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News and Notes   |    
Psychiatric Services 2000; doi: 10.1176/appi.ps.51.4.542
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Richard K. Harding, M.D., of Columbia, South Carolina, was chosen president-elect of the American Psychiatric Association in mail balloting by APA members this winter and will assume the APA presidency in May 2001.

The current president-elect, Daniel B. Borenstein, M.D., of Los Angeles, will become APA president next month at the conclusion of the APA annual meeting in Chicago. He will succeed Allan Tasman, M.D., of Louisville, Kentucky.

Dr. Harding, an APA vice-president since 1998, received 59.5 percent of the vote in a race against Roger Peele, M.D., of Gaithersburg, Maryland. He is professor of clinical psychiatry and pediatrics and vice-chair of clinical affairs in the department of neuropsychiatry at the University of South Carolina in Charleston.

Marcia Kraft Goin, M.D., of Los Angeles was elected to a two-year term as APA vice-president. She received 63 percent of the vote in a race against R. Dale Walker, M.D., of Portland, Oregon. Dr. Goin, who has been an APA trustee-at-large since 1997, is in private practice. She will fill one of two vice-presidential posts; the other is held by Paul S. Appelbaum, M.D., of Worcester, Massachusetts.

Carol A. Bernstein, M.D., of New York City was elected to a two-year term as APA treasurer in a race against Maria T. Lymberis, M.D., of Santa Monica, California, who was seeking reelection as treasurer. Dr. Bernstein, who received 53 percent of the vote, is associate professor of clinical psychiatry and director of residency training in the department of psychiatry at New York University School of Medicine.

Keith W. Young, M.D., who is in private practice in Los Angeles, was elected trustee-at-large in a close race against Jacquelyn B. Chang, M.D., of San Francisco. Dr. Young received 51 percent of the vote. Avram H. Mack, M.D., of Boston, was the winner of a four-way race for member-in-training trustee-elect. His opponents were Esther J. Dechant, M.D., of Boston, Britta Ostermeyer, M.D., of New York City, and Erin Silvertooth, M.D., of Durham, North Carolina.

Kathleen M. Mogul, M.D., of Newton, Massachusetts, was the winner of a three-way race for area 1 trustee. Her opponents were Richard E. Fortier, M.D., of Auburn, Maine, and Lloyd I. Sederer, M.D., of Belmont, Massachusetts. Dr. Mogul is in private practice.

Norman A. Clemens, M.D., who is in private practice in Cleveland, Ohio, was elected area 4 trustee in a race against Richard J. Thurrell, M.D., of Madison, Wisconsin. Albert V. Vogel, M.D., of Albuquerque, New Mexico, was elected area 7 trustee in a race against Vit U. Patel, M.D., of Honolulu. Dr. Vogel is associate dean for clinical affairs at the University of New Mexico Health Sciences Center.

At publication time the outcome of a vote to change APA's federal tax status to 501(c)(6) from 501(c)(3) had not been announced. The new tax status would permit APA to share non-dues revenue with its district branches and to expand its advocacy activities.

Federal funding for mental health and substance abuse research and service programs would increase by approximately 6 percent under President Clinton's budget proposal to Congress for fiscal year 2001. Research on mental health and substance abuse within the National Institutes of Health (NIH) would receive an increase of $92 million, for a total of around $1.7 billion, while funding for programs operating under the Substance Abuse and Mental Health Services Administration (SAMHSA) would total $2.8 billion, an increase of $183 million.

The budget proposal would raise the mental health services block grant to states to $416 million, 17 percent more than in fiscal year 2000. The grant is administered by SAMHSA's Center for Mental Health Services (CMHS), whose budget would total $732 million in 2001 under the President's proposal.

The CMHS budget also includes a request for $30 million for a new Targeted Capacity Expansion program to help establish prevention, early identification, and intervention services for mental illness. The request includes $10 million for a prevention and early intervention program focusing on persons at risk for or in the early stages of mental illness, and $20 million for development of mental health service capacity outside the mental health system in settings such as primary care and Head Start programs.

The Center for Substance Abuse Treatment would receive almost $1.9 billion in fiscal year 2001, the biggest portion of which would be used to fund the substance abuse prevention and treatment block grant to the states. Funding for the block grant would increase by $31 million over the $1.6 billion approved for 2000. The Targeted Capacity Expansion program for substance abuse treatment would receive $163 million, a 43 percent increase over 2000. Funding for the Knowledge Development and Application program would be cut by $5 million to $95 million.

