High-quality Mental Health Care Research Articles

Looking Forward

Over the past quarter century, researchers have developed a body of parent training programs that have proven effective in reducing child behavior problems, but few of these have made their way into routine practice. This article describes the long and winding road of implementation as applied to children’s mental health. Adopting Rogers’ (1995) diffusion framework and Fixsen and colleagues’ implementation framework (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005), we review more than a decade of research on the implementation of Parent Management Training—Oregon Model (PMTO). Data from U.S. and international PMTO implementations are used to illustrate the payoffs and the challenges of making empirically supported interventions routine practice in the community. Technological advances that break down barriers to communication across distances, the availability of efficacious programs suitable for implementation, and the urgent need for high quality mental health care provide strong rationales for prioritizing implementation. Over the next quarter of a century, the challenge is to reduce the prevalence of children’s psychopathology by creating science-based delivery systems to reach families in need, everywhere.

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Mental Health Telephone Triage: Managing Psychiatric Crisis and Emergency

The study aims to identify and articulate how mental health telephone triage (MHTT) clinicians manage psychiatric crisis and emergency via the telephone. An observational design was employed in the study. Wireless headsets were used to observe 197 occasions of MHTT. Clinicians use a range of practical strategies, therapeutic skills, and psychosocial interventions to manage psychiatric crises and emergencies via the telephone. The evidence base for managing psychiatric crisis/emergency in MHTT is minimal. These findings contribute to the MHTT knowledge base and provide evidence-based strategies for high-quality emergency mental health care.

Staff training in intellectual disability services: a review of the literature and implications for mental health services provided to individuals with intellectual disability

The Department of Health (2001, 2009) policy shift from specialist intellectual disability (ID) services towards mainstream mental health service provision has implications for staff. Research suggests that mainstream mental health service staff perceive inadequate training and a consequent knowledge deficit in relation to individuals with ID. Consequently, the implementation of appropriate staff training packages seems imperative to ensure high quality mental health care to this population.PsycINFO and OvidMEDLINE® were accessed to conduct a systematic literature review. The current evidence base on training approaches for staff who provide services to individuals with ID was identified. A broad review of ID staff training approaches provided an opportunity to extrapolate the most relevant research findings with regard to increasing staff skills, knowledge and attitudes for staff in mental health services. Once exclusion criteria was applied, the literature search produced a total of 29 articles, spanning from January 2004 to March 2009, appropriate for inclusion in the review. The review suggested that training for staff who deliver services to individuals with ID can be effective in increasing skills, knowledge and attitudes. This is discussed within the context of training for staff providing mental health services for adults with ID. Future research is proposed in light of the methodological limitations identified within the studies reviewed.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Addicted to Incarceration: Corrections Policy and the Politics of Misinformation in the United States

