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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↗
PubMed2003

[Sociotherapy in German social law. Indication, contents, and aspects of public health].

In German mental health services, the ill-defined term "sociotherapy" has been used to designate nonmedical, social, and work-related components of the care process. Recently, a new component of outpatient/community mental health care called "sociotherapy" (according to Paragraph 37a of the Fifth German Social Code) which is funded by the public health insurance system has been introduced and is now in the process of being implemented. The paper describes (a) patients eligible for the service and (b) the aims and scope of this case management module. The key objectives are to motivate patients with schizophrenia to utilise mental health services and antipsychotic medication and to liaise with psychosocial services. Therefore, sociotherapy is distinct from (a) multidisciplinary inpatient care for people with severe mental illness, (b) assertive community treatment, (c) community care provided by social workers or community psychiatric nurses, and (d) family interventions. So far there has been little evaluation of sociotherapy.

Case Management↗
PubMedDate not supplied

New Zealand's health providers in an emerging market.

Services have almost completely replaced hospitals as the organisational units in the reformed New Zealand health care system. Within the secondary service provider sector service management, the decentralisation of general management to budget-holding clinical groupings has been an important factor in achieving a population focus, cost containment, accountability and integration. It is being further developed within the 23 newly formed Crown health enterprises (CHEs), the main providers of secondary, hospital and related services. The CHEs are evolving roles beyond a narrow definition of 'providers', taking initiatives to collaborate with other providers, or rejecting those elements of competition that might interfere with effective local co-ordination of services. Service management is also being extended to the demand-driven, fee-for-service primary care sector, where inflation-adjusted expenditure over the last decade has grown at more than 6%, compared with zero growth in the capitation-financed secondary sector. This is being achieved in both general practice and community budget-holder groupings through what might be called managed primary health care. The current health reform process has also created four regional health authorities (RHAs), responsible, within capped and capitated budgets, for the fully integrated purchasing of services from both primary and secondary providers. The success of these innovative arrangements, which could be of international significance, will depend upon the quality of the developing relationships between providers and their purchasing RHAs.

Budgets↗
PubMedDate not supplied

Medicare funding for nursing education: proposal for a coherent policy agenda.

Medicare Graduate Medical Education (GME) funding for nursing education, established in 1965, no longer represents a coherent policy agenda, which must support educating the nursing workforce from classroom to practice. Three key concepts must be addressed: nursing education costs for both service and educational institutions, defining nursing education in federal rules and regulations, and the community's role in supporting nursing education. Responsibility for educating a nursing workforce must be shared by the community of academic, health care, professional, and government institutions and organizations, a policy supported by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Knowledge about costs, funding streams, and policies for nursing education is essential for nursing educators to advocate for funding of nursing education and practice. Nursing programs and academic institutions need to initiate discussions with policy makers and potential community partners about service/education partnerships. Finally, community investment in nursing education pays dividends by providing essential health services of a highly skilled professional workforce.

Attitude of Health Personnel↗
PubMed2002

Beneficial effects of a woman-focused development programme on child survival: evidence from rural Bangladesh.

This paper reports results from a prospective study of the impact of a woman-focused development programme on child survival in Matlab, a rural area of Bangladesh. The programme was targeted to households owning less than 50 decimals of land and members selling more than 100 days of labour for living in a year. Programme components included formation of women's groups for saving and credit, training on skill development, functional literacy including legal and social awareness, and technical and marketing support to projects undertaken with the loan money from the organization. A total of 13,549 children born alive during 1988-97 in the study area were included in the study. Hazards of mortality during pre- and post-intervention periods were compared among the programme participants and non-participants controlling the effects of other relevant variables. There has been a substantial reduction in mortality during the post-intervention period; however, the reduction was much greater for infants whose mothers participated in the development programme compared to infants of non-participant mothers from similar socioeconomic background. In a relative sense, there has been a 52% reduction of the pre-intervention level hazard of death of children during infancy of participant mothers compared to 31% reduction for the infants of non-participant mothers from similar socioeconomic background. There had also been a substantial reduction in hazard of death during childhood (1-4 year age group), however, the reduction was statistically similar for all groups of children irrespective of their mothers' participation in the development programmes.

Adult↗
PubMed2001

Community nurses: an urgent need.

When families could not manage to care for the sick, they turned to people who could provide home nursing care. Gradually, however, the sick were moved to institutions and nursing became institution-based. This trend accelerated in almost all countries around the world. Today we see that nurses participate in curative functions, and are concerned with uncommon and/or complex diseases. Very few nurses work in the community to provide services such as illness prevention, encouraging and supporting communities and individuals to participate in their own health care, health promotion and maintenance, and assisting with rehabilitation that address the health needs outside of institutions aimed towards achieving an optimal quality of life.

Community Health Nursing↗
PubMed2002

[Sociopsychiatric care as a municipal problem].

Because of their disease mentally ill persons are often unable to request and receive necessary help on their own. Hence, local authorities have the legal duty to offer support in subsidiary or complementary ways or to organize help together with other participants concerned with psychiatric care. If the transition from community care to the differently structured regular health care system is too fast there is a danger of worsening of the symptoms. In the city of Bochum health insurance bodies agreed to take over the costs of therapy for mentally ill people via the sociopsychiatric services within the scope of crisis intervention. Background information on the sociopsychiatric services of the city of Bochum is given.

Community Mental Health Services↗
PubMed1975

Psychiatry: the battered child of medicine.

Psychiatry has had a troubled history. After the French Revolution "moral treatment" brought to America a period of effective and humane hospital treatment, but this progress was corrupted by the Industrial Revolution, and psychiatry was rejected by society as well as by medicine. Although the Freudian enlightenment and the introduction of social psychiatry have led to greater acceptance, today's criticisms are strident. Psychiatry is criticized for imprecise diagnosis, conceptual vagaries, jargon, therapeutic impotence and class bias. The American system of mental-health care is seen by many as a disaster. The federal comprehensive Community Mental Health Act has been aborted at an early stage. Skills involved in the practice of psychotherapy are not unique to the profession. Social ills, over which psychiatry has little control, play a large part in causing mental disability and retardation. Nevertheless, though embattled, psychiatry has contributed to medical practice and to the humane consciousness of society.

Attitude of Health Personnel↗