Challenges and opportunities in moving toward a public health approach in school mental health

These three outstanding papers are important for the discipline of school psychology, the field of school-based mental health, and more generally for systems of education and mental health for children and adolescents. As the authors emphasize, there is an unprecedented focus on improving programs that remove barriers to learning and enhance development, health, and mental health in youth, in the most universal natural setting—the schools. The authors also correctly highlight that school psychology is uniquely positioned to play a leading role in this reform and change effort. Two interconnected themes of the public health approach—applying the evidence base and moving toward preventive and population-focused interventions—are emphasized in these papers, and while they focus on school psychology, the issues discussed are generalizable to the many disciplines that operate within educational and mental health systems. In the following discussion, I react to the papers' two major themes, discuss realities that should be addressed for progress to be made, and comment on their implications for school psychology.     

Sudden gains as a long-term predictor of treatment improvement among children in community mental health organizations

ObjectiveSudden gains have been described as rapid, sizeable changes observed between treatment sessions and have been associated with improved treatment outcome in adults. The current study examined weekly sudden gains among children seeking treatment in the community mental health setting.MethodParticipants were 161 children (age M = 10.58, SD = 1.73; 69.6% male; 47.8% Caucasian) and their parents who were randomized to one of three treatment modalities and were administered weekly and quarterly assessments throughout treatment.ResultsWhen idiographic (youth- and parent-identified “top problems”) and nomothetic measures (standardized checklists) were used to calculate sudden gains (i.e., gain must be large: in absolute terms, relative to prior session, and relative to changes in prior and subsequent sessions), 20–42% of participants experienced at least one sudden gain during treatment. Most sudden gains occurred early in treatment, and session content of relaxation was associated with sudden gain presence. Using a modified Bonferonni correction, sudden gains predicted overall symptom levels at final assessment (i.e., last assessment obtained following post-treatment) even after controlling for pre-treatment symptom levels and magnitude of the overall gain from pre- to post-treatment.ConclusionsSuddenness of gains may have a direct effect on long-term treatment outcome among children in the community.     

Utah youth suicide study: barriers to mental health treatment for adolescents

Forty-nine suicide cases were drawn from an original sample of 151 consecutive youth suicide deaths. We used information from 270 interviews with parents and other survivors to evaluate mental health treatment sought for and by the decedent and barriers to mental health treatment. Participants reported the same primary barriers for the decedent: belief that nothing could help, seeking help is a sign of weakness or failure, reluctance to admit to having mental health problems, denial of problems, and too embarrassed to seek help. It is suggested that the stigma of mental illness is a considerable barrier to mental health treatment.     

Psychological distance reduces the effect of internalized stigma on mental health treatment decisions

Although stigma is a major barrier to treatment for those with mental health concerns, it is poorly understood when stigma is more or less influential in mental health treatment decisions. In the current work, we examined whether psychological distance—the removal of an event from direct experience—reduced the influence of internalized stigma on willingness to seek treatment. Specifically, we tested the hypothesis that psychological distance versus proximity (e.g., seeking treatment in three months vs. in two days, respectively) decreases the negative influence of stigma on willingness to seek treatment. We focused on a population for whom mental health treatment decisions are personally-relevant: individuals who had previously sought mental health treatment. Experiment 1 showed that the extent to which these individuals internalized (i.e., personally endorsed) stigma about mental illness predicted lower intentions to make an appointment with a mental health care provider for themselves (but not another person). Experiment 2 replicated this result using a different measure of psychological distance (temporal distance) and extended this finding to behavior (time spent reading mental health resources). Overall, this research demonstrated that internalized stigma disrupts mental health treatment-seeking intentions and behaviors when they are psychologically proximal, but not when they are distant. Potential applications of these results are discussed.     

