Ecological constraints on mental health services.

Proposes 4 principles for community mental health programing that are consistent with an ecological thesis: (1) Assessment methods are focused on the total population rather than on those persons who presently receive a mental health service. (2) Mental health services are designed to reduce a high risk for community service. (3) Professional and research services are created as local community resources. "By initiating the informal coordination of current services, the community mental health program helps to create specific new community services as needed." (4) The program plans for change; this involves mobilizing anticipatory problem-solving resources not only for clients but for professionals as well. A "conception of community mental health work based upon the ecological thesis that adaptive programs change" is presented. (39 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transcultural therapy. 2: Mental health and learning disabilities

The first article in this two-part series (Vol 7(15): 901-6) examined the issues surrounding healthcare provision in the context of the UK as a multicultural society in relation to mental health and learning disabilities. This second article considers the development of psychotherapy, theory and skills of working in terms of its impact and influence upon the education and practice of community mental health nurses and community nurses in learning disability within the UK. The major schools of influence in psychology will be examined in relation to their limitations for practice with clients from various cultures. In addition, three multicultural models of counselling which address cultural diversity will be appraised. Finally, the need for educational systems and service providers to foster and develop positive cultural attitudes among nurse practitioners will be emphasized. Both individual practitioners and employment organizations will need to be much more responsive and committed to developing multicultural services as we approach the millennium.     

Challenges of providing mental health services in Spanish.

The disparity in mental health services to Spanish-speaking clients is well documented. This study examines the service delivery experiences of Spanish-speaking mental health providers by exploring their perceptions and concerns regarding their competence and training to provide services in Spanish. It also identifies practitioner priorities for improving training experiences specific to bilingual mental health service delivery. Implications for graduate psychology programs are discussed in an effort to promote and enhance necessary competencies regarding bilingual training endeavors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to the provision of mental health services to individuals with severe physical disability.

Surveyed 86 consumer advocates (67 with physical disabilities), 157 rehabilitation counselors, 94 rehabilitation administrators, 323 mental health administrators and professionals, and 145 severely disabled Ss concerning Ss' perceptions of the nature and extent of mental health services, barriers to mental health service provision for individuals with severe physical disabilities, and personal data. Overall, there was a general consistency among the sample groups in their perceptions of the extent to which each of 10 variables is a barrier to service delivery. The lack of accessible public transportation, especially in nonmetropolitan areas, and the accompanying limitation on costly mental health outreach services were viewed as serious problems. The limited knowledge and skills of many mental health professional regarding severe physical disability was perceived to be a moderate to substantial barrier to service provision. Findings indicate that individuals with severe physical disability are an underserved group. Recommendations regarding policy and program development and training of professionals are offered. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles for psychologists in emerging models of school-related health and mental health services.

Describes contributions of school, clinical, community, and health psychology to emerging school-based and school-linked health and mental health service delivery models. The author contends that these 4 areas integrate well to inform the development and targets of health service delivery approaches in and linked to the schools and to set the stage for defining the emerging and future roles of psychologists providing health and mental health care in these contexts. Emerging and future roles of psychologists as health care providers through schools include roles in development, implementation, and administration of these models, direct and indirect service provision, interfacing of health and educational outcomes, and applied research and evaluation activities. Implications for the education and training of current and future psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental Health Services for Native Americans in the 21st Century United States.

As the population of American Indians and Alaska Natives continues to expand in the 21st century United States, an increasing number of professional psychologists will be called upon to provide culturally appropriate mental health services for Native American people and their communities. This article provides a general overview of contemporary tribal America before describing the legal, political, and institutional contexts for mental health service delivery administered through the federally sponsored Indian Health Service. Recommendations for mental health professionals who desire to avoid a subtle but profound Western cultural proselytization in their therapeutic service to Native clients and their communities are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological services to Spanish-speaking populations: A model curriculum for training competent professionals.

The competent delivery of mental health services to Spanish-speaking clients requires knowledge of Latino cultures, racial and ethnic identity development, variables that impact service delivery, and the Spanish language. We present the Psychological Services for Spanish Speaking Populations (PSSSP) program as a model for training mental health professionals to deliver services to Spanish-speaking clients. The goals for the program were to improve participants' oral and written Spanish language proficiency in work-related contexts and to improve multicultural competence in service delivery to Latino clients. Recommendations for those who wish to offer similar programs include (a) grouping trainees according to Spanish language proficiency, (b) using Spanish language instructors with expertise in teaching heritage language learners, and (c) developing criterion references or measures to assess program outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of The mental health of Asian Americans.

