Community Mental Health Center Services Research Articles

Qualitative insights into mental health treatment through telemedicine during the COVID-19 crisis: a natural experiment in community mental health centers

BackgroundThe COVID-19 pandemic exacerbated existing mental health challenges and introduced new ones, particularly among vulnerable populations such as individuals within the criminal justice system, who disproportionately experienced employment, financial, and housing issues. As mandatory lockdowns and social distancing mandates were implemented, the United States saw unprecedented interruptions to treatment. Telemedicine emerged as a transformative tool in alleviating new and existing treatment barriers. Yet, limited empirical research has examined the impact and implications of telemedicine on mental health treatment in criminal justice populations.MethodsThe timing of this study’s data collection overlapped with the spread of COVID-19 in the United States and provided a unique opportunity to examine the impact of telemedicine as part of a natural experiment. Utilizing interviews with 61 community mental health center service providers, this study qualitatively examined service providers’ experiences in treating criminal justice-involved individuals with serious mental illness who were receiving mental health treatment through telemedicine.ResultsService providers expressed satisfaction with telemedicine in addressing client transportation and childcare barriers while increasing engagement. Service providers voiced new concerns regarding clients’ confidentiality, digital literacy, and limitations to gathering non-verbal client information during virtual treatment.ConclusionsMental health treatment offered through telemedicine mitigates barriers to treatment that disproportionately affect criminal justice clients. Despite its benefits, challenges like access to reliable internet and to internet-enabled devices, confidentiality concerns, and information gathering must be addressed to achieve optimal and equitable mental health treatment through telemedicine. The findings support the continued use of telemedicine in mental health treatment delivery for this population.

Are the Patients with Schizophrenia Who Have Case Managers in Community Mental Health Centers Happier?

When talking about recovery for schizophrenia patients, the absence of symptoms is satisfied and the concept of happiness is generally ignored. In our study, we aimed to compare the happiness levels of patients with schizophrenia who were followed up by the community mental health center (CMHC) and had case managers, and those with schizophrenia in remission who were followed only by the outpatient clinic and at the same time we compare the expression of emotion, which is thought to affect this happiness, the level of support perceived by the patient and the quality of life. Patients with schizophrenia who had regular CMHC follow-up for at least 1 year and had a case manager (CM) (n:100) and were in remission for at least 3 months (n:100) who were followed up in the outpatient clinic were included in the study. Subjective Happiness Scale (SHS), Perceived Available Support Scale (PASS), Quality of Life Scale (QLS), Level of Expressed Emotion Scale (LEES) were applied to both groups. SHS, PASS, LEES, QLS scores were statistically significantly different in the group with CM. A negative correlation was found between the subscales showing the Level of Expression of Emotion and SHS scores. A positive correlation was found between QLS and PASS scores and SHS scores. In the case of VY, it was determined that PASS scores had a mediating effect on SHS scores, but QLS scores did not have a mediating effect. It was determined that the levels of intrusiveness, emotional response and tolerance/expectation, which are subscales of LEES, had a mediating effect on SHS scores, but the levels of attitude towards illness did not have a mediating effect. For people with schizophrenia, happiness is an often overlooked concept when talking about recovery. In our study, we evaluated the effect of case management within the scope of CMHC service and found that it had a positive effect on the happiness of patients with schizophrenia.

Comparison of Hospitalization Rate and Social Functioning of Patients Receiving Community Mental Health Service and Outpatient Psychiatry Policlinic.

This study aimed to compare the hospitalization rates and social functioning of patients receiving Community Mental Health Center (CMHC) services and those treated in the psychiatry policlinics of hospitals. A total of 145 patients who were diagnosed with schizophrenia or schizoaffective disorder according to DSM-V criteria were included in the study. Of them, 81 received CMHC services at least for one year (CMHC group) and 64 were followed-up in psychiatry policlinics (hospital group). A personal information form containing socio-demographic and disease/treatment characteristics and hospitalization counts in the last year, Social Functioning Assessment Scale (SFAS) and Positive and Negative Syndrome Scale (PANSS) were used to collect data. The hospital group received antipsychotic medication therapy while a semi-structured psycho-social intervention program combined with antipsychotic drug therapy was applied in the CMHC group. The hospitalization counts, SFAS and PANSS scores of the groups were compared and the correlation of related factors were evaluated. Hospitalization rates were 0.21±0.56 in the CMHC group and 1.03±1.31 in the hospital group. The mean hospitalization rate was significantly lower in the CMHC group (p<0.001). The mean scores for the overall SFAS and its interpersonal relationships and entertaining subscale; were significantly higher in the CMHC. The mean overall PANSS scores were 84.23±15.28 and 99.50±15.99 in the CMHC and hospital groups, respectively (p<0.05). There was a moderate positive relationship between hospitalization rates and all PANSS scores. CMHC services led to a serious decrease in hospitalization rates, increased the psychosocial functioning of patients and improved their compliance to treatment. Transition to a community-based mental health model should be accelerated for holistic treatment. Further longitudinal studies with a control group should be conducted.

