Research ethics for mental health science involving ethnic minority children and youths

In response to U.S. Public Health Service projects promoting attention to disparities in the outcomes of mental health treatments, in July 2001, the American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions.     

Psychiatric disorders and the use of mental health services among children involved in bullying

This study had two aims: to evaluate the relationship between bullying and psychiatric disorders and to study the probability of using mental health services among children involved in bully/victim problems. The data consisted of interviews with 423 parents and 420 children. Diagnostic measures were based on the Isle of Wight Interview. Children involved in bullying as bullies, bully‐victims, and victims were compared with other children. Children involved in bully/victim problems were more prone to have psychiatric disorders than noninvolved children. The probability of being disturbed was highest among male bullies, followed by male bully‐victims and female victims (9.5‐fold, 7.9‐fold, and 4.3‐fold, respectively) compared with noninvolved same‐sex children. The most common diagnoses among children involved in bully/victim problems were attention deficit disorder, oppositional/conduct disorder, and depression. Furthermore, children involved in bully/victim problems were more likely to have used mental health services at some time during their lives and also during the previous 3 months. Special attention should be paid to children’s mental health when dealing with bullying problems at school. Referral pathways to mental health services and factors affecting the referral processes among children should be further studied. Aggr. Behav. 27:102–110, 2001. © 2001 Wiley‐Liss, Inc.     

Use of mental health services among severely emotionally disturbed children and adolescents in San Francisco

This study examined the mental health services available to severely emotionally disturbed children and adolescents in San Francisco. Social, familial, developmental, and clinical data—as well as service use histories—on 192 youths were collected. Results indicated high levels of family dysfunction, physical and sexual abuse, and neglect in the total study population. The study also identified case history and demographic factors that were associated with repeated psychiatric inpatient hospitalizationand high annual rates of change in residential placement. These factors included being male, older, non-English-speaking, and having a history of physical and sexual abuse. The impact of the service system on the lives and course of illness of these youth is discussed and future directions for research are suggested.     

Predictors of mental distress and poor physical health among homeless women

Abstract

We tested a latent variable path model in which situational, personal, and social resources predicted several mediators and the key health outcomes of mental distress and poor physical health among 871 homeless women. Mental distress was predicted by risky sexual behavior, less social support, avoidant coping, less self-esteem, client abuse history, social support from deviant sources, less drug self-efficacy and health care utilization. Poor physical health was predicted by a client abuse history, less drug self-efficacy, fewer perceived rewards for drug use, higher perceived costs for drug use, and a doctor visit. Current risky sexual behavior was predicted by a parent drug abuse history, less drug self-efficacy, and more social support from deviant sources. Current drug use was predicted by parent drug abuse history, less drug self-efficacy, more social support from deviant sources and by high perceived costs for drug use. Implications of results for intervention and theory are discussed.     

Public and private responsibility for mental health services

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health service give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public-private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems.     

Race differences in the receipt of mental health services among young adults

This study investigates race and ethnic differences in the receipt of mental health services among young adults. Research has indicated that racial minorities receive treatment at a much lower rate than those with middle and upper incomes and whites. We use data from the National Longitudinal Study of Adolescent Health, a nationally representative study of young adults, first interviewed when in Grades 7 through 12. We find significant differences across race-ethnicity. Consistent with prior research, blacks are less likely to have received mental health services. Findings for gender and education differed from previous studies. The relationship of gender on services receipt is mediated by depression. The relationship of race-ethnicity on services receipt is moderated by levels of education and prior services use. Education is associated with greater services use for Whites, but less services use for blacks. Also, blacks who used services in the past are significantly less likely to be current users. The implications of these results are discussed.     

Community mental health services for black and ethnic minorities

An investigation into the provision of community mental health services in one local authority Borough found that facilities for the rehabilitation and resettlement of the recovering mentally ill into the community were very limited and fell far short of ofJicial recommendations and that very little consideration was given to meeting the needs of black and ethnic minorities. An analysis of data porn service providers (Local Authority/Social Services/Health Authority), multidisciplinary teams, voluntary agencies and 120 black and ethnic minorities (users and non-users of mental health services) in the Borough suggested that black and ethnic minorities had little or no say in decisions about the provision of community mental health services to the extent that they feLt excluded. In many instances service providers had limited contact with black and ethnic minorities and some members of the multidisciplinary team had little to do with black people but yet influenced major decisions about the provision of services to meet their needs. The findings drew sharp attention to the diference between the views of service providers and those of service users in terms of the provision of community mental health services to meet the needs of black and ethnic minorities. Ninety six percent of those involved in the study were appalled over the apparent lack of emphasis placed on the provision of services to meet the needs of black and ethnic minorities and felt that nothing was being done to improve the inadequate service which was offered ly the voluntary sector.     

