Burnout has received ongoing attention in the psychotherapist literature, with much of the emphasis placed on examining risks for its development and consequences of its occurrence. However, there is a paucity of research comparing burnout between psychotherapist training levels. The current study examined a sample of licensed psychotherapists (n = 108) from different training levels and educational backgrounds. Differences in emotional exhaustion, depersonalization and personal accomplishment were examined between psychotherapists trained at the master’s-level and those trained at the doctoral-level. Findings indicated that master’s-level psychotherapists experienced more depersonalization on average compared to doctoral-level psychotherapists. Moreover, exploratory regression analyses found that training-level moderated the relationship between treatment hours provided per week and depersonalization scores, which was additionally moderated by control over client caseload. Specifically, master’s level-psychotherapists with less control over their caseload experienced greater depersonalization scores the more time they spent treating clients per week. Whereas no conditional relationships were found for doctoral-level psychotherapists or master’s-level psychotherapists who reported greater control over their caseload in relation to treatment hours per week and depersonalization scores. Allowing master’s-level psychotherapists to have more control over the topography of their client caseload when feasible may help to reduce burnout-related depersonalization.
Integrated treatment services for co-occurring mental health and substance use disorders are recommended best practice, yet their relationship with facility-level provision of detoxification and medications for opioid use disorder (MOUDs) is not well understood. The researchers analyzed 2021–2023 National Substance Use and Mental Health Services Survey (N-SUMHSS) data from 49,623 facilities offering any substance use services. Multivariable logistic regression models examined associations between integrated services and availability of detoxification and MOUD, adjusting for facility characteristics and Chronic Care Model elements. Primary treatment focus (substance use, mental health, mixed) was evaluated as an effect modifier. Overall, 61.2
Evidence suggests that 10-30% of youth have co-occurring physical and mental or neurodevelopmental disorders (multimorbidity) and that up to 40% of youth with multimorbidity that require mental health services report unmet mental health care needs. This study examined mental health service use (i.e., perceived need or utilization) and access barriers among youth with multimorbidity (n = 3307) in comparison to youth with mental or neurodevelopmental disorders only (n = 2391). Data come from the 2019 Canadian Health Survey on Children and Youth (youth aged 5-17 years). Physical health conditions and mental and neurodevelopmental disorders were measured using a standard checklist. Participants were asked about the reasons for youth mental health services, professional consults, and among those who endorsed need/use of services if they had experienced barriers to access. Overall, 66.1% of youth in the sample perceived a need for or used services related to focusing/controlling behaviors, mental health, or learning difficulties; of these, 39.5% experienced barriers to accessing services. Compared to youth with mental or neurodevelopmental disorders only, those with multimorbidity were more likely to perceive need for services for mental health (AOR = 1.29 [1.10, 1.48]), and to consult psychiatrists (AOR = 1.32 [1.14, 1.62]). There was no significant difference in the overall difficulty in accessing services (AOR = 1.11 [0.92, 1.28]); however, youth with multimorbidity were more likely to experience barriers due to service unavailability (AOR = 1.48 [1.09, 2.13]). Findings underscore the importance for health systems to adopt models of care that integrate physical and mental health services, and for policies that eliminate mental health service barriers for youth with multimorbidity.
