David L. Cutler

Comparing practice patterns of consumer and non-consumer mental health service providers.

The practice patterns of consumer andnon-consumer providers of assertive community treatmentare compared using both quantitative and qualitativedata collected as part of a randomized trial. Activity log data showed that there were few substantivedifferences in the pattern of either the administrativeor direct service tasks performed by the two teams. Incontrast, the qualitative data revealed that there were discernable differences in the“culture” of the two teams. The consumerteam “culture” emphasized “beingthere” with the client while the non-consumer teamwas more concerned with accomplishing tasks.

The Professor of Public Psychiatry Model in Ohio: the impact on training, program innovation, and the quality of mental health care.

The Ohio Department of Mental Health and five of Ohio’s University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio’s mental health services. Strategies integral to Ohio’s Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio’s community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as “Coordinating Centers of Excellence” to accelerate adoption of evidence-based practices in community settings.

A participatory planning process for the evaluation of Community Mental Health Centers

The authors review the evolution of external CMHC evaluation approaches from federal and state perspectives, identify some of the problems that have developed, and present and evaluation model which satisfies state accountability requirements, yet preserves local flexibility. They demonstrate how this model can be used by state administrators as a theoretical framework for standards development and site review of CMHCs and finish with a discussion of conclusions and implications of this type of evaluation process.

A Resident's Experience in Cross Cultural/Community Psychiatry

This report examines a psychiatric resident’s consultation experience in a community psychiatry rotation serving South Asian women victims of intimate partner violence. It explores experiences related to negotiating and developing a partnership between culturally specific domestic violence services and community mental health services. It also discusses the resident’s progression from consultant to administrator and ultimately to the rotation’s termination.

Roots, trunks, branches, and blossoms: A preface to gerald Caplan's preventive psychiatry program

Where did community mental health come from in the first place? What are the core operational principles in establishing a community mental health program? Does stress cause illness? Is there something that can be prevented using psychosocial methodologies? These are big quest ions-ones that to a large extent have yet to be answered. They are, however, ideas that have been formulated and vigorously discussed in community and academic circles for the past 40 to 50 years. Gerald Caplan, more than any other person in the world today, was responsible for merging these ideas into a plausible approach to preventive psychiatry based on crisis theory. Dr. Caplan has written several books regarding this theory, which in many places continue to be core literature in any kind of training program for community mental health professionals (Caplan, 1964, 1970, 1974). In fact, he and his daughter, Ruth Caplan, have recently completed a new book, Mental Health Consultation and Collaboration (Caplan & Caplan, 1993), which we will review soon in Community Mental Health Journal. But this paper is not theory. Its something else. Ordinarily we publish reports of this type in brief format, no more than a few pages. However, this work, whatever one might call it, represents a direct translation of practice from theory. It takes great ideas and concretely and heroically shows how something can be done about them.

Productive activities for the chronic patient

This paper examines the common characteristics of chronic psychiatric patients and the principles that should guide the development of any program of activities designed to promote their rehabilitation. A range of productive activities in each segment of a support network is described, and an example from Oregon is presented to illustrate how different levels of activities can be used to meet rehabilitation goals.

Introduction to the Special Issue on Culture and Community Mental Health

Since 1980, the racial/ethnic diversity of the United States has rapidly increased. Also in this time, though the population of the United States has aged in general, the difference between the youngest and oldest age groups and their percentage of non-White population has widened (U.S. Census Bureau, 2002). From 1980 to 2000, the population of races other than White non-hispanic grew by 88% while the White non-hispanic population grew by 7.9%. By 2000, four states and the District of Columbia had minority populations in total exceeding 50% of the population. Data on age by race and Hispanic origin reveals that throughout the period between 1980 and 2000 White non-Hispanics and Asian and Pacific Islanders were relatively older than Black Americans, American Indians and Alaska Natives, and Hispanic Americans. The median age for White non-Hispanics in 1980 was 31.7-years-old and in 2000 was

Heroes in Community Psychiatry: George Saslow MD, PhD

On December 5, 2004, his 98th birthday, George and I were sitting and chatting in his room at the convalescent center where he was recovering from a fall, discussing his birthday party the day before. He had thought he wanted a lemon meringue pie for his birthday but said he had a dream the night before about a chocolate cake. His daughter Margie baked him the chocolate cake instead, and he seemed very pleased with himself about going with one of his dreams. Later we discussed the next selection for the George Saslow book club (a book about Easter Island) and he showed me another new book he was reading on the life of Stalin. Nearly 100 years old, he hasn’t stopped dreaming, he hasn’t stopped learning, and he has defied death on at least four separate occasions that I can remember in the past 25 years. He continues to read all the time, loves to discuss literature, history, politics, and psychiatry with his characteristically broadminded, scholarly, and honest passion (rare in these times). Dr. Saslow has also been in practice since the early 40s and still sees a few patients, attends grand rounds regularly, and as I write this, serves as the psychiatrist on The Oregon Psychiatric Security Review Board. I was somehow geographically blessed, for some

Introduction to Special Issue: Mental Health Around the World

From time to time I think we all get impatient with the way things work in our corner of the world. In fact when it comes to systems of care I usually assume that things are done better elsewhere. That may not necessarily be the case but when the alignment of the continents is correct we here at the journal can sometimes put together a collection of articles which give us myopic Americans an opportunity to see the outside world where things are different. This is one of those opportunities. In this issue we have examples of mental health care on three other continents. From Europe we have an update from the famous South Verona mental health program on 20 years of Italian reform and from London a story of program closures and it’s effects on social networks. A Paper from Switzerland (now a member of the UN) on the effects of stigma rounds out the continent of Europe. From one end of Asia (Israel) we have another paper on stigma and the other side of Asia (Japan) a paper on suicide prevention in the elderly. I grant you Asia is a rather large continent but CMHJ has it covered from one end to the other. Finally from our friends in the land down under we have a needs assessment tool study which borrows something from one continent to test usefulness on another. This business of world wide exchange of ideas seems to me to be a good thing. It is not a new thing. For example after Dr. Pinel freed the mental patients at the Bicetre Hospital in Paris in 1792 the idea of Moral Treatment of the mentally ill traveled across the English channel as the York Retreat and later to N. America in the early 19th century to the first American Moral treatment site the Hartford Retreat. John Galt of the Williamsburg asylum in Virginia tried something similar in the early 1840’s hoping to replicate the mental

What makes a community psychiatrist

We are pleased to be able to present this seminal piece by one of the great psychiatrist innovators of the 20th century. This article was first written as a keynote address given at the tenth anniversary of the APA/Mead Johnson Fellowship. Dr. Leonard I. Stein has written an inspiring message that emphasizes skills and personal characteristics he sees as invaluable to becoming both an effective and satisfied community psychiatrist. For those of us who have made career decisions to serve in the public sector as community psychiatrists, it is a challenging set of principles to keep in mind as we do our daily work and it also validates why we continue to persevere despite the many changes and hurtles in the health care system today. Both of us have worked and done research using the Assertive Community Treatment Model (Stein and Test, 1980) pioneered in earlier times by Dr. Stein and his colleagues. Clearly there is a need to provide this level of service to our most disabled consumers. To do so requires dedication of the sort called for in this article. These ideas are still important despite current pressures experienced by our field requiring even more of the many and varied talents a community psychiatrist needs to possess in order to effectively do her/his job. With the health care system moving relentlessly towards managed care and a blending of the public and private sector, there