Community Mental Health Journal最新文献

Increasingly, adolescents are struggling with poor mental health outcomes, making it essential to improve access to high-quality mental health services. Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) act as key "safety-net" health centers for low-income youth seeking mental health services, as the majority accept Medicaid. This study examines how administrative burdens, i.e., challenges citizens face when interacting with a government agency, may act as barriers to accessing mental health services, especially for adolescents and their caregivers. This exploratory sequential mixed-methods study uses data from semi-structured interviews with hospital- and community-based social workers, and from a mystery shopper study conducted during the COVID-19 pandemic with CMHCs and FQHCs in a large metropolitan county in the United States. It addresses three questions: (1) what kinds of administrative burdens exist in accessing mental health care for adolescents and their families at FQHCs and CMHCs? (2) how do these burdens convey potential learning, compliance, and psychological costs to prospective clients? (3) how do these burdens act as distinct barriers to accessing mental health services for adolescents and their families within safety-net health centers? Moreso than CMHCs, FQHCs implemented a variety of administrative burdens on prospective clients, such as a requirement to designate their primary care physician into the FQHCs network through their insurance prior to scheduling, difficult-to-navigate phone trees, unanswered voicemails, rude or discriminatory interactions with schedulers, and complex referral processes. This study finds that administrative burdens may act as distinct barriers to accessing mental healthcare. Recommendations to reduce administrative burdens at the organizational- and system-levels are discussed.

Objective: This study examines the prevalence of specialized police responses to persons experiencing a mental health crisis across U.S. law enforcement agencies and explores whether organizational and community factors are associated with their presence.

Methods: This study used 2020 data from a nationally representative survey of over 2,500 law enforcement agencies. The primary outcomes included whether agencies implemented one of four responses: (1) designated unit, (2) designated personnel, (3) addressed mental health without designated unit or personnel, or (4) did not address. Logistic regression models assessed factors associated with each response type.

Results: Over half (51.0%, n = 1,349) of agencies addressed mental health but lacked designated units or personnel, while 6.9% (n = 183) did not specifically address mental health. Larger agencies, agencies located in urban areas, as well as those with external partnerships, and a higher number of use of force complaints were significantly more likely to designate a unit or personnel.

Conclusions: Fewer than half of law enforcement agencies have responses for mental health crises. Further research is needed to identify barriers and facilitators to adopting specialized responses, particularly among rural and under-resourced agencies.

Compared to the general population, young adults with early psychosis are at increased risk of violent behavior. Existing research has found contextual similarities between violent behavior and suicidal behavior. Therefore, this study examines the drivers and consequences of violent ideation and behavior among young adults with early psychosis by applying frameworks developed for suicide prevention. This research was conducted at OnTrackNY, a network of early intervention services (EIS) that provides coordinated specialty care services to young adults with non-affective psychosis that began within the past two years. Qualitative interviews were conducted with 6 EIS participants and 12 EIS staff members. The interview guide applied the "suicide narrative" format from the Stanley-Brown Safety Planning Intervention by asking EIS staff and EIS participants detailed questions about a specific episode of violent ideation or behavior. Participant responses were then categorized using Fluid Vulnerability Theory (FVT). This study found that it was feasible to discuss information about a specific violence-related crisis for young adults with early psychosis and their treatment teams by eliciting violence narratives. In doing so, EIS participants and staff identified several risk factors from the FVT domains that previously sparked either violent ideation or behavior. In addition to identifying potential target mechanisms for future interventions, these narratives may lead to more compassionate and therapeutic understandings of violence for young adults with early psychosis. Future research is recommended to explore how best to incorporate violence narratives in the treatment of early psychosis.

Farmers are at increased risk for suicide compared to the general population, with estimates 56% higher among males in agriculture/forestry/fishing roles than the male working population. This study explored a farmer-developed suicide prevention intervention using an adapted military challenge coin for agriculture. An agricultural community member shared a message of appreciation with the farmer recipient. Farmers recently receiving a challenge coin were purposively sampled. Semi-structured interviews via telephone/videoconference explored farmers' challenge coin experiences and perceptions. Interviews were transcribed verbatim and de-identified before thematic coding. Participants (n = 14) were aged 28-68 years. All interviewees were non-Hispanic White, and 71% had off-farm jobs. Themes included the reception of the challenge coin, feelings elicited, and protective nature of the challenge coin against suicide, encouraging farmer connectedness and demonstrating appreciation. These data provide initial exploration of challenge coins adapted for farmer suicide prevention, developed within a farming community. Additional research regarding the impact is needed.

Engaging residents with the support available at community-based residential mental health rehabilitation facilities is an ongoing challenge for health services. This study explored factors associated with residential rehabilitation engagement across Queensland, Australia through regression modelling of cross-sectional data from a statewide benchmarking activity completed in 2023 (n = 208). The Residential Rehabilitation Engagement Scale (RRES) assessed each resident's rehabilitation engagement. A broad range of potential predictors were considered, including resident and unit-level variables. Only 45.2% of residents had an average RRES score consistent with being engaged with rehabilitation support usually or always. Higher levels of rehabilitation engagement were significantly associated with lower levels of psychosocial disability (B = - 0.413, p < .001), length of treatment (B = - 0.165, p = .008), care under the integrated staffing model (B = 0.156, p = .012), higher staff recovery knowledge and attitudes (B = 0.138, p = .037), and physical illness or disability (B = 0.129, p = .045). In conclusion, engagement in residential rehabilitation was associated with both resident and staff factors. The observation that engagement was higher where unit staff endorsed recovery knowledge and attitudes, and under the integrated staffing model is important. This suggests potential modifiable service characteristics that may support improved rehabilitation engagement in the future.

