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)     

Use of Veterans Affairs Health Care Services by Veterans Receiving Addiction Treatment in Washington State.

The authors describe characteristics of treatment use among veterans who had addiction treatment in non-Veterans Affairs (VA) facilities in Washington state and who used health care services, including addiction treatment, in VA facilities. From 1996 through 2000, 2,649 VA patients received addiction treatment in Washington state facilities, with 56% (n = 1,489) also receiving some VA specialty addiction treatment and the remaining 44% (n = 1,160) receiving VA health care services unrelated to addiction treatment. Among all veterans receiving addiction treatment in VA facilities in Washington state (n = 11,663), 11% also had treatment in non-VA centers. Over the more than 4-year period, female veterans seen in both systems were less likely to receive VA specialty addiction treatment than were male veterans (40% vs. 58%). This article shows that a significant number of veterans received addiction treatment in both VA and non-VA facilities in Washington state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary classification system for homeless veterans with mental illness.

The purpose of this study was that of defining psychiatric profiles among veterans based on a structured interview of 3,595 individuals administered by outreach mental health clinicians to individuals who were presently or recently homeless. The interview included ratings of presence or absence of current psychiatric disorders; alcoholism, drug abuse, psychosis, mood disorders, personality disorders, PTSD, and adjustment disorders. We identified three subgroups using cluster analysis each showing different diagnostic profiles that were characterized as "addiction" (n = 3,061), "psychosis" (n = 218), and "personality" disorders (n = 54). Cluster membership was related to demographic characteristics, living situation, length of homelessness, and symptoms and complaints including cognitive difficulties, suicidality, violence, and depression. Group comparison statistics were used to compare intercluster differences in demographics, homeless situation, symptoms, and subjective complaints. There were no major intercluster differences in socioethnic, demographic, and homeless situation variables. Differences occurred in complaints of depression, positive symptoms of psychosis, and suicidality. It was concluded that despite the disproportionate sizes of the clusters homeless veterans with mental illness are nevertheless heterogeneous with regard to their psychiatric profiles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal, medical, and healthcare utilization among homeless veterans served by metropolitan and nonmetropolitan veteran facilities.

This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care utilization varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care utilization characteristics of homeless veterans in metropolitan versus nonmetropolitan areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The significance of cross-racial/ethnic friendships: Associations with peer victimization, peer support, sociometric status, and classroom diversity.

This short-term longitudinal study examined the associations between cross-racial/ethnic friendships and relative changes in forms of peer victimization or peer support and the roles of classroom diversity and sociometric status (i.e., social preference) in these associations. A total of 444 children (age range: 9–10 years) from racially/ethnically diverse elementary schools participated in this study. Results demonstrated that cross-racial/ethnic friendships (but not same-racial/ethnic friendships) uniquely predicted relative decreases in relational victimization. Further, classroom diversity moderated the relations of cross-racial/ethnic friendships with relative decreases in physical victimization and relative increases in peer support, such that these relations were stronger for children in highly diverse classrooms. Finally, social preference mediated the association between cross-racial/ethnic friendships and relative decreases in relational victimization. The associations among cross-racial/ethnic friendships, same-racial/ethnic friendships, social experiences with peers, and classroom diversity are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychologists' roles and opportunities in rehabilitation and recovery for serious mental illness: A survey of Council of University Directors of Clinical Psychology (CUDCP) clinical psychology training and doctoral education.

The emergence of psychiatric rehabilitation and the recovery movement generate new and expanded roles for psychologists in services for people with serious mental illness (SMI). However, the proportion of psychologists working in SMI services today is substantially less than previous decades. This article reviews the roles of psychologists in various mental health systems and outlines the contributions that psychologists can make in implementing evidence based approaches for people with SMI. A survey of American Psychology Association (APA)-accredited Council of University Directors of Clinical Psychology (CUDCP) Clinical Psychology doctoral programs was conducted. The results of the survey indicate an increase, since the early 1990s, in clinical faculty with SMI interests, and suggest that many graduate programs provide opportunities for SMI-relevant research and practicum training. However, the survey also indicates a lack of coursework on topics relevant to SMI and a lack of coursework relevant to assuming administrative and leadership roles in the mental health system. Despite training opportunities in graduate school, production of new PhDs who choose the SMI field is unlikely to meet the demand. According to the present study, the limiting factor is not availability of training, but student career choice. The opportunities and challenges that psychologists face in SMI recovery-oriented service delivery are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in health and illness.

