This Month's Highlights

Racial-ethnic disparities in use of any mental health care increased among Americans between 1990 and 2003, according to analyses reported in the lead article. Disparities increased particularly between whites and blacks who used mental health care in the general medical sector and between whites and Latinos who used care in the specialty sector. Andrea Alexis Ault-Brutus, Ph.D., M.P.A., compared data for adult respondents with a diagnosed mood or anxiety disorder in the 1990–1992 National Comorbidity Survey (NCS) and in the 2001–2003 National Comorbidity Survey Replication (NCS-R). In the earlier survey, the prevalence rates of these disorders were similar for whites, blacks, and Latinos, as were the adjusted rates of receipt of any care. However, in the NCS-R, a significantly higher percentage of white Americans (36%) than black (23%) or Latino (25%) Americans reported receipt of any care. In addition, data from both surveys indicated white-black disparities in receipt of minimally adequate care—41% versus 21% in the NCS and 56% versus 45% in the NCS-R. A possible explanation for the increasing disparities in use of care, especially in the general medical sector, is greater use and acceptance of antidepressant medications among white Americans than among black and Latino Americans, the author notes. She also points to the shortage in the specialty sector of psychiatrists and psychologists from racial-ethnic minority groups (page 531).

The second article in this month's line-up reports positive findings from a randomized controlled trial of Wellness Recovery Action Planning (WRAP), an illness self-management intervention that involves peer support. WRAP has been widely disseminated and is offered in every U.S. state, as well as internationally. WRAP outcomes have been examined in a few pre-post and quasi-experimental studies, and the intervention has been shown to enhance hopefulness and quality of life and to increase knowledge about mental illness. In the randomized controlled trial, Judith A. Cook, Ph.D., and colleagues wanted to look at symptom outcomes among participants with serious mental illness. They found that the intervention not only improved participants' self-perceived recovery over time, but it also significantly reduced their symptoms of anxiety and depression. These results, the authors note, confirm “the importance of WRAP as part of a group of evidence-based, recovery-oriented interventions” (page 541).

The concept of recovery has been widely accepted as a goal for individuals with serious mental illness, and several models have articulated its dimensions. However, most research is based on samples of individuals who have been ill for many years. How do people early in the course of illness view their recovery? Deborah Windell, M.Sc., and colleagues sought to answer this question by interviewing clients of a specialized early-intervention program for psychotic disorders and constructing a typology of clients' personal definitions of recovery. Most of the 30 interviewees considered themselves to be recovered according to their personal definitions. Most described recovery as the achievement of specific benchmarks in three recovery domains—illness, psychological and personal, and social and functional. In this young sample (mean age of 26), many focused on the importance of social recovery, which the authors note “reinforces the early inclusion of interventions, such as supported employment and supported education initiatives, that promote positive functional and social outcomes” (page 548).

Two articles in this issue focus on homeless adults. In the first, Rebecca J. Gordon, Psy.D., and colleagues sought to inform treatment strategies for older homeless adults (age 55 and older) by comparing their health status and needs with those of younger adults before and after a year of intensive case management. The older adults had fewer severe mental health and substance abuse problems at baseline and showed less improvement over the year. The finding of smaller but more satisfying social networks among the older adults may offer a focus for programs that aim to improve the lives of chronically homeless individuals (page 561). Targeting smoking cessation interventions to this population is a high priority. To inform these efforts, Jack Tsai, Ph.D., and Robert A. Rosenheck, M.D., examined smoking status in a sample receiving supported housing services. Most were current smokers (80%), nearly half of whom had tried to limit their smoking or quit. Changes in substance use were associated with changes in smoking status in the same direction (page 569).