Memphis City Schools Mental Health Center

Summary

This article describes a nationally recognized integrated service program in operation since 1969 within the Memphis (TN) City Schools. Memphis City Schools Mental Health Center represents a comprehensive model for the delivery of integrated mental health and substance abuse services to children and youth with a wide range of problems. Notably, the model incorporates elements of primary and secondary prevention and community outreach into service delivery, components that may be under-emphasized in programs that are oriented toward specific clinical populations (e.g., SED). Program components are discussed in detail to demonstrate both unique and inter-related program features, reflecting the complex needs of the children and families being served. Future directions and challenges are also considered.     

Mental Health and Spirituality in Later Life: Pastoral Approaches

SUMMARY

This chapter proposes a perspective on providing pastoral care for people at risk of, or who have mental health problems in later life. Two major areas of mental health, depression and dementia are explored, examining their impact on older people and strategies to identify risk in depression, and signs indicating need for pastoral intervention in depression and/or dementia. The work from two studies that examine issues for meaning of people, the first for older people living independently and the second in residential care, form the basis of the material presented in this chapter. It is maintained that pastoral interventions may greatly improve quality of life for these people, their families and carers.¹     

Mental health consultation to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants—psychologists and psychiatrists—with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions. © 1998 John Wiley & Sons, Ltd.     

Low Cost Needs Assessment for a Rural Mental Health Center

An inexpensive needs assessment was conducted using volunteer university students as telephone interviewers. The procedure and findings are described in terms of the literature, and the applicability of the low-budget approach to other settings is discussed.     

Pastoral counseling in a settled community

Much of the literature in pastoral counseling has been written against the backdrop of an anonymous, changing, technological, and urban community setting. The author contrasts the premium this understanding of counseling places on establishing relationships, confidentiality, gaining information through questions, and the long training required with the way these same matters may be understood from the vantage point of a more settled community, characterized by long-term relations, limited confidentiality, and the support lay persons give each other. He discusses the pastor's role change in this setting and describes an approach to training lay men and women to assume pastoral care responsibility.     

Outcomes of a Therapeutic Gardening Program in a Mental Health Recovery Center

This study evaluated outcomes of a therapeutic gardening project in a community mental health center. The authors worked with 20 adults with severe mental illnesses, to plan, build, and care for raised-bed gardens. Targets for recovery-oriented outcomes related to personal responsibility, emotional and physical well-being, and socialization, were established in advance. Achievement of outcomes was measured using quantitative and qualitative methodology. Results indicated that the program supported recovery. Participants demonstrated significant improvement in mood and markedly higher levels of involvement and spontaneity, when engaged in gardening. Positive changes in diet and social interaction were also reported.     

Family Therapy Training for Paraprofessionals in a Community Mental Health Center

An ecologically oriented family therapy training program is advocated for teaching paraprofessionals to work with high-risk clients in a community mental health setting. The context of training as well as the particular abilities and needs of beginning paraprofessional family therapists are explored in order to design a flexible and effective program in the face of limited resources. This paper describes a variety of educational and supervisory formats such as group supervision, peer supervision, and live supervision. The usefulness of these different models in facilitating skill development and growth in paraprofessionals is evaluated. Recommendations are made to trainers concerning problems encountered in teaching paraprofessionals and in implementing family systems training in community mental health centers.     

Effectiveness of Dialectical Behavior Therapy in a Community Mental Health Center

Dialectical behavior therapy (DBT) has been shown to be effective in randomized controlled trials with women with borderline personality disorder and histories of chronic self-inflicted injury including suicide attempts. The present study is a pre-post replication of a comprehensive DBT program in a community mental health center for individuals who chronically injure themselves and/or have experienced multiple treatment failures. Twenty-four subjects were given the Treatment History Interview to obtain information regarding medically treated self-inflicted injuries and the use of crisis services. After 1 year of treatment, DBT showed a significant reduction in the number and severity of self-inflicted injuries, psychiatric-related emergency room visits, psychiatric inpatient admissions and days, and the number of crisis treatment systems engaged. Results are compared to benchmarks from 3 other clinical trials of DBT. While this pre-post comparison has threats to internal validity, it supports the feasibility of DBT when fully implemented in a community mental health clinic.     

