Mental health facilitators in primary care

In the context of the National Primary Care Facilitation Programme, the Sainsbury Centre for Mental Health has reviewed the membership of the Mental Health in Primary Care Network, and explored members' roles; the findings of the review are reported in this article. Researchers examined the activities undertaken by network members, and identified the proportion working directly with primary health care teams and those working strategically within health authorities. Education and training, health promotion, and liaison and linkworking were undertaken by many staff, while a few worked at a more strategic level. In order to increase the effectiveness of this model, a more focused approach is recommended, targeting those with responsibility for implementing changes and developing mental health care in primary care settings. Learning sets which involve primary care and mental health teams, and strategic work with health authorities, are also recommended.     

Development and evaluation of drop-in centers operated by mental health consumers

As part of a statewide initiative begun in 1989 to promote consumer involvement, the Pennsylvania Office of Mental Health initially funded the development of nine consumer-operated drop-in centers. This paper describes some of the programs and services developed by the centers and presents results of a survey of consumers' use of and satisfaction with services. During the six-month survey period, a total of 478 consumers used services; average daily attendance at each center was 28. Most centers had one paid position supplemented by heavy use of volunteers. Most projects had collaborative relationships with a few providers who maintained a low profile in daily operations. Although consumers were highly satisfied with the drop-in centers, they desired improvements in the number of paid staff, hours of operation, management, and transportation.     

A survey of New Zealand psychiatrists' clinical experience with the Mental Health (Compulsory Assessment and Treatment) Act of 1992

AIMS: This study examines the clinical experience of New Zealand psychiatrists with the Mental Health (and Compulsory Assessment and Treatment) Act of 1992. METHODS: A survey was distributed to all psychiatric specialists residing in New Zealand who were registered with the Medical Council of New Zealand (n = 232). The survey examined the extent of practitioners' use of the Mental Health Act, perceived strengths and weaknesses of the Mental Health Act, and experiences with the family court system. RESULTS: Psychiatrists estimated that almost half (46.4%) of patients retained under the Mental Health Act were released within 3 weeks. Inpatient consultants reported dedicating 18.6% of their working time to Mental Health Act related activities. A majority of respondents indicated that: the Mental Health Act requires major revision (55.6%), the Mental Health Act results in the inappropriate release of some psychiatric patients into the community (70.9%), and that compulsory treatment orders are a useful tool for promoting community treatment of the mentally ill (69.2%). While a majority (81.5%) indicate that individual judges are consistent in their interpretation of the Mental Health Act across cases, only 26.5% of respondents agree that the law is interpreted uniformly by different judges. CONCLUSIONS: The Mental Health Act is perceived as time-consuming and cumbersome to administer. However, compulsory treatment orders do facilitate community treatment, an explicit goal of the Mental Health Act. Proposed areas for refinement of the Mental Health Act are discussed. Further examination of the interface between psychiatrists and the family court system would be useful.     

Psychological testing in outpatient mental health facilities: A national study.

Surveyed psychological testing trends in outpatient mental health centers, clinics, and services in the US. The sample was obtained from the National Directory of Mental Health and the National Registry of Community Mental Health Services. Of 900 facilities with a psychologist on staff, 413 (46%) returned questionnaires. The Minnesota Multiphasic Personality Inventory (MMPI) and the Wechsler scales were the instruments most frequently used, closely followed in usage frequency by the major projective techniques. The Wide Range Achievement Test, the Peabody Picture Vocabulary Test (PPVT), the Peabody, the Beck Depression Inventory, and the Wechsler Memory Scale were also quite popular. Apparently, clinicians rely on traditional tests despite the proliferation of new assessment instruments in the clinical literature. Implications for graduate training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect.

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children's services system. The study took place in the context of a statewide, regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. In the study 21 teams consisting of 153 home-based service providers were followed over a 29-month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values–innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public health advocacy on behalf of women in S?o Paulo: learning to participate in the planning process

In 1988, a new Constitution was adopted in Brazil in which guidelines for community participation in the development and implementation of the national health system were delineated. The health and welfare of women and children were given priority. Implementation of these guidelines presents a major challenge in a city such as S?o Paulo with a population of 15 million, of which an estimated 5.8 million are women of childbearing age. In order to determine the extent to which community organizations are actively participating in planning health services for women and children in S?o Paulo, a study was undertaken to examine the experience of community and professional organizations in public health advocacy. This paper describes a sample of these organizations, their constituents, membership, history, funding, advocacy objectives, and strategies used and results obtained. The information gathered indicates that the community organizations are involved in activities that include major efforts to improve access to health care by providing specialized courses in women's health, including the status of women's work, sexuality, discrimination, family planning, and the politics of health; publishing newsletters; producing radio programs; engaging in legal action; and using petitions, demonstrations, and public meetings to garner public support on specific issues.     

