Cost-Effectiveness of an HIV Prevention Intervention for Mentally Ill Adults

Adults with severe mental illness are at high risk for human immunodeficiency virus (HIV) infection and transmission. Small-group interventions that focus on sexual communication, condom use skills, and motivation to practice safer sex have been shown to be effective at helping mentally ill persons reduce their risk for HIV. However, the cost-effectiveness of these interventions has not been established. We evaluated the cost-effectiveness of a 9-session small-group intervention for women with mental illness recruited from community mental health clinics in Milwaukee, Wisconsin. We used standard techniques of cost–utility analysis to determine the cost per quality-adjusted life year (QALY) saved by the intervention. This analysis indicated that the intervention cost $679 per person, and over $136,000 per QALY saved. When the analysis was restricted to the subset of women who reported having engaged in vaginal or anal intercourse in the 3 months prior to the baseline assessment, the cost per QALY saved dropped to approximately $71,000. These estimates suggest that this intervention is marginally cost-effective in comparison with other health promotion interventions, especially if high-risk, sexual-active women are preferentially recruited.     

NPACT: Enhancing Programs of Assertive Community Treatment for the Seriously Mentally Ill

Morbidity and mortality due to physical illness is extremely high in the population of persons with serious mental illness. The purpose of this study was to examine the impact on psychiatric and physical outcomes through enhancing a standard Program of Assertive Community Treatment (PACT) with Advanced Practice Psychiatric Mental Health Nurses (APNs) and stabilized consumer peer providers (NPACT). In a two-group community comparison design, 38 participants receiving NPACT were compared to 21 participants receiving traditional PACT. Evaluations were conducted at baseline and 6 months. Significant improvements over time were demonstrated for both groups on all summary variables. Treatment effects for NPACT over PACT were demonstrated for psychiatric symptoms, community functioning, and consumer satisfaction. Conclusions: Enhancements for PACT using advanced practice nurses and consumer peer providers have the potential to address both health and mental health problems for the seriously mentally ill.     

Predicting Condom Use Using the Information-Motivation-Behavioral Skills (IMB) Model: A Multivariate Latent Growth Curve Analysis

Background

The Information-Motivation-Behavioral Skills (IMB) model often guides sexual risk reduction programs even though no studies have examined covariation in the theory??s constructs in a dynamic fashion with longitudinal data.

Purpose

Using new developments in latent growth modeling, we explore how changes in information, motivation, and behavioral skills over 9?months relate to changes in condom use among STD clinic patients.

Methods

Participants (N?=?1281, 50% female, 66% African American) completed measures of IMB constructs at three time points. We used parallel process latent growth modeling to examine associations among intercepts and slopes of IMB constructs.

Results

Initial levels of motivation, behavioral skills, and condom use were all positively associated, with behavioral skills partially mediating associations between motivation and condom use. Changes over time in behavioral skills positively related to changes in condom use.

Conclusions

Results support the key role of behavioral skills in sexual risk reduction, suggesting these skills should be targeted in HIV prevention interventions.     

The Seriously Mentally Ill Older Adult: Perceptions of the Patient–Provider Relationship

PURPOSE: The purpose of this study was to give voice to the lived experiences of older adults with serious mental illness and their perceptions of the healthcare provider relationship. DESIGN AND METHODS: A qualitative phenomenological research design was used. In‐depth interviews were conducted with eight members of a mental health clubhouse. FINDINGS: Study themes revealed not only elements of goodwill toward providers but also elements of concern about the reliability and quality of healthcare provider relationships. Findings provided theoretical support for using Peplauian approaches in clinical practice. PRACTICE IMPLICATIONS: Partnering with patients, utilizing peer support networks, and placing a broader emphasis on the recovery model should be explored.     

Healthcare Barriers among Severely Mentally Ill Homeless Adults: Evidence from the Five-site Health and Risk Study

Few studies have examined barriers to physical and mental healthcare among homeless mentally adults. Methods This study examined physical and mental healthcare barriers reported by 154 recently homeless mentally ill persons. Results Practical concerns (e.g. transportation and cost) were key components of barriers to accessing general medical care among uninsured men with poorer overall mental health, PTSD, and STD infections. Perceived stigma was an important component of mental healthcare barriers reported most frequently by those with greater psychiatric symptoms. Conclusion Focusing on individual characteristics underlying barriers to healthcare may lead to better interventions for improving access to needed care.     

