August 2005: This Month's Highlights

Focus on Substance Abuse Care

This issue of Psychiatric Services contains six articles related to substance abuse services. Katherine E. Watkins, M.D., M.S.H.S., and her coauthors review treatment recommendations for patients who have a substance use disorder concurrent with an affective or anxiety disorder (see page 913). Dara A. Charney, M.D., and colleagues present the results of their study of the effect of concurrent depression and anxiety on six-month outcomes of addiction treatment (page 927). Christy Harris Lemak, Ph.D., and Jeffrey A. Alexander, Ph.D., discuss factors influencing staffing of outpatient substance abuse treatment (page 934). Katherine L. Mills, B.Hlth.Sc., and her coauthors analyze the costs and outcomes of treatment for opioid dependence among patients whose dependence is associated with posttraumatic stress disorder (page 940). Li-Tzy Wu, Sc.D., and Chris Ringwalt, Dr.P.H., address utilization of substance abuse treatment services among young adults in the United States who do not have health insurance (page 946). Finally, Katherine M. Harris, Ph.D., and Mark J. Edlund, M.D., Ph.D., present their findings on the use of both mental health care and substance abuse services among persons with dual diagnoses (page 954).

Medicare Cost-Sharing and Service Use

The cost-sharing requirements of Medicare and other health insurance programs are of special concern in the case of enrollees with schizophrenia. Eric P. Slade, Ph.D., and his coauthors conducted a study to explore the association between Medicare cost-sharing requirements and the probability that Medicare enrollees with schizophrenia would use any of seven different outpatient mental health services over a six-month period. Their analysis, based on data from the U.S. Schizophrenia Care and Assessment Program, included 1,088 Medicare enrollees, of whom about 55 percent were also enrolled in Medicaid. These authors found that Medicare cost-sharing affected use of rehabilitation and case management services (see page 960).

Client-Centered Care and Provider Competency

Newly emerging client-centered treatment approaches that emphasize recovery, rehabilitation, and client empowerment can improve outcomes for persons with severe and persistent mental illness. However, many clinicians lack the necessary competencies to use these approaches. Alexander S. Young, M.D., M.S.H.S., and coauthors conducted a study to evaluate Staff Supporting Skills for Self-Help, an innovative consumer-led intervention designed to improve provider quality and empower consumers. The intervention included education, clinician-client dialogues, ongoing technical assistance, and support of self-help. A one-year controlled trial evaluated the effect of the intervention on clinicians' competencies, care processes, and the formation of mutual support groups. The study showed that a feasible, consumer-led intervention can improve provider competencies in domains that are necessary for the provision of high-quality care (see page 967). The subject of consumer empowerment is also addressed in this month's Taking Issue, in which Jonathan D. Prince, Ph.D., and Steven P. Segal, Ph.D., urge a combination of the medical model and empowerment theory as a means of achieving a more holistic and empowering medical model of mental health care (page 901).

Patients Who Threaten the U.S. President

A threat against the President of the United States is a felony under federal law and is punishable by a sentence of up to ten years in prison. If a patient comes into the psychiatric emergency service threatening to kill the President, how do clinicians best balance the patient's right to privacy and confidentiality with their responsibilities under the law? In an Open Forum piece in this issue, Brook Zitek, D.O., and her colleagues present a case example in which they decided to contact the U.S. Secret Service from the emergency department when a patient stated that he wanted to kill President Bush (see page 1017). In a related commentary, Howard Zonana, M.D., questions their decision, arguing that clinicians should not be agents of the police (page 1021).

Briefly Noted …

• The Patient Safety Forum asks whether State Medicaid preferred drug lists affect patient safety (page 1012).

• The author of this month's Personal Accounts column describes how he overcame severe depression and founded a quarterly newspaper to provide mental health information to the community (page 905).

• The books section reviews four books whose authors talk about various physical and mental problems from a distinctly male perspective (page 1026).