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At least 1,207 records · Page 67Linked to original sources
PubMed1986

Mental health care in Southern Italy: application of case-control methodology for the evaluation of the impact of the 1978 psychiatric reform.

A survey to analyse patients' characteristics and the care delivered to them was conducted in several psychiatric facilities, covering the whole range of care offered in the public sector in two regions of Southern Italy. A case-control method of analysis was chosen, and the relative risk estimates (RR), together with their 95% confidence intervals (CI), of being in custodial facilities were computed, comparing patients treated in custodial institutions ('cases') with those in community-based services ('controls') in respect of social and clinical variables. Factors more strongly associated with custodial treatment were: illiteracy (RR = 2.4), unmarried status (RR = 2.4), a history of prolonged illness (RR = 7.6), organic diagnosis (RR = 2.6), previous custodial treatment (RR = 3.9), and expected poor social functioning (RR = 2.4). The suitability and advantages of the case-control method of analysis in the field of psychiatric care evaluation are discussed.

Adult↗
PubMed1989

A comparison of practices, attitudes and interactions in two established units for people with a psychiatric disability.

This study evaluates and compares aspects of residential care in a community hostel setting and a hospital setting for people with a psychiatric disability. The clients were assessed to establish their level of general functioning, the comparison indicating there was no significant difference between the two groups on the measure used. A previously published protocol was used as a method of comparing the units. The findings indicated that the hospital unit was more individually orientated both in practices and staff attitudes, and had staff who were more optimistic about clients' potential accomplishments. No differences were found between perceived involvement of staff in decision making, or staff resident interactions. These findings have implications for the 'Care in the Community' movement, as they indicate that the nature of a service is as important as its location. They suggest that the relocation of services to the community in itself will not automatically overcome some of the difficulties associated with institutional care.

Adult↗
PubMed1992

Cognitive deficit and the prediction of rehabilitation success in a chronic psychiatric group.

This paper describes the second stage (years 4, 5 and 6) of a prospective follow-up of a sample of chronic patients which was designed to investigate the in service use. It also tested the relative predictive power of variables which included demographic, symptomatic and behavioural factors as well as a novel reaction time variable which reflects response processing time. During the six years of the study 91% of the patients in the sample changed either the degree of their day and/or night care. Many moved to more independence but, a number did also become more dependent on psychiatric services. There were no differences in outcome between a schizophrenic group and patients with other diagnoses. These results suggest a level of flexibility in outcome even in a severely disabled chronic group. The main predictor of future service use at each stage of the follow-up for the whole group was chronicity at entry to the study. But, when the group was divided into schizophrenic patients and 'others', the response processing measure was a significant predictor of service use in the schizophrenic group and accounted for between 17% and 30% of the variance. For the 'other' diagnostic group, the age of the patient seemed to be the major determinant of care. The reaction time variable seems to be an extra class correlate of a strict diagnosis of schizophrenia. It may also be a stable or episodic vulnerability factor, but as well as these promising hypotheses, which have yet to be justified, this measure does seem to have pragmatic value in predicting outcome in a rehabilitation network.

Activities of Daily Living↗
PubMed1992

The Mental Impairment and Evaluation Treatment Service: staff attitudes and staff-client interactions.

This study describes and evaluates a new short-term residential service for adults with mild learning difficulties and challenging behaviour, the Mental Impairment Evaluation and Treatment Service. The study examines staff attitudes towards management practices, towards the potential achievement of individuals with learning difficulties, the staff's perceived involvement in decision making, and also the nature of their interaction with the clients, in two different settings on the Unit. The Unit's management practices were found to be client-orientated in nature and staff were more in agreement with client-orientated than institution-orientated management practices. Staff were generally optimistic about clients' potential and felt involved in decision making. Correlations between certain staff characteristics, attitudes and interactions are discussed. The study extends the range of services that have been evaluated in this way, and provides a description of the service in its early stages, which will provide an important comparison point for it when it is more permanently established.

