November 2005: This Month's Highlights

Two articles in this issue of Psychiatric Services address the timely topic of the psychological consequences of disasters. Bruce J. Fried, Ph.D., and his coauthors present their findings on mental health service use in a North Carolina Medicaid population after 1999's Hurricane Floyd. Their findings highlight the importance of being well prepared to implement systems and deliver services in the wake of natural disasters and other catastrophic events (see page 1367). In another article, Thomas A. Grieger, M.D., and his coauthors report on their study of probable posttraumatic stress disorder (PTSD), probable depression, and use of mental health services among 267 Pentagon employees two years after the terrorist attack of September 11, 2001. Their findings highlight the need for government and business leaders to be aware that some employees who are exposed to terrorism and other traumatic situations will require long-term mental health treatment (page 1374).

This issue contains three articles as well as one brief report related to vocational rehabilitation and supported employment. Latha Srinivasan, Ph.D., and Srinivasan Tirupati, M.D., M.R.C.Psych.—in one of many international papers in this issue—present their study of work functioning, cognition, and measures of social functioning in a sample of 88 patients with schizophrenia in rural India (see page 1423). Lauren B. Gates, Ph.D., and her colleagues studied the likelihood that people with psychiatric disabilities who were receiving vocational services through an outcomes-based reimbursement program would obtain and keep jobs, along with factors associated with finding and keeping a job (page 1429). Jonathan Oldman, M.A., and his coauthors present a case report of a sheltered workshop program that was transformed into an evidence-based supported employment program in British Columbia, Canada (page 1436). And in their brief report, Marc Corbière, Ph.D., and associates present their study of the extent to which supported employment programs in British Columbia are similar to those in the United States (page 1444).

Assertive community treatment is another important theme of this issue. Judith A. Joannette, M.Sc., B.N.Sc., and her coauthors describe a study in which they tracked more than 300 consumers after their admission to various assertive community treatment programs in Ontario, Canada—a psychosocial rehabilitation program, a community integration program, and an assertive community treatment team program. These researchers determined when the first hospital admission was most likely to occur, which variables predicted tenure in the community, and whether the availability of hospital beds was associated with community tenure (see page 1387). In a brief report, Renée Henskens, Ph.D., and coauthors describe their evaluation of an outreach treatment program in the Netherlands for chronic, high-risk crack abusers in terms of how closely the program adhered to the assertive community treatment model. The study identified several elements of effective assertive community treatment programs that will be of value in developing future outreach programs for similar populations (page 1451).

It has been demonstrated that models of collaborative care for depression produce better care as well as better outcomes. However, coordinating such care and creating incentives for primary care providers to participate in these models is complicated under systems in which mental health care is carved out to one or more managed behavioral health organizations (MBHOs). Given that 70 percent of all mental health care is managed through carve-out arrangements, it is imperative that collaborative care models be adapted for patients in MBHOs. In this month's Economic Grand Rounds column, Mitchell D. Feldman, M.D., M.Phil., and his coauthors describe a collaborative care model for depression that has been in existence for several years in California, as well as the effectiveness of incentives used to encourage primary care providers to participate in the model. Experience with this program has illustrated the importance of physicians' having ready access to clinical resources—for example, care management and availability of a psychiatrist for consultation—in order to encourage them to participate in collaborative care arrangements (see page 1344).

A brief report looks at the role of regional collaboration in reconstructing mental health services in postwar Bosnia and Herzegovina (page 1455).