The use of unique client identifiers in state mental health service systems

This paper presents the results of a national survey of states mental health authorities regarding the use of unique client identifiers (UCI). Results indicate that 78% of respondents used some UCI, and all used one or more of three types of UCIs, i.e., an existing number, a constructed identifier, or an assigned number. Issues concerning the purpose of use, implementation, barriers and problems with the different UCIs are discussed in order to help state and local authorities make informed policy decisions regarding the selection and implementation of a unique identifier in mental health data systems.This study was partially supported by National Institute of Mental Health Technical Assistance funds. Earlier versions were presented at the Annual Conference on Mental Health Statistics, June 1992, and at the Southern Regional Mental Health Statistics Improvement Program, September 1992. Other members of the work group were Sally Anderson (Texas), Lawrence E. Stivers (Florida), Regis Parsons (South Carolina), and Jacky Stancil (Alabama).     

Transformation of children's mental health services: the role of school mental health

The New Freedom Commission has called for a transformation in the delivery of mental health services in this country. The commission's report and recommendations have highlighted the role of school mental health services in transforming mental health care for children and adolescents. This article examines the intersection of school mental health programs and the commission's recommendations in order to highlight the role of school mental health in the transformation of the child and adolescent mental health system. Schools are uniquely positioned to play a central role in improving access to child mental health services and in supporting mental health and wellness as well as academic functioning of youths. The New Freedom Commission report articulated several goals related to school mental health: reducing stigma, preventing suicide, improving screening and treating co-occurring disorders, and expanding school mental health programs. The authors suggest strategies for change, including demonstrating relevance to schools, developing consensus among stakeholders, enhancing community mental health-school connections, building quality assessment and improvement, and considering the organizational context of schools.     

Hidden cost of children's outpatient mental health services: Lessons from New York state

The cost of outpatient mental health services for children is described in terms of services provided and management practices, and contrasted with spending for adult services. Staff in children's clinics experience more difficulty in fee collection, must schedule more evening hours, require more training and supervision, and have more problems in maintaining caseload standards and clinical records. Administrative staff spend more time marketing services and maintaining a positive community image, and sometimes sacrifice efficiency in the interest of social responsibility.     

Perceptions and effectiveness in state mental health systems

Differences in the perceptions of state and local officials about mental health systems create obstacles to effective functioning. Data from 25 states were analyzed to identify these differences as well as the mechanisms being used to reconcile them. Outcomes from an intervention within one state are presented along with guidelines for reducing the dysfunctional effects of level-specific perceptions.Jeanette M. Jerrell is Associate Research Scientist at Cognos Associates, Los Altos, CA and S. Lee Jerrell is Associate Professor of Management and Organization at San Jose State University, San Jose, CA. Work on this study was partially supported by National Institute of Mental Health Grant #05-RO1-MH38069-02, Division of Biometry and Epidemiology. Requests for information concerning these findings should be addressed to the first author at 1223 Eichler Court, Mountain View, CA 94040.     

Child psychiatrists as leaders in public mental health systems: two surveys of state mental health departments

OBJECTIVE: The purposes of the study were to document the administrative roles that child psychiatrists play in the development of policy in state departments of mental health and to identify barriers to their participation. METHODS: A survey was sent to the director of the department of mental health in each U.S. state and territory to determine the administrative duties of child psychiatrists who work in the department's central administration. A follow-up survey was sent to directors of children's services in state departments of mental health to determine what skills child psychiatrists would need to develop to increase their likelihood of being selected for administrative leadership positions. RESULTS: Nine of the 31 departments of mental health that responded to the first survey had formalized central administrative roles for child psychiatrists as either an administrative consultant or a children's medical director. The 19 respondents to the second survey indicated that to play a role in the central administration of state departments of mental health, most child psychiatrists needed improved knowledge in cultural competency, organizational dynamics, how government functions, the use of an asset-based approach to dealing with families, and use of interventions other than inpatient units, outpatient medication, or psychotherapy. CONCLUSIONS: To improve the leadership role of child psychiatrists in public-sector systems, training opportunities should be developed to increase their knowledge and skills in areas needed for effective participation in policy development. Training should include formal didactic instruction and clinical experiences that focus on the wide range of interventions used in public-sector systems and on the administrative skills needed for leadership positions.     