Depression remains a common and debilitating condition, and measurement-based care is widely recommended to guide treatment decisions. The study examined whether regular versus irregular completion of standardized symptom monitoring predicted differential improvement in depression outcomes within psychiatric specialty care. The research team analyzed electronic health record data from 502 adult outpatients between October 2023 and September 2024. The study categorized patients as regular (> 50
Suicide risk screening is a pivotal step in improving hospital safety and quality of care, with the potential to prevent suicide and facilitate mental health intervention. The Ask Suicide-Screening Questions (ASQ) is a brief, validated tool for pediatric and adult populations. This retrospective cross-sectional study sought to identify prevalence rates of suicide risk among pediatric and adult patients at an academic medical center in the Southeastern United States, examine demographic factors associated with ASQ outcomes, and compare suicide risk rates across presenting medical diagnoses. The ASQ was administered to patients 12 years and older upon admission to the ED or inpatient unit. Partial proportional odds modeling was used to examine associations between demographic factors and suicide risk. Chi-square analyses were used to identify differences in suicide risk across medical diagnoses. On the ASQ, 5
Crisis call centers serve important functions for public health. With the rise of artificial intelligence (AI) and potential roles in crisis call centers, it is important to examine what human behaviors influence the effectiveness of call center outcomes. The authors studied the U.S. Department of Veterans Affairs (VA) National Call Center for Homeless Veterans (NCCHV) to (1) examine differences in staff behaviors between top and average performers and (2) evaluate client outcomes of top-performing and average-performing staff. Of 159 NCCHV staff, 10 top-performing and 10 average-performing staff were randomly selected based on their annual performance ratings from fiscal years 2020-2023. For each NCCHV staff selected, three audio-recorded calls were sampled and blindly rated by researchers on a list of nine coded behaviors (e.g., empathy, thoroughness). Healthcare outcomes of clients served by these NCCHV staff were examined through analysis of their VA medical records data. Results found that top-performing staff were significantly more likely to be rated as tactful and empathetic, thorough with information gathering, and less likely to be rated as providing inappropriate advice and being forceful/rigid with clients than average-performing staff. Clients served by top-performing NCCHV staff showed significant increases in VA healthcare use including outpatient healthcare and homeless services after calling NCCHV which were not observed in clients served by average-performing NCCHV staff. Together, these findings suggest human behaviors of homeless call center staff influence client engagement with care, emphasizing the importance of staff training and caveating any potential use of AI in these call centers.
Older Chinese immigrant adults in the United States, the fastest-growing population among older immigrants, have low service utilization rates despite a high prevalence of mental health disorders. Mental health task-sharing, the delegation of low-intensity mental health tasks to non-licensed providers in community-based settings, has been implemented to improve access, yet research on engaging older Chinese immigrants remains limited, particularly in immigrant-serving community-based organizations. This study aimed to identify barriers and facilitators to engage older Chinese immigrants in the implementation of mental health task-sharing in community-based social services. Semi-structured interviews were conducted in 2023 with 30 frontline providers and administrators from 17 community-based organizations, including older adult centers, social adult day care, and Naturally Occurring Retirement Communities in New York City. Two coders coded transcripts independently and conducted thematic analysis using ATLAS.ti 24, guided by the Consolidated Framework for Implementation Research (CFIR). Results suggest barriers to engagement included community-level stigma and cultural beliefs, with older Chinese immigrant adults fearing negative social consequences within close-tie communities. Facilitators included building rapport, rephrasing mental health terminology, connecting mental health and physical health, and offering payment assistance. Addressing stigma and cultural beliefs was crucial for engagement in task-sharing implementation. Older Chinese immigrants can be effectively engaged by using culturally informed strategies to facilitate mental health task-sharing implementation.
As initiatives to address mental health crises are expanding throughout the United States, many efforts are focused on police, who often respond first to these emergencies. Co-response models have grown substantially over the past several decades. However, there is a limited evidence base for hybrid models that pair in-person police officers with virtual, on-demand behavioral health professionals (BHPs). This hybrid modality is important to assess given the increased use of telehealth for behavioral health services more generally to improve accessibility. Drawing from semi-structured interviews with 21 co-responders (police officers, n = 15; BHPs, n = 6) involved in a hybrid co-response program in Central Florida, this study provides insights into co-responders’ experiences with the partnership and perceptions of the model’s benefits and challenges. Findings revealed that co-responders valued the partnership for providing on-scene mental health support and assessment, real-world training during live emergencies, safety for both partners, and promoting trust with individuals in crisis. The hybrid model expanded service connections beyond mental health crises for substance use, grief counseling, and housing support. However, differing views on averting involuntary mental health examinations highlighted role conflicts rooted in liability concerns, alongside challenges such as securing consent for virtual consultations and limited partnership interactions. These data can guide agencies in refining hybrid models to align with frontline perspectives, especially in the absence of standardized interprofessional policies. Overall, this study has implications for broader behavioral health co-response teams that may involve other partners, such as paramedics in substance use crises.
