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This column describes the development of a partnership between health care, housing, and intellectual disability services to support efforts by homeless adults with intellectual disabilities to exit homelessness. Applying a Housing First approach and philosophy, the partners launched a pilot intervention, which at its first phase engaged 26 homeless adults with intellectual disabilities in Toronto. This cross-sector service model was acceptable to service users, who reported positive experiences and good program engagement. Key enablers of success included the program's capacity to address complexity, stakeholders' approach to choice and compromise, and fulsome collaboration and communication at every level. [ABSTRACT FROM AUTHOR]

Objective: Psychosocial rehabilitation has been established as a critical component of client-centered recovery-oriented services for people with serious mental illness. Despite its importance, the implementation of mental health rehabilitation services in low- or middle-income countries has not been well studied. In this study, the authors document the regional challenges of planning and implementing mental health rehabilitation services in clubhouses in Hunan Province in the People's Republic of China.Methods: Participants were purposively selected and consisted of diverse stakeholders, including rehabilitation directors and psychiatric hospital leaders in Hunan Province, China. Information was collected from 33 individuals by using three focus groups, 23 semistructured interviews of key informants, and participant observation. Interview transcripts were coded and analyzed by using standard qualitative methods.Results: Implementation challenges were characterized by four themes: skepticism toward psychosocial rehabilitation services, resource shortage, insufficient system integration and incentives, and stigma of mental illness.Conclusions: Psychosocial rehabilitation is an emerging public health priority in China. This study on clubhouses in Hunan Province used qualitative methods to inform future directions for service development and research. Early identification of regional implementation challenges is a first step in assessing the applicability of psychosocial rehabilitation services locally in Hunan Province. Successful implementation of clubhouse psychosocial rehabilitation services will benefit not only from strong government commitment but also from developing standard evaluations of evidence-based practices, tackling stigma, and addressing low resource investment. [ABSTRACT FROM AUTHOR]

Objective: This study examined the association between neighborhood characteristics, stigma related to mental illness reported by local community members, and measures of perceived stigma and community participation among individuals with psychiatric disabilities living in independent scattered-site housing or in congregate housing in three neighborhoods in the New York City metropolitan area.Methods: Neighborhood characteristics were drawn from the 2010 U.S. Census. Surveys focusing on attitudes and intended behavior toward people with mental illness were administered to 608 general community members, and clinical interviews were conducted with 343 persons with psychiatric disabilities.Results: Of neighborhood characteristics, both greater socioeconomic disadvantage and more "suburban values" (lower housing density and greater political conservativism) predicted more perpetrated stigma reported by community members. There was no significant relationship between stigma reported by community members and perceived stigma among participants with psychiatric disabilities. Community stigma predicted vocational involvement and demonstrated interaction effects with housing, such that persons living in congregate housing demonstrated more community participation in communities with more stigma, whereas persons living in scattered-site housing demonstrated less participation in these communities. Perceived stigma was significantly negatively related to community participation.Conclusions: Findings suggest that effects of neighborhood characteristics and community stigma on people with psychiatric disabilities are complex and are partly conditioned by housing context. [ABSTRACT FROM AUTHOR]

Objective: This study examined the effects of a three-month Family-to-Family (FTF) Education Program on expressed emotion and subjective knowledge about mental illness among relatives of Mexican patients with severe mental disorders.Methods: A total of 230 relatives of patients with severe mental disorders completed self-reported questionnaires before (pretest) and after (posttest) the FTF program.Results: FTF led to reductions in negative emotional attitudes and improved the understanding of the disorder, regardless of sex or age of the relative.Conclusions: This study supported the evidence-based practice of FTF in a Mexican population and confirmed the importance of providing routine family psychoeducation as an additional component of health care service provision for relatives of people with severe mental illness in the community. [ABSTRACT FROM AUTHOR]

Objective: The authors examined consumer outcomes before and after implementing CommonGround, a computer-based shared decision-making program.Methods: Consumers with severe mental illness (N=167) were interviewed prior to implementation and 12 and 18 months later to assess changes in active treatment involvement, symptoms, and recovery-related attitudes. Providers also rated consumers on level of treatment involvement.Results: Most consumers used CommonGround at least once (67%), but few used the program regularly. Mixed-effects regression analyses showed improvement in self-reported symptoms and recovery attitudes. Self-reported treatment involvement did not change; however, for a subset of consumers with the same providers over time (N=83), the providers rated consumers as more active in treatment.Conclusions: This study adds to the growing literature on tools to support shared decision making, showing the potential benefits of CommonGround for improving recovery outcomes. More work is needed to better engage consumers in CommonGround and to test the approach with more rigorous methods. [ABSTRACT FROM AUTHOR]

Objective: Community mental health providers' attitudes toward criminal justice-involved clients with serious mental illness were examined.Methods: A total of 627 Maryland psychiatric rehabilitation program providers responded to a survey (83% response rate). Measures assessed providers' experience with, positive regard for, and perceptions of similarity, with their clients with serious mental illness. Chi-square tests were used to compare providers' attitudes toward clients with and without criminal justice involvement.Results: Providers reported lower regard for criminal justice-involved clients than for clients without such involvement. Providers were less likely to report having a great deal of respect for clients with (79%) versus without (95%) criminal justice involvement. On all items that measured providers' perceived similarity with their clients, less than 50% of providers rated themselves as similar, regardless of clients' criminal justice status.Conclusions: Future research should explore how providers' attitudes toward criminal justice-involved clients influence service delivery for this group. [ABSTRACT FROM AUTHOR]

Objective: Peer-to-peer interactions and support groups mitigate experiences of social isolation and loneliness often reported by individuals with psychotic disorders. Online peer-to-peer communication can promote broader use of this form of social support. Peer-to-peer interactions occur naturally on social media platforms, but they can negatively affect mental health. Recent digital interventions for persons with psychotic disorders have harnessed the principles of social media to incorporate peer-to-peer communication. This review examined the feasibility, acceptability, and preliminary efficacy of recent digital interventions in order to identify strategies to maximize benefits of online peer-to-peer communication for persons with psychotic disorders.Methods: An electronic database search of PubMed, EMBASE, PsycINFO, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted in February 2017 and yielded a total of 1,015 results. Eight publications that reported data from six independent trials and five interventions were reviewed.Results: The technology supporting peer-to-peer communication varied greatly across studies, from online forums to embedded social networking. When peer-to-peer interactions were moderated by facilitators, retention, engagement, acceptability, and efficacy were higher than for interventions with no facilitators. Individuals with psychotic disorders were actively engaged with moderated peer-to-peer communication and showed improvements in perceived social support. Studies involving service users in intervention design showed higher rates of acceptability.Conclusions: Individuals with psychotic disorders value and benefit from digital interventions that include moderated peer-to-peer interactions. Incorporating peer-to-peer communication into digital interventions for this population may increase compliance with other evidence-based therapies by producing more acceptable and engaging online environments. [ABSTRACT FROM AUTHOR]

