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Purpose The interplay between critical illness and mental disorders is poorly understood. The purpose of this study is to measure both the treated prevalence of mental disorders and psychotropic medication use before and after hospitalization and the impact of intensive care unit (ICU) admission on these outcomes. Methods Using a population-based administrative database in Manitoba, Canada, 49,439 ICU patients admitted between 2000 and 2012 were compared to two matched comparison groups (hospitalized; n = 146,968 and general population; n = 141,937). Treated prevalence of mental disorders and psychotropic medication prescriptions were measured in the 5-year periods before and after the hospitalization. Multivariable models compared adjusted prevalence ratios (APRs) between populations. Results The 5-year treated mental disorder prevalence in the ICU population increased from 41.5% pre-hospitalization to 55.6% post-hospitalization. Compared to non-ICU hospitalized patients, the adjusted treated mental disorder prevalence in ICU patients was lower prior to hospitalization (1-year APR 0.94, 95% CI 0.92-0.97, p < 0.0001; 5-year APR 0.99, 95% CI 0.98-1.00, p = 0.1), but higher following discharge (1-year APR 1.08, 95% CI 1.05-1.11, p < 0.0001, 5-year APR 1.03, 95% CI 1.01-1.05, p < 0.0001). A high proportion of ICU patients received antidepressant, anxiolytic and sedative-hypnotic prescriptions before and after their hospitalization. In multivariable analyses, ICU exposure was associated with an increase in mood, anxiety and psychotic disorders, and sedative-hypnotics use (p < 0.0001 for all Time x Group interactions). Conclusions During the 5 years after admission to ICU, there is a significant increase in treated prevalence of mental disorders and psychotropic medication use compared to the 5 years prior to ICU and compared to general population and hospital cohorts. Prevention and intervention programs that identify and treat mental disorders among survivors of critical illness warrant further study., Author(s): Kendiss Olafson [sup.1], Ruth Ann Marrie [sup.1] [sup.2], James M. Bolton [sup.2] [sup.3] [sup.4], Charles N. Bernstein [sup.1], O. Joseph Bienvenu [sup.5], Maia S. Kredentser [sup.6], Sarvesh Logsetty [sup.3] [...]

The goal of this study was to examine caregiver agreement to hear about local research opportunities by joining a clinical research registry. Data from this cross-sectional study were gathered, between 2014 and 2017, across two outpatient clinics: (1) a multidisciplinary Autism Spectrum Disorder (ASD) clinic (N = 5228) and (2) a general psychology clinic serving youth with, or at risk for, a neurodevelopmental disorder (NDD; N = 5040). Overall, more than 8 in 10 caregivers agreed to join the registry. Several child clinical characteristics, as well as racial and sociodemographic factors, were predictive of parental agreement. Findings suggest caregivers of youth with ASD and NDD are amenable to joining the local research enterprise, however further work is needed to understand why some caregivers decline., Author(s): L. Kalb [sup.1] [sup.2] [sup.4] , L. Jacobson [sup.1] [sup.3] , C. Zisman [sup.1] , E. Mahone [sup.1] [sup.3] , R. Landa [sup.2] [sup.3] , G. Azad [sup.2] [sup.4] [...]

OBJECTIVES: Mental health and substance use have been identified as health priorities currently facing Indigenous peoples in Canada; however, accessible and culturally relevant population health data for this group are almost non-existent. The aim of the Our Health Counts study was to generate First Nations adult population health data in partnership with the De dwa da dehs ney>s Aboriginal Health Access Centre in Hamilton, Ontario. METHODS: Analysis involved data gathered through respondent-driven sampling. Prevalence estimates and 95% confidence intervals were generated for diagnosis and treatment of a psychological disorder or mental illness, depression, anxiety, post-traumatic stress disorder (PTSD) and suicide, alcohol and substance use, and access to emotional support. RESULTS: Of the 554 First Nations adults who participated in the Our Health Counts study in Hamilton, 42% had been told by a health care worker that they had a psychological and/or mental health disorder. High rates of depression (39%) and PTSD (34%), as well as suicide ideation (41%) and attempts (51%) were reported. Half of the sample reported marijuana use in the previous 12 months, and 19% reported the use of cocaine and opiates. CONCLUSION: First Nations adults living in Hamilton experience a disproportionate burden of mental health and addictions. By working in partnership with urban Aboriginal organizations, it is possible to produce policy- and service-relevant data and address the current deficiency in appropriate mental health and substance use services for urban Aboriginal people. KEY WORDS: Canada; urban Aboriginal health; First Nations; community-based research; respondent driven sampling; mental health; substance use Can J Public Health 2015;106(6):e375-e381 doi: 10.17269/CJPH.106.4923 OBJECTIFS: La sante mentale et la consommation de substances sont considerees comme deux enjeux prioritaires pour la sante des peuples autochtones au Canada a l'heure actuelle; cependant, les donnees de sante des populations accessibles et culturellement appropriees sur ce groupe sont presque inexistantes. L'objet de l'etude Our Health Counts etait de produire des donnees de sante des populations sur les adultes des Premieres Nations, en partenariat avec le Centre autochtone d'acces aux soins de sante De dwa da dehs ney>s de Hamilton (Ontario). METHODE: Nous avons analyse des donnees recueillies par echantillonnage en fonction des repondants. Des estimations de prevalence et des intervalles de confiance de 95 % ont ete generes pour le diagnostic et le traitement d'un trouble psychologique ou d'une maladie mentale, la depression, l'anxiete, l'etat de stress post-traumatique (ESPT), le suicide, la consommation d'alcool et de substances et l'acces au soutien affectif. RESULTATS: Des 554 adultes des Premieres Nations ayant participe a l'etude Our Health Counts a Hamilton, 42 % avaient ete informes par un travailleur de la sante qu'ils avaient un trouble psychologique et/ou de sante mentale. Des taux eleves de depression (39 %) et d'ESPT (34 %), ainsi que d'ideation suicidaire (41 %) et de tentatives de suicide (51 %) ont ete declares. La moitie de l'echantillon a dit avoir consomme de la marijuana au cours des 12 mois anterieurs, et 19 % ont dit avoir consomme de la cocaine et des opiaces. CONCLUSION: Les adultes des Premieres Nations vivant a Hamilton portent un fardeau disproportionne de troubles mentaux et de toxicomanie. En travaillant en partenariat avec des organismes autochtones en milieu urbain, il est possible de produire des donnees utiles pour les politiques et les services et de repondre au manque actuel de services en sante mentale et en toxicomanie pour les Autochtones en milieu urbain. MOTS CLES: Canada; sante autochtone en milieu urbain; Premieres Nations; recherche communautaire; echantillonnage en fonction des repondants; sante mentale; consommation de substances, In Canada, cycles of family disruption, abuse, colonization, dislocation from traditional lands and outlawing of spiritual practices among Aboriginal * peoples have led to many health and social inequities. (1,2) [...]

