Community Mental Health Centers Program Research Articles

The frequency of regular participation in the community mental health center program of patients with the diagnosis of psychotic disorders and evaluation of related factors

The frequency of regular participation in the community mental health center program of patients with the diagnosis of psychotic disorders and evaluation of related factors

Communities of color? Client-to-client racial concordance in the selection of mental health programs for Caucasians and African Americans

A discrete-choice logit model was applied to study the determinants of mental health provider choice using data from a large urban county in the Northeast US. The study subjects were 9,544 adult Medicaid recipients who received outpatient treatment from the 20 Community Mental Health Center (CMHC) programs in 2001. In addition to a conventional set of variables representing client and provider characteristics, the regression model included several interaction terms to examine whether racial concordance level among patients influences the choice of an outpatient program. The results revealed that racial concordance among the clients seems to be a factor in choosing a program. In particular, Caucasian clients are much more likely to select a program with a higher percentage of Caucasian clients, even though they have to travel further. More generally, our results suggest that program choice may be driven more by the racial composition of the clients served than by spatial proximity to the program.

Disparities in Adequate Mental Health Care for Past-Year Major Depressive Episodes Among Caucasian and Hispanic Youths

Disparities in Adequate Mental Health Care for Past-Year Major Depressive Episodes Among Caucasian and Hispanic Youths

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

Psychometric Properties of the Dual-Disorder Treatment Fidelity Scale: Inter-Rater Reliability and Concurrent Validity

Psychometric properties of the Dual-Disorder Treatment Fidelity Scale (Mueser et al. Integrated treatment for dual disorders: A guide to effective practice, 2003) were evaluated. Reliability was assessed through measures of inter-rater agreement, and validity was assessed through a concurrent known groups validation procedure. Two raters assessed three community mental health center (CMHC) and three specialized dual diagnosis (DDE) programs for fidelity; inter-rater agreement was good. Total fidelity scores did not distinguish between CMHC and DDE program types; however, a cluster analysis revealed concurrent validity based on the item level ratings. Conclusions drawn from item level ratings appear valid; the validity of conclusions based on total scores remains unsupported.

