Mental Health Center Services Research Articles

Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services

Cultural Competence: A Literature Review and Conceptual Model for Mental Health Services

Children's Beliefs About Causes of Childhood Depression and ADHD: A Study of Stigmatization

Children's Beliefs About Causes of Childhood Depression and ADHD: A Study of Stigmatization

Partnering with families: multiple family group psychoeducation for schizophrenia

Family psychoeducation (FPE) is one of six evidence-based practices endorsed by the Center for Mental Health Services for individuals suffering from chronic mental illnesses. Multiple family group psychoeducation (MFG) has been shown to be an effective component of FPE in reducing symptom relapses and rehospitalizations for individuals with schizophrenia. It is especially effective when family members participate on a consistent basis, which allows them to increase their understanding of the biology of the disorder, learn ways to be supportive, reduce stress in the environment and in their own lives, and develop a broader social network. When used in conjunction with medication, MFG can help an individual with schizophrenia progress towards the rehabilitation phase of recovery. A case illustration describes the engagement of a chronically ill, mid-thirties male in MFG and how his family's participation for 2 years benefits all members, in spite of the longevity of his illness.

Medical Evaluations for Patients With Psychiatric Disorders: Reply

Back to table of contents Previous article Next article LetterFull AccessLetterAileen B. Rothbard Sc.D.Michael B. Blank Ph.D.Aileen B. Rothbard Sc.D.Search for more papers by this authorMichael B. Blank Ph.D.Search for more papers by this authorPublished Online:1 Jun 2009https://doi.org/10.1176/ps.2009.60.6.849aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Medical Evaluations for Patients With Psychiatric Disorders: ReplyIn Reply: We very much appreciate the endorsement by Drs. Grace and Christensen of our findings that there are alarming rates of undetected metabolic disorders and infectious diseases among psychiatric inpatients and our conclusion that the lack of routine screening for these illnesses in inpatient settings presents a missed opportunity to connect patients with primary care and other health services. We certainly agree with our colleagues' recommendation that new patients presenting with psychiatric problems in outpatient settings shouldbe screened for general medical conditions that might be related to their mental health symptoms. Clearly, general medical problems that might cause mental health problems should be ruled out. However, we believe that access to routine primary care is important for other reasons. Our concern in supporting the model that Drs. Grace and Christensen propose is that even if mental health professionals in outpatient settings refer patients to primary medical care, linkage is frequently poor. In fact, psychiatrists have been found to have less access to medical services for their patients than any other specialty care providers ( 1 ). Given the fragmented care system, exacerbated in many ways by the carve-out of behavioral health services from general medical services, persons with serious mental illness often have difficulty being seen by primary care providers, even when referred by psychiatrists. To us it seems unlikely that nonpsychiatrists would be any more effective than their psychiatrist colleagues in connecting their clients to primary care. We believe that a more effective model for this population would be to place primary health providers, such as primary care physicians, nurses, and physician assistants, within the community mental health setting to screen and treat people and refer them to other providers when more intensive treatment is needed. A recent report from the Agency for Healthcare Research and Quality that addresses evidence for integration of primary health services into specialty outpatient settings for adults with serious behavioral health disorders presents results from three trials of this type of model ( 2 ). The collaborative care models that were studied had intermediate to high levels of involvement by primary care providers and regular contact between general medical and mental health staff, some of whom were co-located ( 3 ). These trials were consistent in reporting improvements in medical care, quality of care, and patient outcomes. Other examples of collaborative models have used advanced practice nurses effectively to provide health care services to people who were also receiving community mental health center services ( 4 , 5 ). Because community mental health centers are the most common organizational structure for treating patients with serious mental illness and because there is an established history of integrating other types of services into these centers, we think that this model is likely to be more successful than the model proposed by our colleagues, which is really an amplification of the existing model of fragmented general medical and mental health care. Of course, we will need to do more research on the clinical effectiveness and cost-effectiveness of these varying approaches. We are hopeful that the current crisis in health care presents a real opportunity to implement and test these alternative models of integrated care.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterAileen B. Rothbard Sc.D.Michael B. Blank Ph.D.Aileen B. Rothbard Sc.D.Search for more papers by this authorMichael B. Blank Ph.D.Search for more papers by this authorPublished Online:1 Jun 2009https://doi.org/10.1176/ps.2009.60.6.849aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Medical Evaluations for Patients With Psychiatric Disorders: ReplyIn Reply: We very much appreciate the endorsement by Drs. Grace and Christensen of our findings that there are alarming rates of undetected metabolic disorders and infectious diseases among psychiatric inpatients and our conclusion that the lack of routine screening for these illnesses in inpatient settings presents a missed opportunity to connect patients with primary care and other health services. We certainly agree with our colleagues' recommendation that new patients presenting with psychiatric problems in outpatient settings shouldbe screened for general medical conditions that might be related to their mental health symptoms. Clearly, general medical problems that might cause mental health problems should be ruled out. However, we believe that access to routine primary care is important for other reasons. Our concern in supporting the model that Drs. Grace and Christensen propose is that even if mental health professionals in outpatient settings refer patients to primary medical care, linkage is frequently poor. In fact, psychiatrists have been found to have less access to medical services for their patients than any other specialty care providers ( 1 ). Given the fragmented care system, exacerbated in many ways by the carve-out of behavioral health services from general medical services, persons with serious mental illness often have difficulty being seen by primary care providers, even when referred by psychiatrists. To us it seems unlikely that nonpsychiatrists would be any more effective than their psychiatrist colleagues in connecting their clients to primary care. We believe that a more effective model for this population would be to place primary health providers, such as primary care physicians, nurses, and physician assistants, within the community mental health setting to screen and treat people and refer them to other providers when more intensive treatment is needed. A recent report from the Agency for Healthcare Research and Quality that addresses evidence for integration of primary health services into specialty outpatient settings for adults with serious behavioral health disorders presents results from three trials of this type of model ( 2 ). The collaborative care models that were studied had intermediate to high levels of involvement by primary care providers and regular contact between general medical and mental health staff, some of whom were co-located ( 3 ). These trials were consistent in reporting improvements in medical care, quality of care, and patient outcomes. Other examples of collaborative models have used advanced practice nurses effectively to provide health care services to people who were also receiving community mental health center services ( 4 , 5 ). Because community mental health centers are the most common organizational structure for treating patients with serious mental illness and because there is an established history of integrating other types of services into these centers, we think that this model is likely to be more successful than the model proposed by our colleagues, which is really an amplification of the existing model of fragmented general medical and mental health care. Of course, we will need to do more research on the clinical effectiveness and cost-effectiveness of these varying approaches. We are hopeful that the current crisis in health care presents a real opportunity to implement and test these alternative models of integrated care.

