The multiple functions of the state mental hospital

This report identifies and quantifies the multiple manifest and latent functions of the state mental hospital, using data collected by the National Institute of Mental Health. The data reveal a complex institution providing over 500,000 episodes of care for acute and chronic, voluntarily and involuntarily admitted inpatients and 300,000 episodes of care for the most seriously disturbed and disadvantaged outpatients. In addition, state hospitals employ over 200,000 individuals and train over 3,300 professionals each year. The diversity and significance of these functions, as well as the failure of other institutions to supplant them, account for the endurance of the state mental hospital.

Specialist/generalist division of responsibility for patients with mental disorders

The division of responsibility between general medical staff and mental specialists for care of persons with medical record diagnoses of mental disorders is documented in four organized health care settings. Rates of mental disorders identified in all departments ranged from 35.6 to 122.8 per 1,000 population. Specialty mental health departments treated most severe psychotic and personality disorders, plus transient situational disturbances, whereas neurotic, childhood behavior, and psychophysiological disorders received as much or greater attention in general medical departments. Mental disorder diagnoses were associated with greater patient use of general medical departments. However, joint specialty mental health/general medical treatment of these patients was associated with lower general medical department visit rates in all settings. Such joint care was facilitated by the low average visit frequency use of mental health departments. (2.2 to 8.9 visits per patient per year).

Use of general medical care services by persons with mental disorders

Data are presented on the medical diagnoses and the type of general medical services used by persons with mental disorder diagnoses. This study is based on the 1975 experience of registrants in four medical programs contained in three organizational settings. The data on services were retrieved from each program's automated date system. The percent of patients seen in general medical departments receiving a mental disorder diagnosis ranged from 4.8% to 13.6% among the four programs. Patients with mental disorder diagnoses visit general medical departments from 11/2 to two times as frequently as patients without such diagnoses. Persons with a diagnosed mental disorder are likely to receive care for conditions in more International Classification of Diseases categories than other patients, and are more likely to receive a diagnosis for ill-defined conditions, signs, and symptoms.

Distribution of cytokinin-active nucleosides in isoaccepting transfer ribonucleic acids from Agrobacterium tumefaciens

The cytokinin-active isoprenoid nucleosides of Agrobacterium tumefaciens transfer ribonucleic acid were identified by high-pressure liquid chromatography, permethylation, and mass spectroscopy. Besides the expected 6-[(3-methylbut-2-enyl)amino]-9-(beta-D-ribofuranosyl)purine (i6A) and its 2-methylthio derivative (ms2i6A), substantial amounts of cis- and trans-ribosylzeatin (io6A) and cis-2-(methylthio)ribosylzeatin (c-ms2io6A) were present. These hydroxylated side chain derivatives are normally characteristic of plant tRNA. Fractionation of the total bacterial tRNA on BD-cellulose and RPC-5 allowed isolation of purified iso-accepting species whose cytokinin nucleoside contents were then determined. Distribution of the isoprenoid nucleosides among the U-group tRNA species was not uniform. cis-Ribosylzeatin was found almost exclusively in one tRNASer while ms2io6A was found predominantly in tRNAPhe, tRNASer, and tRNATyr. Not all cytokinin-active species were found in every member of the U-group tRNAs. The only species present in tRNATrp was i6A; it contained no zeatin derivatives. The hydroxylation and methylthiolation processes appear to be highly specific and dependent upon tRNA structure or sequence.

The Epidemiologic Catchment Area Program of the National Institute of Mental Health

We hope that the ECA Program can make a significant, and perhaps unique, contribution to the field of psychiatric epidemiology and to mental health services research. If the Program provides total true prevalence data on mental disorders according to the latest diagnostic criteria, that in itself will be a significant contribution. Such data should be of enormous benefit to those interested in etiology as well as those interested in health services research. For researchers interested in etiology, the data can be used to identify, by comparison, high-risk groups; for those interested in health services research, the results can serve as a health planning guide that does not depend on the presence or absence of treatment facilities in a given area. Incidence data will be the second major contribution of the ECA Program. Its two-wave design enhances the study of incidence, etiology, and the natural history of disorders and also allows study of the social behavior of persons entering treatment for mental disorders--a subject important to health planners. Finally, a significant result of the ECA Program may be the establishment of a viable standardized methodology for the epidemiologic study of mental disorders by means of which demonstrably replicable results can be produced. Once we demonstrate the equivalence of method and results, then the stage is set for comparative studies of all sorts.

