Carole Siegel, Ph.D., Director
Kim Hopper, Ph.D., Co-Director of Research
Dixianne Penny, Dr. P.H., Administrative Director

The Center for the Study of Issues in Public Mental Health (CSIPMH), established in 1993, is supported by a grant from the National Institute of Mental Health (NIMH). The Center is a collaboration of researchers, planners and policy makers from the Nathan Kline Institute, the New York State Office of Mental Health, the Nelson A. Rockefeller College of Public Affairs and Policy of the University at Albany, State University of New York, and the Robert F. Wagner Graduate School of Public Service of New York University. The administrative core of the Center is based at NKI. In addition research partnerships are ongoing with the Florida Mental Health Institute, the World Health Organization, and the Mental Health Empowerment Project. Research aims to increase general knowledge on how to organize, deliver, evaluate and finance services for persons with severe mental disorders (PSMD) with major emphasis on the provision of relevant information for the development of effective mental health policy in order to reintegrate persons with serious mental disorder into the community.

The Center is organized around four Research Cores:

• Promoting Recovery in Target Populations headed by core director Mary Jane Alexander, Ph.D.
• Seeking Systems Integration chaired by core director Colleen Gillespie, Ph.D. and co-director Judith Samuels, Ph.D.
• Negotiating Lives in Communities led by core director Kim Hopper, Ph.D. and co-director Lynn Videka, Ph.D.
• Methods for Mental Health Services Research under the direction of Carole Siegel, Ph.D. and co-director Eugene Laska, Ph.D.

Since its founding more than ten years ago, the Center has forged strategic alliances in policy and program arenas, assembled a broad portfolio of research accomplishments, and earned recognition as a reliable resource for research based information among policy makers, mental health system administrators, clinical and support service providers, consumer advocates, and families. Any number of Center studies has involved consumer input in formulating and carrying out research design.

Study highlights include:

Research on Homeless Persons with Severe Mental Disorders (PSMD)

The ways in which institutions may perpetuate residential instability was documented in two studies of single adults seeking emergency shelter, undertaken in response to a request from the Westchester County Commissioner of Community Mental Health. A descriptive epidemiological study of 180 men and 41 women applying for shelter at the central intake facility documented that over a fifth of this group had significant mental health problems, three-quarters of whom had co-occurring substance abuse problems, and had spent twice as much time in shelters or on the street in recent years as their non-mentally ill counterparts. A second study delved into patterns of residential instability in the lives of 36 subjects - all SSI eligible for psychiatric reasons. Of particular interest is a group of high-use service recipients for whom there appears to be no suitable supported housing available locally, and whose patterns of service utilization in social service, mental health, and criminal justice systems suggest an institutional circuit of residence.

Critical Time Intervention with Homeless Families

In an effort to break the institutional, dependency cycle, this ongoing study focuses on the outcomes attained when homeless families whose mothers experience mental illness or substance abuse disorders receive expedited placement in transitional housing augmented by critical time intervention, an intensive case management model. The President’s New Freedom Commission on Mental Health cited this study as an innovative project in promoting evidence-based practices. A related project is studying the outcomes achieved by the children in these family groups.

Research on Substance use by Persons with Severe Mental Disorders (PSMD)

To develop information on the effects of gender and comorbidity on service use, including mental health, alcohol, substance abuse and the criminal justice system, a random sample of PSMD in 49 clinical settings in eastern NYS (stratified by agency and patient characteristics) was studied. The results underscored the necessity of taking cognizance of parental roles of PSMD who abuse chemicals, almost half (45%) of participants with lifetime mental illness and substance abuse problems reported having at least one child.

Dr. Alexander has been active with efforts of the Office of Mental Health/ Office of Alcohol and Substance Abuse Services Interagency Workgroup to develop a coordinated approach to meet the needs of high-risk populations who present with co-occurring disorders. The lack of systematic tools to differentiate mental illness and substance abuse disorders has been a major barrier in providing adequate services. In a current project, two screening instruments for use with culturally heterogeneous consumers have been validated and are now in pilot-test phases.

Recovery from Severe Mental Illness

An integrated theme in Center research efforts, the concept of recovery has also motivated several consumer-led research projects. Center stakeholders participated in developing this focus in a working conference that convened mental health service recipients, practitioners and researchers in an effort to better understand the management and measurement of recovery from mental illness. Results include the development of a recovery focused-outcome instrument, its use in a World Health Organization study of the long-term course of mental illness, and a new focus on persons in the mental health system who identify themselves as trauma survivors.

"Quick turnaround" Capability on Policy Issues

Two projects demonstrate the Center's capability of obtaining relevant data sets and carrying out policy-relevant analyses within very short time frames:

Center investigators developed a model to estimate the premium increment that might be imposed on payers of health insurance under legislation requiring parity in mental health and health benefits. The findings were included as part of Congressional hearings on this legislation, that were eventually enacted into parity regulations.

The Center also developed a mental health and a social and mental well being index for NYC, measuring the well being of persons with mental disorders living in the community, as well as the well being of the community at large. The study was featured in the New York Times.

Cultural Competency Performance Measures

Cultural competency in behavioral health care refers to the ways providers attune themselves to the cultural sensitivities and needs of the ethnic populations they serve. Numerous studies have demonstrated that members of cultural minorities do not fare as well within the mental health system as does the dominant population. They tend to be hospitalized more frequently, misdiagnosed, drop out of treatment, or find systems and programs inaccessible. Working with multi-cultural and multi-disciplinary Expert Panels, researchers identified domains within the mental health care system where attention to cultural differences is needed. Performance measures for cultural competency were selected, benchmark standards established, and a cultural competency assessment scale field-tested. Validation studies and further pilot testing have been proposed for this scale.

Mini-Grants

The Center’s mini-grant program allows researchers to apply for funding for short-term projects that contribute to the body of research in mental health policy and planning. Projects funded under this program include:

• Informed consumer decision-making in the use of psychiatric advanced directives.
• Assessment of program level performance measures in service environments to understand, from the consumer perspective, how various systems have either helped or hindered processes toward recovery.

Methodological and Statistical Supports

The Center is strongly focused on developing mathematical and statistical models that have meaning in administrative and fiscal planning, cost-effective analyses, estimating population size, and developing cross-over repeated measurement designs. Mathematicians and statisticians assist other researchers in data analyses of ongoing projects.

The Center is in the final year of its current grant. A proposal will be submitted that will define the Center’s focus under new NIMH guidelines that call for integrated partnerships between research and service delivery agencies.

For further information, visit the Center's Web site or Dr. Siegel at 845-398-6590 or by e-mail at