Mental health policy and the psychiatric inpatient care of children

Recent changes in psychiatric inpatient treatment of children and youth are placed in the more general context of, first, the inpatient treatment of adults and, second, multiple public policies affecting children. For adults, the experimental evidence shows that the majority of psychiatric inpatients could be treated in programs outside the hospital more effectively and less expensively. For children, no such data base exists. Contrary to policy intent, between 1980 and 1985 inpatient care of children and youth increased substantially in residential treatment centers, private psychiatric hospitals, and scatter hospitals (general hospitals without any formal specialized units). Thus, psychiatric inpatient care of children and youth is increasing, dramatically so at largely uninvestigated and more expensive sites. The failure of children's mental health policy is placed in the context of the multiple policy failures for children regarding health, welfare, education, and housing. Recent positive efforts by federal agencies are described, but the need is great for data on efficacy and cost-effectiveness of inpatient treatment of children.     

A role for clinical psychology in health care and policy concerning the physical environment

Some persons adversely react to specific environments, while others are impervious or actually thrive. Medical attention often overlooks such sensitivities to the physical environment. Such sensitivities, including phobias and seasonal affectivity, fall within clinical psychology's purview. A theoretical/clinical approach called the Synchronous Systems Model, which defines and uses individual differences in people and in settings, could serve medical health care and policy. When specific people are matched appropriately with specific treatments within the most propitious settings, cost effectiveness and medical efficacy rise. Such documented accountability could make clinical psychologists central to triage of medical services as well as health care policy in these days of the shrinking health care dollar. The Synchronous Systems Model provides theory, supportive data, and clinical assessment devices to strengthen clinical psychology's role in medical settings.     

The intellectual basis for Latino AIDS policy: Towards the humanities and health policy

The AIDS epidemic touches upon basic humanities themes: sex, death and social worth, to name just three. AIDS policy in general builds upon society's discourse on these topics. The growing Latino population (25% of California and Texas) needs an AIDS policy that builds upon the Latino humanities tradition. The contours of the Latino intellectual tradition, as focused on issues attendant to health, are presented, with examples from Aztec, colonial and modern times.     

The myth of technology in health care

Technology is believed to have liberated health care from dogmas, myths and speculations of earlier times. However, we are accused of using technology in an excessive, futile and even detrimental way, as if technology is compelling our actions. It appears to be like the monster threatening Dr. Frankenstein or like the socerer’s broom in the hand of the apprentice. That is, the same technology that should liberate us from myths, appears to be mythical. The objective of this article is to investigate the background for the re-entrance of the myth: How we encounter it and how we can explain it. The main point is that a myth of technology is normative: it relates ‘is’ and ‘ought’ and directs our actions. This becomes particularly clear in health care. Hence, if there is a myth of technology, it is an ethical issue, and should be taken seriously.     

Shades of support: An empirical assessment of D&I policy support in organizations

In this research, we aim to develop a better understanding of the different ways in which employees can advance or resist the diversity and inclusion (D&I) policies implemented by their organization. To this end, we complement prior work by distinguishing between employees' attitudinal and behavioral opposition versus support for D&I policies. We combine these to distinguish different combinations of attitudinal and behavioral responses that characterize specific groups of employees, which we label opponents, bystanders, reluctants, and champions. In a large-scale survey study conducted among employees from seven organizations located in the Netherlands (n = 2913), we find empirical support for the validity of this taxonomy and its value in understanding the likelihood that employees advance or resist D&I policies. Furthermore, we find more convergence between attitudinal and behavioral support when employees perceive a more positive climate for inclusion. Together, these results advance existing scholarly work by providing both a theoretical account of and empirical evidence for the different ways in which D&I policies may find support or resistance from employees. In addition, our work offer practitioners a practical tool to examine the likelihood that D&I policies meet support or opposition from their employees and therefore enables them to design and implement more effective D&I interventions.     

The next wave of change for psychology and mental health services in the health care revolution

Recent national changes in the de facto system of health and mental health care are described. Although the percentage of people without health insurance (always or sometimes) has not decreased, the organization of insured care has changed dramatically. Of the insured population, 75% are under some form of managed care. For 88% of the managed care population, mental health care has not been integrated with health care: the so-called carve-out. The author argues that system integration (carve-ins), for a variety of reasons, will begin soon and will occur very rapidly. A tilt toward carve-ins will have substantial impact on psychologists' training, service delivery, and research.     

The effect of social support on prenatal care.

This article examines the effects of social support on the receipt of adequate prenatal care. A study was conducted to test the hypotheses that social support helps women overcome obstacles to obtaining such care, and that social support has greater effects on women facing the most obstacles. Survey data were gathered for more than 90% of the women who gave birth in Oklahoma hospitals during specific periods in the summer of 1986. The authors found only weak support for the first hypothesis, and for the second hypothesis found only support that must be qualified according to the measure of social support. Strong evidence indicates, however, that difficulty in paying for prenatal care, personal inconveniences, and unwanted pregnancies are obstacles to obtaining such care. The findings account for some of the frequently observed demographic differences associated with receipt of adequate prenatal care, although such differences persisted even after the obstacles were considered. The authors present implications for policy makers seeking to improve women's receipt of adequate prenatal care.     

Children's mental health as a primary care and concern: a system for comprehensive support and service

In response to the serious crisis in mental health care for children in the United States, this article proposes as a priority for psychology a comprehensive approach that treats mental health as a primary issue in child health and welfare. Consistent with the principles of a system of care and applying epidemiological, risk-development, and intervention-research findings, this approach emphasizes 4 components: easy access to effective professional clinical services for children exhibiting disorders; further development and application of sound prevention principles for high-risk youths; support for and access to short-term intervention in primary care settings; and greater recognition and promotion of mental health issues in common developmental settings and other influential systems. Integral to this approach is the need to implement these components simultaneously and to incorporate family-focused, culturally competent, evidence-based, and developmentally appropriate services. This comprehensive, simultaneous, and integrated approach is needed to achieve real progress in children's mental health in this country.     

The right to preventive health care

The right to health care is a right to care that (a) is not too costly to the provider, considering the benefits it conveys, and (b) is effective in bringing about the level of health needed for a good human life, not necessarily the best health possible. These considerations suggest that, where possible, society has an obligation to provide preventive health care, which is both low cost and effective, and that health care regulations should promote citizens’ engagement in reasonable preventive health care practices.     

Opportunities in public policy to support infant and early childhood mental health: the role of psychologists and policymakers

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants, toddlers, and young children have come to the forefront of thinking as children need a "voice" to advocate for their support and care. This article (a) highlights several important policy areas that support the social-emotional development of very young children and (b) gives examples of current policy accomplishments and challenges. The article offers a policy agenda to promote the mental health of infants and young children and suggests ways that psychologists can engage with policymakers to promote policies that foster infant mental health, including contributing to the knowledge base that informs policy decisions, educating the public and policymakers about early childhood development and mental wellness, forming community partnerships to identify and address infant mental health risks, and participating in the development of policy recommendations that improve access to evidence-based practices in infant mental health.     

The hard and soft of health care

For several decades, the American system of health care delivery has trusted scientific modalities to bring healing. This article points out the limitations of scientific medicine, the timelessness of spiritual components of healing, and the ongoing need for hospital personnel who are sensitive to the healing properties of faith, hope, and love.This article was delivered as the keynote address when Dr. Willis received the Wayne E. Oates Award on September 1, 1994.