A percepção da equipe de trabalhadoras do SRT acerca do domicílio e da produção do cuidado no contexto da pandemia de Covid-19 / The perception of the RTS team of workers about the home and the production of care in the context of the Covid-19 pandemic

Resumo Introdução: Os Serviços Residenciais Terapêuticos (SRT) são pontos da Rede de Atenção Psicossocial alinhados com a lógica da desinstitucionalização. O objetivo deste estudo foi analisar a percepção de 'casa' pela equipe de cuidadoras de SRT e suas implicações para a produção do cuidado durante a pandemia de Covid-19. Métodos: Estudo qualitativo de abordagem cartográfica que teve como cenário de estudo 4 SRT do município do Rio de Janeiro. Para a coleta dos dados, foram realizadas entrevistas com 9 trabalhadoras e observação participante de reuniões. Resultados e discussão: Os analisadores Lugar de Casa e Efeitos da Pandemia emergiram do processamento. O primeiro mostra a percepção das trabalhadoras acerca do ambiente da casa, enquanto o segundo traz a influência da pandemia na produção do cuidado nas SRT. O ambiente das residências é múltiplo, diverso e, por vezes, contraditório, permeado por diferentes modos de vida e influenciado por aspectos culturais, percepções e experiências vividas.

Abstract Introduction: The Residential Therapeutic Services (RTS) are places of the Psychosocial Care Network aligned with the logic of deinstitutionalization. This study aimed to analyze the perception of 'home' by the SRT team of caregivers and its implications for the production of care in the Covid-19 pandemic situation. Methods: Qualitative study of cartographic approach, which had 4 SRT in the city of Rio de Janeiro as scenario. Data collection involved interviews with 9 workers and participant observation of the SRTs' meetings. Results and Discussion: The analyzers Home and Pandemic Effects emerged from analysis. The first analyzer shows the workers' perception of the home environment, while the second analyzes the production of care and the influence of the Covid-19 pandemic on the SRT. The residence environment is multiple, diverse, sometimes contradictory, composed of different lifestyles and influenced by cultural aspects, perceptions and life experiences.

Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force.

Objectives: The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers' current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. Methods: A voluntary 27-item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Results: Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents' patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). Significance: The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.

Interconsultas al Área de Psicopedagogía de un hospital de niños de la CABA antes y durante la pandemia por COVID- 19 / Referrals to the Psychopedagogy Area of a CABA children's hospital before and during the VOCID pandemic 19

Investigación destinada a describir y caracterizar las particularidades de las interconsultas solicitadas al Área de Psicopedagogía de la Unidad de Salud Mental del Hospital de Niños Ricardo Gutiérrez durante el año inmediatamente anterior y en el primer año de la pandemia por Covid 19 en la Argentina a partir de un análisis de los registros del equipo. Otros objetivos son: Describir socioepidemiológicamente a los pacientes por los cuales se interconsultó al Área de Psicopedagogía desde marzo de 2019 a marzo de 2021; caracterizar las particularidades de las interconsultas; y comparar las particularidades de las interconsultas antes y durante el ASPO por la pandemia de COVID 19.

Behavioral Health and Service Usage During the COVID-19 Pandemic Among Emerging Adults Currently or Recently Experiencing Homelessness.

PURPOSE: This study provides information on how the coronavirus disease 2019 (COVID-19) outbreak is affecting emerging adults currently or recently homeless in terms of engagement in protective behaviors, mental health, substance use, and access to services. METHODS: Ninety participants in an ongoing clinical trial of a risk reduction program for homeless, aged 18-25 years, were administered items about COVID-19 between April 10 and July 9, 2020. RESULTS: Most participants reported engaging in COVID-19 protective behaviors. Past week mental health symptoms were reported by 38%-48% of participants, depending on symptoms. Among those who used substances before the outbreak, 16%-28% reported increased use of alcohol, tobacco, and marijuana. More than half of the participants reported increased difficulty meeting basic needs (e.g., food), and approximately 32%-44% reported more difficulty getting behavioral health services since the outbreak. CONCLUSIONS: Innovative strategies are needed to address the increased behavioral health needs of young people experiencing homelessness during events such as the COVID-19 outbreak.

