Changing Profiles of Service Sectors Used  for Mental Health Care in the United States

Wang, Philip S.; Demler, Olga; Olfson, Mark; Pincus, Harold Alan; Wells, Kenneth B.; Kessler, Ronald C.

doi:10.1176/ajp.2006.163.7.1187

Cited by 262 publications

(162 citation statements)

References 43 publications

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“…Several studies have confirmed the prominent position of the medical specialty sector in providing services for mental disorders [41], even though the mental health specialty sector has been reported to be the major service sector for children and adolescents with mental disorders [13] and the most common subsequent service sector in adolescents entering the service system through the school mental health sector [18]. While mental health care in the medical specialty sector has improved over the past decade through a better understanding of mental disorders, the availability of practicable screening tools, provision of psychotherapy in these settings, and further development and promotion of psychotropic medications that are mostly prescribed by primary care physicians [24,42,43,44], most primary care pediatricians and child and adolescent psychiatrists believe that pediatricians should identify and refer, but not treat, their patients' mental health problems [45]. Indeed, the appropriateness of treatment of mental disorders in the medical specialty sector as compared to the mental specialty sector remains a matter of debate [46,47,48,49,50], which should be kept in mind when evaluating the referral patterns observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

School Mental Health Services: Signpost for Out-of-School Service Utilization in Adolescents with Mental Disorders? A Nationally Representative United States Cohort

Tegethoff¹,

Stalujanis²,

Belardi³

et al. 2015

Adolescent Mental Health

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Background: School mental health services are important contact points for children and adolescents with mental disorders, but their ability to provide comprehensive treatment is limited. The main objective was to estimate in mentally disordered adolescents of a nationally representative United States cohort the role of school mental health services as guide to mental health care in different out-of-school service sectors.

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Section: Discussionmentioning

confidence: 99%

School Mental Health Services: Signpost for Out-of-School Service Utilization in Adolescents with Mental Disorders? A Nationally Representative United States Cohort

Tegethoff¹,

Stalujanis²,

Belardi³

et al. 2015

Adolescent Mental Health

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“…These questions asked them to describe key features of each topic discussed with the patient including (1) when the topic began and ended, (2) what the topic was about, and (3) how they felt on multiple affect dimensions. This response form was returned to the researcher for analysis.…”

Section: The Visit Reconstruction Methodsmentioning

confidence: 99%

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

Tai–Seale

Kunik

Shepherd³

et al. 2010

Population Health Management

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Primary care remains critically important for those who suffer from mental disorders. Although collaborative care, which integrates mental health services into primary care, has been shown to be more effective than usual care, its implementation has been slow and the experience of providers and patients with collaborative care is less well known. The objective of this case study was to examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters.Participating physicians completed a self-administered visit reconstruction questionnaire in which they logged details of patient visits and described their perceptions of the visits and the influence of collaborative care. Audio recordings of visits were analyzed to assess the extent of discussion about colocated mental health services and visit time devoted to mental health topics.The main outcome measures were the extent of discussion and recommendation for collaborative care during clinical visits and providers' experiences based on their responses to the visit reconstruction questionnaire. Providers surveyed expressed enthusiasm about collaborative care and cited the time constraint of office visits and lack of specialty support as the main reasons for limiting their discussion of mental health topics with patients.

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“…access to and quality of mental healthcare exist, 13,14 and under-served communities with low provider availability may rely on alternative settings, such as faith-based 15,16 or substance abuse programs. 17,18 A recent Institute of Medicine report suggests that integrating heath and nonhealth services settings is essential to address chronic health needs.…”

Section: Main Measuresmentioning

confidence: 99%

“…8 Neighborhood poverty is predictive of depression onset, 9 and while prevalence of depressive disorders is similar for Latinos and African Americans relative to non-Hispanic whites, 10,11 African Americans may have greater severity when depressed. 12 Ethnic and socioeconomic disparities in access to and quality of mental healthcare exist, 13,14 and under-served communities with low provider availability may rely on alternative settings, such as faith-based 15,16 or substance abuse programs. 17,18 A recent Institute of Medicine report suggests that integrating heath and nonhealth services settings is essential to address chronic health needs.…”

mentioning

confidence: 99%

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

et al. 2013

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BACKGROUND:As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE: To understand the distribution of need and current burden of services for depression in underresourced, diverse communities in Los Angeles. DESIGN: Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS: Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES:Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS: Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS: Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.KEY WORDS: depression services; community-partnered; participatory research; CPPR; CBPR; community-based; under-resourced. J Gen Intern Med 28(10):1279-87 DOI: 10.1007/s11606-013-2480-7 © Society of General Internal Medicine 2013 BACKGROUND Current healthcare reforms call for expansions of primary care and integrated medical homes for safety-net populations. 1,2 Primary care is a "de facto" mental health setting, 3 where rates of recognition and treatment for depression are lower than in specialty mental health settings. 4 While collaborative care is effective for primary care depressed patients, [5][6][7] little is known about how to conceptualize depression management in neighborhoods with high rates of poverty and ethnic minority representation. 8 Neighborhood poverty is predictive of depression onset, 9 and while prevalence of depressive disorders is similar for Latinos and African Americans relative to non-Hispanic whites, 10,11 African Americans may have greater severity when depressed. 12 Ethnic and socioeconomic disparities in access to and quality of mental health...

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Changing Profiles of Service Sectors Used for Mental Health Care in the United States

Abstract: How service sectors share responsibility for peoples' mental health care is changing, with more care falling to general medical providers rather than specialists. Efforts are required to ensure that people who would benefit have access to the necessary treatment modalities.

Cited by 262 publications

References 43 publications

School Mental Health Services: Signpost for Out-of-School Service Utilization in Adolescents with Mental Disorders? A Nationally Representative United States Cohort

School Mental Health Services: Signpost for Out-of-School Service Utilization in Adolescents with Mental Disorders? A Nationally Representative United States Cohort

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

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