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PubMed2000

[Homeless persons residing in shelters in the county of Funen II. Comparison between 1990 and 1996 and occurrence of mental disease].

The question has been raised whether the change from hospital to community psychiatry is accompanied by an increasing number of the mentally ill in institutions for homeless people. During week 49, 1996, the residents in institutions for homeless people in the County of Funen were interviewed and diagnosed according to ICD-8, and the results were compared with a similar study from week 47, 1990. The prevalence of psychoses was 11% in 1990 and 14% in 1996. This difference was not significant. Significantly fewer psychotic homeless people were treated for their psychotic disorders in 1996 compared with 1990. The prevalence of alcoholics had fallen by 35%, while the prevalence of narcotics and cannabis addicts had risen by 78% and 110%, respectively. These changes were statistically significant. There was still a high prevalence of personality disorders, 70% in 1990 and 60% in 1996. Even though the deinstitutionalization of the psychiatric service has not been accompanied by more psychotic patients in institutions for the homeless, the clientele is still heavily strained with psychosis, personality disorder and substance abuse.

Adolescent↗
PubMed2000

[Nursing home residents in Northern Jutland].

The purpose of the study was to describe a Danish nursing home population. The study consists of 288 nursing home residents (median age 84.6 years, 68% females). The psychiatric morbidity of the residents was diagnosed with the GMS-AGECAT. The staff was interviewed about the residents' ADL, disturbing behaviour and therapeutic measures. Seventy-one percent had a psychiatric disorder, with organic disorder as the most frequent (61%). Demented residents received significantly less hypnotics, were more often physically restrained and had lower ADL levels compared to other residents. The situation in Denmark can be seen as a paradox. While substantial effort has been made to increase the possibility of choice and to "deinstitutionalize" nursing homes, the majority of the residents are demented and thus not capable of making valid choices.

Activities of Daily Living↗
PubMed2000

[Troubled times in care of the elderly. Increasing number of the "oldest old" and demented, shortage of general practitioners and lack of clarity with regards to locating resources].

The media image of general breakdown in care of the elderly, replete with portrayals of malpractice and maltreatment, is analyzed in the light of changes in demographics, care resources and care delivery systems during the past decades. A substantial increase in the number of people aged 80 years or more, increasing numbers of elderly persons with dementia, deinstitutionalization of health care, together with the present economic crisis, place a considerable burden on the care system, as illustrated by an increased nursing load, a decrease in the number of elderly persons receiving home services, and a concentration of support to the most impaired. The author calls attention to the need for refined methods for describing care delivery systems, longitudinal population based studies, and a national hospital plan. Primary health care, already pushed to the limit by dwindling resources and job vacancies, is hard put to shoulder the burden of responsibility for the elderly.

Aged↗
PubMed2000

The history, economics, and financing of mental health care. Part 2: The 20th century.

1. To understand how mental health nursing practice was affected by the financing and policy changes occurring rapidly in the second part of the 20th century, sources can only be found in the literature in psychiatry, the social sciences, and economics. There was no psychiatric nursing journal until the 1950s, and no article by a nurse in the general nursing literature about finances. 2. Deinstitutionalization was really transinstitutionalization. Changes in regulations in Medicaid allowed the shifting of mentally ill people who were older than age 65 to nursing homes. 3. Community mental health centers never developed programs to serve people who were seriously mentally ill. Rather than serving clients who were psychotic, the community mental health centers marketed their treatment programs to people with anxieties, who were undergoing divorce, or who had mildly troubled children.

Health Care Rationing↗
PubMed1999

Delivery of dental care to persons with disabilities and other special populations.

Although humankind has long suffered from dental ills, and despite progressive efforts by the field of dentistry to provide dental healthcare in a compassionate and anxiety-free manner, the profession of dentistry has suffered a tarnished reputation. Going to the dentist is considered painful and induces fear among most people; however, this mindset is changing. Dentists of today are beginning to take their rightful place as integral members of the health care team, including disability management initiatives. The public and other health care providers are beginning to recognize the importance of oral health to the overall health of the body. Dental care is a vital component to rehabilitation planning. Unfortunately, some government agencies, insurance companies, and other policy making bodies have failed to grasp the importance of this concept. Also, professionals within the field of dentistry have not fully grasped the important of continued dental care for persons with disabilities, geriatric patients, the deinstitutionalized, and others in need of rehabilitation services. Problems associated with the delivery of dental care to patients with disabilities are discussed.

