A Secret Shopper Study of Language Accessibility of Community-based Behavioral Health Services for Children in Families Who Speak Spanish and English.

OBJECTIVE: To compare outpatient behavioral health scheduling for children in Spanish-speaking families in Pennsylvania with that for children in families who speak English. STUDY DESIGN: We made paired English and Spanish telephone calls to outpatient behavioral health facilities using a standardized script, describing a simulated, stable, Medicaid-insured child. Facilities were identified using the Pennsylvania Department of Human Services Online Provider Directory for Mental Health and Substance Abuse Services, which had 288 outpatient facilities with non-duplicate telephone numbers. An English-language caller following a script made up to two call attempts per facility from December 2019 through February 2020. The 126 facilities that did not answer the phone, accept Medicaid, or see children were removed. A Spanish-language caller then made up to two scripted call attempts to the 162 remaining facilities. The primary outcome was whether the facility tried to schedule an appointment for the simulated adolescent. RESULTS: 125 facilities answered both English- and Spanish-language calls. For the English-language caller, 71% of facilities attempted to schedule an appointment and 100% communicated in the caller's preferred language. For the Spanish-language caller, 24% attempted to schedule an appointment (P<0.001) and 25% communicated in the caller's preferred language (P<0.001). CONCLUSIONS: Among outpatient behavioral health facilities for Medicaid-insured children in Pennsylvania, there were inequities in access to appointments for families who speak Spanish compared with English. This a modifiable barrier to care. Community-based behavioral health care for children should strengthen language access training, contracting, and oversight.

Echoes from the past: How America's major moments shaped mental health policies through a young adult lens.

This commentary examines key mental health policies across four transformative historical periods in America: the aftermath of World War II (1939-1946), the Civil Rights Movement (1954-1968), the Great Recession (2007-2009), and the COVID-19 pandemic (2020-2023). The post-WWII era established today's foundational mental health system, emphasizing military personnel, as reflected in the National Mental Health Act of 1946. During the Civil Rights Movement, the focus shifted toward community equality, leading to the Community Mental Health Act of 1963. The economic challenges of the Great Recession, especially affecting young adults, prompted a deep dive into the Affordable Care Act. The social isolation and economic suffering from the COVID-19 pandemic led to the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The article highlights the need for a more inclusive policy development approach, one that recognizes and integrates the unique perspectives of young adults in shaping mental health policies and discourse. It concludes with recommendations to guide future policy evolution for enhanced mental health and societal well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychological distance intervention reminders reduce alcohol consumption frequency in daily life.

Modifying behaviors, such as alcohol consumption, is difficult. Creating psychological distance between unhealthy triggers and one's present experience can encourage change. Using two multisite, randomized experiments, we examine whether theory-driven strategies to create psychological distance-mindfulness and perspective-taking-can change drinking behaviors among young adults without alcohol dependence via a 28-day smartphone intervention (Study 1, N = 108 participants, 5492 observations; Study 2, N = 218 participants, 9994 observations). Study 2 presents a close replication with a fully remote delivery during the COVID-19 pandemic. During weeks when they received twice-a-day intervention reminders, individuals in the distancing interventions reported drinking less frequently than on control weeks-directionally in Study 1, and significantly in Study 2. Intervention reminders reduced drinking frequency but did not impact amount. We find that smartphone-based mindfulness and perspective-taking interventions, aimed to create psychological distance, can change behavior. This approach requires repeated reminders, which can be delivered via smartphones.

Controllability of Structural Brain Networks and the Waxing and Waning of Negative Affect in Daily Life.

