Innovative service redesign and resource reallocation: responding to political realities, mental health reform and community mental health needs

General hospital mental health programs in large inner city communities face challenges in developing responsive services for populations facing high rates of serious mental illness, substance abuse, homelessness, and poverty. In addition provincial political pressures such as Mental Health Reform and hospital restructuring have caused general hospital mental health programs to reevaluate how services are delivered and resources are allocated. This paper describes how one inner city mental health service in a university teaching setting developed successful strategies to respond to these pressures. Strategies included: (a) merging two general hospital mental health services to pool resources; (b) allocating resources to innovative care delivery models consistent with provincial reforms and community needs; (c) fostering staff role changes, job transitions, and the development of new professional competencies to complement the innovative care delivery models; and (d) developing processes to evaluate the effects of these changes on client.     

Integrating mental health services within primary care. A Canadian program

The increasingly prominent role of the family physician in delivering mental health care can be enhanced if productive and collaborative relationships can be established with local mental health services. This paper describes a Canadian program that has achieved this by bringing mental health counselors and psychiatrists into the offices of 87 family physicians in 35 practices in a community in Southern Ontario. The paper describes the program, the activities of counselors and psychiatrists within the practices, and the administrative structures set up to coordinate these activities. Data is presented from the evaluation of the first year of the program's operation (13 practices and 45 family physicians) during which time 3085 referrals were received. The program made mental health care more available and accessible, increased continuity of care, provided additional support for the family physician, offered new opportunities for continuing education, and led to a reduced and more efficient use of other mental health services. The components of the program can be adapted to most communities.     

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)     

Rapid detection and counting of viable bacteria in vegetables and environmental water using a photon-counting TV camera

A physical, cognitive, or mental disability presents significant challenges to an individual in gaining access to a coordinated program of preventive, primary, and secondary health care services. This article describes the health care needs of people with disabilities and discusses how the financial incentives in managed care may threaten access to the health care services they need to maintain their health and functional independence. We argue that despite the shortcomings of present models, managed care has the potential to improve the health care of people with disabilities. Moreover, as health plans become increasingly accountable to consumers (and begin to compete on the basis of quality), they will not be able to ignore the distinct health care needs of people with disabilities.     

A week in the country: a model respite program

A family-oriented camping program for caregivers of children who are HIV infected is described. Major goals of the camping program consisted of: (1) providing respite care to mother and child, and, (2) training health care and mental health workers to provide special services, emphasizing the mental health needs of this population.     

Emergency medical services for children: Beyond lights and sirens.

This article describes the history of emergency medical services for children and identifies important mental health issues. It discusses the roles of psychologists in such services, including intervening with children and their families during times of crisis, helping others who are providing the physical care of children to mitigate rather than exacerbate children's emotional distress, and attending to the emotional needs of health care providers who treat children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and national health care.

Presents the position of the American Psychological Association concerning the national movement toward a "comprehensive and coordinated system of health services which will be of high quality and equally accessible to all persons." Provisions for recognition and management of emotional and mental disorders and for the optimum use of all qualified health care professionals are urged. Guidelines for the development of a health care program are enumerated and include concern for accessibility of services, patient rights, adequate funding, consumer roles, grievance provisions, program evaluation, and research into the system itself. Criteria for evaluating the adequacy of proposed legislation for a health care system in terms of the mental health provisions and the utilization of psychological services are also presented. It is concluded that "psychologists, by training and experience, have the qualifications to provide independent mental health services and should be permitted to do so." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meaningful role for graduate students in disaster mental health services.

Describes the role of graduate students in providing disaster mental health services through a program with the American Red Cross (ARC). ARC Disaster Mental Health Services teams focus on the immediate emotional needs and possible posttraumatic stress disorder (PTSD) associated with the shock of a natural disaster, including the needs and reactions of both victims and volunteers, especially the latter. The implementation of volunteer stress teams by the Minnesota School of Professional Psychology, including 25 students and faculty, is also described. The teams were designed to help assess and limit the effects of acute and traumatic stress resulting from disaster flooding. Specific objectives included assisting local mental health and social service agencies, distributing information, providing support, and triaging victims needing professional mental health services and other flood recovery services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic services in the HMO: Zen and the art of mental health maintenance.

Examines current research data concerning the provision of mental health services within health maintenance organizations (HMOs) and describes in detail one HMO mental health department. Findings of current research indicate that nearly 11 million people are already members of the almost 300 HMOs nationwide. Survey data indicate that the provision of mental health services is universal within such plans. Conclusions are drawn about the ways in which developing prepaid programs might best meet the psychotherapeutic needs of members of HMOs. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services for children: The state of the art.

Throughout this century, people in the United States have been concerned about the serious deficiencies in the mental health care of our children. Despite eloquent needs assessment and recommendations for remediation, most of the unserved needs and deficiencies of our mental-health-care-delivery system remain the same. This article reviews the current status of mental health services to children, youth, and families to highlight the necessity of an integrated system of mental health care. The development of a continuum of care that is coordinated across the mental health and non-mental-health systems that naturally occur in all children's lives has the potential to vastly improve mental health services to children, youth, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reaching out to the families of those who serve: The SOFAR project.

