Community Mental Health Journal最新文献

Global Burden of Disease (GBD) estimates have significant policy implications nationally and internationally. Disease burden metrics, particularly for depression, have played a critical role in raising governmental awareness of mental health and in calculating the economic cost of depression. Recently, the World Health Organization ranked depression as the single largest contributor to global disability. The main aim of this paper was to assess the basis upon which GBD prevalence estimates for major depressive disorder (MDD) were made. We identify the instruments used in the 2019 GBD estimates and provide a descriptive assessment of the five most frequently used instruments. The majority of country studies, 356/566 (62.9%), used general mental health screeners or structured/semi-structured interview guides, 98/566 (17.3%) of the studies used dedicated depression screeners, and 112 (19.8%) used other tools for assessing depression. Thus, most of the studies used instruments that were not designed to make a diagnosis of depression or assess depression severity. Our results are congruent with and extend previous research that has identified critical flaws in the data underpinning the GBD estimates for MDD. Despite the widespread promotion of these prevalence estimates, caution is needed before using them to inform public policy and mental health interventions. This is particularly important in lower-income countries where resources are scarce.

This qualitative study explored reasons for high emergency department (ED) use (3 + visits/year) among 299 patients with mental disorders (MD) recruited in four ED in Quebec, Canada. A conceptual framework including healthcare system and ED organizational features, patient profiles, and professional practice guided the content analysis. Results highlighted insufficient access to and inadequacy of outpatient care. While some patients were quite satisfied with ED care, most criticized the lack of referrals or follow-up care. Patient profiles justifying high ED use were strongly associated with health and social issues perceived as needing immediate care. The main barriers in professional practice involved lack of MD expertise among primary care clinicians, and insufficient follow-up by psychiatrists in response to patient needs. Collaboration with outpatient care may be prioritized to reduce high ED use and improve ED interventions by strengthening the discharge process, and increasing access to outpatient care.

An important and unresolved question in the context of the implementation of coordinated specialty care (CSC) for early psychosis in the United States is the extent to which youth and young adults from marginalized backgrounds are able to equitably access CSC services. In this brief report, we describe pathways between a county hybrid juvenile competency restoration and mental health problem-solving court ('Court'), serving youth with high rates of psychosis and multiple risk factors for poor long-term outcomes, and local CSC services. We found that the Court was overall successful in linking youth with psychosis to care, but in the majority of cases this was not CSC programming more specifically. Drawing on Court and CSC records as well as family interviews, we report on factors contributing to low linkage to CSC, including family-side barriers (lack of transportation, preference for lower intensity / lower demand services) and provider-side barriers, including eligibility criteria such as duration of psychosis, that ultimately exclude otherwise eligible Court-involved youth.

The objective of this randomized controlled trial was to examine the impact of a mindful self-compassion intervention on burden, express emotion, and mental well-being in family caregivers of patients with schizophrenia. Standardized measures, including the ZARIT Caregiving Burden Scale, Expressed Emotion Scale and Warwick-Edinburgh Mental Well-Being Scale, were administered at baseline, post-intervention. Statistical analysis was conducted to assess differences between the two groups. Significant reductions in caregiver burden, expressed emotion, and enhanced mental well-being in the intervention group compared to the control group at post-intervention. The results of this randomized controlled trial indicate that the mindful self-compassion intervention significantly reduces caregiver burden, expressed emotion, and improves mental well-being in family caregivers of patients with schizophrenia. These findings underscore the potential utility of mindful self-compassion interventions as effective support for this population, highlighting the importance of integrating such interventions into caregiver support programs.

Deaths by overdose and suicide have been steadily rising, yet efforts to jointly address them have been limited despite shared risk and protective factors. The purpose of this study was to explore ways of jointly addressing these two significant public health issues at the community level. To accomplish this goal, we distributed an electronic survey via email to all 58 Local Mental Hygiene Directors (LMHDs) and 184 substance use and 57 suicide prevention coalition leads in New York State in March 2019 to better understand attitudes, perceptions, and practice of community-based overdose and suicide prevention. A total of 140 unique individuals completed the survey for a 47% usable response rate. Participants overwhelmingly reported that suicide and overdose are preventable and that individuals with risky substance use would benefit most from suicide prevention services compared to other populations. In addition, substance use prevention coalition leads reported less awareness of key suicide prevention programs than suicide prevention coalition leads and LMHDs; LMHDs were generally most familiar with suicide prevention programs. Finally, substance use and suicide prevention coalition leads were interested in collaborating to raise awareness, provide training, and implement community-based activities. These findings demonstrate a consensus among county leadership and substance use and suicide prevention coalition leads that suicide and overdose are prevalent in their communities and that increased collaboration to address these two public health issues is warranted. Results suggest a need for education, training, and technical assistance to support collaboration.

