Large Public Mental Health System Research Articles

Integrating mental health and substance use treatment with HIV care for people experiencing homelessness

Homelessness is common in high-income and middle-income countries, with an estimated 580 000 people in the USA experiencing homelessness on any given night. 1 Henry M de Sousa T Roddey C Gayen S Bednar TJ The 2020 annual homeless assessment report (AHAR) to congress: part 1. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdfDate: January, 2021 Date accessed: May 24, 2022 Google Scholar People living with HIV have an increased risk of experiencing homelessness: from 2009 to 2015, 8·3% of people living with HIV in the USA reported an episode of homelessness in the previous year, compared with 0·2% of the general population annually. 2 Padilla M Frazier EL Carree T Shouse RL Fagan J Mental health, substance use and HIV risk behaviors among HIV-positive adults who experienced homelessness in the United States—Medical Monitoring Project, 2009–2015. AIDS Care. 2020; 32: 594-599 Crossref PubMed Scopus (12) Google Scholar This overrepresentation is due to many factors; for example, people living with HIV—particularly those with multiple marginalised identities—face discrimination in housing and employment markets, and both HIV infection and homelessness share common risk factors. People who use drugs, those living with mental health problems, and members of ethnic, racial, gender, and sexual minority communities have an increased risk of both HIV and homelessness. 3 Folsom DP Hawthorne W Lindamer L et al. Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. Am J Psychiatry. 2005; 162: 370-376 Crossref PubMed Scopus (388) Google Scholar , 4 US Centers for Disease Control and PreventionHIV in the United States and dependent areas. https://www.cdc.gov/hiv/statistics/overview/ataglance.htmlDate: 2021 Date accessed: May 24, 2022 Google Scholar The underlying drivers of homelessness are structural, including the scarcity of affordable housing, income inequality, and racism. However, individual factors such as mental health and substance use problems are common precipitants, because people with these conditions face barriers to income and housing. Moreover, homelessness increases the severity of these conditions and decreases access to treatments. 5 Gutwinski S Schreiter S Deutscher K Fazel S The prevalence of mental disorders among homeless people in high-income countries: an updated systematic review and meta-regression analysis. PLoS Med. 2021; 18e1003750 Crossref PubMed Scopus (22) Google Scholar Integrating HIV and substance misuse services: a person-centred approach grounded in human rightsIntegrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. Full-Text PDF

The Impacts of COVID-19 on a Statewide Population With Mental Illness.

This survey examined the experiences of individuals receiving treatment in a large public mental health system during the early months of the COVID-19 pandemic. The survey, conducted between May and June 2020, assessed four domains: impacts on mental health, experiences with telehealth, access to care and resources, and sources and adequacy of support. Descriptive analyses were conducted. Of 4,046 respondents, 70% reported increases in their anxiety and stress because of the pandemic. A majority (55%) reported experiencing challenges related to the social determinants of health and functional needs. Most respondents reported that their care went undisrupted, with 92% using telehealth and 90% reporting feeling adequately supported. The pandemic substantially affected individuals with mental illness, particularly with regard to mental health related to the social determinants of health and functional needs. However, respondents felt that their mental health care was maintained and that they were adequately supported.

Associations between cultural identity and attitudes toward routine progress monitoring in a sample of ethnically diverse community therapists.

Community mental health services are increasingly embracing evidence-based interventions (EBIs), and the professional workforce is diversifying to meet the needs of historically underserved groups. As such, it is increasingly important to understand how psychotherapist cultural factors may be associated with attitudes toward EBIs. The use of standardized assessments within routine progress monitoring is a cornerstone of EBIs, yet therapist attitudes remain an obstacle to implementation. The current study examines the associations between therapist cultural identity and attitudes toward and use of routine progress monitoring. An online survey was used to gather data from 229 ethnic minority community therapists delivering EBIs in a large public mental health system serving children and families. Therapists had an average age of 35.2 years (SD = 7.7), 86.5% were female, 69.9% were Hispanic/Latinx and 30.2% were other ethnic minority, 36.2% were licensed, 90.8% held a master's degree, and 76.4% reported ability to deliver services in a non-English language. Hierarchical multiple regression analyses revealed that stronger heritage cultural identity was related to perceptions of potential harm with routine progress monitoring. In addition, more favorable views of standardized assessment instructions were associated with positive attitudes toward routine progress monitoring. We discuss how findings point to the need for additional user-centered research with diverse community therapists to learn how assessment and progress monitoring can be better designed to address their cultural and racial-based concerns. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

From Physical Wellness to Cultural Brokering: Unpacking the Roles of Peer Providers in Integrated Health Care Settings.

