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Biomedical subjects

D Wasylenki

Publications and source records attributed to D Wasylenki.

At least 19 recordsLinked to original sources
PubMed2005

Social disadvantage, mental illness and predictors of legal involvement.

The following study evaluates the complex association between legal involvement and mental illness. It describes a population of consumers of community mental health programs, comparing those with legal involvement to those without legal involvement, on a number of demographic, clinical and social indicators. It is a secondary analysis of data collected in studies making up the Community Mental Health Evaluation Initiative (CMHEI) in the province of Ontario, Canada. Legal involvement was a significant issue among community mental health program consumers; about one in five consumers had at least some contact with the legal system in the preceding nine months. Legally involved consumers were more likely to be in receipt of social assistance and be unstably housed than those legally uninvolved. However, there were no significant differences between legally involved and uninvolved consumers with respect to severity of symptomatology, current medication use or number of hospitalization days in the past 9 months. A predictive model compared the differential impact of clinical and social determinants upon legal involvement. Analyses failed to uncover a significant relationship between severity of psychiatric symptomatology and legal involvement. Significant predictors of legal involvement included gender, race, drug use as well as housing instability, and receipt of social assistance. Legal involvement was attributable to factors other than the severity of mental illness; these results challenge assumptions that the most symptomatically severe consumers are most at risk of legal involvement. Accordingly, the rate of legal involvement in a sample of community mental health program users must be considered in a broad context, with particular emphasis on social disadvantage.

Community Health Services↗
PubMed2000

Tertiary mental health services: I. Key concepts.

There are some individuals with severe and persistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospital-based services. Increasingly, organized systems have been developed to ensure that individuals meet criteria for tertiary care and receive the most appropriate level of care. Most importantly, the delivery of tertiary care must not be tied to particular settings or time frames, and level of care must be delinked from model or location of care in order to create flexible, efficient, effective mental health services.

Community Mental Health Services↗
PubMed2000

Tertiary mental health services: II. Subpopulations and best practices for service delivery.

Tertiary care subpopulations are characterized by having more than one significant condition, each of which has been traditionally dealt with by different systems of care. They experience severe and persistent mental illness and one or more of the following: age-related physical or medical conditions, substance use disorders, developmental handicaps, and acquired brain injury. This paper provides estimates of prevalence for each of these subgroups and discusses best practices which have developed in response to their special needs.

Brain Injuries↗
PubMed1997

A home-based program for the treatment of acute psychosis.

There is evidence that home treatment is an effective alternative to hospital admission for patients with acute psychiatric illnesses. This report describes processes necessary to establish and disseminate home treatment programs as well as the impact and comparative cost of a home treatment program developed in Metropolitan Toronto. Organizational analysis revealed a number of essential structures and interactions necessary to facilitate smooth functioning for home treatment programs involving several agencies. Attitudes towards home treatment were positive, symptoms were reduced, family burden decreased, satisfaction was high and home treatment was preferred to hospital admission. Economic data indicate that home treatment is less costly than hospitalization.

Acute Disease↗
PubMed1997

Process and outcome in a hostel outreach program for homeless clients with severe mental illness.

A longitudinal study followed 55 homeless and severely mentally ill clients of a hostel outreach program to assess outcomes and their relationship to program elements. Results at 18-month follow-up indicated that, despite chronic histories of transiency and shelter use, housing stability had been achieved, and that initial gains in social functioning and symptom reduction had been increased. Development of a strong working alliance proved a key program element in the findings.

Adult↗
PubMed1997

The social contract challenge in medical education.

