Who uses mental health services in Australia? An analysis of data from the National Survey of Mental Health and Wellbeing

OBJECTIVE: This study sought to identify sociodemographic and psychological measures associated with utilisation of mental health services in Australia, using information collected through the 1997 National Survey of Mental Health and Wellbeing. METHOD: Twenty-one potential predictor variables were selected from the National Survey. Predisposing and enabling factors included age, sex, marital status, labour force status, geographical location and level of education. Predictor variables measuring need for services included the General Health Questionnaire score, a neuroticism scale, diagnoses of affective, anxiety and substance-abuse disorders from the Composite International Diagnostic Interview, and self-identified depression, anxiety and substance abuse. Simple and multiple logistic regressions were undertaken to identify predictor variables associated with use of mental health services from general practitioners, psychiatrists, psychologists and other health professionals. RESULTS: General practitioners were the most commonly reported providers of mental health services with 76% of those receiving any mental health care reporting using this type of service. Using multiple logistic regression, the predictor variables most associated with use of mental health services were measures of the need for such services, such as psychological distress and mental disorder. After controlling for need variables, the sociodemographic variables associated with using services provided by any health professional were being female, level of education and being separated. Living in a remote area was associated with lower use of specialist services, but not with general practitioner services. Older age was associated with less use of psychologists and other health professionals. Income and having a usual language other than English did not affect service use. CONCLUSIONS: The factors most strongly related to Australians' use of mental health services are their having a diagnosed affective, anxiety or substance-abuse disorder and their self-identifying as having depression or anxiety. Although there are regional inequalities in levels of utilisation of mental health services, these are seen more with specialist services than with those provided by general practitioners.     

Is the Australian National Survey of Mental Health and Wellbeing a reliable guide for health planners? A methodological note on the prevalence of depression

OBJECTIVE: To consider whether the prevalence of depression reported in the Australian National Survey of Mental Health and Wellbeing is a reliable guide for mental health planners. METHOD: A comparison of methodologies for the detection of depression in the Australian National Survey and a South Australian survey. RESULTS: The Australian National Survey using the Composite International Diagnostic Interview (CIDI) reported considerably less depression than a South Australian survey, which used the mood module of the PRIME-MD 1000 study. Although the PRIME-MD may over-diagnose depression, it is probable that the preclusion criteria of the CIDI result in an under-reporting of depression. CONCLUSIONS: It is probable that the Australian National Survey under-estimates the prevalence of depression in the community. This has implications not only in assessing the morbidity and economic burden of depression, but also for the planning of future mental health services.     

Do older Australians truly have low rates of anxiety and depression? A critique of the 1997 National Survey of Mental Health and Wellbeing

This paper sets out to critically evaluate reports from the Australian-wide National Survey of Mental Health and Wellbeing of very low rates of ICD-10 anxiety and depressive disorders in community resident older Australians. Data from the National Survey, which relied on the Composite International Diagnostic Interview (CIDI) were re-computed and re-analysed to address concerns about population sampling, interview response patterns and alternate measures of mental health. Rates of anxiety and depressive disorders fell to low levels after 65 years and continued to fall thereafter. This is at odds with findings from gerontological surveys that used assessment tools better suited to frail older people. Scores on mental health scales, together with diagnostic algorithms that obviated CIDI skip patterns, showed much less change in mental wellbeing across generations. It is argued that sampling and case ascertainment bias combined to reduce rates of anxiety and depression in very old people, especially when adjustments are made for the high morbidity levels encountered in aged residential facilities. Functional mental disorders almost certainly rise in frequency in advanced old age, often in conjunction with dementia.     

Relationships between adult emotional states and indicators of health care utilization: Findings from the National Health Interview Survey 2006–2014

ObjectiveAdults with serious psychological distress have a high likelihood of mental health problems severe enough to cause serious impairment in social and occupational functioning requiring treatment. These adults visit doctors frequently yet have poor health compared to adults without serious psychological distress. This study examined associations between emotional states of serious psychological distress in relationship to healthcare utilization indicators. A guiding hypothesis was that somatization underlying emotional states contributes to excessive healthcare seeking among adults with serious psychological distress.MethodsUsing 2006–2014 National Health Interview Survey, in adults with serious psychological distress (n = 9271), the six states: unable to make efforts, nervousness, hopelessness, sadness, worthlessness and restlessness were assessed in multivariate models in relation to four healthcare utilization indicators: change in the usual place of healthcare, change due to insurance, having seen a healthcare provider in the last 6 months and having 10 or more doctor visits in the last 12 months. Models were adjusted for sociodemographic variables, having seen a mental health provider, and health conditions.ResultsAdults feeling unable to make efforts were more likely to seek healthcare in the last 6 months and at least ten times in the last twelve months. Adults feeling hopeless were less likely to be heavy healthcare utilizers.ConclusionsPredisposing medical conditions do not fully explain healthcare utilization in adults with serious psychological distress. Educating healthcare providers about the emotional states motivating healthcare seeking, and integrating mental healthcare into primary care, may improve the health of adults with serious psychological distress.     

