Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Association. The journal focuses on issues related to the delivery of mental health services, especially for people with severe mental illness in community-based treatment programs. Each month, Psychiatric Services features 15 or more research reports with results that have practical applications in the diverse settings where today's practitioners work. The journal has long recognized that providing high-quality care involves collaboration among a variety of professionals. Authors of research reports include psychiatrists, psychologists, pharmacists, drug and alcohol treatment counselors, social workers, nurses, economists, and professionals in related systems such as welfare and criminal justice systems. Monthly columns keep readers up to date on important developments in areas such as law and psychiatry and state mental health policy. Issues feature book reviews, news, and letters to the editor. Every member of the treatment team will find Psychiatric Services a valuable source of information.

To visit Psychiatric Services online, please go to http://ps.psychiatryonline.org

In This Issue - March 2013

Improving Treatment Engagement to Address Disparities
Improving treatment availability and access are critical steps toward reducing racial-ethnic disparities. But unless underserved groups are engaged in treatment, such steps will not go far enough. What strategies work to enhance engagement in mental health treatments? A systematic review examined ten randomized trials in which patients from underserved racial-ethnic groups made up at least half the sample. Collaborative care for depression was the only approach that could be designated as efficacious for engagement of underserved groups.

Pediatric Antipsychotic Use, 1997 and 2006
To identify factors contributing to the marked increase in use of antipsychotics by children and adolescents, this study analyzed 1997 and 2006 Medicaid data for more than 450,000 youths. The rate of antipsychotic use rose from 1.2% to 3.2%. A strong factor was the notable increase in the size of the group covered by Medicaid because of low family income (rather than disabilities). In 1997, these youths accounted for 20% of antipsychotic users, compared with 46% in 2006. Another strong contributor was treatment of externalizing behavior symptoms with antipsychotics.

Does Race-Ethnicity Effect Clozapine’s Effectiveness?
Studies have shown that race-ethnicity can modify a drug's effects, but clozapine has not been the focus of such research. This five-year study looked at time to drug discontinuation among black, Latino, and white Medicaid beneficiaries receiving clozapine or other antipsychotics. The study confirmed clozapine’s superior effectiveness and did not find evidence that race-ethnicity modified this effect. Clozapine is underused in routine care, even though it has some advantages over other antipsychotics. These findings highlight the need for efforts to increase clozapine use, particularly among minority groups.

A Model of Internalized Stigma and Its Effects
Recovery goals and illness management can be derailed when patients internalize stigmatizing attitudes and stereotypes. Negative consequences include depression, avoidance, and decreased hope and self-esteem. This study attempts to model the negative pathways in an effort to develop intervention strategies toward recovery.

Is Recovery a Process or an Outcome? A Consumer Speaks Out
Delivering recovery-focused services is a widely embraced goal. However, competing constructs of recovery threaten to derail efforts to achieve this goal, according to the author of the March Open Forum. She draws upon her experiences as a consumer of mental health services to argue that resolving divergent constructs of recovery is essential to avoid the trap of the dualistic “either-or” approach that was so prevalent in the past.

Howard H. Goldman, M.D., Ph.D., is Professor of Psychiatry, University of Maryland School of Medicine, Baltimore, where he is the Director of the Mental Health Systems Improvement Collaborative.

Editor
Howard H. Goldman, M.D., Ph.D.

Editorial Board
David A. Adler, M.D.
Benjamin G. Druss, M.D., M.P.H.
Javier I. Escobar, M.D.
Stephen M. Goldfinger, M.D.
Richard K. Harding, M.D.
Grayson S. Norquist, M.D., M.S.P.H.
Martha Sajatovic, M.D.
Bradley D. Stein, M.D., Ph.D.
Marvin S. Swartz, M.D.
Marcia Valenstein, M.D.
Roy C. Wilson, M.D.
Bonnie T. Zima, M.D., M.P.H.

Editor Emeritus
John A. Talbott, M.D.

Book Review Editor
Jeffrey L. Geller, M.D., M.P.H.

Contributing Editors
Law & Psychiatry: Paul S. Appelbaum, M.D.
Frontline Reports: Francine Cournos, M.D., and Stephen M. Goldfinger, M.D.
Public-Academic Partnerships: Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D.
Personal Accounts: Jeffrey L. Geller, M.D., M.P.H.
Best Practices: William M. Glazer, M.D.
Datapoints: Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D.
Mental Health Care Reforms in Europe: Matt Muijen, M.D.
Mental Health Care Reforms in Latin America: Jos� Miguel Caldas de Almeida, M.D., and Marcela Horvitz-Lennon, M.D., M.P.H.
State Mental Health Policy: Fred C. Osher, M.D.
Case Studies in Public-Sector Leadership: Jules M. Ranz, M.D. and Susan M. Deakins, M.D.
Economic Grand Rounds: Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D.

Editorial Consultants
Norman Clemens, M.D.
Julie M. Donohue, Ph.D.
Robert E. Drake, M.D., Ph.D.
Marcia Kraft Goin, M.D., Ph.D.
Shelly F. Greenfield, M.D., M.P.H.
M. Susan Ridgely, J.D.
Laura Van Tosh