Search results

The purpose of this paper is to determine if dually diagnosed (DDx) patients with severe mental illnesses such as bipolar disorder and schizophrenia are at higher risk of not obtaining prescribed medication.

National Veterans Health Administration records from 2010 identified all DDx patients with Bipolar (BP) spectrum (n=98,894) and Schizophrenia (SZ) spectrum (n=80,654) disorders. Pharmacy records identified the total number of prescriptions dispensed per veteran for antidepressants, antipsychotics, sedative‐hypnotics and anxiolytics, mood stabilizers (anti‐convulsants), and lithium. To identify potential sociodemographic and clinical confounders, bivariate analyses compared four groups: BP and SZ with and without DDx. Analysis of covariance (ANCOVA) was used to determine the association of DDx with the number of dispensed prescriptions, and interaction analysis was used to determine whether any “dual‐diagnosis effect” was greater between BP or SZ. Further ANCOVA examined whether significant differences were accounted for by differences in outpatient mental health visits or co‐morbidities.

Among BP veterans, 33,226 (33.6 percent) were DDx, compared to 19,652 (24.4 percent) among SZ veterans. DDx patients obtained more prescriptions than other patients over a similar period of time, and these effects were somewhat greater for BP DDx patients than for SZ DDx patients. DDx patients also showed more mental health services use and had more co‐morbidities. After controlling for these differences, DDx veterans still were dispensed more total psychotropic prescriptions, but most differences between diagnostic groups and medication class were no longer significant.

The paper shows that DDx veterans consume more resources in terms of both psychotropic medications and clinic visits. Further attention should be paid to the overall complexity of their clinical needs, including the increased likelihood of both licit and illicit drug‐drug interactions rather than just to their substance use.

While many studies have shown that liver diseases (LD) can be caused or exacerbated by substance use disorders (SUD), few have examined the proportion of adults with LD and SUD who receive mental health and addiction treatment or correlates of such use.

Using national Fiscal Year (FY) 2012 data from the United States Veterans Health Administration (VHA), the authors studied all 43,246 veterans diagnosed with both LD and SUD in FY 2012 and compared those who received mental health treatment (n = 30,456; 70.4%) to those who did not (n = 12,790; 29.6%).

Veterans who received mental health treatment were less like to be older than 75 years of age, more likely to have served during recent Middle East conflicts (Operation Iraqi Freedom or Operation Enduring Freedom), more likely to have been recently homeless and to have drug dependence as contrasted with alcohol dependence when compared with those who did not receive mental health treatment. Although the majority, 70.4%, received mental health treatment, only 30.6% of the total received specialized addiction treatment, and these veterans were more likely to experience homelessness and have drug dependence diagnoses.

This is the first study as per the authors’ best knowledge that broadly examines mental health and addiction treatment received by veterans with LD and SUD. High rates of mental health treatment in this population likely reflect the integrated nature of the VHA and its emphasis on providing comprehensive services to homeless veterans. Further research is needed to identify barriers to specialized addiction treatment in this population.

Religion and spirituality (R/S) are recognized components of recovery-oriented mental health services. This study aims to present a clinically focused tool for assessing R/S interest among veterans with serious mental illness (SMI).

A questionnaire including 39 items was developed by experienced chaplains and mental health clinicians and administered to modest pilot sample of 110 participants in a recovery-oriented program at a medical center of the US Veterans Health Administration (VHA).

Altogether 40 (37%) participants said they would like R/S issues to be a greater part of their treatment (i.e. very or extremely). A screening tool to identify veterans for referral to R/S focused interventions was developed based on the selection of the five items most strongly loading on the strongest factor in a factor analysis.

First, the identification of items for the survey was made on the basis of clinical experience with issues discussed by veterans in a VA recovery-oriented program and thus are based on clinician experience and their association with a stated desire for more R/S in their treatment. Since no gold-standard measure of “religion/spirituality” has been universally established and validated, this method, though imperfect, was accepted as practical and as having face validity. Furthermore, the sample size, while substantial, was limited and was not representative of the general population. Again, this was a pilot study of a unique effort to identify R/S issues of greatest relevance in a recovery program for people with SMI.

In this SMI sample, 36% of the participants said that they would like more R/S to be incorporated into their treatment. Factor analysis showed the desire for uplifting religious/spiritual community to be the predominant factor and formed the basis for a five-item screening tool that can be used to briefly identify services needs in this area of recovery.

