Behavioral health services in urban American Indian health organizations: A descriptive portrait.

The federal Indian Health Service (IHS) is the primary funding source for health services designated for American Indians (AIs; Gone & Trimble, 2012). Urban Indian health organizations (UIHOs), funded in part by IHS, are typically the only sites in large metropolitan settings offering treatments tailored to AI health needs. This is a first look at how mental health treatment is structured at UIHOs. UIHO staff at 17 of 34 UIHOs responded to our request to participate (50%), 14 employed behavioral health program directors who could complete the survey on behalf of their programs, and 11 of these submitted complete data regarding their current treatment practices and personal attitudes toward empirically supported treatments. Reported treatment profiles differed less than expected from available data on national outpatient clinics from the National Mental Health Services Survey (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014), and program director attitudes toward empirically supported treatments were similar to national norms reported by Aarons et al. (2010). One way in which treatment differed was in the reported use of traditional AI healing services. All program directors indicated that traditional AI healing services were available within their behavioral health programs in some form. These findings seem promising for the development of new empirically supported treatments for AI clients, but also raise concerns, given what is known about AI treatment preferences and mental health disparities. For example, traditional healing services are often considered "alternative medicine," outside the purview of evidence-based practice as typically construed by mental health services researchers. This potential conflict is a subject for future research. (PsycINFO Database Record

Patterns and Predictors of Dropout from Mental Health Treatment in an Asian Population.

INTRODUCTION: Studies examining mental health treatment dropout have primarily focused on Western populations and less so on Asian samples. The current study explored the prevalence and correlates of mental health treatment dropout across the various healthcare sectors in Singapore. MATERIALS AND METHODS: Data was utilised from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among an adult population (n = 6616) aged 18 years and above. Statistical analyses were done on a subsample of respondents (n = 55) who had sought treatment from the various treatment providers (i.e. mental health, medical, social services and religious healers) in the past 12 months. The World Mental Health (WMH) Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to determine diagnoses of mental disorders, chronic medical disorders and service utilisation. RESULTS: Of those who had received treatment, 37.6% had ended treatment prematurely, 23.2% had completed treatment and 39.2% were still in treatment. The religious and spiritual sector (83.1%) had the highest dropout, followed by the general medical sector (34.6%), mental health services sector (33.9%) and the social services sector (30%). Marital status emerged as the only sociodemographic factor that significantly predicted treatment dropout-with those who were married being significantly less likely to drop out than those who were single. CONCLUSION: The overall dropout rate across the various healthcare sectors was comparable to past studies. While the small sample size limits the generalisability of findings, the current study provides useful insight into treatment dropout in an Asian population.

Ma mahi, ka ora: by work, we prosper--traditional healers and workforce development.

AIM: Rongoa Maori practitioners make a valuable contribution towards Maori health outcomes, albeit with limited resourcing or formal training. This paper reports on a survey of healers/healing practices-specifically healers' aspirations for professional development and training-and considers the implications for healing practice and future training undertakings. METHODS: Healers in seven districts around the country were surveyed about rongoa practice and service delivery during 2013. Consenting healers completed surveys either in person, via phone, or returned them via post, according to their preference and convenience. Resulting data were analysed and reported according to frequency of responses. RESULTS: Thirty-eight healers/rongoa clinics completed the survey--a 79% response rate. Respondents were primarily Maori (88%), female (69%), aged 50 years or older (60%), and worked as volunteers. Informal training modes focused on te reo, matauranga and tikanga were the most common means of skill/ knowledge acquisition, and preferred modes for further training. CONCLUSIONS: The survey highlights the pressing need for expansion of the rongoa Maori workforce and training/service funding, to sustain rongoa practice. The findings add to what little is known about the training pathways and aspirations of practising healers, identified targets of the Maori Health Workforce Development Plan 2006.

Perspectives on psychosocial and spiritual cancer support services in New Zealand.

