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.     

A meaningful role for graduate students in disaster mental health services.

Describes the role of graduate students in providing disaster mental health services through a program with the American Red Cross (ARC). ARC Disaster Mental Health Services teams focus on the immediate emotional needs and possible posttraumatic stress disorder (PTSD) associated with the shock of a natural disaster, including the needs and reactions of both victims and volunteers, especially the latter. The implementation of volunteer stress teams by the Minnesota School of Professional Psychology, including 25 students and faculty, is also described. The teams were designed to help assess and limit the effects of acute and traumatic stress resulting from disaster flooding. Specific objectives included assisting local mental health and social service agencies, distributing information, providing support, and triaging victims needing professional mental health services and other flood recovery services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohort differences in attitudes toward mental health services among older persons.

In order to investigate historical shifts in attitudes toward mental health and mental health services, two independent samples of older adults separated by a 14-year time interval were administered questionnaires. There were 91 in the 1977 sample (mean age 69.91 yrs) and 116 in the 1991 sample (mean age 71.94 yrs). Four newly created, internally consistent scales assessed multiple dimensions of their mental health attitudes (breadth of conceptions, bias, openness to help, range of problems). Analyses suggested that the younger cohorts of older adults held more positive attitudes toward mental health and mental health services than the older cohorts. These cohort differences remained when controlled for age, level of education, self-reported health, and income. These data indicate a positive cohort shift in attitudes toward mental health, a finding with numerous implications for the design and implementation of mental health services for future cohorts of older persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Capitating mental health services

Many employers are contracting mental or behavioral health services separately from other types of health care. Capitation rates are paid for a defined set of benefits. Mental health services are capitated in two ways; both approaches are discussed.     

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)     

Managed care strategy for mental health services

In the UK, managed care is beginning to be recognized as a cost effective, quality-driven system which can be used to structure patient care. This article examines the potential use of managed care pathways in mental health services, focusing on clients with schizophrenia. The strengths of managed care include the effective coordination of healthcare resources, the clear accountable audit of mental health practice and the re-engineering of mental health practice to improve patient outcomes. Problems in designing representative care pathways and encouraging healthcare providers to implement care pathways are some of the disadvantages of this system.     

Provision of mental health services in women's health centers

Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of care and having a belief in women-centered care. Findings indicate that the majority of women using women's health centers do not receive services in a comprehensive care environment that includes key mental health services.     

Issues in mental health services for children and adolescents

Existing system of psychiatric care for children and adolescents is in need of basic reorganization. The authors propose: 1) reestablishment of the speciality of children's and adolescent psychiatrist, a specialist in children's and adolescent narcology, a psychiatrist of early child's age and a pediatric medical psychologist; 2) carrying out the reform of child mental care equal in rights with general psychiatry; 3) preservation and widening of both specialized inpatient and outpatient clinics in general system of child's mental care; 4) legislative and public rehabilitation of children's psychiatry, which suffered considerably from antipsychiatric campaign; 5) professionally organized systematic elevation of psychohygienic, psychiatric and psychotherapeutic knowledges of allied medical and other specialists as well as of parents and of all population too; 6) integration and interaction of govermental services concerning mental health of children and adolescent; 7) organization of regional psychoprophylaxic interdisciplinary centers for children and adolescent.     

Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An overview of mental health services for the elderly

Psychiatric distress is substantially prevalent among elderly individuals, particularly in the primary care and institutional settings, where most older persons receive mental health care. Barriers to care from providers include negative attitudes and stigmatization and poor recognition by general health care professionals. When psychiatric disorders are recognized, the intensity and duration of treatment provided is generally below standards for adequacy. Further research can determine the impact of patient, caregiver, and provider factors on treatment provision and on patient adherence to treatment. Assessment of factors influencing the treatment process are needed to ensure that treatments provided in the real world approximate the efficacy established in controlled clinical trials.     

Bilingual professionals in community mental health services

OBJECTIVE: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles. METHOD: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity. RESULTS: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. CONCLUSIONS: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.     

Community-based systems of care for children's mental health services

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.     

Economics and mental health services.

J. A. Buck and R. Hirschman (see record 1980-26240-001) may have applied the tools of supply and demand analysis somewhat casually. The existence of sizable externalities, poor consumer information, and a maldistribution of services across the nation must be incorporated into the economic models that are applied to the mental health services system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health services give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public–private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging perspectives on the role of psychologists in the delivery of health and mental health services in schools.

This introductory article presents an overview of the APA Committee for the Advancement of Professional Practice Working Group on Schools as Health Care Delivery Sites. Additionally, it provides a health care reform context for exploring the emerging role for psychologists in the delivery of health and mental health services to children in the school setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)