Mental health clinicians' attitudes about reporting threats against the president

OBJECTIVE: A recent review by the United States Secret Service of cases involving threats against the President indicated that about 50 percent of subjects had received mental health care. However, only 12 percent of referrals for investigation came from mental health professionals. This study explored reasons for this discrepancy by examining mental health clinicians' attitudes about reporting threats against the President to the Secret Service. METHODS: A questionnaire developed using findings from a series of focus groups was mailed to a stratified sample of 1,200 psychiatrists, psychologists, and social workers in four states. The instrument included questions about their experience with threats against the President, factors that influence reporting of threats, and knowledge about the Secret Service and its functions. RESULTS: A total of 592 questionnaires were returned, for a response rate of 49.3 percent. Therapists know very little about the Secret Service and are unclear about how to appropriately respond to threats against the President by their clients. The majority of respondents (89.9 percent) indicated they would report a threat against the President only if they thought the threat was "real," contingent on situational and patient variables and elements of the threat itself. Most of the respondents (62.4 percent) indicated that regardless of what information they considered clinically relevant to the investigation. CONCLUSIONS: Given the importance of clinical information for assessing risk to the President, the Secret Service should consider increased educational efforts to inform the mental health community about the functions and mission of the Secret Service and to clarify professional obligations to report threats against the President.     

Interactions between mental health and law enforcement systems: problems and prospects for cooperation

This article examines the challenges posed by system specialization, as illustrated by the difficulties of coordinating the roles of the mental health and law enforcement agencies working with people with severe mental illness. Dealing with the needs of clients in one system when they are most appropriately served by the other may make both law enforcement and mental health systems appear ineffective and inefficient. This could increase the incidence of disorderly or violent behavior, which forments the myth that the seriously mentally ill are inherently dangerous. Despite the evident need to manage these issues, conventional methods of coordinating services have failed. This article concludes by developing a contracting model that creates more appropriate incentives for the two systems and bridges the gap between them.     

Mental health centers and the criminal justice system

Through questionnaires, interviews, and site visits, the authors undertook to ascertain to what extent the 26 community mental health centers in Kansas were contributing to the resolution of problems that concern the criminal justice system. They found that in all large communities some reciprocal programs have developed between the two systems, but meaningful collaboration is rare in small communities. Juvenile courts, urban law enforcement agencies, and county probation officers are most receptive to collaborative programs. An evaluation of several effective programs revealed three basic conditions that attribute to their success: an urban community setting, individual initiative by staff from each system, and location of the program within the criminal justice system.     

Mental health consultation and psychology internship training.

Psychology interns trained in American Psychological Association-approved internship programs are expected to demonstrate an intermediate to advanced level of skill in mental health consultation. Where do students learn the skills to consult with colleagues, other professionals, or the public? This article describes a 1-year, 2-phase training experience in consultation at a university mental health service. The program is theory based, sequential, and builds over the course of the internship. Discussion underscores the positive impact of the training and reviews potential problems that may emerge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An ecological model for categorizing and evaluating student development services.

Based on environmental assessment methodologies, a model was designed to categorize and evaluate student development services. When applying the model to any of a variety of agencies, 4 dimensions need to be specified: target populations, assessment periods, environmental components, and measurement procedures. Actual model implementation is described for a large university counseling center. The advantages of using such a model are discussed with particular focus on the specific implications (e.g., accountability and consultation) for counseling centers and other mental health delivery systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

University-based continuing education and mental health system change.

Describes how a continuing education program successfully effected a change in the organized mental health services in a large metropolitan area. The principles, goals, and outcomes of a program oriented toward mental health system change and using community organization interventions are reported and discussed. Comparisons are made with traditional individually oriented continuing education programs. Mental health professionals were trained in program consultation to community care facilities serving chronic mental patients, and attempts were made to have such consultations incorporated into the organized service delivery systems. It is concluded that university-based continuing education can be a major stimulus and have a major impact on organized mental health delivery systems. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immediate family crisis intervention as preventive mental health: The family consultant service.

