The Mental Health Services Program for Youth

This paper traces the development of The Robert Wood Johnson Foundation's Mental Health Services Program for Youth, a private initiative designed to improve the organization, financing, and delivery of service to seriously mentally ill youth. The rationale and structure of this five-year initiative are discussed. In July 1989, 12 one-year development grants were awarded under the program's first phase. All of the grantees propose to utilize a number of strategies to restructure their mental health financing systems. Other common features include: the development of central intake units, early identification mechanisms, stronger utilization review protocols, and unified client tracking mechanisms.     

Age and Mental Health Services

This paper examines how age is related to theuse of formal and informal mental health services,adjustment to current life conditions, and expectationsfor improvement in future life conditions among a group of persons with serious mental illnesses.Interviews with 301 clients of 3 clinics at a publicpsychiatric facility serving West Brooklyn and StatenIsland provide the data from the study. Outcome measures include nine sorts of help receivedfrom informal members of the social network and frommental health professionals; desires to improve currentlife conditions; and expectations for futureimprovements in life conditions. Through hierarchicalregression procedures we examine the impact of age onthese outcomes, with controls for selfreported symptomsand functioning, sex, and the presence of social network members. The results indicate that youngerpeople receive more help from both informal socialnetworks and from mental health professionals. Inaddition, younger people are more likely to wantimprovements in their current life conditions and to beoptimistic about what the future holds for them. Thedecline in informal and formal support, optimism, anddesire to improve their current life situations among older clients may be cause for concern amongmental health professionals. Mental health serviceproviders should give greater recognition to the impactof age on mental health service needs among persons with serious mental illnesses.     

The Team Approach in Japanese Mental Health Services

This article describes the history and current state of health care professions in Japan and how team-based approaches have been promoted from medical institutions to the regional level and from a medical science model to a living model. This team-based approach is now recognized as being indispensable to practice and development in the field of mental health and welfare, but the independent participation of the client is regarded as fundamentally important, and a trusting and cooperative partnership must be cultivated through mutual communication between team members. From a national point of view, there are also situations in which the team-based approach does not function well due to a variety of factors such as health-care institutions' emphasis on business matters or discrimination and prejudice among local populations. Many problems remain unresolved, preventing effective support for the return of long-term hospitalized patients to the community and for the peaceful settlement of handicapped individuals in the community.     

Mental Health Services in British Columbia: A Problem of Quality Control

Highly centralized control of the British Columbia Mental Health Services has undermined the effectiveness and efficiency of mental health services, according to the author. While quality control policies based upon these assumptions may be fiscally elegant, they are costly and clinically counterproductive.     

Obesity: The Role of Child Mental Health Services

Increasing levels of child obesity are placing pressure on all children's services, including CAMHS. The need for input by mental health professionals is justified by the increased risk of depression, low self-esteem, binge eating, and impaired quality of life seen in obese children and adolescents. Two routes for CAMHS involvement with obese youngsters are described. Balance It!, a service operating in the NE England, is an example of a long-term approach involving Tiers 1-3 of CAMHS. Research testifies to the psychological value of weight loss. However, a series of questions remain regarding best practice, perceived need, and funding of CAMHS in child obesity.     

The Process of Transforming Mental Health Services in Australia

Australia commenced a nationally coordinated transformation of its public and private mental health services in 1993. This paper presents an overview of the changes in mental health service delivery using data from the 2004 Australian National Mental Health Report. In the 10 years from 1993 to 2002, government spending on mental health increased 65 percent in real terms, with a 145 percent growth in expenditure for community-based services. Government subsidies to the private psychiatrist sector have declined. Consumer and carer participation in service planning and delivery increased, measures to improve quality introduced and patient level outcome measures are being adopted widely. However, some consumers with specific needs have been neglected and the transformation has not been implemented uniformly across the country.     

The Staffing of Inpatient Child and Adolescent Mental Health Services

Background:  There is a need for more accurate information regarding the staffing of Child and Adolescent Psychiatric inpatient units. This is both to facilitate clinical governance and to allow planning and focused further development of these services.
Method:  Postal surveys were sent to all units in England and Wales.
Results:  Seventy-three percent ( n  = 1060) of the 1460 staff employed by the units were nurses; 43% of nurses were unqualified. On average there was one consultant psychiatrist for every 25 patients. Only 12% of nurses working on a 'census' day held a specialist qualification in nursing children. The use of agency and bank staff was higher in independent sector units than in NHS units (37% vs 10% of all nurses who worked a shift on the census day).
Conclusions:  Some child and adolescent inpatient units are not staffed by a multi-disciplinary team. There is evidence of problems of recruitment and retention of nurses.     

Developing Quality Indicators for Family Support Services in Community Team-Based Mental Health Care

Quality indicators for programs integrating parent-delivered family support services for children’s mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.     

Why Current and Former Recipients of Foster Care Need High Quality Mental Health Services

This commentary presents data about the emotional, behavioral, and substance abuse disorders of youth in foster care and former recipients of foster care (“alumni”) in the United States to underscore the reasons why high quality mental health services are essential.     

Scaling Up Mental Health Services in Zambia

The need to increase the capacity of developing countries to meet the mental health needs of their populations is widely acknowledged. This article examines some of the challenges associated with a British Council DelPHE project aimed at strengthening the capacity of mental health educators to prepare the mental health workforce in Zambia for a shift from an institutional to a community-based model of care. The analysis draws on data from two focus groups in which the participants were drawn from college educators who had taken part in workshops intended to enhance curriculum alignment to ensure that the education and training provided for clinical officers (psychiatry) and mental health nurses was "fit for purpose." In particular, the article highlights their perspectives on some of the tensions in focusing on mental health as opposed to broader health care and in ensuring appropriate opportunities for practice or field placements. The continuing impact of stigma and limited resources available for mental ill-health is acknowledged within the wider context of inequities in mental health care. Findings of this evaluation may be applicable to other sub-Saharan contexts, but should be understood only within the Zambian context.     

The Role of School Mental Health Services in Addressing Adolescent Pregnancy

The rate of teen pregnancy has begun to rise after a decade of steady decline in the United States, signaling a national crisis. While there are many assumed and well-founded factors related to the cause and outcome of teen pregnancy, this paper focuses specifically on the relationship between teen pregnancy, mental health and school services. The purpose of this paper is fourfold: to highlight key mental health and social risk factors and outcomes related to teen pregnancy, to identify intervention strategies that have been found to reduce teen pregnancy, to target the role that school mental health providers can hold in serving students who are at risk for pregnancy, pregnant or parenting, and to identify future directions for research, public policy and school-based services.     

The Impact of Racism on the Delivery of Health Care and Mental Health Services

This article presents research findings useful in formulating a Best Practices Model for the delivery of mental health services to underserved minority populations. Aspects of the role of racism in health care delivery and public health planning are explored. An argument is made for inclusion of the legacy of the slavery experience and the history of racism in America in understanding the current health care crisis in the African-American population. The development of an outline in APA DSM IV for the use of cultural formulations in psychiatric diagnosis is discussed.