Medicare program: conditions of participation (CoPs) for community mental health centers. Final rule.

This final rule establishes, for the first time, conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program. These CoPs focus on the care provided to the client, establish requirements for staff and provider operations, and encourage clients to participate in their care plan and treatment. The new CoPs enable CMS to survey CMHCs for compliance with health and safety requirements.

Predictors of involuntary hospitalizations to acute psychiatry.

INTRODUCTION: There is little knowledge of predictors for involuntary hospitalizations in acute psychiatric units. METHOD: The Multi-center study of Acute Psychiatry included all cases of acute consecutive psychiatric admissions in twenty acute psychiatric units in Norway, representing about 75% of the acute psychiatric units during 2005-2006. Data included admission process, rating of Global Assessment of Functioning and Health of the Nation Outcome Scales. RESULTS: Fifty-six percent were voluntary and 44% involuntary hospitalized. Regression analysis identified contact with police, referral by physicians who did not know the patient, contact with health services within the last 48 h, not living in own apartment or house, high scores for aggression, level of hallucinations and delusions, and contact with an out-of office clinic within the last 48 h and low GAF symptom score as predictors for involuntary hospitalization. Involuntary patients were older, more often male, non-Norwegian, unmarried and had lower level of education. They more often had disability pension or received social benefits, and were more often admitted during evenings and nights, found to have more frequent substance abuse and less often responsible for children and were less frequently motivated for admission. Involuntary patients had less contact with psychiatric services before admission. Most patients were referred because of a deterioration of their psychiatric illness. CONCLUSION: Involuntary hospitalization seems to be guided by the severity of psychiatric symptoms and factors "surrounding" the referred patient. Important factors seem to be male gender, substance abuse, contact with own GP, aggressive behavior, and low level of social functioning and lack of motivation. There was a need for assistance by the police in a significant number of cases. This complicated picture offers some important challenges to the organization of primary and psychiatric health services and a need to consider better pathways to care.

Comparing sexual offenders at the Regional Treatment Centre (Ontario) and the Florida Civil Commitment Center.

Sexual offender civil commitment (SOCC) continues to be a popular means of managing risk to the community in many U.S. jurisdictions. Most SOCC states report few releases, due in large part to the reluctance of the courts to release sexually violent persons/predators (SVPs). Contemporary risk prediction methods require suitable comparison groups, in addition to knowledge of postrelease behavior. Low SVP release rates makes production of local base rates difficult. This article compares descriptive statistics on two populations of sexual offenders: (a) participants in high-intensity treatment at the Regional Treatment Centre (RTC), a secure, prison-based treatment facility in Canada, and (b) SVP residents of the Florida Civil Commitment Center. Results show that these two samples are virtually identical. These groups are best described as "preselected for high risk/need," according to Static-99R normative sample research. It is suggested that reoffense rates of released RTC participants may serve as a comparison group for U.S. SVPs. Given current release practices associated with U.S. SOCC, these findings are of prospective value to clinicians, researchers, policy makers, and triers of fact.

[Psychiatric care in Italy]. / L'assistenza psichiatrica in Italia.

Law 180 of 1978 started a deep change in psychiatric assistance in Italy, promoting new approaches to mental disease and leading toward new patterns of intervention: from the mental hospital-based model to a territory-based one. Going back over legislative and structural evolution of psychiatric assistance in our Country, we want to highlight how this new approach is still far, for some aspects, from attaining full efficiency. The last contribution to its improvement has been given by National Sanitary Plan 2006-2008, in which several critical points of our assistance system, and the objectives to reach in order to improve it, are pointed out.

State mental health policy: Physical health screening in state mental health clinics: the New York health indicators initiative.

The New York State Office of Mental Health recently mandated that all adult outpatient clinics regularly monitor three health indicators--body mass index, blood pressure, and smoking status. After the population was defined, medical equipment was distributed. Regular training and quality improvement meetings were held to improve the electronic database for indicator data. Clinical directors were provided regular feedback on performance monitoring. Learning collaboratives allowed sharing of implementation strategies. After only four months of this coordinated effort, approximately 7,500 people with mental illnesses had been screened for the three health indicators across New York State.

Categorizing temporal patterns of arrest in a cohort of adults with serious mental illness.

