Epidemiologic data and planning mental health services

The Epidemiologic Catchment Area Program (ECA) is the most comprehensive community and institutionalized epidemiologic data base currently available for mental health service planning. In this report, the authors compare the ECA with a previous community survey used to plan mental health services--the Stirling County Study--in terms of conceptual framework, research design, results and implementation of service planning. Familiarity with the Stirling County Study can inform users of ECA data regarding the strengths and weaknesses of the ECA data for health services research.     

Planning for mental health services

This article outlines the model used to develop and analyze the data needed for the mental health component of a health system plan, required under Public Law 93-641. The model includes a review of existing utilization patterns, an assessment of community levels of risk, and the forecasting of the need for mental health services.Thomas M. Wernert is Executive Director of the Lucas County Mental Health and Mental Retardation Board, One Stranahan Square, Suite 517, Toledo, Ohio 43604.     

State goals for mental health services

As Oregon moved its Medicaid services into the managed care plan, mental health goals were similar to those on the physical health side--cost control, expansion of services, and increased flexibility.     

Integraton of mental health data on hospital and community services

Deinstitutionalization accompanied by the growth in community-based psychiatric care resulted in a fragmented public system of mental health care with diverse, partial and often inconsistent sources of patient information. This paper describes the problems associated with integrating hospital and community data sources and outlines procedures for the construction of integrated mental health data systems.The research was supported by a grant from the Pew Charitable Trusts to the Univ. of Pennsylvania and The Community Council for Mental Health and Mental Retardation Inc. and carried out jointly by the Policy Modeling Workshop of the Wharton School and the Section on Public Psychiatry and Mental Health services Research of the School Medicine.Policy Modeling Workshop, The Wharton School, Univ. of Pennsylvania, 3814 Walnut St., Philadelphia, PA 19104.     

Implications of health psychology for mental health services

Both research evidence and the changing demographics of illness suggest an increasing need to integrate health and mental health services. Health psychology is an example of such a movement. Traditional mental health services contain vehicles for achieving this integration including preventive psychiatry, individual psychotherapy, family therapy, and group therapy, including support groups. Importing these models to health care will require some modifications and cautions, however, and attention to cost-effectiveness will be critical in achieving any integration of services. Examples of cost-effective mental health services in health care delivery are described and offered as potential models for integration.Dr. Taylor is Professor of Psychology, Department of Psychology, University of California at Los Angeles.     

Multicultural mental health services

Oregon has a significant Indochinese minority community. Seen through the eyes of this group, few of the difficulties minorities encounter when seeking culturally competent services have changed under the Oregon Health Plan.     

Problems for paraprofessionals in mental health services

Issues of changing positions and roles for paraprofessionals are considered in the context of the hierarchical structure and process of mental health organizations. A brief history of paraprofessionals in mental health is presented, showing their function as low-status staff who control a troublesome patient population. The mental health organization is examined as a social system with a functional division of labor and a professional caste system. Discussion focuses on problems arising when paraprofessionals are promoted in the functional hierarchy while continuing to occupy the lowest level in the professional caste system, and from the organization's continuing need for low-level staff to serve on the boundary between professional staff and difficult clients.Marjorie Bayes is a member of the Department of Psychiatry, Yale University School of Medicine. T. Kerby Neill is Coordinator of the Children's Service Program, Bluegrass East Comprehensive Care Center, Lexington, Kentucky.     

Philadelphia's capitation plan for mental health services

Dr. Sharfstein's Introduction: Prospective payment is the major economic change that is reshaping the delivery of medical care. Capitation financing for the chronic mentally ill is an innovative and promising alternative to underfunded and bureaucratically rigid public programs on the one hand and underfunded retrospective cost-based Medicaid programs on the other. This month's column describes one such capitation plan. Its impact on the target population as well as on the use of resources by persons with long-term and severe mental illnesses will require close evaluation.     

Strategies for integrating public mental health services

Practical solutions to the issues troubling public mental health systems must be developed within the constraints of existing political structures. A key enabling factor is the inclusion of a broad range of reimbursable mental health benefits within health insurance. However, services cannot be improved without the development of viable frameworks for organizing effective service delivery; such strategies include assertive community treatment, capitation approaches, strong local mental health authorities, and reimbursement structures that achieve key objectives. The author discusses examples of the four strategies and argues for their better integration.     

Disengagement from mental health services

This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.