PREPAID MENTAL HEALTH SERVICES: A NATIONAL PERSPECTIVE

The purpose of this 1982 national survey of all operational prepaid health plans, or PHPs (including health maintenance organizations), was to provide information on the current coverage of PHP mental health and substance abuse services, benefits and service provision, general and mental health organization characteristics, mental health service costs, and physical and mental health service utilization.^ Two survey instruments were designed, pretested and distributed to all operational PHPs throughout the United States. A total of 237 PHPs were surveyed, of which 205 (86.50 percent) completed and returned both questionnaires.^ One result of the rapid growth in the PHP field over the past ten years has been the expansion in both the number of PHPs as well as the organizational characteristics of these PHPs. However, little attention in the research literature has been given to the application of empirical results to the PHP arrangements. This project has attempted to contribute to current knowledge regarding prepaid mental health services from a national perspective, and explore, on a preliminary descriptive basis, the variety of potential service delivery arrangements for physical and mental health services (total services) and for mental health services.^ The study emphasized that PHPs must continue to monitor the costs and utilization of mental health services, particularly in light of the apparent elimination of data collection and statistical summary responsibilities within the federal government regarding PHP activities as well as the proposed legislation to eliminate mandated mental health and substance abuse services from basic health plan benefits for federally qualified PHPs. ^

Gender disparities in utilization, unmet need and expenditure for mental health care

Objectives: To compare mental health care utilization regarding the source, types, and intensity of mental health services received, unmet need for services, and out of pocket cost among non-institutionalized psychologically distressed women and men. ^ Method: Cross-sectional data for 19,325 non-institutionalized mentally distressed adult respondents to the “The National Survey on Drug Use and Health” (NSDUH), for the years 2006 -2008, representing over twenty-nine millions U.S. adults was analyzed. To assess the relative odds for women compared to men, logistic regression analysis was used for source of service, for types of barriers, for unmet need and cost; zero inflated negative binomial regression for intensity of utilization; and ordinal logistic regression analysis for quantifying out-of-pocket expenditure. ^ Results: Overall, 43% of mentally distressed adults utilized a form of mental health treatment; representing 12.6 million U.S psychologically distressed adults. Females utilized more mental health care compared to males in the previous 12 months (OR: 1. 70; 95% CI: 1.54, 1.83). Similarly, females were 54% more likely to get help for psychological distress in an outpatient setting and females were associated with an increased probability of using medication for mental distress (OR: 1.72; 95% CI: 1.63, 1.98). Women were 1.25 times likelier to visit a mental health center (specialty care) than men. ^ Females were positively associated with unmet needs (OR: 1.50; 95% CI: 1.29, 1.75) after taking into account predisposing, enabling, and need (PEN) characteristics. Women with perceived unmet needs were 23% (OR: 0.77; 95% CI: 0.59, 0.99) less likely than men to report societal accommodation (stigma) as a barrier to mental health care. At any given cutoff point, women were 1.74 times likelier to be in the higher payment categories for inpatient out of pocket cost when other variables in the model are held constant. Conclusions: Women utilize more specialty mental healthcare, report more unmet need, and pay more inpatient out of pocket costs than men. These gender disparities exist even after controlling for predisposing, enabling, and need variables. Creating policies that not only provide mental health care access but also de-stigmatize mental illness will bring us one step closer to eliminating gender disparities in mental health care.^

Work instability versus mental health

This contribution is part of a research on guidance and employment in La Plata , province of Buenos Aires (Argentina) undertaken jointly by the Chairs of Preventive Psychology and Vocational Guidance, both pertaining to the course of studies for Psychology at the National University of La Plata. This research is based on four axes, namely, education-work-social policies-health. This paper shall focus around the health axis, which is not provided with placement and employment services. Some unsystematical guidance experiences from the services of Adolescence and Mental Health are currently under way in the area. Research points to the existence of new demands of psychological treatment from a population ("the new poor") afraid of losing their jobs -or even unemployed- who was not in the habit of going to the public hospital. In the casuistry explored here, people afraid of losing their jobs present more psychosomatic complexities. Local population is also analysed and the said analysis is linked with several national and international research projects.

Work instability versus mental health

This contribution is part of a research on guidance and employment in La Plata , province of Buenos Aires (Argentina) undertaken jointly by the Chairs of Preventive Psychology and Vocational Guidance, both pertaining to the course of studies for Psychology at the National University of La Plata. This research is based on four axes, namely, education-work-social policies-health. This paper shall focus around the health axis, which is not provided with placement and employment services. Some unsystematical guidance experiences from the services of Adolescence and Mental Health are currently under way in the area. Research points to the existence of new demands of psychological treatment from a population ("the new poor") afraid of losing their jobs -or even unemployed- who was not in the habit of going to the public hospital. In the casuistry explored here, people afraid of losing their jobs present more psychosomatic complexities. Local population is also analysed and the said analysis is linked with several national and international research projects.

