This study demonstrated excess mortality among patients in Ohio with serious mental illness. Results highlight the need to integrate delivery of currently fragmented mental and physical health services and to target interventions that improve quality-of-life outcomes for this population.

Because of steady population growth and the retirement of more than half the current workforce, the psychiatrist workforce will continue to contract through 2024 if no interventions are implemented, leading to a significant shortage of psychiatrists. Despite an expected workforce expansion beginning in 2025, it is unclear whether the shortage will completely resolve by 2050. Future research should focus on developing strategies to address this quantified shortage in an effort to curb the worsening shortage through 2024 and over the coming decades.

Findings from 2 pivotal government-funded studies of comparative antipsychotic effectiveness undermine assumptions about the marked superiority of the more expensive second-generation "atypical" medications in comparison to the less expensive first-generation "typical" drugs. Because this assumption was the basis for the almost universal recommendation that these newer antipsychotics be used preferentially resulting in a 10-fold increase in state governmental expenditures on this class of medications over the past decade, a reassessment of policy is called for. To address the issue, the Medical Directors Council of the National Association of State Mental Health Program Directors critically reviewed findings of these studies in the context of other data and considered policy implications in the light of the obligations of state government to make available best possible and individually optimized treatment that is cost-effective. The Medical Directors Council unanimously adopted a set of recommendations to promote appropriate access, efficient utilization, and best practice use. We present our policy statement, in which we provide a succinct background, articulate general principles, and describe a set of 4 broad recommendations. We then summarize our understanding of the current state of knowledge about comparative antipsychotic effectiveness, best antipsychotic practice, and considerations for state policy that represent the basis of our position statement.

No abstract

Medication algorithms developed in Texas are being implemented in a number of states in the United States and internationally. This report describes a quality improvement process adapted from the Texas Medication Algorithm Project that was used to implement the Texas algorithm for schizophrenia in Ohio. A total of 38 physicians were surveyed about their perceptions of barriers to implementation of the guidelines. The physicians generally thought that the schizophrenia algorithm was good, current, and applicable. Although they did not perceive barriers to its implementation, they did not seem to alter their practices to a great extent in response to the algorithm. The results of the study may guide other states in their implementation of algorithms.