Implementing and evaluating outcome indicators of performance for mental health agencies.

Regulation-based processes for evaluating the performance of mental health agencies are gradually changing to focus on measuring the effectiveness of mental health services in obtaining the best possible outcomes. The decreased availability of resources for serving people with mental health problems has led to an emphasis on effectiveness, which is often expressed in terms of accountability. Thus, a singular reliance on compliance with practice standards has shifted to the need to be able to demonstrate that funds appropriated for mental health services are being used in ways that result in valued outcomes. In Colorado, this shift has led to the development of performance indicators that provide information reflecting stakeholder values about the performance outcomes of the mental health system. This article describes these performance indicators and presents the data that led to a decision to award monetary incentives to two community agencies. Potential benefits and pitfalls of Colorado's performance indicator process are also discussed.

Empirical correction of seven myths about schizophrenia with implications for treatment.

This paper presents empirical evidence accumulated across the last two decades to challenge seven long-held myths in psychiatry about schizophrenia which impinge upon the perception and thus the treatment of patients. Such myths have been perpetuated across generations of trainees in each of the mental health disciplines. These myths limit the scope and effectiveness of treatments offered. These myths maintain the pessimism about outcome for these patients thus significantly reducing their opportunities for improvement and/or recovery. Counter evidence is provided with implications for new treatment strategies.

Individual psychotherapy with schizophrenic outpatients in the public mental health system.

Forty-two therapists conducting individual psychotherapy with schizophrenic outpatients in a public mental health system responded to a questionnaire that focused on the types of interventions used and the issues and problems encountered in therapy. The therapists spent 59 percent of their time in supportive, problem-solving work and only 32 percent in traditional psychotherapeutic interventions, such as providing insight. The most common issues in therapy were relationship problems, family concerns, depression, losses, and the role of medications in the client's life. The most significant impediments to therapeutic work were the lack of community resources, the client's noncompliance with medications and lack of motivation, and dual diagnoses. Suggestions are offered for improving psychotherapy with schizophrenic outpatients in the public mental health system.

Consumers' attitudes toward psychotherapy, hospitalization, and aftercare.

A sample of 204 chronically mentally ill patients from a variety of outpatient settings was surveyed on their attitudes toward psychotherapy, hospitalization, aftercare, and their condition in life. Generally, they felt various types of psychotherapy and aftercare were helpful and reported good relationships with their therapists. However, their goals focused more on quality of life than on symptom reduction. Patients also were concerned about the perceived power of providers over their lives; unfair treatment, discrimination, and lack of respect because of their illness; and anger over their illness and its consequences. Consumers in advocacy groups showed a slightly higher rate of concern than those not in advocacy groups. However, significantly more consumers in advocacy groups reported anger over their experiences with mental illnesses.