Women,Mental Health,and Managed Care

Abstract

Managed care has changed the way that mental health care is provided. These insurers manage such factors as length and type of therapy made available, access to therapy, and level of payment for therapy. Women, as the majority of those insured by managed care and as consumers of mental healthcare, are differentially affected by these changes.     

略论我国卫生法律制度对健康权的保护

通过分析和回顾我国卫生法律制度的整体架构和历史沿革,对当前制度进行评价并展望未来,系统阐述了我国卫生法律制度如何保障国民健康权。目前我国卫生法律制度框架已初步形成,卫生行政法、民法中的医疗侵权、医疗刑法、有关社会法等均对健康权进行保护,但制度仍面临母法缺失、协调性不佳、精细度不足和立法滞后等挑战。以新医改为契机,卫生法律制度的完善应加快进程,应尽快制定母法,并对相关部门法做出调整,加强有关法律法规之间的协调性。     

监狱民警心理健康状况及影响因素研究

采用症状自评量表 (SCL -90 )及艾森克人格问卷 (EPQ) ,对 2 89名监狱民警作测量。结果显示 ,至少 7 2 7%的监狱警察存在心理健康问题。一线工作的监狱警察与科室工作的监狱警察相比 ,心理健康状况存在显著差异 ,且前者严重。男性监狱警察相对于女性监狱警察心理健康问题更突出。SCL-90与EPQ得分的相关分析表明 ,情绪越不稳定或精神质越明显者 ,倾向于出现更多的心理健康问题 ,性格越内向心理健康问题越突出。     

Sexual Abuse of Women by Women in Psychotherapy

No abstract available for this article.     

Locked Up,Then Locked Out

SUMMARY

Women prisoners face tremendous psychological, emotional, and physical hardships inside prison. These include isolation, separation from their families and children, lack of medical care and general abuse of their basic human rights. When they are released from prison, women confront institutional as well as psychological barriers to a successful return to their communities     

Refusing to be Marginalized: Groupwork in Mental Health Services for Women Survivors of Childhood Sexual Abuse

Childhood sexual abuse is a major aetiological factor in the development of mental health difficulties experienced by women. Although this conclusion is supported by two decades of extensive research, it has had little impact on the provision of mainstream mental health services. It remains exceptional for there to be specialist therapy or counselling provision for women survivors of childhood sexual abuse within statutory mental health services. This represents a serious gap in service provision and, it is argued, results in extended and inappropriate treatment for women survivors using mental health services. In this article, the development of a multi-agency approach to the provision of groupwork for women survivors of childhood sexual abuse within mental health service is described. A women-centred model of groupwork is outlined. Evaluation and funding are discussed. It is argued that, as a time-limited and effective treatment option, groupwork for women survivors of childhood sexual abuse should form a central part of service provision within statutory adult mental health services.     

Sex Differences in Women's Mental Health Problems and Their Causes

No abstract available for this article.     

Women Psychologists within Academic Health Systems: Mentorship and Career Advancement

Women are underrepresented on the faculties and within the senior leadership ranks of academic health systems. Nevertheless, despite the continuing existence of career development challenges related to gender, it is possible for women to thrive professionally in these settings. Mentorship is extremely important, and it is argued that effective mentorship is facilitated by an understanding of both gender differences in social behaviors and the culture of academic health systems. Furthermore, a systems’ level emphasis on faculty diversity and the career development of women faculty is recommended.     

Assessing the Effectiveness of a Trauma-Oriented Approach to Treating Prostituted Women in a Prison and a Community Exiting Program

Women who have been prostitutes are social work clients in many clinical, correctional, and community settings. Unique programming that addresses the high levels of trauma symptoms reported by prostituted women has yet to be explored. The purpose of this study is to explore the effectiveness of a group trauma and abuse intervention for prostituted women from two settings, prison and a community exiting program. A quasi-experimental research design was used. Twenty-nine women participated in a 12-week psychoeducational trauma and abuse intervention program called Esuba. All participants reported decreases in trauma symptoms, but the prison group showed a greater number of significant changes in trauma symptomology than the community group. Implications for practice and future research implications are discussed.     

Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.     

Investigating Occupational Stress,Racial Identity,and Mentoring for African American Women in Health Care

This study examined the influence of racial identity and mentoring experiences on occupational stress among African American women in health care (N = 76). The women were surveyed about their occupational stress (role stress, psychological strain, and personal resources), racial identity, demographic information, and mentoring experiences. Results indicated that racial identity was negatively related to role stress and psychological strain, and level of education was closely related to personal resources. Mentoring was not found to have a significant impact on occupational stress as hypothesized. The implications for enhancing occupational satisfaction were discussed in relation to advocacy for career development professionals.     

