Utilizing a CBPR approach to assess the impact of COVID-19 on individuals who receive publicly funded behavioral health services.

The coronavirus disease pandemic has highlighted significant gaps in community mental health services, placing vulnerable individuals at greater risk for mental health and substance use difficulties via disrupting their wellness journey. Guided by a wellness framework, a needs assessment was conducted among adult consumers of behavioral health services to understand their needs during the pandemic and to help develop and strengthen service delivery strategies. A team of three university researchers and four Consumer Researchers, who receive services at a publicly funded community mental health center, engaged in a community-based participatory project in which 13 focus groups were conducted with 51 consumers.

Leading from the Middle: Practical Innovation in Public Mental Health.

Leaders in public mental health are responsible for ensuring the care environment is conducive to provider wellbeing, and ultimately patient care. Given the effects of stress and burnout, healthcare organizations must explore interventions to support their employees. The Leadership + Innovation Lab is a pilot project focused on enhancing leadership skills, innovation capacity, and peer connections among clinical managers.

The Connecticut Mental Health Center: Celebrating 50 Years of a Successful Partnership Between the State and Yale University.

September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-owned and state-operated joint venture between the state and Yale University built and sustained with federal, state, and university funds. Collaboration across these entities has produced a wide array of clinical, educational, and research initiatives, a few of which are described in this column. The missions of clinical care, research, and education remain the foundation for an organization that serves 5,000 individuals each year who are poor and who experience serious mental illnesses and substance use disorders.

Financial Health and Mental Health Among Clients of a Community Mental Health Center: Making the Connections.

Objectives: This study evaluated financial challenges, satisfaction with financial-management supports, and interest in additional or alternative supports among clients of a mental health center.

Methods: Six focus groups were held with 39 clients of an urban community mental health center who reported having difficulty with their finances. Five focus groups were held with direct-care staff who provided services to the clients.

General Medicine Training in Psychiatry Residency.

With growing awareness of the need for integrated health care settings, psychiatrists may be required to provide clinical care at the primary care and behavioral health interface. This article discusses the curricular changes that could enhance the development of psychiatrists as leaders in integrated primary and behavioral health care. Psychiatrists may be called upon to provide enhanced collaborative care services at primary care or behavioral health settings.

Stakeholders' perspectives on community-based participatory research to enhance mental health services.

Historically, consumers of mental health services have not been given meaningful roles in research and change efforts related to the services they use. This is quickly changing as scholars and a growing number of funding bodies now call for greater consumer involvement in mental health services research and improvement. Amidst these calls, community-based participatory research (CBPR) has emerged as an approach which holds unique promise for capitalizing on consumer involvement in mental health services research and change.

Status of general medicine training and education in psychiatry residency.

Objective: With the current emphasis on integrated care, the role of psychiatrists is expanding to either directly provide medical care or coordinate its delivery. The purpose of this study was to survey general psychiatry programs on the extent of general medicine training provided during residency.

Methods: A short web-based survey was sent to 173 residency program directors to recruit participants for a larger survey.

Prescription of second-generation antipsychotics: responding to treatment risk in real-world practice.

Objective: This study sought to determine the extent of providers' sensitivity to the presence of cardiometabolic disorders in the selection of second-generation antipsychotics.

Methods: As part of an academic detailing effort conducted between October 2007 and May 2009, all psychiatric providers at a single Veterans Affairs medical center completed a survey for every new prescription of an on-patent second-generation antipsychotic. The survey documented the drug prescribed, patients' sociodemographic data, psychiatric and comorbid diagnoses, and reasons for the prescription.

Race and long-acting antipsychotic prescription at a community mental health center: a retrospective chart review.

Objective: There has been concern that racial minorities are disproportionately prescribed long-acting injectable antipsychotic drugs.

Method: Comprehensive administrative data and clinician survey were used to identify all patients with a DSM-IV diagnosis of schizophrenia who received long-acting antipsychotic prescriptions from July 2009 to June 2010 at a community mental health center. Charts were reviewed retrospectively to validate long-acting antipsychotic prescription (eg, medication, dosage) and merged with administrative data from all center patients documenting sociodemographic characteristics (ie, age, race, gender) and comorbid diagnoses.

Prevalence of concomitant oral antipsychotic drug use among patients treated with long-acting, intramuscular, antipsychotic medications.

Objective: Long-acting injectable (LAI) antipsychotic drugs are viewed as monotherapeutic alternatives to oral medications to promote medication adherence, but there have been no descriptive studies of concomitant use of oral and LAI medications.

Methods: A list of all patients receiving services from the Connecticut Mental Health Center from July 1, 2009, to June 30, 2010, was obtained from center administrative records, and those carrying an initial intake diagnosis of schizophrenia or schizoaffective disorder were identified. All team leaders were approached, and all clinicians were asked to identify patients on their case load prescribed LAIs during the time interval above.

Who is paying the price? Loss of health insurance coverage early in psychosis.

Objective: Discontinuities in health insurance coverage may make it difficult for individuals early in psychosis to receive the services that are critical in determining long-term outcome. This study reports on the rates and continuity of insurance coverage among a cohort of early-psychosis patients enrolled in Specialized Treatment Early in Psychosis (STEP) at the Connecticut Mental Health Center.

Methods: Insurance status at baseline, six months, and 12 months was collected from 82 participants from a combination of self-reports, clinical chart review, clinician reports, and a database maintained by the state Department of Social Services.

