Mental health assessment for older people

Marked arteriovenous malformation in the left parietooccipital area manifested only by symptoms of associative migraine involving changes of visual fields indicative of impaired functions of symmetrical compartments of the other brain hemisphere. Visual evoked potentials were changed in this patient because of dysfunction of both hemispheres and largely because of disorders in brain structures symmetrical to the site of arteriovenous malformation. This can be regarded as a manifestation of the so-called stealing phenomenon, when blood supply to one brain compartment is decreased because of excessive blood delivery to other regions of the brain. The results permit us to hypothesize regulation of blood supply to symmetrical compartments of brain hemispheres.     

Caring for older people. Community services: health

Many frail or disabled elderly people are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for older people in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental, and dietetic services. In many areas, services are evolving to meet needs and some examples of innovative practice are included.     

Mental health services in health maintenance organizations: Implications for psychology.

Contends that roles for psychologists in health maintenance organizations (HMOs) are affected by the nature of HMOs, economic considerations, standards set by federal legislation, claims for the cost-effectiveness of mental health services, and the federal administration's goal of removing mental health services from those required in law. Legislation is not precise concerning the nature or extent of mandated mental health services, and administrative interpretation of this legislation encourages considerable latitude in services provided. Studies do not support arguments for mental health services on the basis of their claimed cost-offset effects as strongly as one might wish. It is concluded that if psychologists are to establish areas of unique worth to HMOs, they may have to do so by adding contributions other than traditional clinical services to meet the need structure of HMOs. Possible ways of doing this are discussed, drawing on contributions that are developing in the field of behavioral health and relating these contributions to the prime purposes of HMOs. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting health in young people

This article discusses aspects of health that might affect young people and ways in which nurses can promote healthy living and support this group of clients during a potential period of anxiety.     

Availability of school health services for young children

A survey to assess availability of school health services was distributed to 221 directors of Schools of the 21st Century, an educational model that provides integrated services to children and families. Of this distribution, 126 (57%) surveys were returned; 88% of respondents reported they provided some type of school health services for their students; 75% of schools had access to school nursing services, yet only 33% had a school nurse on-site; 50% had less than daily access to a school nurse. Despite a high reported prevalence of physical and mental health problems, other services such as acute care, nutrition counseling, dental screenings, or mental health services were provided less frequently. Barriers perceived as problematic for schools providing health services included inadequate funding, limited parental awareness, and opposition by school or community members. Respondents believed transportation, limited financial resources, and inadequate health insurance were barriers to care for children and families. Among this sample of schools, school health services varied in availability and comprehensiveness. Educators, health providers, and parents must work together to provide improved school health services for children.     

Mental health services for children: The state of the art.

Throughout this century, people in the United States have been concerned about the serious deficiencies in the mental health care of our children. Despite eloquent needs assessment and recommendations for remediation, most of the unserved needs and deficiencies of our mental-health-care-delivery system remain the same. This article reviews the current status of mental health services to children, youth, and families to highlight the necessity of an integrated system of mental health care. The development of a continuum of care that is coordinated across the mental health and non-mental-health systems that naturally occur in all children's lives has the potential to vastly improve mental health services to children, youth, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services in managed care: quality questions remain

Primary care physicians are often the professionals to whom older patients turn for advice about medical coverage in Medicare managed care health plans. To assist in this dialogue, these authors outline current characteristics and financial arrangements for psychiatric and mental health services in Medicare managed care. Advantages and disadvantages of Medicare managed care for enrollees with mental disorders are outlined. Mental health "carve-out" and "carve-in" models are defined, and questions are raised about the number of psychiatrists and other mental health care providers needed to provide appropriate care for a plan's enrollees.     

Mental health services in the public and private sectors

Analysis of data on mental health service providers indicates that in 1971 the private sector accounted for 34% of inpatient days, 86% of outpatient visits, 44% of expenditures by source of funds, and 51% of expenditures by receipt of funds. The author believes that mental health professionals must familiarize themselves with the economic interests influencing national health insurance proposals and with public policy making processes if they are to help preserve appropriate roles for the public and private sectors in mental health service delivery.     

