Factors influencing placement recommendations for hospitalized individuals with chronic mental illness

This study was undertaken to identify factors that may preclude a patient's discharge from a community mental health center and result in the patient being labeled "unplaceable." Placement recommendations differed between the state hospital staff and a mental health professional employed by the center to evaluate 28 patients. A measure designed to assist in the assessment of patients' competencies suggested the professionals' recommendations were more related to patients' skills in areas associated with community living than were those of the state hospital staff. Follow-up indicated that 15 patients discharged according to the professionals' recommendations maintained community tenure. Use of a more psychometrically sound and comprehensive assessment concerning discharge and placement may improve likelihood of success.     

The interaction of stressful life events and chronic strains on community mental health

One of the possible adaptive costs of coping with stress is diminished capacity to respond to subsequent adaptive demands. This paper examined the complex interplay between major life events and one source of chronic strain. Residents of the greater Los Angeles metropolitan area exposed to higher levels of smog, who had also experienced a recent stressful life event, exhibited poorer mental health than those exposed to pollution who had not experienced a recent stressful life event. There were, however, no direct effects of smog levels on mental health. These patterns of results were replicated in both a cross-sectional and a longitudinal study. The interplay of psychosocial vulnerability and environmental conditions is discussed.     

Modification of interactive behaviors in chronic mental patients

Four chronic mental patients, residents of a token economy treatment unit, were randomly assigned to an experimental or control condition and attended 10 thirty-minute treatment sessions. For the two experimental subjects, contingent reinforcement was received for interacting with each other according to instructions in four distinct phases of interpersonal behavior: talking to another person, attending and talking to another person, asking and answering questions in a dyad, and working cooperatively in the dyad to solve problems. The two control subjects were instructed to perform the same behaviors but received non-contingent reinforcement. The results indicated a strong contingent reinforcement effect on the performance of the treatment sessions' target behaviors. Several baseline, treatment, and post-treatment response measures indicated that the treatment effects had generalized to other areas of social behavior away from the treatment setting.     

Effects of the community mental health centers program on the growth of mental health facilities in nonmetropolitan areas

Using a quasi-experimental design, changes in the numbers of mental health facilities between 1964 and 1974 were examined for a sample of 50 nonmetropolitan catchment areas that established a Community Mental Health Center (CMHC) before January 1973 and a sample that did not. Compared to non-CMHC areas, CMHC areas had a slightly greater number of general hospital psychiatric units in 1974. Nevertheless, the rate of increase in such units over the 10-year period was not significantly different between the two types of areas. Other findings supported the conclusion that the number of outpatient and day/night facilities continued to increase in areas not participating in the CMHC program, but that the program produced even greater numbers of such facilities in areas that did participate. This growth, though, occurred both through introducing additional facilities and supplanting existing ones.     

Closing the gaps: the effectiveness of linking programs connecting chronic mental patients from the hospital to the community.

The research reported in this article tested the effectiveness of a linking program between city hospitals and community treatment programs in reducing the rehospitalization of mental patients following discharge. The authors proposed that the nature of the relationships between the liaison teams of such programs and those providing aftercare services is essential to providing a continuity of care and thus to lowering rates of rehospitalization. Two liaison teams were evaluated, one of which had more positive and ongoing relationships with providers of community services to mental patients. The program with the more positive and continuous relationships was predicted and found to be more effective in reducing rehospitalization rates for chronic mental patients. Testing a case management/primary therapist adaptation by the less effective program demonstrated that patient or staff characteristics did not account for the differences between the programs' effectiveness.     

Service planning for chronic mental patients: some principles

Services for chronic mental patients in this era of deinstitutionalization present a major challenge to clinicians and planners alike. The complexity of these patients' clinical and other programmatic needs requires that an array of viable comprehensive services be made available to them. Following certain established principles of service planning will help facilitate patients' longitudinal, psychological, financial, and geographical access to care.     

Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers

Enhancing the public health impact of evidence-based practices (EBPs) in usual care settings is a key priority of the National Institute of Mental Health. Longitudinal data from community mental health providers (N = 268) participating in a series of state-sponsored workshops in modular approaches to EBPs for youth are presented. EBP workshop attendance for youth anxiety resulted in increased knowledge for EBPs for anxiety (and not other conditions) and EBP workshop attendance for youth disruptive behaviors resulted in increased knowledge for EBPs for disruptive behaviors (and not other conditions). Providers' tendencies toward incorrectly classifying non-EBP therapies as evidence-based increased over time, suggesting that providers over-generalize the EBP label as a result of attending these types of workshops. Regarding EBP attitudes, most measures of attitudes improved when providers attended a workshop. Additionally, an overly inclusive view of what constitutes an EBP at intake was related to significant decreases in openness to trying EBPs over time, whereas more positive attitudes at intake was related to achieving a more refined view of what constitutes an EBP over the course of attending trainings. Study limitations and implications for implementation of EBPs in usual care settings are discussed.     

Trends in community mental health programming

One hundred-seventy-three mental health centers responded to a survey inquiring about allocation of staff time for mental health services and about the availability of an array of services at present, 3 years previous, and 3 years hence. The data reflect an emphasis upon reactive services as opposed to those considered proactive, and on services directed to individuals as opposed to other groups. However, this emphasis seems to be changing. Future projections call for a de-emphasis on individual reactive programs and increased emphasis on programs directed toward families and small groups, and toward proactive programs directed to the communities-at-large. Data about specific programs and services further suggest de-emphasis of services that involve the mental health professional and the client in direct interaction, and continued growth in services that can be delivered by less formally trained mental health workers or volunteers.     

Increased communications of chronic mental patients by reinforcement and by response priming

An attempt was made to increase the frequency with which chronic schizophrenic patients suggested feasible improvements in their treatment. A response priming procedure was devised that was comparable to a previously developed reinforcer exposure procedure. The patients were required to attend a structured meeting during which they were prompted to make suggestions. This priming procedure was compared with the more usual procedure of "welcoming" attendance and suggestions. It was found that more suggestions were made when attendance was required, rather than optional. This increase occurred during a group as well as a private meeting. An attempt was then made to analyze the probable reinforcer for the suggestions by experimentally varying the percentage of suggestions followed. Different staff members served as the discriminative stimuli within a multiple schedule. It was found that the number of suggestions was a direct function of the percentage followed. These results demonstrate the effectiveness of the priming procedure as an adjunct to reinforcement procedures for increasing desired behaviors of mental patients. Few suggestions were made when reinforcement or priming were used alone.     

Some effects of positive life events on community mental health

Measures of positive and negative events were derived from a life-event inventory to test the predictions of an equilibrium model and a positive mental health model of psychological well-being. These measures were related to indicators of individual and community well-being with data obtained through a household survey of 454 residents. Residents who reported more negative events also reported more psychological distress and less positive adjustment. Positive events were associated with reports of positive adjustment. An analysis of census tract scores on life events revealed that the relative absence of positive events in census tracts was associated with higher service utilization rates to the community mental health center serving those tracts. The number of negative events was unrelated to service rates for census tracts but was related to several demographic indicators of well-being.