A randomized controlled trial comparing two vocational models for persons with severe mental illness.

The authors compared 2 approaches to vocational rehabilitation for individuals with severe mental illness: the individual placement and support (IPS) model of supported employment and the diversified placement approach (DPA), which emphasizes work readiness and offers a range of vocational options, including agency-run businesses and agency-contracted placements with community employers. In all, 187 unemployed participants with severe mental illness were randomly assigned to IPS or DPA. Over 2 years, IPS had significantly better competitive employment outcomes than DPA. Competitive employment rates over the 2-year follow-up were 75.0% for IPS and 33.7% for DPA. However, IPS and DPA did not differ on paid employment outcomes. The authors conclude that IPS is more effective than DPA in achieving competitive employment, but not paid employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Statement on mental illness and mental retardation.

The statement made on behalf of the American Psychological Association is in support of Senate Bills 755 and 756 developed by Congress in response to President Kennedy's message on mental illness and mental retardation. "The psychologist is vitually concerned with the problems of mental disorders and of mental retardation. He is especially interested in research, and in the provision of services to people through the organized agencies of society, such as the public schools, community mental health centers, hospitals, institutions for the retarded, and rehabilitation agencies of many kinds." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists' roles and opportunities in rehabilitation and recovery for serious mental illness: A survey of Council of University Directors of Clinical Psychology (CUDCP) clinical psychology training and doctoral education.

The emergence of psychiatric rehabilitation and the recovery movement generate new and expanded roles for psychologists in services for people with serious mental illness (SMI). However, the proportion of psychologists working in SMI services today is substantially less than previous decades. This article reviews the roles of psychologists in various mental health systems and outlines the contributions that psychologists can make in implementing evidence based approaches for people with SMI. A survey of American Psychology Association (APA)-accredited Council of University Directors of Clinical Psychology (CUDCP) Clinical Psychology doctoral programs was conducted. The results of the survey indicate an increase, since the early 1990s, in clinical faculty with SMI interests, and suggest that many graduate programs provide opportunities for SMI-relevant research and practicum training. However, the survey also indicates a lack of coursework on topics relevant to SMI and a lack of coursework relevant to assuming administrative and leadership roles in the mental health system. Despite training opportunities in graduate school, production of new PhDs who choose the SMI field is unlikely to meet the demand. According to the present study, the limiting factor is not availability of training, but student career choice. The opportunities and challenges that psychologists face in SMI recovery-oriented service delivery are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research definitions of mental health and mental illness.

The conceptual and methodological difficulties involved in each of the various categories of definitions of mental health outlined in this review are discussed. Suggestions for further research are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opinions about mental illness in the personnel of two large mental hospitals.

The present research is directed at clarifying the attitudes of the people who work with psychiatric patients. A sample of over 1000 such individuals, ranging from office and kitchen help to psychiatrists in 2 VA hospitals, filled out a specially devised attitude scale. Factor analysis isolated 5 major factors: 2 reflecting negative attitudes (one in which their difference and inferiority to normals was stressed, the other reflecting a desire to place strong social restrictions on them both during and after hospitalization); 2 positive attitude factors (one based on an almost moral sense of obligation to help unfortunates, the other on more professional attitudes towards their treatability). The 5th factor was defined by attitudes towards etiology of psychiatric illness in relation to psychological development. Clear-cut differences of opinion were at the different levels of professional training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social psychological correlates of mental illness and mental health.

If there is ever to be a single comprehensive theory and/or research program concerned with the etiology of mental illness, the widely diversified empirical and theoretical findings will have to be meaningfully integrated. The present paper critically reviews theories and research from the environmental-demographic level and the interpersonal level. The large number of phenotypical relationships reported have led only to vaguely formulated and speculative interpretations suggesting the need for a reformulation which will suggest genotypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pilot study of a health-focused day program on improving health behaviors, clinical functioning, and perceived wellness in individuals with severe mental illness.

