Public Mental Health Programs Research Articles

Improving the utilisation of bilingual counsellors within a public sector mental health service.

An urban, public sector Area Mental Health Program reviewed its own bilingual counsellor program as part of an Area-wide quality improvement project, and found that the counsellors' roles needed to be better defined; that mainstream staff needed to have more access to their expertise as cultural consultants; and that their function as an Area team, rather than as service based staff, needed to be encouraged. The bilingual counsellors decided to take up this challenge, and with the support of the Area Director of Mental Health, worked together to redefine their roles.

Risk factors for juvenile justice system referral among children in a public mental health system.

The objective of this study is to identify, through the use of secondary data, risk factors for juvenile justice system involvement among children entering a public mental health system. Data-sharing agreements between juvenile justice and mental health systems enabled investigators to examine criminal referrals among 645 children between the ages of 10 to 17 who entered community-based public mental health programs in King County, Washington, over the course of a single year. Univariate and logistic regression analyses were performed. Adjusting for age, gender, and ethnicity, children involved in the public mental health system who had juvenile justice referrals were more likely than children involved in the mental health system without juvenile justice referrals to have parents with a history of incarceration, to abuse drugs and/or alcohol, and to have experienced physical abuse. The study shows that some children who receive public mental health services are at particular risk of having an encounter with the juvenile justice system. Understanding the characteristics and experiences of youth who use multiple service systems has important implications for children's mental health services delivery.

18-month outcome of clozapine treatment for 100 patients in a state psychiatric hospital

The atypical antipsychotic medication clozapine is an effective treatment for refractory psychosis; however, the efficacy of clozapine when used in public mental health programs has yet to be fully characterized. This study assessed the outcome of clozapine treatment in a state hospital. The medical records of the first 100 patients to receive clozapine in a state hospital, from six months before clozapine treatment through 18 months of treatment, were reviewed. The patients had chronic psychotic disorders that had responded poorly to treatment with conventional antipsychotic medication. Eighteen months after beginning clozapine, 45 patients were much improved, and 18 were somewhat improved. All except one of the improved patients were continuing clozapine treatment. Forty patients were living in community settings, 59 remained hospitalized, and one had died of an illness unrelated to clozapine. Violent episodes in the hospital decreased during the first six months of clozapine treatment. Thirteen patients had one or two seizures while taking clozapine, 12 of whom successfully continued clozapine treatment. One patient developed agranulocytosis, and one developed leucopenia; each recovered fully after clozapine treatment was discontinued. Clozapine was an effective treatment for refractory psychotic disorders when given as a part of routine state hospital treatment.

The effects of capitation on service access, adequacy, and appropriateness

The authors describe an evaluation of the influences on service access, adequacy, and appropriateness in four capitated public mental health programs. Access, adequacy, and appropriateness were higher than the fee for service programs, suggesting that the financial incentive in capitation was not a significant limiting factor. Access and adequacy were also limited by new program effects as well as by case manager and client preferences.

The Galt Visiting Scholar in Public Mental Health: A review of a model of state-university collaboration

The Galt Visiting Scholar in Public Mental Health program was developed in Virginia to strengthen the relationships between the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services and the Commonwealth's three medical schools. We describe the development and evolution of this program and its accomplishments to date. Despite significant accomplishments, many of the key recommendations of previous Galt Scholars have not been enacted. The Galt Scholar approach of a consultant model is discussed and analyzed structurally using consultation theory. This analysis demonstrates both the potentials and limits of consultant models of state-university collaboration.

Administration and the third ear

AbstractA knowledge of individual and group psychodynamics and technique can enhance leadership and executive functioning in public mental health programs.

Can the public psychiatric administrator be ethical?

AbstractThe complexities and differing targets of accountability can pose conflicting ethical dilemmas for the administrator of public mental health programs, but this situation need not discourage those embarked on such a career.

Collaboration between providers and client‐consumers in public mental health programs

As client-consumer groups grow, their role in the design and implementation of community mental health services is enlarged. Just as the psychotherapist must pay attention to the client's desires, so must mental health providers pay close attention to the wishes of client-consumers and their potential contribution to the evolution of the service delivery system.

Mental Health Programs in the United States: Idiosyncratic Roots

The roots of mental health programs in the United States are complex and varied and include history, economics, politics, geography, law, immigration, ethnicity, and public opinion. There is no simple linear development. All the roots mentioned above and many more are interrelated, interdependent, and interpenetrating. It is important, however, to consider if there are certain distinctive features in American life deeply ingrained in our historical development that make a particular contribution to a form in which these factors influence a pattern of mental health care and, especially, the shaping of public opinion. As a corollary, to what extent does public opinion influence mental health programs? These distinctive features are important and distinguish the United States from other countries, including other highly developed countries of Western Europe with which we would appear to have much in common. However, in the matter of organization of health services, for example, Scandinavia, France, Poland, and Czechoslovakia seem to be closer to each other than any one of them is to the United States.

