Don't Mourn: Organize. Reviving Mental Health Services Research for Healthcare Quality Improvement

The structure, organization, management, and design of the mental health system are changing profoundly as new healthcare policies reshape its configurations. This special issue is a call to action for the mental health services research field. The articles represent an important attempt to identify specific concepts, constructs, and findings from psychosocial treatment research about fidelity and integrity of treatment and align them with healthcare quality. However, the current structure and processes for deriving quality indicators place other demands on the extant research base. These will challenge this migration unless changes are made in leadership around consistent measurement strategies, payment mechanisms to support quality, and attention to technological infrastructure development. The mental health services research field should be proactive. Pediatric issues need special attention, especially as applied to community‐based services for children and their families.     

Integrated dual disorders treatment

Mental health programs are increasingly combining evidence‐based practices to provide comprehensive services. Individuals with complex services needs, such as those dually diagnosed with mental illness and substance use disorders, are at high risk for numerous negative outcomes and may benefit from such comprehensive programs. This report describes the process and outcomes of a program that formally integrated assertive community treatment, supported housing, and integrated dual disorders treatment for a sample of clients with dual diagnoses. Over a 2‐year period, this pilot program targeted 14 clients with 12 clients successfully transitioned out of a state hospital into the community. Results showed large reductions in hospitalization, homelessness, and incarceration, and increases in employment and later stages of treatment for substance abuse. This study demonstrates the potential of such an integrated program and points to areas for further research in housing services. © 2009 Wiley Periodicals, Inc.     

Can't have one without the other: Mental health providers and community parents reducing barriers to services for families in urban poverty

University–community partnerships are widely recognized as critical to the success of community research and advocacy work but difficult to form and sustain. This article will describe a unique facet of that partnership, namely the collaboration between mental health clinicians and community consultants, a partnership that our data suggest was a cornerstone of our school‐based mental health service program called PALS, an ecological model designed to engage African American families living in urban poor communities in mental health services. The service model was designed to promote children's learning and positive behavior through supporting teachers and encouraging parental involvement in school. In PALS, parent representatives from the community and clinicians from the university worked together in school‐based teams to support children, families, and teachers. This article will discuss the evolution of our clinician–consultant partnership and several lessons that emerged regarding the incorporation of community members into the world of academia, research, and mental health service delivery. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 435–446, 2007.     

Housing satisfaction for persons with psychiatric disabilities

Provision of residential services to people with mental illness has assumed increasing importance since deinstitutionalization and as community‐ based services have increased. This large‐scale multisite study of housing programs specifically for persons with mental illness examines one of the factors that lead to successful residential tenure for persons with serious mental illness. To date, the Lehman Quality of Life Scale has been used primarily to assess satisfaction with housing in studies of residential services. This article reports on a new measure of housing satisfaction. This new 25‐item instrument was developed, field tested in a variety of housing settings across the country, and analyzed for reliability and validity by a group of housing researchers and clinicians. The implications of using this instrument for future evaluation and research on housing for persons with mental illness are examined. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 581–590, 2003.     

The importance of ethnic similarity in the therapist‐patient dyad among Surinamese migrants in Dutch mental health care

Empirical evidence is equivocal on whether ethnic matching in the therapist‐patient dyad is preferred by ethnic minority patients and whether it leads to treatment satisfaction. The aim of this study was to establish the importance of ethnic similarity in mental health care among Surinamese migrants in the Netherlands. A convenience sample of Surinamese out‐patients in community mental health care (N = 96) was interviewed. Data were analysed using logistic multivariate techniques. The majority of the Surinamese out‐patients (in particular recently residing participants) rated ethnic matching as relevant; a considerable minority considered compassion and expertise to be more relevant than ethnic background. Most out‐patients reported to be satisfied with the services, especially females and respondents treated by an ethnically similar therapist. Ethnic similarity in the patient‐therapist dyad is a strong predictor for satisfaction with mental health care services. However, although it is preferred by many, ethnic matching per se is no must ‐ empathy, expertise and world view sharing are reported to be of considerable importance as well.     