Policy and organizational changes in state mental health systems

State mental health authorities are currently the primary locus of service policy and funding decisions. In assuming increased authority and responsibility for service delivery, many states are emphasizing program development and funding for the severely acutely and chronically mentally ill while deemphasizing consultation/education, prevention, and evaluation activities. Funding mechanisms are moving towards greater accountability and funding levels are relatively stable. State authorities are exercising more control through regulations, but state-center relations are viewed as generally supportive and positive. There were few other consistent trends regarding changes in state/local relations, funding or regulatory patterns, or policy shifts except that almost all of the states interviewed reported instituting increased accountability mechanisms.Jeanette M. Jerrell is Associate Research Scientist and Judith K. Larsen is Senior Research Scientist at COGNOS Associates. This research was supported by NIMH grant # 5-R01-MH38069-02, Division of Biometry and Epidemiology. Requests for reprints should be sent to Dr. Jerrell at 111 Main St., Suite 5, Los Altos, CA 94022.     

Parent satisfaction with children's mental health services in a children's mental health managed care demonstration

This article presents findings from a quasi-experiment that included the use of satisfaction scales to compare parent's satisfaction with the services their children received through two different mental health care delivery systems. Satisfaction with the following three types of service were compared: (1) intake assessment during the admission process to any service setting, (2) outpatient services, and (3) residential treatment including inpatient hospitalization and residential treatment centers (RTCs). Additionally, satisfaction with several areas of care (e.g., access, treatment process, therapist relationship, parent and family services, discharge and transition planning), as well as global satisfaction, was assessed. In general, parents whose children received services through an innovative continuum of care system reported significantly higher satisfaction with intake assessment and outpatient services than did parents whose children received care in a traditional fee-for-service system. Fewer differences were found in satisfaction with residential services.     

Socioeconomic status and self-reported barriers to mental health service use.

OBJECTIVE: Socially disadvantaged individuals are at high risk for having their mental health service needs unmet. We explored the relations among education level, income level, and self-reported barriers to mental health service use for individuals with a mental illness, using data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). METHODS: Our sample group comprised the 8.3% of adult respondents who met the CCHS 1.2 criteria for an anxiety or affective disorder in the past 12 months (n = 3101). We examined the association between education and income levels and self-reported accessibility, availability, or acceptability barriers to mental health care. RESULTS: Accessibility, availability, and acceptability barriers were reported by 3%, 5%, and 16% of our sample, respectively. Individuals with a high school diploma were less likely than individuals without a high school diploma to report acceptability barriers to care (odds ratio 0.65; 95% confidence interval, 0.45 to 0.93). Higher-income individuals were less likely than lower-income individuals to report acceptability barriers to care (odds ratio 0.69; 95% confidence interval, 0.50 to 0.96). Employment, distress level, age, and family structure were also associated with acceptability barriers. CONCLUSION: Issues related to acceptability explain most of the unmet need for mental health services. Program planners should consider the development of targeted approaches to service delivery and outreach for low-income, working individuals who have not completed high school.     