Despite an abundance of literature documenting the prevalence and dangers of youth tobacco use, there is a relative dearth of literature in the area of effective cessation treatments for youth (Fiore et al. in Clinical tobacco guideline: treating tobacco use and dependence, 2008). Additionally, although it has been widely accepted that mental illness is highly correlated with tobacco use and dependence, little research has been done to support prevention and cessation efforts for youth with mental illnesses. This paper summarizes the literature on tobacco use and cessation in youth, with a focus on describing the existing knowledge base for youth with mental illnesses. Keywords Tobacco * Mental illness * Adolescent * Prevention * Cessation, Much research has been conducted in the area of adolescent tobacco use, and the prevalence rates and adverse effects have been clearly documented (Kessler et al., 1997). Additionally, the association [...]

This is a personal account of the clinical work done in the Palestinian Territories by a clinical psychologist working with an international medical Non Governmental Organization (NGO). In her interventions the author used mindfulness-based therapy with people who suffered from severe psychological distress due to the political conflict. Such interventions can be therapeutic and heal deep suffering, whilst offering clients coping strategies when possibly facing other traumatic events in a situation of 'chronic emergency' such as the one that people have to face in a country that has been under military occupation for over 40 years. Using a case study approach, the author discusses the intervention with two women, one suffering from post-traumatic stress disorder (PTSD) following the loss of her baby after being kept at a military check-point, and the other suffering from depression following the killing of her son. The mindfulness-based intervention allowed them to explore a therapeutic approach which helped them to overcome their symptoms and 'get unstuck'. Keywords Mindfulness-based therapy * Political violence * Trauma * Israel * Palestine DOI 10.1007/s10826-009-9328-0

Objective: This study aimed at identifying the gaps, barriers and successes/solutions associated with mental health services in Mi&apos;kmaq communities in Nova Scotia. Methods: Community-based participatory research, which is consistent with Ownership, Control, Access and Possession principles of research with Aboriginal communities, was employed for this work. Health directors of the 13 Mi&apos;kmaq communities in Nova Scotia were involved with the research question, design and write-up of the study. This qualitative descriptive study consisted of open-ended structured interviews with consumers, family members and health care providers. Systematic data collection and analysis of interviews present an understanding of issues of mental health services in the communities. Results: The findings identified barriers and successes/solutions in mental health services in First Nations communities, where services and resources are different from those in more urban communities. Core programs, covering aspects of education, collaboration and culturally relevant community-based services, were identified as solutions to problems identified by participants. Service providers specified core funding for services as essential for continuity and sustainability. Discussion: While efforts have been made in the past to address mental illness in Mi&apos;kmaq communities, many of these efforts have been proposal driven or crisis oriented. The need for community-based, culturally appropriate, coordinated and sustainable services is evident on the basis of the study&apos;s findings. The final report has been disseminated to local community members, participants, Atlantic First Nations and Inuit Health Branch, the Provincial Department of Health and the Atlantic Policy Congress to provide evidence that can inform policy and practice related to mental health in Mi&apos;kmaq communities in Nova Scotia. Key words: First Nations; mental health; community-based participatory research; OCAP principles La traduction du resume se trouve a la fin de l&apos;article. Can j Public Health 2009;100(6):432-35. Objectif : Reperer les lacunes, les obstacles et les reussites/solutions associes aux services de sante mentale dans les communautes Mi&apos;kmaq de la Nouvelle-Ecosse. Methode : Nous avons employe la recherche participative communautaire, car elle respecte les principes d&apos;appropriation, de controle, d&apos;acces et de possession (ACAP) de la recherche aupres des communautes autochtones. Les directeurs des services de sante des 13 communautes Mi&apos;kmaq de la Nouvelle-Ecosse ont participe a l&apos;elaboration des questions de recherche, a la conception et a la redaction de l&apos;etude. Qualitative et descriptive, cette etude comportait des entrevues dirigees avec des questions ouvertes menees aupres d&apos;usagers, de membres de leur famille et du personnel soignant. La collecte et l&apos;analyse systematiques des donnees d&apos;entrevues a permis de comprendre les enjeux des services de sante mentale dans ces communautes. Resultats : Nous avons releve a la fois des obstacles et des reussites/solutions dans les services de sante mentale des communautes des Premieres nations; dans ces communautes, les services et les ressources sont differents de ce que l&apos;on trouve en milieu urbain. Les problemes signales par les participants semblent pouvoir etre resolus par des programmes de base couvrant a la fois l&apos;instruction, la collaboration et les services communautaires adaptes aux differences culturelles. Et selon les fournisseurs de services, le financement de base est essentiel a la continuite et a la viabilite des services. Discussion : Ce n&apos;est pas la premiere fois que l&apos;on s&apos;attaque a la maladie mentale dans les communautes Mi&apos;kmaq, mais bon nombre des efforts passes ont decoule de propositions de projets ou ont ete deployes en situation de crise. Notre etude montre qu&apos;il existe clairement un besoin de services communautaires adaptes aux differences culturelles, coordonnes et durables. Le rapport final a ete diffuse aux residents locaux, aux participants, a la Direction generale de la sante des Premieres nations et des Inuits--Region de l&apos;Atlantique, au ministere provincial de la Sante et a l&apos;Atlantic Policy Congress [of First Nations Chiefs]; les donnees probantes qu&apos;on y trouve peuvent eclairer les politiques et les pratiques en sante mentale dans les communautes Mi&apos;kmaq de la Nouvelle-Ecosse. Mots cles : Premieres nations; sante mentale; recherche participative communautaire; principes ACAP, Nationally, mental health has been identified as the top health priority by the Assembly of First Nations. (1,2) Regionally, the Mi'Kmaq Health Research Group has identified areas for improvement, a [...]

