Biomedical subjects

Carol Harvey

Publications and source records attributed to Carol Harvey.

10 recordsLinked to original sources

PubMed2005

Community care for people with psychosis: outcomes and needs for care.

People with psychosis living in developed countries in the era of community-based care are likely to be socially isolated, unemployed, and have poor quality of life, despite recent advances in the treatment and understanding of psychosis. Recent work in Australia illustrates the needs for care, especially for those with complex disabilities, and even for those in contact with well-organized clinical mental health services. Insufficient evidence in two key areas impedes progress: the use of effective psychosocial interventions; and the impact of changes in the community care system. Follow-up studies of programs and interventions assessing a range of outcomes in local settings are now required to encourage professionals and the community to address these needs.

Community Mental Health Services↗

PubMed2004

Insight and hopelessness in forensic patients with schizophrenia.

OBJECTIVE: To quantitatively explore the level of insight in forensic patients with schizophrenia, and its relationship to symptoms and to a history of violence. In addition, to test the hypothesis that scores in the insight domains of 'compliance' and 'awareness of illness' are positively correlated with scores on a self-report scale measuring 'hopelessness'. METHOD: The study consisted of a cross-sectional survey. Subjects were inpatients and outpatients in the rehabilitation service of the Victorian Institute of Forensic Mental Health. Twenty-eight patients with a diagnosis of schizophrenia and a history of serious offending consented to take part. Twenty-two of these had committed homicide. Measures were obtained for each on the Schedule for Assessment of Insight, the Positive and Negative Syndrome Scale for Schizophrenia and the Beck Hopelessness Scale. RESULTS: The mean insight score for forensic patients was 8.39 (SD 4.88). Insight scores did not differ significantly between those subjects who had a history of violence prior to their index offence and those who did not. Awareness of illness, but not compliance, was positively correlated with level of hopelessness. A higher level of awareness of having a mental illness was thus related to feeling more hopeless about the future. CONCLUSIONS: Mean insight scores in patients with schizophrenia with a forensic history do not differ significantly from those in non-forensic populations. Being more aware of being mentally ill may be a risk factor for hopelessness about the future. The limitations of the study are the small sample size, and the fact that it is confined to a relatively clinically stable population.

Adult↗

PubMed2004

Self-esteem in patients who have recovered from psychosis: profile and relationship to quality of life.

BACKGROUND: New developments in pharmacotherapy are likely to improve substantially the symptomatic recovery from psychosis but low self-esteem may compromise quality of life. AIMS: To investigate the profile and correlates of self-esteem in individuals who have achieved symptomatic recovery from psychosis and determine its relationship with quality of life. METHOD: Sixty-one individuals who had been free of psychotic symptoms for 6 months were selected during a community-based epidemiological survey of psychoses. Participants were evaluated for subjective assessment of self-esteem using a self-report questionnaire, for clinical and antecedent features of illness, and for quality of life. RESULTS: Forty-three percent had scores in the range indicative of low self-esteem on the questionnaire. Level of self-esteem was unrelated to gender, employment status, the type of psychotic disorder, course of disorder or premorbid social adjustment. Depression was associated with reduced levels of self-esteem. However, independent of depression and other confounding variables, a low level of self-esteem was a risk factor for impaired quality of life. CONCLUSIONS: Self-esteem is often low among persons who have achieved symptomatic recovery from psychosis, is associated with depression and is a predictor of quality of life.

Adolescent↗

PubMed2004

An ethnographic study of three mental health triage programs.

Triage processes are commonly used to manage the interface between demand for, and supply of, health services. This dimension of service provision is particularly pertinent for mental health services in Australia, where demand outweighs services available. This paper draws on the experiences of using participant observation to explore mental health triage processes. Findings highlight the complexities of the researcher role and benefits of using an ethnographic approach to explore mental health triage patterns. Insider participant observation brings many challenges but also, in this study, enabled the researcher to uncover some roles and processes underpinning triage decisions in mental health services.

Anthropology, Cultural↗

PubMed2002

Creating a positive experience of research for people with psychiatric disabilities by sharing feedback.

This paper describes a consumer evaluation that explored the reflections of persons with psychiatric disabilities on receiving individualized feedback following participation in a community research project. Findings indicate that feedback is an important element of research, offering a valued means to reciprocate participants' contributions. Feedback can facilitate mutual learning, fostering hope and empowerment, while participation in performance tests without feedback may reinforce negative self-evaluations. Feedback needs sensitive presentation and discussion, focused on strengths, to be experienced as worthwhile and respectful by people with psychiatric disabilities. This is particularly important as their self-identities may already be undermined by experiences of mental illness. Researchers need dedicated time, resources, and training to incorporate individual feedback in research.

Australia↗

PubMed2002

What is duty/triage? Understanding the role of duty/triage in an area mental health service.

