Journal of Behavioral Health Services & Research最新文献

Mental health difficulties have been on the rise in recent years. Self-disclosure of mental health symptoms is related to a range of positive outcomes, and seeking help for mental health can be life-saving. Help-seeking for one's mental health can be impacted by a variety of factors, such as the help-seeking target (e.g., friend, family member, or professional source) and the presenting problem (e.g., a personal emotional problem vs suicidal ideation). Internalized stigma of mental illness can impede help-seeking; however, it is not known if internalized stigma impedes (1) only certain types of problems or (2) help-seeking only from certain targets. It was hypothesized that the relationship between internalized stigma and willingness to seek help would vary based on (1) help-seeking target and (2) whether someone is seeking help for a personal emotional problem or suicidal thinking. Utilizing a sample of undergraduate students and a sample recruited through Prolific of adults with a history of help-seeking for mental health, bifactor models were run with stigma included as a manifest variable predicting willingness to seek help for suicidal ideation and personal emotional problems (each included as general factors) from three types of targets (friends/intimate partners, family members, and professional sources, each included as specific factors). Results indicate that internalized stigma negatively predicts willingness to seek help for suicidal thinking across targets and negatively predicts willingness to seek help for personal/emotional problems from friends/intimate partners and family members, but not from professional targets. These findings demonstrate that the relationship between internalized stigma and willingness to seek help is not uniform across help-seeking targets and presenting problems.

Peer support workers (PSWs) are trained behavioral health professionals with lived experience of substance use disorders. PSWs are employed by behavioral health agencies to increase uptake of and retention in treatment and recovery services. As their presence in these settings grows, it remains unclear how well PSW job functions align with their unique skills and personal experiences. To fill this gap, a content analysis of online job postings for PSW roles in Missouri across geographic regions and types of behavioral healthcare settings (i.e., treatment facilities, recovery housing, recovery community centers, hospitals, criminal justice settings) posted between April 2023 and September 2024 was conducted and analyzed to assess how they reflect role expectations and the distinct value PSWs contribute to the system. Job tasks were organized into categories and classified as authentic (utilizing PSWs' experience and training, e.g., mentoring, recovery goal setting, and peer advocacy) or generic (not specific to peer roles, e.g., administrative duties, transportation, maintaining relationships with external stakeholders). Results showed that PSWs are expected to perform a near even split of authentic (49.8%) and generic (50.2%) tasks. These findings suggest a lack of consistency in how agencies define and implement the PSW role, potentially contributing to job dissatisfaction and turnover. As organizations continue to employ PSWs in greater numbers, it will be important for agencies to prioritize job clarity and satisfaction, as well as determine the optimal balance of tasks for a more consistent system-level understanding of how to best utilize PSWs in the workplace.

Peer support workers (PSWs) play a key role in the substance use disorder (SUD) recovery field. According to organizational support theory, organizational actions and policies are key factors that promote perceived support and positive job-related outcomes. However, limited qualitative research has examined the construct of perceived organizational support from the perspective of PSWs working in the SUD recovery field. This study sought to determine what organizational actions and policies are perceived as supportive for PSWs. Semi-structured qualitative interviews were conducted with 25 PSWs actively working in the recovery field in South Carolina. Participants were asked "How does your employer or organization support you in the work that you do?" and "How could your organization support you better?" Interviews were recorded and transcribed verbatim. A team-based, rapid qualitative analysis approach was used to analyze data. Themes were identified and mapped onto existing guidelines for incorporation of PSWs into addiction medicine settings. PSWs reported that organizations can foster organizational support for PSWs through valuing PSWs as people with lived experiences. PSWs noted important supports such as living wages, insurance, job-related resources, and high-quality training and supervision. In addition, PSWs described how autonomy and reduced workload enable PSWs to optimize their time. Implications for organizations employing PSWs and recommended best practices are discussed.

Suicide prevention is a critical public health priority. The opportunity to intervene with this population is often in the primary care setting, but many at-risk individuals do not seek treatment. This study examines demographic differences in healthcare utilization patterns among suicide decedents, categorized into three groups: decedents who accessed care for mental health conditions, decedents who accessed care for non-mental health conditions, and decedents who did not access care. Data from the Arkansas All-Payers Claims Database (2013-2021) were linked to vital records to identify adult decedents who died by suicide. Healthcare utilization was categorized based on insurance claims filed in the year before death. Multinomial logistic regression was used to identify predictors of healthcare utilization, including age, gender, race, education, marital status, and rurality. Among 1678 decedents, 38.9% accessed care for mental health conditions, 23.5% accessed care for non-mental health conditions, and 37.5% did not access care in the year before death. Younger decedents (18-44 years) were 49% less likely to access mental health services and 81% less likely to access non-mental health services compared to seniors (65+ years; p < 0.0001). Men were 50% less likely to access mental health services than women (p < 0.0001). African-Americans were more likely to access care for non-mental health conditions (p = 0.01). Identifying decedent characteristics of suicide based on healthcare utilization can help develop targeted interventions for this population. Additional efforts should be made to encourage young people to seek healthcare more regularly, particularly during periods of severe stress.

Substance use disorders (SUDs) are a major public health concern in the USA. In 2023, over 167 million Americans reported substance use, and more than 48 million met the DSM-5 criteria for a diagnosable SUD. Due to this high prevalence, behavioral health providers (i.e., psychologists, social workers, mental health counselors, and marriage and family therapists) regularly encounter clients affected by these disorders. However, many of these providers report receiving limited training in the assessment and treatment of SUDs. This gap in training is especially concerning given how widespread SUDs are and how frequently they co-occur with mental health conditions. To address this issue, this commentary will (1) examine research on SUD training gaps in graduate programs, (2) highlight the risks associated with inadequate SUD training, and (3) propose actionable strategies to enhance SUD-focused training across the behavioral health workforce.

