Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

Personal control and service connection as paths to improved mental health and exiting homelessness among severely marginalized homeless youth

ObjectiveNon-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes.MethodSeventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline.ResultsPersonal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health.ConclusionsThis study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.     

Mental health services for children and caregivers remaining at home after suspected maltreatment

ObjectiveBehavioral problems are common among children remaining at home after suspected maltreatment, but the effectiveness of current mental health services to improve these behavioral problems is unknown. The objective was to determine whether receipt of child and caregiver mental health services was associated with improvements in behavioral problems in maltreated children remaining at home.MethodsWe retrospectively analyzed Second National Survey of Child and Adolescent Well-being data. We included 1117 children ages 2–17 remaining at home after a maltreatment investigation, excluding children with missing outcome, covariate, or survey weight data. We compared mean Child Behavioral Checklist (CBCL) change scores from baseline to 18 months between children who did and did not receive mental health services, before and after adjusting for child, caregiver, and child welfare agency factors using survey-weighted linear regression.ResultsNearly one-quarter (22.6%) of children and 16.0% of caregivers received mental health services. Children receiving services had worse unadjusted baseline and 18-month CBCL scores than children not receiving services (all P < 0.001). Adjusted CBCL change scores revealed behavioral worsening among children receiving services but improvement among children not receiving services (all P < 0.001). However, children had improved behavior, regardless of their own service receipt, if their caregivers received services and reported an absence of depression at 18 months.ConclusionsChildren receiving mental health services had worse behavioral changes than children not receiving services. Caregiver receipt of services was associated with improved child behavior, suggesting that a family-centered approach may be most influential in improving behavioral outcomes among this population.     

Engagement in Mental Health Treatment Among Adolescents and Young Adults: A Systematic Review

The purpose of the present study is to review empirical evidence of the effects of interventions designed to improve engagement in mental health services among adolescents, young adults and their families. Investigators searched relevant databases, prior reviews, and conducted hand searches for intervention studies that met the following criteria: (1) examined engagement in mental health services; (2) included a comparison condition; and (3) focused on adolescents and/or young adults. Effect sizes for all reported outcomes were calculated. Thirteen studies met inclusion criteria. Conceptualizations of engagement and measurement approaches varied throughout studies. Approaches to improving engagement varied in effectiveness based on level of intervention. Individual level approaches improved attendance during the initial stage of treatment. While family level engagement interventions increased initial attendance rates, the impact did not extend to the ongoing use of services, whereas service delivery level interventions were more effective at improving ongoing engagement. The review illuminated that engagement interventions framed in an ecological model may be most effective at facilitating engagement. Implications for future research and practice are discussed.     

Using social support for LGBTQ clients with mental illness to be out of the closet,in treatment,and in the community

ABSTRACT

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are often faced with societal challenges that can lead to mental health or substance abuse issues. They may be misunderstood or mistreated when seeking services because of a lack of training in offering culturally sensitive treatment by service providers. A program, the Rainbow Heights Club, was developed to support LGBTQ individuals with a mental health diagnosis. All of the members are in treatment for their mental health and/or substance abuse problems, but prior to the development of the program did not have a place to feel accepted, supported, or have a sense of community. Members were surveyed determine if Rainbow Heights was helpful in maintaining themselves in the community. Results indicated that 75% of members are more consistent in following prescribed treatments, keeping them free from inpatient hospitalization, and 79% reported being clean and sober since coming to the Club.     

Perceived barriers to mental health treatment among men enrolled in a responsible fatherhood program

ABSTRACT

Low-income men may experience elevated risk for mental health concerns and be less likely to seek treatment; this may be due in part to perceived barriers to accessing and receiving treatment. Men who enrolled in a community based responsible fatherhood program self-identified their health and mental health conditions. Although participants reported serious health conditions at rates consistent with the general population, we found higher than expected rates of depression, anxiety, or other mental health conditions and explored perceived barriers to mental health treatment among this sample. Findings suggest that low income men face a variety of perceived psychosocial and structural barriers impacting access to and compliance with mental health treatment.     

The Mark of Madness

Abstract

Stigma is a major barrier to recovery for individuals with mental illnesses. It interferes with community living and attainment of resources and goals and damages self-esteem and self-efficacy. Given that social workers provide much of the mental health care to individuals with mental illnesses, and that actions to reduce stigma support the social justice mission of social work, addressing stigma should be a focus of social work interventions. The goals of this paper are to explore stigma theory in general and for individuals with serious mental illnesses, discuss the implications of this stigma analysis for social work, and make recommendations for action in both practice and research.     

