Showing papers in "Psychiatric Services in 2014"
TL;DR: Treatment-resistant depression may present an annual added societal cost of $29-$48 billion, pushing up the total societal costs of major depression by as much as $106-$118 billion, and underscore the need for research on the mechanisms of depression, new therapeutic targets, existing and new treatment combinations, and tests to improve the efficacy of and adherence to treatments for treatment- resistant depression.
Abstract: Treatment-resistant depression exacts a heavy price in treatment costs and lost productivity, reaching into the tens of billions of dollars, but its effects on the lives of patients are just as devastating. In this literature review, the authors summarize 62 studies documenting the disease’s toll on quality of life, personal financial resources, and general health. The average patient in the included studies had experienced nearly four earlier episodes of depression, had not responded to 4.7 drug trials, and continued to meet or nearly meet criteria for severe depression.
405 citations
TL;DR: In this article, a literature review found encouraging evidence for the effectiveness of peer support services, but more rigorous studies are needed to pinpoint the contributions of peers, while many states are including supports offered by certified peer support specialists as Medicaid-reimbursable services.
Abstract: Providers of mental health services have shown increasing interest in hiring peer specialists to provide a range of services and supports to persons with severe mental illnesses. In fact, many states are including supports offered by certified peer support specialists as Medicaid-reimbursable services. This literature review found encouraging evidence for the effectiveness of peer support services, but more rigorous studies are needed to pinpoint the contributions of peers, the authors note.
390 citations
TL;DR: Findings from this analysis of NCS-A data confirm those of earlier, smaller studies, that only a minority of youths with psychiatric disorders receive treatment of any sort.
Abstract: ObjectiveThis study examined 12-month rates of service use for mental, emotional, and behavioral disorders among adolescents.MethodsData were from the National Comorbidity Survey Adolescent Supplement (NCS-A), a survey of DSM-IV mental, emotional, and behavioral disorders and service use.ResultsIn the past 12 months, 45.0% of adolescents with psychiatric disorders received some form of service. The most likely were those with ADHD (73.8%), conduct disorder (73.4%), or oppositional defiant disorder (71.0%). Least likely were those with specific phobias (40.7%) and any anxiety disorder (41.4%). Among those with any disorder, services were more likely to be received in a school setting (23.6%) or in a specialty mental health setting (22.8%) than in a general medical setting (10.1%). Youths with any disorder also received services in juvenile justice settings (4.5%), complementary and alternative medicine (5.3%), and human services settings (7.9%). Although general medical providers treated a larger proportio...
351 citations
TL;DR: E-mental health applications are proliferating and hold promise to expand access to care and to apply it to diverse populations, according to a review of the literature, including its applications, strengths, limitations, and evidence base.
Abstract: As e–mental health applications proliferate, the Internet is increasingly viewed as a potentially transformative tool that will broaden access to effective mental health services. This “rapid review” of the literature found an encouraging amount of rigorous research supporting the effectiveness of e–mental health applications, even therapist-assisted cognitive-behavioral therapy for anxiety and depression. Nevertheless, policy makers and health leaders must be sure to incorporate e–mental health applications into the existing service system so they complement—and not detract from—the provision of direct care, the authors said.
331 citations
TL;DR: Drug addiction is often treated as a subcategory of mental illness, and insurance plans group them together under the rubric of "behavioral health."
Abstract: ObjectivePublic attitudes about drug addiction and mental illness were compared.MethodsA Web-based national survey (N=709) was conducted to compare attitudes about stigma, discrimination, treatment effectiveness, and policy support in regard to drug addiction and mental illness.ResultsRespondents held significantly more negative views toward persons with drug addiction. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them. Respondents were more willing to accept discriminatory practices against persons with drug addiction, more skeptical about the effectiveness of treatments, and more likely to oppose policies aimed at helping them.ConclusionsDrug addiction is often treated as a subcategory of mental illness, and insurance plans group them together under the rubric of “behavioral health.” Given starkly different public views about drug addiction and mental illness, advocates may need to adopt differing approaches to reducing stigma and adva...
330 citations
TL;DR: Treatment reach for PTSD after deployment remains low to moderate, with a high percentage of soldiers not accessing care or not receiving adequate treatment.
Abstract: Are efforts to engage veterans in PTSD treatment falling short? A study from the Walter Reed Army Institute of Research found a sharp drop-off in treatment seeking after a mental health evaluation. Seventy-five percent of veterans who were referred for further evaluation after a postdeployment health assessment attended a follow-up appointment. However, among veterans who received a PTSD diagnosis, 22% had only one mental health visit and only 41% received minimally adequate care. The findings are a call to action, the authors said.
