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Castillo EG, Shaner R, Tang L, Chung B, Jones F, Whittington Y, Miranda J, Wells KB. Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support. Psychiatr Serv 2018; 69:195-203. [PMID: 29032700 PMCID: PMC5794612 DOI: 10.1176/appi.ps.201600514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. METHODS This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. RESULTS Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. CONCLUSIONS Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.
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Affiliation(s)
- Enrico G Castillo
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Roderick Shaner
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Lingqi Tang
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Bowen Chung
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Felica Jones
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Yolanda Whittington
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Jeanne Miranda
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Kenneth B Wells
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
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Shaner R, Thompson KS, Braslow J, Ragins M, Parks JJ, Vaccaro JV. How Health Reform is Recasting Public Psychiatry. Psychiatr Clin North Am 2015; 38:543-57. [PMID: 26300038 DOI: 10.1016/j.psc.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews the fiscal, programmatic, clinical, and cultural forces of health care reform that are transforming the work of public psychiatrists. Areas of rapid change and issues of concern are discussed. A proposed health care reform agenda for public psychiatric leadership emphasizes (1) access to quality mental health care, (2) promotion of recovery practices in primary care, (3) promotion of public psychiatry values within general psychiatry, (4) engagement in national policy formulation and implementation, and (5) further development of psychiatric leadership focused on public and community mental health.
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Affiliation(s)
- Roderick Shaner
- Los Angeles County Department of Mental Health, Keck School of Medicine, University of Southern California, 550 South Vermont Avenue, 12th Floor, Los Angeles, CA 90020, USA.
| | - Kenneth S Thompson
- Pennsylvania Psychiatric Leadership Council, 6108 Kentucky Avenue, Pittsburgh, PA 15206, USA
| | - Joel Braslow
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Box 951759, CHS 33-251, Los Angeles, CA 90095-1759, USA; Department of History, UCLA Wilshire Center, University of California, Los Angeles, Suite 300, 10920 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Mark Ragins
- MHA Village Integrated Service Agency, 456 Elm Avenue, Long Beach, CA 90802, USA
| | - Joseph John Parks
- Missouri Institute of Mental Health, University of Missouri-St. Louis, Dome Building, 5400 Arsenal, St Louis, MO 63139, USA
| | - Jerome V Vaccaro
- Right Path HC, Ingenuity Health, 10 Fox Den Road, Mounts Kisco, NY 10549, USA
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Affiliation(s)
- Carol Eisen
- Semel Institute for Neuroscience and Human Behavior, Health Services Research Center, University of California, Los Angeles, CA 90024, USA.
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Abstract
OBJECTIVE The study examined whether outreach teams of mental health professionals and police officers could assess and make appropriate dispositions for psychiatric emergency cases in the community, even in situations involving violence or potential violence. The study also assessed whether such teams could reduce criminalization of mentally ill persons. METHODS One hundred and one consecutive referrals to law enforcement-mental health teams in Los Angeles were studied through records review. Subjects' status during a six-month follow-up period was also examined. RESULTS Referral had a high rate of past criminal arrests, violence, and major psychopathology. Sixty-three had a history of violence against persons, 59 had a criminal arrest history, 79 had prior psychiatric hospitalizations, and 66 were serious substance abusers. At referral, 70 manifested severe psychiatric symptoms, 20 were overtly violent, and 29 others exhibited threatening behavior. However, only two of the group were arrested; 80 were taken to hospitals. At six-month follow-up of 85 referrals, 22 percent had been arrested (12 percent for crimes of violence), and 42 percent had been rehospitalized. CONCLUSIONS Outreach emergency teams composed of a police officer and a mental health professional are able to deal appropriately with persons who have acute and severe mental illness, a high potential for violence, a high incidence of substance abuse, and long histories with both the criminal justice and mental health systems. Such teams apparently avoid criminalization of the mentally ill.
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Affiliation(s)
- H R Lamb
- University of Southern California School of Medicine, Los Angeles 90034, USA
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Abstract
The number of state hospital beds nationwide has been reduced to 40 per 100,000 population; in California, nonforensic state hospital beds have decreased to 8.3 per 100,000. The main effects of this reduction are becoming more evident. Most seriously affected have been the new generation of chronically and severely mentally ill persons who have reached adulthood since deinstitutionalization. Those who need intermediate or long-term hospitalization and cannot receive it may become even more desperate and psychotic; may avoid treatment entirely; and may turn to drug abuse and become homeless or incarcerated in jail. Moreover, the small number of long-stay beds can lead to a breakdown in the public mental health system and attempts to avoid responsibility for persons who need both acute and long-term hospitalization. This avoidance can be manifested by raising admission criteria for acute treatment or shifting responsibility to other systems. The authors recommend providing intermediate and long-stay hospitalization to the extent needed.
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Affiliation(s)
- H R Lamb
- USC Department of Psychiatry, Los Angeles 90033
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