How Psychological Telehealth Can Alleviate Society's Mental Health Burden: A Literature Review

Mental health professionals must establish new means to reach those in need that face obstacles related to geographical location, time limitations, and health. With the high incidence of mental illness, as well as the hypothesized increase in coming years, telehealth modalities propose a novel and far-reaching alternative to traditional therapy. This article outlines the positive aspects and interdisciplinary possibilities when telehealth is incorporated into mental health practice. Novel outlets including mHealth and the utilization of computer tablets as mental health facilitators are outlined. Considerations for practice including training are discussed, as well as potential future directions for the field. Available data supports telehealth as an effective mode for the treatment of clients who are unable to pursue mental health services in their current form. However, careful consideration and training for the mental health professional is needed if telehealth is to be effectively used to alleviate the mental health burden.     

One Hundred Years of College Mental Health

Abstract

Although the first student health service is credited to Amherst College in 1861, almost 50 years passed before Princeton University established the first mental health service in 1910. At that time, a psychiatrist was hired to help with student personality development. Although other schools subsequently established such services, the first 50 years of college mental health were marked by a series of national conferences. At the American Student Health Association's annual meeting in 1920, “mental hygiene” was identified as critical for college campuses to assist students to reach their highest potential. However, it took another 40 years before mental health and psychological counseling services became common on college and university campuses. The American College Health Association formed a Mental Health Section to serve mental health professionals in 1957, and most colleges and universities have now developed mental health and counseling programs commensurate with the size of their student bodies.     

Managed Mental Health Care for Employees:

Managed mental health care has become an increasingly significant influence in the timely, appropriate and cost-conscious delivery of mental health and substance abuse services. Social workers are being presented with new career paths in the private sector as EAP programs and managed health care corporations Look to them to provide the case review, supervision, provider selection, and the quality assurance functions of a well integrated managed health care system.     

Mens Sana: The Growth of Mental Health in the American College Health Association

Abstract

In 1910, the first college mental health service sought to help college students with personality development and building a healthy mind. In 1920, the meeting that founded the American College Health Association (ACHA) identified “mental hygiene” as important, although a separate Mental Health Section was not established in ACHA until 1957. Between 1920 and 1960, a series of national meetings helped define the role and functioning of college mental health and counseling services. Most colleges employed a multidisciplinary staff of psychologists, psychiatric social workers, and psychiatrists to provide clinical services for students and consultation and education for faculty and staff. Mental health services on college campuses grew rapidly in the 1960s and 1970s, leading to discussions in the late 20th century of the use of brief psychotherapies, prevention and treatment of drug and alcohol abuse, prevention of suicide and homicide, the use of psychotropic medications, and effective campus interventions.     

School Spillover and College Student Health

This article uses a stress carryover perspective to examine the association between school spillover and mental and behavioral health outcomes among college undergraduates. School spillover occurs when the obligations and pressures of student life extend into other domains through shared behaviors or stress. The sample (N = 250) consisted of undergraduate students between the ages of 18 and 29 enrolled at a midsized midwestern university. Findings showed that on average, students reported a moderate level of school spillover. Among mental health outcomes, school spillover was positively associated with feeling nervous, restless or fidgety, worthless, depressed, and hopeless. Among behavioral health outcomes, results showed that school spillover was negatively associated with sleep hours per night and positively associated with number of sex partners. Contrary to past empirical studies, school spillover was not significantly associated with drinking or binge drinking. Findings have implications for those who work in student support and campus mental health services.     

Contracting in College Health Instruction

This ten-year survey of the use of student mental health services offered by the University of North Carolina suggests that increased usage over time has been due to greater availability of staff and a broadening of services offered rather than to an increase of the prevalence of mental illness among the student body. The authors believe that college psychiatry, as one of the earliest examples of the provision of mental health services to a community, can be used as a model for other aspects of public health psychiatry.     

Partnering for Mental Health Promotion: Implementing Evidence Based Mental Health Services Within a Maternal and Child Home Health Visiting Program

This article details the clinical foundations of a social work focused community-based participatory research project promoting women’s mental health during and around the time of pregnancy. Specifically, we discuss the theoretical, empirical and organizational implementation of an enhanced engagement model of mental health service delivery that integrates evidenced based practices into the structure and services of an existing non-profit maternal and child health home visiting agency. The model is grounded in literature addressing barriers to accessing mental health care among minority women living in low-income communities. We discuss informing the intervention through direct consumer involvement, as well the rationale supporting the inclusion of Interpersonal Psychotherapy and Cognitive Behavioral Therapy into the design and implementation of the model which emphasizes adequate training of staff with varying levels of mental health experience. Finally, we describe typical client situations and responses reflected by the Enhanced Engagement model and discuss future implications of this approach as a way to offer meaningful intervention to women and families who may not have access or eligibility to utilize specialty mental health services.     