Reviews the book, The mental health of Asian Americans by Stanley Sue and James K. Morishima (1982). In The Mental Health of Asian Americans, Sue and Morishima assess the current status of theory and research strategies in this field and initiate dialogue regarding future directions for our investigative energies and service delivery efforts. They are largely successful at this ambitious mission. Their work represents one of the best and most comprehensive texts on the special issues related to Asian-American mental health. Although this book was published in 1982, the theories presented and issues discussed remain extremely pertinent to the problems encountered today in providing services to this population. The authors' major intent is not to demonstrate how to deal with cross-cultural issues in treating Asian-American clients, although therapeutic techniques with a particular client may be extrapolated from their discussion and numerous case examples. Instead, the authors focus on strategies for improving research and delivery of mental health services, and attaining a theoretical understanding of treatment issues within the cultural context. The content is aimed at those who are in training or currently participating in mental health research and service delivery to persons of Asian descent. Yet, this book is of interest to all professionals who are seeking a well-researched text which is grounded in theory and describes the importance of cultural factors in developing mental health services to an ethnic minority population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experiences of Spanish/English bilingual supervisees.

Supervising mental health services conducted in a language that the supervisor does not speak can present a conundrum for both supervisors and supervisees, especially when the supervisee is the only person in the clinic who speaks the language of the client. This qualitative study explored Spanish-language services supervision experiences of bilingual graduate students and professionals during their graduate training. The participants reported feeling burdened and stressed by additional responsibilities. They had little training or supervision to help them develop the language skills necessary to provide competent services in Spanish, so they relied on peer support and networking to cope with the many challenges they faced. The participants appreciated having supervisors who were culturally competent and open to the clients’ cultural values. Training programs and supervisors need to be aware of the factors contributing to this stress and examine procedures and practices that may exacerbate or minimize the burdens. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Challenge of human service programs for psychologists.

The rationale for, and the manner in which, mental health services are provided in 1971 differs significantly from the patterns of a decade ago. The perspective and activities have expanded from the isolated clinic to the more encompassing community mental health program. During the 1970's psychologists will be challenged to evolve the scope even further by designing far-flung human service systems which seek to provide comprehensive and coordinated assistance to clients. 4 prominent alternative program structures are arising at the community level: information and referral centers, diagnostic centers, multiservice centers, and human services networks. It is predicted that psychologists may well be required to redesign their (a) practice, by developing job roles in nonpsychiatric settings; (b) research, by increased use of the ecological model for the resolution of pressing social problems; and (c) training, by expanded use of multidisciplinary settings offering broadly defined rather than narrowly circumscribed work experiences. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the treatment of dual diagnosis clients who have chronic mental illness.

Examines several issues relevant to treating dual diagnosis clients who have coexisting chronic mental illness and substance abuse diagnoses. The development of various theoretical viewpoints on the relationship between substance abuse and mental illness is described along with a critical review of current research efforts. Suggestions are made for professionals to devote more attention to coordinating services and resources within mental health systems, adjusting academic training and professional development, and developing research efforts that will provide practical guidelines for clinicians. Until more definitive research is available, administrators, clinicians, and professional training programs are advised to adopt a broad clinical perspective of work with dual diagnosis clients that incorporates both mental health and substance abuse treatment modalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and linguistic competence: Welcome challenges from successful diversification.

The increasing numbers of ethnically diverse professionals is filling a need for service provision in agencies that provide mental health services for a diverse clientele. However, the rapid shift in professional demographics provides a sharp generational contrast; these emerging psychologists are placed in potentially ethically charged positions before their careers truly begin as a result of the gap between institutional resources (materials and supervisors) and trainees' specialized needs. The lead article reviews a broad array of points to consider when a supervisee is providing services in the native language of the client and does not know that language. The three invited commentaries highlight (a) the role of language in emotion and subsequent implications for treatment and supervision, (b) the slow institutional development to meet the training needs of emerging therapists that will treat ethnically diverse clients, and (c) the importance of following decision-making models to inform ethical supervisory practice when there is a language mismatch. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client factors related to premature termination of psychotherapy.

