Review of The mental hospital in the 21st century.

Reviews the book, The mental hospital in the 21st century by Emmanuel Persad, Shane S. Kazarian, and Llewellyn W. Joseph (1992). The authors not only review past endeavors in the delivery of mental health services but speculate as to the role the mental hospital may take in the years to come. The starting point for this book is a conference entitled "The Role of the Mental Hospital in the 21st Century" sponsored by the London Psychiatric Hospital in October 1990. The book features 20 brief chapters regrouped in three sections. In all, 29 contributors mainly from Canada, bring forth varying perspectives on the role of the mental hospital. The real contribution of this book is that it puts into perspective the magnitude of the challenge that confronts the major stakeholders in developing a comprehensive and balanced system of mental health services. The present book could serve as a starting point for some serious debate among the stakeholders about the way the mentally ill are treated and to determine how the role of the mental hospital should change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Challenging the therapeutic state: Critical perspectives on psychiatry and the mental health system.

Reviews the special issue of The Journal of Mind and Behavior, Challenging the therapeutic state: Critical perspectives on psychiatry and the mental health system, edited by D. Cohen (1990). This special issue serves as an update on the critique of the medical model in psychiatry. In editing this volume, Cohen has assembled a collection of work from authors in many disciplines—including some laypersons—who are concerned with what they see as the frightening power of the "Therapeutic State." While the work of Thomas Szasz is a guiding light for several of these authors, they certainly are not all associated with his work. In fact, some of them explicitly disavow what they see as Szasz's overly simple stance toward madness. Moreover, the ideas in this volume expand the critique of the medical model far beyond the range of Szasz's work. Disagreements among authors are for the most part confined to a few footnotes in this volume. The book's purpose is to expose the problem before exploring solutions to it. When the volume is at its best, the papers are united by their contention that the medical model in psychiatry is disastrous both for individuals who are victimized by its institutions and practices, and for the society that embraces its disempowering philosophy. There is little, if any, brand new material in this book. Virtually all of the articles contain research and ideas tat the authors have already published elsewhere. The virtue of the book is in bringing together a diversity of work across disciplines that would not ordinarily appear between the same two covers. The common element running through all of these articles is one that the authors almost never state in so many words, but it gives a cumulative force to their very different treatments of psychiatry's problems. Each of these papers, in its own way, reveals aspects of the irrationality implicit in psychiatric orthodoxy. Psychiatry stands at the fringe of medical science, and the fringe of any science is where the inadequacies of its paradigm are most obvious. The attempt to make the medical model fit the problem of madness has not succeeded, but orthodox psychiatry continues to pursue it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research definitions of mental health and mental illness.

The conceptual and methodological difficulties involved in each of the various categories of definitions of mental health outlined in this review are discussed. Suggestions for further research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice makes perfect and other myths about mental health services.

Expenditures for mental health services, as a proportion of health care expenditures, have plummeted in the past decade. Concurrently psychologists have been unable to muster scientific evidence for the effectiveness of typical services. The clinical world failed to collect such evidence while the academic world focused on laboratory studies. Beliefs in the mechanisms thought to assure the quality and effectiveness of typical services may have created complacency. Psychologists seem confident that effective services are assured by (a) more experienced clinicians, (b) degree programs, (c) continuing education, (d) licensing, (e) accreditation, and (f) clinical supervision. After reviewing relevant scientific literature, the author concludes that these are myths with little or no evidence to support them. The author suggests 4 ways to improve the quality and effectiveness of services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Geriatric Mental Health Policy: Impact on Service Delivery and Directions for Effecting Change.

The treatment of mental health problems in older adults has advanced considerably over the past several decades. Nevertheless, the mental health needs of the nation's elderly population remain substantially unmet. This article identifies the significant but previously neglected role of regulatory policies and administrative practices in limiting the use and provision of geriatric mental health services. Such factors are the least recognized and understood by psychologists, although they are the very factors on which psychologists can have the most potential influence. This article subsequently identifies salient legislative proposals and regulatory developments, while addressing the importance of advocacy on agenda setting and policy change. The final section provides specific proposals and mechanisms at micro and macro levels for improving the geropsychology service system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparisons among quality assurance systems: From outcome assessment to clinical utility.

This special section describes contemporary systems for assessing the quality and effectiveness of service delivery. These systems have in common their commitment to the belief that by continuously monitoring treatment-related change, identifying problem cases, and providing feedback to clinicians or agencies regarding patient progress the benefits of treatment may be increased. Aside from their commonalities, much is to be learned from the varying ways with which these systems gather information and provide feedback to clinicians or health care managers. The methods vary both as a function of the sociopolitical climate of the country in which they were developed and of the personal preferences and assumptions of the developers. An articulation of these differences can be of interest to health care managers and to psychotherapy researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Highlander Hookup Between Psychologists and Physicians.

Discusses the current author's work as a clinical psychologist at a community mental health center (CMHC) located in a village of 500 people in the mountains of western North Carolina. The public's perception, which is often loaded with fears and misinformation, of mental health services in small towns and rural settings is addressed. In the author's particular situation, mental health care is allowed only in a non-mental health setting. The role of the local hospital in the service delivery of the CMCH is considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Psychologist in community mental health.

It is "our belief that the field of community mental health is a challenging and stimulating field for research oriented psychologists. We feel strongly that the identity of the psychologist may be best maintained through a scientist-professional model." Recommendations are made for the future training of psychologists in this field. The individual psychologist "must be assisted by adequate post-doctoral interdisciplinary training in a university setting." Major sections are: Maintenance of an Identity, Scientist and Professional, and Training the Scientist-Professional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Outcomes assessment in clinical practice.

