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Results for “Deinstitutionalization”

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PubMed1998

Chronic patients in psychiatric institutions: psychopathology, level of functioning and need for care.

A total of 107 chronic in-patients in a catchment area of 106,000 inhabitants were rated for psychopathology on the Brief Psychiatric Rating Scale expanded version (BPRS-E), for level of functioning on the Rehabilitation Evaluation Hall And Baker (REHAB), and for geriatric problems on the Geriatric Rating Scale (GRS). The results showed low levels of severe psychopathology and low to moderate levels of functioning, indicating that the main obstacle to community placement was the lack of functioning. Global assessment by ward nurses with regard to the future level of care needed divided the patients into three categories: 40 patients in need of a psychiatric nursing home, 30 patients in need of a general nursing home, and 37 patients who could potentially be discharged to apartments with community support. This study indicates that the REHAB may help to identify patients who are potential candidates for community placement, while the BPRS-E may help to identify patients who are still in need of care in a psychiatric institution.

Activities of Daily Living↗
PubMed1998

The Nordic Comparative Study on Sectorized Psychiatry: patients who use only psychiatric in-patient care in comprehensive community-based services--a 1-year follow-up study.

In the present paper a sample of patients using psychiatric in-patient care only is characterized and analysed with regard to characteristics of the psychiatric services. This paper forms part of the Nordic Comparative Study on Sectorized Psychiatry, designed to investigate contact rates and use of psychiatric care by new patients in 7 catchment areas in 4 Nordic countries during a 1-year follow-up. One-year treated incidence cohorts were used. The logistic regression analysis revealed that the variable 'psychiatric service' was one of the statistically significant determinants of using only in-patient care during the follow-up. The diagnostic groups with the highest probability of using only in-patient care were dependencies and functional psychoses. The following factors were associated with a high risk of using only in-patient care: older age, being referred by another psychiatrist, having received previous psychiatric in-patient care, male sex, being retired, and not living with one's parents or a partner. Patients who used only in-patient care had fewer admissions and days in in-patient care than others during the 1-year follow-up period. Lack of 24-hour emergency services in out-patient care correlated positively with the use of only in-patient care.

Adult↗
PubMed1998

The TAPS Project 42: the last to leave hospital--a profile of residual long-stay populations and plans for their resettlement. Team for the Assessment of Psychiatric Services.

This study aims to assess the service needs of residual hospital populations and the adequacy of the alternative facilities provided for them following the closure of psychiatric hospitals. The remaining 368 long-stay patients in four representative English hospitals scheduled for closure within 1 year were assessed by means of a standardized schedule devised to rate problem behaviours. The residual populations consisted predominantly of elderly, male and very long-stay patients. The most frequent problem behaviours were hostility, physical aggression and incontinence. The one hospital which allowed new admissions to continue indefinitely had the highest proportion of problematic patients. Alternative care facilities were provided by a diverse range of agencies. Large residential homes were the predominant type of provision for most patients, and private nursing homes often accommodated mixed groups of elderly people. NHS trusts catered for most of the 'difficult to place' patients within specialized facilities, based in the community. There were some indications that compromises led to insufficient and understaffed specialist facilities. In view of the increasing demand for long-term intensively staffed facilities, this policy might put an extra burden on the local health services.

Adult↗
PubMed2006

Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience.

OBJECTIVE: To describe the development of a community-based mental health service, the patterns of care provided by this new service established in 1978 and its costs. METHOD: The South-Verona Psychiatric Case Register, the South-Verona Outcome Project and studies designed to assess costs provided process and outcome data. RESULTS: This paper summarizes descriptive statistics as well as the results of some evaluative studies conducted over the last 25 years in Verona, Italy. It reports patterns of care provided over the years by this new, comprehensive community-based service, targeted to the severely mentally ill but available also to all other residents in the area who need mental health care. CONCLUSION: Developing community-based mental health care requires a series of coordinated actions that need to be pursued over a long period of time. Service evaluation, including costs assessment, is an important part of this exercise.

Bed Occupancy↗
PubMed2006

The chronic psychiatric patient: problems, promises and perspectives, past, present and future.

OBJECTIVE: To present an overview of the issues involving the severely and chronically mentally ill over the past 50 years and summarize new research that may aid them. METHOD: To present the problems that have faced and will face this population, the promises that have been made about and to them, and assess how well we fulfilled our promises and handled the problems. RESULTS: We have made some but not enough progress in solving the problems facing the severely and chronic mentally ill in the past and at present, but the future holds more hope if recent solid, practical, economically feasible mental health services research is translated through policy and practice into better patient care. CONCLUSION: As pessimistic as we often are about the plight of the chronic mentally ill, their future can be better if recent research is implemented.

Chronic Disease↗
PubMed2006

"It's important to be proud of the place you live in": housing problems and preferences of psychiatric survivors.

TOPIC: It is important to understand housing and mental health issues from the perspective of psychiatric survivors. This paper reports findings from a series of focus group meetings held with survivors of mental illness to address issues concerning housing preferences and housing needs. METHODS: The discussions were recorded, transcribed, and analyzed using an ethnographic method of analysis. The themes that emerged related to oppression, social networks and social supports, housing conditions, poverty and finances, and accessing services. Participants described the ongoing stigma, discrimination, and poverty that reduced their access to safe, adequate housing. FINDINGS: They preferred independent housing where supports would be available as needed. Participants described the dilemma of having to choose between the housing they wanted and the supports they needed, since supports were often contingent upon living in a less desirable housing situation. CONCLUSIONS: Nurses and other mental healthcare workers need to be aware of these issues for discharge planning, community support, and ongoing advocacy. The survivor voices need to be heard by decision-makers at various levels of government in order for housing policy to become more receptive to their realities.

Anthropology, Cultural↗
PubMed2006

Therapeutic interpersonal interactions: the sacrificial lamb?

TOPIC: Emotional upheaval is rampant in society, affecting mental and physical health. Yet the focus, in the "Era of the Brain," lacks direction on how to address these issues. However, psychiatric-mental health nursing possesses the know-how to provide solutions. PURPOSE: To explore the history of psychiatric nursing and its impact on the nursing profession and society and how its legacy can support and facilitate change. SOURCES: Primary and secondary CONCLUSIONS: Therapeutic interpersonal interactions are quintessential competencies for advanced practice psychiatric-mental health nurses and should be upheld, promoted, and implemented to improve outcomes.

Deinstitutionalization↗
PubMed1979

Beyond the mainstream: the special needs of the chronic child patient.

Born of civil rights legislation and promoted by a desire for simple, rapid means of modifying behavior, Public Law 90-142 represents an effort at normalizing behaviorally disturbed children through "mainstreaming." This paper argues that a simplistic insistence on equality through mainstreaming violates the rights and needs of some behaviorally disturbed children to be different.

Adolescent↗
PubMed1984

Differentiating psychiatric readmissions from nonreadmissions.

This study tracked a cohort of 550 discharged state hospital patients through an entire publicly-funded mental health aftercare system. Data from hospital and community agency records indicate that neither social-demographic nor clinical characteristics successfully differentiated psychiatric readmissions from nonreadmissions. Use of aftercare services--in terms of the variety available and their relevance to discharged patients' assessed needs--had the greatest influence on predicting the likelihood of readmission.

Adolescent↗