Communicating evidence‐based mental health care to service users

There is a significant gap between evidence‐based mental health care and patients, their family members and carers. To inform preventative mental health care among existing and potential service users, this review identifies effective methods for communicating evidence. A systematic review located 14 publications that met search criteria. Several methods can effect behavioural and/or intermediary change among existing and/or potential service users: namely, mass media; health warning labels; policy change; community interventions; school‐based programs; parent programs; and psychoeducation. Robust evidence, however, is lacking. Although effective approaches are likely to be founded on several factors, the review concludes with a discussion of a research agenda, and appropriate methodologies that could strengthen the knowledge base that guides the communication of evidence‐based mental health care to service users. This agenda has important implications for practitioners, policymakers, and researchers, which are also discussed.     

Ethnic minority adolescents and the use of community mental health care services

Examined the utilization rates, treatment dropout rates, and length of treatment for minority adolescents in the mental health care system. Data from the Los Angeles County Department of Mental Health from 1983 to 1988 were used. Ss were 853 African Americans, 704 Asian Americans, 964 Hispanics, and 670 whites. Analyses showed that Asian Americans and Hispanics are underrepresented in existing public mental health facilities while African Americans are overrepresented. For dropout rates, no ethnic differences are found between minority groups and whites; but, for length of treatment, Asian Americans tend to stay longer in treatment while African Americans tend to stay in treatment for a shorter period of time than whites. African Americans also have more outpatient episodes than whites. Implications of the results are discussed, and recommendations for future research are suggested.     

The next wave of change for psychology and mental health services in the health care revolution

Recent national changes in the de facto system of health and mental health care are described. Although the percentage of people without health insurance (always or sometimes) has not decreased, the organization of insured care has changed dramatically. Of the insured population, 75% are under some form of managed care. For 88% of the managed care population, mental health care has not been integrated with health care: the so-called carve-out. The author argues that system integration (carve-ins), for a variety of reasons, will begin soon and will occur very rapidly. A tilt toward carve-ins will have substantial impact on psychologists' training, service delivery, and research.     

Behavioral health care dot-com and beyond: computer-mediated communications in mental health and substance abuse treatment

Computer-mediated communications (CMC) such as e-mail, websites, and CD-ROM and DVD programs, both on and off the Internet, will play an ever larger role in the future of behavioral health care. This address describes the current rapid expansion of CMC and some profound changes that are likely in the future. The reasons for using such CMC programs are addressed, and an example of a new multimedia version of the Addiction Severity Index is described. Issues and concerns about future uses of CMC are raised, as are possible implications for psychology.     

Some reflections on spirituality,religion and mental health

For both religion and psychiatry context is becoming more important. Object relations theory, and especially the concept of a transitional object, may be a means of linking religious thinking and psychoanalysis together. The distinction between religion and spirituality is important, though not absolute. Two factors emerge from this engagement: 1) critical questioning at the boundary of each discipline; and 2) both spirituality and mental health are related to life in a specific society. The link between religion and irrational behaviour is important, religion being a primary means of acknowledging the irrational facets of everyday life. But delusion must not be confused with illusion: between these two imagination, art and religion flourish. Each of these is dangerous, since they connect the ‘normal’ with the ‘riskily marginal’. In a multicultural society behaviour which may be acceptable in one context may in another be regarded as a sign of illness. This is particularly true of religious behaviour. Three key issues are examined: 1) the social function of spirituality and religion; 2) the idea of personal wholeness; and 3) the link between external and internal validation of the individual's spirituality. The boundary between psychotic and religious behaviour is a difficult one to discern. Yet neither medical nor spiritual explanations alone seem sufficient. There is a complementary mapping of the complications of human experience.     

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.     

Migrant mental health: a model for indicators of mental health and health care consumption.

OBJECTIVE: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. DESIGN: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. MAIN OUTCOME MEASURES: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" RESULTS: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. CONCLUSIONS: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups.     

How and when to correct for juror hindsight bias in mental health malpractice litigation: Some preliminary observations

This article examines the hindsight bias in the context of mental health malpractice litigation, analyzes various legal mechanisms for dealing with the bias, and discusses whether the law should strive for debiasing in all mental health malpractice cases.     

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross‐sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.     

Carers of adults with mental illness: Comparison of respite care users and non‐users

The aim of this study was to investigate the rate, type and duration of respite care use in carers of an adult with mental illness, and the differences between respite care users and non‐users on demographic, caregiving context and adjustment variables. A total of 106 carers completed a postal survey questionnaire. The majority (76%) of carers who accessed care used it weekly, fortnightly or monthly. The most common types of respite services were in‐home, day programs, and residential respite. The mean duration of respite care periods was 58.18 hr each time respite was used. Compared to respite care non‐users, carers who accessed respite care were more likely to live with their care‐recipient and provide more caregiving. They also reported more benefits associated with their caregiving. Findings suggest that respite care services need to be varied, available for carers on a weekly to monthly basis with a range in duration, but catering for higher use of 2‐day respite periods. Carers who are highly engaged in a range of caregiving tasks and who live with their care recipient are more likely to have a greater need for respite care. Future research should examine the effects of a range of respite care factors on carer adjustment outcomes.     

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.     

Patient experiences with treatment in private practice compared with public mental health services

The study compared patient experiences with psychiatric treatment provided by private practitioners and public outpatient clinics. Questionnaires were completed by 642 outpatients in private practice and 6,677 outpatients in public clinics. The questionnaire included a measure of patient experiences comprising six items: treatment outcome, enough time for contact and dialogue with clinician, clinicians' understanding of patient's situation, suitability of therapy and treatment, clinician follow-up of planned actions, and influence on treatment. Patients in private practice had generally better experiences than patients in public outpatient treatment. The difference between private and public patients was largest for patients with poor self-evaluated mental health or those who had just one consultation in the previous three months. Private practitioners appear to have an important role in mental health services delivery, and patients have relatively good experiences with services. Further studies that assess the patient - clinician interaction in different mental health services may give further insights into potential service improvements.     

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.     

Quantitative and qualitative analysis of a set of goal attainment forms in primary care mental health services

Aims: The aim of this paper is to present an attempt to collate the results of the client‐completed Goal Attainment Form (GAF) and to explore the usefulness of analysing the data in this way. The GAF is used primarily to add qualitative idiosyncratic data to the quantitative data collected by the CORE‐OM (Clinical Outcomes for Routine Evaluation Outcome Measure) questionnaire. Method: A sample of 477 completed GAF were used during short‐term therapy through primary care mental health services to investigate potential correlations in various different aspects between the GAF and the CORE outcome measure (CORE‐OM). The themes from these forms were qualitatively analysed to compare how clients describe their experience of therapy with clinical perspectives. Results: The results reveal several significant correlations. Themes used by clients to describe their problems and benefits of therapy were different from clinicians' perspectives. Discussion and recommendations: Several suggestions and recommendations are offered regarding evaluation, therapy and primary care short‐term therapy services.     

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。