Professionals and managers with severe mental illnesses: findings from a national survey

This study explores the capacity of individuals with severe mental illness to be employed in managerial or professional jobs and the correlates of their vocational success. Using purposive sampling techniques, we identified a national sample of 347 individuals for a mail survey who had succeeded in obtaining and retaining mid to upper level managerial or professional positions. The majority worked full-time and held their job for more than 2 years. Their vocational success was operationalized based on 4 employment outcomes: employment status (full-time vs. part-time), job tenure, occupational rank, and annual income. Key factors that contributed to respondents' vocational success were lesser severity of the illness as indicated by lack of lifetime receipt of disability benefits, capacity to manage one's own psychiatric condition, and higher education. Study findings point to the role of supported education and self-efficacy in promoting the employment outcomes among individuals with severe mental illnesses.     

Epidemiology of severe mental retardation in children: community studies.

Twenty-seven community studies of severe mental retardation, defined as IQ less than 50, were reviewed. The prevalence rate of this condition was about 4 per 1000 in older children; the rate was somewhat higher in males but did not vary by social class. About one-half of severely retarded children had significant associated handicaps. The cause of most cases of severe mental retardation is not known, but Down's syndrome accounted for one-sixth to one-third of cases and a small percentage were due to other chromosomal abnormalities, metabolic diseases, or infection.     

Understanding comorbidity of anxiety disorders with antisocial behavior: findings from two large community surveys

Although a positive association between antisocial behavior and anxiety disorders may seem clinically counterintuitive, some previous studies have in fact found a higher co-occurrence of anxiety disorders and antisocial behavior than in the general population. We investigated the relationship between anxiety disorders and antisocial behavior in two contemporaneous community surveys (National Comorbidity Survey, Ontario Health Survey). A significant association was found between any DSM-III-R anxiety disorder diagnosis and any DSM-III-R antisocial diagnosis (National Comorbidity Survey, odds ratio = 3.05, p <.01; Ontario Health Survey, odds ratio = 2.37, p <.01). This association remained significant after controlling for sociodemographics, depression, and alcohol and drug use disorders. Posttraumatic stress disorder and social phobia complex subtype (i.e., multiple social fears) produced the largest odds ratios. People with comorbid anxiety and antisocial diagnoses displayed high levels of distress, neuroticism, and disability, and poor quality of life. Clinicians and health policy makers need to be aware of the co-occurrence of anxiety disorders and antisocial behavior.     

The organization and management of community mental health services

Development of Community Mental Health Centers has revealed the need for more effective administrative mechanisms for planning, developing, and controlling mental health services and for involving effectively the local community in this process. The public health model of primary, secondary, and tertiary prevention was used as a basis for planning and developing mental health services in two settings. The resulting organizations proved effective in providing qualitative mental health services and in developing effective work groups throughout the organization to take responsibility for program. Experience with this model supports specialization of state hospitals into rehabilitation facilities and their close integration with programs in the communities they serve. It is proposed that this will require state hospital programs becoming the responsibility of local communities.     

The organization and effectiveness of community mental health systems

This article explores five hypotheses on why some county mental health systems are more effective than others. The five hypotheses are: leadership succession, powerful agency, integrated system, service barriers, and resource dependency. The five explanations are tested through multiple regression on eight county service delivery systems in the northwest United States. The results of the study support the first three hypotheses, but not the latter two.     

Childhood adversity and perceived need for mental health care: findings from a Canadian community sample

Previous community surveys have demonstrated that individuals with self-perceived need for mental health treatment in combination with meeting DSM-III-R criteria display the greatest levels of impairment in the community and have a higher likelihood of reporting parental psychopathology. The current investigation aims to replicate and extend these findings by examining the association between a wide range of childhood adversities with self-perceived need for mental health treatment and DSM-III-R diagnosis in a Canadian community sample (N = 8116). All respondents were questioned about their childhood experiences (physical and sexual abuse, emotional neglect, parental discord/separation, parental death, and parental psychopathology). After controlling for covariates in a multiple logistic regression, we found that emotional neglect (OR = 2.07), physical abuse (OR = 2.16), sexual abuse (OR = 2.39), paternal psychopathology (OR = 2.41), and maternal psychopathology (OR = 2.70) were independently and significantly associated with respondents meeting DSM criteria for a mental disorder and perceiving a need for treatment. These findings underscore the importance of future longitudinal studies considering the influence of a wide range of early childhood adversities on adult psychopathology and perceived need for treatment.     