Adult↗
PubMed1996

Factors affecting the success of community placement: the TAPS project 26.

Long-stay patients who were discharged from Friern and Claybury hospitals during the 6-year period between September 1985 and August 1991 were followed up for at least 1 year and the details of all readmissions were recorded. Of the 615 hospital leavers, some 178 (29%) were readmitted at some time during the follow-up period. A proportional hazards regression analysis revealed a number of independent baseline factors which affect the risk of readmission at any time during the follow-up period. Younger patients were more at risk of readmission than were older patients and 'new' long-stay patients had a greater risk than baseline patients. Risk was also greater in patients who had a larger number of pre-discharge admissions, a higher abnormal behaviour score (PSE BSO) or a diagnosis of manic psychosis. An ordinal logistic regression analysis revealed that these same five factors tended to increase the actual number of readmission episodes. The proportion of post-discharge time spent in hospital among the readmitted patients was found to be greater for males, new long-stay patients and for patients with a higher number of positive social behaviour symptoms (SBSPOS score).

Activities of Daily Living↗
PubMed1983

The effects of the community environment on chronic psychiatric patients.

The question of where to place the chronically mentally disabled in the community is essential in this era of brief hospitalization practices. This report examines the effects of the social conditions of the environment on the length of stay in the community for a sample of 119 multiple admission schizophrenics in New York City. Patients returned to a variety of family and non-family living arrangements in poor and depressed areas of the city. The relationship between characteristics of the living arrangements and the patients' clinical functioning and rate of rehospitalization was examined. The findings show that there is no significant differential effect of the type of living arrangement on rehospitalization or clinical functioning, and that these factors did not contribute significantly to the prediction of successful adjustment. However, the socio-emotional characteristics of the environment--i.e. social support and interpersonal stress-together are stronger predictors of outcome than are available out-patient treatment programmes. The findings emphasize the importance of environmental variables as factors independent of the effect of treatment on rehospitalization.

Adolescent↗
PubMed1983

Suicide rates in Ireland.

From a total of 410 post-mortem examinations on Galway residents deceased in 1978 the examining pathologist and 3 psychiatrists were in close agreement in 22 cases that death was by suicide. These figures were extrapolated, and a Republic of Ireland minimum true rate of suicide was computed which was 3 times greater than the official reported rate. Irish suicide data were found not to be dependent on coroners' reports as is commonly believed. It is concluded that under-reporting reduces Irish suicide rates to a far greater extent than has been supposed. The substitution of clinical for legalistic methods of recording suicide data is recommended.

Adolescent↗
PubMed2003

Does 'like predict like' when patients discharged from high secure hospitals re-offend? An instrument to describe serious offences.

BACKGROUND: The statement that past behaviour is the best predictor of future behaviour has empirical support in respect of whether an individual will, or will not, commit a criminal offence. People who have offended in the past are more likely to offend in the future. The aims of this study were to develop an instrument and to examine whether the same statement applies in respect of the nature and circumstances of successive offences committed by the same person. METHOD: A rating instrument to describe seven variables relating to the nature and circumstances of a serious offence, the SODI, was developed by the authors. Inter-rater reliability was measured when the instrument was applied to 80 offences committed by 40 patients leaving high secure hospitals. The data were examined for evidence of similarity in the nature and circumstances of successive offences. RESULTS: For five of the seven items of the instrument the kappa coefficients for inter-rater reliability were > 0.65. No significant associations, in terms of SODI ratings, were found between the offence that led to hospital admission and that which was committed after discharge. CONCLUSIONS: The SODI is a reliable instrument for the description of serious offences committed by this group. Risk assessments in psychiatry should be informed by an awareness that in only a proportion of cases will the nature and circumstances of any serious re-offence resemble the nature and circumstances of the offence which contributed to a patient's admission to hospital.

Crime↗
PubMed1989

Community care for the mentally ill in England and Wales: myths, assumptions and reality.