Temporal patterns of arrest among mental health systems' clientele have not been well explored. This study uses "trajectory analysis," a methodology widely employed by criminologists exploring patterns of desistence in offending, to examine patterns of criminal justice involvement in a cohort of mental health service recipients. Data for this study are from a statewide cohort of individuals who received services from the Massachusetts Department of Mental Health in 1991 (N = 13,876) and whose arrests were followed for roughly 10 years. Zero-inflated Poisson trajectory analysis applied to cohort members having two or more arrests identified five trajectories with widely varying arrest patterns. Analysis of differences in the composition of the five trajectory-based groups revealed few between-group differences in members' demographic and service use characteristics, while certain offense types were disproportionately prevalent among particular trajectory-based groups. The implications of these findings for understanding criminal justice involvement in this population and the utility of the trajectory model for system planning are discussed.

Involvement with the criminal justice system among new clients at outpatient mental health agencies.

OBJECTIVE: This study assessed involvement with the criminal justice system among new clients of community mental health centers and self-help agencies in order to determine the characteristics and service needs of this population. Such information has implications for improving the care available for persons with mental illness who have been involved with the criminal justice system. METHODS: Interview assessments and criminal records were obtained for 673 new clients of 21 outpatient mental health agencies. Descriptive statistics, chi square tests, and multivariate analysis of variance were used to describe these new help-seekers and their involvement with the criminal justice system. RESULTS: A total of 303 study participants (45 percent) had at least one contact with the criminal justice system before arriving at the agency, with an approximately equal percentage at community mental health centers and self-help agencies. The mean+/-SD number of contacts with the criminal justice system was 7.81+/-9.12. A total of 240 individuals (36 percent) had at least one criminal conviction, including 128 (19 percent) with a felony conviction. Common charges and convictions included petty theft, assault and battery, felony theft, narcotics offenses, and misdemeanor drug offenses. Clients who had been involved with the criminal justice system were more likely to be homeless, to have drug dependence, to have greater psychological disability, and to have less personal empowerment than other clients. CONCLUSIONS: The population overlap between the mental health system and criminal justice system and the multiple problems facing criminally involved clients argues for greater collaboration between the two systems and a comprehensive package of services to meet the multiple needs of this population. The equal distribution of these individuals and similar offense patterns at both types of agencies necessitates further consideration of the role that nontraditional service providers have in serving individuals with a history of involvement with the criminal justice system.

Four decades of community mental health: a symphony in four movements.

The authors present a detailed chronological discussion of the evolution of community mental health care in the United States with emphasis on the period of the 40 years since the passage of the Community Mental Health Centers Construction Act of October 31, 1963.

Implementing psychiatric advance directives: service provider issues and answers.

Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to document treatment preferences in advance of periods of incapacity. This article presents and responds to issues most frequently raised by service providers when planning for implementation of PADs. Issues discussed include access to PADs; competency to execute PADs; the relationship of PADs to standards of care, resource availability, and involuntary treatment; roles of service providers and others in execution of PADs; timeliness and redundancy of PAD information; consumer expectations of PADs; complexity of PADs; revocation and "activation"; legal enforceability of PADs; the role and powers of agents; liability for honoring and not honoring PADs; and use of PADs to consent for release of health care information. Recommendations are made for training staff and consumers, consideration of statute development, and methods to reduce logistical, attitudinal, and system barriers to effective use of PADs.

System effects of the Kansas Mental Health Reform Act of 1991.

This paper analyzes the impact of the Kansas Mental Health Reform Act on client outcomes. The Act is of general interest because it reflects a trial of greater accountability without major changes in financial incentives. It made Community Mental Health Centers [CMHCs] gatekeepers that were accountable for services for adults with severe and persistent mental illnesses. The Act sought reductions in hospitalizations rates, expanded use of community support services, and increased independent living. The structure of the Act and Client Status Reports allow rigorous examination of these outcomes. The number of clients served increased significantly. Even though hospital days fell by 23%, there is no clear evidence that the Act itself reduced hospital days per client. The proportion of community support program clients residing independently rose significantly; the proportion participating meaningfully in the labor market fell. The goals of the Act were realized overall, but the performance of CMHCs varied considerably.

Plan moderno de asistencia a los alienados (1926)

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Responsabilidad, ley, salud mental. reflexiones en torno al nuevo código penal / Reflection about the new Penal Code

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