Modeling the mental health service utilization decisions of university undergraduates: A discrete choice conjoint experiment

Objective: We modeled design factors influencing the intent to use a university mental health service. Participants: Between November 2012 and October 2014, 909 undergraduates participated. Method: Using a discrete choice experiment, participants chose between hypothetical campus mental health services. Results: Latent class analysis identified three segments. A Psychological/Psychiatric Service segment (45.5%) was most likely to contact campus health services delivered by psychologists or psychiatrists. An Alternative Service segment (39.3%) preferred to talk to peer-counselors who had experienced mental health problems. A Hesitant segment (15.2%) reported greater distress but seemed less intent on seeking help. They preferred services delivered by psychologists or psychiatrists. Simulations predicted that, rather than waiting for standard counseling, the Alternative Service segment would prefer immediate access to E-Mental health. The Usual Care and Hesitant segments would wait 6 months for standard counseling. Conclusions: E-Mental Health options could engage students who may not wait for standard services.     

Talking About Gender in Motion

Abstract

This is an interview with noted Norwegian sexologists Elsa Almas and Esben Esther Pirelli Benestad, who is bigender and married to Almas. In conversation with narrative therapist Christopher Behan, they discuss, both professionally and personally, working with those who have a transgender family member, the importance of community work to support the transgender child or adolescent, and the continued need for advocacy within the mental health and medical fields for transpeople and their loved ones.     

The Forensic Model

Abstract

Understanding the relationship between psychological ethics and scientifically informed methodology is critical to a competently crafted child custody advisory report. This paper offers a working definition of the forensic model and integrates elements of the 2002 American Psychological Association's Ethical Principles of Psychologists and Code of Conduct(American Psychological Association, 2002) with forensic methods and procedures as applied to child custody evaluations.     

Mental Health on the Campus Revisited

Abstract

The author briefly reviews Mental Health on the Campus: A Field Study, published in 1973, noting areas of consensus and points of tension or disagreement that were reported in that study. He then assesses the extent to which the current state of mental health on the campus is an echo of that report. These comparisons form the basis for anticipating the probable direction of future developments in campus mental health. The areas and issues considered include the increased diversity of the student body, the stable incidence of psychotic disorders, the increased prevalence of gender-related diagnoses such as sexual abuse and eating disorders, the continuing financial pressures bearing on campus mental health programs, and the forms of care and treatment that fiscal and other circumstances are imposing. The author concludes that although the resources available and the particular challenges that are faced may have changed, the traditional goals of a campus mental health program, as articulated 75 years ago when the American College Health Association was founded, remain valid, even if they are difficult to attain.     

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.     

Event-related clinical distress in college students: Responses to the 2016 U.S. Presidential election

Abstract

Objectives: College students have cited the 2016?U.S. presidential election as a significant source of stress. The current study examined the prevalence and demographic correlates of clinically significant election-related avoidance and intrusion symptoms among college students 2–3?months after the election. Participants: College students attending a large public university (N?=?769; M_age?=?19.19; 48.2% female; 58.4% White) were surveyed in January and February 2017. Methods: Participants completed a validated measure of clinically significant event-related distress symptoms (eg, intrusive thoughts, avoidance) and demographic questions. Results: One out of four students met criteria for clinically significant symptoms related to the election. Regression analyses suggested that sex, political party, religion, and perceived impact of the election on relationships were more useful predictors of stress symptoms than race or social class. Conclusions: The high level of event-related distress is concerning because elevated symptoms of event-related stress are predictive of future distress and subsequent PTSD diagnoses.     

Does the Andersen Behavioral Model of Health Services Use predict college students’ use of on-campus mental health services?

Abstract

Objective: 10–50% of college students meet the diagnostic criteria for one or more mental illnesses; unfortunately, less than half seek treatment. This study assessed the predictive power of specific variables on students’ use of on-campus mental health resources using the American College Health Association’s National College Health Assessment (ACHA-NCHA) II. Participants: Respondents included undergraduate and graduate students ages 18–35?years (n?=?96,121). Methods: We analyzed data from the ACHA-NCHA II Fall 2014 and Spring 2015. Andersen’s Behavioral Model of Health Services Use enabled selection of predisposing, enabling, and need predictor variables; these were analyzed individually and collectively. Results: Predisposing, enabling, and need variables accounted for 9%, 2.3%, and 17% of the overall variance. Significant variables associated with a student’s decision to access on-campus mental health services accounted for 23% of variance total. Conclusions: This insight could allow universities to better recognize students at-risk for needing but not accessing mental health services.     

Psychological Distress in Older Portuguese Gay and Bisexual Men: The Mediating Role of LGBT Community Connectedness

Abstract

Objectives: Examining Psychological Distress (PD) among older Portuguese gay and bisexual men (GBM), and the mediator role of LGBT community connectedness (LGBTCC) of minority stress variables on PD. Methods: We performed a mediation analysis with LGBTCC as mediator between minority stress variables and PD with a sample of 110 elderly GBM. Results: We found moderate PD levels; LGBTCC was a significant mediator between concealment of sexual orientation and PD, but not between internalized stigma and expectations of rejection and PD. Conclusions: More attention is needed to Older Portuguese GBM’s mental health. LGBTCC is an important ameliorating factor for older GBM.     