Telemedicine Among Medicaid Beneficiaries in Community Mental Health Care during the First Three Months of the 2020 Covid‐19 State of Emergency

Research ObjectiveLittle is known about the effectiveness of telemedicine for patients with serious mental illness (SMI). We sought to identify and describe characteristics of community mental health center (CMHC) SMI patients associated with treatment retention and use of telemedicine during this time.Study DesignThis research is an observational study of retention in services and use of telemedicine during 12/2019–6/2020 (compared to 12/2018–6/2019) in New Hampshire (NH) CMHC patients. Starting in 3/2020, patients were offered in person and/or telemedicine services based on clinical recommendation and personal choice. NH Medicaid claims provided CMHC service, diagnoses, and demographics. Quarterly use of telemedicine was categorized into <25%, 25–75%, or > 75% of total services. Associations between retention and demographic variables were explored using chi‐square test of independence, logistical regression and correspondence multivariate analysis.Population StudiedAll 16,030 NH Medicaid beneficiaries with SMI, including debilitating schizophrenia, bipolar disorder, major depression, PTSD, and anxiety/other diagnoses, who were engaged in CMHC treatment during the three months prior to the COVID‐19 State of Emergency (SOE) was declared in NH.Principal Findings81.7% of patients were retained in treatment in the quarter following the SOE declaration compared to 86.6% of patients in the 2018–2019 period. Comparing 2020 to 2019, youth demonstrated low retention rates (77% compared to 84%, respectively). In 2020, retention among patients with rural zip codes was lower than among those with urban zip codes (78.8% vs 81.2%), and among patients with PTSD (78.1%) and anxiety/ other diagnoses (76.5%) compared to schizophrenia (93.2%) and bipolar disorder (89%).All three multivariate analyses indicate that age, gender, and condition significantly predicted retention. In adjusted models, male gender, age group 18–34, and PTSD diagnosis predicted low retention. In contrast, female gender, age groups 35–54 and 55+, and schizophrenia and bipolar diagnoses predicted high retention.Similar analyses predicting level of telehealth services utilization showed: patients with <25% telehealth services were more likely in the 55+ year age group and schizophrenia diagnosis group; patients with 25% to 75% telehealth services were more likely to be youth and to have PTSD; those with 75% telehealth services were more likely to be in the 18–55 age group, and to have bipolar disorder or major depression.ConclusionsTelemedicine was utilized by the majority of CMHC patients in the months following the pandemic, likely supporting continuity of CMHC care for vulnerable patients with SMI. Yet, even with this substantial rollout of telemedicine, retention in treatment was less than retention in the prior year, and some sub‐populations were more at risk for treatment interruptions than others.Implications for Policy or PracticeTelemedicine promoted continuity of care during the pandemic but it is not clear how much telemedicine should continue after the pandemic, and for which subpopulations of people with SMI. Further research on the effectiveness and limitations of telemedicine in patients with SMI is needed to inform future policies and clinical practice.

The effect of community mental health center services on the frequency of hospital admission, severity of disease symptoms, functional recovery, and insight in patients with schizophrenia

The effect of community mental health center services on the frequency of hospital admission, severity of disease symptoms, functional recovery, and insight in patients with schizophrenia

Effect of Adjunct Psychosocial Skills Training on Social Functioning of Schizophrenia Patients Who Get Occupational Therapy in a Community Mental Health Center: A Comparative Study.

