Practice, policy and parity: The politics of persistence.

The road to comprehensive mental health parity legislation at the state level often reaches a dead end when mental health advocates are forced to compromise by accepting partial parity for "severe mental illness" (SMI) only. In 1999 Connecticut became the first state to modify a biologically based or SMI mental health parity law into comprehensive mental health and substance abuse parity legislation. In this article we chronicle the fight for mental health parity in Connecticut and discuss subtleties of legislative advocacy. This information should prove useful to psychologists who are pursuing parity in other states. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inmate Perceptions of Mental Health Services.

With the increasing rise in the U.S. prison population, meeting the mental health needs of inmates before, during, and after incarceration remains an obstacle. What are the mental health experiences of inmates? For what types of problems are inmates willing to seek help, and what are the barriers to their service utilization? This study investigated inmates' attitudes and perceptions toward mental health services and examined whether these attitudes and perceptions vary with respect to ethnic group membership or among inmates of differing security levels. Implications of these findings for psychologists, including psychologists not employed in correctional settings, are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental Health Services for Native Americans in the 21st Century United States.

As the population of American Indians and Alaska Natives continues to expand in the 21st century United States, an increasing number of professional psychologists will be called upon to provide culturally appropriate mental health services for Native American people and their communities. This article provides a general overview of contemporary tribal America before describing the legal, political, and institutional contexts for mental health service delivery administered through the federally sponsored Indian Health Service. Recommendations for mental health professionals who desire to avoid a subtle but profound Western cultural proselytization in their therapeutic service to Native clients and their communities are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Our Katrina experience: Providing mental health services in Concordia Parish, Louisiana.

Responding to the call for psychologists to serve Louisiana and the Gulf Coast after Hurricane Katrina, 2 school psychologists spent almost 2 weeks in central Louisiana in early September 2005. They were located in a rural area and provided mental health services to evacuees from Hurricane Katrina in a number of small shelters, an RV park, and the schools. This article describes their experiences as mental health volunteers and the impact those experiences had on their professional and personal lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (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)     

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)     

Prevention and remediation through group interventions.

Reviews the book, The handbook of group intervention for children and families edited by Karen C. Stroiber and Thomas R. Kratochwill (see record 1998-07256-000). This book addresses current needs of psychologists and other mental health practitioners who are working across ecologies to address problems of children and youth. As such, this text is an excellent resource for school psychologists, school counselors, and others who are attempting to broaden service delivery systems and procedures. Although this handbook is appropriate for practitioners across a variety of mental health disciplines, it also meets the current needs of school psychologists by addressing gaps often found in school psychology service delivery and training models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lessons from Katrina: Disaster mental health service in the Gulf Coast region.

In this article, 4 mental health professionals provide firsthand accounts of experiences as volunteers in the Gulf Coast region following Hurricanes Katrina and Rita in the fall of 2006. These accounts are provided with the goal of informing psychologists and other mental health providers about the role of volunteers from a frontline perspective. The authors offer these observations as a compliment to formal training in disaster preparedness that psychologists might receive for volunteer service in the wake of a devastating disaster. Specifically, the authors discuss the training they received, the settings in which they worked, and the client needs and mental health skills they used to meet those needs. Last, the lessons the authors learned about providing disaster mental health services are discussed. It is hoped that these observations might inspire others to lend their expertise and compassion in response to future catastrophic events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists' roles and opportunities in rehabilitation and recovery for serious mental illness: A survey of Council of University Directors of Clinical Psychology (CUDCP) clinical psychology training and doctoral education.

The emergence of psychiatric rehabilitation and the recovery movement generate new and expanded roles for psychologists in services for people with serious mental illness (SMI). However, the proportion of psychologists working in SMI services today is substantially less than previous decades. This article reviews the roles of psychologists in various mental health systems and outlines the contributions that psychologists can make in implementing evidence based approaches for people with SMI. A survey of American Psychology Association (APA)-accredited Council of University Directors of Clinical Psychology (CUDCP) Clinical Psychology doctoral programs was conducted. The results of the survey indicate an increase, since the early 1990s, in clinical faculty with SMI interests, and suggest that many graduate programs provide opportunities for SMI-relevant research and practicum training. However, the survey also indicates a lack of coursework on topics relevant to SMI and a lack of coursework relevant to assuming administrative and leadership roles in the mental health system. Despite training opportunities in graduate school, production of new PhDs who choose the SMI field is unlikely to meet the demand. According to the present study, the limiting factor is not availability of training, but student career choice. The opportunities and challenges that psychologists face in SMI recovery-oriented service delivery are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community Health Centers: Exciting Opportunities for the 21st Century.