Journal Article↗
PubMed2002

[Development of child mental health services in Lithuania: achievements and obstacles].

In 1990, political, economic and social changes in Lithuania introduced the possibility to develop for the first time in nations's history an effective and modern system of child mental health services. During the period between 1990 and 1995 a new model of services was developed in the Department of Social pediatrics and child psychiatry of Vilnius University. The model included development of child and adolescent psychiatric services, as well as early intervention services for infants and preschool children with developmental disabilities. The emphasis, following recommendations of WHO and existing international standards, was made on deinstitutionalization and development of family-oriented and community-based services, which have been ignored by previous system. In the first half of 90's of 20th century, new training programs for professionals were introduced, more than 50 methods of assessment, treatment and rehabilitation, new for Lithuanian clinical practice, were implemented, and a new model of services, including primary, secondary and tertiary level of prevention, was introduced in demonstration sites. However, during next phase of development, in 1997-2001, serious obstacles for replicating new approaches across the country, have been identified, which threatened successful implementation of the new model of services into everyday clinical practice. Analysis of obstacles, which are blocking development of new approaches in the field of child mental health, is presented in the article. The main obstacles, identified during analysis of socioeconomic context, planning and utilization of resources, running of the system of services and evaluation of outcomes, are as follows: lack of intersectorial cooperation between health, education and social welfare systems; strong tradition of discrimination of psychosocial interventions in funding schemes of health services; societal attitudes, which tend to discriminate and stigmatize marginal groups, including disabled children and dysfunctional families; lack of evidence-based decision making in the process of health care reform and reform of social infrastructure.

Age Factors↗
PubMed2002

[Attitudes and beliefs of citizens of Montreal towards psychiatric patients living in a society].

In the past 50 years, new health policies all over the world have led to the introduction of rehabilitation and deinstitutionalization programs to overcome the depersonalizing effects of asylums. As a result, large numbers of former psychiatric patients are now living and working in society. The public's attitudes and beliefs about these former patients play a central role in their harmonious integration into the community. To find out more about these attitudes and beliefs, we interviewed a representative sample of the population of Montreal Island (n = 899). Our study indicates that a majority of respondents show a favourable attitude towards former psychiatric patients (in terms of recognizing their rights, accepting them in the workplace, creating warm relationships, etc.), but that people still entertain many negative beliefs (seeing mental illness as a deviation from the norm). The study interprets these ambivalent signs of tolerance and fear towards ex-psychiatric patients among Montrealers. An encouraging sign is that a trend towards greater acceptance seems to be emerging among young people in terms of both attitudes and beliefs.

Adult↗
PubMedDate not supplied

["European Service Mapping Schedule" (ESMS)--instrument used to describe the structure of mental health care].

There is many changes in psychiatric service last years. In deinstitutionalization process arising new diversified and wide integrated psychiatric services. Traditional names lose significance for example: open or stationary care. Moreover the same names, have different meaning in different centers or countries. Because of that processes in year 1997 EPCAT group with funding from European Commission Biomed grant developed ESMS instrument by Sonia Johnson and Robert Kuhlmann, to modern description and classification of psychiatric services. Instrument is based on standardizing classification accessible services, with different care models in Europe. In this work authors presented structure of questionnaire and typical applications in catchment areas. That compatible with European standards of psychiatric service instrument, portray gaps in old standards system and indicate developmental trends new psychiatric health service in medical care. Instrument ESMS indicates another possibilities in service study area for example analysis and comparison individual service components and helps in planning local development of psychiatric care services.

Catchment Area, Health↗
PubMed2002

Incentives in financing mental health care in Austria.

