Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness. Methods: Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators. Mixedeffects random-regression analysis tested for longitudinal changes in outcomes between the two conditions. Differences in service costs were analyzed with negative binomial and zero-inflated negative binomial regression models. Results: Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No betweengroup differences were found in total per-person service costs in years 1 and 2 or both years combined. However, selfdirected care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups. Conclusions: The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual.

Lessons learned about the importance of community collaboration are discussed in light of the current emphasis on public mental health system transformation through alternative financing mechanisms.

Collateral consequences faced by individuals convicted of a sexual offense have been widely referenced in the literature. There is yet to be a systematic examination of collateral consequences affecting individuals, however, due to measurement inconsistencies and the absence of a psychometrically validated instrument. The current study developed and validated a measure of collateral consequences faced by individuals convicted of a sexual offense. Specifically, this study investigated (a) the underlying factor structure of collateral consequences commonly endorsed by individuals convicted of a sexual offense through Exploratory Factor Analysis (EFA) procedures and (b) reliability and validity indicators of the aforementioned scale. Participants were 218 individuals convicted of and registered for a sexual offense in the state of Texas. Study measures included a pool of 66 collateral consequences items in addition to psychological self-report instruments addressing hopelessness, shame, social well-being, and discrimination. EFA results revealed a two-dimensional construct representing collateral consequences affecting areas of social and psychological well-being. The current measure demonstrated adequate reliability and validity. Limitations and future directions of findings are addressed.

IntroductionHIV testing is not yet a routine procedure in most mental health settings although adults with severe mental illness (SMI) are disproportionately affected by HIV/AIDS.ObjectivesWe focused our attention to explore if the appropriate care of patients with SMI may include a routine HIV testing offering and thus contribute to diagnose HIV-infected persons earlier in the course of their infection.MethodsWe present three case histories related to primary HIV diagnosis in patients presenting with different psychiatric disorders, admitted to Modena teaching Hospital in the passed two years.ResultsPsychiatric symptoms delayed HIV diagnosis in all of the three reported cases.ConclusionsThe case histories here presented suggest that HIV testing is appropriate in the care of people with SMI, avoiding delay in HIV diagnosis with an obvious clinical benefit for the patient. Further studies are needed to assess the prevalence of HIV in those patients. These will be able to validate psychiatric diseases within a specific HIV indicator diseases list and help identifying a segment of the population in which HIV test must be routinely offered as a public health strategy, to face the burden of undiagnosed HIV infection.