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.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

Homeless mothers and depression: misdirected policy.

This paper is a critique of recent service-intensive shelter programs for homeless mothers and the policies that underlie these shelters. We first document the process by which mental health problems and family homelessness became so closely but mistakenly linked. We then demonstrate empirically that shelter programs for homeless families nonetheless presume that mental health problems are part of the causal nexus of family homelessness and indiscriminately deliver mental health services to homeless mothers. Simultaneously, shelter programs encourage the isolation of their residents from what they presume to be their "problematic" social networks. We show that, while mental health services had little impact on depression levels among homeless mothers, isolation from social networks did increase depression among homeless mothers. Our findings suggest that policy should put more emphasis on rapid reintegration into the community through providing housing, and it should put less emphasis on providing services.     

Shared decision making from the service users’ perspective: A narrative study from community mental health centers in northern Norway

This article aims to contribute to the understanding of shared decision making as an important aspect of user involvement in mental health care from the perspectives of service users. A thematic analysis of interviews with 25 individual service users in three different community mental health centers in Norway identified different understandings of shared decision making. Shared decision making was identified as essential in four contexts: 1) during admission, 2) in individualized treatment, 3) in different treatment contexts, and 4) in user-professional relationships. We consider shared decision making to be intertwined with treatment from the service user perspective.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.     

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.     

Costs of Treating Depression With Individual Versus Family Therapy

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost‐effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost‐effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.     

Considering child care and parenting needs in Veterans Affairs mental health services

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans’ access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop “family-friendly” mental health services.     

Institutional contexts and mortality: the case of Peru

Increasingly, attention is being given to institutional contexts to explain differential demographic and health outcomes. Regional inequality in terms of economic development, social institutions, and health services leads to regional disparities in health outcomes, especially infant mortality. The author uses linked data from population and economic censuses, government agencies, and health surveys on 24 Peruvian provinces to explore how differential economic development and institutional contexts influence health outcomes. Regional inequities based on rural population, subsistence activity, women's illiteracy, monthly income, gross domestic product, medical care, and health facilities are compared, with a cluster analysis identifying institutional contexts which have internal similarities. These contexts are able to discriminate differences in infant mortality. The analysis demonstrates that infant mortality in Peru varies systematically with social, economic, and medical contexts. Economic development, income and subsistence levels, women's literacy, and the amount of medical care and public health services influence health outcomes. It is clear that understanding such regional inequities can help explain disparities in health outcomes.     

Outcomes of a randomized trial of continuum of care services for children in a child welfare system

The Connecticut Department of Children and Families Title IV-E waiver demonstration evaluated whether the well-being of children approved for residential mental health services could be improved, and lengths of stay in restrictive placements reduced, by providing case rate payments to community agencies to provide continuum of care services. Children between ages 7 and 15 were randomly assigned to either the demonstration group (n = 78) or to usual state-supported services (n = 79). One-year outcome results indicated that in a situation that is less costly, improvement in outcomes occurred in less restrictive settings. Continuum of care services were more effective in 1) returning children to in-home placements, 2) reducing the length of stay in restrictive placements, and (3) utilizing higher levels of case management through coordination among agencies and family support services.     

Jerk: A Tic-Inspired View of the Self-Determination Paradox in Our Mental Health System

Historically, the mental health field has been dominated by the medical model, placing the “patient” into the backseat of their own treatment. Sometimes this aspect of being controlled can be as hurtful as the out-of-control experience individuals with mental health conditions often face. In recent years, a number of people with mental health conditions have stepped up, showing not only that they can recover but also that they can lead the way in recovery-oriented mental health services. This article provides a commentary on this form of input that is rooted in the author's personal experiences with the system of care.     

Integrated physical and mental health care at a nurse-managed clinic: report from the trenches

The Health and Wellness Center (HWC), located in Joliet, Illinois, is a nurse-managed universally accessible primary health care center funded by a grant from the Health Resources and Services Administration. The goals of the HWC are to improve access to quality primary health care services for all patients, including those who are uninsured and underserved, and to develop and implement a model of nurse-managed primary health care that integrates both physical and mental health assessment and treatment. After 5 years of developing and using this model, it is clear that integration requires strategic supports from the financial, political, and professional sectors to be considered a cost-effective model of health care delivery. Recommendations for policy and practice change are offered based on the author's experiences of providing integrated health care at the HWC and the health care industry's responses to uninsured or underinsured patients' needs.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

Family Intervention and Services for Persons with Mental Illness in the People's Republic of China

ABSTRACT

Family services and intervention for persons with mental illness is crucial in mental health services. In this paper, the writer attempts to describe family intervention and services for persons with mental illness in the People's Republic of China. Family intervention and services like home-based care, guardianship network, family counseling, and psychoeducational programs are only preliminarily developed. Their effectiveness and challenges in future development are discussed.     

Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect

Little research has been conducted among the elderly on the topic of neglect. Not only is there a paucity of research, but also there is the problem of widely varying definitions of neglect. These two challenges led to a study of how neglect is understood by elderly Korean immigrants as it pertains to behaviors of adult children and family members. Interviews with 124 elderly Korean immigrants were conducted to assess conceptualizations of elder neglect. Data were analyzed using a grounded theory approach. Results revealed five interrelated themes with strong connections to dimensions of health and mental health: (a) culture-specific definitions of elder neglect, (b) contexts in which elder neglect occurs, (c) impact of neglect on elders, (d) expectations from adult children, and (e) strategies for dealing with elder neglect. Implications for culturally competent, family-centered service delivery to elderly Korean immigrants are discussed, specifically focusing on service provision of health and mental health care.     

The mental health recovery movement and family therapy, part I: consumer-led reform of services to persons diagnosed with severe mental illness

In 2004, the U.S. Department of Health and Human Services issued a consensus statement on mental health recovery based on the New Freedom Commission's recommendation that public mental health organizations adopt a "recovery" approach to severe and persistent mental illness, including services to those dually diagnosed with mental health and substance abuse issues. By formally adopting and promoting a recovery orientation to severe mental illness, the United States followed suit with other first-world nations that have also adopted this approach based on two decades of research by the World Health Organization. This movement represents a significant paradigm shift in the treatment of severe mental health, a shift that is more closely aligned with the nonpathologizing and strength-based traditions in marriage and family therapy. Furthermore, the recovery movement is the first consumer-led movement to have a transformational effect on professional practice, thus a watershed moment for the field. Part I of this article introduces family therapists to the concept of mental health recovery, providing an overview of its history, key concepts, and practice implications. Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts.