Psychologists working for unions: Developing the United Federation of Teachers' Victim Support Program.

This article describes the development of in-house mental health services in a large labor union local representing public school pedagogical employees. It focuses on the role of a psychologist in guiding program components for a targeted membership group through various stages of development: identifying needs, shaping intervention services, and creating a prevention module. It also describes the movement of services beyond the frame of the specific program to encompass a broader array of emergent mental health service needs, including consultation, technical advice, assistance in dealing with mental health managed care, and expansion of clinical–counseling services to a wider range of membership groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting.

This article discusses the relationship between psychologists and primary care physicians and describes the training and practice of physicians in the areas of mental and behavioral health care. Issues affecting the relationship between psychologists and primary care physicians are then reviewed. Different models of psychological consultation are discussed, and an integrated behavioral systems model of psychological consultation is presented as a potentially effective model for consultation with primary care physicians. This model provides a framework for psychologists to function as coproviders of primary health care services. Practical strategies to enhance collaboration between psychologists and primary care physicians in private practice are discussed. The need for more research on primary care and for the inclusion of psychologists in managed care and health care reform are also highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gerald Caplan (1917–2008).

Presents an obituary for Gerald Caplan who was a world leader in the areas of preventive psychiatry; adult, child, and family psychiatry; and community mental health. His contributions to prevention, crisis intervention, mental health consultation, and social support are monumental and unprecedented. Briefly described is Caplan's life history, educational background, and scholarly accomplishments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating mental health services into primary medical care

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.     

The psychologist as a consultant in a nursing home: Effect on staff morale and turnover.

Many elderly patients have been transferred from long-term psychiatric hospitals to nursing homes, where knowledge of psychological aspects of patient care is generally poor and where emotional and behavioral disorders are poorly tolerated by staff. One solution to this problem is for psychologists to provide in-service training to nursing-home staff in the psychological aspects of patient care, but this approach ignores such problems as poor staff morale and high staff turnover. A 188-bed skilled nursing home was selected for a 12-wk consultation program based on a mental health and organizational development approach. Turnover rates fell from 73.4%, during the quarter prior to consultation, to 27.8%, during the period of consultation, and averaged 33.6% for the next 3 quarters. Staff morale also improved. Results indicate that before training nursing-home staff in the psychological aspects of geriatric care, problems such as high staff turnover and poor morale should be resolved. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Federal involvement in mental health care for the aged: Past and future directions.

Reviews federal legislative trends in mental health services for the elderly under the Reagan administration. The consolidation of 21 health programs into 4 block grants is considered for its impact on elderly mental health care, and Congress's support of important programs such as clinical training, social research, and research on Alzheimer's disease is discussed. Severe limitations for reimbursement of mental health care under Medicare are considered. It is concluded that Community Mental Health Centers under the Reagan administration will further limit non-revenue-producing services such as prevention, consultation, and education as they exhaust their 8-yr federal funding support, and it is unlikely that Medicaid will increase its coverage of services for the mentally ill. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Erratum to Glenwick.

Reports an error in the original article by David S. Glenwick (American Psychologist, 1979[June], 34[6], p.559), a misplaced line occurred in the first paragraph, third column. The paragraph should read: I share Goodstein and Sandler's (1978, p. 891) opinion that "community psychology cannot prosper within the community mental health movement" (my emphasis). Nonetheless, there are some aspects of the community mental health movement (e.g., consultation, crisis intervention, use of paraprofessionals, community education, administration of the community mental health center as an organizational system) that can prosper within community psychology, that are consonant with a community psychology orientation and can lead to mutually productive collaborative undertakings. To prevent the baby from being thrown out with the bathwater, it is these aspects of community mental health that can legitimately be embraced by community psychology without comprising its ideological integrity. (The following abstract appears in record 1990-58513-001.) Comments on L. D. Goodstein and I. Sandler's (see record 1979-22507-001) conceptual analysis of community psychology (CP), focusing on program evaluation, multidisciplinary knowledge, and the community mental health movement (CMHM). There are aspects of the CMHM that can prosper within CP, that are consonant with a CP orientation, and that can lead to mutually productive collaborative undertakings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

NIMH and prevention.

Argues against the suggestion by I. Iscoe (see record 1983-06391-001) that the National Institute of Mental Health (NIMH) is primarily directed away from approaches that focus on prevention. Prevention is a high-priority area at NIMH; NIMH initiated the consultation and education activities in community mental health centers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's Mental Health as a Primary Care and Concern: A System for Comprehensive Support and Service.

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group consultation: Key variables that effect change.

Discusses 2 hypothesized key variables of the effective consultation process, and presents 7 categories of consultant manipulations designed to promote the facilitation of improved consultee information processing behaviors: (a) focusing attention on alternative aspects of the informational field (theme interference reduction), (b) didactic provision of mental health information, (c) intercommunication of perceptions of options for intervention, (d) modeling alternative behaviors, (e) positive reinforcement of the consultee's engaging in information processing behaviors, (f) promoting a group experience of expressing feelings and attitudes, and (g) relinquishing previous intervention behaviors as the group becomes self-assessing. Four stages in the progress of the consultation alliance are delineated: (1) relationship development stage, (2) working stage, (3) group autonomy stage, and (4) consultee–consultant stage. In conclusion, a piece of a theoretical framework for consultation is developed that should facilitate the design of systematic research. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary care in psychiatry residency training

The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends there specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, through their contact with primary care-oriented psychiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.     