Parents play a central role in youth mental health service utilization, including by seeking care, selecting treatment providers, and supporting treatment engagement. This help-seeking process often depends on parents having sufficient mental health literacy, including knowledge of treatment options. However, limited research has examined how parents-particularly those from racially and ethnically minoritized backgrounds-learn about youth mental health treatments and the degree to which they are familiar with evidence-based treatment options. Using a cross-sectional design, this study explored parents' use, preferences, and trust in information sources and their familiarity with treatment modalities, across White, African American, Hispanic/Latino, and Asian parents. Participants were 281 parents who completed an online survey battery. Results from descriptive analyses suggest that parents most commonly use pediatricians, health websites, and family members to gather information, though healthcare providers (i.e., pediatricians, mental health professionals, psychiatrists) were rated as the most trusted sources. Discrepancies emerged between information sources used and those preferred, including an unmet desire for information from mental health professionals. On average, parents recognized 40% of treatment modalities, with highest familiarity for family therapy, medication, and cognitive behavioral therapy. Results from chi-square tests of independence and ANOVAs showed both commonalities and differences in parental information-seeking and knowledge of youth treatment across racial and ethnic groups. Together, findings have implications for the design and delivery of programs designed to improve mental health literacy and ultimately increase mental health service utilization among youth, including those from racially and ethnically minoritized backgrounds.
This study evaluated the factor structure of a measure of mental health literacy (MHL) tailored to the role of helping professionals and assessed its association with help-seeking intentions among a sample of 946 child-serving professionals. Confirmatory factor analysis was used to model different factor structures of MHL for supporting youth, item response theory examined item discrimination, and structural equation modeling tested the relationship between MHL for supporting youth and help-seeking intentions. Results provided support for a higher order factor of MHL for supporting youth, with four first-order factors (i.e., mental health knowledge, attitudes/beliefs, perceived behavior control, subjective peer norms). Item discrimination varied across observed items and first-order factors. The second-order, multidimensional MHL factor was positively correlated with help-seeking intentions. These findings provide an initial step in validating a measure of MHL that accounts for the specific work roles and population characteristics unique to at-risk youth and aligns with prior definitions of MHL and the Theory of Planned Behavior. Future research should seek to replicate these findings across diverse service settings.
This paper describes conclusions from an expert report prepared for litigation against the Office of Refugee Resettlement (ORR) with relevance for all children at risk for placement in restrictive settings. The claims that ORR refused to release unaccompanied immigrant children to appropriate custodians, improperly retained children in restrictive placements, and placed children with behavioral, mental health, or intellectual and/or developmental disabilities in restrictive facilities because of their disabilities rather than their needs have universal relevance to systems of care for children. These conclusions could be used by regulators, funders, advocates, family members, and others to improve decision-making about the management of children at risk for placement in restrictive settings.
Adverse childhood experiences (ACEs) have been linked to food insecurity, poor health outcomes, and socioeconomic challenges. Despite this, there is a dearth of studies connecting ACEs to use of safety net programs in the United States (U.S). This study examines the prevalence and association between ACEs and parent-reported use of SNAP benefits in U.S. households. Data were obtained from the parent-reported 2022 National Survey of Children’s Health ( N = 52,521 children). Descriptive statistics were used to estimate prevalence rates, and six logistic regression models were used to determine the significant association between ACEs and parent-reported SNAP benefits use during the past 12 months. An estimated 57.5
HIV infection has been known to cause or exacerbate psychiatric symptoms. In individuals with HIV, mania may present as part of a bipolar disorder or as a distinct condition referred to as Mania Associated with Advanced HIV Disease (previously known as AIDS mania). We present a case of a 57-year-old patient with new onset symptoms of bipolar disorder in the setting of HIV infection. The patient was admitted for treatment of mania and found to have an HIV infection, but with a CD4 + count that was still above the threshold of AIDS. Eventually, the patient’s mood stabilized on a regimen of valproic acid 1500 mg twice daily and olanzapine 10 mg once daily. He developed infectious symptoms and was found to have cryptococcal pneumonia. He was started on fluconazole, but then subsequently left the hospital against medical advice.
