Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Mandatory Programs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed2006

The relationship between legal status, perceived pressure and motivation in treatment for drug dependence: results from a European study of Quasi-Compulsory Treatment.

This paper reports on intake data from Quasi-Compulsory Treatment in Europe, a study of quasi-compulsory treatment (QCT) for drug dependent offenders. It explores the link between formal legal coercion, perceived pressure to be in treatment and motivation amongst a sample of 845 people who entered treatment for drug dependence in five European countries, half of them in quasi-compulsory treatment and half 'voluntarily'. Using both quantitative and qualitative data, it suggests that those who enter treatment under QCT do perceive greater pressure to be in treatment, but that this does not necessarily lead to higher or lower motivation than 'volunteers'. Many drug-dependent offenders value QCT as an opportunity to get treatment. Motivation is mutable and can be developed or diminished by the quality of support and services offered to drug-dependent offenders.

Adult↗
PubMed1986

Posthospital mandatory outpatient treatment.

Mandatory outpatient treatment invoked after the patient has improved in the hospital is a relatively new development. Tennessee instituted this policy by statute in 1981. While people placed under the constraints of that law showed a reduction in rate of readmission, comparison with control groups failed to support the conclusion that these results are due to the forced outpatient constraints. The author discusses some procedure and policy considerations that stem from these findings.

Aftercare↗
PubMed1986

Rights, wrongs, and the dilemma of coerced community treatment.

An outpatient treatment approach directed to patients with histories of psychotically based dangerousness, poor compliance, and recidivism is described. Cases are presented that suggest favorable outcomes of this approach, but the coercive nature of the treatment raises questions about the psychiatrist's violation of patients' rights and transgression of ethical standards. If psychiatrists are to successfully treat the most difficult chronic patients, can we do it without legally sanctioned, benevolent, coercive treatments? One model of such treatment is outpatient commitment. There is concern that without sound outpatient commitment statutes, we may witness the reemergence of asylums.

Adult↗
PubMed1991

Effects of statutes requiring psychiatrists to report suspected sexual abuse of children.

OBJECTIVE: Reporting of child sexual abuse is mandatory in all 50 states. Conceptual distinctions between privileged communications and mandatory reporting are reviewed, and the impact of recent changes in Maryland's reporting laws is examined. METHOD: Beginning in 1964 Maryland law required reporting if abuse was suspected when a physician examined a child. In 1988 reporting of disclosures by adult patients about child sexual abuse that occurred while they were in treatment was mandated. In 1989 all patient disclosures, even about such abuse that occurred before treatment, became reportable. During the period of statutory changes, the Johns Hopkins Sexual Disorders Clinic had kept track of adult patients who referred themselves for treatment and adult patients' disclosures of child sexual abuse. This allowed analysis of the impact produced by changes in the reporting requirements. RESULTS: 1) Mandatory reporting of disclosures about prior child sexual abuse deterred undetected adult abusers from entering treatment. The rate of self-referrals when such reporting became mandatory in 1989 dropped from approximately seven per year (73 over a 10-year period) to zero. This may have caused some unidentified children to remain at risk. 2) Mandatory reporting deterred patients' disclosures about child sexual abuse that occurred during treatment. In 1988 the disclosure rate during treatment dropped from approximately 21 per year to zero. This deprived clinicians of information important for early intervention. 3) Mandatory reporting failed to increase the number of abused children identified. The number identified secondary to such disclosures was zero. CONCLUSIONS: Optimal protection of children, as well as treatment for adult patients, may be better accomplished by legislation that supports options other than reporting.

Adult↗
PubMed2004

Consumers' perceptions of the fairness and effectiveness of mandated community treatment and related pressures.

