Joshua Bierer and social psychiatry.
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Community Psychiatry↗
Biomedical subjects
F Holloway
Publications and source records attributed to F Holloway.
'Not waving but drowning': psychiatric inpatient services in East Lambeth 1990.
This paper presents the results of the latest in a series of surveys of an inner-city public psychiatric inpatient service. Severe pressures on the service had led to the purchase of inpatient beds in the private hospital sector and intensive care facilities in a large psychiatric hospital. On a census day the nominal occupancy for the inpatient unit was 117%. Implications of the survey, trends over time and possible solutions to the difficulties of the inpatient unit are discussed.
Adolescent↗
Case management for the mentally ill: looking at the evidence.
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Activities of Daily Living↗
Day care in an inner city. I. Characteristics of attenders.
The socio-demographic and clinical characteristics of patients attending psychiatric day care in an inner-urban catchment area were assessed using structured techniques. The overall prevalence of the use of day care was high (164 per 100,000 total population), and 86% of attenders were in prolonged psychiatric contact. Of those in prolonged contact, the clinical and social morbidity of 68 attenders at National Health Service day hospitals was strikingly similar to that of 42 attenders at other units. Users of a 'community mental health centre' and two work centres were less disabled than attenders at other day units. Implications of these results for the organisation of day services and training of staff are discussed.
Activities of Daily Living↗
Day care in an inner city. II. Quality of the services.
Seven units providing psychiatric day care to residents of an inner-city area were surveyed. The extent to which the clinical and special problems of attenders were adequately managed by the services was measured using a 'needs-assessment' technique. Units differed in the proportion of clinical and social problems that were rated as 'unmet needs', although the extent of 'unmet need' was not clearly related to the morbidity of attenders at a unit or the available staffing.
Activities of Daily Living↗
Case management.
"This paper discusses the advantages and disadvantages of case management systems for the co-ordination of care of people with long-term mental illness living in the community. Many of the principles are equally applicable to other client groups with long-term needs, e.g. elderly people or people with learning difficulties. Some of the historical background to the emergence of case management concepts is discussed, culminating in the recent White Paper on Community Care. The underlying concept of case management is examined, together with a number of fundamental questions concerning who should act as case managers, what kinds of training they will require, problems of inter- and intra-agency co-operation, and the empirical evidence regarding its effectiveness. It is concluded that case management could be an important element in a comprehensive range of mental health services, but it is not a substitute for basic community provisions."
Community Mental Health Services↗
A two year follow up of new long-stay patients in an inner city district general hospital.
In 1967 Magnus described 'the new chronics', patients admitted to a psychiatric hospital who then stayed for more than one year. Since that time many studies have examined this patient group but the majority have focussed on psychiatric hospital populations. There is some doubt, however, as to whether the characteristics of new-long stay patients in District General Hospital (DGH) psychiatric in-patient units are comparable. The current paper describes a two year follow-up study of Medium and New-Long Stay patients identified within an inner-city DGH unit in 1986. Elderly patients with affective disorders and patients with organic brain syndromes were particularly highly represented. Length of stay at the time of the original survey, male sex, associated physical disability, and the presence of a secondary diagnosis were particularly associated with poor outcome. The results are discussed in relation to service provision.
Adult↗
Psychiatric day care: the users' perspective.
The literature on consumer opinion about psychiatric day care is reviewed and a study of the views of day care attenders living in an inner city catchment area who are in prolonged contact with psychiatric services is presented. Attenders were broadly satisfied with their care. Analysis of their verbatim comments suggested that attenders perceived the value of attendance at a day unit in social rather than therapeutic terms. The implications of this finding are discussed.
Chronic Disease↗
Prescribing for the long-term mentally ill. A study of treatment practices.
A survey of the drug treatment of long-term mentally ill users of a district psychiatric service is described. The appropriateness of prescriptions was assessed against standard criteria after a detailed clinical review of each patient. Overprescribing, particularly of sedative/hypnotic and of anticholinergic and antipsychotic drugs, was common. Junior psychiatrists and general practitioners are in need of improved training in the management of chronic psychiatric illness: a review of treatment practices might be an appropriate medium for this training.
Adult↗