Zebulon Taintor

Workforce Competencies in Behavioral Health: An Overview

Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.

Models of Mental Health Training for Primary Care Physicians

&NA; Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, autonomous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysiologic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs.

State-university collaboration in psychiatry: The pew memorial trust program

This contribution summarizes the background leading up to the goals of and the experience gained from a major national initiative to expand and improve collaborative activities between state departments of mental health and university departments of psychiatry through regional conferences, national workshops, ongoing consultations, and awards. It details the problems of the public system and how successful collaborative efforts have improved the situation, cites the role of one such a program (in Maryland), recounts the process of holding a national invitational conference and the subsequent “Call to Action,” and summarizes what the Pew Project is intended to do and how the project is progressing.

Diagnosis of manic depressive illness in blacks

INCE the discovery of the effectiveness of lithium as a chemotherapeutic agent in manic illness and the revelations of the US-UK study’ there has been a resurgence of interest in the phenomenology and biology of bipolar illness. Family studies have demonstrated that heredity is a factor in its etiology.2 There is some evidence that there is significant variation in the incidence of manic-depressive illness among different ethnic groups.3 Furthermore, some surveys agree that bipolar illness is seen more frequently in the upper social classes.4s5 Blacks appear underrepresented in the treatment population of bipolar patients. Does this reflect the true prevalence based primarily on biological factors, or, are there social, economic, and cultural factors that influence the diagnosis and disposition of cases treated and untreated? Recent articles have suggested underdiagnosis of mania in blacks. 6*7 This review of a broad base of hospital statistics offers relative rates of bipolar illness in a treatment population and includes annual white:black case ratios. METHOD A computer search of the data base of the Multi-State Information System (MSIS) was made, selecting information provided on the MS-5 admission form. The MSIS is an information processing service located at the Rockland Research Institute, Orangeberg, New York to which many hospitals and clinics in various states, mostly in the northeastern United States, feed data. Black, white, and Puerto Rican first admissions to hospitals and clinics were divided into manic and nonmanic groups. DSM-II diagnoses used were 296.1 (manic-depressive illness, manic type), 296.3 (manic-depressive illness, circular type), and 296.33 (manic-depressive illness, circular type, manic).* Only black and white comparisons were made in this study. The period covered was 1 January 1969 through 28 May 1979. This study is obviously limited by using DSM II diagnoses, but the use of DSM II enabled the authors to serially survey a large population for an entire decade. Other limitations include the lack of interrater reliability and the certainty that MSIS admission forms are filled out casually in some facilities. For this reason only facilities with at least several years of relatively complete data (as judged by sweeps for missing admission form data) were included. Additionally, only users with at least four years of data were included.

Emotional problems in psychiatric residency training: Recommendations for their reduction

Working from an initial study, which attempted to quantify the number of serious mental disorders among psychiatric residents, the authors focused on the relationship of these problems to the exigencies of the training experience. Under the auspices of the American Association of Directors of Psychiatric Residency Trainings Task Force on Emotional Problems of Residents, a questionnaire was distributed to all residents who completed training in 1975. Respondents in this national survey had an opportunity to rate the stressfulness and the impact on personal and professional growth for many specific aspects of residency training. These ratings, plus the considerable demographic data obtained, suggest high stress levels for many aspects of residency training, but also illustrate the growth promoting effects of most of these experiences. Much of this important data was included in an article recently published in this journal. As a follow-up to this initial report, this article provides a further review of the data and offers guidelines for improving the emotional status of our colleagues in training.

