Academic training and case management services in New York State

At the time this paper was written, Richard T. Pulice, Ph.D., was the Director of Community Support and Special Projects Evaluations for the New York State Office of Mental Health; he is currently Assistant Professor of Policy and Management at the School of Social Welfare, State University of New York at Albany, 135 Western Ave., Albany, NY 12222. Steven Huz, MPA, is a Research Scientist III, at the NYS Office of Mental Health. Theresa Taber is an Assistant Research Scientist, NYS Office of Mental Health.     

The impact of client need scores on the allocation of resources for community mental health services in Massachusetts

The allocation of resources for community mental health services (CMHS) should rely on the assessment of client need. Recent emphasis on cost concerns has given further emphasis to allocation decisions. This paper examines the impact of client need scores in the allocation of resources for CMHS in Massachusetts. A mean per capita spending for CMHS was completed for the forty catchment areas in the state; and areas were categorized based on need score. Results of an analysis of variance indicated no significant difference in allocation between groups relative to client need. The impact of other variables on allocation was discussed.Dr. Pulice is currently a Research Scientist III, New York State Office of Mental Health, Albany, NY and a Lecturer in Psychiatry, Harvard University Medical School at Cambridge Hospital. Dr. Malkis is currently a Research Scientist III, New York State Office of Mental Health, Albany, NY. Address reprint requests to Dr. Pulice, Office of Mental Health, 44 Holland Avenue, 7th Floor, Albany, NY 12229.     

Correctional Mental Health Services in New York: Then and Now

This article chronicles the legislation, litigation, and the agency initiatives which have shaped the New York State correctional mental health system into what it is today. An historical perspective provides a context and framework for the examination of the current and future salient issues and challenges in providing a comprehensive range of mental health services in a correctional setting. The Central New York Psychiatric Center organization, which is comprised of a 206 bed maximum-security forensic hospital and a community support network of 23 prison-based mental health units was established in 1977. This article takes an in-depth look at the organization's 25-year growth and development, the implementation and outcome of some innovative treatment programs, and the unique partnership between the New York State Office of Mental Health (OMH) and the New York State Department of Correctional Services (DOCS).     

Predictors of the use of restraint and seclusion in public psychiatric hospitals

The authors report on the replication of a 1984 study of the use of restraint and seclusion at psychiatric hospitals operated by the New York State Office of Mental Health. The results of this study confirm the earlier finding that the hospital itself was the greatest predictor of the use of these interventions, when controlling for patient characteristics associated with the use of restraint and seclusion, such as age, gender, ethnicity legal status, length of stay, and diagnosis. Recent and current attention to these findings has already resulted in reduced rates at high-rate New York State facilities.     

Significant changes in mental health: 1972–1992

In 1972, Dr. Surles was a doctoral candidate at the University of North Carolina and was working with a national network helping states develop their initial federal plans for people with developmental disabilities. In 1974, he moved to the North Carolina Division of Mental Health where he held various positions including Director of the States's Mental Health Study Commission. In 1977, he became Commissioner of Mental Health in Vermont and in 1982 the director of the Philadelphia Office of Mental Health and Mental Retardation. In 1987, Dr. Surles became the State Commissioner of the New York Office of Mental Health.     

Funding children's mental health services in an underfunded climate: collaborative efforts

In New York State and elsewhere, the lack of outpatient services results in inappropriate psychiatric hospitalization of children. Funding for specialized mental health services for children is not federally or state-mandated and county-levied dollars often are required to generate a state match. In New York State, counties relying exclusively on traditional sources of mental hygiene funding are unlikely to develop a variety of quality programs for children. This article discusses in detail how interagency collaboration developed in Dutchess County, New York resulted in procurement of funds that financed an array of children's outpatient mental health services to county residents.     

The mental health HMO: Capitation funding for the chronically mentally ill. Why an HMO?

Excesses associated with deinstitutionalization during the 1970s provided a legacy of homelessness, revolving door rehospitalization, and gridlock in metropolitan hospital emergency rooms. To allow for the seriously and persistently mentally ill to move planfully into community life, caregivers must utilize new and improved care models. One option is the HMO capitation model being tested in the Monroe/Livingston County Mental Health Demonstration in New York State. Experience indicates positive results for patients and lower than anticipated costs. Integrated Mental Health (IMH) is the local authority for this locally designed demonstration in New York State. Community Mental Health Centers (CMHCs) act as Lead Agencies to manage care and rehabilitation for seriously mentally ill patients previously dependent totally on the State hospitals' services. Both improvements in patient functioning and in reduced cost of appropriate community care are being documented by this demonstration project.     

Public-academic partnerships: integrating state psychiatric hospital treatment and clinical research

Collaboration between state clinical treatment services and academic research is fertile ground for clinical research opportunities. Such joint initiatives require careful planning, including provisions for joint training, integration of research staff into clinical activities, and integration of clinical treatment staff into research activities. The authors describe the planning and development of a 24-bed research unit at the Nathan S. Kline Institute for Psychiatric Research, colocated on the same campus as Rockland Psychiatric Center, each of which is an independent facility operated by the New York State Office of Mental Health.     