Objective: Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction.Methods: This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version.Results: Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms.Conclusions: Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD. [ABSTRACT FROM AUTHOR]

Objective: Although supported employment increases job acquisition for people with serious mental illness, data on participants' job tenure have been variable. This study evaluated the effects of a standardized work skills training program (the Workplace Fundamentals Module [WPFM]) on job tenure and other work outcomes among individuals receiving individual placement and support (IPS). The effects of two atypical antipsychotic medications on side effects were also tested. The primary hypothesis tested was that participants in IPS plus WPFM would have increased job tenure compared with those enrolled in IPS only, and the secondary hypothesis was that different antipsychotic medications would yield unique side effects.Methods: A 2×2 randomized controlled trial compared work outcomes, including job tenure, of participants receiving IPS with or without WPFM for up to two years after obtaining a job. Participants were also randomly assigned to olanzapine or risperidone. Measures of work outcomes, clinical status, and medication side effects were collected.Results: Among 107 participants, 63% obtained at least one job. WPFM did not increase job tenure (51.53 and 41.37 total weeks worked for IPS only and IPS plus WPFM, respectively) or affect other work outcomes. Participants on olanzapine experienced increased body mass index, whereas those on risperidone lost weight, but medications did not differentially affect clinical or job outcomes.Conclusions: Clinic-based skills training did not improve work outcomes accruing from IPS. Risperidone, compared with olanzapine, may reduce body mass but has no differential effect on other work or clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: The study examined state variation in rates of Supplemental Security Income (SSI) determinations, allowances, and receipt of benefits for ten selected child mental disabilities in 2013.Methods: SSI administrative and U.S. Census Bureau data collected by a multidisciplinary consensus committee convened by the National Academies of Science, Engineering, and Medicine in 2015 were examined.Results: Less than 1% of children in 2013 were recipients of SSI for mental disabilities. Determination rates ranged from 1,441 to 251 per 100,000 low-income children, an almost sixfold difference. Allowance rates varied from 16% to 78%, a fivefold difference. Receipt of benefits ranged from .7% to 5.3%, a sevenfold difference.Conclusions: Large unexplained discrepancies across states were found in review and receipt of SSI benefits for low-income children with mental disabilities. Inequities that cannot be explained by disability severity or financial need violate the ethos of equitable access to federally entitled services. [ABSTRACT FROM AUTHOR]

Objective: The study compared employment experiences, mental health recovery, and quality of life among peer specialists and vocational rehabilitation (VR) specialists hired by the U.S. Department of Veterans Affairs (VA), the VR specialists under the Homeless Veterans Supported Employment Program. Employment characteristics associated with mental health recovery were examined. Methods: The study was a national, observational survey of 152 peer specialists and 222 VR specialists across 138 VA health care systems in 49 states. The survey, administered over the Internet, included measures describing participant characteristics, employment factors, mental health, and quality of life. The two cohorts were compared by using t tests or chi square tests. Multiple regression analysis controlling for participant characteristics was used to identify employment factors associated with mental health and quality of life. Results: Peer specialists were more likely than VR specialists to share recovery stories, serve as a role model or mentor, and advocate for veterans. Activities by VR specialists tended tofocus more narrowly on job skills. Overall, after adjusting for multiple comparisons, the analysis found high levels of mental health and average quality of life for both cohorts, with no significant differences between the groups. Satisfaction with amount of supervision was consistently associated with aspects of mental health recovery, including work-related and helping-related quality of life, for both cohorts. Conclusions: The results highlight the value of work and the importance of supervision in realizing both the adoption of recovery-oriented services and the promotion of mental health in a community of veterans serving each other. [ABSTRACT FROM AUTHOR]

Objective: California's full-service partnerships (FSPs) provide a combination of subsidized permanent housing and multidisciplinary teambased services with a focus on rehabilitation and recovery. The goal of the study was to examine whether participation in FSPs is associated with changes in health service use and costs compared with usual care. Methods: A quasi-experimental, pre-post, intent-to-treat design with a propensity score-matched contemporaneous control group was used to compare health service use and costs among 10,231 FSP clients and 10,231 matched clients with serious mental illness who were receiving public m ental health services in California from January 1,2004 , through June 30, 2010. Results: Among FSP participants, the mean annual number of mental health outpatient visits increased by 55.5, and annual mental health costs increased by $11,725 relative to the matched control group. Total service costs increased by $12,056. Conclusions: Participation in an FSP was associated with increases in outpatient visits and their associated costs. As supportive housing programs are implemented nationally and on a large scale, these programs will likely need to be more effectively designed and targeted in order to achieve reductions in costly inpatient services. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study examined factors associated with unmet need for care from primary care physicians or from psychiatrists among clients enrolled in mental health court support programs in Toronto, Ontario. Methods: The sample included adults admitted to these programs during 2009 (N=994). Both measures of unmet need were determined by mental health court workers at program intake. Predictors included client predisposing, clinical, and enabling variables. Results: Twelve percent had unmet need for care from primary care physicians and 34% from psychiatrists. Both measures of unmet need were associated with having an unknown diagnosis, having no income source or receiving welfare, homelessness, and not having a case manager. Unmet need for care from psychiatrists was associated with symptoms of serious mental illness and current hospitalization. Conclusions: Obtaining care from psychiatrists appears to be a particular challenge for justice-involved persons with mental illness. Policies and practices that improve access warrant more attention. [ABSTRACT FROM AUTHOR]

People with serious mental illness are more likely to be arrested multiple times for the same crime, spend more time in jail before adjudication, serve longer sentences, and have higher recidivism rates than those without mental illness. Several conceptual foundations, such as the sequential intercept model and the risk-needs-responsivity model, have been developed to help communities address the overrepresentation of people with mental illness in the criminal justice system. The Stepping Up Initiative is a national effort to enlist counties to commit to reduce the number of people with mental illness in their jails. The 21st Century Cures Act has created opportunities to fund community treatment and help people with serious mental illness live a productive life in their community. Public officials may need to be shown the substantial cost savings likely to accrue from an investment in effective community treatment. The time to act is now. [ABSTRACT FROM AUTHOR]

