Mental Health Administration Research Articles

Criminal Justice Involvement of Armed Forces Veterans in Two Systems of Care

This study compared criminal justice involvement of veterans before and after receiving services from community-based programs of the Veterans Health Administration (VHA) (N=1,640) or a state Department of Mental Health (DMH) (N= 693). Anonymous extracts from VHA, DMH, and statewide criminal charging databases were analyzed by probabilistic population estimation to determine criminal charging rates in the years before and after the year of service receipt in each system of care. Veterans who received DMH services experienced a greater reduction in the rate of criminal charging than veterans who received VHA services (43% and 17% reductions). For veterans with co-occurring mental and substance use disorders, rates were reduced 33% among VHA service recipients, whereas they increased 48% among DMH service recipients. These differences indicate that the design of veterans' behavioral health service delivery systems would benefit from cross-sector outcome measures that complement clinical measures such as those used nationally by the VHA.

Gender Identity Disorders in Prisons: What Are the Legal Implications for Prison Mental Health Professionals and Administrators?

In 2009, two Idaho prisoners with gender identity disorders (GIDs) settled lawsuits against the Department of Corrections for failing to treat properly their conditions. Prisoners in other states have also sued prison officials for failing to treat their GIDs. Initially, the courts held that prisoners with GIDs did not have a serious mental disorder and thus were not entitled to treatment. However, later courts have held that a GID is a serious medical problem, which implicates the Eighth Amendment to the U.S. Constitution that requires treatment for prisoners’ serious medical problems. No court, however, has ordered sex-reassignment surgery for any transsexual prisoner, despite holding that GID is a serious medical problem. This issue presents an interesting dilemma for the law and has implications for prison mental health professionals and prison administrators. The authors elaborate on these issues and discuss policy implications.

Toward Successful Postbooking Diversion: What Are the Next Steps?

Toward Successful Postbooking Diversion: What Are the Next Steps?

Best Practices: Best Practices for Improving Engagement of Clients in Clinic Care

Best Practices: Best Practices for Improving Engagement of Clients in Clinic Care

Assessment of evidence-based psychotherapy practices in usual care: challenges, promising approaches, and future directions.

Assessment of evidence-based psychotherapy practices in usual care: challenges, promising approaches, and future directions.

Improving Access to Substance Abuse Treatment Services for Consumers with AIDS: A Formative Evaluation

This paper presents the findings of a formative evaluation used to guide the implementation of programming funded by an HIV/Treatment Capacity Expansion grant received from Substance Abuse and Mental Health Administration. Data were gathered from programmatic records regarding access to treatment, individual interviews with persons with HIV referred to treatment that did not attend, and interviews with persons with HIV currently receiving substance abuse treatment. Findings connected to record review indicate that the program is functioning in accordance with current model standards, while interviews indicated several barriers to access. Suggestions are offered to improve the implementation of substance abuse treatment to persons living with HIV/AIDS.

The Status of States' Policies to Support Evidence-Based Practices in Children's Mental Health

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.

Personal Accounts: A Peer Saplings Story: Lifting the Veil on Parents With Mental Illness and Their Daughters and Sons

Personal Accounts: A Peer Saplings Story: Lifting the Veil on Parents With Mental Illness and Their Daughters and Sons

Ethics Commentary: Fundamentals of Life

Caring for patients involves understanding the ways in which they fulfill their physical natures. Balance in the basic drives of life, such as eating, sleeping, and having sex, is important to the quality of one’s life. Imbalance in these fundamental domains, moreover, may reflect an underlying disruption in mental health or, alternatively, threaten mental well-being. Physiological dysfunction accompanying either illness or treatment may further upset this balance, interfering with the regulation of appetite, sleep patterns, or sexual interest and capacities. These dimensions of life are often very private and involve deeply personal concerns for our patients. Impulses, intimacy, image, and insecurities—these are the complex, overdetermined biological and psychological issues that arise. And as with other such sensitive considerations in psychiatric practice, certain values and bioethical principles are held especially dear in caring for these aspects of our patients’ lives.

