Resarch from...

• From the Rural Assistance Center (www.raconline.org)
• From the National Center for Mental Health and Juvenile Justice (www.ncmhjj.com)
• From The Translational Genomics Research Institute (www.tgen.org)
• From the National Institute of Mental Health
• From the National Survey on Drug Use and Health

From Rural Assistance Center

Question: What are some of the challenges to accessing and providing mental health services in rural areas?

Answer: Nearly half of the American population is affected by a mental disorder at some time in their lives and yet the misconceptions, myths, and cultural taboos associated with mental illness may be the most significant barriers that keep persons with mental disorders from seeking and receiving treatment in rural areas. Inadequate knowledge about mental illness, even in the medical profession; fear of and prejudice toward those with mental illness; and hesitancy on the part of people with mental illness to get treatment instill an atmosphere of disgrace and shame in some rural communities. This stigma combined with other challenges can prevent people with mental illness from seeking help.
Because of their small size and close-knit society, rural communities are known for knowing everybody and everybody's business. Often news gets back into a community before the newsmaker. Cars parked outside of a mental health clinic are recognizable and patients in passing will recognize each other. Familiarity such as this will cause the mental health care seeker to feel insecure in regards to confidentiality and privacy which may suppress their seeking professional care.
Another challenge comes from the lack of mental health care providers and services in rural areas. According to rural health researchers at Texas A&M University's Southwest Rural Health Research Center, 20 percent of nonmetropolitan counties are without mental health services; and in 1999, 87 percent of the 1,669 federally designated Mental Health Professional Shortage Areas in the nation were in nonmetropolitan counties. Because of the scarcity of mental health care providers, primary care doctors, who may not be adequately prepared in mental health care, provide the majority of mental health services in rural areas.
Although small communities display characteristics that stifle mental health services they do rally around their residents and provide community support in times of need. This strong external support group can help facilitate a person's success in treatment and also help support the family's efforts in attending to the care seeker.

Question: What can a community do to minimize these challenges?

Answer: The most significant challenge regarding mental health care in rural America is the lack of health care providers and services. In recent years, health policy experts and health care providers have begun to encourage closer integration of mental, or rather, behavioral health and primary care services, for rural areas. It is assumed that integration will increase access to mental health care services and increase quality of care through enhanced coordination of services. In rural areas, where behavioral health workers and primary care givers are in short supply, integration is vitally important. Integration of these services is an effective strategy for maximizing the use of scarce rural health care resources and improving the quality of care for both behavioral health and primary care patients.

From the National Center for Mental Health and Juvenile Justice

How many youth in the general population have mental health disorders? 
The 1999 Surgeon General’s Report on Mental Health found that approximately 20% of children and adolescents in the general population are experiencing a mental disorder.  Approximately 10% of children and adolescents experience mental illness severe enough to cause impairment at home, school or in the community.  Yet despite these compelling statistics, it is estimated that less than half will receive the treatment that they need.

How many youth in contact with the juvenile justice system have mental health disorders?
For youth involved with the juvenile justice system, the situation is much worse.  A recent study, click here, conducted by the National Center for Mental Health and Juvenile Justice (2006) found that 70% of youth in the juvenile justice system suffer from mental health disorders and that 27% of youth are experiencing disorders so severe that their ability to function is significantly impaired. 

What kinds of mental health disorders do youth in the juvenile justice system typically experience?
The most commonly identified mental health disorders among the juvenile justice population are disruptive disorders and substance use disorders.  However, youth in the juvenile justice system also experience anxiety and mood disorders at a much higher rate than the general population.  For many youth, their mental health status is complicated by the presence of more than one disorder.  In the 2006 NCMHJJ study, of those youth diagnosed with a mental disorder, approximately 79% met criteria for at least one other mental health diagnosis. 

Do many justice-involved youth with mental health disorders also have substance use disorders? 
Yes, although the research base on this is still developing.  The NCMHJJ study (2006) found that among youth with at least one mental health diagnosis, approximately 60 percent also met criteria for a substance use disorder.  Co-occurring substance use disorders were most common for youth with a diagnosis of disruptive disorder, although significant proportions of youth with anxiety disorders (52.3%) and mood disorders (61.3%) also had a co-occurring substance use disorder. 