People with mental illness are often members of multiple stigmatized social groups. Therefore, experienced disadvantage might not be determined solely by mental illness stigma. Nevertheless, most available research does not consider the effects and implications of membership in multiple stigmatized social groups among people with mental illness. Reflecting on intersectionality theory, the authors discuss two intersectional effects determining disadvantage among people with mental illness who are members of multiple stigmatized social groups, namely double disadvantage and prominence. To be effective, interventions to reduce disadvantage experienced by people with mental illness need to be flexible and targeted rather than universal in order to address the implications of intersectionality. Whereas education-based approaches usually assume homogeneity and use universal strategies, contact-based interventions consider diversity among people with mental illness. [ABSTRACT FROM AUTHOR]

Objective: During the transition to adulthood, youths face challenges that may limit their likelihood of obtaining services for psychiatric problems. The goal of this analysis was to estimate changes in rates of service use and untreated psychiatric disorders during the transition from adolescence to adulthood. Methods: In a prospective, population-based study, participants were assessed up tofour times in adolescence (ages 13-16; 3,983 observations of 1,297 participants, 1993-2000) and three times in young adulthood (ages 19, 21, and 24-26; 3,215 observations of 1,273 participants, 1999-2010). Structured diagnostic interviews were used to assess service need (participants meeting DSM-IV diagnostic criteria for a psychiatric disorder) and use of behavioral services in 21 service settings in the past three months. Results: During young adulthood, 28.9% of cases of psychiatric disorders were associated with some treatment, compared with a rate of 50.9% for the same participants during adolescence. This decrease included a near-complete drop in use of educational and vocational services as well as declines in use of specialty behavioral services. Young adults most frequently accessed services in specialty behavioral or general medical settings. Males, African Americans, participants with substance dependence, and participants living independently were least likely to get treatment. For cases of psychiatric disorders among young adults, insurance and poverty status were unrelated to likelihood of service use. Conclusions: Young adults were much less likely to receive treatment for psychiatric problems than they were as adolescents. Public policy must address gaps in service use during the transition to adulthood. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have found that timely mental health treatment can result in savings in both mental health and general medical care expenditures. This study examined whether reducing racial-ethnic disparities in mental health care offsets costs of care. Methods: Data were from a subsample of 6,206 individuals with probable mental illness from the 2004-2010 Medical Expenditure Panel Survey (MEPS). First, disparities in mental health treatment were analyzed. Second, two-year panel data were used to determine the offset of year 1 mental health outpatient and pharmacy treatment on year 2 mental and general medical expenditures. Third, savings were estimated by combining results from steps 1 and 2. Results: Compared with whites, blacks and Latinos with year 1 outpatient mental health care spent less on inpatient and emergency general medical care in year 2. Latinos receiving mental health care in year 1 spent less than others on inpatient general medical care in year 2. Latinos taking psychotropic drugs in year 1 showed reductions in inpatient general medical care. Reducing racial-ethnic disparities in mental health care and in psychotropic drug use led to savings in acute medical care expenditures. Conclusions: Savings in acute care expenditures resulting from eliminating disparities in racial-ethnic mental health care access were greater than costs in some but not all areas of acute mental health and general medical care. For blacks and Latinos, the potential savings from eliminating disparities in inpatient general medical expenditures are substantial (as much as $1 billion nationwide), suggesting that financial and equity considerations can be aligned when planning disparity reduction programs. [ABSTRACT FROM AUTHOR]

Objective: Research investigating the association between continuity of care (CoC) and patient outcomes in mental health care is limited. A previous review (1970-2002) concluded that evidence for an association between CoC and outcomes was inconsistent and limited. This systematic review, conducted a decade later, provides an update. Methods: Searches (1950-2014) were conducted on MEDLINE and PsycINFO. Included studies used a clearly identified measure of CoC and examined its relation to an outcome among adults (ages 18-65). Only English-language publications were included. Results: A total of 984 studies were identified that measured CoC. Eighteen met inclusion criteria, and 13 found an association between CoC and an outcome. As found in the previous review, studies reported conflicting results for the most frequently examined outcomes (hospitalization, symptom severity, social functioning, and service satisfaction). Little consistency was found between studies in choice of CoC measures and outcomes. Studies varied markedly in quality. Two of the three studies rated as good quality reported significant associations between CoC and social functioning. Compared with older studies, studies published since the previous systematic review (2002-2014) found a larger proportion of significant associations. Conclusions: Little consistency was found in the way CoC was measured, which made it difficult to compare studies. Therefore, clear evidence about the association between CoC and outcomes remains limited. Results in regard to social functioning are encouraging. However, in order for conclusions to be made, researchers need to be more consistent with the measures they choose to allow comparison of studies. [ABSTRACT FROM AUTHOR]

Objective: Bipolar disorder is a severe and prevalent psychiatric disease. Poor outcomes include a high frequency of criminal acts, imprisonments, and repeat offenses. This critical review of the international literature examined several aspects of the complex relationship between individuals with bipolar disorder and the criminal justice system: risk factors for criminal acts, features of bipolar patients' incarceration, and their postrelease trajectories. Methods: Publications were obtained from the PubMed and Google Scholar electronic databases by using the following MeSH headings: prison, forensic psychiatry, criminal law, crime, and bipolar disorder. Results: Among patients with bipolar disorder, the frequency of violent criminal acts is higher than in the general population (odds ratio [OR]=2.8, 95% confidence interval [CI]=1.8-4.3). The frequency is higher among patients with bipolar disorder and a comorbid substance use disorder than among those without either disorder (OR=10.1, CI=5.3-19.2). As a result, the prevalence of bipolar disorder among prisoners is high (2%-7%). In prison, patients' bipolar disorder symptoms can complicate their relationship with prison administrators, leading to an increased risk of multiple incarcerations. Moreover, the risk of suicide increases for these prisoners. Conclusions: Criminal acts are common among patients with bipolar disorder and are often associated with problems such as addiction. Thus it is important to improve the diagnosis and treatment of inmates with bipolar disorder. [ABSTRACT FROM AUTHOR]