In New Zealand, support services have been developed in response to patient need but are variable. The benefits of psycho-social-spiritual care in reducing distress and enhancing quality of life for people with cancer and their families are well established yet unmet needs continue to feature. This project aimed to examine how health care professionals assessed for psycho-social-spiritual distress and unmet need, decisions on appropriate support, and identification of barriers in the referral process. A mixed-methods approach was used for this research. The qualitative phase entailed semistructured interviews with health care professionals working in cancer care. The quantitative phase was an online survey of oncologists and nurses. Thematic analysis was carried out by performing a side-by-side analysis of both sets of data. Nurses were most likely to assess for psycho-social-spiritual need and to refer to support services. Despite a clear mandate to provide regular psycho-social-spiritual assessment, there is no consistency of assessment and referral across New Zealand. There are clearly unmet psycho-social-spiritual needs among people affected by cancer in New Zealand, with health care professionals in this study noting structural impediments to adequate supportive care. There is a mismatch between the importance placed on such care and the capacity that is currently available. The results of this study provide evidence that can be used to argue for improvements in the infrastructure, funding allocation and policy that would allow for better psycho-social-spiritual care within the challenging context of increasing numbers of those affected by cancer.

TB questions, East Kwaio answers: community-based participatory research in a remote area of Solomon Islands.

INTRODUCTION: East Kwaio is a remote region on the island of Malaita, Solomon Islands. Atoifi Adventist Hospital (the Hospital) is the only hospital and tuberculosis (TB) services provider in the region. If people come to the Hospital with TB, they are usually admitted for the two-month intensive phase of treatment as there are no community-based TB services. Most people walk or travel by canoe to the Hospital as there are no roads. East Kwaio is known to have high rates of TB; however, it has a low case detection rate and low treatment completion. The aims of this study were to explore why people with TB, especially from the mountain areas, present to the Hospital so late in their illness or do not present at all. The study was part of a larger project to strengthen the research capacity of local health workers and community leaders, supported by visiting researchers from Australia. METHODS: Semi-structured interviews with TB patients, a focus group of key informants and direct interaction with a community with a history of TB were used to explore reasons why people present to the Hospital late in their TB illness. RESULTS: Four interviews and a focus group of 12 key informants were conducted and a mountain hamlet with a history of TB was visited. The results represent the data from the interviews and the focus group. The time delay in presenting to the Hospital from when participants first became unwell ranged between two and three years. In the mountain hamlet, two additional people with probable TB were seen who had not presented to the Hospital during illnesses of five and nine months. Reasons for delays included: seeking care from traditional healers; the challenge of accessing health services due to distance, cost and cultural issues different from the Hospital's worldview; social isolation when in hospital; and being old so not having long to live. Delays in diagnosis of people with TB will increase the risk of transmission to family and through hamlets and villages. This study has led to plans being developed to build a more culturally appropriate TB ward and community treatment program. CONCLUSIONS: The study has identified TB questions that need East Kwaio answers. It has shown that a small project can inform the development of important changes to TB services, such as the redevelopment and relocation of the TB ward. To enable TB control, the local health services need to develop an understanding of, and appropriately engage with, traditional beliefs that influence how people interact with Hospital TB treatment and management. This is the case even if the beliefs are based on a worldview different than that of the health service providers. Ongoing operational research is required into TB diagnosis and treatment services and the many factors that contribute to the high TB burden in this remote area.

Where do people with mental disorders in Singapore go to for help?

INTRODUCTION: This study aims to examine the pattern of services utilisation and the factors associated with help-seeking behaviour among those with mental disorders in the multi-ethnic Asian population of Singapore. MATERIALS AND METHODS: A household survey was carried out on a nationally representative sample of the adult (18 years and above) resident population. The main instrument used to establish the diagnosis of mental disorders and the services sought was the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). The 'services' component of the instrument contains questions, which examine service utilisation for mental health problems. RESULTS: A total number of 6616 completed respondents constituted a representative sample of the adult resident population in Singapore. Only 31.7% of those with mental disorders had sought help: 15.7% from mental health providers, 8.4% from general practitioners, and 7.6% from religious/ spiritual advisors or other healers. Among respondents with severe disability across any disorder assessed in our survey, 50.1% had sought help from some service in the past 12 months. Individuals with moderate or mild levels had lower rates of consultation, i.e. 35.4% and 30.6% respectively. The rate of using the Internet as a source of help was low in this population. CONCLUSION: There is a need to engage and work collaboratively with healthcare providers (including religious and spiritual healers) in the community to detect, assess and treat those with mental illness. More general practitioners need to be involved, and the role of the Internet also requires further consideration as a source for help.

