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To investigate the effectiveness of interventions that aim to improve the mental health of mothers of children with disabilities. Seven databases were searched. Interventions incorporated primarily cognitive-behavioural, psychoeducation, mindfulness or support-group approaches. The Template-for-Intervention-Description-and-Replication guided descriptions. Meta-analyses using a random effect model of randomized controlled trials assessed intervention effects on parenting stress and mental health. Of the 1591 retrieved papers, 31 met criteria to be appraised and 17 were included in the meta-analysis. Cognitive-behavioural approaches reduced parenting stress [2 studies, n = 64, pooled Standardized-Mean-Difference (SMD) = 0.86, 95% CI (0.43, 1.29)] and improved mental health [3 studies, n = 186, pooled SMD = 1.14, 95% CI (0.12, 2.17)], psychoeducation approaches improved mental health [2 studies, n = 165, SMD = 0.60, 95% CI (0.17, 1.03)]. Cognitive-behavioural and psychoeducation interventions are effective. Further research and clinical guidelines are warranted., Author(s): Helen M. Bourke-Taylor [sup.1] , Den-Ching Angel Lee [sup.2] , Loredana Tirlea [sup.3] , Kahli Joyce [sup.1] , Prue Morgan [sup.4] , Terrence P. Haines [sup.2] Author Affiliations: (1) [...]

Background Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention. Methods and findings Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to 'ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view).' We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as 'medical' and 'Eurocentric') and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections. Conclusions In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services., Author(s): Narinder Bansal 1,*, Saffron Karlsen 2, Sashi P. Sashidharan 3, Rachel Cohen 1, Carolyn A. Chew-Graham 4, Alice Malpass 1 Introduction Ethnic inequalities in mental healthcare have been documented [...]

Objectives. We examined gender differences in sociodemographic, military service, and mental health characteristics among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. We evaluated associations between these sociodemographic and service characteristics and depression and posttraumatic stress disorder (PTSD) diagnoses. Methods. In a retrospective, cross-sectional study, we used univariate descriptive statistics and log binominal regression analyses of Department of Veterans Affairs (VA) administrative data on 329049 OEF and OIF veterans seeking VA health care from April 1, 2002, through March 31, 2008. Results. Female veterans were younger and more likely to be Black and to receive depression diagnoses than were male veterans, who were more frequently diagnosed with PTSD and alcohol use disorders. Older age was associated with a higher prevalence of PTSD and depression diagnoses among women but not among men. Conclusions. Consideration of gender differences among OEF and OIF veterans seeking health care at the VA will facilitate more targeted prevention and treatment services for these newly returning veterans. (Am J Public Health. 2010;100:2450-2456. doi: 10.2105/AJPH.2009.166165)

Trainees in psychiatry receive little or no training in the specific mental health needs of transgender persons, even though they constitute a significant number in our population. According to estimates by the Human Rights Campaign Foundation in 2007, 0.25-1% of the U.S. population is transgender. Transgender individuals are especially vulnerable to rejection by loved ones and domestic violence. They are often ostracized by society, and a significant number of transgender persons become homeless. One in five transgender persons are at risk of needing homeless shelter services. This is one article in a series in this issue of the Journal of Gay & Lesbian Mental Health documenting the proceedings from the workshop 'The Psychiatric Needs of the Transgender Homeless Population' at the 2009 American Psychiatric Association's Institute on Psychiatric Services Conference in New York City. In this article, we will present three cases seen by psychiatry residents during their community psychiatry rotation in a women's drop in center in New York City. KEYWORDS transgender, LGBT, trans woman, trauma, substance abuse, mental illness, homeless, shelter, case series DOI: 10.1080/19359705.2010.504422

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults. KEYWORDS access to care, aging, diversity, mental health services DOI: 10.1080/08959420.2010.507650

