Service quality as measured by service fit and mortality among public mental health system service recipients.

Service fit, defined as consistency between mental health services judged needed and services received was measured for a random sample of service recipients in a public mental health system (N = 6588). A variant of small area analysis was used to measure the relationship between catchment area mortality rates from natural causes, suicide, and medicolegal causes and area fit scores for a variety of services. We tested the theory-based hypothesis that service fit would predict interarea variations in mortality better than simple measures of amount of service prescribed and received. We also tested the hypothesis that, controlling for relevant demographic and clinical factors, fit would be protective for mortality from all causes. Findings supported the first hypothesis. With respect to the second, service fit for only certain services was protective. Housing and clubhouses services were particularly protective, suggesting the importance of services providing social support.

Externally caused deaths for adults with substance use and mental disorders.

For decades, there have been reports of shorter life expectancy among those with mental illness, especially those with more serious psychiatric disorders. The purpose of this study was to compare the risk of mortality among Medicaid beneficiaries, aged 18-64 years, treated for mental illness to a comparable group who were not mentally ill and to the general population. The data used were from the Massachusetts Division of Medical Assistance and records of deaths from the Department of Public Health in Massachusetts. Individuals treated for both psychiatric illness and substance use disorders (dual diagnoses) were compared separately from those whose treatment was only for a psychiatric disorder. For all Medicaid beneficiaries, the most common causes of death were attributed to heart disease and cancer. When compared to the general population, adjusted odds ratios estimated death by injury to be twice as likely among the mentally ill when compared to the general population. Medicaid beneficiaries with dual diagnoses are 6-8 times more likely to die of injury, primarily poisoning, than their counterparts treated for medical conditions only.

Shortages of rural mental health professionals.

This study presents a conceptual model of the supply and demand for mental health professionals. It uses national data to profile differences in the supply of mental health professionals in different types of rural and urban areas. It contrasts the availability of general health and mental health professionals. It examines shortage areas identified in 2000 and their related community characteristics. Because of the absence of data on a national level to describe many types of mental health professionals state licensure data for one state were used to show the volume and distribution of these practitioners. To improve rural mental health service delivery it will be necessary to implement system changes to promote the increased availability, competency, and support of rural health professionals.

The association between schizophrenia and cancer: a population-based mortality study.

BACKGROUND: For most of this century there has been speculation that persons diagnosed with schizophrenia have a reduced incidence of cancer. OBJECTIVE: To determine if a history of cancer was more common in persons diagnosed with schizophrenia when compared with the general population, controlling for known risk and demographic factors. DESIGN: We used the 1986 National Mortality Followback Survey (NMFS) which sampled 1% of all deaths in the US from that year. Data were obtained from death certificates and records of hospitalizations in the last year of life. Additional health and demographic data were obtained through interviews with decedents' families and other informants. We compared persons diagnosed with schizophrenia (n=130) to individuals without schizophrenia (n=18,603) and used logistic regression to determine the odds ratio for the occurrence of cancer in persons diagnosed with schizophrenia. Adjustment for age at death was done to correct for the fact that persons diagnosed with schizophrenia die on average 10 years younger than the general population. MAIN OUTCOME MEASURE: A diagnosis of cancer on a hospital record or the death certificate. RESULTS: The unadjusted odds ratio for cancer among individuals with schizophrenia was 0.62 (95% confidence interval (CI) 0.40-0.96). After controlling for age, race, gender, marital status, education, net worth, smoking, and hospitalization in the year before death, we determined that the odds ratio for the diagnosis of cancer in persons with schizophrenia was 0.59 (95% CI 0.38-0.93). CONCLUSION: In this population-based study, we demonstrated a reduced risk of cancer among persons diagnosed with schizophrenia.

Effect of geographic migration on SMI prevalence estimates.

The prevalence of serious mental illness (SMI) varies by the socioeconomic characteristics of communities. This variation is presumed to be due to the differential incidence of disorders caused by adverse social factors (social causation) and differential geographic migration (social selection and drift). The objective of this study was to measure the geographic migration patterns of adults treated for SMI. A sample of 11,725 adults with three or more psychiatric hospital admissions between July 1978 and November 1992 was drawn from inpatient records. At least one third migrated to different counties between first and last admission. Migration rates were higher for Whites than for African Americans and higher for unmarried than for married patients. There were no significant differences in migration rates by gender or mental disorder. Patient migration did not parallel shifts in the general population. Patient migration was generally toward medium-size, low-income urban counties with relatively declining general populations, and movement was away from both the most rural and the largest urban counties. Public needs assessments and resource allocation policies may understate the need in communities with net SMI out-migration and overstate endemic need where there is net in-migration. In the long term, these same policies may induce migration through resource allocation decisions.