This Month’s Highlights

Stigma associated with mental illness has malignant effects on the lives of people with serious mental illnesses. Researchers have described two types—public stigma, or the prejudice and discrimination endorsed by the general population, and self-stigma, or the harm that occurs when a person internalizes this prejudice. Two articles in this month’s issue review a range of strategies used to combat stigma. In the lead article, Patrick W. Corrigan, Psy.D., and colleagues report on a meta-analysis of data from 72 outcome studies representing more than 38,000 research participants in 14 countries. Overall, strategies that include education about mental illness and contact with people who have mental illness are effective in reducing stigma. Contact appears to be more effective for adults, whereas education seems to work best among adolescents (page 963). In the second article, Dinesh Mittal, M.D., and coauthors report findings from a literature review of current research on self-stigma reduction. Two prominent approaches emerged: interventions that attempt to alter the individual’s stigmatizing beliefs and attitudes and interventions that enhance skills for coping with self-stigma through improvements in self-esteem, empowerment, and help seeking. The second approach seems to have gained traction among experts (page 974). In the Taking Issue commentary, Steven S. Sharfstein, M.D., encourages mental health professionals to improve their own attitudes “as we encounter our patients, in our use of language about individuals with mental illness and mental illness itself, and in communications among ourselves and with our patients” (page 953).

Seven reports in this issue focus on service use and needs among children and adolescents with mental and emotional disorders. An analysis of data from a large U.S. sample of adolescents found that more than half of those who had a plan for committing suicide or who had attempted suicide in the past year had not had contact with a mental health professional (page 989). When researchers evaluated the effects of a mental health screening and referral program for youths reentering the community from an Indiana juvenile detention center, they hoped to see declines in recidivism rates—but this was not the case (page 997). Researchers who examined data from a large sample of children in the year after they were placed with child protective services found no racial-ethnic differences in rates of externalizing or internalizing behaviors; however, African-American youths with externalizing behaviors had a higher likelihood of receiving services (page 1004). In Taiwan, researchers investigated overlapping prescriptions for methylphenidate, a controlled substance, among more than 3,000 children with ADHD and found that youths whose physicians were age 46 or older were nearly four times as likely to have prescription overlap (page 1011). Among nearly 5,000 privately ensured youths with new diagnoses of bipolar disorder, the one-year mean reimbursement for health services was $10,372—similar to the overall cost for adults but reflecting a different service use pattern (page 1019). Rapid economic growth and social change in China have meant increased rates of mental health problems among the country’s adolescents, as illustrated by survey results from nearly 2,000 high school students in Shantou (page 1026). The Law and Psychiatry column reviews U.S. Supreme Court decisions that have progressively limited the severity of punishments that can be imposed on juveniles who commit murder and examines recent cases that reemphasize the rehabilitation goals upon which the juvenile court system was founded (page 956).

Years after the heyday of the antipsychiatry movement, a broad array of Internet activists, investigative journalists, psychologists, and academic psychiatrists are questioning the validity of psychiatric categories and diagnostic practices and reliance on pharmaceutical interventions. This month’s Open Forum notes that these critiques may garner increased attention with the publication of DSM-5 (page 1039).

The International Initiative for Mental Health Leadership (IIMHL) facilitates information exchange among developed countries about best practices in service delivery. A survey of 12 IIMHL countries found wide variation in established or planned programs to assess the quality of mental health services (page 982).

Examination of data from nearly 6.5 million Medicaid beneficiaries in eight states found that when analyses controlled for substance abuse and dependence, individuals with serious mental illness were no more likely than other beneficiaries to receive a new diagnosis of HIV/AIDS (page 1032).