Endemic Publishiasis: Redux and Growing

We are delighted thatAcademic Psychiatry has agreed to resurrect our 1982 article “Endemic Publishiasis,” a not altogether tonguein-cheek piece on medical publishing that the two of us wrote for what was then a brand new, now defunct journal, Contemporary Psychiatry. That journal, designed to invite extended essays and reviews stimulated by new books in psychiatry, never made it to PubMed, leaving our orphaned article without a DOI. As editorial board members, we were encouraged to contribute to early issues—our article appeared in volume 1, issue 2 of the journal. The themes addressed in this article seem as relevant to us now as they were 35 years ago when the article first appeared. One of our premises was that a happy collusion exists between the expectation of faculty to publish and the seemingly endless appetite of a constantly growing medical informationindustrial complex. We acknowledged the demands of junior faculty whose need to publish, measured quantitatively as well as qualitatively, was tied directly to such crass but extremely practical outcomes as promotion and salary increases. To contend with these demands, we portrayed ways in which multiauthor collaborations and strict attention to publishing “LPUs” (least publishable units) could lead to increased rates of publication, not entirely in the interests of gaming the system. We noted that the increasing number of journals provided an increasing number of outlets so that most half-decently written manuscripts had a good chance of ultimately being published. In fact, since we published this article, the various factors contributing to endemic publishiasis appear to have grown dramatically, perhaps exponentially. First, the number of authors per scientific article has clearly been increasing, with an estimated rate of one additional author per publication per decade. While some of the large numbers of co-authors can be attributed to the increasing complexity of research necessary for the studies, complexity alone does not account for much of the increase [1]. Rather, social aspects we described as contributing to publishiasis are palpable (as in our description of “how many people can dance on the head of a case report?”). Second, as the number of journals has skyrocketed, the number of published references has doubled approximately every 9 years [2], in part due to proliferation of open-access journals. While many esteemed journals, including those sponsored by learned societies, have introduced open-access options in which authors can underwrite immediate open access to their articles [3], many new open-access journals have emerged based solely on a for-profit “pay for play” or “pay to publish” model. Some of these journals appear to be outright scams that provide little or no peer review and which have no credibility in professional circles [4]. Fake articles can be published in fake journals [5]. Caveat author, caveat reader, and caveat promotions committee. Thankfully, standards for authorship in respectable journals have been progressively increasing. In attempts to reduce the prevalence of ghost authorships and courtesy authorships, most high-quality journals now describe the types of contributions expected of authors, adhering to industry standards as to what merits co-authorships on peer-reviewed articles [6]. We can only hope that professionals follow these expectations. In the meantime, “Endemic Publishiasis” may still provide junior faculty who still need to publish with one or two helpful strategies. Times have not changed all that much. The following paper is reprinted with permission: Yager J, Taintor Z. Endemic Publishiasis, Contemporary Psychiatry, 1:76–79, 1982.

The German Social Insurance Program’s Role in the Rehabilitation of Mentally Ill Patients

The Bismarck legislation of 1881 recognized that health is a public asset. Subsequent legislation has required that everyone either have health insurance or demonstrated ability to pay medical bills by having sufficiently high income.1 It is understood that everyone must pay his/her medical bill, which 90% of the population does through one form or another of health insurance. These are: 1) legal health insurance: financed by employee, employer, pays for diagnosis and treatment of diseases 2) pension insurance: pays for rehabilitation of disabled people likely to return to the workforce 3) unemployment insurance: supports measures to reintegrate workers into the labor force, such as wages if a person unemployed for a year or more is hired, new skills training, etc. 4) nursing insurance: relatively new (1995), this fund is financed compulsory insurance to pay for nursing care at home or in nursing homes if that level of care is needed. For chronic disease. Chronic mental disease is excluded. The counterpart in the U.S.A. for disabled people or those over 65 is Medicare, which also excludes equal coverage for mental illness 5) legal accident insurance: every employer must enroll its employees in this system, which covers acute treatment, rehabilitation, reintegration into the labor market, nursing, etc. Despite its name, it does not resemble Workmen’s Compensation in the U.S.A., but rather the usual indemnity or fee-for-service coverage for workers that was the pre-managed care form of health insurance in the U.S.A. 6) public assistance: financed by local tax income of cities and counties, this system provides backup if any other fund does not provide coverage, or if a person has failed to join the mandatory insurance system

For-Profit Managed Care in the USA

It must be assumed that the cost of health care is potentially infinite, since everyone would like to live forever. No country pays for immortality and some compromises are inevitable.

Discussion on the use of computers in consultation-liaison psychiatry.

Abstract The preceding articles represent excellent work, enabling the discussion to proceed simultaneously along several lines: 1) use of computer hardware and software, 2) problems in implementing and using an information system, and 3) truths and issues in consultation-liaison psychiatry revealed by the data in information systems.

The Extent Of The Problem: A Review Of The Data Concerning The Declining Choice Of Psychiatric Carrers

A review of all data sources shows that the number and percent of American medical graduates entering psychiatry is decreasing. Interest in psychiatric careers is declining among medical school applicants. The number of foreign medical graduates in psychiatric training and the total number of psychiatric residents is also decreasing.