To address high-cost inpatient utilization for those with severe and persistent mental illness, stakeholders from a County Department of Human Services, a Behavioral Health Managed Care Organization, and mental health providers created a value-based payment (VBP) model to shift funding from inpatient mental health treatment (IPMH) to intensive, evidence-based, community-based mental health treatment, Assertive Community Treatment (ACT). Using a retrospective observational study, individuals who received ACT from providers participating in the VBP (N = 2) were compared to individuals who received ACT from providers (N = 17) not supported through a VBP. Results show decreasing average ACT and IPMH expenditures as well as shorter lengths of stay over time for providers under a VBP compared to those not in a VBP. Access to care was not impacted. These results, including implications for behavioral health, are discussed in the context of quality of care.
Delta-8 THC is a psychoactive cannabinoid typically synthesized from hemp, with similar intoxicating effects as delta-9 THC. Surging public interest alongside the lack of federal regulation of delta-8 THC has led to an unclear legal landscape and increasing safety concerns. Educating young adults about the dangers of delta-8 THC is imperative. The current study investigated the effects of a brief educational video about delta-8 THC for college students. First, to help develop the intervention, an exploratory online survey was administered (N = 291) to gather information about perceptions of delta-8 THC and motivations for use. Mixed-methods analysis indicated that many students perceive delta-8 THC to have weaker (less intense, shorter-lasting) effects while being beneficial for mental and physical health. A strong motive for consumption was to enhance positive feelings, while conformity was a significantly weaker motive. These results informed the development of an educational video for students to highlight the risks of delta-8 THC and improve decision-making. Participants (N = 120) were randomly assigned to watch either a brief educational video about delta-8 THC or an unrelated control video about attending college. Results found that the educational video increased knowledge about delta-8 THC across all students, and lowered intentions to use delta-8 THC specifically for students who reported prior but not recent use of the substance. Perceived benefits, perceived costs, and attitudes towards legislation were not affected. Overall, results demonstrate support for the format of a brief stand-alone video intervention to increase knowledge and reduce behavioral intentions regarding delta-8 THC.
Mental health difficulties have been on the rise in recent years. Self-disclosure of mental health symptoms is related to a range of positive outcomes, and seeking help for mental health can be life-saving. Help-seeking for one’s mental health can be impacted by a variety of factors, such as the help-seeking target (e.g., friend, family member, or professional source) and the presenting problem (e.g., a personal emotional problem vs suicidal ideation). Internalized stigma of mental illness can impede help-seeking; however, it is not known if internalized stigma impedes (1) only certain types of problems or (2) help-seeking only from certain targets. It was hypothesized that the relationship between internalized stigma and willingness to seek help would vary based on (1) help-seeking target and (2) whether someone is seeking help for a personal emotional problem or suicidal thinking. Utilizing a sample of undergraduate students and a sample recruited through Prolific of adults with a history of help-seeking for mental health, bifactor models were run with stigma included as a manifest variable predicting willingness to seek help for suicidal ideation and personal emotional problems (each included as general factors) from three types of targets (friends/intimate partners, family members, and professional sources, each included as specific factors). Results indicate that internalized stigma negatively predicts willingness to seek help for suicidal thinking across targets and negatively predicts willingness to seek help for personal/emotional problems from friends/intimate partners and family members, but not from professional targets. These findings demonstrate that the relationship between internalized stigma and willingness to seek help is not uniform across help-seeking targets and presenting problems.
