Nursing home admissions and long-stay conversions among persons with and without serious mental illness

The appropriateness of nursing homes for individuals with serious mental illness remains a controversial issue in long-term care policy more than a decade since the landmark U.S. Supreme Court Olmstead decision in 1999 , which affirmed the rights of persons with disabilities to live in their communities. Using national nursing home Minimum Data Set assessments from 2005, the authors compared the demographic, clinical, and functional characteristics of persons with and without serious mental illness newly admitted to nursing homes. They found that newly admitted people with serious mental illness were younger and more likely to become long-stay residents than those admitted with other conditions, despite a higher proportion of residents with serious mental illness, including the elderly, classified as low-care status. The most substantial and clinically significant difference for rates of low-care status 90 days after initial admission are for persons younger than 65 with serious mental illness versus those younger than 65 without serious mental illness (33% vs. 8.5%, or 3.9 times greater). There is a notable difference in low-care status between persons aged 65 and older with serious mental illness and those aged 65 and older without serious mental illness (14% vs. 6.6%, or 2.1 times greater). These results suggest that a substantial number of adults with serious mental illness residing in nursing homes may have the functional capacity to live in less restrictive environments.     

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under Medicaid.     

Commentary: the forgotten older adult with serious mental illness: the final challenge in achieving the promise of Olmstead?

Older adults with serious mental illness disproportionately reside in nursing homes despite the U.S. Supreme Court Olmstead decision supporting the rights of persons with disabilities to benefit from integrated services in the community. This commentary addresses the neglected policy debate on implementing Olmstead for this rapidly growing, older population with special needs. First, the author describes research findings on older adults with serious mental illness living in nursing homes who might more appropriately reside and receive services in the community. Second, the author summarizes the evidence base for effective psychosocial rehabilitation interventions and services facilitating independent living in community settings for this subgroup. Finally, he concludes with seven policy recommendations aimed at advancing the promise of the Olmstead decision with respect to older adults with serious mental illness.     

Social Enterprise in Mental Health: An Overview

ABSTRACT

This article provides an overview of the models and concepts of social enterprise utilized for and by people with serious mental illness histories. Although social enterprise in mental health is not new, the naming of it as social enterprise and the attention these efforts have garnered is new. This article will provide a brief history of social enterprise in formal social services; review some conceptual issues and differences between social enterprise in Europe and North America—the two major current centers of its activity; and conclude with some observations of the ways in which mental health social enterprises are developing.     

The Social Relationships and Social Support of Aging Mothers Whose Adult Daughters Are Mentally Ill

Guided by a conceptual framework highlighting multiple facets of social relationships and social support, this study examined the extent to which aging mothers of adult daughters with a serious mental illness were socially integrated with members of their network. It further examined the relational content of these mothers’ social ties as tangible or intangible support and the nature of their supportive exchanges with network members, particularly their adult daughters with mental illness. A structured face-to-face interview was conducted with 22 aging mothers of these adult daughters. Two methods of analysis were used to analyze data: counting and content analysis. Findings showed aging mothers of daughters with mental illness were socially integrated with relatives and nonrelatives, evidenced relational content of tangible and intangible support in their social ties and engaged in bidirectional and asymmetrical support exchanges with network members, including their daughters with mental illness. These findings suggest that social resources in the form of social relationships and support are embedded in the networks of aging mothers who have adult daughters with serious mental illness. Practitioners should assess support contributions to the aging mothers of adult daughters with serious mental illness from a wide range of social relationships including their daughters.     

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al., 1994) and the Indiana Mental Health Services and HIV Risk Study (Wright, 2003). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HIV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.     

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al, 1994) and the Indiana Mental Health Services and HTV Risk Study (Wright, 1999). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations’ and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HFV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.     

The variation in family background amongst young homeless shelter users in Denmark

This article analyses variation in the family background of young homeless people in a cohort of young Danes. The study is based on administrative data for individuals who were 18 years old in 2007 and their parents. Homelessness is measured by shelter use over a five-year period. Data also cover education, employment, mental illness, substance abuse problems and placement outside home in childhood for the young persons, and education, employment, civil status, mental illness and substance abuse problems for their parents. A cluster analysis identifies two groups, each comprising half of the young shelter users. In the first group, social marginalisation is transmitted between generations, as most parents have low education and mental illness or substance abuse problems, and are unemployed. In contrast, the young people in the second group come from wider socioeconomic backgrounds, with few of their parents having mental illness or substance abuse problems. These young people develop psychosocial problems and become homeless without strong predictors from their family background. Amongst the young shelter users from families with severe social problems a higher share are in the Not in Education, Employment or Training group. They also have more shelter stays, compared to young shelter users from families with fewer social problems.     

Social class, mental illness, and social mobility: the social selection-drift hypothesis for serious mental illness

The assumptions and methods of previous studies of the social selection-drift hypothesis for serious mental illness are examined by using comtemporary log-linear methods for social mobility analysis. The null hypothesis of no difference in intergenerational social mobility between seriously mentally ill and general population control groups cannot be rejected in previous studies by Birtchnell (1971), Goldberg and Morrison (1963), Langner and Michael (1963), and Turner and Wagenfeld (1967). The findings of this study suggest that previous empirical support for intergenerational social mobility differences is an artifact of not controlling for group differences in origins and destinations when collapsed origin-by-destination tables are analyzed. This study suggests that intergenerational social mobility differences between seriously mentally ill and general population groups in previous studies provide very little, if any, empirical support for social selection-drift processes in serious mental illness.     

