County Mental Health Services Research Articles

Medicaid Enrollment and Mental Health Service Use Following Release of Jail Detainees With Severe Mental Illness

Medicaid Enrollment and Mental Health Service Use Following Release of Jail Detainees With Severe Mental Illness

One Bullet Away: The Making of a Marine Officerby Nathaniel Fick; New York, Houghton Mifflin Company, 2005, 384 pages, $25

Back to table of contents Previous article Next article Book ReviewsFull AccessOne Bullet Away: The Making of a Marine OfficerStuart Graves M.D.Stuart Graves M.D.Search for more papers by this authorPublished Online:1 May 2006https://doi.org/10.1176/ps.2006.57.5.732AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleBut on the battlefield that night, long history marched unchanged into the 21st century. Strong men hauled heavy loads over rough ground. There was nothing relative about it—no second chances and no excuses. It was elemental and dangerous. It was exactly why I had joined the Marines.""The future disappeared … I existed only in the present. The one thing keeping me going was being part of a group…. The epiphany struck one morning the next week as I locked my body in the …'up' pushup position. Sergeant Olds put the whole platoon in that posture while he berated a candidate…. The message wasn't in Olds's words; it was in recognizing that this wasn't about how much we could take, but about how much we could give.""Our values were being inverted, and it threatened to destroy us. Good Marines were sent on a stupid mission governed by harebrained rules of engagement…. Our actions were being thrust in our faces, and the chain of command was passing the buck to the youngest, and most vulnerable, of the troops…. If they got killed or went insane, I had to be able to look at their mothers and explain that they hadn't been victims of their own comrades' mistakes. Those Iraqi boys could die, but I couldn't let them die in our hands." These marvelous passages are a few of the many that await a reader of Captain Nathaniel Fick's book, One Bullet Away: The Making of a Marine Officer . Captain Fick takes us from his days as a classics major at Dartmouth, through myriad Marine training schools, 9/11, a tour of duty in Afghanistan, a tour in Iraq as a reconnaissance officer, and finally through his exit from the Marine Corps and return home. The book is replete with insights into sociobiology, various cultures, psychology, and the genesis and effects of posttraumatic stress disorder. It could be read for those reasons alone. It is notable to me that the one command during training that inflicts too much pain upon Fick and his comrades to bear is to feign being a "psychiatric" casualty. Fick is ordered to pretend to break down, but he cannot bear the separation that comes from continually pretending to let his comrades down, and they cannot bear or understand his absence. One confronts Fick and curses him. At this point Fick tells them of the ruse, and they cover for his breaking the order. This is instructive for people in the field of mental health as we consider the alienation wrought in our patients by illness and injury and the pain of the stigma they must endure.Further, the book is a detailed piece of history that occasionally reads like an adventure story. It will ring true to anybody who has been in or has family members in the military. For example, in reference to listening to his own artillery fire, Fick states, "I slipped back to sleep under a comfortable blanket of outgoing death and destruction." This is an almost an exact quote from my father who served in World War II. But in the end One Bullet Away is a book about a person and a war and so is inevitably sad and lonely. It is a message in a bottle from Captain Fick to us. One could read this book for all the above reasons, but most of all it should be read for the honor of meeting Nathaniel Fick. Dr. Graves is medical director at Washington County Mental Health Services, Inc., in Montpelier, Vermont. FiguresReferencesCited byDetailsCited ByNone Volume 57Issue 5 May, 2006Pages 732-732PSYCHIATRIC SERVICES May 2006 Volume 57 Number 5 Metrics History Published online 1 May 2006 Published in print 1 May 2006

Specialist nurse practitioners in mental health: the Shropshire experience

Alison Marpole BSc (Hons), RMN, NP, is specialist nurse practitioner, Shropshire County Primary Care Trust, Mental Health and Learning Disability Services, Shrewsbury Mental health services for older people vary widely in structure, settings and activities undertaken. The relationship between adult mental health services and mental health services for older people are affected in many areas by limitations of resources in older people’s mental health and inadequate liaison and support between the service types (Draper et al 2003). Some areas continue to support patients into old age because of resource deficits, only transferring care of the patient with enduring mental health needs if cognitive functioning declines and physical frailty increases. Within our area, because of the differences between the teams’ structures, patients would traditionally be transferred from a community mental health team to either a community mental health nursing team or a generic social work team for older people, depending on the discipline of the patient’s care co-ordinator. On occasion this has led to reduced services for the patient as far as either care and social support or review of mental health and psychosocial interventions were concerned. It has also meant that sometimes the support of two teams has been required to provide services that were managed by one team before transfer. Within the new way of working, specialist nurse practitioners will take the lead for many of the clinical decisions, taking the initial referrals from all disciplines within the community mental health teams and having responsibility for assessment, management and onward referral to the most appropriate service. This should help communication between teams and ensure appropriate timely care for the patient. The psychiatrist would only become involved with the most complex and challenging cases, thus empowering the specialist nurse practitioner to take on the role of assessor or gatekeeper (Royal College of Psychiatrists 2003).