Peer support workers (PSWs) are trained behavioral health professionals with lived experience of substance use disorders. PSWs are employed by behavioral health agencies to increase uptake of and retention in treatment and recovery services. As their presence in these settings grows, it remains unclear how well PSW job functions align with their unique skills and personal experiences. To fill this gap, a content analysis of online job postings for PSW roles in Missouri across geographic regions and types of behavioral healthcare settings (i.e., treatment facilities, recovery housing, recovery community centers, hospitals, criminal justice settings) posted between April 2023 and September 2024 was conducted and analyzed to assess how they reflect role expectations and the distinct value PSWs contribute to the system. Job tasks were organized into categories and classified as authentic (utilizing PSWs' experience and training, e.g., mentoring, recovery goal setting, and peer advocacy) or generic (not specific to peer roles, e.g., administrative duties, transportation, maintaining relationships with external stakeholders). Results showed that PSWs are expected to perform a near even split of authentic (49.8%) and generic (50.2%) tasks. These findings suggest a lack of consistency in how agencies define and implement the PSW role, potentially contributing to job dissatisfaction and turnover. As organizations continue to employ PSWs in greater numbers, it will be important for agencies to prioritize job clarity and satisfaction, as well as determine the optimal balance of tasks for a more consistent system-level understanding of how to best utilize PSWs in the workplace.
Peer support workers (PSWs) play a key role in the substance use disorder (SUD) recovery field. According to organizational support theory, organizational actions and policies are key factors that promote perceived support and positive job-related outcomes. However, limited qualitative research has examined the construct of perceived organizational support from the perspective of PSWs working in the SUD recovery field. This study sought to determine what organizational actions and policies are perceived as supportive for PSWs. Semi-structured qualitative interviews were conducted with 25 PSWs actively working in the recovery field in South Carolina. Participants were asked “How does your employer or organization support you in the work that you do?” and “How could your organization support you better?” Interviews were recorded and transcribed verbatim. A team-based, rapid qualitative analysis approach was used to analyze data. Themes were identified and mapped onto existing guidelines for incorporation of PSWs into addiction medicine settings. PSWs reported that organizations can foster organizational support for PSWs through valuing PSWs as people with lived experiences. PSWs noted important supports such as living wages, insurance, job-related resources, and high-quality training and supervision. In addition, PSWs described how autonomy and reduced workload enable PSWs to optimize their time. Implications for organizations employing PSWs and recommended best practices are discussed.
Suicide prevention is a critical public health priority. The opportunity to intervene with this population is often in the primary care setting, but many at-risk individuals do not seek treatment. This study examines demographic differences in healthcare utilization patterns among suicide decedents, categorized into three groups: decedents who accessed care for mental health conditions, decedents who accessed care for non-mental health conditions, and decedents who did not access care. Data from the Arkansas All-Payers Claims Database (2013–2021) were linked to vital records to identify adult decedents who died by suicide. Healthcare utilization was categorized based on insurance claims filed in the year before death. Multinomial logistic regression was used to identify predictors of healthcare utilization, including age, gender, race, education, marital status, and rurality. Among 1678 decedents, 38.9
Substance use disorders (SUDs) are a major public health concern in the USA. In 2023, over 167 million Americans reported substance use, and more than 48 million met the DSM-5 criteria for a diagnosable SUD. Due to this high prevalence, behavioral health providers (i.e., psychologists, social workers, mental health counselors, and marriage and family therapists) regularly encounter clients affected by these disorders. However, many of these providers report receiving limited training in the assessment and treatment of SUDs. This gap in training is especially concerning given how widespread SUDs are and how frequently they co-occur with mental health conditions. To address this issue, this commentary will (1) examine research on SUD training gaps in graduate programs, (2) highlight the risks associated with inadequate SUD training, and (3) propose actionable strategies to enhance SUD-focused training across the behavioral health workforce.