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

Community Psychiatry Experts Hope Mentorship Will Boost Their Ranks

Back to table of contents Previous article Next article Community NewsFull AccessCommunity Psychiatry Experts Hope Mentorship Will Boost Their RanksJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:1 May 2009https://doi.org/10.1176/pn.44.9.0012aDuring the past quarter-century or so, community behavioral health organizations (CBHOs) have found it increasingly difficult to recruit or retain psychiatrists.Prior to the 1980s, the National Institute of Mental Health provided grants to train psychiatrists to work in community mental health settings. Since then, very few psychiatry residency training programs have trained psychiatrists to work in such settings, and many training programs that provide marked community and public training experience have been forced to reduce that portion of their curriculum, David Pollack, M.D., a professor for public policy at Oregon Health and Science University, said during an interview. Moreover, there have been very few postgraduate fellowships in community or public psychiatry, he added.That's the bad news. The good news, however, is that two different, but complementary, programs are emerging to fill this need, he reported.One is the Psychiatric Leadership Development Program (PLDP). It was put together primarily by Anita Everett, M.D., section director of community and general psychiatry at Johns Hopkins University, with input and collaboration from Pollack; Hunter McQuistion, M.D., an associate clinical professor of psychiatry at Columbia University; and business and public health faculty at Johns Hopkins University and the National Association of State Mental Health Program Directors. Kenneth Thompson, M.D., an associate professor of psychiatry at the University of Pittsburgh and associate director of medical affairs at the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services, has also participated, both as a mentor/faculty member and in helping secure SAMHSA funding for the first two years of the project. The program is coordinated by staff from the National Council for Community Behavioral Healthcare.The purpose of the PLDP is to train psychiatrists who are CBHO medical directors to be more effective in their positions. “These organizations,” Pollack explained, “are larger, more complex, and more businesslike than the community mental health centers of a few years ago because of the advent of managed care, because of the tightening of resources, and because staff now have to be much more accountable for their clinical activities. Furthermore, the organizations have taken on a broader range of services than just mental health services, including treatment for co-occurring substance use disorders.”The first group to participate in PLDP—15 physicians, mostly psychiatrists, from all over the United States—began their leadership training and quality-improvement guidance in April 2008 and completed it in December 2008. SAMHSA funded a second round that started last month and will go for a year.The second program designed to enhance participation by psychiatrists in CBHOs is the Community Psychiatric Practice Mentorship Service (CPPMS). It was developed by Pollack and other members of the board of the American Association of Community Psychiatrists (AACP). Its purpose is to provide psychiatrists who are new to working in CBHOs with the management and leadership skills that will enable them to succeed in these centers.Specifically, the CPPMS program will send a seasoned community psychiatrist, selected from a group of mentors recruited by AACP, to a particular CBHO to improve the management and leadership performance of the psychiatrists who are new there. The mentor may also provide organizational consultation on clinical or program issues identified by the CBHO psychiatrists as particularly important to them—for example, co-occurring mental disorders, the integration of behavioral health and primary care, or criminal-justice linkage issues. The consultation will involve an initial site visit followed by regular consultation meetings at least several times a month via phone calls, e-mail, or videoconference. The CBHO will pay the mentoring psychiatrist for his or her mentoring services.To date, 14 seasoned community psychiatrists have signed up to be CPPMS mentors. “We might call them the all-star team of community psychiatrists,” said Pollack. He and his