Complementary alternative medicine use among Chinese Americans: findings from a community mental health service population

OBJECTIVE: Complementary alternative medicine use among Asian Americans is widespread, yet poorly understood. This study explored its use among Chinese Americans reporting mental health symptoms. METHODS: A cross-sectional survey determined the prevalence and correlates of complementary alternative medicine use in an urban sample seen at a community mental health service. RESULTS: Out of 153 Chinese-American patients, 126 (82%) reported current use of complementary therapies (megavitamin therapy, 46%; herbal medicine, 43%; massage, acupuncture, and spiritual healing, about 25% each). Compared with nonusers, users were older, female, employed, less well functioning physically, and less acculturated. CONCLUSIONS: Growing immigrant populations and increasing mental health services consumption by members of ethnic-racial groups in the United States call for more attention to complementary alternative medicine use and its potential to aid conventional medical and mental services delivery.     

Stalking behaviour by patients towards psychiatrists in a large mental health organization

BACKGROUND: Mental health professionals are at greater risk than the general population of being stalked, particularly by patients. AIMS: To assess the prevalence of stalking behaviour by patients towards psychiatrists and ascertain patient characteristics. METHOD: Semi-structured questionnaire to all psychiatrists (n = 324) working in a large mental health organization. RESULTS: The response rate was 61% (n = 198). Forty-one doctors (21%) reported having been stalked by patients, the majority being consultants (n = 31; 76%). No sub-speciality was over-represented. Most stalkers (n = 24; 59%) were male with a diagnosis of personality disorder (39%) or major mental illness (34%). Duration of stalking ranged from several weeks to 16 years, and most commonly occurred at work. On average, victims experienced two types of inappropriate contact. Physical threats were made against 14 psychiatrists (34%). CONCLUSIONS: Stalking by patients towards psychiatrists is common and represents an important occupational risk. Formal training programmes and policy development within healthcare organizations may help manage risk.     

Employee turnover in community mental health organization: A developmental stages study

The purpose of this study was to examine the reasons for employee turnover in community mental-health residential services, and to determine the relationship of workers' developmental stage to those reasons. Three types of variables were collected in the study: 1) Demorgraphics, including tenure and income; 2) Workers' ratings of their effectiveness, satisfaction, desired responsibility, expectancy of leaving the organization, morale, and competence; 3) Workers' ranking of the most important turnover factors for them, at the time of the study. Other personnel data was compiled by the organization for the use of this study. Significant findings were found in all interest areas of this study. The studied organization reached 50% yearly voluntary turnover, and 72% separation rate for the same year. Workers' stages of development found to have significant relationships with the choices workers would make in their selection of turnover factors. Workers in higher stages of development tended to choose higher order turnover factors like rewards and organizational factors. Nevertheless, the most significant factor in a decision to leave a CMH organization was low pay.The research reported in this article is based upon a dissertation submitted in partial fulfillment of the requirement for the degree of Doctor of Education at the University of Massachusetts, Amherst. The author thanks the chairperson of the committee, Prof. Donald Carew, and the members of the committee, Prof. Robert Marx and Dr. Alexander Blount. The author would also like to thank the Center for Human Development and its staff for their participation and important contribution throughout this process.     

Bipolar diagnoses in community mental health: Achenbach Child Behavior Checklist profiles and patterns of comorbidity.

BACKGROUND: There are converging findings about pediatric bipolar disorder (PBD) in terms of associated comorbidity and behavior problem profiles on the Achenbach Child Behavior Checklist (CBCL). However, no study has examined clinical or demographic characteristics of youths clinically diagnosed with bipolar disorder in a low-income, diverse community clinical sample. METHODS: Archival data (N = 3086 cases) from six urban community mental health centers (CMHC) were reviewed to determine the base rate of bipolar disorder and the demographic and clinical characteristics (comorbidity and CBCL profiles) associated with the diagnosis. RESULTS: Roughly 6% of the sample received clinical diagnoses of PBD. Patterns of comorbidity and CBCL profiles were highly similar to published samples. However, elevated CBCL scores were not specific to bipolar disorder, since they were also frequently high for nonbipolar cases. CONCLUSIONS: There appears to be substantial convergence between the demographic and clinical characteristics of cases clinically diagnosed with PBD versus those diagnosed with semistructured research interviews, strengthening the validity of both sets of diagnoses. At the same time, the CBCL appears to do poorly discriminating clinical diagnoses of PBD, due to the pervasive externalizing behavior problems in CMHC samples and the variable presentation of PBD cases.     

