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)     

Women who served in Iraq seeking mental health services: Relationships between military sexual trauma, symptoms, and readjustment.

Eighteen women who served in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) sought mental health services at a Veterans' Affairs (VA) medical center. Ten of the 18 women (56%) reported military sexual trauma (MST) while serving in OIF/OEF. All 10 with MST reported sexual harassment, 6 of the 10 (33% of the sample) reported unwanted physical advances, and 3 (17%) reported completed assault or rape. Fifteen women also completed a questionnaire about their experiences and the Iraq Readjustment Inventory (IRI) developed for this study. High reliability and high correlations with clinician ratings make the IRI a promising measure for future research. A comparison between those with and without MST revealed that those with MST had higher clinician ratings and IRI scores, suggesting greater difficulty with readjustment. And, while MST was significantly correlated with clinician ratings and readjustment scores, the variables "being injured" and "witnessing others injured or killed" were not. These preliminary data suggest that MST OIF/OEF women seeking mental health services is a critical factor for predicting symptoms and difficulty with readjustment to civilian life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating peer support initiatives in a large healthcare organization.

The Veterans Health Administration (VHA) adopted a strategic plan for mental health that emphasizes implementation of recovery-oriented services, including peer support. To provide a baseline for assessing change, a national survey was conducted of peer service delivery for veterans with mental illness, including those with comorbid substance abuse or homelessness. The number of participating programs was small. However, responses indicate that existing VHA peer services can be categorized as partnership services. Program and position structures, such as goals and training requirements are each described. Role and administrative or systems processes, such as acquiring staff buy-in and liability are also described. Future areas of consideration include dissemination of peer support in VHA and other healthcare systems, with specific efforts to increase training protocols, evaluation, and payment options for peers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staffing of mental health organizations, United States, 1988

Between 1986 and 1988, the number of full-time equivalent (FTE) staff employed in specialty mental health organizations in the United States increased 7 percent, from 494,515 to 531,067. Much of this increase could probably be attributed to the increase in number of mental health organizations during this period, from 4,747 to 4,930. With the exception of State mental hospitals and VA psychiatric organizations, all of the other types of mental health organizations showed varying amounts of increase in FTE staff with the most notable gains being reported by private psychiatric hospitals, residential treatment centers for emotionally disturbed children, and multiservice mental health organizations. Of the 531,067 FTE staff employed in mental health organizations in 1988, 72 percent were classified as patient care staff and 28 percent as administrative and support staff. State mental hospitals and VA psychiatric organizations had slightly higher percentages of administrative and support staff (35 and 32 percent, respectively). Seventy percent or more of the staff employed in the various types of specialty mental health organizations in 1988 worked on a full-time basis, the two exceptions being freestanding psychiatric outpatient clinics and non-Federal general hospital psychiatric services in which full-time staff represented only 52 percent and 69 percent, respectively, of all staff. For the most part, the majority (50 percent or more) of each of the staff disciplines employed in mental health organizations worked on a full-time basis. The major exceptions were psychiatrists and other physicians, most of whom worked either on a part-time or trainee basis.     

An analysis of the nature and justification of treatment decisions in inpatient settings.

83 mental health professionals employed at 2 inpatient settings participated in a study on the nature and justification of assessment and treatment decision making. Clinical psychologists, psychiatrists, a psychiatric nursing service staff group, social workers, nonpsychiatric physicians, physician assistants, mental health workers/psychiatric technicians who had at least a high school diploma, rehabilitation specialists, and psychiatric administrators completed a treatment decision questionnaire. It addressed several specific content areas relating to the types of assessment procedures, treatment goals, and treatment methods mental health professionals usually use, as well as the usual reason(s) for such procedures. Results showed that inpatient mental health professionals mostly relied on past success as well as logistical-practical factors in the determination and justification of assessment and treatment methods. Analyses of differences among inpatient institutions and mental health professionals are also presented. The conclusion was that, regardless of the specific assessment and treatment methods relied on, mental health professionals did use systematic decision procedures in choosing such methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care, Medicare, and health policy for older people: A conversation with Arthur Flemming.

Fleming, former secretary of the Department of Health, Education, and Welfare and former US Commissioner on Aging, addresses (a) national health policy and how it might be more supportive of mental and general health needs of older people; (b) the need for changes to the Medicare program, such as enabling psychologists to provide mental health services to the elderly; (c) the need for a national health insurance other than Medicare; and (d) the importance of the Age Discrimination in Employment Act. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classism is overrated: Comment.