Total funding for the Center for Substance Abuse Prevention would increase slightly to $142 million in 2001, of which $85 million would be allocated to the Targeted Capacity Expansion program. Another $50 million—$10 million less than in 2000—would fund the Knowledge Development and Application program. The program for high-risk youth would receive $7 million, the same as in 2000.

Funding for the National Institute of Mental Health would total $896 million in 2001, a 5.9 increase over 2000. The National Institute on Drug Abuse would receive $496 million, a 5.8 percent increase, and the National Institute on Alcohol Abuse and Alcoholism would receive $289 million, a 5.5 percent increase. The percentage increases are in line with the 5.6 percent increase in the total NIH budget, which would reach $18.8 billion in 2001.

Alabama Lawsuit Establishing a Constitutional Right to Treatment Is Settled After 30 Years

Thirty years after being filed in federal court in Alabama, the class-action lawsuit that first established a constitutional right to treatment for people in mental institutions has been settled.

According to the Bazelon Center for Mental Health Law, which has been involved in the case since the early 1970s, Alabama officials signed an agreement in late January to maintain improvements already made in the care of residents in state psychiatric facilities or developmental centers and those who have been moved out into community residences. They also agreed to develop a three-year plan for further progress.

The suit was filed in 1970. Now known as Wyatt v. Sawyer, it challenged a shortage of staff in state facilities housing a total of 9,200 people. In 1972 the late U.S. District Judge Frank M. Johnson declared that people involuntarily confined in such institutions have a constitutional right to treatment in exchange for being deprived of their liberty. Judge Johnson then defined the meaning of "treatment" with minimum standards covering every aspect of institutional life and a requirement that treatment be provided in the least restrictive setting consistent with an individual's need.

Another 25-year-old class-action suit, requiring the District of Columbia to develop community services for mentally ill persons who do not require hospitalization, is still ongoing. The Bazelon Center also represents the plaintiffs in that case.

New guidelines designed to help substance abuse counselors and other mental health professionals identify and treat adults who experienced childhood abuse or neglect were released in February by the Center for Substance Abuse Treatment. Up to two-thirds of adults in substance abuse treatment have experienced childhood maltreatment, according to the report containing the guidelines.

Entitled Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues, the report discusses issues that may complicate treatment for these individuals or cause them to drop out of treatment if not addressed. Because parents with histories of childhood abuse are at increased risk of maltreating their own children, the guidelines provide clinical and legal advice to clinicians who suspect that a client is endangering a child.

More than 3 million cases of abused and neglected children were reported in 1997, and substance abuse was involved in at least 70 percent, according to the report. Children who are abused and neglected are more likely to develop substance abuse problems, and they are also at increased risk of perpetuating abuse and neglect when they become parents. A central focus of the guidelines is on breaking the cycle of intergenerational transmission of both substance abuse and child abuse by ensuring that clinicians recognize clients with histories of maltreatment.

Because having an abuse history may dramatically affect an individual's treatment needs, the guidelines recommend screening as early as possible in the treatment process. Several self-report tools to screen for childhood abuse and neglect are described, and a list of direct screening questions is provided. For more comprehensive formal assessment of individuals who screen positive, the guidelines recommend several standard structured psychiatric interviews as well as assessment tools designed to explore traumatic events and symptoms. An appendix provides information for obtaining the recommended instruments.

The guidelines emphasize the importance of allowing adults with a history of childhood maltreatment to work at their own pace in treatment, especially in the area of disclosure of the details of abuse and neglect. Forcing a person to confront painful memories may recreate an abusive situation, the report notes, and may lead to retraumatization. Many individuals need to address substance abuse issues before they are able to benefit from treatment for past trauma. However, some will not be able to achieve sobriety until the traumatic memories receive attention.

The guidelines caution clinicians that early sobriety may be a time for experiencing emotionally painful memories and posttraumatic stress symptoms. For such clients, continued self-medication with substances may seem overwhelmingly preferable to a perhaps unimaginable time when life may be better without substances. They may bring to treatment a particular sense of urgency, because they are desperately trying to get rid of profound emotional pain and debilitating symptoms. Clinicians must be able to express an understanding of this sense of urgency, while at the same time encouraging clients to "stay the course" and "make haste slowly."