Approximately 1.5 million children experience homelessness in America each year. The current economic recession and staggering numbers of housing foreclosures have caused the numbers of homeless families to increase dramatically. The impact of homelessness on families and children is devastating. Without a place to call home, children are severely challenged by unpredictability, dislocation, and chaos. Homelessness and exposure to traumatic stresses place them at high risk for poor mental health outcomes. Despite the pressing needs of these children, federal policy during the last decade has focused primarily on chronically homeless adult individuals--to the exclusion of the families. In 2010, however, the U.S. Interagency Council on Homelessness issued a comprehensive plan to eradicate homelessness for all people through interagency collaboration and aligning mainstream services. A key goal is to prevent and end homelessness for families, youth, and children within 10 years. This policy-focused article describes several tools that can be used to help achieve this goal, including: general principles of care for serving homeless families and children; BSAFE--a promising practice that helps families access community-based services and supports; and the Campaign to End Child Homelessness aimed at action on behalf of homeless families and children at the national, state, and local levels. DOI: 10.1111/j.1939-0025.2010.01052.x

To determine whether evidence-based, psychosocial treatments developed in the United States and England are applicable to Mexican outpatients with schizophrenia, the present study was carried out to evaluate the relative effectiveness of family psycho-education and psychosocial skills training added to customary treatment vs. customary treatment alone. Clinically stable outpatients with schizophrenia participated in a 12-month randomized, controlled trial at the National Institute of Psychiatry in Mexico City. An experimental group (N = 47) received the combination of psychosocial skills training, family psycho-education and customary pharmacotherapy while the comparison group (N = 36) received customary treatment alone. Patients were assessed at baseline and one year after commencement of treatment. Significant differences favoring the group that received psychosocial rehabilitation were found in ratings of adherence to medication, attendance at appointments, symptoms, social functioning, relapse, and re-hospitalization. While some adaptations were made in the psychosocial treatments to resolve cultural differences, the results provide cross-national validation of evidence-based treatments for persons with schizophrenia.

Self-reports of depression-related distress were obtained from girls of 14 to 17 years of age living in communities of low socioeconomic status in Mauritius (n = 198) and South Africa (n = 275). Of the girls in the two samples, 26.3 and 21.5%, respectively, had thought about self-harm during the past 5 yr., while between 14.6 and 16.7% had made self-harm attempts. Also, 39.9% of the Mauritian girls and 31.0% of the South Africans reported being sad and tearful every day for more than 2 wk. over the past year. Of the girls, Mauritians (54.0%) and South Africans (32.1%) felt their problems were too much to cope with, while 20.4% of the South African girls and 44.4% of the Mauritians knew of no place to go for help when feeling sad or depressed. The findings highlight the extent of depression-related symptoms and issues related to access to mental health services. Increasing mental health services and awareness programmes are indicated. DOI 10.2466/02.10.12.13.PR0.107.4.87-94

College men's health is in crisis, yet men are reluctant to seek mental health services. How can psychologists provide interventions to engage and empower college men to address their health needs? What are the components of culturally-tailored interventions for college men? We describe the origins and operations of a university-based Men's Center devoted to helping college men lead healthy lives. The Men's Center has evolved into a therapeutic and training approach that guides campus psychologists toward unique roles to intervene effectively with college men. Key components of the Men's Center Approach (MCA) include acceptance, nonjudgment and unconditional positive regard, respect for diversity, working from the inside-out, power sharing, strategic use of the planning process, therapeutic experiences in nontherapy settings, and fostering and strengthening commitments to social justice and activism. Central to these components is our notion of possible masculinity, in which we focus on men's aspirations and future goals for their identities and behaviors based on what men need to become healthy, responsible, and nurturing in their families and communities. Practical applications of these components are presented through examples of two Men's Center interventions. We conclude by discussing how psychologists can implement the MCA in their clinical practice with men to increase cultural competence with men while working across various settings. Keywords: psychology of men, possible masculinity, training, men's health, men's center DOI: 10.1037/a0020308

Rural versus urban rates of suicide in current patients of a large area mental health service in Australia were compared. Suicide deaths were identified from compulsory root cause analyses of deaths, 2003-2007. Age-standardized rates of suicide were calculated for rural versus urban mental health service and compared using variance of age-standardized rates with 95% confidence intervals. There were 44 suicides and the majority (62%) were rural. Only urban patients used jumping from heights as a method of suicide (4/17; p = 0.02). Rural patients had 2.7 times higher rates of suicide, similar to findings for rural versus urban community suicides and may reflect the underlying community rates, differences in mental health service delivery, or socioeconomic disadvantage.

