A major focus of state-university collaboration programs in psychiatry has been providing services and manpower from the university to the public mental health system which in turns provides valuable educational experiences to the university. The Program for Public Psychiatry, a state-university collaboration program in Colorado, was founded on a 25-year relationship between the department of psychiatry at the University of Colorado Health Sciences Center and the Colorado Division of Mental Health. The program has enabled Colorado's two state hospitals and most of its urban community mental health centers to almost completely fill previously vacant psychiatric positions. The collaboration has expanded to include programs for forensic psychiatry and developmental disabilities, as well as to fund educational and research missions in developing the public psychiatric work force.

Little is known about panic disorder among American Indians. In a pilot project involving two Northwest Coast Indian villages, community health representatives screened the population for panic disorder, substance abuse, and major depression using DSM-III criteria. Accompanying the screening were subsequent patient education and further evaluation by a psychiatrist, a social worker, and primary care physicians. Of fifty community residents who agreed to take the screening examination, seven were found who met diagnostic criteria for panic disorder. Four of the seven had symptoms of alcohol abuse which complicated the course and diagnosis of panic disorder, and individuals with panic disorder reported more than twice the lifetime prevalence of depression in comparison with other community members. Limitations of the study and refinements of study design are needed in future study discussions.

The public psychiatry programs in Oregon and Colorado, sharing common roots, demonstrate ways such programs can be developed to meet different local needs and conditions.

The chapter entitled "Major Mental Disorders and Behavior" from Health and Behavior: Frontiers of Research in the Biobehaviora/ Sciences (Hamburg, Elliott, & Parron, 1982) takes a highly biological view of major mental illness in the United States. This biological orientation to mental health reflects several . decades of research and clinical experience in the statistical and neurobiological sciences in this country and other Western nations. From the work in these sciences a great deal has been learned about the function of the brain in health and illness. The last several decades of work have produced a revolution in psychopharmacological treatments for major mental disorders, a phenomenological approach to diagnosis, a new understanding of neurochemistry, diurnal rhythms, neuroendocrinology, brain physiology, and functional neuroanatomy. There now exists a much improved understanding of the genetics of mental illness and the social environment of the psychiatric patient from the majority American culture, particularly those patients living in cities. These fields promise to contribute even more substantially to our understanding of human behavior in the near future. In contrast to the impressive body of work in the neurosciences with the majority American culture, relatively little is actually known about major mental disorders among American Indian and Alaska Native people. In the majority culture, decades of research have produced highly refined diagnostic categories for major mental illness. The development of a system of good phenomenological diagnosis, based on statistical clustering of symptoms rather than assumed etiological similarities, has provided a foundation upon which, for example, to describe familial patterns of mental illness, diagnostic instruments that could accurately identify and distinguish cases from noncases were needed. In order to identify aberration in neurotransmitter systems in the brain, diagnoses needed to have sufficient refmement to produce homogeneous groups of subjects with the same symptoms of illness. Because of the difficulties of accurately diagnosing mental illness in Indian people, for reasons discussed below, the very foundation for the application of these biological and statistical insights to Indian people is lacking. Diagnoses of major mental illness in Indian cultures are not yet sufficiently refmed to permit the applications of many of the sophisticated biological models of "Major Mental Disorder and Behavior" to Indian patients.

Until recently, American Indian tribes lacked procedures for the commitment of mentally ill reservation residents. The Red Dog decision (White v. Califano) highlighted the difficult issues inherent in this situation. This article reports the experiences of IHS and tribal service providers who struggle with these issues and describes the commitment procedures developed by five different reservation communities. Similarities and differences in these models are discussed, with special emphasis on

In a pilot study of depression among American Indians, 86 patients from three different tribal cultures were evaluated utilizing systematic diagnostic criteria. Similarity of symptom patterns was greater than differences between those patient groups drawn from the tribes and m comparison to non-Indian patterns of depression. Among the Indian patients major depression occurred in three distinct subgroups: an uncomplicated pattern, a secondary depression in association with a past history of alcoholism, and a complicated depression superimposed upon an underlying chronic depression or personality disorder. Each of these three disorders requires a distinctive diagnostic approach and each disorder may be influenced by cultural factors. High rates of depression among American Indians have been widely reported by treating clinicians (Shore & Manson, 1981). In addition, increased suicide rates among certain Indian tribes have been confirmed by various investigators (Shore, 1975; Kraus & Bailer, 1979; Levy & Kunitz, 1971). These findings have been attributed to rapid cultural change, epidemic patterns of alcohol abuse, increased rates of physical illness, accidents and deaths, and demoralization secondary to enforced dependency. This paper reports the first phase of a research project on major depression in three American Indian tribes. The study was designed to explore the relationship of depression to several of the above

The authors show how the process of establishing and maintaining a therapeutic relationship with the chronic patient is similar, whether the contract is therapy or case management, and they give case examples of technical aspects of the relationship process that arise in supportive treatment.

This paper discusses the civil commitment of American Indians who reside on various reservations in the United States. A primary focus is their unique status as citizens and, as a result, the jurisdictional issues which have arisen in attempts to effect commitment of community members in need of psychiatric treatment. The problems are quite different from those facing nonIndian citizens, where jurisdictional authorities are well-established and commonly recognized. In the latter's case, recent civil commitment cases have been waged over due-process safeguards, the nature of the test for commitment, the severity of the burden of proof, and the prediction of dangerousness. The manner in which civil commitment is presently managed on American Indian reservations has led to considerable conflict over jurisdiction among the federal government, tribal communities, and individual states. As mental health professionals, we should be concerned with the outcome of such jurisdictional disputes, especially as translated into controlling law, and with how these laws affect mentally ill individuals, their families, and communities. Further, we should be equally concerned about those instances in which it appears that no controlling law applies. Indeed, there appear to be reservation communities without civil commitment processes. This paper represents our preliminary inquiry into some of these problem areas. It begins with a brief review of the Red Dog decision, a case that illustrates the nature and potential ramifications of the jurisdictional disputes mentioned above. The discussion turns to Public Law 83-280 and subsequent changes in the control of, as well as responsibility for, civil and criminal law enforcement on reservations. A case study is then described, depicting the informal processes and problems in the commitment of a mentally ill American Indian who lives on a reservation where there is no controlling law. Lastly, this paper