Objective: Many persons with serious mental illnesses are interested in pursuing postsecondary education and are doing so in increasing numbers. Accommodations can be essential, but limited research suggests that few fonnally seek accommodations, although increased efforts to height- en awareness may be changing this. The purpose of this study was to ex- amine whether students with mental illnesses are increasingly aware of, and utilize, accommodations and academic supports and to identify the supports that are most used and perceived to be most helpful. Methods: A national Internet survey was conducted from July 2005 to July 2006, resulting in responses from 190 current and 318 former students with mental ifinesses. Results: The study found modest but significant negative correlations between how long ago students left college and their familiarity with accommodations, their request for or receipt of accommodations, and their use of the Office for Students With Disabilities. These results were particularly noticeable when comparing current and former students. Moderate positive correlations that were significant were found between familiarity with accommodations, use of campus disability offices, and request for or receipt of accommodations. Conclusions: There is in- creased awareness and use of accommodations among students with mental illnesses, but it is also clear that most receive supports directly from instructors without going through the formal accommodations process. Encouraging students to utilize disability offices and greater attention to accommodation barriers may further increase support seeking. Supports that are most used and viewed as most helpful provide direction for service providers and campus personnel in their efforts to facilitate students' educational goals. (Psychiatric Services 59:370-375, 2008) [ABSTRACT FROM AUTHOR]

The article focuses on a study on the decision-making process in identifying mentally ill individuals who are appropriate for jail diversion programs. The study revealed that a greater number of those who are included in the program are composed of women, whites, and older persons. Those who were charged of felony and violence are less likely to be included in the program. It was concluded that there is disproportionate representation among individuals for jail diversion programs. Examination on the process of choosing individuals that must be included in the programs is recommended.

Examines the effects of job development and job support among other services on acquisition and retention of competitive employment. Association of job support with more months in the first competitive job but not total hours of worked; Absence of evidence for the causal role of job support in analyses that tested the effects of job support after the job support was provided; Significance of the causal role of job support.

Reports on the study which found that there is a high prevalence of trauma symptoms among people with serious mental illness who are treated in public-sector mental health systems. Distinction between traumatic and harmful events that occur within the sanctuary of the psychiatric setting; Examination of the safety and dignity of psychiatric settings; Reduction of the use of seclusion and restraint.

Examines the frequency and associated distress of potentially traumatic or harmful experiences occurring within psychiatric settings among persons with severe mental illness. Prevalence rates of traumatic victimization; Efficacy of the use of control procedures; Release of regulations to limit the use of restraint and seclusion.

Objective: The aim of this study was to describe employment according to mental illness severity in the United States during 2009 and 2010. Methods: The sample included all working-age participants (ages 18-64) from the 2009 and 2010 National Survey on Drug Use and Health (N=77,326). Two well-established scales of mental health distinguished participants with none, mild, moderate, and serious mental illness. Analyses compared employment rate and income by mental illness severity. Employment status was estimated with logistic regression models that controlled for demographic characteristics and substance use disorders. In secondary analyses the relationship between mental illness and employment was assessed for variation by age and education status. Results: Employment rates decreased with increasing mental illness severity (no mental illness, 75.9% employment; mild, 68.8%; moderate, 62.7%; and serious, 54.5%, p<.001). Over a third of people with serious mental illness, 38.5%, had incomes <$10,000 (compared with 23.1% of people with no mental illness, p<.001). The gap in adjusted employment rates comparing persons with serious versus no mental illness was 1% among people 18-25 years old versus 21% among people 50-64 (p<.001). Conclusions: More severe mental illness was associated with lower employment rates in 2009 and 2010. People with serious mental illness are less likely than people with no, mild, or moderate mental illness to be employed after age 49. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to fill a gap in the literature on effectiveness of employment accommodations by comparing employment outcomes for individuals with psychiatric disabilities who received or did not receive accommodations, with models informed by a conceptual approach blending static labor supply theory, Sen's capability approach, and the International Classification of Functioning. Methods: Data for the study came from a longitudinal, four-year eight-state multisite demonstration project funded by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration. All participants had been recruited from clinical populations receiving outpatient psychiatric services. The effects of job accommodations on hours worked were assessed with generalized linear modeling (N= 1,538). The effects of job accommodations on duration of employment were assessed with a parametric duration model analysis (N=1,040) that incorporated multiple spells of employment among individuals over the study period. Results: Controlling for covariates suggested by the conceptual model, analyses showed that individuals who reported job accommodations on average worked 7.68 more hours per month and those who reported receiving accommodations worked 31% longer, with each job accommodation reported decreasing the risk of job termination by nearly 13%. Conclusions: Results demonstrate that job accommodations show potential to improve employment outcomes for individuals with psychiatric disabilities receiving supported employment services, indicating that job accommodations should be stressed in policy and continuing education efforts for program staff and clients. [ABSTRACT FROM AUTHOR]

Objective: Peer recovery support services are delivered by individuals in recovery from substance use disorders to peers with substance use disorders or co-occurring mental disorders. This review describes the service and assesses its evidence base. Methods: Authors searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, and Social Services Abstracts for outcome studies of peer recovery support services from 1995 through 2012. They found two randomized controlled trials, four quasi-experimental studies, four studies with pre-post service designs, and one review. Authors chose from tiiree levels of evidence (high, moderate, and low) on the basis of benchmarks for the number of studies and quality of their methodology. They also described die evidence of service effectiveness. Results: The studies met die minimum criteria for moderate level of evidence. Studies demonstrated reduced relapse rates, increased treatment retention, improved relationships with treatment providers and social supports, and increased satisfaction with the overall treatment experience. Methodological concerns included inability to distinguish die effects of peer recovery support from other recovery support activities, small samples and heterogeneous populations, lack of consistent or definitive outcomes, and lack of any or appropriate comparison groups. Conclusions: Peer recovery support providers aim to help individuals achieve and maintain recovery, yet studies to date have not tested die key mechanisms of tiiis intervention. To better demonstrate die effectiveness of peer recovery support, researchers should isolate its effects from other peer-based services. Additional research should solidify its place within die substance use treatment continuum for adults with substance use disorders. [ABSTRACT FROM AUTHOR]

