Paul D. Peterson

Ethnic populations: community mental health services ten years later.

In a replication of a series of studies conducted by Sue and colleagues in the mid-1970s, demographic and service data were retrieved for the Seattle-King County area from the Washington Mental Health Information System. Caucasian clients were compared against Asian, black, Hispanic, and Native American client groups, and, where possible, against the findings reported earlier by Sue. These clients were compared in terms of basic demographic characteristics, characteristics of staff providing the services, dropout rates, and average number of services received. The most notable findings are (a) that failure-to-return rates are dramatically lower for the current sample than for Sues and not greatly different for minorities than for Caucasians, (b) that variability in failure-to-return rates is most strongly related to level of functioning and not related to minority status, and (c) that although Asian Americans still average fewer services than Caucasians (other minorities do not differ significantly), the mean number of services had increased substantially for all groups but more for minorities than for Caucasians.

Forecasting Recidivism in Mentally Ill Offenders Released From Prison.

Little research has focused on assessing the risk of mentally ill offenders (MIOs) released from state prisons. Here we report findings for 333 mentally ill offenders released from Washington State prisons. Logistic regression identified sets of variables that forecasted felony and violent reconviction as accurately as state-of-the-art risk assessment instruments. Sums of simple recoded versions of these variables predicted reoffense as well as complex logistic regression equations. Five of these 9 variables were found to be relative protective factors. Findings are discussed in terms of the value of stock correctional variables in forecasting risk, the need to base actuarial risk assessments on local data, the importance of protective factors in assessing MIO risk, and the need for dynamic, situational, and clinical variables that can further sharpen predictive accuracy of emergent risk in the community.

Racial differences in the utilization of public mental health services in Washington State

This study analyzed racial differences in the use of public outpatient mental health services in four regions of Washington State. Patients in this study were enrolled in the states mental health management information system, which contains detailed information about patient characteristics and service utilization. There were distinct racial differences with respect to baseline characteristics, and even after adjusting for these characteristics and region of the state as well, racial differences in the type and amount of services used persisted. In particular, African-Americans were more likely to use crisis services and were less likely to use individual or group treatment. This previously reported finding requires further exploration.

Merging cultures: Challenges and opportunities in public academic liaison

Collaboration between academia and public mental health service programs is hindered by conflicts between the cultures supporting each sector. Successful collaboration depends, in part, on understanding and resolving these inherent cultural conflicts. Priorities, values, processes and the focus of results underlying the different cultures are discussed. Approaches to merging these cultures as an aid to collaboration are explored.

Community mental health staff utilization in washington state: Characteristics and target groups

This study addresses human resource development issues for the State of Washington by examining relationships among clinical staff characteristics such as sex, educational level, discipline of academic study, race-ethnic group, and years of mental health treatment experience, and relationships between these staff characteristics and characteristics of staff caseloads, primarily percent of caseload falling into various state priority populations: chronically mentally ill, children, elderly, and minority groups. Results are interpreted in terms of past and future state goals for the mental health service system.

Clozapine therapy in a state hospital: Patient care and policy implications

This study assessed the effectiveness and costs of clozapine use with persons experiencing refractory chronic schizophrenia in a state hospital environment. All patients (112) placed on clozapine therapy between May 1990 and March 1992, and who remained on or were discontinued from clozapine therapy and not restarted were followed. Discharge rates, incidents and hours of seclusion and restraint, incidents and hours of authorized leave and scores on the Modified Nurses Observation Scale for Inpatient Evaluation (NOSIE) were collected. The results found that few discharged patients returned to the hospital and lower community maintenance costs produced substantial savings in overall public support costs. Clozapine therapy is a cost effective alternative for the treatment of refractory schizophrenia.

State Mental Health Planning: New Opportunities.

Mental health planning has been limited by conceptual and logistical restraints. As a result, planning has been isolated from management and ineffectual in describing the total system of services required by persons experiencing severe mental illness. New conceptualizations and information technologies can yield enhanced understanding and control of system change. Application of these ideas to state mental health planning and management is described.

Human resource development: An underutilized tool of state mental health administration

Evidence from federally mandated plans suggests that state mental health administrators have not fully utilized human resource development as a management tool. The importance of human resource development interventions used in collaboration with other management strategies is discussed as an effective approach to mental health system development.