Strategies for Community Mental Health Services

Topic Paragraph:

In our current society, many believe that barriers to mental health treatments are “limited availability and affordability of mental health care services, insufficient mental health care policies, lack of education about mental illness, and stigma” (Unite for Site, 2000-2013). If those barriers exist for people with mental health issues to access treatments, then what are the strategies available to problem solve the situation? When it comes to the topic of mental health services, most of us will readily agree that it became more of a vast issue than before due to changes in laws and policies in recent years. Here I am writing to delve deeper into strategies available within community mental health services for people who are suffering from mental health conditions.

1. Correlates of Peer Support in a Clubhouse Setting

Many people assume that peer support is significantly important part of mentally ill individuals’ treatment or part of their daily life. This article observes function of peer networks within the Clubhouse environment as well as types of social supports available.

This study used random sampling. 126 participants were randomly chosen from ICCD certified Clubhouse located in Midwestern state in the US. Participants were interviewed individually in private room for 45 minutes to an hour by trained interviewers.

This article reported that peer support (Clubhouse staff, member, family, friend) in a Clubhouse setting is successful and gives deeper meaning and support to people who are recovering or battling from/with mental health condition or reentering into society. The article suggested that characteristics of socioeconomic status (e.g. low income, living with psychiatric disorder diagnosis) did not matter to the whether individuals valued having peer support or not. They indicated that participants noted “direct participation in the Clubhouse” spread their social circle within the Clubhouse, kindle some friendships, and gaining better employment through the Clubhouse’s training (Biegel, Pernice-Duca, Chang, and D’Angelo, 2013, p.257). They suggested longitudinal studies and ethnographic studies on this matter. Longitudinal study is required to gain more understanding of peer support and other benefits that members receive. Ethnographic study is also required to clarify and confirm the benefit of the Clubhouse as well as an understanding of the Clubhouse social networks and support (Biegel, Pernice-Duca, Chang, and D’Angelo, 2013, p. 259).

2. Feasibility and preliminary outcomes from a pilot study of an integrated health-mental health promotion program in school mental health services

When it comes to the topic of health and mental health for youth in the US, it is often said that needs and demands are high and increasing, however, not utilized or often missed opportunities to receive services in community health/mental health services. This pilot study report, strategies to integrate Changing Lifestyles to Impact Mind and Body’s (CLIMB’s) program that get served within School based Mental Health (SMH). They assessed how easily the CLIMB program can be incorporated, what are the student, family, and clinicians acceptance of the program, and how effective is the program getting served within SMH. The focus of this study was to teach positive parenting and behavior skill training.

The study was run for a 6 week period. They have chosen 10 students who already have been referred to community mental health and have been receiving SMH services for emotional and behavior issues. They have chosen Southeastern region of US for this study. This particular region typically represents a high poverty rate (high numbers of free or reduced lunch and low income families).

The CLIMB program offers promotion and intervention of healthy lifestyle, eating habits and incorporating evidence-based youth mental health treatment. Those with mental health treatment/teaching included self- monitoring, goal-setting, communication skills, learning own behaviors, problem-solving strategies, and maintenance strategies to name a few.

Results showed overall improvement in youth eating habits, lifestyle, mental health issues (e.g. Increase self esteem, better communication skills). Also, parents of youth reported with use of positive parenting to support their youth in healthy lifestyle. The clinicians were accepting of the CLIMB program due to “easier to build a therapeutic relationship,” (George et al., 2014, p. 26). However the clinicians voiced longer and better training as well as updated manuals and accessibility of materials.

3. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems.

It is often said that homelessness is chronic issues around most towns in the US. The article reported that those homeless populations often carried other burden as range from severe alcoholism, comorbid medical issues to psychiatric issues. Those populations incur and often use the emergency room for support or brought in to an emergency room involuntary by law enforcement. Cost and use of the above services are quite hefty and damaging to our government finance. This article focuses on evaluating and determining health care service, criminal justice service, and housing cost can be reduced by use of intervention called “housing first/1811 Eastlake” for homeless with severe problems with alcohol and other comorbidity of health and mental issues.

They used quasi experimental design which lacks the random assignments to study or control. However, they have justified that random assignments were wrong not to offer a housing when there is one available. They chose to offer housing by first come, first serve basis. They compared 95 participants (treated group) who was offered housing and 35 wait-list participants. Enrollment to the program/study run from November 2005 to March 2007.

The study claims tremendous cost reduction in health care service, criminal justice service, housing cost, and participants’ alcohol intake has been reduced. They also suggested a correlation between length of stay at housing and cost reduction of medical, judicial and housing services, longer the participants stayed the outcome of cost reduction is greater (Larimer et al., 2009).

4. Mobile crisis intervention to enhance linkage of discharged suicidal emergency department patients to outpatient psychiatric services: a randomized controlled trial.

It is often said that increase in repeated emergency department (ED) use by homeless with mental health issues or substance related issues are crippling funding and resources available at the hospital. This study look at mobile crisis team (MCT) can decrease the number of homeless populations with other physical and mental ailments repeated return to the ED. They assume that first appointment after ED discharge will create a continuum of mental health treatment which will lead to improvement of symptoms and daily life function of patients.

They used rater-blinded, randomized controlled trial. 120 participants were gathered and evaluated for suicidal thoughts, plans, or behaviors (Currier, Fisher, and Caine, 2010, p36). Those participants were randomly offered to follow up with either MCT or outpatient mental health clinic (OPC).

They reported MCT approach was highly successful in reaching out to the mentally ill population who frequently use ED services for recurring suicidal ideation/thoughts. However, they were not able to report that MCT approach or OPC approach works better in community for the above population to access postdicharge treatment/follow up or if there are signs of improvement in participants’ symptoms or quality of life.  They discuss there are no other study/research out there that the studied effectiveness of MCT as well as a limitation of their study. Such as small sample population was used for study, their study differed from other ED based studies, and most of all the participants were “sufficiently stable and safe for discharge” (Currier, Fisher, and Caine, 2010, p. 42).

I have a question “what are the strategies available for community mental health services?” I have chosen the path to research strategy available to community mental health treatments and that is my main focus. Then I will be incorporating and adding onto research with my other question “what are the barriers to community mental health services/treatments?” as supporting evidence and enhance my main focus “strategy.”

References

Biegel, D., Pernice-Duca, F., Chang, C., & D’Angelo, L. (2013). Correlates of Peer Support in a Clubhouse Setting. Community Mental Health Journal, 49(3), 249-259. doi:10.1007/s10597-012-9502-5

George, M., Trumpeter, N., Wilson, D., McDaniel, H., Schiele, B., Prinz, R., & Weist, M. (2014). Feasibility and preliminary outcomes from a pilot study of an integrated health-mental health promotion program in school mental health services. Family & Community Health, 37(1), 19-30. doi:10.1097/FCH.0000000000000012

Larimer, M., Malone, D., Garner, M., Atkins, D., Burlingham, B., Lonczak, H., & … Marlatt, G. (2009). Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA: Journal of the American Medical Association, 301(13), 1349-1357. doi:10.1001/jama.2009.414

Currier, G., Fisher, S., & Caine, E. (2010). Mobile crisis intervention to enhance linkage of discharged suicidal emergency department patients to outpatient psychiatric services: a randomized controlled trial. Academic Emergency Medicine, 17(1), 36-43. doi:10.1111/j.1553-2712.2009.00619.x