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Individuals suffering from serious mental illness (SMI) face many challenges of navigating a complex and often fragmented health care system and may die significantly earlier from co-morbid physical health conditions. Integrating mental and physical health care for individuals with SMI is an emerging trend addressing the often-neglected physical health care needs of this population to better coordinate care and improve health outcomes.

Population Health Management (PHM) provides a useful framework for designing integrated care programs for individuals with SMI.

This paper examines the structure and evolution of the integrated care program in Missouri in the context of PHM, highlighting particular elements of PHM that facilitate and support development of an integrated mental and physical health care program.

As health care reform provides external motivation to provide integrated care, this study can be useful as other states attempt to address this important issue.

Purpose – This chapter discusses the promise of and challenges to providing effective and culturally responsive trauma-focused mental health services to immigrant and refugee youth and their families within school settings.

Design/methodology/approach – This chapter utilizes “practice-based evidence” to outline successes and address the barriers associated with the implementation of school-based, trauma-focused, evidence-based interventions in four immigrant or refugee-dense cities: Los Angeles, Chicago, Minneapolis, and Boston.

Findings – Making cultural adaptations to identified trauma interventions that were consistent with community priorities, cultural norms, and values resulted in more accessible programs and greater engagement in treatment services.

Practical implications – The strategies tested in these real-world settings contribute to the development of culturally competent trauma-informed services for immigrant and refugee youth and their families. Mental health providers and program developers will better understand the need for multilevel engagement strategies and for culturally driven modifications when employing evidence-based programs with immigrant and refugee youth.

Originality/value – This chapter adds to the scarce evidence about useful methods to engage immigrant and refugee youth and families in treatment and to increase the likelihood of positive outcomes.

Recently, a national priority has been set to improve mental health services for children and families. It has been identified in epidemiological literature that in the United States, an approximate 15% of youth meet diagnostic criteria for emotional or behavioral problems. Furthermore, less than one in every five children that present with such needs receive mental health services. Individual, family, and system barriers such as transportation, competing demands, and long waiting lists have negatively impacted access to mental health services. Therefore, the school system has become the “de facto” mental health system for children and adolescents, in part because of the significant time students spend at school. However, meeting the needs of students with behavioral or emotional problems within the school system poses its own challenges. Schools have reported being limited in their ability to deliver basic mental wellness to students due to the lack of available resources. Specifically, there is a shortage of school-employed mental health personnel and the ratio of student to mental health professional is two to three times larger than recommended. Expanded school mental health programs are partnered systems that utilize existing services and collaborate with community mental health (CMH) professionals at each level of the three-tiered system. This partnership enables CMH staff gain access to youth with emotional and behavioral problems, resulting in increased prevention and intervention services for students. Additionally, a coordinated effort such as student-transition services has an integral role of facilitating the process from the school system to postsecondary employment, training, and or additional education.

Social and economic trends toward local governance form the context for health and mental health policy and the reorganization of care systems for cost-containment in the United States. Local management of public–private collaborations is promoted by state agencies as a means of rationalizing mental health care and community support services. This chapter analyses the local process of developing public–private partnerships for mental health care, based on an ethnographic case study of county Mental Health/Mental Retardation and behavioral health committees and coalitions in Texas, from 1995 to 2001. Following this period, local service agencies continued collaboration to increase community awareness and resources for care. Findings were that while the rapid transition to local control under conditions of reduced resources impeded implementation of a public–private mental health care system, commitment to a service safety net for persons with mental disabilities was sustained.

Two major reform movements have shaped child and adolescent mental health services over the past quarter-century: the Systems of Care movement, and more recently, the movement toward evidence-based practice. Results from several studies indicate that youth served in traditional residential or inpatient care may experience difficulty re-entering their natural environments, or were released into physically and emotionally unsafe homes (Bruns & Burchard, 2000; President's Commission on Mental Health, 1978; Stortz, 2000; Stroul & Friedman, 1986; U.S. Department of Health and Human Services, 1999). The cost of hospitalizing youth also became a policy concern (Henggeler et al., 1999b; Kielser, 1993; U.S. Department of Health and Human Services, 1999). For example, it is estimated that from the late 1980s through 1990 inpatient treatment consumed nearly half of all expenditures for child and adolescent mental health care although the services were found not to be very effective (Burns, 1991; Burns & Friedman, 1990). More recent analyses indicate that at least 1/3 of all mental health expenditures for youth are associated with inpatient hospitalization (Ringel & Sturm, 2001).

Mental illness amongst students in higher education has increased in recent years. Several contributing factors have been identified, including the growing number of students with pre-existing problems who are pursuing university and the fact that emerging adulthood is a time of developmental vulnerability to social pressures. Other key factors include academic pressure, the financial burden of student debt, and increasing uncertainty around making a successful transition to the workplace. These pressures are often more pronounced for minority students – in particular ethnic and sexual minority students. Peer support and connectedness to school have been identified as key areas for building protective factors for positive mental health outcomes and lower rates of health-risk behaviors. Many higher education institutions also offer work-integrated learning programs (WIL) to help ease students’ financial burden and increase their level of employability. However, participation in WIL may impact on students’ academic and social support networks. For instance, programs in which students participate in off-campus work placements (i.e., cooperative education) can cause disruption in students’ connectedness to school and their perceived level of social support. This chapter examines the intensification of mental health problems on campus and explores the importance of sense of belonging and social support as protective factors. Furthermore, the chapter explores how WIL can both protect and hinder students’ mental health and wellbeing and examines current evidence for interventions that can help students prepare for their school-to-work transition.

Large numbers of adults with mental illness detained by police, seen in the courts, and confined in prisons and jails has been a longstanding concern of officials in the mental health and criminal justice systems. Diversion programs represent an important strategy to counteract the criminalization of persons with mental illness. The challenge is to identify and integrate resources in such a way that an organization bridging the police, courts, mental health, substance abuse, homelessness, welfare and entitlements agencies would evolve that would effectively and appropriately serve offenders with mental health issues, keeping them stable in the community and reducing recidivism.

Public schools possess a unique constellation of opportunities and challenges for mental health service provision. Schools, as settings within a larger ecological context, can be a community institution that supports a child as s/he develops assets for resilient development while providing opportunities for a range of life choices. School is the setting where children can learn and practice peer relations and social norms, and it can be a refuge where children who have many environmental risks can find structure and effective methods of success (Doll, 1999). When Willie Horton, the infamous bank robber, was asked why he robbed banks, he responded, “Because that's where the money is.” At a most basic level, schools are where the children are. Every day more than 52 million students attend over 1,14,000 schools in the United States, and including the 6 million adult staff, this amounts to almost one-fifth of the population passing through the Nation's schools on any given weekday (New Freedom Commission on Mental Health, 2003).