Criteria for designation of mental health professional shortage areas--PHS. Final rule

This final rule amends the existing regulations governing the criteria for designation of health manpower shortage areas, or HMSAs (now health professional shortage areas, or HPSAs; name changed by Public Law 101-597, the National Health Service Corps Revitalization Amendments of 1990) under section 332 of the Public Health Service Act. Specifically, this amendment revises the existing criteria for designation of HMSAs having shortages of psychiatric manpower, transforming them into criteria for designation of HPSAs having shortages of mental health professionals, to take into account not only psychiatrists but also mental health service providers other than psychiatrists. The intended effect of this amendment is to more accurately assess the supply of mental health service providers when making shortage area determinations. This notice also summarizes the comments received by the Department on the Notice of Proposed Rulemaking published on August 8, 1989, which set forth the proposed methodology for making this and other changes to the HMSA criteria. It also formally changes "HMSA" to "HPSA" throughout the regulation, to conform with Public Law 101-597.     

Mental health services in New Zealand

The development and reorganization of mental health services in New Zealand is underpinned by a national strategy, with increased funding from the government, and is occurring on a background of radical change in health service policy and delivery. The major challenge will be to sustain the developments to date, and increase the quality and quantity of services in a climate of ongoing change. A more integrated form of service delivery and funding would potentially enhance the development of population-based mental health services, which will allow the alignment of targeting specialty service to the 3% of the population with the highest need, with a more comprehensive approach to overall mental health service through the primary sector.     

A prospective comparative evaluation of a Criminal Justice Liaison and Diversion Service in Belfast

There is continued interest in the planning, development and implementation of services designed to identify detainees with mental illness and connect them to health and social services. However, currently, little is known about how best to configure, organise and deliver these services. The study employed a prospective follow-up design with a comparator group to describe and evaluate a police mental health liaison service based in Belfast. Participants were recruited from two neighbouring police stations, only one of which provided a mental health liaison service. Outcomes including mental health status, drug and alcohol misuse, risk-related behaviour and ‘administrative’ outcomes were assessed at the time of arrest and six months later. The service was successful in identifying and assessing detainees, though there appeared to be similar between-group levels of mental health problems over time. Results highlight a need to develop firmer linkages and pathways between criminal justice liaison/diversion services and routine health and social services.     

Revictimized Adult Women: Perceptions of Mental Health Functioning and Associated Services

In this study, using a sample of adult women (N = 418) from various environments, mental health outcomes and perceptions about different types of support following childhood and adulthood sexual and physical violence were assessed. The respondents were from three locations: general community, state prison, and sexual assault and domestic violence service providers. A cluster analysis based on victimization experiences was conducted; subsequent analyses showed that women who endured more types of abuse had more self-reported mental health difficulties. Somewhat paradoxically, women who utilized more therapeutic services held more negative perceptions of their mental health functioning, while use of tangible services had no significant association. Those who found therapeutic services helpful had significantly higher self-reported concurrent mental health functioning.     

Neoliberalism and its implications for mental health in the UK

This article sets out to outline the tenets of neoliberalism and globalization, prior to the identification of the implications of neoliberalism for the British health system since 1979. The article then focuses on the applications and implications of neoliberalism for the British mental health system in terms of service organization and management, and the impact these changes in direction had on the three existing service sectors: users, carers and professionals. The discussion and the conclusion highlight the significance of these developments in the mental health system in the rather hybrid context of health, mental health, and social care policy and practice in the United Kingdom.     

Risk,response, and mental health policy: learning from the experience of the United Kingdom

Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.     

美国精神卫生制度的发展——兼论我国新《精神卫生法》

美国精神卫生制度的形成经历了从漠视和侵犯人权到尊重和重视人权的发展过程。然而美国现有精神卫生制度领域仍然存在着诸多问题和缺陷,特别体现在医疗服务可获得性缺乏这一问题上。《中华人民共和国精神卫生法》力求在医疗服务可获得性与强制住院之间达到平衡。     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

A tale of two cultures: examining patient-centered care in a forensic mental health hospital

Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers' perceptions of safety is needed.     

Who do I turn to? Resolving complaints by mental health consumers and carers

The current Australian system for handling complaints by mental health consumers and carers against service providers is complex and difficult to navigate. Complaints may be made to a range of people and organisations, including the relevant mental health service, community or official visitors, Health Services Commissioners, Chief Psychiatrists, Public Advocates, Ombudsmen and Members of Parliament. This Legal Issues column provides an overview of the law relating to complaints handling by community or official visitors, health service commissions and offices of the Chief Psychiatrist. It argues that while health service commissions may provide the best current avenue for complaints, there is a need for independent, centralised complaints bodies in Australian jurisdictions with similar powers to that of the Mental Welfare Commission for Scotland.     

