Implementing a college mental health program – an overview of the first twelve months

Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.     

Work as a cure for mental illnesses? Opportunism and seeking ways in psychology and psychiatry in the first decades of state socialism in Hungary

ABSTRACT

In Hungary, until the end of the 1940s, there were two main established methods of occupying the mentally ill who were fit for work. From the end of the nineteenth century, a lesser number of patients underwent work therapy in mental asylums, whereas the others were treated with so-called family therapy (otherwise known as the heterofamilial system), exploiting the capacities of families in the countryside. As an important part of this, the mentally ill helped in housekeeping and agricultural work. However, following the political and ideological turn of 1948, the latter form of treatment became debated, and then it was gradually superseded. Parallel to this process, work therapy came to be the most popular type of treatment for mental illnesses, as work formed the basis of the ideology of the communist state, and thus, healing through work harmonized with the general tendencies of the era. This article examines texts related to work therapy published in neurological–psychiatric and psychological journals and monographs between 1954 and 1964. However, although work therapy appeared to be the “handmaiden of ideology,” and even though it was supposed to fulfil a particular role, in reality, the role and perception of work therapy were a lot more complicated.     

‘I'm not a family therapist. OK?’ Working Constructively with Families in Aged Psychiatry

This paper reports on the first phase of a larger study aimed at investigating factors hindering family work and exploring ways to improve the amount and quality of family contact within a community aged mental health service in Melbourne, Australia. During the first phase of the project, 28 mental health professionals were interviewed about their views and experiences. Interviews were transcribed, coded, and analysed in terms of repeating themes. The range of attitudes, beliefs and feelings about family work is summarised in this paper. Polarities emerged around questions of whether or not to engage family members, and if so, what function family work fulfils. The interviews also provided useful information on clinicians' beliefs about what would increase the possibility of family work. The paper concludes with a discussion about how to recognize and value family work in this area and target sustainable interventions during the second phase of the study.     

Predictors of treatment outcome in a child and adolescent psychiatry clinic: A naturalistic exploration

We present data on predictors of treatment outcome for 3200 consecutive referrals to a child and adolescent psychiatry clinic. Using Reliable Change Index (RCI) methodology, we divided children into those who, between intake and discharge, improved, stayed the same, or got worse according to clinician-rated impairment. Most predictors of improvement were related to parent variables (marital status, maternal anxiety, and ethnicity), while those associated with deterioration were tied to child status (extent of psychiatric comorbidity, history of placement in a self-contained classroom, and a prior trial of psychotropic medications). The implications of these findings for data-driven program development, clinic management, treatment planning, and systems of care are discussed.     

Ethics of research design

Discussions of ethical issues in research involving human subjects most usually provoke concerns about valid informed consent procedures. However, considering the recognized limitations of informed consent, arguably the way a study is designed is a more consequential concern for subject well‐being. This paper summarizes ethical issues in the design of clinical research, with reference to historic and current guidelines. Special attention is given to randomized clinical trials (RCTs) and psychiatric research.     

Can we remember differently? A case study of the new culture of memory in voluntary organisations

This article analyses the positive contribution that Slovenian voluntary, non–governmental organisations, users' organisations and community–based services in the field of mental health have made to the 'new culture of memory' of helpers and users. The conceptual differences between Slovenian psychiatric (institutional) treatment and voluntary community care are presented through the case study of Clare, a young woman who was diagnosed as a chronic schizophrenic. This example shows the importance of community care in voluntary organisations for the reduction of disability associated with mental disorders. The development of the new culture of memory in voluntary organisations and community–based services is not only the 'narrative turn' within social welfare, but also symbolises the 'implicit turn' in the relationship between the helper and the user. The real challenge of the new culture of memory in the process of help to disabled people (in respect of individuals working through traumatic memories) is that the helper can bear and support the user on a daily basis. During the process of their relationship, the deep implicit relational memories of both become activated and influence the change within the user as well as the helper.     

Reshaping Time: Recommendations for Suicide Prevention in LBGT Populations

ABSTRACT

This article serves as one of the supplementary pieces of this special issue on “Mapping Queer Bioethics,” in which we take a solipsistic turn to “map” the Journal of Homosexuality itself. Here, the author examines the journal’s 2011 consensus recommendations for the prevention of LGBT suicide. Invoking the axiom approach of Eve Kosovsky Sedgwick’s seminal Epistemology of the Closet, the author argues that merely offering practical guidelines at the level of the demonstrative and the instructive may not be sufficient models to address the urgency of suicide rates in LGBTQ youth populations.     

The final step: the issue of euthanasia of people with mental disabilities in Denmark

A number of Danish studies on the history of mental disability have been published in recent years, yet little attention has been devoted to the issue of euthanasia. It has been assumed that the Danes generally opposed radical German ideas about euthanasia of people with disabilities, especially after 1945. This article, however, will contend that a breeding ground for euthanasia was created during the early twentieth century and that many Danes were influenced by Nazi propaganda in the 1940s. Debates about euthanasia of people with mental disabilities continued way up to the 1970s. In fact, discussions about euthanasia or ‘mercy killing’ (medlidenhedsdrab) had their heyday in the years after World War II. Actual cases of ‘mercy killing’ of mentally disabled children appeared in this period. This article will argue that knowledge about the past is important in light of current debates in Europe about similar issues.     

Family Support Groups for Family Members of Mentally Ill Offenders: Therapeutic Factors

This study investigates therapeutic factors of a Family Support Group (FSG) intervention for family members of mentally ill offenders. Seventeen family members completed the ‘Group Therapeutic Factors‐Client Questionnaire’ (GTF‐CQ‐28) during four sessions of two FSGs. Results indicate that family members experienced the following therapeutic factors over the course of treatment: the relational climate, interactional confirmation, expressing and experiencing mutual positive feelings, forgetting own problems, hope from seeing progress in others, guidance from therapists, and getting interpersonal feedback treatment. The therapeutic factors, including learning by observation, support from the group, and universality of problems, correlated with a decrease in self‐blame, improved emotional well‐being, and experiencing less loss of control over one's life, respectively. Further, family members were satisfied with what the FSG has provided for them personally and for the relation with their relative. Finally, clinical implications of the FSG are discussed. The study sheds light on valuable therapeutic factors within an FSG and the important role of therapists.