What are important and increasingly available settings for psychologists interested in practicing primary behavioral health care? Community health centers (CHCs) represent the medical "safety net" for millions of uninsured and medically underserved Americans. The recent push to expand mental health services at CHCs creates the need for psychologists and other mental health providers, particularly those familiar with primary behavioral health care approaches. Federal funding to recruit and retain psychologists at CHCs has increased along with opportunities for multidisciplinary service approaches and training. The potential ways in which psychologists can respond to demonstrated societal needs and develop new clinical skills and methods at CHCs are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Editorial: What will the 21st century bring? An emphasis on quality care.

Day-to-day concerns frequently take precedence over abstract concepts for psychologists practicing in the United States. However, traditional mental health services are a subset of the more generic health care environment, and changes in this environment will eventually affect the daily practice of mental health practitioners. For a profession to continue to mature and thrive, leadership must be aware of and capitalize on relevant national and international changes. In the 21st century, advances in technology and communication will affect the quality of services and will likely result in increased stress for practitioners and patients. This article reviews developments within the American Psychological Association and explores both current and potential roles that will shape the future of professional mental health practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and the mental health movement.

The following points are elaborated: "1. Among many other things, mental health is a vast social movement which, for better or for worse, will carry us all along with it. 2. Psychologists, for a number of reasons, have not been enthusiastic participators in this social movement. 3. Psychologists have a great deal to contribute to the mental health movement, and they can contribute mightily without loss of identity." Mental health as a social movement seems due to three factors: (a) The tendency to conceive human behavior in naturalistic terms. (b) The American belief in the almost infinite improvability of almost anything. (c) The rising level of aspiration for health and well-being. The scientific humility of the psychologist "can become maladaptive diffidence, and diffidence sometimes becomes irresponsibility." 6 suggestions for dealing with diffidence are indicated. The psychologists perceptions of mental health, the orientation of the movement toward the "pathological," and the focus on the clinical may have discouraged the interests of psychologists in mental health. The unique contribution of the psychologist to mental health is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research survey: State mental health programs.

"In preparation for the 1959 meeting of chief psychologists in state mental health programs a questionnaire on research was prepared and sent to 77 psychologists who were either functioning as chief psychologists in state programs" or in similar positions. Replies were received from 39 individuals, representing 30 states. "Evaluation of treatment was listed most frequently as an area in need of research." At least 45 different types of ongoing research projects were listed. "Three factors were emphasized as the main obstacles to research in the state programs: lack of personnel… lack of funds… emphasis on service, with subsequent lack of time for research." Psychologists were "seen as the individuals most involved in mental health research in state programs." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring Unique Roles for Psychologists.

Presents a comment on "Psychological Treatments" (see record 2004-21168-001) by D. H. Barlow. Barlow highlighted unique roles that psychologists can play in mental health service delivery by providing psychological treatments--treatments that psychologists would be uniquely qualified to design and deliver. In support of Barlow's position, the authors draw from their own clinical practice with special psychiatric populations, such as adults with severe and persistent mental illness and behaviorally disordered youths, to illustrate some potential unique roles for psychologists. The authors believe psychologists are uniquely trained to design such individualized functional behavioral analysis protocols because of their training in research design, behavior analysis, learning theory, and behavior change. Psychologists may also be uniquely qualified to design, implement, and evaluate many specialized therapy techniques, as Barlow has outlined and suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Creating Partnerships Between Consumer Groups and Professional Psychologists.

There are considerable advantages for professional psychologists who form partnerships with mental health consumer groups. This collaboration can utilize the strengths of both partners and result in benefits to the psychologist, the consumer group, the research field, and the community as a whole. By identifying mutual needs and forming alliances, professional psychologists and consumer groups can gain a great deal from each other's unique perspectives. This article outlines the importance of consumer-professional partnerships, focusing on the authors' experiences with children and their families. (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)     

Challenges of providing mental health services in Spanish.

The disparity in mental health services to Spanish-speaking clients is well documented. This study examines the service delivery experiences of Spanish-speaking mental health providers by exploring their perceptions and concerns regarding their competence and training to provide services in Spanish. It also identifies practitioner priorities for improving training experiences specific to bilingual mental health service delivery. Implications for graduate psychology programs are discussed in an effort to promote and enhance necessary competencies regarding bilingual training endeavors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice makes perfect and other myths about mental health services.

Expenditures for mental health services, as a proportion of health care expenditures, have plummeted in the past decade. Concurrently psychologists have been unable to muster scientific evidence for the effectiveness of typical services. The clinical world failed to collect such evidence while the academic world focused on laboratory studies. Beliefs in the mechanisms thought to assure the quality and effectiveness of typical services may have created complacency. Psychologists seem confident that effective services are assured by (a) more experienced clinicians, (b) degree programs, (c) continuing education, (d) licensing, (e) accreditation, and (f) clinical supervision. After reviewing relevant scientific literature, the author concludes that these are myths with little or no evidence to support them. The author suggests 4 ways to improve the quality and effectiveness of services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)