Substance Use Among the Mentally Ill: A Comparison of Italian and American Samples

Thirty-six patients with long-standing psychotic illness randomly selected among attenders at two community centers of Bologna were interviewed as were their therapists, in order to determine prevalence and patterns of substance use, reasons for use and effects on illness. Protocols were the same as used in previous research carried out in Boulder, Colorado. For all substances, except stimulants and over-the-counter products, prevalence rates were lower in the Bologna sample than in Boulder. Overall lifetime rates of substance use were significantly lower in the Bologna sample. Nevertheless 47.2% of the Bologna sample had a lifetime moderate to severe drug use and nearly two-thirds of the sample had a current drug use of some severity. Reasons for use equally reflected attempts to alleviate unpleasant emotional states and recreational purposes. Patients with high degrees of psychopathology had significantly lower scores on severity of drug use.     

A Capitated Model for a Cross-Section of Severely Mentally Ill Clients: Hospitalization

Hospitalization outcomes are examined in a threeyear random assignment controlled study of two capitatedIntegrated Service Agencies (ISAs) in California. Studyparticipants were a cross-section of severely mentally ill clients. Using the flexibility ofcapitated funding, the urban ISA reduced inpatientlength of stay and days, but not admissions. Elements ofthe capitated ISA model worked together to produce clinically appropriate and less costly use ofinpatient services. At the rural ISA, admissions werereduced substantially during the first two years of thedemonstration but not costs.     

A Model Program for the Treatment of Mentally Ill Offenders in the Community

There is a new and growing interest amongcommunity mental health providers and administrators inthe area of correctional psychiatry. From a column inPsychiatric Times to committees and task forces in APA and the American Academy of Psychiatry andthe Law, increased attention is being paid to the greatneed for the treatment of mentally ill offenders. Inthis article, we will introduce the reader to the magnitude of the correctional system and tothe prevalence of mental illness in the correctionalpopulation. We will then describe several model programsdesigned to work with mentally disordered offenders, and outline a novel collaborative approachbetween a CMHC and a Probation Office designed to helpmentally disordered offenders succeed in communitytreatment. Several barriers to treatment faced by this population will be identified, including doublestigma, lack of family/social support, comorbidity,adjustment problems, and boundary issues. Case vignettesdesigned to illustrate key points will beincluded.     

A Capitated Model for a Cross-Section of Severely Mentally Ill Clients: Employment Outcomes

Employment outcomes are examined in a three year controlled study of two Integrated Service Agencies (ISAs) for a cross-section of severely mentally ill clients. At each site significantly more ISA members than comparison clients obtained some paid employment. At the urban site the difference was dramatic: 73 vs 15 percent worked during the study period, and 29 percent of the ISA clients worked competitively. The significant but still limited ISA results argue for increased employment opportunities for all seriously mentally ill clients.     

The Mentally Ill in Jails and Prisons: Towards an Integrated Model of Prevention

Jails and prisons have become a final destination for persons with severe mental illness in America. Addiction, homelessness, and fragmentation of services have contributed to the problem, and have underscored the need for new models of service delivery. Project Link is a university-led consortium of five community agencies in Monroe County, New York that spans healthcare, social service and criminal justice systems. The program features a mobile treatment team with a forensic psychiatrist, a dual diagnosis treatment residence, and culturally competent staff. This paper discusses the importance of service integration in preventing jail and hospital recidivism, and describes steps that Project Link has taken towards integrating healthcare, criminal justice, and social services. Results from a preliminary evaluation suggest that Project Link may be effective in reducing recidivism and in improving community adjustment among severely mentally ill patients with histories of arrest and incarceration.     

From Custody to Community: Outcomes of Community-Based Support for Mentally Ill Prisoners

The post-release period is associated with a range of adverse outcomes for prisoners, especially those with a mental illness. There is limited research into programmes developed to address the needs of this population upon release from custody. This paper describes the demographic, mental health and criminal justice characteristics of a cohort of 63 mentally ill prisoners referred to the Queensland Prison Mental Health Transition Coordination Program in 2010 and 2011, who received time-limited transitional support. Established criminological predictors such as age and substance abuse history were related to first re-incarceration. When a multi-event analysis was performed, a broader range of factors were associated with the time before re-incarceration, including duration of social and recovery support and a diagnosis of psychosis. This study found that among those receiving post-release social and recovery support, longer duration of support is associated with a lower risk of re-incarceration. Other findings of interest include the significant proportion of re-incarcerations for parole breaches. No deaths occurred during the follow-up period.     

Brief Report: Suitability of the Social Skills Performance Assessment (SSPA) for the Assessment of Social Skills in Adults with Autism Spectrum Disorders

The present study aims at examining whether the ‘Social Skills Performance Assessment’ (SSPA; Patterson et al. in Schizophr Res 48(2–3):351–360, 2001) is a suitable performance-based measure to assess social skills in adults with autism spectrum disorders (ASD). For this purpose, social skills of individuals with ASD and non-ASD participants were assessed through the SSPA role plays. Results of this study suggest that the SSPA is suitable for the assessment of social skills in adults with ASD. The SSPA discriminates between individuals with ASD and non-ASD individuals, with the ASD group scoring significantly lower. Although no evidence was found for convergent validity of the SSPA in participants with ASD, divergent validity of the SSPA and interrater reliability among adults with ASD were good.     

