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PubMed1998

Collaboration between a state alliance for the mentally ill and a state mental health authority in monitoring the consequences of downsizing.

As consumers are released from hospitalization as a result of the downsizing of inpatient psychiatric facilities, their ability to sustain themselves in the community becomes a concern to a number of constituencies. This article describes the development of a program for monitoring persons who were released from hospitals into the community as a result of the downsizing of state psychiatric hospitals. The program's uniqueness was the collaboration between the state mental health authority and the state Alliance for the Mentally Ill in developing and implementing the monitoring system.

Case Management↗
PubMed2002

Mental health service use and cost of care for older adults in assisted living facilities: implications for public policy.

With changing demographics prompting greater demand for assisted living facility (ALF) care, indigent older adults with mental health needs face underfunded residential care options and mental health systems currently unprepared to meet their service requirements. In particular, over-reliance on inpatient mental health services for older individuals with mental illness and inadequate reimbursement of ALF facilities potentially increase costs and threaten availability of ALF care. This article analyzes Florida's administrative data and presents findings on mental health service use and cost of care for poor older persons. Using Florida as an example, the authors recommend policy changes to ensure the quality and availability of residential care for low-income adults with mental health needs.

Adolescent↗
PubMed1996

Physical characteristics of residential psychiatric and substance abuse programs: organizational determinants and patients outcomes.

Described the Physical and Architectural Characteristics Inventory (PACI), which assesses the physical characteristics of hospital- and community-based psychiatric and substance abuse residential treatment programs for adults. Developed using data from 94 representative programs, the PACI has 7 dimensions that assess community accessibility, physical features that add convenience, aid recreation, and provide support for patients, and space for patient and staff functions. In comparison to community-based programs (n = 63), hospital programs (n = 31) had more social-recreational and prosthetic aids, safety features, staff facilities, and space. The PACI dimensions were also related to other organizational features, such as facility ownership and program size and staffing level. Programs with more physical amenities had patients who were more involved in self-initiated and community activities and were more likely to successfully complete the program and be discharged to independent living situations and paid jobs. Programs with more social-recreational and prosthetic aids, space, and access to community resources also had better patient outcomes. In addition, PACI dimensions were related to observers' ratings of facility attractiveness. Potential applications of the PACI and the full inventory of which it is a part are discussed.

Adult↗
PubMed1993

Mental health planning and problem-solving in the 90s: satisficing rather than optimizing during a time of turbulence.

This paper describes one aspect of a community demonstration project in Rochester, New York, which attempted to downsize a state hospital while expanding community services for individuals with serious mental illnesses. In order to successfully transfer resources from the institution to the community, private sector administrators and planners needed to modify some of their original plans based on the realities, constraints and politics of public sector systems. It is suggested that this type of compromise is well documented in systems theory and is of importance to mental administrators and planners as we try to serve more needs with the same or fewer resources during the decade of the 90s.

Community Mental Health Services↗
PubMed1995

Implementing psychosocial rehabilitation in long-term inpatient psychiatric facilities.

Using the focus group methodology, data were gathered from the initial experiences of Missouri's four long-term psychiatric facilities with psychosocial rehabilitation (PSR). Significant implementation factors include the establishment of a firm PSR philosophical base; extensive staff training in PSR values, technologies, and the skills necessary to implement the technologies; support for staff as their roles change with the adoption of PSR; adaptation of PSR for use with forensic clients; use of community resources while clients are still inpatients; maintenance of PSR values and skills learned after clients are released into the community; and the establishment of a program evaluation system that assesses both outcome and process. Clients residing in long-term, public psychiatric facilities also can receive substantial benefits from this approach to service delivery.

Community-Institutional Relations↗
PubMed1996

Reported comorbidity of mental disorders with substance abuse among psychiatric inpatients in Israel.

In preparation for shifting of care from psychiatric hospital to the community, the prevalence of substance abuse comorbidity among discharged psychiatric patients was studied. Such patients are not usually treated by substance abuse programs or mental health clinics. Data from the Israeli National Psychiatric Case Registry were analyzed on reported substance abuse among all 53,379 psychiatric discharges during 1989-92. The Registry consists of data that physicians are mandated to report on all patients. The authors found that reported substance abuse comorbidity was 13.2% for males and 3.6% for females. Patients with a diagnosis of personality disorder had the most reported substance abuse. Reported drug abuse for males increased with age until age 45, and alcohol abuse until age 65. Drug and alcohol abuse by females is the highest for the patients under age 24 and declines with an increase in age. The results were almost identical for each of the four years studied. The results suggest that developing special outpatient facilities to serve this group will be impractical because of the small numbers. Ways of serving these patients in existing community mental health centers are discussed.

Adolescent↗
PubMed1994

A longitudinal study of the impact of changing public policy on community mental health client residential patterns and staff attitudes.

Three studies of perceived residential needs and community residential patterns of adults with severe and persistent mental illness over a period of 12 years are used to assess the effect of changing public policy in this area. During a period in which public policy shifted from advocacy of congregate living in treatment settings to independent living in generic community housing, there were significant changes in community residential patterns and in the attitudes of case managers. Clinical and demographic data collected in the most recent survey provides a much more complete profile of the community living situation of adults with severe and persistent mental illness than was previously available.