Back to table of contents Previous article Next article Book ReviewFull AccessAddicted to Incarceration: Corrections Policy and the Politics of Misinformation in the United StatesH. Richard Lamb M.D.H. Richard Lamb M.D.Search for more papers by this authorPublished Online:1 Nov 2009https://doi.org/10.1176/ps.2009.60.11.1562aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail With at least 350,000 persons with severe mental illness in our jails and prisons, the mental health field is very much in need of the knowledge and perspective of criminologists. Their perspective can only help us in our efforts to deal with criminalization of persons with severe mental illness, one of the most important social issues of our time. Thus this slender volume by an expert on crime and delinquency and the criminal justice system focuses on an area that is one of our greatest challenges.The author's main thesis is that society's emphasis on social support is inversely related to its emphasis on social control. As the State has placed increasing emphasis on its social control function by increasing the power and scope of the criminal justice system, the State has deemphasized its public responsibilities in providing social support in areas such as community mental health and inpatient treatment. Another issue emphasized by the author is the war on drugs, in which the criminal justice system plays a leading role. Given that such a large percentage of persons with severe mental illness have severe substance abuse and dependence problems, many tens of thousands have found their way into our jails and prisons via their problems with drugs and alcohol.The author points out that the State's shift in emphasis from social service to social control has resulted in responsibilities, in addition to punishment, beyond the capabilities of the correctional system. For instance, prisons are simply ill equipped to effectively treat persons with severe mental illness. Society needs to be reminded of this fact, and the author forcefully does that. This statement needs to be qualified, however; if the person has committed a serious crime, such as murder or armed robbery, there is no alternative but to incarcerate that person, no matter how severe the mental illness.In addition to the struggle in society between those who would stress social control and those who would stress social support is the issue of cost. In the case of persons with severe mental illness, there has been an attempt to show, as an argument for decriminalization, that treatment in the mental health system would cost less than incarcerating these persons in jails and prisons. The argument considers all the costs associated with the criminal justice system, such as the courts, law enforcement, public defenders, and so on. However, this is difficult to prove, and, in fact, high-quality mental health care, including therapeutic psychiatric hospitalization, is expensive.An additional issue is the belief on the part of many persons, both in and outside of the mental health system, that hospitals and involuntary mental health treatment often are not necessary. Ironically, this belief often leaves jail and prison as the only alternative for those who need involuntary, structured care.Clearly, the main points of this book are valid. Society has a public responsibility to provide treatment to persons with severe mental illness, and this should be done in facilities designed not for punishment but for treatment.The reviewer reports no competing interests.Dr. Lamb is professor of psychiatry, University of Southern California Keck School of Medicine, Los Angeles. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 11 November, 2009Pages 1562-1563PSYCHIATRIC SERVICES November 2009 Volume 60 Number 11 Metrics PDF download History Published online 1 November 2009 Published in print 1 November 2009

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterMargarita Alegría Ph.D.Margarita Alegría Ph.D.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.2.268aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Disparities in Depression Care: Implications for Population-Based Surveys: ReplyIn Reply: We appreciate Mr. Lee's positive comments on our study. He highlights the importance of adding questions to the assessment battery of the BRFSS that are specifically related to the number of days in which respondents felt totally unable to carry out daily activities. We could not agree more. Like other BRFSS items, additional items on problems with daily living would allow for greater focus on monitoring mental health at the population level. We can no longer continue to plan resources and evaluate the quality of mental health service delivery only at the individual level. Being able to identify geographic, systemic, and sociocultural barriers to high-quality mental health care is paramount to eradicating persistentethnic and racial service disparities. Having a national data source such as the BRFSS could help identify important shortcomings in the U.S. mental health care system. Community estimates of need could be used as outcome measures to monitor the impact of services, as they reflect the overall mental health status of the population ( 1 ). Need estimates by region could help policy makers allocate available resources more efficiently and fairly. Narrow definitions of need fail to provide information that is useful from a community prevention perspective ( 2 , 3 ). Although such definitions capture individual-level cases, they may fail to capture cases that are important to measure in community-level need estimates for monitoring and prevention, rather than for acute care. We do hope that Mr. Lee's suggestion is adopted.