The Loss of Federal Support for Multisite Demonstrations

Back to table of contents Next article Taking IssueFull AccessThe Loss of Federal Support for Multisite DemonstrationsSteven S. Sharfstein, M.D., Steven S. SharfsteinSearch for more papers by this author, M.D., President, American Psychiatric AssociationPublished Online:1 Oct 2005https://doi.org/10.1176/appi.ps.56.10.1185AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail When I arrived at the National Institute of Mental Health (NIMH) 30 years ago, the federally supported Community Mental Health Centers Program was in full swing. At that time 1 percent of the grant funds were set aside for evaluation of these programs in urban and rural America. The findings of these studies led to midcourse corrections and shifts in the direction of federal support, the development and evolution of the Community Support Programs toward improving opportunities of care and treatment of persons with serious and persistent mental illness, and a complementary program for children called CASSP (Child and Adolescent Support System Program). These demonstration programs formed the basis for innovation and the development of knowledge in mental health services across the country for a decade.The 1 percent program disappeared when the federal Community Mental Health Centers Program was block-granted to the states in 1981. With the formation of the Substance Abuse and Mental Health Services Administration (SAMHSA) in 1992, NIMH gave up its demonstration authority. Initially, SAMHSA continued the research demonstration program, along with some efforts by private foundations that supported multisite demonstrations. Since the late 1990s, however, there has been a steady attrition of research demonstration programs in favor of single-site development grants. Most recently SAMHSA stopped conducting rigorous evaluations of its demonstration programs almost entirely.The studies in this month's issue of Psychiatric Services are from the last stage of the federal investment in rigorous studies of services demonstrations. They emphasize the impact of and the need for continued investment in knowledge development for our field. These studies are the result of various multisite services effectiveness trials. Almost all this research was supported by federal funds, which now seem to be disappearing. In this era of evidence-based practices, more than ever we need support for similar multisite demonstrations and effectiveness studies that will help state governments and the federal government prioritize, support, and be a catalyst for innovation in change throughout the service system.In the course of a year, nearly five million Americans receive services from the specialty mental health and substance abuse care system, costing nearly 7percent of the $1.7trillion that we spend on health care. How to effectively organize and deliver this care is an urgent public policy agenda, and a small investment in research can leverage major resources for improved care and treatment.As our technologies of care improve, how we organize, fund, and evaluate our service systems is a strategic imperative. We need the resources and the leadership from the federal government to continue this effort, which has had such an important effect for many decades on patients and families in desperate need of care and support. FiguresReferencesCited byDetailsCited ByInfrastructure Change Is Not Enough: An Evaluation of SAMHSA’s Mental Health Transformation State Incentive GrantsStephen Leff, Ph.D., Benjamin Cichocki, Sc.D., Clifton M. Chow, Ph.D., and Chuck Lupton, M.B.A.1 July 2014 | Psychiatric Services, Vol. 65, No. 7Challenges to Implementing and Sustaining Comprehensive Mental Health Service Programs24 June 2016 | Evaluation & the Health Professions, Vol. 29, No. 2International Journal of Mental Health, Vol. 35, No. 2Recovering the Momentum for Federal Support of Multisite DemonstrationsBernard S. Arons, M.D.1 December 2005 | Psychiatric Services, Vol. 56, No. 12Past and Current Views on the Use of Seclusion and Restraint in TreatmentLucy D. Ozarin, M.D., M.P.H.1 December 2005 | Psychiatric Services, Vol. 56, No. 12 Volume 56Issue 10 October 2005Pages 1185-1185 Metrics PDF download History Published online 1 October 2005 Published in print 1 October 2005

Enriching the Process of "Good Science" through Participation of People with Psychiatric Disabilities in All Aspects of Research.

The purpose of this study is to describe the experiences of researchers with a psychiatric disability participating in a project evaluating the services of Community Mental Health Centers (CMHCs) and to identify strategies for researchers with a psychiatric disability in mental health. A project coordinator and four researchers who were people with psychiatric disabilities were interviewed. The rationale for researchers with a psychiatric disability is discussed, and the facilitators of and barriers to them are described. People with psychiatric disabilities should be involved in formulating research questions, data collection, interpreting the results, identifying implications, and presenting the results to stakeholders. People with psychiatric disabilities' participation in CMHC program evaluation can promote service innovation and enhance people with psychiatric disabilities'satisfaction.