Attitude of Health Personnel↗
PubMed1994

New and borrowed strategies for mental health systems in the decade of the 1990s.

Use of the paradigm shifts advocated by futurists and the supporters of total quality management can facilitate access to new options for mental health systems. New views and innovative systems, however, become difficult to maintain in the context of increasingly rapid and unexpected change occurring in the environment. One strategy that can be employed is the use of leverage, a term usually associated with finance or politics.

Community Mental Health Services↗
PubMed2000

Urogenital symptoms and resulting discomfort in non-institutionalized Dutch women aged 50-75 years.

The aim of this study was to determine the prevalence of urogenital symptoms in non-institutionalized Dutch women aged 50-75 years, and the degree of discomfort suffered as a result. A questionnaire was sent to 2157 women, a sample representative of the female population aged 50-75 years with respect to age, marital status, level of education and menopausal age. The usable response was 81.6% (n = 1761). The overall prevalence of vaginal dryness, soreness and dyspareunia was 27%. The prevalence of micturition symptoms, urinary incontinence and recurrent urinary tract infection was 36%. The prevalence estimates for vaginal dryness and urinary incontinence showed a linear decrease with increasing age. Almost half of the symptomatic women reported moderate to severe discomfort. One-third of those affected received medical care. Previous hysterectomy had no effect on the reported prevalence estimates. Hysterectomized women reported moderate to severe complaints more often than non-hysterectomized ones. There were no significant differences in prevalence estimates between former and current smokers and non-smokers.

Aged↗
PubMed2002

[Specific behaviour therapy day clinic].

Psychiatric day care has a long tradition. However, psychotherapeutic day care institutions specialising in particular disorders or certain therapeutic approaches are still the exception. A day care unit for behaviour therapy was established at the Clinic for Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf in 1998 as part of a complex inpatient, day care, and outpatient behaviour therapy unit. The immediate and high acceptance by patients and their doctors indicates a strong need of such a treatment setting. We present how this day care unit works and how it differs from the traditional psychiatric day care.

Activities of Daily Living↗
PubMed2002

[The Pinel myth].

Explore the source record for details and available documents.

Deinstitutionalization↗
PubMed1997

[Suicide rates in a community psychiatric service system].

Reduction of the elevated suicide rates in psychiatric patients remains an important aim of psychiatric treatment. There has been an ongoing discussion on the question of whether the increased tendency to transfer long-term psychiatric patients from inpatient care to community psychiatric care might go along with increased suicide rates. In our community care system we found an age- and sex-adjusted suicide rate 40 times as high as in the general population in the period between 1973 and 1993. Within the first 4 years suicide rates were significantly elevated. All suicides had the diagnosis of chronic schizophrenia or schizoaffective psychosis. In the non-schizophrenic group no suicide occurred during treatment. Our study shows that in community psychiatric care suicide rates in schizophrenic patients are significantly increased whereas suicide rates is non-schizophrenic patients may be decreased.

Adolescent↗
PubMed2000

[Community psychiatric management of severely ill schizophrenic patients. An exemplary case study].

Psychiatric care for chronic schizophrenic patients has improved in recent years, but for severely ill patients, often with multiple comorbid psychiatric conditions and in great need of care, the situation remains unsatisfactory. Community-based psychiatric care is limited and psychiatric hospitals are now cutting back on inpatient care. The quality of care that chronically mentally ill patients receive at independent psychiatric nursing homes removed from population centers is undetermined, and many patients end up in asylums or homeless shelters unable to provide for their psychiatric needs. Neither a reliable way to assess the needs of these complicated patients nor a scientific basis for therapeutic intervention exists yet. The case study presented here illustrates an interdisciplinary approach to the care and treatment of a chronic schizophrenic patient with several comorbid conditions. Based on the individual needs of the patient and developed over the last 4 years, this approach had positive effects on the course and outcome of treatment and resulted in an impressive reduction of costs. The average annual number of days of hospitalization over a 3-year period was reduced from 206 to two and the total cost of care was reduced from US$70,000 annually to $8000. The results from this single case study are promising. Further investigation of the development and evaluation of highly individualized treatment plans for severely disturbed schizophrenic patients is warranted.

Case Management↗
PubMed2001

[Status and development of psychiatric care in Italy. 22 years after Franco Basaglia's reform regulation no. 180].

Since reforms were introduced in 1978, the treatment of mental illness in Italy is less uniform than ever before. The essential and core aspects of these reforms were not implemented in many southern provinces, but there are flourishing private clinics in Rome and other metropolitan areas, and in the highly developed regions of northern and central Italy there are institutions meeting very high standards of complementary care. However, reforms in these areas had begun as early as in 1968 in accordance with Act 431 passed that year, and in these regions the newer reforms functioned only as a catalyst. The extremely high goals set by the "Italian experiment" were not realized, but the achievements of several Italian provinces in the areas of ambulant and supporting psychiatric care can certainly be viewed as exemplary. A general trend toward increased critical examination of ways of dealing with the mentally ill from the medicinal, humanitarian, and social points of view is emerging.

Ambulatory Care↗