Medical education has been criticized for loss of touch with the health needs of society. A social contract implies that medical schools, their students and teaching staff have certain rights and privileges in return for serving society. Commitment to this important reciprocal relationship makes it necessary to ensure that medical students gain understanding of the basic health needs of the communities they will serve. Health, Illness and the Community (HIC) is a mandatory course in the first and second years of the curriculum at the University of Toronto. Its goal is to provide students with community learning experiences by involving over 300 community agencies as learning sites. The course takes place one half-day per week throughout first and second year. All 177 students initially work with patients in their homes and in public health units and related agencies. Students are then assigned to agencies using health determinants and health promotion strategies. In the second year, each student selects an agency in the community, and carries out for the entire year a major project focused on the interaction of a health problem with a social issue. This educational initiative has been received well by community agencies and patients. Teaching staff have been enthusiastic and students have performed very well. A major obstacle has been the negative attitudes of some students to community-based learning, but these appear to be improving with time. Involving multiple agencies as learning sites is a feasible method for enabling students to learn about community health needs.

Community Medicine↗
PubMed1996

Mood disorders: rural/urban differences in prevalence, health care utilization, and disability in Ontario.

This study examines whether rural Ontario differs from urban Ontario in mood disorder prevalence, health service use and concomitant disability. An epidemiologic community survey of 9953 individuals was conducted, with rural/urban status defined by population-density-related criteria. Overall, Ontario prevalence rates for depression, manic episode, and dysthymia were similar to previous studies, but rural rates were unexpectedly no different from urban ones. Nearly half of mood disorder subjects used no services, and one-third reported significant disability. Rural individuals with mood disorders were similar to their urban counterparts in service use and disability.

Adolescent↗
PubMed1996

From feedback to reciprocity. Developing a student-centered approach to course evaluation.

Reforms to medical education have refocused curricula on the need to produce primary care physicians through a problem-based, student-centered, community-oriented, and integrated approach to instruction. Course evaluations, originally designed for traditional lecture-based, teacher-centered curricula, provide inadequate input from students to support curriculum planning and change and to determine appropriate mixes of educational methods. At the University of Toronto Faculty of Medicine, a unique community-centered course, called "Health, Illness and the Community," developed a student-centered course evaluation to provide adequate student input to support curriculum planning and change. A 35-item evaluation was developed to obtain data to identify student concerns, student learning styles, and preferred community agency utilization. The results suggest that student-centered course evaluation can play a role in managing and identifying key relationships in integrated and systematic courses as well as establishing a method for continual improvement.

Curriculum↗
PubMed1994

Planning mental health services: background and key issues.

Deinstitutionalization in Canada produced a shift in locus of care from provincial psychiatric hospitals to general hospital psychiatric units. As a result of this approach, a number of key planning issues have emerged that most provinces are attempting to address.

Canada↗
PubMed1994

Psychiatric residents' attitudes toward patients with chronic mental illness.

OBJECTIVE: The study examined psychiatric residents' attitudes toward, knowledge about, and training in the care of patients with chronic mental illness. METHODS: The authors constructed a 41-item Residents' Attitude Toward the Chronically Mentally Ill Scale to obtain a systematic assessment of attitudes. The scale's validity was enhanced by input from 12 psychiatrists who were knowledgeable about work with and attitudes toward such patients, and a test showed the scale to have high reliability. The scale was administered to 85 psychiatric residents, along with questionnaires focused on training and knowledge and the Marlowe-Crowne Social Desirability Scale assessing defensiveness and self-deception. RESULTS: No correlation was found between residents' attitudes and years of residency training or between attitudes and knowledge about patients with chronic mental illness. Residents reported many negative attitudes toward this patient population. However, significant positive correlations were found between the residents' attitudes and their training in settings where patients were considered to receive high-quality care and supervisors were good role models. CONCLUSIONS: Constructive training experiences during residency can have a positive influence on residents' attitudes toward patients with chronic mental illness.

Adult↗
PubMed1992

Clinical issues in social network therapy for clients with schizophrenia.

Social networks are viable foci for therapeutic interventions. A social network therapy program for clients with schizophrenia was developed by a community-based mental health agency. This paper presents four of the most common clinical issues encountered and illustrates each with a case example.

Adult↗
PubMed1992

Gender differences among clients of a case management program for the homeless.