BACKGROUND: In Austria, financing health care -and even more so mental health care- is characterized by a mix of federal and provincial responsibilities, lack of uniformity in service provision and service providers, and diverse funding arrangements. The division between financing structures for health care and social care makes the situation even more complex. This state of affairs results in various, partly counterproductive and sometimes paradoxical financial incentives and disincentives for the providers, recipients and financiers of mental health services. In several provinces of Austria, recent reform plans in mental health care have focused strongly on establishing community-based and patient-oriented mental health care. One of the main challenges in implementing this new policy is the re-allocation of resources. AIMS OF THE STUDY: The authors hypothesize that the existing structure of mental health care financing, with its incentives and disincentives, constitutes an obstacle to patient-oriented community-based mental health care. Analyzing the characteristics of the overall mental health care financing system in one Austrian province, Lower Austria, will provide a better understanding of actor-relationships and inherent incentives and highlight implications for the process of deinstitutionalization. METHOD: The authors used an analytical framework based on the principal-agent theory, empirical evidence, and information on financial, organizational and legal structures to identify the characteristics of actor-relationships and the position of single actors within the system. RESULTS: The article shows how incentives are linked to existing constellations of actors involved in mental health care financing and identifies significant power relations. As a consequence, incentives and disincentives within the financing system result in hospital- centered and supply-oriented mental health care in Lower Austria. DISCUSSION: The current system of financing mental health care provides an obstacle to the provision of patient-oriented and community-based mental care. This is due to existing constellations and power relations among the actors where, most importantly, patients are the weakest party in the patient-payer-provider triangle. Balancing power relations will be a significant prerequisite for alternative financing systems. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH: If a community and needs-based mental health care system is to be established in Austria, the financing structures have to be changed accordingly. Applying a principal-agent framework is useful for identifying key aspects in mental health care financing in relation to the provision of services. Further research is needed to help develop alternative financing mechanisms that support community-based and patient-oriented mental health care systems.

Austria↗
PubMed1992

Resource allocation problems and health services for the elderly.

The provision of appropriate health support services for the elderly has increased in importance because of the trend towards aging populations in Europe and other developed regions. Health service resource allocation models and their roles in health service systems, which are also changing to reflect changing needs for the elderly, are discussed in this article. Different types of economic and health care delivery systems are examined, particularly those leading towards decentralization, consumer participation and "deinstitutionalization". A promising resource allocation approach--the "balance-of-care" approach--is described in some detail. This and other potential approaches make it possible to identify areas which hold promise for crossnational research.

Aged↗
PubMed1992

Dental fellowships in developmental disabilities help broaden care of disabled.

Continuation of the national trend toward deinstitutionalization and community placement for persons with developmental disabilities, physical handicaps and other medical problems will mean increased demand for dentists trained to care for this segment of the population. The New York State Office of Mental Retardation and Developmental Disabilities now offers dental fellowships in developmental disabilities to help fill the learning gap.

Academic Medical Centers↗
PubMed2003

[Mental health and welfare law to build community support].

While the rest of the world has experienced or completed deinstitutionalization in the turn of the century, Japan has not come up with a clear plan to decrease mental hospital beds. There are 330,000 people in hospitals, and at least 1/3 of them for social reasons. Japanese hospital-centered policy has been enrooted on paternalism that hospitals are responsible for the care of the severely mentally ill. Enactment of Mental Health and Welfare Act in 1995 was epoque making because this law is provided an opportunity for people with psychiatric disabilities to live in the community with support services. With this act, Central government has introduced care guidelines how to coordinate services by care managers in each municipalities in 2002. It is important to address that this new treatment model be based on individual's need and support given to improve an individual's quality of life in the community.

Attitude of Health Personnel↗
PubMed1992

Factors contributing to the subjective quality of life of the chronic mentally ill.

Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.

Adult↗
PubMed2003

The American Academy of Developmental Medicine and Dentistry: eliminating health disparities for individuals with mental retardation and other developmental disabilities.