This article reviews literature on cross-cultural approaches to assessment, research, and clinical practice, culminating in recommendations For rising a 'cultural exchange' approach when working with multicultural clients. It examines challenges in studying culture and mental illness, including methodological issues and problems in defining constructs in multicultural research. Measurement of disorders cross-culturally, including efforts to validate depression measures for use with multicultural populations, is also discussed. Perspectives on cultural competence are presented, including the American Psychological Association Multicultural Guidelines, and a 'cultural exchange' approach to therapy is presented as a tool for maximizing the benefit of therapy with multicultural clients. Three clinical vignettes are presented to illustrate the use of this approach and how identifying the commission of Type I and Type II multicultural errors can enhance clinical work. Keywords: culture, cross-cultural, therapy, depression, assessment, case study DOI: 10.1037/a0017938

Parents of children with long-term emotional or behavioral conditions often struggle to access and afford mental health services for their children. This article examines the parent-reported reasons for unmet mental health needs in children using the National Survey of Children with Special Health Care Needs, specifically investigating whether insurance status (insured versus uninsured) and insurance type (private versus public) influences why a child has an unmet mental health need. The sample included children whose parents reported a need for mental health care or counseling in the previous 12 months, focusing on children with long-term emotional/behavioral problems rather than children experiencing episodic events that might only require short-term mental health services. Findings indicate that being uninsured increases the likelihood of parents reporting costs too much as the reason for their child having unmet mental health needs, whereas being insured by public health insurance decreases the likelihood of reporting costs too much as the reason. Policy implications include the need for expansion of health insurance coverage for all children and the need to achieve parity for mental health benefits in private health insurance. KEY WORDS: children; health policy; mental health; unmet need, Parents of children with long-term emotional and behavioral problems often struggle to access mental health services for their children. When a child has extensive treatment needs, even parents with high [...]

Abstract In recent years there has been increasing recognition of the social impact of drought on rural communities. This paper provides an overview of a major mental health program developed [...]

Abstract Climate change awareness has taken a dramatic turn in Australia, intensifying debate over the meaning of prolonged drought for rural futures, with critical implications for rural mental health. This [...]

Rural, remote and northern Canada Canada has been described as 'a vast, geographically varied, physically diverse, and politically discrepant federation of people, provinces, and territories, each with its own political [...]

The authors used the Andersen model to compare older adults' help seeking from clergy to help seeking from other sources of formal mental health services. Data were from the Naturally Occurring Retirement Community Demonstration Project. Multinomial logistic regression was used to compare sources from which help was sought. The results indicate that older adults sought help from clergy more frequently than from other formal sources. Increased stress levels, higher intrinsic religiosity, and being younger were related to seeking help from clergy. Greater stress and attendance at religious services were related to help seeking from other sources. Only greater frequency of attending religious services was associated with a greater likelihood of seeking help from clergy versus other formal providers. The increasing elderly population and the attendant crisis in mental health services might best be addressed through public-private partnerships in which mental health professionals assist clergy in identifying problems and making appropriate referrals. Keywords mental health services, older adults, help seeking, religion, religiosity, NORC, clergy DOI:10.1177/0164027509343539

Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed. KEYWORDS Stigma, mental illness, race, aging DOI: 10.1080/01634370902914372

