June 2005: This Month's Highlights

This issue of Psychiatric Services includes five articles and one brief report on emergency services, an important source of care for persons with mental illness living in the community. Gregory Luke Larkin, M.D., M.S.P.H., and coauthors used data from the National Hospital Ambulatory Medical Care Survey to describe trends in mental health-related visits to U.S. emergency departments over the period 1992 to 2001 (page 671). Jagoda Pasic, M.D., Ph.D., and colleagues, in a sample of 761 high utilizers of psychiatric emergency services, determined sociodemographic and clinical characteristics associated with high utilization (page 678). And in a study reported on page 685, Ralph A. Catalano, Ph.D., and colleagues used emergency department visits, a widely cited effectiveness indicator in the mental health sector, to assess the impact of capitated financing. In another study (page 691), Cynthia A. Claassen, Ph.D., and associates examined whether the implementation of managed care in a public mental health system would influence return visits to the psychiatric emergency department after an index visit. On page 699, Dale E. McNiel, Ph.D., and Renée L. Binder, M.D., report on their study of relationships between homelessness, mental disorder, violence, and use of psychiatric emergency services in a sample of 2,294 in San Francisco. Finally, in a brief report on page 743, Linda L. Carpenter, M.D., and coauthors report on a survey of patients' expectations of psychiatric emergency services, in light of previous findings of use of emergency departments for nonurgent care.

Patients' cultural backgrounds can have a significant impact on their access to and use of services. Five articles and two brief reports are devoted to this important theme. G. Eric Jarvis, M.D., and associates, in a sample of 351 patients admitted to a Montreal hospital with psychosis, tested the hypothesis that Afro-Canadian patients would be more likely than Euro-Canadian or Asian-Canadian patients to be brought to emergency services by police or ambulance (see page 705). Daryl E. M. Fujii, Ph.D., and associates report the results of their study of ethnic differences in the assessment of violence risk in a sample of 169 inpatients of African-American, Euro-American, and Native-Hawaiian descent (page 711). Jeanne Miranda, Ph.D., and colleagues investigated whether Latinas who immigrate to the United States and leave their children in their homelands have higher rates of major depression than other Latina immigrants (page 717). On page 721, Helen C. Kales, M.D., and her coauthors report on a study in which they had 329 psychiatrists view videotaped vignettes of white and African-American patients with late-life depression to assess psychiatrists' contributions to racial and gender disparities in diagnosis and treatment among elderly patients. In another study, Rachel Kimerling, Ph.D., and Nikki Baumrind, Ph.D., M.P.H., investigated racial and ethnic disparities in women's access to specialty mental health services in California (page 729). And in their brief report on page 746, Rose M. Barreto, M.S.W., and Steven P. Segal, Ph.D., A.C.S.W., describe their study of the use of mental health services by Asian Americans and other ethnic populations in a large sample in California. Finally, Teresa J. Hudson, Pharm.D., and colleagues discuss disparities in the use of antipsychotics among nursing home residents (page 749).

There are clear differences between "recovering" from schizophrenia and achieving sustained "recovery." Many consumers and clinicians have difficulty grasping the distinction between the processes and stages of preparing for recovery and recovery as an outcome. Such an understanding requires, among other things, a reliable, normative definition of recovery. In an Open Forum in this issue, Robert Paul Liberman, M.D., and Alex Kopelowicz, M.D., address this distinction, summarize the feasibility of recovery as a therapeutic goal, present recent findings relevant to a definition of recovery, provide an operational definition to facilitate further research, and identify factors that might impede or encourage recovery (see page 735). Recovery is also the topic of this month's Taking Issue contribution, by Wesley Sowers, M.D. (page 637).

• Implications of the new prescription drug benefit for elderly and disabled persons, established under the Medicare Modernization Act of 2003, are discussed in Economic Grand Rounds (see page 645).

• The State Mental Health Policy column asks whether California's "Proposition 63," a plan to increase funding for mental health care, should be used as a model for other states (see page 642).