This Month's Highlights

Research has shown that many patients with severe mental illness have significant medical illnesses and unmet needs for medical care. The growth of carve-out arrangements for mental health services under managed care has raised concerns that these patients will find medical care even less accessible. Six papers in this month's issue focus attention on this problem. Barbara Dickey, Ph.D., and her colleagues found that Medicaid beneficiaries with a psychotic illness have a higher treated prevalence of certain disorders, including diabetes, hypertension, and heart disease (see page 861). Michael B. Blank, Ph.D., and coauthors, who also used Medicaid data, showed that having a serious mental illness is associated with a significantly increased risk of HIV infection and other medical conditions (see page 868). Julie Cradock-O'Leary, Ph.D., and colleagues found that patients with mental illnesses in the Veterans Affairs system make fewer visits for medical care than other VA patients; the largest differences they found were for patients with severe mental illness (see page 874). Faith B. Dickerson, Ph.D., and coauthors found high rates of obesity and cigarette smoking and underuse of mammography among older women with schizophrenia (see page 882). Gail L. Daumit, M.D., M.H.S., and colleagues found that very few psychiatrists provide preventive medical services such as counseling about weight or sexually transmitted diseases (see page 884). Finally, Richard W. Goldberg, Ph.D., and coauthors showed that persons with severe mental illness can reliably report their use of medical services (see page 879).

In the Law & Psychiatry column, John Petrila, J.D., LL.M., reviews a decision by the U.S. Supreme Court that will make it more difficult for people with disabilities to successfully pursue claims under the Americans With Disabilities Act (ADA). In Toyota Motor Manufacturing, Kentucky, Inc. v. Williams, a woman filed a suit alleging that her employer had failed to reasonably accommodate her disability. The Court decided against the plaintiff, stating that the ADA must be "strictly interpreted" to limit the number of people who qualify as disabled. For a person to qualify as disabled under the ADA, his or her impairment must create a substantial limitation in a major life activity. In its ruling, the Court noted the "conceptual difficulties inherent in the argument" that work is a major life activity. Mr. Petrila notes that the Court appears to be moving toward the conclusion that work is not a major life activity, and he discusses the implications of such a conclusion for future ADA cases (see page 797).

In this month's issue, Psychiatric Services launches a new quarterly column, Child & Adolescent Psychiatry, edited by Charles Huffine, M.D., medical director for child and adolescent programs at the King County Mental Health, Chemical Abuse, and Dependency Services Division in Seattle. In the introductory column, Dr. Huffine expresses his hope that the column will be a forum for those who have experience integrating mental health services for children and adolescents with other services for this population, such as those provided by social services agencies and juvenile justice programs. He discusses the wraparound process, a strength-based approach to supporting troubled youths in their communities by creating a team of family members, professionals, and important people in a child's life. He describes a program in Washington State that uses this approach and addresses problems encountered in the implementation of such programs (see page 809).

Between October 16 and November 15, 2001, interviewers spoke by telephone with 112 parents of children living in households near the World Trade Center to determine whether the children had received counseling related to the disaster and what factors predicted receipt of counseling. Jennifer Stuber, Ph.D., and her colleagues report that 22 percent of the children received some form of counseling and that more than half of the counseling was delivered in schools, either by teachers or school psychologists. Predictors were male sex, having a parent with a current posttraumatic stress disorder related to the attacks, and having at least one sibling living in the household (see page 815).

• The Rehab Rounds column describes how a board game— "El Tren" (The Train)—developed by a rehabilitation treatment team in Spain is used to improve the social skills of persons with schizophrenia (see page 799).

• Three guidelines and a set of algorithms for the treatment of schizophrenia are compared on scientific rigor, comprehensiveness, and clinical applicability (see page 888).