Unmet Mental Health Service Needs Among Norwegian Children and Adolescents

Background:  The Norwegian 10 year mental health plan identifies important roles for public health nurses in the early identification, care and referral of children and adolescents with mental health problems. This study aims to identify the extent to which public health nurses are meeting these needs.
Method:  Over a 4 week period the mental health needs of 3065 children who were seen by publich health nurses were identified.
Results:  Achieving the ongoing Norwegian mental health plan may require better access to trained professionals in the public health sector, further expansion of specialised mental health services, and efforts to improve inter-agency collaboration.     

Unmet Mental Health Care Needs for Children with Special Health Care Needs Stratified by Socioeconomic Status

Background:  The purpose of this research study was to identify factors that affect mental health care for children with special health care needs (CSHCN) and to identify how these factors vary among different socioeconomic levels.
Methods:  Data were obtained from the National Survey of Children with Special Health Care Needs, 2000–2002. The analysis examined the relationships of demographic characteristics, geographical location of household, severity of condition, and social factors on unmet need for mental health care. Multiple logistic regression models were constructed for four socioeconomic status (SES) levels defined by the federal poverty level (FPL): <133%; 133–199%; 200–299%; ≥300%. Standardised regression coefficients were calculated to compare among SES strata.
Results:  There were 38,866 CSHCNs represented in the survey with 9,639 needing mental health care in the past 12 months. The household income distribution was 22% below the 133% FPL, 15% between 133–199% FPL, 18% between 200–299% FPL, and 45% at or above 300% FPL. Black race, ethnicity, insurance type/status, geographical location of household, and number of kids in the household were significant in the <133% of FPL stratum for predicting having received all needed mental health care in the last 12 months. Age and geographical location of household were significant in the 133–199% of FPL stratum. Maternal education was significant in the 200–299% of FPL stratum. Severity of condition, other race, and insurance type/status were significant in the ≥300% of FPL stratum.
Conclusions:  Factors affecting unmet needs for mental health care differed by socioeconomic status. Future research should explore a more in-depth picture of the CSHCN population that includes stratification by income groups to better understand and serve this population.     

Child and Adolescent Mental Health within Primary Care: A Study of General Practitioners' Perceptions

Background:  Primary Care teams play an important role in the provision of mental health care to children and young people.
Methods:  We developed and distributed a questionnaire to all General Practitioners within one Health Authority area.
Results:  Many of the respondents rated as less than satisfactory their competence and their knowledge and skills in important areas of child and adolescent mental health practice. A significant minority expressed a high level of interest in child and adolescent mental health and most respondents reported that they would value further training.
Conclusions:  General Practitioners should be provided with more training and support in their role as providers of child and adolescent mental health care.     

Children with Complex Mental Health Problems: Needs, Costs and Predictors over One Year

Background:  Little is known regarding children of greatest concern with complex mental health problems.
Method:  A one-year prospective study of psychiatric diagnosis, psychosocial functioning, need status and service receipt in 60 children identified as most concerning.
Results:  Thirty-two (53%) had two or more disorders. The mean number of needs per child was five. One year later mean needs were unchanged but with considerable individual variation. Mean weekly costs were £1017 (€1627) ( SD  = £957 (€1531)). Higher costs related to social factors rather than diagnosis or need.
Conclusions:  The mean annual cost of services to children with complex mental health problems is ten times that in other studies of children with mental health problems.     

A Home and School Support Project for Children Excluded from Primary and First Year Secondary School

Background:  In the last 10 years the problem of exclusion has reached a crisis point. Research suggests that exclusion is a complex phenomenon that needs involvement from all the involved services such as Health, Education and Social Services.
Method:  One hundred and twenty-four pupils, aged 4–12 years who, through school and social exclusion, were at risk of developing more serious mental health difficulties, were randomly allocated to standard care ( n  = 62) or standard care plus the new intervention ( n  = 62).
Results:  There were no significant differences in the primary outcomes between the two groups at either of the outcome assessments. However, the intervention group with non-compliance cases removed from the analysis did significantly better ( p  < . 014, 95%CI −12.8 to −1.4).
Conclusions:  The Home and School Support project managed to reduce the number of excluded days and the appearance of mental health symptoms for pupils who engaged fully with the intervention. The project also highlights the importance of multi-agency involvement at a very early stage.     

