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Objectives. Factors affecting ethnic differences in the use of out-patient mental health services are analyzed in an insured, nonpoor population to determine if lower use by Blacks and Hispanics persists when socioeconomic and other factors are controlled. Methods. To identify significant predictors of the probability and amount of use, insurance claims data for a population of 1.2 million federal employees insured by Blue Cross/ Blue Shield in 1983 were analyzed with the Andersen and Newman model of health service utilization. Logistic and ordinary least squares regression models were estimated for each ethnic group. Results. Blacks and Hispanics had lower probabilities and amounts of use when compared with Whites after controlling for a number of variables. Conclusions. Since ethnic differences in the use of outpatient mental health services exist even in an insured, nonpoor population, factors other than lower socioeconomic status or insurance coverage - for example, cultural or attitudinal factors and service system barriers - are likely responsible. Such findings have policy implications in the current climate of health care reform to increase access to care for the underserved. (Am J Public Health. 1994;84: 222-226), Whites tend to use outpatient mental health services more than other ethnic groups even when insurance coverage is similar among groups. Information from insurance claims filed by 1.2 million federal employees and their families was analyzed. Two options for mental health coverage were available through the health insurance plan. The high-option plan had a lower deductible, a higher copayment and a maximum of 50 mental health visits per year. The low-option plan had a slightly higher deductible, a lower copayment and a maximum of 25 mental health visits. Fifty-eight percent of whites and approximately 75% of blacks and Hispanics chose the high-option plan. Fewer blacks used outpatient mental health services than any other group. Hispanics used outpatient mental health services slightly more often than blacks but had a lower average number of visits. Whites used the mental health services most frequently and had the highest average number of visits. Of women, those on the high-option plan, the more educated and those between 18 and 45 years old had higher rates of mental health service use.

Psychoanalytic interpretation is normally understood as a sequence of two utterances: the analyst gives an interpretation and the patient responds to it. This paper suggests that, in the interpretative sequence, there is also a third utterance where psychoanalytic work takes place. This third interpretative turn involves the analyst's action after the patient's response to the interpretation. Using conversation analysis as method in the examination of audio-recorded psychoanalytic sessions, the paper will explicate the psychoanalytic work that gets done in third interpretative turns. Through it, the analyst takes a stance towards the patient's understandings of the interpretation, which are shown in the patient's response to the interpretation. The third interpretative turns on one hand ratify and accept the patient's understandings, but, in addition to that, they also introduce a shift of perspective relative to them. In most cases, the shift of perspective is implicit but sometimes it is made explicit. The shifts of perspective bring to the foreground aspects or implications of the interpretation that were not incorporated in the patient's response. They recast the description of the patient's experience by showing new layers or more emotional intensity in it. The results are discussed in the light of Faimberg's concept of listening to listening and Schlesinger's concept of follow-up interpretation. [ABSTRACT FROM AUTHOR]

Abstract: Charges for medical services of persons covered by the Blue Cross/Blue Shield Federal Employees Program from 1974 through 1978 who were first diagnosed as having one of four chronic diseases in 1975 and within one year began mental health treatment (MHT) were compared with persons who also were firm diagnosed as having one of these diseases in 1975 but had no subsequent MHT. In the third year following the diagnosis, those having seven to 20 MHT visits had medical charges $309 lower and those having over 21 MHT visits had medical charges $284 lower than the comparison group. The savings in medical charges over three years of the group having seven to 20 MHT visits were a function of lower use of inpatient services and roughly equaled the cost of 20 MHT visits. Outpatient mental health treatment can be included in a fee-for-service medical care system to improve the quality and appropriateness of care and, if not extensive, may also serve to lower medical care costs. (Am J Public Health 1983: 73:422-429.) [ABSTRACT FROM AUTHOR]

A quantitative review of 34 controlled studies demonstrates that, on the average, surgical or coronary patients who are provided information or emotional support to help them master the medical crisis do better than patients who receive only ordinary care. A review of 13 studies that used hospital days post-surgery or post-heart attack as outcome indicators showed that on the average psychological intervention reduced hospitalization approximately two days below the control group's average of 9.92 days. Most of the interventions were modest and, in most studies, were not matched in any way to the needs of particular patients or their coping styles. Beyond the intrinsic value of offering humane and considerate care, the evidence is that psychological care can be cost-effective. [ABSTRACT FROM AUTHOR]

Studies the fears of borderline patients in mid-recovery. Complaints in the termination of psychoanalysis or psychotherapy; Case studies of borderline patients; Expression of sense of uneasiness; Resistance of patients to change.