Peer Support Among Consumers of Professional Mental Health Services

ABSTRACT

Peer-support services have become increasingly prevalent in mental health; consumers now deliver many services once provided by professional mental health providers. Recognizing this key asset in mental health consumers' service environment is critical for social workers. This exploratory study examines differences among 311 consumers of professional mental health services, half of whom also used peer-support services. The two groups (peer support compared with non-peer-support) were compared on a number of dimensions related to their utilization of and satisfaction with professional mental health services. Users of peer-support services perceived greater availability of professional services and used more professional services, but found professional services to be less useful than those not participating in peer support. No differences between the two groups were found for overall satisfaction with professional services. Findings related to policy, practice, and research are discussed.     

The Role of a Psychiatric Pharmacist in College Health

Abstract

Published evidence indicates there is a growing prevalence of psychiatric illnesses on college campuses, and that approximately one quarter of students may be taking psychotropic medications. But attracting and retaining experienced mental health care professionals to college health settings is a challenging task. The psychiatric pharmacist is one professional resource that can serve as both a clinical and educational consultant for college mental health services. A pilot psychiatric pharmacist service project is described.     

Responding to the Mental Health and Grief Concerns of Homeless HIV-Infected Gay Men

Summary

Aging, homeless HIV-infected gay men confront multiple bereavement and mental health issues. Needs assessment interviews with this population in the streets of New York City facilitate the initial review and provision of clinically and culturally appropriate service delivery strategies for these disenfranchised gay men to access bereavement support and mental health care systems.     

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.     

HMOs and the Future of Student Mental Health Services

Abstract

The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nation's health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.     

Family interventions in early psychosis service delivery: A systematized review

The objective of this study was to explore the development of family intervention in an early psychosis context. The role played by family members and friends in the recovery of individuals with early psychosis is extremely important, and there is a growing body of literature that reflects this. However, how mental health services can best support and utilize family and friends as a core component in recovery from early psychosis is not yet established. The methodology entailed a systematic review of the international literature. Results from the current review highlight the principles of family engagement, its effectiveness to enhance service user outcomes, the need to differentiate early psychosis psycho-education from that provided in enduring illness, and challenges in implementation. The number of studies generally, and the number explicitly articulating and trialling family interventions being used in practice, are limited. This seems to highlight that—although practice guidelines acknowledge the importance of family support—there are challenges in implementation of evidence-based practice principles in this area. Changes in policy and service delivery are recommended for programs and services to better achieve family-sensitive and family-inclusive practice as core business in mental health service delivery.     

Engagement in Mental Health Treatment Among Adolescents and Young Adults: A Systematic Review

The purpose of the present study is to review empirical evidence of the effects of interventions designed to improve engagement in mental health services among adolescents, young adults and their families. Investigators searched relevant databases, prior reviews, and conducted hand searches for intervention studies that met the following criteria: (1) examined engagement in mental health services; (2) included a comparison condition; and (3) focused on adolescents and/or young adults. Effect sizes for all reported outcomes were calculated. Thirteen studies met inclusion criteria. Conceptualizations of engagement and measurement approaches varied throughout studies. Approaches to improving engagement varied in effectiveness based on level of intervention. Individual level approaches improved attendance during the initial stage of treatment. While family level engagement interventions increased initial attendance rates, the impact did not extend to the ongoing use of services, whereas service delivery level interventions were more effective at improving ongoing engagement. The review illuminated that engagement interventions framed in an ecological model may be most effective at facilitating engagement. Implications for future research and practice are discussed.     

On the Integration of Science and Practice in College Health

Abstract

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an “all or nothing” proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.     

Access to Mental Health Services: The Struggle of Poverty Affected Urban Children of Color

It is estimated that, in the United States, one in ten children and adolescents suffer from illness severe enough to cause some level of psychosocial dysfunction. Urban children, and in particular low-income children of color, are at greater risk of developing mental health problems, and are less likely to receive effective child mental health services. Prompt and effective access to mental health services by urban children of color is a critical direct practice and social policy concern. This article provides an overview of significant barriers to mental health care experienced by poverty affected urban children of color and their families. It also addresses a broad range of practice and policy issues that need to be raised in order to ensure competent delivery of mental health services for children living in urban environments. The role of social work in assisting poor urban children of color to access and benefit from mental health services is stressed. Manny John González, D.S.W., is an Assistant Professor of Social Work at Fordham University Graduate School of Social Service.     

Program Design and Planning Strategies in the Delivery of Culturally Competent Health and Mental Health Prevention and Treatment Services to Latino Communities

SUMMARY

It is important that the delivery of health and mental health prevention and treatment services within Latino communities be culturally sensitive. This article outlines several ways in which agencies can develop programs that can meet the needs of Latino communities. The most important aspect of the provision of health prevention and treatment services is that the organization integrates itself into the community through outreach, recruitment, and inclusion in decision-making. In addition, the organization needs to be structured so communication and participation from the community and health professionals are open and mixed. Otherwise, the likelihood of success of the provision of services in the community will be diminished.     

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.