November 2008: This Month's Highlights

Peer Providers and Peer Support

Peer provision of mental health services can be seen as a way to operationalize the New Freedom Commission's goals of recovery-oriented, consumer-driven care. But few studies have examined the effectiveness of these services. Sandra G. Resnick, Ph.D., and Robert A. Rosenheck, M.D., assessed confidence, empowerment, and other outcomes among veterans who attended sessions of the Department of Veterans Affairs (VA) Vet-to-Vet program, a peer support program focused on recovery from mental illness. The authors compared the results with those of veterans who received standard care. Their findings suggest that peer support enhances confidence and empowerment and reduces alcohol use ( Original article: page 1307 ). Matthew Chinman, Ph.D., and colleagues evaluated other VA efforts to maximize the potential of peer support. In 2005 the VA began funding new positions for consumer-providers (CPs) on clinical teams at mental health facilities nationwide. More than 120 CPs have now been hired. The researchers analyzed data from focus groups involving nearly 100 CPs and team supervisors and found that despite initial resistance from some team members, CPs have fared well and are valued by both staff and consumers ( Original article: page 1315 ). The success of peer-based treatments has been attributed in part to the ability of peer providers to forge close positive alliances with clients. The therapeutic power of any treatment alliance is believed to derive from the provider's validating qualities, such as warmth and acceptance; however, peer providers may be in a better position than traditional providers to make invalidating communications, such as strong disapproval of a client's recent drug use, without eroding the alliance—such interactions may even result in improved client outcomes. Dave Sells, Ph.D., and colleagues tested this interesting hypothesis in a group of 137 adults with serious mental illness ( Original article: page 1322 ).

An Interview With the President's Commission Chair

In the November 2003 issue of Psychiatric Services, shortly after publication of the President's New Freedom Commission report, Michael F. Hogan, Ph.D., chair of the commission, described its recommendations in a special article. The November 2008 issue features an interview with Dr. Hogan, who is now commissioner of the New York State Office of Mental Health (NYSOMH). Through a series of questions posed by Lloyd I. Sederer, M.D., Dr. Hogan describes ongoing challenges to transforming the mental health system. He concludes on a note of "rational optimism," calling on mental health professionals to "stay the course" during a period that many might view as "the worst of times" ( Original article: page 1242 ). This issue also features the 12th in a series of reports that address the goals of the President's Commission. In the lead article Rosanna M. Coffey, Ph.D., and colleagues discuss a critical step in the transformation process—creating interoperable data systems to address the fragmentation highlighted in the commission's report. With interoperable systems, mental health, substance abuse treatment, and state Medicaid agencies can share information to improve and coordinate care and reduce costs. The authors describe federal and state initiatives to show the benefits of interoperability. They also address the key issue of confidentiality and outline steps for reforming data systems ( Original article: page 1257 ). The series on transformation is supported by a contract with the Substance Abuse and Mental Health Services Administration.

Disparities in Treatment

Three studies in this issue document persistent racial and ethnic disparities in mental health care. In a Taking Issue commentary, Pedro Ruiz, M.D., describes the findings of each of these studies and calls on clinicians to work to ensure that the new administration in Washington, D.C., will prioritize efforts to eliminate disparities ( Original article: page 1239 ). Margarita Alegría, Ph.D., and colleagues analyzed national epidemiological data and found that among individuals with past-year depression, 60% of non-Latino whites accessed treatment; however, access rates for minority groups ranged from 31% to 41% ( Original article: page 1264 ). Ira Lesser, M.D., and associates examined data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and found that Latinos for whom Spanish was the preferred language were slower to respond to an antidepressant than were Latinos who preferred speaking English. The former group's greater social disadvantage appeared to account for this difference, which highlights the role of socioeconomic factors in disparities ( Original article: page 1273 ). Findings from a study by A. Rani Elwy, Ph.D., and colleagues indicate that once individuals access treatment, there are no racial-ethnic differences in treatment use, which suggests that differential rates of treatment seeking account for some of the disparities in care ( Original article: page 1285 ).