Mental Health Center Services Research Articles

Street outreach for homeless persons with serious mental illness: is it effective?

This study examined data on case management clients who are homeless and have a severe mental illness to determine how those contacted through street outreach differ in their socio-demographic characteristics, service needs, and outcomes from those clients contacted in shelters and other health and social service agencies. As part of the Center for Mental Health Services' Access to Community Care and Effective Services and Supports (ACCESS) program, data were obtained from potential clients over the first 3 years of the program at the time of the first outreach contact (n = 11,857), at the time of enrollment in the case management program (n = 5,431), and 3 months after enrollment (n = 4,587). Clients contacted at outreach on the street, as opposed to being contacted in shelters and service agencies, were generally worse off. They were more likely to be male, to be older, to spend more nights literally homeless before the contact, to have psychotic disorders, and took longer to engage in case management. They expressed less interest in treatment and were less likely to enroll in the case management phase of the project. Subjects contacted on the street who did enroll were more impaired than their street counterparts who did not enroll. Three month outcome data showed that enrolled clients contacted through street outreach showed improvement that was equivalent to those enrolled clients contacted in shelters and other service agencies on nearly all outcome measures. Street outreach to homeless persons with serious mental illness is justified as these clients are more severely impaired, have more basic service needs, are less motivated to seek treatment, and take longer to engage than those contacted in other settings. Street outreach is further justified as it engages the most severely impaired among the street population. Street outreach also appears to be effective as the clients reached in this way showed improvement equal to that of other clients in most outcome domains when baseline differences were taken into account.

Cooperative Agreements for CMHS/CSAT Collaborative Program to Prevent Homelessness

Although there has been a considerable investment in housing, treatment, and support services over the past decade, homeless-ness continues to be a risk for individuals with serious mental illnesses and particularly those with co-occurring alcohol and other drug disorders. In 1996, the Center for Mental Health Services and the Center for Substance Abuse Treatment launched a two-phased, three-year initiative to document and evaluate the effectiveness of homelessness prevention interventions that focus on persons with psychiatric and/or substance use disorders who are formerly homeless or at-risk for homelessness, and who are engaged with the mental health and/or substance abuse treatment system(s). This article describes the background, logic model, goals, and structure of the CMHS/CSAT Collaborative Program to Prevent Homelessness.

Behavioral Health Benefits In Employer-Sponsored Health Plans, 1997

Data for 1997 show that three-quarters or more of employer-sponsored health plans continue to place greater restrictions on behavioral health coverage than on general medical coverage. The nature of these restrictions varies by plan type. Some improvement in the treatment of mental health/substance abuse (MH/SA) benefits in employer plans may be occurring, however. Comparisons with data from 1996 show that the proportion of plans with benefits for "alternative" types of MH/SA services, such as nonhospital residential care, has increased. Further, the proportion with special limitations on these benefits shows a modest decrease.

Social support and service use among homeless persons with serious mental illness.

It has been widely hypothesized that persons with greater social support use fewer health care services, although previous studies have shown variable results. This study examines the relationship between levels of social support and formal service use among clients entering 18 community treatment programs for homeless persons with serious mental illness as part of the ACCESS demonstration project of the U.S. Center for Mental Health Services. Baseline and follow-up data on 1,828 clients entering the ACCESS program were used to evaluate the relationship between individual client socio-demographic and clinical characteristics, seven measures of social support, and levels of formal service use in this population. Three measures of social support were positively related to the use of outpatient medical services and one each to the use of substance abuse services and the total days of service use. Six out of seven measures of social support were positively related to the receipt of multiple services. It appears that social support is most strongly associated with improved access to an array of different services--a very important need among this population.

Highlights of the 1998 Institute on Psychiatric Services. Issues in public-sector managed care.

Highlights of the 1998 Institute on Psychiatric Services. Issues in public-sector managed care.

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.

Overcoming service barriers for homeless persons with serious psychiatric disorders.

