The process of mental health consultation: A systematic look within the context of community psychology.

The process of mental health consultation has been generally defined in terms of the techniques which the psychologist uses, "the how" of the consultant's role. The content, "the what" of this process is now being considered. The issues raised are partly based on the analysis of all consultation - contacts (N-56) collected during the first nine operational months of a project serving a sample population previously not reached by traditional clinical settings. Specifically this paper discusses the way in which a record-keeping method, devised specifically to account for "what" happens during a consultation, yields findings clarifying, complementing and at times diverging from what has been impressionistically reported to be content of the consultation process: a focus on psychopathology and intrapsychic conflicts of the consultee's charges. This pilot project in its attempt to systematically record all consultant's activities, has methodological implications for valid functional definitions of the mental health consultant within the context of community psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric consultation: concepts and controversies

There are two major models of consultation in the field of psychiatry, differing in their goals, participants, settings, and methods. The psychiatric-therapeutic model entails provision of optimal care for the individual patient; the community mental health model involves provision of assistance to mental health caregivers. The author believes that to enhance the value of consultation the consultation should restrict his or her role to that for which he or she has been trained. Current social needs, coupled with a limited supply of consultants, suggest that psychiatric consultation should be provided within comprehensive health care systems. There is a pressing need to clarify the concepts of formulations concerning the criteria of outcome of psychiatric consultation so that evaluation of its effectiveness can be advanced.     

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)     

Collaborating with African American churches to overcome minority disaster mental health disparities: What mental health professionals can learn from Hurricane Katrina.

The purpose of this qualitative study was to explore how mental health professionals and African American pastors and their churches could collaborate to overcome minority disaster mental health disparities. Forty-one African American pastors of churches located in south Mississippi, in counties directly affected by Hurricane Katrina, participated in semi-structured interviews approximately 1 year after the storm. The majority of participants reported being interested in collaborating with mental health professionals to: (a) develop educational and outreach opportunities, (b) lead assessment procedures, (c) offer consultation activities, (d) provide clinically focused services, and (e) utilize spiritual resources and support. Participants provided further insight into how these collaborative activities could be modified to meet post-disaster needs and offered novel applications. Following from these discussions, the article provides a number of recommendations that can be used to aid in the development of disaster collaborative activities between African American pastors and churches and mental health professionals to serve minority communities while also decreasing disparities. (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 in the pediatric intensive care unit.

The need for psychosocial intervention to be integrated with medical care on intensive care units is high, but too often mental health professionals are ill-equipped by traditional training programs for such work. Medical crisis counseling provides a conceptual framework useful in developing the skills needed to effectively intervene in such settings. The pediatric intensive care unit ( PICU ) is arguably one of the most emotionally demanding and high-stress areas where mental health clinicians may be asked to consult. This article describes medical crisis consultation in the PICU setting, suggests survival strategies for the mental health consultant to the PICU, and provides illustrative case examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health consultant to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants--psychologists and psychiatrists--with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions.     

Erratum to Glenwick.

Reports an error in the original article by David S. Glenwick (American Psychologist, 1979[June], 34[6], p.559), a misplaced line occurred in the first paragraph, third column. The paragraph should read: I share Goodstein and Sandler's (1978, p. 891) opinion that "community psychology cannot prosper within the community mental health movement" (my emphasis). Nonetheless, there are some aspects of the community mental health movement (e.g., consultation, crisis intervention, use of paraprofessionals, community education, administration of the community mental health center as an organizational system) that can prosper within community psychology, that are consonant with a community psychology orientation and can lead to mutually productive collaborative undertakings. To prevent the baby from being thrown out with the bathwater, it is these aspects of community mental health that can legitimately be embraced by community psychology without comprising its ideological integrity. (The following abstract appears in record 1990-58513-001.) Comments on L. D. Goodstein and I. Sandler's (see record 1979-22507-001) conceptual analysis of community psychology (CP), focusing on program evaluation, multidisciplinary knowledge, and the community mental health movement (CMHM). There are aspects of the CMHM that can prosper within CP, that are consonant with a CP orientation, and that can lead to mutually productive collaborative undertakings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Online counseling: The Internet and mental health treatment.

The author asserts that the mental health profession is unprepared for the likely growth and related implications of mental health therapy delivered over the Internet. Clinical, ethical, and economic issues are addressed. Conclusions are that therapy can be done online, that it can be done ethically, and that online services might not be a serious threat to face-to-face therapy. Regulatory and professional organizations are strongly advised to cooperate with each other. Suggestions include how practitioners and educators might develop skills, how ethics and legislation might be coordinated, how research might be facilitated, and how certain support systems might be established. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family history of breast cancer: what do women understand and recall about their genetic risk?

