Maternal and infant care: comparisons between Western Europe and the United States

A series of studies between 1986 and 1990 gathered data on maternal and infant care in ten Western European countries with lower infant mortality rates than the United States and compared the findings both within the European countries and in aggregate with the United States. Results from these studies reveal great variation among the study countries in how perinatal care is financed, staffed by professional and nonprofessional health workers, and provided by public clinics or private offices, and in the number of and locale of the recommended number of prenatal visits. Invariably consistent among the study countries is the nearly complete enrollment of childbearing women in early and continuous prenatal care, and the strong linkage of that care to a generous spectrum of social supports and financial benefits. None of the benefits generally pertains in the United States. The relevance of these observations for the United States suggests that current policies intended to lower economic barriers to a highly medicalized version of maternity care may yield disappointing results unless the perinatal sequence is linked to a more generous set of maternity-related social supports and financial benefits than is now contemplated.     

Effects of styrene exposure on middle latency auditory evoked potentials and glial cells in rat

The demand for health care and social welfare services for the elderly has increased and in Japan, there is a need in the social system to improve the quality of life, especially for those who are disabled. This article directs attention to bed-ridden elderly persons from the standpoint of social problems attending economic development and population changes based on data from Japan, the United States, Sweden, and OECD countries. Compared to the United States, there are more bed-ridden elderly in Japan, and inadequate public resources for caring. Physicians, nurses, care workers, and rehabilitation specialists such as physiotherapist and occupational therapist per 1000 aged sixty-five or over are 89.5 in Japan while 237.4 in Sweden. Japan has the fewest such health and welfare personnel among developed countries. Even with increases in such personnel through the New Gold Plan, future increase in aged population would off-set the effect and the problem of providing care for the elderly remains.     

The cost of psychotherapy.

Examines the relationship between psychotherapy funding policies and concepts of mental health. Three levels of mental health (necessity, improvement, and potentiality) are proposed. Necessity represents basic adaptation, the current dominant level illustrated by brief psychotherapy funded through managed mental health care. Improvement is the phase beyond necessity aimed at prevention and heightened quality of life, and potentiality is the ideal. The latter 2 now receive limited funding and emphasis. At question are both economic and social policies that endorse a narrow rather than a broad conception of mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional associations' strategies for revitalizing professional psychology.

The professional associations of psychologists are working to revitalize professional psychology. In response to recent challenges, these associations have attempted to (a) remove barriers to quality services within the mental care health delivery system; (b) help psychologists become better integrated within the overall health care system, as opposed to being narrowly defined as mental health professionals; and (c) help more psychologists move into services outside of the health care delivery system. These 3 strategies are motivated by a vision of psychology as a broad problem-solving discipline that can contribute to human welfare in a varied range of domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opportunities in public policy to support infant and early childhood mental health: The role of psychologists and policymakers.

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a “voice” to advocate for their support and care. This article (a) highlights several important policy areas that support the social–emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyzing the evidence on European health care reforms

Health system reform, in Europe as elsewhere, has often been influenced as much by theory and conjecture as by fact and experience. In a study published in September 1997, the Regional Office for Europe of the World Health Organization (WHO) drew together the available evidence about the health care systems in the fifty-one countries of the European region. This paper focuses on western European countries. It reviews a variety of policy strategies and then explores implications from this European experience for the formulation of U.S. health care policy.     