Managed Behavioral Health Services: Perspectives and Practice

Back to table of contents Previous article Next article Book ReviewsFull AccessManaged Behavioral Health Services: Perspectives and PracticeRobert K. Schreter, M.D.Robert K. SchreterSearch for more papers by this author, M.D.Published Online:1 Sep 2004https://doi.org/10.1176/appi.ps.55.9.1075AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The pace of change in managed behavioral health care has been so rapid that, a mere 15 years after this system of care took hold, a book titled Managed Behavioral Health Services: Perspectives and Practice could have been titled "Managed Behavioral Health Care: A Retrospective" or "Managed Behavioral Health Care: A Requiem."The edited volume includes 15 chapters selected, in part, to highlight the positive contributions of managed behavioral health care. The editor, Saul Feldman, is one of the founders of the managed behavioral care movement and industry. He began his career in academics and as director of the community mental health centers program at the National Institute of Mental Health. He went on to start United Behavioral Health, the nation's third largest managed behavioral health organization, responsible for nearly 20 million covered lives. Contributors to this book are prominent members of industry, academia, and consulting. The articles are thoughtful, balanced, based on data to an unusual degree for this type of discussion, and often scholarly.Of particular value to the reader is the choice of topics. Some chapters review areas that have been widely discussed, including effect on clinical practice, law, physical health, public sector, and training. Others deal with topics that have received less attention and are less well understood by many, including clinical risk management, quality management, employers' perspective, and employee assistance programs. A particularly interesting chapter reviews the literature on the impact of managed behavioral health care on spending, quality, and access; how savings are achieved; and the not-well-recognized, confounding economic variables that make it difficult to draw firm conclusions. A third set of chapters on information systems and services research address areas that have yet to achieve their potential for using managed care's vast reach and massive database to contribute to efficient, effective, evidence-based clinical and administrative services.Three perspectives not included in the book are those of practitioner or facility providers, consumers, and employer or government payers who are on the receiving end of the consumer backlash. This omission should come as no surprise. Dr. Feldman is exercising his editor's prerogative and presents viewpoints that best represent his own.Managed care is a profoundly polarizing topic, with managers and chief financial officers on one end and many consumers and providers on the other. This book is recommended reading for all who occupy a position on this continuum—clinicians of all specialties, consumers, employer and government payers, and policy makers. The essays will be particularly enlightening to clinicians, consumers, and managed care critics who are less familiar with managed care's own view of its role and responsibilities and the expectations and motives of the private and public payers who hire managed care organizations and evaluate their performance.The competition for scarce resources between mental health and physical health and between health care and other social claims will not go away. Managed Behavioral Health Services: Perspective and Practice is an important contribution to the understanding of the challenges that confront the designers of our health care system of the future.Dr. Schreter is clinical associate professor at the University of Maryland School of Medicine and medical director at Future Health Corp in Baltimore.edited by Saul Feldman; Springfield, Illinois, Charles C. Thomas Publisher, 2003, 435 pages, $77.95 FiguresReferencesCited byDetailsCited byNone Volume 55Issue 9 September 2004Pages 1075-1075 Metrics PDF download History Published online 1 September 2004 Published in print 1 September 2004

Battles Over Money, Mission Limited CMHCs’ Success

Back to table of contents Previous article Next article Professional NewsFull AccessBattles Over Money, Mission Limited CMHCs’ SuccessKate MulliganKate MulliganSearch for more papers by this authorPublished Online:6 Feb 2004https://doi.org/10.1176/pn.39.3.0007aThe concept of community mental health centers (CMHCs) has been an important part of discussions about how to provide mental health services at least since 1960, when the federal Joint Commission on Mental Illness and Health proposed one “fully staffed, full-time mental health clinic” for each 50,000 of population.In that year, the Democratic Party voted at its convention in favor of a plank in support of “greatly increased federal support for psychiatric research and training and community mental health programs to [help hospitalized mentally ill live in communities].”President John F. Kennedy attempted to fulfill that campaign promise with the appointment of a National Institute of Mental Health (NIMH) study group, which recommended “comprehensive” CMHCs offering inpatient, outpatient, and rehabilitative services, as well as education and public information.A coalition of mental health organizations supported a Kennedy proposal for CMHCs that would have provided funding for construction of CMHCs and limited staffing grants.Congress approved the construction costs but not the staffing grants until President Lyndon B. Johnson requested them with legislation, the Community Mental Health Centers Act Amendments, which passed in 1965.The NIMH mandated that CMHCs were to provide five essential mental health services: inpatient, emergency, partial hospitalization, outpatient, and education.Henry Foley, Ph.D., and Steven Sharfstein, M.D., wrote in Madness and Government (APPI, 1983), “In the beginning, then, CMHC services plus those of the state hospitals theoretically represented a balanced array, but the CMHC program alone did not. . . . The unanticipated consequence. . .was the failure of most CMHCs to develop even minimal rehabilitation and aftercare services for the mentally ill being discharged or diverted from state hospitals.”In 1972 President Richard M. Nixon argued that federal support for the CMHC program should be phased out and replaced with local support.Instead, in 1975 with new legislation, seven new services were added to the definition of “essential service.”“The enactment of PL 94-63 in July 1975 over a presidential veto climaxed a seven-year struggle for program survival, which included appropriation battles and impoundment suits,” wrote Foley and Sharfstein.By 1977, 650 CMHCs had been funded, covering 43 percent of the population and serving 1.9 million people that year. The $1.5 billion federal investment generated another $2.5 billion in other sources of funds.In 1977, however, the average length of stay for a patient in a state hospital was three weeks, down from six months in 1955.“The bold new CMHC approach had little time and too meager resources to test its mettle before being overtaken. . .by the urgent needs of patients with chronic mental illness,” wrote Foley and Sharfstein. In 1977, President Jimmy Carter established the President’s Commission on Mental Health, which ultimately made more than 100 major recommendations and findings.After considerable debate within the administration, Carter submitted the Mental Health Systems Act to Congress in 1979, where it was subjected again to much debate.“The primary mission of community mental health has been disputed since the beginning: the Systems Act forcefully restated each of three missions without resolving priorities,” according to Foley and Sharfstein.The missions are adequate clinical care, particularly for those with serious mental illness; supportive services; and prevention.President Ronald Reagan, who was elected in 1980, recommended that Congress cut the level of funding for the act by 25 percent and convert it into a block-grant program.In August 1981 he signed the Omnibus Budget Reconciliation Act, which “substantially repealed the Mental Health Services Act. . . . The federal government was entirely removed from the direction of the program and became a mere conduit of funds to the states.” ▪ ISSUES NewArchived