Objectives: There is a well-established association between gender and the prevalence of mental illness. The objective of this study was to determine whether gender also influences the timing of remission from illness. The regression analysis undertaken considered remission in terms of all ICD-9 mental disorders (codes 290-314). This analysis compares males and females on average length of treatment for mental illness and examines whether any gender differences in remission are generalized or disorder specific. Methods: The statistical analysis was based on longitudinal (1990-2001) administrative data on 5,118 females and 2,470 males. The target population represented all individuals with an ICD-9 diagnosis of mental illness who were treated through the Medical Services Plan in British Columbia. The regression analysis used the generalized estimating equations method to model differences in length of treatment. Results: There was a non-significant bivariate relation between gender and the timing of remission from mental illness. However, the multivariate findings demonstrated that a significant gender effect on remission emerges after controls were introduced for demographic and socio-economic characteristics. In particular, the timing of remission was somewhat longer for females. This effect was generalized and not restricted to specific illnesses. Conclusions: The emergence of a significant effect after considering demographic and socio-economic characteristics suggests that a social disadvantage within the male sample (more single males) was suppressing a small negative effect of female gender on the timing of remission. In other words, a social disadvantage among males concealed an unexplained female disadvantage in remission. Key words: Gender; remission; mental health La traduction du resume se trouve a la fin de l&apos;article. Objectifs : Il existe un lien confirme entre le sexe et la prevalence des maladies mentales. Nous avons cherche a determiner si le sexe influencait aussi le moment des remissions de ce genre de maladies. Au moyen d&apos;une analyse de regression, nous avons etudie les remissions de tous les troubles mentaux enumeres dans la CIM-9 (codes 290 a 314). L&apos;analyse comparait la duree moyenne des traitements pour maladie mentale chez les hommes et les femmes afin de deceler d&apos;eventuels ecarts entre les sexes dans les remissions et de determiner si ces ecarts etaient generalises ou propres a certains troubles. Methode : Notre analyse statistique etait fondee sur les donnees administratives longitudinales (1990-2001) de 5 118 femmes et de 2 470 hommes. La population cible englobait toutes les personnes presentant un diagnostic de maladie mentale selon la CIM-9 qui avaient ete traitees par le regime de sante de la Colombie-Britannique. Dans l&apos;analyse de regression, nous avons utilise la methode des equations d&apos;estimation generalisees pour modeliser les ecarts dans la duree des traitements. Resultats : Nous observons une relation bivariee non significative entre le sexe et le moment des remissions des maladies mentales. Cependant, les resultats de l&apos;analyse multivariee montrent l&apos;emergence d&apos;un effet sexospecifique significatif apres l&apos;introduction de variables de controle demographiques et socioeconomiques. En particulier, les remissions sont un peu plus tardives chez les femmes. Cet effet est generalise : il ne se limite pas a certaines maladies. Conclusion : L&apos;emergence d&apos;un effet significatif lorsqu&apos;on tient compte de variables demographiques et socioeconomiques donne a penser que l&apos;existence d&apos;un desavantage social dans l&apos;echantillon masculin (compose de plus de celibataires) a annule un leger effet nefaste dans le moment des remissions chez les femmes. Autrement dit, un desavantage social chez les hommes masquait un desavantage inexplique sur le plan des remissions chez les femmes. Mots cles : sexospecificite; remission; sante mentale, Gender differences in the prevalence of mental illness are well documented, (1-6) but whether gender also influences the timing of remission is unclear. Do the factors that contribute to a [...]

Integration and normalization are goals within the community-based care of people with mental illness. The implementation of this care policy has led to increased contact between people with mental illness and so-called normal people and society at large. But we know little about how this change affects the former patients' identity and experience of stigma and stereotyping. This study is based on qualitative interviews with people with mental illness (N=15) living in rural communities in four different municipalities. The focus in the study is on the informants' subjective experiences and the results show that they adapt in different ways, depending on how they negotiate their identity. Those who accept their role as 'mental patients' seem to have easier access to services, they experience less stigmatization and fewer conflicts with their surroundings than those who oppose the patient role. Seem from our informants' perspectives there seems to be a simple definition of integration: Being integrated is feeling accepted as yourself. Some implications for policy and mental health services are discussed. KEY WORDS: mental illness; identity; stigma; community integration.

