Americans are far more likely today than they were 45 years ago to accept, discuss, and seek help for their own mental illness, according to a major study released in September. However, the study also found that for some Americans, stigmatization of mental illness remains "distressingly high."
Americans' Views of Mental Health and Illness at Century's End: Continuity and Change evaluated data collected in four major surveys conducted in 1950, 1957, 1976, and 1996. More than 1,400 Americans responded to the 1996 survey. The 1996 research team, led by Bernice Pescosolido, Ph.D., of the Indiana Consortium for Mental Health Services Research at Indiana University, and Bruce Link, M.S., Ph.D., of the Columbia University School of Public Health, tried to replicate questions asked in the earlier studies.
• A majority of 1996 respondents reported firsthand knowledge of persons who have received mental health treatment.
• In 1996 one in three respondents reported personal fears of an impending "nervous breakdown," up from one in five in 1957.
• In 1996 the majority of respondents believed that mental illness, like other medical treatments, is a condition unlikely to improve without treatment. The respondents endorsed a variety of treatments from a wide range of formal and informal mental health services providers.
• When asked about what they would do when faced with a psychological problem, 1996 respondents were significantly more likely than past respondents to report that they would rely on mental health professionals and prescription medications.
• Americans have broadened their definitions of mental illness to include less severe psychological problems. When respondents were asked in 1950 about "the meaning of mental illness," the largest proportion mentioned behaviors indicating either psychosis or anxiety-depression. Although the same response pattern continued in 1996, the proportion of respondents in this category fell by about 10 percent, from around 45 percent to 35 percent.
• Only one in ten Americans surveyed in 1996 preferred that the government spend less money on mental health services; more than half stated that the government should be spending more.
• More than two-thirds of the 1996 respondents stated that they believed that the government "definitely" or "probably" has the responsibility for providing mental health services to persons with psychological problems.
Some findings of the study highlighted the need to continue public education about the effectiveness of treatment and to reduce stigma, according to the report. For example, an increased proportion of Americans described mental illness in terms consistent with violent or dangerous behavior. The percentage increased from around 7 percent in 1950 to about 12 percent in 1996. The authors of the study attributed some of the increase to news and other media portrayals that show overwhelmingly negative and one-sided images of persons with mental illness.
In addition, in 1996 a majority of Americans reported that they would not wish to have a mentally ill person as a family member, coworker, or guest in their home, regardless of the type of mental health problem. A majority also believed that persons who have schizophrenia or are alcohol or drug dependent are unable to make reasonable decisions about treatment or money management.
Americans' Views of Mental Health and Illness at Century's End was funded by the MacArthur Foundation, the National Institute of Mental Health, and the National Sciences Foundation. The report can be obtained by calling Dr. Pescosolido's office at 812-855-3841.
CMHS Issues Five Publications onManaged Behavioral Health Care
The office of managed care of the Center for Mental Health Services (CMHS) has issued five recent publications on behavioral health care intended to help researchers, policy makers, and providers deliver better services under managed care.
• The Annotated Bibliography for Managed Behavioral Health Care, 1989-1999 presents 410 abstracts of research studies, organized by primary author. A keyword index permits the reader to search for relevant studies.
• Preventive Interventions Under Managed Care: Mental Health and Substance Abuse Services, a literature review, summarizes 54 articles that describe positive outcomes of preventive interventions to promote mental health and discourage the use of tobacco, alcohol, and illicit drugs and the misuse of licit and illicit drugs.
• School-Based Mental Health Services Under Medicaid Managed Care presents the results of a three-state study of well-established school-based mental health programs that have actively implemented managed care contracts with local Medicaid managed care organizations.
• Civil Commitment Under Medicaid Managed Care summarizes the results of an exploratory study in nine states that examined the relationship between Medicaid managed behavioral health care and the use of inpatient civil commitment.
• Contracting for Public Mental Health Services: Opinions of Managed Behavioral Health Care Organizationsbriefly synthesizes the collective experiences of four managed behavioral health care organizations that hold public-sector managed care behavioral health care contracts.
These publications and others from the CMHS office of managed care are available at www.mentalhealth.rg/cmhs/managedcare/index. htm. They can also be ordered free of charge from the Knowledge Exchange Network, 800-789-2647 (TDD 301-443-9006).
Preliminary findings from a four-year effort to develop appropriate and effective treatment models for marijuana dependence among adolescents were announced by the Substance Abuse and Mental Health Services Administration (SAMHSA) in September. Among youths treated in the model programs, the number reporting no past-month use or dependence symptoms increased from 19 percent to 61 percent. Days of use were reduced by 36 percent.
The findings of the study, which was sponsored by the Center for Substance Abuse Treatment, were released in a report entitled Cannabis Youth Treatment Experiment: Preliminary Findings. The center's director, H. Westley Clark, M.D., noted that the study is "the largest experiment ever conducted on outpatient adolescent treatment."
Cannabis Youth Treatment Experiment outlines five models based on the severity of marijuana use. The first protocol is a brief, basic, low-cost treatment consisting of five sessions over six weeks using motivational enhancement and cognitive-behavioral therapy. Two individual sessions are followed by three group sessions. Patients are motivated to change marijuana use and identify situations that could increase the likelihood of relapse.
In the second protocol, seven additional group sessions of cognitive-behavioral therapy are added to the basic model to create a 12-week program. The program helps adolescents develop coping and problem-solving skills and deal with anger, criticism, and depressive symptoms.
The third protocol builds on the second, adding three to four home visits for family therapy, six group meetings for parent education, and case management. This program is designed to improve family cohesion, parenting skills, and parental support by providing services tailored to a family's situation.
The fourth protocol is a 14-session intervention of individualized counseling that can be used for victimized youths, in rural areas, or in any location where having to form a group might delay or increase the cost of treatment.
In the fifth protocol, family therapy and primary substance abuse treatment are integrated in a 12-week program. This approach uses 12 to 15 family-focused sessions as well as individual counseling sessions with adolescents and parents.
The Center for Substance Abuse Treatment is producing a separate manual for each of the five protocols. The manuals should be ready early next year.
The findings of the cannabis treatment study were released at the same time that SAMHSA issued the Treatment Episode Data Set (TEDS), 1993- 1998, a report on admissions for substance abuse treatment in the United States. According to the report, adolescent admissions for marijuana treatment increased by 155 percent from 1993 to 1998—from 30,832 to 78,523 admissions. Half of all persons admitted for marijuana treatment were under age 20. The number of adolescent admissions for treatment of dependence on any drug increased by 45 percent over the same period. TEDS, 1993-1998 is available on the SAMHSA Web site at www.samhsa.org. It can also be ordered from the National Clearinghouse for Alcohol and Drug Information, 800-729-6686.
Menninger Clinic to move: After 75 years in Topeka, Kansas, the Menninger Clinic has announced that it will move to Houston by 2002. The relocation is part of the clinic's new partnership with Baylor College of Medicine and Methodist Health Care System. The decision to move was a response to financial problems. In making the announcement, Walter Menninger, M.D., president and chief executive, attributed the financial losses largely to insurance companies' increasingly restrictive reimbursement practices for mental health treatment. He said that the clinic would be out of business in eight to ten years if it did not move.