Barriers to children's mental health services

OBJECTIVE: To examine the characteristics associated with barriers to children's mental health services, focusing on the effect of children's psychosocial problems on parents. METHOD: Data come from a first-grade, prevention-intervention project conducted in Baltimore, Maryland. Analyses were restricted to 116 families who participated in seventh-grade interviews and indicated the index child needed services. The Services Assessment for Children and Adolescents was used to measure barriers to children's mental health services. RESULTS: More than 35% of parents reported a barrier to mental health services. Types of barriers included those related to structural constraints, perceptions of mental health, and perceptions of services (20.7%, 23.3%, and 25.9%, respectively). Although parenting difficulties were associated with all barriers (structural: OR = 10.63, 95% CI: 2.37, 47.64; mental health: OR = 8.31, 95% CI: 1.99, 34.79; services: OR = 5.22, 95% CI: 1.56, 17.51), additional responsibilities related to attendance at meetings was associated only with structural barriers (OR = 5.49, 95% CI: 1.22, 24.59). CONCLUSIONS: Researchers and policymakers interested in increasing children's access to mental health services should consider strategies to reduce barriers related to perceptions about mental health problems and services, in addition to structural barriers. Particular attention should be given to programs that focus on the needs of families who are most affected by their child's psychosocial problems.     

湖北省精神卫生服务人员现状调查

目的 了解湖北省精神卫生服务人员现状,为人力资源规划提供基本依据.方法 采用自制调查表对全省精神卫生机构人力资源现状进行调查.结果 全省有精神科医师1 398人（2.44/10万人）;精神科护士3 175人（5.55 人/10万人）;心理治疗师293人（0.51 人/10万人）;全省21个县（市）无在岗精神科医护人员,37.8％机构未设置精神疾病预防科开展精神社区服务.结论 全省人力资源分布不均衡,区域差异明显;服务人员整体结构欠合理,专业种类不全;人员总体素质偏低,规范服务能力不足,难以满足社区精神卫生工作.     

A quality improvement process for state mental health systems.

Continuous improvement of the quality of patient care is a major goal in state mental health systems, most of which operate several large hospitals and many community mental health centers geographically dispersed across the state. Although each facility may have an adequate quality assurance program, many opportunities for improvement are lost without integration of these efforts into a unified, statewide quality improvement system. The authors describe development of such a system in South Carolina and give examples of improvements in patient care that have taken place since the program was initiated in 1987. The activities of the central office of quality assurance include collecting and analyzing data about adverse incidents in state facilities, monitoring corrective actions, conducting annual surveys of operations at all state facilities, and investigating and coordinating resolution of complaints about patients' rights.     

聚焦社区精神卫生服务

现结合当今全球社区精神卫生服务的发展趋势,分析我国社区精神卫生服务的现况和未来发展方向,对我国社区精神卫生的未来发展提出建议,供社区精神卫生管理人员参考。     

State mental health policy: critical priorities confronting state mental health agencies

The authors of this column report on an environmental scan conducted via intensive interviews of the 55 state and territorial state mental health agency (SMHA) directors who collectively oversee a $28 billion budget and serve nearly six million Americans who have a serious mental illness. Currently, a dynamic set of forces are substantively reshaping the role, resources, and capacities of the SMHA within the larger fabric of state government. As such, SMHA directors developed year 2007 priorities. These priorities include integrating health and mental health care, enhancing consumer empowerment, addressing mental health workforce crises (for example, training and recruitment), and ensuring financial stewardship.     

A mental health center's aftercare specialty service for discharged state hospital patients

To serve discharged state hospital patients from its catchment area, a mental health and retardation center established an ambulatory community service that has total responsiblity for the community care of those patients. The service is staffed primarily by mental health workers and nurses. They become members of the neighborhood-based teams on the state hosptial unit and take part regularly in discharge planning with patients and hospital staff. They also provide a range of continuing outpatient and support services, including medication review, development of housing placements and recreational activities, and psychiatric follow-up. The service operates as a specialized, autonomous unit, which allows it to shift staff resources in line with changes in patient and program needs, to allocate time for program development, and to pressure other agencies to develop needed services.     

Managing mental health service contracts

This article describes managing mental health service contracts. Specific strategies or methods are selected based on their fit with the organization's overall framework, congruence with internal strengths and external opportunities, and the potential to complement and strengthen service strategies. Criteria are proposed for deciding whether a strategic management approach is useful.At the time of writing he was at the Cuyahoga County Community Mental Health Board in Cleveland, OH, where all co-authors are administrative staff.