Introduction to the special section: The development of infant mental health home visiting in Michigan state government

This issue of the Infant Mental Health Journal presents the first papers from a tripartite evaluation study of state-sponsored infant mental health home visiting program in Michigan, United States. This series of studies has been led by Kate Rosenblum PhD and Maria Muzik MD, Department of Psychiatry, the University of Michigan and faculty from the Michigan Collaborative for Infant Mental Health Research for the State of Michigan, Department of Health and Human Services, Mental Health Services for Children, to fulfill the requirements of state legislation (State of Michigan Act No. 291, Public Acts of 2013) that required that all home visiting programs meet certain requirements to be established as an evidence-based practice. In this introduction, we provide a historical context for the delivery of infant mental health home visiting through the community mental health system in the state of Michigan.     

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush’s New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission’s recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.     

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.     

Implementing a Primary Mental Health Service for Children: Administrator and Provider Perspectives

The Child Mental Health Service (CMHS) is an Australian primary care program introduced in July 2010 to provide mental healthcare to children who have, or are at risk of, developing psychological disorders. The Australian Government provided supports (e.g., training for mental health professionals), resources (e.g., funding for positions devoted to fostering inter-agency linkages or partnerships) and various flexibilities in service delivery. This study aimed to explore the processes used in the implementation of the CMHS in order to achieve its objectives of delivering a high quality standard of service, and forging linkages and support networks with other relevant health and non-health agencies. Structured interviews were conducted with 20 program administrators, six referring professionals and eight mental health professionals. Interviews were recorded, transcribed and analysed for themes using NVivo. The CMHS appears to have made good progress towards achieving its objectives by implementing processes that facilitated the delivery of a high quality service (e.g., engaging appropriately qualified, and encouraging additional training and clinical support for, mental health professionals; employing quality assurance mechanisms and clinical governance arrangements) and establishment of inter-agency linkages (e.g., devoting a professional role—Coordination and Liaison—to this purpose). Provider perspectives suggest that the CMHS has had a positive impact on children and their families. Comparable countries implementing primary mental health programs for children may benefit from considering similar additional supports (e.g., training for mental health professionals), resources (e.g., funding positions devoted to fostering service inter-agency linkages) and service delivery flexibilities as those available in the CMHS.     

The New York Experience

SUMMARY

In response to changes in health care delivery, a coalition of therapists in New York City mounted a campaign to network with peers on the local, state and national level to exchange information and resources. The Mental Health Task Force explored new models of practice such as psychiatric home care, developed alliances with consumers and monitored regulatory agencies and legislation.     

心理健康素养：概念、评估、干预与作用

心理健康素养是促进心理健康的重要途径。狭义概念指帮助人们认识、处理和预防心理疾病的相关知识和信念; 广义概念指综合运用心理健康知识、技能和态度, 保持和促进心理健康的能力。心理健康素养常采用情景案例问卷、单维或多维评估量表等进行评估, 可以通过社会运动、学校教育、自助式应用程序、心理健康急救培训等方式进行有效干预提高, 其中心理健康知识、心理疾病识别、情绪调节、减少病耻感、积极的求助态度等成分都有促进心理健康的作用。未来研究可以在建构评估指标体系、探索作用机制、扩展涵盖群体与内容、加强实证干预研究等方面深入开展。     

The Evidence Base for Occupational Therapy in Mental Health: More Systematic Reviews Are Needed

To shape its work, the Research Centre for Occupation & Mental Health is interested in research priorities. Systematic reviews develop an overview of the research available about an intervention, which can provide evidence to underpin practice. They also however, identify gaps in the knowledge base and so are useful for research-prioritization exercises. A rigorous literature search identified only four systematic reviews about occupational therapy in mental health, which suggests that more are needed to underpin practice. This article also explains a six-stage process for conducting a systematic review that can be used by occupational therapists in mental health.     