The current study has two aims: (1) to look at people's recall of risk information after genetic counselling and (2) to determine the impact of receiving an audiotape of the genetic consultation on level of recall, cancer related worry, and women's uptake of risk management methods. Using a prospective randomised controlled design, subjects receiving an audiotape were compared with a standard consultation group. Participants were drawn from attenders at the genetic clinics of two London hospitals and included 115 women with a family history of breast cancer. Assessment of perceived genetic risk, mental health, cancer worry, and health behaviour was made before counselling at the clinic (baseline) and by postal follow up. Usefulness of audiotapes and satisfaction with the clinical service was assessed by study specific measures. The data indicate that cancer worry is reduced by provision of an audiotape of the genetic consultation. Recall of the genetic risk figure, however, is not affected by provision of an audiotape and neither is it related to women's overall perception of being more or less at risk of breast cancer than the average woman. Forty-one percent of women accurately recalled their personal risk of breast cancer at one month follow up; however, 25% overestimated, 11% underestimated, and 23% could not remember or did not know their breast cancer risk. Recall of the risk figure is more accurate when the clinical geneticist has given this to the woman as an odds ratio rather than in other formats. Subsequent health behaviour is unaffected by whether women have an audiotape record of their genetic consultation. Results suggest that having a precise risk figure may be less important than women taking away from the consultation an impression that something can be offered to help them manage that risk. Provision of an audiotape of the consultation is of limited usefulness. The need for psychological care to be better integrated into genetic counselling at cancer family clinics was highlighted by the study. The results are discussed in terms of future service development.     

Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.

Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-informed perspective in their practices to enhance the quality of care for these children. This includes making sure that children and adolescents are screened for trauma exposure; that service providers use evidence-informed practices; that resources on trauma are available to providers, survivors, and their families; and that there is a continuity of care across service systems. This article reviews how traumatic stress impacts children and adolescents' daily functioning and how various service systems approach trauma services differently. It also provides recommendations for how to make each of these service systems more trauma informed and an appendix detailing resources in the National Child Traumatic Stress Network that have been produced to meet this objective. (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 Theoretical Support for Transgenerationality: The Theory of the Protomental.

Many authors, particularly in the field of psychoanalysis, have demonstrated the intergenerational transmission of fundamental characteristics of personality structure. It has been found that unconscious modes of mental functioning, rather than contents, are transmitted. The structure of the unconscious has been stated to be transgenerational. Present-day research seeks to describe how not only contents but also functional modalities--that is, mental structures--can be transmitted in parent-child relationships and, in particular, in the caregiver-neonate relationship. Current studies describe these events in clinical terms. The author illustrates how his theory of the protomental, on which he has worked for many years and is still working, can not only describe but also explain in psychophysiological terms what is transmitted, and how it is transmitted, from the mother to the fetus and to the neonate. (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.     

Toward effective community-based interventions in child abuse.

Argues that traditional individual and family-oriented clinical and educational approaches to treating child-abusing parents seem to have limited effectiveness. Within an ecological framework, causal factors bearing on the problem of child abuse can be amenable to community intervention through the use of such concepts as natural support systems and community development activities. An example of community development intervention is described, and guidelines for community-level interventions are suggested. The consultation and education program of the community mental health center is cited as one such approach to this problem. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sharing the wealth: A model for brief mental health volunteer work in developing countries.

Much needed mental health services can be provided to developing countries using a model including brief, repeated consultation trips and the help of a translator. The authors describe their experiences in Central America, which led to the development of this model. Entry into the country, exit, and follow-up are addressed as well as mental health work in the context of language and cultural differences. Clinical methods that were found to be useful in the context of this model are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using psychology to promote human welfare: A conceptual analysis of the role of community psychology.

Analyzed according to a conceptually developed matrix the approaches by which psychology can be used to enhance human welfare. The approaches include clinical psychology, community mental health, community psychology, and public policy psychology. Each approach is examined in terms of the intended target, the content of the intervention, the process involved in the intervention approach, and the knowledge base necessary for attempting such interventions. The differences between community psychology and community mental health are emphasized, and it is concluded that community psychology should disengage itself from the community mental health movement to fulfill its most important functions of interfacing with the social systems of deviance control and of socialization and support. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology as a Health-Care Profession: Implications for training.

This article places a magnifying glass on psychology's current training realities in the context of global health developments, particularly those of the Canadian health-care system. The authors argue that curriculum review and revision is needed to solidify psychology as a true health care profession; such a review should be proactive and must consider the likely changes in our overall health-care system. In preparing for anticipated changes in health care, it is proposed that curricula modifications be made to better reflect how psychology can contribute (in a broad fashion) to the health of Canadians. Two particular models for psychology's future role are offered for discussion: a) a modified, comprehensive parallel/vertical model that sees psychologists similar to other health-care providers; versus, b) a more innovative horizontal/cross-cutting model in which psychologists provide a unique blend of education, innovation, teaching, system consultation, prevention, as well as direct service provision, to patients with physical and mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The standard ''Healthcare Information Systems Architecture'' and the DHE middleware

The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. This paper discusses how an open architecture, based on the introduction of a middleware of common health care-specific services not only reduces the effort necessary for allowing existing systems to interwork, but also automatically establishes a functional and information basis common to the whole organisation, on top of which also new applications can be rapidly developed, natively integrated with the rest of the system. Such architecture has been already formalised through the European standard, defined by the CEN/TC251 prENV 12967-1 'Architecture for Health care Information Systems' (CEN prENV 12967-1 'Health care Information Systems Architecture'). Thanks to the availability of industrial products conforming to the standard, the effectiveness and the validity of this approach has been already demonstrated in practice. For example, through the Hansa collaboration hospitals and industries from countries of the Western and Eastern Europe, as well as of the Middle East use the same industrial middleware (i.e. 'The DHE middleware-Information view'-SPRI, 1998, 'The DHE middleware-Functional view'-SPRI, 1998) for integrating existing systems as well as for developing new applications.