Decisions about confidentiality in medical student mental health settings.

Investigated orientations toward confidentiality of 59 mental health practitioners in US medical schools who were requested to respond to 10 case vignettes representing a range of students' problems by indicating the action they would take. Results suggest that Ss were generally unwilling to break confidentiality in response to cluster of presenting problems that involved suicidal tendencies, sexual coercion/seduction, nonviolent social transgressions, and falsifying data. This was most pronounced when risk of suicide was evident. Only a bomb threat scenario clearly elicited responses suggesting a likely breach of confidence. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facing new ethical challenges and dilemmas

Considering the present health policy, health service and health care systems, health condition and health demands of the people, proclaimed priorities in biomedical scientific research in the Republic of Croatia, and expected health and disease status in the first decades of the 21st century, the author raises the question of sensitization of the Croatian physicians and the public to new ethical challenges. These questions are arousing attention in the world and Europe as one of the peculiarities mankind is facing in the midst of new scientific, technical and informatic possibilities, at the same time in the context of global impoverishment and restricted public funds, with existing or expected changes in the demographic structure and the life philosophy system of values. In democratic, pluralistic societies, the dimension of human rights is getting increasingly pronounced. This is reflected in the postulation of international, national or professional bioethical standards related to biomedical research, in the emphasis on the indisputable public right to actively make decisions by consensus mechanisms about goals, priorities and limits of individual and collective health care programmes, forms and levels of medical care in the national health service and obligatory health insurance system, as well as about ethical aspects of the relation doctor-patient, at the boundary of the interactions of doctor-patient-profession-individual-community-society relationships.     

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)     

Ethnic group perceptions of mental health service providers.

Assessed 121 male and 118 female Chicano, 124 male and 123 female Black, and 126 male and 125 female Anglo college students' perceptions of 100 characteristics of 6 service-provider groups and the likelihood that Ss would discuss 9 problem areas with professional groups. Analysis revealed main effects for race, sex, and provider groups; factor analysis of the 9 problem topics revealed personal-social and educational-vocational dimensions. Females were more likely than males to discuss both problem areas with provider groups. Blacks and Chicanos were more likely than Anglos to take personal problems to professionals. Ss preferred to consult psychiatrists and clinical psychologists for the same types of problems more than counseling psychologists, who in turn were preferred more than college counselors, high school counselors, and advisers. For educational-vocational concerns, Ss generally expressed a stronger probability of consulting providers other than psychiatrists and clinical psychologists. Methodological issues, previous findings, and implications for service providers are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender-related ethical dilemmas and ethics education.

After a summary of the current approaches to the ethics education offered in psychology training programs, various assessment techniques and results are presented. On the basis of the summary of the usefulness of such ethics education, three fictional ethical dilemmas involving sexual intimacy with a client, a dual relationship with a graduate student, and a biased child custody evaluation are examined from the perspective of gender. For each situation, possible ethical, unethical, and poor judgment responses are given. Suggestions are given on ways to educate or sensitize graduate students so that they will be prepared to recognize the dilemmas and face the issues involved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cash planning in community mental health agencies

Community mental health agencies often receive funds from a number of different sources with varying restrictions. Cash planning can help them manage these funds properly and avoid serious problems. The use of a projected cash flow statement may even help produce additional income for them.     

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.     

The Psychologist in community mental health.

It is "our belief that the field of community mental health is a challenging and stimulating field for research oriented psychologists. We feel strongly that the identity of the psychologist may be best maintained through a scientist-professional model." Recommendations are made for the future training of psychologists in this field. The individual psychologist "must be assisted by adequate post-doctoral interdisciplinary training in a university setting." Major sections are: Maintenance of an Identity, Scientist and Professional, and Training the Scientist-Professional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing smarter: a decision support system for mental health providers

Financing of mental health care has changed radically, especially with managed care. Shrinking revenues have forced providers to look for creative ways in which to provide quality services at less expense. Delivery of quality services depends largely on the productive use of the provider's prime resource--the clinicians. Productivity was the focus of the PC-based decision support system developed for mental health providers in New York State. It enables administrators to track key indicators of productivity such as face-to-face time and non-face-to-face time against goals. Unmet goals can be pinpointed quickly, and clinicians' caseloads can be reviewed to determine the underlying causes. A key feature of the system is the conversion of raw data into actionable information to help in problem finding and problem solving. The system has been implemented in Ulster County, the pilot site for the project. The software can be customized easily to suit the data of other providers.     

Psychology positions in comprehensive community mental health centers and community clinics.

Analyzed data from 655 questionnaires completed by community mental health centers and community clinics in the US in 1968. 71% of the agencies offered services to adults and children. 15% served primarily adults, while 14% served primarily children. The major sources of financial support, in descending order, were state, county, and federal governments. 69% of agencies had private consultation privileges associated with positions, and a small percentage of agencies also paid professional membership dues. The median maximum salary for the chief psychologist was $16,750. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Master's-level training and employment in community mental health.

The training and employment of master's-level psychologists have long been controversial issues. We describe a master's-level program for training community mental health practitioners, and we present information on the placement of program graduates. The information suggests that there continues to be a demand for well-trained, master's-level practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do we need a new degree for mental health care providers?

