Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Efficacy of a Web‐based Intervention for Concerned Spouses of Service Members and Veterans with Alcohol Misuse

Concerned partners (CPs) of service members and veterans who misuse alcohol face help‐seeking barriers and mental health problems. We used multiple regression to evaluate the efficacy of Partners Connect, a four‐session web‐based intervention (WBI) to address military CPs’ mental health and communication. We randomized 312 CPs to the WBI or a control group. Five months later, WBI CPs reported significant reductions in their anxiety and increases in their social support compared to control CPs. Intervention dose was also associated with improved WBI CP outcomes. Partners Connect appears to fill a need for families who face help‐seeking barriers and provides an alternative to traditional care for those who may not otherwise seek help.     

Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust

Objective

Public health concern surrounding the mental health needs of former system youth is escalating. We know very little about mental health service utilization on the other side of the developmental transition to adulthood. The purpose of this study was to explore the mental health service use experiences among former system youth with childhood histories which included mental disorder, use of publicly-funded mental health services, and use of additional public systems of care.

Methods

In-depth face-to-face interviews were conducted with 60 participants currently struggling with mental health difficulties regarding their service use experiences over the transition. Participants were recruited from one Midwestern state. Multi-phase analysis was conducted utilizing immersion/crystallization, constant comparison and concept matrices.

Results

Few participants received continuous mental health care across the transition, with the majority experiencing interruptions or discontinuation of care. Important facilitators of service use emerged, such as physicians, former caseworkers and family. Health clinics and parenting programs emerged as potential entrée points for reconnecting disengaged young adults to mental health services. Insight, mistrust, and emotions emerged as novel factors associated with service utilization among young adults.

Conclusions

Mental health service utilization remains a complicated phenomenon over the developmental transition to adulthood. Future research is needed that closely examines the associations between insight, emotion, mistrust and service use among young adults.     

‘Widening cross-disciplinary research for mental health’: what is missing from the Research Councils UK mental health agenda?

This current issues article is a brief critical examination of the recent Research Councils UK agenda and call for cross-disciplinary research in mental health. Our argument is based on the fact that patient and public involvement (PPI) is the only involvement and influencing strategy for service users and survivors in the agenda. Service user and survivor research as a discipline in itself remains unacknowledged. We conclude that service user and survivor research is distinct and is different to PPI, and should be recognised in any mental health research agenda.     

Using Values‐Based Webinar Interventions to Facilitate Career‐Life Exploration and Planning

Using a quasi‐experimental design, the authors examined whether career indecision could be reduced by participation in a values‐based career webinar designed to translate various types of psychological data (e.g., Holland‐type themes) into values‐based language. Participants (N = 67; 36 women, 31 men; mean age = 36 years) were divided into 1 control and 2 treatment groups. The 1st treatment group received an interest‐based intervention. The 2nd received a values‐based intervention. Both interventions consisted of 1 additional webinar spanning 1 hour in length. This study demonstrated a statistical significance of career indecision decrease through use of the values‐based, process‐oriented webinar intervention, which is particularly helpful to career counselors working with adults. The study also illustrated the effective application of online technology as a service delivery tool. Future research might examine the efficacy of this intervention in a variety of settings (e.g., K–12, postsecondary, agency, mental health, corporate).     

Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

Does state spending on mental health lower suicide rates?

Using recently released data on public mental health expenditures by U.S. states from 1997 to 2005, this study is the first to examine the effect of state mental health spending on suicide rates. We find the effect of per capita public mental health expenditures on the suicide rate to be qualitatively small and lacking statistical significance. This finding holds across different estimation techniques, gender, and age groups. The estimates suggest that policies aimed at income growth, divorce prevention or support, and assistance to low income individuals could be more effective at suicide prevention than state mental health expenditures.     

Predictors of substance abuse treatment outcomes in Tennessee

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence.This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.     

Risk,Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

Mental health social workers have a central role in providing support to people with mental health problems and in the use of coercion aimed at dealing with risk. Mental health services have traditionally focused on monitoring symptoms and ascertaining the risks people may present to themselves or others. This well-intentioned but negative focus on deficits has contributed to stigma, discrimination, and exclusion experienced by service users. Emerging understandings of risk also suggest that our inability to accurately predict the future makes risk a problematic foundation for compulsory intervention. Therefore it is argued that alternative approaches are needed to make issues of power and inequality transparent. This article focuses on two areas of practice: the use of recovery-based approaches, which promote supported decision-making and inclusion; and the assessment of a person's ability to make decisions, their mental capacity, as a less discriminatory gateway criterion than risk for compulsory intervention.     

