Patrick W. Corrigan, a frequent contributor to Psychiatric Services, died on January 11, 2026. He was an internationally recognized expert on psychiatric rehabilitation and highly cited scholar who studied the nature, causes, and consequences of mental illness stigma, as well as strategies to reduce stigma and improve the lives of people with mental illnesses. He was also a generous mentor to many graduate students, researchers, and practitioners. He was open about his own mental health struggles, which paved the way for others. Above all, he prioritized his family and friends. His impact on the field will live on through his work and those he mentored. Psychiatric Services 2026; 77:467-469; doi: 10.1176/appi.ps.20260117
BACKGROUND:The Affordable Care Act expanded Medicaid as a state option. Despite potential for Medicaid expansion to improve mental health for low-income adults, among whom Hispanic and Black adults are overrepresented, Medicaid expansion research has mostly overlooked differential mental health impacts. AIMS OF THE STUDY:This study examines whether Medicaid expansion improved mental health overall and across white, Black, and Hispanic adults. METHODS:Using 2011-2022 Behavioral Risk Factor Surveillance System data, we identified 474,801 Medicaid-eligible adults aged 18-64. State Medicaid expansions (2014-2021) were analyzed using the Callaway and Sant'Anna difference-in-differences estimator. Five mental health outcomes were examined overall and by race/ethnicity. Robustness was assessed through evaluation of 16 concurrent state-level policies against the common shocks criterion, including empirical testing of the two policies that satisfy the criterion. Validation tests assessed insurance coverage, cost barriers, elderly (age ≥65) placebo, and immigration enforcement as a moderator for Hispanics. RESULTS:Of 20 equations (5 outcomes across overall, Black, Hispanic, and white subsamples), 18 exhibited parallel trends. Among Hispanic adults, frequent mental distress (14+ poor mental health days) decreased by 2.7 percentage points (p < 0.001); controlling for the sole identified policy confounder (medical marijuana) strengthened this to 5.3 percentage points (p = 0.003). Any poor mental health days also decreased by 5.4 percentage points (p = 0.048). In the full sample, frequent mental distress decreased by 1.2 percentage points (p = 0.032), any activity-limiting days decreased by 2.0 percentage points (p = 0.043), and the number of activity-limiting days decreased by 1.9 days (p = 0.001). Among white adults, activity-limiting days decreased by 1.7 days (p = 0.020). Among Black adults, expansion increased insurance coverage by 6.5 percentage points (p = 0.032); the number of poor mental health days showed a reduction of 0.7 days (p = 0.054), with Black subgroup minimum detectable effects (MDEs) 1.1-2.6 times full-sample MDEs. Validation tests confirmed insurance coverage increased 7-9 percentage points and cost barriers decreased 4-5 percentage points. Of 16 concurrent state-level policies evaluated against the common shocks criterion, two satisfied both conditions for potential confounding. Including recreational marijuana policies produced results identical to baseline. Including medical marijuana policies strengthened the Hispanic result. DISCUSSION:Medicaid expansion reduced frequent mental distress and poor mental health days among Hispanic adults. Activity-limiting days declined in the full sample and among white adults. Among Black adults, there were marginally significant mental health improvements. Limitations include reliance on self-reported outcomes and subgroup minimum detectable effects 1.1-2.6 times the full-sample MDEs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Medicaid is an important source of mental health treatment and may reduce disparities for Black and Hispanic Americans. IMPLICATIONS FOR HEALTH POLICY:H.R. 1 (2025) will reduce federal Medicaid matching and create work requirements for expansion beneficiaries. Because Black and Hispanic adults rely more heavily on Medicaid under expansion, these populations may be disproportionately affected. IMPLICATIONS FOR FURTHER RESEARCH:Future research should disentangle contributions of coverage expansion from correlated state policies.
