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Mental Health and Social Welfare Research Group

The Mental Health and Social Welfare Research Group (MHSWRG) is an interdisciplinary group of researchers established to link policy to practice and person outcomes in the mental health field. The name of the group derives from its mission of improving the life situation of people with mental disabilities. While psychological disturbance plays havoc with one's internal environment, it's effects are largely experienced in the "real world" — the world of work, social and community relationships, and in the quality of a person's life situation. It is the nexus between an individual's life situation, the mental health services designed to help the individual deal with their psychological disability, and the programs and policies designed to make these services effective that is the focus of the research effort of MHSWRG. While policy initiatives have made significant differences in the field, they have suffered in their implementation by lack of specification of their relationship to outcomes actually experienced by people with psychological disabilities. For twenty-five years, with the support of the NIMH, the Robert Wood Johnson Foundation, The San Francisco Foundation, and the Zellerbach Family Fund, this group has contributed to the knowledge of how to link policy and practice to improved person outcomes. 

Five major areas of research have included a 20-year investigation of residential care, a 17-year study of general hospital psychiatric emergency room care, psycho-active medication prescription practices, services to the homeless and self-help mental health services.

Below is a list of selected publications from the following main research areas:  RESIDENTIAL CARE; PSYCHIATRIC EMERGENCY SERVICE: DANGEROUSNESS, CIVIL COMMITMENT, QUALITY OF CARE AND MANAGED CARE; PSYCHOACTIVE DRUG PRESCRIPTION PRACTICES; HOMELESSNESS; EMPOWERMENT AND SELF HELP

RESIDENTIAL CARE

Segal, S. P., & Ben-Ari, A. (1992). Reductions in services for severely mentally disabled sheltered-care residents: A 12-year perspective. Psychosocial Rehabilitation Journal, 16(1),163-168.

Segal, S. P., Cohen, D., & Marder, S. (1992). Neuroleptic medication and prescription practices for mentally ill sheltered care residents. American Journal of Public Health, 82(6), 846-852.

Segal, S. P., Hines, A. M., & Florian, V. (1992). Early life experiences and residential stability: A ten-year perspective on sheltered care. American Journal of Orthopsychiatry, 62(4), 535-544.

Segal, S. P., & Kotler, P. L. (1993). Sheltered-care residence and personal outcomes ten years later. American Journal of Orthopsychiatry, 63(1), 80-91.

Segal, S. P., & VanderVoort, D.J. (1993). Daily hassles and health among persons with severe mental disabilities. Psychosocial Rehabilitation Journal, 16(3), 27-40.

Segal, S. P., & VanderVoort, D. J. (1993). Daily hassles of persons with severe mental illness. Hospital and Community Psychiatry, 44(3), 276-278.

Segal, S. P., VanderVoort, D. J., Liese, L. H. (1993). Residential status and the physical health of a mentally ill population. Health & Social Work, 18(3), 208-214. 

Segal, S. P., & Silverman, C. (1993). The survival of sheltered care homes: Facility and neighborhood contributions. Adult Residential Care Journal, 7(2), 88-103.

Segal, S. P., & Hwang, S. D. (1994). Licensure of sheltered-care facilities. Social Work, 39(1), 124-131.

Silverman, C. J., & Segal, S. P. (l994). Who belongs?: An analysis of ex-mental patient's subjective involvement in the neighborhood. Adult Residential Care Journal, 8(2), 103-113.

Segal, S. P., & Holschuh, J. (1995). Reciprocity in social networks of sheltered care residents. In R. K. Price, B. M. Shea and H. N. Mookherjee (Eds.), Social psychiatry across cultures (pp. 73-86). New York: Plenum Press.

Silverman, C. J., & Segal, S. P. (l996). When neighbors complain: Correlates of neighborhood opposition to sheltered care facilities. Adult Residential Care Journal, 10(2), 137-148.

Segal, S. P., & Sawyer, D. (1996). Sheltered care facility size and the social integration of mentally ill adults. Adult Residential Care, 10(2), 75-87.

Segal, S. P., & Choi, J. (1996). Ownership form and quality of care in sheltered care facilities: Chain-affiliated business vs. sole proprietorship. Adult Residential Care, 10(1), 28-37.

Segal, S. P., & VanderVoort, D. J. (1996). Differences in daily hassle patterns among California's seriously mentally ill sheltered residents. Adult Residential Care, 10(1), 54-65.

Segal, S. P., VanderVoort, D. J., & Liese, L. H. (1996). Health and a residential care population. Social Science and Medicine, 42(5), 713-719.

Hwang, S. D., & Segal, S. P. (1996). Criminality of the mentally ill in sheltered care: Are they more dangerous? International Journal of Law and Psychiatry, 19(1), 93-105.

PSYCHIATRIC EMERGENCY SERVICE: DANGEROUSNESS, CIVIL COMMITMENT, QUALITY OF CARE AND MANAGED CARE

Managed care's emphasis on linking clinical process to patient outcomes is believed to have the potential to improve both (Winegar,1992). The overall goal of this research is to improve our understanding of decision making in the psychiatric emergency service(PES) so as to insure better quality of care and patient outcomes in a managed care environment. We have developed a reliable and valid assessment package and a model of PES decision making. Both have shown great utility in predicting process and outcome characteristics of the PES evaluation. Given these tools, we are now able to address a number of pressing questions about PES evaluations under managed care. 

In these studies we have observed 782 patient evaluations in nine California PESs. In addition to documenting the evaluation process, information on the patient's evaluation and post-PES experience was obtained from patient mental health, social service, criminal justice and death certificate records. An eighteen month follow-up on patient records was also completed to check for major adverse outcomes(death, violent crime & recidivism to the PES).

