Psychiatric services最新文献

Objective: This study sought to evaluate how the recent increase in use of online meetings has influenced participant experiences with peer-based mutual support groups for problematic drinking.

Methods: The authors conducted semistructured interviews in June and July 2024 with 20 adults who participated in online mutual support meetings for problematic drinking. Participants were recruited from a nationwide online research panel. The authors conducted an ideal-type analysis to compare the experiences of individuals who differed in their modality (online vs. in person) preferences and motivations for using online meetings.

Results: The authors identified four distinct types of online meeting users, who varied in their perceptions about the advantages of online meetings. Meeting maximizers valued flexibility and convenience and used online meetings to supplement in-person participation. Strategists viewed online meetings as a source of new ideas and urgent support and used a mix of both modalities to capitalize on the perceived distinct advantages of each. Online enthusiasts preferred online meetings because they afforded increased anonymity and control and reduced social pressure. Finally, compliance seekers preferred online meetings for their efficiency in facilitating compliance with legal requirements. Participants of all types reported technological barriers, inconsistent quality, and greater potential for disruptions as disadvantages of online meetings.

Conclusions: Online meetings offer distinct advantages for individuals with differing motivations for engaging in peer-based mutual support groups, functioning as a gateway support for some people and as an essential supplement to ongoing in-person support for others.

Objective: The United States is experiencing a mental health crisis among youths and young adults. Most serious mental health conditions emerge during the transition to adulthood, and unmet mental health needs continue to rise among young adults. Following Australia's success with headspace, several countries are implementing integrated youth mental health programs, which warrant evaluation in the United States. The purpose of this study was to detail the service engagement, acceptability, and preliminary outcomes of the Amplify integrated youth mental health clinic during its first year of operation.

Methods: The University of Texas at Austin Dell Medical School implemented Amplify in a community college setting. Participants completed online standardized self-report measures at enrollment and 60 and 180 days later. Staff recorded service delivery in an electronic health record. Data were analyzed for Amplify's first year of operation (January 1-December 31, 2023).

Results: During year 1, Amplify employed a program director, licensed clinical program manager, therapist, supported employment and education specialist, community navigator, part-time psychiatrist, and receptionist. Amplify delivered 1,308 services to 74 youths, 60 of whom consented to participate in the study. Most participated in two types of services. Mean±SD use per participant was 18±18 service units (i.e., sessions). Service satisfaction was high at 60 and 180 days. Mental distress significantly decreased from enrollment to 60 and to 180 days.

Conclusions: More research on Amplify is needed to further operationalize the model and demonstrate its value to U.S. public and private health care systems and payers.

Objective: The authors sought to quantify the proportion of U.S. postsecondary institutions that offer any on-campus mental health services to their students.

Methods: In this cross-sectional study, data about the availability and descriptions of mental health services were gathered from websites of a main sample of 200 postsecondary institutions other than community colleges and a sample of 50 community colleges. Both samples were selected through a stratified sampling process. Descriptive statistics, weighted (main sample) and unweighted percentages, and confidence intervals were calculated.

Results: In the main sample, 191 institutions (95%, 95% CI=91%-98%) offered mental health services. Among community colleges, 40 (80%, 95% CI=69%-91%) offered such services. In both the main and community college samples, most institutions (92% and 75%, respectively) used "counseling" to describe the services offered.

Conclusions: Extrapolation of these results suggests that >1,700 U.S. postsecondary institutions offer mental health services, making campus services a sizeable mental health services sector.

Objective: This study aimed to assess need factors associated with adequate treatment utilization among adolescents experiencing depression.

Methods: Nationally representative data from the Medical Expenditure Panel Survey (2008-2019) were analyzed via logistic regression. Predictors of adequate depression treatment utilization included household reporting of adolescents' mental health, functional impairment, and general medical health. Adequate treatment utilization was defined as four or more outpatient or office-based visits with an active antidepressant prescription or eight or more outpatient or office-based psychotherapy visits across 12 months.

Results: Of the 887 adolescents (ages 12-17) with depression identified, 276 (34% weighted) utilized adequate treatment. Adequate treatment utilization was positively associated with reports of adolescents' poor mental health and functional impairment (OR=1.69, p<0.001 and OR=1.43, p=0.004, respectively) and negatively associated with reports of adolescents' general medical health (OR=0.55, p<0.001).

Conclusions: Future interventions should include psychoeducation for caregivers in order to increase recognition of adolescents' mental health status and impairments.

Objective: Employment rates are low among individuals receiving assertive community treatment (ACT) services in New York State (9% of approximately 6,400 individuals in 2023). This project aimed to increase employment rates by implementing the individual placement and support (IPS) model of supported employment within ACT services.

Methods: To assess the effectiveness of IPS for ACT participants and what adaptations might be needed, IPS was piloted with six ACT teams from October 2021 to October 2022. The teams received live IPS training and monthly consultation. They took part in pre-post fidelity assessments, provided monthly performance data, and engaged in semistructured interviews at the conclusion of the pilot.