BACKGROUND:The need for mental health care is growing in the U.S., yet care is elusive for many patients. Among people experiencing mental illnesses, those with disabilities often face additional obstacles when seeking care. Therefore, proximity to mental health services is especially important for this population. Although regional differences in travel distances to mental health facilities have been documented, their implications for individuals with disabilities are not well understood. AIMS OF THE STUDY:This study compares geographic proximity to mental health facilities between individuals with and without disabilities. We also compare geographic access to facilities across counties with different characteristics, including having high versus low shares of residents with disabilities. METHODS:This study links American Community Survey population data with mental health facility locations from the Mental health and Addiction Treatment Tracking Repository (MATTR) to estimate the number of people living within a 30-minute drive of a facility. We calculate these estimates overall, and by population and county characteristics. We also estimate a multivariate county-level regression in which the population share in each county that lives within a 30-minute drive of a mental health facility is regressed on county characteristics. RESULTS:Most of the U.S. population (96.2% of individuals without disabilities and 94.8% of individuals with disabilities) lives within a 30-minute drive of one or more mental health facilities. However, geographic access to mental health facilities is low in rural counties, where more than one quarter of the population does not have access to a mental health facility within a 30-minute drive. Compared to non-rural counties, rural counties have a higher concentration of individuals with disabilities and higher rates of clinician-diagnosed depression or self-reported severe depression. After controlling for rurality, state, population, racial composition, income, and depression prevalence at the county level, the share of a county's population within a 30-minute drive of a facility remains negatively correlated with the share of the county's population with disabilities. DISCUSSION:Overall geographic access to mental health facilities is high in the U.S., and there is only a small disparity between individuals with and without disabilities. However, geographic access to mental health facilities is lacking in rural communities. This pattern is especially costly for people with disabilities because of their relatively high concentration in these areas. People with disabilities likely face additional barriers to accessing care compared with people without disabilities living in the same location. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:The lack of nearby mental health facilities remains a significant access barrier to mental health care for people in rural communities. These access gaps are of concern because rural communities are especially vulnerable, as evidenced by a high proportion of individuals with disabilities and a higher prevalence of depression. IMPLICATIONS FOR HEALTH POLICY FORMULATION AND FUTURE RESEARCH:Measuring disparities in geographic access to mental health facilities by disability status may yield different results depending on whether comparisons are performed at the individual or the community level. Community-level and individual-level disparities may require different policy solutions.
BACKGROUND:In the US, several states including New York State (NYS) have adopted Medicaid value-based payment (VBP) policies to improve healthcare quality and reduce spending. However, the impacts of these policies on vulnerable Medicaid beneficiaries with high behavioral health needs including those with serious mental illness (SMI) are unknown. AIMS OF THE STUDY:To inform policy efforts to improve the value of Medicaid-funded care by examining the early impacts of NYS's VBP policy implemented in 2017 on the quality of healthcare received by adult beneficiaries with SMI. METHODS:We conducted a retrospective cohort study to examine the association of the VBP policy with healthcare quality among adult Medicaid beneficiaries with SMI. We estimated difference-in-differences models comparing VBP-exposed and unexposed beneficiaries during the period preceding VBP implementation (2014-2016) and in 2018, a full year following implementation. Quality was assessed with 10 validated and SMI-relevant measures of mental healthcare quality (e.g., adequate Adherence to Antipsychotic Medications for Individuals with Schizophrenia, and Follow-up after Hospitalization for Mental Illness, 30-day), physical healthcare quality (e.g., Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are using Antipsychotic Medications; Comprehensive Diabetes Care, Eye Exam), and overall healthcare quality (All-Cause Readmissions). Models for all outcomes adjusted for concurrent policies, and models for acute care measures also adjusted for need variables. RESULTS:Our diverse cohort included 172,420 person-years with SMI, with 28.5% VBP-exposed. The largest diagnostic groups were schizophrenia and bipolar disorder (42.2% and 41.3%, respectively). The VBP-exposed and unexposed beneficiaries differed on most characteristics, with the unexposed being slightly younger, less diverse, and healthier relative to the VBP-exposed. After adjusting for covariates, VBP-exposure was associated with changes in only two of the 10 quality measures compared with the VBP-unexposed group: a 1.8- percentage-point (pp) increase in adequate Adherence to Antipsychotic Medications for Individuals with Schizophrenia (95% CI, 0.5-3.2) and a 1.4-pp decrease (95% CI, -2.6 to -0.1) in Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are using Antipsychotic Medications. DISCUSSION:A year following its implementation, a Medicaid VBP policy that involved varying degrees of provider risk-bearing had few quality impacts, one positive and one negative, among the state's beneficiaries with SMI. Our study, the first to examine VBP quality impacts with several validated measures of mental, physical, and overall healthcare quality, has some limitations, including that we cannot rule out time-varying unmeasured confounding, nor can we isolate the effects of type of risk arrangement (one-sided versus two-sided) or the mix of measures potentially associated with quality of SMI care included in the VBP contracts. Additionally, our study may not have captured the full impacts of the VBP policy due to our relatively short observation period. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH:Policymakers seeking to use VBP to improve quality of SMI care may consider VBP policy features likely to facilitate achieving this goal, for example, incentives for delivering clinically integrated care and inclusion in contracts of SMI-relevant quality measures. Future studies should be designed to confirm and extend our findings.
