U.S. mental health policy: Proactive evolution in the midst of health care reform.

Argues that it is vital that psychological and behavioral health care perspectives be explicitly recognized during the coming reform of the US health care system. Mental health policy should not be treated as a mere extension of physical health policy; to do so extends all the flaws of the physical health system into the psychological care arena, resulting in a mismatch with the actual health care needs of the nation. Furthermore, organized psychology must remind policymakers that psychologists provide health services in areas of health care beyond mental health. The challenge to psychology is to ensure the continuation of adequate and timely access to appropriate psychological and behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Doomed and double doomed?: Health care reform and the mental health policy challenge.

Comments on C. A. Kiesler's (see record 1993-10935-001) article on health care reform and mental health policy. Much of the current debate is driven by economists, sociologists, political scientists, and physicians, who specialize in health policy analysis and research. To the degree that psychologists are not involved in health policy analysis and research, their interests and perspectives are not likely to be sufficiently represented. Kiesler's work and that of others can serve as models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The new politics of U.S. health policy

Following the demise of comprehensive health care reform in 1994, some reformers are seeking comfort in the successful "incremental" strategy for enacting Medicare that emerged out of President Harry Truman's failed campaign for national health insurance in 1948-50. But despite similarities between the Truman and Clinton health security efforts, overall contexts of government and politics are much less hospitable to governmentally funded reforms today than they were after Truman's defeat. Back then, market transformations and political dynamics were both pushing toward expanded access to health services and insurance coverage. Today, by contrast, both push in the opposite direction. The private insurance market is fragmenting, federal budgetary constraints stymie new programs, and the deficit dominates debate over existing programs. Equally important, a stable pro-reform coalition like that of Truman's day has yet to emerge, while a new and fiercely conservative corps of Republicans is championing coherent programmatic alternatives based on antigovernment premises. Although passage of the Kassebaum-Kennedy health insurance reform bill in 1996 unleashed a wave of enthusiasm about incremental health care reform, formidable political, fiscal, and technical obstacles continue to stand in the way of even relatively modest incremental solutions.     

Barriers to mental health care utilization for U.S. Cambodian refugees.

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

American Indian mental health policy.

Examines the utilization and delivery of mental health services for Native Americans (NAs). Delivery systems discussed include the Indian Health Service, the Bureau of Indian Affairs, university- and urban-based care, and tribal mental health care. It is noted that many NAs view mental illness as a justifiable outcome of human weakness and as a result of excessively individualistic behavior. Treatment of disturbed individuals is considered a community matter. Psychologists often try to impose their values on NAs. It is suggested that psychologists need to become familiar with mental health prevention processes. Recommendations for improving service provision and policies toward NAs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of specialty mental health organizations by older adults: U.S. national profile

Data from the four most recent biennial inventories of mental health organizations and general hospital mental health services conducted by the U.S. Department of Health and Human Services (1988 through 1994) were used to examine utilization of specialty mental health organizations by older adults. The data show steady inverse trends in utilization rates for inpatient and ambulatory care. The oldest clients (age 75 and older) had both the highest percentage decrease in use of inpatient services and the highest percentage increase in use of ambulatory services. The expected growth of the older adult population will challenge the ability of systems of care to maintain or increase the rate of ambulatory mental health care.     

Serious mental health problems: policy changes

Recent developments in services and strategies for helping people with serious mental health problems represent a watershed in mental health provision. This has implications not only for specialist mental health nursing, but also-- as increasing numbers of people with serious mental health problems live in the community-- for nurses working in all areas of health care, who will have to play a role in meeting their needs. This article describes current developments in policy and practice, and seeks to explain the basic principles of working with people in this client group.     

Costs and effects in mental health policy.

Argues that C. A. Kiesler (see record 1982-31029-001) inadvertently overstates the expense of institutionalization in present mental health policy and hence overestimates the relative fiscal viability of alternative care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness analysis in mental health policy research.

Comments on C. A. Kiesler's (see record 1981-30977-001) argument for cost benefit (CB) and cost-effectiveness (CE) studies in mental health program evaluations. The present author maintains that Kiesler failed to mention the work of several psychologists who investigated the application of CB and CE analyses to mental health. Several misconceptions of CB and CE analyses that were not mentioned by Kiesler are reviewed. These include: (1) the confusion that CB and CE are somewhat interchangeable, (2) the misconception that direct or budgetary costs are the only relevant costs in these analyses, (3) the oversimplification that CB and CE involve only quantitative ratios, and (4) the tendency for these techniques to be seen as objective and nonjudgmental. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reimbursement policy and cost-effective mental health care.