The service employs mental health personnel who work closely with the police in order to respond immediately to family-related crises. This paper reports a preliminary evaluation of the program with respect to 5 issues: (a) whether the program is redundant with existing community services, (b) the advantages of early intervention approaches, (c) whether the program is a preventative service to any degree, (d) the evaluation of the program by the police and social agencies, and (e) whether cooperation between mental health and law enforcement professionals is enhanced. Available data collected over a 2-yr period concerning these 5 issues indicated the success of the program. It is concluded that it can serve as a model for community prevention approaches to family crises and mental health problems. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting.

This article discusses the relationship between psychologists and primary care physicians and describes the training and practice of physicians in the areas of mental and behavioral health care. Issues affecting the relationship between psychologists and primary care physicians are then reviewed. Different models of psychological consultation are discussed, and an integrated behavioral systems model of psychological consultation is presented as a potentially effective model for consultation with primary care physicians. This model provides a framework for psychologists to function as coproviders of primary health care services. Practical strategies to enhance collaboration between psychologists and primary care physicians in private practice are discussed. The need for more research on primary care and for the inclusion of psychologists in managed care and health care reform are also highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health consultation with campus ministers: A pilot program.

Monitored issues raised by 15 campus ministers as they participated in a 1-yr mental health consultation program sponsored by a university counseling center. Issues raised (e.g., sexuality, suicide and crisis intervention, assertion training) and strategies used by the group and its leaders in dealing with the issues are discussed. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health practitioners and HIPAA.

The privacy and security of patients' medical records continue to challenge mental health practitioners in an ever-increasing electronic environment. Although practitioners were to be in compliance of the 1996 Health Insurance Portability and Accountability Act (HIPAA) by April 20, 2006, many practitioners still struggle to understand the nuances of the regulations. This article will cover the areas of HIPAA that relate specifically to the mental health practitioner who treats both adults and children. The article begins with important definitions such as “covered entity,” “individually identified health information,” and “electronic transactions.” Establishing that many mental health practitioners likely meet the definition of covered entities, the article details The Privacy Rule and The Security Rule. Included are issues concerning consents, authorizations, and objections along with enforcement of HIPAA. Also changes in enforcement to HIPAA by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of the American Recovery and Reinvestment Act of 2009 are discussed. Examples of violations and resulting enforcement will help practitioners better understand the regulations and how best to comply with these regulations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Stabilizing support of mental health center programs: Testimony on Community Mental Health Centers Amendments of 1969.

Presents information in support of continued federal funding of community mental health centers. Emphasis is placed on the program features of consultation, education and research, evaluation, and the direct treatment services of a center's program. The necessity of support for preventive efforts, the use of indigenous manpower, and training in special problem areas (alcoholism and narcotic addiction) is also stressed. It is felt that effective functioning of community mental health centers requires a continuing pattern of federal support, especially for those activities which are not inherently self-supporting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health consultation and Operation Head Start.

Presents the view that in most settings in which a psychotherapy model was used in consultation in Head Start, the consultation was at best disappointing. A model for community consultation is suggested as an alternative, noting the approach of Gerald Caplan which emphasizes diagnosis and treatment of mental disorders. However, a more comprehensive theory of social environment and its effects on behavior is considered necessary. This would include findings from a number a fields, i.e., psychology, sociology, anthropology, education, and public health. The appropriate academic setting would be in the behavioral sciences unit of a school of public health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles for mental health professionals in critical law enforcement incidents: An overview.

Law enforcement personnel routinely face various critical incidents in the course of their workday including confrontations with irate, violent, and/or mentally challenged individuals. While less frequent, law enforcement personnel also are called in response to hostage incidents, barricaded subject incidents, and attempted suicide/suicide by cop incidents. Over the past 30 years, response strategies utilized by law enforcement personnel have been evolving and have been influenced by mental health professionals. This article briefly reviews the histories of Critical Incident Teams (CITs) and Crisis Negotiation Teams (CNTs), discusses the roles of mental health professionals in the development and continuing evolution of CITs and CNTs, presents some of the obstacles to mental health involvement with law enforcement, and highlights areas in need of more empirical research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Workplace violence: Prevention, response, and recovery.