OBJECTIVE:This randomized pilot trial aimed to evaluate the feasibility, acceptability, and preliminary outcomes of a digital smoking cessation intervention (DSCI)-adapted for psychiatric inpatients and designed to bridge the postdischarge treatment gap-and compare the DSCI with brief counseling (BC). METHODS:Psychiatric inpatients who were tobacco users were randomly assigned to DSCI or BC and assessed at 1 and 3 months postdischarge. Feasibility was examined via enrollment rates, acceptability was assessed by examining program engagement and satisfaction, and preliminary outcomes were assessed via abstinence outcomes at 1 and 3 months following hospital discharge and via postdischarge smoking cessation treatment use. Potential mechanisms of action (tobacco craving, abstinence self-efficacy, and abstinence motivation) were also evaluated. RESULTS:Among 218 eligible patients, 27% (N=58) enrolled in the trial. Among DSCI participants with available data (N=31), 84% used at least one intervention component in the month following discharge, with website visits (65%) and community engagement (58%) being most common. At 1-month follow-up, significantly more DSCI participants reported 7-day abstinence compared with BC participants (N=6 vs. N=0, p=0.04). DSCI participants showed significantly greater increases in abstinence motivation from baseline to 1 month (p=0.05), whereas BC participants' motivation decreased. In qualitative interviews, DSCI participants valued the hospital-based orientation to DSCI and found automated text messages helpful for maintaining abstinence goals. CONCLUSIONS:This pilot trial demonstrated promising signals regarding the feasibility, acceptability, and preliminary postdischarge outcomes of a digital intervention for promoting smoking cessation among psychiatric inpatients.
BACKGROUND:Common mental disorders (CMDs) are a leading cause of sickness absence and early retirement due to health problems. Early identification and treatment of CMDs may have a positive impact on prognosis and associated economic costs, including healthcare expenditure, lost productivity, and the societal burden. The effectiveness of workplace psychotherapeutic interventions has been studied, but information on cost-effectiveness in this population is lacking. AIMS OF THE STUDY:This study evaluates the cost-effectiveness of the FRIAA intervention for employees with CMDs compared to care as usual (CAU), with the aim of reducing sickness absence and preventing early retirement. METHODS:We used data from a multicenter randomized controlled trial involving 549 employees with mental health problems in different companies located near five study centers in Germany, who provided data at nine- and 15-month follow-up. A total of 545 records were available for the economic evaluation (EE). 278 participants were assigned to the intervention group (FRIAA), and 267 participants were assigned to the CAU condition. On average, intervention participants received eight intervention sessions. The use of health and social care services was assessed using the Client Sociodemographic and Service Receipt Inventory (CSSRI) at nine- and 15-month follow-up. Data were transformed to a 12-month reference period. Quality of life was measured using the EQ-5D-5L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional quality adjusted life year (QALY). RESULTS:The annual cost difference between FRIAA and CAU was euro 3,484.29 (95 % confidence interval [CI] euro 1,033.91 to euro 5,934.67), which was significant (p = 0.005). We estimated the average QALY in the CAU group to be 0.768 (SD = 0.200) and in the FRIAA-group to be 0.789 (SD = 0.192). The difference in QALY between FRIAA and CAU was 0.021 (95 % CI -0.013 to 0.055), which was not significant (p = 0.203). The incremental cost-utility ratio (ICUR) showed that the intervention was associated with costs of euro 165,918.57 for one additional year of full health. DISCUSSION:As far as we know, this was the first EE of a psychotherapeutic consultation at work called FRIAA. Compared to CAU, FRIAA did not result in improved quality of life in terms of QALYs, nor favourable cost-utility for FRIAA compared with CAU. The FRIAA intervention cannot be considered cost-effective compared to CAU. IMPLICATIONS:This EE found that differences in costs were significant (with higher costs in the FRIAA group), while no statistically significant differences in QALYs were observed between the study groups. In addition, the cost-utility for FRIAA compared with CAU was not favourable. Participants with CMDs may need more time to integrate what they discuss in psychotherapy sessions into their daily lives before they can improve their personal quality of life and thus show long-term changes in sick days. Longer follow-up periods may be needed in future studies.
