From Fragmentation to Integration

Abstract

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.     

Mental Health Needs and Supportive Services for Elderly and Disabled Residents

Abstract

This study longitudinally assesses the impact that the provision of supportive services has on the mental well-being of the elderly and disabled population living in independent housing developments. The results indicate that the use of supportive services by the mentally ill allowed them to overcome initial lower functional status and achieve a level of mental functioning virtually similar to that of the total resident population. Thus, it is argued that independent living facilities with supportive services can certainly be a successful and cost effective model for a number of frail elderly and mentally ill residents.     

Homelessness Among Older Adults with Severe Mental Illness

ABSTRACT

This article tackles a problem that is often overlooked in the literature-the plight of homeless elders with severe mental disabilities. Drawing on his personal experience working with sheltered homeless persons who were mentally ill, the author argues for a focus not on self-sufficiency but on closely supervised care for this vulnerable population.     

HIV seroprevalence and clinical characteristics of severe inpatient mentally Ill homeless

Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a chart review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical, and psychiatric services. Assertive community outreach programs are necessary to assure delivery of services to this population.     

HIV Seroprevalence and Clinical Characteristics of Severe Inpatient Mentally III Homeless

Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a charl review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical and psychiatric selVices. Assertive community outreach programs are necessary to assure delivery of services to this population.     

Mental Health Among College Students: Do Those Who Need Services Know About and Use Them?

Objective: The objective of this study was to examine connections between university students' mental health and their knowledge and use of campus mental health services. Participants and Methods: In March 2001, a sample of undergraduate students (N = 266) completed a Web-based questionnaire, providing information related to their mental health, knowledge of mental health services, and use of those services. Results: Students who were mentally distressed were more likely to know about and use services; however, some students who reported to be mentally distressed either did not know about services or knew about services but did not use them. Living off campus, identifying as male, and having fewer years in college were related to less knowledge of campus mental health services. In addition, female sex and number of years in college were predictive of higher service use. Conclusions: With the high prevalence rates and severity of mental health problems, university mental health providers must continue to make strategic efforts to disseminate knowledge about mental health services to all students.     

Factors in the transition to homelessness in the chronically mentally Ill

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for theprevious year were significantly correlated with TBH. Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

Co-Occurring Disorders Among Jail Inmates: Bridging the Treatment Gap

ABSTRACT

This paper presents findings based on a retrospective review of health and mental health records of 359 mentally ill jail inmates. Regardless of demographic group, substance-related disorders are the most prevalent disorder. Sixty-seven percent of the sample had a substance-related disorder, 37% an adjustment disorder, 23% a mood disorder, and 12% had schizophrenia or another psychotic disorder. Comorbidity was extensive with close to 45% of the sample having both a substance-related disorder and an additional major mental illness. Study findings indicate that there is a great need to strengthen services and create jail-community linkages for inmates with comorbid mental health and substance abuse disorders. Innovative program and resource information are provided.     

Characteristics of the homeless mentally ill in case management: Differentiation using major diagnostic categories

The homeless mentally ill are more disabled than other homeless people and require more services, but important variations exist. This study examined relationships between broad Axis I diagnostic clusters and demographic and service variables for 328 clients receiving case management at a community program for the chronic mentally ill homeless. Demographic characteristics, medical history, educational, psychological, and marital history, and case management variables were examined for psychotic, affective, and miscellaneous other clients. Differences were found in such areas as suicide attempts and current suicide status, psychiatric treatment history, education, overall impairment of functioning, length of time homeless, and time in case management but not in status at termination or number of services required. Psychotics had lower adaptive functioning, spent less time in case management, but had as successful outcomes as affective clients. Psychiatric diagnosis provides information that might assist case management for the homeless mentally ill.     

Mental Health Recovery

Abstract

Strengths-based approaches that emphasize culturally competent services and naturally occurring community support may be more appropriate than traditional mental health services for African American adults with psychiatric disabilities. An examination of the literature on service utilization and treatment needs for this population highlights the paucity of empirical studies in these areas, while an exploration of the literature related to psychiatric recovery, a prominent strengths-based framework, reveals insufficient application of the approach to the specific interests of African American service recipients. We suggest that recovery is in fact highly compatible with such culturally relevant approaches as the Afrocentric model, and argue that the concept of recovery may therefore provide a resonant and particularly useful framework for practice with this population. Implications for research, practice and policy are discussed.     

Barriers and Promoters of Mental Health Services Utilization in a Latino Context: A Literature Review and Recommendations from an Ecosystems Perspective

ABSTRACT

This article focuses on the problems of disparities in mental health service utilization in the Latino population in the United States. It begins with an overview of the Latino population within the United States, an exploration of the diversity within this group, and shared cultural values and traits with a particular focus on the problems of Latino poverty. A review of the literature follows, including identified barriers to and promoters of mental health services utilization. These are contextualized in a Latino perspective using an ecosystems framework. Recommendations are made for future practice, research, and policy regarding mental health and mental health services utilization in the Latino community.     

The Application of Artificial Neural Networks for Outcome Prediction in a Cohort of Severely Mentally Ill Outpatients

SUMMARY

Social workers and other mental health workers lack clinical decision support tools to predict which clients are at greatest risk of psychiatric rehospitalization. Artificial neural networks (ANNs), are computer decision support tools that make prediction and classification decisions based on accumulated experience and information contained in successfully solved cases (correct decisions). This study evaluates the use of ANNs in predicting rehospitalization of severely mentally ill outpatients. Eight Bayesian ANN models achieved correct prediction rates ranging from 75% to 93% for two prediction conditions. These results support the utility of Bayesian ANN models in the development of clinical decision support tools.     

