Gaps and Barriers in Services for Children in State Mental Health Plans

Significant gaps exist in children’s mental healthcare, and barriers prevent access to existing services. Current federal initiatives call for state governmental agencies to recognize and resolve deficits in their systems of care. Previous work has acknowledged some of the problems in meeting the mental health needs of children within a system of care. This current project sought to discriminate between gaps (e.g., non-existent services) and barriers (e.g., problems that prevent access to existing services) within state mental health care plans. Because acknowledging barriers and gaps in mental health services is a step towards systems improvement, the present project describes how state governments recognize the limits of their children’s mental health care systems. We analyzed state mental health plans submitted to the federal government in applications for block grant funds. Results illustrate that a varied number of gaps and barriers are acknowledged in state plans. Overall, 90% of state plans discussed barriers and 84% of state plans discussed service gaps. The gap most frequently recognized was lack of providers (74%), while lack of funding (52%) was the most common barrier. This project points to some recognition of system limits in the states and reflects potential efforts to create policies for system improvement for children and families.     

Psychology and rural America. Current status and future directions

Rural people constitute about one fourth of the U.S. population, and their special mental health needs have been largely neglected. For a variety of reasons psychologists have focused little attention on this group. Recent economic developments affecting agriculture, farm families, and rural communities have increased awareness of problems facing rural areas. Psychologists can respond to the unique challenges created by rural mental health needs through research on stress, psychopathology, and community well-being. Training programs should be encouraged to recognize rural concerns. Psychologists are needed to practice in rural areas and to help develop effective rural service models. They can also support the development of state and federal policies that address rural needs.     

不同阶层心理健康观念及需求状况的调查研究

运用开放式和封闭式问卷调查法 ,对不同阶层共 483人的心理健康观念及心理健康需求状况进行了调查研究。结果表明 :( 1 )不同阶层、不同年龄段的人关于心理健康标准的观念具有显著差异。 ( 2 )人们认为 ,心理健康的人应具有的最典型特征是“处世乐观、热情、诚恳”和“心平气和、与世无争、乐于助人”。 ( 3 )心理不健康的人或心理变态的人所表现的最典型特征是“性格孤僻、与人不合群”和“对生活失去信心、悲观”。 ( 4)虽然不少人认为心理健康与咨询工作者当前最急需开展的工作是“宣传心理健康知识、开展心理卫生服务” ,但只有极少的人能够正视自己的心理健康需求 ,提出自己需要心理健康服务或咨询。     

Linking level of care to level of need. Assessing the need for mental health care for nursing home residents

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals.     

Economic predictors of mental health service utilization: A time-series analysis

This research was designed to understand the relationships between economic indicators and mental health service utilization. Six monthly and three quarterly time-series analyses were done to assess the time-dependent association between three state-level economic indices and two measures of mental health service utilization. Consistent with the existing literature, increases in manufacturing employment were inversely related to both first admissions in state hospitals and case openings in community outpatient facilities. Labor force participation was also inversely related to first admissions to state hospitals. No relationship was found between service employment and either of the mental health service use indices. The specific findings suggest that two processes may be operating in the relationship of labor force participation and manufacturing employment with mental health service utilization. Some of the findings suggest a "crisis" process, in which service use increases rapidly following an economic stressor, whereas other findings suggest a more insidious process, in which economic stressors slowly weaken the mental health of the community and eventually lead to increased mental health service use. These results can be used to better inform social policy and preventive interventions by highlighting the human costs of changes in economic well-being. The need for more ecological research is 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.     

Mental health counselling in the Black American Church: reflections and recommendations from counsellors serving in a counselling ministry

The goal of this study was to examine the relationship between “The Black Church”, the mental health needs of its members, and addressing those needs from the perspective of counsellors within the church. Four in-depth interviews were conducted with members of the mental health counselling team at one large, African American-serving church in the Midwest to explore their thoughts about their church pastor’s desire to expand their current ministry to a fully operating counselling centre. The findings suggest that “the Black Church” not only has a role and responsibility in addressing the mental health needs of African Americans within and outside of the church but can also use religiosity as a facilitator rather than a barrier to mental health service use among African Americans.     