Reflections of the Annual Meeting

Abstract

In preparation for planning counseling and mental health services at Columbia University, the authors conducted a mental health needs assessment survey that sampled representative numbers of students. Respondents were most concerned about academic and school-related issues, followed by concerns in the area of love relationships. Multiple regression analysis revealed certain subgroups that were more likely to have these concerns and certain health and mental health problems that were significantly associated with these concerns. The study identified serious psychological problems, including suicidal/homicidal thoughts and sexual abuse, and surveyed respondents' treatment preferences. Finally, the authors discuss how the study findings contributed to sharpening and expanding focus on different aspects of program development in the collaboration between mental health and health education.     

Family interventions in early psychosis service delivery: A systematized review

The objective of this study was to explore the development of family intervention in an early psychosis context. The role played by family members and friends in the recovery of individuals with early psychosis is extremely important, and there is a growing body of literature that reflects this. However, how mental health services can best support and utilize family and friends as a core component in recovery from early psychosis is not yet established. The methodology entailed a systematic review of the international literature. Results from the current review highlight the principles of family engagement, its effectiveness to enhance service user outcomes, the need to differentiate early psychosis psycho-education from that provided in enduring illness, and challenges in implementation. The number of studies generally, and the number explicitly articulating and trialling family interventions being used in practice, are limited. This seems to highlight that—although practice guidelines acknowledge the importance of family support—there are challenges in implementation of evidence-based practice principles in this area. Changes in policy and service delivery are recommended for programs and services to better achieve family-sensitive and family-inclusive practice as core business in mental health service delivery.     

The Power of Peer Support: The Development of the Empowerment Center

ABSTRACT

This article discusses the events and influences that led to the author’s contribution to the development of a mental health consumer-run organization, The Empowerment Center in Mount Vernon, NY. The author traces some events that influenced him personally and the evolution of the Empowerment Center from an organization that provided advocacy services (to those with mental health problems who were hospitalized) and community-based support services to people in mental health recovery, to an organization focusing on economic empowerment and economic development for the community of those in recovery. The transition of the Empowerment Center into an organization focused on economic empowerment underscores the importance of economic independence for people in recovery and the consumer-run organizations that support them. The Empowerment Center endeavors to demonstrate that mental health consumer-survivors can take control of their economic health as well as their physical and mental health.     

Peer Support Among Consumers of Professional Mental Health Services

ABSTRACT

Peer-support services have become increasingly prevalent in mental health; consumers now deliver many services once provided by professional mental health providers. Recognizing this key asset in mental health consumers' service environment is critical for social workers. This exploratory study examines differences among 311 consumers of professional mental health services, half of whom also used peer-support services. The two groups (peer support compared with non-peer-support) were compared on a number of dimensions related to their utilization of and satisfaction with professional mental health services. Users of peer-support services perceived greater availability of professional services and used more professional services, but found professional services to be less useful than those not participating in peer support. No differences between the two groups were found for overall satisfaction with professional services. Findings related to policy, practice, and research are discussed.     

Experiences of volunteering: A partnership between service users and a mental health service in the UK

The aim of the study was to investigate how people with serious mental illness perceived the experience of volunteering for the health care organisation in which they had received a service. The study took a qualitative approach and in phase one, eleven service user volunteers were purposefully sampled and interviewed. In depth interviews were analysed using grounded theory. This paper describes the findings from phase one, and highlights the following themes to represent the volunteering experience: 1) rehearsing for a new direction; 2) treading carefully at first; 3) discovering my new self; and, 4) using my experience and extending relationships. These themes further support a tentative theoretical framework that considers supported volunteering to enhance recovery because it fosters positive risk taking and gives individuals a valued identity that integrates their mental health experience. In phase two, this framework will be tested with service users in more diverse volunteer positions. The findings of my study suggest that mental health services are in a unique position to build partnerships with service users to support their recovery and journeys toward employment by providing opportunities for volunteering.     

Asian Americans and Mental Health Services

Abstract

Research in the 1970s and 1980s revealed that Asian Americans, compared with other ethnic groups, tended to under-utilize mental health services. This article is aimed at adding new information to the literature by examining data from the 1990s. The raw data comprised 97,212 total admissions representing 45,774 total individuals utilizing mental health services during a four-year period in San Diego County, California. By comparing our findings with previous research cases on utilization patterns of mental health services, new evidence is found about Asian Americans in terms of their (1) underrepresentation in mental health services, (2) presentation of more severe symptoms than those of other racial/ethnic groups when first seen at clinics, (3) lower dropout rates and higher average lengths of stay than other racial/ethnic groups, and (4) higher percentages of using day treatment and outpatient programs but lower percentage of using inpatient programs.     