Efficacy of a Mental Health Treatment Court with assertive community treatment

This study examined the efficacy of a Mental Health Treatment Court (MHTC) with diversion to treatment supported by an assertive community treatment (ACT) model of case management. A total of 235 participants were randomly assigned to either MHTC or treatment as usual (TAU) and assessed over a 2 year period. It was hypothesized that participants in the MHTC would decrease their criminal activity and improve their psychosocial functioning relative to participants receiving TAU. While there were offenders for whom neither treatment was effective, a majority in both groups decreased jail days and improved psychosocial functioning, with MHTC participants demonstrating greater gains in most areas. The impact of implementing the MHTC on community practices, and the value of integrating criminal justice and mental health systems, is discussed.     

Intensive family intervention in a community consultation framework

This article describes a form of mental health consultation to community workers who have reached a state of crisis in their work with unmotivated, multi-problem families. The central part of the consultation is a therapeutic intervention that draws on principles of time extension and network intervention. The consultant sees the family together with its community workers in a one-time, intensive meeting of up to six hours duration. This meeting is divided into three phases, aimed at achieving respectively (1) structural, (2) emotional, and (3) cognitive imbalancing of the family system. This creates a new situation, which hopefully will enable the community workers and the family to move out of the crisis in which they had become stuck.     

The Effects of Prompts on Minority Children's Screening Attendance at a Community Mental Health Center

This study examined the impact of prompts upon the screening attendence rate at a children's community mental health center (CMHC) serving lower socioeconomic urban minority clients. Subjects (274 children under age 18 and their adult caretakers who contacted the CMHC for screening appointments) were assigned to one of three conditions: (a) a phone prompt one day before the appointment, (b) a letter prompt one to two days before the appointment, and (c) a no-intervention control group. Both phone and letter prompts produced significantly greater attendance than the no-intervention condition. The phone prompt group evidenced a tendency toward greater attendance than the letter prompt group. A cost analysis indicated that the phone prompt generated more net revenue than the other two conditions and had a lower total cost and per subject than the conditon. The data suggest that prompts can be effectively used by mental health facilities to engage minority clients in the intial phase of the treament process.     

Home Groups: Integrating Peer Support and Clinical Care in a Community Mental Health Center

With peer supporters now comprising one of the most rapidly growing components of the mental health workforce, group interventions that combine their expertise with those of more traditional mental health providers are needed. An example of one such intervention, developed and implemented at a large community mental health center for individuals with serious mental illnesses, is presented. Called a “Home Group” and co-led by peers and clinical psychology interns, this intervention provides unique learning opportunities for peers and trainees and many potential benefits to group members. Vignettes to illustrate the model are presented and the potential therapeutic and empowering aspects of this innovative and promising approach are identified and discussed.     

Pastoral care through small groups

Summary Pastoral care has for too long been conceived as the task of the ordained clergyman alone. The concept of shared leadership now offers us a unique tool to implement the pastoral care of the whole church—the laity as well as clergy. The small group, as a locus of care and concern and as a training tool, offers a unique way by which this ministry of the laity may become a reality, but training in small group process is vitally important to release this potential.     

A Comparison of Suicidal and Nonsuicidal Elders Referred to a Community Mental Health Center Program

Sociodemographics, clinical characteristics, and life stressors of community-dwelling suicidal risk and nonsuicidal risk elders referred to a community aging and mental health provider were compared in this study. Information was collected through case manager surveys and agency records on 683 older adults referred to the Elder Services Program of Spokane Mental Health in 1994 and the first 6 months of 1995. This sample included 109 individuals who were clinically judged to be at suicide risk by case managers at the time of initial assessment. Comparisons between suicidal risk and nonsuicidal risk elders indicated that suicidal elders were younger, more likely to be separated or divorced, and more likely to report a previous history of suicidal behavior. Results of a logistic regression analysis indicated that living alone, depression or anxiety disorder, and higher levels of emotional disturbance predicted suicide risk status. In addition, medical problems, family conflict, and relationship loss predicted suicide risk status in this particular sample. Individuals at suicide risk were also more likely to have a family physician than others. Implications of findings for identification and treatment of suicidal elders are discussed.