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.     

Treatment of late-life mental disorders in primary care: we can do a better job

Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.     

One hundred years of college mental health

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.     

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.     

Referrals, language proficiency, and enrolment for children's mental health services

Alberta Health Services maintains a database of children, adolescents and adults referred to the child and adolescent mental health and psychiatry intake service. In this study, we sought to systematically assess the impact, if any, of English language proficiency on enrolment of children for mental health services. Specifically, we assessed the extent to which children referred for mental health services were enrolled. In doing so, we categorized our sample (12,143) as English Proficient (EP), or Less English Proficient (LEP). Overall, we found that LEP children were significantly less likely to be enrolled compared to EP children. This disparity in enrolment was only present when other variables were not taken into account. English Proficiency is an important factor for some subgroups.     

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.     

Developing Advanced Practitioners in Mental Health Social Work: Pedagogical Considerations

Advanced social work practitioners in mental health services daily face the challenges of working alongside the more powerful professions of psychiatry and psychology. Advanced post-qualifying programmes in mental health social work equip practitioners with the knowledge, skills and expertise to confidently work alongside both psychiatrists and clinical psychologists in multi-disciplinary teams. This includes training in empirical research methods, which are used to develop the evidence base for psychiatry and psychology, although social work practitioners find this particularly challenging. This paper explores the importance of research methods teaching in the development of advanced practitioners in mental health social work. Using learning theory to explore possible reasons why practitioners find it so difficult, it offers some solutions which may enhance the learning and teaching of research methodology to experienced social workers.     

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.     

Demographic and Organizational Variables That Affect Southeastern College and University Student Health Promotion

Abstract

This study examined the relationship between demographic and organizational variables and college student health promotion efforts. Two hundred and forty-one college administrators from 14 southern states were surveyed to determine factors that may affect college student health promotion programming. Enrollment, tuition, affiliation, and highest degree offered were the demographic variables that were examined. The organizational variables were goals, control, motivation, interaction, and decision making. The methods of gathering information regarding student health problems, the kinds of health promotion programs offered, the methods of publicizing the programs, and the extent of student participation in health promotion programs were the dependent variables.

The statistical tests for the effects of the demographic and organizational variables on student health promotion efforts indicate that a relationship does exist. Combined multiple regression analysis equations that include all of the organizational variables demonstrated graphically the effects of interaction among the independent organizational variables and the dependent variables. These combined equations were better predictors of student health promotion programs and services than any of the organizational variables taken separately. Future studies of the factors that affect student participation in health promotion programs, the extent of student participation, and the effects of a student participation should be conducted.     

Family Therapy in Child and Adolescent Mental Health Practice: Integrating Family Therapy in Child and Adolescent Mental Health Practice: An Ethic of Hospitality

This article integrates family therapy in contemporary child and adolescent mental health services as an evidence‐based practice. An integrative practice model is proposed where contextual approaches like systemic and narrative therapy complement and enrich individual problem‐focused models such as biological psychiatry and cognitive therapy. This is based on an ethic of hospitality towards all therapy discourses and the following best practice guideline: ‘To make optimum space for a systemic and narrative understanding contributes to evidence‐based practice in a contemporary mental health service.’ After discussing some dilemmas of integrative practice, I illustrate the therapeutic process by a detailed example of integrative family therapy with a depressed suicidal adolescent.     

Motivations to Pursue Accreditation in Children's Mental Health Care: A Multiple Case Study

Accreditation is a growing, worldwide phenomenon that has spread to a range of industries and fields, including nonprofit social services and mental health care. Thousands of organizations are accredited, but it is not known what is driving the growth of this phenomenon. Using a multiple case study design, this exploratory study aimed to understand children's mental health agencies' motivations to pursue accreditation. In‐depth interviews, focus groups, document reviews, and limited observations were conducted at five children's mental health agencies that had recently undergone or were undergoing the Council on Accreditation process. Agencies were influenced by external factors, such as policies that require accreditation, wanting to assert their positions in the field, and the need to increase funding opportunities. Other factors were internal, related to agency leadership using accreditation as a platform for change and agencies' genuine intent to improve services. Implications for agencies, accreditors, and future research are offered.     

Family Grief and Mental Health: A Systemic,Contextual and Compassionate Analysis

Although not always named, grief is central to the experience of mental illness — for people diagnosed, their families and their friends. Yet grief is almost absent from the literature and practice of mainstream psychiatry. This curious fact led to the writing of this article by two workers and a carer, with editorial and political advice from a consumer, as a small step in the direction of integrating perspectives of workers, carers and consumers. It examines the nature of grief associated with mental illness, its impact on family members, and why mainstream mental health services do not directly address it, with suggestions for some therapeutic ways to conceptualise and work with it.     