Performance-Based Contracting: Turning Vocational Policy into Jobs

The New York State Office of Mental Health has implemented a 2-year demonstration to determine if performance-based contracting (PBC) improves rates of competitive employment for people with serious persistent mental health conditions, and promotes best practice among providers. This article reports the interim findings from the demonstration. Initial results suggest that PBC is reaching the target population and promoting employment for a significant proportion of participants. It is also stimulating agency re-evaluation of consumer recruitment strategies, job development models, staffing patterns, coordination with support services, methods of post-placement support, and commitment to competitive employment for consumers.     

Psychiatrists' interest in community mental health centers

A postal inquiry among psychiatrists in New York State revealed a high level of interest in working in community mental health centers. The majority of those interested only wanted to work part-time in a center. The amount of time they would like to spend in the center and the types of work they would like to do were related to their present occupation and practice. Recruitment of personnel for these new services is very likely to aggravate the present staffing problems in state mental hospitals.This research was carried out while he was an Associate Research Scientist, New York State Mental Health Research Unit, Syracuse, New York. It was supported by the New York State Department of Mental Hygiene, Planning Commission. The author wishes to thank Dr. John Cumming and Dr. Elizabeth Tucker for their advice and assistance in carrying out the research on which this paper is based. He is also grateful to the clerical staff of the Mental Research Unit for their help in analyzing data and preparing reports.This paper was prepared before the appearance in print of Dr. F. R. Hassler's Psychiatric Manpower and Community Mental Health (Amer. J. Orthopsychiat., 1965,35, 695–706), which reports similar findings for a sample of Psychiatric Residents in the state of Massachusetts.     

Best practices: New York's outpatient mental health clinic licensing reform: using tracer methodology to improve service quality

This column describes how the New York State Office of Mental Health (OMH) redesigned licensing procedures for outpatient clinics by applying a person-centered focus and clinically relevant standards of care. OMH incorporated a tracer methodology to assess services; a licensing instrument that reflected OMH goals; and a systematic piloting, feedback, and implementation process. Clinic staff reported that the new procedures facilitated communication between OMH and clinics, accurately identified clinics' successes, and provided actionable and programmatic feedback. This initiative represents the first step by a state mental health authority to create a system of accountability that is clinically relevant and supported by stakeholders.     

Working together collaboratively with other professions

Collaboration is not new to nurses in general medical settings, but is less well understood by psychiatric nurses in community mental health centers. This is particularly true where the psychiatric nurse's role is undefined or where she attempts to change her role from a custodial to a therapeutic one. Collaboration is discussed in light of four concepts — professional identity, professional integrity, overlapping of roles, and flexibility — as these affect the nurse and the other mental health disciplines.a psychiatric nurse, was formerly Director of Nursing Services at the South Shore Mental Health Center, Quincy, Mass. This paper was presented to the New York State Nurses Association in Syracuse, November 4, 1964, and New York City, January 12, 1965.     

The differential receipt of rehabilitation services among an aftercare population

This article reports on a study of discharged state psychiatric hospital patients who subsequently received community mental health services. All received standard services, including case management, chemotherapy, emergency services, and group and/or individual therapy. A comparison of those who received both rehabilitation and standard services and those who received only standard services, revealed that blacks were less likely to receive rehabilitation. Nonschizophrenic and substance abusing clients were less likely to receive rehabilitation services. Those clients who received rehabilitation services generally received a greater amount of all types of services.Phyllis Solomon, Ph.D. was director of the Commission on Mental Health of the Federation for Community Planning in Cleveland, Ohio at the time of the study. She is at the Department of Mental Health Sciences, Hahnemann University, Philadelphia, PA. Barry Gordon, Ph.D. was a mental health consultant of the Federation for Community Planning, Cleveland, Ohio at the time of the study.This Research was funded by grants from the Office of Program Evaluation and Research, Ohio Department of Mental Health.     

County mental health directors' evaluation of a statewide intensive case management program: the New York State experience

Case management is increasingly recommended as part of an overall strategy for serving individuals with severe mental illness. The New York State Office of Mental Health developed such a program in 1988, with county mental health directors the key players in its development and operationalization. This article reports the results of a statewide survey administered by the authors to these directors 3 1/2 years after the program's implementation to determine its degree of success. Overall, the program was viewed as effective for individual clients, particularly those most in need of services. However, with respect to overall systems change, there was more variability in results. In general, a combination of strategies to reduce fragmentation within the mental health system and increase collaboration between service providers should be considered by state mental health authorities.     

