The self-help group: The mental health professional's role

The self-help group has become an increasingly important vehicle for providing mental health services for populations that have been otherwise therapeutically disenfranchised. The article discusses the role of the mental health professional in organizing self-help groups and in facilitating their fulfilling their goals. Transference, countertransference, and group dynamic issues are discussed in detail. These issues are illustrated with particular reference to a self-help group for the parents of cult members.The author would like to extend his appreciation and thanks to the Division of Group Psychotherapy of the Department of Psychiatry of the Mount Sinai Hospital, where this paper was first presented. He would also like to express his appreciation to Arnold Markowitz, A.C.S.W., of the Cult Hotline and Clinic of the Jewish Board of Family and Community Services for his help and to the staff of Westchester Jewish Community Services for their support.     

Eavesdropping on the 50-minute hour: managed mental health care and confidentiality

This article discusses managed care, recent case law developments, and the legal basis of confidentiality in the patient-therapist relationship. It discusses how managed care intrudes into the confidential treatment relationship with prospective and retrospective utilization reviews. Some of the areas adversely impacted include public policy, the patient-therapist relationship, and informed consent. In order to be a program in the interest of patients and not simply cost containment, managed care must accommodate patients' reasonable expectations of confidentiality. Suggestions are delineated for the protection of confidentiality by managed care, including expanding the duty of confidentiality to managed care, obligating managed care to secure patients' informational privacy, obtaining informed consent to disclose as little information as necessary, and involving the patient in the cost containment and quality assurance process.     

Group psychotherapy of substance abuse in the era of managed mental health care

The changes in health-care financing that have taken place over the last decade have spurred interest in finding innovative ways of delivering services at manageable cost levels. It comes as no surprise that increased interest and research have focused on group therapies as a major vehicle for reaching large numbers of people in need of psychological care that is brief, effective, and cost-efficient. More specifically, practitioners in the field of substance abuse have long recognized the value of group experiences as an integral part of the recovery and rehabilitative process. The influence of managed care to contain costs has added new incentives to expand the existing knowledge base in group treatment of addictions to comply with reduced funding and time constraints.     

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.     

At the crossroads: managed mental health care,the ethics code,and ethnic minorities

Mental health clinicians are facing an increasing number of ethical problems related to the delivery of managed mental health care services to ethnic minorities. The authors argue that (a) economic pressures have led to the development of the managed health care movement; (b) the combination of such economic pressures and the development of that managed care movement have influenced the promulgated ethical standards of the American Psychological Association; and (c) those influences may have a negative impact on the mental health services available to ethnic minority individuals and communities. The authors review some of the specific potential threats to mental health services for minorities in the face of such health management policy and psychologists' professional standards.     

Martin Buber's relevance to institutional mental health care

A Buberian perspective on problems related to the establishment of therapeutic environments on mental hospital wards is offered. Depersonalization and over-reliance on a medical treatment orientation in human relationships are identified as central problem areas in mental hospitals. The therapeutic community is identified as a major alternative model to respond to these problem areas. Difficulties in applying the therapeutic community model are identified. Buber's social philosophy, especially his interpretations of spiritual crisis, cultural crisis, structural renewal, and genuine dialogue, are identified as useful tools to clarify and resolve those difficulties.     

The responsiveness and equality of mental health care to Chicanos and Native Americans

An examination was made of the services received by Chicano and Native American clients in 17 community mental health facilities. Although these minority clients differed from Anglos in demographic variables, there was no evidence that they were rendered inferior or discriminatory services. However, failure to return for therapy was much higher among minority clients. Possible reasons for this failure to return are discussed. It is suggested that for ethnic group clients, equality of services may not mean responsive services.     

Spiritual issues in mental health care

Religious and spiritual issues in mental health are explored in the context of four conceptual models: the medical, the nursing, the humanistic, and the pastoral. This is done by looking at each model in terms of content, diagnostic focus, language and treatment goals, and primary qualities in the health provider.The models are illustrated by case studies gathered from a multidisciplinary setting. The discovery that each model can incorporate the religious and spiritual dimension in mental health care, but that each model does this in distinctive ways, is a key point.     

A survey of mental health care provider's and managed care organization attitudes toward, familiarity with, and use of group interventions

Managed Care has had a significant impact on delivery systems for mental health services. Direct and indirect persuasion to provide more cost-effective treatments has been one consequence. The cost-saving qualities and the effectiveness of group interventions have produced clear expectations for an increased use of therapy groups. This study compared perceptions and uses of group treatments on a national sample of managed care organizations and mental health providers. Because group psychotherapy encompasses such a broad definition, five specific types of group interventions were defined: problem-focused homogenous, process-oriented heterogeneous, psycho-educational, self-help, and short-term groups. Implications of differences and similarities between directors of managed care organizations and treatment providers are examined and discussed across five response categories (familiarity/training, perceived effectiveness, likelihood of reimbursement/referral, daily use, and expectation for future use).     

Conflict across organizational boundaries: managed care organizations versus health care providers

This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions.     

Personal, practical, and professional issues in providing managed mental health care: a discussion for new psychotherapists

Written by a former corporate manager pursuing counseling as a 2nd career, this article offers pointed views on managed mental health. Values of practitioners that are a mismatch for managed care are noted, and more specific disadvantages and advantages are examined. Loss of client confidentiality is addressed and procedures and technologies for its reclamation are noted. Negative effects on therapy are acknowledged and potential for better accountability and research are pointed out. Economic disadvantages of a small provider's practice as well as opportunities for creating new value and additional income are reviewed. The relatively sudden emergence of managed care is credited with a natural time lag preceding regulatory responses. Acknowledging that most new practitioners have little choice about the clients they serve, the article concludes that it would be shortsighted to rule managed care out of one's practice.     

The European Early Promotion Project: A new primary health care service to promote children's mental health

The number of children in Europe with significant psychologic and social problems is large and increasing. This article describes an innovative crosscultural method of working with families to promote the psychosocial well being of children and prevent the development of psychologic and social problems. A study designed to evaluate the effects of the service is also presented. Primary health care workers in five European countries have been trained to conduct promotional interviews with all prospective mothers in their area one month before and one month after birth. They have also been taught to work with mothers identified as in need of support as a parent by using a specific counselling model to try to prevent the onset of child mental health difficulties. Effects of the intervention on children's psychologic development and family adaptation are being evaluated at two years in comparison with matched groups not receiving the intervention. ©2002 Michigan Association for Infant Mental Health.     

Migrant mental health: a model for indicators of mental health and health care consumption.

OBJECTIVE: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. DESIGN: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. MAIN OUTCOME MEASURES: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" RESULTS: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. CONCLUSIONS: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups.