Another Effort to Get People With Mental Illness Experiencing Homelessness Off the Streets-A Sound Idea?

This Viewpoint assesses the plan to use police officers to arrange hospitalization of people with mental illness experiencing homelessness in New York City and suggests improvements and alternatives.

New Opportunities to Improve Mental Health Crisis Systems.

National, state, and local actors seem ready to address the long-neglected mental health crisis system in the United States. Elements of an organized system of crisis care are in place in some states, including regional or statewide call centers, mobile crisis teams, and crisis care facilities. These necessary advances are not sufficient to address the urgent problems of increasing suicide rates, the inappropriate use of emergency departments to hold people in psychiatric distress, and the problematic reliance on inadequately trained law enforcement who frequently respond to mental health crises. This article describes the immediate challenges and opportunities that can launch nationwide reform in systems of care for individuals in psychiatric crisis. Five action recommendations describe clear, feasible next steps that can be taken to move these systems forward and meaningfully improve access and quality of care for people in crisis. The recommendations include a central coordinating role for Congress, an increase in federal authorization and appropriation of funds, enactment of a 5% Mental Health Block Grant set-aside, expanded funding for research and evaluation, and the pursuit of additional payment mechanisms by states and counties.

"Big Eight" Recommendations for Improving the Effectiveness of the U.S. Behavioral Health Care System.

The purpose of this Open Forum is to highlight strategies that can be implemented by federal health care policy makers to improve the delivery of effective behavioral health care services in the public and private sectors. The recommendations can be accomplished by using existing funds or authorities allocated to federal agencies dealing with the behavioral health system. These recommendations do not require new or additional funding and focus on strategies with a track record for success. The strategies described require relatively small changes but have the potential for big impacts.

Rethinking funding priorities in mental health research.

Mental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritising one area of science over others risks reduced returns on the entire scientific portfolio.

Suicide Prevention: An Emerging Priority For Health Care.

Suicide is a significant public health problem. It is the tenth leading cause of death in the United States, and the rate has risen in recent years. Many suicide deaths are among people recently seen or currently under care in clinical settings, but suicide prevention has not been a core priority in health care. In recent years, new treatment and management strategies have been developed, tested, and implemented in some organizations, but they are not yet widely used. This article examines the feasibility of improving suicide prevention in health care settings. In particular, we consider Zero Suicide, a model for better identification and treatment of patients at risk for suicide. The approach incorporates new tools for screening, treatment, and support; it has been deployed with promising results in behavioral health programs and primary care settings. Broader adoption of improved suicide prevention care may be an effective strategy for reducing deaths by suicide.

Individual Placement And Support Services Boost Employment For People With Serious Mental Illnesses, But Funding Is Lacking.

The majority of people with serious mental illnesses want to work. Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives, but the approach does not lead to fewer people on government-funded disability rolls. Yet individual placement and support employment services are still unavailable to a large majority of people with serious mental illnesses in the United States. Disability policies and lack of a simple funding mechanism remain the chief barriers. A recent federal emphasis on early-intervention programs may increase access to employment services for people with early psychosis, but whether these interventions will prevent disability over time is unknown.

Current practices for measuring mental health outcomes in the USA: International overview of routine outcome measures in mental health.

The prevalence and impact of mental health conditions calls for measuring the adequacy of care, but progress in measuring mental health outcomes in the USA has been uneven, with some important domains (such as employment and other measures of everyday functioning) rarely captured. Bright spots include progress in adopting uniform measures of the quality of inpatient mental healthcare and early progress in measuring adequacy of medication and psychotherapy treatment. To some extent, progress in measurement has been limited by separate governing structures and payment rules in mental health and overall health settings. This is becoming a critical problem as awareness of the scope and impact of mental health co-morbidities emerges at the same time as pressures for healthcare cost controls intensify. A search for better measures may be accelerated as problems linked to co-morbid mental health problems (e.g. readmission to hospitals) come into sharper focus due to changes in healthcare financing related to the US Patient Protection and Affordable Care Act, 2010.

State Partnerships for First-Episode Psychosis Services.

The RAISE (Recovery After an Initial Schizophrenia Episode) Connection Program was a partnership that involved state mental health authorities (SMHAs) in Maryland and New York with research funding from the National Institute of Mental Health. The SMHAs collaborated with researchers to implement a team-based approach designed to serve people with newly emerged schizophrenia to maximize recovery and minimize disability. This column explains why states are interested in first-episode psychosis services and describes the development of the successful partnership, financing mechanisms, and plans to add teams in both states.

A national campaign to finance supported employment.

Medicaid is now the main payment source and financing mechanism for services for adults with serious mental illness. Services formerly paid with state mental health funds have been converted to Medicaid, lightening the burden on state budgets affected by recession and other factors. The change has allowed states to maintain community care and inpatient services (in general hospitals). Medicaid service benefits include clinic and inpatient care, case management, and some rehabilitation services. But using Medicaid to finance some high-priority services such as supported employment has proven difficult. Now critical changes in Medicaid under the Affordable Care Act allow states to amend their Medicaid State Plans to provide more flexible services to people with serious mental illness. Advocacy and support may be needed to encourage this step. A national campaign to finance supported employment would join various stakeholders in the field, including professional organizations, family and service user groups, and organizations representing service providers. The authors of this editorial pledge their energies to support this campaign. They present suggestions for a campaign, including building a coalition, goals and targets, and online resources.

Making room for mental health in the medical home.

Discussions of health care reform emphasize the need for coordinated care, and evidence supports the effectiveness of medical home and integrated delivery system models. However, mental health often is left out of the discussion. Early intervention approaches for children and adolescents in primary care are important given the increased rates of detection of mental illness in youth. Most adults also receive treatment for mental illness from nonspecialists, underscoring the role for mental health in medical home models. Flexible models for coordinated care are needed for people with serious mental illness, who have high rates of comorbid medical problems. Programs implemented in the New York State public mental health system are examples of efforts to better coordinate medical and mental health services.

Mental health crises and public policy: opportunities for change?

Mental health care is a state responsibility. Periodically, tragic incidents involving a person with a mental illness (such as the shootings at Virginia Tech) attract the public's attention. But little is known about the impact of this attention. Does meaningful change occur, and how? In this commentary we explore recent efforts to advance change in the wake of tragedy.

Transforming mental health care: realities, priorities, and prospects.

A remarkable new analysis of mental health policy provides a lucid perspective on the status and impact of changes in mental health. The monograph is a systematic attempt to answer two questions: are people with a mental illness better off today than a generation ago, and if so why? This article considers that analysis and the prospects for transforming mental health care.