This Month's Highlights

The journal continues to celebrate its 50th anniversary year by examining important developments in the mental health field in the last half-century. The article by Jeffrey L. Geller, M.D., M.P.H., and his colleagues, which is reprinted from the March 1998 issue of Psychiatric Services, describes some of the consequences for chronically mentally ill patients in Massachusetts when the state contracted with a proprietary vendor to manage its Medicaid behavioral health accounts (see page 1385). In a related commentary, James E. Sabin, M.D., explains the ethical necessity of rationing health care and describes important strategies learned in recent years from efforts to reform health care and implement public-sector managed care at the state level (see page 1392). In Taking Issue, Laurie Flynn, executive director of the National Alliance for the Mentally Ill, notes that focusing on the inequities of managed care obscures the more fundamental issue of the need to reform the public mental health care system (see page 1347). Finally, Dr. Geller provides additional background in an article describing how the federal government's decision not to pay for care of patients in state hospitals has provided states with a strong incentive to move chronically ill patients to the community (see page 1397).

In this issue the journal introduces Practical Psychotherapy, a quarterly column edited by Marcia Kraft Goin, M.D., Ph.D. A psychoanalyst by training, Dr. Goin will use her column to discuss the role of psychotherapy in public-sector treatment settings. In her first column she vividly portrays a busy day at a county outpatient clinic and tells the stories of two patients whose treatment challenges the psychiatric residents being trained there. She describes the types of knowledge clinicians must have to make psychodynamically informed interventions. Dr. Goin also describes a seminar in which she helps residents gain competency in making psychotherapeutic interventions (see page 1379).

To examine the relative effectiveness of assertive community treatment, clinical case management, and usual treatment, Stephen J. Ziguras, M.A., and Geoffrey W. Stuart, Ph.D., pooled and analyzed data from 44 studies completed between 1980 and 1998. They found that assertive community treatment and clinical case management were more effective than usual treatment in three outcome domains—family burden, family satisfaction with services, and cost of care. The two types of case management were equally effective in reducing symptoms, increasing clients' contacts with services, reducing dropout rates, improving social functioning, and increasing clients' satisfaction. Assertive community treatment appears to be more effective than clinical case management in reducing hospitalization and hospital length of stay (see page 1410).

Psychodynamic psychotherapy was the theme of the 52nd annual Institute on Psychiatric Services, held last month in Philadelphia. Two articles in this month's issue recognize the importance of psychodynamically informed approaches to treatment. Paul Chodoff, M.D., whose psychiatric practice began in 1946—when, as he notes, the influence of Sigmund Freud was at its height—describes how the role of dynamic psychotherapy has changed over five decades. He offers explanations for why this treatment approach has come to be undervalued. Dr. Chodoff argues for the importance of ensuring that dynamic psychotherapy continues to have a strong role in contemporary practice and provides evidence for the effectiveness of this approach (see page 1404). In a related commentary, Gregg E. Gorton, M.D., describes the emergence in the past half-century of a variety of psychodynamically informed therapies, such as cognitive-behavioral therapy and supportive therapy, that have "vastly broadened the therapeutic horizon" (page 1408).

Five outstanding mental health programs are recipients of the American Psychiatric Association's 2000 Achievement Awards, which were presented at the Institute on Psychiatric Services held last month in Philadelphia. Gold Awards were presented to the Emerson-Davis Family Development Center in Brooklyn for developing an integrated program to provide services to single-parent families challenged by homelessness, mental illness, and substance abuse (see page 1433) and to MHA Village of Long Beach, California, in recognition of its program to help persons with severe mental illness successfully integrate into the community (see page 1436). Three programs received Significant Achievement Awards. They were the Center for Autistic Children in Philadelphia, the Criminal Justice-Community Outreach Department of the Montgomery County Emergency Service in Norristown, Pennsylvania, and the Psychosocial Rehabilitation Program of Eastern State Hospital in Williamsburg, Virginia (see page 1439).