Persons with severe mental illness (SMI) have poor physical health and high rates of premature death. There is limited research on health interventions for this population. This pilot study compares the health behaviors and perceived improvement of 2 day programs and comments on conducting research in health intervention in community-based persons with SMI. Nineteen individuals with SMI from a health-focused day program (HFP) and treatment-as-usual day program (TAU) were assessed for clinical functioning, health behaviors, and perceived improvement by using a semistructured interview and the Brief Psychiatric Rating Scale. The special features of the HFP included special dietary planning, a well-equipped gym, staff instruction, supervision of exercise programs, and limited time for smoking. HFP participants reported higher fruit and vegetable intake and greater perceived improvement in confidence than those at the TAU. There were no differences in the amount of exercise and rates of smoking between the programs. Methodological implications for further research in this area are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs about mental illness as a functon of psychiatric status and psychiatric hospitalization.

Beliefs about mental illness were assessed among psychiatric inpatients at a VA hospital, the mental health staff responsible for their treatment, and a group of medical and surgical (control) patients. Results indicated that: (a) Psychiatric and nonpsychiatric patients generally hold similar opinions regarding mental illness. Severely disturbed psychiatric patients, however, view mental illness in more moralistic terms than do "normals." (b) Psychiatric hospitalization is generally accompanied by a change in the patient's beliefs concerning mental illness, toward those held by the staff. (c) Psychiatric patients whose beliefs about mental illness are most strikingly influenced by the staff tend to respond most favorably to treatment, as measured by length of hospital stay and gains in self-esteem during the 1st month of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States.

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65+) and younger (18-64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social consequences of mental illness.

The person who is publicly known to have had a hospitalization for "mental illness" was inferred to be vulnerable to a sharp depreciation of social esteem in a wide range of social roles. Cross-validation across samples of Ss and across time indicated that the frame of reference of the normal adult population, as to the role status of ex-mental-hospital patients, is both general (widely consensual) and specific (differentiated from other negative social roles that evoke anxiety and fear and carry a social stigma). 2 broad dimensions were postulated to underlie the evaluative complex for ex-mental-hospital patients—an "anxiety-fear" dimension and a "sympathy-contempt" dimension. (32 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community mental health service use by older adults with dementia.

We considered the role of community-based public mental health services in providing care to older persons with Alzheimer's disease and other forms of dementia, and examined service outcomes within California's county-based public mental health system over a 3-year period. Treated prevalence rates, repeat service use rates, and service mix patterns were regressed onto individual, market, and contextual variables across 25 counties over 12 observation periods. The number of older adults with dementia who used community mental health services increased slightly over the observation periods, and service use was associated with age and Medicaid status. Service outcomes also were affected by complementary mental health and aging service systems within each county, as well as the poverty rate and location of the county. Future research is needed to clarify how administrative policies and service management practices contribute to increasing community mental health service use by persons with dementia. In the meantime, these findings can help program administrators and service providers understand the role of community-based mental health services in providing care to persons with dementia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A qualitative approach to the evaluation of psychosocial interventions for persons with severe mental illness.

This article describes the development and assessment of a qualitative interview for comprehensively assessing both the process and the outcome of interventions for persons with severe mental illness (SMI). A open-ended 16-question Narrative Evaluation of Intervention Interview (NEII) was developed. The NEII contains questions that ask the participants to evaluate and describe both process and outcome of interventions for persons with SMI. Research participants were 64 persons with SMI attending rehabilitation programs in the community. Analysis of participants' responses to the NEII, using the open step of the grounded theory approach, produced a comprehensive set of themes. Interrater reliabilities for these themes ranged from moderate to high, and these themes differentiated between the three psychosocial interventions. Ways of modifying the NEII so as to make it more sensitive to participants' expectations and experiences are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The working alliance and employment outcomes for people with severe mental illness enrolled in vocational programs.

Purpose: The purpose of this study was to determine the relationship between the working alliance and employment outcomes in persons with severe mental illness receiving vocational services. Another purpose of this study was to determine whether working alliance differences exist between clients receiving evidence-based supported employment services and those receiving traditional stepwise vocational services. Design: This study was a secondary analysis of a 2-year randomized controlled trial comparing two employment programs providing services to people with severe mental illness. Results: Contrary to expectations, no overall relationship was found between the working alliance and employment outcomes. As predicted, supported employment participants each assigned to a single vocational worker had more positive working alliances than participants served by a team of vocational workers in the traditional vocational program. Conclusions/Implications: The lack of an association between the working alliance and employment outcomes is inconsistent with previous literature. Further research is needed using standardized working alliance measures and larger samples that include both working and nonworking clients. Evidence-based supported employment, which employs individual caseloads, seems to foster better relationships than a team-based vocational approach, although future research is needed to replicate this finding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A behavioral study of staff attitudes toward mental illness.

