Psychiatric services最新文献

{"title":"Changes in Mental Health Services Use Under the ACA in One State: Role of Mental Health Provider Shortages.","authors":"Lyoung Hee Kim, Dominic Hodgkin, Mary Jo Larson, Michael Doonan","doi":"10.1176/appi.ps.20230628","DOIUrl":"https://doi.org/10.1176/appi.ps.20230628","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine whether changes in mental health services use under the Patient Protection and Affordable Care Act (ACA) differed in Mental Health Professional Shortage Areas (MHPSAs) versus non-MHPSAs.</p><p><strong>Methods: </strong>Multiple waves of data from the California Health Interview Survey (2011-2018) were analyzed. The sample (N=10,497) was restricted to adults (ages 18-64) who reported experiencing serious psychological distress (SPD) during the past 12 months. MHPSAs were identified by using scores from the Health Resources and Services Administration and were matched to respondents' zip codes. Weighted logistic regression and generalized linear models were used to identify adjusted changes in the rates of four measures of mental health services use (any primary care visit for mental health reasons, any specialty mental health care visit, any prescription psychiatric medication, and total number of outpatient visits for mental health) before and after implementation of the ACA.</p><p><strong>Results: </strong>Rates of uninsured nonelderly adults with SPD in MHPSAs and non-MHPSAs decreased under the ACA. Changes in rates of specialty mental health services use under the ACA were statistically significant only in non-MHPSAs. Changes in mental health services use did not differ significantly between MHPSAs and non-MHPSAs for any of the four measures.</p><p><strong>Conclusions: </strong>Changes in the four measures of mental health use under the ACA did not differ in MHPSAs versus non-MHPSAs. Future research into the ACA's long-term effects should examine systemic and structural barriers to mental health care and to having sufficient numbers of mental health professionals.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Involuntary Hospitalization Applications Submitted to an Urban Police Department.","authors":"Kevin M Simon, Jenna Savage, Lauryn Krebs, Trinity Wegiel, Melissa S Morabito","doi":"10.1176/appi.ps.20230411","DOIUrl":"https://doi.org/10.1176/appi.ps.20230411","url":null,"abstract":"<p><strong>Objective: </strong>To improve understanding of the application process for temporary involuntary hospitalization (Section 12 of the Massachusetts General Laws) in Boston, the authors focused on cases involving the Boston Police Department (PD) and the information shared about the individuals involved.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on all Section 12 applications submitted to the Boston PD by external clinicians from July 14, 2021, to June 30, 2022. The authors analyzed 488 applications processed by the Boston PD's Street Outreach Unit, examining demographic information, reasons for requests, information provided by petitioners, and the status of the applications (completed vs. not).</p><p><strong>Results: </strong>The analysis revealed racial disparities: 41% of involuntary hospitalization applications were for individuals identified as Black or African American, but this racial group represents only 23% of Boston's population. Racial-ethnic data were based on police perceptions, and 21% of cases lacked race-ethnicity data. Seventy-six percent of applications were submitted without a direct clinical examination by petitioners, who did not justify the omission. The Boston PD completed 70% of the requested involuntary hospitalization orders.</p><p><strong>Conclusions: </strong>This study identified substantial racial disparities in Section 12 applications, which disproportionately involved Black or African American individuals. The frequent absence of direct clinical examinations before application submissions and the lack of justification indicated a need for regulatory oversight and enhanced petitioner training. Incomplete demographic data underscored the need for improved data collection and reporting practices. These findings highlight the need for reforms to ensure equitable, transparent, and best practice-aligned involuntary hospitalization processes.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinic-Level Predictors of Psychotherapy Dosage in the Military Health System.","authors":"Carmen P McLean, Chunki Fong, Christopher K Haddock, Jeffrey Cook, Alan L Peterson, David S Riggs, Stacey Young-McCaughan, Allison M Conforte, Araceli Flores, Jeremy Jinkerson, Zachary K Jones, Hana J Kim, Jared S Link, Debra Nofziger, Erik N Ringdahl, Craig Woodworth, Jeffrey McCullen, Emily Ho, Craig S Rosen","doi":"10.1176/appi.ps.20240180","DOIUrl":"https://doi.org/10.1176/appi.ps.20240180","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the demand for, supply of, and clinic processes associated with behavioral health care delivery in the Military Health System and to examine the clinic-level factors associated with receipt of a minimally adequate dosage of psychotherapy.</p><p><strong>Methods: </strong>This retrospective study used administrative behavioral health data from eight military treatment facilities (N=25,433 patients; N=241,028 encounters) that were participating in a larger implementation study of evidence-based psychotherapy for posttraumatic stress disorder. Minimally adequate dosage of psychotherapy was defined in two ways: at least three sessions within a 90-day period and at least six sessions within a 90-day period. The authors then used a path model to examine clinic-level factors hypothesized to predict psychotherapy dosage, including care demand, supply, and processes.</p><p><strong>Results: </strong>Patients had an average of 2.5 psychotherapy appointments per quarter. Wait times for intake, between intake and the first psychotherapy session, and between follow-up sessions all averaged 17 days or longer. Path modeling showed that a higher patient-to-encounter ratio was associated with a longer wait time between follow-up psychotherapy appointments. In turn, a longer wait time between appointments was associated with a lower probability of receiving an adequate dosage of psychotherapy. However, a greater proportion of care delivered in groups was associated with a greater probability of receiving at least six sessions of psychotherapy.</p><p><strong>Conclusions: </strong>Receipt of a minimally adequate dosage of psychotherapy in the Military Health System is hindered by clinic staffing and workflows that increase wait times between follow-up psychotherapy appointments.