Determining Engagement in Services for High-Need Individuals with Serious Mental Illness

This study examined whether Medicaid claims and other administrative data could identify high-need individuals with serious mental illness in need of outreach in a large urban setting. A claims-based notification algorithm identified individuals belonging to high-need cohorts who may not be receiving needed services. Reviewers contacted providers who previously served the individuals to confirm whether they were in need of outreach. Over 10,000 individuals set a notification flag over 12-months. Disengagement was confirmed in 55 % of completed reviews, but outreach was initiated for only 30 %. Disengagement and outreach status varied by high-need cohort.     

Hepatitis C Services and Individuals with Serious Mental Illness

Although individuals with serious mental illness have been shown to be at increased risk for hepatitis C viral (HCV) infection, there is growing concern regarding limited dissemination of recommended HCV related services to this population. This paper presents rates of receipt of HCV prevention services among a cohort of seriously mentally ill adults and reports rates of recommended follow-up care among the subset who tested HCV positive in a pilot study. Previous HCV screening was low and indicated medical follow-up among those who tested positive was also limited. Results stress the need for increased screening and counseling and delivery of preventive and follow-up medical services.     

Utilization of Public Mental Health Services by Adults with Serious Mental Illness

Public mental health (MH) services were examined for non-elderly adults with serious mental illness (SMI) using a database combining information from Medicaid, MH, and substance abuse agencies in three states. These data show that between 23% and 39% of those with SMI received MH services only through Medicaid. Relative use of community versus state hospitals for delivery of psychiatric inpatient care varied across the three states. However, state hospitals accounted for a large proportion of total inpatient days, due to high mean annual days of care. In two states, Medicaid paid for fewer psychiatric inpatient days than expected.     

Mobile Technologies Among People with Serious Mental Illness: Opportunities for Future Services

Several national bodies have proposed using mobile technology to improve mental health services. But rates of current use and interest in using technology to enhance services among individuals with serious mental illness are uncertain. The authors surveyed 1,592 individuals with serious mental illness regarding their use of mobile devices and interest in using mobile technologies to enhance mental health services. Seventy-two percent of survey respondents reported currently owning a mobile device, a rate approximately 12 % lower than the general adult population. The most common uses were for talking, followed by texting, and internet activities. Both mobile device users and nonusers expressed interest in future mobile services.     

Limitations of System Integration in Providing Employment Services for Persons with Mental Illness

This study assessed the influence of service systems integration on employment outcomes for persons with mental illness. A survey was sent to all 125 key program staff that worked for community mental health treatment agencies or vocational rehabilitation agencies. The survey found that referral and employment rates were low; but that these rates were related to characteristics of the interagency systems integration. Community mental health staff referred 448 individuals for employment services. Staff from vocational rehabilitation agencies accepted only 26% of these referrals and found work for just 11%; 7% were employed six months later. Also, 39% of respondents reported that the linkage agreement between their agencies was never established. This study suggests the need for more effective strategies for integrating mental health treatment and vocational rehabilitation systems.A version of this paper was presented at the Academy/Health annual conference in San Diego, June 8, 2004.     

Stigmatizing Attitudes About Mental Illness and Allocation of Resources to Mental Health Services

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.     

Characteristics of Individuals With Severe Mental Illness Who Use Emergency Services

Emergency services are both a safety net and a locus for acute treatment. While the population with severe, persistent mental illness uses emergency services at a high rate, few studies have systematically examined the causes of this service use. This study examines a random sample of 179 people who were high utilizers of services from the Los Angeles County Department of Mental Health. Interviews were conducted and 5years of service use data were studied. Greater use of emergency services was associated with male gender, minority race, severe illness, homelessness, and less family support. Efforts to reduce emergency services need to improve access to appropriate community services, particularly for people who are homeless or lack family support.     

Estimating the Prevalence of Severe Mental Illness in Mental Health Services in Lombardy (Italy)

Although many countries’ policies give Severe Mental Illness (SMI) priority inside Mental Health Services, researches assessing the prevalence of SMI in Mental Health Services according to operational criteria are still few. The aim of this is paper is to define annual SMI treated prevalence, describing socio-demographic and clinical characteristics, patterns of care and treatment costs of SMI and non-SMI patients. SMI prevalence in 10 Departments of Mental Health of the Lombardy Region (Italy) was assessed in 2000 by applying criteria concerning both severity, measured through HoNOS (Health of the Nation Outcome Scales), and utilisation patterns in the previous year. Annual SMI prevalence was equal to 3.1 cases per 1,000 inhabitants aged over 14; SMI patients’ costs were 5.5 times higher than those of non-SMI patients ($5,183 versus $939 per year) and patterns of care were different. The variables predicting the SMI status were diagnosis, presence of paid employment, duration of service contact, care packages delivered in 2000 and severity of some HoNOS items (self harm, drug abuse, cognitive problems, delusions, other symptoms, relationships, activities of daily living and housing). The use of the combined criteria of severity and intensity of contact with mental health services in the previous year seems to be able to define severely ill patients adequately. Funding for this work was provided by the Health Authority of the Lombardy Region. Antonio Lora is affiliated with the Department of Mental Health, Hospital of Desio, Milan, Italy. Roberto Bezzi is affiliated with the Department of Mental Health, Hospital of Legnano, Milan, Italy. Arcadio Erlicher is affiliated with the Department of Mental Health, Niguarda Ca′ Granda Hospital, Milan, Italy.     

