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Yet it has not been determined if the inclusion of cultural elements affects the way mental health clients experience services. This study examined 102 clients who had received mental health treatment from outpatient mental health clinics to investigate whether culturally related elements involving race and ethnicity were important to clients and whether they were related to client satisfaction and perceived treatment outcomes. Ethnic minority clients generally felt that issues regarding race and ethnicity were more important than did White clients. When these elements were considered important but were not included in their care, clients were less satisfied with treatment. Consistent with the notion of cultural responsiveness, these findings provide empirical evidence that culturally relevant aspects of the mental health service experience are salient to ethnic minority clients and can affect how they respond to services.     

NEIGHBORHOODS AND MENTAL HEALTH TRAJECTORIES OF LOW‐INCOME MOTHERS

Research has demonstrated a correlation between living in a low‐income neighborhood and mental health. However, neighborhood variables affecting mental health and the extent they serve as risk or protective factors are not well understood. Using longitudinal data from a representative sample of low‐income mothers from the Welfare, Children, and Families: A Three City Study, the trajectories of total mental health, depression, somatization, and anxiety from the Brief Symptom's Inventory are assessed. Then, the effects of two neighborhood concepts–collective efficacy and neighborhood problems–on mental health trajectories are assessed. Results indicate that total mental health, depression, somatization, and anxiety all decrease in this sample over time. Perceiving one's neighborhood to be high in collective efficacy is predictive of healthier trajectories. The presence of neighborhood problems is associated with declines in mental health trajectories. Findings demonstrate the need to address neighborhood conditions to improve mental health for low‐income mothers living in low‐income neighborhoods.     

MATERNAL CHARACTERISTICS ASSOCIATED WITH CHILD BEHAVIOR REPORTS IN HEAD START SETTINGS

The objective of this study was to examine the association between maternal characteristics and mother‐rated child behavior reports for 435 predominately African American children enrolled in urban Head Start programs. Mothers who were adolescents at the time of their child's birth reported more favorable child behaviors compared with those who were not adolescents at childbirth. Less favorable ratings of child behavior scores were observed for mothers with a history of family substance abuse, depression, and welfare receipt. These findings should assist in policy decisions for the allocation of targeted family and child interventions.     

IDENTIFYING MENTAL AND PHYSICAL HEALTH CORRELATES OF HOMELESSNESS AMONG FIRST‐TIME AND CHRONICALLY HOMELESS VETERANS

This study examined four categories of self‐reported health and mental health factors and their association with recurrent or chronic homelessness in a sample of homeless Veterans presenting for care for the first time. These factors and their relationship to housing status were examined in a cross‐sectional analysis comparing first‐time or single episode homeless Veterans to chronic or repeat emergency sheltered or unsheltered homeless Veterans. Results revealed that while Veterans with a history of chronic or recurrent homelessness were more likely to self‐report diagnoses of substance abuse problems, any mental health problems, and bipolar disorder, those who were homeless for the first time in their adult life were more likely to report a variety of physical health conditions, economic causes of homelessness, and some other mental health problem. These findings suggest that further work should be undertaken to determine how clinical interventions for Veteran homelessness address different risk profiles and treatment needs based on lifetime homeless history.     

CLARIFYING THE PHILOSOPHY BEHIND THE COMMUNITY MENTAL HEALTH ACT AND COMMUNITY‐BASED INTERVENTIONS

The passing of the Community Mental Health Act was supposed to signal a change in the treatment of mental disorders. The idea was to embed interventions as much as possible in a community, so that treatment is accessible and appropriately designed. However, many programs that strive to be community‐based never achieve this status. The problem is that becoming community‐based is often treated as merely a methodological or tactical change, rather than a new philosophy. Clinics were built and services offered without a coherent theory to explain why better assessments and treatments should accompany a community‐based strategy. The purpose of this article, therefore, is to clarify the basis for such an approach so that mental health services are not simply placed in communities, but rather are defined and controlled by the persons who reside in these neighborhoods.     

EARLY HEAD START HOME VISITATION: THE ROLE OF IMPLEMENTATION IN BOLSTERING PROGRAM BENEFITS

Home visitation has emerged as a key strategy for promoting child and family well‐being in the current policy context. This article examines the effectiveness of the Early Head Start (EHS) home‐based program for children and families at the end of the program and 2 years later, with a particular focus on the role of program implementation in the impacts of the EHS home‐based program on child and family outcomes. There was a pattern of broad, modest effects of EHS home visiting for both children and parents, which were strengthened if the programs were fully implemented according to federal guidelines. In particular, impacts for children in the cognitive and language domain were documented. Implications of these findings for policy and practice are discussed.     