The Relationship between Social Dominance Orientation and Child Sexual Abuse Credibility Assessment

ABSTRACT

Allegations of child sexual abuse (CSA) across various contexts have often been denied or ignored by a multitude of people, including those who do not personally know the alleged perpetrators or victims. The lack of belief of children’s CSA reports is problematic, as this may affect the child’s adjustment, the consequences for the alleged perpetrator, and the likelihood of other victims reporting abuse that they experienced. One plausible explanation for low credibility is the variable of social dominance orientation. In the current study, a diverse sample (N = 60) read a hypothetical vignette of a CSA allegation, rated the credibility of the child, and completed the Social Dominance Orientation-7 scale (SDO-7). Results supported that high social dominance orientation predicts low credibility ratings of the child’s CSA allegation. Findings may impact how clinicians and investigators approach the assessment of credibility of CSA allegations, how they appraise the opinions of others about such credibility, and jury selection in the court system.     

Social Inclusion as an Agenda for Mental Health Social Work

Summary

Following New Labour's election to office in the UK in 1997, policy initiatives have proliferated relating to mental health. Much of this policy innovation emphasises the social dimensions of mental health and distress, with an emphasis on employment and social inclusion. Paradoxically, this modernization of the mental health agenda comes at a time when mental health social work is struggling to establish its role and contribution within recently integrated health and social services. The paper considers whether New Labour's flagship programme, Mental Health and Social Exclusion, constitutes a “New Deal” for mental health, and whether it provides a perspective that will help mental health social work to define its distinctive contribution to integrated services.     

Subjective evaluations of alcohol-related consequences among college students: Experience with consequences matters

Objective: Research suggests college students rate some alcohol-related consequences less negatively than others, yet it is unclear how or when these differences in perception develop. The current study compared college students' subjective evaluations of alcohol-related consequences that they had and had not experienced in order to test the hypothesis that students become desensitized to the consequences they experience. Participants: Participants were 269 undergraduate students enrolled at a large, public, Midwestern university. Methods: Participants completed measures of drinking behaviors, consequences experienced, and subjective evaluations of consequences via an online survey. Results: Participants rated the consequences they had personally experienced more positively than those they had not experienced. Similarly, individuals who reported experiencing consequences rated them as significantly more positive than those who had not experienced the same consequences. Conclusions: Experience with consequences is associated with more positive evaluations of those consequences. Therefore, it may be important to consider individuals' experiences with, and evaluations of, alcohol-related consequences in college student drinking interventions.     

When Form Fails to Follow Function

Abstract

Benjamin and Gollan'S (2003) new primer on conducting child custody evaluations, published by the American Psychological Association, presents the authors' flawed evaluation protocol with little discussion of the risks and benefits of the practices they advocate. The authors fail to note where their model varies significantly from the custody evaluation guidelines required by law in some states, and promulgated by various professional organizations. The most troubling practices include not interviewing and assessing pre-adolescent children, destroying videotapes of interviews and observation sessions, organizing the evaluation around parental allegations, use of a suggestive allegation checklist, and limiting consideration of information from collateral witnesses to declarations submitted under penalty of perjury.     

Including At-Risk Adolescents in Their Own Health and Mental Health Care

Summary

As urban adolescents encounter serious health and mental health risks, they present the allied health professions with important opportunities for health promotion and risk reduction interventions. However, the prevailing emphasis on adolescents' risk behaviors rather than on their vulnerability has limited our capacity to understand and serve them. Further limiting are the widely held myths that adolescents as a whole have few health problems and that they are poor judges of their own needs. This article presents an overview of current theories of adolescent risk and vulnerability and suggests Youth Development as an overarching framework for understanding both. Experience within a comprehensive, adolescent health and mental health center demonstrates how to meaningfully engage adolescents in their own health care from the start.     

The effects of a pedometer-based intervention on first-year university students: A randomized control trial

ABSTRACT

Objectives: To assess the effects of a 12-week pedometer-based intervention on the physical activity behavior, health-related quality of life (HRQOL), and psychological well-being of first-year university students. Participants: First-year university students (N = 184) were recruited during September 2012 and randomly assigned to an intervention or a control group. Methods: Intervention participants were provided with a pedometer, monthly tracking logs, and follow-up e-mails. Control participants received no intervention. Physical activity, HRQOL, and psychological well-being were measured at baseline and post intervention. Data were analyzed using multivariate/univariate analysis of variance (MANOVA/ANOVA). Results: All participants experienced an increase in mild physical activity (p < .01) from baseline to follow-up. The intervention failed to produce significant differences between groups for physical activity (p = .28), HRQOL (p = .80), or psychological well-being (p = .72). Psychological well-being (p < .001), vigorous physical activity (p = .04), and mental health status (p < .001) decreased across the duration of the study. Conclusions: More intensive interventions may be required to elicit physical activity behavior change.     