Investigated client factors related to the premature termination of counseling or psychotherapy. A review of 287 mental health center client files revealed 3 variables that were found to be significantly related to premature termination: diagnosis, presenting problem, and previous psychiatric experience. Early terminators had less previous contact with psychiatric services, were usually not psychotic, and presented with problems in the area of interpersonal relationships. Results suggest that community education activities, informed consent procedures, therapist knowledge of the early terminator's profile, and a wider range of services, including more groups, may improve community mental health center service delivery to these clients. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Dexamethasone concentration in vitreous and serum after oral administration

OBJECTIVE: To assess the outcomes of changes in mental health policy introduced in Italy in 1978. METHODS: Data on psychiatric services, before and after the policy change, are presented. Effects of change are evaluated through indicators related to four issues: transfer of care, criminalisation of the mentally ill, suicides, and homelessness. RESULTS: Admissions of new patients to mental hospitals have been stopped and the size of the mental hospital population is now very low (26 per 100,000 population). Psychiatric care has been shifted to community services including general hospital psychiatric units. There has been an overall reduction of psychiatric hospitalisation. However, the provision of residential facilities is inadequate and community services are unevenly distributed across the country. Few negative effects of changing patterns of care have been reported, although the low quality of data limits the validity of such a conclusion. Outcome of care in areas where the full range of community services is available has been rated as satisfactory. CONCLUSIONS: Although care of the mentally ill has been shifted to community services, we lack hard data on the social and clinical outcome of community care at the nation-wide level. Long-term monitoring and evaluation of community services is a high priority in Italy.     

Immediate family crisis intervention as preventive mental health: The family consultant service.

The service employs mental health personnel who work closely with the police in order to respond immediately to family-related crises. This paper reports a preliminary evaluation of the program with respect to 5 issues: (a) whether the program is redundant with existing community services, (b) the advantages of early intervention approaches, (c) whether the program is a preventative service to any degree, (d) the evaluation of the program by the police and social agencies, and (e) whether cooperation between mental health and law enforcement professionals is enhanced. Available data collected over a 2-yr period concerning these 5 issues indicated the success of the program. It is concluded that it can serve as a model for community prevention approaches to family crises and mental health problems. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults, reimbursement, and referrals: Implications for psychologists after Medicare reimbursement changes and before health care reform.

Psychologists' current provision of mental health services to older adults was investigated by a mail survey. One half of licensed psychologists in a metropolitan region in the Northeast were randomly sampled, with a return rate of 61% (n?=?37). 75% saw older adult clients (aged 65 and over), and 72% accepted Medicare payments. Older adults composed 8% of their practice. Solopracticing physicians were the chief referral link to and from the medical community. Barriers to providing mental health services included client's lack of social support network and low levels of reimbursement. The challenges of continuing psychologists' recent advances in serving the mental health needs of older adults in an era of health care reform and managed care are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Volunteerism and the reorientation of health services

Volunteers are increasingly viewed as health agents. This seems to be linked to the reorientation towards primary health care and the current reforms in the health services. Seen as a way of breaking down social and cultural barriers between the formal health care system and the client community it also claims to cut the cost of services. OBJECTIVE: To know the roles of volunteers in promoting health and the practical aspects of implementation and evaluation. DESIGN: This paper is based on a review of published and sentinel papers from the bibliographic databases, MEDLINE (1991-1995), ERIC (1982-1995) and ERIC INTERNATIONAL (1965-1995). We have also reviewed the IME (until 1997) and the Spanish journals in MEDLINE to know the Spanish context (from 1995-98). RESULTS: The practical experiences from developing countries, the USA and the UK were reviewed within the framework of health promotion. A wide variety of experiences exist. There is a striking difference between activities in these countries, depending of the health service provision. In developing countries the aim is to bring primary health care services to areas with few professional resources. In developed countries, however, experiences have developed in response to failings in the formal health care system, to facilitate illness prevention and health promotion. The settings are different but the process is the same, factors fundamental to performance have therefore been identified in: recruitment, training, monitoring, continuing support and evaluation. The impact on health improvements and the quality of services in both systems, developed and developing countries, seems to be positive. We haven't found too much details from the Spanish experience, then, it emphasizes the need to know abroad experiences. CONCLUSIONS: Finally, the benefits and constraints derived from this type of voluntary action in the health field have been raised. Some specific social changes and health care system reforms contribute to establish volunteering in the health system, but we have to remark organization, coordination and community participation.