Disparities in Depression Care: Implications for Population-Based Surveys: Reply

Back to table of contents Previous article Next article LetterFull AccessLetterMargarita Alegría Ph.D.Margarita Alegría Ph.D.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.2.268aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Disparities in Depression Care: Implications for Population-Based Surveys: ReplyIn Reply: We appreciate Mr. Lee's positive comments on our study. He highlights the importance of adding questions to the assessment battery of the BRFSS that are specifically related to the number of days in which respondents felt totally unable to carry out daily activities. We could not agree more. Like other BRFSS items, additional items on problems with daily living would allow for greater focus on monitoring mental health at the population level. We can no longer continue to plan resources and evaluate the quality of mental health service delivery only at the individual level. Being able to identify geographic, systemic, and sociocultural barriers to high-quality mental health care is paramount to eradicating persistentethnic and racial service disparities. Having a national data source such as the BRFSS could help identify important shortcomings in the U.S. mental health care system. Community estimates of need could be used as outcome measures to monitor the impact of services, as they reflect the overall mental health status of the population ( 1 ). Need estimates by region could help policy makers allocate available resources more efficiently and fairly. Narrow definitions of need fail to provide information that is useful from a community prevention perspective ( 2 , 3 ). Although such definitions capture individual-level cases, they may fail to capture cases that are important to measure in community-level need estimates for monitoring and prevention, rather than for acute care. We do hope that Mr. Lee's suggestion is adopted.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterBrason Lee M.S.W., M.S.Brason Lee M.S.W., M.S.Search for more papers by this authorPublished Online:1 Jul 2008https://doi.org/10.1176/ps.2008.59.7.812AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Reducing Barriers to Care by Looking Closely at StigmaTo the Editor: I read with interest the article "Perceived Stigma and Mental Health Care Seeking" ( 1 ) by Golberstein and colleagues in the April issue. This is a timely study in light of recent recommendations from a midcourse review of the Healthy People 2010 initiative to address barriers to mental health care ( 2 ). I agree with the authors' recognition that their study is unique in its focus on a specific population—namely, students from one public university. I propose that this level of focus may be what we need in order to examine the social and personal factors that might influence the decision to seek mental health care. The continued call to reduce disparities in mental health care requires us to more closely examine individual subpopulations, including those defined by ethnic groups. We must look at service utilization by population subgroups in order to advance the nation's efforts in improving access to high-quality mental health care. One of the major findings of the study by Golberstein and colleagues is that Asians were less likely to perceive a need for mental health care, as measured by self-reported claims of needing help for mental health problems. It is not uncommon for Asians to express symptoms of depression through somatic means that may be better understood within their social environment ( 3 ). Although recognizing that the choice of independent variables may have been limited to items contained in the survey, I suspect that the study would have produced much different findings had the authors been able to use more than one indicator for perceived need, such as how frequently poor mental health affected the respondents' ability to perform in everyday life functions, such as work and recreation. I also suspect that the results for service use would have been much different had the authors been able to use multiple measures to describe persons from ethnically diverse populations. Some of these measures may include the respondents' nativity or generational status, length of time in the United States, age at which they arrived in the United States, and cultural identity. The next challenge is to interpret these findings so that they become meaningful to program administrators and policy makers.Mr. Lee is an independent researcher who is also affiliated with the California Department of Public Health, Sacramento. The views expressed are those of the author and may not necessarily represent the policies of the California Department of Public Health.