Differences between 24 female and 35 male clients were assessed at entry into an intensive case management program serving homeless shelter residents and again nine months later. Both men and women were socially isolated, with small social networks and severe deficits in social functioning. Histories of homelessness were similar for both genders, and there were no gender differences in psychopathology at baseline or follow-up. At entry into the program women had higher levels of social skills, larger and more supportive networks, and better housing conditions than men, but these differences disappeared after the subjects spent nine months in the program. Inadequate living conditions may have contributed to the more negative initial picture for men. Although there were more similarities than differences between the men and women in this sample, more research on gender differences is needed to design and evaluate programs for homeless mentally ill persons.

Adult↗
PubMed1992

Planning mental health services: I. Background and key issues.

Planning mental health services is a complex task requiring an understanding of background developments and key issues related to mental health services. In Canada, the deinstitutionalization of patients attempted to shift the locus of care from provincial psychiatric hospitals to general hospital psychiatric units. This resulted in the isolation of provincial psychiatric hospitals, general hospital psychiatric units and community mental health programs, with little overall accountability for the services provided--three solitudes. To move toward the creation of responsible, integrated systems a number of issues must be addressed: target population(s); the roles of provincial psychiatric and general hospitals; community support services; continuity of care; co-morbidity; consumerism; and methods of integration. In the development of a comprehensive mental health plan, each issue should be recognized and decisions made which are in keeping with current knowledge. A companion report will survey Canadian initiatives in mental health planning and discuss approaches to many of the issues identified.

Activities of Daily Living↗
PubMed1992

Planning mental health services: II. Current Canadian initiatives.

A brief overview of recent policy developments across Canada and a discussion of the common themes and challenges they address demonstrates the scope of activity in this field. The federal level of mental health planning and a summary of recent of policy developments in each province are described. Significant progress has been made in Canada in the development of mental health services since deinstitutionalization. Major challenges remain, however, which are being addressed to varying degrees across the country. The challenges related to the key issues of major mental illness, integration and consumerism are illustrated.

Canada↗
PubMed1985

Psychiatric aftercare in a metropolitan setting.

In the face of the trend toward brief hospitalization, rising re-admission rates and other indices of poor community adjustment, concern has developed about the adequacy of psychiatric aftercare services. The authors report on a comprehensive study of psychiatric aftercare in a large metropolitan area (population 2.5 million). The study followed prospectively a group of 747 patients, representative of a significant proportion of patients in the care system. The findings document inadequacies in hospital-based discharge planning, unbalanced use of aftercare services and poor patient outcomes six months and two years post-discharge. The study found heavy reliance on medical/therapeutic aftercare services with a relative neglect of housing, vocational/educational, financial and social/recreational services. Despite the large volume of medical/therapeutic service use, the patient group had a high readmission rate, high levels of symptomatology and poor social adjustment on follow-up. The authors suggest that community-based practitioners with specialized training in psychiatric rehabilitation would improve the system of aftercare.

Adult↗
PubMed1984

From hospital to community. Six-month and two-year outcomes for 505 patients.

The authors have completed a large descriptive study of the system of psychiatric aftercare in Metropolitan Toronto. This article describes the relevant 6-month and 2-year postdischarge outcome in each of five aftercare components for 505 subjects in a traditional system of service delivery. Provincial hospital, research institute, and general hospital subgroups are compared. For the total group, recidivism and employment rates are similar to those found in previous studies. Symptoms and distress levels are high. Considerable numbers of subjects live in inadequate and unsatisfactory housing. Social isolation, inadequate income, and difficulties with instrumental role functioning are persistent problems with little improvement between 6 months and 2 years postdischarge. Differences among the subgroups vary according to type of outcome and, for the most part, can be explained by differences in the characteristics of the patients served by the three types of inpatient treatment settings. These findings provide additional information about serious deficiencies in discharge planning and aftercare service delivery that is focused primarily upon the treatment of illness. The authors conclude that a more balanced system of aftercare requires a shift in resources to rehabilitation programs in the community.

Academies and Institutes↗