对提高公务员心理调适能力的几点思考

目前,我国公务员的心理健康及身体健康状况不容乐观。长期以来,肌体健康问题一直是人类关注的焦点,而心理健康会影响身体健康的问题却被忽视了。现在,越来越多的科学实验及心理学研究揭示了心理健康会影响身体健康这一根本性的问题。因此,提高公务员的心理调适能力,使其以平和的心态面对来自各方面的压力就成为当务之急。     

The mental health and substance misuse needs of male ex-armed forces personnel in prison

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.     

Mentally ill offenders eligible for diversion at local court in New South Wales (NSW), Australia: factors associated with initially successful diversion

Diversion away from the criminal justice system and into mental health treatment services is a key strategy for addressing the well-established burden of mental illness suffered by those presenting to court. While mental health courts, court liaison and court diversion services have been developed in many jurisdictions internationally, there is limited research evidence to support their effectiveness in identifying those with mental health need and achieving successful diversion. The Statewide Community and Court Liaison Service in New South Wales, Australia, identifies mentally ill offenders likely to meet legal eligibility criteria for diversion at the busiest local courts across the state. Utilising data collected by mental health clinicians working in the service, 8317 individuals were identified as being eligible for court diversion on at least one occasion during the study period (1 July 2008 and the 30 June 2015) and 57.3% were subsequently diverted by Magistrates. Successful diversion at this first step was associated with being female, older, of non-Aboriginal and/or Torres Strait Islander background, and having a serious mental illness, replicated when stratified by sex and by Aboriginal and/or Torres Strait Islander background. There may be barriers to mental health diversion at court for individuals with particular socio-demographic characteristics which future service developments may need to take into account.     

Court outcomes for clients referred to a community mental health court liaison service

Court liaison and diversion services come in a variety of forms, but the similarities and differences between these services are not well characterized. Findings from a six-year audit of the Newcastle (Australia) Mental Health Court Liaison (MHCL) service are reported, including client characteristics, offence and service contact profiles, court outcomes, and interrelationships among these variables. During the audit period, there were 2383 service episodes by 1858 clients (1478 males, 380 females). Drug and alcohol disorders (40.9%) and psychotic disorders (17.0%) were the most prevalent mental health problems, while assault (23.1%), theft (23.1%), offences against justice procedures (15.4%), driving offences (13.4%) and malicious damage to property (8.3%) were the most frequently recorded charges. Among service episodes with a finalized court outcome, 70.0% involved a punishment (bond: 49.5%; jail term: 29.7%). Females were less likely to be punished, but more likely to have their case dismissed under sections of the relevant Act that required further assessment and monitoring. Being married, or having an adjustment or drug and alcohol disorder, were also associated with an increased likelihood of punishment, while clients with a psychotic or bipolar disorder were less likely to be punished. Among clients who were punished, those referred from inpatient mental health services were more likely to receive a non-jail punishment, while unemployed clients were more likely to be jailed. A substantial proportion of clients had court outcomes that required an ongoing involvement with local mental health services. By being part of community mental health services, our MHCL service is able to work efficiently and effectively with the criminal justice system, while facilitating ready access to existing mental health services and continuation of care.     

Problematic alcohol consumption by police officers and other protective service employees: A comparative analysis

Purpose

To examine differences between members of protective service occupations (PSOs) and other occupational groups on indicators of alcohol use/abuse and mental health.

Methods

A subset of 25,622 observations from the 2009 National Survey of Drug Use and Health (NSDUH) are used to evaluate whether PSO members exhibit a higher likelihood of problematic drinking behaviors and if so, whether these behaviors are mediated by mental health problems.

Results

Logistic regression models indicated that PSO members do not consume alcohol more frequently nor do they exhibit higher likelihood of alcohol abuse/dependency when compared to members of other occupational groups. However, PSO members report higher occurrence of binge drinking. The relationship between PSOs and binge drinking behaviors is mediated by gender, not mental health problems.

Conclusion

The results provide direction for the development of evidence-based alcohol related intervention programs that address the specific needs of police officers and other public servants.     