Antipsychotic drugs are effective in relieving symptoms in the treatment of schizophrenia, but decreased social functioning is resistant to drugs. In this study, the effect of adjunct Psychosocial Skills Training (PSST) on social functioning for schizophrenia patients who receive service in the community mental health center (CMHC) was investigated. Schizophrenia patients who received routine case management and occupational therapy in CMHC (n=22), patients receiving PSST in addition to CMHC service (n=21) and patients who were followed up in the Psychotic Disorders Outpatient Clinic as control group (n=21), three groups were formed. In the initial evaluations of the participants, the sociodemographic data form was filled. Social functioning and severity of clinical symptoms were evaluated at the beginning and at end of three-month follow-up period with the Social Functionality Scale (SFS), Personal and Social Performance Scale (PSP), Positive and Negative Syndrome Scale (PANSS). At the end of the follow-up period, there was a significant decrease in PANSS total scores, a significant increase in PSP and SFS total scores in the last test evaluations of the study groups. There was not any statistically significant change in the control group. The decrease in PANSS total score in PSST group is significantly higher than CMHC group. There was no significant difference between PSP and SFS scores between intervention groups. The psychiatric rehabilitation in CMHC has a positive effect on the social functioning and clinical symptoms of schizophrenic patients. Adjunct PSST to routine service seems to help relieving clinical symptoms.

HOSPITALIZATION RATES OF PATIENTS USING COMMUNITY MENTAL HEALTH CENTER SERVICES

Non-adherence to treatment and hospital admissions are the common problems in severe mental disorders. To determine the contribution of community mental health center (CMHC) services to increased hospitalization rates of patients previously diagnosed with severe mental disorders such as schizophrenia spectrum and other psychotic disorders and bipolar disorders. 356 patients diagnosed with bipolar disorder, schizophrenia, schizoaffective disorder, and unspecified schizophrenia spectrum and other psychotic disorders in accordance with the DSM–5 criteria and treated in the CMHC on the south coast of Turkey were included in this retrospective study.The hospitalization records of the patients were examined over three different periods. First and second period: two divided years which patients had not yet received CMHC services before registration. Third period: o ne-year, during which patients using CMHC services. A total of 356 patients were included in the study. SPSS 22.0 (IBM Corporation, Armonk, New York, United States) software was used in the analysis of variables. Normal distribution of data was assessed with the Shapiro–Wilk test. The diagnosis of the participants in the study were 157 (44%) schizophrenia, 35 (9.8%) schizoaffective disorder, 102 (28.7%) bipolar disorder and 62 (17.4%) unspecified schizophrenia spectrum and other psychotic disorders. As a result of the hospitalization rates , there was a significant difference between three periods. The median number of hospitalization days during the first episod was calculated as 1.0 (mean 13.9), the second period 0.7 (mean 18.59) and third period 0.6 (mean 5.83), respectively. The rate of hospitalization was 32.9% in the first period, 42.4% in the second period and 12.9% in the third period. This study provides the new evidence regarding the ability of primary services offered in the community mental health centers.

HOSPITALIZATION RATES OF PATIENTS USING COMMUNITY MENTAL HEALTH CENTER SERVICES

Non-adherence to treatment and hospital admissions are the common problems in severe mental disorders. To determine the contribution of community mental health center (CMHC) services to increased hospitalization rates of patients previously diagnosed with severe mental disorders such as schizophrenia spectrum and other psychotic disorders and bipolar disorders. 356 patients diagnosed with bipolar disorder, schizophrenia, schizoaffective disorder, and unspecified schizophrenia spectrum and other psychotic disorders in accordance with the DSM–5 criteria and treated in the CMHC on the south coast of Turkey were included in this retrospective study.The hospitalization records of the patients were examined over three different periods. First and second period: two divided years which patients had not yet received CMHC services before registration. Third period: one-year, during which patients using CMHC services. A total of 356 patients were included in the study. SPSS 22.0 (IBM Corporation, Armonk, New York, United States) software was used in the analysis of variables. Normal distribution of data was assessed with the Shapiro–Wilk test. The diagnosis of the participants in the study were 157 (44%) schizophrenia, 35 (9.8%) schizoaffective disorder, 102 (28.7%) bipolar disorder and 62 (17.4%) unspecified schizophrenia spectrum and other psychotic disorders. As a result of the hospitalization rates, there was a significant difference between three periods. The median number of hospitalization days during the first episod was calculated as 1.0 (mean 13.9), the second period 0.7 (mean 18.59) and third period 0.6 (mean 5.83), respectively.The rate of hospitalization was 32.9% in the first period, 42.4% in the second period and 12.9% in the third period. This study provides the new evidence regarding the ability of primary services offered in the community mental health centers.

Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project.