The literature on sex differences in illness and disease was examined. Although some biologic sex differences are thought to exist, the overlap between the sexes precluded separation of the sexes for treatment or control of problem conditions. Statistics Canada data on mental illness among males and females in Canada were also examined, and deficiencies in available information were discussed. Most notably lacking were statistics on the use of outpatient mental health services. A number of recommendations were made regarding the collection of Canadian mental health statistics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences in resistance to peer influence.

Prior research describes the development of susceptibility to peer pressure in adolescence as following an inverted U-shaped curve, increasing during early adolescence, peaking around age 14, and declining thereafter. This pattern, however, is derived mainly from studies that specifically examined peer pressure to engage in antisocial behavior. In the present study, age differences and developmental change in resistance to peer influence were assessed using a new self-report instrument that separates susceptibility to peer pressure from willingness to engage in antisocial activity. Data from four ethnically and socioeconomically diverse samples comprising more than 3,600 males and females between the ages of 10 and 30 were pooled from one longitudinal and two cross-sectional studies. Results show that across all demographic groups, resistance to peer influences increases linearly between ages 14 and 18. In contrast, there is little evidence for growth in this capacity between ages 10 and 14 or between 18 and 30. Middle adolescence is an especially significant period for the development of the capacity to stand up for what one believes and resist the pressures of one's peers to do otherwise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A group-intensive peer support model of case management for supported housing.

A group-intensive peer support (GIPS) model of case management for supported housing initiatives is proposed. The principles behind the model and initial experiences with its implementation are described. To promote social reintegration and recovery, GIPS provides housing subsidies and is clinically based on group meetings as the default mode of case management, relying on individual community-based case management interventions on an as-needed basis. The process of finding and sustaining independent housing is articulated as a 21-step process in which peers coach and support one another in achieving each of the steps. The GIPS model has been implemented at the Connecticut VA by five full-time case managers serving approximately 80 veterans. Group meetings are conducted four times a week at various locations ranging in size from three to 25 clients per group. Groups helped maintain frequent contact with clients, minimized staff travel time, and fostered client information-sharing, peer support, and community adaptation. Case vignettes from three different phases of GIPS are used to illustrate the potential benefit for both client well-being and more efficient use of staff time. GIPS is a conceptually promising alternative approach that may be of special value in large multisite programs because it promotes peer support, staff efficiency, and client social reintegration. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Opinions about mental illness in the personnel of two large mental hospitals.

The present research is directed at clarifying the attitudes of the people who work with psychiatric patients. A sample of over 1000 such individuals, ranging from office and kitchen help to psychiatrists in 2 VA hospitals, filled out a specially devised attitude scale. Factor analysis isolated 5 major factors: 2 reflecting negative attitudes (one in which their difference and inferiority to normals was stressed, the other reflecting a desire to place strong social restrictions on them both during and after hospitalization); 2 positive attitude factors (one based on an almost moral sense of obligation to help unfortunates, the other on more professional attitudes towards their treatability). The 5th factor was defined by attitudes towards etiology of psychiatric illness in relation to psychological development. Clear-cut differences of opinion were at the different levels of professional training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recovery in Serious Mental Illness: A New Wine or Just a New Bottle?

The notion of recovery has become a dominant force in mental health policy, evident in reports of the Surgeon General and President's New Freedom Commission. In both reports, recovery is stipulated as the overarching goal of care and foundation for reforms at state and local levels. Little consensus exists regarding the nature of recovery in mental illness, however, or about the most effective ways to promote it. The authors offer a conceptual framework for distinguishing between various uses of the term, provide a definition of recovery in mental health, and conclude with a discussion of the implications of this concept for meaningful reform. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consumer-Run Drop-In Centers and Clubhouses: Comparisons of Services and Resources in a Statewide Sample.

Consumer-run programs and clubhouses are 2 important models in the emerging field of psychosocial rehabilitation according to the 1999 Surgeon General's report (U.S. Department of Health and Human Services, 1999). However, no published studies have compared the operations and services of these 2 models. The research reported here involves a statewide study of a matched sample of 29 clubhouses and 29 consumer-run drop-in centers (CDIs), with data gathered by obtaining documents from and conducting on-site interviews with agency directors. As expected, the authors found greater member control and involvement at CDIs and more instrumental services and activities at clubhouses. The authors also found that clubhouses had substantially more resources than CDIs and that CDIs showed significantly greater variance across programs on most measures. Implications for planning and further research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exiting homelessness without a voucher: A comparison of independently housed and other homeless veterans.

