Role utilization of nurses in public psychiatry.

This study examined the professional, work and organizational characteristics, and the actual and preferred work activities of nurses employed by one state mental health agency. Findings include neutral ratings by this older and experienced group of nurses in relation to job satisfaction, work autonomy, and organizational commitment regardless of educational background or work setting. Specific activities of the nurses varied appropriately based on education, but differences emerged among functions performed by nurses in inpatient and community settings. All nurses preferred to increase their direct care activities and significantly reduce their clerical activities. Factors related to the appropriate utilization of public sector psychiatric nurses are analyzed.

The Oregon experience: a point of view.

What has not been addressed is how Oregon will maintain and expand the early breakthrough of the statewide consensus dialogue that created the "list" of prioritized medical conditions.

State services research capacity: building a state infrastructure for mental health services research.

State mental health agencies in the United States manage increasingly larger and complex systems of care. This requires an increasingly sophisticated workforce and decision support infrastructure. However, with the exception of larger states with their own research and evaluation offices, few states have the necessary resources to develop these important elements. Bringing in talent from academic organizations who have research as a priority may be the preferred direction for many states. The unique approach developed in South Carolina is the first systematic collaboration between a state mental health system and a multi-institutional, inter-disciplinary academic group oriented towards developing a comprehensive, statewide infrastructure for policy-relevant mental health services research.

A community-based public-academic liaison program.

OBJECTIVE: The authors discuss obstacles and incentives associated with successful community-based public-academic liaison activities and illustrate their conclusions by describing their public-academic liaison program, which received the American College of Psychiatrists' first annual Award for Creativity in Psychiatric Education. METHOD: The first 8 years of a state/university collaboration are described in which the parties involved first developed a variety of innovative services designed to fill specific gaps in the public service delivery system and subsequently integrated academic research and training components. RESULTS: The carefully planned and monitored process resulted in the exponential growth of interest in public sector work, the realization of the university's primary goals of developing high quality training and research sites, a substantial increase in the number of graduates accepting positions in the public sector, several projects funded by the National Institute of Mental Health, and two national awards. CONCLUSIONS: These collaborations illustrate the highly complementary relationship of public-academic liaison activities and their potential capacity to improve access to services, substantially improve the quality of these services, generate extramural support for services research, and increase the number of well-trained professionals in the public sector.

A multidisciplinary public-academic liaison to improve public mental health services in South Carolina.

The state of South Carolina is in the process of transforming its core services for people with severe and persistent mental illnesses to a community-based model. This paper describes the planning and on-going implementation of an alliance of academic programs, mental health advocates, and service providers forged by the state department of mental health in 1990. Goals of the consortium are to develop graduates who possess the needed knowledge, skills, and attitudes to work in the public sector; to undertake collaborative research to improve services in that sector; and to maintain the effectiveness and satisfaction of current workers in the public system. The authors describe activities of the consortium to achieve these goals and give examples of enhanced academic involvement in the public mental health system as a result of the consortium's activities.

Providing assertive community treatment for severely mentally ill patients in a rural area.

OBJECTIVE: The authors' goals were to describe an assertive community treatment program developed for patients in rural South Carolina and to evaluate the effect of the program on rates of hospital utilization and cost of care. METHODS: Twenty-three patients with chronic psychotic disorders living in rural areas of South Carolina were assigned to an assertive community treatment program. The patients' average number of days per year in the hospital, length of stay per admission, number of admissions per year, and estimated annual cost of care during the five years before assignment to the program and during a period from four to 26 months after assignment were compared. RESULTS: The intervention was associated with a 79 percent decrease in hospital days per year, a 64 percent decrease in the number of admissions per year, a 75 percent decrease in the average length of stay per admission, and a 52 percent reduction in estimated direct cost of care. CONCLUSIONS: Although the methods of assertive community treatment may need to be modified to suit the travel requirements and other characteristics of rural settings, the study results suggest that the model can be successfully used in rural areas.

A quality improvement process for state mental health systems.

Continuous improvement of the quality of patient care is a major goal in state mental health systems, most of which operate several large hospitals and many community mental health centers geographically dispersed across the state. Although each facility may have an adequate quality assurance program, many opportunities for improvement are lost without integration of these efforts into a unified, statewide quality improvement system. The authors describe development of such a system in South Carolina and give examples of improvements in patient care that have taken place since the program was initiated in 1987. The activities of the central office of quality assurance include collecting and analyzing data about adverse incidents in state facilities, monitoring corrective actions, conducting annual surveys of operations at all state facilities, and investigating and coordinating resolution of complaints about patients' rights.