Utilization of health and mental health services in a large insured population

The authors analyzed 1975 data on the use of health and mental health services by the 2.3 million people covered by Michigan Blue Cross and Blue Shield. Only 4.6% of the covered population submitted hospital or physician claims for mental disorder; these people accounted for 7.3% of total hospital and physician charges for all health services in the covered population. According to the claims submitted, nonpsychiatric physicians saw almost half of all patients who were given a diagnosis of mental disorder, but psychiatrists accounted for the great bulk of mental health services and charges to these patients. High utilizers comprise a small proportion of all patients but account for a high proportion of charges for mental disorders and for all diagnoses.

Diagnosis of mental disorder in adults and increased use of health services in four outpatient settings

The differential use of medical services by patients with and those without a diagnosis of mental disorder was examined in four adult populations by age, sex, diagnosis, and medical department used. The four settings offered comprehensive services to patients who varied greatly in socioeconomic status. In all four settings patients with a diagnosis of mental disorder used all services and general health services more than patients without such a diagnosis. Results document increased medical morbidity and a greater likelihood of a diagnosis of an ill-defined condition in patients with mental disorder than that found in patients without a diagnosis of mental disorder.

Community mental health centers and the treatment of severe mental disorder

Between 1970 and 1975 the number and rate of admissions to community mental health centers of people given a diagnosis of schizophrenia increased dramatically. However, the proportion of patients with schizophrenia admitted to community mental health centers declined because the increase in the rate of admissions of patients with schizophrenia was diluted by the large increase in the rate of admissions of patients with other diagnoses. The authors review the data on trends in admissions of patients with a diagnosis of schizophrenia in the context of an expanding system of mental health services characterized by changes in the locus of care.

The role of the pediatrician in the delivery of mental health services to children

Nine pediatricians reported on all patients seen during a four-week period in January and February 1976 in Monroe County, N.Y., to determine the prevalence and nature of mental health problems seen in their practices, the characteristics of the affected children, and the treatment provided to them. Of the 3,742 patients seen, 187, or 5.0%,were reported to have an emotional, behavioral, or school problem. The prevalence rate ranged from 1.4% to 7.8% by pediatrician, with five reporting rates within +/- 1.2% of the mean. High rates were associated with children in the 7 to 14 year age group (9.9%), those on Medicaid (8.6%), those who were not living with a father (10.9%), those whose presenting complaint was a chronic physical condition (11.7%), and children with a disease of the digestive system (16.7%) or with ""symptoms, signs and ill-defined conditions'' (14.3%). Functional impairment was reported to be moderate or severe in 40% of the 187 children with mental health problems. The most frequently reported problems (primary or otherwise) were adaptation reaction (22.5%), specific learning disorder (19.3%), hyperkinetic disorder (19.3%), psychosomatic disorder (12.8%), and conduct disorder (12.8%). The most frequent form of treatment provided was supportive therapy or counseling (85.6%) and suggestions regarding environmental changes (43.3%). Drugs were prescribed for 16.0% of the affected children, with 6.4% receiving methylphenidate or amphetamines. Referral for psychological care or consultation was made for 36.9%. The frequency of mental health problems observed by the pediatricians was about five times the annual rate of Monroe County children contacting a psychiatric inpatient or outpatient setting.

The de facto US mental health services system: a public health perspective

The President's Commission on Mental Health has highlighted a heretofore unmet need for the linkage of data on the prevalence of mental disorder with national data on the use of mental health services. This study analyzes available epidemiological data and recent mental health services research findings to estimate the percent of the population with a mental disorder and the proportion utilizing various types of specialty mental health and general medical treatment settings. Provisional estimates indicate that at least 15% of the US population is affected by mental disorders in one year. In 1975, only one fifth of these were served in the specialty mental health sector, with about three fifths identified in the general medical (primary care) sector.

Factors relating to the use of mental health services in a neighborhood health center

Six-month utilization data are presented for the mental health unit of a comprehensive neighborhood health center. Almost 5% of the 16,877 people in Charlestown, Mass., used these services at a rate of 48.7 per 1,000 residents. Nearly all the residents of this Boston neighborhood were white; the median family income was $8,828 annually; and 14% of the families received public assistance. Age, sex, marital status, census tract of residence, and diagnostic factors were quantitatively related to the use of services. Those 0-17 years represented 39.6% of the total caseload and had a utilization rate of 57.0 per 1,000. Boys and women were the biggest users of service, and married adults constituted 47.7% of the adults using the service. About 55% of the patients paid through Medicaid. During the study period 999 diagnoses were recorded for 822 separate patients, or 1.2 diagnoses per patient. Findings from the center's caseload are compared with utilization data for other mental health services and available national data. The study data demonstrate that the health center's goals of providing accessible, family-oriented, comprehensive mental health services that are targeted particularly to the lower socioeconomic groups in the community were largely accomplished.