It is widely recognised that there are many problems with the community care policy for the mentally ill which has been in operation in England and Wales since the late 1950s. However, many existing accounts of the development of the policy rest upon a variety of erroneous assumptions about how it has evolved, and which in turn affect our understanding of how it might be changed. Some of these assumptions are examined, and it is argued that frequently they fail to acknowledge how both the rhetoric and the reality of the policy have developed. Taking this critique into account, a more accurate assessment of how to understand community care for the mentally ill is offered.

Community Mental Health Services↗
PubMed2000

Stigma and mental disorder: conceptions of illness, public attitudes, personal disclosure, and social policy.

The end of the last millennium witnessed an unprecedented degree of public awareness regarding mental disorder as well as motivation for policy change. Like Sartorius, we contend that the continued stigmatization of mental illness may well be the central issue facing the field, as nearly all attendant issues (e.g., standards of care, funding for basic and applied research efforts) emanate from professional, societal, and personal attitudes towards persons with aberrant behavior. We discuss empirical and narrative evidence for stigmatization as well as historical trends regarding conceptualizations of mental illness, including the field's increasing focus on genetic and neurobiological causes and determinants of mental disorder. We next define stigma explicitly, noting both the multiple levels (community, societal, familial, individual) through which stigma operates to dehumanize and delegitimize individuals with mental disorders and the impact of stigma across development. Key developmental psychopathology principles are salient in this regard. We express concern over the recent oversimplification of mental illness as "brain disorder," supporting instead transactional models which account for the dynamic interplay of genes, neurobiology, environment, and self across development and which are consistent with both compassion and societal responsibility. Finally, we consider educational and policy-related initiatives regarding the destigmatization of mental disorder. We conclude that attitudes and policy regarding mental disorder reflect, in microcosmic form, two crucial issues for the next century and millennium: (a) tolerance for diversity (vs. pressure for conformity) and (b) intentional direction of our species' evolution, given fast-breaking genetic advances.

Attitude to Health↗
PubMedDate not supplied

Can deinstitutionalised care be provided for those at risk of violent offending?

OBJECTIVE: The aim of this article is to explain the current status of deinstitutionalisation and of community care development in the UK. DESIGN: Literature review of articles and reports on deinstitutionalisation. SETTING: Articles included in the review related either to the whole of the UK, to England and Wales, or to a specific area such as London. MAIN OUTCOME MEASURES: The review was carried out pertaining to the question of the extent to which community care can or should take over the functions of the asylum, with particular reference to those at risk of behaving violently. These functions include those that are manifest, or explicit, and those that are latent, or unintended but implicit (Bachrach, 1976). RESULTS: The example of patients at risk of violent behaviour is-one that highlights the continuing relevance of both these sets of functions, which are argued to be exerting a powerful influence on the processes of asylum closure and community care development. This influence is seen in delayed asylum closure, transinstitutionalisation (the shift of some patients from asylums to other institutions), and the institutionalisation of aspects of community care. CONCLUSIONS: Both the manifest and the latent functions of asylums must be acknowledged by those involved in planning community care; where it is felt desirable that community care does not take over certain functions, the consequences of this must be anticipated so that they can be prevented or dealt with in other ways.

Community Health Planning↗
PubMed2000

The legislative tenets of client's right to treatment in the least restrictive environment and freedom from harm: implications for community providers.

For over four decades, national legislation has supported efforts to move persons with severe and persistent mental illness out of restrictive hospital settings and into community based services. Within institutional walls, numerous duties of state have been established to help ensure humane and effective treatment. However, the legal protections afforded hospitalized residents have not appeared to follow these individuals into the community. This article analyzes relevant case law and attempts to establish similarities between the state hospital's duty to protect its residents and the responsibility of community mental health centers to do the same for the persons they serve. The authors argue that the client's right to freedom-from-harm must receive increased attention and community based service providers will have to enhance their capacity to deliver more effective risk management services if mental health reform is to become a successful social policy.

Community Mental Health Services↗