Results: During the pilot, 109 ACT participants received IPS services. The monthly employment rate ranged from 25% to 46% and fluctuated over time. ACT participants receiving IPS started 71 jobs during the pilot. ACT teams demonstrated a culture shift that embraced employment and IPS principles such as zero exclusion. They dedicated a mean of 0.5 full-time equivalent (FTE) hours to providing IPS services, divided among one to six team members. The total IPS fidelity score increased (i.e., improved) by an adjusted mean of approximately 14 points from the start (77.5 points) to the end (91.8 points) of the pilot.

Conclusions: Future efforts to implement IPS within ACT teams may need to incorporate extended or additional supports and ways to dedicate vocational specialist time to IPS service provision in order to achieve better employment outcomes.

Objective: Jail detention may be a marker of suicide risk in the community. This article aimed to describe the phenomenology of suicide risk, including lifetime suicidal behaviors and comorbid conditions, observed among individuals recruited into a suicide prevention trial who passed through pretrial jail detention before returning to the community.

Methods: Data on baseline characteristics of 800 adult participants from the SPIRIT (Suicide Prevention Intervention for At-Risk Individuals in Transition) study were analyzed.

Results: Half the participants reported a suicide attempt in the 30 days prior to study enrollment, 85% reported at least one lifetime suicide attempt, and (93%, N=743) reported any suicidal behavior in their lifetime. Most (85%) suicide attempts in the past 30 days were made in the community, prior to arrest. Participants had a mean±SD of 14.1±53.6 lifetime suicide attempts. One-third (34%) reported that their first attempt occurred when they were ≤10 years old. Comorbid conditions were common, with high rates of problematic substance use as well as symptoms of depression, posttraumatic stress, psychosis, and mania.

Conclusions: Individuals passing through pretrial jail detention have a complex suicide risk profile that often includes addiction, serious mental illness, and long histories of suicidal behaviors. Because most of these individuals return to the community within days, effective postdetention suicide prevention services in the community are needed.

Objective: This study examined the impact of state medical licensure exemptions and telehealth registries on college students' access to psychiatric care.

Methods: The authors attempted to contact 901 psychiatrists who advertised online on Psychology Today by using a simulated patient, described as a student attending college in a state with a medical licensure exemption or telehealth registry.

Results: Contact was established with 282 (31%) psychiatrists across 10 states. Of the 143 contacted psychiatrists who were accepting new patients, seven (5%) were aware of state medical licensure exemptions, 43 (30%) were willing to establish care with students attending college in another state regardless of state laws, 42 (29%) were willing to learn about licensure exemptions, and 51 (36%) were unwilling to care for students in another state even when permitted by law.

Conclusions: Given psychiatrists' lack of awareness of licensure exemptions and telehealth registries, interstate access to and continuity of care may be limited.

Objective: The purpose of this study was to identify implementation challenges to and solutions for integrating medications for opioid use disorder (MOUD) into community mental health centers (CMHCs).

Methods: Between February and July 2024, 17 semistructured interviews were conducted with CMHC program leaders. Participants described the impetus for MOUD provision or reasons for not implementing MOUD, as well as key implementation challenges and strategies to address them.

Results: Participants included staff from 10 CMHCs that provided MOUD and seven that did not. MOUD clinic staff noted that community need and leadership advocacy impelled them to offer MOUD, despite facing challenges. Reasons from non-MOUD clinic staff for not providing MOUD included a perceived lack of opioid use disorder among clients, concerns about treating people with opioid use disorder, and the need for appropriate staff and training. Implementation challenges identified by participants from MOUD clinics concerned the complexity or lack of reimbursement for MOUD-related services, lack of staff training and support, workflow misalignment, client nonadherence to MOUD, and medication costs. Several strategies were described to address these challenges, including streamlining workflows and pathways to treatment, increasing staff training and support, and leveraging telehealth.

Conclusions: Identifying implementation strategies that assist CMHCs in overcoming barriers to integrating MOUD can increase access in settings where people with co-occurring mental and opioid use disorders regularly receive care. This article provides illustrative examples of successful strategies used to address challenges faced by CMHCs and recommendations to increase MOUD uptake.

Objective: Long-acting injectable antipsychotics (LAIAPs) enable safe and effective long-term management of chronic psychotic disorders but are underused in clinical practice. The authors examined whether Medicare formulary restrictions (prior authorization [PA] or step therapy) impose barriers to LAIAP uptake.

Methods: The authors analyzed formulary restrictions and patient cost-sharing for several LAIAPs and estimated the percentage of plans (N=2,494 were available per year) applying formulary restrictions. Analyses were stratified by Medicare Advantage, dual Medicare-Medicaid eligibility plans, and Part D plan group and weighted by the number of enrollees at the per-year, per-plan level.

Results: Application of formulary restrictions for LAIAPs was low (<12% requiring PA [apart from olanzapine] and <4% requiring step therapy) and decreased among nearly all plan types between 2019 and 2023.

Conclusions: Formulary restrictions do not appear to present a significant barrier to use of LAIAPs for psychiatric patients with Medicare prescription drug coverage. Additional research is needed to further understand factors influencing LAIAP use.