Changing to problem-oriented methods. Implementation in psychiatric institutions.

The so-called problem-oriented methods for organizing and recording clinical information offer many potential benefits to users in psychiatric institutions. Beyond the mechanical aspects of implementation, incorporating a problem-oriented approach into the practices of clinical teams entails conceptual and practical readjustments of considerable magnitude. Based on an 18-month study of eight psychiatric teams with diverse characteristics, the paper discusses rationales and priorities, as well as administrative and educational considerations in the conversion process. Such a process must be studied and understood in setting objectives and channeling resources, if outcomes are to match the expectations.     

Schizophrenia in Denmark. Incidence and utilization of psychiatric institutions

All first admitted in 1972 to Danish psychiatric institutions diagnosed schizophrenics at least once until September 1983 (310 males and 277 females) are followed up. The incidence of schizophrenics diagnosed at their first admission is 7.8 males and 3.4 females/100,000 inhabitants and when those diagnosed as schizophrenics only at a later admission are included the incidence is correspondingly 15.0 and 8.7. The number of in-patient days is highest in the first year and stabilizes at a lower level in the last 7 to 8 years of the follow-up. The patients spent proportionately more days in mental hospitals than in psychiatric departments in general hospitals. Hebephrenic schizophrenics predominate in mental hospitals. Schizophrenics diagnosed during their first admission spent 19.5% of the 10-year follow-up period in institutions, while schizophrenics diagnosed during a later admission spent 17.4% (NS). Males spent 19.7% of the 10-year follow-up period in institutions, females 16.0% (P less than 0.05).     

The prevalence of psychiatric morbidity among adults living in institutions

This paper presents prevalence data from the 1994 OPCS survey of psychiatric morbidity among adults permanently resident in institutions catering for people with mental health problems in Great Britain. It describes briefly the survey methods used, and how diagnoses of psychiatric morbidity were derived. Its main aim is to show the prevalence of psychiatric morbidity in different types of institutional settings. Residents were eligible for the survey if they were aged 16 to 64 at the date of sampling and were permanently resident at the establishment. Residents were defined as permanently resident if they had been living in the sampled establishment for six months or more, or had no other permanent address, or were likely to stay in the establishment for the foreseeable future. In 1994, about 33,200 adults aged 16 to 64 were permanently resident in accommodation for people with mental health problems. About a third of residents were in NHS hospitals, while about two-thirds were in residential care facilities. About two-thirds of adults interviewed suffered from schizophrenia, delusional and schizoaffective disorders. About 8% suffered from neurotic disorders and 8% suffered from affective psychoses (mainly bipolar affective disorder). The prevalence of schizophrenia, delusional, and schizoaffective disorders was higher in hospitals than in residential care, while the prevalence of neurotic and related disorders was higher in residential accommodation. The prevalence of schizophrenia, delusional, and schizoaffective disorders was higher in NHS psychiatric hospitals and general hospital units than in private hospitals, clinics or nursing homes.     

The prevalence of psychiatric morbidity among adults living in institutions

This paper presents prevalence data from the 1994 OPCS survey of psychiatric morbidity among adults permanently resident in institutions catering for people with mental health problems in Great Britain. It describes briefly the survey methods used, and how diagnoses of psychiatric morbidity were derived. Its main aim is to show the prevalence of psychiatric morbidity in different types of institutional settings. Residents were eligible for the survey if they were aged 16 to 64 at the date of sampling and were permanently resident at the establishment. Residents were defined as permanently resident if they had been living in the sampled establishment for six months or more, or had no other permanent address, or were likely to stay in the establishment for the foreseeable future. In 1994, about 33,200 adults aged 16 to 64 were permanently resident in accommodation for people with mental health problems. About a third of residents were in NHS hospitals, while about two-thirds were in residential care facilities. About two-thirds of adults interviewed suffered from schizophrenia, delusional and schizoaffective disorders. About 8% suffered from neurotic disorders and 8% suffered from affective psychoses (mainly bipolar affective disorder). The prevalence of schizophrenia, delusional, and schizoaffective disorders was higher in hospitals than in residential care, while the prevalence of neurotic and related disorders was higher in residential accommodation. The prevalence of schizophrenia, delusional, and schizoaffective disorders was higher in NHS psychiatric hospitals and general hospital units than in private hospitals, clinics or nursing homes.     

Quality of life of schizophrenic psychiatric outpatients as a criterion for treatment planning in psychiatric institutions

BACKGROUND: Subjective quality of life (QoL) is an indispensable part of the current concept of health. Therefore it should serve as a criterion for treatment planning in social psychiatric institutions. AIM: We looked at the QoL of our outpatients diagnosed with schizophrenia in order to identify possible areas of life that might need further attention in treatment planning. METHODS: We used the short German version of the Lancashire Quality of Life Profile (BLEP-KF) to evaluate the QoL of 164 schizophrenic outpatients. All patients were diagnosed with the International Diagnostic Checklists (IDCL) for ICD-10. Demographic and treatment data are analysed cross-sectionally in relation to their QoL. RESULTS: The majority of patients was moderately happy with their general QoL. They were least satisfied in the domains of job and financial situation, mental health and sexuality. Psychopathology and especially the quality of individual care had a significant influence on the evaluation of QoL. CONCLUSION: This result supports an argument in favour of more individual patient-centred forms of case management to reduce the burden of severe psychopathological symptoms experienced in everyday activities by patients suffering from schizophrenia.     

Health care reform: implications for academic psychiatric institutions

Health care reform provides an opportunity to redefine all aspects of our health care delivery system. This article focuses on mental health services and on the implications of health care reform for academic psychiatric institutions. Questions are raised regarding the challenges that academic psychiatric centers will face in pursuing the traditional responsibilities of research, education, and clinical care. The authors propose that intersystems dialogue will create solutions to the questions. The challenge to academic psychiatric institutions rests in creating the dialogue that will inform and guide new decisions regarding research, education, and clinical priorities with the ultimate aim of ensuring that quality is preserved through reform.     

Facilitating discharge in state psychiatric institutions: a group intervention strategy

Despite more than 30 years of deinstitutionalization, a significant number of individuals continue to experience prolonged stays in state psychiatric hospitals. Many of these individuals appear to develop an ambivalence or resistance to discharge. This can itself contribute to further delay in discharge planning and implementation. We will describe a group intervention for persons with long stays labeled as "resistant." This effort was guided by the premise that each individual could benefit from personally exploring those aspects of his or her experience that may be contributing to continued hospitalization. The group utilized standard methods of rehabilitation and training with strong emphasis on validating individual needs and feelings, peer support and practical results. After 1 1/2 years of group intervention, 5 of the 7 group members had achieved discharge and initial community success.