Administration and Policy in Mental Health and Mental Health Services Research最新文献

Unmet needs refer to the gap between the health services individuals require and what they receive. Individuals with mental health issues often face barriers preventing them from accessing the care they need. A meta-analysis was conducted to estimate the pooled prevalence of unmet needs for care and barriers to care among individuals with mental health issues. The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from December 1, 1985 to August 1, 2024. Following the screening process, 204 included studies remained for meta-analysis. Individuals with mental health issues reported significant pooled prevalence rate of unmet care needs over the past year, with the most common being related to work/occupation (43%), dental care (41%), counseling (40%), social intervention (37%), mental health (34%), physical health needs (33%), skills training (32%), social network (32%), psychological distress (31%), information (27%), intimate relationships (27%), benefits (26%), harm reduction (25%), psychotic symptoms (24%), housing (24%), money and food (21%), education (20%), sexual expression (19%), home care (16%), safety (15%), self-care (15%), telephone support (9%), and child care (8%). The pooled prevalence rates of barriers to accessing care were motivational (38%), structural (37%), financial (31%), and stigmatization (25%). The findings indicated that patients with substance use disorders experienced a significantly higher prevalence of unmet care needs and barriers to accessing care compared to those with mental health disorders and homeless individuals. The results showed that unmet care needs were highest among those in established adulthood, while harm reduction was more common among adolescents and emerging adults. Physical health and food needs were most prevalent among midlife adults. Barriers to care were most common among adolescents and emerging adults, except for structural barriers, which were most frequent among midlife adults. To address the unmet employment needs of Individuals with mental health issues, comprehensive training in essential skills is recommended. Enhancing dentists’ mental health understanding and fostering collaboration among healthcare providers is crucial. Government-funded, low-barrier service models for substance use disorder patients is suggested to enhance accessibility and effectiveness, while improving health service affordability and acceptability is essential.

Shared decision-making (SDM), known to improve client engagement in care and its quality, is crucial to achieve family-tailored care. However, when providing integrated youth care, SDM can be challenged by the complexity of families’ problems and the multiple family members and professionals involved. Commonly used SDM models may not adequately address these specific challenges. Therefore, this qualitative study explores families’ and professionals’ perspectives on essential elements of SDM with families experiencing multiple and enduring problems on different life domains (e.g., mental health, parenting, financial, and social problems). Semi-structured interviews were conducted with 18 parents, 3 youth, and 22 professionals from Specialist Integrated care Teams in four regions of the Netherlands. A framework method - comprising essential elements of SDM - was applied to systematically code the transcripts both deductively and inductively. Our study shows the nine essential elements of SDM require a specific interpretation in the context of integrated youth care, regarding the diversity of participants in decision-making, the complexity of the problems, and SDM as a continuous process of multiple decisions. In addition, families and professionals mentioned three complementary elements: (1) build collaborative relationships, (2) prioritize problems, goals and actions, and (3) interprofessional consultation. Thus, in integrated youth care professionals are recommended to consider SDM as a cyclical process of larger and smaller decisions and take time to build collaborative relationships with families and the care network. Throughout the care process families and professionals balance their mutual roles in decision-making in line with the changing needs and preferences of families.

The interpretation of effectiveness research can be enhanced by understanding what prescribed (i.e., adherence) and non-prescribed (i.e., differentiation) techniques were delivered. However, few measures exist that can assess both adherence and differentiation. The current study examined how the Therapy Process Observational Coding System for Child Psychotherapy Revised Strategies Scale (TPOCS-RS) can assess adherence to and differentiation from family therapy for youth with externalizing problems. Treatment sessions (N = 103) from 42 adolescents (M age = 15.0, SD = 1.4; 47.6% female; 59.5% Hispanic/Latinx/e, 19.0% Black, 11.9% multiracial, 4.8% other race) with primary externalizing problems treated by 24 clinicians (M age = 33.2, SD = 8.3; 66.7% female; 33.3% Hispanic/Latinx/e, 20.8% White, 12.5% Asian, 8.3% multiracial, 8.3% other race) in routine practice settings were coded with the TPOCS-RS. Treatment sessions were from three groups: (a) routine family therapy, (b) routine family therapy plus the medication integration protocol, or (c) usual care. Interrater reliability for the TPOCS-RS Family Therapy subscale was ICC = 0.90, and scores demonstrated evidence of convergent and discriminant validity via associations with treatment integrity and alliance measures. The TPOCS-RS Family Therapy subscale also demonstrated evidence of discriminative validity by identifying expected group differences. Results provide preliminary evidence that the TPOCS-RS can measure adherence to and differentiation from family therapy.

