Middle-aged and older people with urgent, unaware, and unmet mental health care needs: Practitioners' viewpoints from outside the formal mental health care system.

BACKGROUND: Mental health challenges are highly significant among older individuals. However, the non-utilization of mental health services increases with age. Although universal health coverage (UHC) was reported to reduce unmet health care needs, it might not be sufficient to reduce unmet mental health care needs from a clinical perspective. Despite the existence of UHC in Japan, this study aimed to explore the factors related to the non-utilization of formal mental health care systems among middle-aged and older people with urgent, unaware, and unmet mental health care needs. METHODS: Purposeful sampling was used as the sampling method in this study by combining snowball sampling and a specific criterion. The interviewees were nine practitioners from four sectors outside the mental health care system, including long-term care, the public and private sector, as well as general hospitals in one area of Tokyo, where we had conducted community-based participatory research for five years. The interviews were conducted by an interdisciplinary team, which comprised a psychiatrist, a public health nurse from a non-profit organization, and a Buddhist priest as well as a social researcher to cover the broader unmet health care needs, such as physical, psychosocial, and spiritual needs. The basic characteristics of the interviewees were enquired, followed by whether the interviewees had case of middle-aged or older individuals with urgent, unaware, and unmet mental health care needs. If the answer was yes, we asked the interviewees to describe the details. The interviews pertinent to this study were conducted between October 2021 and November 2021. In this study, we adopted a qualitative descriptive approach. First, we created a summary of each case. Next, we explored the factors related to the non-utilization of formal mental health care systems by conducting a thematic analysis to identify the themes in the data collected. RESULTS: The over-arching category involving "the factors related to an individual person" included two categories, as follows: 1) "Individual intrinsic factors," which comprised two sub-categories, including "difficulty in seeking help" and "delusional disorders," and 2) "family factors," which comprised "discord between family members," "denial of service engagement," "multiple cases in one family," and "families' difficulty in seeking help." The over-arching category "the factors related to the systems" included four categories, as follows: 1) "Physical health system-related factors," which comprised "the indifference of physical healthcare providers regarding mental health" and "the discontinuation of physical health conditions," 2) "mental health system-related factors," which comprised "irresponsive mental health care systems" and "uncomfortable experiences in previous visits to clinics," and 3) "social service system-related factors," which comprised "the lack of time to provide care," "social service not allowed without diagnosis," and "no appropriate service in the community," as well as 4) " the lack of integration between the systems." Apart from the aforementioned factors, "the community people-related factor" and "factors related to inter-regional movements" also emerged in this study. CONCLUSIONS: The results of this study suggest a specific intervention target, and they provide further directions for research and policy implementation. The suggested solutions to the issues pertinent to this study are as follows: the recognition of the ways in which older people may inadequately understand their health or be unaware of available services, the building of a therapeutic alliance for "the individual intrinsic factors." Regarding the "family factors," the solutions include the provision of particularly intensive care for families with family discords, families with multiple cases, and families who find it difficult to seek help, as well as making intensive efforts for ensuring early involvement after contact with health care services. Regarding the "the factors related to the systems," the solutions include the implementation of mental health education campaigns aimed at enhancing mental health knowledge among non-mental health professionals, as well as formulating and implementing reforms ensuring that such professionals are increasingly responsible especially with regard to emergency inpatient care. It also include listening without ageism in clinical practice, the expansion of social services regarding human resources and the flexibility of use which increases the breadth of the types of care, as well as facilitating the integration between the associated health care systems. Further suggestions include encouraging community residents to join social security systems as well as the provision of particularly intensive care for people who have just moved in.

Morphological and optical properties of α- and ß-phase zinc (∥) phthalocyanine thin films for application to organic photovoltaic cells.

