HIV prevention services for adults with serious mental illness in public mental health care programs

Despite well-documented need, little is known about the HIV prevention services provided to adults with serious mental illness in the public mental health system. This study examined the types, frequency, and client-level correlates of HIV prevention services provided to a representative sample of clients in five public mental health care programs. Although results indicate that HIV prevention care is infrequent, clients identified as being at higher risk for HIV infection reported receiving prevention interventions more frequently. However, both the clients' gender and the service setting influenced the types and frequency of services that clients received.     

Rapid assessment of existing HIV prevention programming in a community mental health center

In preparation for implementation of a comprehensive HIV prevention program in a Community Mental Health Center for persons with mental illness who are also abusing substances, a rapid assessment procedure (RAP) of existing prevention services that may have developed in the setting over time was undertaken at baseline. In addition to an ecological assessment of the availability of HIV-related information that was available on-site, in-depth interviews and focus groups were conducted with Center administrators, direct-care staff, and mental health consumers. Results indicated that responses regarding available services differed depending upon type of respondent, with administration reporting greater availability of preventive programs and educational materials than did direct-care staff or mental health consumers themselves. But overall, formalized training on HIV prevention by case managers is extremely rare. Case managers felt that other providers, such as doctors or nurses, were more appropriate to deliver an HIV prevention intervention.     

Community-level HIV prevention for persons with severe mental illness living in supportive housing programs: a pilot intervention study

Individuals with severe mental illness (SMI) are at risk for HIV/AIDS. Despite the availability of supportive community programs for those with SMI, there have been no published evaluations of community-level HIV prevention trials among this population. A pilot intervention trial was conducted to determine the feasibility of such an intervention in supportive housing programs (SHPs). A multi-component community-level trial was implemented in two SHPs with a total of 28 residents. Participants completed assessments at three time points: prior to the intervention (baseline), following skills training (post-assessment), and following the 4-month community intervention (follow- up). Results demonstrated significant improvements in psychosocial risk factors at both post- and follow-up assessments, with indications of sexual behavior change at follow-up. The community-level intervention appeared to reduce the risk of HIV among persons with SMI living in SHPs, and supports the importance of conducting larger scale intervention trials.     

Mental Health Treatment Experiences and Expectations in Foster Care: A Qualitative Investigation

This study explores perspectives on mental health treatment experiences and expectations for youth in foster care and their foster parents. In-depth interviews were conducted and identified for major themes: (1) the dual stigma of foster care and mental health care; (2) the lack of engagement in mental health therapy; (3) trust issues with the therapist and other individuals; and (4) the desire to integrate mental health services with primary care services. These results have implications for mental health service delivery and suggest opportunities to improve mental health treatment through an integrated care approach.     

The 2012 sandy hook elementary school shooting: Connecticut’s department of mental health crisis response

This article reports on the role, activities, and lessons learned of a state mental health authority—the Connecticut Department of Mental Health and Addiction Services—in responding to the mental health needs of families and community members following the 2012 Sandy Hook Elementary School shooting. Following the introduction, we provide a brief case study of Department of Mental Health and Addiction Services’ role in the aftermath of the Sandy Hook shooting. This role included use of the Incident Command System (ICS) to deploy a standing statewide network of clinicians who provided direct care for surviving children and school personnel, victims’ family members, and others, and coordination of its mental health response with the activities of other state, private, and individual players. We then discuss key themes and lessons learned and offer recommendations to mental health authorities for planning and implementing their own responses to possible like incidents in the future.     

Triple jeopardy for HIV: substance using Severely Mentally Ill Adults

Severely Mentally Ill (SMI) adults have disproportionately high HIV seroprevalence rates. Abuse of alcohol and other substances (AOD) and lifetime exposure to trauma by others are particularly potent risk factors, which, in combination with psychiatric disabilities, create triple jeopardy for HIV infection. This study examined the predictive utility of demographic characteristics; history of physical, emotional, or sexual abuse; extent of drug and alcohol abuse; knowledge about HIV/AIDS; sexual self-efficacy; and condom attitudes toward explaining the variance in a composite of HIV high-risk behavior among 188 SMI women and 158 SMI men. History of sexual abuse, engaging in sexual activities while high on substances, and lower cannabis use were the most significant predictors of HIV sexual risk behaviors. Given the triple jeopardy for HIV risk in this population, a triple barreled approach that simultaneously addresses multiple health risks within an integrated treatment setting is warranted.     