Describes a model of collaboration between business leaders and mental health clinicians in developing programs and strategies to prevent violence, handle acute crises, and cope with recovery and rebuilding in the aftermath of a workplace violence incident. Sections address the following: (1) demographics, costs, and risk factors and warning signs of workplace violence; (2) workplace violence prevention policies, including hiring, discipline, and termination practices; (3) responses to emergencies, such as potentially dangerous situations, violent episodes, and guns or weapons in the workplace; and (4) strategies for recovery following workplace violence that involve mental health and law enforcement mobilization, dealing with the media, assisting employees and families, legal issues, identification and treatment of posttraumatic stress disorder (PTSD), and follow-up procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental disorder and violent behavior: Perceptions and evidence.

Throughout history and in all known societies, people have believed that mental disorder and violence were somehow related. The consensus of modern scholarly opinion, however, has been that no such relationship exists. Recent epidemiological studies cast doubt on this no-relationship position. Evidence now indicates that mental disorder may be a consistent, albeit modest, risk factor for the occurrence of violence. Denying that mental disorder and violence may be in any way associated is disingenuous and ultimately counterproductive. Dire implications for mental patient advocacy, for mental health law, and for the provision of mental health treatment need not follow from candidly acknowledging the possibility of a limited connection between disorder and violence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violent storms and violent people: How meteorology can inform risk communication in mental health law.

Meteorology is often thought of as a field with highly developed techniques for forecasting rare and severe events. Risk assessment of another type of rare and severe event—violence to others—occurs in mental health law. The analogy between these 2 forms of risk assessment is explored in this article. How meteorologists go about assessing the risk of harmful weather is described. Implications from the meteorological analogy are drawn for 1 aspect of violence prediction that is routinely ignored in mental health law: the communication of risk "forecasts." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating mental health services into primary medical care

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.     

Mental health services in health maintenance organizations: Implications for psychology.

Contends that roles for psychologists in health maintenance organizations (HMOs) are affected by the nature of HMOs, economic considerations, standards set by federal legislation, claims for the cost-effectiveness of mental health services, and the federal administration's goal of removing mental health services from those required in law. Legislation is not precise concerning the nature or extent of mandated mental health services, and administrative interpretation of this legislation encourages considerable latitude in services provided. Studies do not support arguments for mental health services on the basis of their claimed cost-offset effects as strongly as one might wish. It is concluded that if psychologists are to establish areas of unique worth to HMOs, they may have to do so by adding contributions other than traditional clinical services to meet the need structure of HMOs. Possible ways of doing this are discussed, drawing on contributions that are developing in the field of behavioral health and relating these contributions to the prime purposes of HMOs. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a correctional-clinical psychology program.

Describes the development of a graduate training program in correctional-clinical psychology at the University of Alabama. Since 1971, the Department of Psychology has combined academic instruction, field consultation, research, and social activism in this program. An organizational component within the department, the Center for Correctional Psychology, has served the primary coordination role and has been the primary training vehicle. The center's involvement includes not only correctional settings and offenders, but also hospitals, patients, law enforcement systems, police, and courts. Major areas of activity are briefly described, including consultation with criminal justice agencies, the training of criminal justice personnel, provision for a clearinghouse for correctional information, and the preparation and presentation of expert testimony in court. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hairdressers and helping: Influencing the behavior of informal caregivers.

Six 30–55 yr old hairdressers who participated in a 10-wk group mental health consultation and training program were compared with 7 control hairdressers on pre- and posttests of an inventory designed to assess helping strategies. Although on the pretest both groups heavily used the strategies of advice giving and presenting alternatives, only program participants showed an increase in the "reflection of feelings" on the posttest. The consultation program included goals such as (a) maximizing helping effectiveness through modeling and (b) education about referrals within the local mental health network. It is suggested that training in interpersonal help giving be offered to other groups of informal caregivers. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)