Developing community mental health services: an evaluation of Glasgow's mental health resource centres

Greater Glasgow Health Board's strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow.     

驻马店市医专学生心理健康状况调查

目的了解医专学生心理健康状况,为开展心理健康教育提供依据。方法采用SCL—90症状自评量表,对河南省某医学专科学校365名学生进行测试。结果医专学生心理健康状况水平低于全国常模。主要心理卫生问题是抑郁、强迫、偏执、敌对,人际关系等(检出率1.92%-12.33%);心理问题发生率(23.84%)高于全国大学生抽样调查结果。心理问题发生率一年级学生最高(26.15%),其次是二年级(23.36%),再次是三年级(21.13%),主要心理问题基本相似。结论医专学校健康教育应针对学生心理健康状况和特点进行。     

健康教育对住院患者心理健康的影响

目的 探讨护理健康教育对住院患者心理健康的影响.方法 选择接受过心理护理课程和护理健康教育课程培训的护理人员,对患者实施心理护理和护理健康教育.结果 患者在接受心理护理和健康教育培训前、后心理因子分比较(t=4.135、4.012,均P＜0.01),有显著性差异.结论 护理健康教育能有效改善患者的心理状况,对患者心理因子分的改变有显著统计学差异,患者对医院的满意度有显著性差异.     

Self perceived health and mental health among women flight attendants

Aims

The authors investigated associations of work related risk factors with self perceived health as less than “good” and psychological distress among Italian women flight attendants.

Methods

The authors conducted a cross sectional survey on health and mental health among 1955 former and current flight attendants, using a postal questionnaire.

Results

More current than former flight attendants reported self perceived health as fair to poor and psychological distress measured as a GHQ‐12 score of six or more. Among current flight attendants, reporting health as fair to poor was associated with low job satisfaction (OR 1.89) and recent experiences of sexual harassment by passengers (OR 2.83). Psychological distress was associated with low job satisfaction (OR 2.38) and frequent tension with partner over childcare (OR 1.79).

Conclusions

Perceived health as fair to poor and psychological distress were greater among current flight attendants and were related to job characteristics and family difficulties. Perceived poor health has been shown in the literature to be related to mortality, high job strain, and early retirement, and psychological distress is associated with work absence. The effect of sexual harassment by passengers on perceived health of flight attendants may be relevant to other working women dealing with the public. The health effects of family/work conflicts, low job satisfaction, and sexual harassment should be explored more in depth, using qualitative as well as quantitative methods among working women in various occupations.     

Vulnerability and mental health

Abstract

The vulnerability of children has long been recognized in terms of their development needs and the importance of protecting their physical health. The extent, severity and impact of their mental health problems, including the particular vulnerabilities associated with such problems in both childhood and through to adult life, have been less of a public health priority. Vulnerabilities come in many forms, all of which may impact on the mental health and wellbeing of children and may do so in complex ways. These include the diversity of family structures, of cultures, of childrearing practices, the influence of developmental trajectories, experiences of illness and disability in child or parent and multiple strengths, resilience and protective factors. In understanding the patterns and sources of vulnerability, several themes need to be taken into account. Advocacy is also a central issue. Children do not have a political voice. The most vulnerable children from the most vulnerable families are rarely heard. This brings a responsibility for all, in terms of advocacy, engagement with their issues and recognition and building of their strengths and hearing their voices in all these matters.     

Challenges faced by general practitioners and allied mental health services in providing mental health services in rural Queensland

