Mental health services for homeless mentally ill persons. Federal initiatives and current service trends

Recent research suggests that approximately one third of the population of homeless single adults suffer from severe mental illnesses. Despite multiple health, mental health, and social welfare needs, this population is often unable to obtain necessary housing and community-based services. For this reason, since 1982, the National Institute of Mental Health (NIMH) has undertaken a number of federal initiatives to encourage research and assist states and localities in improving services focused on this vulnerable subgroup of the homeless population. This article describes the target population, NIMH research findings, and current mental health service trends--with particular emphasis on two mental health programs established under the Stewart B. McKinney Homeless Assistance Act. Proposed future directions for federal research and evaluation efforts in this area are also discussed.     

Overview: forging research priorities for women's mental health

After a decade of reports underscoring the inadequacy of existing scientific knowledge for understanding gender differences in mental disorder and its treatment, the National Institute of Mental Health has developed a women's mental health research agenda with five priority areas for research: diagnosis and treatment of mental disorder, mental health issues for older women, violence against women, multiple roles, and poverty. This overview highlights some of the major findings in each of these five areas and introduces the more in-depth treatment given in this Psychology in the Public Form section to the areas of violence, poverty, and multiple roles. It also underscores the importance of identifying sources of gender bias in all mental health research. Women's mental health issues have become officially recognized as part of the NIMH research agenda. Only time and continued monitoring will determine how these official policy priorities will become translated into actual funding and research initiatives.     

Psychology research and NIMH. Opportunities and challenges

As an essential contributor to the scientific understanding of mental health and illness, psychology continues to be the leading discipline receiving National Institute of Mental Health (NIMH) research support. Future behavioral science research initiatives at NIMH are likely to emphasize cognitive science, behavioral genetics, behavioral patterns and physiological systems, and personality, motivation, emotion, and interpersonal processes. Although prognostication is particularly risky in times of transition such as the present, advocacy efforts focused on mental-illness-related research are most likely to help the NIMH and the field if they avoid polarization and factionalization by providing equal encouragement for studies of biological aspects, of behavioral aspects, and of their interaction.     

Telepsychiatry with rural American Indians: issues in civil commitments

The use of live interactive videoconferencing to provide psychiatric care, telepsychiatry, has particular relevance for improving mental health treatment to rural American Indian reservations. There is little literature on civil commitments in telepsychiatry and none specifically addressing this topic among American Indians. This article reviews telepsychiatry in the mental health care of American Indians, civil commitments and telepsychiatry in general, and the current state of civil commitments in American Indian communities. We conclude by considering commitment through telepsychiatry in rural reservations and offering guidelines to assist practitioners in navigating this challenging landscape. Civil commitments of American Indian patients residing in rural reservations can be successfully accomplished through videoconferencing by thoughtful and informed clinicians. However, much more work is needed in this area, including research into the cultural attitudes and perspectives towards commitments and further inquiry regarding potential legal precedents, as well as case reports and examples of this work.     

Psychology and rural America. Current status and future directions

Rural people constitute about one fourth of the U.S. population, and their special mental health needs have been largely neglected. For a variety of reasons psychologists have focused little attention on this group. Recent economic developments affecting agriculture, farm families, and rural communities have increased awareness of problems facing rural areas. Psychologists can respond to the unique challenges created by rural mental health needs through research on stress, psychopathology, and community well-being. Training programs should be encouraged to recognize rural concerns. Psychologists are needed to practice in rural areas and to help develop effective rural service models. They can also support the development of state and federal policies that address rural needs.     

Do State Mental Health Plans Address the New Freedom Commission’s Goals for Children’s Mental Health?

The latest initiative to address mental health needs of the nation, including those of children and youth, is the President’s New Freedom Commission on Mental Health (NFC). The NFC formulated a benchmark of six goals and related recommendations toward which the U.S. should strive, including the recommendation that each state develop a comprehensive mental health plan. It is not clear, however, whether the states’ developed plans address the goals established by the NFC and to what degree. This project provides a summary of 50 state mental health plans regarding children and youth in the U.S. by examining components that address each of the six NFC goals and is a test of federal leadership on a state issue. Results indicate that state mental health plans addressed the NFC goals to differing degrees with specific attention to children and youth mental health services. Overall, the NFC goal of eliminating disparities in mental health services was addressed most completely, while the NFC goal of understanding that mental health and physical health are associated was addressed least often. The information provided by this analysis represents a first step in gaining a comprehensive picture about public policies for the mental health of children, adolescents, and their families.     

