Substance abuse and mental health statistics sourcebook /

Prepared by Beatrice A. Rouse of the Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

Reauthorization of the Substance Abuse and Mental Health Services Administration : hearing before the Subcommittee on Substance Abuse and Mental Health Services of the Committee on Health, Education, Labor, and Pensions, United States Senate, One Hundred Eighth Congress, first session, on examining proposed legislation authorizing funds for the Substance Abuse and Mental Health Services Administration, focusing on the importance of substance abuse prevention, July 15, 2003.

Shipping list no.: 2004-0105-P.

Alcohol, Drug Abuse, and Mental Health Administration research programs.

Mode of access: Internet.

Alcohol, Drug Abuse, and Mental Health Administration public advisory committees : authority, structure, function, members.

Mode of access: Internet.

Telemedicine for rural and remote child and youth mental health services

The E-Child and Youth Mental Health Service was designed to provide children and adolescents in Queensland with access to specialist mental health consultations using telemedicine. A project officer provided a single point of contact for referral management and clinic coordination, thereby reducing barriers of access to the service. Over a six-month period from November 2004, 42 point-to-point videoconferences were conducted to nine sites in Queensland. Three multipoint conferences were also conducted. Eleven videoconferences (24%) were arranged for administrative purposes, and 34 (76%) were conducted for the delivery of clinical services (30 patients). The referral and consultation activity suggests an improvement in the capacity of rural and remote mental health service providers to deliver specialist services for children and adolescents.

The use of email in a child and adolescent mental health service: are staff ready?

All staff members of a child and adolescent mental health service were invited to participate in a survey about the use of email. Sixty-two of the 105 staff members responded to the survey, a participation rate of 59%. Of the respondents, 32 were allied health staff, 10 were nurses, seven were administrative staff, six were medical staff, three were operational staff and four were acting in a combination of these roles. The respondents reported extensive work-related email usage and considered that they were confident in using email despite low levels of training. However, they did not feel that they understood the legal and ethical issues involved. Furthermore, there was limited incorporation of email into standard record keeping. The majority of respondents thought that increased use of email would lead to a greater workload, a consequence they considered would probably increase over time. Many commented on the quick and practical use of this medium, but were wary about using email with individuals outside the service organization, especially if it were to contain clinical material. There was low use of email directly with clients, and clinicians were ambivalent about incorporating email into therapy. The results suggest that it is timely to consider the utility and appropriateness of email communication with clients and external service providers, and to formulate guidelines and procedures to ensure the confidentiality of client information and the safety of clients and staff.

PRN Sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service

Objective: To identify utilisation rates of prn (pro re nata) sedation in children and adolescents receiving inpatient psychiatric treatment, and to compare correlates of prn prescribing and administration. Method A retrospective chart review examined 122 medical charts from a child and youth mental health inpatient service. Results 71.3% of patients were prescribed prn sedation and 50.8% were administered prn sedation. Patients received an average of 8.0 doses of prn sedation, with 9.8% receiving 10 or more doses. Chlorpromazine and diazepam were the most commonly utilised agents. Prescribing of prn sedation was only related to use of regular medications (p < 0.01), and non-parent carers (p < 0.01). In contrast, administration of prn sedation was associated with multiple diagnoses (p < 0.01), pervasive development disorder (p < 0.01), mental retardation (p < 0.01) ADHD (p < 0.01), longer hospital admission (p < 0.01), use of atypical antipsychotics (p < 0.01) and polypharmacy (p < 0.01). Conclusions Despite lack of data to inform practice, prn sedation is widely utilised, especially in complex patients. Future research in this area needs to incorporate nurses and examine whether patients benefit from prn sedation, which drugs and dosing patterns optimise safety and efficacy, and what is the role of prn sedation in the context of other medication.

Introducing evidence-based family assessment and therapy in child and youth mental health services: Applying systemic principles to maintain, sustain and build capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change, finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.

Relationship between childhood abuse and psychosexual adjustment in adult women

Study 1 found that poor attachment relationships, dysfunctional family environments, re-victimisation experiences and poor coping skills contibute towards mental health problems as well as the child abuse experiences. Study 2 implemented a therapy program that demonstrated an improvement in the sexual response of women who experienced childhood sexual assault.