Work instability versus mental health

This contribution is part of a research on guidance and employment in La Plata , province of Buenos Aires (Argentina) undertaken jointly by the Chairs of Preventive Psychology and Vocational Guidance, both pertaining to the course of studies for Psychology at the National University of La Plata. This research is based on four axes, namely, education-work-social policies-health. This paper shall focus around the health axis, which is not provided with placement and employment services. Some unsystematical guidance experiences from the services of Adolescence and Mental Health are currently under way in the area. Research points to the existence of new demands of psychological treatment from a population ("the new poor") afraid of losing their jobs -or even unemployed- who was not in the habit of going to the public hospital. In the casuistry explored here, people afraid of losing their jobs present more psychosomatic complexities. Local population is also analysed and the said analysis is linked with several national and international research projects.

Avaliação de boas práticas em saúde mental na atenção psicossocial

A partir do redirecionamento do modelo assistencial no Brasil emerge a necessidade de discussão da reinvenção de práticas alinhadas com o cenário de transformações. As práticas agora devem se desenvolver no sentido de superar o isolamento das grades, dos muros e das chaves, do apagamento do sujeito, da supressão de sintomas e das personalidades dos sujeitos em sofrimento psíquico. Diante disso, é que este estudo tem como objetivos avaliar boas práticas em saúde mental na atenção psicossocial no contexto de um município da região Sul do Brasil. Para tanto, organizou-se como uma pesquisa avaliativa construtivista, com enfoque responsivo, a medida que desenvolve um consenso critico entre os grupos de interesse. Está baseada na Avaliação de Quarta Geração, proposta por Guba e Lincoln (2011), que emerge como opção metodológica e se articula com o referencial teórico das \"Boas Práticas em Saúde Mental Comunitária\", proposto por Thornicroft e Tansella (2010). Este é apresentado de modo a identificar boas práticas na saúde mental, com base na articulação de 3 eixos indispensáveis e indissociáveis: a ética, como princípio fundamental que deverá orientar o planejamento, a assistência e a avaliação dos serviços. A evidência deve embasar as intervenções e serviços. E a experiência como uma evidência do que vem sendo produzido nas experiências locais e regionais de organização da rede de serviços. Como resultado do processo as práticas de Acolhimento, Projeto Terapêutico Singular e Transferência de Cuidados emergiram para discussão. O Acolhimento torna-se concreto nas ações da Porta Aberta, e significa escuta qualificada no momento em que a necessidade emerge, além de representar a oferta de atenção de qualidade baseada no processo relacional que fortalece o estabelecimento de vínculos e a construção de projetos de vida. O Projeto Terapêutico Singular apresenta-se como uma boa prática, a medida que é capaz de dar resposta singularizada e individualizada às necessidades do sujeito, de modo a oportunizar como resultado uma pessoa capaz de andar na vida. É definido de forma compartilhada entre equipe, usuário e família, segundo os objetivos terapêuticos para cada sujeito, e utiliza o técnico de referência, as mini equipes, as oficinas terapêuticas, os grupos terapêuticos, as assembleias, enfim, ofertas e propostas que permitem ao sujeito retomar o envolvimento com os espaços da cidade, no caminho da produção de vida. Com relação à Transferência de Cuidados, esta possibilita ao sujeito que vive o processo não só circular em uma rede de serviços, mas, acima de tudo, buscar, com suporte dela, sua emancipação. Para tanto, investe em práticas que estimulem a autonomia dos sujeitos, por meio de instrumentos como o Acompanhamento Terapêutico, Grupo de Apoio à Alta, espaços de decisões e discussões, estímulo à busca e resolução de problemas, atividades de reconhecimento dos espaços da cidade, transporte, cultura e lazer. Além disso, investe nas ações com a Atenção Básica, a partir do Apoio Matricial com processos de formação continuada com as equipes, e mapeamento da situação da saúde mental nos territórios. Ao final deste estudo, é possível concluir que o modelo de atenção psicossocial demonstrou potencialidade de produzir boas práticas na atenção à saúde mental, e que estas tem transformado a vida dos sujeitos em sofrimento psíquico, bem como tem auxiliado no processo de reconquista de espaços sociais

Competencies Needed By Mental Health Professionals Working With Parents of Children With Asthma

This paper describes clinical competencies necessary for mental health professionals working with parents of children with Asthma. Seven highly accomplished mental health clinicians from the Pediatric Behavioral Health Department at the nationally ranked hospital, National Jewish Health in Denver, Colorado were interviewed about the competencies they feel are needed to work with this specific population. The results of these interviews are organized into knowledge, skills and attitudes. Recommendations for other mental health providers are provided.

Working Therapeutically with Interpreters in Mental Health: A Curriculum for Clinicians.