The Environment and Staff of Residential Facilities: Findings from the Italian ‘Progres’ National Survey

We administered structured interviews to managers and staff of a random sample of 265 Italian psychiatric Residential Facilities (RFs). Most are independent buildings, located in urban and suburban areas. The median number of residents is 10. The few RFs (5.7%) with more than 20 beds have a higher rate of drop-outs and escapes. The average indoor space per resident is 36 square meters, there is often a garden, and residents generally live in two-bed rooms. Most facilities are located within walking distance of shopping centers or recreational facilities. Three-quarters have 24-hour staff coverage. On average, each facility has about 10 full-time equivalent workers, with a staff:resident ratio of 0.92. Most of the professional input is provided by nurses and auxiliary staff. Critical issues to be considered in planning facilities include the physical environment, the size, and the staffing patterns. Angelo Picardi, Giovanni de Girolamo, and Pierluigi Morosini are affiliated with the National Mental Health Project, Italian National Institute of Health, Rome, Italy.Giovanni Santone is affiliated with the Psychiatric Clinic, United Hospitals of Ancona and University of Marche, Ancona, Italy.Ian Falloon is affiliated with the University of Auckland, Auckland, New Zealand.Angelo Fioritti is affiliated with the Program on Mental Health and Pathological Dependence, AUSL of Rimini, Rimini, Italy.Rocco Micciolo is affiliated with the Chair of Biostatistics, University of Trento, Trento, Italy.Enrico Zanalda is affiliated with the Department of Mental Health, Turin, Italy.The PROGRES Group includes: National Coordinators: G. de Girolamo, M.D., A. Picardi, M.D., P. Morosini, M.D. (National Mental Health Project, National Institute of Health, Rome); Biostatistician: R. Micciolo, M.D. (University of Trento); Regional Coordinators: P. Argentino, M.D., G. Borsetti, M.D., M. Casacchia, M.D., P. Ciliberti, M.D., G. Civenti, M.S.W., A. Colotto, M.D., G. Dell’Acqua, M.D., W. Di Munzio, M.D., G. Fagnano, D.Psyc., A. Fioritti, M.D., N. Longhin, M.D., M. Miceli, M.D., M. Nicotera, M.D., M. Pisetta, R. Putzolu, E. Rossi, M.D., M.E. Rotunno, M.D., D. Semisa, M.D., R. Tomasi, M.D., P. Tulli, D.Psyc., E. Zanalda, M.D.     

Absconding from Public Mental Health Inpatient Units – Who Does it,and why?

Psychiatric Quarterly - Patients who abscond from acute inpatient psychiatric wards put themselves and others at risks of variable nature and severity. There is a limited understanding of what...     

Older adult problem drinkers: Who presents for alcohol treatment?

Objectives: To describe a treatment population of older adults (60+ years) assessed for alcohol treatment over a 20-year period.

Method: Retrospective analysis of alcohol treatment assessment data relating to all older adults assessed by one UK NHS Trust Community Alcohol Team (n?=?585) between April 1988 and March 2008.

Results: Over the 20-year period, the number of assessments per year increased though the demographic profile of those assessed for treatment remained the same: male (62%), white ethnic origin (94%) and average age 65.7 years. The average amount of alcohol consumed per week was 102.91 units. Most were drinking alcohol on a daily basis (79%), mainly spirits (79%), at home (84%), alone (82%) and ‘to reduce tension/anxiety’ (22%). The average length of having had an alcohol problem was 9.7 years. Significant gender differences were found in terms of demographic profile and drinking patterns.

Conclusions: The older adults assessed for alcohol treatment were drinking in amounts comparable to the treatment population of younger adult problem drinkers, men more so than women. The majority were not reporting problems with their drinking until they were on average in their middle-to-late 50s and were therefore considered to be late onset ‘reactors’ rather than early onset ‘survivors’ of longer term heavy drinking patterns reported in earlier studies.     

Health behaviors among people with epilepsy—Results from the 2010 National Health Interview Survey

ObjectivesThis study aimed to estimate and compare the prevalence of selected health behavior—alcohol use, cigarette smoking, physical activity, and sufficient sleep—between people with and without a history of epilepsy in a large, nationally representative sample in the United States.MethodsWe used data from the 2010 cross-sectional National Health Interview Survey (NHIS) to compare the prevalence of each health behavior for people with and without epilepsy while adjusting for sex, age, race/ethnicity, and family income. We also further categorized those with epilepsy into active epilepsy and inactive epilepsy and calculated their corresponding prevalences.ResultsThe percentages of adults with a history of epilepsy (50.1%, 95% CI = 45.1%–55.2%) and with active epilepsy (44.4%, 95% CI = 37.6%–51.5%) who were current alcohol drinkers were significantly lower than that of those without epilepsy (65.1%, 95% CI = 64.2%–66.0%). About 21.8% (95% CI = 18.1%–25.9%) of adults with epilepsy and 19.3% (95% CI = 18.7%–19.9%) of adults without epilepsy were current smokers. Adults with active epilepsy were significantly less likely than adults without epilepsy to report following recommended physical activity guidelines for Americans (35.2%, 95% CI = 28.8%–42.1% vs. 46.3%, 95% CI = 45.4%–47.2%) and to report walking for at least ten minutes during the seven days prior to being surveyed (39.6%, 95% CI = 32.3%–47.4% vs. 50.8%, 95% CI = 49.9%–51.7%). The percentage of individuals with active epilepsy (49.8%, 95% CI = 42.0%–57.7%) who reported sleeping an average of 7 or 8 h a day was significantly lower than that of those without epilepsy (61.9%, 95% CI = 61.2%–62.7%).ConclusionsBecause adults with epilepsy are significantly less likely than adults without epilepsy to engage in recommended levels of physical activity and to get the encouraged amount of sleep for optimal health and well-being, promoting more safe physical activity and improved sleep quality is necessary among adults with epilepsy. Ending tobacco use and maintaining low levels of alcohol consumption would also better the health of adults with epilepsy.     

