Barriers to adequate care for mentally ill people

A serious and chronic problem that confronts mentally ill people and mental health professionals is the inability of society to provide the requisite resources for adequate care-giving systems. This difficulty has been evident for almost two hundred years. The present paper summarizes the major causal processes as these were revealed in the course of a case study of a mental health centre and its catchment area in Nova Scotia. These barriers to adequate care systems are then considered in historical perspective in order to illustrate how they function more generally. The historical perspective reveals a further handicap in the fact that experiences gained in one reform movement are not transmitted and utilized in subsequent efforts.     

Community care for people who are homeless and mentally ill

This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.     

Case management with homeless mentally ill people

This article reports the findings of a National Institute of Mental Health (NIMH) services demonstration project that used a mobile case management team to serve homeless mentally ill clients. The project examined three issues: (1) factors associated with client engagement in case management, (2) clients' perceptions of how case management affected their quality of life, and (3) significant differences between clients who remained engaged in case management services and those who discontinued involvement. The results indicated that clients who received more frequent case management contact, had higher assessed independent living skills, were older, were less likely to be substance abusers, and had experienced fewer periods of homelessness and fewer prior psychiatric hospitalizations were more likely to remain engaged in case management services. After six months of case management, clients perceived significant improvement in their global well-being, living situation, use of leisure time, finances, and physical health. Implications for providing case management services to homeless mentally ill people are presented.     

Families of chronically mentally ill people: siblings speak to social workers

Twenty siblings of chronically mentally ill people discussed their emotional responses to the mental illness of their brother or sister. The findings were drawn from a study that was part of the author's practice experience as a social worker in a community mental health setting. The findings also paralleled the author's life experiences as a sibling of a chronically mentally ill person. Sibling emotional responses were categorized into grief and loss phases of denial, anger, bargaining, depression, relief/respite, and acceptance. Siblings believed that their expressions of grief and loss were impaired by characteristics of mental illness and by mixed messages from the mental health system. The siblings recommended inclusion of siblings in client treatment; support and education for siblings; clear communication between social worker and family; a social worker focus on family strengths; and, most of all, effective client intervention. The sibling perspective points out the salient need for social workers to use their ecological, person-in-environment training to facilitate healthier family support networks for chronically mentally ill people.     

Health care practices and health status of the mentally ill in the community

The chronically mentally ill generally need a variety of social supports to maintain themselves in the community. This study assessed the health care practices and health status of community-based respondents to determine if the health care needs of this chronic population were being met. Although positive results were found, service gaps deserving of attention were also revealed.     

Educating family physicians to care for the chronically mentally ill

More than 50 percent of the chronically mentally ill receive their medical, psychiatric, and social support services from primary care physicians in the general health sector. Despite this high level of involvement with these patients, the majority of family physicians consider their training in the management of patients with mental disorders to be inadequate. This paper describes six categories of critical competencies that should be included in the mental health curricula of family physician training programs: therapeutic attitudes and skills, diagnosis and differential diagnosis, functional assessment, psychopharmacology, management of emergencies, and psychosocial treatments. It outlines the manner in which specific competencies could be incorporated in medical school, in family practice residency training, and in postgraduate continuing medical education as well as the specific elements included in each. The discussion is based on the assumption that more effective participation by family physicians in the treatment of chronic psychiatric illness requires active attention throughout the continuum of medical education.     

Community-based care of the mentally ill: a research review

A review designed to assess the state of the art of social work research in mental health discovered that a number of important studies have built knowledge cumulatively on community-based care of the chronically mentally ill. This article highlights the major findings of the studies, as well as their methodological strengths and weaknesses.     

Fitting dietary advice for oral health into the roles of food for elderly, mentally ill people

Aim: To identify the roles of food in a day-centre for elderly, mentally ill people, so that dietary recommendations for optimal oral health are made within the overall philosophies of the day-centre. Method: A qualitative approach was adopted. It comprised an observational study of the daily routine and a semistructured interview to examine the attitudes, beliefs and knowledge of the care-staff related to diet, general health and oral health. Results: The use of food was pivotal to the functioning of the centre. Food was used for nutrition, as a focus for communal activities, to express love and caring, and to maintain cognitive, daily living and social skills. All staff considered oral health important and appreciated the link between oral health, general health and diet (primarily sugar consumption). Despite this, one-third of carers considered tooth loss an inevitable consequence of ageing. Sugar was generally regarded as detrimental to general health, but attitudes towards use of sweeteners as an alternative were mixed. However, it was believed that elderly people can adapt to dietary changes. Conclusion: Dietary advice for oral health would be acceptable if put in the context of general health and the changes take account of the overall philosophies of the centre. To this end a ‘Healthy Eating Resource Pack’ was produced for use in the centre.     

Family care for the mentally ill: a new perspective.

Family care has been a subject of controversy since large numbers of discharged psychiatric patients have been placed in these homes. The debate has centered on whether such community facilities offer a meaningful alternative in caring for the mentally ill. Findings of a study dealing with the quality of care in the homes and factors deemed responsible for these conditions provide a new perspective on the dilemma.