Category Archives: Behavioral/mental health care
Jason Houle, PhD, is a Robert Wood Johnson Foundation Health & Society Scholar at the University of Wisconsin. He recently published a study online in the journal Psychosomatic Medicine that finds association between depressive symptoms and mortality is due to later health problems, not prior physical health conditions.
Human Capital Blog: Why did you decide to look at this particular topic?
Jason Houle: I first started looking at this topic in graduate school, when I took a course on event history models (a quantitative method often used when studying mortality). Up to that point, most of my research focused on the social determinants of mental health, but I had become increasingly interested in the link between mental and physical health. While there’s a long literature on how depression influences physical health (and vice versa), as a demographer, I was really interested in the link between depression and mortality. When researching this topic, I discovered a rather large literature that showed that people who experience depression tend to die younger, on average, than those who do not. However, it wasn’t clear from prior research why, exactly, depressed people tend to die younger than those who are not. Though it makes sense that depression is linked with mortality, the reasons behind it remained a puzzle, and I thought it would make an interesting project.
Bonnie Zima, MD, MPH, an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (1989-1991), published a study this month that appeared in a special supplement of Pediatrics with articles by RWJF Clinical Scholars on child health quality. Pediatrics is the official journal of the American Academy of Pediatrics. Zima is a professor-in-residence in child and adolescent psychiatry at the University of California in Los Angeles (UCLA) and associate director of the UCLA Center for Health Services & Society.
Human Capital Blog: Why did you decide to review the new child mental health quality measures?
Bonnie Zima: This paper was written to stimulate discussion about the need for a paradigm shift for quality measurement for children that more closely aligns research with the accelerated pace of quality measure development.
These are exciting times for those who believe that the quality of child health care can be improved through measurement and public reporting. However, this direction also raises questions about how to improve our methods and data infrastructure to monitor the quality of care received in real-time and to link adherence to quality indicators to clinical outcomes that are meaningful to parents, child advocates, providers, agency leaders and policy-makers.
HCB: Why did you focus on child mental health?
Zima: We focused on child mental health care because quality measurement poses additional challenges that can be used as a stimulus to improve future measure development.
Some of the areas for future research include development of a stronger evidence base to support nationally recommended care processes in community-based populations; models of care coordination across multiple care sectors that often have discrete funding streams, such as specialty mental health, public health, education, child welfare, and juvenile justice; and the development of interventions that more flexibly align service delivery with children’s clinical needs, especially for those with co-morbid mental and physical health conditions.
Jason Schnittker, PhD, and Chris Uggen, PhD, both recipients of Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research, recently published a study in the Journal of Health and Social Behavior on incarceration and psychiatric disorders. They found that incarceration increases the risk of mood disorders after release and that these disorders increase disability. Schnittker is an associate professor in the Department of Sociology at the University of Pennsylvania. Uggen is the Distinguished McKnight Professor in the Department of Sociology at the University of Minnesota.
More than 650,000 inmates are released from prison every year.[i] Although their debt to society may be paid, their struggles have just begun. Reentry is not easy. Former inmates need to find a place to live. They need to find a job. And many need to support families. All told, 4 million people in the U.S. are dealing with the “mark” of a prison record and its consequences for their work and personal lives.[ii] Most will struggle for years following their release.
Given all these difficulties, it’s hard to imagine health being a major part of their struggle. After all, many former inmates are still quite young and, for that reason, unlikely to suffer from major health problems. Mental health is part of the picture, but usually considered through a different lens: policy-makers ask how mental illness affects criminal offending—that is, what leads to prison in the first place—but rarely consider the pivotal role of mental health in making a successful return to the community.
Yet the role of mental illness is just as relevant after release as before.[iii]
E. Alison Holman, PhD, FNP, is an assistant professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar. She has received the Chaim Danieli Young Investigator’s Award from the International Society for Traumatic Stress Studies for her research on early cognitive predictors of long-term adjustment following trauma. She studies how people cope with highly stressful experiences with special interest in understanding how trauma affects long-term mental and physical health.
The tragedy in Newtown CT violated everything we hold dear, with 20 innocent children among the carnage. My heart aches for Newtown, the families who lost their children, the children who lost their siblings and friends. It is so sad.