Assessing the prevalence of mental health disorders and mental health needs among preschool children in care in England

Although school‐aged children living in foster care have been identified as a high‐risk group for mental health and developmental disorders, there is a paucity of data relating to preschool children in care (CIC). This study aimed to identify the prevalence of mental health and developmental disorders along with corresponding need for interventions in preschool CIC. All CIC aged 0 to 5 years in an inner city local authority underwent comprehensive, multifaceted assessments consisting of the Ages and Stages Questionnaire (J. Squires, D. Bricker, & E. Twombly, 2003), interviews with caregivers based on the Preschool Age Psychiatric Assessment (H.L. Egger & A. Angold, 2006), Mullen Scales of Early Learning (E.M. Mullen, 1995 ), and systematic clinical observation. Of 58 eligible preschoolers, 43 completed the assessment. At least one mental health disorder was found in 26 (60.5%) participants, and at least one developmental disorder was found in 11 (25.6%). When mental health and/or developmental disorders were considered together, 30 (69.8%) preschoolers fulfilled criteria for at least one diagnosis, and 18 (41.9%) had two or more comorbid conditions. Whereas 36 (83.7%) of the preschoolers needed an intervention, only 3 of these had received adequate input. In conclusion, preschool CIC constitute a high‐risk group for mental health and developmental disorders. Without age‐appropriate assessments, their needs go undetected, and opportunities for early intervention are being missed.     

State planning of mental health services

Planning is the vital process that links needs to solutions. The interorganizational field of human services constitutes a "turbulent environment," a condition of rapid change, and there needs to be greater receptivity toward comprehensive planning on the part of state departments of mental health. Increased overlap with various welfare and educational service, advances in scientific knowledge, and shifts in general attitudes and social philosophy lead to demands for new and different types of service and require changes in approach and method. Generalized findings of a study of 14 state departments of mental health are presented.     

Cross-cultural generalizability of the youth self-report and teacher's report form cross-informant syndromes

Exploratory factor analyses on 569 Youth Self-Reports and 1,221 Teacher's Report Forms of clinically referred Dutch children revealed six and eight factors respectively, very similar to the eight YSR and TRF cross-informant syndromes derived by Achenbach (1991c, 1991d). Mean cross-cultural correlations were .89 for YSR syndromes and .95 for TRF syndromes. In confirmatory factor analyses of the Dutch and American YSR and TRF factor models in cross-validation samples of 570 YSRs and 1,221 TRFs, goodness-of-fit indices were only slightly better for Dutch factor models. The American cross-informant Social Problems and Attention Problems syndromes had the poorest fit. The application of the eight American cross-informant syndromes to Dutch self-and teacher reports was supported.We wish to thank Dr. Thomas Achenbach for his comments and advice on this article.This research was supported by grants from the Sophia Foundation for Medical Research and from the Dutch National Program for Stimulation of Health Research.     

Sexual assault history and use of health and mental health services

A history of sexual assault may be associated with increased current use of mental health and medical services because of the psychologically and physically disruptive consequences of assault. To test this hypothesis, we estimated rates of mental health and medical services use among 2560 randomly selected community residents, 343 of whom had been sexually assaulted. Sexual assault was associated with seeking both forms of care. Controls for demographic variables, psychiatric diagnosis, health status, and insurance suggested that assault increases use indirectly, through poor mental and physical health. Uninsured, assaulted respondents were especially likely to consult medical providers. Respondents assaulted during childhood were particularly likely to seek mental health care. Assault was more common among mental health service users than nonusers, and among women using medical services compared to female nonpatients. The high prevalence of assault among service users underscores the need for providers to recognize and treat sexual assault-related problems.     

Adolescents' perceptions of outpatient mental health services

Thirty-three adolescents from three mental health service settings were interviewed regarding their perceptions of the purpose, goals, expectations, frustrations and benefits of mental health experiences. They provided satisfaction ratings and importance rankings of seven domains of satisfaction: (a) Convenient/Accessible, (b) Meeting Needs, (c) Staff Competence, (d) Personal Relationship with Staff, (e) Effectiveness of Treatment, (f) Comfort/Appropriateness of Center, and (g) Costs and Paperwork. In addition, participants completed the Client Satisfaction Questionnaire (CSQ-8). Results indicated that, in general, the adolescents were very satisfied with the services they received. Gender, race/ethnicity and treatment site were not related to satisfaction scores, nor was the adolescent's perceived choice in seeking services. Some significant gender differences were found both in terms of the rankings of satisfaction domains, as well as in the adolescents' perceptions of their reasons for initiating counseling and the perceived goals and benefits of counseling. Additional differences in perceptions of services were found for treatment site and race/ethnicity. In general, adolescents were able to generate informative, sophisticated responses to questions regarding their perceptions of mental health services, and demonstrated that they are capable of evaluating services they receive.     

Making the case for dedicated infant mental health services

SUMMARY

This paper seeks to demonstrate the case for establishing dedicated Infant Mental Health Services. It is argued that the 0–3 age-group is not well served by the current arrangement for the provision of mental health services along child/adult lines, and falls between these two stools. It is further argued that priority should be given to services for this group because of the immense potential of early intervention programmes. The nature and ethos of such services are discussed, and it is suggested that the time is now ripe for Infant Mental Health to be given institutional recognition as a distinct specialism in its own right.     

Religion and mental health among blacks

The positive role of religion in the mental health of black Americans is a much neglected theme in the literature. This paper considers religion as one of the important retained black cultural traits, which continues to play a vital role in the mental health and survival strategies of black Americans. The paper examines Grier and Cobbs's appraisal of the religion-mental health connection in black communities and identifies different ways for mental health practitioners to think about religious phenomena and the primal partnership between religion and mental health. The paper concludes with a challenge to keep awareness of the religion-mental health partnership together in the treatment of black Americans.This paper was originally presented at a two-day conference on Some Dynamics and Psychotherapeutic Methods in Rendering Treatment to Blacks, March 15 and 16, 1980, in Oakland, California. This particular paper discussed religion as one of the important retained black cultural trains.