VA to Bring Mental Health Programs to Primary Care Settings
One day before resigning as secretary of the Department of Veterans Affairs (VA), Jim Nicholson announced that the VA will begin locating some of its mental health programs closer to places where primary care is provided. The plan to increase access was announced at a special mental health forum attended by the VA's top clinicians and researchers.
"Given the reluctance of some veterans to talk about emotional problems, increasing our mental health presence in primary care settings will give veterans a familiar venue in which to receive care—without actually going to an identified mental health clinic," Nicholson said. He described VA as "a long-standing leader in mental health," with $3 billion devoted this year to mental health services. He noted that mental health care is currently provided by more than 9,000 mental health professionals at VA's 153 medical centers and 882 outpatient clinics.
Nicholson pointed to recent expansion of VA mental health services in several areas. For example, the VA has made telepsychiatry programs more widely available, and 20,000 patients participated in such programs in 2006. In addition, the number of vet centers has been increased from 209 to 232, and 100 new combat veterans have recently been assigned to operate outreach programs for their former comrades. Vet centers provide readjustment counseling and outreach services to all veterans who served in any combat zone.
Nicholson also told forum attendees that the VA plans to initiate a series of regional conferences about providing mental health care to veterans with "our partners at the state, local and community levels." Earlier in July he announced the establishment of a national suicide prevention hotline for veterans, to begin operations by August 31. The hotline will be based at the Canandaigua VA Medical Center in New York. Staffed by mental health professionals, it will operate seven days a week, 24 hours a day. In addition to staffing the hotline, the suicide prevention coordinators will take part in training clinicians and nonclinicians about warning signs of suicide, guide veterans into care, and work within facilities to identify veterans at risk of suicide.
The embattled Nicholson abruptly resigned on July 17, under increasing criticism about shoddy outpatient treatment of veterans returning from Iraq and other issues.
Donald W. Hammersley, M.D., Former Editor Psychiatric Services
Donald W. Hammersley, M.D., who served as editor from 1970 until 1981 of Hospital and Community Psychiatry —the former title of the journal—died on July 16. As editor he introduced peer review of research articles as well as ongoing features of the journal, such as brief reports, Taking Issue, and Open Forum.
Dr. Hammersley joined the staff of the American Psychiatric Association (APA) in 1961 and was APA's deputy medical director from 1971 until he retired in 1987. He served with three of APA's medical directors and was a close friend of the first—Daniel Blain, who founded this journal.
Dr. Hammersley's many contributions to APA and to the journal are described in an appreciation in the January 1988 issue of Hospital and Community Psychiatry (pages 9–10).
SAMHSA's Co-occurring Disorders Series
The Substance Abuse and Mental Health Services Administration (SAMHSA) has added two new titles to its series of overview papers on the treatment of co-occurring mental and substance use disorders. The series is designed to help treatment professionals, policy makers, and others understand and address the needs of people with co-occurring disorders.
More than half of all people with co-occurring disorders do not receive substance abuse or mental health treatment. However, because of the disabilities and social consequences associated with co-occurring disorders, a large number of untreated persons may come in contact with public health, public safety, and social welfare organizations. Addressing Co-Occurring Disorders in Non-Traditional Service Settings: Overview Paper 4 describes how professionals who work in primary care, criminal justice, and social service settings can identify and respond effectively to people with co-occurring disorders. The paper explains how these initial contacts, if handled with sensitivity, can increase the likelihood that these individuals will take advantage of treatment.
The paper describes a six-item screening instrument and a continuum of responses—from identification and initial management to collaborative care and integrated care. It extends the "no wrong door" principle—whereby every point of contact with a health care system is seen as an opportunity for connecting people with needs to services—to non-health care settings, such as jails and homeless shelters.
The second title, Understanding Evidence-Based Practices for Co-Occurring Disorders: Overview Paper 5, could be used as a primer for policy makers and other officials who may not be familiar with the concept of evidence-based approaches to care. It provides concise explanations of different levels of evidence and attempts to clarify the meaning of related terms, such as promising practices, model programs, and best practices.