Objective: Community integration is integral to recovery for individuals with severe mental illness. This study explored the integration of individuals with severe mental illness into mental health and non-mental heakh communities and associations with mental health service intensity. Methods: Thirty-three ethnically diverse participants with severe mental illness were categorized in high-intensity (N=18) or low-intensity (N= 15) mental health service groups. Community integration was assessed with measures of involvement in community activities, social capital resources, social support, social network maps, and subjective integration. Results: Although participants rated themselves as being more integrated into the mental health community, their social networks and social capital were primarily derived from the non-mental health community. The high-intensity group had a higher proportion of members from the mental health community in their networks and had less overall social capital resources than the low-intensity group. Conclusions: The findings suggest opportunities and possible incongruities in the experience of community integration. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to extend research on the potential benefits of adding ongoing feedback, coaching, and consultation to initial therapist training workshops to ensure fidelity of delivery of evidence-based practices, specifically for the Incredible Years parenting program. Methods: A randomized controlled trial compared two models for training therapists to deliver the parenting program for children at high risk of developing conduct problems. Therapists (N=56) from ten community-based mental health service organizations in California were trained in either a three-day workshop model (N=25), based on active, experiential, self-reflective, principle-based learning, video modeling, and manuals, or an enhanced training model (N=31) that included all elements of the workshop model plus ongoing expert coaching, video review of and feedback on group sessions, and consultation for therapists and agency supervisors. Results: Overall fidelity across both conditions was rated >3 on a 5-point scale in seven of eight domains measured. Therapists in the condition that received ongoing coaching and consultation were significantly stronger in four of the domains: practical support, collaboration, knowledge, and skill at mediating vignettes. Conclusions: Consultation and expert coaching for training therapists beyond the standard three-day training enhanced skills and therapists' adherence to the model. [ABSTRACT FROM AUTHOR]

Objective: This study examined progress in making the mental health workforce more diverse and in better representing racial-ethnic minority groups in randomized intervention trials of common mental disorders since the publication of the U.S. Surgeon General's 2001 report Mental Health: Culture, Race, and Ethnicity. Methods: Data on the mental health workforce were drawn from a work group comprising research staff from the American Psychiatric Association, American Psychological Association, and the National Association of Social Workers; representatives of professional psychiatric nursing; and staff from the National Institute of Mental Health. Additional data were pooled from clinical trials published between 2001 and 2010, which were examined for inclusion of racial- ethnic minority populations. Proquest, PubMed, and Google Scholar were searched for the terms "clinical trials" and "randomized trials." The search was constrained to trials of adults with bipolar disorder, schizophrenia, and major depression, along with trials of children and adults with attention-deficit hyperactivity disorder. Results: Between 1999 and 2006, professionals from racial-ethnic minority groups increased from 17.6% to 21.4% in psychiatry, from 8.2% to 12.9% in social work, and from 6.6% to 7.8% in psychology. Reporting race-ethnicity in clinical trials has improved from 54% in 2001 to 89% in 75 studies of similar disorders published by 2010, although few ethnic-specific analyses are being conducted. Conclusions: Little progress has been made in developing a more diverse workforce; racial-ethnic minority groups remain highly underrepresented. There is more representation of racial-ethnic minority populations in randomized intervention trials, but their numbers often remain too small to analyze. Recommendations for improving both areas are considered. [ABSTRACT FROM AUTHOR]

Objective: Illness Management and Recovery (IMR) is a standardized psychosocial intervention that is designed to help people with severe mental illness manage their illness and achieve personal recovery goals. This literature review summarizes the research on consumer-level effects of IMR and articles describing its implementation. Methods: In 2011, the authors conducted a literature search of Embase, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library by using the key words "illness management and recovery," "wellness management and recovery," or "IMR" AND ("schizophrenia" OR "bipolar" OR "depression" OR "recovery" OR "mental health"). Publications that cited two seminal IMR articles also guided further exploration of sources. Articles that did not deal explicitly with IMR or a direct adaptation were excluded. Results: Three randomized- controlled trials (RCTs), three quasi-controlled trials, and three pre-post trials have been conducted. The RCTs found that consumers receiving IMR reported significantly more improved scores on the IMR Scale (IMRS) than consumers who received treatment as usual. IMRS ratings by clinicians and ratings of psychiatric symptoms by independent observers were also more improved for the IMB consumers. Implementation studies (N=16) identified several important barriers to and facilitators of IMR, including supervision and agency support. Implementation outcomes, such as participation rates and fidelity, varied widely. Conclusions: IMR shows promise for improving some consumer-level outcomes. Important issues regarding implementation require additional study. Future research is needed to compare outcomes of IMR consumers and active control groups and to provide a more detailed understanding of how other services utilized by consumers may affect outcomes of IMR. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the impact of Oregon's 2007 parity law, which required behavioral health insurance parity, on rates of follow-up care provided within 30 days of psychiatric inpatient care. Methods: Data sources were claims (2005-2008) for 737 individuals with inpatient stays for a mental disorder who were continuously enrolled in insurance plans affected by the parity law (intervention group) or in commercial, self-insured plans that were not affected by the law (control group). A difference-in-difference analysis was used to compare rates of follow-up care before and after the parity law between discharges of individuals in the intervention group and the control group and between discharges of individuals in the intervention group who had or had not met preparity quantitative coverage limits during a coverage year. Estimates of the marginal effects of the parity law were adjusted for gender, discharge diagnosis, relationship to policy holder, and calendar quarter of discharge. Results: The study included 353 discharges in the intervention group and 535 discharges in the control group. After the parity law, follow-up rates increased by 11% (p=.042) overall and by 20% for discharges of individuals who had met coverage liniits (p=.028). Conclusions: The Oregon parity law was associated with a large increase in the rate of follow-up care, predominantly for discharges of individuals who had met preparity quantitative coverage limits. Given similarities between the law and the 2008 Mental Health Parity and Addiction Equity Act, the results may portend a national effect of more comprehensive parity laws. [ABSTRACT FROM AUTHOR]

Objective: People with severe mental illness have a higher risk of developing cardiovascular disease and die sooner than the general populalion. This study of a national sample of primary care patients in the United Kingdom compared screening for cardiometabolic risk factors among patients with severe mental illness and diabetes. Methods: Screening for cardiovascular disease among 2,488,948 patients with diabetes (2010-2011) and 422,966 patients with severe mental illness (2011-2012) at 8,123 primary care practices was compared. Results: The percentage of patients who received screening across four parameters (body mass index, blood pressure, blood glucose, and cholesterol) in the previous 15 months was higher among patients with diabetes than among those with severe mental illness (97.3% versus 74.7%, p<.001). Conclusions: The proportion of patients in primary care who were given screening for cardiometabolic risk was much lower among those with severe mental illness than among those with diabetes. [ABSTRACT FROM AUTHOR]