As the emphasis on home-based care grows, it is important to understand factors that affect caregivers' quality of life (QOL). Despite the rise of caregiving responsibilities among all demographics, limited literature examines young adult caregivers. The purpose of this study was to 1) examine the difference in mental health (MH) and QOL among young adult caregivers (YAC) and non-caregivers (YANC) and 2) explore how coping and psychological inflexibility moderate the association of caregiver status with MH and QOL. 60 YAC and YANC (age 18-29) were matched via a one-to-one nearest-neighbor propensity score matching with a caliper of 0.1. Participants completed a questionnaire measuring depression and anxiety, QOL, psychological inflexibility, and coping. ANCOVA revealed YAC reported lower physical health-related QOL than YANC (η² = .09, p = .024) but there were no significant differences in depression, anxiety, or mental health-related QOL. Moderation analyses revealed avoidant coping was associated with worse depression, anxiety, and MH-related QOL among YANC (p's < .0001), but not YAC. Exploratory moderated mediation analyses revealed that for YANC, psychological inflexibility was associated with greater avoidant coping, which in turn was associated with worse depression, anxiety, and MH-related QOL; this indirect effect was not observed for YAC. In this study, YAC did not report significantly worse mental health than YANC, but did report poorer physical health-related QOL. Additionally, results suggest being a YAC may buffer the impact of avoidant coping on MH. Further studies are needed for a better understanding of the young adult caregiver experience. Trial Registration: This study was pre-registered on Open Science Framework ( https://osf.io/hcwqg/?view_only=d777b5061b724801914df6893a426aa4 ).

Major Depressive Disorder is one of the most common mental illnesses worldwide, with oral antidepressant medication being the first-line psychopharmacological treatment option. The term Treatment Resistant Depression (TRD) is used to describe patients who remain symptomatic despite multiple trials of antidepressant medication. There had been limited FDA-approved treatment options for patients with TRD, but in 2019, intranasal esketamine was approved by the FDA for patients with TRD after safety and efficacy were established in the drug development clinical trial program. Since approval, multiple researchers have explored esketamine's effectiveness in real-world treatment settings. Despite established efficacy and effectiveness, most psychiatric treatment settings do not offer intranasal esketamine. This limited implementation is reviewed using the Consolidated Framework for Implementation Research (CFIR), and steps forward are proposed to improve accessibility for patients with TRD.

The COVID-19 pandemic led to ongoing unmet demand for mental health services, with integrated behavioral health (BH) in primary care facing challenges due to reduced in-person consultations. Although telehealth helped maintain access, opportunities for collaboration in resident precepting clinics were limited. The authors developed a program in two academic primary care practices in 2021-2022, adapting the BH clinician schedules to support regular, timely consultation during resident precepting clinics, while balancing financial sustainability in the clinical sites' fee-for-service payment models. BH collaboration time was consolidated into a single clinic session to align with resident precepting clinics. BH clinicians tracked data related to consult volume, source, clinical domain, time spent, disposition, and direct patient contact. Preliminary data suggests that regular availability and accessibility of BH clinicians contributed to consultation by multiple medical team members across two practices. This flexible scheduling improved collaboration between medical and BH team member and maintained care access.

Suicide remains a leading cause of death in the U.S. military, with the majority of suicides enacted by firearm. A recommended intervention for suicide prevention in clinical settings, including in the Military Health System (MHS), is counseling at-risk patients about reducing access to firearms and other lethal means of suicide. The team sought to examine MHS clinicians' views on a firearm suicide prevention toolkit that included (1) clinician training, (2) the "Lock to Live" (L2L) decision aid, and (3) connection to out-of-home firearm storage options. The study team conducted one-on-one, semi-structured qualitative interviews with MHS clinicians, administrators, and other stakeholders (January-October 2022). Interviewees viewed the toolkit items and completed a brief questionnaire. The study used a team-based, mixed deductive-inductive approach to qualitative analysis. The study had institutional review board approval. Across interviews (n = 18), there was general support for the lethal means safety counseling toolkit, including clinician training, L2L use, and connection to out-of-home storage options. Participants also provided recommendations for optimal uptake in the MHS, including military-specific messaging. Firearm suicide prevention is a key focus within the Department of Defense, and the findings from this qualitative study can support incorporation of tools for MHS clinicians and patients.

Cultural humility is an important provider-level strategy for improving engagement and retention in mental health care. Yet, little research has used theoretical frameworks to examine beliefs and intentions to practice with cultural humility among mental health providers. The current study aimed to fill this gap by using the Theory of Planned Behavior (TPB) to qualitatively explore beliefs, norms, and attitudes regarding cultural humility practice among a sample of 16 professional mental health providers. Participants were predominately women (89.5%), with an average age of 38 years old (SD = 7.98). Participants completed a 30- to 60-min online interview. Thematic analysis was used to examine patterns and identify overarching themes within TPB constructs of behavioral, normative, and control beliefs. Themes within behavioral beliefs reflected improved practice, particularly for working with clients from marginalized groups. However, there was uncertainty in navigating cultural humility practice and concerns about potentially altering the client relationship. Referents for normative beliefs were clinical agencies, professional organizations, university training programs, and supervisors and mentors. Within control beliefs, themes for facilitators and barriers centered around lack of support from mental health systems, personal limitations and strengths, and professional development. This study furthers understanding of mental health providers' attitudes and intentions to practice with cultural humility, as well as underscoring the nuances of when and how these practices are used. This research can help to address barriers and promote cultural humility practice among mental health providers across multiple fields.