October 2006: This Month's Highlight

Several articles in this issue focus on workforce participation. In the lead article, Judith Cook, Ph.D., describes barriers to employment and offers recommendations for addressing them. The article is an update of a report to a subcommittee of the President's New Freedom Commission. It is the third article in a series supported by the Substance Abuse and Mental Health Services Administration ( page 1391 ). Two studies showed that assertive community treatment programs and clubhouse programs that delivered supported employment services could achieve employment rates comparable to those of evidence-based supported employment teams ( pages 1406 and 1416 ). The fourth article describes strategies used by specialists in supported employment programs to help clients cope with cognitive impairments ( page 1421 ). Use of a self-report scale on which consumers' rated their desire to work increased referrals by practitioners to supported employment services ( page 1430 ). An examination of Florida unemployment claims and police data showed a positive correlation between the unemployment rate and the number of men presented for examination for involuntary hospitalization ( page 1435 ). In a commentary on the articles related to supported employment, David S. Salkever, Ph.D., notes that "even when an intervention deserves the appellation 'evidence-based,' further questions about its comparative and overall efficacy and effectiveness are still worth asking" ( page 1440 ). Finally, the Open Forum describes growth of "affirmative businesses" created to employ people with mental illness ( page 1488 ).

Gregory E. Simon, M.D., M.P.H., and colleagues evaluated the effectiveness of telephone-based care management for patients with depression in a prepaid health plan. Compared with patients patients assigned to usual care, patients contacted by telephone at two weeks, one month, and three months after receiving a new antidepressant prescription made significantly more medication management visits over six months, but the program had no effect on depression symptoms at six months ( page 1441 ). Elderly persons hospitalized for depression have been shown to have medical, functional, and psychosocial needs in addition to psychiatric needs. Mi Jin Lee, Ph.D., and colleagues assessed the quality of post-discharge depression care by examining the extent to which it met these needs in a sample of 148 elders. At six months, those whose functional and psychosocial needs were met had significantly better depression outcomes ( page 1446 ).

Two articles describe measurement tools used to improve the quality of care. G. Richard Smith, M.D., and colleagues recruited a sample of 100 substance-abusing patients to evaluate the reliability and validity of the Substance Abuse Outcomes Module (SAOM), a self-report tool designed to assess processes and outcomes of care by using a minimum amount of information. The SAOM provided diagnostic accuracy. Several of its baseline case-mix measures were significant predictors of outcomes, and the SAOM was sensitive to clinically important change ( page 1416 ). Richard C. Hermann, M.D., M.S., and colleagues describe a method for developing statistical benchmarks for 12 process measures of the quality of care for mental and substance use disorders. Rates of conformance to these measures were calculated for providers of care to Medicaid beneficiaries in six states. Statistical benchmarks, defined as the care received by the top 10 percent of patients, adjusted for the number of patients per provider, can enhance quality improvement by identifying performance levels that are high but achievable ( page 1461 ).

Two brief reports examine ways to promote an orientation to recovery among consumers and staff. In a study of more than 1,800 consumers Patrick W. Corrigan, Psy.D., found that those who had participated in a peer support program in the past four months had higher scores on measures of recovery and empowerment ( page 1493 ). Trevor P. Crowe, Ph.D., and colleagues found that a two-day, recovery-based training program for mental health workers increased their knowledge of recovery principles and belief in the effectiveness of collaboration and support for consumers' autonomy and other strategies for promoting recovery ( page 1497 ).

• Two studies—one in Ohio and one in Florence, Italy—examined excess mortality among people with serious mental illness ( pages 1474 and 1482 ).

• The Best Practices column looks at ways of designing inpatient facilities to create safe and healing environments ( page 1376 ).