OBJECTIVE: To examine the views of rural practitioners concerning issues and challenges in mental health service delivery and possible solutions. DESIGN: A qualitative study using individual semi-structured interviews. SETTING: Eight general practices from eight rural Queensland towns, three rural mental health services and two non-government organisations, with interviews being conducted before recent changes in government-subsidised access to allied health practitioners. PARTICIPANTS: A sample of 37 GPs, 19 Queensland Health mental health staff and 18 participants from community organisations. MAIN OUTCOME MEASURES: Analysis of qualitative themes from questions about the key mental health issues facing the town, how they might be addressed and what challenges would be faced in addressing them. RESULTS: There was substantial consensus that there are significant problems with inter-service communication and liaison, and that improved collaboration and shared care will form a critical part of any effective solution. Differences between groups reflected differing organisational contexts and priorities, and limitations to the understanding each had of the challenges that other groups were facing. CONCLUSIONS: Improvements to mental health staffing and to access to allied health might increase the ability of GPs to meet the needs of less complex patients, but specific strategies to promote better integrated services are required to address the needs of rural and regional patients with complex mental health problems. The current study provides a baseline against which effects of recent initiatives to improve mental health care can be assessed.     

Information in mental health: qualitative study of mental health service users

BACKGROUND: Despite the widespread proliferation of consumer health information provision, little is known about information needs or information-seeking behaviour in mental health. A qualitative study was therefore undertaken to explore these issues for mental health service users. DESIGN: In-depth interview study with purposive sample of 36 men and women with experience of mental health problems. RESULTS: Four main themes were identified. A general lack of information was equated with a lack of respect. People undertook their own research into their condition, and recognized the challenge to professionals. Stigma was widespread and inhibited information seeking. There was a desire for an explanation of mental health problems in physical terms. People particularly valued hearing other people's experience of mental health problems, for reasons of universality, instillation of hope, and understanding and empathy. CONCLUSIONS: The findings provide support for a more equal partnership between patients and professionals. Information providers and health practitioners should take account of the value of other people's experience as an information source.     

Cognitive appraisals of specialty mental health services and their relation to mental health service utilization in the rural population

Abstract Purpose: Rural individuals utilize specialty mental health services (eg, psychiatrists, psychologists, counselors, and social workers) at lower rates than their urban counterparts. This study explores whether cognitive appraisals (ie, individual perceptions of need for services, outcome expectancies, and value of a positive therapeutic outcome) of help‐seeking for depression symptoms are related to the utilization of specialty mental health services in a rural sample. Methods: Demographic and environmental characteristics, cultural barriers, cognitive appraisals, and depression symptoms were assessed in one model predicting specialty mental health service utilization (MHSU) in a rural sample. Three hypotheses were proposed: (1) a higher number of environmental barriers (eg, lack of insurance or transportation) would predict lower specialty mental health service utilization; (2) an increase in cultural barriers (stigma, stoicism, and lack of anonymity) would predict lower specialty mental health utilization; and (3) higher cognitive appraisals of mental health services would predict specialty mental health care utilization beyond the predictive capacities of psychiatric symptoms, demographic variables, environmental barriers, and cultural barriers. Findings: Current depression symptoms significantly predicted lifetime specialty mental health service utilization. Hypotheses 1 and 2 were not supported: more environmental barriers predicted higher levels of specialty MHSU while cultural barriers did not predict specialty mental health service utilization. Hypothesis 3 was supported: cognitive appraisals significantly predicted specialty mental health service utilization. Conclusions: It will be important to target perceptions and attitudes about mental health services to reduce disparities in specialty MHSU for the rural population.     

Risk and mental health

This editorial reflects on an emerging body of mental health care research which draws on the social science of risk, and introduces a collection of papers presented in a special edition of the journal Health, Risk & Society on risk and mental health. The trend in research outputs concerned with risk and mental health is documented through a quantitative analysis of cited research literature for the period 1993–2004. It is argued that the underpinning concepts of mental health, now labelled mental/personality disorder, and risk are both problematic. Completed work falls roughly into two categories, oriented primarily either towards service development or critical deconstruction. The special edition papers of Mcguire and Ryan illustrate the former trend in distinctive ways, making a critical but supportive case for the actuarial approach to risk assessment and for the no-fault approach to risk management respectively. The other papers offer insights into the needs of service users and critical analyses of existing provision. They illuminate three overlapping themes: unreflective risk selectivity; the role of the beholder in liminal or marginal diagnostic classification; and the complexities of mental health care risk management.     

