Michelle R. Munson

Adolescent Experience of Psychotropic Treatment

Despite growing concern over the treatment of adolescents with psychiatric medications, little research has examined youth understandings and interpretations of mental illness and psychotropic treatment. This article reports the exploratory findings of semi-structured and open-ended interviews carried out with 20 adolescents diagnosed with one or more psychiatric disorders, and who were currently prescribed psychiatric medications. Grounded theory coding procedures were used to identify themes related to adolescent subjective experience with psychiatric medications. The categories identified are interpreted as different points of view through which adolescents understand and take action upon their illness concerns; their need for medication treatment; their perceptions of how medications work; their responses to parental and other influences upon medication treatment; and, their everyday management activities.

Static, dynamic, integrated, and contextualized: A framework for understanding mental health service utilization among young adults

Research has illuminated the problem of untreated mental illness among young adults, including evidence that young people who exit public care systems often discontinue mental health services in adulthood. The present study explored mental health service use experiences during the transition to adulthood among sixty young adults, ages 18-25, from a Midwestern U.S. state. In-depth semi-structured interviews were conducted. All participants had mood difficulties, and shared three childhood experiences: (a) mood disorder diagnosis; (b) use of public mental health services; and (c) experience with social service systems. Immersion and grounded theory coding techniques were applied to the interview data. Two major themes about mental health service use emerged from the findings, namely the changing nature of service use over time and characterizations of experiences associated with service use at a given point in time. Categories of explanatory constructs that emerged in the latter theme included perceived need, emotions, perceived efficacy of services, and social considerations, among others. Findings suggested a four-facet mid-level theory of service utilization, highlighting both the cross-sectional and time-variant character of service use and decision-making within context. Links between broader theoretical frameworks of service utilization and social psychological models of decision making were noted, and guidelines were presented for ten classes of variables that researchers interested in understanding service use by young adults should consider.

Case managers speak out: responding to depression in community long-term care.

OBJECTIVE This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients. METHODS Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care. RESULTS Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression. CONCLUSIONS Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers.

Are Health Beliefs Related to Adherence Among Adolescents with Mood Disorders

This study explored the illness perceptions, attitudes towards mental health services and adherence behaviors among a group of adolescents in treatment for mood disorders in an urban city in the United States. Seventy adolescents completed a battery of questionnaires assessing demographics (e.g., gender, family income), perceptions of illness (e.g., consequences, treatment control) and overall attitudes towards mental health services. Adolescents and their parents also reported on the youth’s adherence to both psychotropic medication and mental health appointments. Simultaneous logistic regression analyses revealed that attitudes and family income made a significant and unique contribution in explaining adolescents’ adherence behaviors. Interventions that help adolescents become aware of their attitudes toward mental health services and provide information on dimensions of mood disorders, such as the chronic nature of depression and the effectiveness of treatment, may impact adherence behavior. Also, among a group of families with access to services, yearly family income remained a significant barrier to attending appointments all of the time. Policy implications are discussed.

An Engagement Intervention for Young Adults with Serious Mental Health Conditions

Young adults with serious mental health conditions (SMHCs) often do not engage continuously with mental health services, and there are few engagement interventions designed for them. This qualitative study presents a blueprint for conceptualizing and developing an engagement intervention designed for young adults with SMHCs. The blueprint includes the following activities: (1) establishing a strong theoretical basis, (2) designing an initial manual based on previous research and practice, (3) systematically examining feedback on the manual from stakeholders, and (4) examining the feasibility, acceptability, and implementation demands of the intervention. Interviews, group discussions, and journaling were utilized to collect information from young adult participant-researchers, intervention facilitators (i.e., recovery role models and clinicians), and additional stakeholders (e.g., clinic staff and administrators) (N = 43). Analyses were performed with multiple coders using constant comparative methods. Results revealed critical information to improve the intervention, while also suggesting that the engagement intervention for young adults with SMHCs has promise.

Supportive Relationships Among Former System Youth With Mental Health Challenges

This study explored the supportive relationships that former system youth (FSY; e.g., foster care) with mental health challenges identified as “key” in making the transition to adulthood. In-depth semi-structured interviews were conducted with 59 FSY, ages 18 to 25, with mental health challenges. Participants were asked to reflect on their relationships with a key helper or what the literature defines as a natural mentor, “an adult that has been particularly helpful, or supportive,” in this case with their mental health. Seventy-six percent (N = 45) of the participants identified a key helper. Relationship qualities that emerged as salient to successful transition included consistency, mutuality, and empathy. The nature of support received included emotional, informational, and tangible support. Implications for research, practice, and policy are discussed.

Mental Health Service Use Among Young Adults: A Communication Framework for Program Development

Research on mental health service engagement has been dominated by attempts to identify determinants of engagement. Such knowledge is important but incomplete. Once identified, program designers need to use evidence-based principles to design programs to bring about changes in the empirically identified determinants. Research is relatively silent on such principles. This article develops a framework to guide program designers’ as they address factors that constrain and/or facilitate engagement. The framework is grounded in communication theory and evidence from related behavioral science research. The literature is summarized and used to generate a check-list of questions to consider when structuring engagement programs.

Older Youth Nearing Their Exit from Congregate Care: Current Innovative Programs

SUMMARY The present paper reviews literature on older youth in foster care with a focus on those older youths in residential. We aim to examine what has been written in the scholarly literature about this specific group. Literature was reviewed from the last decade on the problems these youths face and potential solutions for them in the program literature. A literature review was done utilizing keywords. Further, this paper presents highlights from two informational interviews with residential agencies. Here we aim to describe what the Executive Directors and staff members believe older youths need, how they work with them and the important components of a residential facility for older youth. Findings uncovered that both agencies highlighted the importance of pro-social attachments, or caring relationships, along with education and safety. Also, the critical importance of preparing youths enough so that when they leave residential they will have reduced the gap between their skills and others their age, so as to be able to compete in society for jobs and further education. Limitations include lack of generalizability, among others.

Exploring the perceptions of workers on young adult mental health service (dis)engagement

Abstract The purpose of this research is to glean how social workers understand and address engagement in mental health services among transition-age youth and young adults (TAYYA). Five focus groups with 26 social workers were conducted. Workers were asked questions about their perspectives on the concept of engagement. Data analysis consisted of the constant comparative method. Results revealed that workers perceive many layers of the ecosystem impact TAYYA engagement in mental health services, including factors at the individual, meso, and systems levels. Results suggest that agencies may be able to increase TAYYA engagement by focusing on both worker and agency-level characteristics.

Social Context in Mental Health Service Use Among Young Adults

ABSTRACT Examining the sources of health communication that young adults with mental health challenges receive regarding service use is critical to curbing the societal concern of unmet mental health needs of this population. Semistructured interviews were conducted with 59 young adults, all of whom were diagnosed with a mood disorder and used public mental health services and additional public systems of care during childhood. Thematic analysis was utilized. Of the 59 participants, 45 nominated at least one supportive adult, with a total of 97 relationships analyzed. Results indicate that the majority of messages came from informal supports (e.g., family) who spoke positively about mental health services. Fewer messages came from formal supports (e.g., professionals). Messages included statements surrounding beliefs toward services, social norms (approval and disapproval), self-efficacy, and image considerations around using services. These findings can suggest ways that mental health service engagement interventions can leverage communication from informal supports. Future research can explore what messages young adults find most influential in persuading them to use mental health care consistently and the relationship between messages and health behavior.