Propuestas para ampliar la cobertura de salud mental infantil en Chile / Proposals to expand the coverage of Child Mental Health in Chile / Propostas para expandir a cobertura de saúde mental infantil no Chile

Las experiencias tempranas de vida impactan de manera significativa en la arquitectura del cerebro del infante, pudiendo fortalecerla o debilitarla permanentemente. La sintomatología psicológica presente en la infancia no es transitoria, por lo que la intervención temprana supone beneficios directos, tanto sociales como económicos. El presente trabajo propone fundamentar, con base en los hallazgos de la literatura más reciente, la incorporación en Chile de nuevas Garantías Explícitas en Salud, destinadas específicamente a tratar patologías mentales de la infancia. Se argumenta que se trata de una política pública altamente eficiente, capaz de aportar significativamente en la disminución tanto de los costes asociados a Salud Mental como de las brechas de equidad en salud.

Early life experiences can make an important impact in the architecture of the infant's brain, which can strengthen or weaken it permanently. The childhood psychological symptomatology is not fleeting, so early intervention involves direct social and economic benefits. This paper offers, based on the most recent findings, the addition of new Health Care Guarantees specifically aimed to treating mental pathologies in childhood. This public policy has been shown to be highly efficient and capable to make a real contribution to the reduction of both, the costs associated with Mental Health and the equity gaps in child health care.

As experiências iniciais da vida afetam significativamente a arquitetura do cérebro da criança, que pode fortalecê-lo ou enfraquecê-lo permanentemente. A sintomatologia psicológica presente na infância não é transitória, portanto a intervenção precoce envolve benefícios sociais e econômicos diretos. O presente trabalho propõe basear, com base nos achados da literatura mais recente, a incorporação no Chile de novas Garantias Explícitas de Saúde especificamente voltadas ao tratamento de patologias mentais da infância. Argumenta-se que se trata de uma política pública altamente eficiente, capaz de contribuir significativamente para a redução tanto dos custos associados à Saúde Mental quanto das disparidades de equidade em saúde.

Hard routes of mental health in Portugal: what can we offer to an adolescent with serious mental illness and multiple social risk factors?

Worldwide, millions of children and adolescents are suffering due to a lack of efficient mental healthcare. Although some progress has been made to address the mental health problems in this age group, currently, even developed countries fail in providing psychiatric patients with the best practice care. We present a case of a Portuguese adolescent with a first episode of psychosis in whom multiple social and environmental risk factors were identified as triggers to his clinical presentation, as well as fundamental determinants of prognosis in the short and long term. In this case, we demonstrate how social determinants, including poverty, family dysfunction and difficulties in accessing appropriate mental healthcare, strongly influence the development, maintenance and prognosis in early psychosis during adolescence. Furthermore, we consider the implications of an absence of community-based mental healthcare and rehabilitation services and reasons for why this may complicate the management and limit opportunities to this patient population.

Mental health resources and awareness of anxiety and depressive disorders in general hospitals in China

Abstract Background Mental health disorders are common in China. There is a lack of knowledge and resources of mental health in China. Objectives To assess the levels of psychiatric resources and services in general hospitals in China. Methods Data regarding psychiatric departments, wards and staff were collected from 57 general hospitals in four provinces of China (Hubei, Zhejiang, Heilongjiang and Yunnan) between April 2014 and June 2014. Questionnaires were distributed to 1,200 non-psychiatric clinicians. Results Among the 57 hospitals, 50 provided mental health services, 36 had mental health wards, and seven had neither mental health clinics nor wards. The median number of mental health clinicians was six per hospital. The median number of specialized nurses was 42 per hospital. A total of 1,152 non-psychiatric clinicians with a career duration of 9.4 ± 8.9 years returned completed questionnaires. Only 6.9% reported a good understanding of the manifestation of anxiety and depressive disorders, 4.5% reported a good understanding of the diagnostic criteria, and 3.8% reported a good understanding of the treatment protocols. Discussion There is inadequate awareness of anxiety and depressive disorders among non-psychiatric clinicians in general hospitals in China. This awareness/understanding increased with increasing hospital level.