Christian social policy and homosexuality in The Netherlands, 1900-1970

This essay explores the historical process in which homosexuality became an object for pastoral, medical, and mental health care in the Dutch Catholic community during the twentieth century. The confrontation between a moral-religious approach and the professional (medical and psychological) treatment of homosexuality is the central issue. In a continuing dialogue and a process of changing power relations between clergymen, physicians, psychiatrist, psychologists, and pedagogues as well as Catholic homosexuals themselves, homosexuality was transformed from sin and pathology into a psychological and social problem that could be treated in pastoral and mental health care. The changing attitudes of Catholics towards homosexuality can be explained in the context of the changing relations between religion on the one hand and health care on the other hand. Current viewpoints resulting from sociohistorical studies on the development of the medical and welfare professions have concluded that religion lost importance in modern society because physicians, psychiatrists, psycho-therapists, and social workers not only created new areas of intervention in people's private lives, but also took over the traditional tasks of the church in the field of charity and pastoral care. Medical anamnesis, psychoanalysis, and psychotherapy took the place of confession and pastoral care, thus the argument runs, and remission of sins and redemption were replaced by health and welfare. However, especially in the case of the development of the Dutch welfare state, there was a more complicated interplay between changing religious values and professional strategies. In the Netherlands professional health care and welfare institutions often were organized in a religious context and it is difficult to make a clear differentiation between religious and moral discourses on the one hand and medical and psychological ones on the other hand. Moreover, professional interventions did not take the place of pastoral care; it appears that pastoral care for homosexuals gained ground and was intensified after medical and psychological definitions of homosexuality had found acceptance in the Catholic community. Professional strategies did not supersede religion, but rather contributed to a moral re-orientation and a new pattern of Christian values and appreciations in the field of sexuality.     

Delivering health and mental health care services to children in family foster care after welfare and health care reform

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.     

Oral health in Europe with changing socioeconomic structures as seen by the epidemiologist

During the 20th century in Europe remarkable results were obtained in health and social care systems which positively influenced general and oral health. Among others this was favoured by the WHO-initiated multinational movement "Health for all by the year 2000". Political changes in Eastern Europe levelled the way for constructive collaboration also in the field of health promotion. In contrast to this, economic deprivation in all European countries limits the financing of continually increasing costs of dental care. Oral health improved during the last decades, although differences in the health level between socioeconomic classes increased. In Eastern Europe the transformation process towards a new dental care system is quite difficult and is still going on. The establishment of new health-structures depends on socioeconomic resources and has so far attained different levels in various countries. The epidemiological situation also varies greatly. In general, caries prevalence is higher than in Western Europe.     

Children's Mental Health as a Primary Care and Concern: A System for Comprehensive Support and Service.

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health and aging: The need for an expanded federal response.

Discusses the mental health problems that may occur as elderly people must face adjustments because of bereavement, poor physical health, the demands of caring for an ill spouse, drug/alcohol abuse, dementia and cognitive impairments, and multiple health problems. Negative social stereotypes associated with both elderly patients and mental health care, limited access to and a lack of trained professionals in the area of geriatric mental health care, lack of outreach, inadequate benefits under prepaid health plans, Medicare and Medicaid, and special problems of ethnic minority and rural elderly people all contribute to an inadequate mental health care system. The author, a US representative, suggests a redesigning of the system and outlines an initiative that addresses the development of an effective mental health care system for the elderly, modification of Medicare and Medicaid, and improvements in quality assurance and access protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of children's health care use: an investigation of psychosocial factors

Factors related to the amount of health care used by 5- to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system. Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while children's depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of children's health care use. When included in a comprehensive analysis, child and family psychosocial characteristics help to explain children's health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed.     

Education and mental disorders

Mental health and education are crucial contributory factors in the welfare of the individual. Higher incidences of many mental disorders are found among populations with a low level of education. Difficulties in school and professional education may also predict adult mental disorders. The relationship between education and mental disorder has fairly seldom been analysed in empirical studies and further studies are therefore needed, as is an integration of educational policies in the prevention and care of mental disorders. In the Northern Finland Health and Well-being Study based on the Northern Finland 1966 Birth Cohort, education and its determinants is one of the main aspects studied.     

A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children.

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences for their mental and physical health. Research on normal development and developmental psychopathology has shown that early development unfolds in an ecology of transactional influences among biological, interpersonal, and environmental domains. Psychologists should collaborate with other early intervention disciplines to create systems of care based on an ecological–transactional model of development that includes early mental health principles in order to serve the needs of these young children. Didactic courses, practicums, and internships in infant and early childhood mental health should become integral components of undergraduate and graduate curricula in psychology in order to build capacity to achieve this goal. Recommendations are offered for systemic change by integrating infant and early childhood mental health principles into existing systems of care for young children and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Needs assessment and policy development: Native Hawaiians as Native Americans.