Adolescent Satisfaction with School-Based Mental Health Services

Examining adolescents' satisfaction with mental health services is an important program evaluation activity. Their perceptions of whether services were beneficial and resulted in improved functioning are indices of treatment quality. Assessment of adolescent satisfaction with school-based mental health programs has been limited. In our study, adolescents receiving services from a School Mental Health Program (SMHP) completed satisfaction surveys. Participants were predominantly minority youth residing in an urban area. Results indicated that students were highly satisfied with their mental health services. Students valued the therapeutic relationship, catharsis associated with therapy, and skills they learned during therapy. Several factors influenced satisfaction ratings including clinician training and availability.     

Ageism in Mental Health and Health Care: A Critical Review

Discussions of aging and mental health widely assume that ageism among mental health providers is an important factor limiting access to mental health services for older adults. Given the widespread citation of ageism as a problem, we critically review the history of the ageism construct, and evidence for its existence in both mental health and medical professionals. There is surprisingly little empirical evidence for age bias among mental health providers. Considerable evidence does suggest differential medical treatment for older adults in such diverse areas as physician–patient interaction, use of screening procedures, and treatment of varied medical problems, although it is unclear whether age bias accounts for these differences. We suggest that innovations in delivery of psychological services, such as collaborative medical/psychological care in primary care settings, may ultimately prove more useful in improving access to mental health services than efforts to combat ageism.     

论健康权的国际合作与援助义务

目前,在全球健康领域存在诸多不平等,各国均有义务对外开展合作与援助。这种健康权的国际合作与援助义务主要以国际法规则和有关政治承诺为基础,由此也明确了该义务的依据和范围。我国作为发展中的大国,要辩证地看待这项国际义务：既应积极履行该项国际义务,同时也要努力寻求国际合作,并完善本国健康权保护体系。     

国际健康目标与卫生改革的新导向——重视预防保健的作用

由于认识到卫生系统的大部分资源主要花费在疾病的治疗上,这种资源配置不当不仅导致巨额医疗费用负担和低效率,并没有获得好的健康结果;因此,近年许多发达国家的健康目标与卫生改革出现了一个新的导向,日益重视预防保健的作用;并采取优先选择的方式,确保资源优先配置给对人群健康最需要、资源投入最具有成本效果的保健服务。这种改革已取得了一些成效。这一改革导向对我国正在进行的医药卫生体制改革的制度设计与政策开发提供了启示。     

Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women

Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. In-person interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status.     

Self-Discrepancy and Mental Health in Older Women with Chronic Illnesses

Self-discrepancy was investigated as a self-enhancing mechanism by which older women maintain their mental health and psychological well-being while coping with declines in physical health. In this 6-year longitudinal study, the mediating and moderating effects of self-discrepancy on mental health outcomes in older women with chronic health problems were tested. Participants were 103 community-dwelling older women who completed multiple, self-report measures of physical and mental health and self-discrepancy. There was a decline in physical health over time but an improvement in self-discrepancies. Low self-discrepancy (i.e., little discrepancy between the actual and ideal self) mediated and moderated the effects of physical health decline on mental health and psychological well-being. Thus, self-discrepancy appears to play a significant role in maintaining mental health in the face of declining physical health in older women.     

School-Based Mental Health Services: Definitions and Models of Effective Practice

ABSTRACT

School-based mental health services are those delivered by school-employed and community-employed providers in school buildings. With the implementation of provisions of the Patient Protection and Affordable Care Act (2010) that funds school-based health centers, school-based mental health services could become more broadly available in communities throughout the United States. Playing a pivotal role in promoting models for school-based services that maximize benefits to children and adolescents while making efficient use of communities' mental health resources are school psychologists. School psychologists, who recognize and respect the separated development of school and community mental health professions, can foster school–agency partnerships to coordinate children's mental health services that are comprehensive, child centered, family focused, and culturally competent. In this article, we provide three case examples using the Participatory Culture-Specific Intervention Model (B. K. Nastasi, R. B. Moore, & K. M. Varjas, 2004 Nastasi, B. K., Moore, R. B., & Varjas, K. M. (2004). School-based mental health services: Creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association. [Google Scholar]) as exemplars for the implementation of community partnerships providing comprehensive culturally and contextually relevant school-based mental health services.     

Ethics and Changing Mental Health Care: Concerns and Recommendations for Practice

Recent developments in health care delivery in the United States have left many professionals baffled by the continuing changes in practice sparked by the relatively new managed care environment. Psychologists who practice in medical settings are struggling to balance the seemingly competing needs to deliver quality care to clients and patients, while meeting the demands of third-party payers and trying to remain true to their ethical responsibilities. Critical elements of managed care, which many suggest compromise the ethical provision of quality care, include utilization review, financial incentives, and threats to confidentiality. Recommendations are proposed so that mental health professionals may be proactive in protecting their ethical responsibilities in this changing environment.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.