Use of health services by children and young people according to ethnicity and social class: secondary analysis of a national survey

OBJECTIVE: To assess whether equity is achieved in use of general practitioner, outpatient, and inpatient services by children and young people according to their ethnic group and socioeconomic background. DESIGN: Secondary analysis of the British general household survey, 1991-94. SUBJECTS: 20 473 children and young people aged between 0 and 19 years. MAIN OUTCOME MEASURES: Consultations with a general practitioner within a two week period, outpatient attendances within a three month period, and inpatient stays during the past year. RESULTS: There were no significant class differences in the use of health services by children and young people, and there was little evidence of variation in use of health services according to housing tenure and parental work status. South Asian children and young people used general practitioner services more than any other ethnic group after controlling for socioeconomic background and perceived health status, but the use of hospital outpatient and inpatient services was significantly lower for children and young people from all minority ethnic groups compared with the white population. CONCLUSIONS: Our results differ from previous studies, which have reported significant class differences in use of health services for other age groups. We found no evidence that children and young people's use of health services varied according to their socioeconomic status, suggesting that equity has been achieved. A child or young person's ethnic origin, however, was clearly associated with use of general practitioner and hospital services, which could imply that children and young people from minority ethnic groups receive a poorer quality of health care than other children and young people.     

Mental health services in Louisiana school-based health centers post-Hurricanes Katrina and Rita.

Following Hurricanes Katrina and Rita, Louisiana school-based health centers (SBHCs) were called on to respond to a sharp increase in mental health needs, especially for displaced students coping with grief, loss, trauma, and uncertainty. To assess the impact of the hurricanes on the students and the needs of SBHC mental health providers (MHPs), we surveyed MHPs in each of the SBHCs under the auspices of the Louisiana Department of Health and Hospitals, Office of Public Health. SBHC practitioners from around the state reported that mental health service utilization rose during the 2005-2006 school year, but utilization of services increased most significantly in schools receiving the majority of displaced students. Anxiety and adjustment problems were noted as increasing the most following the hurricanes. A multitude of other conditions was also reported. By the time of this survey in April 2006, the reported prevalence of most symptoms had declined, but all remained above their pre-hurricane levels. Self-reported needs of SBHC MHPs are also discussed in light of the major natural disasters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services for homeless mentally ill persons: Federal initiatives and current service trends.

Recent research suggests that approximately one third of the population of homeless single adults suffer from severe mental illnesses. Despite multiple health, mental health, and social welfare needs, this population is often unable to obtain necessary housing and community-based services. For this reason, since 1982, the National Institute of Mental Health (NIMH) has undertaken a number of federal initiatives to encourage research and assist states and localities in improving services focused on this vulnerable subgroup of the homeless population. This article describes the target population, NIMH research findings, and current mental health programs—with particular emphasis on two mental health programs established under the Stewart B. McKinney Homeless Assistance Act. Proposed future directions for federal research and evaluation efforts in this area are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of carers in evaluating mental health services for older people

OBJECTIVES: To examine, using the published literature and local service experience, the contributions that carers can make to the development and evaluation of specialist mental health services for the elderly. METHODS: MEDLINE search for relevant papers about carers and the elderly, especially with mental disorders; review of recent experience of service planning, implementation and evaluation in the Cambridge area. RESULTS: Increased emphasis on the role of carers in recent literature, extending into acknowledgement of the carer perspective in official publications; few papers on the role of carers specifically in evaluating services, with only one study looking solely at an old age psychiatry service. CONCLUSIONS: There is considerable scope for involving carers in the development and evaluation of services, though there are also some potential concerns, not least that carers and users may have different perspectives. These issues are discussed, along with possible future developments, such as the need for a standardized assessment of carer satisfaction.     

Mental health services to children and adolescents under CHAMPUS: Fiscal year 1975.

CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) serves over 6 million military-related persons in the US. Data on children and adolescents were compared with data on adults. It was found that the younger the age group, the longer the duration of hospital stay and the fewer the professional visits, even for diagnoses that are usually considered functional and less serious. Psychologists provide a relatively higher proportion of their time to children and adolescents than do the other provider groups. Individual psychotherapy is obviously the treatment procedure most often used by practitioners, accounting for 75% of all outpatient visits. Psychological services on other than an outpatient basis are very limited. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services to children and adolescents: A national view of public policies.

Summarizes and discusses the implications of a national study conducted by the present author (1982) on public policies affecting the delivery of mental health services to disturbed children and adolescents. Relevant state officials and advocacy organizations were surveyed, state reports and child and adolescent mental health statutes were analyzed, federal programs and policies were reviewed, and responsive program models were identified. Findings suggest that there is more knowledge about how to help children and adolescents in need of mental health services than is reflected in the organization, funding, and delivery of these services. Three encouraging developments, policy recommendations, and implications for psychologists are discussed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services and the emerging role of psychology in Greece.

Notes that, of the few mental health services available in Greece, those resources that do exist are centralized in large cities and few psychologists are involved. The majority of persons requesting help receive pharmaceutical treatments; psychotherapy and counseling are rare. The present authors discuss how recently psychology is rapidly emerging as a science/profession in Greece. Licensure now is required of most academic psychologists, who are expected to practice as well as teach and do research. Although all Greek psychologists must be trained abroad, this multicultural education provides opportunity for broader theoretical perspectives; however, this same multicultural orientation may also pose difficulties in establishing standards for practice. Current increasing demand for psychological services may result in needed support for training programs within Greece. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services in a single payer system: Lessons from Canada and principles for an American plan.

Reviews the advantages of financing mental health care in the US along the lines of the Canadian single-payer system and argues that the pillars of the Canadian system (accessibility, comprehensiveness, portability, public administration, and universality) are standards a restructured US system could achieve. The merits of including mental health coverage in a basic benefits package are also discussed. The authors believe limits on reimbursement for psychologists in Canada should not keep US psychologists from supporting single-payer proposals because (1) the professional Zeitgeist in the US in 1992 is very different from that of Canada in the late 1960s and (2) Canadian psychologists could have participated but failed to achieve professional consensus on the merits of inclusion in the national health program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications for health services

Health services for older people in the NHS have developed pragmatically, and reflect the nature of disease in later life and the need to agree objectives of care with patients. Although services are likely to be able to cope with the immediate future, the growth of the elderly population anticipated from 2030 calls for long-term planning and research. The issue of funding requires immediate political thought and action. Scientifically the focus needs to be on maximizing the efficiency of services by health services research and reducing the incidence of disability in later life through research on its biological and social determinants. Senescence is a progressive loss of adaptability due to an interaction between intrinsic (genetic) processes with extrinsic factors in environment and lifestyle. There are grounds for postulating that a policy of postponement of the onset of disability, by modifications of lifestyle and environment, could reduce the average duration of disability before death. The new political structures of Europe offer under exploited-unexploited opportunities for the necessary research.     

Mental health service use among young children receiving pediatric primary care

OBJECTIVE: To investigate the factors associated with mental health service use among young children. METHOD: Five hundred ten preschool children aged 2 through 5 years were enrolled through 68 primary care physicians, with 388 (76% of the original sample) participating in a second wave of data collection, 12 to 40 months later. Consensus DSM-III-R diagnoses were assigned using best-estimate procedures. The test battery included the Child Behavior Checklist, a developmental evaluation, the Rochester Adaptive Behavior Inventory, and a videotaped play session (preschool children) or structured interviews (older children). At wave 2, mothers completed a survey of mental health services their child had received. RESULTS: In logistic regression models, older children, children with a wave 1 DSM-III-R diagnosis, children with more total behavior problems and family conflict, and children receiving a pediatric referral were more likely to receive mental health services. Among children with a DSM-III-R diagnosis, more mental health services were received by children who were older, white, more impaired, experiencing more family conflict, and referred by a pediatrician. CONCLUSIONS: Young children with more impairment and family conflict are more likely to enter into treatment. Services among young children of different races with diagnoses are not equally distributed. Pediatric referral is an important predictor of service use.