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PubMed2005

Characteristics of schizophrenia residents and staff rejection in community mental health hostels.

BACKGROUND: In the era of deinstitutionalization, increasing numbers of schizophrenia patients reside and receive rehabilitational treatment within the framework of community hostels. The quality of staff-patient relationships is a crucial determinant of the rehabilitational process outcome. METHOD: This study examined the characteristics of 56 schizophrenia hostel residents, measured the degree of staff criticism and rejection expressed towards these patients and assessed the contribution of residents and staff characteristics to the induction of staff rejection. Measures included assessments of patients' symptoms using the Positive and Negative Syndrome Scale (PANSS), staff attitudes using the Patient Rejection Scale (PRS), and patients' living skills using the Independent Living Skills Survey (ILSS). RESULTS: Young, relatively inexperienced instructors represented 60% of the hostels staff. Residents' symptoms and staff rejection levels were overall low. However, significantly increased rejection was expressed towards patients who were more symptomatic, as measured by PANSS total and positive symptoms scores and had diminished job-related and health care living skills. Staff older age and longer professional experience were correlated with higher rejection scores. LIMITATIONS: Relatively small sample size and catchment area. CONCLUSIONS: These findings highlight the need for a better definition and understanding of schizophrenia residents selection criteria and treatment goals in community hostels. Moreover, they suggest that improvements in this area should be coupled with the provision of specialized staff training aiming at the achievement of more flexible staff attitudes. Within this framework, the PRS may serve as a practical, cost-effective tool for monitoring crucial aspects of staff-patients relationships.

Adult↗
PubMed2005

[Forensic patients in Denmark--2000-2004].

INTRODUCTION: In Denmark the number of forensic patients increased exponentially from 1980 to 1999, with an annual growth rate of 6.8%. In 2000 some psychiatric orders became time-limited. This study maps out the development from 2000 to 2004. MATERIALS AND METHODS: The material includes forensic patients under supervision by a probation officer. Since 1977, the Department of Prisons and Probation has registered their prevalence and, since 1989, also the incidence and the lifting of previously established orders. The material is representative and has been corrected according to new legislation. The monthly prevalence is analysed 1980-2004, the monthly incidence 1989-2004. RESULTS: The incidence increased exponentially from 1989 to 1999, with an annual growth rate of 6.2%, the annual growth rate from 2002 to 2004 being 12.8% (p=0.078). The whole period 1989-2004 showed a constantly increasing growth rate (p<0.001). The prevalence decreased from 2000 to 2001, as many orders were lifted due to new legislation. The prevalence in 2002-2004 shows an annual growth rate of 11.0%. The difference between the growth rates of incidence and prevalence 2002-2004 is not significant. Thus the number of forensic patients is now increasing exponentially, with an annual growth rate of 11% CONCLUSION: Increasing criminality among schizophrenic patients has been established in many countries. The main reason is supposed to be deinstitutionalization, which probably applies to Denmark as well. Today forensic patients occupy about 20% of the total number of psychiatric beds in Denmark, and whatever the reasons for the growing number are, this fact, in combination with the decreasing number of available beds, points towards a disastrous development for the mentally ill.

Crime↗
PubMed2005

Psychiatric admissions and hospitalization in Israel: an epidemiologic study of where we stand today and where we are going.

BACKGROUND: Analysis of the trends in psychiatric admissions and discharges is necessary to correctly plan and distribute resources, especially given the current international climate of "deinstitutionalization." Israel, too, is implementing "reform" in the national psychiatric system - to transfer psychiatric treatment from a hospital to a community setting. OBJECTIVES: To analyze admission and discharge patterns, explore trends in psychiatric hospital length of stay, and compare these characteristics between first-episode and chronic patients, between children, youth and adults, and between hospitals. METHODS: All admissions and discharges from inpatient psychiatric wards between the years 2000 and 2004 were analyzed and characterized according to age, length of hospitalization, legal status, and nature of admitting institution (state hospital, health fund, general hospital). RESULTS: Mean length of stay in adults decreased during the 5 year study period, from 37.6 days in 2000 to 36.4 days in 2004. In years with higher admissions, hospital stay was shorter (P < 0.05). Length of stay in psychiatric wards in general hospitals was shorter than in state hospitals (P < 0.001). In contrast to adults and children, length of stay among adolescents showed a gradual increase (P < 0.05). Involuntary hospitalization comprised 25.3% of all admissions, and 16.8% of discharged patients were re-admitted within 30 days. A dramatic decrease (24.3%) in the number of chronic hospitalizations was noted. CONCLUSIONS: Various factors may account for these developments. Protracted hospitalizations may be reduced through changes in various aspects of treatment planning and psychiatric care continuum. The decrease in number of admissions, length of stay and number of chronically admitted patients remains in line with international practices. Particular attention needs to be devoted to planning and funding so that availability of community services matches reduction in psychiatric hospitalization.

Adolescent↗
PubMed1987

[The young adult in psychiatry : the problem and experiences in intervention.].

