Over the last few decades, clinical psychologists have played a key role in the development of empirically-validated psychosocial interventions for those with serious mental illness (SMI). However, in contrast to these substantial contributions, clinical psychologists in the United States are grossly underrepresented in treatment provision with this population (Roe, Yanos, & Lysaker, 2006; Rollins & Bond, 2001). This review aims to highlight various factors contributing to the establishment and perpetuation of this underrepresentation. First, we highlight systemic factors (e.g., the emergence of managed care) through an examination of the evolving role of the clinical psychologist. Next, we review training-based factors (e.g., limitations to SMI specific training) through a review of training in clinical psychology. Through an examination of training factors, the role of mental health stigma amongst clinicians toward individuals with SMI is identified as a potential perpetuating factor of this underrepresentation. Factors associated with clinician stigma are then reviewed and the relationship between clinical training and clinician stigma is considered. Lastly, important future directions to further investigate and address this underrepresentation are suggested – namely, investigating factors (training and individual) that may impact clinical psychology doctoral students' attitudes toward those with SMI.

在过去的几十年里，临床心理学家在为患有严重精神疾病 (SMI) 的人开发经过实证验证的社会心理干预措施方面发挥了关键作用。然而，与这些重大贡献相比，美国的临床心理学家在为这一人群提供治疗方面的代表性严重不足（Roe、Yanos 和 Lysaker，2006 年；Rollins 和 Bond，2001 年）。本次审查旨在强调导致这种代表性不足的建立和长期存在的各种因素。首先，我们通过检查临床心理学家不断演变的角色来强调系统性因素（例如，管理式医疗的出现）。接下来，我们通过对临床心理学培训的回顾来回顾基于培训的因素（例如，对 SMI 特定培训的限制）。通过对培训因素的检查，临床医生对 SMI 个体的心理健康污名的作用被确定为这种代表性不足的潜在持续因素。然后审查与临床医生污名相关的因素，并考虑临床培训和临床医生污名之间的关系。最后，提出了进一步调查和解决这种代表性不足的重要未来方向——即调查可能影响临床心理学博士生对 SMI 患者态度的因素（培训和个人）。然后审查与临床医生污名相关的因素，并考虑临床培训和临床医生污名之间的关系。最后，提出了进一步调查和解决这种代表性不足的重要未来方向——即调查可能影响临床心理学博士生对 SMI 患者态度的因素（培训和个人）。然后审查与临床医生污名相关的因素，并考虑临床培训和临床医生污名之间的关系。最后，提出了进一步调查和解决这种代表性不足的重要未来方向——即调查可能影响临床心理学博士生对 SMI 患者态度的因素（培训和个人）。