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.     

Are case management services associated with increased utilization of adolescent mental health treatment?

Retention in treatment is one of the strongest predictors of positive mental health outcomes. Adolescents, however, are particularly challenging to retain in mental health treatment. Concurrent case management services may offer one strategy for retaining youth in mental health treatment as it aims to reduce barriers to services, coordinate multiple services, and establish a consistent relationship between each client and a single contact person. This study combines three extant data sources from the state of Kansas to examine whether youths' participation in case management is associated with increased utilization of individual and group mental health treatment, controlling for client satisfaction, severity of mental health symptoms, and demographic factors. Linear regression results indicate that participation in case management services predicts increased utilization of both individual and group mental health treatment. Case management may be a useful tool for retaining adolescent clients in mental health services. Practical implications for community mental health service delivery are discussed.     

Internet-Based Delivery of Cognitive Behaviour Therapy Compared to Monitoring,Feedback and Support for Problem Gambling: A Randomised Controlled Trial

The aim of this study was to investigate the efficacy of an Internet-based cognitive behavioural therapy program (I-CBT) for the treatment of problem gambling, when compared to a waitlist control and an active comparison condition consisting of monitoring, feedback, and support (I-MFS). Participants (N = 174) were randomly allocated to the three conditions. Variables of interest were gambling outcome and related mental health measures. Participants in the active conditions (I-CBT and I-MFS) completed six online modules. Both I-CBT and I-MFS conditions resulted in significant treatment gains on gambling severity. However, I-CBT was also associated with reductions in a range of other gambling-related and mental health outcomes. Compared with I-MFS, I-CBT produced greater effects across seven outcomes measures, relating to gambling urges, cognitions, stress, and life satisfaction. I-CBT participants also rated the program as significantly more satisfactory. Treatment gains observed for both active conditions were found to be stable through to 12 month follow up. The results indicate that the benefits of I-CBT were more than simply the non-specific effects of engaging in online treatment or receiving motivation, feedback, and support. Online treatments for gambling may be a valuable tool in increasing help-seeking and treatment engagement in this population, and be integrated as part of stepped care approaches to treatment.     

The case for mandatory outpatient treatment

Research on the effectiveness of mandatory outpatient treatment, which is court-ordered mental health follow up, supports its use with individuals who have serious mental illness. Many states already have some kind of mandatory outpatient treatment in place, but it is often underused. Much of the criticism of mandatory outpatient treatment is based on the fact that research demonstrating its efficacy is limited and that its implementation infringes on individuals' rights. However, sufficient evidence can be found in the literature to support its use for some individuals with chronic mental illness living in the community. In addition, the ethical principles of beneficence, utilitarianism, and communitarianism support its use in some situations. Mandatory outpatient treatment is an ethical and effective method shown to be helpful with individuals who have mental illness and are nonadherent to treatment. Expanding its use in appropriate situations is in the best interest of those with serious mental illness and society in general.     

Medicare Funded Mental Health Social Work: Better Access to What?

ABSTRACT

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative (Better Access), is an Australian Federal Government scheme aiming to improve access to mental health services. Accredited mental health social workers have been involved in the delivery of services under Better Access for more than a decade. In this time, there have been significant changes in the field of mental health services, with consequent increases in size and costs for Better Access. Better Access now represents public spending of more than one billion dollars per annum, yet there is no ongoing account of its impact. In this paper we consider the policy chronology and evaluation of the program, using current available data to question the impact of Better Access on both the service system and the nature of mental health social work practice. This case highlights the importance of a clear articulation of the scope of mental health social work, and ongoing monitoring of the impact of policy in a policy environment increasingly characterised by individualised funding and service delivery structured according to the principles of New Public Management.

IMPLICATIONS

• Social workers' increasing involvement with Better Access has reshaped the scope of mental health social work practice.

• The impact of Better Access on outcomes for service users and mental health social work is not currently a focus of research attention.

• Better Access is a case study illustrating the potential of the policy context to directly shape social work practice, therefore critical engagement with the impact of Better Access is an essential professional imperative.

     

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.