Young Adults represent a significant proportion of health care beneficiaries; in the field of psychiatry, their proportion is as significant as it is troublesome for those dispensing care. Young Adults aged 18 to 35 must rely on short-term health care policies that stress deinstitutionalization as the final goal; in short, they must deal with solutions that only partially address their problems and needs. This article focuses on Young Adults on a treatment center in the U.S.A. that specializes in this area and on a project of clinical intervention introduced by Louis-H. Lafon-taine Hospital.

English Abstract↗
PubMed1986

[From Italy to Québec : impact of the Italian psychiatric reform.].

This article has two aims: 1) to help in the understanding of the much discussed Italian reform in psychiatry. 2) to offer for review, discussion or action, a certain number of implications uncovered by this reform with regard to the ongoing discussions on the reorganization of Mental Health Services in Quebec. On the first aim, the key message is as follows: it is possible to create another psychiatry if society in general and those actually participating really want such a project. On the second aim, the main conditions of success for a global and deinstitutionalized psychiatry seem to be as follows: Sufficient resources, freedom to develop policies (a deep decentralisation of the decision making process and the organization) that are central to the integration of the services in a given territory; a dedicated study of the culture and the local social live; a continuous presence (intime and space) of the service in the territory; a total response (and deinstitu-tionalization) to the patient's needs; a democratic team work. However, there are no miracles in Italy; in the cooled down society of the 80's there is room for experimentation.

English Abstract↗
PubMed1988

[The social role of municipalities in mental health policy.].

In recent years, there has been an increasing number of cases of intolerance and rejection on the part of communities in which attempts have been made to establish housing for the mentally ill. This illustrates to what extent strategies promoting local involvement are absent and were never designed to coincide with deinstitutionalization. The result is that zoning has become an instrument of discrimination despite declarations to the contrary made by government. As a result, municipalities must become involved in the process of attitudinal change. On the same note, mental health workers must get involved politically in order to reduce the emphasis placed on utilitarian and individualistic approaches.

English Abstract↗
PubMed1989

[Living in a natural environment : a question of mental health.].

Ever since the beginning of the 80s, we are witness to a debate on deinstitutionalization, of the elderly as well as of psychiatric clients, that has overemphasized the benefits of placing people in their natural surroundings. This debate has in effect omitted to talk of the living conditions of functionally impaired elders maintained in their natural surroundings, of families who take care of a dependant parent. This article examines the conditions and factors liable to affect the mental health of all concerned.

English Abstract↗
PubMed1984

[Psychiatric emergencies : specific phenomenon.].

In as much as it is situated at a crossroads, emergency psychiatric practice provides a remarkable observation point in relation to a number of new facts: the recession, unemployment, the lack of health, the growth and development of the autonomy of the para-psychiatric professions, deinstitutionalization, the poorly-defined extension of the field of psychiatry. The réponse, even the site of this response, to demands for urgent service, its ties to medicine and to society, represent major questions. The essential reasons for providing emergency psychiatric care remain the curtailment of pathology, the early assumption of care, the reduction of errors in diagnosis and the teaching of psychiatry in the medical milieu. Although seemingly evident, these affirmations deserve to be evaluated, to be the subject of epidemiological and démographie research. Beginning with the new problems posed by the economic recession, and in the face of the situation of medicine and psychiatry, the author describes two critical situations concerning the current organization of emergency care: the saturation of transitory units and the connections between the specialties.

English Abstract↗
PubMed1990

Medicaid versus state funding of community residences: impact on daily life of people with mental retardation.

The unintended effects on quality of life that flow from decisions regarding funding sources used to support community-based residential programs were documented. Results show that community residence program structures play an important role in determining quality of life after deinstitutionalization. Clients living under program structures flowing from the Medicaid ICF/MR funding source were less active and involved in life than were clients living in programs funded by non-Medicaid state sources. We hypothesized that the reason for this differential outcome was the result of Medicaid funding regulations and their interpretation, which create an institutional-like set of program structures leading to restrictive care patterns.

Activities of Daily Living↗
PubMedDate not supplied

A case study: service delivery and parents with disabilities.

A Specialized Family Program, through a supervised paraprofessional, provided time-intensive, home-based service to a family in which both parents were deinstitutionalized disabled individuals. Interventive procedures consisted of systematic educational procedures in basic child care and home management and the case management of many active but uncoordinated agencies. Through this case history, the programmatic needs of disabled parents and their families are discussed, with emphasis on (1) an orientation of family support and advocacy; (2) active, home-based intervention; (3) educational methods based on systematic, behaviorally based instruction; (4) coordination of all workers involved; and (5) client control of decisions related to intervention.

Adult↗
PubMed1990

[The need of special services in the future care of the mentally retarded].