Engagement in treatment may be difficult for persons with childhood abuse or neglect because problems in forming attachments are often paramount, the report notes. Many are unable to trust, to make healthy choices in partners, to manage stress constructively, and to nurture themselves and others. Clinicians must respect these individuals' boundaries and limitations and offer them opportunities to increase their interpersonal skills. Anger management, assertiveness training, and conflict resolution are particularly important skills for this population, the report states, as is learning how to recognize unhealthy relationships.

Countertransference may be a particular problem for clinicians working with clients who were maltreated as children, the report notes. Many may find the level of violence and cruelty they are exposed to in this work upsetting and incomprehensible. Some clinicians may unintentionally, or unconsciously, dismiss or minimize a history of abuse in an attempt to avoid uncomfortable feelings. The guidelines offer several recommendations to protect clinicians from burnout. Establishing a treatment frame—the conditions necessary to support a professional relationship—is critical, as is avoiding the role of rescuer. Other issues for clinicians discussed in the report are dealing with seductive clients and with violent behavior and recognizing one's own professional limitations.

Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues is number 36 in the Treatment Improvement Protocol series of the Center for Substance Abuse Treatment (CSAT). It is available on the CSAT Web site at www.samhsa.gov/csat/csat.htm and can be ordered free of charge from the National Clearinghouse for Alcohol and Drug Information, at 800-729-6686.

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News Briefs

Youth advocacy campaign: The National Association of Psychiatric Health Systems (NAPHS) has launched a year-long campaign to help policy makers and community leaders understand the importance of meeting the behavioral health needs of young people and to overcome gaps in the mental health system that prevent them from taking full advantage of significant treatment advances. Using the slogan "Make behavioral health for youth a priority," the campaign is advocating for changes in three priority areas: expanded coverage for behavioral health care for youth, improved coordination of care, and fair funding. Campaign kit materials, including fact sheets and policy recommendations, are available on the NAPHS Web site at www.naphs.org. Also available is a report by the Lewin Group commissioned by NAPHS that provides baseline information on current knowledge and thinking about care for youths with psychiatric, emotional, and behavioral problems.

New PTSD Alliance: Four national professional and advocacy organizations have joined to form the Posttraumatic Stress Disorder (PTSD) Alliance to raise awareness and provide education to the public and front-line professionals. They are the American College of Obstetricians and Gynecologists, the Anxiety Disorders Association of America, the International Society for Traumatic Stress Studies, and the Sidran Foundation for Traumatic Stress. A statement announcing formation of the alliance said that an estimated 13 million Americans, 5 percent of all adults, are affected by PTSD, and approximately 70 percent of adults have experienced a traumatic event at least once in their lives.

Grants for delivery of substance abuse services: A total of $3 million in grants is available from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA) to identify effective approaches for the delivery of substance abuse services in outpatient substance abuse treatment agencies to persons with both substance use and mental disorders. Nine grants ranging between $300,000 and $400,000 will be awarded for evaluation and documentation purposes and may not be used to provide treatment services. More information is available on SAMHSA's Web site (www.samhsa.gov/grant) or by calling 1-800-729-6686. Applications will be accepted until May 23, 2000.

New hospital building: Historic St. Elizabeths Hospital in Washington, D.C., will be replaced by a new, state-of-the-art psychiatric facility that will house 320 patients, about half the current number, in three new buildings on a section of the hospital's campus. Hospital officials told the Washington Post that they plan to pare the existing population by shifting most long-term, noncriminal patients into community settings, as mandated by a 1974 class-action lawsuit and a 1980 federal consent decree. The new facility, estimated to cost $75 million, is expected to open in 2003. It will consist of about eight new buildings, three of which will house patients. St. Elizabeths, founded in 1855, currently has 80 buildings, some of which are historic landmarks and many are which are in a state of serious disrepair.

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People & Places

Appointment:Darrel A. Regier, M.D., M.P.H., has been named executive director of the American Psychiatric Institute for Research and Education and director of the office of research of the American Psychiatric Association. His appointment became effective March 1. Dr. Regier formerly was associate director for epidemiology and health policy research of the National Institute of Mental Health.

Paul Barreira, M.D., deputy commissioner for clinical and professional services for the Massachusetts Department of Mental Health, has been named chief of community clinical services and director of medical education at McLean Hospital in Belmont, Massachusetts. He will also serve as director of public and community psychiatry for Partners Psychiatry and Mental Health System, whose member hospitals provide mental health services in the Boston area. Dr. Barreira's appointment becomes effective April 3.

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