Actions on Access Issues Follow Senator's Address

Actions on Access Issues Follow Senator's Address

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterCathleen E. Willging Ph.D.Melina Salvador M.A.Miria Kano M.A.Cathleen E. Willging Ph.D.Search for more papers by this authorMelina Salvador M.A.Search for more papers by this authorMiria Kano M.A.Search for more papers by this authorPublished Online:1 Aug 2006https://doi.org/10.1176/ps.2006.57.8.1217aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: We agree with Dr. Hellman's assertion that the problem of disparities in mental health services for lesbian, gay, bisexual, and transgender (LGBT) people is widespread. We are also frustrated that as federal and state governments increasingly mandate culturally relevant care, political efforts have sought to limit services for and research regarding the health and mental health of sexual and gender minorities—a move which can only intensify existing inequities. We find that conducting in-depth research among segments of the LGBT population offers concrete examples of how LGBT individuals are subjected to disparities. This concentrated view can challenge dominant notions of the "LGBT experience" and help determine the compounding factors that prevent LGBT individuals from obtaining high-quality mental health care. Similarly, Hellman ( 1 , 2 ) and Lucksted ( 3 ) have cast critical attention upon the unique needs of individuals with serious mental illness, who constitute a stigmatized, underserved, and neglected segment of the broader LGBT population. Our research involving 38 rural and 38 urban New Mexicans points to important commonalities in their help-seeking narratives, such as lack of insurance and financial resources, limited access to LGBT-friendly services, and homophobic-transphobic encounters in treatment settings. Nevertheless, our ongoing analysis of these narratives suggests that disparities associated with rural life in New Mexico make it even harder for rural LGBT individuals to access mental health care either from specialty providers or in informal settings. The most obvious example is that some 80 percent of psychiatrists, 70 percent of psychologists, 47 percent of social workers, and 53 percent of mental health counselors are based in New Mexico's two largest urban centers ( 4 ). Rural LGBT people are thus greatly restricted in both access to basic services and the ability to choose their providers. Another difference worth noting is the isolation that rural LGBT people feel from informal mental health resources. Compared with their urban counterparts, rural LGBT people have substantially less access to LGBT-friendly environments, including religion-based social networks, other community support systems, and LGBT-specific support groups, organizations, and help-lines. This isolation is exacerbated by conditions of poverty and complicates the already difficult living situations of many LGBT people who seek help for mental health issues. Such difficulties were tackled in the seminal article on mental health care for rural LGBT people almost two decades ago ( 5 ), and we find that they continue to occur unabated. We advocate for research and reform that attends to all LGBT people but that also considers the context-specific reality of rural LGBT individuals who, much like people with serious mental illness, experience extensive stigmatization and are an underserved and neglected segment of a larger population. Voices of rural LGBT people—and of rural residents in general—are not typically represented in mainstream mental health literature. The narratives of our rural LGBT participants reinforce the efforts of other researchers and demonstrate that the barriers to culturally relevant services discussed by Dr. Hellman in his 1996 Psychiatric Services article ( 2 ) remain salient today. And, as he concluded in that article, "A change in attitudes and practice is overdue." We might add that such a change now is disturbingly long overdue.

Fascinating Sessions in Exciting City Promise Not-to-Be-Missed Meeting

Fascinating Sessions in Exciting City Promise Not-to-Be-Missed Meeting

Advanced Practice Psychiatric Nurses: 2005 Legislative Update

Mental health disorders continue to be identified as a major health problem in the United States and throughout the world (New Freedom Commission on Mental Health, 2003; World Health Organization World Mental Health Survey Consortium, 2004). Yet easily accessed, safe, and high-quality mental health care is difficult for many people to secure, even those who are insured. Psychiatric–mental health advanced practice registered nurses (PMHAPRNs) and their scope of practice are clearly critical to addressing these gaps in care. In all states but Georgia,PMHAPRNs can prescribe psychopharmacologic agents. In 45 states, PMHAPRNs can prescribe controlled substances. Prescriptive authority implementation, hospital admitting privileges, and reimbursement persist as important focus areas related to advanced practice (Haber et al., 2004). Vigilance is paramount in regard to legislative efforts that attempt to reduce or restrict advanced practice psychiatric nursing. In this annual legislative update, titling, prescriptive authority,and certification for PMHAPRNs are reviewed for each state and the District of Columbia. Workforce characteristics, which have implications for future legislative efforts and influence the future of this group of advanced practice nurses (APNs) to provide needed mental health services, are discussed.

Hargrave v. Vermont and the quality of care.

