This Month’s Highlights

This issue marks the introduction of a series of reviews that summarize and update the evidence base for 14 commonly used, recovery-focused services. The series was commissioned by the Substance Abuse and Mental Health Services Administration to help state and local authorities make informed decisions about which behavioral health services to include in new health benefit packages implemented as part of health care reform. The Affordable Care Act stipulates that insurance plans must cover behavioral health care, but it leaves the selection of specific services to state and local decision makers. Decisions about which services to cover will make a critical difference in the lives of people with serious mental illness. This issue presents the introduction to the Assessing the Evidence Base Series (page 11) and a review of supported employment (page 16). In a Taking Issue commentary, Robert E. Drake, M.D., Ph.D., outlines some of the challenges facing widespread implementation of evidence-based practices. The 14 articles in the series were reviewed by a special panel of Psychiatric Services peer reviewers. They are being published online ahead of print in Psychiatric Services in Advance (http://ps.psychiatryonline.org/PSInAdvance.aspx) and will appear in print issues throughout 2014.

Two literature reviews examine how information technology and the Internet are being used to improve the accessibility and delivery of mental health services. In the first, Shalini Lal, Ph.D., and Carol E. Adair, Ph.D., reviewed more than 100 publications to document recent developments in e–mental health applications in four areas: information provision; screening, assessment, and monitoring; intervention; and social support. The review uncovered a rich set of information on proliferating applications. Policy makers and health leaders must consider how e–mental health applications fit into the existing service system, the authors note, to ensure that they complement—and not detract from—the provision of direct care (page 24). How well is information technology serving people with psychotic disorders? A review by Lian van der Krieke, M.Sc., M.A., and colleagues explored the state of the art of e–mental health applications for self-management of psychotic disorders. Many studies have shown that this population is able and willing to use such technology. Outcomes have been strongest for technologies that help with medication management (page 33).

A number of mass shootings have prompted political debate and various proposals to prevent persons with serious mental illness from gaining access to guns. In the fifth article in this month’s line-up, Emma Elizabeth McGinty, Ph.D., M.S., and colleagues review the history of such gun restriction policies. The authors examine the relationship between serious mental illness and violence, the effectiveness of restriction policies in reducing gun violence by persons with serious mental illness, the impact of such policies on public attitudes toward this population, and whether such policies affect suicide risk. A priority for future research is to investigate how these policies influence mental health treatment seeking, the authors conclude (page 50).

Two studies in this issue found continuing evidence of disparities in receipt of mental health care in the United States. One study looked at 1993–2008 data for more than 750,000 outpatient visits to physicians which involved patients with a primary diagnosis of a mental disorder from three groups: non-Hispanic whites and blacks and Hispanics. The diagnosis-specific analysis conducted by Marc Manseau, M.D., M.P.H, and Brady G. Case, M.D., found marked and persisting differences over time in receipt of care for anxiety disorders—particularly obsessive-compulsive disorder—as well as dysthymia, personality disorders, nicotine use disorder, and attention-deficit hyperactivity disorder (page 59). Another investigation examined use of mental health services by non-U.S. citizens. Sungkyu Lee, Ph.D., and colleagues analyzed survey data from nearly 1,500 Latino and Asian adults who did not have U.S. citizenship. They found that only 32% of Latinos and 52% of Asians with psychiatric needs used services from nonspecialty providers over the past year (page 68).

The Veterans Health Administration has invested heavily in expanding its psychotherapy services. What is the result for veterans? In a retrospective cohort study of outpatient data for more than 400,000 veterans, Juliette M. Mott, Ph.D., and colleagues found improvements over time, even though most newly diagnosed patients received no or little psychotherapy (page 106). In the Open Forum, Michelle D. Sherman, Ph.D., encourages the VA to embrace a communitarian model to build and sustain a strong workforce (page 113).