Harmonizing databases? Developing a quasi-experimental design to evaluate a public mental health re-entry program

Our study is the first-ever initiative to merge administrative databases in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcomes of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007–2011, comparing FTT clients to released prisoners who, despite having serious mental health disorders, did not meet the criterion for DMH services. By systematically describing our original study design and the barriers we encountered, this report will inform future efforts to evaluate public programs using merged administrative databases and electronic health records.     

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.     

Evaluation in the community mental health centers program: A bold new reproach?

The Federal Community Mental Health Centers Program (CMHC)-from 1963 to 1981-was heralded as a revolution in mental health care. Championed by many, and severely criticized by others, the actual impact of the program on the nation's mental health remains unclear. The authorization to evaluate the CMHC Program came originally from congressional legislation (PL 90-174), and later from the policies and regulations of NIMH under a series of Federal laws, notably PL 94-63. From 1976-1980, two dominant evaluation strategies were prevalent: funds expended by NIMH each year for studies of CMHC services or program-wide evaluations, and a much larger expenditure by CMHCs to conduct their own, independent evaluations following federal guidelines. As the Center's Program was turned over to the states in the form of block grants (PL 97-35), a group of professionals involved with setting and carrying out federal CMHC evaluation policy of both varieties met in public forum to debate the impact of these two evaluation approaches. While some participants cited gains in evaluation technology and impact upon local management of CMHCs, others found the lack of a coordinated and systematic approach to evaluating the CMHC Program to have been an opportunity missed. The impact of CMHC evaluation efforts are also discussed in terms of their major contribution to the field of evaluation research as a whole.     

From pathology to postmodernism: a debate on ‘race’ and mental health

This article suggests that ‘race’ and psychiatry are inextricably linked and as such ‘mental illness’ constitutes a precondition of black people's psyche. Postmodernist and poststructuralist analysis are used to question the way in which mental health problems have been socially constructed in western psychiatry. In order for health and social care workers to effectively respond to racism within psychiatry and community care provision it is necessary for them to understand the relationship that exists between and informs ‘race’ and psychiatry.     

Recovery capital: what enables a sustainable recovery from mental health difficulties?

There is increasing international interest in recovery approaches in mental health—and this connects with an emerging focus within European social work around promoting capability and sustainability. Research at a population level would suggest that social factors rather than medical interventions are the main determinants of recovery from mental health difficulties—but this is not yet reflected in social work practice, which can still be dominated by biomedical perspectives and a focus on risk management. Drawing upon and extending analyses of social and other forms of capital, this paper outlines the basis for a new paradigm for mental health social work that is specifically oriented towards enabling the development of personal efficacy and social capability—an approach that is explicitly focused on achieving longer-term sustainability rather than shorter-term problem solving.     

Vision and state health department public relations practitioners: Prepared to lead?

Visions are important to organizational effectiveness. Although providing vision has been identified as one of the behaviors that best captures organization-wide public relations leadership, little public relations research has focused on vision. Similarly, state health departments have drawn little interest among public relations scholars even though states are a central part of the nation's public health system. This study addressed the perceptions of the top public relations professionals at state health departments concerning vision and their involvement in the visioning process. The practitioners were nearly unanimous in their belief that organizational visions are important. However, results indicate that some top public relations practitioners at state health departments are not prepared to make optimal contributions to the visioning process. In order to take full advantage of opportunities to serve as organization-wide leaders, public relations practitioners should seek out information about visioning in order help chart their organization's future and enhance their careers.     

Psychiatrist–consumer relationships in US public mental health care: consumers’ views of a disability system

The US public mental health system is a disability system. By this is meant that public programs for people with mental illness serve consumers who are seriously and chronically ill, functionally disabled and eligible for benefits by virtue of their disability. This study explores, through focus groups and qualitative data analysis, the perceptions of these consumers of their relationships with public sector psychiatrists. Thematic analysis finds relationships of three types – compliance, collaboration and contention – and constituent sub‐themes that specify these further. Issues of poverty and powerlessness arise in every category, but especially in contentious relationships. Although the converse is widely believed to be true, this paper argues that the economic and political empowerment of people with psychiatric disabilities is vital to the success of their clinical care     

Disabled people,inclusion and policy: better outcomes through a public health approach?

The social model of disability has implications for evaluation of disability policy. Public health analyses suggest that a population and environmental approach to enablement is more likely to impact positively on disabled people than person-centred action. The capacity of people living with disabilities to participate in a range of social activities and the attitudes of others to such participation are, along with environments, important factors contributing to disability situations and therefore the restriction of our promotion of personhood. These are areas where metrics could be used to evaluate the impact of disability policy.     