Obesity and associated complications in patients with severe mental illnesses: a cross-sectional survey

BACKGROUND: This naturalistic cross-sectional survey of patients with severe mental illnesses explores the association between important variables and obesity, extreme obesity, diabetes mellitus type 2, hypertension, and hyperlipidemia in the clinical environment. METHOD: Weight and height were obtained from 560 patients with severe mental illnesses (including DSM-IV schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder) at central Kentucky inpatient and outpatient facilities to estimate their body mass index (BMI). Chart diagnoses of diabetes mellitus, hypertension, and hyperlipidemia were obtained. RESULTS: When comparing the patients with severe mental illnesses with Kentucky adults from the general population, the odds ratio (OR) of obesity (BMI > or = 30 kg/m(2)) was 2.6 (95% confidence interval [CI] = 2.2 to 3.0), and the OR of diabetes mellitus was 2.9 (95% CI = 2.3 to 3.6). Female gender, African American race, early start of psychiatric medication, and long psychiatric medication duration were significantly associated with obesity. Current alcohol and nicotine use exhibited significant ORs of obesity lower than 1, particularly in males. Obesity was closely associated with hypertension, type 2 diabetes mellitus, and hyperlipidemia. These complications were closely associated with each other and may indicate a further progression of obesity after aging. CONCLUSIONS: These results suggest a complex pattern of variables that may influence the development of obesity and its complications in patients with severe mental illnesses, but they need replication. The major factors associated with obesity appear to be a long-term illness or treatment duration and substance use. The former may be more important in females, while the latter may be more important in males. Clinical diagnoses (schizophrenic or mood disorders) or current treatment did not appear to be fundamental factors.     

Families' perceptions of community mental health programs for their relatives with a severe mental Illness

Realization that families are providing a major portion of the care for people with a severe and persistent mental illness has led to attempts to form an alliance with such families. Many professionals are aware that there is much cognitive distance between families and the professional community. Bridging this gap requires knowledge of the subjective experience of families. This paper reports the results of a study of the families' perspective of their experience with community mental health programs. Attention is given to the families' experience and needs; to changes in practice which address those needs; and to a variety of curriculum strategies for more adequately preparing future cadres of mental health professionals.     

Assessment of community functioning in people with schizophrenia and other severe mental illnesses: a white paper based on an NIMH-sponsored workshop

People with schizophrenia frequently have significant problems in community functioning. Progress in developing effective interventions to ameliorate these problems has been slowed by the absence of reliable and valid measures that are suitable for use in clinical trials. The National Institute of Mental Health convened a workgroup in September 2005 to examine this issue and make recommendations to the field that would foster research in this area. This article reports on issues raised at the meeting. Many instruments have been developed to assess community functioning, but overall insufficient attention has been paid to psychometric issues and many instruments are not suitable for use in clinical trials. Consumer self-report, informant report, ratings by clinicians and trained raters, and behavioral assessment all can provide useful and valid information in some circumstances and may be practical for use in clinical trials. However, insufficient attention has been paid to when and how different forms of assessment and sources of information are useful or how to understand inconsistencies. A major limiting factor in development of reliable and valid instruments is failure to develop a suitable model of functioning and its primary mediators and moderators. Several examples that can guide thinking are presented. Finally, the field is limited by the absence of an objective gold standard of community functioning. Hence, outcomes must be evaluated in part by "clinical significance." This criterion is problematic because different observers and constituencies often have different opinions about what types of change are clinically important and how much change is significant.     

Management of complex and severe personality disorders in community mental health services

PURPOSE OF REVIEW: To describe the prevalence and specific management of severe and complex personality disorders in community mental health services and similar settings. RECENT FINDINGS: Conflicting reports exist in the literature but the consensus of evidence suggests that more complex personality disorder (more so than simple personality disorder) impairs response to treatment of most psychiatric disorders and complicates their management. Poor adherence to treatment may be one of the mechanisms underlying this. SUMMARY: Increasing evidence now suggests that more complex and severe personality disorders have a negative impact on the outcome of most psychiatric disorders. Some indications, however, are there to show that pharmacological treatments may not handicap the outcome of pharmacological treatment as much as other types of intervention and may be selectively chosen in this group. Severe personality disorder needs to be identified early in community services as by anticipating and adjusting to its effects it is likely to improve treatment plans and prognosis.