Community Participation Needs of Families With Children With Behavioral Disorders: A Systems of Care Approach

The purpose of the current study was to convey findings regarding the community participation needs of families who have children with behavioral disorders. The changing focus of community-based service provision to the systems of care approach for children with mental health needs requires family input to identify and better address their needs. This study identified characteristics of community participation in families of children with mental health needs through a survey, using mixed methods design and purposeful sampling. Evolved themes supported challenges for policymakers to make changes in professional, school, and community supports. Occupational therapists have a strong skill set to offer these families and must work collaboratively with family organizations, provide support for successful engagement in desired social activities, and build adaptive behaviors in children with mental health needs.     

A student-operated crisis center

In this article we describe an attempt to meet a university community's needs for emergency mental health services through the establishment of a student-operated telephone emergency service. The service provides an interesting model for use of nonprofessionals in mental health services, in which the professional functions primarily as a trainer and consultant rather than offering direct services. We describe the structure of the center and then discuss further innovations and projects.     

The Application of Behavior Change Theory to Family-Based Services: Improving Parent Empowerment in Children’s Mental Health

We describe the development of a parent empowerment program (PEP) using a community-based participatory research approach. In collaboration with a group of dedicated family advocates working with the Mental Health Association of New York City and state policy makers, academic researchers took an iterative approach to crafting and refining PEP to better prepare family advocates to help bridge the gaps in service access among children with emotional and behavioral problems. Despite the growth of family-led, family support programs nationally, research that demonstrates the positive benefits of such programs is scarce in the children’s mental health literature. The PEP model is based on research data about barriers families face in mental health service utilization (e.g., stigma, perceptions of providers, attitudes towards mental illness, service availability, etc.). PEP is premised on (a) the concept of empowerment as a process, (b) the need to engage parents in becoming active agents of change, and (c) the application of an integrated framework to empower parents, called the Parents as Agents of Change model. Our paper focuses on describing the application of a Unified Theory of Behavior Change as a theoretical framework to help activate parents as change agents in meeting their children’s mental health needs. Based on an integrated model of grassroots driven Principles of Parent Support and research-based Unified Theory of Behavior Change, PEP’s Parents as Agents of Change model provides a conceptual framework for testing the effectiveness of family support services in children’s mental health, a much-needed area for future research.     

Comparing the mental health needs of female and male incarcerated juvenile delinquents

The present study was undertaken to survey the prevalence of mental disorder in juvenile justice facilities and to compare the mental health needs for females and males. Girls displayed significantly more mental health needs than boys. The estimated prevalence of mental disorder for boys was 27%, compared with 84% for girls. The difference is highly significant and is discussed in terms of service system issues in juvenile justice that affect males and females differently. ©1997 John Wiley & Sons, Ltd.     

Identifying young people's guidance needs through telephone counseling.

This study examined the needs that young people in Guadalajara, in the state of Jalisco, Mexico, expressed in phone calls to a research unit of the Mexican Social Security Institute. Three hundred forty-five calls, from individuals 11 to 24 years old who phoned from June 1995 to November 1998, were analyzed. Two hundred ninety-four of the callers were female and 51 were male. Greater percentages of females than males called to ask about sexuality and family problems. Males more than females asked about reproductive health (particularly pregnancy) and mental health. There were significant differences by gender and age, differences that were not detected in health service statistics. The findings have implications for decision makers and health and education service providers. They point to the need for programs that will reinforce young people's good health practices and help them avoid risky behaviors.     