An empirical examination of stigma toward mental health problems and psychotherapy use in Veterans and active duty service members

Although many Veterans and active duty service members experience mental health problems, most do not seek out any sort of mental health help. Stigma (a significant predictor of treatment-seeking) has been documented among Veterans and active duty service members; however, previous research on stigma in these groups has primarily utilized correlational and qualitative designs. The purpose of this study was to gain a better understanding of stigma toward mental health problems in Veterans and active duty service members using an experimental design. One hundred sixty-five Veterans and active duty service members were randomized to read a vignette that described a Veteran who either did or did not experience a mental health problem and did or did not seek psychotherapy. Results indicated that the participants held more stigmatizing attitudes toward the Veteran who was described as having a mental health problem, but not toward the Veteran who was described as seeking psychotherapy. Additionally, participants held more positive attitudes toward the Veteran, compared to the attitudes that they believed other military members would hold. Last, with this sample of Veterans and active duty service members, self-stigma toward seeking psychotherapy was found to partially mediate the relationship between perceived public stigma and attitudes. Implications for addressing stigma in military service members and Veterans are discussed.     

Community types and mental health: a multilevel study of local environmental stress and coping

Research has found that neighborhood structural characteristics can influence residents' mental health. Few studies, however, have explored the proximal reasons behind such influences. This study investigates how different types of communities, in terms of environmental stressors (social and physical disorder and fear of crime) and social resources (informal ties and formal organizational participation), affect well-being, depression, and anxiety in adult residents. Data are from a survey of 412 residents nested in 50 street blocks. Block stressors and resources were cluster analyzed to identify six block types. After controlling for several individual- and block-level characteristics, results from multilevel models suggest that in communities facing relatively few stressors, higher levels of formal participation are associated with better mental health. Because high levels of formal participation were not found in communities with higher levels of stressors, the impact of participation in such contexts could not be examined. However, results suggest that in communities where stressors are more common, isolation from neighbors may have a protective effect on mental health.     

Religion and self-efficacy: a multilevel approach

Can the religious values of an entire geographic area affect the self-efficacy of emerging adults living in that area? Although prior research has demonstrated that individual religious characteristics are associated with self-efficacy, less is known about how the overall religious context influences self-efficacy. Using multilevel analyses on two waves of the National Study of Youth and Religion (NSYR) merged with county-level variables, this study finds that a county’s higher conservative Protestant population share is associated with lower self-efficacy even after controlling for various variables. Surprisingly, this conservative Protestant contextual effect also applies to residents who are not conservative Protestants but live in a conservative Protestant county. In contrast, county-level Catholic population share is linked with higher self-efficacy. However, this Catholic contextual effect is explained when controlling for county-level variables.     

Personality change and personality as predictor of change in psychotherapy: A longitudinal study in a community mental health clinic

Research suggests that personality may change due to important life events, such as psychotherapy, and that personality and attitudes may predict treatment progress. Longitudinal data in a community mental health clinic showed positive changes in Emotional Stability, Hope, Gratitude, and Motivation during the course of psychotherapy. The static approach relating baseline personality and attitudes to treatment progress did not yield fruitful results. The dynamic approach was more effective, in which we treated personality and attitudes as malleable and used changes in these variables as predictors of progress. Treatment progress correlated with an increase in Emotional Stability. Positive changes in general life attitudes (Hope, Gratitude, Quality of Life) more so than therapy-specific attitudes (Motivation, Working Alliance) predicted symptom reduction.     

The stigma of having a parent with mental illness: Genetic attributions and associative stigma

Children often report associative stigma because they are ‘contaminated’ by association with a parent who has a mental illness. An exploratory study was conducted to investigate the role of genetic attributions in the aetiology of associative stigma. The first hypothesis was that genetic attributions would predict associative stigma over and above the contribution of biochemical and stressful‐event attributions, while the second hypothesis was that the relationship between genetic attributions and associative stigma would be mediated by the perceived likelihood that children would develop the same disorder as their parents. Two‐hundred‐and‐two individuals were asked to read a hypothetical scenario describing a teenage girl whose mother had been diagnosed with either schizophrenia or depression. Both hypotheses were supported. The findings of the study have implications for a number of professions working in the community such as teachers and psychologists. Additional avenues for future research are also explored.     

Regulatory focus as a predictor of attitudes toward partitioned and combined pricing

Partitioned pricing is a widely used pricing strategy, but little is known about the buyer characteristics that influence its effectiveness. The current research contributes to the pricing literature by investigating the impact of regulatory focus on the perceived attractiveness of partitioned and combined pricing. In four studies, we hypothesized and found support for the idea that promotion focused individuals perceive partitioned prices to be more attractive than combined prices, while prevention focused individuals do not differentiate between the two pricing types. Our results also show that regulatory focus influences consumers' information processing style, which in turn leads to important differences in attitudes towards partitioned and combined pricing. Specifically, promotion focused consumers are more likely to engage in global processing and global processing is linked to preferences for partitioned (versus combined) prices.     