Comments on A. E. Shapiro and J. G. Wiggins's (see record 1994-31325-001) call for a new degree to identify psychologists who provide doctoral-level health services. Wiederman contends that adding a new degree would not address the primary concerns addressed by Shapiro and Wiggins: protection of the public and distinction of professional psychologists from other mental health care providers. Wiederman argues that the 1st concern is covered by the current licensure process and the 2nd concern is best addressed with public education. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologist administrators in community mental health organizations.

We studied 52 psychologists who are managers in public-sector, community-level mental health systems. Data included biographical, work history, and role characteristics; job responsibilities, activities, skills, and problems; and career, affective, and perceptual variables. Primary activities include working with people and budget. Reflecting this, general management skills are those most needed, yet almost no subjects had such formal training. Comparisons made with a managerial sample of social workers (MSWs) revealed few differences. Implications for organizations and individuals are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social workers'' orientations toward community mental health concepts

Rabbits on a high cholesterol diet were divided into three groups: one group received subcutaneous injections of physiological saline 3 times/day, 5 days/wk for 10 wk; another group received subcutaneous injections of L-ascorbic acid (0.37 mmole) according to the same timetable; and the third group was administered an equivalent amount of L-ascorbate 2-sulfate as outlined above. Each week the serum levels of total and free cholesterol and triglycerides were measured. At the end of 10 wk the animals were killed and the cholesterol content of the livers, spleens, and adrenal glands was measured. The aortas were examined for plaque deposition; the deposits were excised and pooled according to groups; and the total mass and cholesterol contents of the pooled plaques were determined. Administration of ascorbic acid or ascorbate 2-sulfate did not prevent hypercholesterolemia or elevated levels of serum triglycerides. No significant differences among the groups were found either in tissue cholesterol levels or in the extent or type of lesions found. Although plaque deposition appeared to be similar in the aortas of these animals, a marked difference was found in total mass and cholesterol content of the plaques: The plaques of the saline-treated group had a total mass and cholesterol content approximately 2.5 times that found in the group injected with ascorbic acid and about 1.5 times that found in the animals treated with ascorbate 2-sulfate. These results indicate that ascorbic acid, in particular, minimizes the total quantity of plaque deposition even though it is ineffective in preventing hypercholesterolemia, elevated serum triglycerides, and accumulation of cholesterol by several tissues.     

Psychologists can direct community mental health centers.

Psychologists in Divisions 12 and 13 of the American Psychological Association are concerned about the apparent downgrading of their profession in community mental health centers by the Federal Government. In 1963, The Community Mental Health Centers Act (Pub. L. No. 88-164, 88th Cong., 1st Sess., Oct. 31, 1963) authorized Federal grants for the construction of local sites and stated in Section 54.212, Subsection C,2 "a qualified psychiatrist will be responsible for the clinical program, and the medical responsibility for every patient will be vested in a physician." Some psychologists have interpreted this regulation as discriminating against their experience, training, and competence by assuming that the director of a community mental health center must be selected on the basis of identity with a particular profession--medical. After having conferred with his Congressman, the author notes there is no Federal discrimination against professions or competency in the selection of a director for a community mental health center. Instead, the qualifications of this official are a matter of individual state policy, as long as there is medical responsibility for each patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trainee-designed continuing education in community mental health.

Describes a continuing education program in mental health that has proved useful as a model for planners and trainers as well as consumers of continuing education services. Grass roots planning, peer education, and accountability are 3 basic characteristics inherent in program operation. Two types of training approaches, role oriented and topic oriented, are reviewed in terms of their applicability. Evaluation procedures for training programs are discussed and are illustrated by examples for the continuing education program. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient pharmacotherapy in a community mental health center

A 78-year-old man underwent ectropion repair with a monopolar electrosurgical unit. A flash fire occurred, resulting in a loss of eyelashes of the left upper and lower eyelids. A retrospective analysis of the case was conducted, including a review of the relevant literature. Although rare, the possibility of a flash fire should be considered when performing surgery with an electrosurgical unit. Minimizing supplemental oxygen and electrosurgical power settings may help to avoid such an incident.     

The need for continuing education in ethics as reported by rural and urban mental health care providers.

Continuing professional education (CPE) sponsors planning events for mental health care licensees can assure better attendance if they can successfully address the needs of their target audience. Offering topics of interest is particularly crucial when CPE events need to draw large numbers of attendees to be financially viable. A survey of nearly 400 health licensees regarding CPE needs, especially as related to ethics, revealed that the greatest interest in such CPE was reported by master's-level mental health care providers. Topic areas with the greatest draw were the management of clients who present with special issues (e.g., substance abuse, medical illness, or cultural diversity) and competent management of colleague misconduct and impairment, rather than more traditional ethics issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social history, mental health, and community control.

Develops 4 themes in discussing community control of mental health services: (a) the community mental health movement is considered from the viewpoint of social history; (b) the movement is discussed in terms of its underlying professional ideology; (c) some of the shifts which have taken place in the field that go beyond the traditional framework of mental health are considered; and (d) community control, one of the newer developments in the field, is discussed, and some of its unforeseen problems examined. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)