Conceptualizing psychosocial nursing in the jail setting

1. The deinstitutionalization movement led to the release of thousands of mentally ill patients, many of whom were incarcerated as a way of dealing with their disturbed behavior. More restrictive civil commitment laws have also contributed to the number of mentally ill who are incarcerated. 2. Health care and security can be perceived as competing interests in the correctional institution. These competing interests may also be perceived as sources of conflict because each interest aims towards divergent goals that interfere with the other. 3. A problem central to the inadequate services for the mentally ill offender is that few people are aware of the poor conditions for this population. Correctional and mental health organizations must educate the public about the plight of the mentally ill offender.     

Psychoeducational Model for Caregivers of Persons with AIDS

ABSTRACT

For every individual infected with the HIV virus, there is a group of friends, family and loved ones who are affected by the disease. Although support groups for these caregivers have begun to develop throughout the country, there is a paucity of research examining the effectiveness of these groups in relieving the stresses experienced by this hidden population. A review of the literature on caregiver groups of other chronically ill family members indicate that both education and support are necessary ingredients in effecting change. The authors propose a practice framework which integrates the determinants of burden, the stage of illness and the stage of mourning in assessing the differential needs of the caregiver for support and education. Implications for further research in this area are discussed. Finally, the authors delineate the usefulness of the model not only in assessing the stresses experienced by the individual caregiver but in developing and implementing a psychoeducational group.     

USING SOCIAL NETWORK INTERVENTIONS TO IMPROVE MENTALLY ILL CLIENTS’ WELL-BEING

This paper reviews empirical evidence showing that the structures of the social networks of mentally ill clients influence both their well-being and their use of mental health services. Network interventions that might help clients better address network-related problems, and might help their families improve relationships and prevent caretaker’s burn-out are presented. A case illustration will demonstrate how practitioners can assess a client’s social network, involve the client’s family in treatment, evaluate that treatment, and select tailored interventions. This case will emphasize both how practitioners can help a client restructure her network, and the complementary roles of formal and informal networks. The author shows practitioners how to match clients’ initial network structures to interventions and desired outcomes. Practitioners can thus help clients modify their social networks, increase the use of preventive services, and improve their well-being. Dr. Pinto has been supported by a training grant from the National Institute of Mental Health (732MH19139, Behavioral Sciences Research in HIV Infection; Principal Investigator, Anke A. Ehrhardt, Ph.D.) at the HIV Center for Clinical Behavioral Studies for Clinical and Behavioral Studies.     

Caring for Persons with Serious Mental Illness

Abstract

This article places evidenced-based knowledge of practice within the social context of care and proposes five policy objectives and specific policy and program changes to address care needs of people with serious mental illness. In spite of demonstration programs that provide the basis for proposed policy initiatives throughout the United States, treatment provision for this population remains inadequate and their safety and well-being continues to be at risk. The authors suggest that treatment initiatives need to be tied to stable policies protecting the mentally ill from adverse social context changes. The authors conclude that policies are needed that will enhance housing assistance, independent social functioning, personal empowerment, and treatment engagement. In addition, efforts are needed to make better use of inpatient hospital care, to better understand the role of assisted treatment, and to better develop consistent long-term fiscal support for the seriously mentally ill. They offer specific policy recommendations for changes in HUD programs, Medicaid and Medicare funding, and treatment programming that address these needs.     

Factors in the Transition to Homelessness in the Chronically Mentally III

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for the previous year were significantly correlated with TBH Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

Characteristics of the Homeless Mentally III in Case Management: Differentiation Using Major Diagnostic Categories

The homeless mentally ill are more disabled than other homeless people and require more services, but important variations exist. This study examined relationships between broad Axis I diagnostic clusters and demographic and service variables for 328 clients receiving case management at a community program for the chronic mentally ill homeless. Demographic characteristics, medical history, educational, psychological, and marital history, and case management variables were examined for psychotic, affective, and miscellaneous other clients. Differences were found in such areas as suicide attempts and current suicide status, psychiatric treatment history, education, overall impairment of functioning, length of time homeless, and time in case management but not in status at termination or number of senlices required. Psychotics had lower adaptive functioning, spent less time in case management, but had as successful outcomes as affective clients. Psychiatric diagnosis provides information that might assist case management for the homeless mentally ill.     

The experiences of youth serving as caregivers for mentally ill parents: a background review of the literature

Young caregivers of mentally ill parents are a vulnerable population. These vulnerabilities include risks for developmental issues, poor socialization, and poor school performance. The purpose of this background review of the literature is to explore the experiences of young caregivers of mentally ill parents and detect the gaps in the literature. The guiding research questions were: What is the experience of young caregivers of mentally ill parents? and What is the experience for those who witness or must assist their parent during a crisis? The majority of research has been conducted outside the United States, primarily in the United Kingdom, and studies have focused mostly on young caregivers of parents with physical rather than mental illness. No studies focused on young caregivers who witnessed or assisted their mentally ill parent in crisis. Information gained through this review will add to the body of knowledge for child mental health and build a case for additional research.