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)     

American Indian mental health policy.

Examines the utilization and delivery of mental health services for Native Americans (NAs). Delivery systems discussed include the Indian Health Service, the Bureau of Indian Affairs, university- and urban-based care, and tribal mental health care. It is noted that many NAs view mental illness as a justifiable outcome of human weakness and as a result of excessively individualistic behavior. Treatment of disturbed individuals is considered a community matter. Psychologists often try to impose their values on NAs. It is suggested that psychologists need to become familiar with mental health prevention processes. Recommendations for improving service provision and policies toward NAs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed mental health care: problems and possibilities

To investigate the molecular mechanisms involved in paramyxovirus-induced cell fusion, the function and structure of synthetic peptide analogs of the sequence from the leucine zipper region (heptad repeat region 2) of the Newcastle disease virus fusion protein (F) were characterized. As previously reported (Young et al., Virology, 238, 291), a peptide with the sequence ALDKLEESNSKLDKVNVKLT (amino acids 478-497 of the F protein) inhibited syncytia formation after transfection of Cos cells with the hemagglutinin-neuraminidase and F protein cDNAs. A peptide analog which had an alanine residue in place of the first leucine residue in the zipper motif (ALDKAEESNSKLDKVNVKLT) retained inhibitory activity but less than the original peptide. Further loss in activity was observed in a peptide in which two of the leucine residues were replaced with alanine (ALDKAEESNSKADKVNVKLT), and a peptide which had all leucine residues in the zipper motif replaced with alanine (ALDKAEESNSKADKVNVKLT) had no inhibitory activity. The three-dimensional conformations of these peptides in aqueous solution were determined through the use of nuclear magnetic spectroscopy and molecular modeling. Results showed that while the wild-type peptide formed a helix with properties between an alpha-helix and a 3(10) helix with leucine residues aligned along one face of the helix, progressive substitution of leucine residues with alanine resulted in the progressive loss of helical structure. The results suggest that alterations of leucine residues in the zipper motif disrupt secondary structure of the peptide and that this structure is critical to the inhibitory activity of the peptide.     

Supply dynamics of the mental health workforce: implications for health policy

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.     

Costs and effects in mental health policy.

Argues that C. A. Kiesler (see record 1982-31029-001) inadvertently overstates the expense of institutionalization in present mental health policy and hence overestimates the relative fiscal viability of alternative care. (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.     

Cost-effectiveness analysis in mental health policy research.

Comments on C. A. Kiesler's (see record 1981-30977-001) argument for cost benefit (CB) and cost-effectiveness (CE) studies in mental health program evaluations. The present author maintains that Kiesler failed to mention the work of several psychologists who investigated the application of CB and CE analyses to mental health. Several misconceptions of CB and CE analyses that were not mentioned by Kiesler are reviewed. These include: (1) the confusion that CB and CE are somewhat interchangeable, (2) the misconception that direct or budgetary costs are the only relevant costs in these analyses, (3) the oversimplification that CB and CE involve only quantitative ratios, and (4) the tendency for these techniques to be seen as objective and nonjudgmental. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reimbursement policy and cost-effective mental health care.

Examines past efforts to curb the cost of insuring mental health care that have involved such devices as cost-sharing, benefit ceilings, and limitations on eligible providers. More recently, attention has been turned to regulatory schemes that would employ the results of efficacy research. Specifically, public debate has focused on using demonstrated effectiveness as a criterion for approving certain treatments for reimbursement. Such a strategy may increase costs, inhibit innovation, and interfere with clinical practice. A regulatory model is proposed that would use the criterion of cost as well as the criterion of effectiveness. This method would permit effective, lower cost treatments to be substituted for high-cost therapies. Provider participation and systems innovation would be fostered through decentralized implementation. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New directions in children's mental health policy: Psychology's role.

The policies that influence the practice of children's mental health affect psychologists across the nation. Major recent events have brought this topic to the attention of national policymakers at the highest level and have created opportunities for psychologists to present information regarding recent scientific advances in the treatment of childhood disorders and to be involved in the development of solutions to address the needs of our nation's children. This article reviews these recent events, summarizes current knowledge in the field, and addresses specific issues and critical gaps in current national policies on children's mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory mental health treatment under universal coverage: policy insights from Israel

Untested assumptions concerning ambulatory treatment have shaped mental health policies for decades. Three opinions prevail: (1) all use is alike; (2) any use leads to high use; and (3) all high use is discretionary and therefore excessive. These assumptions were tested, using data from a nationwide survey of ambulatory utilizers in Israel, a country that has universal coverage. The findings, based on detailed clinical and treatment records, challenge all three assumptions. Moreover, they document a diversity of clinical needs while also verifying substantial variations in the type, frequency, and duration of treatment provided to meet those needs. In brief, Israeli data do not confirm continuing concerns by policy makers about uncontrollable use of services with expanded mental health coverage. Special policy limitations on mental health treatment should be reconsidered in light of empirical evidence from a system without the restrictions that exist in the United States.     