RIPPLE EFFECTS OF IMPLEMENTING EVIDENCE‐BASED MENTAL HEALTH INTERVENTIONS IN A COMMUNITY‐BASED SOCIAL SERVICE ORGANIZATION

Concerns over the quality of mental health services in the United States have led to the creation, dissemination, and implementation of evidence‐based mental health interventions (EBMHIs). Though it is widely acknowledged that interventions have ripple effects, the effects of these interventions on the systems in which they are implemented (i.e., practice settings) are unclear. The purpose of this qualitative pilot study was to explore both practitioner‐ and organization‐level ripple effects of EBMHIs implemented in a community‐based agency. We identified 4 categories of effects on practitioners (work roles and responsibilities, knowledge, thoughts and feelings, and behavior and communication) and 2 categories of effects on the organization (structure, programming). Findings suggest that it is possible to identify ripple effects through qualitative interviews. Implications for future research on mental health intervention effects are discussed.     

The genesis,implementation and impact of the Better Access mental health initiative introducing Medicare‐funded psychology services

The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare‐funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has also had a substantial impact on the profile of the psychology profession. After a full year of implementation, analysis of the impact of the availability of funded psychology services identified a number of issues and challenges. However, it is evident that the inclusion of these services under Medicare has been a most important advance for the psychology profession and the mental health of the Australian community.     

COMMUNITY NEEDS AMONG SERVICE MEMBERS AFTER RETURN FROM COMBAT DEPLOYMENT

To build on research concerning the development of postdeployment community‐based programs, we surveyed active duty soldiers from two Brigade Combat Teams (N = 693; N = 1,385) after return from a combat deployment. The Brigade Combat Teams were located on different installations in rural areas representing 2 large military communities. The survey included an assessment about a range of community services (social events, cultural integration opportunities, family, chaplain, and mental health services, etc.). We also examined whether ratings of services varied as a function of Posttraumatic Stress Disorder symptoms, deployment experiences, organizational leadership and support, and attitudinal variables related to mental health. Differences in ratings between the 2 communities suggest the measure detected perceptions of community needs that are idiosyncratic to the particular community, and may be useful for informing program planning and service needs.     

Changing Patterns of State Responsibility: A Case Study of North Carolina

Over the past two decades, there has been an increasing focus on the needs of children with mental health problems. Although there has been a commitment to developing a continuum of child mental health services by mental health professionals and others involved in the treatment, education, and care of children, progress has been remarkably slow. The state of North Carolina, in response to litigation, has established a precedent by developing integrated systems of services for seriously behaviorally disturbed children and adolescents that may serve as a model for others. The North Carolina mental health system, primarily through the community mental health centers, has served as the lead agency in this initiative. After 4 years o f program development, it appears to be well established that seriously disturbed youngsters can be served in community based systems, especially in a strong and expansive case management function is in place.     

Television and attitudes toward mental health issues: Cultivation analysis and the third‐person effect

A television content analysis and survey of 419 community respondents supports the hypothesis that media stereotypes affect public attitudes toward mental health issues. A content analysis of network, prime‐time television demonstrates that portrayals are violent, false, and negative. The mentally disordered are portrayed as 10 times more likely to be a violent criminal than nonmentally disordered television characters. A survey demonstrates that as television viewing increases so does the belief among viewers that locating mental health services in residential neighborhoods will endanger the residents. Viewers who watch television news are less likely to support living next to someone who is mentally ill. The survey also tests the third‐person effect, and finds that viewers believe television portrayals of mental illness affect others more than themselves. © 2007 Wiley Periodicals, Inc.     

The influence of sense of community on the relationship between community participation and mental health for individuals with serious mental illnesses

The goal of the current study is to better understand the association between community participation and mental health by investigating sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning. A survey was administered to 300 adults with serious mental illnesses using community mental health services in the United States in a cross‐sectional design. Hayes PROCESS macro (model 4, version 2.16; Hayes, 2013) was employed to test all of the hypotheses. Results indicate that sense of community partially mediated the association between community participation and psychological distress, as well as mental health functioning. Implications include contributing to the current knowledge base about the influence of community factors on mental health and informing future interventions aimed at promoting community participation of adults with serious mental illnesses.     

How nonclinical are community samples?