Given the increasing numbers of people who lack proficiency in spoken English, it would not be uncommon for American healthcare practitioners to encounter clients whose primary language is not English. Additionally, for those clinicians who specifically wish to work with immigrants, refugees or asylees, it is likely that their clientele will be comprised of LEP individuals and families. While many professional interpreters have completed formal training and been certified to provide their unique services, mental health clinicians rarely receive such training to help negotiate the complex dynamics inherent in working with LEP populations where the therapeutic relationship is altered with the addition of an interpreter. This training curriculum proposes the detailed, in-depth training for clinicians as recommended by numerous sources in the literature.

Mental Health Effects of Equine Therapy with Children

This study examined the effects of eight weekly lessons of therapeutic horseback riding (THR) on five children between the ages of 6 and 12 years who displayed behavioral issues, mood disturbance, relationship issues, or other mental health disorders. All of the children's parents/caregivers completed the Child Behavior Checklist for Ages 6-18 at the onset of the lessons and at the conclusion of the lessons. The children did not show any significant improvement on the Internalizing, Externalizing, Total Problems scales or the syndrome scales. However, comparisons between the pre-test and post-test scores on the Behavior scale and the Externalizing scale showed positive trends which warrant further study. The lack of significance in the data suggests that a greater participant population or a mixed method study using a combination of quantitative and qualitative strategies may yield more conclusive results.

Recovery from Pediatric Brain Injury: A Preliminary Comparison of Longitudinal Data on Psychological Symptomology and Mental Health Treatment

Objective: To document the course of psychological symptomology, mental health treatment, and unmet psychological needs using caregiver reports in the first 18 months following pediatric brain injury (BI). Method: Participants included 28 children (aged 1-18 years) who were hospitalized at a children's hospital's rehabilitation unit. Caregiver reports of children's psychological symptoms, receipt of mental health treatment, and unmet psychological needs were assessed at one month, six months, 12 months, and 18 months post-BI. Results: Caregivers reported a general increase in psychological symptoms and receipt of mental health treatment over the 18 months following BI; however, there was a substantial gap between the high rate of reported symptoms and low rate of reported treatment. Across all four follow-up time points there were substantial unmet psychological needs (at least 60% of sample). Conclusions: Findings suggest that there are substantial unmet psychological needs among children during the first 18 months after BI. Barriers to mental health treatment for this population need to be addressed.

Evidence-Based Practice in the Juvenile Justice System: Balancing Clinical Expertise with Best Available Research and Client Variables

Each year, thousands of adolescents are processed through the juvenile justice system -- a system that is complicated, expensive, and inadequately addressing the needs of the youth in its care. While there is extensive literature available in support of interventions for youthful offenders that are clinically superior to current care and more cost-effective than the existing structure, there is a gap between research and practice that is preventing their implementation. The use of Evidence-Based Practice in Psychology (EBPP) as defined by the American Psychological Association is presented as one method to bridge this gap. This paper identifies and discusses each of five barriers to effective use of EBPP: cost, fragmentation of the mental health system, historical and systemic variables, research methodology, and clinician variables. These barriers are first defined and then illustrated using examples from the author's experience working in the juvenile justice field. Finally, recommendations for the field are presented.

Impact of economic crisis on mental health of migrant workers: what happened with migrants who came to Spain to work?

Objectives: To assess changes in mental health in a sample of migrant workers after the eruption of the economic crisis in Spain. Methods: 318 migrant workers were interviewed. Mental health, sociodemographic, and economic crisis related variables were obtained through face-to-face (2008) and phone (2011) interviews. Prevalence of poor mental health (PMH) was compared (2011–2008) and multivariate logistic regression models were fitted. Results: Change in prevalence of PMH was higher in men (aOR 4.63; 95 % CI 2.11–10.16). Subgroups of men showing the largest detrimental mental health effects were: unemployed, with low salaries (≤1,200 euros) and those reporting family burden. An increase of PMH was found in women, without significant associations. Conclusions: Mental health of migrant workers in Spain has worsened during the economic crisis.

Postcolonial healing landscapes and mental health in a remote Indigenous community in subarctic Ontario, Canada

The concept of therapeutic landscape is concerned with a holistic, socio-ecological model of health, but most studies have attempted to explore land-health links from a Western perspective. On an Indigenous reserve in Northern Ontario, part of the Canadian subarctic, we explore the importance of spaces and places in creating postcolonial therapeutic landscapes to treat the wounds inflicted by colonialism. The aim of this research is to gain insight from views and experiences of First Nations residents living on reservations that are undergoing a process of regaining traditional spiritual beliefs and teachings to construct therapeutic spaces to face mental health problems caused by legal opioid analgesic abuse. This qualitative study used semi-structured interviews with Cree and Ojibwe participants to understand how they are reconnecting with earth, spirituality and traditional animist beliefs on their way to recovery. We find that practices such as taking part in ceremonies and ritual spaces, and seeking knowledge and advice from Elders assist with personal healing and enable Indigenous people to be physically and mentally healthy. Our research findings provide important insights into the relationship between space, healing and culture as determinants of health and well-being and document some key factors that contribute to substance abuse recovery.

Mental Health Research Institute, July 13, 1967

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