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Objective: Current information on treatment and clinical characteristics of U.S. adults with schizophrenia spectrum disorders (i.e., schizophrenia, schizoaffective, and schizophreniform disorders) may help inform public health policy and service development for this population. Methods: Data were from the U.S. Mental and Substance Use Disorders Prevalence Study, conducted from October 2020 to October 2022. Clinicians administered the Structured Clinical Interview for the DSM-5 for past-year psychiatric and substance use disorder diagnoses among adults ages 18–65 years. Using sampling weights, the authors examined clinical and treatment characteristics among those with schizophrenia spectrum disorders and compared sociodemographic characteristics and comorbid behavioral health conditions of individuals with or without such disorders (N=4,764). Results: Among 114 adults with schizophrenia spectrum disorders, the most common comorbid conditions were major depressive episode (52%, 95% CI=34%–69%) and alcohol use (23%, CI=3%–43%), cannabis use (20%, 95% CI=1%–39%), and posttraumatic stress (17%, 95% CI=5%–30%) disorders. Global Assessment of Functioning scores were lower among people with than among those without schizophrenia spectrum disorders (mean±SE=44.8±2.0 vs. 77.2±0.5, p<0.01, respectively), indicating worse functioning. In the past year, 71% (95% CI=55%–87%) of adults with schizophrenia spectrum disorders received at least some mental health treatment, and 26% (95% CI=13%–38%) received minimally adequate treatment. Conclusions: Individuals with schizophrenia spectrum disorders face substantial challenges in the United States, including high rates of comorbid mental health conditions and substance use; few received adequate treatment. A strong social safety net and active clinical interventions are required to address the socioeconomic challenges and unmet mental health service needs of this population. [ABSTRACT FROM AUTHOR]

More than 7 million people are released each year from U.S. jails or prisons, many with chronic diseases that would benefit from primary care in their returning communities. The objective of this study was to provide an in-depth, payer-agnostic description and associational analysis of primary care need and utilization by all individuals ever detained in one county detention facility over a 7-year period. Detention records 2014–2020 were merged with data from an electronic health record with excellent coverage of local primary care, emergency, and hospital services. We found low primary care participation for the group as a whole, with under three quarters of those with serious chronic diseases ever seeing a primary care provider over a 7-year period and less than half ever having a year with more than one visit. Multivariable regression models estimated associations between individual characteristics (demographic, detention-related, and clinical) and ever having access to primary care (logistic) and the number of primary care visits (zero-inflated negative binomial). We found that having more jail bookings was associated with fewer primary care visits, but not one-time access, even controlling for time out of community, age, insurance, and other demographic characteristics. This finding was driven by subgroups with chronic disease such as hypertension, obstructive lung disease, and diabetes, who most need regular primary care. Being Black retained an independent effect, even controlling for bookings and other variables, and was also associated with fewer primary care visits, though not one-time access. To promote primary care utilization among individuals who have the combined challenges of repeated jail involvement and chronic disease, it is crucial to focus on engagement, as much as formal access. Access to health insurance alone will not resolve the problem; Medicaid expansion should be coupled with specialized, tailored support to promote engagement in primary care. [ABSTRACT FROM AUTHOR]

Objective: The Mental and Substance Use Disorders Prevalence Study (MDPS) builds upon previous epidemiologic studies to provide estimates of prevalence and treatment rates of mental and substance use disorders among adults aged 18–65 in the U.S. The study background and methods are described. Method: The MDPS employed novel techniques such as the inclusion of household, prison, homeless and state psychiatric hospital populations, a semi‐structured clinical interview administered by trained clinical interviewers to assess disorders, the assessment of both past year and lifetime schizophrenia spectrum disorder (SSD) using full Diagnostic and Statistical Manual 5 criteria, as well as other mental and substance use disorders, and video‐based interviewing. Population specific and combined sample weights were developed to estimate nationally representative prevalence and treatment rates. Results: Data collection was conducted between October 2020 and October 2022 resulting in 5679 clinical interviews. The statistical weighting and analytic plan are described. Weighted response rates and reasons for non‐response are provided for each study population. Conclusions: The MDPS successfully developed and employed novel techniques to estimate the prevalence and treatment rates of mental and substance use disorders in both household and non‐household populations, including some of the most impairing disorders such as SSD. [ABSTRACT FROM AUTHOR]

Précis: Despite significant scholarship, research, and funding dedicated to implementing criminal diversion programs over the past two decades, persons with serious mental illness and substance use disorders remain substantially overrepresented in United States jails and prisons. Why are so many U.S. adults with behavioral health problems incarcerated instead of receiving treatment and other support to recover in the community? In this paper, we explore this persistent problem within the context of "relentless unmet need" in U.S. behavioral health (Alegría et al., 2021). [ABSTRACT FROM AUTHOR]

Objective: To review the prevalence, benefits, and problems associated with families who, either informally or formally as representative payees, manage money for adults with severe mental illness. Methods: Based on empirical research and clinical cases, suggestions are offered for minimizing downsides and capitalizing upon benefits of family money management. Results: The findings and case vignettes demonstrate four specific strategies for treatment providers: facilitating collaboration, increasing knowledge about disability funds, improving money-management skills, and developing plans for financial decision-making. Conclusion: By following these recommendations and becoming aware of whether their clients had family money managers, clinicians can promote independent functioning and family support for a substantial number of people with severe mental illness.

Community psychiatrists serve multiple institutional roles, and at times these roles may include the review of grant proposals from nonprofit organizations. In this column, the authors argue that privilege and social capital can easily become concentrated among a small group of centralized model organizations and influence the grant review process. Established and wealthy nonprofits can co-opt the growing interest in health equity by leveraging their existing resources, thereby excluding emerging organizations within communities in need. By applying a structural lens to this problem, funding entities can identify approaches that more effectively promote equity throughout the grant life cycle. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the author discusses articles within the issue on topics including police role in responding to mental health crises, triage of first responders to mental health-related 911 events, and occupational stressors among police and its effects on police mental health and police practice.