Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

A Systems Perspective on the Introduction of Narrative Practice in Human Services Organizations in the Era of Managed Care

General System Theory is used to examine the structure and activity of human services organizations for conditions which support the introduction of selected narrative ideas in a systemic approach to mental health services. The inquiry includes examination of the influence of larger systems (such as managed care companies and regulatory bodies) on such introduction.     

Transitioning Between Systems of Care: Missed Opportunities for Engaging Adults with Serious Mental Illness and Criminal Justice Involvement

Individuals with serious mental illness are overrepresented in the criminal justice system and face difficulties accessing mental health services both during incarceration and upon re‐entry into the community. This study examines how such individuals describe their experiences receiving care both during and after their time in custody and explores the perspectives of mental health service providers who treat this population upon re‐entry. Semi‐structured interviews were conducted with 43 individuals identified as having a history of serious mental illness and criminal justice involvement, as well as with 25 providers who have worked with this population. Clients noted the stress of transitioning to criminal justice settings, the uneven availability of services within jail and prison, and the significant challenges faced upon re‐entry. Providers reported barriers to working with this population, including minimal coordination with the criminal justice system and challenging behaviors and attitudes on the part of both clients and providers. Findings identify potential target areas for improved care coordination as well as for additional provider education regarding the unique needs of this population. Copyright © 2013 John Wiley & Sons, Ltd.     

Ethnic Differences in Children’s Entry into Public Mental Health Care via Emergency Mental Health Services

For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care.     

Alternative professional roles in health care delivery: leadership patterns in self-help groups.

The increasing professionalization of health care delivery systems, improved client awareness, funding cutbacks, and an emphasis on voluntarism have led recipients of health services to turn increasingly to self-help groups. This article examines the leadership and organizational pattern of such groups, using a study of 43 self-help groups from around the U.S. whose members are parents of children with cancer. Three leadership patterns emerged: groups were independent and parent-led, were led by professionals, or had a shared leadership of parents and professionals. Data indicate that the professionally led groups were the smallest, least formal, and had the narrowest range of activities. The groups with shared leadership had the greatest longevity, tended most often to retain as members parents of deceased children. The authors conclude that such coalitions of clients and professionals are vital for ensuring proper service delivery at a time when health care systems will likely remain bureaucratic and public resources for professional care are being reduced.     

DISCIPLINED DECISION MAKING IN AN INTERDISCIPLINARY ENVIRONMENT: SOME IMPLICATIONS FOR CLINICAL APPLICATIONS OF STATISTICAL PROCESS CONTROL

This paper explores some of the implications the statistical process control (SPC) methodology described by Pfadt and Wheeler (1995) may have for analyzing more complex performances and contingencies in human services or health care environments at an organizational level. Service delivery usually occurs in an organizational system that is characterized by functional structures, high levels of professionalism, subunit optimization, and organizational suboptimization. By providing a standard set of criteria and decision rules, SPC may provide a common interface for data-based decision making, may bring decision making under the control of the contingencies that are established by these rules rather than the immediate contingencies of data fluctuation, and may attenuate escalation of failing treatments. SPC is culturally consistent with behavior analysis, sharing an emphasis on data-based decisions, measurement over time, and graphic analysis of data, as well as a systemic view of organizations.     

Report of the Working Group on Governance and Administration

Prepared by the Working Group on Governance and Administration from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper delineates the various trends in health care that may impact upon organizational structures for psychologists within academic medical centers. Ten variables that describe various functional issues within academic medical centers or health science centers are defined. Finally, seven organizational guidelines and recommendations pertaining to governance of psychological services are detailed.     

Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies

The role of psychologists and other mental health professionals in long‐term care settings is undefined in Australia. Graduate psychology students receive little training in clinical geropsychology, and residential aged care providers do not routinely employ psychologists within such settings. Further, despite high rates of depression, neurocognitive problems, and other mental health problems, residents are rarely referred for evidence‐based psychological treatment. This article presents four case studies showing how psychology services may be employed in such settings within the context of a postgraduate psychology placement programme. These case studies emphasise the importance of engagement, the use of flexible and individualised treatment approaches, and the involvement of family and professional carers in the provision of psychological services. Psychology services in residential settings can have a positive impact on the care of older adults and their families.     