The Rasch Scaling of Mystical Experiences: Construct Validity and Correlates of the Mystical Experience Scale (MES)

This study evaluated the relationships that exist between the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the mental health of individuals with heterogeneous medical disorders. The participants were 168 individuals with heterogeneous medical disorders (i.e., 61 brain injury, 32 stroke, 25 spinal cord injury, 25 cancer, 25 primary care). The measures were BMMRS subscales (conceptualized as spiritual experiences, religious practices, and congregational support), Medical Outcomes Scale–Short Form 36 General Mental Health scale. Pearson correlations indicated that, in general, mental health is positively correlated with positive spiritual experiences and positive congregational support but negatively correlated with negative spiritual coping and negative congregational support. Mental health was not correlated with private religious practices (e.g., prayer). Hierarchical regressions indicated that congregational support was the only BMMRS scale to predict mental health, explaining 6% of the variance beyond the 14% explained by demographic factors. The mental health of individuals with significant medical conditions appears to be primarily related to positive spiritual beliefs and especially congregational support. Mental health does not appear to be related to religious practices such as prayer, which is likely related to the fact that many individuals with serious medical conditions increase prayer with declining mental health status. These results stress the need for active congregational support and spiritual interventions to improve the mental health of persons with serious medical conditions.     

Convergent Validity of the Early Memory Index in Two Primary Care Samples

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.     

Child and adolescent services research at the national institute of mental health: Research opportunities in an emerging field

This article describes an important new area of research on services for children and adolescents with mental disorders at the National Institute of Mental Health, the parameters of mental health services research for youth, and the opportunities that are available for grant-funded investigations in this area.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

SAMHSA philosophy and statement on ethical principles

As the major federal agency responsible for improving the delivery and effectiveness of substance abuse and mental health services to the American public, the Substance Abuse and Mental Health Services Administration (SAMHSA) is aware that its programs deal with especially sensitive issues. As a national leader in advancing effective services to persons with addictive and mental disorders, SAMHSA has stewardship over important interventions affecting personal, community, institutional, and social values. Inherent in SAMHSA's mission and goals is a commitment to protect and promote the human, civil, and legal rights and moral freedoms of those individuals and groups who participate in SAMHSA-funded activities and to demonstrate that Agency policies and procedures are congruent with publicly acceptable ethical principles and standards of conduct. A foundation of mutual trust between SAMHSA officials and participants as well as sensitivity to issues of public accountability will hasten and strengthen progress toward this shared vision.     

Training the next generation of counseling psychologists in the practice of telepsychology

Training programs that integrate the use of technology are needed to prepare students for the future of service delivery in psychology. Training opportunities in telepsychology can equip students to develop, implement, and evaluate innovative modalities for mental health care. However, few options are available for trainees seeking to acquire these experiences, and while guidelines for service provision using technology are emerging, guidelines for and documented examples of training programs in telepsychology are virtually non-existent. The Telehealth Counseling Clinic, located at the Texas A&M Health Science Center, has developed a training model to prepare the next generation of psychologists to work with new technology to provide counseling services to low-income and uninsured individuals living in designated Mental Health Professional Shortage Areas in rural Texas. Training competencies necessary to serve this population through telepsychology are discussed and preliminary evaluation data of the training program are presented.     

Community-Based Interventions: A Return to Community Mental Health Centers' Origins

Consultation services offered by community mental health centers (CMHC) have gone through several significant changes since the signing of the Community Mental Health Center Act of 1963 (The President's Commission on Mental Health, 1978). Initially, consultation and education services were an integral part of the CMHC mission. With the passage of additional legislation that promoted a shift in focus, consultation services declined. By 1981, with the passage of the Omnibus Budget Reconciliation Act (Cutler, 1992) national mental health policy was adrift. Consultation and education were no longer seen as central components of mental health services, which increasingly were tied to acute care hospitalization. With a renewed focus on consultation and education, a coherent mental health policy can be reintroduced at the community level.     