Objective: More research is needed about forensic assertive community treatment (FACT) and challenges that offenders with severe mental illness present to jail diversion and prison reentry teams. Jail diversion and prison reentry populations may require different interventions and strategies to engage and serve them. Methods: This study used data from a mental health agency in a large urban area in Ohio to compare the demographic and clinical characteristics of 212 consumers served by jail diversion FACT teams and 192 consumers served by prison re-entry FACT teams. Results: Findings suggest that jail diversion and prison reentry consumers have different demographic and clinical profiles, which may present unique challenges to FACT teams. Conclusions: Population- and gender-specific strategies and interventions could be warranted to better serve FACT consumers. This study furthers the literature about the needs of justice-involved consumers and offers important information for providers of FACT for jail diversion and prison re-entry. [ABSTRACT FROM AUTHOR]

Objectives: This study examined national trends in antidepressant use before and after implementation of Medicare Part D and compared utilization among individuals with different types of insurance. Methods: The data source was the Medical Expenditure Panel Survey Household Component (1997-2009), and logistic regression was used for the analysis. Results: The odds of antidepressant use among people with depression increased between 1997 and 2009 in each insurance group (Medicare: adjusted odds ratio [AOR]3.30, 95% confidence interval [CI]=1.84-5.92; Medicaid: AOR=2.97, CI=2.01-4.40; dually eligible for Medicare and Medicaid: AOR=2.24, CI=1.11-4.54; and private coverage: AOR=6.63, CI=5.23-8.42). The odds of antidepressant use after implementation of Part D increased more among Medicare beneficiaries than among Medicaid beneficiaries (AOR=1.35, CI=1.05-1.72). Conclusions: The use of anti-depressants among people with depression increased in all insurance groups up to 2009; however, the patterns of utilization and the degree of increase over time differed by insurance type. [ABSTRACT FROM AUTHOR]

Objective: This article describes the clinical utility and feasibility of proposed DSM-5 criteria and measures as tested in the DSM-5 Field Trials in Routine Clinical Practice Settings (RCP). Methods: RCP data were collected online for six months (October 2011 to March 2012). Participants included psychiatrists, licensed clinical psychologists, clinical social workers, advanced practice psychiatric-mental health nurses, licensed counselors, and licensed marriage and family therapists. Clinicians received staged, online training and enrolled at least one patient. Patients completed seff-assessments of cross-cutting symptom domains, disability measures, and an evaluation of these measures. Clinicians conducted diagnostic interviews and completed DSM-5 and related assessments and a clinical utility questionnaire. Results: A total of 621 clinicians provided data for 1,269 patients. Large proportions of clinicians reported that the DSM-5 approach was generally very or extremely easy for assessment of both pediatric (51%) and adult (46%) patients and very or extremely useful in routine clinical practice for pediatric (48%) and adult (46%) patients. Clinicians considered the DSM-5 approach to be better (57%) or much better (18%) than that of DSM-IV. Patients, including children age 11 to 17 (47%), parents of children age six to ten (64%), parents of adolescents age 11 to 17 (72%), and adult patients (52%), reported that the cross-cutting measures would help their clinicians better understand their symptoms. Similar patterns in evaluations of feasibility and clinical utility were observed among clinicians from various disciplines. Conclusions: The DSM-5 approach was feasible and clinically useful in a wide range of routine practice settings and favorably received by both clinicians and patients. [ABSTRACT FROM AUTHOR]

Objective: This study examined lifetime treatment contact and delays in treatment seeking, including rates for receipt of helpful treatment, after the onset of specffic mental disorders and evaluated factors that predicted treatment seeking and delays in treatment seeking. Methods: Data were from the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative, face-to-face survey of the general population aged 18-64 (N=6,646). DSM-IV diagnoses, treatment contact, and respondents' perception of treatment helpfulness were assessed with the Composite International Diagnostic Interview 3.0. Results: The proportion of respondents with lifetime mental disorders who made lifetime treatment contact ranged from 6.5% to 56.5% for substance use disorders and from 75.3% to 91.4% for mood disorders. Delays in initial treatment contact varied among persons with mood disorders (median=0 years), substance use disorders (0-4 years), impulse-control disorders (4-8 years), and anxiety disorders (0-19 years). The proportion of respondents who received helpful treatment ranged from 33.5% for substance use disorders to 69.5% for mood disorders. Men, older cohorts, and respondents with younger age at onset of the disorder generally were more likely to have no lifetime treatment contact, to have longer treatment delay, and to have not received helpful treatment. Conclusions: There was substantial variation in lifetime treatment contact and delays in initial treatment contact by mental disorder. Lifetime treatment contact, delays in treatment seeking, and receipt of helpful treatment did not vary by educational level. [ABSTRACT FROM AUTHOR]

Objective: Mental health systems internationally have adopted a goal of supporting recovery. Measurement of the experience of recovery is, therefore, a priority. The aim of this review was to identify and analyze recovery measures in relation to their fit with recovery and their psychometric adequacy. Methods: A systematic search of six data sources for articles, Web-based material, and conference presentations related to measurement of recovery was conducted by using a defined search strategy. Results were ifitered by title and by abstract (by two raters in the case of abstracts), and the remaining papers were reviewed to identify any suitable measures of recovery. Measures were then evaluated for their fit with the recovery processes identified in the CHIME framework (connectedness, hope, identity, meaning, and empowerment) and for demonstration of nine predefined psychometric properties. Results: Thirteen measures of personal recovery were identified from 336 abstracts and 35 articles. The Recovery Assessment Scale (RAS) was published most, and the Questionnaire About the Process of Recovery (QPR) was the only measure to have all items map to the CHIME framework. No measure demonstrated all nine psychometric properties. The Stages of Recovery Instrument demonstrated the most psychometric properties (N=6), followed by the Maryland Assessment of Recovery (N=5), and the QPR and the RAS (N=4). Criterion validity, responsiveness, and feasibility were particularly underinvestigated properties. Conclusions: No recovery measure can currently be unequivocally recommended, although the QPR most closely maps to the CHIME framework of recovery and the RAS is most widely published. [ABSTRACT FROM AUTHOR]

