The Emergence of Mental Health Self-Direction: An International Learning Exchange.

Self-direction has emerged worldwide as a promising practice for persons with serious mental health conditions and as a means toward creating more person-centered service systems. In self-direction, service users control an individualized budget, purchasing goods or services that can help them achieve personal recovery goals. This Open Forum describes an international learning exchange meeting, held in September 2015, in which experts in self-direction and mental health from seven nations convened for sharing best practices, discussing challenges, and laying the groundwork for a learning community to support the continued development of self-direction. Meeting participants identified three themes that represent next steps toward ensuring that the promise of self-direction is realized. First, self-direction involves creating a culture shift for value-based systems change. Second, people with lived experience must be involved and supported at every level, including direct support, leadership, and oversight. Third, stakeholder communication about self-direction's impact is critical.

The impact of job accommodations on employment outcomes among individuals with psychiatric disabilities.

OBJECTIVE: This study aimed to fill a gap in the literature on effectiveness of employment accommodations by comparing employment outcomes for individuals with psychiatric disabilities who received or did not receive accommodations, with models informed by a conceptual approach blending static labor supply theory, Sen's capability approach, and the International Classification of Functioning. METHODS: Data for the study came from a longitudinal, four-year eight-state multisite demonstration project funded by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration. All participants had been recruited from clinical populations receiving outpatient psychiatric services. The effects of job accommodations on hours worked were assessed with generalized linear modeling (N=1,538). The effects of job accommodations on duration of employment were assessed with a parametric duration model analysis (N=1,040) that incorporated multiple spells of employment among individuals over the study period. RESULTS: Controlling for covariates suggested by the conceptual model, analyses showed that individuals who reported job accommodations on average worked 7.68 more hours per month and those who reported receiving accommodations worked 31% longer, with each job accommodation reported decreasing the risk of job termination by nearly 13%. CONCLUSIONS: Results demonstrate that job accommodations show potential to improve employment outcomes for individuals with psychiatric disabilities receiving supported employment services, indicating that job accommodations should be stressed in policy and continuing education efforts for program staff and clients.

Infrastructure Change Is Not Enough: An Evaluation of SAMHSA's Mental Health Transformation State Incentive Grants.

OBJECTIVE: The authors evaluated the Substance Abuse and Mental Health Services Administration's mental health transformation state incentive grant program, which provided more than $100 million to nine states to make infrastructure changes designed to improve services and outcomes. METHODS: The authors measured infrastructure changes, service changes, and consumer outcomes in the nine programs. Although the federal program had no logic model, the authors adopted a model that hypothesized positive, but small, correlations between the program elements. RESULTS: There were few statistically significant correlations and a number of negative correlations between infrastructure changes, service changes, and consumer outcomes. CONCLUSIONS: Federal investments should take into account evidence that infrastructure changes alone do not necessarily contribute to better consumer outcomes, support operationally defined infrastructure improvements, require that service improvements accompany infrastructure changes, and provide sufficient resources to oversee grantee behaviors. In addition, future evaluation should support evaluation best practices.