This qualitative study explored peer provider experiences working in newlyintegrated mental health and primary care pilot programs within a large public mental health system. Nineteen peer providers participated in semistructured interviews that focused on experiences delivering care within integrated teams. Interviews were analyzed using constant comparative methods informed by grounded theory. Findings were organized into three themes that speak to variation in the definition and function of peers; lack of clarity in the peer role; and relating to other providers. Integrated settings need ongoing support to ensure clarity in the peer role and an inclusive work environment.

Factors Associated with Assignment of Therapeutic Homework in a Large Public Children's Mental Health System.

Therapeutic homework is a fundamental skill-building component of the majority of evidence-based therapies and is associated with better treatment outcomes. However, it is rarely utilized in public mental health settings. To determine barriers to homework use and identify predictors of clinicians' assignment of homework, an online survey was administered to 267 clinicians in a large diverse public mental health system. Clinicians who were younger, licensed, whose supervisors asked about homework and whose clients completed their homework more frequently were predictors of greater homework utilization. The survey results are discussed and a novel idea to increase the use of homework is introduced.

Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors

This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.

Therapist- and Client-Level Predictors of Use of Therapy Techniques During Implementation in a Large Public Mental Health System.

Many youths receiving community mental health treatment do not receive evidence-based interventions. Research suggests that community mental health therapists use a broad range of therapeutic techniques at low intensities. This study examined the relationship between therapist- and client-level predictors of community-based therapists' report of cognitive, behavioral, psychodynamic, and family techniques within the context of implementation efforts. A total of 130 therapists participated from 23 organizations in an urban, publicly funded behavioral health system implementing evidence-based practices. Therapist-level predictors included age, gender, clinical experience, licensure status, and participation in evidence-based practice initiatives. Child-level predictors included therapist-reported child primary disorder (externalizing, internalizing, or other) and child age. Therapists completed the Therapist Procedures Checklist-Family Revised, a self-report measure of therapeutic techniques used. Unlicensed therapists were more likely than licensed therapists to report using psychodynamic and behavioral techniques. Therapists who did not participate in an evidence-based practice initiative were less likely to report use of cognitive techniques. Those with clients with externalizing disorders were more likely to report use of behavioral and family techniques. Therapists with the youngest clients (ages three to seven years) were most likely to report use of behavioral techniques and less likely to report use of cognitive and psychodynamic techniques. Results suggest that both therapist and client factors predict self-reported use of therapy techniques. Participating in an evidence-based practice initiative was associated with increased reports of using cognitive techniques. Therapists reported using behavioral and family techniques more than other techniques when working with youths with externalizing disorders and using fewer cognitive and psychodynamic techniques with young clients.

Predictors of community therapists' use of therapy techniques in a large public mental health system.

Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist-Family Revised. Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique.

The roles of individual and organizational factors in burnout among community-based mental health service providers.

Public-sector mental health care providers are at high risk for burnout, which negatively affects not only provider well-being but also the quality of services for clients and the functioning of organizations. This study examines the influence of demographics, work characteristic, and organizational variables on levels of burnout among child and adolescent mental health service providers operating within a public-sector mental health service system. Additionally, given the dearth of research examining differences in burnout levels among mental health subdisciplines (e.g., social work, psychology, marital and family therapy) and mental health programs (e.g., outpatient, day treatment, wraparound, case management), analyses were conducted to compare levels of burnout among multiple mental health disciplines and program types. Surveys were completed by 285 providers across 49 mental health programs in a large urban public mental health system. Variables representing dimensions of organizational climate and transformational leadership accounted for the greatest amount of variance in provider reported burnout. Analyses demonstrated significantly lower levels of depersonalization among wraparound providers compared to traditional case managers. Age was the only demographic variable related to burnout. Additionally, no significant effects were found for provider discipline or for agency tenure and caseload size. Results suggest the need to consider organizational development strategies aimed at creating more functional and less stressful climates and increasing levels of transformational leadership behaviors in order to reduce levels of burnout among clinicians working in public mental health settings for youth and families.