Who is willing to come back? College students' willingness to seek help after using campus mental health services

Objective: To examine characteristics of college students who have previously received mental health (MH) services on campus and are willing to seek help again in the future. Participants: Spring 2015 ACHA-NCHA II (N = 12,501) undergraduate respondents who had previously used MH services on their current campus. Methods: Binary logistic regression with willingness to seek MH services in the future as the dependent variable. Results: Among students who had already utilized campus MH services, significant predictors for future help-seeking were: female, white, gay/lesbian, those not working for pay, having the college/university health insurance plan, and not currently/previously serving in the military (p < .05). Conclusions: The predictors for willingness to use services in the future were consistent with the existing literature related to initial use. Colleges and universities need to consider factors that influence openness to MH services after a previous experience in addition to initiating care. Implications for college MH professionals are provided.     

Can we prevent deaths of homeless persons? Police led public health approach to prevent homeless deaths

Abstract

Research on homeless populations demonstrates that homelessness in itself is an independent risk factor for death. However, there is a dearth of detailed data on homeless decedents and the situations surrounding their deaths. This lack of knowledge, a desire to understand how and why homeless individuals were dying, and a sentinel event death led the Indianapolis Metropolitan Police Department Homelessness and Panhandling Unit to partner with a local researcher and begin conducting homeless death reviews. The approach is modeled after the evidence-based, public health approach of the Fetal and Infant Mortality Review process (FIMR). The FIMR model is a systematic approach to understanding system gaps and obtaining insights into the factors that resulted in homelessness and ultimately death. This article reports on the process to develop this unique multi-agency, police-led review of homeless deaths in Indianapolis, Indiana and resulting recommendations for action to decrease these deaths.     

Is it really worse to have public health insurance than to have no insurance at all? Health insurance and adult health in the United States

Using prospective cohort data from the 1979 National Longitudinal Survey of Youth, this study examines the extent to which health insurance coverage and the source of that coverage affect adult health. While previous research has shown that privately insured nonelderly individuals enjoy better health outcomes than their uninsured counterparts, the same relationship does not hold for those publicly insured through programs such as Medicaid. Because it is unclear whether this finding reflects a true causal relationship or is in fact due to selection bias on socioeconomic status and health, previous estimates of the contribution of health insurance to inequities in health may have been biased. This study attempts to disentangle these competing hypotheses of causation or selection bias by using fixed effects models with sibling clusters to corroborate--or contradict--the results of a conventional OLS regression. By controlling for unobserved factors shared by siblings, such as parental genetic influences, sibling models estimate health insurance effects that are less affected by selection bias. Findings suggest that, among the US. birth cohorts of 1957 to 1961, the negative relationship between public health insurance and health is not causal, but rather due to prior health and socioeconomic status. Conversely, the lack of health insurance coverage has a strong cumulative negative impact on adult health.     

Is a picture worth a thousand words? Using films and television shows to teach public relations

While a number of studies have looked at the image of public relations practitioners as portrayed in films and other media, few if any of those studies have focused primarily on the pedagogical perspective of using films. Therefore, a benchmark international survey of public relations educators was undertaken to answer questions about how (or whether) to use films as a teaching tool. Among other things, the findings of the study shed light on how often PR instructors use films in the classroom; the value that films provide; why some professors decline to use them; which specific films and television shows are being used; and guidelines for utilizing movies and television programs as an effective pedagogical technique.     

What does learning by listening bring to citizen engagement? Lessons from a government program

In public relations research, the concept of engagement is often theorized but seldom observed in practice. This research focuses on what public leaders learn when they undertake actions centered on learning by listening to society to implement governmental citizen engagement programs. Taking an inductive grounded approach to data analysis which draws on tools and methods of grounded theory as well as including a review of key concepts from public relations literature, a reflexive analysis of an action learning intervention involving the members of a provincial government was conducted. Results show that, when reflecting on interaction with stakeholders of the program, government members: increase their knowledge about both sides of the public organization-society relationship; become more sensitive to what listening is and implies, and, hence, more supportive of two-way communication; are challenged about the authenticity of the motivations behind their listening; become more aware of ways in which they work to build social capital; and, subsequently, increase their willingness to act together with society. This paper shows that reflection on the real implementation of engagement programs gives policy makers a better understanding of normative assumptions, and hence it instantiates public relations theories and concepts about engagement. By identifying acting-by-listening as integral to citizen engagement, it presents implications for the study and practice of public relations in public sector organizations.     