Mental health services are underutilized in our society by both adults and children. This finding presents a potential problem for researchers conducting community‐based research. Previous studies have demonstrated that community‐based researchers frequently do not screen participants for the presence of psychopathology nor do they ascertain whether therapeutic services are currently utilized. The present study explored the prevalence of psychopathology and treatment involvement in a sample of families recruited from the community. Results indicated that a fifth of the participants in this community‐based sample met diagnostic criteria for a psychiatric disorder or were in treatment for psychological difficulties at the time of recruitment for this study. Furthermore, mothers, fathers, and adolescents who met the criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV; American Psychiatric Association, 1994 ) for a psychological disorder had higher symptomatology than those who did not meet criteria. Methodological suggestions are provided. © 2008 Wiley Periodicals, Inc.     

Helping community mental health work: a model for the professional role of liaison

Community mental health centers were created to provide mental health services within the community. However, these centers have had difficulty delivering community-based services and have, all too often, become isolated from the communities they serve. A model for the role of professional liaison is presented. The liaison model is seen as providing a solution to service delivery problems by acting as an adjunctive agency providing broadly based referral and linking services between agencies in the community. Essential features of the liaison role include an ecological perspective, indirect service delivery, an emphasis on liaison role rather than technique, and the inappropriateness of advocacy.     

A bitter bean: Mental health status and attitudes in chinatown

This interview sample survey of adult residents of San Francisco's Chinatown was conducted in an effort to understand the phenomenon of underutilization of mental health services by Chinese Americans and the reasons underlying this phenomenon. Findings revealed that the use rate of mental health services was extremely low, with only 5% of respondents having sought mental health services, suggesting that this ethnic community has not yet seen the gains promised by the community mental health movement. At the same time, reported psychological disorders in the community were quite prevalent; a sizable number of respondents admitted to symptoms of emotional tension, depression, loneliness, and psychological-physiological symptoms. Thus, need is high, but demand is small. Findings suggested that underutilization is not due to unwillingness to admit to symptoms nor to use of alternative cultural sources of help; rather, lack of knowledge of existing services seems to be a major contributor to low use rates. Other contributing factors include the belief among some respondents that mental disorders cannot be prevented, lack of awareness of how psychological problems can be treated, and a low priority attached to seeking professional help for depression. Compared to other low-income Americans, Chinatown residents demonstrated more determination than resignation in handling personal problems. Moreover, approaches to handling problems were varied and often multiple in nature. The survey confirmed some existing notions about mental health among Asian Americans, while disconfirming other assumptions.     

Vietnamese Americans' attitudes toward seeking mental health services: Relation to cultural variables

This study examined the relation between culturally based variables and attitudes toward seeking mental health services among a community sample of Vietnamese Americans ( N = 148) with at least 8 years' residence in the United States (U.S.). Variables included Stigma, Traditional Beliefs about Mental Illness, Help‐Seeking Preferences, Problem Prioritizing, and Disclosure. The results indicated that Disclosure, Help‐Seeking Preferences, and Problem Prioritizing were significant predictors of attitudes. Greater willingness to disclose, greater preference for professional resources over family/community resources, and higher priority placed on mental/emotional health concerns over other concerns were each associated with more favorable attitudes toward seeking mental health services. Stigma and Traditional Beliefs about Mental Illness did not appear to be significant predictors. Implications of the findings are discussed. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 213–231, 2005.     

‘Chipping in’: Clinical psychologists’ descriptions of their use of formulation in multidisciplinary team working

Objectives. To investigate clinical psychologists’ accounts of their use of psychological case formulation in multidisciplinary teamwork. Design. A qualitative study using inductive thematic analysis. Methods. Ten clinical psychologists working in community and inpatient adult mental health services who identified themselves as using formulation in their multidisciplinary team work participated in semi‐structured interviews. Results. Psychological hypotheses were described as shared mostly through informal means such as chipping in ideas during a team discussion rather than through explicit means such as staff training or case presentations that usually only took place once participants had spent time developing their role within the team. Service context and staff's prior experience were also factors in how explicitly formulation was discussed. Participants reported that they believed that this way of working, although often not formally recognized, was valuable and improved the quality of clinical services provided. Conclusions. More investigation into this under‐researched but important area of clinical practice is needed, in order to share ideas and support good practice.     

