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At least 19 recordsLinked to original sources

PubMed1979

Collaboration, consultation and referral in an integrated health-mental health program at an HMO.

The paper describes interactions between primary care physicians (PCP's) and mental health clinicians (MHC's) in a "team collaborative model." A study of the interactions showed there were about two consultations a day with PCP's for each MHC, that they were largely unscheduled, took place mostly in PCP or MHC offices or in corridors, and increased in frequency over a two-year period. Role definition was a continuing process; PCP's and MHC's each learned through repeated discussions what to expect from the other in patient care. It is found that a model with close working arrangements between PCP's and MHC's is of therapeutic value for that large population of emotionally disturbed patients seen often by PCP's much less often by MHC's.

Community Mental Health Services↗

PubMed1990

Improving the physical health-mental health interface for the chronically mentally ill: could nurse case managers make a difference?

Although the increased incidence and prevalence of medical illnesses among the chronically mentally ill has been well documented, access and use of general health care services by this population remains problematic despite the implementation of case management. This article describes the problems experienced in meeting physical health care needs through the five core case-management components of client identification and outreach, assessment, service planning, monitoring of service delivery, and advocacy. A model of case management is proposed that uses psychiatric nurse clinical specialists in supervisory and consultative rôles, and nurse practitioners to deliver primary care.

Health Services Accessibility↗

PubMed1985

Mental health of the elderly: use of health and mental health services.

The utilization of services by older patients with mental morbidity is examined in this paper. The population is drawn from a large, multi-site study, the Epidemiological Catchment Area studies, and reports on the findings from the Baltimore, Maryland, site, The Eastern Baltimore Mental Health Survey. The fact that older individuals with mental disorders are less likely to be seen and treated for these disorders than are younger individuals was substantiated by data from this study. Of those under age 65, 8.7 per cent have made a visit to a specialty or primary care provider for mental health care; for those age 65 to 74, the rate is 4.2 per cent, and of those 75 and over, only 1.4 per cent have had such care. In this last group, 75 and over, not a single person saw a specialty mental health provider. The likeliest source of care for older individuals for emotional or psychiatric problems is their primary care providers within the context of a visit made for physical medical problems. Past work and these data suggest that the factors that influence this low level of care can be found in the characteristics of the population as well as in the characteristics of the health care system. The implications of these findings are discussed.

Adolescent↗

PubMed1992

Community mental health and mental retardation services in the United States: a comparative study of resource allocation.

OBJECTIVE: Preliminary studies suggest that during the 1980s, spending for community mental retardation services in the United States may have grown much more rapidly than spending for community mental health. The primary objective of this study was to test empirically the validity of this thesis on a national basis. An additional objective was to determine why such a distinction in community spending patterns might have evolved nationally. METHOD: The study used states as the units of analysis and employed a five-factor hierarchical regression to predict variance in mental health and mental retardation spending. Factors were state size, state wealth, degree of federal assistance, state civil rights activity, and strength of consumer advocacy groups. Strong roles for the civil rights and consumer advocacy factors were hypothesized. A collateral opinion survey in the 10 states exhibiting the greatest within-state difference in community mental health and mental retardation spending was also completed. RESULTS: Community mental retardation spending grew nearly four times more rapidly than community mental health spending in the 1980s. The consumer advocacy and civil rights factors were strongly associated with spending for community mental retardation services in the states, but these factors did not predict spending for community mental health services. CONCLUSIONS: Study recommendations included strengthening mental health family and consumer advocacy groups in the states and promoting systematic exchange between the mental health and mental retardation fields through joint state planning initiatives, studies, and conferences. The need for Medicaid reform is a unifying theme in both the mental health and mental retardation fields.

Community Mental Health Services↗

PubMed1991

A comparison of users and nonusers of a school-based health and mental health clinic.

This study compares student health and mental health knowledge, behavior, and access to services for adolescents who used and did not use a school-based health and mental health clinic. Data were collected as part of an anonymous, self-administered survey completed by all students in a school housing a clinic that had been in operation for a school year. Comparisons of clinic users and nonusers revealed differences in health- and mental health-related knowledge and behavior and access to needed care. The clinic was found to be serving adolescents at high risk for a variety of psychosocial problems (e.g., drug use, depression, dropout).

Adolescent↗

PubMed1985

Seeking professional help for personal problems: black Americans' use of health and mental health services.