Designing rites to re-enchant secularized society: new varieties of spiritualized therapy in contemporary Sweden.

Detraditionalization in late modernity in Western society has affected the domains of both traditional religion and clinical psychotherapy. Sweden, which is said to be one of the most secularized societies in the world, instead, has allowed the public domain to be colonized by new, spiritualized practices. Sold as therapy, the services of new spiritual leaders offer anti-stress techniques to prevent burnout, or leaders are trained to develop their leadership in coaching activities. New varieties of spiritualized therapy are rapidly increasing in contemporary Sweden, typical of which is to have added healing rhetoric to their agenda, such as "find your inner self" or "develop your inner potential." Four common denominators seem to guide these practices: self-appointed leaders, individual-centered rites, realization of one's Self, and intense emotions. We might also add a fifth aspect: profit. Rites have become a commodity and are sold as liberating practices for burnt-out souls or for people in pursuit of self-realization.

Prevalence and sociodemographic correlates of spiritual healer use: findings from the National Survey of American Life.

OBJECTIVES: This study investigates sociodemographic and health-related correlates of use of a spiritual healer for medical help. A large national, multiracial-multiethnic data source permits a more comprehensive investigation than was possible in previous studies. It also enables a closer focus on socioeconomic disadvantage and health need as determinants of utilization. DESIGN AND SETTING: Respondents are from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), a nationally representative multi-stage area-probability survey of U.S. adult African Americans, Caribbean Blacks, and non-Hispanic Whites conducted from 2001 to 2003. The sample contains 6082 adults aged 18 and over. MAIN OUTCOME MEASURES: NSAL respondents were surveyed about lifetime use of alternative providers for medical care or advice. Response categories included two types of spiritual healers: faith healers and psychics. These outcomes were logistically regressed, separately, onto 10 sociodemographic or health-related indicators: race/ethnicity, age, gender, marital status, education, household income, region, medical care use, insurance coverage, and self-rated health. RESULTS: Lifetime utilization of a faith healer is more prevalent among respondents in good health and less prevalent among Caribbean Blacks and never married persons. Users of a psychic healer are more likely to be educated, residents of the Northeast or West, and previously married, and less likely to report excellent health. CONCLUSIONS: Use a spiritual healer is not due, on average, to poor education, marginal racial/ethnic or socioeconomic status, dire health straits, or lack of other healthcare options. To some extent, the opposite appears to be true. Use of a spiritual healer is not associated with fewer social and personal resources or limitations in health or healthcare.

Health seeking behaviour of childless women in Bangladesh: an ethnographic exploration for the special issue on: loss in child bearing.

This paper deals with the health seeking behaviour of childless rural poor and urban middle class women in Bangladesh. Data for this study were collected from a northern district of Bangladesh named Mymensing, using various qualitative methods including life histories, in-depth interviews, and key-informant interviews The study shows that social class and the geographical location of the childless women determine their health seeking behaviour. Local healers in the informal sector were found to be the most popular health service option among the rural childless women. The factors for utilising them included low costs, the gender of the provider (with same-sex providers being preferred), having a shared explanatory model with the healers, and easy availability. Unlike their rural counterparts, urban childless women predominantly seek expensive Assisted Reproductive Technologies (ART) treatment which is available only in the formal sector, in private services. However, despite their affiliation with modern treatment, urban childless women still believe, like their rural counterparts, that the remedy for childlessness ultimately depends on God. As a result, in addition to biomedical treatment, many return to or simultaneously pursue various traditional, spiritual or folk treatments. It was found in this study that in Bangladesh, where fertility control is the main focus of health policy, childless women are excluded from mainstream discussions on women's health. Consequently the childless women have to suffer in various ways as a result of their health seeking behaviour.

Traditional medicine as an alternative form of health care system: a preliminary case study of Nangabo sub-county, central Uganda.

