This paper reviews the literature which relates to the role of social isolation in suicide. Major areas include theories on suicide and social isolation, measures of social isolation, and empirical studies which concern the relationship of social isolation to suicide. Social isolation seems to be related to suicidal behaviors in a direct and fundamental way. Implications for helping contacts and the community are addressed.

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Managed behavioral health care is a rapidly growing field that is becoming more complex, resulting in a blum'ng of traditional distinctions between different sectors of the industry. Practice guidelines and outcome research will become critical elements of future managed care approaches, and these elements will be pamt of an overall focus on improvement in the quality of care. Here a model of quality improvement that emphasizes differing levels of organization is proposed, and the role of psychology in the emerging health care system is discussed. The field of psychology has not ascended to a leadership role in the evolving health care system. Suggestions are made to move the field of psychology to assume a more significant role in the managed care system. Key words: managed health care, managed behavioral health care, industry and clinical trends in managed behavioral health care, quality improvement, prychology. [Clin Psycho1 Sci Prac 553-66, 79981Managed behavioral health care is a significant aspect of the evolving system of health care delivery in the United States-managed care. It is difficult to think of a phrase that evokes more varied responses within the health care community than the phrase "managed care." The phrase means different things to different people and unfortunately has taken on an emotive connotation. Despite the differing responses to managed care, the fact remains that the current health care system is becoming, and soon will be completely, organized around managed care principles. Managed behavioral health care will be the dominant organization of the delivery of mental health and substance abuse services by the turn of the century. In this article, we describe the series of activities, structures, and business arrangements that are now known as "managed behavioral health care."The general goal of this article is to provide a backdrop and context in which to read the articles on specific topics that follow. The articles included in this section are an important but small subset of many areas that need to be explored in depth to arrive at an understanding ofthe relationship between health care organizations and the delivery of behavioral health care services. This article is organized into four major sections, each ofwhich identifies key issues within the industry. In the first, we define and &scuss the core structural features of managed behavioral health care. All too ofien, managed care is viewed from a narrow or singular perspective. We attempt to identify the range of activities and processes that are identified with managed care. Second, we provide our own comments on emerging industry trends-both business and clinical. As we will show, there are no shortages of prognostications on this topic; however, we enter the foray and offer our own suggestions in this area. In the third section, we elaborate on one of the trends in our business-the focus on quality management and quality improvement. We provide a fiamework designed to understand quality management and quality improvement that...