Fatores intervenientes na adesão ao tratamento de usuários de drogas atendidos no Caps-Ad / The intervening factors on the treatment adherence of drug users assisted by a Caps-Ad / Factores intervenientes en la adhesión al tratamiento de usuarios de droga atendidos en el Caps-Ad

Objective: The study's purpose has been to recognize the interfering factors on the ambulatory treatment adherence by drug users. Methods: It is a descriptive study with a qualitative approach. Data were collected over the period from August to December 2015 through an interview process with seven users and following taken to thematic content analysis. Results: The first contact with drugs usually occurs by friends influence, while the search for treatment in the Psychosocial Care Center for Alcohol and other Drugs [Centros de Atenção Psicossocial Álcool e outras Drogas (CAPS-AD)] occurs by own person's will, considering that the family interferes positively in the initiation and also in the continuity of the treatment. The factors favoring adherence to treatment were as follows: the availability of health professionals to provide the care, which goes against the difficulty in accessing the service. Conclusion: The following was perceived as necessary in order to maintain the adherence to ambulatory treatment: the user's desire to stop using drugs, family support, personal bonds with the professionals, and easy access to the service in regard to the geography, financial and structural parameters

Objetivo: Conhecer os fatores que interferem na adesão de usuários de drogas ao tratamento ambulatorial. Métodos: Estudo descritivo, de natureza qualitativa, cujos dados foram coletados entre agosto e dezembro de 2015 por meio de entrevista com sete usuários e submetidos à análise de conteúdo temática. Resultados: O primeiro contato com as drogas normalmente ocorre por influência de amigos, enquanto a busca por tratamento no CAPS-ad ocorre por vontade própria, sendo que a família interfere positivamente no início e também na continuidade do tratamento. Os fatores que favorecem a adesão ao tratamento foram: disponibilidade dos profissionais de saúde no atendimento aos pacientes, o que se contrapõe à dificuldade de acesso ao serviço. Conclusão: Para manter a adesão ao tratamento no âmbito ambulatorial se faz necessário: desejo do usuário em parar de usar drogas, apoio familiar, vínculo com os profissionais e facilidade de acesso ao serviço, em termos geográfico, financeiro e estrutural

Objetivo: Conocer los factores que interfieren en la adhesión de usuarios de drogas al tratamiento ambulatorial. Métodos: Estudio descriptivo, de naturaleza cualitativa, cuyos datos fueron recolectados entre agosto y diciembre de 2015 por medio de una entrevista con siete usuarios y sometidos al análisis de contenido temático. Resultados: El primer contacto con las drogas normalmente ocurre por influencia de amigos, mientras que la búsqueda por tratamiento en el CAPS-ad ocurre por voluntad propia, siendo que la familia interfiere positivamente al inicio y también en la continuidad del tratamiento. Los factores que favorecen la adhesión al tratamiento fueron: disponibilidad de los profesionales de salud en la atención a los pacientes, lo que se contrapone a la dificultad de acceso al servicio. Conclusión: Para mantener la adhesión al tratamiento en el ámbito ambulatorio se hace necesario: deseo del usuario en dejar de usar drogas, apoyo familiar, vínculo con los profesionales y facilidad de acceso al servicio, en términos geográfico, financiero y estructural

Psychopathology and self-harm among incoming first-year students in six Mexican universities / Psicopatología y autolesiones en alumnos de nuevo ingreso en seis universidades mexicanas

Abstract: Objective: To estimate psychopathology and self-harm behavior of incoming first-year college students, socio-demographic correlates, service use and willingness to seek treatment. Materials and methods: 4 189 male and female incoming first-year students of six universities in four different states of Mexico responded to an online survey with a 79.3% response rate. Results: Almost one in three incoming students has experienced some type of psychopathology; however, only one in five has received treatment. Female, students who are older, whose parents are not married or deceased, and who have a non-heterosexual orientation, no religion or a non-Catholic/Christian religion have greater odds (1.18 - 1.99), whereas those who attend a private university and have a parent with some college education have lower odds (0.68 - 0.75) of experiencing any probable disorder. Conclusions: Substantial unmet need for mental health services combined with reported willingness to use university services suggests an opportunity for the detection, referral, and treatment of incoming students to promote a successful transition.