Values and priorities: their effect on knowledge utilization in public mental health programs.

Developing and maintaining shared values and priorities in public mental health systems is crucial to clinical, program, policy and administrative success. The issues of establishing priority populations, mobilizing resources, and improving quality of care and personal leadership style are discussed as examples of the ways in which such consensus contributed to progress in Pennsylvania's public mental health system.

Academic, community and state mental health program collaboration: the Oregon experience.

The authors review the relationship that has evolved over the years between the Department of Psychiatry at Oregon Health Sciences University and Oregon's community and state mental health programs. They describe the compatibility that exists between the basic requirements of academic psychiatry departments and public mental health programs and demonstrate how these organizations have been able to fulfill one another's needs in Oregon. Specific examples of successful collaborations in the areas of education, administration, research, and service are presented to illustrate how relationships that have been designed to meet specific requirements of one organization can fulfill many requirements of both. Suggestions are provided for those organizations contemplating similar collaborative endeavors.

A strategic planning model for community mental health centers

Community mental health centers are facing dramatic changes in the way they carry out their missions. As federal and state programs are being cut back, community mental health centers are faced with the issue of their own survival while public demands on them continue to increase. In order to help other public service organizations plan for the future, this report outlines a strategic plan developed at a specific community mental health center, the Summit Center for Human Development. The strategic plan was, in essence, an examination of the current and prospective services offered by Summit Center and how the Center can continue to provide mandated public mental health programs while increasing its financial capability to offer a variety of optional services. The strategic plan, then, outlined the directions that need to be taken to enhance the mandated and optional services being provided while improving the financial viability of Summit Center.

Life at the State summit: views and experiences of 18 psychiatric leaders.

In 1981 the American Psychiatric Association appointed an ad hoc committee to investigate the decline of psychiatrist leadership of public mental health programs. As part of the committee's research, the 18 psychiatrists who were then state commissioners or directors of mental health were surveyed on how they got their jobs and on their backgrounds, present responsibilities, support systems, and future plans. The results of the survey are discussed and presented in tabular format. The psychiatrists surveyed recommended that future commissioners have backgrounds similar to their own, which consisted of a great deal of previous on-the-job experience in mental health administration but little formal training or education in administration; none of the commissioners had obtained APA certification in administrative psychiatry. The commissioners felt they received the most support in their work from their subordinates; among the major groups listed as providing support, APA ranked lowest. The authors discuss the implications of the survey findings as well as issues surrounding the administration of public mental health programs by psychiatrists.

Can quality survive in public mental health programs? The challenge for training.

Can quality survive in public mental health programs? The challenge for training.

Can quality survive in public mental health programs? The challenge for training.

Can quality survive in public mental health programs? The challenge for training.

Accountability revisited: The arrival of client outcome evaluation

In the past few years, “accountability” for public mental health programs has become differentiated in the minds of not only program evaluators, but also program managers and funders, including state and local-level legislators. Increasingly, these officials are becoming concerned with more than just the numbers and targets of services delivered, and the cost involved, and are looking for evidence of positive outcome or impact on clients to justify program implementation and maintenance. This represents a significant move beyond the two accountability models that most recently seemed to be the focus of most formal accountability efforts—performance measurement and quality assurance. Pressures for implementing these two alternatives seem to have been reduced somewhat by the new federal Administration, but even prior to its advent there had been a rapid escalation in awareness of and concern for client outcome measurement among important audiences, including state and local mental health policy-makers and the U.S. Congress. This presents a major new opportunity and challenge for program evaluators as this new accountability focus continues to gather momentum.

Utilization of psychologists in positions of responsibility in public mental health programs: A national survey.

Utilization of psychologists in positions of responsibility in public mental health programs: A national survey.

The Politics of Mental Health: Organizing Community Mental Health in Metropolitan Areas.

As all levels of government increasingly participate in public mental health programs, the political framework in which these programs must operate is important to know. This volume by Robert H. Connery and contributors is the first to try and examine this dimension of mental health programming. The study itself, which grew out of the work of the National Institute for Mental Health's Committee on Social and Environmental Variables as Determinants of Mental Health, correctly addresses itself to the problem of such program development in urban metropolitan areas. One aspect of Urban America is governmental fragmentation (eg, in 75 standard metropolitan statistical areas of 300,000 population, there are 12,287 governmental bodies), and it is this reality and its effect on the development of popular support, the generation of funds, the recruitment of personnel, and their training for new mental health programs that Professor Connery and his contributors examine. The examination is

State planning for community mental health programs: Implications for psychologists

Official planning bodies in every state are engaged in an intensive two-year analysis of public and voluntary mental health programs. This planning is an integral part of the national effort to provide community mental health services to regions of 75,000 to 200,000 persons. Experiences in establishing and operating the Massachusetts Planning Project are described. Particular attention is paid to the manner in which broad citizen and professional participation has been obtained. Implications for the future functioning of mental health professionals are highlighted. Specific reference is made to the profound crises confronting psychologists and their professional organizations.