Patient-centered psychiatric care for youth in foster care: a systematic and critical review

Youth in the U.S. foster care system are prescribed risky psychotropic medications at high rates. In response, state child welfare agencies have developed policies, yet there is little research to inform patient-centered care (PCC) approaches. To fill this gap, we aimed to identify (1) the perspectives of youth in or formerly in foster care and their caregivers and providers regarding how psychiatric care aligns or does not align with PCC, and (2) effectiveness of interventions aiming to improve PCC within this context. We conducted a systematic review of the literature based on PRISMA-P guidelines, searching four databases and gray literature. Eleven studies met inclusion criteria and quality appraisal benchmarks, none of which were interventions. We applied narrative synthesis techniques to six studies that described youth/former youth perspectives. They described a pervasive lack of knowledge, perceived little voice in decision-making, and described imbalanced power between patients and providers and weak therapeutic relationships, whereas feeling understood by providers and being provided autonomy in decisions were helpful. Systemic barriers also contributed to many concerns. We make a limited number of recommendations to leaders and policy-makers based on our synthesis, however, many critical research steps are needed.     

Urban planning and mental health

Abstract

Both the product and the process of city planning have been shown to have an influence on mental health. This paper presents a model of the process through which community design characteristics influence mental health. The model emphasizes the importance of local social interaction and physical stimulation, as well as adjustment mechanisms used to dampen stress resulting from undesirable levels of interaction and stimulation. The research on the relationship between four community design characteristics and social interaction, stimulation and mental health is then reviewed. An argument for the importance of citizen participation is also presented, stressing the influence of participation on both sense of control and the development of social support. Commonly employed participation techniques, however, differ in their ability to affect support and control. Neighborhood council programs are identified as having the greatest potential for influencing sense of control and social support. Finally the obstacles to improving community design and specific recommendations for the prevention of environmentally induced mental health problems are presented.     

Assessing and meeting the health needs of Roman Catholic priests in the archdiocese of Chicago

In 1985, the Bishops' Committee on Priestly Life and Ministry recommended bishops form holistic health boards for their priests based on the results of a 1982 U.S. survey of Catholic priests. In 1995, a holistic health committee was formed under the office of the vicar for priests for the archdiocese of Chicago. One of the committee's first actions was to survey the priests of the archdiocese of Chicago to identify baseline health behaviors and needs. Survey results (n = 524; 52% response rate) revealed the need for the committee to promote health education, preventive care, and annual physicals. The committee conducted a series of health fairs, improved the insurance benefit for an annual physical, and conducted a series of health-related talks targeted to priests. A follow-up survey in 2006 (n = 389; 46% response rate) indicated improvements in health behaviors of the priests. Comparisons to statewide and national data indicate that overall, engagement in healthy behaviors is higher for priests than for men who are not priests.     

Emotional distress in African American women with HIV

This study identified factors associated with emotional distress in 109 African American women with HIV. The relationship of personal factors (demographic, social conflict, social support, and spirituality), health-related factors (perception of health, physical and mental health problems, and years diagnosed), and cognitive/coping responses (stigma, worry, and emotion focused coping) on depressive symptoms and mood state was examined. Younger age, more social conflict, less social support, lower perception of health, and more HIV worry were associated with higher depressive symptom scores. Variables most often affecting various mood states included personal factors (public housing, unemployment, and social conflict) and worry about having HIV worry.     

Addressing the mental healthcare needs of foster children: perspectives of stakeholders from the child welfare system

A qualitative study was conducted to better understand the factors that contribute to psychotropic medication (PM) overuse among children in the child welfare system in Kentucky, including barriers to providing psychosocial interventions that potentially minimize the need for PM. Semi-structured interviews were conducted with personnel in the Department of Community-Based Services (DCBS). Participants identified important areas to target for system-wide quality improvement efforts, which included improved exchange of health information, training, and communications on the use of PM, and measures to improve access to non-pharmacological psychosocial interventions to address the mental healthcare needs of children in the child welfare system.     

Psychology in the community: a community psychologist looks at 30 years in community mental health

I review my 30 years in the community mental health field, emphasizing the personal and historical context that shaped this career. I especially highlight the origins of the values that guided significant career decisions, including family, neighborhood, religious and educational influences. The core guiding value was the belief that public service is both a privilege and an obligation, and that righting social injustice through such service is a noble calling. I trace the evolution of my thoughts and actions reflecting this value, from an early desire to "help children," through preparation to become a child psychologist, and ultimately to practice in a public community mental health setting and a career dedicated first to primary prevention and then to broader safety net services for those in need. I highlight a corresponding intellectual evolution as well, a progressive change in identity from "clinical psychologist in the community" to community psychologist.     

