ABSTRACT
OBJECTIVES: This study tested a psychiatric rehabilitation approach for organizing and delivering services to street-dwelling persons with severe mental illness. METHODS: Street-dwelling persons with severe mental illness were randomly assigned to the experimental program (called Choices) or to standard treatment in New York City. We assessed study participants at baseline and at 6-month intervals over 24 months, using measures of service use, quality of life, health, mental health, and social psychological status. The average deviation from baseline summary statistic was employed to assess change. RESULTS: Compared with persons in standard treatment (n = 77), members of the experimental group (n = 91) were more likely to attend a day program (53% vs 27%), had less difficulty in meeting their basic needs, spent less time on the streets (55% vs 28% reduction), and spent more time in community housing (21% vs 9% increase). They showed greater improvement in life satisfaction and experienced a greater reduction in psychiatric symptoms. CONCLUSIONS: With an appropriate service model, it is possible to engage disaffiliated populations, expand their use of human services, and improve their housing conditions, quality of life, and mental health status.
Subject(s)
Community Mental Health Services/organization & administration , Ill-Housed Persons/psychology , Mental Disorders/rehabilitation , Persons with Mental Disabilities/rehabilitation , Urban Health Services/organization & administration , Adult , Aged , Community-Institutional Relations , Female , Health Services Research , Humans , Interview, Psychological , Male , Mental Disorders/psychology , Mental Health , Middle Aged , Models, Organizational , Needs Assessment , New York City , Outcome Assessment, Health Care , Personal Satisfaction , Program Evaluation , Public Housing , Quality of LifeABSTRACT
In the early 1990s the National Institute of Mental Health sponsored projects in four cities that served a total of 896 homeless mentally ill adults. Each project tested the effectiveness of different housing, support, and rehabilitative services in reducing homelessness. Most homeless individuals resided in community housing after the intervention. The proportion in community housing varied between sites. A 47.5 percent increase in community housing was found for those in active treatment conditions. At final follow-up, 78 percent of participants in community housing were stably housed. The findings indicate that effective strategies are available for serving homeless individuals with severe mental illness.
Subject(s)
Ill-Housed Persons/legislation & jurisprudence , Mental Disorders/rehabilitation , Public Housing , Urban Population , Adult , Case Management/legislation & jurisprudence , Female , Follow-Up Studies , Ill-Housed Persons/psychology , Humans , Male , National Institute of Mental Health (U.S.) , Outcome and Process Assessment, Health Care , Patient Care Team/legislation & jurisprudence , United StatesABSTRACT
OBJECTIVE: The study examined whether employing mental health consumers as peer specialists in an intensive case management program can enhance outcomes for clients with serious mental illness. METHODS: A quasiexperimental, longitudinal, nonequivalent control group design was used to compare outcomes of clients assigned to three case management conditions: teams of case managers plus peer specialists, teams of case managers plus nonconsumer assistants, and case managers only. Outcomes were measured at baseline and at three six-month intervals. Repeated-measures analysis of variance was used to assess between-group differences. RESULTS: Complete data were available for 104 clients. Compared with clients in the other two groups, clients served by teams with peer specialists demonstrated greater gains in several areas of quality of life and overall reduction in the number of major life problems experienced. They also reported more frequent contact with their case managers and the largest gains of all three groups in the areas of self-image and outlook and social support. No differences in outcomes were found between clients served by teams with nonconsumer assistants and those served by case managers only. CONCLUSIONS: Integration of peer specialists into intensive case management programs appears to lead to enhanced quality of life for clients and more effective case management.
Subject(s)
Case Management , Mental Disorders/rehabilitation , Patient Care Team , Patient Participation , Peer Group , Adult , Female , Ill-Housed Persons/psychology , Hospitals, Psychiatric , Humans , Long-Term Care , Longitudinal Studies , Male , Mental Disorders/psychology , Middle Aged , New York City , Patient Advocacy , Quality of Life , Self Concept , Social Adjustment , Social Support , Treatment OutcomeABSTRACT
Classifying clients with serious and persistent mental illness (SPMI) into groups with differential demographic and clinical characteristics that relate directly to the need and receipt of services and changes in functioning provides a strong foundation on which to build program- or system-level planning, development, and evaluation efforts. In this study, clinician-generated problem data and cluster-analytic techniques were used to develop a four-group typology for a sample of 293 clients with SPMI. Each of the types--extremely disabled, young adult, personally distressed, and adapted--was profiled demographically and clinically in terms of human service needs, prognosis, and treatment outcomes. Each of the four types evidenced a unique pattern of needs and outcomes that was consistent with its clinical profiles. The typology, associated service needs, and outcomes provide valuable information for use in service planning and program development for clients with SPMI.
