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Better but not well : mental health policy in the United States since 1950
The past half-century has been marked by major changes in the treatment of mental illness: important advances in understanding mental illnesses, increases in spending on mental health care and support of people with mental illnesses, and the availability of new medications that are easier for the patient to tolerate. Although these changes have made things better for those who have mental illness, they are not quite enough.
In Better But Not Well, Richard G. Frank and Sherry A. Glied examine the well-being of people with mental illness in the United States over the past fifty years, addressing issues such as economics, treatment, standards of living, rights, and stigma. Marshaling a range of new empirical evidence, they first argue that people with mental illness—severe and persistent disorders as well as less serious mental health conditions—are faring better today than in the past. Improvements have come about for unheralded and unexpected reasons. Rather than being a result of more effective mental health treatments, progress has come from the growth of private health insurance and of mainstream social programs—such as Medicaid, Supplemental Security Income, housing vouchers, and food stamps—and the development of new treatments that are easier for patients to tolerate and for physicians to manage.
The authors remind us that, despite the progress that has been made, this disadvantaged group remains worse off than most others in society. The \"mainstreaming\" of persons with mental illness has left a policy void, where governmental institutions responsible for meeting the needs of mental health patients lack resources and programmatic authority. To fill this void, Frank and Glied suggest that institutional resources be applied systematically and routinely to examine and address how federal and state programs affect the well-being of people with mental illness.
eBook
Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial
Background
The mental health treatment gap—the difference between those with mental health need and those who receive treatment—is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the
Building and Sustaining Interventions for Children (BASIC)
study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery.
Methods
BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called
Pamoja Tunaweza.
Lay counselors are trained and supervised in
Pamoja Tunaweza
by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites’ counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences’ sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors.
Discussion
The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts.
Trial registration
Trial Registration:
ClinicalTrials.gov
Identifier: NCT03243396. Registered 9th August 2017,
https://clinicaltrials.gov/ct2/show/NCT03243396
Journal Article
Preventing Mental, Emotional, and Behavioral Disorders Among Young People
Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of younger populations which often carryover into adulthood. The costs of treatment for mental health and addictive disorders, which create an enormous burden on the affected individuals, their families, and society, have stimulated increasing interest in prevention practices that can impede the onset or reduce the severity of the disorders.
Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations (such as children and youth in the child welfare system), school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations.
Preventing Mental, Emotional, and Behavioral Disorders Among Young People updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders , focusing special attention on the research base and program experience with younger populations that have emerged since that time.
Researchers, such as those involved in prevention science, mental health, education, substance abuse, juvenile justice, health, child and youth development, as well as policy makers involved in state and local mental health, substance abuse, welfare, education, and justice will depend on this updated information on the status of research and suggested directions for the field of mental health and prevention of disorders.
eBook
Mental health challenges, treatment experiences, and care needs of post-secondary students: a cross-sectional mixed-methods study
Background
Post-secondary students frequently experience high rates of mental health challenges. However, they present meagre rates of treatment-seeking behaviours. This elevated prevalence of mental health problems, particularly after the COVID-19 pandemic, can lead to distress, poor academic performance, and lower job prospects following the completion of education. To address the needs of this population, it is important to understand students' perceptions of mental health and the barriers preventing or limiting their access to care.
Methods
A broad-scoping online survey was publicly distributed to post-secondary students, collecting demographic, sociocultural, economic, and educational information while assessing various components of mental health.
Results
In total, 448 students across post-secondary institutions in Ontario, Canada, responded to the survey. Over a third (
n
= 170; 38.6%) of respondents reported a formal mental health diagnosis. Depression and generalized anxiety disorder were the most commonly reported diagnoses. Most respondents felt that post-secondary students did not have good mental health (
n
= 253; 60.5%) and had inadequate coping strategies (
n
= 261; 62.4%). The most frequently reported barriers to care were financial (
n
= 214; 50.5%), long wait times (
n
= 202; 47.6%), insufficient resources (
n
= 165; 38.9%), time constraints (
n
= 148; 34.9%), stigma (
n
= 133; 31.4%), cultural barriers (
n
= 108; 25.5%), and past negative experiences with mental health care (
n
= 86; 20.3%). The majority of students felt their post-secondary institution needed to increase awareness (
n
= 231; 56.5%) and mental health resources (
n
= 306; 73.2%). Most viewed in-person therapy and online care with a therapist as more helpful than self-guided online care. However, there was uncertainty about the helpfulness and accessibility of different forms of treatment, including online interventions. The qualitative findings highlighted the need for personal strategies, mental health education and awareness, and institutional support and services.
Conclusions
Various barriers to care, perceived lack of resources, and low knowledge of available interventions may contribute to compromised mental health in post-secondary students. The survey findings indicate that upstream approaches such as integrating mental health education for students may address the varying needs of this critical population. Therapist-involved online mental health interventions may be a promising solution to address accessibility issues.
Journal Article
Mental health promotion in schools : cross-cultural narratives and perspectives
The narratives of the children and young people, school teachers and school leaders, parents and carers, policy makers and service managers, and mental health workers and professionals, presented in this book, should provide an invaluable resource for all those involved in mental health promotion in school. The insights drawn from these direct field experiences may help to inform policy and good practice and serve as an inspiration to schools in their efforts to introduce and promote mental health for their communities. Most of the chapters present original research carried out in schools, services, universities and other contexts across different cultures. Through various qualitative studies carried out in different cultural contexts, Mental Health Promotion in Schools provides a platform for children, teachers, school leaders, parents, professionals, policy makers and teacher educators, to express their views on what works and does not work in mental health promotion in school. In our continued quest for evidence based research, we may tend to underestimate the value and significance of capturing the views and experiences of those most directly involved in mental health promotion, such as children and young people, school teachers and parents/carers, in seeking to enhance policy and practice in the area. This book should be of particular interest to those involved in mental health promotion in school at practice, training and research levels and we are sure that among these chapters, they will discover many new and stimulating insights into the promotion of mental health in such complex systems as schools.
Book
Adolescent mental health in crisis
We need to understand the causes to inform prevention
Journal Article