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.     

EDITORIAL

Abstract

Hope is a key construct for successful community adjustment among those with severe mental illnesses, particularly given the strengths-based recovery model increasingly prevalent in mental health services and in social work. Consumer-run mental health self-help agencies (SHAs) are well suited to fostering hope via their supportive program environments. This study examines factors associated with hope among members of four self-help agencies via a two-stage least squares regression model (N =310). Findings provide evidence of both individual and program-level associations with hope. These findings mirror social work ethical values of focusing on consumer strengths and self-determination, which are primary goals of SHAs.     

Acceptance of Online Health Services for Self-Help in the Context of Mental Health: Understanding Young Adults’ Experiences

ABSTRACT

This article explores the understanding of the acceptance of online health services from a self-help perspective in the context of mental health. By examining the experiences of young adults, this article develops a framework to leverage the current understanding of the factors that would support the acceptance and use of these types of services. To this end, a multidisciplinary perspective incorporating knowledge from the service marketing, health, and information systems literature is used. The results suggest that the production of online services that are meant for self-help purposes necessitates a focus on the acceptance of technology and, more importantly, instrumental value creation, as the purpose of using these types of services should be better understood and supported by technological solutions. This study also identifies several technological features supporting both the acceptance of technology and users’ ability to achieve well-being. Furthermore, when developing services for health self-help purposes, the issue of branding to increase acceptance should be assessed. From a user perspective, there appears to be a difference regarding whether the services are positioned as health services or as wellness services.     

Factors contributing to eviction from permanent supportive housing: Lessons from HUD-VASH

IntroductionEviction from housing is associated with several negative outcomes, further exacerbated among high-need populations requiring financial and supportive services to maintain housing stability. This study investigated risk and protective factors—both characteristics and precipitating events of tenant eviction—informing permanent supportive housing (PSH) programs’ efforts to identify tenants at risk and intervene.MethodsUsing administrative data for a cohort of 20,146 Veterans participating in PSH, this study assessed differences in Veterans who exited the program due to eviction and Veterans who exited because they accomplished their goals. A series of logistic regressions identified patterns of health services use that may signal imminent eviction.ResultsVeterans with a drug use disorder and those who received inpatient, emergency, or outpatient care related to mental/behavioral health and substance use conditions proximal to program exit had greater risk for eviction. Receipt of outpatient primary medical care and supportive services was generally protective against eviction. The likelihood of eviction was greatest for Veterans with acute care use within 30 days of exit.DiscussionPSH providers may use these correlates of eviction to identify Veterans in need of an intervention to prevent eviction. Future work should focus on operationalizing these findings and identifying appropriate interventions.     

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.     

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.     

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.     

Use of Various Health Care Services by Students in Helsinki

Abstract

Review of the working of various health care schemes has revealed predominant use by a certain group of “large-scale consumers.” The concomitant use of various services (health, dental, and mental health care) was studied within the Helsinki Health Center of the Finnish Student Health Service from January 1, 1980 to August 31, 1980. The group consisted of 16,174 students. The characteristics of the groups of patients who used only the mental health care service and of those who used all three services were also studied. Within each sector, there were fewer patients than expected who did not use the services of other sectors. The number of patients visiting dental and health care services, mental health and health care services, and all three services were greater than expected. The groups of patients who used only the mental health care service and those who used all three services were surprisingly similar. The greatest difference between the groups probably lay in their need for somatic and dental care. The organization, which incorporates mental health, dental, and health care services in the same building offers improved possibilities for care of the patient as a whole. On the basis of this study, there is no reason to think that such an organization leads to misuse of the various services.     

The Theory of Planned Behavior as it predicts potential intention to seek mental health services for depression among college students

ABSTRACT

Background: Between 9.5% and 31.3% of college students suffer from depression (American college health association national college health assessment II: reference group executive summary spring 2013. Amer. Coll. Health Assoc. 2013; Eagan K, Stolzenberg EB, Ramirez JJ, Aragon, MC, Suchard, RS, Hurtado S. The American freshman: national norms fall 2014. Higher Educ. Res. Inst.; 2015). Universities need to understand the factors that relate to care-seeking behavior. Objective: Across 3 studies, to relate attitudes, social norms, and perceived behavioral control to intention to seek mental health services, and to investigate barriers to care-seeking. Participants: University college students (N = 845, 64% female, 26% male, and 10% unspecified). Methods: New measures were created in Studies 1 and 2, and were examined using structural equation modeling in Study 3. Results: Partially consistent with the Theory of Planned Behavior (Ajzen, I, Fishbein, M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980), a model with an excellent fit revealed that more positive attitudes about care and higher perceived behavioral control directly predicted higher intention to seek mental health services. Conclusions: Educating college students about mental health disorders and treatments, enhancing knowledge about available services, and addressing limited access to long-term care might improve treatment rates for students suffering from depression.     

Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.     

