Providing mental health care services to Americans.

Summarizes legislation introduced or cosponsored by the author, a US Senator from Minnesota, to respond to Americans' need for mental health services. This legislation included the Medicare Ambulatory Mental Health Services Access Amendments of 1987; S.123, a bill that would amend Part B of the Medicare program to recognize and reimburse psychologists as independent mental health providers; S.763, the Services for Homeless Mentally Ill Individuals Act of 1987; S.809, the Urgent Relief for the Homeless Act; and S.1663, the Child Abuse Prevention Act of 1987. The author encourages mental health professionals to promote public policies that expand Americans' access to public health services through research, effective communication of this research, and preventive mental health efforts (such as programs aimed at preventing teen suicide). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Administration of substance abuse treatment: Local and national developments.

Discusses increases in attention to and funding of solutions for substance abuse problems. At the federal level, more resources have gone to interdiction and supply reduction rather than to substance abuse treatment or prevention. In San Francisco, substance abuse administrators increased the focus on demand reduction by organizing local resources, creatively seeking financial resources, and gathering community support to reduce problems of drug abuse and HIV. The federal reorganization of substance abuse programs presents a unique opportunity to widen the influence of treatment and prevention approaches. The impact of the Alcohol, Drug, and Mental Health Administration Reorganization Act of 1992 and the organization of the newly created Substance Abuse and Mental Health Services Administration are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Idiosyncratic ocular symptoms associated with the estradiol transdermal estrogen replacement patch system

BACKGROUND: The medical review officer is a position established by federal statute in 1988. The role of the medical review officer is to interpret positive urine drug tests in view of the donor's medical history. With more than 4 million workers affected by the Department of Transportation guidelines for workplace drug testing, and many private employers having urine drug screening programs, there is a need for medical review officers. METHODS: Materials for this report were collected while the first author was pursuing certification from the Medical Review Officer Certification Council. Much of the data was published in the Federal Register from 1988 through 1993. RESULTS AND CONCLUSIONS: Urine drug testing is divided into three stages: collection, laboratory analysis,and medical review of results. Because the workplace urine drug test is a forensic test, the urine is collected under strict chain of custody. Analysis of specimens is conducted by laboratories that have met stringent technical criteria and are approved by the Substance Abuse and Mental Health Services Administration (formerly the National Institute on Drug Abuse). Family physicians are in a unique position to become medical review officers because of their training and professional roles. Educational programs are available for physicians interested in becoming a medical review officer.     

Review of Strategies for building multicultural competence in mental health and educational settings.

Reviews the book, Stategies for building multicultural competence in mental health and educational settings edited by M. G. Constantine and D. W. Sue (2005). Strategies for Building Multicultural Competence in Mental Health and Educational Settings is an excellent resource designed for mental health professionals who may lack knowledge and expertise in working with diverse clients. It provides hands-on strategies and suggestions in a variety of contexts, using the Multicultural Guidelines as a framework. This book is strongly recommended for clinicians working with culturally diverse populations. The Surgeon General's report Mental Health: Culture, Race and Ethnicity (U.S. Department of Health & Human Services, 2001) clearly demonstrates the disparity in the mental health care of racial and ethnic minorities as compared with Whites. This book is useful not only to novices exploring diversity but also to those who are already cross-culturally competent. The authors successfully apply the APA Multicultural Guidelines in clinical practice and educational, training, and organizational settings while providing specific strategies for clinicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Federal involvement in mental health care for the aged: Past and future directions.

Reviews federal legislative trends in mental health services for the elderly under the Reagan administration. The consolidation of 21 health programs into 4 block grants is considered for its impact on elderly mental health care, and Congress's support of important programs such as clinical training, social research, and research on Alzheimer's disease is discussed. Severe limitations for reimbursement of mental health care under Medicare are considered. It is concluded that Community Mental Health Centers under the Reagan administration will further limit non-revenue-producing services such as prevention, consultation, and education as they exhaust their 8-yr federal funding support, and it is unlikely that Medicaid will increase its coverage of services for the mentally ill. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Case managed mental health care in the San Antonio catchment area: the crisis-intervention unit

Through the use of government nursing case management, this crisis-focused inpatient psychiatric program provided cost-effective and therapeutically directed services to Civilian Health and Medical Program for the Uniformed Services (CHAMPUS)-eligible beneficiaries in the San Antonio catchment area. Using managed care principles and a continuum-based case management model, these services were provided in local contracted civilian facilities. This acute care mental health program directly saved Brooke Army Medical Center 1.1 million mental health dollars and saved 7.7 million CHAMPUS dollars in total cost avoidance. Program costs were minimal, resulting in a 557% return on investment. A joint Army/Air Force endeavor, the program was originally administered by the Coordinated Care Division, Brooke Army Medical Center as a CHAMPUS recapture initiative. Currently under TRICARE management, the program continues intact as a managed care mental health service alternative.     