High voltage electron microscopic studies of endothelial cell tubular structures in the mouse blood-brain barrier following brain trauma

Summary High-voltage electron microscopy was applied to the study of endothelial cell (EC) transport of macromolecules in a murine model of blood-brain barrier injury to study the role of the EC canalicular system following brain insult. Semithick sections from mouse brains subjected to acute (2–3 h) mechanical trauma demonstrated permeation of intravenously injected horseradish peroxidase via tubular structures either (a) in the absence of lysosome-associated structures in close proximity, or (b) in association with lysosomes, dense bodies or multivesicular bodies. Our data suggest a dual-purposed system of tubules, one portion that supplies the metabolic requirements of the cell and another portion, suggested to be more limited, that opens up as a result of brain injury.Supported in part by the New York State Office of Mental Retardation and Developmental Disabilities and the NIH Resource for the High Voltage Electron Microscope, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany, New York, NIH Grant RR01219     

Capacity for Delivering Culturally Competent Mental Health Services in New Mexico: Results of a Statewide Agency Survey

The Federal government has promoted National Standards for Culturally and Linguistically Appropriate Services (CLAS) to reduce mental health disparities among Hispanic and Native American populations. In 2005, the State of New Mexico embarked upon a comprehensive reform of its behavioral health system with an emphasis on improving cultural competency. Using survey methods, we examine which language access services (i.e., capacity for bilingual care, interpretation, and translated written materials) and organizational supports (i.e., training, self-assessments of cultural competency, and collection of cultural data) mental health agencies in New Mexico had at the onset of a public sector mental health reform (Office of Minority Health 2001). This work was presented at the nineteenth National Institute of Mental Health Conference on Mental Health Services, Washington, DC, July 2007. An erratum to this article can be found at     

Housing environments and community adjustment of severely mentally ill persons

This study examined relationships between the quality and appropriateness of housing environments and community adjustment of 729 deinstitutionalized severely mentally ill clients in a state-wide community support service program. Environmental measures included ratings of the physical condition of the client's residence, its adequacy for six key life activities, and the overall appropriateness of the residential setting for the client. Community adjustment measures included global level of functioning, degree of maladaptive behavior and client's perceived quality of life. Evidence is presented that quality and appropriateness of housing environments significantly affect aspects of client's community adjustment outcomes over a nine-month period.The author gratefully acknowledges the assistance of James Intagliata, david Mandell, Harry Straus, and David jodrey in the collection and analysis of the data reproted here. These data were collected as part of an evaluation of the New York State CSS program funded by a contract between the New York State Office of Mental Health and the Psychotechnical Applied Research Organization, Inc. of Buffalo, New York. Preparation of this paper has been partially supported by NIMH Grant No. MH 43703. A version of this paper was presented at the American Public Health Association Annual Meeting in Boston, MA on November 16, 1988.     

When less is more: reducing the incidence of antipsychotic polypharmacy

In 2003, the New York State Office of Mental Health initiated a program aimed at supporting patient recovery by simplifying antipsychotic regimens. A key component of the program, which has been essential in supporting physician autonomy, was the introduction of a software program, Psychiatric Clinical Knowledge Enhancement System, termed "PSYCKES." This software program enables physicians to visualize at a glance the medication history of each of their patients as well as of their colleagues' patients, as a way of making better-informed decisions. The fiscal impact, in the direction of a significant reduction in antipsychotic polypharmacy, was not lost on policy-makers, who have included $1.3 million in the current state budget for the dissemination of this program.     

HIV Service Provision and Training Needs in Outpatient Mental Health Settings

Objective: Despite high rates of HIV infection among people with serious mental illness little is known about the provision of HIV related services in outpatient mental health settings. This study examined HIV service provision and staff training needs among New York State outpatient providers. Methods: An anonymous survey regarding patient characteristics, provision of routine HIV risk assessment, general HIV service provision, and staff training needs regarding HIV was sent to the directors of all New York State Office of Mental Health licensed and certified outpatient programs. Results: Less than one-third of respondents stated that HIV risk assessment was performed routinely upon intake. Programs that served more HIV identified patients were more likely to have staff trained in HIV service provision. The number of identified HIV infected patients also influenced the frequency with which programs stated that their staff needed additional training in HIV risk interviewing, with clinics serving over 100 known HIV infected patients annually reporting the least training need and clinics serving between 11-50 known HIV infected patients annually reporting the most training need. Conclusions: It appears that clinics with large numbers of known HIV infected patients have mobilized to deal with the unique needs of these patients by providing specialty services and training staff in HIV service provision. However, the majority of clinics have failed to realize that severe mental illness is associated with behaviors that place individuals at risk of HIV infection or else routine HIV risk assessment would be more common.     

An introduction to the American Psychiatric Association's new diagnostic nomenclature for New York State Department of Mental Hygiene Personnel

Summary For many years the New York State Department of Mental Hygiene has used two nomenclatures to record psychiatric diagnoses. The state hospitals used the 1942 Revised Classification, a revision of the American Medical Association's 1934 classification, and all other mental health facilities used the first edition of theDiagnostic and Statistical Manual of the American Psychiatric Association.As of October 1968 all New York State mental health facilities will begin using one nomenclature: the second edition of theDiagnostic and Statistical Manual of the American Psychiatric Association. This article is an introduction to this new nomenclature for readers who have been using the 1942 Revised Classification. The background to the new nomenclature and the differences between it and the 1942 Revised Classification are discussed. Finally, a conversion table is presented which lists each diagnosis in the old classification and its counterpart, if present, in the new one.This work was supported in part by Public Health Service grants MH-08534 and MH-09219 from the National Institute of Mental Health.