Major depressive disorder (MDD) is a serious public health concern in the United States. Prior research has shown that neighborhood characteristics serve as protective factors against depression in adolescents. Few studies have examined the association between perceived neighborhood characteristics and depression during middle and older adulthood. We examined the association between each perceived neighborhood social environment (i.e., social cohesion and safety) and the presence of MDD among Midlife in the United States III (MIDUS) participants (n = 2,435, mean age = 63.6 years, Female = 54.4%). Moreover, we investigated whether these associations were moderated by sex and income, separately. All models were adjusted for demographic variables. Overall, perceived neighborhood social cohesion and safety were negatively associated with the presence of MDD. The associations varied when analyses were stratified by sex and income. Findings offer support for the perceived neighborhood social environments as protective factors against depression during middle and older adulthood.

Recovery support and treatment linkages are critical during transitions from incarceration to community but can be challenging to deliver to hard-to-reach populations. This paper will examine Facebook contacts between peer navigators (PNs) and women with opioid use disorder (OUD) following jail release to explore women's use of PN services, including purpose and content of Facebook messages. As part of a larger clinical trial under the Justice Community Opioid Innovation Network (JCOIN), PNs provided OUD treatment navigation and recovery support for 12 weeks following women's release from jail, using remote options such as Facebook. Facebook Messenger transcripts between PNs and participants were qualitatively coded by general and specific conversation topic, and described using quantitative measures (e.g., number of messages). Of the 231 women contacted by PNs through Messenger, 53.7% (n = 124) interacted with their PN. About a third of participants who interacted through Messenger (31.6%) were provided with resource referrals (M = 2.9 resources sent). Most conversations were coded generally as needs/struggles (70.7%) or successes (24.2%). Conversations most frequently discussed family, friends, or partners (15.8%), financial and work matters (14.7%), or housing (13.0%). Analyses indicated that PNs used similar supportive strategies over Facebook as they would in other modalities, including sharing lived experience and providing motivation or encouragement. Peer recovery supports are valuable for women, particularly at critical transitions, like jail release. Social media platforms like Facebook can be a viable strategy to engage participants and provide remote support, especially in areas that may lack in-person resources (e.g., rural regions).

There is increasing recognition of the importance of integrating social determinants of mental health (SDoMH) into research frameworks to better understand how socioeconomic and environmental stressors shape mental health outcomes, particularly in low-resource settings. This paper presents an innovative conceptual approach that combines the Research Domain Criteria (RDoC) with a social determinants lens to explore the pathways linking social adversity to mental health challenges. Drawing on insights from the NIH-funded TOPOWA Study, which examines the effects of poverty and social disadvantage on young women's mental health in urban Uganda, the approach integrates diverse data sources, including biomarkers, wearable sensors, and self-report surveys, to capture multilevel influences on mental health. This framework illustrates how RDoC can be adapted for community-based, context-sensitive research and supports the development of more targeted mental health interventions in low resource settings. By situating individual-level processes within broader structural conditions, the model contributes to a more nuanced understanding of mental health risk and resilience. While grounded in a specific study, the framework offers a scalable model for advancing mental health research and intervention in other low-resource or underserved contexts.

Nationwide around 226,080 homeless individuals are unsheltered each night. The U.S. Department of Veterans Affairs (VA) Low Demand program is a community-based model which provides supportive transitional housing to hard-to-reach, unsheltered veterans who often have complex needs and may be unable or unwilling to participate in supportive services which aim to prevent or rapidly re-house veterans when facing housing instability or homelessness. The goal of this study was to examine Low Demand community providers' perceptions of the facilitators and barriers to Low Demand model engagement and effectiveness among unsheltered homeless veterans. Semi-structured interviews, composed of 20 open-ended questions, were conducted with a convenience sample of VA Low Demand community providers and VA staff affiliated with the programs. Interviews were transcribed verbatim, and an inductive approach was employed allowing the data to determine the main categories and subthemes. Three coders independently summarized, coded, and compared transcripts. Qualitative analyses were performed in Atlas.ti. Forty-five Low Demand community providers completed the interview. Providers reported an average four years (range: 3 weeks-14 years) of experience in their current role. Five categories were identified from the qualitative data: (1) Barriers to Low Demand model success, (2) Facilitators of Low Demand model success, (3) Collaborative assessments with VA guide Low Demand program resident retention, (4) Recommendations to reduce returns to homelessness among Low Demand residents, and (5) Low Demand model areas for improvement. Community providers consider the Low Demand model to be an effective option for housing unsheltered veterans who have complex needs. Barriers to retaining and transitioning Low Demand residents to permanent housing were noted. In-facility basic life skills education, financial planning, and relationship reconstruction along with onsite mental health services may support positive program exits. Engaging veterans in aftercare programs and/or retention case management is crucial in the prevention of returns to homelessness. Strong community and VA collaborations are essential to maximizing positive Low Demand program outcomes.