December 2007: This Month's Highlights

Six reports in this month's issue highlight the importance of addressing racial-ethnic and cultural issues. Benjamin L. Cook, Ph.D., M.P.H., and colleagues report that disparities in mental health care have persisted and worsened for African Americans and Hispanics. The authors compared Medical Expenditure Panel Survey data for 2003–2004 with data for 2000–2001 using a more rigorous definition of racial disparity that adjusts for health status and allows for mediation of disparities through socioeconomic factors ( page 1533 ). Hoyt S. Alverson, Ph.D., and colleagues report on an 18-month study in which field ethnographers spent time with 25 ethnically diverse persons with severe mental illness, sharing in activities and engaging in informal interviewing. The aim was to record each client's "illness account"—the changing narrative that an individual uses to tell others about his or her illness. The authors found group commonalities in the accounts of African Americans, Puerto Rican Americans, and European Americans, which have important implications for the treatment alliance ( page 1541 ). Erum Nadeem, Ph.D., and coauthors report on a study in which more than 15,300 low-income women were screened for depression. They compared U.S.-born white women with U.S.-born black women and immigrant black and Latina women and found differences in their reported desire for treatment, which were linked to stigma-related concerns ( page 1547 ). Todd P. Gilmer, Ph.D., and colleagues examined how more than 9,200 persons with severe mental illness, some with limited English proficiency, initially accessed public mental health services. The authors found that Latino and Asian clients with limited proficiency were less likely than their English-proficient peers to first access the system through emergency services; the pattern persisted for the Asian clients but not for the Latino clients ( page 1555 ). In the Open Forum, Rob Whitley, Ph.D., discusses the ways in which two powerful paradigms—cultural competence and evidence-based medicine—can enrich each other ( page 1588 ). Finally, Alejandro Interian, Ph.D., and colleagues conducted a qualitative analysis of the discussions of six focus groups of Latino outpatients taking antidepressants and found that stigma was a prominent concern ( page 1591 ).

Three research reports address involvement of people with mental illness in the criminal justice system. Jeffrey Draine, Ph.D., M.S.W., and Daniel B. Herman, D.S.W., discuss how the empirically supported practice of critical time intervention can be used to help people with mental illness successfully reenter the community after release from jail ( page 1577 ). To better understand the response of police to people with mental illness, Melissa Schaefer Morabito, Ph.D., reviewed the criminal justice literature on factors influencing arrest. She describes three "horizons of context" that come into play during a police encounter ( page 1582 ). Henry J. Steadman, Ph.D., and colleagues tested whether a 12-item version of the Brief Jail Mental Health Screen (BJMHS) outperformed the original eight-item version. The newer version, which added items on depression and trauma to improve the screen's performance with women, was less powerful than the original screen in identifying detainees in need of further assessment ( page 1598 ).

Timely follow-up care after hospital discharge, which significantly reduces readmission, has become an important quality measure. Bradley D. Stein, M.D., Ph.D., and colleagues looked at data for more than 6,700 Medicaid-enrolled adults to determine whether known predictors of timely postdischarge follow-up in non-Medicaid populations were evident in the Medicaid population. Forty-nine percent received follow-up care within 30 days. Prior community treatment predicted timely follow-up; race, comorbid substance abuse, and involuntary admission predicted lower rates of follow-up ( page 1563 ). In a commentary on this study in Taking Issue, Carol E. Adair, Ph.D., notes that attaching timely aftercare to the patient safety imperative might be a reasonable next step ( page 1521 ).

In the State Mental Health Policy column, Cathleen E. Willging, Ph.D., and colleagues describe efforts to reform the behavioral health system in New Mexico, which is one of nine states that received a Transformation State Incentive Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). The five-year process, begun in July 2005, seeks to establish a "collaborative culture" among state agencies, consumers, families, advocates, and providers. The authors describe several challenges to system integration. The column is the ninth report in a series addressing the President's New Freedom Commission's goals. The series is supported by a contract with SAMHSA ( page 1529 ).