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)     

Mental illness and mental retardation: Message from the President of the United States relative to mental illness and mental retardation.

2 health problems of critical size and tragic impact are mental illness and mental retardation. "There are now about 800,000 such patients in this Nation's institutions—600,000 for mental illness and over 200,000 for mental retardation." A 3-fold attack is proposed: (a) Ascertain causes and eradicate them. (b) Strengthen underlying resources of knowledge and of skilled manpower. (c) Strengthen and improve facilities serving the mentally ill and mentally retarded. A national program for mental health is proposed which emphasizes comprehensive community mental health centers, improved care in state mental institutions, and expansion of research activities and increase in professional manpower. A national program to combat mental retardation emphasizing prevention, community services, and research is also proposed. (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)     

Factors predicting levels of female inmates’ use of psychological services.

The number of female inmates in state and federal correctional institutions has increased dramatically over the past several years. In addition to this overall increase in number, women have greater levels of mental health service use than men, both in the community and during incarceration. It is important to understand what factors are associated with varying amounts of mental health service use as this population continues to grow. This study explores the influence of female inmate characteristics, including demographic variables and mental health service use before incarceration, on a continuous dependent measure of overall psychological services use during incarceration. Results indicate that for a sample of female inmates within the federal prison system, U.S. citizenship, prior community-based receipt of mental health services, and history of substance abuse were the strongest predictors of increased service use while incarcerated. Findings concerning routine versus volitional services suggest that female inmates with less severe mental health problems are among those who volitionally seek mental health services during incarceration. Recommendations for correctional mental health services training, practice, and research are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction: Methodological issues in school-based mental health services research.

New research directions on the effectiveness of mental health services for children and adolescents offer the opportunity for school psychology to apply its knowledge base to the systemic juncture between mental health and school systems. Models of service delivery to children, adolescents, and their families that integrate school, mental health, and other service sectors are being actively studied to answer questions about the outcomes of these services for children with mental health problems. The papers in this journal were first presented at the 6th Annual Research Conference of the Florida Mental Health Institute on "A System of Care for Children's Mental Health: Expanding the Research Base." The papers describe state-of-the art studies of school-based mental health interventions for children, adolescents, and their families. In each of the papers, particular attention is paid to the salient methodological issues researchers face in conducting these studies within school settings. It is hoped that these articles will foreground the healthy and creative tensions that exist between different research paradigms and multiple service communities, especially mental health and school systems, by encouraging new research on important and as yet unanswered questions about the effectiveness of school-based service delivery to children and adolescents with mental health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The shift to community mental health as an organizational phenomenon.

Mental health professionals often fail to recognize organizational phenomena which are significant to delivery of services. A current shift in service delivery is the move away from residential care to prevention programs. Rather than seeing this as the result of "new discoveries", the shift is viewed as an outcome of organizational developments. It is suggested that community mental health programs are produced by an institution having resources in excess of stabilized demands for treatment technology. This process of organizational diversification may have the surprising result of creating greater tendencies toward custodial treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving Mental Health Service Utilization for Children and Adolescents.

Approximately 10% of children and adolescents have mental health problems necessitating intervention, but well below 50% of these children receive needed services, and far fewer receive the quality of care required to effectively reduce their impairments. Although system reform is needed to improve service utilization and quality of care for all children, preschoolers, girls, individuals of minority status, and the uninsured are most at risk for being underserved. Factors contributing to poor service utilization can be classified into two broad sets: sociopolitical factors referring to issues related to funding and access, and cultural/familial factors including beliefs about mental health services, providers, and treatments. This article describes the help-seeking process and focuses on cultural and familial factors that contribute to movement through these stages, with a particular focus on variables that are amenable to change by practitioners in the school and community, including school psychologists. Guidelines for understanding and changing the help-seeking behavior of families, including suggestions for creating service options, providing family education, and offering individualized family services, are described. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The community and the community mental health center.

The community has responsibility "for the quality and adequacy of the mental health services that it gets. The opportunities are now open for communities to employ the mechanism of the comprehensive mental health center to take major strides toward more intelligent, humane, and effective provision for their people. If communities rise to this opportunity, the implications for the national problem of mental health and for the quality of American life are immense." Guidelines are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Range Way.

The author explains that the Range Mental Health Center was founded as a result of recognition by interested citizens on the Iron Range that the problems of mental disorder and the stimulation of positive mental health requires a broad program based on strengthening and co-ordinating community resources. The program carries a sociological and public health orientation. The intent is not merely the diagnosis and treatment of mental disorders, nor is the goal limited to prevention and educational endeavors. Rather, the goal is the conservation, development, and full utilization of human resources for the betterment of the individual and society. The basic philosophy underlying the program is the conviction that assisting people in emotional distress is not a skill restricted to personnel trained in psychiatry, psychology, or psychiatric social work, but rather it is a human skill which all people possess. He goes on to outline the Center's philosophy and practice in addressing mental illness issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The mental hospital in the 21st century.