Neuronal signals are required for estrogen-mediated induction of progesterone receptor in cultured rat Schwann cells

This paper presents a methodology for estimating costs of delivering specific substance abuse treatment services. Data collected from 13 programs indicate that the mean cost of residential treatment is $2,773 per patient per month, and outpatient treatment costs average $636 per patient per month. Data are presented on the cost patient per month for individual treatment and nontreatment services, average number of services, cost per unit of service, and intensity of services. In addition to their application to insurance benefit cost estimation, these data illustrate the costing of best-practice adolescent treatment consistent with a Center of Substance Abuse Treatment (CSAT) Treatment Improvement Protocol. In the emerging policy environment, detailed cost estimates like these will aid the design of cost-effective treatment programs, and serve the development of the substance abuse benefit in a health care reform insurance package.     

Assessment of the Massachusetts Medicaid managed Behavioral Health Program: year three

This evaluation of the third year of the Massachusetts Medicaid managed Mental Health/Substance Abuse Program showed that overall utilization increased slightly and expenditures were nearly the same in FY1994 compared to FY1993; however, they were lower for disabled members. Providers believed that access to care, utilization, and quality of care were the same or better than a year earlier and that the clinical review process was improved. Client severity was higher. Aftercare planning improved but gaps in services persisted. Integration of care improved. Administrative and management problems continued. Lessons for similar, more recent initiatives are discussed.     

Investments in behavioral health services: Strengthening the safety net.

As the primary Federal agency at the U.S. Department of Health and Human Services for improving access to health care services to the medically, financially and geographically vulnerable, the Health Resources and Services Administration (HRSA) is committed to improving health outcomes and achieving health equity by funding access to quality services, a skilled health workforce, and innovative delivery programs. Furthermore, HRSA recognizes the importance of access to quality behavioral health services. This article describes HRSA's current efforts to address behavioral health needs within the safety net through the delivery of quality health services and a strengthened workforce. Also, it highlights HRSA's commitment to providing good quality mental health and substance abuse services through key federal and nonfederal partnerships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Acquiring CMS funding for an APA-accredited postdoctoral psychology fellowship program.

In 2001 Congress reinterpreted existing legislation allowing hospital based, postdoctoral psychology training programs that were accredited by the American Psychological Association (APA) to file for and receive allied health reimbursement through the Center for Medicare/Medicaid Services (CMS). This became effective on March 13, 2001 (Health Care Financing Administration, 2001). Historically physician and other allied health training programs have received government funding, while psychology training has been nonfunded. This new legislation symbolized a shift in federal health policy and recognized psychology as a valuable discipline within the health care system. This article discusses several postdoctoral programs' successful approach in obtaining CMS funding and encourages other eligible programs to pursue it as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing evidence-based psychosocial treatment in specialty substance use disorder care.

Implementing evidence-based psychosocial or behavioral treatments for clients with substance use disorders (SUDs) presents significant challenges. In this article, we first identify the treatments for which there is some consensus that sufficient empirical support exists to designate them as “evidence-based,” and then briefly consider the nature of that evidence. Following that, we review data from a Substance Abuse and Mental Health Services Administration survey on the extent to which these evidence-based treatments (EBTs) are used in SUD treatment in the United States. The main focus of the article is a review of 21 studies attempting to implement EBTs from which we glean information on factors associated with more and less successful implementation. We conclude that more conceptually driven, organizationally focused (not just individual-provider-focused) approaches to implementation are needed and that, at least with some providers in some organizational contexts, it may be more effective to implement evidence-based practices or processes (EBPs) rather than EBTs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mary Starke Harper (1919-2006).

Presents an obituary for Mary Starke Harper, a leading authority on mental health care for minorities and the aged. Harper earned a bachelor's degree in education and a master's degree in nursing education with a psychiatric nursing clinical specialty. She moved unpretentiously among the politically influential, showing tireless drive and tenacity on behalf of her causes. She served as an advisor on mental health and aging for Presidents Carter, Reagan, G. H. W. Bush, and Clinton; directed the Office of Policy Development and Research for the 1981 White House Conference on Aging; served as a consultant for the 1995 White House Conference on Aging; and cochaired the Clinton administration's Mental Health/Public Sector Task Force for Healthcare Reform. After formal retirement in 1995, she remained an active, outspoken advocate for improved mental health care for minorities and the aged. She served as an expert adviser on women's health for the U.S. Department of Health and Human Services, a member of the National Institute of Aging's National Advisory Council, a state of Alabama trustee on mental health, and a consultant or member of the board of directors for a wide array of other organizations, foundations, and universities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of preintake attrition in a rural community mental health center.