Background: Adults who suffer with severe and persistent mental illness (SPMI) rarely access medical care to receive preventive vaccines. Aims: To increase the rate of vaccines among the SPMI population in an outpatient community mental health center (CMHC). Methods: A review of the literature identified a gap between the general population and SPMI clients in receiving preventive vaccinations. An initial mixed-method convenience survey of SPMI clients (n = 392) provided information on current vaccination status, demographics, beliefs, and interest in receiving vaccines. A vaccination program was developed to address identified barriers and increase vaccination rates. Postintervention data were collected through a mixed-method convenience survey of SPMI clients (n = 60) who participated in immunizations clinics to evaluate client satisfaction. A partnership between the health department and CMHC was developed to deliver vaccines in a nontraditional site. Vaccines administered included annual influenza; hepatitis A; hepatitis B; herpes zoster; measles, mumps, and rubella; pneumococcal; and tetanus, diphtheria, and pertussis (Tdap). Results: More than 1,000 vaccines were administered in the first 8 months, with a significant increase in vaccination rates over baseline for individual vaccines ranging from 18.75% to 83%. Postintervention survey results found a 95% satisfaction rate. Conclusions: Implementation of a vaccination program in a nontraditional site that facilitates access for SPMI clients can promote an overwhelming increase in the vaccination rates for this underserved population. Results suggest that the integration of mental health and CMHC services can have a profound positive effect on SPMI population health.

The effects of one community mental health center on antipsychotic polypharmacy: 12-months follow-up of patients with schizophrenia

Objective: Treatment with multiple antipsychotic medications (antipsychotic polypharmacy [APP]) in schizophrenia is recommended to be considered as a last resort, due to non-compliance, metabolic side effects and high mortality. On the other hand, in current clinical practice, APP is quite commonplace. The effects of one “community mental health center” (CMHC) activities on APP and clinical symptoms of enrolled schizophrenia patients were investigated in order to determine changes on antipsychotic treatment processes for schizophrenia. Methods: Sociodemographic Data Form, Positive and Negative Symptom Scale for Schizophrenia (PANSS) scores, Pharmacotherapy Compliance Scale evaluations and modes of medication utilization of 120 patients who were followed-up in this center for one year were evaluated retrospectively. Results: All PANSS subscale (positive, negative and general) scores of the patients decreased and compliance with drug treatment increased; rates of APP remained the same and mean drug treatment doses did not change. Conclusion: The insistence on APP, in spite of improvements in symptoms and patient compliance, shows the importance of maintaining community mental health activities as well as interventions targeting prescription habits of psychiatrists. Such interventions can provide a decrease in use of multiple medications. Results indicate the need to utilize community mental health center services to increase the effectiveness of psychopharmacotherapy for schizophrenia.

Elevating stakeholder voice: Considering parent priorities in model development for community mental health center services

Peer-support services, including Parent Support and Training, have traditionally subscribed to a strict definition of what it means to qualify as a peer, and therefore as a provider of these services. This article examines views of peer and non-peer stakeholders in Kansas CMHCs on additional characteristics of “peer-ness.” The findings of this analysis result in a call for a broadening of the definition of “peer” in order to creatively meet the needs of families in the current service climate while still providing support for upholding the family-driven paradigm that brought about inclusion of parent voice in the treatment process—a hallmark of the PST service.

Predictors of Consumer Satisfaction in Community Mental Health Center Services

Kentucky Department for Behavioral Health Developmental and Intellectual Disabilities conducted a survey to evaluate consumers' satisfaction with services delivered at the Community Mental Health Centers (CMHCs) in Kentucky. The survey was administered at outpatient clinics operated by fourteen CMHCs in 2010. The purpose of this study was to identify factors that predict whether clients will respond that they were "generally satisfied" with services received from CMHCs. A logistic regression model was developed using respondents' characteristics and their responses to survey questions. Survey questions were grouped into seven core domains: general satisfaction, access, quality, participation in treatment planning, outcomes, functioning, and social connectedness. In result, responses to domains of access, quality and participation in treatment planning significantly affected clients' perception of general satisfaction. Respondents who positively assessed those domains of services were more likely to answer that they were generally satisfied with services. Based on the analysis in this report, improvement in certain domains of services, especially access, quality and participation in treatment planning could increase the level of positive responses in general satisfaction.

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.

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.

