Does the use of telemental health alter the treatment experience? Inmates' perceptions of telemental health versus face-to-face treatment modalities.

In corrections, where staffing limitations tax an overburdened mental health system, telemental health is an increasingly common mode of mental health service delivery. Although telemental health presents an efficient treatment modality for a spectrum of mental health services, it is imperative to study how this modality influences key elements of the treatment experience. In this study, the authors compared inmates' perceptions of the working alliance, postsession mood, and satisfaction with psychiatric and psychological mental health services delivered through 2 different modalities: telemental health and face-to-face. Participants consisted of 186 inmates who received mental health services (36 via telepsychology, 50 via face-to-face psychology, 50 via telepsychiatry, and 50 via face-to-face psychiatry). Results indicate no significant differences in inmates' perceptions of the work alliance with the mental health professional, postsession mood, or overall satisfaction with services when telemental health and face-to-face modalities were compared within each type of mental health service. Implications of these findings are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Epidemiologic assessment of overmet need in mental health care

The traditional purpose of psychiatric epidemiologic surveys has been the assessment of mental illness and, by implication, the need for care. Previous research has focused on unmet need, defined as those who meet "caseness" but do not receive care, but has rarely examined the converse. Since survey respondents receiving care but not meeting caseness have been found to represent up to one-half of mental health service users, this is a significant service delivery issue. The data are drawn from the Mental Health Supplement to the Ontario Health Survey (the Supplement), a household survey of 9,953 respondents, which used the University of Michigan's version of the Composite International Diagnostic Interview (UM-CIDI) as its diagnostic instrument. Community residents who used formal mental health services in the past year but who did not have a concurrent UM-CIDI/DSM-III-R (Diagnostic and Statistical Manual 3, revised) diagnosis were defined as "treated without CIDI disorder". Their need for care was evaluated by comparing them to "treated depressed" and "healthy" respondents, using indicators of functional impairment, vulnerability to developing disorder, and risk of relapse. The match between need and care levels was examined by comparing their type and intensity of use with those of the treated depressed. Results present strong evidence for conceptualizing need as continuous, rather than discrete. The results for the group defined as "treated without CIDI disorder" were consistently between those for the other two groups (with the "treated depressed" always showing the highest need) on all indicators as well as on a summary need index. However, their type and intensity of service use appeared to be unrelated to their level of need. Although some of the "treated without CIDI disorder" group may require preventive or follow-up treatment, the need for service for others is not as convincingly demonstrated. Outcome studies are needed to provide comparative data to describe more fully the problems experienced by this group and indicate whether treatment is helpful. In an age of fiscal restraint, when resource reallocation (rather than generation of new resources) is the likely scenario, such close examination of the fit between need and care is critical if services are to be targeted appropriately.     

Gender differences in experiences of sexual harassment: Data from a male-dominated environment.

The goal of this investigation was to examine gender differences in experiences of sexual harassment during military service and the negative mental health symptoms associated with these experiences. Female (n = 2,319) and male (n = 1,627) former reservists were surveyed about sexual harassment during their military service and current mental health symptoms. As expected, women reported a higher frequency of sexual harassment. Further, women had increased odds of experiencing all subtypes of sexual harassment. Being female conferred the greatest risk for experiencing the most serious forms of harassment. For both men and women, sexual harassment was associated with more negative current mental health. However, at higher levels of harassment, associations with some negative mental health symptoms were stronger for men than women. Although preliminary, the results of this investigation suggest that although women are harassed more frequently than men, clinicians must increase their awareness of the potential for sexual harassment among men in order to provide the best possible care to all victims of harassment. (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.     

Struggling for control: the care experiences of 'difficult' patients in mental health services

Although there is increasing recognition of the existence of 'difficult' patients who present particular challenges to mental health nurses, no research has been conducted into their perceptions of services and their experiences of care. This study identifies mental health service users who are defined by nurses as 'difficult' and explores their perceptions of their care experience. The results support earlier studies which suggested that 'difficult' patients challenge nurses' competence and control: despite their different roles both nurses and 'difficult' patients were aware of the struggle to gain or retain a notion of control. Respondents were able to identify the qualities of nurses and nursing interventions which had a positive effect on their care experience. Where nurses were perceived to demonstrate respect, time, skilled care and a willingness to give patients some control and choice in their own care, feelings of anger were reduced. These findings are discussed within the conceptual framework of 'power over' and 'power to' and implications for practice and research are considered.     

Outreach interventions for the homeless mentally ill

There has been a steady rise in the number of homeless mentally ill in Britain. This article reviews the scale of the problem and identifies the need for change within mental health services in order to address this challenge. It is argued that mainstream psychiatric services need to become more diverse and open in their approach to this potentially isolated group of users. The authors suggest that this could be achieved by embracing assertive outreach interventions. Innovative projects using a range of care providers, including voluntary workers, past users of the service and professional mental health workers, are discussed as an alternative framework to traditional services. In conclusion, the article highlights some of the professional and social implications for psychiatric nurses and mental health practice.     

