Sociodemographic associations with mental health and residential care utilization among juvenile delinquents.

Research has supported the notion that ethnoracial minorities in the juvenile justice system use fewer mental health services than Caucasians do. The authors' aim was to examine potential sociodemographic (including racial background) associations with the use of mental health and residential care among juvenile delinquents adjudicated through court services. The authors extracted demographic, mental health, and residential care data from archival records of 149 juveniles consecutively adjudicated from a midwestern city's juvenile court services facility (from 1999 to 2002). The authors found no significant associations with mental health treatment or residential care utilization based on ethnoracial background, age, gender, and educational level, neither in bivariate nor multivariate analyses. Implications for policy in the juvenile justice system are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Predictors of mental and physical health service utilization among Vietnam veterans.

This study investigated predictors of mental and physical health care service utilization among 1,632 male (n = 1,200) and female (n = 432) Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. Using Anderson's theory as a model (Anderson & Bartkus, 1973), the authors examined both direct and mediated relationships among predisposing factors (i.e., age, marital status, and combat exposure), enabling factors (e.g., household income and insurance), and need factors (e.g., medical and psychological symptomatology) and physical and mental health care utilization outcomes. Need factors were the most consistent and strongest mediators of predisposing variables for both physical and mental health care service utilization, although there were differences between male and female veterans. For men, combat exposure indirectly predicted mental health care utilization through the need variables (with the effects of posttraumatic stress disorder being greatest). For women, physical health problems mediated the relationship between combat exposure and physical health outpatient care utilization. These findings have implications for screening and outreach efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital distress and mental health care service utilization.

Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for specific sectors of treatment providers, including psychiatrist, other mental health provider, other medical provider, and religious services provider. Interviews were used to assess past-year service utilization and presence of anxiety, mood, and substance use disorders. Results: Approximately 12% of married individuals sought help for problems with their emotions, nerves, or substance use during the 12 months preceding the interview. Marital distress was significantly associated with (a) overall mental health service utilization and service utilization provided by each of the sectors of providers when controlling for demographic variables and (b) overall mental health service utilization and receiving treatment from a psychiatrist when additionally controlling for past-year anxiety, mood, or substance use disorders. There was little evidence that the associations between marital distress and service utilization were moderated by gender or presence of psychiatric disorders. Conclusion: The finding that marital distress is associated with greater mental health care service utilization suggests that clinicians should assess both individual and relationship factors among individuals presenting for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The community and the community mental health center.

The community has responsibility "for the quality and adequacy of the mental health services that it gets. The opportunities are now open for communities to employ the mechanism of the comprehensive mental health center to take major strides toward more intelligent, humane, and effective provision for their people. If communities rise to this opportunity, the implications for the national problem of mental health and for the quality of American life are immense." Guidelines are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The need for continuing education in ethics as reported by rural and urban mental health care providers.

Continuing professional education (CPE) sponsors planning events for mental health care licensees can assure better attendance if they can successfully address the needs of their target audience. Offering topics of interest is particularly crucial when CPE events need to draw large numbers of attendees to be financially viable. A survey of nearly 400 health licensees regarding CPE needs, especially as related to ethics, revealed that the greatest interest in such CPE was reported by master's-level mental health care providers. Topic areas with the greatest draw were the management of clients who present with special issues (e.g., substance abuse, medical illness, or cultural diversity) and competent management of colleague misconduct and impairment, rather than more traditional ethics issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The shift to community mental health as an organizational phenomenon.

Mental health professionals often fail to recognize organizational phenomena which are significant to delivery of services. A current shift in service delivery is the move away from residential care to prevention programs. Rather than seeing this as the result of "new discoveries", the shift is viewed as an outcome of organizational developments. It is suggested that community mental health programs are produced by an institution having resources in excess of stabilized demands for treatment technology. This process of organizational diversification may have the surprising result of creating greater tendencies toward custodial treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confrontations with aggression and mental health problems in police officers: The role of organizational stressors, life-events and previous mental health problems.

The extent to which the frequency of facing aggression incidents is associated with mental health problems among police officers when organizational stressors, life-events, and previous mental health problems are taken into account is unclear. To elucidate this data from a longitudinal study of police officers was analyzed (N = 473). Mental health problems (MHPs) are here defined as severe anxiety, depression, hostility, burnout symptoms, and/or sleeping problems according the SCL-90–R and MBI. All MHPs were assessed at baseline and 27 months later. Logistic regression showed that serious threat was statistically significant associated with MHPs at follow-up among officers without MHPs at baseline, but not among those with MHPs at baseline. However, stepwise logistic regression showed that serious threat and/or physical aggression were not independently associated with MHPs at follow-up. Organizational stressors, that is, problems with colleagues were independent predictors in all analyses. Among the total study sample, previous MHPs were the strongest independent predictors. These findings suggest superiors should attend to the mental health, organizational stressors and life-events of their officers regularly and not only following critical incidents at work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States.

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65+) and younger (18-64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma exposure, mental health, and service utilization rates among immigrant and United States-born Hispanic youth: Results from the Hispanic family study.

