This Month’s Highlights

Many adults with serious mental illnesses have chronic medical conditions. To address these conditions, programs and practices are implementing integrated models of care. However, self-management models, which are considered an integral part of typical health care, are not frequently used with this population. Erin L. Kelly, Ph.D., and colleagues undertook a literature review to examine empirical support for collaborative and integrated models that include self-management components for individuals with serious mental illnesses. The authors identified 14 studies and found promising evidence that individuals with serious mental health issues can collaborate with health professionals or be trained to self-manage their health and health care. Evidence supports the use of mental health peers or professional staff to implement these interventions. However, the substantial heterogeneity in study design, types of training, and outcome measures limits conclusions about comparative effectiveness, and the authors call for future work to determine what elements of training or skills lead to the most salient changes (page 1300).

As permanent supportive housing programs spread to communities across the country, evidence is accumulating for the effectiveness of Housing First. This model, which focuses on individuals with histories of chronic homelessness, emphasizes client-centered services and provides immediate housing that is not conditional on treatment participation. Findings from two studies illustrate the promise of this approach. In California, Todd P. Gilmer, Ph.D., and colleagues used a mixed-methods design to examine the relationship between fidelity to the Housing First model and residential outcomes of clients of full service partnerships (FSPs). FSPs are a cornerstone of California’s Mental Health Services Act, which beginning in 2004 applied a tax of 1% to incomes over $1 million to fund mental health services. FSPs do “whatever it takes” to improve clients’ mental health and housing. Dr. Gilmer and colleagues assessed outcomes of 6,584 FSP clients in 86 programs and found that days spent homeless declined substantially more for clients in programs with high fidelity to Housing First principles, compared with clients in low-fidelity programs (page 1311). In New York City, Clare Davidson, M.S.W., and colleagues examined housing and substance use outcomes for individuals in nine scatter-site Housing First programs. Clients in programs with greater fidelity to consumer participation components of Housing First were more likely to be retained in housing and were less likely to report using stimulants or opiates at 12-month follow-up (page 1318).

Three articles this month describe service use and outcomes among veterans. Renee D. Goodwin, Ph.D., M.P.H., and colleagues looked at mental health service use in a representative sample of Ohio Army National Guard soldiers, some of whom were newly returned from deployment in Iraq or Afghanistan. Overall, 16% used services in the past year. The rate was 37% among those with depression, PTSD, anxiety, alcohol use disorders, or suicidal ideation. In the group with mental health problems, only black race predicted service use. The results suggest a substantial level of unmet need among National Guard soldiers, the authors note (page 1347). In a study of more than 87,000 veterans with schizophrenia from all service eras, Denis G. Birgenheir, Ph.D., and colleagues found a high rate of comorbid anxiety disorders (24%), including PTSD (15%). These disorders were associated with increased hospitalization and use of outpatient services. Because comorbid anxiety appeared to convey an additional level of disability, the authors call for research on ways to improve detection and treatment among veterans with schizophrenia (page 1354). Katherine D. Hoerster, Ph.D., M.P.H., and colleagues evaluated the effectiveness of MOVE!, a weight management program, among 20,000 veterans with PTSD, other mental health conditions, or no mental health diagnoses. Veterans with mental disorders, especially those with PTSD, lost significantly less weight than veterans with no mental health diagnoses, suggesting that adaptations to MOVE! are needed for this group (page 1383).

◆High rates of psychotropic polypharmacy were found among Medicaid-enrolled youths in Ohio, especially those in foster care (page 1332).

◆Researchers confirmed the feasibility of using Medicaid claims data to “flag” individuals at high short-term risk of inpatient psychiatric hospitalization (page 1341).

◆The Best Practices column describes a six-state collaborative to improve psychotropic prescribing in Medicaid programs (page 1297).

◆Four exemplary programs are recipients of the 2014 APA Achievement Awards, presented at the Institute on Psychiatric Services in San Francisco (page 1396).