Assessing the effectiveness of conflict management training in a health sector organization: evidence from subjective and objective indicators

This study assessed the effectiveness of an intervention for handling interpersonal conflicts at work. In contrast to the mainstream approach in the health care industry, which focuses on developing formal systems of conflict resolution, our intervention consisted of enhancing health care workers’ conflict management skills through training. A pre- and post-test nonequivalent comparison group design was used (intervention group = 258 workers; comparison group = 243 workers). Participants perceived that the training was successful in reducing the number and intensity of conflicts with co-workers, patients, and patients’ relatives. Moreover, organizational indicators calculated on the basis of data obtained from human resources (HR) records show that the intervention was effective, insofar as the number of requests for third-party interventions to mediate conflicts at work, the number of patients’ complaints, and the level of absenteeism all decreased for trained workers, whereas workers from the comparison group exhibited no corresponding changes over time. In the light of these results, this article discusses the design of conflict management measures which could help improve both employees’ well-being and organizational productivity.     

Pathways to vocational services: factors affecting entry by veterans enrolled in Veterans Health Administration mental health services

The current study provides naturalistic data documenting the pathways-to-care to vocational services for 155 veterans who were receiving some form of mental health care from the Veterans Health Administration and had a vocational need but were not currently enrolled in vocational services. Of the participants, 94.2% had recognized their vocational need, 80.6% reported that they or someone else had sought help to alleviate the need, and 77.4% had previously received some form of vocational services. The median length of the participants' vocational need was more than 4.2 years. Delays associated with recognition, help-seeking, and treatment entry all contributed to the overall delay in entering appropriate care. Filtering factors associated with quicker recognition, seeking help, and receiving services included diagnosis, level of disability, type of vocational need, and support from primary providers, family, and friends. The results provide information for designing interventions to improve service entry by adults with mental health problems and vocational needs.     

Organizational climate in Spanish Public Health Services: Administration and Services Staff

The main goal of this research is to explore the organizational climate perceived by administrative and healthcare personnel working in Spanish healthcare services, analyzing the differences according to their health specialization, sex, age and professional status. The sample was made up of 3,787 individuals working in the administrative and healthcare services of the Public Health System of the Principality of Asturias, 88.7 % were working in specialist care and 11.3 % in primary care. Mean age was 51.88 (standard deviation of 6.28); 79.9 % were women and 20.1 % men. The organizational climate was assessed with the CLIOR scale. The organizational climate perceived is moderately positive, with a global mean of 3.03 on a scale of 1 to 5 points. The differences are statistically significant (p < .01) according to specialty, age and profession. A better working climate is perceived in primary care than in specialist care, and among older as compared to younger workers. The results indicate that the working climate perceived by administration and services staff employees in the Spanish healthcare context is moderately positive, with a better perceived climate in primary care than in specialist care.     

At the crossroads: managed mental health care,the ethics code,and ethnic minorities

Mental health clinicians are facing an increasing number of ethical problems related to the delivery of managed mental health care services to ethnic minorities. The authors argue that (a) economic pressures have led to the development of the managed health care movement; (b) the combination of such economic pressures and the development of that managed care movement have influenced the promulgated ethical standards of the American Psychological Association; and (c) those influences may have a negative impact on the mental health services available to ethnic minority individuals and communities. The authors review some of the specific potential threats to mental health services for minorities in the face of such health management policy and psychologists' professional standards.     

A Scale to Measure Perceptions of Organizational Maturity

While there are several standard scales in use for measuring various dimensions of human resource management, research is very limited in terms of scale development for variables that form part of the People Capability Maturity Model (PCMM) for organizational maturity. This study covers a perception measurement scale for people governance variables and organizational maturity developed, validated with industry experts and statistically tested. The scale was developed with 113 items grouped into 11 variables covering governance, staffing, performance management, rewards, quality, training, organizational maturity and business outcomes around staff, firm and customer aspects. The reliability analysis was performed for each of the variables based on inputs from 521 respondents across the services industry. The respondents were experienced professionals in functional management and human resources. Detailed analyses of results provide high scores for the variables, indicating good consistency of items. Convergent and discriminant validity analyses were performed for evaluating validation of item dimensions within each of the variables. The overall results indicate that the newly developed scale is a reliable and validated one to measure variables around people, process and organizational maturity, for researchers particularly in the services industry. This fills in a missing gap in terms of a validated scale for measuring people management variables. Further research can be done to extend this scale to other industries and to look at a model fitment across the related variables.     