Psychological Injury from Licensing Complaints Against Mental Health Practitioners

Today's mental health practitioners are subject to governmental (e.g., licensing boards) and legal (e.g., professional liability or malpractice) monitoring and regulation. Regrettably, the governmental and legal oversight of health care has proven to be tilted in favor of the service user, with frequent unfair processing and unjustifiably harsh penalties imposed on mental health practitioners—which often result in psychological injury. Stress and anxiety caused by a licensing complaint is common; and in this article, the psychological effects are set forth. It is concluded that there is no reason to expect relief from the risks of practice in the future, that is, typical licensing complaints plus added ethical issues are likely as the mental health professions evolve. This means that, whenever there is an indication of a possible complaint from a service user, today's mental health practitioner must, as part of the support services essential for practice, be prepared to rely on legal counsel.     

Stopping the revolving door: a meta-analysis on the effectiveness of interventions for criminally involved individuals with major mental disorders

Faced with high and increasing rates of mental disorder within the criminal justice system (CJS), a range of interventions have been implemented in an effort to prevent continued involvement in criminal activities among this population. A meta-analytic review was undertaken to consider the effectiveness of interventions for criminally involved adults with a mental disorder targeting either improved criminal justice or mental health outcomes. Furthermore, characteristics that were hypothesized to predict better outcomes were examined. Studies that considered sex offender interventions, or focused solely on antisocial personality, intellectual and cognitive, or substance use disorders were excluded. Results assuming a fixed-effects model combining 37 effect sizes from 25 studies (N = 15,678) support the effectiveness of these interventions in terms of reductions in any CJS involvement (d = 0.19 excluding one outlier). Interventions had no significant effect on an aggregate mental health outcome (d = 0.00). However, when considering distinct mental health outcomes, intervention participants had significantly better functioning (d = 0.20) and fewer symptoms (d = 0.12). There were no significant effects of the interventions on mental health service or medication use. Moderator analyses identified seven sample, intervention, and design characteristics that were related to the magnitude of the effect sizes for criminal justice outcomes, and suggest implications for service provision, policy, and research. Results suggested some relationship between intervention effects on mental health and criminal justice reinvolvement, although future research is needed in this area, especially given the absence of mental health outcome data in many studies.     

A National Survey of Mental Health Services Available to Offenders with Mental Illness: Who Is Doing What?

The purpose of this study was to examine the national practices of psychotherapy services for male offenders with mental illness (OMI) in state correctional facilities. Participants consisted of 230 correctional mental health service providers from 165 state correctional facilities. Results indicated that mental health professionals provided a variety of services to OMI that can be conceptualized by six goals considered important in their work: mental illness recovery, emotions management, institutional functioning, re-entry, risk-need, and personal growth. Mental health professionals in this study generally viewed mental illness recovery, institutional functioning, and personal growth as significantly more important and spent more time focused on these goals than emotions management, re-entry, and risk-need. Mental health professionals tended to believe the services they provided were effective across four key treatment foci including mental illness, skill development, behavioral functioning, and criminogenic needs with more progress perceived in areas related to mental illness and skill development than their ability to effectively change behavioral functioning. Implications of these findings and directions for future research are discussed.     

The political and economic context of mental health care in the United States

Since the mid-1970s, the mental health treatment system in the U.S. has faced budgetary famine. This is in stark contrast to the growing cornucopia of fiscal resources enjoyed by the overall health care system. This paper explores the complex reasons for this disproportionate allocation in health spending. On the one hand, mental health may suffer from the perception that its diagnoses are largely "subjective" and its treatments do not fit the traditional "medical model" that can be defined precisely and paid for by third-party insurers. But more importantly, the death of mental health resources can be attributed to the peculiar nature and characteristics inherent in American politics. This paper describes the American political environment, from both a historical and a contemporary perspective, to give some insight into the development of policies affecting the mental health system in the U.S. Given the current climate of fiscal conservatism in this country toward any increases in social spending, it is likely that the profound mismatch in need and spending for mental health programs will continue indefinitely.     

Short-term outcomes for offenders with mental illness released from incarceration

Using data on 247 offenders with mental illness, this analysis seeks to identify characteristics that distinguish those who are returned to prison or a psychiatric hospital with those who remain in the community. Sociodemographic, mental health, criminal history, and service variables are compared across a range of outcome categories with a focus on those reinstitutionalized and those reincarcerated. Those returning to institutions have somewhat different mental health service and criminal justice histories than the engaged/community group. In particular, the group that is reincarcerated is more likely released from misdemeanor sentences, and the group being released from felony sentences is more likely to be found in a psychiatric hospital after release from correctional custody. These findings have implications regarding the cumulative effects of engagement with the criminal justice system and the process through which persons with mental illness and a criminal history cycle through institutions.