To help homeless persons with comorbid psychiatric and substance use disorders gain access to community services, in 1993 the Center for Mental Health Services implemented the five-year Access to Community Care and Effective Services, or ACCESS program, in 15 cities. One aim of the program is to encourage collaboration between agencies serving the multiple needs of this population. This study examined the extent of linkages between agencies in the 15 demonstration cities. One respondent from each of the 1,060 community-based programs in tie 15 cities rated the extent to which his or her agency was linked with each of the other agencies in the local community in 1994 and again in 1996. Overall, there were 20,801 potential pairwise linkages. Linkages were classified into four types: a mutual tie, in which both agencies send and receive clients; a unidirectional tie, in which one agency sends and the other receives; an attempted tie, in which one agency sends but the other agency does not confirm receiving; and an unattempted tie. In 1994 and 1996, of the 20,801 pairs of potential service linkages, about a third were in place, while the remaining two-thirds were absent. Overall, linkages showed a slight but significant increase between 1994 and 1996. More than half of the linkages changed in type, indicating fluid service systems. Linkages between community agencies serving homeless persons with comorbid psychiatric and substance use disorders are not extensive. However, they increased slightly under the first two years of the ACCESS program, and there are good reasons to anticipate greater improvements in the future.

HIV infection linked to substance use among hospitalized patients with severe mental illness.

Back to table of contents Previous article Next article ColumnFull AccessDatapoints: HIV Infection Linked to Substance Use Among Hospitalized Patients With Severe Mental IllnessKaren McKinnon, M.A., and Francine Cournos, M.D.Karen McKinnonSearch for more papers by this author, M.A., and Francine CournosSearch for more papers by this author, M.D.Published Online:1 Oct 1998https://doi.org/10.1176/ps.49.10.1269AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Last June the National Institute of Mental Health adopted new priorities to address the AIDS epidemic among people with severe mental illness. Besides prevention and treatment, the priorities emphasize the need for a fuller understanding of the extent and social organization of sexual and drug use behavior, the nationwide prevalence of HIV, and the nature of causality between mental illness and HIV infection (1). Eleven studies of 2,873 predominantly hospital-based psychiatric patients in New York City, Baltimore, and Columbia, South Carolina, indicate the average HIV infection rate among adults with severe mental illness is 7.8 percent (2), nearly 20 times the rate of .4 percent estimated for the general population (3). Across studies, psychiatric patients with identified comorbid alcohol or other drug use disorders have a significantly higher rate of infection than those without (χ2 =47.56, df=9, p<.001) (see Figure 1). Among patients treated on dual diagnosis units, HIV seroprevalence is significantly related to type of substance used (χ2 =8.82, df=2, p<.03) (see Figure 2). Drug injection confers the highest risk, but even use of noninjected drugs or alcohol alone resulted in rates of infection substantially higher than the average rate. Patients with alcohol or other drug use disorders may be members of social networks where sex and drugs combine to create vulnerability to sexually transmitted HIV infection.Mental health care providers are often in the best position to assess patients' sexual and drug use behaviors. Only by asking can providers learn their patients' HIV-related risks and service needs and appropriately address them to reduce the human and economic costs of the AIDS epidemic.AcknowledgmentsThis work was supported by the New York State Office of Mental Health and the Center for Mental Health Services. The authors are affiliated with the department of psychiatry at Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute. Send correspondence to Ms. McKinnon at 722 West 168 Street, Unit 112, New York, New York 10032 (e-mail [email protected]). Harold Alan Pincus, M.D., and Terri L. Tanielian, M.A., are coeditors of this column. Figure 1. HIV infection rate (in percentages) among 2,873 psychiatric patients, by treatment settingFigure 2. HIV infection rate (in percentages) among 174 patients on dual diagnosis units, by type of drug used

The effect of victimization on clinical outcomes of homeless persons with serious mental illness.