Gay Gaer Luce and Julius Segal: Distinguished Science Writing Award.

This year's Distinguished Science Writing Award, presented by the American Psychological Foundation, is given jointly to: Gay Gaer Luce and Julius Segal for their book entitled Sleep--published by Coward-McCann. This year's award is of special interest for at least two reasons: Gay Luce is a two-time winner, having received the award in 1962 for her magazine articles; and Julius Segal is the first APA member to receive the award. Gay Gaer Luce is a science writer who began preparing her material on the subject of sleep for the National Institute of Mental Health. Julius Segal is a psychologist and writer on the staff of the National Institute of Mental Health in Bethesda, Maryland. Brief autobiographical sketches are presented for the two writers. Through their painstaking research combined with clear and eloquent writing, Gay Luce and Julius Segal have made a brilliant contribution and have set a new standard for popular writing in the behavioral sciences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association for the Advancement of Psychology: 1977.

The Association for the Advancement of Psychology (AAP) is a nonprofit corporation founded in 1974 under the auspices of the Council of Representatives of the American Psychological Association. In the interest of psychology and the public, AAP interacts with Congress, the executive branch, and the judicial branch of the federal government. AAP is governed by a 24-member Board of Trustees selected equally, by mail ballot of AAP members, from the professional, public-social, and scientific sectors of psychology. Some major public-policy activities in 1977 included confirmation hearings on the new director of the Alcohol, Drug Abuse, and Mental Health Administration; Psychology-Medicare bills; the equal rights amendment; research, training, and service funding in the National Institute of Mental Health, the National Institute of Education, the National Science Foundation, the Veterans Administration, the Office of Naval Research, etc.; welfare reform; antidiscrimination amendments in employee insurance plans; President Carter's Commission on Mental Health; a complaint to the Federal Trade Commission against the Joint Commission on Accreditation of Hospitals and the American Medical Association; services and provider status in CHAMPUS, the Veterans Administration, the Federal Employees Health Benefits Program, and the military; governmental reorganization; the "Child Health Assessment Plan"; development of national health insurance proposals; the Community Mental Health Centers Act; rights of institutionalized persons; the Health Planning Act; educational and industrial testing; evaluation of persons with access to nuclear materials; the Professional Standards Review Organizations Act; the Consumer Protection Agency; federal workers' compensation; zero-based budgeting of federally funded programs; disability determination procedures in the Social Security Administration; protection of human subjects; and copyright law revision. AAP officials and staff also worked informally on a continuous basis with individual Representatives, Senators, and their staffs, as well as with the staffs of various committees in both Houses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health in schools: expanded opportunities for school nurses

Emerging trends are reshaping the work of school nurses and other school service personnel. With respect to direct service and consultation, school nurses increasingly are called upon to deal with psychosocial and mental health problems. Beyond that, school nurses must continue to actuate their roles as advocates, catalysts, brokers, and facilitators of the type of reforms that can effectively address barriers to student learning and promote healthy development. Continuing education is seen as key to enabling school nurses to build capacity for such roles and functions. The newly formed Center for Mental Health in Schools at the University of California, Los Angeles (UCLA) hopes to be of assistance in this respect. This presentation highlights the Center's orientation to mental health in schools and offers a draft outline for related continuing education.     

Innovative service redesign and resource reallocation: responding to political realities, mental health reform and community mental health needs

General hospital mental health programs in large inner city communities face challenges in developing responsive services for populations facing high rates of serious mental illness, substance abuse, homelessness, and poverty. In addition provincial political pressures such as Mental Health Reform and hospital restructuring have caused general hospital mental health programs to reevaluate how services are delivered and resources are allocated. This paper describes how one inner city mental health service in a university teaching setting developed successful strategies to respond to these pressures. Strategies included: (a) merging two general hospital mental health services to pool resources; (b) allocating resources to innovative care delivery models consistent with provincial reforms and community needs; (c) fostering staff role changes, job transitions, and the development of new professional competencies to complement the innovative care delivery models; and (d) developing processes to evaluate the effects of these changes on client.     

Psychologists as legislators: Results of the 1998 elections.

The November 1998 elections saw a significant increase in the number of psychologists elected to the U.S. Congress and to state legislatures. These psychologists bring health care expertise to their positions as legislators, which enhances their contributions to public policy. They are playing key roles in sponsoring health care reforms such as patient protection legislation and mental health parity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A strategy for assessing family interaction patterns in schizophrenia.