Predicting patient deterioration in youth mental health services: community mental health vs. managed care settings

Objective: To examine differences across a community mental health system and a private managed care system in the accuracy of a warning system designed to identify youth at risk for deterioration in mental health services. Design: Longitudinal outcome data from the Youth Outcome Questionnaire (Y‐OQ) were examined using multilevel modeling for 2,310 youth ages 4–17 who received outpatient treatment. Results: The warning system correctly identified 69% of cases that ultimately ended in deterioration in the community mental health setting, compared to 61% in the managed care setting. The overall hit rate (overall accuracy in classifying cases as deteriorators/non‐deteriorators) was the same in the two settings (75%). Conclusions: Results are consistent with previous research demonstrating that patient‐focused warning systems can be reasonably accurate in identifying youth cases at risk for treatment failure. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–17, 2011.     

A PRELIMINARY EXAMINATION OF THE MEANING AND EFFECT OF LIMITED LITERACY IN THE LIVES OF PEOPLE WITH SERIOUS MENTAL ILLNESS

The relationship between literacy and health has been well documented: research shows that people with limited literacy skills have worse health outcomes for numerous chronic conditions. However, little is known about how literacy relates to mental health, including access to treatment and recovery. A pilot study was conducted with mental health services users with varying literacy skills at two urban, public mental health clinics to more fully understand how literacy affects the lives of people living with serious mental illness. The study was designed using a Community‐Based Participatory Research approach; mental health service users informed the development of the interview guide. Findings demonstrate that those with limited literacy skills experience increased stigma, have fewer options for accessing information about conditions and treatment plans, and may be excluded from certain cognitive‐behavioral treatments that require basic literacy skills. These barriers can significantly affect service utilization and mental health outcomes.     

A longitudinal study of mental health consumer/survivor initiatives: Part 1—Literature review and overview of the study

Mental health consumer‐run organizations are alternatives to mainstream mental health services, and they have the dual focus of supporting members and creating systems change. The existing literature suggests that these organizations have beneficial impacts on social support, community integration, personal empowerment, subjective quality of life, symptom distress, utilization of hospitals, and employment/education. However, much of this research is cross‐sectional or retrospective and has not used comparison groups, thus limiting conclusions about the effectiveness of these organizations in improving the lives of members. Although many consumer‐run organizations also have a focus on social systems change, there has been little research documenting either the nature of these activities or the system changes that result from such activities. We provide an overview of a longitudinal study of four mental health Consumer/Survivor Initiatives. The study examines both individual‐level and systems‐level activities and impacts by using both quantitative and qualitative methods with a participatory action research framework. © 2006 Wiley Periodicals, Inc.     

Considering a multisite study? How to take the leap and have a soft landing

Although most policymakers agree that a fundamental goal of the mental health system is to provide integrated community‐based services, there is little empirical evidence with which to plan such a system. Studies in the community mental health literature have not used a standard set of evaluation methods. One way of addressing this gap is through a multisite program evaluation in which multiple sites and programs evaluate the same outcomes using the same instruments and time frame. The proposition of introducing the same study design in different settings and programs is deceptively straightforward. The difficulty is not in the conceptualization but in the implementation. This article examines the factors that act as implementation barriers, how are they magnified in a multisite study design, and how they can be successfully addressed. In discussing the issue of study design, this article considers processes used to address six major types of barriers to conducting collaborative studies identified by Lancaster or Lancaster's six Cs—contribution, communication, compatibility, consensus, credit, and commitment. A case study approach is used to examine implementation of a multisite community mental health evaluation of services and supports (case management, self‐help initiatives, crisis interventions) represented by six independent evaluations of 15 community health programs. A principal finding was that one of the main vehicles to a successful multisite project is participation. It is only through participation that Lancaster's six Cs can be addressed. Key factors in large, geographically dispersed, and diverse groups include the use of advisory committees, explicit criteria and opportunities for participation, reliance on all modes of communication, and valuing informal interactions. The article concludes that whereas modern technology has assisted in making complicated research designs feasible, the operationalization of timeless virtues such as mutual respect and trust, flexibility, and commitment make them successful. © 2002 John Wiley & Sons, Inc.