THE EFFECTS OF HEAD START DURATION ON THE BEHAVIORAL COMPETENCE OF SOCIALLY DISADVANTAGED CHILDREN

This study examined the influence of Head Start duration on teacher‐reported children's approaches to learning, behavioral problems, and cooperative classroom behaviors at the end of kindergarten. Propensity score matching was used to create comparable samples of children who experienced different durations of Head Start. Analysis of the Head Start Family and Child Experiences Survey showed that children who attended 2 years of Head Start showed a higher level of approaches to learning (effect size [ES] = .53), cooperative classroom behaviors (ES = .35), and fewer problematic behaviors (ES = ‐.43) in kindergarten. The effects of 2 years of attendance of Head Start were most prominent for children raised in families with high‐risk factors and for Black children, particularly with improvement in approaches to learning. This finding supports the argument that a longer exposure from an earlier age to a preschool program may contribute to improving school readiness for children from economically disadvantaged families.     

HOUSEHOLD INCOME LEVEL AS A MODERATOR OF ASSOCIATIONS BETWEEN CHRONIC HEALTH CONDITIONS AND SERIOUS MENTAL ILLNESS

This study examined the influence of household income level on associations between common chronic health conditions (e.g., cardiovascular disease, diabetes, asthma) and probable serious mental illness (SMI). Data from the 2011 New York City Community Health Survey (N = 8,792) were examined using logistic regression modeling, including interaction terms or models stratified by household income to determine whether there was effect modification. Associations between chronic conditions and probable SMI varied across household income levels. Specifically, there was a significant interaction between diabetes and household income on probable SMI. In stratified models, asthma was associated with probable SMI only among individuals from poor households (< 100% federal poverty), whereas diabetes was associated with probable SMI only among those from middle‐income households (200% to < 400% federal poverty). The findings highlight the mental health needs of individuals with chronic health conditions. Efforts to integrate physical and mental health services in community settings may be crucial for those from poor and middle‐income households.     

RELATIONSHIP OF EVIDENCE‐BASED PRACTICE AND TREATMENTS: A SURVEY OF COMMUNITY MENTAL HEALTH PROVIDERS

Evidence‐based treatments (EBTs) are interventions that have been proven effective through rigorous research methodologies. Evidence‐based practice (EBP), however, refers to a decision‐making process that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service providers’ knowledge of EBP and perceived advantages, disadvantages, reasons for not implementing full EBT protocols, and attitudes toward EBTs. Qualitative examination of mental health service providers’ definitions of EBP reveals confusion between the terms EBP and EBT. Service providers indicated several advantages and disadvantages of using EBTs. Analysis suggests that many perceived EBT disadvantages would be eliminated if EBTs are implemented as part of the EBP approach, thus allowing for clinician expertise and patient characteristics to be combined with EBTs. Alternatively, distinguishing between EBP and EBT may be more confusing than useful for most community mental health practitioners, which indicates new terminology may be needed.     

IAPT,ANXIETY AND ENVY: A PSYCHOANALYTIC VIEW OF NHS PRIMARY CARE MENTAL HEALTH SERVICES TODAY

The Labour government's response to the Layard (2004 ) report was to implement the ‘Improving Access to Psychological Therapies’ (IAPT) programme within Primary Care Trusts in the NHS. In this paper, I argue that the IAPT programme's explicit commitment to ‘well‐being work’ risks distorting the unconscious anxiety‐containing function that society traditionally allocates to mental health practitioners. Drawing on the social defence paradigm of Menzies Lyth (1959 ) and later work by Stein (2000 ), I use an organizational case example to explore some of the unconscious dynamics within an IAPT service and explore how mechanisms such as defensive splitting and projective identification within the multidisciplinary team result in psychotherapists coming to represent an unwanted, vulnerable and expendable aspect of the service. I contend that psychotherapists may serve an important function as unconscious ambassadors of a split‐off affective aspect of IAPT primary care mental health services, and that as such they will urgently need to ensure they do not succumb to burnout or unhelpful ways of working and relating within the team.     

CHARACTERISTICS OF EARLY COMMUNITY ADVERSITY,SOCIAL RESOURCES,AND ADOLESCENT LONG‐TERM MENTAL HEALTH

This study examined early life community characteristics to predict mental health from adolescence to adulthood. Confirmatory factor and latent growth analyses were conducted with 1,796 participants from the National Longitudinal Study of Adolescent Health spanning adolescence (Wave 1) through early adulthood (Wave 4). Analyses modeled community structural adversity and social resources as predictors of depressive symptoms trajectories via indirect effects of parent mental health and parent–child relationships. Community connectedness and integration were protective factors for long‐term mental health via parental happiness and positive parent–child relationships. Findings add to the body of work distinguishing structural community characteristics from social characteristics, specifying them as two simultaneous dimensions and identifying social resources as early life factors that provide long‐term protection.