According to FBI records, on average, 27 Americans were murdered with firearms every day in 2011. Yet, last Friday, White House spokesman Jay Carney said "today is not the day for a debate on gun control." But if not now, when? On April 28, 1996, 35 people were murdered in Port Arthur, Tasmania by a gunman from New Town, Australia. Within 12 days the Australian government adopted bipartisan gun control legislation. In the 15 years since these new gun control laws were passed, no mass shootings have occurred in Australia. Do we have the resolve to do the same here?
Human Capital News Roundup: 'Citizen science,' compensation for medical errors, gunshot wounds, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:
The New York Times Well blog reports on a study by RWJF Health & Society Scholar Jason Fletcher, PhD, MS, that finds that about half of smokers carry a specific genetic characteristic associated with susceptibility to tobacco taxes and other health policy approaches intended to deter smoking. The other half have a different genetic mix and are largely unaffected by such measures. Medical XPress also reported on the findings. Read more about the study.
A study led by RWJF Investigator Award in Health Policy Research recipient Michelle Mello, JD, PhD, MPhil, finds that “patients who are offered disclosure, explanations, apologies and monetary compensation for medical errors may be more likely to accept lower rather than maximum compensation, apparently due to distrust of the motives behind a full compensation offer,” Cardiovascular Business reports.
People who frequently use the Internet to get health or medical information are more likely to have a positive outlook on cancer prevention and diagnosis, a study co-authored by Health & Society Scholars alumnus Jeff Niederdeppe, PhD, MA, finds. United Press International reports on the findings.
Laurie Theeke, PhD, RN, is an assistant professor of nursing at West Virginia University and a Robert Wood Johnson Foundation Nurse Faculty Scholar. Her research emphasizes the development of interventions that target loneliness as a psychosocial stressor that impacts overall health.
Due to increased longevity in the older adult population, significant numbers of older adults are finding themselves serving as caregivers for spouses, children, and grandchildren. Loneliness has been identified as a key predictor of poor quality of life for caregivers.
Caregivers make difficult personal choices on an everyday basis that frequently involve personal sacrifice of time spent in leisure activities, time with family beyond the specific caregiving relationship, and time spent enjoying and maintaining normal social networks that enhance wellness.
Caregivers can experience internal conflicts between not wanting to leave the loved one who needs them and the need for personal expression, development, and socialization. This conflict can present as psychological stress, potentially contributing to negative health outcomes for the caregivers.
As nurses, it is important to recognize that the loneliness experienced by caregivers is predictive of depression and may ultimately be the demise of the caregiving arrangement if it results in functional decline or illness in the caregiver.
Eileene Shake, DNP, RN, NEA-BC, is CEO of the Foundation for Nursing Excellence. The Robert Wood Johnson Foundation Human Capital Blog asked scholars and experts to consider what the election results will mean for health and health care in the United States.
The 2012 election is over and now, as health care leaders, we are trying to figure out how to move forward with implementing the Affordable Health Care Act (ACA). Yes, there will be an influx of Americans entering the health care system who did not have access to health care in the past. The impact on nursing will be significant as nurses are being recognized as important to providing care to the large number of new patients entering the system. Nurses will be key players working on interdisciplinary teams to redesign how health care is delivered. Nurses and advanced practice nurses will need to practice to the full extent of their education in order to care for the increased number of citizens entering the health care system.
There will be less resistance to implementing the ACA and more emphasis will be placed on how to implement it. Hospitals are already putting processes in place to reduce readmission rates for patients with chronic disease. New programs are being implemented to manage health care after the patient is discharged to reduce readmission rates. Nurses are following up with patients to ensure they are taking their medications, checking their blood pressure, and following their therapeutic diets. It is important to note that there will still be some resistance to implementing the ACA from states that do not feel they can afford to pay for the health care program.
What the Election Means for Health and Health Care… The Country Needs More Providers, Better Mental Health and Elder Care, and an End to Poverty
Carolyn Montoya, RN, MSN, CPNP, is a fellow with the Robert Wood Johnson Foundation (RWJF) Nursing and Health Policy Collaborative at the University of New Mexico. A PhD Candidate, Montoya serves on the New Mexico Medicaid Advisory Committee, an advisory body to the Secretary of the state’s Human Services Department and the Director of the Medical Assistance Division Director. The RWJF Human Capital Blog asked scholars and fellows from a few of its programs to consider what the election results will mean for health and health care in the United States.
