Mothering Through Mental Illness: Exploring the Experiences of Motherhood for Criminally Involved Women on Mental Health Probation

As the number of criminally involved women has increased substantially over several decades, the prevalence of mothers impacted by criminal justice involvement has also increased. The current paper seeks to examine a specific subset of these criminally involved mothers—those with significant and long-term mental illness. This study explores how these women describe their experiences mothering through semistructured qualitative interviews with 48 women on a specialty mental health caseload in Maricopa County, Arizona. Using an inductive approach inspired by grounded theory to analyze the narrative accounts of criminally involved women with mental illness, the maternal identities of these women are placed at the forefront of the discussion, with an emphasis on examining their experiences beyond motherhood’s influence on desistance.

Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study

Background People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated “behavioral health home” models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers. Methods This pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers’ self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI. Discussion While we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery. Trial registration ClinicalTrials.gov, NCT04696653. Registered on January 6, 2021

Specialty Probation Officers as Street-Level Bureaucrats: Exploring How Discretion Is Perceived and Employed on a Mental Health Caseload

This study explores the perceptions of specialty mental health caseload probation officers and their use of discretion in day-to-day supervision of individuals with mental illness in one large jurisdiction in the United States. Scholars have examined overall effectiveness of specialty probation programs, probation officers’ roles as street-level bureaucrats, and the impact of the mental health caseload probation officer and probationer relationship on successful completion. Less attention, however, has been placed on examining how the officers supervising these specialty caseloads perceive their roles as mental health probation officers and how they use discretion in their caseload management. The current study examines the narratives of 24 specialty mental health caseload probation officers and supervisors to understand how discretion is used on a problem-solving caseload and how discretionary decision-making may impact probationer outcomes.

Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

Background Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development. Methods We will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies. Discussion Findings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide.

Telemental Health and US Rural–Urban Differences in Specialty Mental Health Use, 2010–2017

Objectives. To examine whether growing use of telemental health (TMH) has reduced the rural–urban gap in specialty mental health care use in the United States. Methods. Using 2010–2017 Medicare data, we analyzed trends in the rural–urban difference in rates of specialty visits (in-person and TMH). Results. Among rural beneficiaries diagnosed with schizophrenia or bipolar disorder, TMH use grew by 425% over the 8 years and, in higher-use rural areas, accounted for one quarter of all specialty mental health visits in 2017. Among patients with schizophrenia or bipolar disorder, TMH visits differentially grew in rural areas by 0.14 visits from 2010 to 2017. This growth partially offset the 0.42-visit differential decline in in-person visits in rural areas. In net, the gap between rural and urban patients in specialty visits was larger by 2017. Conclusions. TMH has improved access to specialty care in rural areas, particularly for individuals diagnosed with schizophrenia or bipolar disorder. While growth in TMH use has been insufficient to eliminate the overall rural–urban difference in specialty care use, this difference may have been larger if not for TMH. Public Health Implications. Targeted policy to extend TMH to underserved areas may help offset declines in in-person specialty care.