OBJECTIVE: To describe the duty/triage system within one urban area mental health service in Australia and to investigate the factors that affect the decision to organize a comprehensive assessment. METHOD: Data was collected from 3 months of duty/triage information and key informant interviews. Policies and procedures related to duty/triage were reviewed. Quantitative and qualitative analyses were conducted. RESULTS: Two thousand, six hundred and three contacts with duty/triage occurred over a -3-month period. Half of these were related to patients new to the service. Most contacts were self-referrals or referrals from a carer. Few referrals came through the primary health care sector. New patients were more likely to be assessed if the referral was presented in technical language and if it was initiated by a health professional, particularly a general practitioner, emergency department or other mental health service. Assessment was less likely if the patient or carer initiated the referral, if the problem was presented in vague or non-technical terms, if there was a drug or alcohol problem or if the person refused care. CONCLUSIONS: A substantial number of potential patients contact a duty/triage worker every day. However, there is little interaction with the primary care sector, limited documentation of risk and a lack of consistency in the documented reasons for the service response. Further investigation is needed of the conditions conducive to consistent quality decision making at the point of entry to a specialist mental health service.

Australia↗

PubMed2002

Understanding and evaluating qualitative research.

Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience dimensions of humans' lives and social worlds. Central to good qualitative research is whether the research participants' subjective meanings, actions and social contexts, as understood by them, are illuminated. This paper aims to provide beginning researchers, and those unfamiliar with qualitative research, with an orientation to the principles that inform the evaluation of the design, conduct, findings and interpretation of qualitative research. It orients the reader to two philosophical perspectives, the interpretive and critical research paradigms, which underpin both the qualitative research methodologies most often used in mental health research, and how qualitative research is evaluated. Criteria for evaluating quality are interconnected with standards for ethics in qualitative research. They include principles for good practice in the conduct of qualitative research, and for trustworthiness in the interpretation of qualitative data. The paper reviews these criteria, and discusses how they may be used to evaluate qualitative research presented in research reports. These principles also offer some guidance about the conduct of sound qualitative research for the beginner qualitative researcher.

Comprehension↗

PubMedDate not supplied

Disability and service use among homeless people living with psychotic disorders.

BACKGROUND: The prevalence of psychosis and needs for care among homeless people were studied in inner Melbourne. METHOD: This was a two-stage nested study within the Australian National Survey of People Living with Psychotic Illness. A screen for psychosis was administered to a representative sample of men and women living in marginal housing in a mental health service catchment area. A selected subsample of 82 screen-positive respondents was interviewed using the Diagnostic Interview for Psychosis (DIP), a semistructured, standardized interview with three modules: (i) demography, functioning and quality of life; (ii) diagnosis; and (iii) service use. RESULTS: An unexpectedly high prevalence of people living with psychotic disorders (estimated lifetime prevalence 42%, 95% CI=37-47%) may reflect a concentration of vulnerable people in the shrinking marginal housing supply in the inner city areas. Disability in everyday, occupational and social functioning is greater for this subgroup than for other people living with psychosis in Australia. Most people were single and unemployed, and many reported social isolation and feeling unsafe. Substance use disorders were common. Most people were using health services, including specialist mental health services, but few were receiving rehabilitation, vocational or housing support. CONCLUSIONS: Despite high levels of contact with a well-organized, sectorized mental health service in an affluent country, this pocket of several hundred people had high levels of persisting disability and needs. The literature and local experience suggest that changing this situation is likely to require co-ordinated policy and practice between the health, welfare and housing sectors.

Adolescent↗

PubMedDate not supplied

Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: clinical outcomes.

OBJECTIVE: This study examined the effectiveness of community treatment orders (CTOs) used in the treatment of patients with schizophrenia. The hypotheses were that CTOs enhance outcome for patients whose mental health would otherwise be compromised by poor adherence with treatment and that CTOs would enable this when either oral or depot antipsychotic medication was prescribed. METHOD: This was a naturalistic study using a retrospective mirror-image design. The sample consisted of patients with schizophrenia (n = 94) who were treated on a CTO between November 1996 and October 1999. Two subgroups were defined: patients treated with oral antipsychotic medication (n = 31), and patients treated with depot medication (n = 63). Data were gathered via file review using a questionnaire. RESULTS: For the whole sample and both subgroups the findings included significant increased number of service contacts, decreased number of admissions and decreased length of inpatient stay. For the total sample numbers of crisis team referrals and other episodes of relapse were significantly decreased. For the subgroup on depot medication there was a non-significant trend towards fewer crisis team referrals and a significant decrease in other episodes of relapse. There were no significant differences for the oral subgroup in crisis team referrals or other episodes of relapse. CONCLUSIONS: This study provides further evidence that CTOs may be effective in improving the outcome for selected persons with schizophrenia and some evidence that they may enhance the outcome for selected patients with schizophrenia on oral antipsychotic medication.

Administration, Oral↗

PubMedDate not supplied

Wound healing.

Wound healing in orthopaedic care is affected by the causes of the wound, as well as concomitant therapies used to repair musculoskeletal structures. Promoting the health of the host and creating an environment to foster natural healing processes is essential for helping to restore skin integrity. Normal wound healing physiologic processes, factors affecting wound healing, wound classification systems, unique characteristics of orthopaedic wounds, wound contamination and drainage characteristics, and potential complications are important to understand in anticipation of patient needs. Accurate wound assessment and knowledge of nursing implications with specific wound care measures (cleansing, debridement, and dressings) is important for quality care. New technologies are enhancing traditional wound care measures with goals of effective comfortable wound care to promote restoration of skin integrity.

Aging↗