Issues of Daily Living for Persons with Mental Illness

Abstract

The essential elements of well being and health include an adequate income from meaningful employment, healthful diet, comfortable and safe housing, and good health. Well being also includes being able to improve one's life through education and the building of good relationships. The absence of these elements is faced by people who have experienced mental illness, and thus, in addition to being challenged by the illness, they are also challenged by the social consequences which are the result of the absence of the elements of well being. This paper elaborates on these issues and the difficulties faced by people with mental illness. People who experience mental illness are challenged not only by their illness, but also by the social consequences, which follow or even exacerbate their illness. The impact of poverty, homelessness, inadequate and unsafe housing, low quality or no physical health care, and lack of or interrupted education and unemployment on the lives of mental health consumers/survivors is incalculable. These social consequences are the “side effects” which result from the inadequate system of care for persons with mental illness. This paper further expands upon these challenges of daily living for those who struggle with mental illness.     

Family Practice Enhancements for Patients with Severe Mental Illness

Individuals with severe mental health disorders experience difficulty maneuvering the complexity encountered in primary care (PC). This study describes the impact of three components of primary care practice enhancements on: changes in missed appointments, changes in health outcomes, number of ER visits and hospitalization days, and perceptions of integrated care. Missed PC appointments: baseline to post practice enhancement changed from 42 to 11, statistically significant (p < .01). Changes in health outcomes: SF-12 scores had no significant change nor did ER utilization and hospitalization; however, outcomes are low-base rate and assessment period was short. Integration of care: liaison was most helpful in accessing and navigating PC, educating and reconciling medication lists. Behavioral health staff voiced relief regarding access and felt better informed. Strategies focusing on increasing communication, staff education, and reducing barriers to access and receipt of PC may improve integration and continuity of care.     

Community Mental Health Care for Women with Severe Mental Illness Who Are Parents

Women with SMI are involved in childbearing and childrearing, but may have problems with parenting related to symptoms, lack of knowledge and skills, or lack of environmental supports. They may need intensive services to manage their mental illness and to parent to the best of their abilities. Preliminary research suggests that mental health interventions can improve family functioning, but that these services are not widely available in community mental health systems. This paper describes services to help clients who are parents, which includes integration of adult's and children's services, long-term, home-based parent training, and linkage with community supports.     

A Community Mental Health Support System for People with Mental Illness in Japan

Over 40 years has passed since primary supports for people with mental illness in developed countries shifted from institutions to communities. The level of treatments for mental illness in Japan is not considered immature; however, despite the general shift from institutional care to community care, Japan has the highest number of psychiatric beds in the world. One characteristic of the Japanese mental health system is that community supports have developed while the main treatment focus continued to be on inpatient care. This article explores various qualities of a Japanese community mental health system in historical context, as contrasted with the international standard set by the World Health Organization, and the impact of cultural aspects in the field. In addition, a case of a person with schizophrenia illustrates an initial intervention in Japanese communities and hospitals. The findings suggest that noninstitutional characteristics of the mental health system, including enthusiasm in clinical settings, flexible social structures, and sensitivity in interpersonal relationships, play important roles in the community support system in Japan. Because a great number of Japanese empirical studies related to community mental health are not published in English, many practices, which have proven to be beneficial to the field, remain unrecognized by the international community of mental health providers. The next challenge is to introduce the skills and systems that are worthwhile from Japan to the international community.     

Motherhood in Women with Serious Mental Illness

This study aimed to determine the prevalence of motherhood among inpatient females at a large state psychiatric hospital in suburban New York, as well as develop an understanding of the characteristics and needs of this unique population. Data on motherhood status was gathered from October 2010 through April 2011 via medical records. Data on custody status, frequency of contacts with children, and effect of mental illness on parenting was assessed through patient surveys and focus groups. 38.5 % of female inpatients were found to be mothers, almost half of whom reported at least weekly contact with children despite their inpatient status. The majority of identified mothers reported having maintained custody of their minor children and expressed great pride at being primary caretakers for their children, yet also emphasized the challenging effects of stigma associated with mental illness and parenting. A significant proportion of women at this psychiatric hospital were found to be mothers. Although acknowledged by some clinicians at the individual level, motherhood appears to remain a forgotten role systemically. Determining motherhood status and recognizing the varied roles our patients have is one more way mental health providers can model and promote recovery-oriented care.     

Cognitive Rehabilitation of People with Mental Illness

Abstract

Most clinical profiles of schizophrenia place cognitive deficits in its center. Specific information processes that might be deficient include attention, memory, executive functioning, language processing, and psychomotor functioning. Intervention programs are better designed for the specific deficits shown by an individual rather than a generic pattern for all persons with schizophrenia. Errorless learning strategies have been successfully adapted to address specific cognitive deficits.     

HIV Among People with Chronic Mental Illness

Rates of HIV infection, STDs, and sexual and drug-use risk behaviors are high among people with severe mental illness. Clinicians often are in the best position to connect psychiatric patients to the particular HIV-related services they need. These may include prevention interventions, risk assessment, antibody test counseling, and medical care. This review article describes the AIDS epidemic and its underpinnings in this population in an effort to help clinicians to recognize when their patients are at risk for acquiring or transmitting the virus and to intervene appropriately and effectively with an array of relevant services. The importance of training to enhance clinicians' skills and comfort in delivering these services is emphasized. The lives and well-being of psychiatric patients are threatened by the AIDS epidemic, and there is much clinicians can do to minimize the devastating impact of HIV and AIDS on clients in hospitals, clinics, and other psychiatric treatment settings.     

Assessing Readiness for Change Among Persons with Severe Mental Illness

Studies focusing on the readiness of persons to change have burgeoned in recent years. Assessing readiness for change is viewed as important for interventions aimed at promoting health behaviors, such as smoking cessation and substance abuse programs. This study is the first to examine readiness for change, as conceived by Prochaska and his colleagues, among a sample of persons with severe mental illness who were about to participate in a vocational rehabilitation program. We examined the reliability, validity, and other psychometric properties of the Change Assessment Scale and its ability to predict attrition and actual change.