National Institute of Mental Health Five-Year Strategic Plan for Reducing Health Disparities

The NIMH has a long history of concern and action related to health disparities and ethnic minority groups as well as other underrepresented groups (i.e. women, children, and disabled persons). In 1980, NIMH established the position of Associate Director for Special Populations and subsequently established an Office for Special Populations (OSP) to oversee NIMH activities concerning underrepresented groups, including ethnic minorities. Recently, NIMH in collaboration with consultants and public comment has developed a five-year Strategic Plan to address mental health outcome disparities through research that aims to describe, understand, and remedy the disproportionate impact on minority populations of mental disorders and behaviorally influenced physical health conditions such as HIV/AIDS. The research takes into consideration relevant contextual frameworks, including interpersonal, socio-cultural, and organizational factors

Promoting the Readiness of Minors in Supplemental Security Income (PROMISE) [CFDA 84.418P]

Over the past two decades, New York State (NYS) has been actively and collaboratively engaged in systems change across three primary domains: 1) to develop a comprehensive employment system to reduce barriers to work and improve employment outcomes of individuals with disabilities; 2) to enhance the post-school adult outcomes of youth with disabilities, by collaboratively advancing evidence-based secondary transition practices at the regional, school district and individual student levels; and, 3) to support the return-to-work efforts of individuals with disabilities who receive Social Security Administration (SSA) disability benefits under the Supplemental Security Income (SSI) program and Social Security Disability Insurance (SSDI). These domains have been supported by numerous federal and state initiatives including: the US Department of Education’s Office of Special Education and Rehabilitation Services (OSERS)-sponsored Transition Systems Change grant; the SSA-sponsored State Partnership Initiative (NYWORKS); two Youth Transition Demonstrations (YTD); the Benefits Offset National Demonstration (BOND); and, three cycles of funding for the National Work Incentives Support Center (WISC); the US Department of Labor (DOL)-sponsored Work Incentive Grant, Disability Program Navigator Initiative, and Disability Employment Initiative; three rounds of funding from the Center for Medicaid and Medicare Services (CMS) for Medicaid Infrastructure Grants (MIG, NY Makes Work Pay); the NYS Education Department (NYSED) sponsored Model Transition Program (MTP); and three multi-year cycles of the statewide Transition Coordination Site network. Most recently, NYS has sponsored the Statewide Transition Services Professional Development Support Center (PDSC); the NYS Developmental Disability Planning Council (DDPC)-sponsored Transition Technical Assistance Support Program (T-TASP), NYS Work Incentives Support Center (NYS WISC), and NYS Partners in Policy Making (PIP); the NYS Office of Mental Health (OMH)-sponsored Career Development Initiative; and others. The growing statewide and gubernatorial emphasis on employment for New Yorkers with disabilities developed over the past two decades stemming from these initiatives, supported by service innovations and shared vision across state agencies and employment stakeholders, establishes a strong foundation for implementing and sustaining a research demonstration to “Promote the Readiness of Minors in Supplemental Security Income” (PROMISE). The NYS PROMISE will build upon NYS’ past successes and significantly support NYS in removing systems, policy and practice barriers for transition-age youth who receive SSI and their families. The NYS OMH through the Research Foundation for Mental Hygiene (RFMH), with their management partners the New York Employment Support System (NYESS) Statewide Coordinating Council (SCC) and Cornell University Employment and Disability Institute, along with the proposed research demonstration site community, join the NYS Governor’s Office in designing and implementing a series of statewide strategic service interventions to support the transition and employment preparation of youth ages 14-16 who receive SSI

Multinational Experiences in Reducing and Preventing the Use of Restraint and Seclusion

Restraint and seclusion (R/S) have been used in many countries and across service sectors for centuries. With the recent and increasing recognition of the harm associated with these procedures, efforts have been made to reduce and prevent R/S. Following a scathing media exposé in 1998 and congressional scrutiny, the United States began a national effort to reduce and prevent R/S use. With federal impetus and funding, an evidence-based practice, the Six Core Strategies1 to Prevent Conflict, Violence and the Use of Seclusion and Restraint, was developed. This model was widely and successfully implemented in a number of U.S. states and is being adopted by other countries, including Finland, Australia, and the United Kingdom. Recently, the first cluster randomized controlled study of the Six Core Strategies in Finland provided the first evidence-based data of the safety and effectiveness of a coercion prevention methodology. Preliminary findings of some of the international efforts are discussed. Reduction in R/S use and other positive outcomes are also reported

A devolved model for public involvement in the field of mental health research: case study learning

Background: Patient and public involvement in all aspects of research is espoused and there is a continued interest in understanding its wider impact. Existing investigations have identified both beneficial outcomes and remaining issues. This paper presents the impact of public involvement in one case study led by a mental health charity conducted as part of a larger research project. The case study used a devolved model of working, contracting with service user-led organizations to maximize the benefits of local knowledge on the implementation of personalized budgets, support recruitment and local user-led organizations. Objective: To understand the processes and impact of public involvement in a devolved model of working with user-led organizations. Design: Multiple data collection methods were employed throughout 2012. These included interviews with the researchers (n = 10) and research partners (n = 5), observation of two case study meetings and the review of key case study documentation. Analysis was conducted in NVivo10 using a coding framework developed following a literature review. Findings: Five key themes emerged from the data; Devolved model, Nature of involvement, Enabling factors, Implementation challenges and Impact. While there were some challenges of implementing the devolved model it is clear that our findings add to the growing understanding of the positive benefits research partners can bring to complex research. Conclusions: A devolved model can support the involvement of user-led organizations in research if there is a clear understanding of the underpinning philosophy and support mechanisms are in place

Do adults in contact with Australia's public sector mental health services get better?