Moving Science Into State Child and Adolescent Mental Health Systems: Illinois' Evidence-Informed Practice Initiative

In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

The psychometric properties of the Illness Management and Recovery scale in a large American public mental health system

The Illness Management and Recovery (IMR) scale was created to measure recovery outcomes produced by the IMR program. However, many other mental health care programs are now designed to impact recovery-oriented outcomes, and the IMR has been identified as a potentially valuable measure of recovery-oriented mental health outcomes. The purpose of this study was to examine the psychometric properties and structural validity of the IMR clinician scale within a variety of therapeutic modalities other than IMR in a large multiethnic sample (N=10,659) of clients with mental illness from a large U.S. county mental health system. Clients completed the IMR on a single occasion. Our estimates of internal consistency were stronger than those found in previous studies (α=0.82). The scale also related to other measures of theoretically similar constructs, supporting construct and criterion validity claims. Additionally, confirmatory factor analyses supported the multidimensional representation of the IMR clinician scale. The three-factor model of illness self-management and recovery was represented by dimensions of recovery, management, and substance use. These reliable psychometric properties support the use of both the original one-factor and revised three-factor models to assess illness self-management and recovery among a broad spectrum of clients with mental illness.

Incarceration Among Adults Who Are in the Public Mental Health System: Rates, Risk Factors, and Short-Term Outcomes

Incarceration of people with mental illness has become a major social, clinical, and economic concern, with an estimated 2.1 million incarcerations in 2007. Prior studies have primarily focused on mental illness rates among incarcerated persons. This study examined rates of and risk factors for incarceration and reincarceration, as well as short-term outcomes after incarceration, among patients in a large public mental health system. The data set included 39,463 patient records combined with 4,544 matching incarceration records from the county jail system during fiscal year 2005-2006. Risk factors for incarceration and reincarceration were analyzed with logistic regression. Time after release from the index incarceration until receiving services was examined with survival analysis. During the year, 11.5% of patients (N=4,544) were incarcerated. Risk factors for incarceration included prior incarcerations; co-occurring substance-related diagnoses; homelessness; schizophrenia, bipolar, or other psychotic disorder diagnoses; male gender; no Medicaid insurance; and being African American. Patients older than 45, Medicaid beneficiaries, and those from Latino, Asian, and other non-Euro-American racial-ethnic groups were less likely to be incarcerated. Risk factors for reincarceration included co-occurring substance-related diagnoses; prior incarceration; diagnosed schizophrenia or bipolar disorder; homelessness; and incarceration for three or fewer days. Patients whose first service after release from incarceration was outpatient or case management were less likely to receive subsequent emergency services or to be reincarcerated within 90 days. Modifiable factors affecting incarceration risk include homelessness, substance abuse, lack of medical insurance, and timely receipt of outpatient or case management services after release from incarceration.

A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping

BackgroundThe goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States.MethodsParticipants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data.ResultsA total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups.ConclusionsEBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light.

Predisposing, Enabling, and Need Factors Associated with High Service Use in a Public Mental Health System

