Recovery Services and Outcomes in a State Psychiatric Hospital.

Recovery has emerged as a focus of mental health rehabilitation in the past decade. Many have suggested that various domains of recovery-orientated services are integrated to an efficacious mental health care system. In this study we examined the association of domains of recovery-oriented services with recovery outcomes among inpatients in a state psychiatric hospital. A convenience sample of 36 hospital patients participated in a survey that included two standardized scales, with one measuring 6 domains of recovery-orientation of hospital-based services and one measuring 5 aspects of patients' recovery outcomes. We used regression analysis to estimate the association between recovery-oriented services and recovery outcomes adjusting for gender, race, and education. Nearly 90% of patients had lengths of stay of more than 3 months. On average, patients reported receiving moderate levels of recovery-oriented services. Nevertheless those who reported receiving higher levels of recovery-oriented services also reported better recovery outcomes. Specifically three domains of recovery-oriented services, i.e., life goal vs. symptom management, individual tailored, and diversity of treatment options, are associated with better overall recovery and 3 specific aspects of recovery, namely willingness to ask for help, goal and success orientation, and reliance on others. The data from a small sample of patients at a state psychiatric hospital suggest that self-reported recovery-oriented services received are associated with better recovery outcomes. Future larger studies are warranted to confirm the study findings, and to examine whether a contemporary recovery-focused care model can facilitate even greater recovery outcomes.

The First Step in Health Reform for Those With Serious Mental Illness: Integrating the Dis-Integrated Mental Health System.

Increasing attention is being directed toward meeting the psychiatric and medical needs of persons with persistent or recurrent mental illness through the integration of behavioral and medical healthcare. There are many models being considered or tested to achieve this objective. These models, however, generally ignore the challenge of integrating systems that are themselves dis-integrated. Also ignored is the fact that many persons with persistent or recurrent mental illness operate in the context of an array of entitlements; receive "services" from the criminal justice, as well as the health and behavioral health systems; and all these systems are both siloed and fail to meet the needs of this population. This article examines the current state of the cornucopia of services available to individuals with persistent or recurrent mental illness inclusive of federal statutes and policies to impact these services. Recommendations are made to move the dis-integrated system of mental health services toward an internally integrated system that would have the capacity to become integrated with a medical system of care and treatment to achieve a behavioral-medical integrated health delivery system.

Interdisciplinary treatment planning in inpatient settings: from myth to model.

The staffs of many mental health facilities describe their treatment planning processes as interdisciplinary, but as most practicing clinicians know, this is more of a myth than reality. Individualized, person-focused treatment planning itself is not a simple endeavor. Effective treatment planning is further complicated by the fact that most discipline training programs teach neither treatment planning nor interdisciplinary methods to provide care and treatment. Psychiatric treatment teams are at a disadvantage from the start. Additionally, although facility and agency administrators expect treatment planning to occur, often the infrastructure to support the work is not there. This article describes a practical and effective treatment planning implementation model or framework developed by the authors, concentrating on three sub-sets of the treatment planning system: structure, content, and process.

Commentary: is CIT today's lobotomy?

Birthed in Memphis, Tennessee, in 1988, Crisis Intervention Teams (CITs) have had remarkable growth spurts with few, if any, developmental milestones to document their progress. Compton and colleagues investigated the evidence basis for CIT and found very little. They perhaps found even more than there actually is. There are contributions to CIT outcomes that are rooted in local variations in mental health services and regional culture. These are considered in this commentary, using Memphis as the example. None of us should be surprised that reform is evidence-absent. The mental illness delivery system and the criminal justice system have been instituting reform, and these reforms have had reverberating changes between the two systems, with little or no data to support the changes, for centuries. That there would be unexpected consequences should be obvious. But apparently not so evident that we don't continue to take one blind step after another. Is CIT on firm footing, or just another fool's journey?

Within-state availability of transition-to-adulthood services for youths with serious mental health conditions.

OBJECTIVE: This study describes the existence and nature of services within state child and adult mental health systems that support the transition from adolescence to adulthood. METHODS: State child and adult mental health administrators from all but one state were interviewed by telephone with a semistructured questionnaire regarding transition services in their state mental health system, such as supported housing, vocational support, preparation for independent living, and dual diagnosis treatment. Eight states were deemed sufficiently decentralized to render state-level administrator reports invalid. Specific service data from the remaining 41 states and the District of Columbia were analyzed with descriptive statistics. RESULTS: One-quarter of child state mental health systems and one-half of adult state mental health systems offered no transition services, and few provided any kind of transition service at more than one site. Most types of transition services were available at all in less than 20 percent of the states. CONCLUSIONS: Across the United States transition support services are lacking. The adult system in particular will require major transformation to provide the service capacity that is needed to meet the current standards of transition service accessibility for young Americans with serious mental health conditions.

The evolution of outpatient commitment in the USA: from conundrum to quagmire.

Outpatient commitment (OPC), a major form of involuntary community-based treatment, has evolved in the United States on a state-by-state basis amidst a storm of controversy. The polarizing debate that has gone on intensely about OPC for the last two decades has all too often been devoid of data. This article reviews the various arguments pro and con about OPC, and then examines the research on the effectiveness of OPC. Since the newest data seem to support OPC as a useful tool in dealing with specific subpopulations of persons with chronic mental illness, the paper examines the question of whether OPC is a legitimate use of government power. The most extensive analysis of this question to date has occurred in the New York State Courts which have supported the New York State OPC statute, Kendra's Law. The paper concludes with an examination of the future of OPC in the states, calling in particular for further research into the question of determining to whom, from a clinical point of view, should OPC be delivered.

Involuntary outpatient treatment as "desintitutionalized coercion": the net-widening concerns.

In American jurisprudence, two justifications have traditionally been put forth to support the government's social control of persons with mental illness: police power and parens patriae. As public mental hospitals became less available as loci in which to exercise these functions, governments sought alternative means to achieve the same ends. One prominent but quite controversial means is involuntary outpatient treatment (IOT). While the concerns about IOT have been myriad, one often alluded to but never documented is that of "net-widening." That is, once IOT became available, it would be applied to an ever greater number of individuals, progressively expanding the margins of the designated population to whom it is applied, despite the formal standard for its application remaining constant. We tested the net-widening belief in a naturalistic experiment in Massachusetts. We found that net-widening did not occur, despite an environment strongly conducive to that expansion. At this time, whatever the arguments against IOT might be, net-widening should not be one of them.

Patient-centered, recovery-oriented psychiatric care and treatment are not always voluntary.

Explicitly coercive measures are sometimes necessary in the care and treatment of psychiatric patients. The author describes how use of such measures is not antithetical to patient-centered, recovery-oriented practice either in inpatient or outpatient settings. Citing a definition widely used by advocates to describe the overarching goal of recovery--"a full, meaningful, and self-determined life in the community … regardless of psychiatric status"--the author draws parallels between coercive measures taken by society to prevent and treat citizens' dangerous behaviors, such as speeding and public inebriation, and coercive interventions to address dangerous behaviors of psychiatric patients, such as harm to self or others. Society applies coercive interventions to address dangerous behaviors, not psychiatric status.