Families of those in the U.S. Army Reserves represent a population at risk for mental health problems. Strategic Outreach to Families of All Reservists (SOFAR) is a pro bono outreach program serving families with soldiers deployed in Afghanistan, Iraq, and Kuwait. Program components include prevention, intervention, and the production of educational materials. SOFAR negotiated with the reserves (a hierarchical system wary of mental health), recruited pro bono therapists, and oriented them to the needs of reservists' families. During the pilot phase, SOFAR participated in support services, direct services, and psychoeducation. The project is a pilot for a national program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family involvement in expanded school mental health

Expanded school mental health (ESMH) programs address the limitations of traditional mental health agencies in meeting the needs of youth by providing a full range of services in a familiar and nonstigmatizing setting. Because of the central role families play in the lives of children, their involvement in ESMH can enhance the effectiveness of treatments and ensure that services are responsive to the needs of the larger community. Increasing family involvement, however, is a complex and resource-intensive endeavor, and requires consideration of the goals of the ESMH program and potential obstacles to meeting those goals. The challenges of involving family members in ESMH, guidelines for determining the program's goals with respect to family involvement, and strategies for achieving these goals are described. Underlying the strategies is the need to be flexible, creative, and respectful of the beliefs and concerns of the families served by the ESMH program.     

Mental health services for homeless mentally ill persons: Federal initiatives and current service trends.

Recent research suggests that approximately one third of the population of homeless single adults suffer from severe mental illnesses. Despite multiple health, mental health, and social welfare needs, this population is often unable to obtain necessary housing and community-based services. For this reason, since 1982, the National Institute of Mental Health (NIMH) has undertaken a number of federal initiatives to encourage research and assist states and localities in improving services focused on this vulnerable subgroup of the homeless population. This article describes the target population, NIMH research findings, and current mental health programs—with particular emphasis on two mental health programs established under the Stewart B. McKinney Homeless Assistance Act. Proposed future directions for federal research and evaluation efforts in this area are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Latino Health Advocacy Program: a collaborative lay health advisor approach

There have been numerous calls in the literature for health educators to develop programs to improve access to and utilization of health and human services by traditionally underserved communities, including Latinos. While the literature suggests several principles that can guide the development of these programs, it is important to address the needs, and build on the strengths, of the specific community of interest. It is, therefore, important to use collaborative approaches in which community members take an active role in the initiation, design, implementation, and evaluation of program activities. Lay health advisor programs are particularly well suited to this approach as they are designed to build on the strength of already existing community relationships to improve community health. This article describes a collaborative, culturally appropriate, holistic, and ecological lay health advisor program--the Latino Health Advocacy Program. Lessons learned and implications for future program development are discussed.     

Training in rural mental health delivery: A response to prioritized needs.

Describes the development of a rural mental health specialty within a clinical psychology training program. The structure and content of the specialty was in response to the National Institute of Mental Health's prioritized needs of the nation's mental health system. The University of Nebraska—Lincoln's clinical training program and the needs of the rural environment were assessed to determine if an adequate relationship could be developed. Once this was determined, the program was founded. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Needs assessment and policy development: Native Hawaiians as Native Americans.

Discusses needs assessment and policy development for Native Hawaiians (NHs) whose educational, social, and health needs resemble those of Native Americans and minority groups. A US government report indicated that NHs have a need for standardized achievement tests, special education, and culture-related education. Studies suggest that culture loss may be linked to negative personal health and educational outcomes for NHs. It is noted that NHs have high rates of suicide, alcohol and drug abuse, crime, child abuse, school adjustment problems, and mental illnesses. Cultural barriers prevent NHs from using existing mental health services. Recommendations for improving health care for NHs and development of policies including NHs as Native Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investments in behavioral health services: Strengthening the safety net.

As the primary Federal agency at the U.S. Department of Health and Human Services for improving access to health care services to the medically, financially and geographically vulnerable, the Health Resources and Services Administration (HRSA) is committed to improving health outcomes and achieving health equity by funding access to quality services, a skilled health workforce, and innovative delivery programs. Furthermore, HRSA recognizes the importance of access to quality behavioral health services. This article describes HRSA's current efforts to address behavioral health needs within the safety net through the delivery of quality health services and a strengthened workforce. Also, it highlights HRSA's commitment to providing good quality mental health and substance abuse services through key federal and nonfederal partnerships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Health care, Medicare, and health policy for older people: A conversation with Arthur Flemming.

Fleming, former secretary of the Department of Health, Education, and Welfare and former US Commissioner on Aging, addresses (a) national health policy and how it might be more supportive of mental and general health needs of older people; (b) the need for changes to the Medicare program, such as enabling psychologists to provide mental health services to the elderly; (c) the need for a national health insurance other than Medicare; and (d) the importance of the Age Discrimination in Employment Act. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characterization of acellular dermal matrices (ADMs) prepared by two different methods

This paper describes a program in Hamilton-Wentworth, Ontario, Canada, that brings mental health counselors and psychiatrists into the offices of 87 local family physicians, working in 35 practices serving 170,000 people. It outlines the organization of the mental health teams in the family physician's office and the way in which these teams are coordinated and discusses how this "shared care" approach can overcome many of the problems that traditionally bedevil the relationship between psychiatric services and family practices. It summarizes the benefits of this approach for patients providers and the health care system and looks at its implications for learners and for new approaches to continuing education. This model can be adapted to most communities.