Mind-Body Therapies for Late-Life Mental and Cognitive Health

Purpose of Review

A growing body of research supports the use of mind-body therapies (MBTs) as minimally invasive and effective approaches for the management of late-life mood and cognitive disorders.

Recent Findings

Recent randomized controlled trials and meta-analyses indicate that MBTs are effective for enhancing well-being, mood, sleep, and cognition in older adults. Evidence suggests that mindful movement (e.g., yoga, tai chi, walking meditation) may even outperform conventional physical exercise with regard to effects on quality of life, mood, and cognitive functioning.

Summary

Practitioners may recommend MBTs as holistic, effective approaches for the management of common late-life mood and cognitive disorders. Continued research on MBTs will inform the development of even more effective/targeted interventions and contribute to greater acceptance and integration of these therapies into geriatric medicine and psychiatry.

     

Peer Models in Mental Health for Caregivers and Families

Peer-delivered mental health models may hold important benefits for family members, yet their prevalence, components, and outcomes are unknown. We conducted a review of peer-delivered services for families of children and adults with mental health problems. Randomized studies of interventions published between 1990 and 2014 were included if the intervention contained a component for family members and examined familial outcomes. Of 77 studies that were assessed for their eligibility, six met criteria. Familial components included coping and parenting skills, knowledge about mental health, and emotional support. Outcomes were uneven, although significant improvements in family functioning, knowledge about mental illness, parental concerns about their child, and parenting skills were associated with the intervention. Peer-delivered services for family members may have important benefits to family members and individuals with mental health problems; however, the research base remains thin. A research agenda to develop and examine these models is discussed.     

Creating Shared Mental Models for Evidence-Based Mental Health Promotion in Schools

In postulating the need for a more inclusive conceptualisation of knowledge that improves the practice of prevention science in mental health programs, Rowling (2008) makes a case for acknowledging the validity of the disparate research and practice cultures from both health and education. A review of literature using narrative synthesis was undertaken to explore the differing research and practice cultures. Three recurring themes were identified at the interface of these differing traditions: individual versus group orientation, school leadership and change in schools. These are perceived differently due to the mental models being used by program developers and education professionals. These alternative views consistently emerge in relevant evaluation reports. It is proposed that the identified problems of sustainable implementation in schools are not restricted to health-related programs, but are consistent across interventions. Building on this analysis, several actions are suggested that will increase the capacity to develop, implement and sustain universal and evidence-based promotion and prevention activities in Australian schools.     

Rural Models for Integrating Primary Care and Mental Health Services

This paper presents findings from a study designed to identify and describe models for integrating primary care and mental health services in rural communities. Data were obtained from telephone interviews with staff at rural primary care sites around the country. Findings are based on the responses of 53 primary care organizations in 22 states. The authors identify four integration models—diversification, linkage, referral and enhancement—which appear to exist in combination, rather than as pure types. The proposed analytic framework outlines aspects of integration that are readily amenable to study.     

Human Rights Protections for People with Mental Health and Cognitive Disability in Prisons

People with a mental health or cognitive disability are vastly over-represented in the Australian prison system. Investigatory reports by Ombudsmen and similar organisations reveal that there is considerable scope for improving the treatment of this cohort. One avenue for doing so is using a human rights framework, given that Australia's international human rights law obligations require (among other things) that imprisoned people be treated with respect for their human dignity and, furthermore, recent international research demonstrating that fair and respectful treatment in prison may improve psychological well-being. However, there are considerable challenges involved in implementing this requirement in overcrowded and hierarchical prison settings. It is even more difficult to comply with the legal requirements given the web of provisions at the international, national and State/Territory levels, causing complexity and a lack of clarity as to their interrelationship. This article condenses the requirements into four principles and discusses how these have been applied by courts in relevant international and domestic cases. This analysis aims to assist correctional managers and policy makers seeking to comply with these legal requirements. Such compliance should form part of a multifaceted approach to protecting these vulnerable individuals from further harm.     

Early Intervention for Substance Abuse Among Youth and Young Adults with Mental Health Conditions: An Exploration of Community Mental Health Practices

This mixed method study examined current practices and barriers for screening and assessing substance use among youth/young adults in community mental health systems. Substance use rates remain high among youth/young adults in the general population and substance use disorders are prevalent among young people involved in public service systems such as mental health. In an effort to understand the dynamics for early intervention, 64 case managers and/or clinical directors from children’s mental health systems in two states participated in an online survey or focus group in fall 2008. Quantitative survey questions and qualitative focus group questions explored attitudes and perspectives about screening and early intervention for substance use among youth/young adults involved in the mental health system and current agency practices. Mixed method results suggest a number of barriers to substance use screening and early intervention and point to innovations that could be more effectively supported.     