Reviews the book, Outcomes assessment in clinical practice edited by Lloyd I. Sederer and Barbara Dickey. This book is a timely publication dealing with the urgent and imperative situation in health care delivery, especially in the area of mental health services. There are four Sections in the book. Section I is titled Integrating Outcomes Assessment into Clinical Practice. This section conveys in a rational and reasonable sequence the definition, impetus, history, scope, process, and current crisis-like status of mental health care, in terms of its financing, its validity, and its effectiveness. Section II is called Instruments of Outcomes Assessment and contains sixteen chapters, each describing a different instrument of assessment. Section III optimistically proclaimed a future improvement of health care delivery and access. These five chapters were exciting, but require a most open and direct acknowledgement of the need for protection of patients and therapists in this field. Complementing Section II is Section IV which contains the Appendices. According to the reviewer, this book has the potential to advance the practice of psychotherapy. But presenting it as a means to satisfy so many volatile and uncontrolled social, political, economic, and other forces can lead to its corruption. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The shift to community mental health as an organizational phenomenon.

Mental health professionals often fail to recognize organizational phenomena which are significant to delivery of services. A current shift in service delivery is the move away from residential care to prevention programs. Rather than seeing this as the result of "new discoveries", the shift is viewed as an outcome of organizational developments. It is suggested that community mental health programs are produced by an institution having resources in excess of stabilized demands for treatment technology. This process of organizational diversification may have the surprising result of creating greater tendencies toward custodial treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Psychology and Medicine: Psychobiological Dimensions of Health and Illness.

Reviews the book, Psychology and Medicine: Psychobiological Dimensions by Donald Bakal (1979). Bakal believes that psychology "is rapidly becoming an integral part of modern health care delivery systems" and directs his book toward developing this interest by showing the theoretical and practical relevance of psychological concepts to major health problems. In the first section, which has the inclusive title "Medicine: Mind and Body", he describes a "paradigm shift" in medicine, away from an emphasis on the physiological and biochemical systems as basic to understanding disease toward a "psychobiological" approach to illness which focuses on the inter-relationships between the social, psychological, and physiological determinants of health and disease. He amplifies this point by discussing such matters as personality-disease relationships, psychomatic medicine, a cross-cultural variation in models of health and illness and the implications of the split brain research for states of consciousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing Role Slippage During Work in the Community: Guidelines for New Psychologists and Supervisees.

Psychologists are increasingly delivering or supervising services in their clients' homes or community. However, because of the looser emotional and temporal boundaries associated with these settings, they may enter problematic roles that place them at risk of boundary crossings or boundary violations. Supervisees and inexperienced psychologists may be unprepared for these opportunities and challenges. The author reviews problematic roles that are somewhat unique to these settings (guest, parent, and buddy-friend) and makes recommendations to ensure the quality of psychological services delivered there. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's Mental Health as a Primary Care and Concern: A System for Comprehensive Support and Service.

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice, policy and parity: The politics of persistence.

The road to comprehensive mental health parity legislation at the state level often reaches a dead end when mental health advocates are forced to compromise by accepting partial parity for "severe mental illness" (SMI) only. In 1999 Connecticut became the first state to modify a biologically based or SMI mental health parity law into comprehensive mental health and substance abuse parity legislation. In this article we chronicle the fight for mental health parity in Connecticut and discuss subtleties of legislative advocacy. This information should prove useful to psychologists who are pursuing parity in other states. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction: Methodological issues in school-based mental health services research.

New research directions on the effectiveness of mental health services for children and adolescents offer the opportunity for school psychology to apply its knowledge base to the systemic juncture between mental health and school systems. Models of service delivery to children, adolescents, and their families that integrate school, mental health, and other service sectors are being actively studied to answer questions about the outcomes of these services for children with mental health problems. The papers in this journal were first presented at the 6th Annual Research Conference of the Florida Mental Health Institute on "A System of Care for Children's Mental Health: Expanding the Research Base." The papers describe state-of-the art studies of school-based mental health interventions for children, adolescents, and their families. In each of the papers, particular attention is paid to the salient methodological issues researchers face in conducting these studies within school settings. It is hoped that these articles will foreground the healthy and creative tensions that exist between different research paradigms and multiple service communities, especially mental health and school systems, by encouraging new research on important and as yet unanswered questions about the effectiveness of school-based service delivery to children and adolescents with mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based treatments and delivery of psychological services: Shifting our emphases to increase impact.

Evidence-based psychological treatments (EBTs) have made enormous gains in the range of techniques that are available and the scope of problems to which they can be applied. Debates about the advances focus on issues related to applicability of the evidence to clinical work, limits of highly controlled studies, and decision making in clinical practice. Less often discussed is arguably the more salient issue, namely, that most people in need of psychological treatment do not receive services, whether evidence based or not. This article discusses EBTs as currently studied in relation to an overarching goal of our interventions, namely, to reduce the burden of mental illness and the full range of social, emotional, and behavioral problems leading to impairment. The diversity of clients, the range of settings in which treatments must be delivered, and the models of delivery ought to receive greater attention in developing evidence-based interventions. In the context of treatment of children and adolescents, this article discusses service needs and how EBTs can better align with these needs to exert broad impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Mental Health Concept.

In its recent report (Amer. Psychologist, 1959, 14, 820-825, see record 1961-00974-001) the Ad Hoc Planning Group on the Role of the APA in Mental Health Programs and Research makes several critical comments on the concepts of mental health and mental illness. These are listed in this article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Services and Health Care Economics: The Health Psychology Marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)