Duration of pharmacotherapy with long-acting injectable risperidone in the treatment of schizophrenia.

Although long-acting injectable risperidone (LAIR) has been hypothesized to improve medication adherence compared to oral medications, data from real-world practice have yet to be presented on time to treatment discontinuation. Records of all new prescriptions for antipsychotic medication during the first 2 months of FY 2006 for VA patients diagnosed with schizophrenia (N = 11,821) were examined and duration of treatment with LAIR and oral antipsychotics were calculated for the next 2 years. Multivariable logistic regression was used to identify patient characteristics independently associated with receipt of LAIR.

Developing a policy for second-generation antipsychotic drugs.

Second-generation antipsychotics (SGAs) have replaced older drugs in the treatment of schizophrenia; their costs in the United States have reached $13 billion a year. Recent research, however, shows that their net risk/benefit profiles are no better than some older, cheaper drugs. Stepped therapy, allowing exceptions with prior authorization and giving preference to generic drugs with low risk of both neurologic and metabolic side effects, could increase the cost-effectiveness and safety of antipsychotic drugs.

Antipsychotic use in the treatment of outpatients with schizophrenia in the VA from fiscal years 1999 to 2006.

Objective: This study examined changes in prescribing patterns of antipsychotic medications to treat schizophrenia.

Methods: Pharmacy records for patients with schizophrenia were obtained from Department of Veterans Affairs databases. The proportion of patients prescribed specific second-generation antipsychotics or any first-generation antipsychotic was calculated per year.

Clinicians' reasons for deviations from recommended dosing practices for antipsychotic medications.

Objective: This study was designed to investigate clinician rationales for prescribing higher than recommended dosages of antipsychotic medications in patients with schizophrenia.

Methods: Prescribers for all patients at two VA medical centers whose dosage exceeded PORT recommendations were interviewed.

Results: For 91/107 (85%) of patients, the prescriber responded that the current dosage should not be decreased.

Implementation of monitoring and management guidelines for second-generation antipsychotics.

It has long been known that psychiatric patients experience increased morbidity and mortality associated with a range of physical disorders. Lifestyle, inadequate health care, and a variety of other factors all contribute to the poor physical health of people with severe mental illness. Second-generation antipsychotics have gained widespread acceptance for the management of patients with schizophrenia and other forms of severe mental illness.

Identifying metabolic risks with antipsychotics and monitoring and management strategies.

Mental health providers have an especially important responsibility to monitor the physical changes that patients have in response to medication. The current public health focus is on adiposity as a major risk factor for diabetes, coronary heart disease, insulin resistance syndrome, metabolic syndrome, and other diseases. Adiposity has an adverse effect on insulin action, which can lead to a cycle in which insulin loses its ability to stop the breakdown of fat.

Generic fluoxetine and choice of antidepressant medication.

Objective: In 2002 generic fluoxetine, the first generic product in a relatively expensive medication class, became available at Veterans Affairs medical centers at only 5% of its previous cost. This study examined whether its availability was associated with an increase in use compared with other medications.

Methods: All new starts of 15 antidepressants during fiscal year (FY) 2001 (before generic fluoxetine became available) and FY2003 were identified from administrative records, and the change in proportions of new starts across years was examined.

Metabolic monitoring for patients treated with antipsychotic medications.

Objectives: Metabolic side effects of antipsychotic treatment include weight gain, dyslipidemia and increased susceptibility to diabetes. Patients with schizophrenia have increased coronary heart disease mortality and reduced life expectancy. There is an urgent clinical need to monitor antipsychotic-treated patients for metabolic disturbance.

Undiagnosed hyperglycemia in patients treated with atypical antipsychotics.

Background: The use of atypical antipsychotics has been associated with abnormalities of glucose metabolism in patients with schizophrenia. This study was designed to determine the proportion of undiagnosed hyperglycemia in patients receiving a broad range of atypical antipsychotics.

Method: All outpatients treated at an urban Veterans Affairs medical center who received a prescription for clozapine, risperidone, olanzapine, quetiapine, or ziprasidone were identified, and an attempt was made to obtain a fasting plasma glucose (FPG) test.

Clinicians' reasons for antipsychotic coprescribing.

Background: Prescribing more than 1 antipsychotic is common but has received little supportive evidence in the literature. This study was designed to systematically survey clinicians about their rationale for prescribing more than 1 antipsychotic for specific patients.

Method: Patients with schizophrenia (diagnosed according to ICD-9 criteria from October 1, 1999, to September 30, 2000) at 2 Veterans Administration (VA) medical centers and their prescriptions for anti-psychotics (filled within the VA system from June 1, 2000, through September 30, 2000) were identified from administrative databases.

Predictors of antipsychotic medication change.

Atypical antipsychotics account for more than 60% of antipsychotic prescriptions written for the treatment of schizophrenia. While switching from one antipsychotic to another is a dynamic process, there has been no research on individual patient and institutional characteristics that predict antipsychotic switching. VA national administrative data were used to identify patients (n = 9660) with schizophrenia maintained on antipsychotic medication.

Risk adjustment in studies using administrative data.

Administrative data are increasingly used to evaluate service use and cost of treatments in "real world" settings. However, the degree to which administrative data can be used to risk-adjust for differences between nonrandomized groups receiving different treatments has not been studied. This study used data from a large randomized trial to determine whether administrative data describing previous utilization and cost are as good as clinical data in predicting future resource utilization and cost.