This paper describes the outcomes of episodes of care for adults in public sector mental health services across Australia, with a view to informing the debate on service quality. Health of the Nation Outcome Scales (HoNOS) change scores and effect sizes were calculated for 14,659 acute inpatient episodes and 23,692 community episodes. The results showed that people in contact with public sector mental health services generally do get better, although the magnitude of improvement depends on the setting and episode type. This confirmatory finding is particularly positive, given current community concerns about the quality and effectiveness of mental health services

"They're Really PD Today": An Exploration of Mental Health Nursing Students' Perceptions of Developing a Therapeutic Relationship With Patients With a Diagnosis of Antisocial Personality Disorder

The therapeutic relationship is of particular importance when working with patients with antisocial personality disorder, but despite this, there is a paucity of literature exploring student nurses’ perceptions of developing a therapeutic relationship with such patients. Hence, this qualitative study explored the perceptions of second-year mental health nursing students of developing a therapeutic relationship with this patient group. Student nurses from a University in the Northwest of England participated in two focus groups, to compare the perceptions of a group of student nurses who had experience in secure settings (forensic hospital) with those who had not. Four key themes emerged: diagnosis, safety, engagement, and finally environmental influences. Both groups commented on looking beyond the diagnosis and seeing the person. The student nurses cited other staff in their clinical placement areas as hugely influential in terms of the development of their perceptions of patients with antisocial personality disorder and how to relate to them

Mainstream education as a possible route to recovery and social inclusion: a review

To focus on the findings of a review of the Learning Advice Service which provided mainstream learning opportunities and individual support to people using mental health services. The service was decommissioned after 15 years due to service reconfiguration and cost-cutting. Semi-structured Interviews were carried out with members of the Learning Advisor's caseload by a researcher with no affiliation to the NHS or the Institute of Mental Health and no connection to the clients. The researcher also transcribed and analysed the interviews. This ensured there could be no personal or positive bias. The clients faced significant mental health challenges and used the Learning Advice Service to facilitate and support their entry into mainstream learning. The service enabled individuals facing significant mental health challenges to gain access to Adult, Community, Distance and Further and Higher Education facilitated by individual advice, guidance and support. They were able to broaden their sense of identity beyond that of someone using Mental Health Services and to widen their social and educational base. Lack of funding within Mental Health Services to continue this type of work limits research which would further explore the value of mainstream education in the recovery of people with a mental health diagnosis. While this cohort was small because of funding and staffing constraints, it would be possible to generalize to a larger scale, using flexible person-centred ways of working if the will, staffing and funding were made available. Further research is certainly indicated as current practice has moved away from mainstream inclusion to discrete provision with associated limitations. The practical implications include the development of autonomy and the development of a sense of identity that is separate from a mental health diagnosis and where appropriate to gain qualifications and further the student's knowledge. Social implications include broadening one's experience, developing communication skills in a broad context, transferable skills, independence and strengthening one's sense of identity separate from a mental health diagnosis. Individuals from a variety of educational and other backgrounds who expressed an interest in pursuing education in mainstream facilities were encouraged and supported in doing so in flexible and individual ways. It appears to be more usual that people using mental health services are encouraged to learn in groups comprising other people using such services, frequently on mental health service premises with associated limitations

The personal and national costs of mental health conditions: impacts on income, taxes, government support payments due to lost labour force participation

<p>Abstract</p> <p>Background</p> <p>Mental health conditions have the ability to interrupt an individual's ability to participate in the labour force, and this can have considerable follow on impacts to both the individual and the state.</p> <p>Method</p> <p>Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model built on data from the Australian Bureau of Statistics' <it>Survey of Disability, Ageing and Carers </it>and STINMOD, an income and savings microsimulation model was used to quantify the personal cost of lost income and the cost to the state from lost income taxation, increased benefits payments and lost GDP as a result of early retirement due to mental health conditions in Australians aged 45-64 in 2009.</p> <p>Results</p> <p>Individuals aged 45 to 64 years who have retired early due to depression personally have 73% lower income then their full time employed counterparts and those retired early due to other mental health conditions have 78% lower incomes. The national aggregate cost to government due to early retirement from these conditions equated to $278 million (£152.9 million) in lost income taxation revenue,$407 million (£223.9 million) in additional transfer payments and around $1.7 billion in GDP in 2009 alone.</p> <p>Conclusions</p> <p>The costs of mental health conditions to the individuals and the state are considerable. While individuals has to bear the economic costs of lost income in addition to the burden of the conditions itself, the impact on the state is loss of productivity from reduced workforce participation, lost income taxation revenue, and increased government support payments - in addition to direct health care costs.</p

Understanding major depressive disorder among middle-aged African American men

http://dx.doi.org/10.1111/j.1365-2648.2010.05345.