March 2006: This Month's Highlights

This issue of Psychiatric Services includes four articles on the interface between psychiatry and the legal system. First, Jennifer L. Skeem, Ph.D., and Jennifer Eno Louden, M.A., note the phenomenon whereby individuals with serious mental illness who are on probation or parole are twice as likely as those who are not mentally ill to fail on supervision. These authors reviewed a small but growing body of research on this problem and on practices designed to respond to it (see page 333). Marvin S. Swartz, M.D., and coauthors present the results of a study of lifetime use and correlates of outpatient commitment and related civil court-ordered outpatient treatment (page 343). Eric B. Elbogen, Ph.D., M.L.S., and his colleagues present their survey results on mental health professionals' attitudes toward laws regarding psychiatric advance directives and decision making related to these directives (page 350). Finally, Cynthia L. Blitz, Ph.D., and coauthors address the question of whether women with behavioral health needs are more likely to receive treatment in prison or in the community and the extent to which prison disrupts or establishes treatment involvement (page 356).

Two articles and a column address the importance of spirituality to both patients and their family members. Aaron B. Murray-Swank, Ph.D., and coauthors, in a sample of 83 caregivers, assessed the role of religiosity and receipt of spiritual support in coping with a relative's mental illness. Among their findings was an association between spirituality and reduced depression, higher self-esteem, and better self-care (page 361). Philippe Huguelet, M.D., and coauthors asked a sample of outpatients with schizophrenia about their spiritual beliefs and practices and compared their responses with their clinicians' perceptions of the patients' spirituality. These authors found that clinicians were commonly not aware of their patients' religious involvement (page 366). In the Innovations: Alcohol & Drug Abuse column, Marc Galanter, M.D., discusses the role of spirituality in promoting recovery among members of Alcoholics Anonymous (AA). His column highlights the need to conduct further research on AA and the role of spirituality and to incorporate these concepts into psychiatric services (page 307).

Stigma is the subject of two articles, an Open Forum, and a brief report. Jo C. Phelan, Ph.D., and coauthors address the question of whether attributions of a genetic cause of serious mental illness are associated with more positive orientations to professional treatment among the general public (page 382). Marjorie L. Baldwin, Ph.D., and Steven C. Marcus, Ph.D., analyzed the extent to which self-reports of job-related discrimination by persons with serious mental illness are associated with econometric measures of discrimination (page 388). Patrick Corrigan, Psy.D., and Betsy Gelb, Ph.D., in their Open Forum piece, present three case studies of programs for addressing the stigma associated with mental illness (page 393). In a brief report, Nicolas Rüsch, M.D., and colleagues describe their study of perceived legitimacy of discrimination and self-stigma among women with borderline personality disorder or social phobia in Germany and Switzerland (page 399).

There has been conflicting evidence about socioeconomic disparities in mental health care under universal health coverage in Canada. Leah S. Steele, M.D., Ph.D., and coauthors compared rates of mental health visits to family physicians and psychiatrists across economic quintiles in Toronto, Ontario. The findings revealed marked socioeconomic disparities in the use of psychiatric care, suggesting that unlimited coverage of mental health care by a psychiatrist is insufficient to fairly distribute services to those most in need (page 317). This study is highlighted in a Taking Issue piece by Steven S. Sharfstein, M.D., who also raises questions such as, Should less ill, wealthier patients pay for a greater proportion of mental health services? Would managed care effectively address the equity issue in Canada? He concludes that to solve this equity problem, the mental health care profession will need to become more involved—providing economic access will not be enough (page 297).

• The Best Practices column describes a private-public-academic collaboration that used best practices of dissemination to improve delivery of supported employment in six states and the District of Columbia (page 302).