Environmental scan 2000: issues facing state mental health agencies.

With the new millennium, state mental health agencies (SMHAs) are facing a variety of new issues. In this article, the authors report on the changes in state mental health systems that have occurred during the 2 years between interviews conducted with directors of each SMHA. While issues such as managed care, the influence of state Medicaid waivers on the development of public/private partnerships, and federal welfare reform continued to be key concerns, directors are focusing more on other issues such as assessing SMHA operations, establishing linkages with other state health and human service agencies, and inculcating new knowledge, technologies, and model practices.

Performance contracting: the Colorado model.

Through a process of negotiation between a community mental health centers association (CMHCA) and the state division of mental health (DMH), a performance contracting system has created entrepreneurial freedom for the mental health centers while still providing adequate controls by the DMH.

Expenditures and revenues of state mental health agencies, 1981-1985.

Data compiled by the National Association of State Mental Health Program Directors were used to compare expenditures and revenues of state mental health agencies in fiscal years 1981, 1983, and 1985. The agencies had direct control of funds totaling $8.3 billion in 1985, compared with $7.1 billion in 1983 and $6.1 billion in 1981, but spending in the three years varied by less than 1 percent in inflation-adjusted dollars. Spending for state mental hospitals declined by 5 percent, while spending for community-based programs grew by 10 percent. The great majority of the agencies' funds, 78 percent in 1985, were provided by state governments. Information about the budgets of state mental health agencies can help fill the financial information gap that confronts policymakers in the federal, state, and local mental health service delivery systems.

Effect of dihydroxyanthraquinone on the response of a rat solid tumor to radiation therapy.

Dihydroxyanthraquinone (DHAQ, NSC 279836, a new cancer chemotherapeutic agent presently in clinical trials) was tested, alone and in combination with radiation, for therapeutic effectiveness in a rat solid tumor model. The Walker 256 fibrosarcoma was implanted subcutaneously in the leg via trochar so as to yield palpable tumors within 7-11 days. When tumor diameters reached 1 cm, the animals were treated as follows: as controls; with DHAQ (3.0 mg/kg, i.p.); with 300 KVP x-rays (15 Gy to the tumor-burdened leg); or with a combination of DHAQ and radiation. Tumor diameters were measured three times a week to monitor the response to therapy. DHAQ alone had no effect on tumor growth rate. Radiation alone produced a delay in tumor growth. The combination of DHAQ and radiation resulted in a consistently better therapeutic response than did radiation only, but at only a marginal level of statistical significance (0.05 less than p less than 0.10). However, there were 3/10 long-term survivors (greater than 80 days post treatment) without evidence of tumor in the combination therapy group; whereas all animals in the radiation group died or were sacrificed because of progressive tumor growth by day 71. These results suggest that even though DHAQ is only minimally effective against this rat solid tumor when used alone, there may still be some added therapeutic benefit derived from a combination of DHAQ and radiation therapy.