[Correction Notice: An erratum for this article was reported in Vol 6(2) of Psychological Services (see record 2009-06563-006). The article contains data that were obtained from archival records of the same community mental health center (serving adults, adolescents, and children), and that reflect information from initial consumer contacts made with the center during the same period of time, as that reported in “Clinical Intake of Child and Adolescent Consumers in a Rural Community Mental Health Center: Does Wait-time Predict Attendance?” by Marne L. Sherman, David D. Barnum, Adam Buhman-Wiggs, and Erik Nyberg (Community Mental Health Journal, 2009, Vol. 45, No. 1, pp. 78–84). Information is provided in this clarification about the data used in both articles.] Preintake attrition presents a challenge in outpatient mental health settings, in part due to the waste of limited clinical resources when potential consumers do not attend appointments. While understanding the phenomenon of mental health consumer attrition has received clinical and empirical attention for more than 40 years, the data remain somewhat mixed as to the key predictors of preintake attrition. Additionally, little attention has been directed at understanding missed intake appointments in community mental health centers within rural settings. This study examines predictors of attended appointments for intake in a rural community mental health center, with particular attention to the effect of intake delay or wait-time between call for appointment and scheduled appointment. Wait-time is identified as a significant predictor of appointment attendance in logistic regression analysis, even after controlling for consumer variables, such as referral source and payor source. The impact of wait-time on the likelihood of attending the intake appointment was not moderated by the case urgency. Considerations for applying these results to the organization of clinical service delivery in a rural community mental health center are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research ethics for mental health science involving ethnic minority children and youths.

In response to U.S. Public Health Service projects promoting attention to disparities in the outcomes of mental health treatments, in July 2001, the American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The training program of the National Institute of Mental Health: Its implications for mental health programs.

The year 1956 marked the tenth anniversary of the Training Grants Program of the National Institute of Mental Health (NIMH). From very meager beginnings in 1948 they had advanced to the very substantial position which they now occupy in fiscal year 1957. This article looks backward briefly to when the National Mental Health Act was passed with the goal of improving the mental health of our nation. It describes the objectives and growth of the NIMH mental health program, which was established to help attain this goal. The article also describes several ongoing public mental health programs that reflect NIMH training grant support and problems in program implementation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Predictors of preintake attrition in a rural community mental health center”: Clarification.

Reports an error in "Predictors of preintake attrition in a rural community mental health center" by Marne L. Sherman, David D. Barnum, Erik Nyberg and Adam Buhman-Wiggs (Psychological Services, 2008[Nov], Vol 5[4], 332-340). The article contains data that were obtained from archival records of the same community mental health center (serving adults, adolescents, and children), and that reflect information from initial consumer contacts made with the center during the same period of time, as that reported in “Clinical Intake of Child and Adolescent Consumers in a Rural Community Mental Health Center: Does Wait-time Predict Attendance?” by Marne L. Sherman, David D. Barnum, Adam Buhman-Wiggs, and Erik Nyberg (Community Mental Health Journal, 2009, Vol. 45, No. 1, pp. 78–84). Information is provided in this clarification about the data used in both articles. (The following abstract of the original article appeared in record 2008-16478-003.) Preintake attrition presents a challenge in outpatient mental health settings, in part due to the waste of limited clinical resources when potential consumers do not attend appointments. While understanding the phenomenon of mental health consumer attrition has received clinical and empirical attention for more than 40 years, the data remain somewhat mixed as to the key predictors of preintake attrition. Additionally, little attention has been directed at understanding missed intake appointments in community mental health centers within rural settings. This study examines predictors of attended appointments for intake in a rural community mental health center, with particular attention to the effect of intake delay or wait-time between call for appointment and scheduled appointment. Wait-time is identified as a significant predictor of appointment attendance in logistic regression analysis, even after controlling for consumer variables, such as referral source and payor source. The impact of wait-time on the likelihood of attending the intake appointment was not moderated by the case urgency. Considerations for applying these results to the organization of clinical service delivery in a rural community mental health center are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.