Risk of juvenile justice systems referral among children in a public mental health system

This study established the risk of police referral among a cohort of children who were recipients of public mental health services. Investigators used secondary data to calculate the incidence of criminal referral among 645 children, ages 10 to 17, who entered community-based public mental health programs in King County, Washington. Children receiving public mental health services were nearly three times more likely to be referred to the juvenile justice system compared to children of similar age and gender in the general population. Relative risks were particularly high for younger children (10-13 years) and for children of Hispanic, Native American, and Caucasian origin. Understanding the characteristics and experiences of children who use multiple-service systems has important implications for services delivery. In addressing the needs of youth who have both mental illness and criminal involvement, age- and culturally specific interventions and advocacy efforts are warranted.     

Developing an inpatient practicum program for patients with serious and persistent mental illness.

Training psychology students to treat patients with serious and persistent mental illness (SPMI) can provide an excellent opportunity for psychologists to help an historically disenfranchised and ignored population. With proper training, psychologists can play an important role in the development, provision, and administration of services to people with SPMI. We outline some of the issues to be considered in developing such a training program for practicum students, discuss the clinical skills and systemic issues that need to be mastered at the graduate level, and delineate the process by which this can be achieved in an inpatient, acute-care setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's mental health problems and services: Current federal efforts and policy implications.

This article discusses the current federal role in the collection of information about the mental health problems of children and the provision of mental health services to children. It also describes the federal programs that help finance mental health services, support their coordination, and provide funding for research and training of mental health researchers and clinicians. Recent changes in federal policy are also described. This article, and the Office of Technology Assessment report on which it is based, conclude that although it is in some ways considerable, the federal role in providing mental health services to children is fragmented. This lack of cohesive policies toward children and across service programs may create difficulties for those who would move public policy toward the continuum of care that many observers conclude is needed to address children's mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists working for unions: Developing the United Federation of Teachers' Victim Support Program.

This article describes the development of in-house mental health services in a large labor union local representing public school pedagogical employees. It focuses on the role of a psychologist in guiding program components for a targeted membership group through various stages of development: identifying needs, shaping intervention services, and creating a prevention module. It also describes the movement of services beyond the frame of the specific program to encompass a broader array of emergent mental health service needs, including consultation, technical advice, assistance in dealing with mental health managed care, and expansion of clinical–counseling services to a wider range of membership groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging trends in mental health policy and practice

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.     

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health services give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public–private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dental care for children with mental retardation: thoughts about the Americans with Disabilities Act

The Americans with Disabilities Act bars discrimination in public accommodations, housing, employment and health care for people with disabilities. Efforts to "mainstream" (in housing and education) many of the individuals with mental retardation have altered the setting for dental services and place demands for services by dental practitioners in the community. These developments should be considered within the jurisdiction of this new legislation. Demographic characteristics and dental needs of children with mental retardation are reviewed to provide a background for this discussion.     

Reaching out to the families of those who serve: The SOFAR project.

Families of those in the U.S. Army Reserves represent a population at risk for mental health problems. Strategic Outreach to Families of All Reservists (SOFAR) is a pro bono outreach program serving families with soldiers deployed in Afghanistan, Iraq, and Kuwait. Program components include prevention, intervention, and the production of educational materials. SOFAR negotiated with the reserves (a hierarchical system wary of mental health), recruited pro bono therapists, and oriented them to the needs of reservists' families. During the pilot phase, SOFAR participated in support services, direct services, and psychoeducation. The project is a pilot for a national program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Le régime d'assurance-maladie du Canada--Arrive-t-il à un tournant?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family and professional perceptions of family needs and coping strengths.

Compared the results of a national survey of the needs and coping strengths of 231 families with members who have a psychiatric disability (FPDs) with the results of a survey of 93 mental health professionals' (MHPs) perceptions of families' satisfaction with mental health services and activities. Results indicate that there were wide differences in the perceptions of the 2 groups. FPDs had a high level of dissatisfaction, whereas MHPs perceived FPDs as satisfied with these same services and activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health and well-being of black women: toward strategies of empowerment

This review of the literature on Black women's mental health has three goals: 1) to describe the mental health issues, needs, and adaptive behaviors of Black women; 2) to discuss the research, intervention, and public policy efforts of mental health professionals and Black women's groups to address the multiple needs of this population; and 3) to identify effective strategies by which community psychologists can improve the mental health status of Black women through efforts to reduce their environmental stressors, to increase their resources and access to services, and to facilitate their empowerment in American society. The authors propose a number of recommendations to improve Black women's mental health, including changes in research paradigms, changes in education and training programs, and the development of culturally competent service delivery systems.     

Frank J. Sullivan: Award for Distinguished Professional Contributions to Public Service.