316 citations
TL;DR: A systematic review of 28 articles published between 1989 and 2013 confirmed the high prevalence of mental illnesses among prisoners and identified a litany of health problems associated with the incarceration of persons with mental illness and profound difficulties in finding housing and employment after release.
Abstract: Two federal reports dating from 1999 and 2006 are by far the most widely cited sources for the prevalence of mental illness among persons in U.S. jails and prisons. To provide a broader picture of the issue, the author undertook a systematic review of 28 articles published between 1989 and 2013. Not only did the review confirm the high prevalence of mental illnesses among prisoners, it identified a litany of health problems associated with the incarceration of persons with mental illness and profound difficulties in finding housing and employment after release.
267 citations
TL;DR: The moderate level of evidence indicates that permanent supportive housing is promising, but research is needed to clarify the model and determine the most effective elements for various subpopulations.
Abstract: Permanent supportive housing for individuals with mental illness and substance abuse is predicated on the simple idea that housing has an impact on health and should be part of the treatment and recovery process. Service providers offer ongoing support and collaborate with property managers to preserve tenancy and help individuals resolve crisis situations and other issues. This comprehensive literature review (1995–2012) found substantial research evidence demonstrating that this approach has been successful, but more rigorous studies are needed to clarify which components of the model are most effective and for which subpopulations.
231 citations
TL;DR: MMT in pregnancy was associated with improved maternal and fetal outcomes, and rates of neonatal abstinence syndrome were similar for mothers receiving different doses, so MMT should be a covered service available to all individuals.
Abstract: Five decades after its introduction, methadone maintenance treatment (MMT) for opioid addiction remains in high demand as a more effective alternative to abstinence-based treatments. The authors of this literature review describe a significant body of research supporting MMT’s positive impact on treatment retention and suppression of heroin use, particularly at higher doses. Efforts should be made to increase access to MMT for all individuals who struggle with opioid use disorders, they said.
199 citations
TL;DR: Substantial evidence demonstrates the effectiveness of supported employment, and policy makers should consider including it as a covered service.
Abstract: After 20 years of research, evidence of the effectiveness of supported employment for individuals with mental disorders is irrefutable. Across the country, this approach has replaced sheltered workshops for people who want the benefits and satisfaction of holding a job. Supported employment has consistently demonstrated positive outcomes, including higher rates of competitive employment, fewer days to the first competitive job, more hours and weeks worked, and higher wages. But how to expand the supported employment model to meet demand remains an open question, according to the authors of this review.
193 citations
TL;DR: TF-CBT is a viable treatment for reducing trauma-related symptoms among some children who have experienced trauma and their nonoffending caregivers and should be available as a covered service in health plans.
Abstract: Developed to address PTSD symptoms associated with sexual abuse, trauma-focused cognitive-behavioral therapy (TF-CBT) has been adapted to help children cope with physical or emotional abuse or neglect, community or domestic violence, traumatic loss, and war or natural disasters. Children who complete the program show consistent pre- to posttreatment decreases in PTSD symptomatology, according to the authors of this literature review. While acknowledging that TF-CBT is not as effective in treating depression, the authors conclude that it is a viable treatment for many types of trauma and should be a covered service in private and public health plans.
TL;DR: In this literature review, the last in the Assessing the Evidence Base (AEB) Series, the authors review the evidence supporting peer recovery support services, noting that more research is needed to distinguish the effects ofpeer recovery support from other recovery support activities.
Abstract: In recent years, peer recovery support services have become an accepted part of the treatment of substance use disorders, providing a more extensive array of services than typically associated with mutual support groups. Peer providers may help consumers set recovery goals, develop a plan, and work toward and maintain recovery. In this literature review, the last in the Assessing the Evidence Base (AEB) Series, the authors review the evidence supporting peer recovery support services, noting that more research is needed to distinguish the effects of peer recovery support from other recovery support activities.
TL;DR: Cognitive-behavioral therapy was associated with robust improvements in the positive symptoms of psychotic disorders and the improvements were sustained at follow-up, the authors reported.
Abstract: Patients with schizophrenia often continue to experience disabling positive symptoms, despite adequate trials of medication. In these situations, patients may be prescribed an adjunctive medication, but a more effective choice may be cognitive-behavioral therapy (CBT). This review of 16 published articles from 12 randomized controlled trials found that CBT was associated with robust improvements in the positive symptoms of psychotic disorders. In addition, the improvements were sustained at follow-up, the authors reported.
