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)     

Ecological constraints on mental health services.

Proposes 4 principles for community mental health programing that are consistent with an ecological thesis: (1) Assessment methods are focused on the total population rather than on those persons who presently receive a mental health service. (2) Mental health services are designed to reduce a high risk for community service. (3) Professional and research services are created as local community resources. "By initiating the informal coordination of current services, the community mental health program helps to create specific new community services as needed." (4) The program plans for change; this involves mobilizing anticipatory problem-solving resources not only for clients but for professionals as well. A "conception of community mental health work based upon the ecological thesis that adaptive programs change" is presented. (39 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to the provision of mental health services to individuals with severe physical disability.

Surveyed 86 consumer advocates (67 with physical disabilities), 157 rehabilitation counselors, 94 rehabilitation administrators, 323 mental health administrators and professionals, and 145 severely disabled Ss concerning Ss' perceptions of the nature and extent of mental health services, barriers to mental health service provision for individuals with severe physical disabilities, and personal data. Overall, there was a general consistency among the sample groups in their perceptions of the extent to which each of 10 variables is a barrier to service delivery. The lack of accessible public transportation, especially in nonmetropolitan areas, and the accompanying limitation on costly mental health outreach services were viewed as serious problems. The limited knowledge and skills of many mental health professional regarding severe physical disability was perceived to be a moderate to substantial barrier to service provision. Findings indicate that individuals with severe physical disability are an underserved group. Recommendations regarding policy and program development and training of professionals are offered. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

J. Wilbert Edgerton.

J. Wilbert Edgerton's career has been devoted to the development of rural mental health services and the enhancement of mental health services in the public sector. His extensive studies on mobilizing citizen advocates and developing community programs have greatly influenced the community mental health movement in this country. His advocacy for the profession led to the passage of licensure for psychologists in North Carolina. He is a tireless volunteer advocate and is widely known for his development of residential living arrangements for the mentally ill. An articulate man of high integrity, he has used his skills to do something concrete and practical about human problems and has devoted his life to making a difference in the lives of those affected by mental illness (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bilingual professionals in community mental health services

OBJECTIVE: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles. METHOD: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity. RESULTS: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. CONCLUSIONS: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.     

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)     

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)     

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)     

Reaching out, reaching in: Two examples of public education.

Thirty-five years after former American Psychological Association (APA) President George A. Miller (1969) exhorted psychologists to "give psychology away," then-current APA President Ronald F. Levant (2005) encouraged us to "make psychology a household word"--but how do we go about accomplishing this goal? To highlight the value, issues, and challenges of providing such services, 2 case examples of public outreach are described: The Mental Health Tune Up, a 2-day community outreach event, involves multiple mental health organizations in seminars, a resource fair, mental health self-screenings, and workshops; the Toronto Marathon Psyching Team offers mental skills, support, and mental and emotional triage to runners before, during, and after a major international marathon. Event organization, volunteer training and support, interdisciplinary collaboration, corporate community support, systems integration, publicity, and program evaluation are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The care of patients with chronic schizophrenia: a comparison between two services

BACKGROUND: There has been a widespread development of community multi-disciplinary teams aimed to deliver coordinated comprehensive mental health care, yet there is little published evidence on the quality of care and economics of providing such care for people with severe mental illness. METHOD: This is a clustered randomized controlled economic comparison of the quality of care for patients with chronic schizophrenia by a multi-disciplinary community team with close links with primary care, and a traditional psychiatric service in a district general hospital psychiatric unit. RESULTS: Two years after it was established, patients with access to the community team had more of their needs met; they had fewer unmet needs; and they were more satisfied with the care they had received. They had more service contacts and received more interventions. The community team resulted in savings in the use of some hospital resources but these were not sufficient to offset the cost of the new service. The community team successfully directed care to patients with more needs, whereas no such relationship was evident for the traditional hospital-based service. Four years after the team was established, it met a greater proportion of needs for underactivity, daily living skills, use of public amenities and managing finances. CONCLUSIONS: Better quality care was provided at 2 and 4 years after its establishment by the multi-disciplinary community service than the traditional hospital-based service. Resources were targeted more efficiently by the community service.     

Academia and the training of human service delivery program evaluators.

Many think the demand for high-quality evaluation personnel has reached the point where universities should consider the development of program evaluation curricula. Although much of this article focuses on the training of evaluators for the mental health service delivery system, the suggestions made are applicable to the training of evaluation specialists who will function in a variety of public and private human service settings. Among the several issues considered are the body of knowledge to be taught in program evaluation curricula, the specific concepts and skills needed by the evaluator to function effectively, and whether training should be structured as an interdepartmental or intradepartmental specialty. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community mental health: Corpse or phoenix? Personal reflections on an era.

The death of community mental health practice has been predicted for many years. In the US, the community mental health era began in the mid-19th century. However, the movement reached its height, conceptually and programmatically, in the national program of the 1960s and 1970s. Ideological shifts have led to its decline since that time. Nevertheless, the contributions of the community mental health movement have permeated the current service structure, and the future rise of more community mental health activities appears inevitable. These trends are traced in a personal odyssey through the era. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of master's-level staffing patterns and clinical roles.