65 nurses and aides completed 2 factor analyzed attitude questionnaires. Hospitalized psychiatric patients (N = 188) screened for ability to identify their staff and make valid behavioral ratings, rated their ward staff on a 55-item interpersonal behavior inventory. Relationships between perceived behavior and endorsed attitudes were examined. Restrictive attitudes were consistently related to controlling and restricting behavior. Protective Benevolence was related to such behaviors as aloofness, distance, and dishonesty. Hence, some attitudes were related to behaviors which were congruent with the endorsed attitude, some attitudes were related to seemingly incongruent behaviors, while other attitudes had no significant behavioral correlates. A new attitude area, highly related to outgoing interpersonal behavior, was identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness.

The purpose of this study was to develop an understanding of the design elements that influence the ability of persons with severe mental illness (SMI) and cognitive deficits to use a website, and to use this knowledge to design a web-based telehealth application to deliver a psychoeducation program to persons with schizophrenia and their families. Usability testing was conducted with 98 persons with SMI. First, individual website design elements were tested. Based on these results, theoretical website design models were used to create several alternative websites. These designs were tested for their ability to facilitate use by persons with SMI. The final website design is presented. The results indicate that commonly prescribed design models and guidelines produce websites that are poorly suited and confusing to persons with SMI. Our findings suggest an alternative model that should be considered when designing websites and other telehealth interventions for this population. Implications for future studies addressing the characteristics of accessible designs for persons with SMI and cognitive deficits are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The mental hospital. A study of institutional participation in psychiatric illness and treatment.

Reviews the book, The mental hospital. A study of institutional participation in psychiatric illness and treatment by Alfred H. Stanton and Morris S. Schwartz (see record 2005-02933-000). This is a rich and rewarding book. It is a report of research, conducted in collaboration by a psychiatrist and a sociologist, into the social organization of a psychiatric hospital and into the effects of this social organization on the behavior of patients. Although it is primarily intended as a contribution to administrative psychiatry, it is also a major contribution to the general literature of social science and, in particular, to the broad area of personality and social structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting post-treatment-initiation alcohol use among patients with severe mental illness and alcohol use disorders.

Few investigators studying alcohol abuse among individuals with a severe mental illness (SMI) have examined predictors of posttreatment alcohol outcomes. In the present study, a multivariate approach based on a theoretical model was used to study the relationship between psychosocial factors and post-treatment-initiation alcohol use. Predictors of alcohol use outcomes were examined in 278 individuals diagnosed with a current schizophrenia-spectrum or bipolar disorder and an alcohol use disorder (AUD). At 6-months follow-up, 144 of 228 available participants (63%) had good clinical outcomes. The results of structural equation modeling indicated that type of pretreatment residential setting was directly related to treatment, with participants who lived in supervised settings (41%) reporting significantly more days of treatment (β = .34, p     

Access to health care services among people with rehabilitation needs receiving Medicaid.

Objective: To investigate access to care for individuals with rehabilitation-related conditions receiving fee-for-service Medicaid. Study Design: Telephone survey. Participants: One hundred thirty-eight individuals with spinal cord injury (SCI), brain injury (BI), or stroke. Main Outcome Measures: Frequency of difficulty or failure to access medical services, perceived effect on health, services most difficult to access, and reasons for difficulty. Results: People with SCI reported the most frequent difficulty accessing services (87%), followed by persons with BI (79%) and stroke (65%). In a subgroup of respondents, 60% reported failure to receive at least 1 service; 81% reported that access difficulties affected health or daily routine. Conclusions: People with rehabilitation-related disabilities may experience greater barriers to needed services than the larger population of persons with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)