Jeanette Semke

One system, many perspectives: Stakeholders and mental health system evaluation

Abstract The use of an action research model to integrate the perspective of multiple stakeholders in the evaluation of a states mental health reform is described. The process of forming the evaluation team (a mix of university and state legislative staff) is addressed in the context of the political and scientific nature of public systems evaluation. A brief description of action research and its role in program evaluation provides the basis for discussing how the principles of action research were incorporated into the study, from the definition of research questions, to sampling, measurement, analysis and dissemination.

Effects of mental health reform on client characteristics, continuity of care and community tenure

This article examines the impact of mental health services reform on aspects of service delivery within the State of Washington. Data from the state Mental Health Divisions information systems were used to examine client characteristics, continuity of care, and community tenure across a 2-year period spanning the early implementation of services reform. Findings were that (a) caseloads increased, (b) client characteristics (gender, age, ethnicity, client priority status) did not change much, (c) continuity of services between state hospitals and community services improved a great deal, and (d) hospital admissions and readmissions changed only slightly, but discharges increased considerably. It was not clear whether there were changes in time in the community between admissions. These results suggest that there are no indications of deterioration in services, as might be expected to occur during major system changes, and that in some respects service delivery has been improved.

Regional Patterns of Service for Individuals with Severe Mental Illness

There is broad recognition in the mental health field that a continuum of care is essential to increased community tenure for mentally ill individuals at risk for high inpatient utilization (Bachrach, 1993). Evaluations of model case management programs that provide for a continuum of need offer the empirical support for this service approach (Bond, Miller, Krumwied, & Ward, 1988; Brekke & Test, 1987; Field & Yegge, 1982; Test, Knoedler & Allness, 1985). Through legislative mandates, financing mechanisms, economic incentives, and organizational restructuring, state governments attempt to ensure that the continuum of need by public mental health clients is met. Over the last decade, many states have decentralized administrative and fiscal responsibility for publicly funded mental health services. Typically, local mental health authorities are responsible for mental health services for all residents in catchment areas that are geographically defined subregions of the state. Thus, analysis at the level of the catchment area is required to understand the extent of implementation of various state mental health policy initiatives. The mental health services described in this paper were among services that were mandated by the Mental Health Reform Act of 1989, legislation that decentralized authority for mental health services in Washington State. The statute describes the community mental health continuum of care in broad categories that involve activities and concrete assistance by mental health providers. This paper focuses on those services that meet two criteria: (1) they are hypothesized to be important alternatives to use of inpatient psychiatric services by individuals with severe mental illness, and (2) estimates of the extent to which the need for the services is met varies significantly among local catchment areas in Washington State. Implementation of the mental health Jeanette Semke, Ph.D., is Research Assistant Professor, School of Social Work, University of Washington. Sondra Perdue, Dr.P.H., is Senior Statistical Scientist and Owner, Analysis Plus. This study was funded by the National Institute of Mental Health, Grant #1 R29 MH5147S01, and was presented at the 1995 National Association of State Mental Health Program Directors Research Institute Conference. Address for correspondence: Jeanette Semke, Ph.D., School of Social Work JH-30, University of Washington, Seattle, WA 98195.

Shifts in Case Mix and Locus of Mental Health Care for Washington State Adults with Severe Mental Illness

The author describes outcomes of interventions that were aimed at decreasing high use of state hospitals. Research focused on changes in state hospital case mix and dynamics of use by individuals identified as “high utilizers” before and after the Washington State Mental Health Division (MHD) implemented a series of interventions designed to reduce use. A set of recommendations are offered for policymakers who plan interventions that shift the locus of care for severely and persistently mentally ill adults.

State Mental Hospitals in Washington State in an Era of Policy Change

This paper examines changes in use of state mental hospitals in Washington State from July 1, 1990, to July 1, 1997. It focuses on the phenomenon of ongoing use of state mental hospital by patients over a period of years. Two panels of state mental hospital users were identified: one preceded and one followed implementation of state mental hospital downsizing policies. Though the number of adults per year using the state mental hospital decreased following policy implementation, there was a significant increase in the overall rate of ongoing use. A logistic regression for ongoing use with multiple individual and regional predictor variables is described.

A public-academic approach to designing a state mental health program evaluation

This article describes a collaboration between a state legislature and a state university to evaluate the impact of a legislatively-mandated reorganization of the states mental health service delivery system for adults. The authors address political, logistical, and methodological issues associated with the collaborative evaluations design and implementation.

Functions of State Hospitals in the Care and Treatment of Older Adults

This paper reports results of analyses of case mix and state hospital use patterns for older adults from 1984 to 1988 in nine states. Results show that states differ in the following ways in how they use state psychiatric hospitals for care of older adults with neuro-psychiatric disorders: (1) their emphasis on long-, intermediate-, and short-term care functions, (2) which length of stay functions are used for different types of neuro-psychiatric disorders, and (3) the extent to which they rely on the state hospital for care of the older adult population. Implications for mental health policy planning are discussed.

Impact of mental health reform on service use

Abstract This article will explore the impact of early implementation of mental health reform on community mental health service use by clients. The results from a review of agency charts for mental health clients are reported. Service use for all clients in the sample, for elderly clients, for ethnic minority clients, and for clients who are chronically mentally ill was compared for a 3-month period prior to implementation of the mental health reform and a 3-month period subsequent to reform. The following questions were addressed: (a) Did use of case management services increase in comparison to day treatment and individual therapy services? (b) Did use of medication management services increase? (c) Did use of vocational services increase? (d) Did use of crisis services increase? (e) Did use of substance abuse services increase? (f) Following implementation of the mental health reform, were clients more likely to receive a wider range of services than prior to reform?