Balance theory as a model for coordinating delivery of rural mental health services

The chaotic nature of rural mental health services is due, at least in part, to a lack of consistent theory guiding their purpose and structure. The failure to plan mental health care systematically for rural areas is a result of diverse opinions and policies grounded in changing social, political, and economic conditions. The Balance Theory of Coordination (Litwak & Meyer, 1966) offers a viable perspective to guide service system development and evaluation. This article identifies current difficulties in the rural mental health systems, offers balance theory as a basis for further work, and posits a model for case management rooted in balance theory. The intent is to stimulate research and theory development for rural mental health systems.     

Mental health problems in rural contexts: A broader perspective: Response to Jackson et al. (2007) Mental health problems in rural contexts: What are the barriers to seeking help from professional providers?

The objectives of this article are to expand and comment upon a recent review in Australian Psychologist of the literature in relation to mental health problems in rural contexts by Jackson et al. (2007). In the present article we review recently published qualitative research on the help‐seeking attitudes and experiences of rural Australian adolescents. While we agree on the utility of the Macintyre, Ellaway, and Cummins (2002) conceptual framework based on notions of health and place, we note that this framework specifically emphasises the importance of the collective dimension. We present a broader perspective on health and place than Jackson et al. (2007) by incorporating social geographic research. We argue that rural mental health research has been hampered by a simplistic view of social stigma of mental illness and that a more thorough conceptualisation of the phenomenon is needed. Finally, we make some further recommendations based on a broader perspective of mental health in rural contexts: one that incorporates an in‐depth understanding of the help‐seeking attitudes and experiences of rural adolescents as well as an appreciation of the collective social functioning of rural communities.     

Challenges of Urban Mental Health Disaster Planning

Summary

Establishing disaster preparedness is an urgent matter, particularly with regard to mental health. This article examines the challenges of mental health disaster planning in the context of an urban setting, which may differ from those pertaining to rural areas. The need to better integrate public health disaster planning and mental health disaster planning is critical. This document particularly focuses on the challenges involved in leading, coordinating, and convening an urban mental health disaster response. With time, dedication, resources, and creation of effective policy, successful mental health response capability will evolve and endure.     

Mental health and well-being of black women: Toward strategies of empowerment

This review of the literature on Black women's mental health has three goals: 1) to describe the mental health issues, needs, and adaptive behaviors of Black women; 2) to discuss the research, intervention, and public policy efforts of mental health professionals and Black women's groups to address the multiple needs of this population; and 3) to identify effective strategies by which community psychologists can improve the mental health status of Black women through efforts to reduce their environmental stressors, to increase their resources and access to services, and to facilitate their empowerment in American society. The authors propose a number of recommendations to improve Black women's mental health, including changes in research paradigms, changes in education and training programs, and the development of culturally competent service delivery systems.     

Call to Action: Family Therapy and Rural Mental Health

Rural communities experience considerable disparities in mental health. Research about this topic is limited, however, especially in the family therapy field. What is known comes primarily from work in other disciplines, which points to three primary barriers that prevent rural communities from accessing high quality mental health care: availability, accessibility, and acceptability of services. A search for papers published over the past 20 years in family journals yielded only 18 articles. A review of these articles in presented here, alongside a call for family clinicians and researchers to advance further contributions. Specific directions for such research are discussed, including telehealth technology, collaboration with existing structures and institutions in rural communities, and the need for more precise definitions and measures of rurality. Family clinicians and researchers are uniquely positioned to conceptualize systemic challenges that rural communities face, and would be advised to join other disciplines in developing innovative methods to address them.     

Access to Child and Adolescent Mental Health Services

Adequate access to child and adolescent mental health services for young people in high need populations is an important concern of service systems researchers and program evaluators. We present results of a statewide study of access to community mental health services for eight populations of special concern. The analysis relied exclusively on existing databases in conjunction with innovative statistical techniques to provide comprehensive measures of access to care. Our findings indicate that access to care varied substantially across special populations, although children and adolescents in each of our eight “special populations” had greater access to public mental health services than members of the general population of the state. The interpretation of the findings and directions for future research are discussed.     