BACKGROUND:Access to mental health care and its integration with primary care remain critical challenges worldwide. In France, these problems are compounded by fragmented provision, poor coordination, and limited reimbursement for psychotherapy, despite the country's high levels of health expenditure. AIMS:This perspective examines how community health centers (centres de santé) can contribute to integrated care, understood as the systematic coordination of physical and mental health services across providers. We analyze the case of the Centre de Santé de Belleville in Paris as an illustration of how CDS can host significant mental health capacity for vulnerable populations, and explore why the model remains marginal in the French health system. METHODS:We combine analysis of national policy reports, academic literature, and internal audit data from the Belleville center to situate CDS within French health system dynamics. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) grid is used to summarize the model. RESULTS AND DISCUSSION:The Belleville case illustrates that CDS can deliver integrated mental and primary care, with salaried teams of general practitioners, psychologists, and a psychiatrist serving a disproportionately vulnerable population. However, structural weaknesses - financial fragility, fragmented representation, reputational risks, and the enduring dominance of the self-employed, independent physician ("liberal medicine") - limit their wider diffusion. Policy windows linked to financing reform, workforce shortages, and broader frames such as sustainability occasionally elevate CDS on the agenda, but institutional path dependency keeps them peripheral. IMPLICATIONS:Community health centers in France illustrate how institutional legacies and professional power can constrain the adoption of organizational models aligned with policy goals. For international readers, the case underlines the importance of political economy and system values - in this case, liberal universalism - in shaping the possibilities for integrating mental and primary health care.
OBJECTIVE:This study examined the characteristics and quality of lethal means counseling (LMC) action plans documented as part of the Safety Planning Intervention (SPI) carried out in U.S. Department of Veterans Affairs Medical Centers (VAMCs), as well as differences in documentation quality based on patient and clinical characteristics. METHODS:Three authors rated 910 LMC action plans abstracted from six VAMCs selected for geographic and facility-level diversity. Ratings, based on the SPI scoring algorithm, range from 0 (no text pertaining to lethal means access reduction) to 3 (highly specific). RESULTS:LMC action plans received low quality scores (mean±SD=1.29±0.86). Documentation was often vague or reviewed past actions instead of formulating a specific plan for lethal means access reduction. Steps to reduce firearm access were documented in plans for 74% of veterans reporting firearm access (54% of all veterans). Steps to reduce access to medications (20%) and other lethal means (13%) were less frequently documented. Plan text was in veterans' own words, as intended, only 27% of the time. Quality of LMC action plans was rated higher for male versus female veterans, for veterans with versus without documented access to firearms, and for outpatient versus residential and emergency settings. CONCLUSIONS:In this study examining documentation quality of a sample of LMC action plans across a health care system, the average score for quality was low. Findings indicate clinician awareness of firearm risks but less discussion about other lethal means. Future work should develop training and implementation strategies to improve LMC action plan documentation.
