Browsing by Subject "Mental Health Services"
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Item Open Access Accuracy of proactive case finding for mental disorders by community informants in Nepal.(Br J Psychiatry, 2015-12) Jordans, Mark JD; Kohrt, Brandon A; Luitel, Nagendra P; Komproe, Ivan H; Lund, CrickBACKGROUND: Accurate detection of persons in need of mental healthcare is crucial to reduce the treatment gap between psychiatric burden and service use in low- and middle-income (LAMI) countries. AIMS: To evaluate the accuracy of a community-based proactive case-finding strategy (Community Informant Detection Tool, CIDT), involving pictorial vignettes, designed to initiate pathways for mental health treatment in primary care settings. METHOD: Community informants using the CIDT identified screen positive (n = 110) and negative persons (n = 85). Participants were then administered the Composite International Diagnostic Interview (CIDI). RESULTS: The CIDT has a positive predictive value of 0.64 (0.68 for adults only) and a negative predictive value of 0.93 (0.91 for adults only). CONCLUSIONS: The CIDT has promising detection properties for psychiatric caseness. Further research should investigate its potential to increase demand for, and access to, mental health services.Item Open Access Child welfare agency ties to providers and schools and substance abuse treatment use by adolescents.(Journal of substance abuse treatment, 2011-01) Wells, R; Chuang, E; Haynes, LE; Lee, IE; Bai, YPolicy makers and advocates are increasingly encouraging child-serving organizations to work together. This study examined how child welfare agency ties with substance abuse treatment providers and schools correlated with substance abuse treatment for adolescents receiving child protective services. A sample of adolescents with substance use risk was extracted from a national survey of families engaged with child welfare. Logistic regressions with adjustments for complex survey design used child welfare agency ties to substance abuse treatment providers and schools to predict treatment. As expected, adolescents were more likely to report treatment when child protective services and substance abuse treatment were in the same agency and when child welfare agency directors reported joint planning with schools. However, child welfare agency agreements with substance abuse treatment providers were negatively associated with treatment. This unexpected finding implies that agencies may sometimes cooperate to address problems and to improve service utilization.Item Open Access Differences in behavioral health disorders and unmet treatment needs between medical marijuana users and recreational marijuana users: Results from a national adult sample.(Drug and alcohol dependence, 2017-11) Park, Ji-Yeun; Wu, Li-TzyBACKGROUND:Available data suggest that medical marijuana users may have more mental health problems than recreational marijuana users. There is limited information about differences in behavioral health disorders and unmet treatment needs between medical and recreational marijuana users. METHODS:We compared past-year prevalence of behavioral health disorders and unmet treatment needs across three marijuana subgroups (recreational use only, medical use only, and both). Sex-stratified logistic regression was performed to determine their associations with marijuana use status. We analyzed data from adults (≥18 years) who used marijuana in the past year (N=15,440) from 2013 to 2014 National Surveys on Drug Use and Health. RESULTS:Among 15,440 past-year marijuana users, 90.2% used recreational marijuana only, 6.2% used medical marijuana only, and 3.6% used both. Both users had the highest prevalence of behavioral health disorders and unmet treatment needs overall, with no significant sex differences. In the sex-specific logistic regression analysis, medical only users and both users showed somewhat different patterns of associations (reference group=recreational only users). Medical only users had decreased odds of alcohol or drug use disorders, and unmet need for alcohol or drug treatment among males and females. Additionally, female medical only users had decreased odds of opioid use disorder. Both users had increased odds of major depressive episode, hallucinogen use disorder, and unmet need for mental health services among males, and cocaine use disorder among females. CONCLUSIONS:Different approaches tailored to individuals' sex and motives for marijuana use is needed for the prevention and treatment of behavioral health problems.Item Open Access Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the National Comorbidity Survey.(The American journal of psychiatry, 1999-08) Wu, LT; Kouzis, AC; Leaf, PJOBJECTIVE: This study sought to determine how comorbidity of psychiatric and substance abuse disorders affects the likelihood of using mental health services. METHOD: The analysis was based on data on adults aged 18-54 years in the National Comorbidity Survey (N = 5,393). Users and nonusers of mental health and substance abuse services were compared in terms of their demographic characteristics, recent stressful life events, social support, parental history of psychopathology, self-medication, and symptoms of alcohol abuse/dependence. RESULTS: The prevalence of service utilization varied by diagnostic configurations. Comorbid psychiatric or alcohol disorders were stronger predictors of service utilization than a pure psychiatric or alcohol disorder. Factors predicting utilization of services differed for each disorder. CONCLUSIONS: Since comorbidity increases the use of mental health and substance abuse services, research on the relationship of psychiatric and alcohol-related disorders to service utilization needs to consider the coexistence of mental disorders. Attempts to reduce barriers to help seeking for those in need of treatment should be increased.Item Open Access Outcomes for implementation science: an enhanced systematic review of instruments using evidence-based rating criteria.(Implementation science : IS, 2015-11) Lewis, Cara C; Fischer, Sarah; Weiner, Bryan J; Stanick, Cameo; Kim, Mimi; Martinez, Ruben GBackground
High-quality measurement is critical to advancing knowledge in any field. New fields, such as implementation science, are often beset with measurement gaps and poor quality instruments, a weakness that can be more easily addressed in light of systematic review findings. Although several reviews of quantitative instruments used in implementation science have been published, no studies have focused on instruments that measure implementation outcomes. Proctor and colleagues established a core set of implementation outcomes including: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, sustainability (Adm Policy Ment Health Ment Health Serv Res 36:24-34, 2009). The Society for Implementation Research Collaboration (SIRC) Instrument Review Project employed an enhanced systematic review methodology (Implement Sci 2: 2015) to identify quantitative instruments of implementation outcomes relevant to mental or behavioral health settings.Methods