Resumen: Objetivo: Estimar psicopatologías y autolesiones en universitarios de nuevo ingreso, así como los correlatos sociodemográficos, el uso de servicios y la disposición para recibir tratamiento. Material y métodos: 4 189 estudiantes de nuevo ingreso de seis universidades en cuatro estados contestaron una encuesta en línea con una tasa de respuesta de 79.3%. Resultados: 32.5% han padecido psicopatologías en su vida, pero únicamente 19.5% han recibido tratamiento. Mujeres, estudiantes con una orientación no heterosexual, estudiantes de mayor edad, quienes tienen padres fallecidos o no casados, sin religión o con una religión no católica/cristiana tienen mayor probabilidad de presentar psicopatologías (RM= 1.18-1.99), mientras que aquellos de universidades privadas y cuyos padres tienen estudios universitarios tienen menor probabilidad (RM= 0.68-0.75). Conclusiones: La alta tasa de psicopatologías no tratadas combinada con la disposición reportada de recibir servicios a través de su universidad sugiere una oportunidad para la detección, canalización y tratamiento de alumnos de nuevo ingreso para promover una transición exitosa.

Mental health insurance access and utilization among childhood cancer survivors: a report from the childhood cancer survivor study.

PURPOSE: To describe and compare the prevalence of mental health access, preference, and use among pediatric cancer survivors and their siblings. To identify factors associated with mental health access and use among survivors. METHODS: Six hundred ninety-eight survivors in the Childhood Cancer Survivor Study (median age = 39.4; median years from diagnosis = 30.8) and 210 siblings (median age = 40.4) were surveyed. Outcomes included having mental health insurance coverage, delaying care due to cost, perceived value of mental health benefits, and visiting a mental health provider in the past year. RESULTS: There were no differences in mental health access, preferences, and use between survivors and siblings (p > 0.05). Among respondents with a history of distress, most reported not having seen a mental health provider in the past year (80.9% survivors vs. 77.1% siblings; p = 0.60). Uninsured survivors were more likely to defer mental health services due to cost (24.6 vs. 8.4%; p < 0.001). In multivariable models, males (OR = 2.96) and survivors with public (OR = 6.61) or employer-sponsored insurance (ESI; OR = 14.37) were more likely to have mental health coverage. CONCLUSIONS: Most childhood cancer survivors value having mental healthcare benefits; however, coverage and use of mental health services remain suboptimal. The most vulnerable of survivors, specifically the uninsured and those with a history of distress, are at risk of experiencing challenges accessing mental health care. IMPLICATIONS FOR CANCER SURVIVORS: Childhood cancer survivors are at risk for experiencing high levels of daily life stress that is compounded by treatment-related sequelae. Integrative, system-based approaches that incorporate financial programs with patient education about insurance benefits can help reduce some of the financial barriers survivors face.

Mental Health Support Provided Throughout the Bariatric Surgery Clinical Pathway in French Specialized Care Centers for Obesity.

OBJECTIVE: Pre-operative psychological assessment is recommended by international guidelines for bariatric surgery candidates. Thereby, service teams caring for bariatric patients should include at least one mental health provider (e.g., a psychologist or psychiatrist). The objective of this study was to evaluate the psychology and psychiatry resources and practices in the 37 specialized obesity centers (CSOs) created by the French Ministry of Health. MATERIALS AND METHODS: CSO coordinators were contacted by e-mail to collect general information on the centers (e.g., number of bariatric operations). Secondly, psychologists and psychiatrists of each center completed an anonymous questionnaire assessing their professional practices and their organization of care pathways. RESULTS: The vast majority of CSO coordinators (81%, n = 26/32) answered our survey. These results show significant differences and shortages in terms of the psychology/psychiatry resources available. Most of the psychologists (n = 26/31) and psychiatrists (n = 10/10) stated that they systematically meet new patients only before surgery (56%) or both before and after the operation (30%); however, some psychologists and psychiatrists (14%) do not systematically meet all the patients (before and/or after surgery). Nevertheless, all the professionals provide psychology assessments, and about 75% of them offer a psychological follow-up, indicating a similarity regarding the practices of psychologists and psychiatrists. CONCLUSION: Our results highlight the place of psychological/psychiatric evaluations in French CSOs and emphasize the absence of mental health providers in several of these services. Post-operative psychological follow-up is not usually provided. It would be appropriate to create clear recommendations for post-operative psychological or psychiatric long-term follow-up.

