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9 result(s) for "Public Policy and Public Health (G Norquist"
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Community Interventions to Promote Mental Health and Social Equity
Purpose of Review We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. Recent Findings There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. Summary There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
Social Determinants of Mental Health: Where We Are and Where We Need to Go
Purpose of Review The present review synthesizes recent literature on social determinants and mental health outcomes and provides recommendations for how to advance the field. We summarize current studies related to changes in the conceptualization of social determinants, how social determinants impact mental health, what we have learned from social determinant interventions, and new methods to collect, use, and analyze social determinant data. Recent Findings Recent research has increasingly focused on interactions between multiple social determinants, interventions to address upstream causes of mental health challenges, and use of simulation models to represent complex systems. However, methodological challenges and inconsistent findings prevent a definitive understanding of which social determinants should be addressed to improve mental health, and within what populations these interventions may be most effective. Summary Recent advances in strategies to collect, evaluate, and analyze social determinants suggest the potential to better appraise their impact and to implement relevant interventions.
Global Burden of Disease and the Impact of Mental and Addictive Disorders
Purpose of Review This contribution reviews the newest empirical evidence regarding the burden of mental and addictive disorders and weighs their importance for global health in the first decades of the twenty-first century. Recent Findings Mental and addictive disorders affected more than 1 billion people globally in 2016. They caused 7% of all global burden of disease as measured in DALYs and 19% of all years lived with disability. Depression was associated with most DALYs for both sexes, with higher rates in women as all other internalizing disorders, whereas other disorders such as substance use disorders had higher rates in men. Summary Mental and addictive disorders affect a significant portion of the global population with high burden, in particular in high- and upper-middle-income countries. The relative share of these disorders has increased in the past decades, in part due to stigma and lack of treatment. Future research needs to better analyze the role of mental and addictive disorders in shifts of life expectancy.
Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap
Purpose of Review Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing—engaging non-specialist providers—to deliver mental health care. Recent Findings There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies. Summary Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.
Evolving Models of Integrated Behavioral Health and Primary Care
Purpose of Review Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption. Recent Findings Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care. Summary Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.
Measuring Psychiatric Symptoms Remotely: a Systematic Review of Remote Measurement-Based Care
Purpose of Review This article systematically reviews studies examining remote measurement-based care (RMBC), defined as using technology to measure patients’ psychiatric symptoms outside the context of a clinical encounter. Recent Findings Thirty-six studies were identified that measured patients’ psychiatric symptoms remotely and provided feedback to treatment providers. The majority were single group designs. There was evidence supporting the short-term feasibility and acceptability of RMBC, although long-term sustainability was less clear. Thirteen randomized controlled trials were identified. RMBC was typically implemented as part of a multicomponent intervention (e.g., internet-based cognitive behavioral therapy with feedback to provider). Three studies experimentally isolated the clinical effects of RMBC, with two reporting no statistically significant differences between the RMBC and control conditions and one reporting greater symptom improvement associated with RMBC. Summary RMBC appears feasible and acceptable and may be a promising intervention for improving mental health care, but additional experimental studies are needed.
Mental and Addictive Disorders and Medical Comorbidities
Purpose of Review Mental and addictive disorders commonly co-occur with medical comorbidities, resulting in poor health and functioning, and premature mortality. This review provides an overview of the intertwined causal pathways and shared risk factors that lead to comorbidity. Additionally, this review examines the strategies to prevent the onset of and to effectively manage chronic medical conditions among people with mental and addictive disorders. Recent Findings Recent research provides further evidence for the shared genetic and biological, behavioral, and environmental risk factors for comorbidity. Additionally, there is evidence of effective approaches for screening, self-management, and treatment of medical conditions among people with mental disorders. There are promising health system models of integrated care, but additional research is needed to fully establish their effectiveness. Summary A combination of public health and clinical approaches are needed to better understand and address comorbidity between mental and addictive disorders and chronic medical conditions.
Update on Assisted Outpatient Treatment
Purpose of Review Assisted outpatient treatment (AOT) is an outpatient court-ordered treatment for people with severe mental illness (SMI) whose care needs are often unmet in the community due, in part, to treatment non-adherence. AOT is controversial, and the goal of this review is to provide an update on recent research, the status of AOT in the United States, and future directions for research and implementation. Recent Findings Several recent studies have demonstrated that it is not just a lack of access to appropriately intensive care that prevents some individuals with SMI from engaging in and benefiting from treatment and that AOT can improve engagement and patient outcomes over and above the provision of care. Summary The future of AOT in the United States is still somewhat uncertain and will largely depend on the effectiveness and sustainability of the SAMHSA AOT grant programs. Future research efforts should investigate the conditions under which and for whom AOT can be most effective, to help avoid poor outcomes for this vulnerable population.
National Child Mental Health Quality Measures: Adherence Rates and Extent of Evidence for Clinical Validity
Purpose of Review To provide an overview of the selection process and annual updates of the child mental health measures within the Child Core Set, describe national and statewide adherence rates, and summarize findings from a systematic literature review examining measure adherence rates and whether adherence is associated with improved clinical outcomes. Recent Findings Five national quality measures target child mental health care processes. On average, national adherence varied widely by state, and performance did not substantially improve during the past 5 years. Mean national adherence rates for the two measures related to timeliness of care were below 50%. For each measure, scientific evidence to support the association between adherence and improved clinical outcomes was scarce. Summary Investment in academic-agency partnered research to standardize methods for publicly reporting adherence to national child mental health quality measures and validation of these measures should be a national priority for child healthcare research.