A proposal for deinstitutionalization of the mentally retarded in Norway passed the Norwegian Storting in May 1988. The Ministry of Health and Social Affairs has prepared guidelines for planning and implenting this reform. On 1 January 1991 the responsibility for providing the necessary services was transferred to the municipalities. Many problems have to be solved in order to ensure that the life of each mentally retarded person is qualitatively improved after normalization and integration into society. In July 1989 the Ministry of Health and Social Affairs issued a document which assumed that necessary specialists and special services for the mentally retarded already exist, and are being used. Our study has questioned this assumption as being incorrect or incomplete. We interviewed persons in charge of the system of health care in all 19 Norwegian counties. Our conclusions are as follows: The mentally retarded do receive specialist services in various areas of somatic medicine. Their needs as regards psychiatric care are not taken care of by psychiatric specialists in hospitals or at out-patient facilities. Data shows that the system of institutionalized health care for the mentally retarded provides unique services which are best described as systematically applied behaviour analyses. Such special competence is often lacking in the Norwegian health services otherwise. In order to ensure that the mentally retarded will receive the best possible care, this competence must be integrated into the future system of care. It is most importance to consider these problems without delay. This article also discusses organizing special training and treatment for the mentally retarded themselves and special training for the persons providing the care.

Health Planning Guidelines↗
PubMed1987

[Model of crisis intervention: theoretical actuality and clinical usefulness].

The efficiency of the crisis intervention model has been reviewed for its usefulness as it appears in the recent literature. On the practical level this has been done on a crisis ward, the Brief Therapy Center CTB (= Centre de thérapies brèves) in Carouge; but also the theoretical level has been taken into account. This model has been in the center of the deinstitutionalization during the seventies and eighties. Through its application, essentially admissions to hospital treatment could be prevented, as we can see it from the case report statistics. Furthermore the study of these case report statistics reminds us of the fact that even patients with serious psychiatric illnesses like schizophrenias show "crises" in their evolution which might be approached by this intervention model.

Crisis Intervention↗
PubMed1978

How will dental education adapt to the third-party payment system?

An increasing number of dental patients will contract for and pay a third party to assume the fiscal responsibility for their dental care. Dental schools, through faculty and students, regularly provide the most carefully monitored, high quality dental services. Dental schools must continue to provide these services in the most "deinstitutionalized" and personalized manner possible. Third parties, whether commercial or governmental, must assure their clients (dental patients) of comprehensive dental coverage and reimbursement policies that are realistic, equitable, and based only upon receiving quality coverage. The quality of the dental educational system is essential to the success of any dental health care program.

Dental Care↗
PubMed1985

The young adult chronic patient: population overview.

Uninstitutionalized young adults with chronic mental disorders and social disabilities pose a new challenge in community psychiatry. These attention-seeking, help-rejecting young men and women spend most of their lives in the community and differ markedly from older deinstitutionalized chronic psychiatric patients. Many confound identification by their abuse of drugs and/or alcohol. Most deny their mental illness and make inappropriate use of mental health services available to them. Because of the different problems and aspirations of these patients compared to older chronic patients, treatment programs must be age segregated to address these differences. Young adult chronic patients are best helped via flexible, accessible, nonstigmatizing, team-oriented treatment programs. Some patients require long-term neuroleptic therapy at low maintenance doses. In addition to their role as the primary provider of psychiatric care to these patients, psychiatrists must act as advisors to families and community planners and as political activists to focus additional attention on community-based (rather than state hospital-oriented) programs.

Adolescent↗
PubMed1987

[Unemployment and mental health].

Evidence linking unemployment with psychiatric morbidity is available since the thirties, but it is only in the seventies that a renewed research interest on this subject took place. Two research strategies seem to be emerging: an "ecological" approach establishing correlations between economical and health indicators for a given population. Another approach focuses on the psychiatric morbidity of samples of individuals who have lost their job compared to matched control groups of individuals still employed. Many of those studies did not limit themselves on the mental health of the unemployed but on the "rippling" effect of unemployment on the family and community. Many aspects of the consequences of unemployment on mental health remain to be explored such as the effects of long-term unemployment, unemployment among women. Methods of emotional supportive interventions for the unemployed need also to be explored. Furthermore the effects of a high level of unemployment on the programs of deinstitutionalization of the chronic mentally ill as well as the mentally handicapped should be evaluated.

Economics↗
PubMed1987

Client characteristics and residential placement patterns.

Recent emphases on deinstitutionalization and community placement have been accompanied by the development of a range of residential placement alternatives and by shifts in the control of placement decisions. In this study we examined the patterns of placement into these alternatives for 66,367 clients receiving services for mentally retarded persons from the state of California and evaluated the ability of client characteristics to discriminate among clients in four residential placement types. Results of the discriminant analyses suggest that client characteristics, including maladaptive behavior, age, ethnicity, medical problems, ambulation, toileting, and speech, are important factors in the consideration of residential placement for mentally retarded people.

Activities of Daily Living↗
PubMed1986

Alcohol and drug use by mentally retarded adults.

Alcohol and drug use have been reported to affect adversely the community adaptation of deinstitutionalized mentally ill persons. Data from ethnographic studies of four samples of community-living mentally retarded persons were presented showing that the majority of these persons used drugs and alcohol rarely or not at all; indeed, they used these substances less often than did their nonretarded parents, siblings, spouses, and friends. Those who did use alcohol or drugs typically did so in socially acceptable ways. Reasons for these patterns of low alcohol and drug use were discussed.

Adolescent↗