Barriers to and Facilitators of Perinatal Depression Screening.

Depression is a significant health issue for women of reproductive age. A number of professional organizations have issued guidance regarding perinatal depression screening. However, some health care providers are reluctant to screen women. This column takes a second look at two recent research studies in which investigators examined the barriers to and facilitators of perinatal depression screening.

Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico.

OBJECTIVE: To provide evidence on perinatal mental healthcare in Mexico. MATERIALS AND METHODS: Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. RESULTS: Over half (64.0%) of units offer mental healthcare; fewer offer perinatal depression (PND) detection (37.1%) and care (40.3%). More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1%) than in Southern (26.5%; 36.4%), Northern (27.3%; 28.1%) and Central Mexico (50.0%; 52.7%). CONCLUSION: Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.

Prevalencias y brechas hoy: salud mental mañana / Prevalence and gaps today: mental health tomorrow / Prevalências e lacunas hoje: saúde mental amanhã

La OMS coloca a Chile entre los países con mayor carga de morbilidad por enfermedades psiquiátricas (23,2%) en el mundo. La depresión mayor y los trastornos por consumo de alcohol ocupan el primer y segundo lugar en las discapacidades atribuidas entre adultos. Casi un tercio de la población mayor de 15 años ha sufrido un trastorno psiquiátrico en su lapso de vida y un 22,2% ha tenido uno durante el año pasado. Los trastornos de ansiedad son los más prevalentes, seguidos por depresión mayor y trastornos por consumo de alcohol. Solo el 38,5% de quienes han sido diagnosticados reciben algún tipo de servicio de salud mental, ya sea de un especialista o un médico de atención primaria. En niños y adolescentes, la prevalencia de cualquier trastorno psiquiátrico es de 22,5% (19,3% para niños y 25,8% para niñas). Estos trastornos son principalmente de ansiedad y disruptivos. La prevalencia es más alta entre niños de cuatro a once años de edad (27,8%) que entre aquellos de 12 a 18 años, y esta diferencia se debe principalmente a trastornos disruptivos. La prevalencia de trastornos de ansiedad es la segunda más alta, aunque menos asociada con discapacidades, mientras que muchos niños y adolescentes con trastornos afectivos están discapacitados y solo un quinto de las personas con necesidad de servicios buscan alguna forma de asistencia. Casi un cuarto de aquellos que usan los servicios no presentaron diagnóstico psiquiátrico durante el año pasado. La comorbilidad ocurre en el 27% de aquellas personas que presentan trastornos, pero solo el 7% tienen tres o más diagnósticos. No abordar la brecha de tratamiento en salud mental tiene serias implicaciones en la salud pública.

WHO places Chile among countries with greater morbidity burden for psychiatric diseases in the world (23,2%). Major depression and alcohol consumption disorders hold the first and second place in disabilities attributed to adults. Almost a third of the population older than 15 years have suffered a psychiatric disorder during life span and 22,2% persons have had one in the last year. Anxiety disorders have more prevalence, followed by major depression and alcohol consumption disorders. Only 38,5% of those diagnosed receive some type of mental health care, by an specialist or a primary health care physician. In children and adolescent, prevalence of any psychiatric disorder is 22,5% (19,3% for boys and 25,8% for girls). These disorders are mainly disruptive and of anxiety. Prevalence is higher for children between 4 to 11 years (27,8%) than between 12 and 18 years, and this difference is due mainly to disruptive disorders. Prevalence of anxiety disorders is the second highest, even though less associated with disabilities, while many children and adolescents with affective disorders are disabled and only a fifth of persons with health care needs look for some form of care. Almost a fourth of those that use health care services did not present psychiatric diagnosis during last year. Co morbidity occurs in 27% of those with disorders, but only 7% have three or more diagnosis. Not addressing treatment gap in mental health has serious implications in public health.