Promoting adolescent mental health in primary care: a review of the literature

High levels of psychological disturbance amongst adolescents have been linked to behaviours which can damage physical health, and with mental health problems in adulthood. The aim of this review was to see if published literature supports the hypothesis that primary care is a suitable setting in which mental health problems in adolescents can be prevented by early detection and treatment. Medline, BIDS, SIGLE and Psychlit databases (January 1990-February 1997) were systematically searched for English language studies on adolescent health promotion and mental health in primary care; reference sections were checked for earlier work. When offered, adolescent health checks and clinics have been well received with attendance rates of 73% and 83% reported, respectively. Primary care offers a setting for the prevention and detection of mental health problems in adolescents. Further research is needed to determine cost effective ways of using these opportunities.     

Primary prevention in aircraft disasters: Integrating research and practice.

The integration of rigorous scientific research with program development and implementation is essential in new areas of psychological practice, such as primary prevention for aircraft disaster victims. Research on primary prevention for air disasters can provide practical information on how to help victims cope with traumatic events, as well as contributing to theoretical understanding about the role of trauma in the development of psychopathology. Both epidemiological research on the mental health effects of disasters and practitioner experiences are used in this article to identify high risk groups and types of primary prevention interventions for air disasters. Practical suggestions are provided for research in this area, including discussions of design issues, access to victims, selection of instruments, and issues involved in obtaining funding. Implications of media attention and litigation also are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Open systems consultation: Some lessons learned from case experience.

Contends that mental health consultation has been dominated by G. Caplan's (see record 1964-06327-001) approach. Recently, it has been argued that mental health consultation can be better understood in open systems terms. The present article provides a case study of how the entry phase of the consultation process can be conceptualized in open systems terms and how this conceptualization provides both particular clarity of analysis and clearer directions for the solution of consultation problems. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health state preferences of persons with anxiety

We have described a program that integrates clinical approaches of infant mental health to infants and toddlers in foster care. The juxtaposition of a mental health program in a forensic setting creates a number of special features that we have highlighted. Unique from the clinical perspective, the team is explicitly relationship-focused, attempting to understand all of the young child's caregiving relationships as they affect development. We strive to enhance the quality of all of relationships in which infants participate, fostering healthy attachments and development. Also unique is the emphasis on system liaison, and making programmatic efforts to affect various systems involved in making custody determinations about infants and toddlers. Unique from the forensic perspective, we offer multidisciplinary expertise about an especially high-risk population, a comprehensive service delivery system in which we provide or coordinate and monitor all intervention efforts for a given family, a prevention orientation, and clinical follow-up with infants for as long as they are in care. The goals of the program include expediting permanency planning decisions, increasing continuity in high-quality foster care placements, increasing court satisfaction with mental health consultation, decreasing the number of court-ordered evaluations for adjudicated families, and increasing CPS satisfaction with available treatment and continuity of care. We believe that this approach integrates delivery of services to the youngest and most vulnerable victims of maltreatment and expedites permanency planning.     

Mental health consultant to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants--psychologists and psychiatrists--with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions.     

Psychiatric consultation: concepts and controversies

There are two major models of consultation in the field of psychiatry, differing in their goals, participants, settings, and methods. The psychiatric-therapeutic model entails provision of optimal care for the individual patient; the community mental health model involves provision of assistance to mental health caregivers. The author believes that to enhance the value of consultation the consultation should restrict his or her role to that for which he or she has been trained. Current social needs, coupled with a limited supply of consultants, suggest that psychiatric consultation should be provided within comprehensive health care systems. There is a pressing need to clarify the concepts of formulations concerning the criteria of outcome of psychiatric consultation so that evaluation of its effectiveness can be advanced.     

Angiocardiographic digital still images compressed via irreversible methods: concepts and experiments

OBJECTIVE: Primary care occupies a strategic positive in the evaluation, treatment, and prevention of the mental disturbances of later life. This article highlights four themes that are crucial to understanding mental disturbances among older adults: 1) subsyndromal depression, 2) coexisting depression and anxiety, 3) comorbidity of depression and chronic medical conditions, and 4) risk factors for cognitive impairment. METHOD: The literature was selectively reviewed for each theme to ask the central question, "What can primary care physicians learn about mental disturbances of their older patients from epidemiologic and community studies?" RESULTS: The primary care setting itself is an important venue for an examination of aging issues and mental health. Workers in the "middle ground of psychiatric epidemiology"--primary health care--have not yet reached a full appreciation for the value of research in the primary care setting for enhancing our understanding of the mental disturbances of late life, and how these intersect with other salient factors. CONCLUSIONS: Primary care physicians and others who work in primary care should advocate for further mental health integration and research in primary care. Research is needed that will lead to new ways of maximizing the health and quality of life of older adults and their families.     

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)     

Critical issues in mental health service delivery: what are the priorities?

The director, one other professional, and one para-professional in 515 community mental health centers and 193 state hospitals throughout the United States were asked to rate 57 critical issues in mental health services as to their importance now and five years from now. Issues judged most important now are services for children and for adolescents; five years from now children's services still top the list. Answers to two other questions revealed that respondents placed research on prevention at the top of a list of needed research areas, and that the most useful NIMH service to agencies was person-to-person assistance such as consultation and workshops.