TL;DR: Buprenorphine maintenance treatment is associated with improved outcomes compared with placebo for individuals and pregnant women with opioid use disorders and should be considered for inclusion as a covered benefit.
Abstract: In 2002, buprenorphine and buprenorphine-naloxone became the first medications to be approved under a new federal law that permits long-term opioid treatment in settings other than opioid treatment clinics. In short order, buprenorphine has established a reputation as an effective alternative to methadone maintenance treatment with a key advantage: availability. In this literature review, the authors describes research evidence for buprenorphine treatment, including no fewer than 16 adequately designed randomized controlled trials indicating its positive impact on treatment retention and illicit opioid use.
TL;DR: There is a need for a clearly defined and agreed measurement of service engagement and disengagement across FEP services and those who enter an FEP program without family involvement and support as well as those who maintain persistent substance abuse are at higher risk of disengagement.
Abstract: Despite the increased popularity of interventions for first-episode psychosis (FEP), approximately 30% of individuals with FEP disengage from services. In an attempt to understand the reasons for the disengagement, the authors examined rates and definitions of disengagement among services for FEP and identified the most relevant demographic and clinical predictors of disengagement. Not surprisingly, perhaps, substance abuse was the most robust predictor of disengagement, and family involvement was the most important factor in treatment retention.
TL;DR: Anticipated self-stigma and perceived public stigma appeared to have a differential impact on attitudes toward formal and informal help seeking, including the perceived importance of care from medical providers (general practitioners and psychiatrists).
Abstract: ObjectiveIndividuals in need of psychiatric treatment often avoid seeking help because of stigma. This study examined the impact of two stigma dimensions on help-seeking attitudes. Perceived public stigma refers to discrimination and devaluation by others, and anticipated self-stigma refers to internalization of negative stereotypes about people who seek help.MethodsData were from the 2009 Stigma in a Global Context–Belgian Mental Health Study, in which face-to-face interviews were conducted with a representative sample of the general Belgian population. The study reported here included 728 respondents who received a vignette depicting major depression or schizophrenia. Perceived public stigma and anticipated self-stigma were measured with validated instruments. Respondents’ attitudes toward help seeking were measured by the importance they assigned to care from formal and informal providers: general practitioners, psychiatrists, psychologists, family members, or friends. Multiple linear regression models...
TL;DR: The prevalence of serious mental illness and its co-occurrence with substance use disorders and PTSD in this multisite sample suggest the critical need for comprehensive assessment of mental health at the point of women's entry into the criminal justice system.
Abstract: ObjectivesThis multisite study aimed to answer the following research questions about women in urban and rural jails. First, what is the current and lifetime prevalence of serious mental illness (major depressive disorder, bipolar disorder, and psychotic spectrum disorders) of women in jail? Second, what level of impairment is associated with their serious mental illness? Third, what is the proportion of incarcerated women with serious mental illness who also have posttraumatic stress disorder (PTSD), a substance use disorder, or both?MethodsParticipants were 491 women randomly sampled in jails in Colorado, Idaho, South Carolina, and the metropolitan area of Washington, D.C. Structured interviews assessed lifetime and 12-month prevalence of disorders and level of impairment.ResultsForty-three percent of participants met lifetime criteria for a serious mental illness, and 32% met 12-month criteria; among the latter, 45% endorsed severe functional impairment. Fifty-three percent met criteria for ever having...
TL;DR: CIT training appears to increase the likelihood of referral or transport to mental health services and decrease the likelihoodof arrest during encounters with individuals thought to have a behavioral disorder, and early evidence of successful prebooking jail diversion is found.
Abstract: ObjectiveThe crisis intervention team (CIT) model is a widely implemented police-based program to improve officers’ responses to individuals with behavioral disorders. The authors examined levels of force used by officers with or without CIT training and disposition decisions in a large sample of encounters with individuals whom they suspected of having a serious mental illness, a drug or an alcohol problem, or a developmental disability.MethodsA total of 180 officers (91 with CIT training and 89 without) in six departments reported on 1,063 encounters, including level of force and disposition (resolution at the scene, referral or transport to services, or arrest).ResultsCIT training status was generally not predictive of level of force, although CIT-trained officers were significantly more likely to report verbal engagement or negotiation as the highest level of force used (odds ratio [OR]=2.00, p=.016). For CIT-trained officers, referral or transport was a more likely outcome (OR=1.70, p=.026) and arres...