Does self-help increase rates of help seeking for student mental health problems by minimizing stigma as a barrier?

Objective: This study examined whether self-help (books, websites, mobile apps) increases help seeking for mental health problems among college students by minimizing stigma as a barrier. Participants and Methods: A survey was conducted with 200 college students reporting elevated distress from February to April 2017. Results: Intentions to use self-help were low, but a significant portion of students unwilling to see mental health professionals intended to use self-help. Greater self-stigma related to lower intentions to seek professional help, but was unrelated to seeking self-help. Similarly, students who only used self-help in the past reported higher self-stigma than those who sought professional treatment in the past. Although stigma was not a barrier for self-help, alternate barriers were identified. Conclusions: Offering self-help may increase rates of students receiving help for mental health problems, possibly by offering an alternative for students unwilling to seek in-person therapy due to stigma concerns.     

Self-rated health and mortality: does the relationship extend to a low income setting?

Although a relationship between poor self-reported health status and excess mortality risk has been well-established for industrialized countries, almost no research considers developing countries. We use data from Indonesia to show that in a low-income setting, as in more advantaged parts of the world, individuals who perceive their health to be poor are significantly more likely to die in subsequent follow-up periods than their counterparts who view their health as good. This result characterizes both men and women, holds for multiple time periods, and remains after inclusion of measures of nutritional status, physical functioning, symptoms of poor physical health and depression, and hypertension. We also consider the correlates of self-rated health. Symptoms and physical functioning are strong predictors of reporting poor rather than good health, but neither these indicators nor other covariates we consider distinguish between reports of excellent rather than good health.     

Sexual self-concept and sexual self-efficacy in adolescents: a possible clue to promoting sexual health?

This study examined the associations between sexual self-concept (sexual esteem and sexual anxiety) and sexual self-efficacy (situational and resistive) in a sample of 388 high school students (59% Caucasian, 28% African American). Males reported lower sexual esteem and lower sexual self-efficacy than females. Males and African Americans reported higher levels of sexual anxiety and lower levels of resistive self-efficacy than females and Caucasians. In regression models, higher sexual self-esteem uniquely predicted higher sexual self-efficacy scores, even after controlling for demographic variables, knowledge of sexual risk, and previous coital experience. In post hoc analyses, sexual self-esteem mediated the relation between knowledge of sexual risk and both types of sexual self-efficacy. Results suggest the need for interventions to promote male sexual self-efficacy and sexual esteem and the need for longitudinal research that explicates models of sexual health in adolescence.     

Is caring for older parents detrimental to women’s mental health? The role of the European North–South gradient

In the last decades, both the lengthening of life expectancy and an accentuated decline in birth rates have reduced the consistency of the younger generational cohorts. Due to an ageing population, the burden of caregiving is expected to intensify in the next quarter of the century in Europe, especially for mature women. This paper investigates the impact of the provision of constant care for older parents on the mental health of adult daughters, between the ages of 50 and 75, living in different European countries. Data is drawn from the Survey of Health, Ageing and Retirement in Europe. Information on mental health status is provided by Euro-D depression scale, a measure of depression standardized across European countries. We focus on differences in the effects according to the North–South gradient: we test whether the relationship between informal caregiving and mental health differs across European macro-regions. Our results, robust under different specifications of the propensity score model, reveal a clear North–South gradient: the provision of informal care has a negative and significant impact on daughters’ mental health in the Mediterranean countries only, where the amount of resources allocated to the Long Term Care is minimal and the local system of health and social services for the elderly lacks the necessary structures to meet the increasing demand for eldercare.     

Do student service members/veterans experience worse mental health stigma than their peers? A comparative study in a national sample

ABSTRACT

Objectives: Examine differences in mental health treatment-related stigma in student service members and veterans (SSM/Vs) and peers from 57 post-secondary institutions across the United States. Methods: In total, 909 SSM/Vs and 1818 demographically- and institutionally-matched non-SSM/Vs completed assessments of stigma-related barriers to mental health service utilization as part of the Healthy Minds Study between 2011 and 2015. Results: When compared to non-SSM/V peers, SSM/Vs reported more mental health treatment-related stigma toward help-seekers and less confidence in the helpfulness of therapy/counseling and psychotropic medications. However, effect sizes were small in magnitude (ds = .10 to .16), and depressed students in both groups reported greater stigma. Conclusions: SSM/Vs experience greater treatment-related stigma than non-SSM/V peers, which may deter service use in many cases. However, differences in stigma were small and other under-studied barriers to help-seeking may apply to the substantive subset of SSM/Vs and non-SSM/Vs who may benefit from utilizing available services.