The Human Right to Justice for Older Persons With Mental Health Conditions

This article explores the nature and extent of barriers to access to justice that older persons experience, including those with mental health conditions. It finds that access to justice—the right to fair, prompt and responsive decisions by administrative decision-makers and equal access to courts and tribunals to obtain timely and effective remedies—is not only an important right in itself but also enables the enjoyment of many other human rights. Yet older persons, particularly those with mental health conditions, face a significant “justice gap.” Ageist attitudes, laws and practices interact with other forms of bias such as mentalism, sexism, ableism, racism, homophobia, and heterosexism exacerbating older persons’ disadvantage and marginalization, particularly those with mental health conditions, and older indigenous persons. These discriminatory practices, together with the phenomena of elder abuse, all severely limit older persons’ access to timely and responsive justice. International and national standards, both general and specific to older persons, have been shown to be inadequate to respond to this justice gap. An international standard in the form of a binding legal obligation that specifically addresses older persons’ rights of access to justice is needed urgently as part of a new international treaty on the human rights of older persons.     

Human Rights to Inclusive Living and Care for Older People With Mental Health Conditions

Although older persons wish to age at home, many older persons with mental health conditions and psychosocial disability (MHC-PSD) spend the last few years of their life in residential facilities. This paper will examine the impact of ageism and human rights violations manifested in environmental design, specifically regarding social isolation, loneliness, inadequate psychosocial, environmental, recreational and spiritual support. This is compounded by failure to meet basic care needs-nutrition, hydration, pain and medication support. This paper highlights two innovative initiatives from the Netherlands, which show that older persons’ rights can be maintained in innovative, collective living arrangements. It is concluded that the creation of inclusive and safe environments for older persons with MHC-PSD can facilitate the enjoyment of Human Rights.     

Models of Case Mix Adjustment for Ohio Mental Health Consumer Outcomes Among Children and Adolescents

Outcome data collection systems provide the opportunity for comparing agencies, programs, and therapists. However, the political stakes of comparisons raise important issues regarding their perceived validity. The goal of case-mix adjustment is to eliminate potential biasing factors that might render comparisons as inappropriate or irrelevant. In this paper, case-mix adjustment variables are identified using regression analysis followed by developing models of case mix adjustment using a sample of youth participants in the Ohio Mental Health Consumer Outcomes System. Results indicate that certain client level variables do predict outcomes. The total variance accounted for by variables other than baseline ratings of the outcome measure was small. When comparing agencies using adjusted and unadjusted models, some agencies did vary relative to other agencies. As with previous studies, however, the rank order of agencies was largely unchanged and the correlation between adjusted and unadjusted outcomes among agencies was significant.     

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

     

Improving Health Care for Mental and Substance Use Conditions: A Framework for Bridging the Quality Chasm

This article highlights selected findings of the 2005 Institute of Medicine (IOM) report on quality problems in health care for mental and substance use (M/SU) conditions and proposes a new framework for organizing and implementing recommendations of the IOM or any organization that would study and report on significant issues in health care administration, delivery, financing, policy, and research. The model, depicted as a "Quality Cube," proposes three essential axes of consideration for implementing broad-scale improvements in health care for M/SU and other health conditions: (a) quality-improvement aims (what goals need to be accomplished), (b) agents (who should take responsibility for their achievement), and (c) actions (how quality aims should be pursued).     

Testing Social Cognitive Models of Mental Illness Stigma: The Prairie State Stigma Studies

Abstract

Social cognitive models of stigma define the relationship among: signals that suggest a person is mentally ill, stigmatizing attitudes about the person with mental illness, affective reactions to the stigmatizing attitude, and behavior responses to these attitudes and emotions. The Prairie State Stigma Studies were a set of investigations completed over the past five years examining stigma from the perspective of the general public. Several of the studies examined path models that explain the relationship between stigmatizing attitudes and discriminatory behavior. Among the many results was the finding that stigmatizing attitudes about dangerousness were especially problematic, leading to fear and avoidance of persons with mental illness. The studies also examined ways to change stigmatizing attitudes and corresponding behaviors. Results suggested that contact with persons who are challenged by psychiatric disabilities has a broad and positive effect on public stigma. Future directions for research on social cognitive models of stigma are discussed.     

CCK in Anxiety and Cognitive Processes

DAUGÉ, V. AND I. LÉNA. CCK in anxiety and cognitive processes. NEUROSCI BIOBEHAV REV 22(6) 815–825, 1998.—Extensive studies were carried out on the involvement of the CCKergic system in anxiety-, panic- and stress-related behaviour. The stimulation of CCK-A or CCK-B receptors is implicated in the physical and psychological responses of CCK to stress. Furthermore, several selective CCK-B agonists produce anxiogenic-like effects, while CCK-B antagonists induce anxiolytic-like responses in several models of anxiety. However, BC264 a highly selective CCK-B agonist, does not produce anxiogenic-like effects but increases attention and/or memory. These effects are dependent on the dopaminergic systems. Together with biochemical data, this led to the hypothesis of the existence of two CCK-B binding sites, CCK-B1 and CCK-B2, which could correspond to different activation states of a single molecular entity. Investigations into CCK-B1 and CCK-B2 systems might be of critical interest, since only one site, CCK-B1, appears to be responsible for the effects on anxiety. Furthermore, the improvement of attention and/or memory processes by CCK, through CCK-B2 receptors, could offer a new perspective in the treatment of attention and/or memory disorders.