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PubMed2000

Community care and criminal offending in schizophrenia.

BACKGROUND: The introduction of community care in psychiatry is widely thought to have resulted in more offending among the seriously mentally ill. This view affects public policy towards and public perceptions of such people. We investigated the association between the introduction of community care and the pattern of offending in patients with schizophrenia in Victoria, Australia. METHODS: We established patterns of offending from criminal records in two groups of patients with schizophrenia over their lifetime to date and in the 10 years after their first hospital admission. One group was first admitted in 1975 before major deinstitutionalisation in Victoria, the second group in 1985 when community care was becoming the norm. Each patient was matched to a control, by age, sex, and place of residence to allow for changing patterns of offending over time in the wider community. FINDINGS: Compared with controls, significantly more of those with schizophrenia were convicted at least once for all categories of criminal offending except sexual offences (relative risk of offending in 1975=3.5 [95% CI 2.0-5.5), p=0.001, in 1985=3.0 [1.9-4.9], p=0.001). Among men, more offences were committed in the 1985 group than the 1975 group, but this was matched by a similar increase in convictions among the community controls. Those with schizophrenia who had also received treatment for substance abuse accounted for a disproportionate amount of offending. Analysis of admission data for the patients and the total population of admissions with schizophrenia showed that although there had been an increase of 74 days per annum spent in the community for each of the study population as a whole, first admissions spent only 1 more day in the community in 1985 compared with 1975. INTERPRETATION: Increased rates in criminal conviction for those with schizophrenia over the last 20 years are consistent with change in the pattern of offending in the general community. Deinstitutionalisation does not adequately explain such change. Mental-health services should aim to reduce the raised rates of criminal offending associated with schizophrenia, but turning the clock back on community care is unlikely to contribute towards any positive outcome.

Adult↗
PubMed2003

Inpatient treatment of mood disorders in the era of de-institutionalisation, depression awareness campaigns and development of new antidepressants.

OBJECTIVE: To analyse changes in inpatient treatment for mood disorders during the period of de-institutionalisation, de-centralisation of service planning, economic recession, attempts to increase depression awareness and increasing biological treatment possibilities. A special interest is paid to whether de-institutionalisation at specialist level psychiatric care results in transfer of inpatient care into non-specialised institutions. METHOD: A register study of all inpatient treatment due to psychiatric disorders from four health care districts in Northern Finland, with a population of more than 600,000. Treatment undertaken by psychiatric hospitals and wards, primary care wards and medical and surgical wards in general hospitals are distinguished. RESULTS: Inpatient treatment for mood disorders increased vastly in all kinds of health care institutions. The increase was due to growing inpatient treatment of depression. LIMITATIONS: The National Discharge Register does not include treatment episodes in private nursing homes or details about the contents of the treatment. CONCLUSION: Even during explicit active de-institutionalisation, other policies may have a greater impact on hospital use, resulting in unexpected changes in patient populations and service utilisation. In Finland, de-institutionalisation failed concerning mood disorders. The depression awareness policies during the 1990s increased inpatient use of depression across institutions.

Antidepressive Agents↗
PubMed1984

Career paths through mental retardation services: an epidemiological perspective.

Children born during a five year period, resident in a British city, and administratively defined as mentally retarded were followed up at age 22. Age specific prevalence rates ranged from 2.5/1000 at age 5 to 14.7/1000 at age 11. The various mental retardation services for children and adults are described and the frequencies with which different paths through services were followed are given. Almost three-quarters of those who had been at a school for educable, mentally retarded children received no services in the young adult period. The distributions of various associated disabilities among those receiving different services after leaving school are given. These illustrate the multiple problems presented by those who continue to require services in adulthood. The epidemiologic data presented provide a basis for estimating service needs.

Adolescent↗
PubMed1999

Factors associated with caregiver burden in mental illness: a critical review of the research literature.

This article reviews caregiver burden studies that evaluated burden of care for a mentally ill relative using measurement instruments with established validity and reliability. The review identifies aspects of caregiving that are most burdensome to caregivers. It describes the nature of the relationships between variables and different dimensions of caregiver burden, and identifies mixed findings that are theoretically relevant to caregiver burden. The review discusses research findings in light of the methodological issues and research designs characterizing the literature, and briefly summarizes the effects of burden on the caregiver's life. Finally, it identifies advances made in this line of research in recent years and highlights areas that need further attention in future research work. Summary tables are included.

Adult↗