U.S. mental health policy: Doomed to fail.

Changes in the de facto system of mental health care in the last decade reflect organizational and entrepreneurial responsiveness to changes in health policy, not mental health policy. Various other actions described here reduced statutory or institutional leadership roles in mental health and increased the pace at which mental health policy was becoming dependent on health policy. In turn, US health policy in the 20th century has been inherently flawed. The short-term general hospital, the "doctors' workshop," emphasizing acute care and surgery, has been the cornerstone of US health policy throughout the 20th century. The mimicry of health services by mental health leads to demonstrably more expensive and less effective mental health care and dooms mental health policy to failure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confrontations with aggression and mental health problems in police officers: The role of organizational stressors, life-events and previous mental health problems.

The extent to which the frequency of facing aggression incidents is associated with mental health problems among police officers when organizational stressors, life-events, and previous mental health problems are taken into account is unclear. To elucidate this data from a longitudinal study of police officers was analyzed (N = 473). Mental health problems (MHPs) are here defined as severe anxiety, depression, hostility, burnout symptoms, and/or sleeping problems according the SCL-90–R and MBI. All MHPs were assessed at baseline and 27 months later. Logistic regression showed that serious threat was statistically significant associated with MHPs at follow-up among officers without MHPs at baseline, but not among those with MHPs at baseline. However, stepwise logistic regression showed that serious threat and/or physical aggression were not independently associated with MHPs at follow-up. Organizational stressors, that is, problems with colleagues were independent predictors in all analyses. Among the total study sample, previous MHPs were the strongest independent predictors. These findings suggest superiors should attend to the mental health, organizational stressors and life-events of their officers regularly and not only following critical incidents at work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing community capacity to treat post-deployment mental health problems: A public health initiative.

Meeting the mental health needs of Veterans returning from recent deployment requires the coordinated effort of partnerships across Department of Defense (DoD), Department of Veterans Affairs (VA), and state and local communities. Although the proportion of Veterans of Iraq and Afghanistan who have accessed VA health care has grown, the majority of these new combat Veterans have yet to present for VA care. The stigma associated with reporting a deployment-related mental health problem may be one factor in this, but access to treatment may also be an important concern among the one third of American Veterans who live in rural or highly rural areas. As these Veterans are more likely to present to a primary care, faith-based or mental health provider in their own community, partnerships between community providers, DoD, and VA are of critical importance in ensuring appropriate care, regardless of treatment setting. In an effort to improve services and access to services, especially to rural Veterans, an educational public health initiative was created to educate community providers about military culture, deployment-related mental health issues, VA resources, and evidence-based treatments. We describe the development, dissemination and evaluation of this initiative, as well as lessons learned for future similar endeavors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

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)     

U.S. mental health policy: Proactive evolution in the midst of health care reform.

Argues that it is vital that psychological and behavioral health care perspectives be explicitly recognized during the coming reform of the US health care system. Mental health policy should not be treated as a mere extension of physical health policy; to do so extends all the flaws of the physical health system into the psychological care arena, resulting in a mismatch with the actual health care needs of the nation. Furthermore, organized psychology must remind policymakers that psychologists provide health services in areas of health care beyond mental health. The challenge to psychology is to ensure the continuation of adequate and timely access to appropriate psychological and behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infants' meaning-making and the development of mental health problems.

We argue that infant meaning-making processes are a central mechanism governing both typical and pathological outcomes. Infants, as open dynamic systems, must constantly garner information to increase their complexity and coherence. They fulfill this demand by making nonverbal “meaning”—affects, movements, representations—about themselves in relation to the world and themselves into a “biopsychosocial state of consciousness,” which shapes their ongoing engagement with the world. We focus on the operation of the infant–adult communication system, a dyadic, mutually regulated system that scaffolds infants' engagement with the world of people, things, and themselves, and consequently their meaning-making. We argue that infant mental health problems emerge when the meanings infants make in the moment, which increase their complexity and coherence and may be adaptive in the short run, selectively limit their subsequent engagement with the world and, in turn, the growth of their state of consciousness in the long run. When chronic and iterative, these altered meanings can interfere with infants' successful development and heighten their vulnerability to pathological outcomes. Cultural variations in meaning-making and implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)