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Biomedical subjects

R W Manderscheid

Publications and source records attributed to R W Manderscheid.

At least 19 recordsLinked to original sources
PubMed1997

Specialty mental health services in metropolitan and nonmetropolitan areas: 1983 and 1990.

This paper provides information about the changes between 1983 and 1990 in the availability and volume of specialty mental health services in counties with different levels of metropolitanization and urbanization. The analysis uses the 1983 county metropolitan and urbanization designations for both 1983 and 1990 in order to obtain an accurate determination of the changes that occurred in the 7-year period. The results indicate that during the study period, metropolitan counties experienced increasing availability of specialty mental health services, while nonmetropolitan counties did not. Implications for future rural mental health policy are discussed.

Community Mental Health Services↗
PubMed1997

Principles for assessment of patient outcomes in mental health care.

With the dramatic changes that are occurring in mental health and substance abuse treatment systems, it is imperative that the field keep its focus on the patient and the patient's outcomes of care. Outcomes management systems that measure the processes of care, the patient's characteristics, and the patient's outcomes of care can be helpful in maintaining this focus. To facilitate the development of these systems, the Outcomes Roundtable, a group of mental health consumer, professional, service, and policy-making organizations, has articulated a set of 12 broadly applicable principles of outcomes assessment. The principles call for outcomes assessments that are appropriate to the question being answered, that use tools with demonstrated validity and reliability and sensitivity to clinically important changes over time, and that always include the consumer perspective. In addition, the principles recommend outcomes assessments that create minimal burden for respondents and are adaptable to different health care systems, that include general health status as well as mental health status, and that include consumers' evaluation of treatment and outcomes. Outcomes assessment tools should quantify the type and extent of treatment, should include generic and disorder-specific information, and should measure areas of personal functioning affected by the disorder. Outcomes should be reassessed at clinically meaningful points in time. Outcomes assessment should use appropriate scientific design and representative samples and should examine outcomes of consumers who prematurely leave treatment as well as those who continue in treatment.

Humans↗
PubMed1996

Trends in state and county mental hospitals in the U.S. from 1970 to 1992.

OBJECTIVE: The authors document changes in state mental hospitals from 1970 to 1992 in four areas: the number of hospitals, the average daily census, expenditures, and number of full-time-equivalent staff. METHODS: Data examined were derived from information collected in the Inventory of Mental Health Organizations and General Hospital Mental Health Services. RESULTS: From 1970 to 1992, the number of state hospitals dropped from 310 to 273, and their inpatient populations were drastically reduced (a 77 percent decrease), a continuation of a trend that began in 1956. Most of the reduction was due to the downsizing of existing hospitals rather than to hospital closings. A complex combination of medical, social, economic, legal, and political factors were responsible for the decrease. Although expenditures for state hospitals were nearly $8 billion in 1992, a 339 percent increase over 1970, the level of expenditures in current dollars has leveled off in recent years, and expenditures measured in constant dollars (adjusted for inflation) have actually decreased since the early 1980s. The number of professional patient care staff increased by about half, while nonprofessional staff decreased by about the same proportion. CONCLUSIONS: In the near future, it appears that state hospitals will continue to reduce their patient populations, although at a slower rate than in the past, and will continue to care for large numbers of persons who either are involuntarily admitted or do not have alternative living arrangements. However, state hospitals are likely to decrease in importance.

Forecasting↗
PubMed1995

Human resource issues in rural mental health services.

Human resource issues related to the provision of mental health care in rural areas under the proposed health care reform are addressed. Rural areas continue to utilize more non-specialty providers in the provision of mental health care. First, issues surrounding the training, recruitment, and retention of specialty mental health providers differ between urban and rural areas. Next, innovative strategies currently being used to attract and retain specialty providers to rural practice are presented. Finally, implications for expanding the knowledge base related to rural providers are explored.

Community Mental Health Services↗
PubMed1994

The effect of inflation on expenditures by mental health organization between 1969 and 1990.

At first glance, the rise in current dollar expenditures for all mental health organizations from $3.3 billion in 1969 to $28.4 billion in 1990 seems enormous. However, if the annual expenditures are adjusted for inflation and expressed in constant dollars, the rise in expenditures is only from $3.3 billion in 1969 to $5.6 billion in 1990. Thus, most of the increase in expenditures by mental health organizations over the past two decades is due to inflation, with less than 10 percent due to increases in real purchasing power. Since both the number of private psychiatric hospitals and the expenditures they incurred increased dramatically between 1969 and 1990, these hospitals showed gains in absolute dollar amounts and in dollar amounts per capita, even if the expenditures are expressed in constant dollars. To a lesser extent, the same was true of RTCs. Although both VA medical centers and State mental hospitals showed increases in expenditures as measured in current dollars, if expenditures are expressed in constant dollars, these organizations showed net decreases. Their inpatient populations also decreased during this period. However, if expenditures per inpatient under care are examined, the reverse is true. The per patient expenditures for State mental hospitals increased between 1969 and 1990, even if the results are stated in constant dollars.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

CMHS data highlights on: availability of psychiatric beds, United States: selected years, 1970-1990.

