Modeling the mental health service utilization decisions of university undergraduates: A discrete choice conjoint experiment

Objective: We modeled design factors influencing the intent to use a university mental health service. Participants: Between November 2012 and October 2014, 909 undergraduates participated. Method: Using a discrete choice experiment, participants chose between hypothetical campus mental health services. Results: Latent class analysis identified three segments. A Psychological/Psychiatric Service segment (45.5%) was most likely to contact campus health services delivered by psychologists or psychiatrists. An Alternative Service segment (39.3%) preferred to talk to peer-counselors who had experienced mental health problems. A Hesitant segment (15.2%) reported greater distress but seemed less intent on seeking help. They preferred services delivered by psychologists or psychiatrists. Simulations predicted that, rather than waiting for standard counseling, the Alternative Service segment would prefer immediate access to E-Mental health. The Usual Care and Hesitant segments would wait 6 months for standard counseling. Conclusions: E-Mental Health options could engage students who may not wait for standard services.This project was supported by the Jack Laidlaw Chair in Patient-Centered Health Care and a grant from the Canadian Health Services Research Foundation

The utility of treatment orders in the restoration of competence to stand trial

Involuntary treatment orders to restore competence to stand trial under the Criminal Code of Canada provide an opportunity to explore variables associated with restoration. We reviewed all 199 defendants assessed for fitness to stand trial in a catchment area of 2.3 million people over a two-year period, of which 26 were admitted to a regional psychiatric program under a treatment order. All had a psychotic disorder, and 92% (n=24) were restored to competence within the 60-day order period. No specific factors were associated with restoration. Unlike other studies, our study found that psychosis did not militate against restoration of competence.</jats:p

Modeling the Reduction of Attrition in Campus Mental Health Services: A Discrete Choice Conjoint Experiment

A significant percentage of college students discontinue mental health treatment prematurely. Using a discrete choice experiment, 909 students chose between experimentally manipulated descriptions of mental health services, selecting the option that would encourage them to stay in treatment. Latent class analysis identified three groups. The community class (36.7%) would remain in treatment at community walk-in clinics. The campus class (27.3%) would be more likely to remain in an on-campus student health service. The residence class, 36.0% of participants, would be most likely to remain in treatments at their residence. All classes would be more likely to remain in services including the option of medication, psychotherapy, or alternative treatments such as diet and exercise. Simulations predicted that most students would trade individual treatment for more cost-effective groups if students who had experienced mental health problems recommended these services and access to text messages and telephone help was included. </jats:p

Investigating service features to sustain engagement in early intervention mental health services

Aim: To understand what service features would sustain patient engagement in early intervention mental health treatment. Methods: Mental health patients, family members of individuals with mental illness and mental health professionals completed a survey consisting of 18 choice tasks that involved 14 different service attributes. Preferences were ascertained using importance and utility scores. Latent class analysis revealed segments characterized by distinct preferences. Simulations were carried out to estimate utilization of hypothetical clinical services. Results: Overall, 333 patients and family members and 183 professionals (N = 516) participated. Respondents were distributed between a Professional segment (53%) and a Patient segment (47%) that differed in a number of their preferences including for appointment times, individual vs group sessions and mode of after-hours support. Members of both segments shared preferences for many of the service attributes including having crisis support available 24 h per day, having a choice of different treatment modalities, being offered help for substance use problems and having a focus on improving symptoms rather than functioning. Simulations predicted that 60% of the Patient segment thought patients would remain engaged with a Hospital service, while 69% of the Professional segment thought patients would be most likely to remain engaged with an E-Health service. Conclusions: Patients, family members and professionals shared a number of preferences about what service characteristics will optimize patient engagement in early intervention services but diverged on others. Providing effective crisis support as well as a range of treatment options should be prioritized in the future design of early intervention servicesCanadian Health Services Research Foundation; Faculty of Health Sciences, McMaster University; Social Sciences and Humanities Research Council of Canad