Trends in Mental Health and Substance Abuse Services at the Nation's Community Health Centers: 1998-2003.
(17/129)
OBJECTIVE: We examined trends in delivery of mental health and substance abuse services at the nation's community health centers. METHODS: Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care's (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. RESULTS: Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210,000 to 800,000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. CONCLUSIONS: Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve. (+info)
The Psychosocial Care Center on the users point of view.
(18/129)
The present study has as its aim to describe the daily work of a psychosocial care center and to aprehend how the users cared by such service experience the offered therapeutic process. Semi-structured interviews were carried out with eleven users of the Psychosocial Care Center, located in the countryside of Sao Paulo state. The data were submitted to Theme Analysis, based on Minayo. The themes which came from the data analysis, allowed the configuration of three topics. In the first one, the user experiences the treatment on an organicist focus of the care, assessed by the medical professional value, in the medicine-based approach and the symptom control. The second topic brings the perception of the space in CAPS as a helping scenario of social exchanges. And the third topic is about the therapeutic process as being towards the daily life of the users. Based in these data, we could reflect on the directions of the new facilities in mental health, the CAPS. (+info)
The GPs' Experiences Questionnaire (GPEQ): reliability and validity following a national survey to assess GPs' views of district psychiatric services.
(19/129)
BACKGROUND: The measurement of patient and professional views of quality are important components in the evaluation of health care delivery. OBJECTIVE: To describe the development and evaluation of the GPs' Experiences Questionnaire (GPEQ) for assessing the quality of community mental health clinics in Norway. METHODS: DESIGN: Literature review, GP interviews, pre-testing of questionnaire items and a cross-sectional national survey. SETTING: Postal survey of GPs in Norway evaluating 73 community mental health clinics in the five health regions in Norway during spring of 2006. SUBJECTS: Three thousand four hundred and sixty-three GPs were sent a postal questionnaire with the GPEQ and were asked to assess their community mental health clinic responsible for general adult psychiatric services. RESULTS: Two thousand one hundred and thirty (61.5%) GPs returned a completed questionnaire. Low levels of missing data suggest that the questionnaire is acceptable. Factor analysis identified five scales: workforce situation (four items), discharge letter (three items), competence (four items), guidance (three items) and emergency situations (two items). All scales met the criterion of 0.7 for Cronbach's alpha and test-retest correlations were 0.72-0.87. The results of validity testing were as hypothesized with scale scores significantly related to knowledge of the community mental health clinic, overall satisfaction, negative experiences with the clinic, waiting time and acceptance of referrals. CONCLUSIONS: The GPEQ is a self-administered questionnaire that includes the most important aspects of the GPs' experience of quality at community mental health clinics. All scales have good evidence for internal consistency, test-retest reliability and validity. (+info)
Emotional distress among first-time patients attending outpatient mental health clinics in Israel: an Arab-Jewish comparative study.
(20/129)
BACKGROUND: Few studies have focused specifically on the role of ethnicity in emotional distress and symptoms among first-time psychiatric outpatients. METHODS: 251 first-time patients, aged 18-72 years, attending three outpatient mental health clinics in Israel, were surveyed. Three methods of case detection were used: a GHQ-12 score (equal or >3), self-reported symptoms (using a checklist) and a psychiatrist's provisional ICD-10 diagnosis. In addition, self-efficacy and perceived social support were measured using standardized self-report questionnaires. Univariate and multivariate analyses compared the two ethnic groups: Israeli Arabs and Israeli Jews. RESULTS: Compared to Jewish patients, Israeli Arab patients had a higher "distress caseness" rate based on GHQ-12 score (70.8% versus 41.2%) and a higher rate of psychiatrist-detected ICD-10 stress-related disorders (46.7% versus 23.3%), but a lower rate of self-reported emotional distress (36% versus 54.3%) and symptoms of mood disturbances (38.7% versus 64.7%). The Israeli Arabs also had lower mean scores on measures of self-efficacy (2.0 versus 2.4) and perceived social support from friends (12.2 versus 17.6) and significant others (16.7 versus 20.0). In a parsimonious regression model, the best predictors of emotional distress had low self-efficacy and social support from significant others, and, being Arab, these variables accounted for 27.1%, 7.2% and 8.8%, respectively, of the total variance in GHQ distress scores. CONCLUSION: The results suggest that the detection of emotional distress and symptoms varies markedly by patients' ethnic background. These variations can be predicted by a lower sense of self-efficacy and social support among Israeli Arabs as compared to Israeli Jews. (+info)
Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy.
(21/129)
BACKGROUND: Legislation in 1978 led to the gradual replacement of mental hospitals in Italy with a full range of community-based services, including facilities for acute in-patient care. AIMS: To survey the main characteristics of Italian public and private in-patient facilities for acute psychiatric disorders. METHOD: Structured interviews were conducted with each facility's head psychiatrist in all Italian regions, with the exception of Sicily. RESULTS: Overall, Italy (except Sicily) has a total of 4108 public in-patient beds in 319 facilities, with 0.78 beds for every 10,000 inhabitants, and 4862 beds in 54 private in-patient facilities, with 0.94 beds per 10,000 inhabitants. In 2001 the rates of psychiatric admissions and admitted patients per 10,000 inhabitants were 26.7 and 17.8 respectively. In the same year the percentage of involuntary admissions was 12.9%, for a total of 114,570 hospital days. Many in-patient facilities showed significant limitations in terms of architectural and logistic characteristics. Staffing showed a great variability among facilities. CONCLUSIONS: The overall number of acute beds per 10,000 inhabitants is one of the lowest in Europe. The survey has provided evidence of two parallel systems of in-patient care, a public one and a private one, which are not fully interchangeable. (+info)
Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors.
(22/129)
Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or juvenile detention. Findings demonstrated high levels of trauma-related symptoms for both groups. Worry about family, greater runaway episodes, and living with a father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged. (+info)
Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark.
(23/129)
BACKGROUND: The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group of asylum seekers to study if the incidence of mental disorders increased with length of stay. METHODS: The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 - December 2002 the Red Cross prospectively registered health related data on all new applications (n = 4516) to the Immigration Service regarding referrals to medical specialists. We used these records to analyse the association between length of stay in the asylum centres and overall rate of referral for mental disorders. Data was analysed using weighted linear regression. RESULTS: We found that referrals for mental disorders increased with length of stay in asylum centres in a large, multiethnic population of asylum seekers. The association was found in all the categories of psychiatric illness studied and for a majority of the nationality groups studied. CONCLUSION: Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness among asylum seekers should be addressed by political and humanitarian means, giving prevention of illness the highest priority. (+info)
Supportive-expressive group therapy for primary breast cancer patients: a randomized prospective multicenter trial.
(24/129)
OBJECTIVE: The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community settings, to determine whether highly distressed patients were most likely to benefit and whether therapist's training or experience was related to outcome. METHOD: Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were randomly assigned to receive supportive-expressive group therapy or to an education control condition. Participants were recruited from two academic centers and nine oncology practices, which were members of NCI's Community Clinical Oncology Program (CCOP) and were followed over 2 years. RESULTS: A 2x2x19 analysis of variance was conducted with main effects of treatment condition, cohort, and baseline distress and their interactions. There was no main effect for treatment condition after removing one subject with an extreme score. Highly distressed women did not derive a greater benefit from treatment. Therapist training and psychotherapy experience were not associated with a treatment effect. CONCLUSIONS: This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer. Future studies might productively focus on women with higher initial levels of distress. (+info)