OBJECTIVE:Immigrants are less likely to use mental health treatments than their U.S.-born counterparts despite demonstrated needs. Whether this pattern holds across specific treatments, including antidepressant use or seeing a mental health professional (MHP), is unknown. This study used a nationally representative sample of Asian and Latine adults to examine associations of nativity with engaging in any mental health treatment, past-month antidepressant use, and past-year MHP visit. METHODS:Cross-sectional analysis of the National Health and Nutrition Examination Survey (2011-March 2020) examined 9,356 adults (mean age=47.5 years, 52.6% female, 71.8% foreign born) identifying as non-Hispanic Asian (N=3,259) or Latine (N=6,097). RESULTS:Logistic regressions controlling for demographic and health care access variables found that foreign-born (vs. U.S.-born) respondents had significantly lower odds of any treatment use (odds ratio [OR]=0.59, 95% CI=0.50-0.70), past-month antidepressant use (OR=0.57, 95% CI=0.45-0.73), and past-year MHP visit (OR=0.63, 95% CI=0.52-0.77). Among foreign-born groups, Asian (vs. Latine) respondents had significantly lower odds of using any treatment (OR=0.44, 95% CI=0.34-0.58) or seeing an MHP (OR=0.42, 95% CI=0.31-0.57) but not using antidepressants. CONCLUSIONS:Foreign-born adults are less likely to use mental health treatments, including using antidepressants or seeing an MHP. Independent of nativity, Asian (vs. Latine) respondents were less likely to engage in all treatment types. Asian and Latine group differences in any treatment use and seeing an MHP were present among foreign-born respondents only, suggesting that these differences may be driven by nativity-related factors.
Housing First provides immediate, permanent, supportive housing with consumer choice, harm reduction, and separation of housing and services. This descriptive, cross-sectional study surveyed five Housing First programs that operate in Brazil and represent all known initiatives during data collection. Although programs adhered to Housing First's core principles, substantial variation existed across sites in governance, funding, staffing, and public service integration. Key implementation barriers included food insecurity and neighborhood safety concerns. National policy momentum provides a pathway for coordinated scale-up; however, funding mechanisms, integration with local services, and monitoring structures remain underdeveloped. Additionally, operational guidance was lacking.
OBJECTIVE:The authors of this review aimed to examine the characteristics of published research on the clinical diagnosis of malingering and to critically assess the reporting of data on housing, race-ethnicity, and co-occurring psychiatric disorders. METHODS:Five databases (Embase, MEDLINE, ProQuest Dissertations and Theses Global, PsycInfo, and Web of Science) were searched from database inception to June 17, 2025. Results were independently screened by two researchers to identify studies of patients given a diagnosis of malingering in a clinical setting. PRISMA guidelines were followed. RESULTS:Of 3,150 records screened, 21 articles were included. Methods of identifying malingering used by these studies included the nonmutually exclusive categories of chart review (N=17 studies, 81%), ICD codes (N=7, 33%), and DSM criteria (N=3, 14%). Only five (24%) articles reported the housing status of individuals given a diagnosis of malingering. The racial-ethnic characteristics of people determined to be malingering were seldom reported (N=6, 29%). Although nine (43%) articles reported the prevalence of co-occurring psychiatric disorders among people determined to be malingering, the focus of reporting was overwhelmingly on personality, mood, psychotic, and substance use-related disorders, with limited coverage of cognitive disorders and anxiety- and trauma-related disorders. Only three (14%) articles reported data on longitudinal mental health outcomes such as overdose and suicide. CONCLUSIONS:Limited data are available with regard to how diagnostic decisions about malingering take into consideration patients' housing status and mental health history. Potential racial-ethnic disparities in malingering diagnoses are poorly characterized.
OBJECTIVE:Rigorous research robustly supports individual placement and support (IPS) as the leading evidence-based vocational rehabilitation practice for adults with serious mental illness. Randomized controlled trials have consistently shown positive competitive employment outcomes over 1 or 2 years for IPS participants, compared with those who receive a variety of comparison interventions. Although long-term follow-ups are scarce, they matter because recovery is a longitudinal process. In this narrative review, the authors examined the available evidence from long-term IPS follow-ups (≥3.5 years). METHODS:A literature search included an examination of recent IPS systematic reviews and a Google Scholar search. RESULTS:Among eight long-term IPS follow-up studies, all but one showed persistence of competitive employment, some for as long as 10 years. The studies did not consistently collect data regarding ongoing support, other important recovery outcomes, and disability status. CONCLUSIONS:IPS often leads to long-term competitive employment, but other critical recovery issues remain uncertain.