A Collaborative Relationship Between a Community Mental Health Center and Family Practice Residency Program.

A Collaborative Relationship Between a Community Mental Health Center and Family Practice Residency Program.

Implementing the lessons of mental health service demonstrations: human rights issues.

Is the failure to implement the lessons of mental health service demonstrations an ethical problem? This paper reviews the experience with evaluating multi-site service demonstration programs in the United States. Some of the lessons have been adopted and others have not. There appears to be a pattern to the adoption of lessons: ideological and inexpensive changes in organization or treatment approach are more likely to be adapted than costly changes in the availability of services or 'transfer' resources (such as disability benefits or rental subsidies) to support independent housing. The paper reviews this experience for demonstrations such as the Community Mental Health Centers program, the Community Support Program, and the Robert Wood Johnson Foundation Program on Chronic Mental Illness, and it discusses prospects for current federal demonstrations.

Research on Mental Health Services for Hispanics: Targets of Convergence.

In reaching to serve the mental health needs of new catchment neighborhoods, the 1963 federally funded Community Mental Health Center (CMHC) program stimulated culturally oriented research on the effectiveness of mental health services for Hispanics. The research, at first scattered and diffuse, has converged on a number of targets. This article examines four of the targets of research and how they can be brought into a unified perspective if they are viewed in temporal order as sequenced disadvantages Hispanics confront in using mental health services. The targets can be arrayed longitudinally: reasons for Hispanics' underutilization of professional mental health services, difficulties in retaining Hispanics in such services, errors in evaluating their mental health, and the problems of adapting treatment modalities to their needs.

Diagnoses Assigned and Issues Brought Up in Therapy by Older Adults Receiving Outpatients Treatment

An archival study was conducted on the case records of 298 clients, aged 60 to 98, treated by a community mental health center program which offered a full range of psychotherapeutic services and an active outreach program to elders. Data were collected on the clients' diagnoses and the specific issues raised during therapy. The majority (81.1%) of the clients were classified into only four DSM-III categories: adjustment disorders, affective disorders, organic brain disorders, and conditions not attributable to a mental disorder. Clients residing in long-term care facilities showed a higher incidence of organic brain disorders and schizophrenia but were as likely as community-residents to be diagnosed with emotion-based problems. Three types of issues predominated among the aged clients in therapy: family conflicts, poor physical health, and the feeling they were not in control of events in their lives. The pattern of issues addressed by clients in the two residential groups showed strong similarities, although community-residents more frequently reported family problems while long-term care residents were more worried about cognitive losses. Women were more concerned with aches and pains while men were more concerned with loss of work role.