We have investigated the morphological and optical properties of α- and ß-phase Zinc Phthalocyanine (ZnPc) thin films for application to organic photovoltaic cells (OPVs). It was found that the α-phase is completely converted to the ß-phase by thermal annealing at 220 °C under ultrahigh vacuum conditions. When the α- to ß-phase transition takes place, the surface roughness of the ZnPc film became flat uniformly with a nanometer order of unevenness by anisotropic growth of crystalline grains along a lateral direction to substrates. Correspondingly, the optical absorbance of the ß-phase film became greater by 1.5-2 times than that of the α-phase one in an ultraviolet-visible-near infrared (UV-vis-NIR) wavelength range, which plays a role in increasing the number of photogenerated excitons. On the contrary, time-resolved photoluminescence measurements showed that the average lifetime of excitons for the ß-phase film became shorter by 1/6-1/7 than that for the α-phase one, which plays a role in decreasing the number of excitons achieving the donor/acceptor interface where excitons are separated to carriers (holes and electrons). Both the increase in the number and the shortening in the average lifetime have a trade-off relationship with each other for contribution to the photoelectric conversion efficiency of OPVs. Then, we examined an external quantum efficiency (EQE) of OPVs using the α- and ß-phase films as a donor and obtained that the former OPV (α-phase) exhibits a higher EQE by ∼2 times than the latter one (ß-phase) in the wavelength range of 400 nm-800 nm.

[Health status and support needs of low-income people admitted to supportive housing in urban areas of Japan: Research on new residents across several age groups].

Objectives　The aim of this study is to report on the health status of residents in supportive housing in urban areas of Japan, and to explore the differences in health conditions across different age groups within this population.Methods　The participants were 341 residents who had newly been admitted to supportive housing managed by a nonprofit organization. We examined their admission records and documented their health conditions. Differences in health conditions across age groups were also explored.Results　More than 90 percent of the participants were single men, aged 40 or older, and living on welfare. The main reasons for their utilization of supportive housing were the lack of accommodation after leaving a hospital or facility, decrease in physical function, and progression of dementia. A high proportion of participants under 40 years had an addiction problem, schizophrenia, intellectual disorders, or developmental disorders. Participants aged 40-59 years had high rates of lifestyle-related diseases in addition to mental illnesses. Furthermore, for those aged 60 years and older, the prevalence of geriatric syndromes such as dementia, hearing impairment, and visual impairment was high. Additionally, there was a high proportion of elderly participants whose health status was unknown when they were admitted to supportive housing.Conclusion　Most residents who had been admitted to supportive housing in the urban areas of Japan had physical or mental illnesses, and their life and support needs varied by age group. These findings suggest that it may be necessary for residents living in urban supportive housing in Japan to receive not only increased medical and psychological care but also age group-specific care.

Characteristics of Individuals With Mental Illness in Tokyo Homeless Shelters.

OBJECTIVE: Japan has the largest number of psychiatric beds in the world and has been in the process of deinstitutionalization since 2004. The majority of psychiatric inpatients are elderly long-term patients, who are at risk of homelessness after they are discharged. There is little information about homeless people with mental illnesses in Japan, and the aim of this study was to describe characteristics of people with a mental illness in homeless shelters in Tokyo. METHODS: A face-to-face survey was conducted from December 2012 to March 2013 by the staff of a nonprofit organization (NPO) that helps socially isolated persons. Of the 1,056 people who received help during the study period, 684 completed the survey. RESULTS: Eighteen percent of the 684 survey participants had a mental illness. Of the 210 individuals who lived in shelters, one-third had a mental illness. The mean age of shelter users with mental illness was 64.9; they tended to be referred from hospitals, and their mental well-being was poorer than other NPO service users in the study. Among the service users with mental illness, those living in shelters were older than those living in the community and more likely to have a history of trouble with alcohol, poor family relationships, and impaired instrumental activities of daily living. CONCLUSIONS: Unmet mental health needs were noted among discharged hospital patients living in Tokyo homeless shelters. An integrated and community-based support system with more effective health care delivery, including critical time interventions, is needed.