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This article reviews three forces that currently influence US mental health policy: cost-effectiveness, mental health services research and consumerism. Rising mental health care costs, managed care cost-containment strategies, and concerns about the quality of services all influence the emphasis on cost-effectiveness by mental health service policy makers. The emphasis on cost-effectiveness co-occurs within the larger zeitgeist of data-driven policy making. Appropriations for mental health services research are a major funding priority. Finally, the concerns and perspectives of mental health consumers are more frequently voiced and heard, and are influencing service delivery concepts and how services are evaluated.

This article introduces the special issue on measuring quality of care. The overall purpose of this issue is to encourage an increased presence of evaluators in quality-of-care research. The sections of this special issue are devoted to conceptual issues concerning quality and the future of quality measurement. They include a description of current governmental and pnvate efforts in measuring quality, a brief report on quality measurement efforts in Great Britain, and four quality-of-care research reports.

Background: People with serious mental illnesses have elevated levels of depressive symptoms. Limited engagement in meaningful activities, such as work, social interactions, volunteering, and participation in faith, are one plausible explanation for this. Increased community participation over time may be associated with decreased depressive symptoms. Aim: Examine whether an increase in participation over time predicts a decrease in depression after controlling for depression at the baseline. Methods: Participants were 183 adults with schizophrenia spectrum, bipolar disorder, or major depressive disorder who completed the Hopkins Symptom Index – Depression subscale and the Temple University Community Participation Measure. Participants completed these measures at baseline and either a 12- or 24-month follow-up timepoint. Multiple regression analyses were conducted with the depression score as a dependent variable and changes in community participation as a predictor variable. Demographics, baseline depression score, and time interval between baseline and last observation were entered as control variables. Results: Endorsing more activities as important, participating in more important areas that are important, and participating 'enough' in more important areas over time were each significant predictors of decreases in depression. Conclusion: These findings enhance the connection between community participation and depression and suggest that a focus on participation may be important in terms of boosting both community functioning and treatment goals.

This article defines two new solution concepts for non-sidepayment games - the λ-transfer nucleolus and the λ-transfer disruption value - and reports the results of an experiment testing their predictive accuracy against that of a third solution concept, the well-known λ-transfer value (Shapley, 1969). The test was based on data from a laboratory experiment utilizing five-person, two-choice games that were constant-sum in normal form. Goodness-of-fit results show that the λ-transfer value and the λ-transfer disruption value were about equally accurate in predicting the observed payoffs to players in these games; both of these solutions were more accurate than the λ-transfer nucleolus.

Participation in various aspects of community life (e.g., education, employment) plays a critical role in fostering young adult development and health. To support behavioral health services in addressing a broader array of meaningful community participation areas, the current study examined the participation interests of young adults with serious mental illnesses via a literature review and focus groups interviews. Literature review results revealed a range of community participation areas of interest to these individuals, including employment, education, religion and spirituality, social networking (e.g., using social media), volunteering activities, socializing, and civic and artistic participation (e.g., attending a political event, playing music). Focus group participants named many of these same areas, but also mentioned unique areas of participation that have not been the focus of previous research (i.e., playing games, sports, exploration of other communities (e.g., traveling), hanging out, and nature-based participation). Implications for future research and behavioral health practice are discussed.