Given the growing linguistic diversity in the United States, many practicing psychologists will work with foreign language interpreters. However, few clinicians receive formal training in providing interpreteraided psychological services. By federal law (88th Congress, 1964; PL-88-352), psychologists or their agencies are responsible for providing interpreter services. To maintain a patient-centered, rather than interpreter-centered dialogue, psychologists should initiate pre- and postsessions to orient the interpreter to the pending encounter, clarify expectations, and discuss cultural issues. Psychological testing, diagnostic interviewing, crisis intervention, family, child, and individual adult therapy present distinct challenges when an interpreter is involved. Mental health is a specialized area requiring advanced interpreter knowledge and skills. According to the American Psychological Association's (2002) 'Ethical Principles,' psychologists are responsible for ensuring that interpreters demonstrate competence and professionalism. Because there are relatively few interpreters trained specifically for mental health practice, psychologists and health care institutions may need to assist in providing specialized interpreter education. Keywords: foreign language translation, language proficiency, cultural differences, multicultural education, education DOI: 10.1037/a0016788

The provision of ethical and responsive treatment to clients of diverse cultural backgrounds is expected of all practicing psychologists. While this is mandated by the American Psychological Association's ethics code and is widely agreed upon as a laudable goal, achieving this mandate is often more challenging than it may seem. Integrating culturally responsive practices with more traditional models of psychotherapy into every practitioner's repertoire is of paramount importance when considering the rapidly diversifying population we serve. Psychologists are challenged to reconsider their conceptualizations of culture and of culturally responsive practice, to grapple with inherent conflicts in traditional training models that may promote treatments that are not culturally responsive, and to consider the ethical implications of their current practices. Invited expert commentaries address how conflicts may arise between efforts to meet ethical standards and being culturally responsive, how the application of outdated theoretical constructs may result in harm to diverse clients, and how we must develop more culturally responsive views of client needs, of boundaries and multiple relationships, and of treatment interventions. This article provides additional considerations for practicing psychologists as they attempt to navigate dimensions of culture and culturally responsive practice in psychology, while negotiating the ethical challenges presented in practice. Keywords: ethics, multicultural, psychotherapy, culture, cultural competency DOI: 10.1037/a0016871

For children and youth making a mental health crisis visit, we investigated ethnic disparities in whether the children and youth were currently in treatment or whether this crisis visit was an entry or reentry point into mental health treatment. We gathered Medicaid claims for mental health services provided to 20,110 public-sector clients ages 17 and younger and divided them into foster care and non-foster care subsamples. We then employed logistic regression to analyze our data with sociodemographic and clinical controls. Among children and youth who were not placed in foster care, African Americans, Latinos, and Asian Americans were significantly less likely than Caucasians to have received mental health care during the three months preceding a crisis visit. Disparities among children and youth in foster care were not statistically significant. Ethnic minority children and youth were more likely than Caucasians to use emergency care as an entry or reentry point into the mental health treatment, thereby exhibiting a crisis-oriented pattern of care. Keywords Children * Race * Emergency * Crisis Mental health

Mental health concerns pose a substantial threat to the immediate and future health of children and their functioning at home, at school, and in the community. Research indicates that 1 in 5 children has a diagnosable mental or addictive disorder and 1 in 10 has a serious emotional disturbance. This review considers emerging trends, national initiatives, and the roles of related professions in responding to the crisis in children's mental health. Recommendations are offered for counseling practice, training, leadership, and research., Mental health problems among children have been described as a public health crisis as a direct result of the troubling, and oftentimes tragic, impact mental health disorders have on the [...]

The authors explored the use of critical consciousness as a training tool to provide effective, culturally competent disaster response counseling services to disaster-affected communities. The results are presented of a qualitative study evaluating the outcomes for participants in a disaster response outreach project serving residents of post-Katrina New Orleans. Participants demonstrated increased personal and cultural awareness and also constructed new knowledge related to counseling outreach competencies., Because of the devastating effects of natural and human-made disasters, there is an increasing global need for mental health professionals to provide disaster relief outreach services (Guha-Sapir, Hargitt, & Hoyois, [...]

