Weberudsen5800

This study provides evidence of health disparities among sexual minority older adults within a public mental health system. The results suggest that health disparities persist into older adulthood and that new health concerns emerge with the aging of the sexual minority population. Targeted prevention and intervention programs are needed to effectively engage older LGB adults into treatment for general medical and mental illnesses as well as substance use disorders.

This study provides evidence of health disparities among sexual minority older adults within a public mental health system. The results suggest that health disparities persist into older adulthood and that new health concerns emerge with the aging of the sexual minority population. Targeted prevention and intervention programs are needed to effectively engage older LGB adults into treatment for general medical and mental illnesses as well as substance use disorders.

This study aimed to examine the proportion of U.S. mental health facilities that provide non-English language services.

Using data from the 2018 National Mental Health Services Survey, the authors examined differences between mental health facilities that provided non-English language services and those that did not across 23 organizational characteristics. Further analyses compared facilities by their method of language service provision.

Of 7,503 facilities, 5,186 (69.1%) provided non-English language services. These facilities were more likely than others to have high patient volume, be publicly owned, and be located in the 10 states with the highest percentage of residents with limited English proficiency. Among facilities with language services, 592 (11.4%) relied on multilingual staff, 2,532 (48.8%) relied on external on-call interpreters, and 2,062 (39.8%) relied on both.

Most mental health facilities provide non-English language services, and those that do tend to be large public organizations located in areas of greatest need.

Most mental health facilities provide non-English language services, and those that do tend to be large public organizations located in areas of greatest need.

This article describes policy surveillance methodology used to track changes in the comprehensiveness of state mental health insurance laws over 23 years, resulting in a data set that supports legal epidemiology studies measuring effects of these laws on mental health outcomes.

Structured policy surveillance methods, including a coding protocol, blind coding of laws in 10% of states, and consensus meetings, were used to track changes in state laws from 1997 through 2019-2020. The legal database Westlaw was used to identify relevant statutes. The legal coding instrument included six questions across four themes parity, mandated coverage, definitions of mental health conditions, and enforcement-compliance. Points (range 0-7) were assigned to reflect the laws' comprehensiveness and aid interpretation of changes over time.

The search resulted in 147 coding time periods across 51 jurisdictions (50 states, District of Columbia). Intercoder consensus rates increased from 89% to 100% in the final round of blinded duplicate coding. Since 1997, average comprehensiveness scores increased from 1.31 to 3.82. In 1997, 41% of jurisdictions had a parity law, 28% mandated coverage, 31% defined mental health conditions, and 8% required state agency enforcement. In 2019-2020, 94% of jurisdictions had a parity law, 63% mandated coverage, 75% defined mental health conditions, and 29% required state enforcement efforts.

Comprehensiveness of state mental health insurance laws increased from 1997 through 2019-2020. The State Mental Health Insurance Laws Dataset will enable evaluation research on effects of comprehensive legislation and cumulative impact.

Comprehensiveness of state mental health insurance laws increased from 1997 through 2019-2020. The State Mental Health Insurance Laws Dataset will enable evaluation research on effects of comprehensive legislation and cumulative impact.

The experience of homelessness for young people can affect social, emotional, and physical development, resulting in poorer physical and mental health outcomes. To reduce rates of youth homelessness, a better understanding of both risk and resilience is needed to inform future intervention development. This article presents a systematic review of published research reporting risk or resilience factors related to homelessness among young people in Western countries.

After thorough examination for inclusion criteria, 665 abstracts of peer-reviewed quantitative studies of risk or resilience factors for homelessness among young people (ages 0-25) that included an adequate comparison group (e.g., not homeless) were selected. After abstract and full-text screening, 16 articles were reviewed. A primary prevention framework was used to create an explanatory model for the onset of homelessness using risk and resilience factors.

Common risk factors for youth homelessness included difficulties with family, mental health or substance use problems, a history of problem behaviors, a history of foster care, homelessness as a child, and running away. Common protective factors included a supportive family, a college education, and high socioeconomic status. Findings were integrated into a provisional developmental model of youth homelessness risk. Clinical implications of the model for service development are discussed, and a model for monitoring homelessness risk and resilience factors is proposed.

Factors affecting homelessness risk among youths and adults differ, with family, foster care, and schooling playing a much more important role among youths. Findings highlight opportunities for youth homelessness prevention strategies and monitoring.

Factors affecting homelessness risk among youths and adults differ, with family, foster care, and schooling playing a much more important role among youths. Findings highlight opportunities for youth homelessness prevention strategies and monitoring.

