Meeting the mental health needs of elderly clients

1. Older individuals in both community and institutional settings have traditionally underused mental health services. Providers of such care devote a minimum of their professional time to those over 65 years of age. 2. Ageism and difficulty with diagnosis are the most frequent explanations for inadequate mental health care to the elderly. This study found that lack of referrals and failure of the aged to seek services partially accounted for underuse. 3. Legislative changes mandating that aged persons be screened for and receive appropriate mental health services will increase the demand for qualified providers. 4. Nursing's approach to care of the older adult, which focuses on both physiological and psychological needs, can facilitate the delivery of comprehensive effective mental health interventions in and out of the institutional setting.     

Meeting the mental health needs of the aging veteran population

The growth in the veterans population parallels the graying of America, accompanied by an increasing need for health care and mental health services from the U.S. Department of Veterans Affairs (VA) health care system. With the incidence of posttraumatic stress disorder (PTSD) rising in veterans of the wars in Iraq and Afghanistan and the already strained mental health resources in use by veterans with persistent PTSD from previous wars, the VA mental health system is and will continue to be in overload. In addition, recent research has noted an increased incidence of dementia in veterans with PTSD. The VA's long-term care facilities cannot meet their current demands, nevermind provide support for veterans with cognitive deficits who can no longer be cared for at home. It is imperative that immediate measures be taken to strengthen resources for research, manpower, and training to accommodate the future mental health needs of our aging veterans.     

Planning for the delivery of special services in public schools : A multidimensional needs assessment framework

Public Law 94–142 requires that public school districts provide special service programs to handicapped and potentially handicapped children with diverse psychological, educational, and physical needs. In order for such programs to be developed and implemented in an appropriate and timely manner, procedures for assessment of pupil needs as well as assessment of school district resources that might address those needs, have been considered as important service delivery prerequisites. Toward that end, a Multidimensional Needs Assessment Framework, which has been developed by the authors and used in numerous public schools, is described in this paper. The Framework, which allows needs assessment to be seen as an integral part of the program planning process, requires that needs assessment and program planning activities occur in relation to three distinct, yet interrelated dimensions: Special Service Recipients, Special Service Resources, and Organizational Unit. Considerations necessary for design and implementation of needs assessment using the Framework are discussed, and suggestions for further development of the approach are noted.     

A multi-dimensional assessment of the health needs of homeless infants and pre-school children in Phoenix

The dual purpose of this study was to identify the comprehensive health needs of a selected group of homeless children in Phoenix, Arizona, and to utilize the findings in developing needed services. A non-random sample of 60 infants and pre-school children were given on-site physical, dental, developmental, behavioral, and nutritional assessments. The study included Medicaid's Early Periodic Screening, Diagnosis, and Treatment procedures, complete oral screening, the Denver Developmental and Denver Articulation Screening Test, the Pre-school Behavior Inventory, and parental interviews. Fifty-eight of the 60 children screened needed further evaluation, treatment, or followup services. The most significant problems included low hematocrit readings, inadequate immunizations, and untreated medical and dental problems specific to this age group. Also identified were developmental delays and potential behavior problems. It is imperative that aggressive outreach and followup services be developed to reach homeless children and to insure that needed interventions are provided.     

Rolling forward: addressing needs in the homeless community

ABSTRACT

The purpose of this pilot study was to use a bottom up, or grounded, approach to understand, from the perspective of the individuals living in the homeless community, what they feel would enable them to become housed and stay permanently housed. Organizations which serve homeless individuals often use a top down approach and implement programs without asking the homeless what they most need to find permanent housing. This project used intensive interviews to determine the needs of unhoused individuals in a mid-sized city with a tourist-centered economy in the south eastern United States. Working local homeless shelters, and various other intermediaries we collected data from 102 homeless individuals and 11 service providers. The major theme that emerged in our research is that the homeless individuals we interviewed were, for the most part, they were able to meet many of their basic needs, such as securing food, clothing, a place to bathe and wash their clothes, as well as obtain physical and mental care. However, they perceived lack of reliable and affordable transportation to be a significant barrier to obtaining and maintaining employment, making and keeping appointments, and maintaining their social support network.     

Comprehensive behavioral medicine in community mental health. A needs assessment that needs assessment.

It is suggested that the massive costs incurred nationally in health care are in large part a fitting concern of Community Mental Health (CMH). There is considerable data available to suggest that as much as half of the variance in common health disorders is associated with behavioral factors. There is a rapidly growing movement to provide interventions geared toward these behavioral components in health disorders, but much of this has occurred outside of the traditional mental health environment. There are arguments to suggest that CMH should be more involved in the development of comprehensive behavioral medicine services, both in terms of the expertise and resources that it can bring to bear upon these problems, and its potential to reach segments of the population which are otherwise likely to be underserved, if served at all. Implications for CMH planning and financing are discussed, drawing upon a selective literature review and clinical illustrations.     

Improving youth mental health through family-based prevention in family homeless shelters

This exploratory study examines changes in suicidal ideation among a sample (N = 28) of homeless youth, ages 11–14, residing within family shelters in a large metropolitan area. Changes in suicidal ideation from pretest to posttest are compared across two group approaches to delivering HIV prevention. Youth and their families participating in the HOPE Family Program, incorporating a family strengthening approach, are compared to those receiving a traditional health education-only approach. Multivariate analyses reveal that youth in the HOPE Family Program were 13 times more likely to report a decrease of suicidal ideation. These findings indicate that health education programs integrating a family strengthening approach hold promise for positively impacting mental health outcomes for vulnerable youth.     

