Expanding Mental Health Services to Older High-Utilizing HMO Patients: A Pilot Study

Background: Expanded mental health benefits were offered to older HMO patients who were high medical utilizers. Outcomes of interest were use of services, subjective well-being, and psychopathology. Methods: Sixty-nine (25 male, 44 female) patients age 55 or above seeking frequent outpatient medical care completed the SF-36 health survey and the revised Symptom Check List (SCL-90-R). Patients were assigned to usual care, health education, or expanded mental health benefit conditions. Results: Patients showed high initial levels of psychopathology and distress. Over the 6 months of the study, patients in the expanded benefits group made a mean of 11.5 visits to mental health professionals versus a mean of 3.4 visits by usual care patients. Patients in the expanded benefits group showed significant improvement in SF-36 General Health and Mental Health well-being scores. Patients in the health education group showed no improvement. Patients in the usual care group showed improvements in Vitality scores. Psychopathology summary scores showed improvement for both usual care and enhanced benefit groups. Conclusions: Mental health treatment may improve well-being and reduce psychopathology in older high-utilizing patients. Creativity will be needed in expanding access to mental health services for this population.     

Reflexive action research: Developing knowledge through practice

This paper gives an overview of different ways of conducting counselling and psychotherapy research. An approach to research is described which overcomes the research‐practice gap: reflexive action research. It is argued that this approach to research is particularly appropriate and relevant for practitioners since it draws upon skills and awareness necessary for clinical work, and can complement positivist methods of research which are already well established in the profession. The wider use of systematic clinical case studies is suggested as a means of promoting the reflexive action research approach. Further consideration of issues of validity and reliability is required on the part of those intending to apply this approach within the field of therapy research.     

Counsellors' experiences of working with suicidal clients: An exploratory study

Counselling is increasingly available in a wide variety of contexts, including mental health and psychiatric services. As a consequence, counsellors increasingly work with clients who present with suicidal ideation, expressing either suicidal thought and/or intent in the counselling session. This paper describes an exploratory study that examined the experience of counsellors when working with suicidal clients. The paper considers counsellors' behavioural, cognitive and emotional responses to such suicidal expression, both on a personal and professional level. The research employed semi‐structured interviews. A constant comparative method was used in analysing the transcribed interview text. Results suggest that counsellors experience a range of responses when their clients express suicidal thought, including fear, anxiety, anger and professional impotence. The interviewees also expressed self‐doubts about their professional competence. In addition, they identified the threat of litigation for negligent practice and the lack of confidence in appropriate risk assessment approaches as significant causes for concern. The implications for further research, and practice, are discussed.     

Policy, Principle, and Incrementalism: Dworkin's Jurisprudence of Race

For several decades, Ronald Dworkinhas been one of the most prominent voicesdefending the legality and justifiability ofrace-conscious programs aimed at undoing thecontinuing effects of prejudice. Writingwithin the framework of a liberal legalphilosophy, he has formulated powerfularguments against the view that color-blindpolicies are the only defensible ones. Nonetheless, I argue that a more completeliberal defense of race-conscious policieswould need to develop and modify Dworkin's lineof argument. Such a defense would go beyondhis policy-based arguments and incorporatearguments of principle. Race-conscious policiesdo not only promote the general good; they arealso required in order to help realize theconstitutional right of equal citizenship.     

Moral Testimony and its Authority

A person sometimes forms moral beliefs by relying on another person's moral testimony. In this paper I advance a cognitivist normative account of this phenomenon. I argue that for a person's actions to be morally good, they must be based on a recognition of the moral reasons bearing on action. Morality requires people to act from an understanding of moral claims, and consequently to have an understanding of moral claims relevant to action. A person sometimes fails to meet this requirement when she relies on another person's moral testimony, and so there are moral limits on such reliance.     

FUNCTIONAL ANALYSIS AND TREATMENT OF INAPPROPRIATE VERBAL BEHAVIOR

The present study examined the possible function of inappropriate verbal behavior of an adult man who had been diagnosed with both mental retardation and psychosis. Results of a functional analysis indicated that inappropriate verbal utterances were maintained by attention. An intervention consisting of the differential reinforcement of appropriate verbal behavior effectively reduced the inappropriate behavior.     

自我和物体为参照系的心理旋转分离：内旋效应

采用虚拟的旋转不同角度左、右手模型,构建“左右手判断(Left and right hand judgment: LR)”任务和“相同－不同判断(same and different judgment: SD)”任务,考察这两种实验任务是否都存在内旋效应和角度效应,以此推论被试采用何种旋转策略。结果发现：（1） 两种实验任务结果均表现出显著的角度效应。（2）在LR任务条件下,存在显著的内旋效应,而在SD任务中不存在内旋效应。从而表明当人手图片作为心理旋转材料时,它具有双重角色。被试心理旋转加工时究竟选用何种参照系的旋转策略,与实验材料和实验任务两者都密不可分     

中国军人心理健康状况的元分析

研究的目的在于深入探讨军人的心理健康状态。通过文献查阅收集了77篇用SCL-90作为测评工具的关于军人心理健康状况的研究,样本量为56164人,根据被试情况把这些研究分为两组,一组为军事应激条件下的军人,另一组为非军事应激条件下的军人,分别对两组研究进行了元分析。研究发现非军事应激条件下军人的心理健康水平与军人常模差不多;军事应激条件下军人的心理健康水平在应激前高于军人常模,应激中低于军人常模,应激后与军人常模差不多。其中城镇驻军的心理健康水平高于高原驻军,高于边防驻军;应激中的心理健康水平低于应激后,低于应激前;地域、人员类别以及应激水平等因素对军人SCL-90得分有显著影响。敏感性分析和发表偏倚显示本研究的稳定性较好,没有发表偏倚。表明中国军人的心理健康状况并非很差;与金华等的地方成人常模和蔡心培的国家军用标准相比,王焕林19662人的军人常模更适合于做军人的比较标准;地域、人员类别以及应激水平等因素对SCL-90得分有显著影响     

心理疾病污名形成理论述评

心理疾病污名是加诸于患者身上的耻辱标记,妨碍患者的治疗和康复。心理疾病污名的成因理论包括功能主义和生物文化两个派别,污名的发展模型解释了污名的形成过程,身份威胁模型对污名的作用机制进行了阐述。通过抗议、教育和接触可以有效地减少污名。在中国开展相关研究应注重分析传统文化、心理疾病类型与污名的关系,探讨各种减少污名策略的可行性