Despite the decrease from 474,190 to 250,541 between 1970 and 1990 in the overall number of non-Federal psychiatric beds (excluding "scatter" beds in non-Federal general hospitals), the trend was by no means constant over time. Between 1970 and 1982, a period of rapid deinstitutionalization of State mental hospitals, the number of beds in all organizations combined dropped precipitously from 474,190 to 222,666, led by State mental hospitals which decreased from 413,066 to 140,140 beds. This was the height of the community mental health center movement and the prevailing view of mental health administrators was that persons with mental illness could be cared for better in the community, rather than at State mental hospitals, far from their homes. Thus, some hospitals closed altogether, and many others closed wards and units as part of the downsizing process. Contrary to a decrease in the number of beds in State mental hospitals during the 1970-82 period, the number of beds in other organization types, in particular private psychiatric hospitals and separate psychiatric services of non-Federal general hospitals, remained relatively constant. The net result was a substantial decrease in the overall number of non-Federal psychiatric beds. In the 1982-90 period, a different phenomenon occurred. The number of beds in State mental hospitals was continuing to decline, but at a slower rate from 140,140 to 98,789, while the number of beds in other types of mental health organizations, particularly private psychiatric hospitals and separate psychiatric inpatient services of non-Federal general hospitals, expanded somewhat.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Bed Capacity↗
PubMed1993

The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services.

After initial interviews with 20,291 adults in the National Institute of Mental Health Epidemiologic Catchment Area Program, we estimated prospective 1-year prevalence and service use rates of mental and addictive disorders in the US population. An annual prevalence rate of 28.1% was found for these disorders, composed of a 1-month point prevalence of 15.7% (at wave 1) and a 1-year incidence of new or recurrent disorders identified in 12.3% of the population at wave 2. During the 1-year follow-up period, 6.6% of the total sample developed one or more new disorders after being assessed as having no previous lifetime diagnosis at wave 1. An additional 5.7% of the population, with a history of some previous disorder at wave 1, had an acute relapse or suffered from a new disorder in 1 year. Irrespective of diagnosis, 14.7% of the US population in 1 year reported use of services in one or more component sectors of the de facto US mental and addictive service system. With some overlap between sectors, specialists in mental and addictive disorders provided treatment to 5.9% of the US population, 6.4% sought such services from general medical physicians, 3.0% sought these services from other human service professionals, and 4.1% turned to the voluntary support sector for such care. Of those persons with any disorder, only 28.5% (8.0 per 100 population) sought mental health/addictive services. Persons with specific disorders varied in the proportion who used services, from a high of more than 60% for somatization, schizophrenia, and bipolar disorders to a low of less than 25% for addictive disorders and severe cognitive impairment. Applications of these descriptive data to US health care system reform options are considered in the context of other variables that will determine national health policy.

Adolescent↗
PubMed1993

Use of services by persons with mental and addictive disorders. Findings from the National Institute of Mental Health Epidemiologic Catchment Area Program.

The use of ambulatory and inpatient mental health and addiction services in the United States was estimated by means of data from the National Institute of Mental Health Epidemiologic Catchment Area Program standardized to the 1980 US census for adults 18 years of age and older. In a 1-year period, 22.8 million people used ambulatory services for mental or addictive disorder treatment; 54% of them had a current Diagnostic Interview Schedule/DSM-III mental disorder and another 37.4% had a history of psychiatric disorder or significant psychiatric symptoms. A total of 325.9 million ambulatory visits were made, and the average number of visits per treated person per year was 14.3. There were 1.4 million persons admitted to at least one inpatient mental health or addiction setting during a 1-year period; 80% of them had a current DIS/DSM-III disorder, and the remainder had a history of psychiatric disorder or significant psychiatric symptoms. Results were determined for specific mental and substance use diagnoses and service settings. Among treated persons with any mental or addictive disorder, the majority of visits were to mental and addictive disorders specialty settings (40.5% of total visits) and to support networks composed of friends, relatives, and self-help groups (37.0% of total visits). Although a large number of persons with mental and substance use disorders were seen in the general medical sector for mental health or addiction problems, they were seen less frequently and therefore made fewer visits to this sector (10.9% of total visits).

Ambulatory Care↗
PubMed1993

Congruence of service utilization estimates from the Epidemiologic Catchment Area Project and other sources.

