November 2007: This Month's Highlights

Hurricane Katrina struck the U.S. Gulf Coast in late August 2005, and news media have recently featured stories about its long-term effects on mental health. The lead article in this month's issue provides a picture of survivors' mental health soon after the disaster. Philip S. Wang, M.D., Dr. P.H., and colleagues report the results of a telephone survey carried out from January to March 2006, among more than 1,000 displaced and nondisplaced Katrina survivors. Almost a third had symptoms indicating a mood or anxiety disorder, but only a third of this group reported use of any mental health care since the hurricane. Many reported that services were not available because of loss of the system's infrastructure. Some had lost jobs and insurance coverage, creating financial barriers ( page 1403 ). In Taking Issue two commentators—from New Orleans and from New York City—discuss the interaction of disasters and social forces ( page 1393 ).

Severe mental illness often leads to long-term disability, and disability leads to loss of employment. Six research reports in this month's issue examine these consequences. Gary R. Bond, Ph.D., and colleagues present evidence that persons with severe mental illness receiving Social Security Administration benefits are able to do nearly as well in supported employment programs as nonbeneficiaries ( page 1412 ). Nicole H. J. van Erp, M.A., and colleagues report on implementation of supported employment in the Netherlands and two-year outcomes among clients ( page 1421 ). In France, Audrey Cougnard, Ph.D., and coauthors found a median delay of four years between schizophrenia onset and initial request for disability status—a period during which most persons with the illness had no income and relied on financial support from their families ( page 1427 ). Eric B. Elbogen, Ph.D., M.L.S., and colleagues took a closer look at the dynamics of representative payeeship by asking 50 persons with disabling mental illness and their family member payees about their experiences ( page 1433 ). In a study of veterans with bipolar disorder, Lori Altshuler, M.D., and colleagues found that unemployed veterans had neurocognitive impairment in executive function ( page 1441 ). In a brief report from Norway, Simon Overland, Psy.D., and colleagues present data showing that a third of adults who were pensioned out of the workforce for a disability involving mental illness had never received and mental health treatment ( page 1479 ).

Three research reports and the Open Forum examine aspects of involvement of persons with mental disorders in the justice system. In a cohort of nearly 14,000 adults who received public mental health services between June 1991 and July 1992, William H. Fisher, Ph.D., and colleagues found that by the end of the decade 5% had at least one drug-related arrest. The authors discuss several pathways to drug involvement in this population and suggest ways to help individuals understand the grave consequences of drug convictions ( page 1448 ). Maryann Davis, Ph.D., and colleagues examined data for a cohort of adolescents who used public mental health services between 1994 and 1996. By age 25, most males (69%) and nearly half the females (46%) had been arrested. Risk of arrest was many times higher among those arrested in the previous year ( page 1454 ). John A. Pandiani, Ph.D., and colleagues found that among more than 2,600 adults with mental illness who had received community-based services in rural Vermont, 6.6% were identified in a police database as criminal offenders and 7.1% were identified as crime victims ( page 1483 ). In the Open Forum Fred C. Osher, M.D., and Henry J. Steadman, Ph.D. synthesize findings from expert panels that were convened by the National GAINS Center to examine the effectiveness of six evidence-based practices as adapted for persons with severe mental illness involved in the justice system ( page 1472 ).

Three brief reports focus on services for children and adolescents. In Madison, Wisconsin, researchers found that adolescent and young adult participants of the Program for Assertive Community Treatment experienced large reductions in the number of days spent hospitalized or incarcerated ( page 1486 ). A two-year study of youths who visited a pediatric emergency department found that about a fifth (19%) were repeat users. Most of the repeat users were receiving mental health services in the community ( page 1489 ). In Washington State primary care physicians reported being highly satisfied with a videoconferencing telepsychiatry arrangement for psychiatric evaluations and treatment of their child and adolescent patients ( page 1493 ).