Expanding Mental Health Services to Older High-Utilizing HMO Patients: A Pilot Study

Background: Expanded mental health benefits were offered to older HMO patients who were high medical utilizers. Outcomes of interest were use of services, subjective well-being, and psychopathology. Methods: Sixty-nine (25 male, 44 female) patients age 55 or above seeking frequent outpatient medical care completed the SF-36 health survey and the revised Symptom Check List (SCL-90-R). Patients were assigned to usual care, health education, or expanded mental health benefit conditions. Results: Patients showed high initial levels of psychopathology and distress. Over the 6 months of the study, patients in the expanded benefits group made a mean of 11.5 visits to mental health professionals versus a mean of 3.4 visits by usual care patients. Patients in the expanded benefits group showed significant improvement in SF-36 General Health and Mental Health well-being scores. Patients in the health education group showed no improvement. Patients in the usual care group showed improvements in Vitality scores. Psychopathology summary scores showed improvement for both usual care and enhanced benefit groups. Conclusions: Mental health treatment may improve well-being and reduce psychopathology in older high-utilizing patients. Creativity will be needed in expanding access to mental health services for this population.     

The importance of cooperation among child health professionals and agencies in an inner city infant mental health service

The clientele of our Infant Mental Health Service mainly consists of unwed teenage mothers and babies beset by medical, social, and psychological complications. Efforts to help these families usually extend beyond the caregiver-infant dyad and may include working with grandmothers, pediatricians, and high-risk neonatology nurses, as well as outside social agencies and foster homes. Thus, cooperation among various disciplines, departments, and agencies'is indispensible in infant mental health practice. Problems and successes in building and maintaining such cooperation, its impact on clinical practice, staff work, administrative functioning, and therapeutic strategies are discussed. Clinical examples illustrate the nature of the cooperation.     

The Reliability and Validity of a Brief Self-Report Questionnaire to Screen for Mental Health Problems: The Health Dynamics Inventory

Mental health problems are underrecognized in medical settings, leading to inadequate treatment. The present paper describes the development of the Health Dynamics Inventory (HDI), a brief, self-report questionnaire developed to evaluate mental health functioning. The HDI was written to evaluate the three aspects of mental disorders as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM): (1) the experience of emotional or behavioral symptoms; (2) emotional distress; and (3) psychosocial impairment. This study evaluated the psychometric properties and construct validity of its items, scales, and subscales. Results indicated that the items distinguish patients from nonpatients, that the instrument's scales and subscales are reliable, and that the scales and subscales discriminates between persons with mental health concerns or diagnosable problems and those without such concerns or problems. The utility of the instrument for screening mental health problems in primary care settings is discussed.     

Inanspruchnahme psychosozialer Versorgungsstrukturen

In spite of the high proportion of persons with a migration background in Germany, professional mental health care utilization by this population group still seems to be insufficient. This could be due to social as well as structural and individual barriers which impede the professional mental health care-seeking process. The heuristic Mental Health Action Process Approach (M-HAPA) model was developed in order to be able to empirically investigate the specific mechanism of action as well as the specific time of influence of these factors. An empirically supported model should possibly be able to justify targeted interventions. The M-HAPA model describes mental health care utilization behavior, combines the basic ideas of already existing models describing health behavior and health care utilization behavior as well as factors which are specifically relevant for the health care utilization behavior of persons with a migration background. This combination may serve as a basis for future research in the field of mental health care utilization behavior of persons with a migration background.     

Religious institutions and the prevention of mental illness

It is estimated that fifteen percent of the population is in need of some kind of mental health service at any given time, thus constituting a primary health problem. The President's Commission on Mental Health (PCMH) recognized that religious institutions can help to prevent mental illness by providing support in the community. This paper presents types of programs the PCMH found that were supportive and describes the program of one church to illustrate additional ways that clergy and their congregants, working collaboratively with professionals and agencies, can contribute significantly to the prevention of mental illness.is in the private practice of clinical social work and an M.T.S. student at Wesley Theological Seminary.