Are there treatment interventions that can effectively respond to the mental health needs of youth in the juvenile justice system?
Fortunately, over the last decade, a number of approaches have emerged to help the field better identify and respond to the mental health needs of youth. One of the most significant advances is the development of demonstrated effective interventions which are commonly referred to as Evidence-Based Practices:  interventions that involve standardized treatment and that have been shown, through controlled research, to result in improved outcomes across multiple research groups.
These interventions include improved psycho-social approaches, medication therapies, and family and community-based models that are well documented and proven effective for treating mental disorders among youth (Hoagwood, 2005).  The Blueprint for Change includes a comprehensive discussion of some of the most effective interventions for youth.  These include:

• Home and Community-Based Models:
  • Multi-Systemic Therapy
  • Functional Family Therapy
  • Multi-Dimensional Treatment Foster Care
• Psychosocial Therapies:
  • Cognitive Behavioral Therapy
  • Brief Strategic Family Therapy
  • Aggression Replacement Therapy
  • Dialectical Behavior Therapy
• Medication Therapies for treating:
  • Attention Deficit Hyperactivity Disorder
  • Depression
  • Certain Anxiety Disorders

From The Translational Genomics Research Institute

Research Overview

The ability to better diagnose, treat, and ultimately cure disease in the 21st century will depend on two things: understanding the genetic cause of disease, and the ability to translate this information into new diagnostic tests and therapeutics.

We now know more about genes than ever before and this increased understanding provides scientists with an unparalleled opportunity to study and understand diseases. Thanks to the mapping of the human genome, clinical practice is shifting from treatment based on symptoms to treatment based on each person's unique genetic make-up—in other words, personalized medicine.

Translational research is the process of translating basic scientific discoveries into clinical applications such as new diagnostics and treatments. Translational research serves as a bridge between lab bench discoveries and the patient bedside. Information collected at the patient bedside can circle back to the laboratory to fuel additional discoveries.

Translational research provides the data and tools necessary to identify the genes that play a role in hereditable diseases and understand the genetic changes contributing to disease progression and resistance to therapy. Through partnering relationships with academic, clinical, and corporate entities, TGen's mission is to deliver these discoveries to the patient bedside as improved healthcare interventions. TGen's layered, multidisciplinary approach combines a solid infrastructure with scientific technologies and programs, academic and corporate partnerships, and enterprise efforts.
At TGen, investigators are pushing the limits of cutting-edge research and technology to discover the genetic cause of disease. Experiments that were impossible and impractical only a few years ago are now conducted every day.

From the National Institute of Mental Health

Effective Parenting

Treatment that includes medication plus a structured training program for parents reduces serious behavioral problems in children with autism and related conditions, according to a study funded by the National Institute of Mental Health (NIMH). The study, which was part of the NIMH Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, was published in the December 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Results from a previous RUPP study reported in 2002 showed that the antipsychotic medication risperidone (Risperdal) reduced such behavior problems as tantrums, aggression and self-injury in children with autism. However, most children's symptoms returned when the medication was discontinued. Although effective, risperidone is associated with adverse effects such as weight gain, which can lead to metabolic changes, obesity and related health problems.  (For more, see http://www.nimh.nih.gov/science-news/2009/parent-training-complements-medication-for-treating-behavioral-problems-in-children-with-pervasive-developmental-disorders.shtml)

Drugs and Alcohol Interfere with Treatment of Depression

Depressed teens who report low levels of impairment related to drug or alcohol use tended to respond better to depression treatment than depressed teens with higher levels substance-related impairment, according to an analysis of data from the NIMH-funded Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study. However, it is unclear whether less substance-related impairment allowed for better response to depression treatment, or if better treatment response led to less substance-related impairment. The study was published in the December 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.  (For more, see http://www.nimh.nih.gov/science-news/2009/substance-use-associated-with-low-response-to-depression-treatment-among-teens.shtml)

Long-term Depression Treatment Leads to Sustained Recovery for Most Teens

Long-term treatment of adolescents with major depression is associated with continuous and persistent improvement of depression symptoms in most cases, according to the most recent analysis of follow-up data from the NIMH-funded Treatment of Adolescents with Depression Study (TADS). The report, along with a commentary compiling the take-home messages of the study, was published in the October 2009 issue of the American Journal of Psychiatry.  (For more, see http://www.nimh.nih.gov/science-news/2009/long-term-depression-treatment-leads-to-sustained-recovery-for-most-teens.shtml)