Back to table of contents Previous article Next article LettersFull AccessHargrave v. Vermont and the Quality of CareMichael AllenMichael AllenSearch for more papers by this authorPublished Online:1 Sep 2004https://doi.org/10.1176/appi.ps.55.9.1067AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Paul S. Appelbaum's column (1) on psychiatric advance directives in the July issue of Psychiatric Services suggests that the sky is falling in the wake of the U.S. Court of Appeals decision in the Hargrave v. Vermont case. The court's modest conclusion—that Vermont cannot discriminate against people with psychiatric disabilities when it comes to expressing binding preferences for their treatment should they become incapable of making such decisions in the future—merely extends coverage of the Americans With Disabilities Act to an area that has been the exclusive domain of psychiatrists.That Dr. Appelbaum finds the Hargrave decision so potentially cataclysmic says more about the profession of psychiatry and its uneasiness about consumer input than anything else. Change can be unsettling, but, as last year's report of the President's New Freedom Commission on Mental Health reminds us, transforming the existing mental health system depends on adopting a new vision of recovery in which a partnership of personalized care is central.The commission's final report (2) states: "This partnership of personalized care means basically choosing who, what, and how appropriate health care will be provided…sharing in decision making, and having the option to agree or disagree with the treatment plan."Far from being the end of high-quality public mental health care, the Hargrave decision may be a fresh beginning. When mental health professionals can no longer automatically override a consumer's wishes—especially with respect to psychotropic medications—they may have to resort to other tools, such as trust building, peer support, talk therapy, and other naturalistic supports that have been shown, by the late Loren Mosher and others (3), to be successful in helping people with psychiatric disabilities achieve long-term recovery and greater satisfaction with their quality of life.As always, the Bazelon Center stands ready to help realize this new vision for public mental health in which the goal of high-quality outcomes and respect for consumer choice guide treatment decisions to promote recovery.Mr. Allen is senior staff attorney at the Bazelon Center for Mental Health Law in Washington, D.C.

Scully Urges Black Caucus To Back Parity, Other MH Reforms

Back to table of contents Previous article Next article Government NewsFull AccessScully Urges Black Caucus To Back Parity, Other MH ReformsChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:7 Mar 2003https://doi.org/10.1176/pn.38.5.0002Members of ethnic and racial minorities are less likely to seek and receive psychiatric care and are underrepresented in research on psychiatric treatment and in mental health professions, said APA Medical Director James H. Scully, M.D., at a Congressional Black Caucus (CBC) conference held in the House of Representatives in January.The 2001 “Surgeon General’s Report on Mental Health: Race, Culture, and Ethnicity” notes that “more than other areas of health and medicine, the mental health field is plagued by disparities in availability and access to its services,” said Scully at the Conference on Anti-Stigma and Mental Health sponsored by Rep. Donna Christian-Christensen (D-Virgin Islands), chair of the CBC Health Braintrust. The conference was convened by the National Consortium for African-American Children Inc.A major reason that the disparities exist is that minorities are overrepresented among homeless, institutionalized, and incarcerated populations that do not receive adequate mental health services. “These populations are served by a fragmented public health system with few resources at the state and local level,” explained Scully.These factors, when coupled with discriminatory coverage of mental illness, are “creating a crisis in mental health care that disproportionately affects ethnic and cultural minority populations,” said Scully.In addition, a physician’s ethnic and cultural background can be a barrier to treatment when patients are from a different ethnic background, said Scully. “It is critical that physicians understand all the factors—including ethnicity and culture—that can have an impact on a patient’s mental health,” said Scully.Research and TrainingAPA’s Committee on Ethnic Minority Elderly found that only a small percentage of ethnic minorities participate in clinical trials of new psychiatric medications. “This is a potentially serious shortcoming that can have profound consequences for effective treatment of mental illness,” said Scully. “We need to better understand the ethnic and cultural contexts of mental health care to overcome barriers to access, including the reluctance to seek treatment and the reluctance to participate in clinical trials.”Better incentives are needed for mental health professionals to practice in underserved inner-city and rural communities. “We should also expand special incentives to recruit and retain minority health professionals,” said Scully.APA has been promoting cultural competence as an integral part of psychiatric training through the work of the Committee on Ethnic Minority Elderly and the Council on National Affairs, according to Scully.Improving Access to CareScully said the mental health conference was a positive step in assessing the impact of stigma on minorities and addressing their needs.Scully urged CBC members to support the 2003 mental health parity legislation introduced in the Senate in January (S 10) in memory of the late Sen. Paul Wellstone. The bill is identical to the Mental Health Equitable Treatment Act introduced last year in Congress.“We must also ensure that the public safety net protects those with mental illness who cannot afford to pay for their own care and lack private insurance,” said Scully. He urged CBC members to support the APA-backed bill (HR 599) to repeal Medicare’s discriminatory 50 percent copayment requirement for mental health treatment.“We advocate that mental health treatment should not be viewed differently from other medical treatment and that all Medicare beneficiaries pay the routine copayment of 20 percent,” said Scully. A significant number of nonelderly disabled persons are insured through Medicare, and a significant portion of their disabilities are due to severe and persistent mental disorders, Scully explained.“Finally, as we end discriminatory coverage of treatment of mental illness, we must be diligent in assuring access to high-quality mental health care for all Americans that is sensitive to differences in culture and ethnicity,” said Scully.Christian-Christensen told Psychiatric News that “very few people in this country have adequate access to mental health care, and rural and minority populations have even less access. The problem is compounded for children because of their vulnerability, dependence on others, and unique presentation of mental disorders.”Christian-Christensen vowed to continue to work on issues related to mental health, along with ensuring that children and adolescents are included in mental health legislation.Ericka Goodwin, M.D., the APA 2003 Jeanne Spurlock Congressional Fellow, attended the CBC mental health conference on behalf of Christian-Christensen.Goodwin told Psychiatric News that she chose to be a fellow in Christian-Christensen’s office because it offers a unique learning experience. “As a family medicine physician, Dr. Christian-Christensen has special insights into health issues. She also chairs the Congressional Black Caucus’s Health Braintrust, so I am exposed to many health policy issues. Working here also allows me to focus on the needs of minority and underserved populations, which is important to me.”The text of Scully’s remarks at the Congressional Black Caucus conference is posted at www.psych.org/pub_pol_adv/scullyremarks.cfm. ▪ ISSUES NewArchived