The study examined the prevalence and correlates of criminal victimization and the relationship between victimization and client outcomes for homeless clients with mental illness. Subjects were clients in community treatment programs participating in the Access to Community Care and Effective Services and Supports (ACCESS) program of the Center for Mental Health Services. Data were obtained through interviews conducted at program entry and at three and 12 months after entry with ACCESS clients in 18 sites during the first year of program operation (N = 1,839). Self-reports of victimization during the past two months as well as data on sociodemographic, health, and social adjustment indicators were obtained at each time point. Multiple regression was used to determine both the correlates of victimization among this population and the effect of recent victimization on client outcomes three and 12 months after program entry. Forty-four percent of the clients were the victims of at least one crime during the two months before entering the program. Women were significantly more likely than men to have been victimized. Multivariate analysis showed that the more severe the client's psychotic symptoms, alcohol abuse, and criminal history, the more likely he or she was to have been victimized. Recent victimization had a significant impact on client outcomes in terms of increased homelessness and decreased quality of life. Victimization shortly before program entry was also the single most important predictor of victimization at both follow-up points. These findings suggest the critical need for service providers who work with homeless people with serious mental illness to assess the extent to which they have been victims of crime and to address issues of victimization and safety along with psychiatric and social adjustment problems.

Constraints to advanced psychiatric-mental health nursing practice

Constraints and barriers to advanced practice psychiatric nursing were reported by respondents of the Primary Mental Health and Advanced Practice Psychiatric Nursing survey of certified psychiatric clinical nurse specialists. Primary data (N = 507) were the qualitative responses to a survey item about constraints and secondary data were the literature and theoretical memos. Methodology was based on principles of qualitative data analysis and procedures for manifest and latent content analysis. Findings resulted in eight themes that explained both constraints and barriers to advanced practice: (1) reimbursement, (2) prescriptive authority, (3) admitting privileges, (4) bureaucracy, (5) practice environment, (6) colleagues, (7) image, and (8) personal. Themes were interpreted within the context of regulatory, market-based, and inter/intraprofessional constraints and barriers that led to suggestions for organizational and individual strategies for action. The survey was funded by the Society for Education and Research in Psychiatric-Mental Health Nursing with technical support from the Center for Mental Health Services.

Development and Implementation of an Experimental Study of the Effectiveness of Intensive In-Home Crisis Services for Children and Their Families

This article describes a 3-year research demonstration project originally funded by the National Institute of Mental Health and now funded in part by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. This project, which was conducted in the Bronx, New York, examined the efficacy of 3 models of intensive in-home services as alternatives to hospitalization for children experiencing serious psychiatric crises. All programs were 4- to 6-week interventions. The first, Home-Based Crisis Intervention (HBCI), was modeled on the Homebuilders model of family preservation; the second, Enhanced HBCI (HBCI+), added respite care, flexible service money, parent advocate and support services, and additional staff training in cultural competence and violence management. Crisis Case Management, the third model, used case managers to assess child and family needs and link them to services, as well as respite care and flexible money. The specific features of the 3 program models, the research design, and data collection measures are described. The intake data on the children and families are presented, and implications for providing services and for future research are discussed.

Homeless mentally ill clients' and providers' perceptions of service needs and clients' use of services.

Clients' and providers' perceptions of clients' needs were compared in 18 community treatment programs participating in the Access to Community Care and Effective Services and Supports program of the Center for Mental Health Services, a national demonstration project on treatment of homeless persons with mental illness. The study sought to determine whether perceptions differed and whether assessed needs for services were related to service use. A total of 1,482 clients contacted through community outreach who entered the case management phase of the program after an average of 32 days were given an evaluation interview at entry into the program. The clients and outreach workers identified clients' needs in seven core domains-mental health, general health, substance abuse, public financial support, housing assistance and support, dental care, and employment. Use of related services in the 60 days before the case management evaluation was determined. The greatest differences between clients' and providers' perceptions of service needs were in dental and medical services, which were more frequently identified as needs by clients, and in substance abuse and mental health services, which were more frequently identified by providers. Clients' and providers' assessments of need were significantly, but not strongly, correlated with each other, and both were correlated with use of mental health and substance abuse services. Mental health service providers are less likely than clients to identify needs for services other than mental health services. Service use, at least in the short run, is related to both clients' and providers' assessments of need.