The trend toward adopting a strengths approach to mental health practice with children and adolescents amounts to a paradigm shift from an emphasis on diagnosing disorders to tapping child capacities and assets toward the achievement of treatment goals. While the potential value and challenges associated with this shift has received ample attention in the literature, minimal research has been conducted to assess the benefits and barriers related to the use of strength-based strategies with youth. Utilizing an experimental design, this author examined the impact of strength-based assessment using the Behavioral and Emotional Rating Scale (BERS) with seriously emotionally or behaviorally disturbed children and adolescents. Results revealed that child functioning outcomes were significantly better for youth who received BERS-guided assessment versus the usual deficit-based assessment protocol only when the treating therapist reported an orientation toward service that reflects highly strength-based attitudes and practices. Furthermore, high adherence to the strength-based assessment protocol was associated with significantly higher parent satisfaction with services and lower rates of missed appointments. These findings highlight the importance of accounting for practitioner effects and treatment fidelity in future studies of strength-based practice effectiveness. KEY WORDS: strength-based assessment; children's mental health; practitioner orientation.

In this introduction to a special issue, the author suggests that a third generation of research on subjective well-being has emerged that is focused on health and human development as the presence of well-being (i.e., health) and not merely the absence of illness, disease, and developmental deficiencies. In turn, this article describes the construct of subjective well-being, its historical ties to the aftermath of World War II and the creation of the National Institute of Mental Health, its conceptual foundations, and empirical evidence supporting the view that it consists of two theoretical traditions--hedonia and eudaimonia. The nearly 50 years of research on subjective well-being has yielded as many as 13 distinct dimensions of subjective well-being in the United States. Consequently, new directions in subjective well-being are emerging such as the study of mental health as a complete state, which suggest the need for greater scientific attention to the integration of hedonic and eudaimonic measures and theory.

The purpose of this cross-sectional study was to examine the number and type of active medical conditions among psychiatric patients treated by an assertive community treatment (ACT) team in an urban setting. Psychiatric hospitalization admission and discharge summaries of 70 patients were reviewed, and case managers on the treatment team were interviewed. Patients had a median of three active medical conditions. Osteoarthritis, hypertension, viral Hepatitis C infection, gastroesophageal reflux disease (GERD), and reactive airway disease were the most common active medical illnesses. The majority of patients were cigarette smokers and were diagnosed with alcohol or illicit substance use disorders, which were associated with viral hepatitis C infection and reactive airway disease in this patient population. KEY WORDS: mental illness; assertive community treatment; medical illness; tobacco; substance abuse.

Leverage is often applied to persons with mental illnesses who live in the community to encourage them to adhere to treatment. Given the underlying assumption that the targets of such leverage are unable to make good decisions about treatment on their own, one might expect that decisional incapacity regarding treatment would correlate with the use of leverage. As part of a multi-site study of leverage in community treatment, 120 subjects at two sites reported on their leverage experiences and completed a decisional capacity assessment with the MacCAT-T. No strong or consistent associations were found between capacity and use of leverage, raising questions about the basis on which decisions to employ leverage are being made. KEY WORDS: leverage; adherence; capacity; competence.

This brief report reviews recent updates to the S.A.F.E. Program, a family psychoeducational intervention for serious mental illness created in the Veterans Affairs (VA) system. The improvements and significant content additions to the curriculum are outlined. Further, positive five-year program evaluation data are described, including high levels of participant retention and satisfaction. Program attendance is positively correlated with understanding of mental illness, awareness of VA resources, and ability to engage in self-care activities--and inversely correlated with caregiver distress. This data lays the groundwork for a randomized clinical trial and raises questions about the necessity of diagnostic-specific family programming. KEY WORDS: serious mental illness; family psychoeducation; veteran; PTSD; family therapy.

This study utilized a large clinical dataset of patients representative of those in routine U.S. psychiatric practice to assess the influence of sociodemographic variables and diagnostic class on health plan membership (public or private). Data on patients with schizophrenia or other psychotic disorders (n=288) and patients with mood or anxiety disorders (n=1304) were obtained from a cross-sectional practice-based survey conducted by the American Psychiatric Institute for Research and Education. The likelihood of health plan membership was lower among males and among those from a minority race/ethnicity. Health plan membership was also affected by educational attainment and employment status. Even after controlling for these sociodemographic determinants of health plan membership, individuals with schizophrenia/other psychotic disorders were significantly less likely to belong to a health plan than those with mood/anxiety disorders. KEY WORDS: disparities; health plan; insurance; psychosis; schizophrenia.

Byline: Kam-shing Yip (1) Keywords: community mental health in China; mental health service; mental health policy Abstract: Community mental health has long been the crucial modality in service delivery of mental health services. This paper is an attempt to evaluate community mental health services in the People's Republic of China. The writer critically argues that community mental health services in the People's Republic of China still have faced a lot of difficulties such as huge demand but scarce resources, withdrawal of governmental funding in related services, inaccessibility of services to deprived and remote rural areas, political control, high mental health illiteracy and problems in formation of multidisciplinary team. An articulation of community mental health in the China context is also discussed. Author Affiliation: (1) Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Article History: Registration Date: 25/10/2005 Online Date: 28/03/2006

Previous research suggests that consumer operated services facilitate recovery from serious mental illness. In part I of this series, we analyzed the content of the GROW program, one example of a consumer operated service, and identified several processes that Growers believe assists in recovery. In this paper, we review the qualitative interviews of 57 Growers to determine what actual participants in GROW acknowledge are important processes for recovery. We also used the interviews to identify the elements of recovery according to these Growers. Growers identified self-reliance, industriousness, and self-esteem as key ingredients of recovery. Recovery was distinguished into a process--an ongoing life experience--versus an outcome, a feeling of being cured or having overcome the disorder. The most prominent element of GROW that facilitated recovery was the support of peers. Gaining a sense of personal value was also fostered by GROW and believed to be important for recovery. The paper ends with a discussion of the implications of these findings for the ongoing development of consumer operated services and their impact on recovery. KEY WORDS: recovery; rehabilitation; qualitative research.