Multiple types of child maltreatment and adolescent mental health in Viet Nam

Objective To examine the prevalence of multiple types of maltreatment (MTM), potentially confounding factors and associations with depression, anxiety and self-esteem among adolescents in Viet Nam. Methods In 2006 we conducted a cross-sectional survey of 2591 students (aged 12–18 years; 52.1% female) from randomly-selected classes in eight secondary schools in urban (Hanoi) and rural (Hai Duong) areas of northern Viet Nam (response rate, 94.7%). Sequential multiple regression analyses were performed to estimate the relative influence of individual, family and social characteristics and of eight types of maltreatment, including physical, emotional and sexual abuse and physical or emotional neglect, on adolescent mental health. Findings Females reported more neglect and emotional abuse, whereas males reported more physical abuse, but no statistically significant difference was found between genders in the prevalence of sexual abuse. Adolescents were classified as having nil (32.6%), one (25.9%), two (20.7%), three (14.5%) or all four (6.3%) maltreatment types. Linear bivariate associations between MTM and depression, anxiety and low self-esteem were observed. After controlling for demographic and family factors, MTM showed significant independent effects. The proportions of the variance explained by the models ranged from 21% to 28%. Conclusion The combined influence of adverse individual and family background factors and of child maltreatment upon mental health in adolescents in Viet Nam is consistent with research in non-Asian countries. Emotional abuse was strongly associated with each health indicator. In Asian communities where child abuse is often construed as severe physical violence, it is important to emphasize the equally pernicious effects of emotional maltreatment.

Applying the recovery approach to the interface between mental health and child protection services

There are a range of theoretical approaches which may inform the interface between child protection and adult mental health services. These theoretical perspectives tend to be focused on either child protection or mental health with no agreed integrating framework. The interface continues to be identified, in research, case management reviews and inquiry reports, as complex and problematic. This paper proposes that more positive, integrated approaches to service user engagement, risk assessment and management may lead to better outcomes in working with families experiencing parental mental health problems and child protection concerns. It is proposed that the recovery approach, increasingly used in mental health services, can inform the processes of engagement, assessment and intervention at the mental health and child protection interface. The article provides a critical overview of the recovery approach and compares it with approaches typifying interventions in child protection work to date. Relevant research and inquiries are also examined as a context for how to more effectively respond to cases where there are issues around parental mental health problems and child protection. The article concludes with case material to illustrate the potential application of the recovery approach to the interface between mental health and child protection services.

Fracturing the façade : exploring the impact of childhood sexual abuse

Examination of previous empirical literature illustrates how researchers have concentrated on documenting the impact of childhood sexual abuse (CSA) on the later psychological functioning of survivors, through comparisons with those who have not had such a history. Only more recently has there been a focus on assessing the relationship between aspects of the abuse and specific psychological difficulties. This thesis investigated the relationships between CSA characteristics and women’s later psychological adjustment. The role of attributions, coping methods, parenting competency and marital satisfaction were also investigated. Qualitative data on perception of benefit and general reflections of participants were used to explore participants’ self-esteem, locus of control, decisions relating to parenting, disclosure experiences, and attributions in relation to their abuse, including the search for meaning. Recruitment through newspapers and counselling services led to 118 women volunteering to complete a questionnaire evaluating the characteristics of their CSA and their current psychological adjustment. Of this group, 33 subsequently volunteered to participate in a telephone interview that explored in greater depth issues related to the long-term impact of their CSA. Both quantitative and qualitative analyses were conducted on the data. The women reported a high prevalence of dysfunction in their families of origin. Abuse had generally commenced by middle childhood, and lasted for a number of years and often involved a number of perpetrators. Perpetrators were most likely to be intrafamilial, with stepfathers being over-represented. Sexual activities generally involved physical contact, with participation often induced by the use of coercion. Participants demonstrated significant difficulties in psychological adjustment, but attributions regarding the abuse improved over time. Some concerns were expressed regarding parenting competency, and avoidant coping methods were favoured. In general, participants were satisfied with their current marital relationship. Significant associations were found between coping methods, attributional style, beliefs and various psychological adjustment measures. Participants, in general, demonstrated low self-esteem and displayed an external locus of control. As a consequence of their experience of CSA, many participants reported they had decided not to have children. For those who did have children, CSA was almost universally seen as having had an impact on their parenting. Disclosure of CSA was usually delayed for a number of years, with poor outcomes generally resulting from disclosure when it occurred. Women with current partners rated them as very caring and not controlling. Participants were generally still searching for meaning in their abuse, despite many having accepted it. Survivors outlined an extensive range of long-term effects of CSA, and nominated a number of strategies that would assist in reducing these effects. The results of the study indicated that there are a number of characteristics associated with CSA which signal a higher risk of difficulties in psychological adjustment. Concerns of survivors regarding parenting were confirmed according to those who undertook this role. Unfortunately, concerns expressed by survivors that disclosure of their CSA would have had negative consequences was usually the case when they did finally disclose. However, the accessing of social and family support appeared to have an important role in changing the attributions of survivors regarding their CSA. Furthermore, change of attributions in relation to abuse may provide the key to resilience in survivors against the negative impact of CSA on later psychological adjustment.

Innovations in mental health services to disaster victims /

Mode of access: Internet.

Q's & A's on child mental health : an interview with Dr. T. Berry Brazelton.

Mode of access: Internet.