Annotation: New research into general psychiatric services for adults with intellectual disability and mental illness

Background   There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either model with research being often of a poor quality, lacking replication, and outcome measures were often inappropriate or varied between studies. This review aims assess differences in outcome for patients with ID and mental disorders treated in general or specialised ID mental health services.
Method   A literature review was conducted using electronic databases and websites of ID and mental health organisations to locate all references where people with ID receive mental health care in general psychiatric services from 2003. No meta-analysis was attempted because of the divergent nature of the studies.
Results   People with ID (especially severe ID) have reduced access to general psychiatric services. General psychiatric inpatient care is unpopular especially with carers but can be improved by providing specially trained staff and in-reach from community ID teams. Opportunities may exist to enhance the care of people with borderline intellectual functioning within general psychiatric services.
Conclusions   Although no new randomised controlled trials have been published, the weight of research is accumulating to suggest that provision of general psychiatric services without extra help is not sufficient to meet the needs of people with ID.     

Overcoming the Dual Stigma of Mental Illness and Aging: Preparing New Nurses to Care for the Mental Health Needs of Older Adults

ObjectiveRegistered nurses are uniquely positioned to fill shortages in the geropsychiatric healthcare workforce. With training, nurses can coordinate both mental and physical healthcare and deliver mental health interventions. Our objective was to determine how nursing educators are preparing students to care for the mental health needs of older adults and to explore the challenges they face in this effort.MethodsThis was a qualitative study using semi-structured, in-depth interviews. Participants were undergraduate psychiatric nursing instructors recruited from schools of nursing in the Northeastern United States. Semistructured interviews focused on challenges and strategies related to preparing nursing students to meet the mental health needs of older patients.ResultsFourteen interviews were conducted. An overarching theme of bias against geropsychiatric care was identified as a challenge for educators. Educators reported that nursing students carry biases against patients with mental illness and older patients. Nursing students indicated negative perceptions of the psychiatric and geriatric nursing specialties. Most nursing students plan to work in nonpsychiatric settings and do not consider mental health a priority for their patients. To overcome these challenges, educators suggested increased exposure and integration. To prepare new nurses to care for the mental health needs of older patients, nursing schools should expose nursing students to older adults in a variety of settings and integrate mental health topics and training throughout the undergraduate nursing curriculum.ConclusionNursing schools should evaluate their curricula to ensure that mental health content is prioritized and sufficiently integrated with physical health topics. An increased focus on geropsychiatric and integrated mental health content should be supported by nursing programs and state boards of nursing.     

Predictors of Service Use for Mental Health Problems Among British Schoolchildren

Background:  Most previous studies of service use in relation to mental health have examined services in the USA. We wanted to provide up-to-date findings from a general population sample of British schoolchildren.
Method:  A total of 2461 children aged 5–15 from the 1999 British Child and Adolescent Mental Health Survey were followed up for 3 years. We examine the relationship between a wide variety of potential predictors gathered in 1999 and the use of services over the following 3 years.
Results:  Contact with most services was predicted by three factors: the impact of psychopathology; contact with teachers or primary health care; and parents' and teachers' perceptions that the child had significant difficulties. Other predictors were specific to each service.
Conclusions:  Education of parents, teachers and other important adults might increase the proportion of children with impairing psychiatric disorders reaching services.     

What Makes a Good CAMHS Primary Mental Health Worker?

Background:  The role of primary mental health worker (PMHW) in CAMHS was established in 1995 although comparatively little research has explored the attributes required to successfully undertake this role.
Method:  Qualitative interviews with PMHWs and staff working in primary care were conducted and thematic analysis was performed.
Results:  In addition to clinical skills and mental health knowledge all respondents consistently emphasised the importance of inter-personal attributes such as general accessibility, flexibility, and self-motivation.
Conclusions:  Both professional competencies and inter-personal skills are perceived as important characteristics for PMHWs. It therefore seems appropriate for these to be made more explicit in competency frameworks.     