心理健康教育对大学生手机依赖及心理健康的干预效果

目的 分析心理健康教育干预(抑制控制训练联合积极情绪训练)对大学生手机依赖的干预效果。方法 对河南省3所高校600名大学生采用大学生手机成瘾倾向量表对其手机依赖情况进行调查,筛选存在手机依赖大学生随机分为对照组(66人)与观察组(67人),对照组给予抑制控制训练干预,观察组在此基础上联合积极情绪训练干预,比较2组干预前后手机依赖程度及心理健康状况的变化。结果 干预前2组手机成瘾量表评分、手机使用时间、心理弹性量表评分、认知情绪调节量表评分、抑制冲突效应量对比差异均无统计学意义(P>0.05)。干预后3个月,观察组手机成瘾量表评分(37.11±5.01)分,低于对照组的(41.25±6.33)分;观察组手机使用时间(2.72±0.71)h,低于对照组的(3.37±0.55)h;观察组认知情绪调节量表评分(88.79±5.66)分、心理弹性量表评分(76.63±3.97)分,高于对照组的(81.14±4.79)分、(71.75±4.55)分;观察组抑制冲突效应量(40.35±10.22)ms,低于对照组的(45.14±5.66)ms,差异均有统计学意义(P<0.01)。大学生手机成瘾倾向量表评分与认知情绪调节量表、心理弹性量表评分呈负相关(r=-0.397、-0.453,P<0.01),与冲突抑制效应量呈正相关(r=0.498,P<0.01)。结论 手机依赖直接影响大学生认知情绪调节及心理韧性;而以积极心理学为指导,开展抑制控制训练联合积极情绪训练,可减轻大学生手机依赖,提升认知情绪调节能力及心理韧性,改善自我控制能力,有助于促进其心理健康发展。     

Developing mental health indicators in England

OBJECTIVES: This paper reports on the construction of a set of indicators for mental health and the publication of a report for England's Chief Medical Officer. The report was the seventh in a series of reports aimed at initiating public health action to improve health at a regional level in England. STUDY DESIGN: Observational study using routine data. METHODS: A set of over 80 indicators was constructed by an expert group. These indicators were then populated from routine datasets. Commentary was provided on each indicator in the report. RESULTS: A small team compiled this large set of indicators from routine data working in a public health observatory in one region of England. CONCLUSIONS: It is possible to produce a large array of indicators about mental health. The conclusion from examining these indicators is that there are many unexplained differences in mental health across the regions of England. Many of these indicators are closely linked to deprivation. Some indicators show a lack of difference across the country, and in many instances, service provision is inconsistent and does not always relate to need. In some cases, there was a worrying absence of data, e.g. data on ethnicity and the mental health of offenders.     

Videoconferencing could reduce the number of mental health patients transferred from outlying facilities to a regional mental health unit

Objective : To determine if the addition of a video link to the existing phone connection, enabling patients admitted for mental and behavioural disorders to be seen by a centrally located psychiatrist or mental health clinician, would change the probability of these patients being transferred to the central mental health unit. Methods : Data analysed were patients admitted (n=1,943) to a health services regional hospital with a primary diagnosis of mental and behavioural disorders (ICD10‐AM code F00‐F99) between January 2002 and December 2010. The probability of being transferred was modelled using multilevel random intercept logistic regression. The introduction of videoconferencing in January 2008 was examined by testing if the inclusion of a binary intervention variable was significant when added to the best fitting risk adjustment model. Results : After the introduction of videoconferencing the percentage of patients transferred fell from 66.8% (95%CI 64.0 to 69.5) to 59.6% (95%CI 56.1 to 63.1) (χ²=10.42, p=0.001). After adjusting for age, sex, clustering in hospitals and repeat visits the odds of transfer were 0.69 (95%CI 0.49 to 0.97) of previous. Aboriginality, being non‐Australian, long‐term linear trend, admitted on the weekends or after hours were not significant predictors of the probability of transfer. Conclusions and Implications : The ability for the psychiatrist or senior mental health clinician to see mental health patients via videoconferencing was associated with a reduced probability of the patient being transferred. This satisfies the preference of patients to remain in their community and access mental health services.     

Rural mental health: neither romanticism nor despair

ABSTRACT: This paper explores the relationship between rural places and mental health. It begins with a definition of mental health and an outline of the data that have led to the current concern with promoting positive mental health. We then consider aspects of rural life and place that contribute to positive mental health or increase the likelihood of mental health problems. Issues identified include environment, place, gender identity, violence and dispossession and the influence of the effects of structural changes in rural communities. The paper concludes with a discussion of some of the determinants of resilience in rural places, including social connectedness, valuing diversity and economic participation.     

Case management in mental health services:the role of community mental health support teams

The progressive reduction in the numbers of hospital places available for people with mental health problems has led to an increasing demand on community support services. One response has been the development within social services departments of community mental health support teams, which employ largely unqualified staff who offer support to people with longer term mental health needs. The paper examines to what extent the practice of one authority's support teams reflects an appropriate ‘case management’ style of service, as developed in the USA to address the needs of long-term community patients. Key features of this approach are identified, and used as the basis of analysis of the support teams' practice in relation to 214 cases. It is concluded that a ‘case management’ model can be appropriate for work involving unqualified staff, provided that the service structure as a whole enables access to other skills as appropriate. Two specific risks are identified: firstly that the service is developed because of cost rather than appropriateness; and secondly that the service can rapidly become silted up with increasing numbers of people who need service of indefinite duration.     

初中生心理健康状况及家庭影响因素分析

目的了解初中生心理健康状况及家庭影响因素,为心理健康教育提供参考依据。方法采用中国中学生心理健康量表、家庭亲子关系量表和自拟相关问题,对吉林省长春市2所中学538名初中生进行问卷调查。采用SPSS 13.0软件进行统计分析。结果（1）家庭经济水平低的学生更易产生敌对、人际关系紧张、抑郁、焦虑、学习压力、适应不良等不良状态;（2）离异家庭的学生更易产生偏执、敌对、人际关系紧张、抑郁、适应不良的心理问题;（3）心理健康水平与父母教养方式相关;（4）家长对孩子的态度对其心理健康影响最大,其次是家庭经济条件、父母之间的关系。结论家庭的主客观因素均对初中学生的心理健康水平及行为发展有影响,家庭因素在学生的心理健康教育中不容忽视。     

GP Clinic: promoting access to primary health care for mental health service clients

Objective: To evaluate an innovative rural service offering comprehensive primary health care for mental health service clients. Design: A formative evaluation using mixed methods. Setting: A rural NSW community. Participants: Fifteen health care providers and 120 adult clients. Intervention: A monthly clinic held in a general practice to provide primary health care for clients of the community mental health team. Main outcome measures: Client utilisation and clinic activity data. Provider views of service effectiveness, possible improvements and sustainability. Results: The GP Clinic has operated successfully for 2.5 years without access block. Some 52% of clients had no physical illness and 82% were referred to other health and community services. In total, 40% continued to attend the clinic while 32% went on to consult a GP independently. Client access to care improved as did collaboration between the community mental health team and primary care providers. Conclusion: The GP Clinic is a straightforward and flexible service model that could be used more widely.     

杭州市某区女工心理健康状况调查分析

目的 了解目前工厂企业女工的心理健康状况及其影响因素。方法 应用症状自评量表( SCL-90)对杭州市某区815名女工的心理健康状况进行调查。结果 企业女工SCL-90各因子异常检出率较低,仅为5％,除躯体不适症状明显高于常模外,其余8个项目因子分均明显低于常模,差异有统计学意义(P＜0.01)。从事电子行业的女工各项目因子分均明显高于其他行业。结论 企业女工心理健康状况较好,仅躯体不适症状发生较多。但电子行业的女工心理状况较差,提示不同行业类型对女工的心理健康状况影响不同。