This study investigated the relationship between individual and job characteristics of mental health social workers and professional dissonance--an experienced conflict between values and job tasks. A 33-item questionnaire, designed specifically for the study's purposes was utilized. A total of 320 usable study questionnaires were returned (44.5% response rate). The primary study hypothesis, that professional dissonance is related to individual and job characteristics, was partially supported by the data. While job characteristics appeared to have little influence on dissonance, several individual characteristics of the respondents were statistically related to level of dissonance. Specifically, men with the most years of experience and with lower reported attachment to self-determination reported higher levels of dissonance. Study participants affirmed the importance of life-long supervision in managing dissonance in practice. KEY WORDS: mental health practice; values; dissonance; involuntary treatment.

The role of state mental health authorities (SMHA) is critical to implementing and sustaining evidence-based practices. This paper describes the seven major tasks of SMHA's that comprise that role and provides examples from states which have been actively pursuing evidence-based practices. KEY WORDS: mental health administration; evidence-based practice; mental health policy; state mental health authorities.

Family intervention for serious mental illness is known to be highly efficacious in reducing patient relapse, improving social functioning, enhancing caregivers' knowledge of mental illness, and ultimately reducing overall costs of care. However, very few families receive services. The reasons for this gap between empirical findings and program implementation are complex and not yet fully understood. Prochaska and DiClemente's Readiness to Change Model provides a helpful structure for understanding key issues for the four relevant stakeholders (patients, family members, clinicians and administrators). Staging each stakeholder group and applying corresponding 'interventions' (processes of change) are useful in a site's implementation of family services. KEY WORDS: family education; family psychoeducation; serious mental illness; readiness to change; Transtheoretical Model.

Psychometric properties of a brief self-report measure of personal loss for adults coping with psychiatric disability are examined. The Personal Loss from Mental Illness Scale (PLMI) is a 20-item measure that assesses overall perceptions and four interrelated aspects of personal loss from mental illness. Using a sample of 158 adults with serious mental illness, the PLMI was found to have a meaningful factor structure, good internal consistency and high test-retest reliability. Construct validity is evidenced by positive correlations between personal loss scores, number of psychiatric hospitalizations, self-reports of loneliness, psychological symptoms, and problems with alcohol. PLMI scores were unrelated to scores on a personal growth measure and negatively correlated with scores on a positive well-being scale. Implications of the PLMI for research on coping, adaptation and recovery from serious mental illness are discussed. KEY WORDS: personal loss; serious mental illness; instrument; scale; recovery.

Family intervention for serious mental illness is known to be highly efficacious in reducing patient relapse, improving social functioning, enhancing caregivers' knowledge of mental illness, and ultimately reducing overall costs of care. However, very few families receive services. The reasons for this gap between empirical findings and program implementation are complex and not yet fully understood. Prochaska and DiClemente's Readiness to Change Model provides a helpful structure for understanding key issues for the four relevant stakeholders (patients, family members, clinicians and administrators). Staging each stakeholder group and applying corresponding 'interventions' (processes of change) are useful in a site's implementation of family services. KEY WORDS: family education; family psychoeducation; serious mental illness; readiness to change; Transtheoretical Model.

The two of the most commonly advocated service improvement proposals for adults with severe mental illnesses are to redesign services based on recovery principles and to increase the availability of services with strong research support. The two improvement strategies complement and inform each other much more than they conflict. To improve, the field needs the insights of people who have personally experienced severe mental illnesses and it needs the scientific process. Applied together, the two strategies can guide the development of an optimal service system: The kind of service system that most people would want for themselves or their family should they have the need. KEY WORDS: severe mental illness; schizophrenia; illness management; psychiatric rehabilitation, recovery.

This research assessed the extent of unmet service need for rural youth with mental health (MH) and/or substance use (SU) problems. All adolescents (12-18 years old) living in a three-county region of Iowa and discharged from outpatient MH or SU treatment were included (n = 177). Chart review was used to retrospectively assess service utilization and clinical characteristics at time of admission and discharge. Two-thirds (64%) of adolescents with co-occurring disorders did not receive treatment consistent with widely supported guidelines recommending that individuals with co-occurring disorders receive treatment for both their MH and SU problems. Higher severity of depression, more supports, prior MH service utilization and lower prevalence of prior abuse predicted the receipt of dual services. Finally, adolescents with co-occurring problems who received only MH treatment showed improvement on MH needs at discharge but no improvement on SU needs. Similarly, adolescents with co-occurring problems who received only SU treatment showed improvement on SU needs but not on MH needs. There is considerable unmet treatment need among rural adolescents with co-occurring disorders. Efforts to improve care must focus on adolescent, familial, program, funding and policy factors that act as barriers to unifying philosophies and practices needed to advance appropriate care. KEY WORDS: mental health; substance abuse; adolescents; rural; community-based services.

This study examined mental health and attachment problems in children in foster care. This study also obtained data concerning the validity of the Randolph Attachment Disorder Questionnaire (RADQ). Children were selected according to length of time in placement and age and screened for mental health symptoms using the Child Behavior Checklist and the RADQ. The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care. KEY WORDS: Attachment; Foster Care; Randolph Attachment Disorder Questionnaire.