Although the largest immigrant group in the United States is Hispanic, little is known about their rates of traumatic experiences and psychiatric disorders, particularly for youth. Findings with adults suggest that recent immigrants have lower rates of mental illness than long-time residents or U.S.-born Hispanics, but use health-related services less often. The present study examined this relationship in a convenience sample of 131 foreign-born (64.5%) and 72 U.S.-born (35.5%) Hispanic youth, ages 8–17 years and a subset of their caregivers (n = 110). Findings from youth interview data suggest that immigrant and U.S.-born youth did not differ significantly in experiences of potentially traumatizing events or psychiatric disorders. However, findings from caregiver interview data suggest that there were significant disparities between the two groups in health service utilization for doctors and other medical professionals, with caregivers reporting that foreign-born youth utilize these health services at lower rates than U.S.-born youth. Results are discussed in the context of prior findings and recommendations offered for increasing service utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based disaster mental health services: Clinical, policy, and community challenges.

The consequences of Hurricane Katrina have far-reaching implications for the mental health system in the Gulf Coast region, with some of the most vulnerable survivors being children and adolescents. School-based services have been proposed as an ideal way to provide care; however, significant challenges remain in providing trauma-informed services in schools postdisaster. The authors discuss the consultation and training activities of the Los Angeles Unified School District Trauma Services Adaptation Center for Schools and Communities following Hurricane Katrina. Issues related to the dissemination of evidence-based treatment in schools following a disaster are discussed, as are the particular needs of providers and school staff and the importance of community collaboration in identifying ways to adapt implementation strategies for specific communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnicity and mental health treatment utilization by patients with personality disorders.

The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic but not White participants, underscoring the importance of special attention to the treatment relationship with minority patients. These treatment use differences raise complex questions about treatment assessment and delivery, cultural biases of the current diagnostic system, and possible variation in PD manifestation across racial/ethnic groups. Future studies need to assess specific barriers to adequate and appropriate treatments for minority individuals with PDs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mental health establishment and the stifling of change.

It is postulated that a major characteristic of the mental health establishment is that of the stifling of ideological and practical innovation. Various illustrations are cited from the sociology of mental health and some general methods for effective resistance and change are briefly discussed. Lastly, some aspects of conformity in mental health are mentioned in the context of Pettigrew's "latent liberal". (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behavior associated with HIV transmission (substance use and risky sexual behavior) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behavior. Our findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behavior occur more in tandem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth.

In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed, (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Challenging the therapeutic state: Critical perspectives on psychiatry and the mental health system.

Reviews the special issue of The Journal of Mind and Behavior, Challenging the therapeutic state: Critical perspectives on psychiatry and the mental health system, edited by D. Cohen (1990). This special issue serves as an update on the critique of the medical model in psychiatry. In editing this volume, Cohen has assembled a collection of work from authors in many disciplines—including some laypersons—who are concerned with what they see as the frightening power of the "Therapeutic State." While the work of Thomas Szasz is a guiding light for several of these authors, they certainly are not all associated with his work. In fact, some of them explicitly disavow what they see as Szasz's overly simple stance toward madness. Moreover, the ideas in this volume expand the critique of the medical model far beyond the range of Szasz's work. Disagreements among authors are for the most part confined to a few footnotes in this volume. The book's purpose is to expose the problem before exploring solutions to it. When the volume is at its best, the papers are united by their contention that the medical model in psychiatry is disastrous both for individuals who are victimized by its institutions and practices, and for the society that embraces its disempowering philosophy. There is little, if any, brand new material in this book. Virtually all of the articles contain research and ideas tat the authors have already published elsewhere. The virtue of the book is in bringing together a diversity of work across disciplines that would not ordinarily appear between the same two covers. The common element running through all of these articles is one that the authors almost never state in so many words, but it gives a cumulative force to their very different treatments of psychiatry's problems. Each of these papers, in its own way, reveals aspects of the irrationality implicit in psychiatric orthodoxy. Psychiatry stands at the fringe of medical science, and the fringe of any science is where the inadequacies of its paradigm are most obvious. The attempt to make the medical model fit the problem of madness has not succeeded, but orthodox psychiatry continues to pursue it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teacher key opinion leaders and mental health consultation in low-income urban schools.

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward adoption of evidence-based practices: A comparison of autism early intervention providers and children’s mental health providers.

Across the country, states are reporting increases in the number of children with autistic spectrum disorders (ASDs) served each year in the early intervention system. Research examining factors impacting the successful dissemination and implementation of evidence-based practices (EBPs) into service systems for these children is limited. Preliminary information indicates that adoption of EBPs is variable. Provider attitudes toward the adoption of EBPs may be one factor that limits or facilitates implementation of efficacious treatments and these attitudes vary by organizational context and provider individual differences. The current study examines cross-context differences in provider attitudes toward EBPs by comparing the attitudes of 71 education-based early intervention providers working with children with ASD to the attitudes of 238 mental health providers in the public mental health system. This provides the first examination of ASD early intervention provider attitudes toward EBP. Results indicated that early intervention providers reported significantly more favorable attitudes toward adopting EBPs than did mental health providers. Early intervention providers with extended experience in the field perceived less divergence between their current practice and EBPs. Implications are discussed. (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)