Mental Health Needs Assessment of a Major Urban University

Abstract

A questionnaire surveying mental health needs was administered in class to 1,412 Virginia Commonwealth University (VCU) students, and a service utilization questionnaire was administered to 154 students applying for mental health services at four campus-based agencies. The nature of the specific problems of concern to students tended to remain stable over the course of a semester. Study habits and grades was the most frequently cited problem area on the needs survey, though help was sought most frequently for physically oriented concerns. Students lacking important sources of social support reported the most difficulties. Students who sought help had more problems and higher levels of concern than those not seeking help. A comparison of the two data sources indicated a slight but significant tendency for agencies to deal with the greatest areas of need at the severity levels indicated in the needs survey.     

Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

The dual role of the action researcher

This article aims to provide more insight into advantages and challenges of conducting action research with the intention to improve health care. Action research is distinctive in the sense that the researcher has a dual role as both researcher and implementer of the program studied. The article is based on two Norwegian action-oriented studies that aimed to explore the potential role of online self-help groups for breast cancer patients and adolescents with mentally ill parents respectively. We argue that action research can contribute both to the generation of knowledge, as well as a greater sense of ownership to the program among those who are intended to use it. Nonetheless, a potential conflict between the researcher's pursuit of data, and ethical considerations became apparent in the contexts studied here. Bearing these challenges in mind, we still conclude that action research offers an important contribution for the further development of health care services.     

Co-Occurring Disorders Among Jail Inmates: Bridging the Treatment Gap

ABSTRACT

This paper presents findings based on a retrospective review of health and mental health records of 359 mentally ill jail inmates. Regardless of demographic group, substance-related disorders are the most prevalent disorder. Sixty-seven percent of the sample had a substance-related disorder, 37% an adjustment disorder, 23% a mood disorder, and 12% had schizophrenia or another psychotic disorder. Comorbidity was extensive with close to 45% of the sample having both a substance-related disorder and an additional major mental illness. Study findings indicate that there is a great need to strengthen services and create jail-community linkages for inmates with comorbid mental health and substance abuse disorders. Innovative program and resource information are provided.     

Program evaluation of trauma-informed yoga for vulnerable populations

BackgroundTrauma is highly prevalent among vulnerable populations, including those who are incarcerated, in treatment for substance use, or seeking mental health services. Trauma-informed yoga seeks to create a safer yoga practice for individuals with a trauma history and may improve emotional and physical wellbeing. Thus, we conducted an evaluation of a trauma-informed yoga program to gain insight into participant experiences.MethodsTrauma-informed yoga classes were led by trained volunteers and held in three sectors that work with vulnerable populations: corrections and reentry, substance use treatment and recovery, and community and mental health. Data were collected via anonymous survey using a retrospective pre-post design. The survey instrument captured reasons for student participation and perceived effects of yoga on emotional and physical wellbeing.ResultsStudents were motivated to participate in yoga classes by expectations of physical, mental, and spiritual benefit. Students reported perceived improvements in emotional and physical wellbeing and greater use of self-regulation skills after starting yoga.ConclusionOur findings suggest trauma-informed yoga is perceived as beneficial by vulnerable individuals, especially those in the correctional system or recovering from substance use. Our results support the value of offering trauma-informed yoga in institutionalized and community settings. Improvements in emotional and physical wellbeing warrant formal study.     

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.     

Factors Associated with Drug Treatment Entry Patterns Among Hispanic Women Injection Drug Users Seeking Treatment

SUMMARY

This paper examines patterns of drug treatment entry and factors that are associated with these patterns among 1,849 Hispanic women injection drug users (IDUs). The data analyzed originates from a statewide drug-treatment database covering seven years, 1996–2002. Through the use of logistic regression analyses, the study identified significant differences in predisposing, need and enabling factors in the use of detoxification only, residential treatment, or methadone maintenance. Compared to other Hispanics, Puerto Rican women were 40 percent less likely to use only detoxification services and one and a half times more likely to use methadone maintenance. Having health insurance was an especially important factor associated with methadone treatment utilization. Two of the most important factors associated with residential treatment use were history of mental health services utilization and involvement with the criminal justice system. This article discusses specific social work practice implications including the need for social work practitioners to promote services such as residential treatment, to be trained in treatment of co-occurring mental health disorders, especially among women in residential treatment, and the need to establish close linkages with the mental health and criminal justice systems.     

An interprofessional internship model for training master’s level social work and counseling students in higher education settings

ABSTRACT

The mental health needs of college students are steadily on the rise, which compels mental health service providers and educators to explore innovative ways to provide more collaborative, supportive, and interdisciplinary service models of practice and professional training. Graduate programs in social work and counseling are at the crux of producing internship training programs to help accommodate the influx of students with persistent mental health concerns across a variety of needs and cultures. This article describes an interprofessional internship program structured and designed to meet the clinical training needs of master’s level students matriculating in social work and counseling who aspire to provide mental health services in higher education settings. The interprofessional internship training model proposes an innovative interdisciplinary approach to field education which may result in positive training outcomes and learning experiences for social work and counseling students. This paper discusses the model’s emphasis on individual and interdisciplinary group supervision, objectives of the internship experience, internship site criteria, and professional and personal benefits to pre-service social workers and counselors. Recommendations for training and limitations of the model are provided.     

From Fragmentation to Integration

Abstract

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.     

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.