David A. Pollack

Prioritization of mental health services in Oregon.

The Oregon Health Plan is an approach to health care reform that increases access to mental health and chemical dependency services. A key feature is the integration of mental and physical health care. The mental health community had to educate policy makers about the importance of mental health and chemical dependency services. They constructed a prioritized list of mental health and chemical dependency services and interdigitated the list with the set of physical health services. The result is a unique attempt to develop a seamless health care system that minimizes discrimination against persons affected by mental illness. The opportunity to achieve parity for mental health must not be delayed or compromised; to do so would worsen the lives of persons already affected by the trauma and stigma associated with mental illness.

Population-based guidelines for performance measurement: a preliminary report.

&NA; This paper describes the development of—and early efforts to validate—guidelines that indicate average amounts of service expected to be used by a population of patients with a given disorder who are served by a comprehensive mental health system. These guidelines address expected service use by individuals in 55 diagnostic groups. The purpose of these guidelines is to provide a gauge for evaluating the amounts of service being delivered by managed care organizations. Three population‐based guidelines (for attention‐deficit/hyperactivity disorder, major depressive disorder, and schizophrenia) are compared to actual amounts of service delivered to enrollees in large behavioral health care systems.

Psychiatry in community mental health centers: everyone can win.

The purpose of this paper is to describe the psychiatrists role in community mental health programs, beginning with the evolution of psychiatric involvement in community mental health centers (CMHCs). There is a discussion of the current state of psychiatry in community mental health programs with descriptions of the types of roles psychiatrists occupy and their thoughts about those roles. The concluding sections focus on the ways psychiatrists can be utilized in community mental health programs so that both the psychiatrist and the agency benefit and are satisfied.

Effective Mental Health Consumer Education: A Preliminary Exploration

People with serious mental illnesses are increasingly becoming more active participants in their treatment and recovery. At times, their participation may be limited by incomplete, unclear, or insufficient information. The authors used a grounded theory approach to look at the unmet informational needs described by consumers. Participants in this study called for materials appropriate to their level of understanding, assistance with interpreting and comprehending information when necessary, and information on policies that affect the treatment they receive. Ultimately, an informed consumer is one empowered to make decisions about the course of his or her recovery and participate meaningfully in the patient–provider relationship.

The role of psychiatrists in community mental health centers: A survey of job descriptions

There is little data about the role of psychiatrists within CMHCs. To gain perspective on this issue, job descriptions for medical directors and staff psychiatrists were collected from 214 CMHCs. The data demonstrated that most CMHCs want fully trained psychiatrists involved in a variety of activities in addition to prescribing medication. Policy development was specifically included as part of the medical directors job for 69% of the CMHCs, and 50% mentioned training as part of the staff psychiatrists job. Although job descriptions may not accurately reflect the actual roles of the psychiatrist in all cases, these data suggest that CMHCs support a multifaceted role for their psychiatrists.

Ethics and value strategies used in prioritizing mental health services in Oregon

The authors describe the ethical considerations underlying the inclusion of mental health services into a prioritizedhealth care system. The Oregon Health Plan is a process for defining and delivering basic health services to an entire state. As the plan was developed, the mental health community needed to decide whether or not to participate in the process and, if so, how. Lengthy discussions among mental health consumers, family members, and providers led to a strategy that emphasized the integration of mental health and chemical dependency services into a comprehensive and universal health care program. This approach appears to have achieved relative parity for mental health.

Integrated Care and Psychiatrists

The world of health care in the United States is changing fairly rapidly, especially with regard to how care is delivered. Providers, patients, and payers need to adapt to the changing healthcare environment to maximize their effectiveness and to avoid being made irrelevant by this cataclysm of system transformation, particularly the specialized interface between primary care (PC) and behavioral health (BH) (which includes mental health and substance use disorders and the patients/services/providers associated with such conditions). It is abundantly clear that delivery system redesign is essential to improve health of the population, improve patient experiences with the delivery of healthcare services, and reduce per capita costs for such services.

A Psychiatric Defense of Aid in Dying

In November 1997, the voters of Oregonresoundingly affirmed the Oregon Death With Dignity Act.This law allows competent, terminally ill persons whoare suffering in the final 6 months of life to obtain a lethal prescription from a physician. Thispaper presents a psychiatric defense of the Death WithDignity Act including the role of mental healthprofessionals in evaluating competence in compliancewith the law. Ethical, logistical, and politicalissues related to aid-in-dying are reviewed and astrategy for assessing competence is offered.

Preparing to implement medication algorithms: staff perspectives and system infrastructure.

To assess the readiness of mental health facilities in Oregon to implement medication algorithms using the Medication Management Approaches in Psychiatry toolkit (MedMAP) developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), researchers conducted interviews with 68 clinical and administrative employees of four inpatient and four outpatient mental health facilities in Oregon. Respondents had generally positive opinions about the algorithms, but they also expressed many concerns about logistics and implementation, chiefly related to medication selection and expected restrictions on choices for prescribing providers and patients. In implementing medication algorithms, it may be beneficial to assess staff perspectives as well as the capabilities of the programs infrastructure. The extent to which staff concerns, values, and needs are anticipated and promptly and responsively addressed is likely have a major influence on successful implementation.

Introduction to the Special Issue of Community Mental Health Journal Commemorating the 40th Anniversary of The Community Mental Health Centers Act of 1963.

We are pleased to introduce this special issue of Community Mental Health Journal commemorating the 40th anniversary of the Community Mental Health Centers Act of 1963. That event was a turning point in the history of mental health policy and services in the United States. It resulted from and fostered sustained proactive thinking and planning for the mental health needs throughout this country. Up until then, most care was provided in long-term institutions, in spite of the fact that Clifford Beers and others had urged the development of community based care in less restrictive environments more than 50 years earlier. This anniversary provides us an opportunity to mark time and review how far we have come, and to honor those dedicated to enhancing services. It also allows us to identify how much more work we have left to do. This watershed event in 1963 spawned the modern community mental health movement. It led eventually to much more organized and comprehensive care delivery systems, increased attention to prevention and earlier intervention, recognition of the psychosocial rehabilitative and recovery needs of our patients, the importance of working more effectively with families, and the value of integrating care for mental health, chemical dependency and primary care conditions. These service system