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factor Structure, Reliability, and Construct Validity of the Wellness Inventory.","authors":"Margaret Swarbrick, Angelo Di Bello, SunHee Jang Eissenstat, Patricia B Nemec, Denise Aimee Hien, Kenneth J Gill","doi":"10.1176/appi.ps.20230622","DOIUrl":"https://doi.org/10.1176/appi.ps.20230622","url":null,"abstract":"<p><strong>Objective: </strong>Wellness has been associated with various general medical and mental health outcomes; however, few empirically supported measures capture the breadth of the wellness construct. The first author had previously developed the Wellness Inventory through an iterative process with key stakeholders to establish face and content validity and examined the psychometric properties of the Wellness Inventory as a tool for assessing wellness across eight dimensions.</p><p><strong>Methods: </strong>The authors assessed the Wellness Inventory by using data from self-report online surveys in three samples of data collected from two groups of respondents: students and faculty members in a public university and behavioral health providers (N=3,446; 50% White and 43% female). Exploratory and confirmatory factor analyses and data from samples 1 and 2 were used to examine the factor structure and fit of the inventory. Data from sample 3 were used to assess test-retest reliability and convergent and discriminant validity.</p><p><strong>Results: </strong>Factor analyses yielded a one-factor model comprising 54 items. A revised instrument based on this model revealed good fit to the data, internal consistency, and test-retest reliability and reasonable construct validity.</p><p><strong>Conclusions: </strong>The Wellness Inventory is a comprehensive and psychometrically valid tool for assessing wellness. The findings support a single dimension of wellness, suggesting wellness as a holistic, general construct. This inventory has implications for research on health promotion and prevention and clinical outcomes in both research and treatment.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Inpatient Occupational Therapy Utilization With Reduced Risk for Psychiatric Readmission Among Veterans.","authors":"Adam R Kinney, Molly E Penzenik, Jeri E Forster, Frederica O'Donnell, Lisa A Brenner","doi":"10.1176/appi.ps.20230650","DOIUrl":"10.1176/appi.ps.20230650","url":null,"abstract":"<p><strong>Objective: </strong>The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA).</p><p><strong>Methods: </strong>The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition).</p><p><strong>Results: </strong>Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses.</p><p><strong>Conclusions: </strong>Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer-Run Respite Approaches to Supporting People Experiencing an Emotional Crisis.","authors":"Lauren Spiro, Margaret Swarbrick","doi":"10.1176/appi.ps.20230599","DOIUrl":"10.1176/appi.ps.20230599","url":null,"abstract":"<p><p>Research shows that guests experience peer-run respites as empowering and safe places where they feel more seen, heard, and respected than they do in conventional settings. This column describes the successful and unique processes of peer-run respites that support guests in emotional crisis and facilitate healing. In a discussion informed by their experiences and the literature, the authors examine how peer-run respites differ from conventional psychiatric crisis response services in their basic philosophy: how emotional crisis is understood, the goal of crisis response, how trauma is viewed, the importance of self-determination, power dynamics, and relationality.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis.","authors":"Christin Hempeler, Lydia Schneider-Reuter, Anne-Sophie Windel, Jona Carlet, Lea Philipsen, Georg Juckel, Jakov Gather, Amma Yeboah, Mirjam Faissner","doi":"10.1176/appi.ps.20230252","DOIUrl":"10.1176/appi.ps.20230252","url":null,"abstract":"<p><strong>Objective: </strong>Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care.</p><p><strong>Methods: </strong>The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed.</p><p><strong>Results: </strong>Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices.</p><p><strong>Conclusions: </strong>Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Aluri et al.","authors":"","doi":"10.1176/appi.ps.20240085correction","DOIUrl":"https://doi.org/10.1176/appi.ps.20240085correction","url":null,"abstract":"","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Evaluation of Suicide Risk Assessment in Crisis Counseling Calls.","authors":"Zac E Imel, Brian Pace, Brad Pendergraft, Jordan Pruett, Michael Tanana, Christina S Soma, Kate A Comtois, David C Atkins","doi":"10.1176/appi.ps.20230648","DOIUrl":"10.1176/appi.ps.20230648","url":null,"abstract":"<p><strong>Objective: </strong>Counselor assessment of suicide risk is one key component of crisis counseling, and standards require risk assessment in every crisis counseling conversation. Efforts to increase risk assessment frequency are limited by quality improvement tools that rely on human evaluation of conversations, which is labor intensive, slow, and impossible to scale. Advances in machine learning (ML) have made possible the development of tools that can automatically and immediately detect the presence of risk assessment in crisis counseling conversations.</p><p><strong>Methods: </strong>To train models, a coding team labeled every statement in 476 crisis counseling calls (193,257 statements) for a core element of risk assessment. The authors then fine-tuned a transformer-based ML model with the labeled data, utilizing separate training, validation, and test data sets.</p><p><strong>Results: </strong>Generally, the evaluated ML model was highly consistent with human raters. For detecting any risk assessment, ML model agreement with human ratings was 98% of human interrater agreement. Across specific labels, average F1 (the harmonic mean of precision and recall) was 0.86 at the call level and 0.66 at the statement level and often varied as a result of a low base rate for some risk labels.</p><p><strong>Conclusions: </strong>ML models can reliably detect the presence of suicide risk assessment in crisis counseling conversations, presenting an opportunity to scale quality improvement efforts.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intellectual and Developmental Disabilities.","authors":"Asees Dhinsa, Avra Selick, Nicole Kozloff, Lisa B Dixon","doi":"10.1176/appi.ps.24075017","DOIUrl":"https://doi.org/10.1176/appi.ps.24075017","url":null,"abstract":"","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}