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Over the past decade philanthropic giving for health has increased dramatically, but giving for mental health has not kept pace. Historically, foundations have been key partners in efforts to improve care for people with mental disorders, and foundation funding has influenced the evolution of U.S. mental health services and systems. Although mental health giving grew in the 1990s, the rate of growth was far below that for total foundation giving or giving for health. The authors suggest possible reasons why mental health funding lost ground and describe promising funding approaches and models for increasing both the amount and the impact of philanthropic giving for mental health.

Depression is a serious, often chronic disease that can be managed effectively with a chronic care model in primary care settings. Depressed persons are likely to be seen by a primary care physician, but their condition often goes unrecognized and untreated. There are effective treatment models that consist of efficacious psychotherapeutic and pharmacological interventions, use of evidence-based guidelines for primary care treatment of depression, development of explicit plans and protocols, reorganization of practice, longitudinal follow-up, patient self-management, decision-making support, access to community resources and leadership commitment. Moving these models into everyday practice requires overcoming both clinical and system barriers. Barriers consist of issues surrounding patients, providers, practices, plans, and purchasers. An understanding of these barriers at each level helps to provide a framework for the changes required to overcome them. The Robert Wood Johnson Foundation National Program on Depression in Primary Care will seek to apply simultaneously both clinical and system strategies in a new five-year initiative to overcome these barriers.

The Robert Wood Johnson Foundation (RWJF) is the nation's largest philanthropy devoted to health. The foundation long has been concerned about increasing diversity in the health professions. Between 1972 and 1981, grants totaling nearly $6.7 million were made to medical, medical/dental schools, or other educational organizations to support minority students. Funds enabled students who were interested in applying to medical or dental school to enroll in special preparatory courses. Most students were African American. One program, however, targeted US Puerto Rican students and other Hispanic students. Nearly 2500 students enrolled in these preapplication enrichment programs. Data reported to the foundation on medical or dental school acceptance for 1959 of these students indicated that 57% of students were successful. An additional $10.5 million in grants were awarded during this period: $2.5 million to provide scholarships for minority group medical students, $580,000 to support preceptorships with minority physicians/mentors, and $7.5 million to strengthen Meharry Medical College's Comprehensive Primary Care Health Science Program. In the early 1980s, the RWJF Board of Trustees considered a series of staff analyses, which resulted in additional direct support to historically black medical schools, including Meharry and those at Drew University and Morehouse College. These analyses also set the stage for two RWJF programs, the Minority Medical Faculty Development Program and the Minority Medical Education Program, which exist today. This article describes these programs, along with the more recent Health Professions Partners Initiative, and offers reflection and analysis about their impact on diversity in the medical profession.

In this introduction, we describe the overall context and rationale for the Depression in Primary Care program and the design and implementation of its key components, especially emphasizing its unique combined clinical and economic/systems framework. We also discuss some of the new challenges and opportunities that may impact the program’s evolution and the state of behavioral health care more generally. We conclude with some thoughts on potential future scenarios and strategies for improving the quality of behavioral health care, including the treatment of depression in primary care.

Recently, World War II veterans have come forward to claim compensation for health effects they say were caused by their participation in chemical warfare experiments. In response, the Veterans Administration asked the Institute of Medicine to study the issue. Based on a literature review and personal testimony from more than 250 affected veterans, this new volume discusses in detail the development and chemistry of mustard agents and Lewisite followed by interesting and informative discussions about these substances and their possible connection to a range of health problems, from cancer to reproductive disorders. The volume also offers an often chilling historical examination of the use of volunteers in chemical warfare experiments by the U.S. military--what the then-young soldiers were told prior to the experiments, how they were "encouraged" to remain in the program, and how they were treated afterward. This comprehensive and controversial book will be of importance to policymakers and legislators, military and civilian planners, officials at the Department of Veterans Affairs, military historians, and researchers.

Fluorescent retrograde double-labeling methods were used in which Fast blue and Nuclear yellow or Diamidino yellow dihydrochloride were injected into the midbrain periaqueductal gray (PAG) and medullary reticular formation (MRF). Double-labeled neurons were most frequently observed in the lateral part of lamina V, in laminae VII, VIII and X and in the lateral cervical and lateral spinal nuclei. The data demonstrate that some spinal neurons project to both the PAG and the MRF via axon collaterals.

The present study examined the values of volunteers for a crisis center “hotline” telephone service. The volunteers (19 males, 23 females) were compared to an aggregately sex-matched control group of 42 evening college students at a major urban regional university. Both groups completed a Rokeach Value Survey. A total of 12 values discriminated between the volunteer and control groups. Results suggest that, in contrast to control subjects, volunteers for crisis-intervention centers are demonstrably more altruistic, with more highly developed interests in social activity and an increased need for inner-direction. A subsequent value comparison of the 23 volunteers who remained for at least 2 mo. beyond the training period with 19 who dropped out disclosed only 2 minor differences. Value differences appear to be critical in volunteer selection but are generally unrelated to retention.