The role of 12-step programs and 12-step-oriented treatments for dually diagnosed individuals (DDI) remains unclear. Here are presented the results of a pilot study in which 10 seriously mentally ill patients received a modified 12-step facilitation (TSF) therapy emphasizing engagement of DDI in a specialized 12-step program for DDI. Participants significantly increased their 12-step attendance and decreased their substance use during the 12 weeks of treatment. Larger and longer-term studies are needed to assess the efficacy of modified TSF for DDI relative to other treatments, and to determine what forms of TSF are most effective in this population.

Byline: Friedhelm Meyer (1), Jurgen Matzat (2), Anke Hoflich (1), Sigrid Scholz (1), Manfred E. Beutel (1) Keywords: Self-help groups; Psychiatric and psychosomatic disorders; Care system Abstract: Self-help groups have found increasing recognition by health professionals in recent years. However, considerable research deficits remain, particularly regarding self-help groups for persons with psychiatric and psychosomatic disorders. We present a survey on the dissemination and differentiation of such groups in Germany and their support by self-help advice centres. Most likely, more than 5,000 of these groups exist covering a broad range of psychiatric disorders, particularly groups for families and partners, bereavement, anxiety disorders, depression, and eating disorders. These groups are supported by self-help advice centres in various ways from information to group counselling in difficult periods. The results of the survey encourage further in depth study of self-help groups, their cooperation with psychotherapists, and their health promoting potentials. Author Affiliation: (1) Klinik fur Psychosomatik und Psychotherapie, Friedrichstrasse 28, , 35392, Giessen, Germany (2) Kontaktstelle fur Selbsthilfegruppen, Friedrichstrasse 33, 35392 , Giessen, Germany Article History: Registration Date: 13/09/2004 Received Date: 22/03/2004 Accepted Date: 10/08/2004 Online Date: 21/10/2004 Article note: Funded by BKK Bundesverband, project grant 'Self-help groups for psychiatric and psychosomatic disorders'.

This study investigated the importance of competitive work as compared to participating in community-based activities and having no regular daily activity for people with long-term mental illness. One hundred and three persons visiting an outpatient unit and representing the three targeted occupational conditions were randomized to the study and assessed on satisfaction with daily occupations, health, and wellbeing. Persons with work were more satisfied with their daily occupations and were interviewer-rated as better functioning than the other groups, but the groups did not differ on self-ratings of health and wellbeing. Unexpectedly, people participating in community-based activities did not show better satisfaction or functioning than those without regular daily activity. It was concluded that competitive work should be an urgent end goal for services designed for occupational or vocational support. KEY WORDS: daily occupations; work; mental illness: health: wellbeing; psychiatry.

This study compared the effectiveness of the behavioral model to predict two service utilization variables: case manager visits and total services used. Nearly 4000 individuals who were homeless and suffered from severe mental illness provided data for the study. Enabling variables explained more variance of both service utilization variables than predisposing or need variables. Social support from professionals was the strongest predictor for both service utilization variables. KEY WORDS: behavioral model; service utilization; social support.

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. KEYWORDS: stigma; mental illness; mental health services.

Objective: Little research is conducted on service closures. We examined the social, clinical and service use impact of the closure of a partial hospitalisation service (day hospital) on its users. Methods: Patients attending the closing day hospital were studied at closure and one year after, and compared to patients at an unchanged day hospital. Results: The closure did not increase use of inpatient beds, primary care or emergency room. Overall clinical improvements were similar for both groups as were costs. Social networks of the discharged patients decreased. Conclusions: Closures of services need to be as carefully evaluated as new developments. KEY WORDS: partial hospitalization; mental illness; service closure.

Byline: Katherine I. Morley (1), Wayne D. Hall (1) Keywords: Pharmacogenetics; Pharmacogenomics; Bioethical issues; Socioeconomic factors; Psychopharmacology Abstract: Current pharmacotherapies for psychiatric disorders are generally incompletely effective. Many patients do not respond well or suffer adverse reactions to these drugs, which can result in poor patient compliance and poor treatment outcome. Adverse drug reactions and non-response are likely to be influenced by genetic polymorphisms. Pharmacogenetics holds some promise for improving the treatment of mood disorders by utilising information about genetic polymorphisms to match patients to the drug therapy that is the most effective with the fewest side effects. Pharmacogenomics promises to facilitate the development of new drugs for treatment. However, these technologies raise many ethical, economic and regulatory issues that need to be addressed before they can be integrated into psychiatry, and medicine more generally. We discuss ethical and policy issues arising from pharmacogenetic testing and pharmacogenomics research, such as informed consent, privacy and confidentiality, research on vulnerable persons and discrimination and economic viability of pharmacogenetics and pharmacogenomics. We conclude with recommendations for the regulation and distribution of pharmacogenetic testing services and pharmacogenomic drugs. Author Affiliation: (1) Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, 4072, St. Lucia, Queensland, Australia Article History: Received Date: 29/04/2003 Accepted Date: 09/09/2003 Online Date: 04/11/2003

Byline: M. G. Starchenko (1), N. P. Bechtereva (1), I. V. Tamatorin (2), V. L. Sazhin (2), S. I. Dobrovol'skii (2) Abstract: The influence of the drug dilantin on the mental state of humans in the presence of objective neuroticizing factors (restriction of freedom and the concomitants) was studied. A positive effect of the drug on the emotional state of prisoners, namely, decreases in the levels of reactive and personal anxiety and depression, as well as in the probability of the development of neurotic disorders, was shown. Author Affiliation: (1) Institute of the Human Brain, Russian Academy of Sciences, ul. Akademika Pavlova 9, St. Petersburg, 197022, Russia (2) Medical Department for St. Petersburg and Leningrad oblast, Main Directorate of Corrections, Ministry of Justice of the Russian Federation, St. Petersburg, Russia Article History: Registration Date: 16/01/2005

