Mental Health

The Petris Center analyzes mental health reform in California as well as behavioral disorders, emphasizing attention deficit hyperactivity disorder (ADHD). We illustrate the variation in diagnoses and treatment of mental health disorders.

The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance

By Stephen P. Hinshaw and Richard M. Scheffler | Published March 2014 by Oxford University Press | Link to Purchase Book

Attention-deficit/hyperactivity disorder (ADHD) is one of the most controversial and misunderstood medical conditions today. With skyrocketing rates of diagnosis and medication treatment, it has generated a firestorm of controversy. Hinshaw and Scheffler uniquely blend clinical wisdom, current science, medical and school policy, and global trends to debunk myths and set the record straight in The ADHD Explosion. They describe the origins of ADHD and its huge costs to society; the science behind its causes as well as medication and behavioral treatment; and the variation in diagnosis and treatment across the U.S. Dealing directly with stimulants as “smart pills,” they describe the epidemic of medicalization, arguing that accurate diagnosis and well-monitored care could ease the staggering economic burden linked to ADHD. Learn More.

Mental Health Care Reform in the Czech and Slovak Republics, 1989 to the Present

Edited by Richard M. Scheffler and Martin Potůcĕk | Published in 2008 by Karolinum Press | Link to Book Website

This book analyzes the needs, processes, and challenges of mental health care reform in the Czech Republics and Slovakia. Comparing these two countries (which used to be one state until the end of 1992), it identifies many obstacles to ongoing reforms: low funding levels distributed in inefficient ways, not always reaching those with greatest needs; the reliance on psychiatrists and reluctance to expand the role of other staff groups; and  the lack of information for appropriate decision making and poor systems of quality control.

California on the Eve of Mental Health Reform

By Tracy L. Finlayson and the Nicholas C. Petris Center | Published November 2007 by the Petris Center | Link to Full Report

This report summarizes baseline information derived from a survey of county mental health directors about key organizational and budgetary characteristics in California’s county mental health departments. These findings are intended to provide stakeholders, policymakers, researchers and others with a snapshot of county and system characteristics prior to the implementation of the Mental Health Services Act (MHSA) of 2004, which was created by the passage of Proposition 63. Much of the report’s findings, on topics such as financing, organizational structure, staffing patterns, information technology and mental health boards, cannot be found elsewhere. Key findings indicate that California’s counties, while highly diverse, share some common features and strengths. These include: 1) high participation in innovative demonstration programs, 2) minimal spending on institutional care, 3) low administrative overhead, and 4) provision of care in languages beyond the state requirements. This report can provide information on where counties are beginning their transformation process. While each county is different, the similarities between counties may be useful in providing lessons for improving the system as a whole.

The Global Market For ADHD Medications

By Richard M. Scheffler, Stephen P. Hinshaw, Sepideh Modrek, and Peter Levine | Published April 2007 in Health Affairs | Link to Full Article

Little is known about the global use and cost of medications for attention deficit hyperactivity disorder (ADHD). Global use of ADHD medications rose threefold from 1993 through 2003, whereas global spending (U.S. $2.4 billion in 2003) rose ninefold, adjusting for inflation. Per capita gross domestic product (GDP) robustly predicted use across countries, but the United States, Canada, and Australia showed significantly higher-than predicted use. This article finds that use and spending grew in both developed and developing countries, but spending growth was concentrated in developed countries, which adopted more costly, long-acting formulations.

Measuring Mental Health in California’s Counties: What Can We Learn?

By Daniel Eisenberg, Nicole Bellows, Timmothy T. Brown, Richard M. Scheffler | Published in January 2005 by the Petris Center | Link to Full Report

This report provides the first county-level comparison of a detailed set of mental health-related measures in the general California population utilizing the first California Health Interview Survey (CHIS), which took place in 2001. The main questions are how do counties differ in terms of their population’s mental health status, service utilization, insurance coverage, availability of providers, and government financial resources? This report provides data and information on a series of mental health indicators that enable us to draw a picture of the mental health status throughout Califomia. These mental health indicators include the following: ‘doing less overall due to emotional problems,’ ‘doing one’s work less effectively due to depression or anxiety,’ ‘feeling downhearted and sad,’ ‘not feeling calm and peaceful,’ and ‘lacking energy.’

An Analysis of the Significant Variation in Psychostimulant Use Across the U.S.

By Farasat Bokhari, Rick Mayes, and Richard M. Scheffler | Published May 2004 in Pharmacoepidemiology and Drug Safety | Link to Full Article

Psychostimulants (methylphenidate and ampheta-mines) are primarily used to treat attention deficit hyperactivity disorder (ADHD), which is the most commonly diagnosed behavioral disorder in children, making up more than 50% of all child psychiatric diagnoses. This article seeks to provide a national profile of the area variation in per-capita psychostimulant consumption in the U.S. We separated 3030 U.S. counties into two categories of ‘low’ and ‘high’ per-capita use of attention deficit hyper-activity disorder (ADHD) drugs (based on data from the Drug Enforcement Administration), and then analyzed them on the basis of their socio-demographic, economic, educational and medical characteristics. We found significant differences and similarities in the profile of counties in the U.S. that are above and below the national median rate of per-capita psychostimulant use (defined as g/per 100K population). Compared to counties below the median level, counties above the median level have: significantly greater population, higher per-capita income, lower unemployment rates, greater HMO penetration, more physicians per capita, a higher ratio of young-to-old physicians and a slightly higher students-to-teacher ratio. Our analysis of the DEA’s ARCOS data shows that most of the significant variables correlated with ‘higher’per-capita use of ADHD drugs serve as a proxy for county affluence.