Clinical Tests Begin on Medication to Correct Fragile X Defect

NIH-supported scientists at Seaside Therapeutics in Cambridge, Mass., are beginning a clinical trial of a potential medication designed to correct a central neurochemical defect underlying Fragile X syndrome, the most common inherited cause of intellectual disability. There has to date been no medication that could alter the disorder's neurologic abnormalities. The study will evaluate safety, tolerability, and optimal dosage in healthy volunteers. (For more, see http://www.nimh.nih.gov/science-news/2009/clinical-tests-begin-on-medication-to-correct-fragile-x-defect.shtml)

Telephone-based Depression Treatment Program Effective While Cost Efficient

Patients who receive structured, telephone-based support to manage their depression gain significant benefits with only moderate increases in health care costs compared to those who receive usual care, according to an NIMH-funded analysis published in the October 2009 issue of the Archives of General Psychiatry.  (For more, see http://www.nimh.nih.gov/science-news/2009/telephone-based-depression-treatment-program-effective-while-cost-efficient.shtml)

New Approach to Reducing Suicide Attempts Among Depressed Teens

A novel treatment approach that includes medication plus a newly developed type of psychotherapy that targets suicidal thinking and behavior shows promise in treating depressed adolescents who had recently attempted suicide, according to a treatment development and pilot study funded by the National Institute of Mental Health (NIMH). The study, described in three articles, was published in the October 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. (For more, see http://www.nimh.nih.gov/science-news/2009/new-approach-to-reducing-suicide-attempts-among-depressed-teens.shtml)

Short-term Intensive Treatment Not Likely to Improve Long-term Outcomes for Children with ADHD

Initial positive results gleaned from intensive treatment of childhood attention deficit hyperactivity disorder (ADHD) are unlikely to be sustained over the long term, according to a recent analysis of data from the NIMH-funded Multimodal Treatment Study of Children with ADHD (MTA). The study was published online ahead of print March 2009 in the Journal of the American Academy of Child and Adolescent Psychiatry.  (For more, see http://www.nimh.nih.gov/science-news/2009/short-term-intensive-treatment-not-likely-to-improve-long-term-outcomes-for-children-with-adhd.shtml)

Clues to Role of Brain Development as Risk for Mental Disorders May Also Lead to Better Treatments

WASHINGTON, DC, May 6 — Increasing evidence points to links between the timing and growth rates of specific brain areas in the young brain and the likelihood of developing a wide range of mental disorders later in life, say researchers convened by the National Institute of Mental Health (NIMH), a part of the National Institutes of Health. Included among these mental disorders are autism, anxiety, bipolar disorder, eating disorders, substance abuse, and attention deficit hyperactivity disorder (ADHD).  (For full article, click here.)

Neuroimaging and Mental Illness: A Window Into the Brain

Researchers use brain scans to study brain development in healthy people and people with illnesses. This publication answers frequently asked questions about what brain scans can and cannot do related to diagnosing mental illnesses. (2009).  (For more, see http://www.nimh.nih.gov/health/publications/neuroimaging-and-mental-illness-a-window-into-the-brain/neuroimaging-and-mental-illness-a-window-into-the-brain.shtml)

From the National Survey on Drug Use and Health

Serious Psychological Distress among Adults Aged 50 or Older: 2005 and 2006

• Combined data from 2005 and 2006 indicate that an annual average of 7.0 percent of persons aged 50 or older experienced serious psychological distress (SPD) in the past year, with 8.8 percent of those aged 50 to 64 and 4.5 percent of those aged 65 or older having experienced past year SPD
• Among persons aged 50 or older with past year SPD, 53.7 percent received mental health treatment in the past year, 6.2 percent did not receive treatment although they felt they needed it, and 40.1 percent did not receive treatment and did not perceive a need for it
• Persons aged 50 to 64 with SPD, compared with their counterparts aged 65 or older, were more likely to have received mental health treatment (57.8 vs. 41.8 percent), more likely not to have received treatment although they recognized a need for it (7.9 vs. 1.3 percent), and less likely not to have received mental health treatment and not to have recognized a need for it (34.2 vs. 56.8 percent)

For full report, see http://www.oas.samhsa.gov/2k8/SPDolder/SPDolderadults.htm

Results from the 2008 National Survey on Drug Use and Health: National Findings (from the Substance Abuse & Mental Health Services Administration)

This report presents the first information from the 2008 National Survey on Drug Use and
Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health
Services Administration (SAMHSA). The survey is the primary source of information on the use
of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United
States aged 12 years old or older. The survey interviews approximately 67,500 persons each year.  (For report click here)