This screening tool can help incorporate religious and spiritual issues into mental health treatment, and area of importance that is often neglected. The results could help destigmatize this area of recovery practice for people with SMI.

This R/S survey of SMI adults suggests that over one-third of the participants in a pilot sample in a recovery-oriented program would like more R/S emphasis in their treatment. Factor analysis showed the desire for uplifting religious/spiritual community to be the predominant factor.

Opioid use disorder (OUD) poses a national public health challenge including for the Veterans Health Administration (VHA). However, the responsiveness of VHA, as a centralized national health care system, to local conditions has not been studied. The purpose of this paper is to examine the correlation of measures of population-based OUD case identification and provision of opioid agonist treatment (OAT) in VHA and in local systems at the state level thus evaluating the responsiveness of VA as centralized health system to local conditions.

Correlation of VHA administrative data and local survey data reflecting OUD and OAT rates were evaluated with Pearson correlations. Further analyses examined the correlation of VHA and non-VHA OUD and OAT measures with state rates of opioid-related deaths, median income, health insurance coverage and education levels.

VHA rates of OUD and OAT at the state level were both significantly correlated with corresponding state data from the National Survey on Drug Use and Health (r=0.28, p=0.048 and r=0.71, p=0.002, respectively). Both OUD and OAT in VHA were positively and significantly correlated with state rates of opioid-related deaths, while indicators of OAT were significantly associated with higher state-level median income, health insurance coverage and levels of education.

Although centrally managed from Washington, D.C., VHA case identification and OAT service delivery appear to be correlated with relevant local measures.

Significant associations with general population indicators point to underlying conditions that may shape both VHA and local health system performance.

Public health systems would benefit from performance evaluation data to examine responsiveness to local conditions.

Veterans with post-traumatic stress disorder (PTSD) have high lifetime rates of smoking and often have substantial difficulty quitting. However, relatively little research has focussed on the use of Veterans Health Administration (VHA) intensive tobacco cessation counseling services by veterans with PTSD and the characteristics of veterans with PTSD who do and do not use these services. The paper aims to discuss these issues.

The present study is an analysis of national VHA administrative data fiscal year 2012 that identified utilization rates of VHA intensive tobacco cessation counseling among veterans with diagnoses of both PTSD and tobacco use disorder (TUD) (N=144,990) and the correlates of tobacco cessation counseling use.

Altogether, 7,921 veterans with PTSD diagnosed with TUD used VHA tobacco cessation services (5.5 percent). Veterans with PTSD who used tobacco cessation counseling services were more likely to have been homeless, to have a comorbid drug use disorder, and had used other VHA services more frequently than their counterparts who did not access tobacco cessation counseling. The use of outpatient mental health and substance use services was the strongest correlate of tobacco cessation counseling use by veterans in this sample. Notably, veterans with PTSD, TUD and HIV were more likely to engage in tobacco cessation services.

This study demonstrates that future efforts should focus on increasing provider and veteran awareness of and accessibility to VHA intensive tobacco cessation counseling for veterans with PTSD.

This paper seeks to investigate the role of leadership styles in the implementation of evidence‐based treatment methods (EBP) for drug abuse and criminal behaviour.

The paper employs a triangulation approach through mail questionnaires to 112 treatment personnel (49 per cent response rate), interviews with 65 employees and managers, observations and feedback workshops.

Responses from treatment personnel involved in the implementation of EBP indicated that their views on their immediate superior's leadership behaviour was significantly related to the perceptions of organisational innovative climate, job satisfaction and work output. Problems with workload, lack of collegial and managerial support and a low priority given to the programmes and treatment integrity were the most common barriers to implementation of the programmes. Effective managers were providing space, time and opportunity for the staff to perform their treatment‐related tasks and to be creative during the implementation process. This functional space had to be continually protected, both vertically from demands from higher levels of the organisation and horizontally from non‐helpful colleagues.

The correlational design used in this study does not permit conclusions about causality.

Implementation of evidence‐based treatment programmes in clinical settings should pay attention to the impact of leadership styles on the experiences of treatment staff (climate, job‐satisfaction, burnout) and programme outcome. These variables should also be considered in the evaluation of treatment effects. The process of implementation can be seen as a route for learning and innovation, and managers should pay attention to the facilitation of these processes.