The paper briefly describes program- and treatment-level interventions that have been widely evaluated, such as integrated dual disorders treatment, motivational enhancement, and modified therapeutic communities.
SAMHSA is creating these training materials as part of its response to the November 2002 Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders. SAMHSA established the Co-Occurring Center for Excellence (COCE) to expand the knowledge base about treatment advances, build treatment capacity, and foster evidence-based practices. The two new titles, along with the previously published short papers in the series, are available at the COCE Web site at coce.samhsa.gov.
News Briefs
New online resource: Mental Health America (formerly the National Mental Health Association) and Psych Central have announced a partnership to create an online mental health social and information network to provide consumers with credible and trustworthy mental health information and serve as an Internet community. The partnership, which will be launched later this year, will feature content from both organizations, including daily news articles, research briefs, book reviews, interviews with experts, and online forums. The portal will also enable consumers to personalize content based on their needs. Psych Central (www.psychcentral.com), founded in 1995, features peer-reviewed editorial content, news, research briefs, clinical trials, ratings and reviews of medications and treatments, the World of Psychology blog, and a thriving online support community. Each month more than 600,000 people visit Psych Central's independent libraries and communities, contribute to their own blogs, take an interactive screening quiz, and track their progress over time. Psych Central does not provide professional diagnosis or treatment. Mental Health America has a network of more than 320 affiliates nationwide that support the awareness and support of mental health issues.
Focus on health care and the presidential campaign: The Kaiser Foundation has launched a Web site—www.health08.org—that will provide analysis of health policy issues, regular public opinion surveys, and news and video coverage from the 2008 presidential campaign. Health care is a top domestic issue in the 2008 election. Forty-five million Americans do not have any health coverage, and insurance premiums are up 87% over the past six years, more than four times the growth in wages, according to a Kaiser survey. The site, which will be free of charge and will not include advertising, will provide original content produced by Kaiser and easy access to health-related resources from the campaigns, other organizations, and news outlets. The site will have dedicated pages for the candidates, with links to their health positions and other resources. Visitors can sign up for a weekly e-mail roundup of developments related to health and the election and free syndication of content.
Updated directory of treatment programs: The Substance Abuse and Mental Health Services Administration (SAMHSA) has updated its guide to local treatment programs. The National Directory of Drug and Alcohol Abuse Treatment Programs, 2007 provides information on more than 11,000 alcohol and drug treatment programs located in all 50 states, the District of Columbia, Puerto Rico, and four U.S. territories. It includes public and private facilities that are licensed, certified, or otherwise approved by substance abuse agencies in each of the states. It is organized and presented in a state-by-state format for quick reference by health care providers, social workers, managed care organizations, and the general public. Information on programs for special populations, such as adolescents, persons with co-occurring disorders, individuals living with HIV-AIDS, and pregnant women is provided. The guide lists forms of payment accepted and special language services available. Free copies of the National Directory of Drug and Alcohol Abuse Treatment Programs, 2007 can be ordered online at ncadi.samhsa.gov or by calling SAMHSA's Health Information Network at 1-877-726-4727. Request inventory number SMA07-4290.
SAMHSA toolkit to prevent fetal alcohol spectrum disorders among Native Americans: The American Indian/Alaska Native/Native Hawaiian Resource Kit, now available from SAMHSA, is designed to help mothers-to-be and their friends, relatives, health professionals, and leaders understand and prevent fetal alcohol spectrum disorders (FASD). These disorders comprise the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, or learning disabilities with possible lifelong implications. Each year in the United States at least 40,000 babies are born with such a disorder, and Native communities have some of the highest rates. The kit, which was developed and reviewed by representatives from Native communities and FASD experts, includes current data and statistics on FASD; fact sheets and brochures for women, men, youths, and communities on how to prevent FASD and how to find help; strategies for FASD education and prevention; posters; a slide presentation for people with no prior knowledge of or experience with FASD; and a CD with an electronic version of the entire resource kit. Free copies of the toolkit can be ordered online at ncadi.samhsa.gov or by calling SAMHSA's Health Information Network at 1-877-726-4727. Request inventory number SMA07-4264.