The Poor General Health of the Severely Mentally Ill: Impact of Schizophrenic Diagnosis

This study focused on poor health among the severely mentally ill and additional risks associated with schizophrenia. Records of 781 clients in short-term residential treatment programs provided data. The schizophrenic subgroup was compared to others in bivariate analyses, with significant findings included in logistic regression. Those with schizophrenia were more likely to be male, unemployed, and insured by MediCal/Medicare. Most health problems occurred at similar rates across diagnoses, reflecting common environmental risk factors. Those with schizophrenia had less substance abuse and fewer liver conditions, but more diabetes and chronic respiratory problems. Implications for providers and for research are discussed.This work was partially supported by grants from the Bureau of Health Professions (Chafetz and Collins-Bride, Adult Nurse Practitioners for Severely Mentally Ill Adults, D24 NU 00777, 1997–2001); and the National Institute for Nursing Research (Chafetz and White, Clinical Trial of Wellness Training for the Mentally Ill, RO1-NRO5350, 2000–2005).     

The Substance Use Risk Profile Scale: Comparison of Norms and Outcomes for Australian and Korean Adults

The Substance Use Risk Profile Scale (SURPS) has been constructed in order to predict substance abuse before it occurs; hence most studies using the SURPS have focussed on adolescents. We examined the SURPS in a Korean and an Australian adult population from each respective country, using a population sampling technique that accurately represented each country. The SURPS was presented as part of an internet survey on alcohol consumption patterns (N?=?669), in English and Korean versions. The Korean version was constructed by translating the English version using an accredited technique. We replicated the four-factor structure of the SURPS. Australians scored lower than Koreans on all four sub-scales based on the factors. Australians also scored lower on the total SURPS, and there was a nationality by gender interaction. The total SURPS, but not the subscales, predicted weekly alcohol consumption regardless of nationality. Our results suggest that we have successfully translated the SURPS into Korean, a country that is receiving increasing attention for health research. The relatively high SURPS scores for the Korean sample, along with the increasing popularity of alcohol consumption in that country raises important concerns for social policy developers. The sampling technique utilised also allows the data to be used for normative purposes for future Australian and Korean research. We further suggest that the predictive value of the SURPS applies across a wider group than ‘Western’ adolescents.     

Beardslee's Preventive Family Intervention for Children of Mentally Ill Parents: A Swedish National Survey

Beardslee's family intervention (FI) is a preventative method for children of depressed parents and included among evidence-based methods in the US. In Finland and Sweden the FI has been used in families with varying parental diagnoses, although research is lacking for other parental diagnoses than depression. The aim of this questionnaire study is to investigate the introduction and implementation of the FI in Sweden, its safety and its feasibility in clinical services. Professionals in adult psychiatry using FI recruited 103 families who had participated in FI during 2007, regardless of parents’ diagnosis. Children between the ages of eight and 18 years were included. Parents and children were generally satisfied with FI and predominantly reported a positive impact of FI. No differences in responses were found between diagnostic groups. The study lends support to the assumption that FI is safe and feasible for use in general psychiatric populations.     

A Psychoeducational Program for Caregivers of the Chronic Mentally Ill Residing in Community Residencies

The objective of this study was to develop apsychoeducational program for caregivers of thechronically mentally ill residing in communityresidencies. An evaluative component was added todetermine how well the program was received by caregivers andwhat impact the program had on the residents. A total of20 caregivers and 63 residents participated in theprogram. In general, the psychoeducational program was well received by the caregivers. Theyespecially liked the mental health component andopportunity to meet and interact with other caregivers.There was a significant drop in hospital admissionsfollowing the program. There was also improvement in anumber of quality of life activities such as trips tothe local coffee shop and mall.     

The Consequences of Official Labels: An Examination of the Rights Lost by the Mentally Ill and Mentally Incompetent Ten Years Later

This study presents a survey of state statutes which restrict the civil rights of persons with a mental illness or who have been declared mentally incompetent. Five civil rights (jury service, voting, holding public office, marriage, and parenting) are examined. The results of the 1999 study are compared with the results of a 1989 study, to reveal any trends in the restriction of the civil rights of those suffering from mental problems. This comparison reveals that states continue to restrict the rights of the mentally ill and incompetent, and that there is a trend toward increased restriction of the familial rights of marriage and parenting.