TL;DR: Although mental health professionals held more positive attitudes than the general public about people with mental health problems, strong stereotypes persisted in both groups, especially concerning schizophrenia.
Abstract: ObjectivesThe authors compared attitudes of the U.S. general public and of mental health professionals about the competence and perceived dangerousness of people with mental health problems and the desire for social distance from them. Factors related to negative attitudes and the desire for social distance also were examined.MethodsVignettes describing individuals meeting DSM-IV criteria for major depression and schizophrenia were included in the 2006 General Social Survey (GSS) and a 2009 study of mental health professionals, and responses were descriptively compared (GSS, N=397 responses to depression vignette, N=373 responses to schizophrenia vignette; 731 mental health professionals responded to both vignettes). Regression analyses examined whether demographic and provider characteristics were associated with perceptions of less competence and perceived dangerousness of the vignette character and with respondents’ desire for social distance.ResultsCompared with the American public, mental health prof...
TL;DR: Rates of criminal behavior, contacts with the criminal justice system, and victimization among homeless adults with severe mental illness are higher than among housed adults withsevere mental illness.
Abstract: Violent events involving homeless persons often precipitate an anguished examination by the public and the media of the role of severe mental illness in homelessness, violence, and crime—a barrage of public commentary that often produces more heat than light. A systematic review of these issues found very high rates of victimization among homeless persons, especially women. The magnitude of this problem is not adequately addressed by current research, which tends to disproportionately focus on crime perpetration rather than victimization in this population, the authors concluded.
TL;DR: More severe mental illness was associated with lower employment rates in 2009 and 2010 and people with serious mental illness are less likely than people with no, mild, or moderate mental illness to be employed after age 49.
Abstract: As sheltered work for persons with mental illness is defunded, persons with mental illness are increasingly affected by the same forces that shape the broader economy. This study examined employment survey data from 2009 and 2010, a period of slow recovery from a devastating recession. The results depict a mixed jobs picture for persons with mental illness, with employment rates varying widely by severity of mental illness. College graduates with serious mental illness had relatively strong employment outcomes, but unemployment spiked among people with serious mental illness over age 50.
TL;DR: Significant evidence is found to support the use of the RAS in recovery science as a means to measure recovery and to include it in mental health research.
Abstract: Although developed early in the recovery movement, the Recovery Assessment Scale (RAS) has proven to be an effective and reliable measure of the wide spectrum of recovery, including psychological well-being, positive illness outlook, higher levels of social participation and support, sense of belonging, and community participation. Researchers and policy makers can feel assured that the RAS reliably and validly measures recovery, which will further increase research in this critically important area.
TL;DR: Evaluation of treatment provided by the VA at specialty PTSD clinics in New England during the first six months of fiscal year 2010 suggested that additional research is needed to understand implementation of evidence-based therapy in mental health settings.
Abstract: ObjectiveThe U.S. Department of Veterans Affairs (VA) has engaged in substantial efforts to promote the use of evidence-based psychotherapies for posttraumatic stress disorder (PTSD). The authors evaluated the effectiveness of these efforts.MethodsThis study used a cross-sectional, mixed-methods evaluation of treatment provided by the VA at specialty PTSD clinics in New England during the first six months of fiscal year 2010. Natural language processing algorithms were applied to clinical notes to determine utilization of evidence-based psychotherapy (prolonged exposure therapy and cognitive-processing therapy) among patients who were newly diagnosed as having PTSD. Data regarding efforts to implement evidence-based psychotherapy and other clinic characteristics were obtained through qualitative interviews with clinical and administrative staff (N=30), and the Promoting Action on Research Implementation in Health Services framework was used to identify clinic factors associated with use of evidence-based ...
TL;DR: Perceived public stigma, shame, and self-labeling appear to be associated with stigma stress and reduced well-being among young people at risk of psychosis.
Abstract: ObjectiveWhen young people at risk of psychosis experience early signs of the disorder or early intervention, they may label themselves as “mentally ill.” However, empirical data related to the potentially harmful effects of self-labeling and stigma among young people at risk of psychosis are lacking. This study used a stress-coping model to examine mechanisms by which stigma may exert an impact on young people at risk of psychosis.MethodsThe authors assessed self-reports of perceived public stigma, shame about having a mental illness, self-labeling, and the cognitive appraisal of stigma as a stressor (stigma stress) as predictors of well-being among 172 residents of Zurich, Switzerland, who were between 13 and 35 years old. All participants were at high risk or ultra-high risk of psychosis or at risk of bipolar disorder. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale, and well-being was measured by instruments that assessed quality of life, self-esteem, and self-efficacy.R...