In 2008, the Veterans Health Administration (VHA) established a suicide high-risk flag (HRF) for patient records. To inform ongoing suicide prevention activities as part of operations and quality improvement work in the U.S. Department of Veterans Affairs, the authors evaluated suicide risk following HRF activations and inactivations.

For annual cohorts of VHA users, HRF receipt and demographic and clinical care contexts in the 30 days before HRF activations were examined for 2014-2016 (N=7,450,831). Veterans were included if they had VHA inpatient or outpatient encounters during the index or previous year. Suicide rates in the 12 months after HRF activations and inactivations were assessed. Using multivariable Cox proportional hazards regression, the authors compared suicide risk following HRF activation and inactivation with veterans without HRFs, adjusted for age, gender, and race-ethnicity.

HRF activation (N=47,015) was commonly preceded within 30 days by a documented suicide attempt (39.5%) or inpaation criteria and support veterans after HRF inactivation.

The authors evaluated the likelihood of hospital admission, mechanical ventilation, and mortality within 30 days after a COVID-19 diagnosis among persons with or without serious mental illness.

Adults with and without serious mental illness diagnosed as having COVID-19 in the first year of the pandemic were identified in the TriNetX database, a network of electronic health records from 49 U.S. health care systems representing 63.5 million individuals. A propensity score approach was used to compare outcomes of unmatched and matched cohorts (N=85,257).

Compared with persons without serious mental illness, persons with serious mental illness were more likely to be hospitalized or to die after COVID-19 diagnosis. No difference in mortality or use of mechanical ventilation was observed among groups admitted to the hospital with COVID-19.

Disparities in overall mortality after COVID-19 for persons with serious mental illness likely were driven by factors outside of acute care settings.

Disparities in overall mortality after COVID-19 for persons with serious mental illness likely were driven by factors outside of acute care settings.The emergency department (ED) physicians working for the French Service d'Aide Medicale d'Urgence (SAMU) refer about 84% of individuals who contact SAMU for psychiatric problems to the psychiatric ED (PED), compared with only 20% of those calling with other medical emergencies. Physicians' lack of psychiatric knowledge may contribute to the high PED referral rate. The authors created a new psychiatric nurse-led service to improve the identification of psychiatric emergencies and assessed PED referrals and inpatient hospitalization rates before and after the new service commenced. After service implementation, the proportion of PED-referred patients fell from 84% to 38%, and inpatient hospitalization rates for those referred to the PED increased from 27% to 36%.This Open Forum describes the process of integrating personal experience; clinical experience in providing care; and research background, methods, and data in creating an arts project (i.e., an opera) highlighting veterans' resilience and recovery in the context of posttraumatic stress disorder and homelessness. Specifically, an approach of using research interviews to identify storylines and characters for veterans, along with personal and clinical experiences to frame provider characters and stories, is described to illustrate an arts-in-medicine approach to portraying recovery among veterans.

Mindful Mood Balance (MMB) is an effective Web-based program for residual depressive symptoms that prevents relapse among patients with partial recovery from major depressive episodes. This cost-effectiveness analysis was conducted from the health plan perspective alongside a pragmatic randomized controlled trial of MMB.

Adults were recruited from behavioral health and primary care settings in a large integrated health system and randomly assigned to MMB plus usual depression care (MMB+UDC) or UDC. Patients had at least one prior major depressive episode; a current score of 5-9 on the Patient Health Questionnaire-9, indicating residual depressive symptoms; and Internet access. Program costs included recruitment, coaching, and MMB licensing. Center for Medicare and Medicaid fee schedules were applied to electronic health record utilization data for psychotropic medications and psychiatric and psychotherapy visits. UNC3866 solubility dmso Effectiveness was measured as depression-free days (DFDs), converted from PHQ-9 scores collected monthly for 1 year. Incremental cost-effectiveness ratios were calculated with various sets of cost inputs.

A total of 389 patients (UDC, N=210; MMB+UDC, N=179) had adequate follow-up PHQ-9 measures for inclusion. MMB+UDC patients had 29 more DFDs during follow-up. Overall, the incremental cost of MMB+UDC was $431.54 over 12 months. Incremental costs per DFD gained ranged from $9.63 for program costs only to $15.04 when psychiatric visits, psychotherapy visits, and psychotropic medications were included.

MMB offers a cost-effective Web-based program for reducing residual depressive symptoms and preventing relapse. Health systems should consider adopting MMB as adjunctive to traditional mental health care services.

MMB offers a cost-effective Web-based program for reducing residual depressive symptoms and preventing relapse. Health systems should consider adopting MMB as adjunctive to traditional mental health care services.