Supporting pupils with special health needs in mainstream schools: policy and practice

Education policy favouring ‘inclusion’, together with medical advances, mean that a growing number of pupils in mainstream schools may have health‐related support needs in respect of a chronic illness or physical disability. Data from an empirical research study investigating these needs and carried out between 1996 and 1998 are used to reflect on the position of this group of pupils within policy guidance on special educational needs (SEN) and medical needs. Evidence of confusion and ambiguity, both in the guidance and its interpretation, suggests that the needs of this group remain somewhat hidden. More recent developments in special needs policy guidance are discussed in terms of the prospect for strengthening support for this group of pupils. Copyright © 2001 John Wiley & Sons, Ltd.     

The mental health of African-American and Caucasian-American women who are homeless.

1. Nurses can use research findings to educate other health professionals about homeless subcultures with attention to specific cultural and socioeconomic needs, as well as to develop interventions for homeless women. 2. Minority women are more susceptible to homelessness as they experience increased poverty levels and are often single mothers. Of all minority women, African-American women are the most vulnerable to physical and psychological illness. 3. In this study, 75% of the subjects had scores on a psychological assessment test that indicated they needed additional psychological testing.     

The accommodation and support needs of people with a mental illness: A process and framework for action

Abstract

This paper reports the results of a consumer-focused assessment of the accommodation and support needs of people with a mental illness living in a regional city. The study utilises a 'pathway to stability' approach to assess the phase-contingent accommodation and support needs of mental health consumers through interviews and focus groups with consumers, carers and service providers. The study identifies five broad phases of the life course impacted by mental illness—beginnings, long-term needs become clearer, instability as needs evolve, finding stability and ongoing. Five key issues—information, self-competence, comorbidity, coordination and flexibility were expanded upon in focus groups. Principles for planning future service delivery are identified. The implications of the findings and research methodology for social work practice and research are discussed.     

The health of the homeless

Studies of homelessness and health date back to at least the 1970s. The current paper presents a summary on the state of the literature on homelessness and health since the onset of Housing First initiatives. Housing First initiatives represent a change in the previously used model used by social services providers and government agencies from recovery first to housing first, a recognition that homeless people should be housed before contending with other issues such as mental health treatment. Since this time, researchers have pushed research inquiry into areas that were only touched on lightly before. These new areas of research fall generally into that categories of access and utilization, newer demographics, and emerging health concerns. Each of these areas is thoroughly reviewed in the paper. Despite Housing First legislation, homelessness continues to threaten the health of the urban population and will continue to do so as long as it is allowed to persist.     

Student mental health needs: survey results and implications for service.

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.     

Educating for mental health practice: Results of a survey of mental health content in Bachelor of Social Work curricula in Australian schools of social work

Health problems are amongst the most pressing encountered by social workers in practice. Health policy, largely through deinstitutionalisation, has placed mental health problems in the mainstream of health practice. One in 25 Australians will require professional assistance with mental health problems. Moreover, other professions are increasingly claiming that mental health is their area of expertise. Social work needs to reclaim this area as their own and hence it is incumbent on social work education to prepare students to practise in this area. As the second of a two-part survey of health and mental health curricula in Australian schools of social work, the findings of the survey on mental health curricula conducted in 1997 are presented in this article. Based on responses from 95% of the schools, nine of the 20 respondent schools were found to offer a separate mental health unit. The remaining 11 schools' coverage ranged from no coverage at all through to considerable integration in other subjects. Overall it was concluded that the majority of students received a significant amount of input on mental health. A number of recommendations are made to improve mental health input including more skill development, greater local contextualisation, more attention to an anti-oppressive agenda, and more explicit links to field education.     

Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust

Objective

Public health concern surrounding the mental health needs of former system youth is escalating. We know very little about mental health service utilization on the other side of the developmental transition to adulthood. The purpose of this study was to explore the mental health service use experiences among former system youth with childhood histories which included mental disorder, use of publicly-funded mental health services, and use of additional public systems of care.

Methods

In-depth face-to-face interviews were conducted with 60 participants currently struggling with mental health difficulties regarding their service use experiences over the transition. Participants were recruited from one Midwestern state. Multi-phase analysis was conducted utilizing immersion/crystallization, constant comparison and concept matrices.

Results

Few participants received continuous mental health care across the transition, with the majority experiencing interruptions or discontinuation of care. Important facilitators of service use emerged, such as physicians, former caseworkers and family. Health clinics and parenting programs emerged as potential entrée points for reconnecting disengaged young adults to mental health services. Insight, mistrust, and emotions emerged as novel factors associated with service utilization among young adults.

Conclusions

Mental health service utilization remains a complicated phenomenon over the developmental transition to adulthood. Future research is needed that closely examines the associations between insight, emotion, mistrust and service use among young adults.     

The validity of assessing mental health needs with social indicators.

Selection of the appropriate number and types of social indicators for use in mental health planning has been a perennial problem. Social indicators have been associated with several concepts (quality of life, community disorganization, populations at risk) of varying relevance for planning mental health services, and abstracting social indicators from these conceptual domains poses a variety of validity issues. The issues are discussed, and the viability of social indicators in mental health planning is reexamined.