Despite increasing mental health provider supply shortages, research on capacity planning and management in the field of outpatient community mental healthcare is limited. There is an immediate need for strategies to plan and manage the capacity of existing mental healthcare providers to ensure a balance between demand and resources. To address this need, research on capacity planning and management in healthcare and mental healthcare settings is reviewed. Next, the Capacity-to-Serve Model is introduced and defined as a data-driven process for quantifying and reporting real-time standardized estimates of mental health provider availability based on qualifications, monitoring of outcome targets, and use of the Capacity-to-Serve Ratio and Realizing Capacity Measure. Finally, implications for using the model as an innovative solution for capacity management to meet demand in mental health are addressed. A case example is provided to demonstrate the application of the model. Ultimately, the Capacity-to-Serve Model can standardize capacity reporting of existing provider organizations and networks, both small and large, to support increased access to and supply of mental health services.

Individuals with psychiatric illness believe that voting is important. However, these individuals have lower rates of voting when compared to the general population. A survey of psychiatrically hospitalized adult patients was conducted to assess perceptions of and barriers to voting in patients with psychiatric illness. Data from 113 surveys was analyzed. A majority of survey participants agreed that they cared about voting, that their vote made a difference, and that their vote was important. 74% of individuals reported previously experiencing at least one barrier when exercising their right to vote. The most commonly experienced barriers reported were not having enough information to make an informed choice, not knowing where to vote, not having transportation, and not being registered to vote. Individuals who encountered a higher number of barriers in the past had a higher chance of encountering barriers more often. In conclusion, a high percentage of individuals with mental illness severe enough to warrant hospitalization have experienced barriers to voting, with many experiencing multiple barriers. Reduction of these barriers is important, as voting and the resultant public policies can directly affect this population's mental health and access to both mental and physical healthcare services.

A meta-analysis was performed to determine pooled prevalence of non-suicidal self-injury (NSSI), suicide behaviors (including ideation, attempts), and associated risk factors among runaway and homeless youth (RHY). The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from January 1995 to May 2023. Initially, 8465 papers were screened, resulting in 69 included studies. The results showed that among RHY, lifetime prevalence rates were 42% for NSSI, 38% for suicidal ideation, and 27% for suicide attempts. Lifetime prevalence of NSSI and suicide behaviors was higher among adolescent minors (aged 12-17 years) compared to young adults (aged 18-24 years). Also, NSSI and suicide behaviors were associated with having a childhood history of physical and sexual abuse. Developing an impactful community-based suicide prevention campaign tailored for RHY appears warranted. Peer groups and mentorship programs would provide invaluable support for young individuals, as supportive friendships protect against NSSI.

In this paper we introduce the Intensive Mobile Treatment (IMT) model, which arose from a 2016 New York City initiative to engage individuals who were "falling through the cracks" of the mental health, housing, and criminal justice systems. People who are referred to IMT often have extensive histories of trauma. They experience structural racism and discrimination within systems and thus can present as distrustful of treatment teams. We detail the structure of the program as we practice it at our non-profit agency and outline the psychodynamic concepts that inform our work with challenging populations. We acknowledge IMT's role in engaging in advocacy and addressing social justice in our work. We also discuss how through this model we are able to both mitigate and tolerate risk in participants with difficult-to-manage behaviors. This is typically a long-term, non-linear process. We address how this impacts the team dynamic as a whole and explain how with long-term, trusting therapeutic relationships, participants can change and grow over time. We also explain the ways in which our non-billing model plays an integral role in the treatment we are able to provide and identify several challenges and areas for program growth. In outlining our model and its methodology, we hope to empower other practitioners to adapt IMT to other settings beyond the New York City area.

To inform early intervention, this study describes correlates of substance use among young people with serious mental illness (SMI) enrolled in integrated care in community mental health settings. 227 adults ages 18-35 were assessed for clinical characteristics and substance use. Logistic regressions were used to describe relationships between substance use and participant characteristics. Over a third (38.9%) reported daily cannabis, 15.9% past month other illicit drug, 13.5% frequent/heavy alcohol and 47.4% any of these; 50.2% reported daily tobacco smoking and 23.3% current vaping. Daily cannabis and tobacco were the most common combination. Alcohol, drug, and cannabis with tobacco were associated with higher mental health symptoms but not with emergency room or hospital utilization. Cannabis and other substance use was common and associated with higher symptoms but not with greater hospital utilization, suggesting that early intervention could prevent long-term negative consequences.