Pediatricians could help SUD workforce by using SBIRT

Most studies on the use of screening, brief intervention and referral to treatment (SBIRT), a primary care model for screening and prevention of substance use, in adolescents have looked only at outcomes related to substance use. But SBIRT can also affect use of medical services, as well as comorbidities. Researchers found that SBIRT does reduce psychiatry visits, mental health diagnoses and chronic conditions at one and three years following the intervention. Ultimately, providing SBIRT in primary care may reduce utilization in other areas of health care later on, researchers write in the May issue of Pediatrics.     

'In the real world we're all put on the spot at some time or other,so you need to be prepared for it': An exploratory study of an oral method of assessing knowledge of mental health law

The education and training of Approved Social Workers (ASWs) involves at least 60 days of college and practice-based learning. A major component of the college-based curriculum is the teaching and assessment of knowledge of mental health law. One programme in England assesses student knowledge of law by an oral examination that includes a case discussion and questions about the Mental Health Act 1983. Oral assessment of knowledge of law is commonplace for those entering legal professions. Oral assessment of clinical knowledge in professions such as medicine and psychiatry is similarly frequent. However, examination by oral assessment is not usual in social work education. An exploratory study by postal questionnaire of all past students of the programme and their line managers was undertaken to establish their views of this means of assessing knowledge of law. This paper considers the results of the research and outlines student perceptions of the law oral assessment as preparation for practice as an ASW. The paper focuses on three distinct but interlinked areas--education, assessment and practice--and suggests some implications for educators and practitioners, which are especially relevant in the light of the current review of mental health legislation.     

Identified Problems and Service Utilization Patterns Among Kinship Families Accessing Mental Health Services

Abstract

This study examined the mental health problems and service utilization patterns of kinship families who accessed services in an urban outpatient child psychiatry clinic. A random sample of children who completed the intake process during a calendar year yielded 47 children, or 19% of the sample, whose primary caregiver was a relative, other than a biological parent; approximately half of those families were involved with the child welfare system. Data from an administrative database and from medical records describe the diagnoses, identified problems, and services used by the kinship families. Academic or school-related problems emerged as an identified problem in approximately half of the kinship cases, but school intervention was not a primary target for clinicians. The kinship sample was also compared with a random stratified sample of children who were living with primary caregivers other than kin. Kinship families were more likely to be African-American, but few differences were found between kin and non-kin cases on diagnoses and frequency, duration, or type of services received. The findings suggest that collaboration with schools might increase the engagement and retention of kinship families in mental health services.     

The status of nutrition education in ACHA college and university health centers.

An assessment of the prevalence and scope of nutrition services offered through 208 randomly selected American College Health Association member student health centers revealed that 79% of the 160 respondents provided some type of nutrition education for students. One-to-one counseling, available at 96% of the institutions, was the most common approach. The larger the school's enrollment, the more likely it was to provide programs in nutrition. All of the institutions with student populations of more than 35,000 offered some type of nutrition service, as did 52% of the 19 schools with enrollments between 2,000 and 5,000. Health educators, nurses, doctors, dietitians, and trained peer educators provided the services, with registered dietitians the most common providers and often coordinators of the programs. Costs to students for nutrition interventions were nominal; weight-management programs were the most expensive and showed the greatest variation in content.     

Issues in mental health care benefits: the costs of mental health parity

This Issue Brief discusses issues in mental health care benefits. It describes the current state of employment-based mental health benefits and discusses studies and issues regarding full mental health parity. It also includes an analysis of the effect of full mental parity on the uninsured population and the effects of the limited mental health parity provision contained in the VA-HUD appropriations bill. The final section discusses the implications of mental health parity for health plans and health insurers. When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable. The general strategies employers have used to manage their health care costs are cost sharing, utilization review, managed care, and the packaging of provider services. Employers' cost management strategies may be restricted, however. Five states have mental health parity laws, but three of the states--Rhode Island, Maine, and New Hampshire--apply these laws only to the seriously mentally ill. In addition, 31 states mandate that mental health benefits be provided. However, state mandates apply only to insured plans, not to self-insured employer plans, which are exempt from state regulation of health plans under the Employee Retirement Income Security Act of 1974 (ERISA). A number of recent studies have examined the effect of mental health parity on health insurance premiums in a "typical" preferred provider organization and on the uninsured. In general, the studies concluded that mental health parity could increase health insurance premiums, decrease health insurance coverage for non-mental health related illnesses, and increase the number of uninsured individuals. All studies of mental health parity, and mandated benefits in general, assume that there is a strong likelihood that increased health benefit costs would be passed along to workers in the form of higher cost sharing for health insurance, lower wage growth, or lower growth in other employee benefits.