Evaluations of organizational effectiveness in mental health programs

We present a conceptual framework derived from organizational theory for understanding the evaluation of the effectiveness of mental health services. We postulate that organizations are deemed "successful" by their constituents when they conform to institutional demands and expectations that are both internally and externally generated. We empirically assess institutional conformity by examining evaluations of effectiveness by 269 mental health providers in 29 different mental health programs. Specialist programs responded to institutional demands by targeting services to those considered most in need: clients with severe mental illnesses. The formal structure and program philosophy of these programs clearly reflected this emphasis; consequently, levels of goal incongruence were low and evaluations of effectiveness were high. Generalist programs continued to provide care to diverse client groups, had more professionals, offered traditional services (such as psychotherapy), and exhibited higher levels of goal incongruence; these factors resulted in lower evaluations of effectiveness. This research is important because it demonstrates that organizational processes of institutional conformity (program objectives meet the demands of external constituents) and goal congruence (program objectives meet with expectations of internal constituents) are critical to positive evaluations of effectiveness. With the current institutional demand for effective, efficient services, it is critical that researchers have a conceptual framework for analyzing those factors which influence evaluations of effectiveness.     

Consumer information, patient satisfaction surveys, and public reports

This article describes information useful for consumers and purchasers in making choices about health care services. Two types of information are described, patient satisfaction surveys and public reports about the price and outcomes of health care services such as those published by the Pennsylvania Health Care Cost Containment Council. Patient satisfaction surveys can be used to provide valuable information about health care. The goal of patient satisfaction reporting is to incorporate the patient's perspective to improve care. Public reports about the price and outcome of hospital and physician services not only facilitate consumer and purchaser choice, they also encourage continuous quality improvement by providers.     

Primary care in psychiatry residency training

The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends there specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, through their contact with primary care-oriented psychiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.     

The importance of caring as a determinant of patient satisfaction among active duty beneficiaries

The satisfaction scores of active duty Department of Defense beneficiaries with the medical care they receive in military facilities are compared to test the hypothesis that caring is a primary determinant of patient evaluations. Patient satisfaction scores and sociodemographic and social psychological correlates of patient satisfaction were regressed to illuminate the attributes patients use to judge their health care experiences. Results show that very specific interpersonal aspects, such as reassurance, support, and interest in outcomes of the care experience, are important to patients.     

Comparability and representativeness of clinical homeless, community homeless, and domiciled clinic samples: Physical and mental health, substance use, and health services utilization.

Evaluating the representativeness of homeless samples is important for generalizing research findings on the homeless and designing interventions targeting their health needs. The present study contrasts homeless and domiciled free-clinic users (216 homeless [132 men, 84 women], 212 domiciled [102 men, 110 women]) and 531 community homeless persons (388 men, 143 women) on latent variables representing substance use, mental and physical health, appearance, life satisfaction, and health services utilization (HSU). Homeless clinic patients equalled the community sample in substance abuse and psychological problems but exceeded the sample in HSU and cleanliness. Homeless clinic users reported more substance abuse, poorer health, greater mental illness and mental HSU, less cleanliness, and lower life satisfaction than domiciled patients. Relationships among the variables are reported, and implications concerning health needs among the homeless are discussed (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Providers' views of HMO mental health services.

112 health maintenance organization (HMO) mental health providers from 19 HMOs were asked to describe the services provided by their mental health department, give demographic data about providers themselves, and rate the services provided as well as their satisfaction with providers' benefits and compensation. More than half of the Ss reported having a private practice in addition to their position at an HMO. The average full-time person doing direct clinical practice reported seeing about 23 clients per week. Other results suggest differences in satisfaction level varying with salary and patient load. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adapting clinical services to accommodate needs of refugee populations.

The diversity of the refugee population in the United States requires practicing psychologists to respond by adapting clinical services to meet their mental health needs. However, the available literature on culturally adapted treatments is only a first step in guiding the process for adapting clinical services. This paper describes our experiences with designing and adapting a variety of clinical services for youth and families with refugee status. Guided by Sue's (2006) tenets for culturally competent service delivery, we discuss a therapeutic model of tiered service delivery used to deliver preventative services and treatment to refugee youth and adults. We discuss how we adapted treatments to help overcome access barriers to mental health treatment, and we provide specific examples of how existing treatments were used with refugee populations. In addition, we discuss information and approaches for how practicing psychologists can develop additional skills for working with refugee populations. We conclude by focusing on the need for our field to work toward improving access to mental health treatment for refugee youth and families and developing evidence-based treatments for this population. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A review of studies of heavy users of psychiatric services

OBJECTIVES: This paper reviews studies of patients who are heavy users of psychiatric services and identifies areas in which further research and evaluation are indicated. METHODS: Extensive searches were conducted of the English language psychiatric and psychological literature before 1994. Important references from initially identified studies were followed up. More than 200 articles were reviewed, 72 of which are described in this review. The 72 papers were selected because they dealt with three questions: What is heavy service use? What patient characteristics contribute to it? What service delivery characteristics contribute to it? RESULTS AND CONCLUSIONS: Criteria for identifying and defining heavy users of psychiatric services vary among studies. Few studies of heavy service users have attempted to examine use of all psychiatric services, both inpatient and community based. In most studies, 10 to 30 percent of patients are identified as heavy users, those who utilize between 50 and 80 percent of service resources. This group consists of a constantly changing cohort of patients who generally have psychotic illnesses as well as comorbid personality disorders and high levels of drug and alcohol misuse. Few studies have examined social issues such as isolation, homelessness, and social support, although these factors appear to contribute significantly to heavy service use. Few attempts have been made to define heavy-user groups in fiscal terms. More research on heavy users of psychiatric services is clearly needed to improve providers' ability to plan appropriately targeted mental health services for this disabled group of patients who use expensive resources.     

The Youth Client Satisfaction Questionnaire: development, construct validation, and factor structure

Developed and pilot-tested a measure of satisfaction with mental health services for young clients. One hundred fifty youth from 11 to 17 years of age who had completed services received the measure as a telephone interview. Fourteen of 17 candidate items met criteria for test-retest reliability, part-whole correlation, and correlation with a validation item, and they were retained in the instrument. Total score test-retest reliability and internal consistency were highly satisfactory. Principal components analysis revealed two factors, labeled Relationship With Therapist and Benefits of Therapy. Unexpectedly, satisfaction scores were not related to change in youth self-reported behavior problems. However, convergent validity was indicated by significant relationships with change in parent-reported behavior problems, parent satisfaction, parent ratings of treatment progress, therapist ratings of progress, and Global Assessment of Functioning change scores. These results indicate that the Youth Client Satisfaction Questionnaire is a reliable and valid measure of consumer evaluations of their treatment.     

Description and evaluation of the Iowa Depression Awareness, Recognition, and Treatment Program

OBJECTIVE: The National Institute of Mental Health developed the Depression Awareness, Recognition, and Treatment Program to provide up-to-date information and training to health, mental health, and social service professionals regarding the identification and treatment of depression. This study was undertaken to evaluate a series of these programs for professionals who provide services to rural residents in the Midwest. METHOD: The 18 2-day training programs were attended by a total of 1,221 participants, physicians, psychologists, social workers, and nurses. Participants' knowledge regarding depression was assessed both before and after each program. Practice characteristics and perceived ability to assess and treat depression were assessed. Finally, 6-month follow-up evaluations of the usefulness of the training to the participants were undertaken. RESULTS: Following the programs, participants evidenced significant increases in levels of knowledge of depression and a high degree of satisfaction with most elements of the program. Six-month follow-up evaluations indicated a continued positive evaluation of the program. CONCLUSIONS: These outcomes suggest that the goals of the Depression Awareness, Recognition, and Treatment Program were met and provide support for the wider dissemination of these training programs.     

Health state preferences of persons with anxiety

We have described a program that integrates clinical approaches of infant mental health to infants and toddlers in foster care. The juxtaposition of a mental health program in a forensic setting creates a number of special features that we have highlighted. Unique from the clinical perspective, the team is explicitly relationship-focused, attempting to understand all of the young child's caregiving relationships as they affect development. We strive to enhance the quality of all of relationships in which infants participate, fostering healthy attachments and development. Also unique is the emphasis on system liaison, and making programmatic efforts to affect various systems involved in making custody determinations about infants and toddlers. Unique from the forensic perspective, we offer multidisciplinary expertise about an especially high-risk population, a comprehensive service delivery system in which we provide or coordinate and monitor all intervention efforts for a given family, a prevention orientation, and clinical follow-up with infants for as long as they are in care. The goals of the program include expediting permanency planning decisions, increasing continuity in high-quality foster care placements, increasing court satisfaction with mental health consultation, decreasing the number of court-ordered evaluations for adjudicated families, and increasing CPS satisfaction with available treatment and continuity of care. We believe that this approach integrates delivery of services to the youngest and most vulnerable victims of maltreatment and expedites permanency planning.     

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.     

Qualitative study of patients' perceptions of doctors' advice to quit smoking: implications for opportunistic health promotion

OBJECTIVES: To determine the effectiveness and acceptability of general practitioners'opportunistic antismoking interventions by examining detailed accounts of smokers' experiences of these. DESIGN: Qualitative semistructured interview study. SETTING: South Wales. SUBJECTS: 42 participants in the Welsh smoking intervention study were asked about initial smoking, attempts to quit, thoughts about future smoking, past experiences with the health services, and the most appropriate way for health services to help them and other smokers. RESULTS: Main emerging themes were that subjects already made their own evaluations about smoking, did not believe doctors' words could influence their smoking, believed that quitting was down to the individual, and felt that doctors who took the opportunity to talk about smoking should focus on the individual patient. Smokers anticipated that they would be given antismoking advice by doctors when attending for health care; they reacted by shrugging this off, feeling guilty, or becoming annoyed. These reactions affected the help seeking behaviour of some respondents. Smokers were categorised as "contrary," "matter of fact," and "self blaming," depending on their reported reaction to antismoking advice. CONCLUSIONS: Doctor-patient relationships can be damaged if doctors routinely advise all smokers to quit. Where doctors intervene, a patient centred approach-one that considers how individual patients view themselves as smokers and how they are likely to react to different styles of intervention-is the most acceptable.