TL;DR: CIT training of police officers resulted in sizable and persisting improvements in diverse aspects of knowledge, attitudes, and skills, and research should now address potential outcomes at the system level and for individuals with whom officers interact.
Abstract: Since the 1980s, police officers in cities around the country have volunteered for crisis intervention team (CIT) training to gain skills needed to de-escalate situations involving people with serious mental illness. This study of nearly 600 Georgia police showed that officers who received CIT training felt more confident in deescalating such crises and in making appropriate referrals. CIT training not only improved officers’ skills and confidence, it also improved their attitudes toward people with mental illnesses.
TL;DR: Clozapine initiation was significantly associated with male sex, younger age, white race, more frequent outpatient service use for schizophrenia, and greater prior-year hospital use for mental health.
Abstract: A national study of Medicaid claims for more than 325,000 people with schizophrenia discovered a pattern of irregular access to clozapine that may be limiting opportunities for recovery. Clozapine is the only antipsychotic approved for treatment-resistant schizophrenia, yet there were no new starts of clozapine between 2002 and 2005 in 1,240 of the 2,885 counties examined. The rates of clozapine treatment fell far below the proportion of patients likely to benefit from its use, the authors said.
TL;DR: The photovoice intervention demonstrated promise for reducing self-stigma and enhancing proactive coping with prejudice and discrimination and was associated with significantly reduced self-Stigma.
Abstract: ObjectivePsychiatric stigma is a major barrier to the recovery of persons with serious mental illnesses. This study tested the efficacy of an innovative peer-run photography-based intervention, called antistigma photovoice, which targets self-stigma and promotes proactive coping with public stigma.MethodsA total of 82 individuals with serious mental illnesses enrolled at a university-based recovery center were randomly assigned to the antistigma photovoice program or to a wait-list control group. Mixed-effects regression models were used to examine the impact of photovoice on self-stigma, coping with stigma, empowerment, perceived recovery, self-efficacy, and depression.ResultsParticipation in the photovoice intervention was associated with significantly reduced self-stigma, greater use of proactive coping with societal stigma, greater increase in a sense of community activism, and perceived recovery and growth.ConclusionsThe photovoice intervention demonstrated promise for reducing self-stigma and enhanc...
TL;DR: IMR shows promise for improving some consumer-level outcomes and several important barriers to and facilitators of IMR, including supervision and agency support are identified.
Abstract: Illness Management and Recovery (IMR) was developed as a way to pull together evidence-based practices regarding self-management of serious mental illness into a single program. More than a decade later, studies from the United States and around the world have provided encouraging evidence that the IMR package leads to positive consumer outcomes. This literature review summarizes research indicating the effectiveness of IMR and describes facilitators and barriers uncovered in IMR implementation studies.
TL;DR: When promoting physical activity among individuals with schizophrenia, health care professionals who work in mental health settings should provide an individual approach, taking into account patient related and situational factors.
Abstract: ObjectiveThis study examined the experience, perceptions, and knowledge of physical therapists who work within mental health services regarding barriers to and facilitators of physical activity among people with schizophrenia.MethodsA total of 151 physical therapists, members of the International Organization of Physical Therapists in Mental Health, completed an online survey. Data-driven and concept-driven content analysis was conducted with the responses.ResultsThe most frequently cited barriers were patients’ lack of motivation (45% of respondents) and a lack of priority given to physical activity by other health care professionals (28%). The most frequently cited facilitators included the provision of esteem support by health care professionals (28%) and the promotion of enjoyment and autonomy for the patient (25%).ConclusionsWhen promoting physical activity among individuals with schizophrenia, health care professionals who work in mental health settings should provide an individual approach, taking ...
TL;DR: Results suggest that e-mental health services are at least as effective as usual care or nontechnological approaches and may support self-management among service users with psychotic disorders.
Abstract: Online therapies, Web-based self-management systems, and Internet forums are rapidly becoming part of the mental health services repertoire, but can they be effective for individuals with psychotic disorders? This literature review indicates that people with psychotic disorders are able and willing to use e-health services. In fact, e-health interventions for this population are at least as effective as standard, non–technology-based care. Their greatest benefit, the authors said, may be to reduce health care costs for service providers as well as service users.