Evaluation of a CAMHS in Primary Care Service for General Practice

Background:  Many CAMH Services have Tier 2 provision in primary care, but there has been little published evaluation. In a service aimed at general practice, this study examined: 1) the clinical activities of the primary mental health workers; 2) the effect of the service on referrals to specialist CAMHS; and 3) the utilisation and perceived usefulness of the service.
Method:  clinical activity data collection, evaluation of referral patterns, and a postal questionnaire.
Results:  Informal (unstructured) consultation-liaison was used more than formal consultation. Referrals to specialist CAMHS increased from practices using the service. The service was perceived as helpful and accessible.
Conclusions:  The service supported primary care staff in their work with child and adolescent mental health issues. Referrals to Tier 3 may increase as a result of the service.     

Ethnic variation in service utilisation among children with intellectual disability

Background   This study examined whether service utilisation among children with intellectual disability (ID) varied by ethnic cultural group.
Method   Survey carried out in four special schools in London. Information was provided by school teachers using case files, and 242 children aged 7 to 17 years with mild and moderate ID were identified. Ethnic categories were derived from self-reported main categories. Service utilisation categorised as use of: child and adolescent mental health services (CAMHS), social services, physical health and education services.
Results   Child and adolescent mental health services uptake was lower for South Asians than for White British ( P  = 0.0487). There were statistically significant differences among ethnic groups for community-based social services uptake (being the highest for the Black groups and the lowest for South Asians, P  = 0.015) and respite care uptake (being the highest for the Black and White European groups and the lowest for South Asians, P  = 0.009). In regression analysis family structure predicted CAMHS service utilisation and social service community support. Ethnicity predicted use of respite care.
Conclusions   Significant ethnic differences in service utilisation among children with ID were found for both CAMHS and social service contact. There was particularly low service use for the South Asian group. These differences might arise because of differences in family organisation, as more South Asian children lived in two-parent families, which may have been better able to provide care than single-parent families. Other factors such as variation in parental belief systems and variation in psychopathology may be relevant. Implications are discussed.     

Burden and coping strategies in mothers of patients with schizophrenia in Japan

Aim:  The present study was conducted to identify factors contributing to burden of care in 57 mothers caring for patients with schizophrenia.
Methods:  Members of the Federation of Families of People with Mental Illness in Nagasaki Prefecture were evaluated using well-validated scales to evaluate burden of care (eight-item short version of the Japanese version of the Zarit Caregiver Burden Interview), general health status (General Health Questionnaire 12-item version), difficulty in life, coping strategies, emotional support, and understanding of mental illness and disorders.
Results:  Burden of care was significantly associated with general health status and difficulty in life.
Conclusion:  On multiple regression it was found that 'social interests' and 'resignation', both of which are the subscales of coping strategies, exerted significant and independent effects with respect to burden of care.     

Child Mental Health is Everybody's Business: The Prevalence of Contact with Public Sector Services by Type of Disorder Among British School Children in a Three-Year Period

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed-up over 3 years. Parents provided summary information on service contacts in relation to mental health; selected subgroups provided more detailed information by telephone interview.
Results:  Common overlaps in service use were between health services, between teachers and educational specialists, and between the latter and CAMHS or social services. Services other than primary health care saw more children with externalising disorders, while children with anxiety disorders were less likely than children with other psychiatric disorders to be in contact with any service.
Conclusions:  Child mental health is everybody's business, and professionals need to be alert(ed) to the types of disorders that children using their service may have.     

Perceived stigma and mental health care seeking

OBJECTIVE: There is limited empirical evidence on the extent to which perceived public stigma prevents individuals from using mental health services, despite substantial recent policy interest in this issue. This study investigated associations between perceived public stigma and mental health care seeking. METHODS: This study used cross-sectional survey data from a representative sample of undergraduate and graduate students (N=2,782) at one university. A five-item scale was used to assess perceived public stigma toward mental health service use. Perceived need for help in the past 12 months and current presence of depressive and anxiety disorders were also assessed. RESULTS: Perceived stigma was higher among males, older students, Asian and Pacific Islanders, international students, students with lower socioeconomic status backgrounds, and students with current mental health problems. Perceived stigma was also higher among those without any family members or friends who had used mental health services and among those who believed that therapy or medication is not very helpful. Perceived stigma was negatively associated with the likelihood of perceiving a need for mental health services, but only among younger students. Among those with probable depressive or anxiety disorders, there was no evidence that perceived stigma was associated with service use. CONCLUSIONS: These results suggest that, at least in this population, perceived stigma may not be as important a barrier to mental health care as the mental health policy discourse currently assumes.     