Psychiatry Choice Sometimes A Delayed Reaction

Psychiatry Choice Sometimes A Delayed Reaction

Current trends in the community treatment of seriously emotionally disturbed youths.

It is a pleasure to initiate this column on child and adolescent psychiatry. Psychiatrists and other mental health care professionals who work with children and adolescents have needed a forum for discussing issues related to community practice—in particular, for bringing innovations in community programs for youths into our professional dialogue. Through federal and private grants, programs have emerged that have realized the ideals of the original initiatives of the Child and Adolescent Service System Program (CASSP) for the community treatment of youths (1). These initiatives promote CASSP values and principles—that is, that care should be family centered, child focused, culturally competent, community based, and integrated. This system-of-care reform movement has been greatly advanced by The Children’s Mental Health Initiatives Grants from the Center for Mental Health Services. These grants have created laboratories for experimenting with ever more effective ways of addressing the needs of our most challenging young people. Many of these programs address the fragmentation of services in poorly conceived systems of care. I hope this column will be a forum for those who have experience in in

Jury Still Out on Effects Of Psychiatric Drug Limits

Jury Still Out on Effects Of Psychiatric Drug Limits

Referral sources, diagnoses, and service types of youth in public outpatient mental health care: a focus on ethnic minorities.

Racial/ethnic variations in clinical and service delivery characteristics among youth in public outpatient mental health services were examined using data from San Diego County mental health service programs for fiscal year 1996 to 1997 (N = 3,962). Differences in referral sources, primary diagnoses, and service types were investigated for three racial/ethnic groups (African Americans, Asian/Pacific Islander Americans, and Latinos) compared to non-Hispanic whites. Controlling for age, gender, functional impairment, and prior service use, significant differences by race/ethnicity were found for all three variables studied. Possible explanations for these variations and future directions for research are discussed.

Hales Joins APA Staff to Address Education, Career Development

Hales Joins APA Staff to Address Education, Career Development

A Longitudinal Analysis of Family Empowerment and Client Outcomes

We examined the relationship between family empowerment, parent satisfaction, and mental health outcome across time. Based on the Vanderbilt Family Empowerment Project Model, increased empowerment should lead to positive changes in client outcomes. Data consisted of the Family Empowerment Scale (FES), which was used to assess the caregiver's perception of empowerment, Child and Adolescent Functional Assessment Scale (CAFAS), which measures the degree of disruption in the youth's current functioning, Client Satisfaction Questionnaire (CSQ), and demographic information gathered from families receiving services from a county mental health service system at intake and discharge. The results showed that the CAFAS and CSQ were related to empowerment at intake and discharge. Results also indicated significant increases in the knowledge subscale of the FES and the CAFAS and moderate increases in the advocacy subscale of the FES and the CSQ. We discuss the implications of these findings for systems of care, such as stronger parent-professional relationships.

Children in foster care: factors influencing outpatient mental health service use

Objective: To determine factors influencing outpatient mental health service use by children in foster care. Method: Detailed survey and administrative data were collected on 480 children who entered long-term foster care in San Diego County from May 1990 through October 1991. These data were linked with claims data from Medicaid and San Diego County Mental Health Services information systems. A Poisson regression model was used to determine whether the following factors influenced outpatient mental health service use: age, race/ethnicity, gender, maltreatment history, placement pattern, and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL). Results: Except for maltreatment history, all independent variables included in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age, male gender, and non-relative foster placements. Relative to Caucasians, visits were lower for Latinos, and Asian/Others, but comparable for African-Americans. Concerning maltreatment history, differences were only found in one category; children experiencing caretaker absence received fewer visits compared to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than 60. Conclusions: Both clinical and non-clinical factors influence outpatient mental health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematically link children in foster care with behavioral problems to appropriate services.

Local-state government relations and the development of public sector managed mental health care systems

This article presents an overview of the impact of changes at the state and federal levels on local county governments, and describes the innovations adopted by counties to deal with changing policies and procedures. The future of unpredictable revenue streams, increasingly complex caseloads, and changing state and federal policies have significant implications for the operation of local county mental health services.

The effect of enrollment in a prepaid health plan on utilization of a community Crisis Intervention Center by chronically mentally ill individuals

When a prepaid Medicaid Demonstration Project was initiated in Hennepin County, Minnesota, concerns were raised that the new system might place an additional service burden on County-funded mental health agencies responding to underprovision of mental health services by prepaid health plans. This study examined the use of a single County mental health services agency, the Crisis Intervention Center, by a group of vulnerable and frequent users, the chronically mentally ill. The study found that use of the Center by persons enrolled in a prepaid plan declined after enrollment and was different and lower for the prepaid group than for a comparison group of fee-for-service system users during the same time periods. The difference did not meet conventional levels of statistical significance. This finding is nonetheless important since it may be an indication of successful case management by prepaid health plans in serving chronically mentally ill individuals.