Fulfilling institutional responsibilities in health care: organizational ethics and the role of mission discernment

In this paper we highlight the emergence of organizational ethics issues in health care as an important outcome of the changing structure of health care delivery. We emphasize three core themes related to business ethics and health care ethics: integrity, responsibility, and choice. These themes are brought together in a discussion of the process of Mission Discernment as it has been developed and implemented within an integrated health care system. Through this discussion we highlight how processes of institutional reflection, such as Mission Discernment, can help health care organizations, as well as corporations, make critical choices in turbulent environments that further the core mission and values and fulfill institutional responsibilities to a broad range of stakeholders.     

Organizational social context and psychopathology of youth in residential care: The intervening role of youth–caregiver relationship quality

Drawing on an ecological approach with multiple informants, this study investigated the mediating role of youth–caregiver relationship quality in associations between different features of residential care settings' organizational social context and youth's psychopathology. Participants were 378 youth aged between 12 and 25 years old, and 54 caregivers aged between 24 and 57 years old, from 29 generalist residential youth care settings in Portugal. Given the hierarchical structure of data, analyses were performed using multilevel modeling. Results revealed that organizational social contexts characterized by higher levels of engagement, stress, and centralization, as perceived by the caregivers, were associated with lower levels of youth's externalizing problems (e.g., aggressive behavior and delinquency), reported by the caregivers, via better youth–caregiver relationship quality, perceived by the youth in care. These findings highlight the relevance of creating an organizational social context in residential care settings that supports caregivers in establishing high-quality relationships with the youth in care, thereby promoting their mental health. This study contributes to the clarification of conflicting findings in previous studies of this field, by offering further empirical investigation of these issues.     

THE CHALLENGE TO MENTAL HEALTH SERVICES IN THE 1980s

Robert W. Gibson MD, is interviewed concerning the potential impact of restricted funding for mental health services in the 1980s, particularly as this applies to the practice of occupational therapy. Topics covered include the decreasing length of inpatient hospitalization; the possibility of a shifting emphasis lo the treatmcnt of the severely and chronically ill; increasing utilization of rehabilitative services; and suggestions to facilitate greater interprofessional collaboration. Thc establishment of measurable outcomes for continued or improved reimbursement of occupational therapy services is stressed, and the potential for multiprofession group practices as a cost-effective approach to reduced business and industry health care costs is suggested.     

The mental health system and older adults in the 1990s.

Trends in mental health services for older adults during the past decade were used to predict salient issues for the current decade. These include overreliance on inpatient treatment, increased use of general hospitals as treatment sites, inadequate integration with the nursing-home industry, and insufficient mental health referrals from general medical providers. In the decade ahead, the mental health needs of older adults are unlikely to be an identified focus; rather the issues will overlap with other priorities (e.g., biomedical research on brain functioning, alternative treatment programs for the chronically mentally ill, and containing health care costs). Advocates for the elderly will be successful to the extent that they cast aging services within the context of these other concerns.     

Organizational ethics in Catholic health care: honoring stewardship and the work environment.

Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.     

Structure and provision of services in Black churches in New Haven, Connecticut

Historically, Black (or African American) churches have played a central role as a center of religious and political life and also as a provider of human services and a healing community. This article examined the extent to which African American churches in 1 Northeastern urban environment are involved in the delivery of health and human service programs to their communities. It also explored how comfortable Black clergy are in referring their parishioners to the formal mental health system and identified the actual level of referrals. In addition, the analyses considered the individual and organizational characteristics that predict variations in the levels of support services and the likelihood of referral. Analyses revealed that African American churches deliver a broad range of services to the community. More than two thirds of the clergy feel comfortable in making a referral to a mental health agency or professional, and more than half have actually made a referral. Both service delivery and referral levels varied by several clergy and congregational characteristics. The implications of these findings for research and health policy are considered.