Browsing by keyword "distribution"
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A national survey of mobile crisis services and their evaluationOBJECTIVE: Although mobile crisis services have been widely accepted as an effective approach to emergency service delivery, no systematic studies have documented the prevalence or effectiveness of these services. This survey gathered national data on the use and evaluation of mobile crisis services. METHODS: In 1993 mental health agencies in 50 states, the District of Columbia, and U.S. territories were surveyed. Repeated follow-up was done to ensure a 100 percent response. RESULTS: A total of 39 states have implemented mobile crisis services, dispatching teams to a range of settings. Although respondents reported that use of mobile crisis services is associated with favorable outcomes for patients and families and with lower hospitalization rates, the survey found that few service systems collect evaluative data on the effectiveness of these services. CONCLUSIONS: The claims of efficacy made for mobile crisis services, which have led to their widespread dissemination, are based on little or no empirical evidence. More rigorous evaluation of new and existing modes of service delivery is needed. The need for such evaluation will increase in the climate promulgated by managed care, in which greater emphasis is placed on cost-effectiveness.
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Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mixA 1978 consent decree affecting one region of Massachusetts mandated a drastic reduction of census at its state hospital, where considerable deinstitutionalization had already occurred over the prior two decades. The transfer of patients from hospital to community was to be accomplished through the unprecedented expansion of community resources. This second-generation deinstitutionalization effort achieved substantial census reduction but less than was envisioned. It was most effective in discharging geriatric and mentally retarded patients but far less effective with longterm and new chronic patients, many of whom continue to require repeated hospitalizations despite the availability of a comprehensive array of community-based services.
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The responsiveness of State Mental Health Authorities to parents with mental illnessThe majority of adults with serious mental illness living in the community are parents, many of whom may be receiving services from State Mental Health Authorities (SMHA). Innovative intervention approaches are available to improve outcomes for these parents and their children. Analyses of SMHA and state-level data, as well as qualitative interviews of administrators, service providers, and consumers, underscore the importance of organizational structure and philosophy, an advocacy presence, and available funding to SMHA efforts on behalf of parents and their families.
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Within-state availability of transition-to-adulthood services for youths with serious mental health conditionsOBJECTIVE: This study describes the existence and nature of services within state child and adult mental health systems that support the transition from adolescence to adulthood. METHODS: State child and adult mental health administrators from all but one state were interviewed by telephone with a semistructured questionnaire regarding transition services in their state mental health system, such as supported housing, vocational support, preparation for independent living, and dual diagnosis treatment. Eight states were deemed sufficiently decentralized to render state-level administrator reports invalid. Specific service data from the remaining 41 states and the District of Columbia were analyzed with descriptive statistics. RESULTS: One-quarter of child state mental health systems and one-half of adult state mental health systems offered no transition services, and few provided any kind of transition service at more than one site. Most types of transition services were available at all in less than 20 percent of the states. CONCLUSIONS: Across the United States transition support services are lacking. The adult system in particular will require major transformation to provide the service capacity that is needed to meet the current standards of transition service accessibility for young Americans with serious mental health conditions.