Bias in mental health assessment and intervention: theory and evidence.

A recent surgeon general's report and various studies document racial and ethnic disparities in mental health care, including gaps in access, questionable diagnostic practices, and limited provision of optimum treatments. Bias is a little studied but viable explanation for these disparities. It is important to isolate bias from other barriers to high-quality mental health care and to understand bias at several levels (practitioner, practice network or program, and community). More research is needed that directly evaluates the contribution of particular forms of bias to disparities in the area of mental health care.

A research agenda to improve the accessibility and quality of mental health care for Latinos.

Given the persistent underutilization of mental health services by Latino persons, the mental health research agenda for this population should be shaped by a single practical issue: how to get quality mental health services to Latino consumers and their families. To address this issue, studies are needed that are longitudinal in design, that assess social factors in Latino communities, and that evaluate new and existing interventions. Collaborative investigations that draw on multidisciplinary perspectives and that are informed by multiple stakeholders (service providers, consumers, and policy makers) will increase the likelihood that such research has an impact on existing services. Moreover, careful planning of dissemination and implementation of research findings will enhance the influence that these findings have. A research agenda focused on questions that can be directly translated into accessible high-quality mental health care is needed to address the mental health needs of the nation's growing Latino communities.

Economic grand rounds: the business case for high-quality mental health care.

Untreated mental illness in the workplace costs U.S. corporations billions of dollars each year. In this column we summarize the growing body of evidence that investing in high-quality mental health care for employees is a wise decision for business leaders. We also describe an initiative undertaken by the American Psychiatric Association (APA) in a collaboration directed at chiefs of U.S. corporations and their financial advisers to help ensure that they have the information to make sound decisions about their health care purchases.

Privatizing Medicaid-funded mental health services: Trading old political challenges for new ones.

States have aggressively pursued privatizing the management of Medicaid-funded mental health services. Although privatized managed care addresses many concerns, it brings several challenges. This article evaluates the impact of privatization on Medicaid-funded mental health services and highlights several contracting issues that should be considered to ensure high-quality mental health care.

Developing psychiatric training and services in Cambodia.

Developing psychiatric training and services in Cambodia.