August 2008: This Month's Highlights

Many of the studies in this issue focus on general medical care for people with serious mental illness. In recent years advocates have worked hard to raise awareness of the 25-year disparity in life expectancy between these individuals and other Americans—a disparity not explained by unnatural causes such as suicide or accidents. Largely as a result of these efforts, general medical care for this group, which was an "orphan topic" a decade ago, has now moved into the mainstream of research and policy initiatives, notes Benjamin G. Druss, M.D., M.P.H., in his Taking Issue commentary ( page 833 ). In the lead article Daniel W. Bradford, M.D., M.P.H., and colleagues present results of their analysis of U.S. population data for more than 156,000 adults, which indicates that persons with psychotic or bipolar disorders have markedly more difficulty obtaining care than persons without mental disorders ( page 847 ). In a study involving extensive interviews with 119 older persons with schizophrenia and a comparison group without the disorder, Ipsit V. Vahia, M.D., and colleagues found that the former group received less adequate treatment for four common medical disorders ( page 853 ). In the third article Ray Block, Ph.D., and a group of Canadian researchers present a financial analysis that sought to determine whether integrating specialized mental health services with general health services, which was done in the province of Alberta in 2003, increased or decreased spending on mental health care as a proportion of all health care spending ( page 860 ). When general medical practitioners in Norway refer patients to their local community mental health center, they continue to monitor patients' treatment. Oyvind Andresen Bjertnaes, M.A., and colleagues conducted a survey of all general practitioners in Norway and found that many reported negative experiences with the centers; their responses indicated areas for improving care and collaboration ( page 864 ). In addition to these articles, the four brief reports in this issue focus on general medical care. The first presents results from a national survey of community mental health centers about the availability of on-site medical screening and medical services ( page 917 ). The second examines perceptions of barriers to medical care among veterans with serious mental illness ( page 921 ). The third reveals a very high rate of psychiatric conditions in a large cohort of veterans with epilepsy ( page 925 ). The final brief report looks at use of cancer-screening services by persons with serious mental illness in a California county ( page 929 ).

Persons with common mental disorders, such as depression and generalized anxiety disorder, and persons with chronic pain conditions, such as arthritis or back problems, are likely to experience some work disability. However, the presence of both a mental disorder and a pain condition appears to have synergistic negative effects on the ability to work, especially among women, according to an analysis of U.S. population survey data conducted by Jennifer Brennan Braden, M.D., M.P.H., and colleagues ( page 878 ). The evidence-based practice of supported employment improves outcomes for people with serious mental illness who want to work. Tina Marshall, Ph.D., and coauthors analyzed data from interviews conducted at nine sites where supported employment was being implemented with varying fidelity. Strong leadership and clinical experience were key factors in high-fidelity implementation. Implementation was slowed down by staff who were doubtful about the principles of recovery and supported employment ( page 886 ).

Katherine M. Keyes, M.P.H., and colleagues analyzed epidemiologic data for nearly 33,000 adults to determine whether disparities in service use between black and white Americans vary by type of disorder. Although white adults were more likely to receive treatment for mood and anxiety disorders, use of substance abuse treatment did not differ between groups, and among respondents with a drug use disorder, black adults were more likely to receive treatment ( page 893 ). A study by Ellen P. Fischer, Ph.D., and colleagues that involved more than 250 adults with schizophrenia showed that ongoing family support reduced the adverse impact of substance abuse on consumers' use of outpatient services ( page 902 ). In 2002 physicians with special training were granted permission to treat opiate-addicted patients in their offices—a move designed to attract more addicted persons into treatment. Cindy Parks Thomas, Ph.D., and colleagues surveyed addiction specialists and general psychiatrists to identify factors that may prevent physicians from using this treatment ( page 909 ).