A microcomputer-based laboratory for psychopathology research in rural settings

An Apple-based computer system for research use in rural mental health settings is described. Hardware and software modifications are detailed. Techniques to aid in the acceptance of psychopathology research programs in these rural settings are discussed.     

Self-help research and the public mental health system

Discusses views of self-help leaders, researchers, and policy makers from the public mental health system about collaborative research with self-help groups. Topics include assumptions underlying collaborative research, barriers to collaborative research, and the potential benefits of collaborative research. Special attention is given to the rationale and methods for including minorities in self-help research. Initial discussions were held at a meeting convened by the NIMH-funded Center for Self-Help Research and Knowledge Dissemination at the University of Michigan.     

How to Fix Peer Review: Separating Its Two Functions—Improving Manuscripts and Judging Their Scientific Merit—Would Help

Adequate access to child and adolescent mental health services for young people in high need populations is an important concern of service systems researchers and program evaluators. We present results of a statewide study of access to community mental health services for eight populations of special concern. The analysis relied exclusively on existing databases in conjunction with innovative statistical techniques to provide comprehensive measures of access to care. Our findings indicate that access to care varied substantially across special populations, although children and adolescents in each of our eight “special populations” had greater access to public mental health services than members of the general population of the state. The interpretation of the findings and directions for future research are discussed.Reprinted with permission from The Scientist. Originally published in the June 6, 2005 issue of The Scientist (www.the-scientist.com).     

Rural mental health in America

Mental health services are in short supply in rural America. This article describes both the mental health service needs in rural areas and the barriers to improving the availability, accessibility, and acceptability of rural mental health services. Federal programs in rural mental health care in the Departments of Health and Human Services, Agriculture, and Education are described, as well as selected congressional initiatives. The role of the federal Office of Rural Health Policy is emphasized, and policy recommendations for improving rural mental health care delivery are presented.     

Nontraditionally Trained Women as Mental Health Counselors/Psychotherapists

Among a number of mental health needs is that of additional manpower for providing traditional counseling/psychotherapeutic services. An intramural NIMH pilot training program, conducted by Rioch, aimed at this problem through the training of mature, bright, socially sensitive women who had raised families of their own. The women so trained have been employed in various mental health settings over the past three years. The results of this program have been under continuous study during this three-year period. Methods of study have included inventories, tapes, and ratings. Considerable weight was given to evaluations by supervisors and by co-workers in the various agencies. The results indicate these women to be providing quite creditable professional counseling and psychotherapy. The implications for mental health manpower are numerous and are discussed at some length.     

Education and Training of Children's Mental Health Professionals: The Existing and Potential Role of Schools of Public Health

Since the early 1980s, increasing attention has been devoted in the literature to the conceptualization, development, and implementation of integrated and comprehensive mental health systems of care for children and adolescents. In establishing this new children's mental health paradigm of community-based systems of care, there are presently very few well-trained professionals and leaders focused on collaborative (including interagency) initiatives in the delivery of children's mental health services. Nevertheless, the field of public health offers an interdisciplinary setting for the education and training of individuals in children's mental health services. This national survey of all 27 accredited schools of public health in the United States and Puerto Rico examined the existing capacity for and potential to expand educational and training opportunities in the organization, financing, and delivery of children's mental health services.     

The mental health of children of migrant workers in Beijing: The protective role of public school attendance

The present study aims to understand the mental health status of an understudied group of migrant children – children of migrant workers in China. A total of 1,466 children from Beijing participated in the study that compared migrant children (n = 1,019) to their local peers (n = 447) in public and private school settings. Results showed that overall, migrant children reported more internalizing and externalizing mental health problems and lower life satisfaction than local peers. However, public school attendance served as a protective factor for migrant children's mental health. The mental health status of migrant children attending public schools, including externalizing problems as well as friend and school satisfaction, was not different from local children. In addition, our data indicates that the protective effect of public school attendance for migrant children may be even more salient among girls than boys, and for younger children than older children.