Byline: Damon Jones (1), Kenneth A. Dodge (2), E. Michael Foster (3), Robert Nix (1) Keywords: prevention; behavioral disorders; service utilization Abstract: Children and adolescents with serious and persistent conduct problems often require large public expenditures. Successfully diverting one high risk child from unfortunate outcomes may result in a net savings to society of nearly $2 million, not to mention improving the life of that child and his or her family. This figure highlights the potential of prevention, which often rests on the ability to identify these children at a young age. This study examined the ability of a short conduct-problems screening procedure to predict future need for mental health assistance, special education services, and the juvenile justice system during elementary schoolages. The screen was based on teacher and parent report of child behavioralhabits in kindergarten, and was used to identify children as either at risk or not at risk for behavioral problems. Service outcomes were derived from a service-use assessment administered to parents at the end of the sixth grade, while special education information was gathered through a survey of school records. Study participants (463 kindergarten children 54% male, 44% African American) were from economically disadvantaged neighborhoods in four diverse communities across the United States. Results indicated that, while controlling for demographic background variables, the risk indicator strongly predicted which children would require services related to conduct disorder or behavioral/emotional problems. Additional analyses revealed that the dichotomous high risk indicator was nearly as strong as the continuous screening variable in predicting the service-use outcomes, and that the screening of both parents and teachers may not be necessary for determining risk status. Author Affiliation: (1) Department of Psychology and Human Development, Vanderbilt University, Sewanee, Tennessee (2) Center for Child and Family Policy, Duke University, UK (3) Department of Health Policy and Administration, Pennsylvania State University, USA Article History: Registration Date: 13/10/2004

Recent research has suggested that religion and spirituality can be a resource or a burden for those with serious mental illness (SMI). Investigators have begun to explore the nature and impact of interventions that focus on spiritual issues in this population. This study describes an innovative program for people with SMI who are dealing with spiritual/religious issues. The program was a seven-week semistructured, psychoeducational intervention in which participants discussed religious resources, spiritual struggles, forgiveness, and hope. This paper also reviews participants' feedback about the group intervention. Suggestions are made that may add to the clinical utility of this program in the future. KEY WORDS: psychoeducational; spirituality; serious mental illness.

Outcome research is beginning to suggest that mutual-help programs lead to significant improvements in the quality of life and related factors of members who have serious mental illness. This paper is the first in a series that examines recovery processes that may account for these positive outcomes. In Study 1, a content analysis was completed on one dimension of the written program for GROW, a mutual-help program with more than 40 years of experience. Thirteen reliable recovery processes emerged from this analysis; most prominent among these was to 'be reasonable' and to 'decentralize from self by participating in community.' In Study 2, the recovery processes that emerged from this analysis of one aspect of GROW's written program were applied to 22 written testimonies made by Growers. Results of this analysis again showed being reasonable and decentralizing from self by participating in community were essential processes in this mutual-help program. Analysis of the personal testimonies also showed accepting one's personal value as an important element in the GROW program. KEY WORDS: mutual-help programs; recovery processes; International GROW Movement; content analysis.

Objective: To provide a rationale for working with families of clients with psychiatric and substance use disorder, and to describe a new program, family intervention for dual disorders (FIDD). Method: We developed and manualized the FIDD program, which includes both single-family and multiple-family group formats. We trained several clinicians at a local mental health center in the model and conducted a small pilot study. Results: Clinicians were able to implement the program, and to successfully engage families in treatment. Most clients demonstrated significant improvements in substance abuse over one to two years of treatment. Conclusions: The FIDD program is feasible and appears to promote collaboration between families and professionals; thereby improving the course of dual disorders. Controlled research is underway to evaluate the effects of the FIDD program on client and family outcomes. KEY WORDS: family therapy; co-occurring disorders; dual disorders; severe mental illness; substance abuse.

This study examined the work histories of 7,228 homeless persons with mental illness who were enrolled into the multi-site Access to Community Care and Effective Services and Supports (ACCESS) research demonstration program. Multiple logistic regression analyses suggest that use of vocational services is significantly associated with increased likelihood of paid employment. The role of vocational rehabilitation services in removing persons from homelessness and improving their quality of life is discussed. KEY WORDS: homelessness; mental illness; employment.

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. KEY WORDS: parent; severe mental illness.

Psychiatrists have shown that African Americans in the US have faced a lot of psychological problems due to the racial discrimination, social and cultural identity crises. Various psychologists have evolved a new approach to deal with such grave issues with the use of counseling, diversified training programs and social betterment as a therapeutic treatment.

The extent to which prejudicial views of both genders influence college students' clinical evaluations was investigated. Primarily White and working-class students listened to 1 of 4 audio-tapes of either a male or a female actor with identical major or minor psychological problems. Participants selected 1 of 4 intervention levels (no intervention, workshops/seminars, counselor, or psychiatrist) for the actor and for themselves if they were to experience the actor's problems. The results indicated that both actor gender and participant gender influenced intervention choice. Participants, especially men, tended to select a higher intervention level for the actor than for themselves. These findings are congruent with the self-serving biases exhibited in therapeutic contexts and support the position that gender affects clinical decisions. KEY WORDS: gender; clinical; intervention; decision; evaluation; bias; psychological problem.