Emotional intelligence as predictor of mental, social, and physical health in university students

This study examined the association between emotional intelligence (EI), anxiety, depression, and mental, social, and physical health in university students. The sample was made up of 184 university students (38 men and 146 women). El was evaluated by the Trait Meta-Mood Scale (Salovey, Mayer, Goldman, Turvey, and Palfai, 1995), which evaluates the three dimensions (Attention, Clarity, and Mood Repair). Anxiety was evaluated with the Trait Anxiety Questionnaire (Spielberger, Gorsuch, Lushene, Vagg, and Jacobs, 1983) and depression with the Beck Depression Inventory (Beck, Rush, Shaw, and Emery, 1979). Mental, social, and physical health were evaluated with the SF-12 Health Survey (Ware, Kosinski, and Keller, 1996). Results showed that high Emotional Attention was positively and significantly related to high anxiety, depression, and to low levels of Role Emotional, Social Functioning, and Mental Health. However, high levels of emotional Clarity and Mood Repair were related to low levels of anxiety and depression, high Role Physical, Social Functioning, Mental Health, Vitality, and General Health. This study confirmed the predictive value of Attention, Clarity and Mood Repair regarding the levels of anxiety, depression, and areas related to mental, social, and physical health in university students.     

Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health

This article summarizes the conception and diagnosis of the mental health continuum, the findings supporting the two continua model of mental health and illness, and the benefits of flourishing to individuals and society. Completely mentally healthy adults--individuals free of a 12-month mental disorder and flourishing--reported the fewest missed days of work, the fewest half-day or greater work cutbacks, the healthiest psychosocial functioning (i.e., low helplessness, clear goals in life, high resilience, and high intimacy), the lowest risk of cardiovascular disease, the lowest number of chronic physical diseases with age, the fewest health limitations of activities of daily living, and lower health care utilization. However, the prevalence of flourishing is barely 20% in the adult population, indicating the need for a national program on mental health promotion to complement ongoing efforts to prevent and treat mental illness. Findings reveal a Black advantage in mental health as flourishing and no gender disparity in flourishing among Whites.     

Voluntariness, intention, and the defence of mental disorder: toward a rational approach

This article addresses how mental disorder may be used in common law countries to negate the requirements of voluntariness and intention in serious criminal offences as well as to provide the basis for current versions of the insanity defence. The notion that mental disorder can cause conduct to become completely involuntary or unintentional is questionable, given current thinking in the behavioral sciences. This article argues that different forms of mental disorder should be subsumed within a separate defence of mental disorder. Providing that a range of dispositional options is available, the law in this complex area would be simplified and brought into line with current psychological notions of goal-directed behavior.     

Using modeling and vicarious reinforcement to produce more positive attitudes toward mental health treatment

In this study, the authors evaluated the effectiveness of a video, developed for this study and using principles of cognitive learning theory, to produce positive attitudinal change toward mental health treatment. The participants were 35 men and 45 women who were randomly assigned to watch either an experimental video, which included 3 positive 1st-person accounts of psychotherapy or a control video that focused on the psychological construct of self. Pre-intervention, post-intervention, and 2-week follow-up levels of attitude toward mental health treatment were measured using the Attitude Toward Seeking Professional Help Scale (E. H. Fischer & J. L. Turner, 1970). The experimental video group showed a significantly greater increase in positive attitude than did the control group. These results support the effectiveness of using the vicarious reinforcement elements of cognitive learning theory as a basis for changing attitudes toward mental health treatment.     

An internet survey of emotional health,treatment seeking and barriers to accessing mental health treatment among Chinese-speaking international students in Australia

The present internet survey examined the demographic characteristics of Chinese-speaking international students in Australia, psychological distress levels as measured by the Kessler-10 (K-10) Item scale, help-seeking history and preferences, as well as treatment barriers. Of the 144 respondents, 54% reported high psychological distress (mean K-10 score?=?23.96; SD?=?9.03). However, only 9% of those who were highly distressed reported they had sought mental health services in the past year. While the majority preferred help from informal social networks, they tended to favour mental health services over traditional culture-specific forms of help. Common barriers to accessing mental health services reported by respondents with high psychological distress included costs or transportation concerns, limited knowledge of available services, time constraints, the perception that symptoms were not severe enough to warrant treatment, language difficulties and lack of knowledge of symptoms of psychological distress. Although the majority preferred face-to-face treatments over internet treatments, a considerable percentage of respondents were willing to try either treatment modality. Chinese-speaking international students are a high risk group for developing psychological distress, yet they tend to underuse mental health services. Education about the effectiveness of face-to-face and online treatments may increase treatment seeking by this population.     

