Psychiatric services最新文献

Family-based intervention approaches hold tremendous promise for improving mental health in scalable and relevant ways that address social determinants of health, yet family-focused prevention and care interventions are underused in global mental health. This article provides a brief overview of the evidence and types of programs. It then outlines five future directions for family-focused global mental health interventions: integrating implementation science into family-focused programs, expanding research on family-focused work to other populations and different modalities, encouraging transdisciplinary learning from other fields, understanding what works for whom and where, and disseminating family interventions grounded in locally derived theoretical frameworks.

Objective: Black adults experience depression that is more severe than that of their White counterparts, yet they are less likely to receive treatment from a mental health professional. This study aimed to examine the relationships between medical mistrust or trust and the willingness to seek mental health care.

Methods: The authors conducted an online cross-sectional survey of 1,043 Black adults in the United States. The primary variables of interest were medical mistrust (measured via the 12-item Group-Based Medical Mistrust Scale; GBMMS) and a single item, derived from the General Help-Seeking Questionnaire, that assessed willingness to seek mental health care. The authors hypothesized that mistrust would have a negative correlation with willingness to seek help from a mental health professional. To estimate the association between level of mistrust and willingness to seek care, gamma regression models were fitted with a log link, and the analyses were adjusted for age, ethnic identity or origin, education, insurance status, personal income, citizenship status, and length of time in the United States.

Results: At low levels of medical mistrust (GBMMS scores ≤3), an increase in mistrust was significantly associated with an increase in the probability of seeking mental health care (rate ratio [RR]=1.55, p<0.001). At high levels of medical mistrust (GBMMS scores >3), an increase in mistrust was associated with a decrease in care seeking (RR=0.74, p<0.001). Similar patterns were observed for medical trust.

Conclusions: At low levels of medical mistrust among Black adults, each unit increase in mistrust was counterintuitively associated with an increase in willingness to seek care from a mental health professional.

Social support improves outcomes for individuals after first-episode psychosis (FEP). Illness-related changes in social behavior (e.g., social anxiety, withdrawal, and stigma) may hinder such individuals' comfort with in-person interactions; however, online relationships may appeal to emerging adults (i.e., those ages 18-29 years) with FEP who frequently rely on and are facile with digital interactions. Despite the large footprint of the Internet in emerging adults' lives, little work has examined online social support for those with FEP. In this column, the authors suggest approaches that clinicians and researchers can take when assessing sources of social support to consider online relationships as potential alternatives to in-person interactions for emerging adults with FEP.

Objective: Although certification can raise the status of peer support work, certified peer specialists (CPSs) may continue to face financial hardship that affects their employment choices. This study aimed to explore how wages and financial well-being changed for CPSs over a 3-year postcertification period.

Methods: This study examined wages, job characteristics, and financial well-being for a cohort of 448 employed CPSs working in peer support (PS) or other, nonpeer (NP) jobs during the study period. Self-report survey data were collected on current jobs, hours worked, and job tenure. Financial well-being was assessed by using the Consumer Financial Protection Bureau's Financial Well-Being Scale. Differences in job characteristics over time were described by using chi-square and t tests, and mixed-effects logistic regression models were used to model job attributes and financial well-being.

Results: Hourly wages for both PS and NP jobs increased significantly between 2020 and 2022, with smaller increases for PS than for NP positions. Individuals with PS jobs were significantly more likely to have longer job tenures than those with NP jobs. Higher hourly wages were associated with a greater likelihood of longer job tenure. Financial well-being did not improve significantly over time.

Conclusions: The larger wage increases and shorter tenures characteristic of NP jobs, relative to PS positions, suggest that workers may have switched from PS jobs to other jobs to improve their financial and career mobility opportunities. CPSs are part of a trend in the general U.S. adult population of declining financial well-being, despite increased wages.

Objective: Delayed access to behavioral health services results in poor outcomes and higher costs. This brief report describes the elimination of a 702-person behavioral health waitlist through phase-based care (PBC), an innovative approach that aligns behavioral health resources with new patients with high-acuity need.

Methods: Two PBC clinics, one triage and another high-acuity treatment, were established. Comparisons of pre-post interventions analyzed nonbehavioral health medical encounters, behavioral health productivity, and no-show rates.

Results: Of 702 waitlisted persons, 614 attended triage clinics within 3.5 months, with patients needing acute care (37%) entering the treatment clinic within 2 weeks. Following evaluation, the waitlisted patients had 23% fewer medical encounters per month (p<0.001), behavioral health revenues increased 29% (p<0.001), behavioral health visits increased 165% (p<0.001), health evaluations increased 287% (p<0.001), and no-shows decreased 33% (p<0.001).

Conclusions: Reallocating resources to new patients and those needing acute care resulted in increased behavioral health evaluations and productivity and reduced nonbehavioral health services without adding staff.

Objective: This study aimed to develop and pilot the Clinical High Risk for Psychosis Services Fidelity Scale (CHRPS-FS).

Methods: A literature review was conducted to identify evidence-based treatments for individuals at clinical high risk for psychosis (CHRP). These findings were compared with the First-Episode Psychosis Services Fidelity Scale (FEPS-FS). Common items were retained, and others were added, modified, or deleted. Next, the Delphi process was conducted with 17 clinical and academic experts in CHRP care to determine consensus on the importance and validity of each item. Concurrently, the preliminary tool was piloted in eight coordinated specialty care (CSC) clinics serving individuals with CHRP.

Results: The literature review identified two components of CHRP care that were not detailed in the FEPS-FS and were added to the CHRPS-FS; furthermore, one FEPS-FS item was modified and six were removed. In the Delphi process, clinical and academic experts achieved a consensus of >80% in two rounds, with some changes in item wording and the addition of one item (stepped care approach). A CHRPS-FS assessment was successfully piloted in eight CSC clinics. The mean CHRPS-FS rating score was 3.96 (range 3.75-4.23), and the median proportion of items rated at good to high fidelity was 72% (range 66%-78%).

Conclusions: The CHRP-FS is feasible to implement, has face validity based on expert consensus, can be completed in conjunction with a FEPS-FS assessment or alone, and captures variability across programs. The CHRPS-FS measures service delivery and is suitable for clinical trials, learning health care systems, and quality improvement efforts.