Mental health and well-being of black women: Toward strategies of empowerment

This review of the literature on Black women's mental health has three goals: 1) to describe the mental health issues, needs, and adaptive behaviors of Black women; 2) to discuss the research, intervention, and public policy efforts of mental health professionals and Black women's groups to address the multiple needs of this population; and 3) to identify effective strategies by which community psychologists can improve the mental health status of Black women through efforts to reduce their environmental stressors, to increase their resources and access to services, and to facilitate their empowerment in American society. The authors propose a number of recommendations to improve Black women's mental health, including changes in research paradigms, changes in education and training programs, and the development of culturally competent service delivery systems.     

Implementation and evaluation of a juvenile mental health training for law enforcement in a medium-sized jurisdiction

The need for specialized training programs that are focused on youth mental health needs, awareness of community-based services, and de-escalation skills is growing across law enforcement agencies due to calls for service that involve youth in mental health crisis. The current study evaluates a juvenile mental health training for law enforcement that was developed based on agency needs. The training was completed by 159 officers and a pre-/post-test design was used. Findings suggest that officers were satisfied with the training and improvements were seen across several training constructs (confidence, preparedness, stigma, resource awareness, and de-escalation skills). Satisfaction with the training predicted change in confidence and preparedness. Recommendations for future research and the implementation of juvenile mental health trainings are discussed.     

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.     

Hmong Mental Health Needs Assessment: A Community-Based Partnership in a Small Mid-Western Community

The overall goal of this assessment was to verify the mental health needs of Hmong living in a mid-west community in order clarify the format, content, and feasibility of providing mental health services for Hmong in the future. Using a Community-Based Participatory Research (CBPR) model, we held four focus groups with 36 men, women, adolescents and professionals, all of Hmong descent, as well as interviewed 28 individual medical, mental health, education, and social service providers in the Eau Claire community. Our Hmong sample was frequently unclear about what “mental” health meant, indicating a low level of mental health literacy. Results confirmed that there are significant mental health needs in this refugee and immigrant population. Participants described problems consistent with depression, post-traumatic stress disorder (PTSD), anxiety disorders, somatoform disorders, and severe social stress and acculturation difficulties in every generation. Elder people and male adolescents were described as the most disaffected and in need of immediate services. It will be critical to address mental health literacy before designing future interventions. Treatment suggestions were provided with the intention of removing barriers and incorporating culturally sensitive methodologies, while continuing to work closely with our local mental health providers and Hmong leadership.     

Mental health teaching to UK psychology undergraduates: report of a survey

One of the limitations on developing more progressive applied psychology training is the teaching received by students at undergraduate level. In this study, we focus on the provision of teaching about mental health or its equivalents (e.g. abnormal psychology and clinical psychology) on UK undergraduate psychology programmes. Most students who go on to train as clinical psychologists will have received teaching on modules like these. A survey questionnaire was sent to 109 university departments which might offer a module in mental health mental health module and 348 individuals who might be involved in such modules. The majority of programmes responding offered a mental health module, which was available each year as an optional subject. A number of findings on the content and delivery of the modules are reported and a number of recommendations are made including more involvement from practitioners and service users. Copyright © 2007 John Wiley & Sons, Ltd.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

“We don't Talk about that Around Here”: religion,Spirituality and Mental Health in Northern Ireland

Since the early 1970s, Northern Ireland has experienced violent conflict, the boundaries of which are shaped by religious identification. Although the violence has significantly decreased since the late 1990s, its legacy remains. Research evidences a complex relationship between religious and spiritual beliefs and mental well-being, there is a lack of research about how political conflict, in which religion plays a dominant role, may shape how beliefs may shape the impact of faith on mental health. This article draws upon the views and experiences of mental health service users’ from a qualitative study about religion, spirituality, mental health and social work practice. Participants’ accounts state that while the role of religion and spirituality within mental health was recognised, its exploration was marked with questions of legitimacy. This article proposes that support is needed for service users to both acknowledge this aspect of their mental well-being and promote their having choice about its inclusion in their mental health care.