This Month's Highlights

This year the journal has been celebrating 50 years of publication. The first 11 issues examined key developments in the creation and delivery of mental health services over the past five decades, with reprinted articles from the journal's archives and commentaries on these historical changes by contemporary psychiatrists. This final anniversary issue looks to the future—what is there to hope for and to be concerned about in the next 50 years? Leona Bachrach, Ph.D., whose work on behalf of the chronically mentally ill has spanned several decades, shares her perspectives in an interview with John A. Talbott, M.D. Dr. Bachrach says she is especially hopeful about the young psychiatrists who are entering the public-sector field with an idealism she has not seen for a few decades (page 1511). In a roundtable discussion, seven psychiatrists discuss future treatment breakthroughs, changes in settings of care, troubling economic forces, and other issues. A recurrent theme is better outcomes for patients (page 1513). In Taking Issue, Darrell G. Kirch, M.D., challenges mental health professionals to be willing to change their attitudes and their practices over the next 50 years in order to build psychiatric services that will last (page 1477).

Twenty-eight women with schizophrenia who were living in the community met in five focus groups to discuss their health-related needs. Wanda M. Chernomas, R.N., Ph.D., and her coworkers audiotaped and transcribed the discussions. In the article, the women's concerns are organized around eight themes—loss, work, stigma and rejection, relationships and intimacy, pregnancy and motherhood, responsibility for illness, physical health, and hope and spirituality. The authors' use of direct quotations from the focus group participants allows them to communicate more fully the impact of illness and treatment on these women's lives. The authors found that despite isolation and loss, many of the women had an enduring sense of wanting life to improve and hoping that it would (page 1517).

For the past 30 years, telepsychiatry has offered hope for an affordable means of solving workforce problems in delivering services to populations in remote areas. In this issue B. Christopher Frueh, Ph.D., and his associates review the literature since 1970 on the use of this technology to provide mental health care. They find that interviews conducted by telepsychiatry are generally reliable and that patients and providers are satisfied with them. Because of the lack of empirical studies in this area, especially cost analyses and clinical outcome studies, the authors outline a research agenda on procedural and methodological issues that would improve the effectiveness of telepsychiatry (page 1522).

In a discussion of evolving standards of care in the use of conventional and atypical antipsychotic medications, Douglas Mossman, M.D., and Douglas S. Lehrer, M.D., point out that many U.S. psychiatrists have concluded that novel antipsychotic drugs should be a first-line therapy and represent an emerging standard of care. The authors ask whether doctors who prescribe conventional antipsychotics are engaging in malpractice or violating patients' rights. They explore why psychiatrists might continue to treat patients with the older drugs. They conclude that recent clinical data and court decisions suggest that prescription of the conventional agents is not a deviation from the current standard of care (page 1528).

Concerns about whether disability payments to mentally ill persons facilitate substance use have led to studies with contradictory outcomes. To examine more closely the effects of receiving disability benefits, Robert A. Rosenheck, M.D., and his colleagues assessed a group of 50 homeless mentally ill veterans just before and three months after they began to receive benefits and compared their status at three months to that of 123 homeless mentally ill veterans who did not receive benefits. More than 60 percent of the sample had a current substance use disorder. The beneficiaries reported a higher quality of life at three months, and their alcohol or drug use did not increase and was not higher than that of the comparison group (page 1549).

• Forty mentally ill clients met in focus groups to discuss their views on tobacco smoking and why they were or were not ready to quit (page 1544).

• A homeless mentally ill Puerto Rican man who would not cooperate in treatment is helped by an espiritista, or spiritist, who understands his cultural beliefs (page 1572).

• The books section opens with a review of two books that summarize empirical research on the practice of psychoanalysis (page 1575).