colleagues will now work with various national organizations, including the National Council for Community Behavioral Healthcare and the Mental Health Corporation of America, to recruit CBHOs to purchase the service. They have developed a process to bring together mentors whose geographic location and areas of expertise match CBHOs' particular needs.In essence, these two programs are a “rational and hopeful response to some of the medical-leadership difficulties facing community-based mental health programs,” Pollack said.The two programs will be discussed during a workshop at the forthcoming APA annual meeting titled “Becoming a Public Psychiatry Leader: Mentoring Models for Everyone, From Residents to Medical Directors.” The workshop will be held on May 18 from 11 a.m. to 12:30 p.m. in Room 226, Mezzanine Level East, Moscone Center. ▪ ISSUES NewArchived

Focus on Transformation: A Public Health Model of Mental Health for the 21st Century

In 2003 the President's New Freedom Commission called for the transformation of the public mental health system to one that is person centered, recovery focused, evidence based, and quality driven. In this column the director of the Center for Mental Health Services describes progress made by the center over the past five years as well as challenges and opportunities. She presents a strategic forecast, based on stakeholder input, to guide policy formulation and resource allocation. Central to the forecast is the concept of a public health model of mental health that takes a community approach to prevention, treatment, and promotion of well-being.

Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

Initial Outcomes of a Mental Illness Self-Management Program Based on Wellness Recovery Action Planning

Initial Outcomes of a Mental Illness Self-Management Program Based on Wellness Recovery Action Planning

Transitioning Clients from Assertive Community Treatment to Traditional Mental Health Services

The original assertive community treatment (ACT) model included time-unlimited treatment. However, resource restrictions and subsequent research call into question the feasibility and necessity of time-unlimited services. This study compares the outcomes of 48 individuals who successfully transitioned from ACT to less intensive Community Mental Health Center (CMHC) services to 19 persons who required return to ACT or did not remain in CMHC treatment. There were no statistically significant differences in demographics, diagnoses, and other treatment factors between the two groups.

Changing Trends in State Psychiatric Hospital Use From 2002 to 2005

Changing Trends in State Psychiatric Hospital Use From 2002 to 2005

Changing Trends in State Psychiatric Hospital Use From 2002 to 2005

National surveys have shown dramatic declines in the number of residents in state psychiatric hospitals since the 1950s and in the number of admissions since the 1970s. However, data from 2002 and 2005 indicate a reversal of these long-term trends. The objective of this study was to present the new data and to advocate for research on the factors contributing to these changes. This study is based on state-level data submitted annually to the Center for Mental Health Services. The 11 states showing increases in admissions and residents between 2002 and 2005 were surveyed by telephone about the factors leading to the changes. Between 2002 and 2005, the number of admissions nationwide increased 21.1%, and the number of residents increased by 1.0%. State mental health agency staff attributed the increases principally to one factor-the increase in the number of forensic admissions and residents. Staff also identified increases in the number of admissions with schizophrenia (increased 23.2%) and affective disorders (increased 16.3%) as a second factor, plus declines in the availability of housing and community-based care providers. The reversal of long-term trends may signal threats to the goal of community-based mental health care. Research is urgently needed to examine the factors associated with these increases. Potential factors to be investigated include the increase in the number of forensic admissions and the antecedents of this phenomenon, increases in the number of admissions with schizophrenia, the changing capacity of general hospital inpatient psychiatric services in the community, and changes in the demographic makeup of American society, reflected in an aging population and increased racial-ethnic diversity.