Announces Frank J. Sullivan as the recipient of the Award for Distinguished Professional Contributions to Public Service for 2002. A biographical statement is included, along with major works and contributions for the field. Sullivan received this award for a variety of contributions to public service, including responding to the needs of people with severe mental illness, AIDS, and dual diagnoses; bridging chasms between agencies; increasing the number of minority researchers; pulling people and policies together in polarized areas of animal welfare and mental health vs substance abuse; rationalizing mental health research and service systems; funding national services; creating services for neglected populations of children, depressed women on Medicaid, and the homeless; and contributing to the implementation of the Surgeon General's report on mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Canada's Medicare--At the crossroads?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric assessments of nursing home residents under OBRA-87: should PASARR be reformed? Pre-Admission Screening and Annual Review

OBJECTIVE: As part of nursing home practice reforms, OBRA-87 mandates formal psychiatric assessments (PASARR) of nursing home residents suspected of having mental disorders, a responsibility it delegates individually to states. We describe the initial year of implementation of the PASARR process in King County, Washington, and characterize the mental disorders and mental health services needs of nursing home residents referred for psychiatric screening. DESIGN: Cross-sectional study. SETTING: The 54 Medicare-certified King County nursing homes (total beds = 7013). PARTICIPANTS: All patients referred for psychiatric evaluation under PASARR (n = 510). MEASUREMENTS: A systematic, multidimensional evaluation including a semistructured psychiatric diagnostic examination, validated measures of cognitive dysfunction, depression, and global psychopathology, functional variables relevant to need for nursing home care, and selected mental health services indicators. RESULTS: Fewer than 10% of all nursing home residents were referred for psychiatric evaluation. A primary mental illness, evenly divided between psychoses and mood disorders, was found in 60% of the sample, and a psychiatric disorder associated with dementia or mental retardation was found in 25%. Six percent had complex neuropsychiatric features defying classification, and 4% had no mental disorder. Other disorders, such as substance abuse, were rare. Cognitive impairment and global psychopathology were prevalent in all diagnostic groups, and depressive symptoms were common even in patients without affective diagnoses. Eighty-eight percent of the sample were appropriately placed, based on their needs for daily care. Fifty-five percent had unmet mental health services needs. CONCLUSIONS: The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.     

Major mental illness, housing, and supports: The promise of community integration.

Providing housing and supports for people with psychiatric disabilities, particularly those who are homeless, is a major public policy challenge. This article summarizes the ways in which the concept of these needs is rapidly shifting in the mental health field. The article is based on research on the effectiveness of non-facility-based community support and rehabilitation approaches, the findings of other disability fields, and the emergence of mental health consumers' own preferences for expanded choices, normal housing, and more responsive services, including consumer-operated services. These new sources of knowledge are facilitating a paradigm shift in which people with psychiatric disabilities are no longer seen as hopeless, or merely as service recipients, but rather as citizens with a capacity for full community participation and integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counting the stitches that count: preventive intervention promises and public health

Continued public support for the design, implementation, and dissemination of preventive interventions depends on achievement of four major criteria: (a) Reductions in the incidence or prevalence rates of diagnosable emotional and behavioral disorders, (b) reductions in the need for mental health services through effective primary and secondary interventions, (c) enhancement of the effectiveness of obtained services as screening and early detection efforts are implemented, and (d) reductions in the nation's health care costs associated with emotional and behavioral dysfunctions. Strategies including risk reduction, risk avoidance, health promotion, empowerment, and resource development are preventive insofar as they contribute to achievement of the aforementioned outcomes.     

Clinical Decision Making About Psychopathy and Violence Risk Assessment in Public Sector Mental Health Settings.

Although there has been extensive research on psychopathy, it is unknown how, or whether, clinicians in public sector mental health settings consider the Psychopathy Checklist (PCL) for assessing violence risk. Mental health clinicians (N = 135) from 4 facilities were interviewed by using multiple methods for collecting data on decision making. Participants considered clinical information most often when assessing violence risk, indicating that these data were most readily available. Clinicians perceived formal testing results (e.g., PCL) to be least available and considered testing least often, especially if clinicians had less clinical experience. Participants did not explicitly report using the PCL but did implicitly rely on psychopathy factors when assessing violence risk. Clinicians in crisis settings reported less availability of historical data typically needed for the PCL. The data point to specific ways to improve the clinical practice of violence risk assessment in public mental health settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community-based systems of care for children's mental health services

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.     

Psychologists: The Backbone of the VA Health Care System.

Veterans returning from Iraq and Afghanistan are presenting in large numbers with serious mental health needs. Chairman Akaka addresses this concern and the role of the Department of Veterans Affairs in caring for those in need of mental health services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)