Service utilization estimates for inpatient and ambulatory mental health care from the Epidemiologic Catchment Area Project were compared with similar estimates from other sources, principally the Center for Mental Health Services National Reporting Program. Generally, results showed closer correspondence between estimates of the number of persons who used inpatient care than of similar estimates for ambulatory mental health care. Subtotal estimates for the specialty alcohol/other drug abuse/mental health and health care sectors were more similar than were estimates for individual settings. The specialty sector subtotals showed only a 7% difference in patient counts for inpatient care and 13% for ambulatory care, with an 11% difference in visits for the latter. Generally, a reasonable level of congruence was observed, given pronounced differences in methods, procedures, and instruments. Future directions may be able to close data gaps and improve the quality of the national mental health services database.

Ambulatory Care↗
PubMed1993

Demographic and diagnostic characteristics of inmates receiving mental health services in state adult correctional facilities: United States, 1988.

The demographic and diagnostic characteristics of inmates in State adult correctional facilities who received 24-hour hospital mental health care, residential treatment care, and counseling/therapy in 1988 are reported by State and by type of administrative auspices under which the services are provided. Rates under treatment for 24-hour hospital mental health care were highest for the youngest (under 18) and oldest (65 and over) age groups, for females, and for whites. For counseling/therapy, rates were also highest for the youngest, for females, and for whites, but they declined with age. Rates in residential treatment were highest for the young and old and for whites, but about equal for males and females. Primary diagnoses of major psychoses predominated in 24-hour hospital mental health care. In residential treatment, a comparatively small proportion of the caseload had major psychotic disorders and a comparatively large proportion had substance abuse and mental retardation diagnoses. In counseling/therapy, personality disorders predominated. Individual State figures vary widely on these characteristics, both within and between service auspice types.

Adolescent↗
PubMed1993

Persons with substance use disorders in mental health organizations in the United States in 1988.

Data from a 1988 enumeration of mental health organizations and separate psychiatric services of non-Federal general hospitals in the United States were used to derive estimates of the number of person with alcohol and/or drug abuse (substance use) disorders in these organizations. For all organizations combined, the percent of persons with substance use disorders were 8% each in inpatient, residential treatment, and outpatient care and only 3% in partial care program elements. However, within type of program element, there was variation according to type of organization. It should be noted that the percent of persons with substance use in mental health organizations would be even greater than reported if: (1) the universe of mental health organizations surveyed was expanded; (2) the reporting period included persons receiving services throughout the year rather than on a single day; and (3) provision was made for including persons with a secondary diagnosis of substance abuse.

Comorbidity↗
PubMed1993

Projections of inpatient admissions to specialty mental health organizations: 1990 to 2010.

OBJECTIVE: To help predict changes in patterns of service delivery, the total number of inpatient admissions to specialty mental health organizations and the number of elderly persons (over age 65) admitted were projected in five-year intervals between 1990 and 2010. METHODS: One set of projections is based on 1986 rates of use and their coefficients of variation. A second, more accurate, set is based on 1990 rates derived from logarithmic projections of trends from 1980 to 1986 and the coefficients of variation for the 1986 rates. RESULTS: Projections based on 1990 rates show an increase of more than 25 percent in the total number of inpatient admissions to all specialty mental health organizations between 1986 and 2010 and an increase of more than 40 percent in elderly admissions. Nonfederal general hospitals are expected to have the largest increases in the number of total admissions, and state and county mental hospitals the smallest. The greatest percentage growth in total admissions will occur in private psychiatric hospitals. For elderly persons, inpatient admissions to Veterans Affairs medical centers will show the largest percentage increase, and admissions to state and county mental hospitals the smallest. By 2010 the majority of elderly admissions (67.6 percent) will be to nonfederal general hospitals. CONCLUSIONS: Plans to cope with increased demand for inpatient services should take into account the potential economic consequences of the forecasted changes as well as their effects on allocation of and access to services.

Aged↗
PubMed1993

Overview of mental health services provided by state adult correctional facilities: United States, 1988.

State-by-State data concerning the administrative auspices, volume of use, and sources of funding and expenditures for mental health services in adult correctional facilities are reported for 1988 from the first national survey of prison mental health services conducted by the Center for Mental Health Services. In all States reporting, a total of 11,546 State prison inmates--about 25 per 1,000--were receiving 24-hour psychiatric inpatient or residential treatment care for a psychiatric disorder on September 30, 1988. During the month of September 1988, nearly 10 percent of State prison inmates (95.6 per thousand) received some form of mental health counseling or psychotherapy from a physician, nurse, psychologist, or social worker; about 5 percent (49.7 per thousand inmates) received monitoring or evaluation of a psychotropic medications regimen; and about 4 percent (41.7 per thousand inmates) received psychiatric assessment or psychological testing to determine their mental health or emotional status. In the majority of States, 24-hour mental health care was provided in a mix of psychiatric and prison hospital settings, both on and off prison grounds, through interagency agreements, or through a mix of interagency and contractual arrangements. Individual State figures vary widely on these characteristics, as well as on length of stay for 24-hour hospital and residential treatment care, both within and among auspice types.

Adult↗