Intersection of homelessness and mental health: A mixed methods study of young adults who accessed psychiatric emergency services

Young adults who experience homelessness have high rates of mental disorders, yet low rates of outpatient mental health service use. This mixed methods study examined the intersection of homelessness and mental health in a sample of 54 young adults (ages 18–25) who were hospitalized on a short-term, inpatient psychiatric unit. Nearly half (n = 26) reported being homeless in the prior year and more than a quarter were homeless at the time of admission (n = 15). Qualitative analyses identified key factors that contributed to both mental health problems and homelessness including disrupted support networks, fragile family relationships, foster care involvement, substance use and traumatic events. Homelessness was both a facilitator and a barrier to successfully accessing mental health services to manage mental health symptoms. Findings highlight the interconnection of homelessness and mental health and their common relationship with additional underlying risk factors. Providers across service settings need to recognize the overlap of client populations and provide integrated, trauma informed care to address housing instability, mental health, and substance use together.     

Out‐of‐Home Placement of Children Exposed to Violence

There is growing concern about the increasing number of children in the USA who are exposed to community violence and the need to remove some of them from their families. This study examines risk factors for out‐of‐home placement among a large pool of children and adolescents who were referred for general clinical assessment following exposure to violence and/or psychological trauma in their communities or homes. Children with greater familial and environmental support and children exposed to incidents involving a non‐parental personal threat were associated with a significantly lower risk of out‐of‐home placement. A greater likelihood of being placed out of home was associated with older age (adolescents), history of mental health service use, involvement with law enforcement agencies, higher clinical ratings of depression or impaired thought processes, lower clinical functioning and greater exposure to traumatic events. Evidence of maltreatment and a threat to life was associated with 13.6 times greater likelihood of being placed out of the home. This study raises an important issue in respect to the children's past use of mental health service and current symptoms. It is not just the risk of violence but also evidence of psychiatric problem that trigger out‐of‐home placement. Further studies are needed to assess the quality and effectiveness of mental health services provided to children exposed to violence. © 2007 The Author(s). Journal compilation © 2007 National Children's Bureau.     

Mitigating Harm: Considering Harm Reduction Principles in Work with Sexually Exploited Young People

A growing awareness of child sexual exploitation (CSE) in the United Kingdom and throughout the world has prompted human service and legal/policy professionals to seek ways of engaging young people experiencing sexual exploitation, although much remains unknown regarding effective practice, and whether or not current knowledge regarding best practices with young people can be expanded to address CSE. This paper considers how principles of harm reduction, a public health approach widely used to engage adults and young people in help‐seeking behaviours, can be considered as part of a children's rights‐centred approach to policy and practice with young people experiencing CSE.     

Working across borders to promote positive mental health and well‐being

World health reports highlight the increasing prevalence of mental health problems and the need to recognize that mental well‐being is a fundamental aspect of any health policy. The scale and cost of mental health problems mean that appropriate policies and strategies must be developed and implemented. In Ireland this is a period of substantial review and reflection on mental health policy and practice, but to date little consideration has been given to the development of a cross‐border strategy. Cooperation and collaboration has been largely dependent on the leadership of a number of individuals supported by short‐term European Union funding. This paper is informed by a study which was concerned with examining the issues associated with promoting mental health across the Irish border. Insights were provided by 38 individuals who were involved in the delivery of cross‐border mental health services in the North West region. The article argues that there is substantial support for working across borders and developing sustainable cross‐border health strategies. In the absence of a statutory all‐Ireland coordinated policy overseeing the development of mental health promotion, the sustainability of projects emerged as a key issue. The results suggest that whilst much innovative and creative work has been undertaken by committed individuals, what is now required is a strategic response from both the British and Irish governments which will ensure the needs of service users in these deprived border regions can be effectively addressed. Also, at a policy level this strategic development would be seen as a reflection of the value placed on promoting mental health and well‐being.     

Hurricane Katrina and Mental Health: A Research Note on Mississippi Gulf Coast Residents*

Katrina was the most devastating and deadliest hurricane in recent U.S. history. The storm was particularly destructive for residents of the Mississippi Gulf Coast where sustained winds of 135 mph and a storm surge of 32 feet literally obliterated the built and modified environments. Limited research exists on the chronic (32 months) mental health impacts of survivors in this geographical area. Random‐digit dialing telephone surveys were administered in Harrison and Hancock counties (Mississippi) in April and May 2008 and data were collected on a number of mental health outcomes. The results of the calculation of Oridinary Least Squares (OLS) regression models revealed that females, African Americans, and less‐educated residents manifested the most severe mental health impacts. Most important, consistent findings for depression and Katrina‐related psychological stress indicate that residents who were separated from family members, had maximum residential damage, and suffered severe financial problems remained significantly impacted 32 months after Katrina’s landfall. A secondary stressor, in the form of having applications to the Mississippi State Grant Program denied or not processed also predicted personal depression. The implications of these findings are discussed.     

Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.     

Feminism and gendered impact of COVID‐19: Perspective of a counselling psychologist

When women, girls and gender‐diverse people — who have been disproportionately impacted by the COVID‐19 pandemic outbreak since the public health crisis has also become a crisis for feminism — will identify and acknowledge their organismic phenomenological self, wholeness and growth will be fully functioning. Psychological aspects for the public health emergency operated through counselling psychologists to manage mental health, emotional, psychological, cognitive, behavioural, relational and social impacts are fundamental. And the role of counselling psychologists in maintaining personal mental health and their clients is a crucial indicator of collective wellbeing. This perspective is embedded in the gendered approach and feminist framework which attempts to explore and offer the embodied intersectional and divergent impact on living during the COVID‐19 pandemic lockdown.     

Racial/ethnic disparities in prior mental health service use among incarcerated adolescents

Research on racial and ethnic disparities in mental health and substance abuse service use among incarcerated youth in the U.S. is inconclusive. This cross-sectional study adds to our understanding of racial and ethnic disparities by examining the prior use of mental health and substance abuse services among incarcerated juveniles. Guided by Andersen's behavioral model of health service utilization, a series of logistic regression analyses were conducted on a non-probability sample of 13–19 year-old youth in two residential facilities for juvenile offenders in Western Pennsylvania (N = 181). Black and Hispanic youth were less likely than White youth to have used mental health and substance abuse services, even when controlling for predisposing, enabling, and need factors. Additional analyses revealed that these differences did not hold across all service types, specifically with regards to outpatient service use. Significant differences did exist, however, in the prior use of inpatient mental health and substance abuse services. This suggests that White youth are often funneled into the mental health system, while youth of color enter the justice system. Implications for racial/ethnic disproportionality in service use and justice system involvement are discussed.     

Service user involvement in Swedish mental health and social care: an analysis of ideological dilemmas and subject positions in a collaboration context

Service user involvement is steadily on the rise, bringing questions of tokenism and power imbalance. This article studies service user organisation representatives (URs) and human service organisation representatives (HSORs) in mental health and social care strategic collaboration councils through qualitative interviews and participant observations. Talk on service user involvement through UR is studied through the discourse analytical concepts of ideological dilemmas and subject positions. The participants' constructions, actions, and rhetoric therein are considered. Findings show participants' oscillation between standpoints within two main themes: the ideal vs. the inadequate UR and balancing power positions. The first theme discusses the missing perspective brought by UR narrations in terms of expected conduct and awareness of organisational conditions. This also concerns service users' positions as being simultaneously dependent and independent. The second theme concerns the implicit UR influence and the explicit HSOR influence. User involvement through URs is construed as a needed narration told by citizens with rights and responsibilities, while conditioned, as the UR is a layperson with mental health problems. The actions accompanying such constructions cause HSORs to balance between paternalism and professionalism and URs between adaptation and using their voice. In this, the URs have a stronger influence than acknowledged.     

‘The times,are they a‐changing?’ As the world enters a new millennium are we as paediatricians keeping up with the changing needs of children?

This paper describes changes that are occurring in paediatric practice in a variety of settings. The ‘new morbidity’ demands focused training of paediatricians of the twenty‐first century. Areas that include advocacy, public health, adolescence, chronic illness, health promotion, behavioural issues, parenting and family dynamics, social influences, health and social inequalities, managerial decision making and technological advances should be a part of paediatric training. These factors assume different importance in developing nations where priorities may be more focused on public health, nutrition and health promotion. Partnership with others who have children's interests at heart, for example mental health services, public health, social sciences, education and social services is imperative in planning service development informed by good information systems incorporating measures of mortality and morbidity. Copyright © 2000 John Wiley & Sons, Ltd.     

College men's health in practice: a multidisciplinary approach

After a needs assessment indicated that male students underutilized campus health services, the San Francisco State University Student Health Service developed a coordinated complement of outpatient health services for men. The authors review their experience in developing, implementing, operating, and evaluating this ongoing clinical service. The needs assessment and subsequent program evaluation data suggest that male students on a large, culturally diverse, urban campus would respond favorably to targeted, multidisciplinary health initiatives that incorporate the principles of health promotion and disease prevention.