October 2009: This Month's Highlights

Widespread unmet need for treatment and the shortage of mental health professionals have been persistent concerns for decades. System transformation will require large-scale workforce development and initiatives to redistribute workers where need is greatest. Planners and policy makers must have detailed data: Where is the need? Where are the professionals? The mismatch between them will pinpoint areas with shortages. In this issue, three articles map current estimates of the need for care in the nation's 3,140 counties, the supply of mental health professionals in these counties, and the shortages that are evident when the two maps are overlaid. A research group from the University of North Carolina at Chapel Hill led by Joseph P. Morrissey, Ph.D., merged national epidemiologic data with information from professional associations and licensing and accrediting bodies. According to their estimates, in 2006 nearly every U.S. county (96%) had unmet need for mental health professionals able to prescribe medications, and one in five counties (18%) had unmet need for nonprescribers. The authors outline strategies to address the shortages and conclude by describing research to fill critical data gaps revealed by their studies ( page 1307 ).

The sweeping system changes called for by national policy makers will happen to a large extent at the state level. The vision of transformation will be balanced against the idiosyncratic political forces that characterize state policy making. Will states embark on wholesale redesign? Can they set up the coordinated systems necessary for cultural change? To examine these questions, Rachel L. Garfield, Ph.D., M.H.S., interviewed 35 key stakeholders in four states—California, Massachusetts, New Jersey, and New Mexico—and used qualitative data to assess whether and how state policy making reflects the broader context of transformation. Although many recent state priorities are in line with the goals of transformation, the goals are likely to be achieved in a piecemeal fashion, driven by executive control, grassroots pressures, and crises ( page 1329 ).

Five articles and four brief reports address race-ethnicity as a factor in attitudes toward, access to, and quality of care. In an analysis of data from the National Comorbidity Survey Replication, Ruth S. Shim, M.D., M.P.H., and colleagues were surprised by findings that contradicted their hypothesis: African Americans and Latinos reported greater willingness to seek care than non-Hispanic whites and less embarrassment if others found out about their treatment ( page 1336 ). In a pooled sample of more than 2,200 participants with mental illness from two national surveys, Amanda T. Woodward, Ph.D., and associates found that 34% had used some form of complementary and alternative medicine in the past year; differences were evident among three racial-ethnic groups—African Americans, black Caribbeans, and whites ( page 1342 ). In a nine-month follow-up study of more than 2,500 clients of 43 community-based drug treatment programs in California, Noosha Niv, Ph.D., and colleagues found higher severity levels at entry in several domains among white clients and racial-ethnic disparities in treatment placements, treatment use, and outcomes ( page 1350 ). Several studies have shown that Youth Partners in Care (1999–2003) improved the quality of depression care. A re-examination of the data, by Victoria K. Ngo, Ph.D., and colleagues has revealed particularly strong intervention effects for black youths and weak effects for white participants ( page 1357 ). Among nearly 1,500 Caucasian and Hispanic youths with past-year major depression, Pierre K. Alexandre, Ph.D., M.P.H., and colleagues found that 34% received adequate treatment, but the proportion was significantly higher among Caucasian youths (36%) than among Hispanic youths (27%) ( page 1365 ). The four brief reports look at race-ethnicity as a factor in rates of mental health-related 911 calls ( page 1376 ), inconsistencies in diagnosis and symptoms among bilingual and English-speaking Latinos and Euro-Americans ( page 1379 ), Latinos' preferences for psychiatric advance directives ( page 1383 ), and service use among maltreated youths from African-American families ( page 1386 ).

• A GAP committee issues a call for implementation of standardized patient outcome assessments in routine care ( page 1372 ).

• A new column, Case Studies in Public-Sector Leadership, shows how an electronic mailing list was used to elicit suggestions and support for a clinician-administrator when she encountered problems implementing changes at her clinic ( page 1298 ).

• Four exemplary programs are winners of the 2009 Gold, Silver, and Bronze APA Achievement Awards ( page 1392 ).