Family Advocacy, Support and Education in Children’s Mental Health: Results of a National Survey

In conjunction with the national survey of mental health service organizations (Schoenwald et al. this issue), a separate but complementary national survey was conducted of family advocacy, support and education organizations (FASEOs). Directors of FASEOs within the same localities as the mental health agencies responded to a survey and provided information in four areas: (1) structure and funding; (2) factors influencing advocacy decisions about children’s mental health; (3) types of services provided by FASEOs and factors perceived as related to improved outcomes; and (4) the types of working relationships between FASEOs and local mental health clinics. Findings from a total of 226 (82% response rate) portray a network of family advocacy, support and education organizations that are strategically poised to effect substantive change and characterized by significant fiscal instability. Results from this survey and implications for delivery of family-based services are provided. The Research Network on Youth Mental Health is a collaborative network funded by the John D. and Catherine T. MacArthur Foundation. Network Members at the time this work was performed included: John Weisz, Ph.D. (Network Director), Bruce Chorpita, Ph.D., Robert Gibbons, Ph.D., Charles Glisson, Ph.D., Evelyn Polk Green, M.A., Kimberly Hoagwood, Ph.D., Peter S. Jensen, M.D., Kelly Kelleher, M.D., John Landsverk, Ph.D., Stephen Mayberg, Ph.D., Jeanne Miranda, Ph.D., Lawrence Palinkas, Ph.D., Sonja Schoenwald, Ph.D.     

Excess functional disability among demented subjects? Findings from the Canadian Study of Health and Aging

Dementia has been recognized as the strongest determinant for developing functional disability. However, dementia patients typically present with concomitant illness, thereby making difficult a determination of the fraction of disability due to dementia. The objective of this study was to estimate the prevalence of functional disability among demented and nondemented people and to estimate the excess disability in demented subjects net of conditions independently associated with disability in older people, using data on nearly 2,900 subjects from the clinical examination of the 1991 Canadian Study of Health and Aging. Unadjusted specific disability prevalence (in bathing, dressing, grooming, toileting and stool and urinary incontinence) is considerably greater among demented subjects than among cognitively normal or cognitively impaired but not demented subjects. After adjustments, specific disability in demented subjects is somewhat reduced in comparison to nondemented and cognitively impaired but not demented subjects. Thus, even when one considers the influence of a history of physical illnesses that typically result in disability, the link between disability and dementia is only marginally attenuated.     

Who Cares for Former Child Soldiers? Mental Health Systems of Care in Sierra Leone

While numerous studies on former child soldiers (FCS) have shown mental health needs, adequate services are a challenge. This study aimed to identify priorities, barriers and facilitators of mental health care for Sierra Leonean FCS. Thematic analysis was done on 24 qualitative interviews with participants from diverse sectors. Priorities of mental distress, substance abuse, and gender-based violence were common among FCS clients. Barriers were governmental support and communication with other providers. Perceived facilitators of care were primary- and secondary-level interventions. A public mental health model would feasibly build upon local, culturally embraced interventions, targeting local priorities and reducing barriers to care.     

Who Needs to Observe Infants? Infant Observation in the Training of Child and Adolescent Mental Health Workers

Infant Observation is a valuable training experience for workers in child and adolescent mental health, helping both to conceive the infantile experience of the children under their care, and to understand the parents' accounts of a child's history. It is an experience that gives trainees a unique opportunity to observe the development of an infant, systematically and practically from birth, in the child's natural setting, thus facilitating the acquisition of a meaningful understanding of how human relationships emerge and develop. Infant Observation gives the trainee a clear focus on the baby and his family, whilst remaining as a participant observer, and spontaneously encouraging problem-free talk.     

Does the Sunset of Mental Health Parity Really Matter?

The 1996 Mental Health Parity Act (MHPA), which became effective in January 1998, is scheduled to expire in September 2001. This article provides an overview of what the MHPA intended to do and what it actually has accomplished. We summarize state legislature actions through the end of 2000 and report on their effects on employer-sponsored mental health coverage using a national survey fielded in 1999–2000. We then discuss possible amendments to the MHPA and reforms beyond full parity that might be considered.     

Getting Them Through the Door: a Survey of Men’s Facilitators for Seeking Mental Health Treatment

International Journal of Mental Health and Addiction -