Objective: Approximately 10% of convicted homicide perpetrators in England and Wales have symptoms of mental illness at the time of homicide. The prevalence among perpetrators of adult domestic homicide is unclear. Methods: The study was a consecutive case series of all convicted adult domestic homicide perpetrators in England and Wales between 1997 and 2008. Sociodemographic, clinical, and offense characteristics were gathered from the United Kingdom Home Office, the Police National Computer, psychiatric court reports, and, for psychiatric patients, questionnaires completed by supervising clinicians. Results: A total of 1,180 perpetrators were convicted of intimate partner homicide, and 251 were convicted of homicide of an adult family member. Fourteen percent of perpetrators of intimate partner homicide and 23% of perpetrators of adult family homicide had been in contact with mental health services in the year before the offense; 20% of intimate partner homicide perpetrators and 34% of adult family homicide perpetrators had symptoms of mental illness at the time of offense. Perpetrators with symptoms of mental illness at the time of offense were less likely than perpetrators without symptoms to have previous violence convictions or history of alcohol abuse. Conclusions: A significant minority of adult domestic homicide perpetrators had symptoms of mental illness at the time of the homicide. Most perpetrators, including those with mental illnesses, were not in contact with mental health services in the year before the offense. Risk reduction could be achieved through initiatives that encourage individuals with mental health problems to access mental health services and that develop closer interagency working, including between mental health services, police, social services, and domestic violence services. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to test the effects of a nine-month family-led peer support group for Chinese people with schizophrenia in Hong Kong over a three-year follow-up and to compare outcomes with those of psychoeducation and standard psychiatric outpatient care. Methods: A randomized controlled trial of 106 Chinese families of patients with schizophrenia was conducted between August 2007 and January 2011 in three psychiatric outpatient clinics. Families were randomly assigned to peer support (N=35), psychoeducation (N=35), or standard care (N=36). In addition to standard care received, peer support and psychoeducation consisted of 14 two-hour group sessions, with patients participating in six to 14 sessions. Multiple patient and family outcomes-including families' support service utilization and functioning and patients' functioning mental state and rehospitalization rate—were measured at recruitment and one week, 18 months, and 36 months after completion of the interventions. Results: Patients and families in the peer support group reported consistently greater improvements over three years in overall functioning (family p<.005; patient p<.001) and reductions in duration and number of hospitalizations (p.<.01 for both), without any increase in service utilization. Conclusions: Family-led peer support groups were an effective intervention for Chinese people with schizophrenia, resulting in long-term effects of improving patient and family functioning and reducing rehospitalizations. [ABSTRACT FROM AUTHOR]

Objective: Self-help agencies (SilAs) are consumer-operated service organizations managed as participatory democracies involving members in all management tasks. hierarchically organized board- and staff-run consumer-operated service programs (BSR-COSPs) are consumer managed, but they afford members less decision-making power. This study considered the relative effectiveness of SHAs and BSR-COSPs working joinfly with community mental health agencies (CMHAs) and the role of organizational empowerment in reducing self-stigma. Methods: Clients seeking CMHA services were assigned in separate randomized controlled trials to a trial of combined SHA and CMHA services versus regular CMRA services (N=505) or to a trial of combined BSR-COSP and CMHA services versus regular CMHA services (N=139). Self-stigma, organizational empowerment, and self-efficacy were assessed at baseline and eight months with the Attitudes Toward Persons With Mental Illness Scale, the Organizationally Mediated Empowerment Scale, and the Self-Efficacy Scale. Outcomes were evaluated with fully recursive path analysis models. Results: SHA-CMHA participants experienced greater positive change in self-stigma than CMHA-only participants, a result attributable to participation in the combined condition (b=1.20, p=.016) and increased organizational empowerment (b=.27, p=.003). BSR-COSP- CMHA participants experienced greater negative change in self-stigma than CMHA-only participants, a result attributable to participation in the combined service (b=-4.73, p=.031). In the SHA-CMHA trial, participants showed positive change in self-efficacy, whereas the change among BSR-COSP-CMHA participants was negative. Conclusions: Differential organizational empowerment efforts in the SHA and BSR-COSP appeared to account for the differing outcomes. Members experienced reduced self-stigma and increases in self-efficacy when they were engaged in responsible roles. [ABSTRACT FROM AUTHOR]

Objective: Mental disability in China has become a significant public health problem. However, few studies have examined utilization of mental health services in China among people with mental disabilities. This study explored patterns of service use and associated socioeconomic factors among Chinese adults with mental disabilities. Methods: Data from a population-based survey representing approximately 75% of the Chinese population were analyzed. Mental disability was defined as having a mental disorder (cognitive, affective, or behavior disorder) lasting more than one year that limited daily life and social functioning. The study assessed use of any mental health specialty care and use of specific types: medical services only, rehabilitation services only, and medical and rehabilitation services. Standard weighting procedures were used. Population weighted numbers, weighted proportions, and the odd ratios (ORs) were calculated. Results: A total of 1,909,199 noninstitutionalized adults (weighted N=984,698,518) age 18 and older were interviewed. The weighted prevalence rate of mental disability was .81%. More than 4.2 million adults with a mental disability (52%) had never used a mental health service. Several variables were associated with greater use of mental health services: urban residence (OR= 1.65), high school education or higher (OR=1.66), being married (OR= 1.12), medical insurance coverage (OR=1.39), and higher annual family income (OR=1.28). Conclusions: The findings indicate unmet needs for mental health services among Chinese adults with mental disabilities, as well as socioeconomic inequalities in use. Strategies are needed for enhancing community mental health service systems and reducing barriers to mental health service use in China. [ABSTRACT FROM AUTHOR]

Objective: This study described the epidemiology of serious mental illness in the adult household population. Methods: Data from the 2007 National Health Interview Survey of 23,393 adult respondents were used. Serious mental illness was defined when respondents reported that a health professional had told them that they had schizophrenia, bipolar disorder, mania, or psychosis. Sociodemographic and health characteristics, health care utilization, and participation in government assistance programs among adults with and without serious mental illness were compared. Results: Over 2% of adults reported having received a diagnosis of serious mental illness. Thirty-five percent of adults with serious mental illness had a history of homelessness or of having been in jail. Fewer than two-thirds of adults with serious mental illness had seen a mental health professional in the past year. Conclusions: Adults with serious mental illness were socially disadvantaged and had worse health compared with adults without serious mental illness. (Psychiatric Services 63: 1042-1046, 2012; doi: 10.1176/ appi.ps.201100442) [ABSTRACT FROM AUTHOR]