Therapy termination and persistence patterns of elderly clients in a community mental health center.

Analyses were conducted on 180 community and nursing home clients, ages 60 to 98, who received psychotherapy as part of a community mental health center program. Case records were reviewed to identify factors associated with persistence in therapy and dropout patterns. Very few (less than 12%) terminated therapy appropriately (as judged by the therapist), about 59% completed at least 10 sessions, and a majority of the community residents themselves initiated termination. Persistence in treatment was associated with nursing home residence, religious beliefs, and receiving the therapy at home. Contrary to predictions, persistence was not associated with self-referral, type of psychiatric diagnosis, age, or gender.

Did CMHCs fail or succeed? Analysis of the expectations and outcomes of the community mental health movement

The community mental health center (CMHC) movement provoked controversy and debate from its inception. This paper establishes a context for further assessments of the impact of the CMHC program. Comparisons are made between original expectations and the current issues,threats and challenges facing community mental health providers.

Referral Patterns of Elderly Clients to a Community Mental Health Center

Data for this exploratory study were collected from case records of 298 elderly clients treated by a community mental health center program which offered a full range of psychotherapeutic services. Data were collected concerning the source of referrral and the reason for the referral. Findings revealed that only 12% of the clients referred themselves and did so primarily over family conflicts. Social service workers initiated most of the referrals with families and medical professionals accounting for very few. Although nursing home clients (n=100) were primarily referred for management problems, almost as many were referred for emotionally based problems. Community-resident clients (n=182) were generally referred for depression and family conflicts.

Designing Community Treatment Systems for the Most Seriously Mentally Ill: A State Administrative Perspective

State mental health authorities confront many challenges in the post‐deinstitutionalization era, especially in assuring appropriate treatment for the most seriously and persistently mentally ill. This paper identifies current problems in the community treatment system, which stem from lack of coordination between the deinstitutionalization process and development of the Community Mental Health Centers program, and from the effects of reimbursement mechanisms on client residential placement. Two New York State program initiatives, Intensive Case Management and Supported Housing, are described to illustrate state efforts to address these problems by reforming the community treatment system. There is an important state role in determining treatment priorities and in contributing to the evolution of models for community treatment.

Entrepreneurship and state/mental health center relationships.

An effective Community Mental Health Center (CMHC) program in entrepreneurship--the provision of services in the marketplace at a profit to subsidize other programs--requires the support and encouragement of the state-level mental health authority. This paper discusses potential financial, programmatic, political, and managerial risks and rewards to CMHCs and to state authorities from such efforts. As each party faces certain risks as well as rewards from such efforts, it is important that they participate in a process of mutual risk reduction involving: Documenting and legitimizing the entrepreneurship program; Separating funding for seed monies and working capital for ventures, Restructuring the Centers' finances and/or corporate structure to reduce the problems of funds diversion and comingling, Negotiating in advance how the proceeds of the ventures will be used to benefit programs, and Providing technical assistance to enhance the probabilities of success in such ventures. For these steps to work the state authorities must be willing to give up some financial and programmatic control to motivate entrepreneurship on the part of CMHCs.

Consultation and education in community mental health: a historical analysis

A historical analysis of consultation and education services within community mental health centers is presented with a focus on the two major tasks that these services were intended to address:prevention andcommunity service system enhancement. This analysis begins with events that shaped the development of the initial community mental health center (CMHC) legislation, then examines key factors that influenced the nature and scope of consultation and education services as the federal CMHC program was implemented, and ends with a look at the changes that have occurred in these services since block grant funding was instituted. Throughout the analysis, central problems are discussed that have seriously hindered the development of viable consultation and education programs, and key policy, definitional and organizational issues are identified that must be addressed if these services are to become a meaningful component of the mental health service system.