Govt. Decision Threatens Key CMHC Funding Source

Back to table of contents Previous article Next article Government NewsFull AccessGovt. Decision Threatens Key CMHC Funding SourceKate MulliganKate MulliganSearch for more papers by this authorPublished Online:1 Apr 2005https://doi.org/10.1176/pn.40.7.00400012Advocates charge that the federal government is reneging on a deal to allow the use of savings captured through managed care to be applied to mental health services for people who are not eligible for Medicaid.The Centers for Medicare and Medicaid Services (CMS) notified Washington state officials that beginning January 1, 2005, the state's Regional Support Networks (RSNs) could no longer use unspent funds for individuals who are not eligible for Medicaid. Counties and their nongovernmental providers are organized into 14 RSNs that provide community-based treatment.Implementation of the ruling would mean a reduction of $82 million, or approximately 20 percent, in the state's community mental health care budget. About 43,000 people who use community mental health center services in the state are not eligible for Medicaid.Washington state officials and U.S. Rep. Brian Baird (D) were able to negotiate an extension until June 30, but the Washington state legislature must fill the funding gap; otherwise, people will lose services at that time.Members of the Washington State Psychiatric Society (WSPS) are concerned about the precedent the action could set for other states and the difficulty of finding new funds in a time of severe budget constraints.The chair of the WSPS Public Affairs Committee, Christos Dagadakis, M.D., said, “This action removes incentive for innovation. A private managed care company able to save money and still provide mandated services can spend the savings any way it chooses, but a public provider of services cannot.”Charles Huffine, M.D., chair of WSPS's Government Relations Committee, said the state's budgetary situation is difficult.Advocates, however, are cautiously optimistic about their prospects for supplementing the lost revenue with state funds and even implementing reforms in the mental health system.The Joint Legislative and Executive Task Force on Mental Health Services and Funding recommended in 2004 that “funds lost due to the changes in interpretation of the Medicaid law be replaced by state funds, to the maximum extent possible....”A recount gave Democrat Christine Gregoire a very slim victory in the 2004 gubernatorial race, and Democrats control both chambers of the state legislature.Last month, after seven years of failed efforts, the legislature passed a mental health parity bill, which the governor signed.An influential Democrat, Sen. Jim Hargrove, supports legislative action to avoid the threatened cuts. He introduced an ambitious bill (S 5763) that would help integrate treatment for mental illness and substance abuse and improve the screening process to identify people with those disorders.The bill would allow counties to levy a local-option sales tax to pay for expanding treatment. Washington state has no income tax, so that option is particularly important.Hargrove described himself to an Associated Press reporter as “not a trigger-happy, tax-and-spend kind of person,” and added that his experience reforming the juvenile justice system shows that prevention pays off.He argued that the current mental health system wastes “piles of money, and I mean piles,” because mental health and substance abuse treatment are uncoordinated.Another influential Democrat, Rep. Eileen Cody, has introduced community mental health legislation (H 1290) that emphasizes implementation of recovery-based programs involving families and the use of outcome measures and improved data collection.The bill also could have the effect of reducing the number of RSNs and thus changing local administrative structures and service areas.Huffine is worried, however, that even if Washington state is able to compensate for the lost Medicaid revenue, other states soon will be faced with similar cuts.He has reason for alarm. President George W. Bush projected federal Medicaid savings of $3.3 billion for Fiscal 2005-15 and an equivalent reduction in funding to states by instituting “cost-based reimbursement for government providers.”Psychiatric Newswants to learn about the specific impact on mental health services of Medicaid cuts, exclusive of cuts to pharmaceutical benefits. Please send information to [email protected].▪ ISSUES NewArchived

The recovery vision as a service improvement guide for community mental health center providers.

Many mental health consumers are calling for Community Mental Health Center services to focus on creating opportunities for recovery. First person accounts of recovery portray a process which entails developing hope, taking personal responsibility for health, and building a broad sense of self that is not illness-dominated. Community Mental Health Centers can facilitate recovery by enhancing their clinicians' abilities to (1) communicate hope, (2) teach the skills and knowledge consumers need to effectively manage their health concerns, and (3) support consumers' efforts to get on with life beyond illness.

Student Ratings of Outpatient Learning Favor Rural Community Mental Health Centers

All students (N = 185) in 8 consecutive rotations within a private Southern schools multisite, inpatient-based psychiatry clerkship completed a survey of perceived educational experiences while assigned to 1 of 5 part-time outpatient services (usable response rate 82%). The rural community mental health center (CMHC) students reported increased 1) appreciation for the nature and implications of psychiatric disorders; 2) appreciation for treatment effectiveness; 3) interest, enjoyment, and hopefulness; 4) firsthand experience with patient evaluation and treatment; 5) community treatment resource information; and 6) teaching model helpfulness. The rural CMHC and Veterans Affairs Medical Center students reported a learning model based on experience. The rural CMHC and university student mental health service better exemplified the biopsycho-social treatment approach.

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.

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.