Influence of Caregiver Substance Dependence and Serious Mental Illness on Children’s Mental Health: Moderating Effects of Social Support

This study examined the relationships between caregiver alcohol dependence, drug dependence, and serious mental illness and internalizing and externalizing behaviors and whether these risks were moderated by social support. The study included 3,225 children ages 2–17 and their current caregivers, who participated in the second cohort of the National Survey on Child and Adolescent Well-Being. Regression analysis indicated that caregiver alcohol dependence, serious mental illness, and social support were significantly associated with internalizing behaviors and caregiver serious mental illness and social support were significantly associated with externalizing behaviors. Results indicated that social support moderated the associations between caregiver alcohol dependence and internalizing and caregiver drug dependence and externalizing behaviors. Implications for practice and future research are discussed.     

Social Work Students’ Interest in Working with Persons with Serious Mental Illness

Educating and recruiting practitioners to work in community-based settings with persons with serious mental illness has become a national health issue, particularly in underserved rural areas. To inform curriculum development and recruitment efforts, the authors conducted a needs assessment. Graduate and undergraduate social work students in a rural New England state university were surveyed about their interest, perceived competence, and perceived training needs in working with persons with serious mental illness. The findings indicated that almost half of the students expressed an interest in working with this population. The extent and nature of previous work with this population and educational level were shown to be related to students’ responses, in areas including interest in work with persons with serious mental illness and the perceived ability to handle a psychiatric crisis. The findings suggest important implications for the social work curriculum, additional needs assessment, and recruitment activity.     

Mental illness etiology beliefs among African American men with serious mental illness and their social support networks

Semi-structured qualitative interviews were conducted with 26 African American men with serious mental illness who were consumers of community mental health services and 26 members of their social support networks. All participants were asked what they believed had caused the consumers’ mental illness. Consumer participants most commonly identified chronic life stressors as a causal factor, while social supports most often identified intrinsic factors such as genetics or biology as causes of mental illness. Some support participants believed that unintentional drug use had precipitated the onset of mental illness or had no causal theories. The fact that some support participants could not identify a causal explanation may indicate failure on the part of mental health care systems to engage with consumers’ social support networks and provide education about mental illness and its causes. The implications of etiology beliefs on mental health service utilization are discussed.     

Police encounters among a community sample of children and youth accessing mental health services

Generally, within the Canadian context, scholarship on police encounters with persons living with mental illness has focused on the experiences of adults and not children and youth. In this article, we present preliminary work of a secondary data analysis of intake statistics collected over a 5-year period (2009–2014) and a thematic content analysis of qualitative intake notes collected over a 2-year period (2009–2011) about police involvement among a community sample of children and youth accessing mental health services. Of 8,920 intakes completed, 1,449 children and youth, birth to 24 years old, had had police involvement at the time of accessing mental health services. Over the 5 years, the average number of young people with police involvement at the time of accessing mental health services was 16%, or one in six children and youth. Analysis of the qualitative intake notes revealed two main reasons for police involvement: (1) support in the home for a distressed child, and (2) concerns about a child’s conduct and behaviors in the community. The implications for social work practice and future research are discussed.     

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.     

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.     

Forensic Patients and Forensic Mental Health in Victoria: Legal Context,Clinical Pathways,and Practice Challenges

Forensic mental health services in Australia have evolved and developed considerably over the past two decades. To clinicians unfamiliar with them, the contemporary practice environments in which professionals deliver specialised forensic mental health services and the legislation governing offenders with a mental illness can appear extremely complex. This article outlines the legislation applying to individuals found not guilty of a serious offence on the grounds of mental impairment in the State of Victoria, describes the characteristics of the forensic patient population, and delineates the clinical pathway forensic patients typically take, using an illustrative case example. The competencies and attributes required by forensic practitioners are highlighted, along with the clinical challenges they face, including the inherent need to address risk in a service that has become recovery-focused in orientation. A central theme of the discussion is how social workers adapt their practice within these highly regulated settings to effectively meet forensic patients' needs.     

Mental disorders among non-elderly nursing home residents

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nation's youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Mental Disorders Among Non-Elderly Nursing Home Residents

Many Medicaid beneficiaries aged 22 to 64 with serious mental illness may be admitted to nursing facilities rather than psychiatric facilities as a result of Medicaid policies prohibiting coverage of inpatient psychiatric care in institutions of mental disease while requiring states to cover nursing facility care. Using nationwide Medicaid Analytic Extract claims from 2002, we found that nearly 16% of nursing home residents aged 22 to 64 had a diagnosed mental disorder, while 45.5% received antipsychotic medication, but these rates varied widely across states. Further research is necessary to determine whether, among the nation's youngest nursing home residents, care in nursing homes is potentially substituting for care in institutions for mental disease or community-based settings.     

The family caregiving context among adults with disabilities: A review of the research on developmental disabilities,serious mental illness,and traumatic brain injury

ABSTRACT

A majority of adults with serious disabilities are cared for in the home by family members. Guided by an ecological framework, this article presents the findings of a literature review of research on family caregiving and family support for adults with disabilities. This review included 33 research studies published between 2000 and 2015 focused on three disabilities: Developmental disabilities, serious mental illnesses, and traumatic brain injury. A synthesis of the findings underscores the critical role that family caregivers occupy in addressing the needs of their loved one with a disability; however, the needs of the caregiver are insufficiently met by existing service approaches. A better understanding of the unique needs and strengths of the family support context of caregivers and care recipients is needed, giving greater attention to ethnic, racial, and cultural considerations in future research.