1,157 mental health agencies were surveyed concerning the employment of master's-level clinical psychologists, and usable data were provided by 637. Numbers and proportions of staff positions, salaries, job functions performed, and training models preferred for master's-level clinicians are reported for 9 types of mental health agencies. Community mental health centers and state hospitals provided the best sources of employment. The optimal training program should prepare the student to perform group and individual therapy, psychological testing, and community mental health functions. Research skills were more important in state hospitals than in community mental health centers. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiple functions for psychologists in community consultation.

"Psychologists are assuming a wider range of responsibilities in community program administration and community consultation: in mental health, corrections, education, and anti-poverty." A program for training consultants was developed in New Mexico during a 4-yr demonstration project. Selection criteria include: (1) sound graduate training including the PhD for psychologists, (2) substantial clinical skills in diagnosis and therapy, (3) experience in consultation and administration, and (4) experience in community work. A 2-mo., full-time orientation program was conducted for the consultants hired. The project stimulated development of various new resources in local communities including, among others, a day school for retarded children, a family casework agency, a day center for emotionally disturbed children, a training and consultation service to an orphanage, and an alcoholism treatment and rehabilitation program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health nurses working purposefully with people with serious and enduring mental illness--an international perspective

There has been a world-wide refocus on people with serious and enduring mental health problems. This has provided major challenges for all those involved in mental health care, as the last two decades have produced radical changes in service delivery and a range of new interventions. Mental health nurses are playing a central role as community based clinical case managers and are beginning to use a range of psychosocial interventions. They are also revitalizing skills in the more traditional areas of medication management and residential care. In addition, there are growing problems of substance abuse and violence which needs to be addressed. Mental health nursing is responding in this new era by various training initiatives. However, these programmes need rapid expansion as mental health nurses will continue to play a key role in the services of the future and therefore need these new skills.     

Emory L. Cowen.

Presents an overview of the career contributions of Emory L. Cowen. For his remarkable contributions to conceptual, empirical and human service advances in the fields of community and clinical psychology, community mental health and education. He has been instrumental in the creation of a field for an entire generation of psychologists. His work has changed public schools throughout the United States. His ideas, research, model programs, program evaluations, and workshops have inspired others to generate new programs that provide affordable human services to thousands of children who are otherwise unlikely to receive help. He pioneered early detection and secondary prevention research. His clear thinking and conceptual challenges have fostered the study of primary prevention and wellness in mental health, both as a field for research and as a social policy. His tireless efforts as President of APA's Division of Community Psychology, a member of the Prevention Task Panel of the President's Commission on Mental Health, and the APA Task Force on Promotion, Prevention and Intervention Alternatives in Psychology are examples of his energetic contributions to psychology in the public interest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advancing mental health in political places.

The author describes his career as a psychologist serving in elected office. He found that by his attending to individual concerns, supporting community consensus on key issues, playing the outsider role, leading an issue individually, and calling media attention to a problem, city hall could be moved to action. In the state legislature, the author serves in the minority but has made an impact by amending legislation, sponsoring less controversial bills, or generating enough public support for a bill that the majority advances its own similar bill. He identified the following mental health needs in Ohio: better understanding by legislators of the nature and impact of mental illness, adequate funding, mental health parity legislation, and more effective advocacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anne S. Labowitz: APA/APAGS Ddistinguished Graduate Student Award in Professional Psychology.

Announces Anne S. Labowitz as the recipient of the APA/APAGS Distinguished Graduate Student Award in Professional Psychology for 2002. A biographical statement is included, along with major works and contributions for the field. Labowitz is commended for her ability to alternate focus between her individual clients' needs and their implications for the community. Her career choices demonstrate an intense commitment to public service and public mental health: Pathways to Housing, a nonprofit agency serving the homeless mentally ill; the New York City Department of Health; the Consultation Center of the Yale University School of Medicine; and the Adolescent Health Alliance, a nonprofit organization that she cofounded. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Triple P-Positive Parenting Program as a public health approach to strengthening parenting.

Parenting programs have considerable potential to improve the mental health and well-being of children, improve family relationships, and benefit the community at large. However, traditional clinical models of service delivery reach relatively few parents. A public health approach is needed to ensure that more parents benefit and that a societal-level impact is achieved. The Triple P-Positive Parenting Program is a comprehensive, multilevel system of parenting intervention that combines within a single intervention universal and more targeted interventions for high-risk children and their parents. With Triple P, the overarching goal is to enhance the knowledge, skills, and confidence of parents at a whole-of-population level and, in turn, to reduce the prevalence rates of behavioral and emotional problems in children and adolescents. The distinguishing features of the intervention and variables that influence its effective implementation are discussed. Self-regulation is a unifying concept that is applied throughout the entire system (e.g., to interactions between children, parents, service providers, and agencies involved in delivering the intervention). Challenges and future directions for the development of public health approaches to parenting are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of independent living on persons with chronic mental illness: an assessment of the Section 8 certificate program

The feasibility of the Section 8 certificate program for individuals with chronic mental illness (CMI) and the outcomes associated with independent housing are examined. The analysis is based on data from a longitudinal survey of Section 8 certificate users in Baltimore and Hamilton County (Cincinnati) and on information from Section 8 application forms in each site. A pre-post research design was used to examine changes in hospitalization, residential stability, and mental health service outcomes. Four key dimensions of the CMI certificate program are examined: affordability, housing conditions, neighborhood conditions, and service gaps. Results suggest that the certificate program has a positive effect on independent living, that certificate use is associated with positive mental health outcomes, and that there is no evidence of "creaming" among program applicants.