Differences in HIV-related knowledge, attitudes, and behavior among psychiatric outpatients with and without a history of a sexually transmitted infection

HIV infection among the mentally ill is estimated to be at least eight times the prevalence in the general population. Psychiatric patients may also be disproportionately vulnerable to other sexually transmitted infections (STIs), but this has not been well studied. We sought to characterize the prevalence and correlates of STIs in a sample of psychiatric outpatients (N=464). Over one-third of the sample (38%) reported a lifetime history of one or more STIs. Multivariate analyses showed that, relative to those without an STI history, patients with a lifetime STI history were more knowledgeable about HIV, expressed stronger intentions to use condoms, and perceived themselves to be at greater risk for HIV. However, those with a past STI were also more likely to report sex with multiple partners and reported more frequent unprotected sex in the past 3 months. Treatment for an STI may increase HIV knowledge and risk reduction motivation, but does not necessarily lead to changes in sexual risk behavior among psychiatric patients. Findings highlight the need for STI/ HIV risk reduction interventions in psychiatric settings, particularly for patients with high-risk profiles.     

Adverse Childhood Experiences (ACE) Within a Social Disadvantage Framework: Distinguishing Unique, Cumulative, and Moderated Contributions to Adult Mental Health

The deleterious impact of adverse childhood experiences (ACE) may be confounded with frequently co-occurring social disadvantage. In this analysis we test the effects of ACE on adult mental health within a social disadvantage framework, using a population-based survey (n?=?7,444; mean age?=?55.2 years) from Washington State. We also examined the protective effects of socioemotional support, and the distinct and combined contribution of the measured ACE factors. Results demonstrated sustained impact of ACE on mental health many decades later, even net of social disadvantage and demographic contributors. Protective factors provided both direct and moderating influences, potentially masking the elevated effects of ACE for those with few resources. Toxicity examination of ACE items evinced differential effects of ACE experiences on mental health. These results demonstrate that interventions ameliorating the effects of ACE and bolstering protective resources such as socioemotional support may be effective toward augmenting mental health even late in life.     

社会性别视野中的健康公平性分析

健康公平是社会公平的重要内容。健康公平性的性别特征是性别平等与否的重要特征。本文利用2000年第二期中国妇女社会地位调查数据、历年人口和卫生统计资料以及其它相关调查结果,对健康公平性的性别特征、地区和城乡差异进行分析。结论认为健康水平、卫生保健服务利用在性别之间、地区之间和城乡之间都存在明显差异。女性与男性相比健康水平更低,健康服务的利用更为有限;边远贫困地区农村妇女健康水平、卫生保健服务利用与城市地区和发达地区妇女相比相对处于劣势。说明中国妇女公平享有卫生保健和提高健康水平还需要政府和社会各方面的进一步努力。     

中国农村生殖健康领域社会性别行为量表的发展

为了对中国县区级计划生育/生殖健康领域的服务对象和服务提供者的社会性别角色行为进行评价,本文基于中国农村生殖健康领域的现实背景,采用了文献研究、访谈、专家评议以及心理计量的方法,分别发展了适用于中国县区级计划生育/生殖健康领域的服务对象和服务提供者社会性别行为量表(GBRHS-SC和GBRHS-SP),并于2005年6月在中国东部1个县区601个农村服务对象的样本和541个服务提供者的样本中测试了量表的心理计量学特征,发现GBRHS-SC具有较好的内部一致性信度和建构效度,GBRHS-SP具有较好的内部一致性信度,但是在建构效度方面还需要得到进一步改进和验证。     

谈警察职业与身心健康

警察是一种特殊的社会职业,由于长期从事超负荷、高风险工作,其大多数成员健康状况不佳、心理压力增大。因此,为维护社会稳定、有效履行警察职责,必须切实关心警察的身心健康,减少其工作负担与心理压力:要加强警察健康教育、构建警察健康保障体系,使其更好地完成公安工作使命。     

The Positive Role of School Climate on School Victimization,Depression, and Suicidal Ideation Among School-Attending Homeless Youth

Although homeless youth face a higher risk of victimization and mental health problems, little is known about school victimization and mental health outcomes for school-attending homeless youth. This study examined the relationship between school climate and school-related victimization and mental health problems among homeless youth. Multivariate analyses were conducted to examine the relationship between school climate factors and school victimization, suicidal ideation, and depression tendency in a representative sample of 1,169 school-attending homeless youth in 9th and 11th grades in California. Findings show that school-attending homeless youth are at high risk of being victimized at school and have high rates of depression tendency and suicidal ideation. Positive school climate, especially perceived high expectations from teachers and safety in school, was associated with lower rates of school victimization and mental health problems. The role of supportive school climate in the lives of school-attending homeless youth is discussed and future implications are suggested.     

The mental health association and prevention

Summary

The history of the Mental Health Association's involvement in prevention is described. From its inception in 1909 the Association has played a key role in advocating for prevention. It contributed to the Child Guidance Center movement, the community mental health center movement, and helped focus the 1978 President's Commission on Mental Health on prevention. In recent years, it has served as the catalyst for the formation of a coalition of national organizations with an interest in prevention.