Educational and behavioral family treatments for schizophrenia patients and their relatives have proven to be highly effective, but there is scant evidence on how these treatments work. We assessed family interaction patterns, in the context of the Collaborative Study on Treatment Strategies in Schizophrenia, National Institute of Mental Health, to examine the effect of treatment on communication and problem solving in the family and to determine if change in interaction patterns was related to outcome. This article reports on the development of a behavioral assessment strategy, the Family Problem-Solving Task ( FPST), and a related coding system that were developed for the larger project. The codes were rated reliably and had high internal consistency. The FPST procedure had high test-retest reliability from baseline through 2-year assessments. The data provided considerable support for the construct validity of the coding system. It is notable that critical and intrusive behavior by relatives during the FPST was significantly correlated with dissatisfaction and hostility expressed about the patient during an interview. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating an internship into a market-driven psychology practice.

The article describes how a psychologist-led, market-driven, entrepreneurial practice provides an excellent setting for an internship. Interns learn about the following: the role of accrediting organizations, such as the Joint Commission of Accreditation of Healthcare Organizations and the National Committee on Quality Assurance; quality improvement; utilization improvement; performance improvement; cutting-edge service delivery systems; how to assess market needs; capitation; marketing services; how to work as part of a multidisciplinary team; how to integrate behavioral health care and medical health care; provider networks; and how to assess and use consumer satisfaction and clinical outcomes for service improvement. Interns develop scientist-practitioner skills and coping skills for innovating in response to a rapidly changing marketplace. The article also addresses costs and logistics for market-driven practices sponsoring an internship program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychodynamic research perspectices on development, psychopathology, and treatment in later life.

Reports on a meeting held at the National Institute of Mental Health (NIMH). At this meeting, over 700 psychoanalysts and other mental health professionals and investigators gathered to consider research on the interplay of personality, biology, and society in shaping adaptation to aging. The convening of this meeting, co-sponsored by the Center for Studies of the Mental Health of the Aging and the Psychosocial Treatments Research Branch, marked the first time that NIMH had sponsored a conference in which the clinical and theoretical contributions of psychoanalysis to the study of normal and pathological development had been so explicitly recognized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ward sisters' views of the effect of NHS changes

The role of the ward sister or charge nurse has long been acknowledged as being central to the provision of high-quality patient care. Health service reforms since the 1980s have led to greater managerial responsibility for ward sisters and charge nurses, who are often now known as ward managers. This paper reports on a study carried out in one hospital which described how 15 charge nurses and ward sisters saw their roles in the light of recent changes. While the informants spoke of areas of their jobs with which they were satisfied, such as control over financial resources, there were also areas of concern. These included the pace of change and the sense of isolation that they experienced. The ward sister's responses are described and recommendations for practice outlined.     

The challenge of Alzheimer's disease.

Discusses, using the case of a 73-yr-old female with Alzheimer's disease, the complexity of the challenge of Alzheimer's disease (e.g., difficulty of diagnosis, treatment of the patient and his/her family) and the multi-disciplinary effort underway at the National Institute of Mental Health to meet the challenge. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why Britain is reorganizing its national health service--yet again

The Labour government's 1997 plans for Britain's National Health Service (NHS) have been presented as a reaction to the reforms introduced by its Conservative predecessor in 1991. But to a large extent they build on the Conservative legacy. The centerpiece of the Labour reform--managed care organizations based on groups of primary care physicians--is based on the Conservative experiment with general practitioner fund holding. Welcomed when published, Labour's plans may arouse opposition in implementation, for they imply greater central control and threaten medical autonomy. If the political costs are to be contained, Labour may have to choose between increasing spending on the NHS or making concessions to the medical profession--and quite possibly have to do both.     

A survey of mental health consumers' and family members' involvement in advocacy

As the service delivery system is redesigned, the involvement of consumers and family members in mental health policy-making is essential. Advocacy is a way for them to have an impact on policy or decision-making. To determine the extent of their participation in advocacy efforts, consumers and family members were surveyed by other consumers and family members about their involvement in advocacy and mental healthcare reform. Although more family than consumers reported receiving mental healthcare reform information, both groups had difficulty understanding this information. Consumers were more likely to have received information from a mental health professional while family were more likely to have received information from an advocacy group. Lack of economic resources and communication problems were the most often cited barriers to advocacy for consumers. Strategies are suggested for how to increase involvement of consumers and family in advocacy efforts. The limitations of conducting a state-wide study with consumers and family as data collectors is discussed.