Espiritismo and Santeria: a gateway to child mental health services among Puerto Rican families?

Background Barriers to mental health care access among Latinx children contribute to mental health disparities. It is unclear whether traditional spiritual guides in Latinx communities may function more as gateway providers or in some instances as deterrents to mental health treatment. This study assesses whether family involvement in Espiritismo and/or Santeria, two forefront non-Christian spiritual traditions among Latinx families, is associated with mental health care utilization among Puerto Rican children in two contexts. Methods Data are from Waves 1–3 (2000–2004) of the Boricua Youth Study, a population-based longitudinal cohort study of Puerto Rican children from San Juan and Caguas, Puerto Rico (PR), and the South Bronx, New York (SBx), 5 to 17 years of age (N = 2491). Results At baseline, 5.02% (n = 58) of the families reported involvement with Espiritismo and/or Santeria in the SBx and 3.64% (n = 52) in PR. Logistic regression models predicting mental health service use found, after adjusting for multiple risk and protective factors, that families involved with Espiritismo and/or Santeria were 2.41 times more likely (p = 0.0034) to use mental health services over the course of 3 years than children with no family involvement in these practices in the SBx. The same association was not found in PR. Conclusions The findings among PR families in the SBx lend support to the gateway provider model in which spiritual guides open doors to mental health treatment. Forming community connections between mental health providers and traditional spiritual groups may be a culturally considerate, fruitful approach to reducing barriers to mental health treatment among Latinx families.

Mental Health Treatment Histories, Recovery, and Well-being

Epidemiological and sociological research on recovery from mental disorder is based on three rarely tested medical model assumptions: (1) recovery without treatment is the result of less severe illness, (2) treatment predicts recovery, and (3) recovery and well–being do not depend on individuals’ treatment histories. I challenge these assumptions using National Comorbidity Survey-Replication data for individuals with any disorder occurring prior to the current year ( N = 2,305). Results indicated that (1) untreated remissions were fully explained by less serious prior illness, (2) treated individuals were less likely to recover due to more serious illness, and (3) people who had past–only treatment were more likely to recover than the never–treated, while those in recurring and recently initiated care were less likely to recover. Treatment histories predicted greater well–being only if recovery had been attained. Histories of care help to explain recovery rates and suggest new directions for treatment–seeking theory and research.

A Case of the Tail Wagging the Dog: The Medicare Mental Health Coverage Gap and Its Impact on Providers and Beneficiaries

Nearly one in four Medicare beneficiaries have been diagnosed with mental health or substance use disorders, and research indicates this population responds well to mental health treatment. However, Medicare policy omits licensed mental health counselors (LMHCs) and licensed marriage and family therapists (LMFTs) as approved providers, exacerbating an existing national provider shortage. Emerging research demonstrates that the provider omission, referred to as the Medicare mental health coverage gap (MMHCG), profoundly impacts excluded providers and the communities they serve. This paper represents a synthesis of the most current scholarship on Medicare research, policy, and advocacy. In particular, we explore three ways the MMHCG impacts providers and beneficiaries alike: limiting provider choices, thwarting continuity of care, and creating challenging decisions for beneficiaries and providers. Our aim is to help mental health counselors better understand and navigate the MMHCG and aid in advocacy efforts for legislation to include LMHCs and LMFTs as approved Medicare providers.

The pathway to violence and public mass shooters in mental health treatment before attacks

Purpose The purpose of this study is to provide mental health practitioners with a framework for conceptualizing individuals who may be at risk of targeted violence, mass shootings in particular. Design/methodology/approach Through the lens of the Path to Intended Violence model, a non-experimental descriptive design was chosen to explore the characteristics and behaviors of perpetrators who had engaged in mental health treatment within six months before their attacks. Findings The perpetrators in this study demonstrated behaviors included in each of the stages of the Path to Intended Violence model. Thus, it may be important for practitioners to be familiar with this model, especially the earlier stages, to potentially identify and intervene with individuals who may be at risk of committing mass violence. Originality/value This paper highlights how the Path to Intended Violence model can provide practitioners with a framework for identifying progressive warning signs in patients and how to take action to stop them from continuing their journey toward violence.

A Social Media Website (Supporting Our Valued Adolescents) to Support Treatment Uptake for Adolescents with Depression or Anxiety: Outcomes From a Pilot Randomized Controlled Trial (Preprint)

BACKGROUND Adolescents with depression or anxiety initiate mental health treatment in low numbers due to multiple factors, with a top reason being negative attitudes towards treatment. We developed a peer-support website intervention, Supporting Our Valued Adolescents (SOVA), for adolescents seen in primary care settings and their parents with the goal of increasing treatment uptake through changing negative health beliefs, enhancing knowledge, offering peer emotional support, and increasing parent-adolescent communication about mental health. OBJECTIVE The aim of this pilot study was to refine recruitment and retention strategies, document intervention fidelity, and explore change in study outcomes (primary outcome being treatment uptake). METHODS We conducted a two-group, single blind, pilot randomized controlled trial in a single adolescent medicine clinic. Participants were aged 12 to 19 with clinician-identified symptoms of depression or anxiety for which a health care provider recommends treatment. The patient and parent, if interested, were randomized to receive the SOVA websites and Enhanced Usual Care (EUC) compared to EUC alone. Baseline, 6-week, and 3-month measures were collected by web-based self-report survey and blinded electronic health record review. Main pilot outcomes assessed were feasibility of recruitment and retention strategies. Implementation outcomes, intervention fidelity, missingness, and adequacy of safety protocols were documented. Descriptive statistics were used to summarize mental health service use, and target measures (examine change in health beliefs and knowledge, emotional support, and parent-adolescent communication) using 2-sample t tests to compare differences between arms. RESULTS A little under half of adolescents offered patient education material (195/461; 42%) were referred by their clinician to the study. Of 146 adolescents meeting inclusion criteria, 38 completed the baseline survey, qualifying them for randomization, and 25 (66%; 95% CI 51 - 81%) completed 6-week measures. There was limited engagement in the treatment arm with (5/11) 45% of adolescents who completed 6-week measures reporting accessing SOVA, mostly citing forgetting. Changes were found in target factors at 6-weeks, but not in per protocol analyses. Despite this, at 12 weeks, 15/18 (83%) adolescents randomized to SOVA received mental health treatment as compared to 10/20 (50%) adolescents randomized to EUC (P=.03), where receipt of treatment was measured by combined adolescent or parent self-report and a blinded manual EHR extraction. CONCLUSIONS In this pilot trial of a peer-support website intervention for adolescents with depression or anxiety we found lower than expected study enrollment post recruitment. While generalizability may be enhanced by not requiring parental permission for adolescent participation in trials of mental health interventions, this may limit study recruitment and retention. We found implementing patient education introducing the study into provider workflow was feasible and acceptable, resulting in almost 500 study referrals. Lastly, we found preliminary evidence that the SOVA intervention may increase uptake of mental health treatment as compared to usual care. CLINICALTRIAL ClinicalTrials.gov NCT03318666; https://clinicaltrials.gov/ct2/show/NCT03318666 INTERNATIONAL REGISTERED REPORT RR2-10.2196/12117