OBJECTIVE:The authors sought to elicit public mental health workers' recommendations for increasing the behavioral health workforce. METHODS:Semistructured interviews were conducted with 20 mental health workers in Philadelphia from September to October 2024. Thematic analysis was used to determine the most effective strategies for recruiting and retaining the behavioral health workforce. RESULTS:The workers supported various policy strategies to increase the workforce, such as employment and financial incentives, including sign-on bonuses and health care benefits. Workers noted that regarding current policies, updated information on federal loan forgiveness programs was challenging to find. They also emphasized that combining several policy strategies would effectively sustain the workforce. CONCLUSIONS:Comprehensive efforts are needed to adequately address the shortage of behavioral health workers in community settings. Workers championed a combination of several changes to increase the behavioral health workforce, with implications for mental health research, systems, and policies.
As the world recovers from the height of the COVID-19 pandemic with ongoing plans for a strengthened behavioral health infrastructure-from crisis services to long-term care-one of the health conditions that has emerged is long COVID. This multisystem condition is characterized by persistent symptoms that develop after the acute phase of COVID-19 infection. Although the full clinical and scientific understanding of long COVID's neuropsychiatric impact is still evolving, a sizable cohort of patients has emerged with various long-term and often confusing symptoms, which can include cognitive impairment, mood dysregulation (e.g., anxiety or depression), sleep disturbances, posttraumatic symptoms, and chronic fatigue. Recognizing long COVID's debilitating impact on quality of life and wide-ranging societal consequences, the authors sought to summarize current knowledge about long COVID among individuals with a preexisting serious mental illness and to propose care and treatment recommendations for clinicians and public policy makers.
OBJECTIVE:The Early Psychosis Intervention Network (EPINET) is funded by NIMH and includes 111 early psychosis programs across the United States. EPINET presents an opportunity to examine characteristics of early psychosis programs and their participants on a national scale in order to maximize the utility of person-level data and understand the context of the programs within this national sample. In this study, the authors explored structural characteristics of programs participating in EPINET-funded hubs. METHODS:EPINET hubs and programs collected data from a measure that gathers contextual information, including program age, size, funding, and eligibility criteria. RESULTS:Most EPINET programs were administered by community mental health centers (60%) funded through multiple sources (87%), including Medicaid and non-Medicaid insurance. More than three-quarters were initiated during or after 2014, when the federal government allocated an influx of funding for early psychosis programs. CONCLUSIONS:EPINET provides opportunities to advance an understanding of and improve outcomes in early psychosis care through large-scale, data-driven research. This study revealed program-level characteristics of the sample relevant to service capacity, funding streams, and other contextual factors that may affect the quality and effectiveness of service delivery. Sustainability of current financing mechanisms remains an important consideration for the maintenance and expansion of coordinated specialty care programs. Future studies could investigate factors that shape implementation efforts of early psychosis programming, such as state-level policy, use of federal funding for program development, and considerations about sustainability.
OBJECTIVE:This study aimed to assess associations between characteristics of contacts with the Veterans Crisis Line (VCL) and subsequent Veterans Health Administration (VHA) mental health care use, suicide-related events (SREs), and suicide mortality from 2016 to 2023. METHODS:This retrospective cohort study used VCL user data and administrative records from the Veterans Affairs Corporate Data Warehouse for 365,222 unique veterans who contacted the VCL between January 2016 and December 2022. The authors examined relationships between VCL contact characteristics, including contact type (calls, texts, and transfers), responder-assessed suicide risk level, and day of contact, and outcomes within 12 months of VCL contact (VHA mental health care use, VHA emergency department use, SREs, all-cause mortality, and suicide-specific mortality). RESULTS:High-risk users, those requiring emergency dispatch or welfare checks, and those contacting VCL on weekends were more likely than their counterparts to use mental health services and experience SREs. Users contacting the VCL by text had a lower likelihood of all-cause mortality than direct callers. Changes in user characteristics since VCL service expansion in 2016 were observed, indicating a broader demographic reach and altered risk profiles. CONCLUSIONS:The findings underscore the critical role of the VCL in facilitating access to health care for veterans experiencing a crisis and the necessity of targeted interventions for high-risk groups. The evolution in VCL user profiles and contact characteristics suggests ongoing changes in veterans' needs and preferences, reinforcing the importance of continuous adaptation of suicide prevention strategies. Future evaluations should focus on longitudinal outcomes and qualitative user experiences to enhance the effectiveness of crisis intervention services for veterans.