A model for crisis intervention services within local jails

Identifying and providing adequate care for suicidal and mentally ill jail prisoners is a serious problem for correctional administrators throughout the country (Chaisson, 1981; James & Gregory, 1980; Rundle in Gruson, 1983; Wilson, 1980). Neither the mental health nor the local correctional systems have the resources or expertise to independently address the needs of this population; resolution rests with a systematic approach which coordinates the efforts of both systems (Cox & Robinson, 1983; Newman & Price, 1977; Steadman, McCarty, & Morrissey, 1986). Between 1984 and 1986, the New York State Office of Mental and the New York State Commission of Correction collaborated with Ulster County Mental Health Services, the State Division of Criminal Justice Services (Bureau for Municipal Police), and a Statewide advisory committee to design a program for identifying and managing suicidal and seriously mentally ill inmates within local jails and police lockups. This interagency effort culminated in the development of the New York State Local Forensic Suicide Prevention Crisis Services Program. The program, which is multifaceted, offers a cost effective interagency approach to the identification and treatment of high risk prisoners. It utilizes existing community resources and requires cooperation between mental health and local correctional personnel at both the administrative and direct service levels. The underlying premise of this program is that jail suicides can be dramatically reduced if jail/detention officers are trained to provide timely identification and referral services and if mental health programs provide appropriate clinical backup for these referrals. The program has been in operation within jails and police lockups in New York State since 1986. Participating correctional facilities have experienced a

Developing productivity in mental health organizations

Although the new wave of attention to human services productivity is often motivated by fiscal concerns, a well-balanced approach calls for attention to the organizational processes and clinical practices that yield productivity as well as to numerical measures and “bottom lines.” This article presents a comprehensive view via a ten-point model of organizational development addressing fiscal, programmatic, technical and interpersonal apsects of productivity development. A case illustration drawn from the Alameda County (California) Mental Health Service is also presented.

California: Sacramento County's experience with community care.

Since 1969 treatment of the mentally ill in California has shifted from the use of large state institutions to reliance on community-based programs. The author describes the shift, the legislation precipitating it, and the public controversy surrounding the closing of state mental hospitals. The Sacramento County Mental Health Services handled the change to community care by contracting with the School of Medicine of the University of California at Davis to provide the necessary leadership and service programs; a crisis intervention approach was used.

Mental health consumer survey on a shoestring budget-it is possible!

Consumers of service in a decentralized unit of a county mental health services organization were surveyed. Two samples, one of 100 and one of 386 former clients, were selected for a questionnaire survey of satisfaction and perception of ensuing changes. This report is offered as an example of what a busy clinical team can accomplish in the midst of its basic task of providing therapeutic and diagnostic help.

Planning a rural alcoholism program.

British Journal of Addiction to Alcohol & Other DrugsVolume 65, Issue 3 p. 199-202 Planning a Rural Alcoholism Program E. B. RITSON, E. B. RITSON E. B. Ritson, M.D., D.P.M., Director, Sheffield Regional Addiction Unit, Mapperley Hospital, Nottingham. Formerly Visiting Psychiatrist from Laboratory of Community Psychiatry, Harvard Medical School.Search for more papers by this authorC. P. THOMPSON, C. P. THOMPSON C. P. Thomson, M.D., M.S. Hyg., Program Chief, Yolo County Mental Health Services; Assistant Clinical Professor of Psychiatry, University of California Medical Center, San Francisco.Search for more papers by this author E. B. RITSON, E. B. RITSON E. B. Ritson, M.D., D.P.M., Director, Sheffield Regional Addiction Unit, Mapperley Hospital, Nottingham. Formerly Visiting Psychiatrist from Laboratory of Community Psychiatry, Harvard Medical School.Search for more papers by this authorC. P. THOMPSON, C. P. THOMPSON C. P. Thomson, M.D., M.S. Hyg., Program Chief, Yolo County Mental Health Services; Assistant Clinical Professor of Psychiatry, University of California Medical Center, San Francisco.Search for more papers by this author First published: August 1970 https://doi.org/10.1111/j.1360-0443.1970.tb01153.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume65, Issue3August 1970Pages 199-202 RelatedInformation

DAY HOSPITAL AS AN ALTERNATIVE TO THE PSYCHIATRIC WARD. ATTITUDES AND RESPONSES OF RELATIVES.

I. Background of Study IN January of 1963 the psychiatric day hospital and the psychiatric inpatient service, both facilities of the San Mateo County Mental Health Services, began a project which gave the day hospital staff the opportunity to screen patients who had been accepted for hospitalization for alternate treatment in the day hospital. These facilities—day hospital as well as psychiatric ward—are located at the San Mateo County General Hospital in San Mateo on different floors. The psychiatric ward is a 30-bed unit for emergency admission and treatment with an open door policy and therapeutic community orientation dating back to 1956. The day hospital was established in January of 1961 in its present location on the ground floor of the hospital. The project was set up to answer the following questions: 1. What percent of patients considered in need of full-time hospitalization on a