OBJECTIVE: Little research has been conducted on the attitudes of persons with psychiatric disorders toward the potentially adverse or beneficial effects of involuntary outpatient commitment and other forms of mandated community treatment. This study examined mental health consumers' appraisals of the fairness and effectiveness of mandated community treatment and related pressures to promote treatment adherence. METHODS: A total of 104 consumers who had been in treatment for schizophrenia or related disorders were interviewed in person to assess their perceptions of mandated community treatment and other legal pressures. RESULTS: Approximately 62 percent of the consumers regarded mandates as effective, and 55 percent regarded them as fair. Perceptions of the effectiveness and fairness of mandates were highly correlated. Consumers who regarded schizophrenia as a biopsychosocial disorder and who viewed themselves as ill and in need of treatment also tended to endorse the fairness and effectiveness of mandates. Those who rejected mandates as ineffective and unfair were more symptomatic and rejected a view of themselves as being ill. CONCLUSION: S: Consumers with schizophrenia who adopt a biopsychosocial view of their own illness, who are less symptomatic, and who have better insight also tend to believe that they benefit from a range of formal and informal sanctions to adhere to treatment and believe that they are imposed in the consumers' best interests and out of concern for their well-being. In contrast, consumers who reject treatment mandates tend to have more psychotic symptoms yet are less likely to perceive themselves as ill.

Adult↗
PubMed2005

Use of leverage to improve adherence to psychiatric treatment in the community.

OBJECTIVES: A variety of tools are being used as leverage to improve adherence to psychiatric treatment in the community. This study is the first to obtain data on the frequency with which these tools are used in the public mental health system. Patients' lifetime experience of four specific forms of leverage-money (representative payee or money handler), housing, criminal justice, and outpatient commitment-was assessed. Logistic regression was used to examine associations between clinical and demographic characteristics and receipt of different types of leverage. METHODS: Ninety-minute interviews were conducted with approximately 200 adult outpatients at each of five sites in five states in different regions of the United States. RESULTS: The percentage of patients who experienced at least one form of leverage varied from 44 to 59 percent across sites. A fairly consistent picture emerged in which leverage was used significantly more frequently for younger patients and those with more severe, disabling, and longer lasting psychopathology; a pattern of multiple hospital readmissions; and intensive outpatient service use. Use of money as leverage ranged from 7 to 19 percent of patients; outpatient commitment, 12 to 20 percent; criminal sanction, 15 to 30 percent; and housing, 23 to 40 percent. CONCLUSIONS: Debates on current policy emphasize only one form of leverage, outpatient commitment, which is much too narrow a focus. Attempts to leverage treatment adherence are ubiquitous in serving traditional public-sector patients. Research on the outcomes associated with the use of leverage is critical to understanding the effectiveness of the psychiatric treatment system.

Adult↗
PubMed2006

Conditional release: a less restrictive alternative to hospitalization?

OBJECTIVE: This study examined conditional release--that is, involuntary outpatient commitment orders upon release from hospitalization--as a least restrictive alternative to psychiatric hospitalization in Victoria, Australia. METHODS: Records were obtained from the Victorian Psychiatric Case Register for patients who experienced psychiatric hospitalization: between 1990 and 2000 a total of 8,879 patients were given conditional release and 16,094 were not. RESULTS: Compared with the group that was hospitalized but did not receive a conditional release, the group that received a conditional release was more likely to have more prior hospitalizations of greater than average duration. Patients with schizophrenia were more likely to be given conditional release. Patients given conditional release experienced a care pattern involving briefer inpatient episodes (8.3 fewer days per episode), more inpatient days, and longer duration of restrictive care--that is, combined inpatient and conditional release periods (5.1 more days per month in care). CONCLUSIONS: For patients at risk of long-term hospitalization, conditional release may help to shorten inpatient episodes by providing a least restrictive alternative to continued hospitalization. However, patients who were given conditional release doubled the amount of days they spent under restrictive care, compared with the amount of time they previously spent in the hospital before entering a period of combined inpatient and conditional release commitment. Additional oversight may have led to more frequent hospitalization. This consequence raises new questions regarding the possible benefits of such extended oversight and new challenges for release planning using conditional release as a least restrictive method of care.

Adult↗
PubMed2006

Effect of conditional release from hospitalization on mortality risk.