Examines past efforts to curb the cost of insuring mental health care that have involved such devices as cost-sharing, benefit ceilings, and limitations on eligible providers. More recently, attention has been turned to regulatory schemes that would employ the results of efficacy research. Specifically, public debate has focused on using demonstrated effectiveness as a criterion for approving certain treatments for reimbursement. Such a strategy may increase costs, inhibit innovation, and interfere with clinical practice. A regulatory model is proposed that would use the criterion of cost as well as the criterion of effectiveness. This method would permit effective, lower cost treatments to be substituted for high-cost therapies. Provider participation and systems innovation would be fostered through decentralized implementation. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New directions in children's mental health policy: Psychology's role.

The policies that influence the practice of children's mental health affect psychologists across the nation. Major recent events have brought this topic to the attention of national policymakers at the highest level and have created opportunities for psychologists to present information regarding recent scientific advances in the treatment of childhood disorders and to be involved in the development of solutions to address the needs of our nation's children. This article reviews these recent events, summarizes current knowledge in the field, and addresses specific issues and critical gaps in current national policies on children's mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent health: Reflections on a report to the U.S. Congress.

The Office of Technology Assessment (OTA) found that the conventional wisdom that American adolescents are so healthy that they do not require health and related services is not justified; US adolescents often face formidable barriers to obtaining needed health care, and relatively little appropriate attention has been paid to adolescents by the federal government. OTA suggested that Congress could act to (1) increase adolescents' access to health care by supporting comprehensive health services specifically for adolescents, (2) restructure the federal role in adolescent health by creating an office of adolescent health in the US Executive Branch, and (3) improve adolescents' social environments by providing more support to families of adolescents, limiting adolescents' access to firearms, supporting the expansion of their recreational opportunities, and further increasing opportunities for community service. Federal actions taken since OTA's report are summarized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes of U.S. and Czech/Slovak mental health and health professionals toward five types of sexually explicit materials

Mental health and health professionals' attitudes toward sexually explicit materials in the U.S. and Czech/Slovak Republics were investigated. An instrument measuring attitudes toward educational, soft-core, hard-core, violence, and bizarre/paraphiliac sexually explicit materials was administered to sexologists, psychologist/counselors, and medical professionals. These professionals were attending conferences in the U.S. and the Czech/Slovak Republics between November 1992 and September 1993. Mental health and health professionals had the most favorable attitudes toward educational sexually explicit materials followed by soft-core and hard-core materials, respectively. They had unfavorable attitudes toward violent and bizarre/paraphiliac sexually explicit materials, with particularly negative attitudes toward violent materials. Analysis of covariance showed that strength of religious conviction was a significant covariate; thus professionals with stronger religious conviction had more negative attitudes toward all five types of sexually explicit materials. When controlling for strength of religious conviction: (i) sexologists had more positive attitudes toward most types of sexually explicit materials; (ii) Czech professionals generally had more positive attitudes toward such materials than their U.S. counterparts; and (iii) there were few differences between female and male professionals in their reported attitudes. While previous literature has reported gender differences in attitudes toward sexually explicit materials, findings from this study suggest that this effect may be due to differences in religiosity among women and men, namely, that women tend to be more religious.     

Supply dynamics of the mental health workforce: implications for health policy

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.     

The financial health of the U.S. consumer

The spending and saving habits of the household sector play a major role in the U.S. economy. Consumer spending accounts for two-thirds of gross domestic product (GDP). A rise in consumer debt as a percent of disposable income has sparked concerns that this sector is overextended and may begin to experience financial difficulty. This article examines the household sector's finances from the standpoint of income, wealth accumulation and debt burden. It concludes that although individual households will experience difficulties, overall the consumer's financial position appears to be sound and does not portend an imminent downturn in the economy.     

Children's mental health problems and services: Current federal efforts and policy implications.

This article discusses the current federal role in the collection of information about the mental health problems of children and the provision of mental health services to children. It also describes the federal programs that help finance mental health services, support their coordination, and provide funding for research and training of mental health researchers and clinicians. Recent changes in federal policy are also described. This article, and the Office of Technology Assessment report on which it is based, conclude that although it is in some ways considerable, the federal role in providing mental health services to children is fragmented. This lack of cohesive policies toward children and across service programs may create difficulties for those who would move public policy toward the continuum of care that many observers conclude is needed to address children's mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based disaster mental health services: Clinical, policy, and community challenges.

The consequences of Hurricane Katrina have far-reaching implications for the mental health system in the Gulf Coast region, with some of the most vulnerable survivors being children and adolescents. School-based services have been proposed as an ideal way to provide care; however, significant challenges remain in providing trauma-informed services in schools postdisaster. The authors discuss the consultation and training activities of the Los Angeles Unified School District Trauma Services Adaptation Center for Schools and Communities following Hurricane Katrina. Issues related to the dissemination of evidence-based treatment in schools following a disaster are discussed, as are the particular needs of providers and school staff and the importance of community collaboration in identifying ways to adapt implementation strategies for specific communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)