Reviews the book, The mental hospital in the 21st century by Emmanuel Persad, Shane S. Kazarian, and Llewellyn W. Joseph (1992). The authors not only review past endeavors in the delivery of mental health services but speculate as to the role the mental hospital may take in the years to come. The starting point for this book is a conference entitled "The Role of the Mental Hospital in the 21st Century" sponsored by the London Psychiatric Hospital in October 1990. The book features 20 brief chapters regrouped in three sections. In all, 29 contributors mainly from Canada, bring forth varying perspectives on the role of the mental hospital. The real contribution of this book is that it puts into perspective the magnitude of the challenge that confronts the major stakeholders in developing a comprehensive and balanced system of mental health services. The present book could serve as a starting point for some serious debate among the stakeholders about the way the mentally ill are treated and to determine how the role of the mental hospital should change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (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)     

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)     

Provoking evolution in child and youth mental health in Canada.

Approximately 14–25% of Canadian children and youth have a diagnosable mental disorder. Fewer than 25% of those with such disorders receive specialised services. Even for those receiving services, there is no guarantee that the interventions provided are effective or based on any credible evidence. It is time that child and youth mental health be recognised as the health priority that it truly is. The barriers to meaningful change in child and youth mental health are many and include historical, attitudinal, cultural, financial, and systemic considerations. True change will require creativity, innovation, collaboration, and leadership. Mindsets need to be shifted and the status quo needs to be challenged. Canadian psychologists have skillsets that should be critical in accelerating change in child and youth mental health. We should not shy away from taking on leadership roles to provoke such change. Examples of where this is occurring and opportunities for further action are profiled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Highlander Hookup Between Psychologists and Physicians.

Discusses the current author's work as a clinical psychologist at a community mental health center (CMHC) located in a village of 500 people in the mountains of western North Carolina. The public's perception, which is often loaded with fears and misinformation, of mental health services in small towns and rural settings is addressed. In the author's particular situation, mental health care is allowed only in a non-mental health setting. The role of the local hospital in the service delivery of the CMCH is considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

L'amorce du virage préventif en santé mentale au Québec: Enquête sur les politiques, les structures et les programmes de prévention en santé mentale.

This study represents the Quebec contribution to a Canada-wide survey that sought to determine the status of mental health prevention programs as health services undergo major restructuring. Similar to the Canada-wide survey, data on prevention policies, resources and programs were collected from provincial authorities who were responsible for mental health promotion. Data were also obtained from regional health and social services boards (Régies régionales de la santé et des services sociaux) which were in the process of being formed and from other departments which offered mental health services. Although the data support the vitality of prevention programs within government departments they also suggest that those prevention programs may need greater administrative structure and that there are gaps between government promises and commitments, notably with respect to ongoing financing for prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Predictors of preintake attrition in a rural community mental health center”: Clarification.

Reports an error in "Predictors of preintake attrition in a rural community mental health center" by Marne L. Sherman, David D. Barnum, Erik Nyberg and Adam Buhman-Wiggs (Psychological Services, 2008[Nov], Vol 5[4], 332-340). The article contains data that were obtained from archival records of the same community mental health center (serving adults, adolescents, and children), and that reflect information from initial consumer contacts made with the center during the same period of time, as that reported in “Clinical Intake of Child and Adolescent Consumers in a Rural Community Mental Health Center: Does Wait-time Predict Attendance?” by Marne L. Sherman, David D. Barnum, Adam Buhman-Wiggs, and Erik Nyberg (Community Mental Health Journal, 2009, Vol. 45, No. 1, pp. 78–84). Information is provided in this clarification about the data used in both articles. (The following abstract of the original article appeared in record 2008-16478-003.) Preintake attrition presents a challenge in outpatient mental health settings, in part due to the waste of limited clinical resources when potential consumers do not attend appointments. While understanding the phenomenon of mental health consumer attrition has received clinical and empirical attention for more than 40 years, the data remain somewhat mixed as to the key predictors of preintake attrition. Additionally, little attention has been directed at understanding missed intake appointments in community mental health centers within rural settings. This study examines predictors of attended appointments for intake in a rural community mental health center, with particular attention to the effect of intake delay or wait-time between call for appointment and scheduled appointment. Wait-time is identified as a significant predictor of appointment attendance in logistic regression analysis, even after controlling for consumer variables, such as referral source and payor source. The impact of wait-time on the likelihood of attending the intake appointment was not moderated by the case urgency. Considerations for applying these results to the organization of clinical service delivery in a rural community mental health center are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)