Enhancing Pediatric Mental Health Care: Strategies for Preparing a Primary Care Practice

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

County-Level Estimates of Need for Mental Health Professionals in the United States

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

The central place of psychiatry in health care worldwide.

The American Academy of Pediatrics (AAP) policy statement entitled “The New Morbidity Revisited: A Renewed Commitment to the Psychosocial Aspects of Pediatric Care”1 from the Committee on Psychosocial Aspects of Child and Family Health is found in this month's issue of Pediatrics . Few experienced pediatric practitioners would disagree with this description of our life's work. Most embrace this “renewed commitment” to relevant and comprehensive care for our children and families. It is not hard to look past the examination room and appreciate the struggles, tensions, and morbidities that this complex world presents our patients as they grow and develop. But what about the complex world of our practices? We are well-intended, but are we well-trained, and are we able to follow through on our “commitment”? “ Mental health needs of children and adolescents are increasing while access to behavioral health, mental health, and substance abuse service is decreasing .”2 The rate of psychosocial problems identified by primary care physicians in the children they care for has increased from 7% to 18% in the past 20 years. Information accumulated by the Pediatric Research in Office Settings (PROS) group3 confirmed what practicing pediatricians already know: the children we see for earaches bring with them symptoms of their behavioral health. These children may have attentional difficulties, conduct issues, or significant problems of mood. They may suffer acute adjustment difficulties or evidence posttraumatic stress from physical, emotional, or sexual abuse, and may experience family poverty, family divorce, or a host of other intrinsic or situational problems that impact on their health and the ability of their family and caregivers to provide for their health. We are seeing more problems and, lacking referral sources, often have to provide more care. Skills needed to address the new morbidities are part of our …

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

Meso-level Comparison of Mental Health Service Availability and Use in Chile and Spain

In 2004, the American Academy of Pediatrics (AAP) Board of Directors appointed the Task Force on Mental Health and charged it to assist pediatricians and other primary care clinicians* in enhancing the mental† health care they provide. The task force determined that 3 goals were important to accomplishing its purpose: The task force recommended addressing the goals sequentially; that is, before implementing the clinical process proposed in this report, clinicians need to (1) accomplish system changes such as payment for mental health services provided by primary care clinicians1,2 and development of clinical relationships with mental health specialists,3 (2) achieve mental health competencies,4 and (3) enhance their office systems by applying chronic care methods to the care of children with mental health problems.5 Strategies the task force used to address these goals are summarized in the introduction to this supplement.6 In this report, the task force proposes a clinical process for delivering mental health services in pediatric primary care settings. The report summarizes key features of this clinical process, then provides algorithms developed in collaboration with informaticians from the AAP Council on Clinical Information Technology; these algorithms are intended to ensure clarity of the proposed process and facilitate its translation to electronic systems. Appendix S5 lists procedural codes that can be used in billing for each step of the process. An accompanying toolkit to assist with implementation is scheduled for distribution in spring 2010. The concepts and process proposed in this report were developed by consensus of 4 groups, the members of which are listed in Appendix S6. These members recognized that the “primary care advantage”7 is the opportunity for longitudinal relationships with children and families—relationships … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Mental Health Policy and Services Five Years After the President's Commission Report: An Interview With Michael F. Hogan

Mental health care for Latinos: introduction to the special section.

10.1176/appi.ps.59.1.105

ABSTRACTThis presentation will focus on the importance of addressing mental health in the overall response to the Deepwater Horizon Oil Spill. Emphasis will be placed on evidence based, integrated mental and behavioral health services in primary care clinics as an essential component of physical and mental health care. Community surveillance data collected by LSUHSC Department of Psychiatry in the fall of 2010 and one year post spill revealed increased symptoms of depression, anxiety, and posttraumatic stress compared to national norms. Symptoms were higher for individuals directly impacted by the spill. The Mental and Behavioral Health Capacity Project (MBHCP), part of the Gulf Region Health Outreach Program (GRHOP), was developed across the four impacted states of Louisiana, Mississippi, Alabama, and Florida.In collaboration with the Primary Care Capacity Project (PCCP) and other GRHOP projects, it is designed to decrease disparities in care and develop an evidence-based system of integrated mental and behavioral health services within primary care clinics. In Louisiana, seven impacted parishes, culturally diverse and predominantly rural, were designated for services. Louisiana MBHCP (MBHCP-LA) is applying established principles of collaborative care combining on-site and telemedicine consultation, training, therapeutic services, and care management. It is working with PCCP to develop and utilize a technologically advanced telemedicine system to integrate mental and behavioral health into electronic health records to meet physical and mental health needs. Preliminary analysis of screening and follow-up data beginning in May 2013 from 303 clients who completed measures at intake into services indicates that integrating mental health services in primary care clinics resulted in significant decreases at follow-up in reported depression, generalized anxiety, and posttraumatic stress disorder symptoms. The data showed that the greater the decrease in reported depression, anxiety, and posttraumatic stress symptoms at follow-up, the greater the decrease in physical health symptoms. While the MBHCP-LA integration of mental and behavioral health in primary care clinics in parishes heavily impacted by the Deepwater Horizon Oil Spill has been in place for less than a year, the outcomes are promising in reducing both behavioral and physical health symptoms. The clinics are reporting greater comfort in addressing mental and behavioral health problems as well as more resilience by having mental and behavioral health partners. MBHCP-LA will continue to evaluate improvement in physical and mental health symptoms as well as resilience and quality of life by more fully addressing mental and behavioral health concerns.