Segal, S. P., Lauri, T., & Segal, M. J. (2001). Factors in the use of coercive retention in civil commitment evaluations in psychiatric emergency services. Psychiatric Services, 52 (4), 514-521.

Segal, S. P., & Dittrich, E. A. (2001). Quality of care for psychiatric emergency service patients presenting with substance use problems. American Journal of Orthopsychiatry, 71(1), 72-78. 

Segal, S. P., Akutsu, P. D., & Watson, M. A. (1998). Factors associated with invountary return to a psychiatric emergency service within 12 months. Psychiatric Services, 49(9), 1212-1217. 

Segal, S. P., Egley, L., Watson, M. A., & Goldfinger, S. (1997). The quality of psychiatric emergency evlauations. Breakthrough, 1(3), 17-30.

Watson, M. A., Segal, S. P., & Newhill, C. E. (1993). Police referral to psychiatric emergency services and its effect on disposition decisions. Hospital and Community Psychiatry. 44(11), 1085-1090.

Segal, S. P., Egley, L., Watson, M., & Goldfinger, S. (1995). The quality of psychiatric emergency evaluations and patient outcomes in county hospitals. American Journal of Public Health, 85(10), 1429-1431.

Segal, S. P., Egley, L., Watson, M., Miller, L., & Goldfinger, S. (1995). Factors in the quality of patient evaluations in general hospital psychiatric emergency services. Psychiatric Services, 46(11), 1144-1149. 

Segal, S. P., Bola, J. R., & Watson, M. (1996.) Race, quality of care, and antipsychotic prescription practices in the psychiatric emergency service. Psychiatric Services, 47(3), 282-286.

Segal, S. P.,Watson, M., & Akutsu, P. (1996). Quality of care and use of less restrictive alternatives in the psychiatric emergency service. Psychiatric Services, 47(6), 623-627.

Segal, S. P., Egley, L., & Watson, M., & Goldfinger, S. (1997). The quality of psychiatric emergency evaluations. Breakthrough, 1(3), 17-30.

PSYCHOACTIVE DRUG PRESCRIPTION PRACTICES

Segal, S. P., Bola, J. R., & Watson, M. (1996). Race, quality of care, and antipsychotic prescription practices in the psychiatric emergency service. Psychiatric Services, 47(3), 282-286.

Segal, S. P., Cohen, D., & Marder, S. (1992). Neuroleptic medication and prescription practices for mentally ill sheltered care residents. American Journal of Public Health, 82(6), 846-852.

Segal, S. P., Chandler, S., & Aviram, U. (1980). Antipsychotic drugs in community- based sheltered-care homes. Social Science and Medicine, 14A, 589-596.

HOMELESSNESS

Homelessness is studied in the context of social responsibility for the poor. Using both ethnographic and survey methodology the life situations of homeless individuals are described. The building social margin provides a theoretical framework for understanding coping efforts and programmatic suggestions. 

Segal, S. P., Baumohl, J., & Johnson, E. (1977). Falling through the cracks: Mental disorder and social margin in a young vagrant population. Social Problems, 24(3), 387-400.

Segal, S. P., & Baumohl, J. (1980). Engaging the disengaged: recommendations on madness and vagrancy. Social Work, 25, 358-365.

Segal, S. P., & Baumohl, J. (1982). In search of a caring community: A typology of environments and their impacts. In H. Fishman (Ed.), Creativity and innovation: Challenge of the 80's (pp. 203-216). Davis, California: Pyramid Systems Press.

Segal, S. P., & Specht, H. (1983). A poorhouse in California, 1983: Oddity or prelude? Social Work, 28(4), 319-323.

Segal, S. P., & Baumohl, J. (1985). The community living room. Social Casework, 66(2), 111-116.

EMPOWERMENT AND SELF HELP

Segal, S. P., Redman, D., & Silverman, C. (2000). Measuring clients' satisfaction with self-help agencies. Psychiatric Services, 51(9), 1148-1152.

Segal, S. P., Silverman, C., & Gomory, T. (1998). Health status of long-term users of self-help agencies. Health and Social Work, 23(1), 45-52.

Segal, S. P., Silverman, C., & Temkin, T. (1997). Program environments of self-help agencies. Journal of Mental Health Administration, 24(4), 456-464. 

Segal, S. P., Silverman, C., & Temkin, T. (1997). Social networks and psychological disability and homeless users of SHAs. Social Work in Health Care, 25(3), 49-61.

Segal, S. P., Tracy, L., & Silverman, C. (1997). "Coping, catastrophic life events and disability experiences among users of mental health self help agencies." Psychiatry in Medicine, 27(4), 350-351.

Segal, S. P., Silverman, C., & Temkin, T. (1993). Empowerment and self-help agency practice for people with mental disabilities, Social Work, 38(6), 705-712.

Segal, S. P., Silverman, C., & Temkin, T. (l994). Issues in self -help agency research. Innovations and Research, 3(1), 47-49.

Segal, S. P., Silverman, C., & Temkin, T. (1995). Characteristics and service use of long-term members of self-help agencies for mental health clients. Psychiatric Services, 46(3), 269-274. 

Segal, S. P., Silverman, C., & Temkin, T. (1995). Measuring empowerment in client-run self help agencies. Community Mental Health Journal, 31(3), 215-227.

Segal, S. P., Silverman, C., & Temkin, T. (1996). Self help mental health programs. Breakthrough, 1(1), 23-34.

Segal, S. P. Silverman, C., & Temkin, T. (CoEditors). (1996). Self help. Special issue of The Journal of the California Alliance for the Mentally Ill, 6(3).

Temkin, T., Silverman, C., & Segal, S. P. (1996) Making self-help work. The Journal of the California Alliance for the Mentally Ill, 6(3), 4-5.