Human Capital Blog: Do you think there will be fewer challenges to the Affordable Care Act and more attention to how to implement it?
Montoya: Now that the election is over, the reality is that the Affordable Care Act (ACA) will not be repealed. As we go forward with the ACA in place, a strong emphasis should be placed on evaluation. Outcome measures, such low rates of diabetes complications or increased immunization rates, will be essential in terms of being able to establish what aspects of the ACA are working and which ones need to be revised.
An APHA Presentation: Addressing Racial Health Disparities with Culturally Competent Interventions Delivered from the African American Church
By Daniel L. Howard, PhD, executive director of the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. The Center’s mission is to provide leadership in health policy education, research and reform, while improving the health and health care of underserved communities. This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.
This week, I am part of a team that had the honor of being chosen to conduct a presentation on mental health in African American faith-based communities at the 140th Annual Meeting and Exposition for the American Public Health Association (APHA). This is a significant topic for clinicians, researchers and policy-makers to consider when addressing mental health needs for African American individuals and their communities.
The Surgeon General’s Report Supplement (2001) noted that science can offer effective treatments for most disorders. However, it noted, “Americans do not share equally in the best that science has to offer.” Numerous others researchers have concluded that publicly provided behavioral health services must be improved for ethnic minorities.
Research has consistently shown that, despite significant prevalence of mental health issues in the United States, most individuals do not seek treatment for these issues. Historically, research has shown that African Americans are even less likely to seek mental health treatment than their Caucasian counterparts. There are several reasons for this that are not exclusive to, but do include, the stigma that surrounds mental health in African American communities, the perceptions of mental health in African American communities, and the limited mental health resources available to address mental health needs in the community.
Despite the indication that the majority of mental health service needs for African Americans are unmet, there has been a strong and consistent response from the African American church to serve as the surrogate for the medical sector. Many published studies have found that African American churches have strong potential to serve as a highly effective gateway for the successful delivery of health intervention. The compatibility between health and wellness and African American churches, and particularly between mental health wellness and African American churches, can be attributed to several factors including the church’s consistent tradition of supporting its members and the inherent emphasis on the healing of psychological ills.
By Jooyoung Lee, PhD, assistant professor of sociology at the University of Toronto and a 2009 – 2011 Robert Wood Johnson Foundation Health & Society Scholar at the University of Pennsylvania
Ervin is a black Rastafarian. He has a calm and easy-going demeanor, something that he attributes to growing up in a small Jamaican village near Kingston. On most days, Ervin rolls his long set of locks into a beehive that he conceals beneath brightly colored turbans.
He was one of the first gunshot victims that I met while conducting ethnographic research in Philadelphia. On a chilly Friday in January, Ervin hobbled into the trauma clinic at The University of Pennsylvania. His work boots were covered with tufts of snow and his puffy winter jacket hid a lean and muscular 35-year old body.
When I first introduced myself and the purpose of my study, Ervin smiled from ear-to-ear. He was anxious to tell his story and gave me a detailed play-by-play of how he had been shot twice in the legs—both 9mm bullets had been retained and were causing him great discomfort and pain.
Although he was nearly a year removed from his shooting, Ervin spoke openly about recurrent nightmares, trouble sleeping at night, and described feeling frightened by loud noises in his neighborhood—some of which were “false alarms” and others which were gunshots fired near his home. Although I am a sociologist by training and have never been trained in counseling or psychotherapy, my gut told me that Ervin was suffering from post-traumatic stress symptoms.
A couple weeks later, I visited Ervin at his home. During my visit, I asked Ervin if he had ever spoken to a mental health professional about his trauma. He shook his head and explained that he knew of free mental health services in Philadelphia, but could not afford to go. As a day laborer, Ervin relied on landscaping, construction, and other manual labor that often required him to be ready for work at a moment’s notice. He explained, “If they call me and I’m at some office, I might lose a job that could be the only one I get for a few weeks.”