OBJECTIVES: This study considered the protective value provided by conditional release. It assessed the contribution of conditional release to mortality risk among patients with mental disorders severe enough to require psychiatric hospitalization during a mental health treatment span of 13.5 years in Victoria, Australia. METHODS: Death records were obtained from the Australian National Death Index for a sample of 24,973 Victorian Psychiatric Case Register patients with a history of psychiatric hospitalizations: 8,879 had experienced at least one conditional release during community care intervals and 16,094 had not. Risk of death was assessed with standardized mortality ratios of the general population of Victoria. Relative risk of death among patients with and without past experience of conditional release was computed with risk and odds ratios. The contribution of conditional release to mortality, taking into account use of community care services, age, gender, inpatient experience, and diagnosis, as well as other controls, was assessed with logistic regression. RESULTS: Patients who had been hospitalized showed higher mortality risk than the general population. Sixteen percent (4,034) died. Patients exposed to conditional release, however, had a 14 percent reduction in probability of non-injury-related death and a 24 percent reduction per day on orders in the probability of death from injury compared with those not offered such oversight throughout their mental health treatment, all other factors taken into account. CONCLUSIONS: Conditional release can offer protective oversight for those considered dangerous to self or others and appears to reduce mortality risk among those with disorders severe enough to require psychiatric hospitalization.

Adult↗
PubMed2006

Factors in the selection of patients for conditional release from their first psychiatric hospitalization.

OBJECTIVE: This study examined a sample of patients in Victoria, Australia, to identify factors in selection for conditional release from an initial hospitalization that occurred within 30 days of entry into the mental health system. METHODS: Data were from the Victorian Psychiatric Case Register. All patients first hospitalized and conditionally released between 1990 and 2000 were identified (N=8,879), and three comparison groups were created. Two groups were hospitalized within 30 days of entering the system: those who were given conditional release and those who were not. A third group was conditionally released from a hospitalization that occurred after or extended beyond 30 days after system entry. Logistic regression identified characteristics that distinguished the first group. Ordinary least-squares regression was used to evaluate the contribution of conditional release early in treatment to reducing inpatient episodes, inpatient days, days per episode, and inpatient days per 30 days in the system. RESULTS: Conditional release early in treatment was used for 11 percent of the sample, or more than a third of those who were eligible for this intervention. Factors significantly associated with selection for early conditional release were those related to a better prognosis (initial hospitalization at a later age and having greater than an 11th grade education), a lower likelihood of a diagnosis of dementia or schizophrenia, involuntary status at first inpatient admission, and greater community involvement (being employed and being married). When the analyses controlled for these factors, use of conditional release early in treatment was significantly associated with a reduction in use of subsequent inpatient care.

Adult↗
PubMed1990

Ethical and clinical considerations in selecting patients who will receive clozapine.

In a large state hospital population, more treatment-resistant schizophrenic patients may be clinically eligible to receive clozapine than the hospital can afford to pay for, given the costs of the medication and its mandatory monitoring system. The authors review clinical criteria for selecting patients and discuss two ethical principles that might be useful: select patients on the principle of providing the greatest good for the greatest number of patients (based on expected outcomes such as likelihood of discharge and benefit to the milieu) and give priority to patients for whom the fewest treatment alternatives are available. Issues such as family pressures for administration of clozapine to a relative must also be dealt with.

Adult↗
PubMed1993

Euthanasia policy in The Netherlands: the role of consultation-liaison psychiatrists.

The authors describe national guidelines introduced in the Netherlands in late 1990 for carrying out euthanasia requests by medically ill patients. In about 49,000 of the 130,000 annual deaths in that country, doctors make a decision that may influence the duration of life. In 2,300 cases doctors perform euthanasia. Thus euthanasia accounts for 1.8 percent of all deaths and 5 percent of the cases in which doctors' decisions play a role. The authors point out cultural differences between the U.S. and the Netherlands, such as in access to health care and in social tolerance and pragmatism, that should be considered by American policymakers who address the issue of euthanasia. The role of Dutch consultation-liaison psychiatrists in euthanasia was assessed by a survey of members of the Netherlands Consortium of Consultation/Liaison Psychiatry. Most felt that involvement of psychiatrists in such cases should not be mandatory and that their most important role was to assess patients' decision-making capacity. Half of the psychiatrists felt that their role was to support the decision-making process of the ward staff.

Aged↗