Self‐criticism and self‐reassurance as mediators between mental health attitudes and symptoms: Attitudes toward mental health problems in Japanese workers

Japanese workers suffer high rates of mental health symptoms, recognised recently by the Japanese government, which has enacted workplace well‐being initiatives. One reason for poor mental health concerns negative attitudes about mental health problems such as shame, which may be mediated by self‐reassurance and self‐criticism. This study aimed to evaluate shame‐based attitudes toward mental health problems and explore the relationship between mental health attitudes, self‐criticism, self‐reassurance, and mental health symptoms. Japanese workers (n = 131) completed three measures: attitudes toward mental health problems, mental health symptoms, and self‐criticism/reassurance. A high proportion of workers reported negative attitudes about mental health problems. There were strong relationships between mental health attitudes, mental health symptoms, self‐criticism, and self‐reassurance. Path analyses revealed that the total and indirect effects (through self‐criticism and self‐reassurance) of mental health attitudes on mental health were larger than the direct effect alone. Hated‐self and family reflected shame were identified as predictors for mental health symptoms. The findings suggest the importance of self‐criticism and self‐reassurance in mental health and mental health attitudes. Implications for help‐seeking behaviours also are discussed. Interventions aimed at reducing self‐criticism and enhancing self‐reassurance are recommended to improve mental health attitudes and increase help‐seeking in Japanese workers.     

心理健康服务的文化胜任力：理论取向与实践策略

心理健康服务的文化胜任力随着欧美对多元文化群体的重视而逐渐发展起来。该领域存在两种不同的理论取向及相应的实践策略。内容取向关注静态的、结构化的文化胜任力; 过程取向则关注动态的、非结构化的文化胜任力。两种取向的异同体现了文化胜任力的研究和实践中对文化特异性和普遍性因素的平衡。在此基础上, 本文最后讨论了如何参考国外经验, 立足中国现实问题和加强社会心理服务体系建设的大背景, 来发展中国的文化胜任力。     

Religion and youth educational aspirations: a multilevel approach

Previous research has demonstrated that individual religious beliefs and practices are associated with educational outcomes. However, less is known about the manner in which the overall religious cultural influence of a religion can affect an individual’s educational aspirations. Using multilevel analyses on two waves of the National Study of Youth and Religion (NSYR) merged with county-level variables from the US Census, and the Religious Congregations and Membership Study (RCMS), the study shows that a county’s higher Jewish population share is associated with a higher level of educational aspirations for the youth, regardless of being Jewish or not. This Jewish contextual effect remains robust even after controlling a wide range of individual and county-level variables, such as individual academic achievement and religious identity. Consistent with the relevant theory and literature, the negative main effect of county-level conservative Protestant population share on educational aspirations is explained by county-level socioeconomic characteristics. The same mechanism is used in part to explain the initially positive relationship between Catholic population share and educational aspirations. Finally, the study highlights the importance of using a multilevel approach to examine and provide understanding of the relationship between religious influence and educational outcomes.     

Female and male attitudes toward life: Implications for theories of mental health

In an attempt to better understand the ways in which females and males perceive their sociopsychological condition, the relationship of 12 independent variables to satisfaction with life is investigated using multivariate analysis. The analysis is premised on the assumption that a relationship may exist between differential feelings of life satisfaction of females and males and the known variations in mental health rates between the sexes. Data come from a national survey of 2,164 adults. The dependent variable is derived by factor analyzing semantic differential scales in which respondents select adjectives best describing their lives. Although a sharp difference by sex exists regarding satisfaction with life (36.1% of the males compared to only 13.5% females report high satisfaction), a high degree of congruence is found between the sexes in the variables contributing to life satisfaction: work satisfaction, personal competence, age, and marital adjustment index.