Recent reports by Special Olympics International and the U.S. Surgeon General have revealed significant disparities and unmet health needs encountered by persons with mental retardation and other developmental disabilities (MR/DD). Factors contributing to these disparities include deinstitutionalization, increased survival of individuals with MR/DD, lack of appropriately trained providers, and inadequate financing of dental services. To address these problems, a group of academically oriented dentists and physicians formed the American Academy of Developmental Medicine and Dentistry (AADMD). The mission of the AADMD is to improve the quality of health services provided to persons with MR/DD by improving dental and medical school-based training of dentists and enhancing clinically relevant research. A central theme of the AADMD is full collaboration between physicians and dentists in meeting its goals. The National Action Strategy developed by the AADMD focuses on creating a series of university-based Developmental Medicine and Dentistry Programs (UDMDPs) in medical and dental schools, which collaborate in service, teaching, and research with community-based primary care clinics, community hospitals, intermediate care facilities, and other private service delivery systems such as the Special Olympics Healthy Athletes Program that serve these patients. Oral-systemic interactions will receive special emphasis by the training and research programs.

Adolescent↗
PubMedDate not supplied

[Evolution of antipsychotic drug consumption in the autonomous community of Castile and Leon, Spain (1990-2001)].

BACKGROUND: Over the past ten years, new drugs and new approaches to treatment have been implemented making it possible to assume changes in the use of antipsychotic drugs in our environment. This study is aimed at characterizing the pattern of use of antipsychotic drugs in Castile and Leon throughout the 1990-2001 period as well as ascertaining the bearing which the marketing of new antipsychotic drugs may have had on the pattern of consumption of these drugs. METHODS: The drug consumption data was obtained from the Ministry of Health and Consumer Affairs' consumption database ECOM (Especialidades Consumo de Medicamentos). This database contains information on the consumption of medications dispensed charged to the Social Insurance system in community pharmacies nationwide. To estimate the consumption outside of the National Health System, data from the IMS (International Marketing Services) firm for the years 2000 and 2001 was used. The data was given in Defined Daily Doses/1000 inhabitants/day. RESULTS: The use of antipsychotic drugs rose by 146% within the 1990-2001 period. Throughout the period studied, haloperidol was the antipsychotic drug most used in Spain and in Castile and Leon. The atypical antipsychotic drugs totaled 49% of the total consumption for 2001 and 90% of the costs, a strong trend being found toward an increase in the consumption of these atypical antipsychotic drugs in detriment to the typical antipsychotic drugs. It has been estimated that 14% of the antipsychotic drugs used in Castile and Leon were used outside of the National Health System.. Appreciable differences exist among the different provinces. CONCLUSIONS: The consumption of antipsychotic drugs in Castile and Leon grew by 146% throughout the twelve months studied. The marketing of new atypical antipsychotic drugs and the legal measures related to the deinstitutionalization of mental patients may have played a major role in this increase. The marketing of the new antipsychotic drugs has led to a change in their pattern of use and has give rise to an rise in the direct costs. The consumption of these medications not charged to the National Health System is minor, but not negligible.

Antipsychotic Agents↗
PubMed2004

[Homeless-disabled people--medical, moral and social problem].

Many factors contribute to homelessness, including extreme poverty, extended periods of unemployment, disruption of regular sources of income and employment, deinstitutionalization and substance abuse. As a result, the needs of the homeless are both broad and complex. This assessment is based on literature reviews and reviews of local documents and reports. For homeless people, healthcare competes with more immediate needs, such as obtaining adequate food and shelter and it is our duty as a society to help.

Delivery of Health Care↗
PubMedDate not supplied

Pain and anxiety control in Down syndrome.

The most recent pain and anxiety control techniques employed in patients with Down syndrome are described in relation to how cooperative the patient is and what assessment is made of his or her general condition. The growing deinstitutionalization of these patients and the growing social opportunities for them are matched by an increasing demand for dental treatment. Down syndrome is thus one of the disabilities with which the dentist is most likely to come into contact in his own surgery. Pain control is one of the keys to building the relationship between physician and patient and obtaining patient compliance in the conviction that only regular controls can maintain the oral health of these patients. A local anaesthetic, combined when possible with psychological techniques, remains the approach of choice and only a level of compliance that is really wanting or the need to carry out numerous operations in a single session should lead the dentist to choose conscious sedation or a general anaesthetic. The choice of technique, however, should take into account any systemic disease present, such as congenital heart and neurological diseases, bearing in mind that conscious or deep sedation and general anaesthesia should only be adopted in a hospital environment and require the presence of an anaesthesiologist.

Anesthesia↗