Chronic Disease Screening and Prevention Activities in Mental Health Clinics in New York State: Current Practices and Future Opportunities

Associations between Social Adversities and Chronic Medical Conditions in a Statewide Sample of Individuals in Treatment for Mental Illnesses

Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p < .0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities.

Overrepresentation of In-Home, Natural Deaths Among Individuals Treated for Mental Illnesses in New York State

OBJECTIVE

The authors compared rates of in-home, natural death among individuals receiving treatment for mental illnesses with those in the general population.

METHODS

Two data sets were used to determine the prevalence of in-home, natural deaths in the general population and among those receiving treatment for mental illnesses in New York State, outside New York City, for the period 2016-2018.

RESULTS

Overall, 37% of natural deaths among individuals receiving mental health treatment occurred in the home, compared with 26% in the general population. Earlier death was also apparent; for example, 26.4% of in-home deaths among those receiving mental health treatment were among those ages 45-54 years, compared with 5.5% in the general population. In-home, natural deaths were also higher among non-Hispanic Black and Hispanic subpopulations.

CONCLUSIONS

These findings suggest a need for programmatic and policy advances to reduce disparities in general health care for those living with mental illnesses. Additional analyses are warranted.

Affordability of Forensic Assertive Community Treatment Programs: A Return-on-Investment Analysis

OBJECTIVE

In this study, the authors assessed return on investment (ROI) associated with a forensic assertive community treatment (FACT) program.

METHODS

A retrospective secondary data analysis of a randomized controlled trial comprising 70 legal-involved patients with severe mental illness was conducted in Rochester, New York. Patients were randomly assigned to receive either FACT or outpatient psychiatric treatment including intensive case management. Unit of service costs associated with psychiatric emergency department visits, psychiatric inpatient days, and days in jail were obtained from records of New York State Medicaid and the Department of Corrections. The total dollar value difference between the two trial arms calculated on a per-patient-per-year (PPPY) basis constituted the return from the FACT intervention. The FACT investment cost was defined by the total additional PPPY cost associated with FACT implementation relative to the control group. ROI was calculated by dividing the return by the investment cost.

RESULTS

The estimated return from FACT was $27,588 PPPY (in 2019 dollars; 95% confidence interval [CI]=$3,262-$51,913), which was driven largely by reductions in psychiatric inpatient days, and the estimated investment cost was $18,440 PPPY (95% CI=$15,215-$21,665), implying an ROI of 1.50 (95% CI=0.35-2.97) for FACT.

CONCLUSIONS

The Rochester FACT program was associated with approximately $1.50 return for every $1 spent on its implementation, even without considering potential returns from other sources, including reductions in acute medical care, crime-related damages, and public safety costs. ROI estimates were highly dependent on context-specific factors, particularly Medicaid reimbursement rates for assertive community treatment and hospital stays.

The effects of a training program for reducing nurses' discrimination towards PLWHAs

Performing a training program for reducing nurses' discrimination towards AIDS clients, and then evaluating the effect of the training model and analyzing the influencing factors of the training effect to form a long-run training model. 150 clinical nurses were selected to attend the program to reduce nurses' discrimination towards AIDS clients. The program included 3 steps: knowledge education, psychological intervention, and behavior correcting. Before the program, we conducted pre-research to learn the current situation, including existing discrimination and training needs. Selected nurses were asked to complete questionnaires before and 6 months after training, and the trainees were from several hospitals in Haikou. The research period was from March to September 2020. The scores for AIDS-related knowledge, discrimination attitudes, and nursing standard behavior before training were (49.69 ± 3.80), (47.01 ± 3.70), and (35.98 ± 3.01), respectively, and the scores from 6 months after training were (59.01 ± 3.88), (52.19 ± 4.98), and (38.12 ± 2.98), respectively. Correlation analysis revealed that the scores for the nurses' AIDS-related knowledge and behavior were positively correlated (R = 0.31, P < .05); however, there was no correlation found between attitude and behavior (P > .05); no significant differences were observed in the 3 scores among nurses in different departments and nurses with different working durations. There was a significant difference detected among nurses in their experience caring for AIDS clients (F = 3.80, P < .05). The nurses with higher education levels also showed a significant difference compared to those with low education levels on their knowledge and behavior scores ([F = 3.49, P < .05] and [F = 4.68, P < .05], respectively). AIDS-related knowledge training and psychological intervention can effectively reduce the discriminatory attitudes of nurses towards AIDS clients.

Decoding health status transitions of over 200 000 patients with traumatic brain injury from preceding injury to the injury event

For centuries, the study of traumatic brain injury (TBI) has been centred on historical observation and analyses of personal, social, and environmental processes, which have been examined separately. Today, computation implementation and vast patient data repositories can enable a concurrent analysis of personal, social, and environmental processes, providing insight into changes in health status transitions over time. We applied computational and data visualization techniques to categorize decade-long health records of 235,003 patients with TBI in Canada, from preceding injury to the injury event itself. Our results highlighted that health status transition patterns in TBI emerged along with the projection of comorbidity where many disorders, social and environmental adversities preceding injury are reflected in external causes of injury and injury severity. The strongest associations between health status preceding TBI and health status at the injury event were between multiple body system pathology and advanced age-related brain pathology networks. The interwoven aspects of health status on a time continuum can influence post-injury trajectories and should be considered in TBI risk analysis to improve prevention, diagnosis, and care.

Screening and Treatment of Tobacco Use Disorder in Mental Health Clinics in New York State: Current Status and Potential Next Steps

The prevalence of smoking is higher among individuals with serious mental illnesses than the general population. Evidence-based practices exist for tobacco cessation, but little is known about mental health clinics' tobacco cessation treatment practices/protocols. Mental health clinics in New York State were surveyed about their tobacco use treatment protocols and outdoor-smoking policies. One-third of clinics were not providing individual counseling for tobacco use disorder, 39% were not prescribing nicotine replacement therapy, and nearly half reported not prescribing bupropion or varenicline. Even smaller proportions reported implementing other clinical practice guidelines, with only 25.2% providing staff training and 20.3% having a dedicated staff member for coordinating tobacco use disorder treatment. Regarding outdoor smoke-free policies, 38% of clinics reported not allowing any tobacco use anywhere on grounds. Despite some successes, many clinics do not provide evidence-based tobacco use treatments, meaning important opportunities exist for mental health clinics and oversight agencies to standardize practices.

Intention to Use Behavioral Health Data From a Health Information Exchange: Mixed Methods Study

BACKGROUND

Patients with co-occurring behavioral health and chronic medical conditions frequently overuse inpatient hospital services. This pattern of overuse contributes to inefficient health care spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management; however, their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information.

OBJECTIVE

This study aims to identify and describe factors influencing the intention to use behavioral health information that is shared through HIEs.

METHODS

We used a mixed methods design consisting of two sequential phases. A validated survey instrument was emailed to clinical and nonclinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision making. Follow-up interviews were conducted with a subsample of participants to elaborate on the survey results. Partial least squares structural equation modeling was used to analyze survey data. Thematic analysis was used to identify themes from the interviews.

RESULTS

A total of 62 participants completed the survey. In total, 63% (n=39) of the participants were clinicians. Performance expectancy (β=.382; P=.01) and trust (β=.539; P<.001) predicted intention to use behavioral health information shared via HIEs. The interviewees (n=5) expressed that behavioral health information could be useful in clinical decision making. However, privacy and confidentiality concerns discourage sharing this information, which is generally missing from patient records altogether. The interviewees also stated that training for HIE use was not mandatory; the training that was provided did not focus specifically on the exchange of behavioral health information.

CONCLUSIONS

Despite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.