Iradj Siassi

What gets surveyed in a psychiatric survey? A case study of the MacMillan Index.

This research tests and analyzes the operation of one of the earliest psychiatric screening instruments. It remains a most suitable instrument for surveying a general population with lay interviewers. The instrument used was an abbreviated version of the MacMillan Index first used in the Stirling County studies. The research design was to compare the scores obtained from a general population to the scores obtained by a group of clinic patients drawn from the same population. Results show that the index clearly discriminates between patients and the undiagnosed parent population. 1) Thirteen of the 15 questions discriminate between the two groups far beyond chance (p <.0001). 2) A principal factor analysis indicates the operation of two independent factors in the responses of non patients, one characterized by impaired work and social functioning and the other by symptoms of general anxiety. 3) Discriminant function analysis reveals four key questions, two dealing with impaired function, one with somatic distress, and one with fear of a “nervous breakdown.” The authors conclude that the economy, ease, and speed of administration of the MacMillan Index, combined with its demonstrated ability to discriminate between known patients and a general population, make it an excellent instrument for psychiatric epidemiological studies, although its lack of specificity impairs its use as a diagnostic instrument. They urge its further development and analysis.

The social acceptance of the ex-mental hospital patient

The belief that the public stigmatize, stereotype, and reject the former mental hospital patient has been so pervasive among professionals that it has formed the framework of reference for major studies dealing with attitudinal social distance from the exmental hospital patient. Using a different approach, it is shown that the sociological characteristics of the patient rather than their normative characterization may be the significant variable for consideration.

COST-FINANCED MENTAL HEALTH FACILITY: II. UTILIZATION PROFILE OF A LABOR UNION PROGRAM

Specific data are presented concerning the utilization profile of a cost-financed mental health facility. The utilization is enhanced by a mental health education campaign, but total utilization remains within manageable limits (13 per 1000). The visit rate is 8.5 units per patient and remains well within the plans dollar limits. Comparison between utilizers and the population from which they are drawn shows disproportionate numbers of males in contrast to other outpatient insurance studies. This may be a unique feature of work-related programs. “Acting out” disorders are more common among these workers than in other psychiatric programs in the same geographic area.

Who should be counselors in methadone maintenance programs: Ex-addicts or nonaddicts?

Counselors play a central role in most methadone maintenance programs. Yet the choice of who should be employed as counselors is based on little more than personal whims of decision makers. And in evaluating the effectiveness of this highly controlled rehabilitative therapy, the influence of the counselors as an important factor is often ignored. The total changeover of the counselors from an exaddict to a nonaddict group in an otherwise stable clink provided an unusual opportunity to compare the performance of the two groups. Both the objective and subjective data supported the hypothesis that exaddicts as a group compare unfavorably with a similar group of nonaddicts when employed as counselors in a methadone maintenance clinic.

Cost-financed mental health facility. III. Economic issues and implications for future patterns of health care.

Data are presented concerning the economics of a cost-financed mental health facility and a labor union insurance program. The total cost per insured enrollee for all mental health services did not exceed

Cost-financed mental health facility. I. Clinical care pattern in a labor union program.

5.41 per year. The cost per treated patient per year remained under

Women's Liberation and the Two Adolescent Movements

490. These data strongly support the feasibility of including mental health benefits in national health insurance. Costs are then compared between fee-for-service insurance and cost financing. Average costs per treated patient in the cost-financed facility were

Are the Ranks Closed? Attitudinal Social Distance and Mental Illness

302 over a 4-year period. Similar computations under fee-for-services financing showed costs of

Contemporary attitudes toward mental illness

824. The difference reflects much greater use of hospitalizations in the fee-for-service system. These data and the data from the preceding two papers on the clinical and utilization patterns of cost-financed facilities suggest that these facilities are practical clinical forms. Implications for national health insurance, HMO legislation, and community mental health centers are explored.

Loneliness and Dissatisfaction in a Blue Collar Population

Cost-financed mental health facilities create opportunities for new patterns of mental health service analogous to community mental health centers in some ways and to HMOs in others. This paper describes the first facility based on such financing. The concept of cost-financed mental health practice is introduced and defined as including a multidisciplinary team serving a defined population of enrollees through prepaid or prebudgeted financing. The financing may be capitation based or generated through an agreed-upon budget for predefined services. Ordinary fee-for-service insurance creates purchasing power but no care system. Cost financing can create service mechanisms. The paper describes the clinical system made possible through such financing. The direct patient service systems for the United Auto Workers at the Johns Hopkins Hospital funded through cost financing included an early case-finding program, intake and evaluations specially designed for blue-collar workers, a full range of continuous treatment modalities, and programs in chronic care and rehabilitation. Programs in prevention, consultation, and education were also included. Consumer control was effected through elected officials of the labor union. The staffing pattern is described. The authors conclude that this clinical form has the potential to offer both the advantages of the community mental health center and of the private practice system.