Subject(s)
Health Services Needs and Demand , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Outcome and Process Assessment, Health Care , Adaptation, Psychological , Adolescent , Adult , Chronic Disease/epidemiology , Cluster Analysis , Colorado/epidemiology , Disabled Persons , Humans , Mental Disorders/epidemiology , Mental Disorders/physiopathology , PrognosisABSTRACT
Reimbursement strategies represent a key tool in implementing public policy. Often the relationship between changes in reimbursement policy and changes in provider behavior is difficult to predict, particularly in complex service systems. Here we present findings from a multiyear study involving the comparison of alternative Medicaid reimbursement systems for intensive case management services: a fee-for-service arrangement developed specifically for this study, and the partial capitation system in use in New York State. We focus on the impact of these two reimbursement schemes on the number and types of services provided by case managers and on client outcomes.
Subject(s)
Capitation Fee , Fee-for-Service Plans , Managed Care Programs/economics , Mental Disorders/economics , Mental Health Services/economics , Adolescent , Adult , Cost Savings , Humans , Medicaid/economics , Mental Disorders/rehabilitation , Middle Aged , New York , Outcome and Process Assessment, Health Care , Reimbursement Mechanisms/economics , State Health Plans/economics , United StatesABSTRACT
The outcomes of a reform of the Denver mental health system, cosponsored by the state and the RWJF, are contrasted with changes in a comparison area of the state. The study examines the structural characteristics of the mental health system, staff attitudes and satisfaction, and client-reported services and outcome. Results indicate that, in Denver, structural changes, the introduction of new services, and an intervening financial crisis increased worker dissatisfaction. Client reports documented parallel changes in the following variables: continuity of care, unmet need for case management services, frequency of symptoms, and satisfaction with services. The reform had no impact, however, on most quality-of-life indicators. The possibly adverse consequences of centralizing the system and the indirect influences of system integration on quality of life are discussed.
Subject(s)
Community Mental Health Services/organization & administration , Financing, Organized , Program Evaluation , Adult , Aged , Chronic Disease/economics , Colorado , Community Mental Health Services/economics , Continuity of Patient Care/organization & administration , Female , Foundations , Health Care Reform/organization & administration , Humans , Longitudinal Studies , Male , Mental Disorders/economics , Mental Disorders/therapy , Middle Aged , Patient Care Planning , Quality of Life , Treatment OutcomeABSTRACT
To assess the prevalence of physical disorders among outpatients treated in Colorado's public mental health system, a total of 175 patients from two community mental health centers received a comprehensive medical screening that included a standard physical examination and laboratory analyses. Of these patients, 46 percent had physical conditions or laboratory test results warranting further medical evaluation. A previously undiagnosed physical health problem was identified in 20 percent of the screened patients, and about 16 percent had conditions that could cause or exacerbate their mental disorder. The authors conclude that public mental health systems should ensure routine assessment of the physical health of psychiatric outpatients and suggest guidelines for developing medical screening procedures in public settings.
Subject(s)
Community Mental Health Centers/organization & administration , Mass Screening/methods , Mental Disorders/complications , Adult , Colorado , Diagnosis , Epidemiology , Female , Humans , Male , Mass Screening/standards , Prevalence , Random Allocation , Rural Population , Urban PopulationABSTRACT
Thinking regarding the needs of the chronically mentally ill has changed substantially in the post-deinstitutionalization period. Increasingly, the heterogeneity existing within this population has been recognized along with the need for an integrated continuum of residences and services. At a state level, this realization has stimulated the development of planning models which are used to predict the number and types of residential/service slots needed by the chronically mentally ill. In Colorado, a model was developed which uses data-based client profiles to predict needs along a continuum of services ranging from inpatient treatment to independent living with mental health support. In this paper, we discuss the development of the model and present the results of implementing it for a sample of 5,017 chronically mentally ill clients. The practical and heuristic value of the model is featured as well as its implications for further research.