This study examined whether African American and Caucasian male youths had similar rates of referral to mental health services in a juvenile justice secure facility when controlling for differences obtained in the initial screening and assessment process. Data from the Massachusetts Youth Screening Instrument-2 (MAYSI-2), Initial Health Care Screening and Youth Level of Services/Case Management Inventory were analyzed from 937 male youths (12-18 years old) admitted to a secure care facility. There were few differences between African American and Caucasian youths on MAYSI-2 scales and no difference on the YLS total score. However, Caucasian youth reported higher frequencies of mental health treatment history than African American youth. Even when controlling for differences in MAYSI-2 elevations and history of receiving mental health treatment, Caucasian youths were provided access to mental health services at a greater rate than African American youth. This study indicates that race is a potential factor in mental health service access for youth in a secure care setting. KEYWORDS assessment, juvenile justice, mental health, race differences, race disparity

There is considerable evidence indicating that Asian American college students have less favorable attitudes toward and are less likely to use mental health services than other ethnic groups in the United States. Because a person's attitudes are often strongly associated with their voluntary behaviors, understanding what influences help-seeking attitudes may help shed light on why Asian American college students refrain from seeking mental health treatment. Andersen's Sociobehavioral Model is commonly used as a guide to understand help-seeking in the mainstream population. A modified version of this model that includes culture-related variables (i.e., level of acculturation and stigma tolerance) was used to guide this study. Results indicated that stigma tolerance predicted help-seeking attitudes above and beyond traditional variables associated with help-seeking. These findings suggest that reducing societal stigma and increasing individual tolerance to stigma should be a focus for prevention and intervention programs on college campuses. Keywords: Asian American, help-seeking attitudes, stigma, college students, acculturation

Given the evidence from studies indicating that children in care have significant developmental, behavioral, and emotional problems, services for these children are an essential societal investment. Youth in foster care and adults who formerly were placed in care (foster care alumni) have disproportionately high rates of emotional and behavioral disorders. Among the areas of concern has been the lack of comprehensive mental health screening of all children entering out-of-home care, the need for more thorough identification of youth with emotional and behavioral disorders, and insufficient youth access to high-quality mental health services. In 2001, the American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA) formed a foster care mental health values subcommittee to establish guidelines on improving policy and practices in the various systems that serve foster care children (AACAP and CWLA, 2002). Because of the excellent quality and comprehensiveness of these statements, the Casey Clinical Foster Care Research and Development Project undertook consensus development work to enhance and build upon these statements. This article presents an overview of mental health functioning of youth and alumni of foster care, and outlines a project that developed consensus guidelines., Recent research underscores the urgent need to improve the access and quality of health and mental health care services for the large numbers of children in foster care (about 800,000, [...]

Despite the recognized importance of mental health concerns among youth in the child welfare population, data suggest a significant gap between children who need services and children who receive services. This paper aims to address this problem by focusing on the ways in which the system identifies--or fails to identify--children as needing mental health services. The paper reviews current guidelines, policies, and practices for mental health screening and assessment of youth in child welfare including available evidence-based screening instruments that have been evaluated in child welfare or other settings. It is concluded that the use of evidence-based screening and assessment instruments will improve the identification of children needing mental health services and offer the opportunity to provide appropriate care to children who are currently being overlooked., The child welfare system is responsible for ensuring the safety, permanency, and well-being of children and adolescents who have been maltreated. Types of maltreatment experienced by children (1) in the [...]

Between one-half and three-fourths of children entering foster care exhibit behavioral or social-emotional problems warranting mental health care. This paper, condensed and updated from a technical report prepared for Casey Family Programs in 2005, reviews evidence-based and promising interventions for the most prevalent mental conditions found among children in foster care. This paper also makes several recommendations regarding increasing access to mental health care and effective psychosocial interventions for foster care children., This paper is a condensed version with selected updates of a technical report developed for Casey Family Programs in 2005 (referred to in this paper as the Casey Technical Report) [...]

This study examined the relationships between Mexican acculturation, cultural values, gender, and help-seeking intentions among Mexican American community college students. Findings suggest that as Mexican Americans lose their culture of origin and increase their generational status, their attitudes toward help seeking become less favorable. This contradicts cultural barrier theory as an explanation for underuse of mental health services by Mexican Americans. Furthermore, adherence to traditional Mexican culture and cultural values may actually encourage help seeking., Census predictions indicate that by 2020 Latinos/as will constitute 15% of the U.S. population (U.S. Census Bureau, 2000). As of the 2000 Census, Latinos/as represented approximately 12.5% of the U.S. [...]

