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This paper describes a novel approach to engaging psychiatric patients in care after discharge from inpatient or ER treatment. The Access Group model provides rapid, flexible, high-volume intake for up to 20 patient referrals per day. Patients are scheduled for intake by referring hospital clinicians using an online scheduling software and can be seen within 1-3 days of hospital discharge. Access allows flexibility, easy rescheduling, and limited wait time. At intake, patients and family members participate in a structured group intake procedure from which they are scheduled for follow-up psychiatry, therapy, and social work appointments. Same-day appointments are available for urgent needs. Initial evidence suggests that the Access Group model is effective at providing rapid access to and engagement in care, and is acceptable to patients. Generalizability and funding approaches for the model are discussed.

The movement towards managed care in the public mental health system has surpassed efforts to develop a systematic literature concerning its theory, practice, and outcome. In particular little has been written about potential challenges and difficulties in translating managed care systems from their origins in the private sector to the delivery of public sector mental health services. This paper provides an overview of managed care definitions, organizational arrangements, administrative techniques, and roles and responsibilities using a theoretical framework adopted from economics referred to as principal-agent theory. Consistent with this theory, we assert that the primary function of the managed care organization is to act as agent for the payor and to manage the relationships between payors, providers, and consumers. From this perspective, managed care organizations in the public mental health system will be forced to manage an extremely complex set of relationships between multiple government payors, communities, mental health providers, and consumers. In each relationship, we have identified many challenges for managed care including the complexity of public financing, the vulnerable nature of the population served, and the importance of synchronization between managed care performance and community expectations for the public mental health system. In our view, policy regarding the role of managed care in the public mental health system must evolve from an understanding of the dynamics of government-community-provider-consumer "agency relationships".

Many nonpsychiatrists are now functioning as psychiatric team leaders and ward administrators. Some authors have pointed out several advantages of this organizational arrangement, whereas others have reported on the problems that can and do arise. Specifically, conflicts between nonphysician team leaders and psychiatrists have been reported. Yet little has been written about the precise nature and cause of these conflicts. This paper attempts to assess the roles of the team leader and psychiatrist in order to discover areas of role overlap and conflicts. It is suggested that more formal structure and clarity in role delineation could eliminate many such conflicts.

Good principles and practices of community mental health have been demonstrated by religious communities and leaders within these communities for many years. Using Caplan's model of primary-secondary-tertiary prevention, this paper articulates the unique and cooperative contributions of present-day religious institutions and personnel to the total community mental health endeavor. The validity of church's and clergy's involvement is supported by research data and is consistent with the social-psychological models of conceptualizing emotional problems. Consultation from mental health professionals can aid churches and clergy to actualize even more fully their contributions to community mental health.

This paper describes a community psychology program that was based in a pediatrician's office in a rural community. Three broad categories of psychological problems were encountered: (1) emotional disturbance, (2) developmental delay in children, and (3) ineffective child management procedures used by parents. The advantages and the problems involved in using the pediatric office as a setting to provide primary mental health care to children and families are outlined.

This paper is an attempt to look at mental health consultation from a variety of different points of view; to distinguish it from clinical consultation and direct services to patients; to relate it to mental health and mental illness, social handicap, and social functioning; to program goals and caretaker populations; and, finally, to discuss evaluation both in terms of current studies and future needs.