OBJECTIVE:Understanding is limited about how youths (ages 12-24) engage with peer support services across in-person, virtual, and hybrid formats, particularly within integrated youth services (IYS) settings. This study aimed to examine the demographic, health, and social characteristics of youths accessing peer support services; explore the types of peer support services utilized at an IYS initiative; and identify potential differences between clients who access in-person, virtual, and hybrid (i.e., in-person and virtual) services. METHODS:A secondary data analysis was performed for all youths who accessed youth peer support services at an IYS initiative in British Columbia, Canada, from April 2018 to February 2023. Self-reported demographic characteristics, mental health, and distress and the services accessed were examined across three modalities (in-person, virtual, and hybrid services). RESULTS:During the study period, 3,586 unique youths attended 12,343 peer support visits. Youths had low self-rated mental health (poor, 35%; fair, 36%) and high distress (mean±SD Kessler Psychological Distress Scale score=30.73±9.08 out of 50) upon initial presentation. Significant differences were found among the in-person, virtual, and hybrid groups by age, race, and sexual and gender minority status. CONCLUSIONS:This large cohort of youth peer support clients had extremely high distress at initial presentation. Youth peer support, provided through an IYS model with multiple modalities to improve service access for diverse youths, should be considered as one option for addressing systemic inequity in health care and the current global youth mental health crisis.
OBJECTIVE:Hospitals face ongoing challenges in managing unnecessary readmissions. The aim of this study was to implement a novel, pattern-focused approach in order to identify and describe distinct patterns of readmissions among recurrently admitted psychiatric inpatients. METHODS:Admission records from 11,986 inpatients of an acute psychiatric hospital in the territory of Western Australia were retrospectively analyzed, with a focus on 1,831 patients with recurrent admissions (three or more admissions within 5 years). Cluster analysis grouped these patients on the basis of overall and dynamic temporal patterns of their readmissions across time. RESULTS:Five distinct readmission patterns were identified, characterized by patients' admission frequency (mild, moderate, or intense) and whether they were readmitted in an episodic or stable pattern. CONCLUSIONS:The pattern-focused approach identified novel readmission patterns reflecting both static and dynamic characteristics of recurrent inpatient care. This study provides the foundation for research into early indicators, risk prediction, and time-sensitive, patient-specific interventions. These clinical applications can guide hospitals to effectively prevent unnecessary inpatient readmissions.
Literacy is a social determinant of health that can affect perinatal help seeking and maternal and neonatal outcomes. This study aimed to evaluate the readability of online information concerning perinatal mental health and psychotropic medication safety. Online materials were identified through Google searches that mirrored a typical patient's experience; readability was assessed via the Flesch-Kincaid Grade Level. On average, general and perinatal mental health information was written at or above a 12th-grade level, higher than the national recommended reading level. Information regarding medication safety during pregnancy required even higher levels of literacy. Patients may benefit from having perinatal mental health education materials tailored to their literacy level.
OBJECTIVE:The authors aimed to assess return on investment (ROI) in the implementation of individual placement and support (IPS) for employment in Norway. METHODS:A four-state, 4-year Markov model was constructed to explore the costs and benefits of IPS implementation for 561 new recipients (ages 18-40) of a time-limited, health-related rehabilitation welfare benefit. Data were from multiple sources, including a difference-in-differences analysis of longitudinal registry data, detailed IPS resource use and cost data, and the literature. The primary outcome was ROI, from societal and public-purse perspectives, compared with outcomes in areas in Norway without IPS. RESULTS:Net economic benefits of 2025 international dollars (Int$) 2.6 million and Int$240,000, equivalent to ROIs of 4.76 and 1.34, were generated from societal and public-purse perspectives, respectively. Of the target population, 9% received IPS per year, at a cost of Int$700,000, equal to 67.8 additional full-time equivalent (FTE) years of work if employment gains were sustained over 4 years. For each additional FTE year of work, 33.1 work assessment allowance (WAA) recipients would need to receive IPS. The most sensitive model parameter, WAA benefit, would have to be reduced by 24% for IPS not to have a positive ROI. CONCLUSIONS:Even under conservative assumptions, the addition of IPS to supported employment approaches is likely to have a positive ROI from societal and public-purse perspectives in just over 1 and 3 years, respectively, even before broader benefits, such as impacts on health services utilization and reduction in the use of alternative supported employment services, are considered.