Adult siblings of people with serious mental illness are increasingly being called upon to serve as caregivers for their loved ones. The present study investigated 111 adults' reports of their relationships with their afflicted siblings and with their parents in an attempt to explain well siblings' reports of: (1) current caregiving, (2) hypothetical caregiving willingness, and (3) future intention to care for their brother or sister with mental illness. Results of hierarchical multiple regression analyses indicate that perceived sibling need, sibling affection, reciprocity with ill siblings, felt obligation toward parents, and parental requests for help with caregiving are associated with current sibling caregiving. Findings also suggest that adults' beliefs about their ill siblings' need for assistance and their parents' need for assistance are related to future sibling caregiving intentions. The implications of these findings for researchers and mental health professionals are discussed. KEY WORDS: sibling; caregiving; mental illness; family.

Recovery from substance abuse and mental health disorders (dual-diagnosis) requires time, hard work and a broad array of coping skills. Empirical evidence has demonstrated the buffering role of social support in stressful situations. This paper investigates the associations among social support (including dual-recovery mutual aid), recovery status and personal well-being in dually-diagnosed individuals (N = 310) using cross-sectional self-report data. Persons with higher levels of support and greater participation in dual-recovery mutual aid reported less substance use and mental health distress and higher levels of well-being. Participation in mutual aid was indirectly associated with recovery through perceived levels of support. The association between mutual aid and recovery held for dual-recovery groups but not for traditional, single-focus self-help groups. The important role of specialized mutual aid groups in the dual recovery process is discussed.

Recovery in severe mental illness is a powerful concept for consumers, invoking a journey through understanding and acceptance of illness and disability, along with hope for a quality life, self-empowerment, and responsibility. Although not widely recognized, the journey toward recovery is also important for family members of individuals with severe mental illnesses, who often serve in a care-giving or supportive role for their loved ones. From the family perspective, to make recovery a real possibility, several issues must be confronted. First, progress toward recovery must acknowledge and involve care-giving and supportive family members, recognizing their significant role in the lives of many individuals with severe mental illnesses as well as the journey of family members in understanding and accepting a severe mental illness in a loved one. Second, a real, recovery-oriented system implements treatments and supports shown to be effective. In this day and age, the gap between research findings and ordinary care condemns too many consumers and their families to outcomes far short of what is possible. This includes not only medications, psychotherapy, employment services, dual diagnosis services, housing and other supports for consumers, but also family education, shown to be effective by a large body of research. Third, a recovery-oriented system of care cannot afford to dance around the thorniest and most controversial issues in severe mental illnesses - such as individuals with the most intractable forms of illness or the relatively infrequent but very real situations in which either consumers or family members are assaultive or abusive. All of these elements are essential if recovery is to be more than a slogan, but rather a true goal in a system of care that respects consumers with these disorders and their care-giving family members. There are only two lasting bequests we can hope to give our children. One is roots; the other, wings. (Hodding Carter)

Families are beginning to be included in the process of recovery from mental illness. Conventional mental health services may not be as effective if they do not include family support.

In an exploratory study, case managers held divergent views about their appropriate roles in involuntarily committing clients to psychiatric care. In light of vague organizational guidelines about appropriate use of involuntary commitment, case managers drew on professional social work values to form views about commitment. These values supported client self-determination, but did not clearly delineate ways for case managers' use of power and discretion concerning involuntary hospitalization, resulting in a range of understandings among case managers. This article provides a history of discretionary choices in the helping professions, cases illustrating divergent views about commitment among case managers and consequences for clients, and a discussion of ways this range may be narrowed in the future. KEY WORDS: mental health; case management; involuntary commitment; worker discretion; decision-making.

Mental health advocates have proposed recovery as a vision for severe mental illness. The purpose of this study is to examine psychometric characteristics of a measure of the psychological construct. Thirty-five participants in a partial hospitalization program were administered the Recovery Scale and measures of quality of life, social support, self-esteem, consumer empowerment, psychiatric symptoms, needs and resources, global functioning, and verbal intelligence. Results showed the scale to have satisfactory test-retest reliability and internal consistency. Analysis of the concurrent validity of the Recovery Scale showed recovery to be positively associated with self-esteem, empowerment, social support, and quality of life. It was inversely associated with psychiatric symptoms and age. Implications of these findings for a psychological model of recovery are discussed.

This paper examines patient (N = 75) ratings of treatment satisfaction and outcome for severely mentally iii dually diagnosed outpatients participating in long-term integrated dual focus treatment. In addition, it compares these ratings with case manager ratings of patient outcome over a one year period. Satisfaction ratings ranged from very good to excellent. Combined means of several outcomes ratings indicated that most patients rated themselves as improved. Satisfaction with over-all care and with case management was significantly, though weakly (r = .3 and .31, respectively, p < .05), related to patient ratings of overall outcome. While most patients rated that they had improved, satisfaction with treatment was only weakly related to either patient or case manager rated clinical outcomes. These findings indicate the relatively independent relationship of satisfaction with treatment outcome and caution against over generalizing the meaning of treatment satisfaction measures.

Mutual- and self-help groups for persons with severe mental illness have typically been most accessible to individuals who live independently. In an effort to make their organization more accessible to those who live in residential treatment facilities, Schizophrenics Anonymous (SA) ran introductory mutual-help meetings in four group homes. The results of a quantitative/qualitative case study of this effort are reported. The SA meetings were characterized as more and less successful based on the criteria of residents' attendance, participation, evaluation of the meetings, and interest in continued participation. The following characteristics distinguished between more and less successful meetings: staff support, referent power (i.e., identification with group leaders), and resident characteristics (e.g., gender, education, marital status, level of symptomatology). In spite of behavioral and self-reported evidence of interest and involvement in the meetings and the potential for continued involvement in the organization, no group home residents continued their participation in SA following the introductory meetings. This finding is interpreted from an institutional theory perspective that focuses on incompatibility between the ideologies underlying mutual help and the residential treatment system.