The gap between the growth of ethnic minority groups nationally and the numbers of such groups within psychology is described. Three topics relevant to professional psychology are considered: mental health services, the educational pipeline, and the governance structure within the American Psychological Association. The authors outline past and current data and recommend actions for the future. Keywords: ethnic minority, mental health services, educational pipeline, American Psychological Association governance, demographics

Though researchers have described psychosocial barriers to mental health care-seeking, limited research has examined ways in which gender and race-ethnicity are associated with individuals' perceptions and attitudes. This study investigates correlates of psychosocial barriers to mental health care in a population of adults reporting unmet need for mental health care, focusing on gender and race-ethnicity. Data are from the 2002 National Survey on Drug Use and Health. Multivariate analyses show that non-Latino white male status is positively associated with stigma avoidance and mistrust/fear of the mental health care system. Persons of lower income or educational status are less likely to report negative attitudes towards care. Findings imply a need to reconsider the roles of gender, race-ethnicity, and socioeconomic status within investigations of psychosocial barriers to care. Future research should examine the relationships among social status, help-seeking behaviors, and attitudes toward mental health care.

This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and the Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One-year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, postdischarge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords: inpatient psychiatric hospitalization, adolescents, readmission

The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic but not White participants, underscoring the importance of special attention to the treatment relationship with minority patients. These treatment use differences raise complex questions about treatment assessment and delivery, cultural biases of the current diagnostic system, and possible variation in PD manifestation across racial/ethnic groups. Future studies need to assess specific barriers to adequate and appropriate treatments for minority individuals with PDs. Keywords: personality disorders, race, ethnicity, treatment utilization

For over a decade, there have been increasing efforts in counseling psychology and other areas of applied psychology to understand the role of culture in preventive and mental health services for ethnically, economically, and religiously diverse communities. In this Major Contribution, the authors offer examples of three prevention programs in which cultural relevance and competence were central to each program's development, implementation, and evaluation. The interventions each focus on an ethnic minority population, and they are offered in diverse settings. Participants differ in age and contexts in which they receive the intervention (e.g., individual, family, or classroom). Each article highlights similarities and differences likely in any prevention effort with diverse populations. In this introduction, the authors discuss the theoretical and empirical rationale for such interventions, as informed by literature on cultural competence and social justice, and the disproportionate health, educational, and economic disparities that poor and ethnic minority groups experience.

With the significant growth of the Muslim population in the United States, there has been a corresponding increase in the need for mental health services. The author discusses techniques for [...]

Despite their growing numbers, Asian Indians in the U.S., specifically Indian women, seek mental health services at a lower rate than other populations, but not due to a lesser need. This paper seeks to present an emergent intervention model for working with Hindu Indian immigrant and second-generation women by incorporating components of Hinduism and an understanding of the cultural ideals and gender roles in Indian culture. Cultural values and religious beliefs are explored through descriptions of the roles of women, impact of immigration, and the ethnic-specific constructs of mental illness and spiritual functioning for this population. Special emphasis is placed on the Hindu concept of Shakti, spiritual feminine power, explicating the conflict between the dichotomous roles maintained by Indian women living in the U.S. and ways in which Shakti can serve as a construct of change in the therapeutic process. Information for a therapist to apply these principles even when unfamiliar with Hinduism is provided. KEYWORDS. Asian-American, Asian-Indian, culture, Hinduism, multicultural counseling, women

Sexual assault victims experience significant mental health sequelae from being victimized. Despite these psychological symptoms, survivors seek traditional mental health services at low rates. Little research has addressed the potential barriers that may lead to lower rates of mental health service seeking or whether these services in fact help survivors to recover from the psychological impact of sexual assault. This paper reviews literature on sexual assault victimization and mental health service seeking to examine what is currently known. Certain demographic background, assault characteristics, and post-assault factors appear to be related to likelihood of mental health service seeking, yet most studies of correlates of victims' help-seeking have been limited to nonprobability samples. Suggestions for theory, research, and clinical practice are made including longitudinal investigations studying a range of potential mental health support sources and development of innovative mental health services targeting underserved subpopulations. doi:10.1300/J015v30n01_04 KEYWORDS. Sexual assault, mental health services, barriers, women