A OMS coloca o Chile entre os países com maior carga de morbidade por enfermidades psiquiátricas (23,2%) no mundo. A depressão maior e os transtornos por consumo de álcool ocupam o primeiro e segundo lugar nas descapacidades atribuidas entre adultos. Quase um terço da população maior de 15 anos tem sofrido um transtorno psiquiátrico em seu lapso de vida e cerca de 22,2% tiveram um durante o ano passado. Os transtornos de ansiedade são os mais prevalentes, seguidos por depressão maior e transtornos por consumo de álcool. Somente 38,5% daqueles que foram diagnosticados recebem algum tipo de serviço de saúde mental, seja de um especialista ou de um médico de atenção primária. Em crianças e adolescentes, a prevalência de qualquer transtorno psiquiátrico é de 22,5% (19,3% para meninos e 25,8% para meninas). Estes transtornos são principalmente de ansiedade e disruptivos. A prevalência é mais alta entre meninos de quatro a onze anos de idade (27,8%) do que entre aqueles de 12 a 18 anos, e esta diferença se deve principalmente a transtornos disruptivos. A prevalência de transtornos de ansiedade é a segunda mais alta, embora menos associada com descapacidades, enquanto muitos meninos e adolescentes com transtornos afetivos estão descapacitados e somente um quinto das pessoas com necessidade de serviços busca alguma forma de assistência. Quase um quarto daqueles que usam os serviços não apresentou diagnóstico psiquiátrico durante o ano passado. A comorbidade ocorre em 27% daquelas pessoas que apresentam transtornos, porém só 7% têm três ou mais diagnósticos. Não abordar a lacuna de tratamento em saúde mental tem sérias implicações para a saúde pública.

Indicators for routine monitoring of effective mental healthcare coverage in low- and middle-income settings: a Delphi study.

High-quality information to measure the need for, and the uptake, cost, quality and impact of care is essential in the pursuit of scaling up mental health care in low- and middle-income countries (LMIC). The aim of this study was to identify indicators for the measurement of effective coverage of mental health treatment. We conducted a two-round Delphi study (n = 93 experts from primarily LMIC countries Ethiopia, India, Nepal, Nigeria, South Africa and Uganda), in order to generate and prioritize a set of indicators. First, 52 unique indicators were generated (based on a total of 876 responses from participants). Second, the selected indicators were then scored for significance, relevance and feasibility. Mean priority scores were calculated per indicator (score range, 1-5). All 52 indicators had a weighted mean score that ranged from 3.20 for the lowest ranked to 4.27 for the highest ranked. The 15 highest ranked indicators cover the different domains of measuring effective mental health treatment coverage. This set of indicators is highly stable between the different groups of experts, as well as between the different participating countries. This study provides data on how mental health service and financial coverage can be assessed in LMIC. This is an important element in the move to scale-up mental health care.

Modeling the Impact of School-Based Universal Depression Screening on Additional Service Capacity Needs: A System Dynamics Approach.

Although it is widely known that the occurrence of depression increases over the course of adolescence, symptoms of mood disorders frequently go undetected. While schools are viable settings for conducting universal screening to systematically identify students in need of services for common health conditions, particularly those that adversely affect school performance, few school districts routinely screen their students for depression. Among the most commonly referenced barriers are concerns that the number of students identified may exceed schools' service delivery capacities, but few studies have evaluated this concern systematically. System dynamics (SD) modeling may prove a useful approach for answering questions of this sort. The goal of the current paper is therefore to demonstrate how SD modeling can be applied to inform implementation decisions in communities. In our demonstration, we used SD modeling to estimate the additional service demand generated by universal depression screening in a typical high school. We then simulated the effects of implementing "compensatory approaches" designed to address anticipated increases in service need through (1) the allocation of additional staff time and (2) improvements in the effectiveness of mental health interventions. Results support the ability of screening to facilitate more rapid entry into services and suggest that improving the effectiveness of mental health services for students with depression via the implementation of an evidence-based treatment protocol may have a limited impact on overall recovery rates and service availability. In our example, the SD approach proved useful in informing systems' decision-making about the adoption of a new school mental health service.