Availability of Trauma-Specific Services in US Substance Use Disorder and Other Mental Health Treatment Facilities: 2015-2019.

This study assessed trends in provision of trauma-specific services, defined as dedicated programming for persons with a history of trauma, in US Substance Use Disorder (SUD) and other Mental Health (MH) facilities. Facility level data from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey (2015-2019) were used to examine trends in provision of trauma specific-services. Trauma specific service provision trended up significantly between 2015 and 2019. In 2019, they were more commonly offered at MH facilities (49.9%) than SUD facilities (42.7%). Licensing by state SUD authorities were associated with provision of trauma-specific services at both MH (Adjusted Odds Ratio (AOR) = 1.23, 95% Confidence interval (CI) = 1.18-1.47, p < .001) and SUD (AOR = 1.19, 95% CI = 1.04-1.37, p = .012) facilities. The proportions of facilities that offer trauma-specific services were correlated within states (Pearson's r = .44, p = .001). State policies to implement trauma screening at public facilities were associated with higher odds of offering trauma-specific services in MH (AOR = 1.31, 95% CI = 1.04-1.64, p = .021) and SUD (AOR 1.51, 95% CI = 1.19-1.12, p = .001) facilities; whereas, state implementation of trauma-specific CBT at public facilities was associated with higher odds of this outcome only in MH facilities (AOR = 1.23, 95% CI = 1.01-1.51, p = .043). Although trauma-specific services trended up significantly, fewer than half of treatment facilities offer such services nationally. Certain facility characteristics, such SUD authority certification, are associated with trauma-specific services. Variability among states in these services is linked to state policy. Increased efforts by states may be an effective point of intervention to further disseminate trauma-specific services.

Symptom severity and medication-assisted treatment for individuals with serious mental illness and a history of heroin use.

The study examined associations between medication assisted treatment (MAT) and psychiatric symptom severity, measured by Positive and Negative Symptom Scale (PANSS), among individuals with serious mental illness and a history of heroin use. Of 271 participants, 32% (n=87) reported a history of heroin use and, of those, 14.9% (n=13) reported MAT. Higher scores in PANSS Total, Negative, and Disordered subscales were associated with lower odds, while being on an antipsychotic with higher odds, of receiving MAT. This supports the greater need for clinician attention to different symptom clusters and targeted multidimensional interventions as a way to increase MAT participation.

Integrated dual diagnosis treatment among United States mental health treatment facilities: 2010 to 2018.

OBJECTIVE: Little is known about the correlates of and recent trends in implementation of Integrated Dual Diagnosis model, an evidence-based approach for dual diagnosis services, in US mental health facilities between 2010 and 2018. METHODS: Changes over time in Integrated Dual Diagnosis Treatment use were examined using multiple waves of a national survey of mental health treatment facilities that reported offering any substance use services. State and facility correlates of offering integrated dual diagnosis services among these facilities in 2018 were examined. RESULTS: The proportion of mental health treatment facilities that reported offering any substance use services increased significantly from 50.1% in 2010 to 57.1% in 2018. Among these facilities, significantly fewer reported offering Integrated Dual Diagnosis Treatment in 2018 (74.8%) than in 2010 (79.6%). The prevalence of Integrated Dual Diagnosis Treatment use increased in more recent years in tandem with increase in substance use services, though the increases in Integrated Dual Diagnosis Treatment have not matched the expansion of substance use services. Mental health facilities with substance use services more commonly offered other mental health services and had more funding sources available. Facilities with any substance use disorder services that offered Integrated Dual Diagnosis Treatment were more commonly licensed by State Substance Agencies and more commonly offered psychotropics and group therapies. Facilities located in states that implemented the Integrated Dual Diagnosis Treatment model had a higher odds of offering this model. CONCLUSIONS: The growth in the co-location of substance use treatment services within mental health treatment facilities has not been matched by true integration of these treatments, highlighting the need for further efforts to comprehensively address the complex needs of dually diagnosed patients.

Telepsychiatry Use in U.S. Mental Health Facilities, 2010-2017.