Correlation between addictive behaviors and mental health in university students

Aims:  The present study aims to clarify the relationships of addictive behaviors and addiction overlap to stress, acceptance from others and purpose in life.
Methods:  A survey was conducted on 691 students at eight universities. The Eating Attitude Test-20 was used to identify students with food addiction or food addictive tendencies. The Kurihama Alcoholism Screening Test was used to identify students with alcohol addiction or alcohol addictive tendencies. The Fagerström Test for Nicotine Dependence was used to identify students with nicotine addictive tendencies or nicotine addiction. The Visual Analog Scale was used to assess stress and acceptance from others. The Purpose in Life Test was used to measure meaning and purpose in life. Results were compared between students with addictive behaviors, with addictive tendencies and without addictive behaviors.
Results:  Significant differences among the three groups were observed for stress, acceptance from others, and Purpose in Life scores for students with food and nicotine addiction, but no significant differences existed in relation to alcohol addiction. In addition, 28.8% of students displayed addictive behaviors in one of the three areas (food, alcohol or nicotine), 8.5% displayed addictive behaviors in two of the three areas, and 0.4% had addictive behaviors in all three areas. Significant differences existed in stress and acceptance from others among students with one addictive behavior, ≥two addictive behaviors and no addictive behaviors. However, no significant differences existed in Purpose in Life scores with respect to overlapping addictions.
Conclusion:  The results suggest a relationship between mental health, addictive behaviors and overlapping addiction among university students.     

Service Contacts Among the Children Participating in the British Child and Adolescent Mental Health Surveys

Method:  A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed up over 3 years. Parents provided summary information on service contacts for emotional, behavioural and concentration difficulties, with more detailed information being obtained by telephone interview for selected subgroups.
Results:  Having a psychiatric disorder predicted substantially increased contact with social services, special educational needs resources, the youth justice system and mental health services (district CAMHS and tier four, but not tier two). Of those children with psychiatric disorders, 58% had been in contact with at least one of these services for help with emotional, behavioural or concentration difficulties, including 23% who had been in contact with mental health services.
Conclusions:  British children attend a wide variety of services for help with emotional, behavioural and concentration difficulties. The proportion seeing specialist mental health services is higher than that generally reported in the research literature.     

Informal Role Expansion in Australian Mental Health Nursing

PURPOSE.  This study aims to determine the extent to which community mental health nurses are currently practicing beyond the traditional scope of nursing practice .
DESIGN AND METHODS.  A self-administered questionnaire was distributed to community mental health nurses in Victoria, Australia.
FINDINGS.  The majority of participants reported routine involvement in practices that would normally be considered beyond the scope of nursing practice, such as prescribing, ordering diagnostic tests, and referral to specialists.
PRACTICE IMPLICATIONS.  The extent to which the current mental health service system is dependent upon nurses transgressing professional and legal boundaries warrants further study. Psychiatrists and community mental health nurses need to work collaboratively to understand their respective knowledge and skills and to be clear about how they take responsibility for client care.     

Developing Services with Limited Resources: Establishing a CAMHS in Pakistan

Background:  There are very few mental health services in Pakistan. In 2002, the Department of Psychiatry at Aga Khan University Hospital started a separate clinic for children under the age of 15 years to meet the population needs. This service took direct referrals from other physicians as well as from parents and schools.
Method:  A DSM-IV based semi-structured interview with a uniform written format was used for an initial evaluation by a child psychiatrist. Data regarding demographic characteristics, referral source, diagnoses and treatment were collected.
Results:  A total of 290 new referrals were made to the clinic over 3 years. The most common reason for referral was aggressive behaviour, although this possibly masked other kinds of mental health problems, as indicated by the assessment. Attention deficit-hyperactivity disorder was the most frequent diagnosis, made in 25% of children.
Conclusions:  Despite the limited resources and the high level of need in developing countries, resources can be used effectively within the framework of their health and educational systems, so maximising protective factors within their communities.