Mental Health Policy Development in the States: The Piecemeal Nature of Transformational Change

Mental Health Policy Development in the States: The Piecemeal Nature of Transformational Change

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

1167 T important role of general practitioners in prescribing antidepressant medications and treating depression has been documented. However, the extent to which general practitioners are prescribing other types of psychotropic medications has received less emphasis. This study used data from August 2006 to July 2007 from the National Prescription Audit (NPA) Plus database of IMS to examine this question. IMS collects transaction information each month from approximately 36,000 retail pharmacies, representing about 70% of all retail pharmacies, which when weighted represent all prescriptions filled in retail outlets in the United States. Using a separate sample of retail pharmacy transactions that includes the physician’s Drug Enforcement Administration number, IMS assigns physician specialty information to obtain an estimate of the total number of prescriptions filled in retail pharmacies by medical specialty. As shown Figure 1, of the 472 million prescriptions for psychotropic medications, 59% were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and nonphysician providers. General practitioners wrote prescriptions for 65% of the anxiolytics in the sample, 62% of the antidepressants, 52% of the stimulants, 37% of the antipsychotics, and 22% of the antimania medications. Conversely, psychiatrists and addiction specialists wrote prescriptions for 66% of the antimania medications, 49% of the antipsychotics, 34% of the stimulants, 21% of the antidepressants, and 13% of the anxiolytics. Pediatricians were included as general practitioners and wrote 25% of all stimulant prescriptions but only 3% of all other types of psychotropic medications (data not shown). Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment. However, concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment. Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty

Shared Decision Making Is an Ethical Imperative

Shared Decision Making Is an Ethical Imperative

Understanding Community Mental Health Administrators' Perspectives on Dialectical Behavior Therapy Implementation

In this study, key informant interviews were conducted with 13 administrators from nine community-based mental health agencies implementing dialectical behavior therapy in order to assess their perspectives on implementation. Four major themes were identified. They include opinions about dialectical behavior therapy and its fit with existing practices, resource concerns (for example, reimbursement issues, time commitment, and staff training), staff selection for training and staff turnover, and ongoing client referrals. Understanding agency administrators' unique perspectives and addressing their concerns is critical to treatment implementation given administrators' role in determining whether and how a treatment will be implemented. Better understanding of the fit between dialectical behavior therapy and existing service structures, the impact of staff turnover on implementation, and the resources required for implementation are all needed to ensure successful implementation and sustainability.

Premature death among state mental health agency consumers: assessing progress in addressing a quiet tragedy

Ronald W. Manderscheid, Ph.D., has served as the Director of Mental Health and Substance Use Programs at the Global Health Sector of SRA International since 2006. Concurrently, he is Adjunct Professor at the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, a Member of the Secretary of Health and Human Services Advisory Committee on Healthy People 2020, and President-Elect of the American College of Mental Health Administration. Dr. Manderscheid serves on the boards of the Employee Assistance Research Foundation, the Danya Institute, and the Public Manager.

Cultural Competence in Child Psychiatric Practice

The United States faces a rapidly changing demographic landscape with an increasing multiracial and multicultural population. These changes largely result from three major factors: progressive aging and low birth rate of its European-origin population, lower mean ages and increasing birth rates in non-European minority groups, and a significant rise in immigration from Latin America, Asia, and Africa. By the year 2050, European-origin Americans will no longer be the numerical majority; this will happen before 2030 among children younger than 18 years and is already true among 6-year-olds. 1 U.S. Office of the Surgeon General Mental Health: Race, Ethnicity, and Culture: A Supplement to the Surgeon Generals Report on Mental Health. Substance Abuse and Mental Health Administration, U.S. Department of Health and Human Services, Washington2001 Google Scholar These growing populations of children are diverse in their racial, ethnic, national origin, immigration, and socioeconomic makeup. However, as a group, they are different from the older, European-origin, white, and higher socioeconomic mainstream population.