Full details of the enhanced systematic review methodology are available (Implement Sci 2: 2015). To increase the feasibility of the review, and consistent with the scope of SIRC, only instruments that were applicable to mental or behavioral health were included. The review, synthesis, and evaluation included the following: (1) a search protocol for the literature review of constructs; (2) the literature review of instruments using Web of Science and PsycINFO; and (3) data extraction and instrument quality ratings to inform knowledge synthesis. Our evidence-based assessment rating criteria quantified fundamental psychometric properties as well as a crude measure of usability. Two independent raters applied the evidence-based assessment rating criteria to each instrument to generate a quality profile.Results
We identified 104 instruments across eight constructs, with nearly half (n = 50) assessing acceptability and 19 identified for adoption, with all other implementation outcomes revealing fewer than 10 instruments. Only one instrument demonstrated at least minimal evidence for psychometric strength on all six of the evidence-based assessment criteria. The majority of instruments had no information regarding responsiveness or predictive validity.Conclusions
Implementation outcomes instrumentation is underdeveloped with respect to both the sheer number of available instruments and the psychometric quality of existing instruments. Until psychometric strength is established, the field will struggle to identify which implementation strategies work best, for which organizations, and under what conditions.Item Open Access Patient and Health Care Professional Perspectives on Stigma in Integrated Behavioral Health: Barriers and Recommendations.(Annals of family medicine, 2023-02) Phelan, Sean M; Salinas, Manisha; Pankey, Tyson; Cummings, Gabrielle; Allen, Jay-Sheree P; Waniger, Anne; Miller, Nathaniel E; Lebow, Jocelyn; Dovidio, John F; van Ryn, Michelle; Doubeni, Chyke APurpose
Stigma related to mental health is well documented and a major barrier to using mental and physical health care. Integrated behavioral health (IBH) in primary care, in which behavioral/mental health care services are located within a primary care setting, may reduce the experience of stigma. The purpose of this study was to assess the opinions of patients and health care professionals about mental illness stigma as a barrier to engagement with IBH and to gain insight into strategies to reduce stigma, encourage discussion of mental health, and increase uptake of IBH care.Methods
We conducted semistructured interviews with 16 patients referred to IBH in a prior year and 15 health care professionals (12 primary care physicians and 3 psychologists). Interviews were transcribed and inductively coded separately by 2 coders for common themes and subthemes under the topic headings of barriers, facilitators, and recommendations.Results
We identified 10 converging themes from interviews with patients and the health care professionals, representing important complementary perspectives, with respect to barriers, facilitators, and recommendations. Barriers included professionals, families, and the public as sources of stigma, as well as self-stigma or avoidance, or internalizing negative stereotypes. Facilitators and recommendations included normalizing discussion of mental health and mental health care-seeking action, using patient-centered and empathetic communication strategies, sharing by health care professionals of their own experiences, and tailoring the discussion of mental health to patients' preferred understanding.Conclusions
Health care professionals can help reduce perceptions of stigma by having conversations with patients that normalize mental health discussion, use patient-centered communication, promote professional self-disclosure, and are tailored to patients' preferred understanding.Item Open Access Private health insurance coverage for substance abuse and mental health services, 1995 to 1998.(Psychiatric services (Washington, D.C.), 2004-02) Wu, Li-Tzy; Schlenger, William EFour years of data from the National Household Survey on Drug Abuse were combined to examine the characteristics of underinsurance in a sample of privately insured Americans aged 18 to 64. Among these adults, 38 percent (45 million) reported not having behavioral health coverage or not knowing their coverage. Young adults aged 18 to 25, Hispanics, Asians, adults in the lowest income level, and less educated adults were more likely to be underinsured. Untreated addictive and psychiatric problems are costly to society. Underinsurance among socially disadvantaged subgroups deserves greater attention from researchers and policy makers.Item Open Access Use of alcohol treatment and mental health services among adolescents with alcohol use disorders.(Psychiatric services (Washington, D.C.), 2006-01) Wu, Li-Tzy; Ringwalt, Chris LOBJECTIVE:This study examined the use of and perceived need for alcohol treatment services among adolescents (aged 12 to 17 years) who received mental health services in the previous year compared with same-aged adolescents who did not receive such services. METHODS:Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. The authors conducted logistic regression analyses to identify the characteristics associated with the receipt of and perceived need for alcohol services among adolescents with alcohol use disorders. RESULTS:Adolescents who received mental health services were much more likely than those who did not to meet criteria for alcohol use disorders in the previous year (10 percent compared with 4 percent). Among adolescents with alcohol use disorders, 15 percent of those who received mental health services used any alcohol services, compared with only 6 percent of those who did not receive mental health services. Of adolescents with alcohol use disorders who did not receive any alcohol services, only 3 percent reported a need for alcohol treatment. Among adolescents with alcohol use disorders who received mental health services, Hispanics were significantly less likely than whites to receive any alcohol services. CONCLUSIONS:These findings from a nationally representative sample of adolescents reveal a largely unrecognized and underserved population at risk. Factors related to the underutilization of alcohol services by adolescents with alcohol use disorders deserve greater research attention.