Reducing the burden of suicide in the U.S.: the aspirational research goals of the National Action Alliance for Suicide Prevention Research Prioritization Task Force.

BACKGROUND: The National Action Alliance for Suicide Prevention Research Prioritization Task Force (RPTF) has created a prioritized national research agenda with the potential to rapidly and substantially reduce the suicide burden in the U.S. if fully funded and implemented. PURPOSE: Viable, sustainable scientific research agendas addressing challenging public health issues such as suicide often need to incorporate perspectives from multiple stakeholder groups (e.g., researchers, policymakers, and other end-users of new knowledge) during an agenda-setting process. The Stakeholder Survey was a web-based survey conducted and analyzed in 2011-2012 to inform the goal-setting step in the RPTF agenda development process. The survey process, and the final list of "aspirational" research goals it produced, are presented here. METHODS: Using a modified Delphi process, diverse constituent groups generated and evaluated candidate research goals addressing pressing suicide prevention research needs. RESULTS: A total of 716 respondents representing 49 U.S. states and 18 foreign countries provided input that ultimately produced 12 overarching, research-informed aspirational goals aimed at reducing the U.S. suicide burden. Highest-rated goals addressed prevention of subsequent suicidal behavior after an initial attempt, strategies to retain patients in care, improved healthcare provider training, and generating care models that would ensure accessible treatment. CONCLUSIONS: The Stakeholder Survey yielded widely valued research targets. Findings were diverse in focus, type, and current phase of research development but tended to prioritize practical solutions over theoretical advancement. Other complex public health problems requiring input from a broad-based constituency might benefit from web-based tools that facilitate such community input.

The 'millionaires tax' and mental health policy in California.

Despite long-standing and widespread opposition to new taxes, in 2004 Californians approved a so-called millionaires tax, levied on those with taxable net income over $1 million. The proceeds, estimated to be $700 million to $1 billion per year, can only be spent on improving mental health services for people with or at risk of a disabling mental disorder. Progress has been made in access to services, prevention programs, supported housing, and integrating mental health with the other human services. Challenges include a complex administrative structure, a paucity of change agents, a less-than-robust oversight and accountability process, and high public expectations.

Advanced practice psychiatric nurses as a treatment resource: survey and analysis.

Access to behavioral health services, particularly pharmacotherapy, continues to be a significant problem. This is particularly the case for public sector beneficiaries and managed care members. The greater use of advanced practice psychiatric nurses (APPNs) with prescribing privileges could help. To better understand the availability and competence of APPNs to prescribe, the authors conducted 1) a national survey of APPNs' availability and prescribing practices, 2) a comparative analysis of pharmacy claims data generated by APPNs and psychiatrists, and 3) a comprehensive clinical record review comparing APPNs to psychiatrists. About 25% of the sample of APPNs reported having prescription authority and a private practice. The analysis of prescribing practices between APPNs and psychiatrists showed that with a few exceptions, there were no differences between the groups, as did a retrospective clinical record review. These results lead the authors to recommend greater efforts to increase the supply of APPNs.

Mental health parity: a review of research and a bibliography.

This article summarizes the content of a meeting held in July 2001 to (1) review what is known about the effect of parity based on research already done, (2) identify what is likely to be known from research in progress, and (3) identify the knowledge gaps that still exist. An annotated bibliography of studies and reports on parity from 1996 through 2001 is included.

Enfermedad mental y economía / Mental illness and the economy

Los efectos de la economía sobre el bienestar humano y las relaciones entre enfermedad mental y economía son importantes para la investigación y de interés para el público. Es todavía inseguro a dónde conducirán los estudios citados en éste artículo, pero parece probable que serán objeto de creciente atención e influirán en la capacitación y la práctica de los profesionales de salud (AU)

Administración en salud mental: enfoques, problemas y perspectivas / Administration in mental health: issues, problems and prospects

El rápido desarrollo del campo de la salud mental exige un sistema administrativo cada vez más complicado y refinado. En muchos casos, los conocimientos y métodos administrativos no han avanzado al mismo ritmo. Este artículo contribuye a explicar las razones de esta situación y cómo pueden dominarse las limitaciones actuales (AU)

Administration in mental health: issues, problems, and prospects

The mental health field has grown larger and more complex in recent years, but this has not been equalled by increased administrative sophistication. Two problems, neither one irremediable, have contributed to this state of affairs. First, mental health organizations have generally been administered by mental health professionals with little administrative knowledge or training. And second, we have often failed to recognize the very special circumstances faced by administrators in the mental health field. These special circumstances are legion. For one thing, mental health services depend on public funding and must often deal with a high degree of government regulation. For another, the typical staff in a mental health organization is multidisciplinary, professional, and highly autonomous-a bit like a Navy with more admirals than ships. Then too, the transaction between therapist and patient is much more private and intimate in mental health than in most other fields; we are often dealing with a highly dependent patient population; our product is intangible and the success achieved is hard to judge; the boundaries of the field are very hard to define; and the enduring public stigma associated with use of mental health services, combined with the problem of confidentiality, complicates the administrative task. Finally, on top of all this, it is absolutely essential that the mental health administrator understand the need to create and maintain an organizational climate of efficacy and hope. Taken individually, many of these conditions have obvious counterparts in other fields; but taken as a group, they separate mental health from all the other human services, even ones that are closely related. To be effective, therefore, academic programs in mental health administration must reflect these conditions by developing specialized curricula and training procedures (Au)

Administración en salud mental: enfoques, problemas y perspectivas / Administration in mental health: issues, problems and prospects

El rápido desarrollo del campo de la salud mental exige un sistema administrativo cada vez más complicado y refinado. En muchos casos, los conocimientos y métodos administrativos no han avanzado al mismo ritmo. Este artículo contribuye a explicar las razones de esta situación y cómo pueden dominarse las limitaciones actuales (AU)

Enfermedad mental y economía / Mental illness and the economy

Los efectos de la economía sobre el bienestar humano y las relaciones entre enfermedad mental y economía son importantes para la investigación y de interés para el público. Es todavía inseguro a dónde conducirán los estudios citados en éste artículo, pero parece probable que serán objeto de creciente atención e influirán en la capacitación y la práctica de los profesionales de salud (AU)