A Study on Family Satisfaction with Community Mental Health Center Services in Gyeonggi Province by Families of People with Mental Illness

The purpose of this study was to evaluate the service satisfaction for families who have someone with mental illness, and are using community mental health centers in Gyeonggi Province. The participants in this study were 796 family members. Data were collected using Family satisfaction survey questionnaire developed by the author (23 items on family service and 15 items on client service). The total satisfaction level for the service with family and client resulted in above average scores. Of the 23 service items, data showed the highest level of satisfaction was with professional skills and attitude, and day rehabilitation programs, and the lowest for professional activities for advocacy and social welfare benefits, emergency & crisis intervention, medical expense subsidies. Of the 15 service items, job and housing related service had the lowest level of satisfaction. It is recommended that psychiatric emergency & crisis intervention programs and system development be accelerated. Also, there is a need to develop medical expense subsidy programs for older family caregivers, job and housing focused rehabilitation programs and community facilities for the client, as well as more active and powerful professional advocate activities for persons who have mental disabilities and their families.

Mental Health Policy and Services Five Years After the President's Commission Report: An Interview With Michael F. Hogan

Mental Health Policy and Services Five Years After the President's Commission Report: An Interview With Michael F. Hogan

Implementation of Integrated Dual Disorders Treatment: A Qualitative Analysis of Facilitators and Barriers

Implementation of Integrated Dual Disorders Treatment: A Qualitative Analysis of Facilitators and Barriers

An Orphan Comes of Age

Back to table of contents Next article Taking IssueFull AccessAn Orphan Comes of AgeBenjamin G. Druss M.D., M.P.H.,Benjamin G. Druss M.D., M.P.H.Search for more papers by this author,Published Online:1 Aug 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As a postdoctoral fellow in the mid-1990s, I attended a session at the American Psychiatric Association's annual meeting at which the presenter discussed psychiatrists' role in ensuring that their patients receive primary medical care. I looked around the room and saw three other psychiatrists in the large and otherwise empty auditorium. After the talk, I went up to the podium and asked the speaker why he thought that so few people had attended. He said he supposed that general medical topics made mental health providers uncomfortable and that persons with serious mental illness made primary care providers uncomfortable. The topic, he said, was an orphan that had yet to find a home.What a difference a decade makes. The topic of general medical care for persons with mental illnesses has moved into the mainstream of research and policy efforts in the United States and abroad. Accumulating evidence has documented high rates of medical comorbidity and premature death in this population. Even more troubling is the evidence that we mental health providers are partly complicit in this excess morbidity and mortality. We are guilty both of sins of omission, through our failure to focus on our clients' physical health care needs, and commission, through the iatrogenic effects of psychotropic agents that we use to treat psychiatric symptoms.As this evidence has accumulated, a broad and diverse range of stakeholders, including state mental health program directors, consumer groups, community mental health organizations, and federal agencies, have begun to address the problem of medical morbidity and mortality among mental health care consumers. The Center for Mental Health Services is currently spearheading the "Ten by Ten" campaign, which aims to reduce the disparity in life expectancy for persons with serious mental illness by ten years (from 25 years to 15 years) within the next ten years. Many of the most important studies in this emerging area have been published in Psychiatric Services. In this issue the journal continues its leading role in drawing attention to this topic, featuring studies that document the burden of comorbid mental and medical illnesses, the problems in access to and quality of medical care for persons with serious mental illnesses, and the challenges that systems of care face when they seek to address these problems. Now that this orphan topic has been adopted by policy makers and advocates, these new studies have an even greater opportunity to help drive national efforts to improve health and health care for mental health consumers. Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Emory University FiguresReferencesCited byDetailsCited byNone Volume 59Issue 8 August, 2008Pages 833-833PSYCHIATRIC SERVICES August 2008 Volume 59 Number 8 Metrics PDF download History Published online 1 August 2008 Published in print 1 August 2008