The purpose of this study was twofold: (1) To investigate the individual- and system-level characteristics associated with high utilization of acute mental health services according to a widely-used theory of service use—Andersen’s Behavioral Model of Health Service Use —in individuals enrolled in a large, public-funded mental health system; and (2) To document service utilization by high use consumers prior to a transformation of the service delivery system. We analyzed data from 10,128 individuals receiving care in a large public mental health system from fiscal years 2000–2004. Subjects with information in the database for the index year (fiscal year 2000–2001) and all of the following 3 years were included in this study. Using logistic regression, we identified predisposing, enabling, and need characteristics associated with being categorized as a single-year high use consumer (HU: >3 acute care episodes in a single year) or multiple-year HU (>3 acute care episodes in more than 1 year). Thirteen percent of the sample met the criteria for being a single-year HU and an additional 8% met the definition for multiple-year HU. Although some predisposing factors were significantly associated with an increased likelihood of being classified as a HU (younger age and female gender) relative to non-HUs, the characteristics with the strongest associations with the HU definition, when controlling for all other factors, were enabling and need factors. Homelessness was associated with 115% increase in the odds of ever being classified as a HU compared to those living independently or with family and others. Having insurance was associated with increased odds of being classified as a HU by about 19% relative to non-HUs. Attending four or more outpatient visits was an enabling factor that decreased the chances of being defined as a HU. Need factors, such as having a diagnosis of schizophrenia, bipolar disorder or other psychotic disorder or having a substance use disorder increased the likelihood of being categorized as a HU. Characteristics with the strongest association with heavy use of a public mental health system were enabling and need factors. Therefore, optimal use of public mental services may be achieved by developing and implementing interventions that address the issues of homelessness, insurance coverage, and substance use. This may be best achieved by the integration of mental health, intensive case management, and supportive housing, as well as other social services.

Characteristics of Inpatients With a History of Recurrent Psychiatric Hospitalizations: A Matched-Control Study

Characteristics of Inpatients With a History of Recurrent Psychiatric Hospitalizations: A Matched-Control Study

Trends in Use of Antipsychotics and Mood Stabilizers Among Medicaid Beneficiaries With Bipolar Disorder, 2001–2004

This study examined longitudinal trends in the use of mood stabilizers and antipsychotics for treatment of bipolar disorder in a large public mental health system and whether trends differed by age, gender, and race-ethnicity. Data were from Medicaid beneficiaries with bipolar disorder receiving services in the San Diego County public mental health system from 2001 to 2004. For each year the proportion of clients receiving any pharmacotherapy and the proportion receiving antipsychotics alone, mood stabilizers alone, or antipsychotics plus mood stabilizers were determined. Pharmacotherapy use was examined by age, gender, and race-ethnicity. A total of 1,473 clients were identified who were continuously enrolled in Medicaid during the four years. Seventy-five percent received mood stabilizers or antipsychotics. Of this group, 33% received antipsychotics alone, 23% mood stabilizers alone, and 44% both antipsychotics and mood stabilizers. The percentage receiving mood stabilizers or antipsychotics increased significantly, from 71% in 2001 to 77% in 2004, primarily because of increased use among women. Use of mood stabilizers alone declined from 25% to 20%, and use of antipsychotics alone increased from 32% to 36%. African Americans and Latinos were less likely than non-Latino whites to receive mood stabilizers or antipsychotics; this pattern was stable over time. Antipsychotics were prescribed for a larger percentage of clients than mood stabilizers. Persons from ethnic minority groups were less likely to receive either medication type. Research is needed to examine factors affecting pharmacotherapy in bipolar disorder and mechanisms underlying racial-ethnic disparities in pharmacotherapy, including their persistence over time.

Trends in Use of Antipsychotics and Mood Stabilizers Among Medicaid Beneficiaries With Bipolar Disorder, 2001-2004

Trends in Use of Antipsychotics and Mood Stabilizers Among Medicaid Beneficiaries With Bipolar Disorder, 2001-2004

Datapoints: Second-Generation Antipsychotic Medication Combinations for Schizophrenia

Combination pharmacotherapy for schizophrenia is reportedly increasingly common in the community (1). Yet efficacy of medication combinations for the treatment of schizophrenia and the frequency of such practices in different treatment settings remain largely unstudied. In addition, second-generation antipsychotics in combination pose an increased side-effect and risk burden at significant public and private cost. In order to determine patterns of prescribed second-generation antipsychotic combinations, we calculated frequencies using administrative and prescription data for over 6,000 individuals served by a large public mental health system for one month in 2002. Individuals were over the age of 18 and had a schizophrenia spectrum disorder. Seventy-six percent of individuals in the study (5,083 of 6,666 individuals) were given prescriptions for at least one second-generation antipsychotic medication. As shown in Figure 1, of the individuals who received a secondgeneration antipsychotic, many also received at least one other medication. Our study demonstrates how analysis of a large administrative database can improve knowledge of real-world psychopharmacological practices and enhance treatment improvement efforts. Despite the reported milder side-effect profile of second-generation antipsychotics, many patients received anticholinergic medications. This may reflect higher total dosages of antipsychotic medications, multiple antipsychotic medications, or overuse of anticholinergic medication (2). Other than for a brief period while a drug is being tapered, antipsychotic polypharmacy is inconsistent with current treatment guidelines, unsupported by rigorous research, and costly. This administrative database did not