This study was conducted in Nangabo sub-county of Wakiso district. The purpose was to document the common Traditional Medicine (TM) practices; assess the local people's preferences for TM versus western medicine (WM) and lastly to determine the awareness about the importance of TM by local people. Data were collected using semi-structured administered face-to-face with respondents. A total of 120 interviewed. Six focused group discussions (FGDs) were held to validate the questionnaire responses. Data were analyzed descriptively using Statistical Package for Social Sciences (SPSS). The findings indicated that most (43%) respondents derive their livelihoods from traditional medicine practices. Three forms of TM were reported-herbalism (67%), spiritual counseling (23%) and bone setting (10%). Although the majority (81%) of respondents were quite aware of the importance of TM in the sustenance of health care system, majority (55%) of them shunned TM in preference to WM, largely because of the belief that TM is evil-founded and devilish in nature. Only 45% of the respondents preferred TM to WM. The main reasons given for visiting TM practioners rather than western medical practitioners were that TM is sometimes more effective than WM and that in many instances it has very minimal side effects on the human body. There is, however, a need for Ugandan government to legitimize the practice of TM since it contributes a lot to health care needs in areas where western medicine is insufficiently provided. In addition, there is a need for further research into the efficacy and safety of traditional medicines if it is to be adequately integrated into western medicine.

Does use of CAM for specific health problems increase with reduced access to care?

The objective of this paper was to determine predictors of complementary and alternative medicine (CAM) use among individuals with specific health problems. Data were derived from the 1998 Medical Expenditure Panel Survey (MEPS). After adjustment for potential confounders, individuals with perceived barriers to obtaining care were more likely to use any CAM treatment (OR 2.16), herbal therapy (OR 2.70) and spiritual care (OR 3.99) for a specific health problem. Individuals dissatisfied with their family's access to care were more likely to use acupuncture (OR 3.43). Dissatisfaction with quality of care was associated with increased use of spiritual therapy (OR 4.74). Perceptions of inadequate access to health care may contribute to utilization of CAM therapies; such therapies in this instance appear to be used as an alternative to mainstream medicine.

Use of complementary and alternative medical therapies among children with special health care needs in southern Arizona.

OBJECTIVE: The objective of this study was to assess the frequency and type of complementary and alternative medicine (CAM) therapies used by families of children with special health care needs in southern Arizona, as well as the correlates of their use. METHODS: Families of 376 children who were receiving services in a regional facility that serves children with special health care needs and were residing in southern Arizona were surveyed regarding CAM use. RESULTS: Sixty-four percent of these families reported using CAM for their child. The most common CAM therapies were spiritual healing/prayer/blessings. Of the conditions that were evaluated as correctable, the use rate was 24% as compared with a 76% use rate for children with a nonrepairable condition. Use of CAM for the child was strongly related to the use of CAM in the past by the family member who responded to the survey. The reasons that parents most frequently chose for using CAM were advice from a medical practitioner and advice from a family member. CONCLUSIONS: Use of CAM for children with special health care needs is common. Its frequency and type are significantly associated with the child's condition and prognosis.

[Spiritual needs and palliative care: assessment of a new care package]. / Besoins spirituels en soins palliatifs: évaluation d'un nouveau dossier de soins.

The approach taken in our palliative care document regarding spiritual needs is under three headings: 1) illness in the personal and sociocultural dimension 2) communication and self-esteem 3) spirituality: religions, philosophical or other beliefs, with twenty-eight items, including several sub-items. This approach has been used in sixty-four cases. In the first quatitative analysis, we determined which were the most utilized items, that is: the stages of bereavement, the patient's awareness of his/her illness, the observation of the means of communication he or she uses, and his/her mental state. In the second qualitative analysis, we considered the responses given for each item and sub-item. This enabled the enhancement of the first analysis, by highlighting other items ou subitems, such as beliefs, or messages and touch. From those two analysis, we sought to establish new re-groupings of items. Eleven themes have been highlighted, of which the three most important are: acceptance of the illness and self-image communication relationships with proxies On this basis, we propose to reformulate our approach to spiritual needs in palliative care.