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Previous research has documented the fact that policy makers underutilize social science research literature in shaping their decisions. The two factors most often identified as accounting for this utilization gap are quality of research and organizational/political constraints. A third factor that has received relatively less attention is barriers to accessing relevant literature. To determine the importance ofaccessproblems among mental health professionals, a national sample (N = 367) of community mental health center (CMHC) executives was surveyed regarding attitudes and practices with respect to published social science research. Thefindings revealed that CMHC policy makers (1) consider published literature as important relative to other sources of information; (2) have difficulty accessing desired information via traditional means (e.g., personal and institutional librariesf, and (3) are generally unfamiliar with currently available information accessing technologies (i.e., computer-based bibliographic retrieval systems). Thesefindings suggest the need for greater emphasis on access barriers in a model predicting utilization of social science research in mental health policy formulation.

This article reviews procedural and methodological characteristics of 121 outcome studies published by community mental health centers during the decade 1969-1979. These studies were compared with 2906 studies conducted at other mental health treatment sites. Attention is focused on the adequacy of description of sample characteristics, mental health condition treated and treatment or intervention employed, sophistication of study design, and quality of outcome measures. The findings suggest that CMHC studies are less precise and less rigorous than studies at other sites, although there appears to be consistent improvement in research quality over time. The findings raise the question of whether CMHCs generally should conduct high-level outcome research, aside from essential internal program monitoring. A feasible alternative may befor such research to be carried out at a few centers of mental health research excellence and for such findings to be disseminated to the mental health community at large.

In a previous study it was found that mental health professionals working within community mental health centers (CMHCs) value published social science research as input into the policy decision-making process, yet frequently experience problems in accessing such literature in a timely and efficient manner. The current study was undertaken in order to determine whether access barriers could be reduced via the use of computer-based literature searching. Both short-term (six week) and long-term (six month)follow-up data revealed substantial use of the search materials for both conceptual and instrumental purposes. Further, the positive experiences reported with regard to the study-specific search were mirrored in a more general assessment of the potential usefulness of such information-retrieval systems in meeting future information needs.

THE MAGNITUDE of the public health problem posed by mental illness has led to an increasing emphasis on programs of prevention. The prevailing belief that the origins of mental disorder are, in part or in whole, to be found in disturbances in early childhood has as its corollary the hypothesis that effective treatment at this age might serve to lower the rate of psychiatric illness in later life.' Whether or not this thesis of early origin is completely supportable with present evidence, it has been a motivating force in a number of cities for the establishment of therapeutic nursery programs, of which the Children's Guild of Baltimore is one recent example. The multiplication of such programs, their potential value and, we must add, their cost, all combine to suggest the importance of attempts to measure their effectiveness. In a service setting, this is more easily said than done; problems of method and conflicts in philosophy between research workers and clinicians tend to abort enthusiasm for such unLandowne, M.S.W.; Daniel M. Wilner, Ph.D.

A survey of the psychiatric literature reveals that a number of confusions and conflicts exist among psychiatrists and other professional personnel with regard to the efficacious management of elderly mentally ill patients. This study was an attempt to throw some light on the subject by obtaining from 50 state official mental hygiene agencies and the administrators of 269 public mental hospitals their estimates of the dimensions of the geriatric psychiatric problem in their respective states, and of the prevailing therapeutic climate for the mentally ill aged in their hospitals. This was done by means of a two-section questionnaire. Responses were received from 48 agencies and 216 hospitals, but only those from 43 agencies and 178 hospitals were in usable form. The following is a summary of the findings: There was substantial agreement between official mental hygiene agencies and hospital administrators with respect to the size of the geriatric populations in public mental hospitals in the various states. When there was a disagreement, it could be attributed to factors such as inadequacy of official or state records and/or poor communication between official agencies and their system hospitals. Perhaps as a consequence of being closer to the actual care of patients, hospital administrators tended to be less optimistic than mental hygiene agencies about the number of unnecessary admissions, the possible benefits of therapy, and the conceivable hospital discharge rates for patients in the older age groups. Regarding the therapeutic climate, only two items elicited nearly unanimous responses among the mental hygiene agencies and within their states: 1) the importance of adequate diagnosis in the management of older patients, and 2) the undesirability of long-term therapy programs for them. All other “climate” items elicited a wide divergence of opinions. For example, respondents in both groups were about evenly divided concerning their views about rehabilitation potential, and the cooperativeness in therapeutic activities among geriatric patients. Based upon the survey of comments from both respondent groups, it is concluded that: Currently there is emphasis upon rehabilitation programs for older mental patients in some state hospitals (probably a minority), with gratifying results. Both old and new concepts of mental illness and its therapeutic management in elderly patients may exist side by side within the same hospital system, leading to inconsistencies and inefficiencies in the total state rehabilitation program. There is great variability in the existence and the expected usefulness of community facilities and resources across the country. When the state hospitals have assumed the mantle of leadership, guidance and support of community facilities, a large number of aged patients have been successfully discharged and adequately cared for. Hospital emphasis upon and official agency support of geriatric screening programs have resulted not only in a reduction in the number of admissions to state mental hospitals through more proper placement in nursing homes and other community facilities, but also in the return of many adequately functioning elderly patients to their own community homes.

Outcome evaluation studies in the areas of alcohol and drug abuse have suffered from design problems. The lack of control groups, prospective designs, adequate outcome measures, and sufficient follow-up has presented the major difficulties. This study reviews all such studies reported in 50 major journals between 1969 and 1979 and compares them to outcome evaluations on other mental health topics reported in the same journals. We find that significant problems remain in each of these areas. In general, drug abuse studies employ the least adequate methodologies. Alcohol evaluations are approximately as rigorous as other mental health evaluations. A major finding is the lack of rigor found in all types of outcome evaluations. Attention must be paid to these issues if outcome evaluations are to remain credible and able to secure continued support.

A RECENT overview of the gerontological literature suggests that confusions and conflicts continue among professionals in mental health about the management of elderly mentally ill patients in psychiatric hospitals. Observers have noted, for example, that some professionals in psychiatry still hold that very little can be done for the older patient either in or outside the mental institution. Ostensibly, these professionals are oriented primarily toward custodially supportive care for older patients, preferring to focus treatment almost solely on the alleviation or modification of the somatic manifestations of the illness. On the other hand, increasing numbers of investigators have demonstrated that judicious intervention has produced significant improvement in the mental and physical health of many oider patients. This variation in contemporary orientations toward treatment suggests that old and new conceptions of mental illness and its management may exist side by side within the same hospital system, possibly leading to confusions and inconsistencies in interpreting those institutional policies which determine what may be most desirable or feasible in the psychiatric care of older patients. Such possible disharmony could have long-reaching effeets, especially since there appear to be ever-increasing proportions of older psychiatric patients in the resident populations of many mental hospitals and other long-term care institutions. In this paper we report on an attempt to obtain from the administrators of public mental hospitals and their respective State official mental hygiene agencies (a) their perceptions of the dimensions of the geriatric problem and (b) the prevailing Dr. Hefferin is a lecturer and associate researcher in health services administration at the University of California School of Public Health, Los Angeles. She serves also as coordinator for the school's research program in organized health services. Dr. Wilner is a professor of preventive medicine and public health. He holds the position of chairman and associate dean of the school of public health. Tearsheet requests to Dr. Elizabeth Hefferin, School of Public Health, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, Calif. 90024.