Comments on "Psychotherapy, classism, and the poor: Conspicuous by their absence" by Laura Smith (see record 2005-11834-002). This article might have improved Smith's argument that prejudice and oppression (classism) are significant obstacles preventing the poor from receiving psychological services if she had presented evidence to substantiate her claim that "psychology has fallen short in its services" (p. 687) to the poor in the first place. In fact, there is reason to believe that psychotherapists are meeting the mental health needs of the poor in some areas of the country. In Maine, the poor are eligible for Medicaid, which allows for mental health benefits that are more generous in some cases than those provided by private insurance. In addition, the poor in southern Maine may take advantage of programs that pay for mental health services in ways that the middle class cannot. Many psychologists in Maine do provide mental health services to the poor. This is not to say that barriers do not exist or that the mental health needs of the poor are being met. However, I think it is fair to challenge the premise of Smith's (2005) article that the poor either are not being served or are being disproportionately served compared with the nonpoor. (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)     

Patterns of mental health services provided by HMOs.

Surveyed 145 US health maintenance organizations (HMOs) to determine outpatient mental health services offered, psychologists and other providers used, and practices followed in offering such services. Results show that basic assessment and intervention modalities were available to almost all HMO members. Health education programs (weight control, smoking control, and stress adaptation) were not as broadly available as were the more traditional mental health efforts. Almost all HMOs utilized psychologists as providers, either as employees or consultants; subdoctoral qualifications for employment were accepted by one-fifth of the plans. In most plans, physicians referred patients for psychological services. HMOs based on individual practice association models offered fewer services than either group or staff models. The level of mental health service required for federal qualification is exceeded by plans enrolling 82% of all members. Data did not support the argument that requiring mental health services results in forcing both services and costs upward. It is concluded that the current rate of HMO growth will not provide large numbers of additional jobs for psychologists. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

L'amorce du virage préventif en santé mentale au Québec: Enquête sur les politiques, les structures et les programmes de prévention en santé mentale.

This study represents the Quebec contribution to a Canada-wide survey that sought to determine the status of mental health prevention programs as health services undergo major restructuring. Similar to the Canada-wide survey, data on prevention policies, resources and programs were collected from provincial authorities who were responsible for mental health promotion. Data were also obtained from regional health and social services boards (Régies régionales de la santé et des services sociaux) which were in the process of being formed and from other departments which offered mental health services. Although the data support the vitality of prevention programs within government departments they also suggest that those prevention programs may need greater administrative structure and that there are gaps between government promises and commitments, notably with respect to ongoing financing for prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Volunteering in times of community crises: An integration within Caplan's theory of support systems.

Community work done during a period of national crisis, the October 1973 War in Israel, led to some assumptions about the mental implications of volunteering. It appeared to be a "natural phenomenon" at a point at which a community was hit by a disaster in which both those helping and those being helped derived mental health benefits. Within Caplan's theory of Support Systems (1974) volunteeering is considered a phenomenon that can be "mimicked", as avenues for mental health intervention are sought for populations hit by a disaster. The issue of how to best utilize the services of volunteers is raised as the phenomenon appears to proceed through different phases. Following Caplan's (1974) distinction between two types of informal care-givers, the "generalist" and the "specificist", this paper suggests that volunteers should be differently used at specific phases of crises, in order to have mental health benefits for both helpers and those being helped. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transgene expression kinetics after transfection with cationic phosphonolipids in hematopoietic non adherent cells

Persons with chronic mental illnesses have a higher prevalence of medical illnesses and higher mortality rates than the general population. Those living in the community are usually linked with mental health services but are expected to manage their own medical care. The ability to manage their health care and the ability of "surrogate families" to assist them were measured among residents and staff of supervised community residences. In its surrogate role, the agency promoted routine health examinations and follow-up care. Its staff was a central resource for the residents, who sought out staff members for assistance with their health problems. However, residents and staff alike lack knowledge about health problems, medications, and approaches to modifying unhealthy lifestyle practices. Although residents identified lack of knowledge about sexually transmitted diseases as a major concern, staff indicated discomfort with this topic. These findings suggest the importance of supporting chronically mentally ill persons and residential staff in managing residents' health care functions.     

Ecological constraints on mental health services.