Background: The waxing and waning of negative affect in daily life is normative, reflecting an adaptive capacity to respond flexibly to changing circumstances. However, understanding of the brain structure correlates of affective variability in naturalistic settings has been limited. Using network control theory, we examine facets of brain structure that may enable negative affect variability in daily life. Methods: We used diffusion-weighted imaging data from 95 young adults (age [in years]: mean = 20.19, SD = 1.80; 56 women) to construct structural connectivity networks that map white matter fiber connections between 200 cortical and 14 subcortical regions. We applied network control theory to these structural networks to estimate the degree to which each brain region's pattern of structural connectivity facilitates the spread of activity to other brain systems. We examined how the average controllability of functional brain systems relates to negative affect variability, computed by taking the standard deviation of negative affect self-reports collected via smartphone-based experience sampling twice per day over 28 days as participants went about their daily lives. Results: We found that high average controllability of the cingulo-insular system is associated with increased negative affect variability. We also found that greater negative affect variability is related to the presence of more depressive symptoms, yet average controllability of the cingulo-insular system was not associated with depressive symptoms. Conclusions: Our results highlight the role that brain structure plays in affective dynamics as observed in the context of daily life, suggesting that average controllability of the cingulo-insular system promotes normative negative affect variability.

Purpose in life, neural alcohol cue reactivity and daily alcohol use in social drinkers.

BACKGROUND AND AIM: Alcohol craving is an urge to consume alcohol that commonly precedes drinking; however, craving does not lead to drinking for all people under all circumstances. The current study measured the correlation between neural reactivity and alcohol cues as a risk, and purpose in daily life as a protective factor that may influence the link between alcohol craving and the subsequent amount of consumption. DESIGN: Observational study that correlated functional magnetic resonance imaging (fMRI) data on neural cue reactivity and ecological momentary assessments (EMA) on purpose in life and alcohol use. SETTING: Two college campuses in the United States. PARTICIPANTS: A total of 54 college students (37 women, 16 men, and 1 other) recruited via campus-based groups from January 2019 to October 2020. MEASUREMENTS: Participants underwent fMRI while viewing images of alcohol; we examined activity within the ventral striatum, a key region of interest implicated in reward and craving. Participants then completed 28 days of EMA and answered questions about daily levels of purpose in life and alcohol use, including how much they craved and consumed alcohol. FINDINGS: A significant three-way interaction indicated that greater alcohol cue reactivity within the ventral striatum was associated with heavier alcohol use following craving in daily life only when people were previously feeling a lower than usual sense of purpose. By contrast, individuals with heightened neural alcohol cue reactivity drank less in response to craving if they were feeling a stronger than their usual sense of purpose in the preceding moments (binteraction = -0.086, P < 0.001, 95% CI = -0.137, -0.035). CONCLUSIONS: Neural sensitivity to alcohol cues within the ventral striatum appears to be a potential risk for increased alcohol use in social drinkers, when people feel less purposeful. Enhancing daily levels of purpose in life may promote alcohol moderation among social drinkers who show relatively higher reactivity to alcohol cues.

Centering mental health in society: A human rights approach to well-being for all.

Applying a human rights lens to mental health and well-being will improve the systems that govern and operate U.S. society. Achieving this requires learning from successful approaches and scaling up the implementation of effective strategies that promote equity by actively addressing determinants and barriers across systems that impede overall health. As a country, the U.S. has shown significant success in innovation but has failed at taking successful programs and initiatives to scale. Having endured over a year of loss in education, social connection, and routines, the COVID-19 pandemic illuminated America's deeply rooted structural inequities that have worsened population mental health and well-being. Integrating mental health into institutions and systems, while recovering and rebuilding, must be at the forefront to provide a path for transformation. Three recommendations are derived from the strategies and initiatives described throughout this article that offer tangible steps for achieving wellbeing as a human right: 1. Embed mental health within and across all systems, and expand its definition across the continuum; 2. Prioritize prevention and health promotion through person-centered and community-driven strategies; and 3. Expand the diversification and training of the mental health workforce across sectors. The inequities addressed in this article are not the products of a global pandemic. Instead, they result from historical oppression, injustice, and inaction, exacerbated by the current context. Embedding a human rights approach to mental health in the United States is fundamental to individual and community well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).