Objectives: Repetitive aggression by a patient receiving mental health inpatient care is likely to elicit various patterns of response from care staff over time. This study sought to examine patterns of coercive physical intervention in relation to repeated episodes of aggression by particular patients. Methods: A data set of 9,945 aggression and self-harm incidents over a five-year period in one mental health service in England was constructed. Incidents by a specific individual were categorized according to their position in a sequence (first, second, and so on) and by the use of physical intervention by staff to manage the incident. Results:Trends in the use of physical intervention varied across settings. There was a significant tendency in general (nonforensic) services for use of physical intervention to increase in response to physical aggression (physical intervention in first versus subsequent incidents: odds ratio [OR]=.69, 95% confidence interval [CI]=.54-.90) and to decrease in response to threats (physical intervention in first threat versus subsequent threats: OR=1.62, CI=1.09-2.39). Conclusion: There were significant trends over time in the use of physical intervention to manage violence and self-harm. However, the dynamics behind this finding will remain unclear without further research. [ABSTRACT FROM AUTHOR]

Objective: Trauma-informed treatment increasingly is recognized as an important component of service delivery. This study examined differences in treatment-related characteristics of facilities that offer moderate or high levels of trauma-informed counseling versus those that offer no or low levels of such counseling. Methods: Responses from 13,223 substance abuse treatment facilities surveyed in 2009 by the National Survey of Substance Abuse Treatment Services (NSSATS) were used. Results: A majority (66.6%) of facilities reported using trauma counseling sometimes or always or often. Facilities that provided moderate or high levels of trauma counseling were more likely to provide additional treatment services, such as disease testing and specialized group therapy, as well as child care, employment counseling, and other ancillary services. Conclusions: A majority of facilities reported provision of trauma counseling. Additional training and resources may be needed for programs that reported low rates of trauma counseling. (Psychiatric Services 63:390-394, 2012; doi: 10.1176/ appi.ps.201000560) [ABSTRACT FROM AUTHOR]

Objective: As the Internet has become a ubiquitous tool for health information, the use of Internet support groups for mental health concerns has grown. Despite the widespread use of these groups, little research has examined the efficacy and effectiveness of online communities for ameliorating mental health symptoms or factors that prompt people to seek online support rather than formal treatment. Our study addresses this gap in the literature by investigating Internet support group use as an alternative to formal mental health services. Methods: Logistic regression was conducted with data from the 2008 National Survey on Drug Use and Health (NSDUH) to examine relationships among treatment beliefs, practical variables such as time and afford- ability, stigma, and use of Internet support groups among 2,532 survey participants who reported a need for mental health treatment but were not receiving formal services. Results: Four significant predictors of Internet support group use emerged: fear of being hospitalized or taking medication (adjusted odds ratio [AOR]=8.81, 95% confidence interval [CI]=4.25-18.27), inadequate insurance coverage (AOR=3.22, CI= 1.44-7.20), age 26-34 years (AOR=.22, CI=.07-.69), and age 35 or older (AOR=.21, CI=.08-.56). Conclusions: Fear of coercion and the costs of traditional mental health services were important predictors of Internet support group use. The finding that inadequate insurance coverage prompted people to seek Internet support aligns with a substantial literature regarding lack of financial resources and reduced access to treatment. Individuals' fears of hospitalization and of taking medication suggested that they may view formal treatment as potentially coercive. Further work is needed to decrease public stigma regarding mental health services and the conditions under which involuntary treatment occurs. {Psychiatric Services 63:370-376, 2012; doi: 10.1176/appi.ps.201100196) [ABSTRACT FROM AUTHOR]

Objective: The study developed information on behavioral health spending and utilization that can be used to anticipate, evaluate, and interpret changes in health care spending following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA). Methods: Data were from the Thomson Reuters' MarketScan database of insurance claims between 2001 and 2009 from large group health plans sponsored by self-insured employers. Annual rates in growth of total health spending and behavioral health spending and the contribution of behavioral health spending to growth in spending for all diseases were determined. Separate analyses examined behavioral health and total health spending by 135 employers in 2008 and 2009, and simulations were conducted to determine how increases in use of mental health services after implementation of parity would affect overall health care expenditures. Results: Across the nine years examined, behavioral health expenditures contributed .3%, on average, to the total rate of growth in all health expenditures, a contribution that fell to .1%, on average, when prescription drugs were excluded. About 2% of employers experienced an increased contribution by behavioral health spending of more than 1%. More than 90% of enrollees used well below the maximum 30 inpatient days or outpatient visits typical of health insurance plans before parity. Simulations indicated that even large increases in utilization would increase total health care expenditures by less than 1%. Conclusions: The MHPAEA is unlikely to have a large effect on the growth rate of employers' health care expenditures. The data provide baseline information to further evaluate the implementation effect of the MHPAEA. (Psychiatric Services 63:313-318, 2012; doi: 10.1176/appi.ps.201100312) [ABSTRACT FROM AUTHOR]

Objective: Despite growing interest in the use of evidence-based treatment practices for treating substance use disorders, adoption of medications by treatment programs remains modest. Drawing on resource dependence and institutional theory, this study examined the relationships between adoption of medications by treatment programs and their perceptions about the state policy environment. Methods: Data were collected through mailed surveys and telephone interviews with 250 administrators of publicly funded substance abuse treatment programs in the United States between 2009 and 2010. Multiple imputation and multivariate logistic regression were used to estimate the associations between perceptions of the state policy environment and the odds of adopting at least one medication for the treatment of substance use disorders. Results: A total of 91 (37%) programs reported having prescribed any medication for treatment of a substance use disorder. Programs were significantly more likely to have adopted at least one medication if they perceived greater support for medications by the Single State Agency. The odds of adoption were significantly greater if the program was aware that at least one medication was included on their state's Medicaid formulary and that state-contract funding permitted the purchase of medications. Conclusions: States may play significant roles in promoting the adoption of medications, but adequate dissemination of information about state policies and priorities may be vital to further adoption. Future research should continue to study the relationships between the adoption of medications for treating substance use disorders and the evolving policy environment. [ABSTRACT FROM AUTHOR]