Discusses needs assessment and policy development for Native Hawaiians (NHs) whose educational, social, and health needs resemble those of Native Americans and minority groups. A US government report indicated that NHs have a need for standardized achievement tests, special education, and culture-related education. Studies suggest that culture loss may be linked to negative personal health and educational outcomes for NHs. It is noted that NHs have high rates of suicide, alcohol and drug abuse, crime, child abuse, school adjustment problems, and mental illnesses. Cultural barriers prevent NHs from using existing mental health services. Recommendations for improving health care for NHs and development of policies including NHs as Native Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lessons in transferring resources: the system of fees per patient

Dowries can be defined as lump sum payments or continuing grants which health authorities make between themselves and to local authorities or voluntary organisations in respect of people with severe mental disorders to be cared for in the community instead of in hospital. This paper has three aims. First to describe how dowries and other processes were set up to encourage the closure of two psychiatric hospitals in England. The broader financing context for mental health care (prior to the reforms in England engendered by the NHS and Community Care Act, 1990) is also described and shows some similarities to the current arrangements in Québec. Second, we abstract some information from a long-running evaluation of the reprovision programme to look at the type of services used in the community by former long-stay patients of these two hospitals and the comparative costs of hospital and community-based care. After leaving hospital, former patients require considerable inputs from other health and social care services; any development of community care for these patients should at the least mirror the facilities provided on the hospital campus. The final aim of this paper is to examine the extent to which this English system of budget reallocation ("dowries") can be employed in Québec to further reduce long-stay hospital provision. There are many similarities between the health and social care systems of the two countries but there are also organisational and political differences. It is not sensible, therefore, to transfer the English budget reallocation to Québec wholesale, but we suggest that there are important process and implementation issues which can guide the development of financing mechanisms in Québec.     

The challenge to meet the mental health and biopsychosocial needs of the poor: expanded roles for hospital social workers in a changing healthcare environment

Despite the absence of coordinated federal health care reform, social workers in hospital settings have opportunities to identify, develop, advocate for, and facilitate access to innovative health care services, resulting in improved capacity to meet the mental health and biopsychosocial needs of the poor and, potentially, reduced hospital costs over time. There are opportunities for expanded roles for social workers in forging better linkages between hospital services and the community, developing an integrated biopsychosocial healthcare delivery system within hospitals and primary care settings, utilizing information systems as tools in an integrated system, and advocating for a client-centered approach to mental health services.     

Community mental health service use by older adults with dementia.

We considered the role of community-based public mental health services in providing care to older persons with Alzheimer's disease and other forms of dementia, and examined service outcomes within California's county-based public mental health system over a 3-year period. Treated prevalence rates, repeat service use rates, and service mix patterns were regressed onto individual, market, and contextual variables across 25 counties over 12 observation periods. The number of older adults with dementia who used community mental health services increased slightly over the observation periods, and service use was associated with age and Medicaid status. Service outcomes also were affected by complementary mental health and aging service systems within each county, as well as the poverty rate and location of the county. Future research is needed to clarify how administrative policies and service management practices contribute to increasing community mental health service use by persons with dementia. In the meantime, these findings can help program administrators and service providers understand the role of community-based mental health services in providing care to persons with dementia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Local Medicare policies: A pathway for providing mental health services to older adults.

Inconsistent local Medicare service coverage policies constitute one of the most prominent barriers encountered by mental health professionals who provide services to older adults. In this study, the authors analyzed the scope and delineation of local Medicare policies for 19 types of psychiatric and psychological services in 2003 and again in 2006. Results indicated policies now exist for all Medicare services in all the states, and many of the local policies provide definitive statements to guide practice. However, some policies lacked delineation and variability persists from one region to the next. While researchers ascertain how local policies can impact service outcomes, providers should form issue networks and resolve current problems such as the inequities surrounding service documentation requirements and the lack of guidance in providing mental health care to older persons with dementia. Given that the Medicare administrative structure will undergo substantive changes in the next five years, there is an exceptional opportunity for providers to address these problems successfully and pave a pathway for providing specialty mental health services to older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rural psychiatry in developing countries

During the last two decades several initiatives have been taken to improve psychiatric services in low-income rural areas in developing countries. They have included the formulation of national mental health programs and establishment of pilot programs for integration of mental health care with primary health care in India, Iran, and other countries in Asia, Africa, and South America. The psychiatrist has multiple roles to play in meeting the many challenges of providing mental health care in rural areas in developing countries.