This article explored the use of health and mental health services for serious personal problems in a national sample of adult black Americans. The results indicated low usage of the mental health sector in response to problems. Only 9% of the respondents who sought professional help contacted a community mental health center, psychiatrist or psychologist. Mental health usage was low even among respondents who felt their problem brought them to the point of a nervous breakdown and among respondents who conceptualized their distress in "emotional" terms. The traditional health care sector (doctors, hospitals) and ministers were used more often by blacks in distress. When the use of professional help only is considered, there appeared to be a large pocket of unmet need in the black community. When the use of informal help is taken into consideration, however, the percentage of respondents who did not receive help was considerably lower. The implications of these findings for professional service delivery are discussed.

Adolescent↗

PubMed1992

The health and mental health of New Zealand Vietnam war veterans with posttraumatic stress disorder.

AIM: To examine the extent of posttraumatic stress disorder (PTSD) in a sample of New Zealand Vietnam veterans and to compare the pattern of health and mental health between veterans classified as posttraumatic stress disorder cases and non-cases. METHOD: Five hundred and seventy-three randomly selected male Vietnam veterans participated in a mailed survey. The questionnaire assessed several mental health dimensions and a number of components of physical health. Demographic and military service details were also gathered. RESULTS: The study classified 12% of the sample of veterans as suffering from posttraumatic stress disorder. The posttraumatic stress disorder group differed from the non-posttraumatic stress disorder group on all measures of physical and mental health. They reported higher symptom scores, more disability days, lower self rated health and made more frequent contacts with health care providers. They also experienced greater anxiety, depression and loss of control, and lower wellbeing. Significant differences on some demographic and military service measures were also found between the groups. CONCLUSIONS: A number of New Zealand Vietnam veterans may be classified as exhibiting the symptoms of posttraumatic stress disorder, with the proportion being comparable to rates found in US studies. Veterans with posttraumatic stress disorder experience significantly poorer physical and mental health. Combat experience in Vietnam appears to contribute to posttraumatic stress disorder level. It is suggested that posttraumatic stress disorder may be under-utilised as a diagnostic category because it may coexist with depression or anxiety states and that physicians should be attentive to military service as an indicator of posttraumatic stress disorder.

Adult↗

PubMed1987

Utilization of health and mental health services by Los Angeles Mexican Americans and non-Hispanic whites.

Utilization of general medical and mental health services by respondents in the Los Angeles Epidemiologic Catchment Area (ECA) site was compared with that in three ECA sites studied previously (New Haven, Conn, Baltimore, and St Louis). Within the Los Angeles sample, Mexican-American patterns of utilization were compared with those for non-Hispanic whites. Los Angeles respondents were less likely than those at other ECA sites to make ambulatory health care visits and to be hospitalized for physical or mental health reasons. Mexican Americans were less likely than non-Hispanic whites to report ambulatory health care but were as likely to have been hospitalized. Six percent of Los Angeles respondents reported a recent mental-health-care visit as compared with 6% to 7% of respondents at the other ECA sites. However, among respondents with Diagnostic Interview Schedule DSM-III disorders diagnosed within the six months prior to the interview, a lower proportion made a mental health visit in Los Angeles (14%) compared with the other sites (16% to 20%). Of those who made a mental-health-care visit, Los Angeles respondents with a recently diagnosed disorder were more likely than comparable respondents at the other ECA sites to visit a mental health specialist rather than a general medical care provider. Mexican Americans with a recently diagnosed mental disorder were only half as likely as non-Hispanic whites (11% vs 22%, respectively) to have made a mental health visit. However, when Mexican Americans with Diagnostic Interview Schedule/DSM-III did make a mental health visit, they were as likely as non-Hispanic whites to see a mental health specialist.

Adult↗

PubMed1988

Sexual assault history and use of health and mental health services.

A history of sexual assault may be associated with increased current use of mental health and medical services because of the psychologically and physically disruptive consequences of assault. To test this hypothesis, we estimated rates of mental health and medical services use among 2560 randomly selected community residents, 343 of whom had been sexually assaulted. Sexual assault was associated with seeking both forms of care. Controls for demographic variables, psychiatric diagnosis, health status, and insurance suggested that assault increases use indirectly, through poor mental and physical health. Uninsured, assaulted respondents were especially likely to consult medical providers. Respondents assaulted during childhood were particularly likely to seek mental health care. Assault was more common among mental health service users than nonusers, and among women using medical services compared to female nonpatients. The high prevalence of assault among service users underscores the need for providers to recognize and treat sexual assault-related problems.

Adult↗

PubMed1991

Revisiting health and mental health linkages: a policy whose time has come ... again.