Studies that have shown the superiority of housing voucher programs over standard care for homeless adults with mental illness have also incidentally shown that many are able to obtain independent housing without subsidies. The current study examined how individuals obtain housing without a voucher and whether greater employment earnings or better clinical outcomes were associated with such housing success. Data from an experimental evaluation of the Housing and Urban Development-Veterans Affairs Supportive Housing program were used for an observational study that compared participants who, at 3 months, were: (1) Independently Housed Without a Voucher (n = 96), (2) Independently Housed With a Voucher (n = 93), (3) Housed In Another Individual's Place (n = 60), or (4) Not Yet Housed (n = 170). Participants who obtained independent housing without a voucher worked more days and had higher employment income than those who did use a voucher, but they were less satisfied with their housing. About a third of participants who lived in independent housing without a voucher had others living with them. Homeless veterans with mental illness are able to use employment and shared housing as naturalistic ways to obtain independent housing. (PsycINFO Database Record (c) 2011 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)     

Validity of peer nominations in predicting a distant performance criterion.

This paper reports the follow-up phase of a study of peer nominations begun in 1955 at the Naval OCS in Newport, Rhode Island. Over 700 trainees completed several peer nomination forms at various stages of training, 1 in particular on "success as a future Naval Officer" (FO). Subsequently, 639 trainees were identified who had gone on to duty as officers for about 3 yr. The average grade they secured on a key portion of the fitness report ratings assigned by their direct superior officers was used as a performance criterion; it had a split-half reliability of .90 In the prediction of this criterion, the FO peer nomination score from the 3rd wk. of training gave a validity of .40 which was as high as that for later FO scores and which was only slightly diminished after academic grades and popularity were partialed. The findings support the use of early peer nominations as a valid supplemental measure in predicting performance after training. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in 2- and 3-years-olds: Mother-child relations, peer relations, and peer play.

This paper examines the different behavior patterns utilized by boys and girls as they form peer relationships and engage in peer play; the nature of their relations with their mothers is also reported. Girls manifested more intense involvement with their mothers, engaged in less peer play than boys, showed lower mood, lower levels of play, less direct aggression, and more controlling play with peers. Furthermore, their mothers handled their requests for contact and aggressive behavior differently than did mothers of boys. Boys were slower to become aware of separateness but once aware, they came to terms with it faster than girls. The boys took longer to pay attention to peers; once peers were focused on, the play moved more quickly to high levels than did the play of the girls. Qualitative findings were supported by quantitative findings-boys showed more contact and more involvement with their peers than did girls. The hypothesis is tentatively offered that the reaction to the awareness of psychological separateness from their mothers is more intense in girls than in boys partly because girls experience this awareness earlier, owing to their more rapid cognitive maturation. . . (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental illness, milieu therapy, and social organization in ward groups.

"It was concluded that as degree of mental illness increases, there is a decrease in social organization and social relationship involving positive or negative feelings. This process appears to be reversed by milieu therapy." (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 Psychologist Connection: Service Linkage and Role Definition.

The mental health field is not always perceived in terms of benevolent experiences, and Gothic attitudes can still prevail. Although the stigma attached to mental illness has diminished, some lay and professional people, including physicians, still have difficulty recognizing mental health problems and/or if recognized, knowing where to refer patients for proper treatment. In addition, many people lack awareness of the range and role of mental health professionals who are available to deal with the complex issues of treatment and prevention surrounding mental illness. This commentary highlights some of the shortcomings that exist when professional roles are not clearly understood and how such a lack of understanding adds to the separation that already exists between professionals when attempting to provide appropriate service linkages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multidimensional wellness group therapy program for veterans with comorbid psychiatric and medical conditions.

Development of a healthy lifestyle is an important aspect of mental health that is infrequently targeted in outpatient mental health settings. Although the interrelationship of psychological and physical factors has often been noted, interventions frequently focus on just one aspect of functioning. This project demonstrated the feasibility of a multidimensional weekly wellness group program focused on the overall health behaviors of patients in a Veterans Affairs mental health clinic. The modal participant was a male in his mid-50s, living alone, not employed, depressed, obese, and with many chronic medical problems. Eighty-three patients participated in a 15-week program promoting changes in such areas as stress management (abdominal breathing, muscle relaxation, visualization, and mindfulness), physical health care (exercise, nutrition, sleep routine, and substance use), and behavioral activation (activity scheduling, social affiliation, and use of community resources). Substantial improvement was found for most patients, in both psychosocial and physical functioning domains, and was maintained over time. The melding of psychoeducational and skills training into a positive psychology orientation appears to have been beneficial. In addition, the group process was quite effective in encouraging change in these highly comorbid, chronically ill veterans. The feasibility and importance of integrating psychosocial and physical interventions is underscored by this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)