An Orphan Comes of Age

Back to table of contents Next article Taking IssueFull AccessAn Orphan Comes of AgeBenjamin G. Druss M.D., M.P.H.,Benjamin G. Druss M.D., M.P.H.Search for more papers by this author,Published Online:1 Aug 2008AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As a postdoctoral fellow in the mid-1990s, I attended a session at the American Psychiatric Association's annual meeting at which the presenter discussed psychiatrists' role in ensuring that their patients receive primary medical care. I looked around the room and saw three other psychiatrists in the large and otherwise empty auditorium. After the talk, I went up to the podium and asked the speaker why he thought that so few people had attended. He said he supposed that general medical topics made mental health providers uncomfortable and that persons with serious mental illness made primary care providers uncomfortable. The topic, he said, was an orphan that had yet to find a home.What a difference a decade makes. The topic of general medical care for persons with mental illnesses has moved into the mainstream of research and policy efforts in the United States and abroad. Accumulating evidence has documented high rates of medical comorbidity and premature death in this population. Even more troubling is the evidence that we mental health providers are partly complicit in this excess morbidity and mortality. We are guilty both of sins of omission, through our failure to focus on our clients' physical health care needs, and commission, through the iatrogenic effects of psychotropic agents that we use to treat psychiatric symptoms.As this evidence has accumulated, a broad and diverse range of stakeholders, including state mental health program directors, consumer groups, community mental health organizations, and federal agencies, have begun to address the problem of medical morbidity and mortality among mental health care consumers. The Center for Mental Health Services is currently spearheading the "Ten by Ten" campaign, which aims to reduce the disparity in life expectancy for persons with serious mental illness by ten years (from 25 years to 15 years) within the next ten years. Many of the most important studies in this emerging area have been published in Psychiatric Services. In this issue the journal continues its leading role in drawing attention to this topic, featuring studies that document the burden of comorbid mental and medical illnesses, the problems in access to and quality of medical care for persons with serious mental illnesses, and the challenges that systems of care face when they seek to address these problems. Now that this orphan topic has been adopted by policy makers and advocates, these new studies have an even greater opportunity to help drive national efforts to improve health and health care for mental health consumers. Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Emory University FiguresReferencesCited byDetailsCited byNone Volume 59Issue 8 August, 2008Pages 833-833PSYCHIATRIC SERVICES August 2008 Volume 59 Number 8 Metrics PDF download History Published online 1 August 2008 Published in print 1 August 2008

The Role of Staff Turnover in the Implementation of Evidence-Based Practices in Mental Health Care

This study examined turnover rates of teams implementing psychosocial evidence-based practices in public-sector mental health settings. It also explored the relationship between turnover and implementation outcomes in an effort to understand whether practitioner perspectives on turnover are related to implementation outcomes. Team turnover was measured for 42 implementing teams participating in a national demonstration project examining implementation of five evidence-based practices between 2002 and 2005. Regression techniques were used to analyze the effects of team turnover on penetration and fidelity. Qualitative data collected throughout the project were blended with the quantitative data to examine the significance of team turnover to those attempting to implement the practices. High team turnover was common (M+/-SD=81%+/-46%) and did not vary by practice. The 24-month turnover rate was inversely related to fidelity scores at 24 months (N=40, beta=-.005, p=.01). A negative trend was observed for penetration. Further analysis indicated that 71% of teams noted that turnover was a relevant factor in implementation. The behavioral health workforce remains in flux. High turnover most often had a negative impact on implementation, although some teams were able to use strategies to improve implementation through turnover. Implementation models must consider turbulent behavioral health workforce conditions.

Experiential Knowledge of Serious Mental Health Problems

In 1998, a dialogue between mental health consumers and psychologists was sponsored by the Center for Mental Health Services. It is against this backdrop that the author briefly discusses her personal experience with serious mental health problems and how it has informed her clinical training and practice, especially in working with individuals with serious mental health problems and disorders. Using some of the overall recommendations of the 1998 meeting as guiding principles, the author reviews the literature on four topics that have become salient in her role as client—scientist—practitioner. Her experiential, academic, and clinical knowledge has led her to focus on how she can provide hope to her clients—patients in their recoveries and increase the use of first-person stories of individuals with mental disorders in both her practice and teaching. The discussion of therapist self-disclosure is reexamined in light of current research evidence and shifts in theoretical paradigms. Finally, readers are encouraged to examine the ongoing stigma associated with mental disorders perpetuated within the profession and look at experiential knowledge of mental disorders as an additional competence in the field of psychology rather than solely as an issue of professional competence or impairment.