Datapoints: Second-Generation Antipsychotic Medication Combinations for Schizophrenia

Back to table of contents Previous article Next article ColumnFull AccessDatapoints: Second-Generation Antipsychotic Medication Combinations for SchizophreniaCarol Eisen M.D., M.S.Roderick Shaner M.D.Jürgen Unützer M.D., M.P.H.Arlene Fink Ph.D.Kenneth B. Wells M.D., M.P.H.Carol Eisen M.D., M.S.Search for more papers by this authorRoderick Shaner M.D.Search for more papers by this authorJürgen Unützer M.D., M.P.H.Search for more papers by this authorArlene Fink Ph.D.Search for more papers by this authorKenneth B. Wells M.D., M.P.H.Search for more papers by this authorPublished Online:1 Mar 2008AboutSectionsView articlePDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article Combination pharmacotherapy for schizophrenia is reportedly increasingly common in the community ( 1 ). Yet efficacy of medication combinations for the treatment of schizophrenia and the frequency of such practices in different treatment settings remain largely unstudied. In addition, second-generation antipsychotics in combination pose an increased side-effect and risk burden at significant public and private cost. In order to determine patterns of prescribed second-generation antipsychotic combinations, we calculated frequencies using administrative and prescription data for over 6,000 individuals served by a large public mental health system for one month in 2002. Individuals were over the age of 18 and had a schizophrenia spectrum disorder. Seventy-six percent of individuals in the study (5,083 of 6,666 individuals) were given prescriptions for at least one second-generation antipsychotic medication. As shown in Figure 1 , of the individuals who received a second-generation antipsychotic, many also received at least one other medication. Figure 1 Medications given in combination with a second-generation antipsychotic Our study demonstrates how analysis of a large administrative database can improve knowledge of real-world psychopharmacological practices and enhance treatment improvement efforts. Despite the reported milder side-effect profile of second-generation antipsychotics, many patients received anticholinergic medications. This may reflect higher total dosages of antipsychotic medications, multiple antipsychotic medications, or overuse of anticholinergic medication ( 2 ). Other than for a brief period while a drug is being tapered, antipsychotic polypharmacy is inconsistent with current treatment guidelines, unsupported by rigorous research, and costly. This administrative database did not allow verification of diagnoses with standardized instruments, and limited information about dosages and duration did not allow us to determine total dosage or whether polypharmacy was short or long term.Subsequent steps should include further research to explore efficacy and risks of medication combinations for treatment of schizophrenia and other alternative strategies to polypharmacy.Acknowledgments and disclosuresDr. Eisen and Dr. Wells were co-principal investigators on a study funded by Eli Lilly and Company. The other authors report no competing interests.Dr. Eisen is affiliated with the Department of Mental Health, Los Angeles County, and with the Semel Institute for Neuroscience and Human Behavior, Health Services Research Center, University of California, Los Angeles (UCLA), 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 (e-mail: [email protected] edu). Dr. Shaner is the medical director of Los Angeles County Department of Mental Health. Dr. Unützer is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Fink is with the Department of Medicine, UCLA. Dr. Wells is affiliated with the Semel Institute for Neuroscience and Human Behavior, Health Services Research Center, UCLA, and with RAND Corporation, Santa Monica. Harold Alan Pincus, M.D., and Amy M. Kilbourne, Ph.D., M.P.H., served as editors of this column.

Public-Academic Partnerships: Improving Care for Older Persons With Schizophrenia Through an Academic-Community Partnership

Public-Academic Partnerships: Improving Care for Older Persons With Schizophrenia Through an Academic-Community Partnership