Psychiatric Illness and Obesity: Recognizing the "Obesogenic" Nature of an Inpatient Psychiatric Setting

The prevalence of obesity and obesity-related diseases is higher among individuals with psychiatric illness than in the general population. This study examined environmental factors that contribute to obesity in one psychiatric hospital in Canada. Semistructured interviews were conducted with 25 key stakeholders from multiple professional disciplines at the hospital. Transcribed interviews were analyzed through content analysis with the analysis grid for environments linked to obesity (ANGELO) framework as a categorical template. Factors contributing to obesity in this setting were related to increased energy intake, such as easy access to high-calorie snacks and beverages, and reduced energy expenditure, such as lack of access to staircases. Psychiatric settings may contribute to the high prevalence of obesity among individuals with psychiatric illness. Ecologically framed interventions are required to address obesity in this population.

Screening for Serious Mental Illness in the National Survey on Drug Use and Health (NSDUH)

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004. Statistically significant difference between Sample A and Sample B estimate (P ! .05). yLow precision; no estimate reported. Public Law (Pub. L.) No. 102-321, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act (1), created the Substance Abuse and Mental Health Services Administration (SAMHSA) and established a block grant program for U.S. states to fund community mental health services for adults with serious mental illness (SMI). The criteria for SMI require adults (18 years and older) to have at least one 12-month DSM disorder, other than a substance use disorder, resulting in functional impairment that substantially interferes with or limits one or more major life activities (2). Since then, national SMI estimates have been generated from mental disorder diagnosis and impairment data yielded from the National Comorbidity Survey (3) and, most recently, the National Comorbidity Survey–Replication (NCS-R) (4). Although the NCS-R is a large, in-depth psychiatric epidemiology study, it is not conducted frequently enough to produce annual or biennial estimates, nor is it designed to generate state level estimates. To address these data needs, SAMHSA’s National Survey on Drug Use and Health (NSDUH) was nominated as the vehicle to collect adult SMI prevalence estimates for the agency. A methodological study to examine the accuracy of a variety of psychiatric symptom and impairment screeners to predict SMI in NSDUH was conducted in 2000 (5). The study obtained clinical assessments on a small sample of NSDUH respondents in the Boston area. All of the scales used in the methodology study were included in a new mental health module added to the 2001 NSDUH (before the results from the methodological study were available) with the expectation that the study would be completed in time to be used to generate SMI estimates based on the 2001 NSDUH data. Ultimately, one scale, the K6 measure of non-specific psychological distress (K6), was determined to be the most

What do persons with mental illnesses need to quit smoking? Mental health consumer and provider perspectives.

Forty-one percent (41%) of persons in the U.S. who reported having recent mental illnesses also smoke cigarettes. Tobacco use among this population is associated with up to 25 less years of life and excess medical comorbidity compared to the general population. While research demonstrates that tobacco interventions can be effective for persons with mental illnesses, they are not commonly utilized in clinical practice. The current study explored how to adapt evidence-based tobacco cessation interventions to meet the unique physiological, psychological, and social challenges facing persons with mental illnesses. Ten focus groups were conducted utilizing a semi-structured discussion; 5 for adult mental health consumers (n = 62) and 5 with mental health clinicians and administrators (n = 22). Content analysis was used to organize themes into categories. Five thematic categories were found: (1) Barriers to treatment, (2) Resources and infrastructure, (3) Negative influences on smoking behavior, (4) Knowledge deficits, and (5) Treatment needs. These findings are instructive in developing appropriate tobacco cessation services for this population. Specifically, these data have been incorporated into a mental health provider toolkit for smoking cessation and have informed the development of a tobacco cessation intervention study.

Long-Term Follow-Up Study of Patients With Refractory Obsessive-Compulsive Disorder

Long-Term Follow-Up Study of Patients With Refractory Obsessive-Compulsive Disorder