CMHS/CSAT Collaborative Demonstration Program for Homeless Individuals

The Collaborative Demonstration Program for Homeless Individuals is providing an opportunity for several community agencies in the United States to explore innovative intervention and treatment strategies to address the needs of homeless people with co-occurring (mental illness and substance abuse) disorders. This cooperative agreement, funded jointly by the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Treatment (CSAT), is a $3 million project supporting programs in various community

Characteristics and service use of seriously mentally ill persons living in rural areas.

Data from a cross-sectional survey of 210 current or former inpatients at Mississippi State Hospital and 197 informants, usually patients' family members, were used to compare the demographic, clinical, and service use characteristics of patients living in rural areas with those of patients living in nonrural areas. All subjects completed structured face-to-face interviews. Information on recent use of community mental health center (CMHC) services was obtained from CMHC records. Characteristics of rural patients (N = 107) and nonrural patients (N = 103) were compared using chi square and t tests. Rural patients were less likely to have completed high school and more likely to be living with family members. Although rural and nonrural subjects were clinically similar, rural subjects were less likely to have received certain community mental health services such as case management and day treatment and were more likely to have used physical health services and to have been involved with the criminal justice system. Differences between rural and nonrural patients in patterns of service use are most likely a reflection of less availability or accessibility of mental health services in rural areas, resulting in spillover into physical health and criminal justice sectors. Rural community mental health centers need to formally incorporate families, local medical providers, and law enforcement officials into their network of care.

The M word: Multicollinearity in multiple regression

Journal Article The M word: Multicollinearity in multiple regression Get access Nancy Morrow-Howell, PhD, ACSW Nancy Morrow-Howell, PhD, ACSW Associate Professor and Investigator Center for Mental Health Services, George Warren Brown School of Social Work, Washington University , Campus Box 1196 St. Louis, MO 63130 Search for other works by this author on: Oxford Academic Google Scholar Social Work Research, Volume 18, Issue 4, December 1994, Pages 247–251, https://doi.org/10.1093/swr/18.4.247 Published: 01 December 1994 Article history Received: 11 September 1992 Revision received: 09 September 1993 Accepted: 30 September 1993 Published: 01 December 1994

At the crossroads: research and services development in mental health financing.

†Reprint requests: Bernard S. Arons, Director, Center for Mental Health Services, Room 15-105 Parklawn Building, 5600 Fishers Lane, Rockville, MD, 20857

The future of CMHCs: The role of the state

The author contends that the “new de-institutionalization” is masking the inability of states to establish clear authority and responsibility for the mentally ill. The determination of authority and responsibility was fatally flawed by the community Mental Health Centers Act when it did not clarify the state's role. Also discussed is how the withdrawal of direct federal funds affected community mental health center services.

Mental Health and Substance Abuse Coverage Under Health Reform

President Clinton's health care reform proposal articulates a complete vision for the mental health and substance abuse care system that includes a place for those traditionally served by both the public and the private sectors. Mental health and substance abuse services are to be fully integrated into health alliances under the president's proposal. If this is to occur, we must come to grips with both the history and the insurance-related problems of financing mental health/substance abuse care: (1) the ability of health plans to manage the benefit so as to alter patterns of use; (2) a payment system for health plans that addresses biased selection; and (3) preservation of the existing public investment while accommodating in a fair manner differences in funding across the fifty states.

One community's response to the multi-system service needs of individuals with mental illness and developmental disabilities.

Individuals with mental illness and mental retardation often fall between system and agency service cracks. This paper describes some of the barriers individuals and communities confront in developing new or expanding existing services to meet the needs of this population. It then describes how one community initiated multi-system collaboration in its delivery of crisis intervention services, community mental health center services and specialized short-term residential living. By increasing the multi-system services available to individuals with dual diagnosis at the community level, fewer individuals encountered placement failure and re-institutionalization.

Opportunities in mental health services research.

Opportunities in mental health services research.