Looking Outside the (Voice)Box

Laura S. Brown, PhD, is a clinical and forensic psychologist in independent practice in Seattle, Washington. The bulk of her scholarly work has been in the fields of feminist therapy theory, trauma treatment, lesbian and gay issues, assessment and diagnosis, ethics and standards of care in psychotherapy, and cultural competence. She has authored or edited ten professional books, including the award-winning Subversive Dialogues: Theory in Feminist Therapy, as well as more than 140 other professional publications. She has also recently published her first book for general audiences, Your turn for care: Surviving the aging and death of the adults who harmed you. Laura has been featured in five psychotherapy training videos produced by the American Psychological Association. She was President of American Psychological Association Divisions 35 (Society for the Psychology of Women), 44 (Society for the Psychological Study of Lesbian, Gay and Bisexual Issues), and 56 (Trauma Psychology). Laura was also President of the Washington State Psychological Association. She is the founder and Director of the Fremont Community Therapy Project, a low-fee psychotherapy training clinic in Seattle. In the fall of 2000, she was the on-site psychologist for the reality show Survivor: The Australian Outback. In 1987, Laura lost her voice and was diagnosed with spasmodic dysphonia. In 1988, she found her voice again.     

The Community College Nurse as an Occupational Health Nurse

Abstract

Objective: This multisite study assessed college student's perceptions and practices regarding carrying concealed handguns on campus. Participants: Undergraduate students from 15 public midwestern universities were surveyed (N = 1,800). Methods: Faculty members distributed the questionnaire to students in general education classes or classes broadly representative of undergraduate students. Results: Useable questionnaires were returned by 1,649 students (92%). The majority (78%) of students was not supportive of concealed handguns on campuses, and 78% claimed that they would not obtain a permit to carry a handgun on campus, if it were legal. Those who perceived more disadvantages to carrying handguns on campus were females, who did not own firearms, did not have a firearm in the home growing up, and were not concerned with becoming a victim of crime. Conclusions: The majority of students was not supportive of concealed handguns on campus and claimed that they would not feel safer if students and faculty carried concealed handguns.     

Reacting to the Uncooperative,Severely Disturbed Student: A Survey of Health Center Policies

Abstract

All members of the Pacific Coast College Health Association were surveyed to determine their policies for evaluating and restricting the attendance of severely disturbed students who were not cooperative with mental health intervention.

One hundred of the 135 institutions returned questionnaires. Fifty-eight percent of the respondents reported that they medically exclude or otherwise restrict students due to their emotional condition. Privately funded schools were more likely to restrict than were tax supported schools. The more residential the campus, the more probable the students were to be restricted. The mean number of students excluded during one academic year was 3.15 (range = 0–25). Despite general recognition of the difficulties involved in responding to uncooperative, severely disturbed students, only 7% of the restrictive schools had written policies which detailed the procedures to be followed when considering restricting students for mental health reasons.

The need to develop clear procedures which respond to the needs of the students as well as the institutions was emphasized.

“Acquired Immune Deficiency in Haitians: Opportunistic Infections in Previously Healthy Haitian Immigrants,” JEFFREY VIEIRA, et al. We describe acquired immune deficiency manifested by opportunistic infections in 10 previously healthy heterosexual Haitian men. The opportunistic pathogens included Toxoplasma gondii (in four patients), Cryptococcus neoformans (in one), Pneumocystis carinii (in four patients), and Candida albicans (in three). Six of the patients also had Mycobacterium tuberculosis. Immunologic studies of three patients showed a decrease in the numbers and activity of helper T cells, with normal or increased populations of supporessor T cells. Serologic markers for previous infections from hepatitis A, cytomegalovirus, and herpes simplex virus were detected in several patients. Six of the patients died despite specific antimicrobial therapy. The clinical and immunologic findings in these 10 Haitians are similar to those reported in drug addicts and homosexuals with the acquired immune-deficiency syndrome.     

Critical Reflection on the Ethics of Mindfulness

Mindfulness is a way to achieve mental wellbeing that has been widely adopted as part of counselling and mental health treatment. However, there is a distinct lack of critical reflection about the origins of this technique, how it is used, and the implications it has for the beliefs of clients. The purpose of this paper is to provide a carefully considered response to the use of humanistic mindfulness. Social workers need to explain why they recommend mindfulness, and explore culturally consistent and sensitive practice, so that they are abiding by the Australian Association of Social Workers Code of ethics.

IMPLICATIONS

• The use of mindfulness in social work practice requires careful consideration as to its impact and relevance to clients’ needs.

• Mindfulness originates in philosophical traditions distinct from mental health treatment.

• In choosing to use mindfulness social workers require consistent and sensitive understanding of clients’ needs, world views, and culture.