OBJECTIVE: The study examined the use of telepsychiatry in U.S. mental health facilities between 2010 and 2017. METHODS: Changes over time in the availability of telepsychiatry were examined by using multiple waves of a national survey of mental health facilities. State and facility correlates of offering telepsychiatry in 2017 were examined. RESULTS: The proportion of state facilities that self-reported offering telepsychiatry increased significantly from 15.2% in 2010 to 29.2% in 2017, with wide variability among states.. In 2017, facilities with telepsychiatry were more commonly publicly owned than to have others forms of ownership (odds ratio [OR]=2.72, 95% confidence interval [CI]=2.47-2.99, p<0.001), although the percentage of privately owned facilities offering telepsychiatry has increased significantly since 2010 (OR=2.94, 95% CI=2.14-4.05, p<.001). Facilities offering telepsychiatry had lower odds of receiving funding from Medicaid (OR=0.86, 95% CI=0.75-0.98, p<0.001) but higher odds of receiving funding from all other sources. Facilities in states that did not fund telepsychiatry had lower odds of offering these services in 2017 (OR=0.57, 95% CI=0.51-0.62, p<0.001). Telepsychiatry was more commonly offered in states with higher proportions of rural population (OR=1.64, 95% CI=1.45-1.85, p<0.001) and designated medically underserved areas (OR=1.36, 95% CI=1.25-1.47, p<0.001), compared with other states. CONCLUSIONS: Nearly twice as many U.S. mental health facilities offered telepsychiatry in 2017 than in 2010. Medicaid funding lagged behind other funding sources, suggesting state administrative barriers. Telepsychiatry was commonly used by facilities in medically underserved and rural areas.

Prescription opioid use among individuals with serious mental illness.

Prevalence and correlates of prescription opioid use were explored in individuals with serious mental illness (SMI) by examining a sample of adults from two inner city community psychiatry clinics. Of 271 participants, 12.9% (n = 35) were on a prescribed opioid. Being on an opioid was significantly associated with history of heroin use and active prescription sedative-hypnotic use, including benzodiazepine use. Concurrent use of opioids with sedative-hypnotics was significantly associated with suicidal ideation. The results highlight risks of prescription opioid use in those with SMI, particularly in combination with prescription sedative-hypnotics.

Exposure to Direct-to-Consumer Pharmaceutical Advertising and Medication Nonadherence Among Patients With Serious Mental Illness.

OBJECTIVE: This study explored the association of exposure to direct-to-consumer advertising (DTCA) with medication nonadherence among individuals with serious mental disorders. METHODS: Results of an anonymous survey administered at an inner-city mental health clinic were examined by using logistic regression. Nonadherence was defined as not taking prescribed medications for at least two out of seven days. RESULTS: Of 246 respondents, 48% reported DTCA exposure and 43% reported nonadherence. Sixty-one percent of those exposed to DTCA reported nonadherence, compared with 26% of those not exposed (adjusted odds ratio=4.96, 95% confidence interval=2.64-9.33, p<.001). Among those exposed to advertisements and reporting nonadherence, 59% reported changing medication-taking behaviors or stopping prescribed medications because of side effect information in advertisements. Only a minority communicated with providers before becoming nonadherent. CONCLUSIONS: This study found an association between self-report of DTCA exposure and self-reported nonadherence. These results support further research on DTCA as a possible risk factor for nonadherence.

Interrater reliability of the modified Monitoring of Side Effects Scale for assessment of adverse effects of psychiatric medication in clinical and research settings.

The assessment of adverse effects of psychiatric medications is important in clinical and research settings because they are often associated with medication discontinuation, symptom exacerbation, and reduced quality of life. Currently available assessment tools are either limited with regard to the number and variety of included adverse effects or are not practical for use in most clinical or research settings owing to specialized rater training required and administration length. This report describes a modification of the Monitoring of Side Effects Scale (MOSES), an established adverse effect rating scale, by adding severity anchors to improve its reliability and ease of use. Interrater reliability was good for 7 of the 8 bodily adverse effects assessed, with intraclass correlation coefficients ranging from 0.76 to 0.91 in a sample of patients with severe mental illness. This modified version of the Monitoring of Side Effects Scale holds promise as a useful tool for assessing medication adverse effects in clinical and research settings.