The role of leadership in implementation concerns not only production and structure but also learning, creativity and persistency during the process. The triangulation approach in this study also sheds light on the limitations of questionnaires in capturing the dynamics of leadership in human service organisations.

Sociology promotes and describes public health, helping to explain macro-social dynamics of mental health care through studies of organizations, networks, and systems of care.

This chapter summarizes sociological research on mental health care organizations and systems, illustrating a macro-social perspective by examining the problem of transitions in care for young adults. Summary findings from a regional mental health services research project describe a system of care that includes 100 organizations. This system helps young adults with mental health needs.

The scope and management of care involves a focus on modes of treatment supported by research evidence and delivered effectively by people with cultural competencies. Care and continuity of care are delivered through coordinated systems of inter-organizational networks, linking organizations and providers. Active inter-organizational linkages are needed to support mental health for young adults during challenging and sometimes difficult transitions.

This research summarizes original and regional data on mental health care organizations within a regional system of care. Practical implications include support for the importance of coordination, transition planning, and cultural competence within and among organizations. Sociological and original research on organizations and systems should continue to elaborate the needs and values of mental health services for regional planning and public health.

The focus of the study was to explore the understanding of family among homeless adults in Southeast Texas. We incorporated both qualitative and quantitative methods by interviewing two key groups (short-term homeless, long-term homeless) over a 16-week period. Thirty homeless participants were interviewed using 18 questions designed to explore their understanding of family and the social supports that lead to resiliency. Participant ages ranged from 19 to 56 with an average of 44 years. Twenty-six participants were male and four were female. Half of all homeless participants claimed to lack familial support from either biological family or close friends. Among short-term homeless individuals, five of seventeen identified their biological family as fulfilling the role of a traditional family, while among long-term homeless adults, five of thirteen identified their friends as fulfilling the role of a familial unit. A recurring theme emerged in which participants defined family as those individuals who were consistently accessible for support, whether biological relations or non-related friends and companions. As we seek to improve our programs of assistance and advocacy, these findings become important as a step toward honoring our clients and recognizing the validity of their perceived realities as we reconstruct the models by which we facilitate interaction and intervention.

Housing First has been upheld as an evidence‐based best practice for transitioning homeless individuals into permanent housing in a maximally cost‐effective and humane manner. However, there is much variance in the implementation and structure of Housing First programming in the USA. This paper aims to focus on a collaborative, interdisciplinary Housing First effort to house and provide case management and ancillary services to chronically homeless individuals in The City of San Mateo, California.

The paper is a case study in which the philosophy, structure, and impact of San Mateo's outreach and housing team are discussed. To explore the project's impact, data concerning arrests and other criminal justice contacts, as well as health costs associated with these clients, both prior to and post housing and services, were collected and analyzed. These are corroborated with qualitative data on client outcomes.

After participants received housing and wrap‐around supportive services provided through the collaboration of police, local stakeholders, and non‐profits, the cost of medical care and criminal justice interventions were dramatically reduced. While challenges such as the availability of housing units remain, the findings of this study strongly support the interdisciplinary outreach team as a model for Housing First programming.

This is an in‐depth study, derived from a particularly innovative project; and therefore the sample size is limited by the size of the project.

The originality of this study lies in its analysis of a Housing First model which incorporates an interdisciplinary outreach team designed to provide highly individualized care for clients. The San Mateo permanent supportive housing pilot project is itself unique in that it incorporates a Homeless Outreach Team (HOT) comprised of the police, other government entities, local stakeholders, and other non‐profits engaged with homelessness.

For decades, since at least the famous Hawthorne studies, the happy/productive worker thesis has forcefully captured the imagination of management scholars and human resource professionals alike. According to this “Holy Grail” of management research, workers who are happy on the job will have higher job performance, and possibly higher job retention, than those who are less happy. But what is happiness? Most typically, happiness has been measured in the management sciences as jobsatisfaction. This viewpoint is unnecessarily limiting. Building upon alittle remembered body of research from the 1920s, we suggest a twofold, expanded view of this thesis. First, we suggest the consideration of worker happiness as psychological well-being (PWB). Second, incorporating Fredrickson's (1998, 2001) broaden-and-build model ofpositive emotions as the theoretical base, we suggest that the job satisfaction to job performance and job satisfaction to employee retentionrelationships may be better explained by controlling for the moderating effect of PWB. Future research directions for human resource professionals are introduced.