Proposes 4 principles for community mental health programing that are consistent with an ecological thesis: (1) Assessment methods are focused on the total population rather than on those persons who presently receive a mental health service. (2) Mental health services are designed to reduce a high risk for community service. (3) Professional and research services are created as local community resources. "By initiating the informal coordination of current services, the community mental health program helps to create specific new community services as needed." (4) The program plans for change; this involves mobilizing anticipatory problem-solving resources not only for clients but for professionals as well. A "conception of community mental health work based upon the ecological thesis that adaptive programs change" is presented. (39 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working as a psychologist in the Medical Reserve Corps: Providing emergency mental health relief services in Hurricanes Katrina and Rita.

This article details before, during, and after "snapshots" of what it is like to go into a disaster to provide emergency mental health as part of the nation's emerging Medical Reserve Corps. It is a first-time responder's personal account of "lessons learned" and "priorities" for psychologists in similar situations. Twelve recommendations for improving psychologists' effectiveness in addressing widespread mental health disasters are identified. These include (a) team deployment and mission, (b) anticipation of frustrations, (c) prioritization in a disaster, (d) ethical dilemmas, (e) recognition of the benefits, (f) development of rapid screening tools to identify those in greatest need of mental health intervention, (g) training allied health professionals in mental health response, (h) mental health interventions specific to Katrina, (i) the importance of supporting caregivers and systems, (j) identifying and activating one's own support system, (k) slowing down interventions, and (l) training. (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.     

Interpreting the Fort Bragg Children's Mental Health Demonstration Project: The cup is half full.

The Fort Bragg study is a significant contribution to understanding mental health services. The study"s finding of no differences between treatment and comparison sites raises difficult questions about the benefits of providing a continuum of care approach. The authors note a number of limitations of the study and suggest a more cautious set of conclusions. The findings must be interpreted in light of the knowledge base of children"s mental health services and the unequivocal lesson learned that a continuum of care is feasible and that children with a variety of mental disorders improve when they are provided with comprehensive care. Also, the results may speak more to the unique population of military families and the broad range of services available to those in the comparison sites rather than to a failure of the underlying construct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pursuing an evidence-based culture through contextualized feedback: Aligning youth outcomes and practices.

How can contextualized feedback on therapy practices and youth outcomes promote an evidence-based culture for adolescent mental health? Relative to other quality improvement tools, feedback and progress monitoring systems are generally underutilized. This article describes a feedback system collaboratively developed by the Hawai'i Department of Health Child and Adolescent Mental Health Division and private agency staff contracted to provide mental health services to youth. Feedback reports allow providers to monitor progress of their youth clients, compare their progress with youth receiving similar services, examine the extent they are using practices derived from evidence-based protocols, and compare these practice profiles to what other youth are receiving. Providers gather to discuss reports, share success stories, and offer suggestions to improve practices and outcomes based on data from the reports. The provider feedback system in Hawai'i has emphasized youth outcomes and has promoted an “evidence-based culture.” This article encourages direct providers and supervisors to consider how such a system might fit in their current practice and whether contextualized feedback might be one way to enhance services and outcomes for youth with mental health needs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Organizational culture and climate and mental health provider attitudes toward evidence-based practice.

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How the public perceives psychiatrists, psychologists, nonpsychiatric physicians, and members of the clergy.

Accompanying two decades of change in the mental health system have been a diffusion of the roles and practices of mental health professionals as well as shifts in the public's perceptions of the various specialties. In the present study, samples of patients and nonpatients used a 4-point Likert scale to rate (a) the competence of psychologists, psychiatrists, nonpsychiatric physicians, and the clergy to treat 10 different patient types, and (b) the personal qualities of the four practitioner groups along nine different dimensions. Psychiatrists and psychologists received significantly higher ratings than both nonpsychiatric physicians and the clergy on competence to treat most mental health problems. Intergroup differences on the ratings of personal qualities suggest a less uniformly favorable perception of psychiatrists and psychologists in comparison with the other two groups. Implications for the marketing and public relations efforts of mental health practitioners are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health financing, service utilization, and national policy: A conversation with Stan Jones.

Interviews Stan Jones, Vice President for Government Relations for Blue Cross/Blue Shield, about his perspective on major health care issues. Topics discussed include access to health care, the role of government in health care services, and factors affecting rising health care utilization and increasing costs. The moral and economic issues related to competition as a means of cost containment are considered. Also discussed is the importance of consumer demand in securing new health insurance benefits, such as coverage for mental health services. Marketplace and diagnostic/treatment issues that make insurance coverage for mental health services problematical are explored. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)