This study examined the referral patterns of Chinese, Japanese, Filipino, and Korean Americans at ethnic-specific versus mainstream programs in a public mental health system. As predicted, social/ community-based services and family/friends to a lesser degree referred each Asian American group to ethnic-specific programs more than other referral sources (e.g., criminal justice and health services). Referrals by social/community-based programs to ethnic-specific versus mainstream programs were the most significant for Chinese Americans, followed by Japanese and Filipino Americans, and the least significant for Korean Americans. These findings suggest Asian American clients themselves and their social networks may view ethnic-specific programs as more culturally responsive than mainstream programs. Keywords: Asian Americans, professional referral, mental health programs, community-based organizations

Objectives. We examined whether self-reported racial discrimination was associated with mental health status and whether this association varied with race/ethnicity or immigration status. Methods. We performed secondary analysis of a community intervention conducted in 2002 and 2003 for the New Hampshire Racial and Ethnic Approaches to Community Health 2010 Initiative, surveying African descendants, Mexican Americans, and other Latinos. We assessed mental health status with the Mental Component Summary (MCS12) of the Medical Outcomes Study Short Form 12, and measured discrimination with questions related to respondents' ability to achieve goals, discomfort/anger at treatment by others, and access to quality health care. Results, Self-reported discrimination was associated with a lower MCS12 score. Additionally, the strength of the association between self-reported health care discrimination and lower MCS12 score was strongest for African descendants, then Mexican Americans, then other Latinos. These patterns may be explained by differences in how long a respondent has lived in the United States. Furthermore, the association of health care discrimination with lower MCS12 was weaker for recent immigrants. Conclusions. Discrimination may be an important predictor of poor mental health status among Black and Latino immigrants. Previous findings of decreasing mental health status as immigrants acculturate might partly be related to experiences with racial discrimination.

Clinical trials have seldom included adequate samples of people of color. Therefore, practitioners serving ethnic minorities often do not have access to readily available evidence-based interventions. This article summarizes the development and empirical evaluation of prevention and treatment manuals designed for low-income ethnic minority populations at San Francisco General Hospital. The manuals were often designed by people of color familiar with the communities for which they were developed. Independent research teams in multi-site national and international clinical trials have evaluated many of these manuals with encouraging results. Keywords: Latino mental health, depression prevention and treatment, smoking cessation, cognitive--behavioral therapy, evidence-based treatments

By the end of 2003, 3.2% of the U.S. adult population or 6.9 million adults were incarcerated, on probation or on parole. While non-whites constitute approximately 25% of the general U.S. population, they represent the majority of the prison (62%) and jail population (57%), a 33% increase since 1980. Approximately 15% of this prison and jail population has active symptoms of serious mental illness with two-thirds likely to have a co-occurring substance use disorder diagnosis. Meanwhile, the lack of adequate mental health and substance abuse treatment within all levels of the criminal justice system continues to exist. This is further exaggerated by the dearth of evidence showing appropriate cultural awareness and competence in delivery of these much needed services to a majority non-white population. This article will review the existing racial disparities present in the criminal justice system, the lack of appropriate psychiatric services, and the effect of cultural dissonance in service provision when services do exist. Policy implications and recommendations are included in the conclusion with a call for action to all agencies directly and indirectly affected by this multifaceted problem.

Although clinicians are encouraged to be more sensitive to cultural factors in the diagnosis and treatment of mental disorders, as evidenced by the significant changes in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), little information is provided to help them determine which aspects of culture are important to the mental health of African Americans. This article discusses the importance of cultural mistrust as a psychological construct in the lives of African Americans. The origins of the construct, the research it has generated over the past 2 decades, and implications for improving interventions with Black clients seeking mental health care are discussed.