Designing mental health services that align with individual preferences is a cornerstone of patient-centered care, enhancing both service utilization and treatment outcomes. This study applied the precision framework of mental healthcare to explore preferences for first-contact mental health services among community residents and family members with mild psychiatric symptoms in Chinese megacities. Using a discrete choice experiment, an online survey was conducted with 4,057 participants from Beijing, Shanghai, Guangzhou, and Shenzhen. Mixed logit analysis identified service providers as a key determinant of mental health service utilization across cities. While both potential patients and family members favored lower-cost public services, notable variations emerged in preferences for psychological counseling/therapy across cities and between patient and family contexts. Latent class analysis further revealed four distinct preference groups among potential patients. Psychological distress levels and hukou type were significantly associated with preferences. These findings highlight the importance of tailored interventions that accommodate patient and family needs, leveraging the unique features of China’s mental healthcare system to improve access, quality, and equity in mental health services.

Peers are individuals with lived experience of mental health challenges trained to provide support to others with similar challenges. Help@Hand was a multi-site project that integrated peers into digital mental health intervention (DMHI) implementation. This study uses the Consolidated Framework for Implementation Research (CFIR) to frame challenges reported by peers when implementing DMHIs. Individuals leading the local peer workforce completed quarterly online surveys about perceived challenges to DMHI implementation. Biannual interviews probed for details on survey-reported challenges. 103 quarterly surveys and 39 bi-annual interviews were collected from key informants at 11 Help@Hand sites between Summer 2020 and Fall 2022. One challenge was tied directly to DMHIs; namely, device distribution. Several related to the Implementation Process, including challenges with recruiting qualified peers and integrating peers into DMHI implementations; communication and collaboration; and translation. Challenges in the Individual domain included unclear peer roles and multi-tasking across various projects. Inner Setting challenges included structural barriers to hiring peers, issues with communication and project management, and workforce turnover. Outer Setting challenges related to environmental technology readiness, COVID-19, unclear decision-making processes across the collaborative, and uneven communication between sites’ peers. Funding uncertainty bridged the Inner and Outer Settings. Using the CFIR model to frame challenges to DMHI implementation yielded useful lessons, especially when peers are engaged as partners in planning and implementation process. Successful implementation will be enhanced by ensuring adequate environmental readiness for tech-based interventions, clear role definition, streamlined peer hiring processes, and well-delineated lines of communication locally and across sites.

The goal of this paper is to explore the experiences of formerly incarcerated people navigating mental health care post-release and understand how mistrust of mental health services and providers is manifested among this population. Interviews were conducted between 2021 and 2022 with 25 people released from incarceration within the past five years. We partnered with community organizations to recruit a diverse sample of participants, using voluntary response and purposive sampling. The interview transcripts were coded using a modified grounded theory approach and the analysis further guided by critical phenomenology in order to center silenced or marginalized perspectives. Mistrust of mental health care was a prominent theme across interviews. Overall, participants felt that they did not have autonomy over their treatment planning and management. Participants described experiencing stigmatizing treatment from providers, suspicion of mandated mental health treatment, and believing that profit over patients was prioritized in the industry–all of which contributed to growing mistrust of the larger mental health system. The participants’ experiences of losing control over their lives and treatment, compounded by a perceived complicity between mental health and carceral systems, shaped their mistrust toward mental health care. Nevertheless, many demonstrated remarkable persistence in seeking care and engaging with multiple providers, while also actively seeking to reclaim their autonomy.

Maternal depression has been associated with negative parenting behaviors and poor developmental outcomes in children. Home visiting programs have positively impacted parenting behaviors and child outcomes; however, such programs often require specialized, highly trained professionals, resulting in a limited number of home visiting providers. One home visiting parenting program, Attachment and Biobehavioral Catch-up (ABC), does not have requirements regarding experience or background to become an ABC parent coach and deliver the intervention. ABC consists of ten 1-hour weekly sessions for parents of children between 0 and 6 months (ABC-Newborn), 6–24 months (ABC-Infant) or 24–48 months (ABC-Early Childhood). ABC has demonstrated efficacy in improving parental sensitivity and children’s developmental outcomes. A randomized clinical trial in one community implementation setting showed that ABC decreased maternal depressive symptoms. The current study aimed to replicate this finding across multiple implementation sites and expand on it by exploring if the effect differed by ABC model. Data included a community sample of 163 families from six countries who completed ABC. Maternal reports of depressive symptoms were collected prior to and after receiving ABC. Results showed a significant decrease in maternal depressive symptoms scores from pre-intervention to post-intervention regardless of ABC model. Findings demonstrate that a home visiting parenting intervention program can successfully leverage non-traditional mental health providers to ensure that mothers and children receive necessary resources and support.

Community Health Workers (CHW) are part of an emerging workforce in the field of mental health, but few studies have examined their training, supervision, and service delivery needs in the United States. Individual semi-structured interviews were conducted with CHWs (n = 9) and their administrators (n = 6) affiliated with a medical center and school districts in Southern California. Guiding questions focused on CHW roles, work-related stress, clinical decision making, and professional development. Findings pointed to high rates of stress, primarily attributed to role ambiguity, and need (and desire) for more training and supervision related to mental health interventions, and more systematic structures for data-informed decision-making. Discussion provides reflections and recommendations to the field about ways to support this growing and critical workforce.