This review and policy analysis examines the connection between physical and mental health. The review includes an analysis of individual diagnoses of physical and mental illness and training issues for both health and mental health professionals. A summary of earlier efforts to link health and mental health services includes a brief history of federal involvement and evaluation of linkage efforts. Linkage examples from a rural context are described briefly. Barriers to successful linkages are discussed with some suggestions for overcoming these obstacles. Policy recommendations for encouraging and establishing health and mental health linkages are presented.

Education, Medical↗

PubMedDate not supplied

The relation of physical activity and exercise to mental health.

Mental disorders are of major public health significance. It has been claimed that vigorous physical activity has positive effects on mental health in both clinical and nonclinical populations. This paper reviews the evidence for this claim and provides recommendations for future studies. The strongest evidence suggests that physical activity and exercise probably alleviate some symptoms associated with mild to moderate depression. The evidence also suggests that physical activity and exercise might provide a beneficial adjunct for alcoholism and substance abuse programs; improve self-image, social skills, and cognitive functioning; reduce the symptoms of anxiety; and alter aspects of coronary-prone (Type A) behavior and physiological response to stressors. The effects of physical activity and exercise on mental disorders, such as schizophrenia, and other aspects of mental health are not known. Negative psychological effects from exercise have also been reported. Recommendations for further research on the effects of physical activity and exercise on mental health are made.

Alcoholism↗

PubMed2025

Policy paper of the Committee on Ethics and Task Force on Migration and Mental Health: Migration and mental health of migrants, refugees, asylum seekers - Ethical dilemmas and concerns.

BACKGROUND: International migration is a complex phenomenon of global and historical relevance. It includes voluntary, forced, and workforce migration, shaped by diverse determinants. Push factors comprise war, persecution, and political instability, while pull factors include stability, economic opportunities, education, and favorable living conditions. Forced migration is frequently associated with displacement and a disproportionate burden of mental health disorders, which are urgent yet difficult to address due to structural, cultural, and legal barriers. METHODS: Evidence demonstrates that restricted health care access exacerbates psychiatric disorders, while treatment delays contribute to poorer outcomes. Barriers include administrative limitations, linguistic and cultural differences, stigma, and resource shortages. This policy paper was developed by the Committee on Ethics and the Task Force on Migration and Mental Health of the European Psychiatric Association (EPA). Relevant literature was reviewed and combined with the professional expertise of committee members. The draft was subsequently evaluated by the Publication Committee and the EPA Board, and revised accordingly. RESULTS: Ethical principles in refugee care are insufficiently implemented in many European countries. Core principles of medical ethics - beneficence, respect for autonomy, non-maleficence, and justice - as well as the obligation to advance psychiatric standards and apply psychiatric expertise for societal benefit, are inconsistently upheld. CONCLUSIONS: The primary duty of physicians is to promote health and well-being through competent, timely, and compassionate care. The EPA therefore advocates coordinated strategies to mitigate the mental health consequences of war, displacement, and trauma, and to secure equitable access to psychiatric services for migrants and refugees.

Humans↗

PubMed1975

Program evaluation of Texas mental health and mental retardation centers.

The diversity of programs offered by the 24 mental health and mental retardation centers in Texas required that program evaluation take a management-by-objectives approach, with each center examined as a unique system with its own goals, techniques, and activities. The approach required the centers to develop statements of management objectives, which they did with varying degrees of success. The evaluations were carried out by site-visit teams. The authors describe the evaluation process, the difficulties encountered, and some of the beneficial effects.

Community Mental Health Services↗

PubMed1987

Inside the hidden mental health network. Examining mental health care delivery of primary care physicians.

Mental disorder diagnoses among 51 patients, made by a group of 20 family physicians, were compared with diagnoses generated by the Diagnostic Interview Schedule (DIS). Processes of diagnosis, decision making, and treatment planning were then examined through structured physician interviews and chart audits. In this study, 75 of 94 DIS diagnoses (79%) were undetected. During interview and chart audit, the physicians were found to have consistently underestimated, misinterpreted, or neglected psychiatric aspects of care among a majority of patients in the study. These physicians had all satisfactorily completed a psychiatry curriculum designed for family physicians. Analysis of these results suggests that a mental health role is often not integrated into primary care practice, regardless of physician performance during psychiatric training experiences. Assumption of this role appears to be state dependent on involvement with a psychiatric treatment setting. Primary care practice patterns do not seem to result in application of appropriate skills and therapeutic attitudes to detect, diagnose, and correctly manage the majority of mental disorders that occur. The need is reaffirmed for active collaboration between mental health professional and primary care providers in training and in incorporation of psychiatric skills into primary care practice.

Adult↗

PubMed1989

Forensic mental health services provided by mental health organizations, United States, 1985.

Results from the 1985 NIMH Inventory show that 1,339 (43 percent) of the 3,118 mental health organizations surveyed provided mental health services to mentally disordered adult offenders. Almost three-fifths of these forensic services were in multiservice mental health organizations, 23 percent were in freestanding psychiatric outpatient clinics, 14 percent in State mental hospitals, 4 percent in private psychiatric hospitals, and less than 2 percent in residential treatment centers for emotionally disturbed children and freestanding psychiatric partial care organizations. About two-thirds of the 289 State mental hospitals provided forensic services; 55 percent of the 1,383 multiservice mental health organizations and 40 percent of the 756 freestanding psychiatric outpatient clinics offered these services. Psychiatric assessment was the forensic service provided by the largest number of mental health organizations. This was followed, in order, by consultation to law enforcement staff and attorneys, psychiatric outpatient care, monitoring of medication, emergency mental health care, inpatient/residential care, partial care, and emergency detention. About 200,000 mentally disordered offenders received psychiatric assessment services from mental health organizations; slightly over 100,000 were provided psychiatric outpatient care, and smaller numbers of clients received other types of forensic services. A total of 14,538 full-time equivalent (FTE) patient care staff were involved in the delivery of forensic services. In addition, State mental hospitals reported 4,525 FTE administrative and support staff serving forensic patients. Special funding for forensic services, totaling $639 million, was received by just over half of the mental health organizations with these services. About four-fifths of this funding came from State mental health agencies, with the remainder provided by sources such as State correctional agencies, State courts or other State sources, city/county jails, city/county courts, and other local public sources.

Forensic Medicine↗

PubMed1979

Adaptational problems of Vietnamese refugees. I. Health and mental health status.

The forced migratory influx of Vietnamese to the United States has raised questions regarding the resettlement process, the effect of culture shock, the refugees' coping behavior and adaptabilities, and their health and mental health status. We report the two-year results of ongoing research on the Vietnamese refugees based on the use of the Cornell Medical Index (CMI). The responses on the CMI on the first (1975) and second (1976) administrations indicate a high and continuing level of physical and mental dysfunction. The second administration also revealed significant shifts in dysfunctions as well as exposing factors that related to these dysfunctions, ie, age/sex interactions, marital status, family groupings, and public assistance. The follow-up CMI also showed an increase in anger and hostility with concomitant reductions in feelings of inadequacy.

Acculturation↗

PubMed1987

Industrialization and mental health in Japan--mental health of large enterprise employees in their 40s and 50s.

Some difficulties in dealing with the mental health of large company employees in their 40s and 50s are discussed based on the authors' experiences as infirmary psychiatrists over the last decade. Some characteristics of Japanese enterprise are introduced and explained, such as "Tanshin-Funin," "Madogiwazoku" and "Shukko," which are intimately related to the management system of modern Japanese companies. The most prevalent psychiatric disorders among company employees are briefly discussed. They are usually diligent and hard-working middle management employees at least until the disorder becomes manifest. Form the socio-psychiatric viewpoint, it is assumed to be of increasing importance to deal with such a large cohort of individuals working in large companies as one of the significant objects of contemporary hygienic activities.

Adult↗

PubMed1985

[Relation between the parents' mental health and the mental health of children in an urban population of Salvador-Bahia].

An epidemiological study of the correlation between parent's mental status and children's psychological health was completed in a representative sample of 1516 adults and 829 children, living in a low-income area of the City of Salvador, Bahia-Brazil. Trained interviewers applied a family questionnaire (20 items on demographic and socio-economic information) and screening symptom scales to all the families (493) in the sample. The survey employed the QMPA (Adult Psychiatric Morbidity Questionnaire) and the QMPI (Child Psychiatric Morbidity Questionnaire), as instruments developed and tested especially for studies in that sociocultural setting. A second step of the survey consisted of a psychiatric examination of all suspected cases, thus allowing for an assessment of validity and reliability of both questionnaires, that showed high sensitivity, specificity and adequate overall misclassification rates. A multiple regression analysis was performed on selected variables. Results showed that mother's scores, family size and child's age are the only variables that reach significance levels to enter the regression model. Father's score showed no isolated effect on children's mental health variation even in interaction with other covariates. However, all the fitted equation explain only 16 per cent of the total regression on the dependent variable.

Adolescent↗