Cost-effectiveness of substance disorder interventions for people with severe mental illness

This study examines the cost effectiveness of three intervention strategies for people with severe mental illness who are dually diagnosed clients in terms of service use and costs. The interventions represent three primary approaches to treating these disorders: 12-step recovery, case management, and behavioral skills training. Interim findings from the study indicate that all three approaches are reducing acute and subacute service use and increasing involvement with outpatient and case management treatments. However, both the case management and behavioral skills approaches reduce costs more than the 12-step recovery approach, although not to a statistically significant degree in the data collected thus far. Overall, the societal costs for these clients are reduced by 43% without increasing the burden on client families or on the criminal justice system.     

Guardianship of people with mental disorders

The duty of a guardian is to protect a patient who is unable to care for himself or herself. Guardianship has been considered an abrogation of autonomy while conversely it often prevents irreversible harm to the patient. We examined the decision-making process for appointing a guardian in 60 cases from one mental health center in Israel, by examining the patients' medical records and court appeals. The results of our study suggest that guardians are usually appointed only in extreme cases, though alternative solutions are rarely sought, and that clear criteria for physicians when recommending guardianship are lacking.     

Legal dilemmas for clinicians involved in the care and treatment of children and young people with mental disorder

Background The 2008 revised Mental Health Act Code of Practice describes the legal framework governing the admission to hospital and treatment of children and young people for mental disorders as complex. Clinicians are required to be conversant with common law principles as well as the Mental Health Act (MHA), Children Act, Mental Capacity Act (MCA), Family Law Reform Act, Human Rights Act, and the United Nations Convention on the Rights of the Child. Professionals working with the MHA and the MCA have a legal duty to have regard to the respective Codes of Practice (MHA Code and MCA Code). In addition there is a need to keep up‐to‐date with developments in case law. The recent guidance from the National Institute for Mental Health in England, ‘The Legal Aspects of the Care and Treatment of Children and Young People with Mental Disorder’ draws all of the legal regimes together and suggests pointers on the most appropriate course of action when the regimes overlap. Discussion This paper will aim to highlight legal dilemmas relating to the care and treatment of under 18‐year‐olds for mental disorder and to discuss the impact of these on clinical practice. The new legal framework will be discussed with reference to hypothetical cases. Key issues include age and maturity, capacity, deprivation of liberty and the zone of parental control (ZPC). Conclusions It is essential that clinicians are aware of their responsibilities within the new legal framework in order to avoid becoming a target for litigation. This paper is aimed at meeting the recommendation for clinicians to be aware of their responsibilities and engage in appropriate training.     

Violence and mental disorder

There is increasing evidence that certain groups of mentally ill patients are at greater risk of behaving violently. The majority of the violence occurs in established cases of schizophrenia who have drifted out of ongoing care and supervision. Improved community services and more rigorous follow-up of at-risk groups could both improve the quality of life for these patients and reduce the chance of their acting violently.     

Managing physical illness in people with severe mental illness

People with severe mental illness have poor physical health, and increased morbidity and mortality compared to the general population. Community-based mental health care has led to hospital doctors being more involved in the physical care of psychiatric patients. This paper focuses on key issues in the medical management of psychiatric patients in a general hospital setting.     

Employment rehabilitation schemes for people with mental health problems

Although work and employment are important elements in the lives of people recovering from psychiatric illness, their access to meaningful occupation and paid employment is limited. A number of state and voluntary vocational rehabilitation schemes provide training or retraining for open employment but whether this is a realistic aim in the current economic climate has been questioned. This study, using direct observation and informal interviewing, explored the interaction between the staff and trainees of one such rehabilitation workshop. It sought to elicit information about the role of the workshop from both the trainer and trainee perspectives. The results indicate a number of differences between the staff and trainee models and illustrate the problems faced by the workshop in balancing its smooth operation against the needs and expectations of its staff and trainees. In particular, its organization around a relaxed interpretation of the ‘through-put’ concept of rehabilitation did not meet the requirements of all the trainees. We consider how employment rehabilitation schemes can achieve the dual role of both helping service users move into employment or other forms of meaningful occupation, and providing work and work substitutes for long-term users.     

Treatment of people with mental illness: a decade-long perspective

Many believe that managed behavioral health care has been associated with reduced access to care. Data from a variety of sources suggest that access has increased, although patterns of care and locations of treatment have changed. Data from Healthcare for Communities, a nationally representative community survey, show that access to care has not decreased for people with the most serious conditions who were more likely to receive specialty mental health care after 2000. Further, once people enter specialty care, the number of visits appears unrelated to need. The data highlight the urgent need for a greater focus on the quality of care and patient outcomes.     

250 labels used to stigmatise people with mental illness

Background  

The stigma against people with mental illness is a major barrier to help-seeking in young people for mental health problems. The objective of this study was to investigate the extent of stigma in relation to treatment avoidance in 14 year-old school students in England in relation to how they refer to people with mental illness.     

Models of specialist employment for people with mental health problems

There is a growing interest in work schemes for people with mental health problems. They appear to offer great promise, both in the delivery of community care and in social re-integration. However, the models operating in Britain are diverse and little is known about their operation, much less their effectiveness. In this paper the characteristics of nine models of specialist employment are described, and their similarities and differences are portrayed on three dimensions: productivity, integration, and permanence. Within this proto-typology it is hoped that clearer distinctions may be made between work schemes and what they have to offer. Recognition of fundamental differences between work opportunities should aid matching needs to services, facilitate more effective use of rehabilitation resources, and guide the commissioning of mental health services.     

Chronic disease and mental disorder

The aim of this study was to achieve a better understanding of the relationship between chronic medical illness and mental distress. Therefore, the association between chronic medical illness and mental distress was analysed, taking into account the modifying effects of generic disease characteristics (concerning course, control and possible stressful consequences), physical quality of life indicators and social and relationship problems. Panel data from the Dutch national Panel of Patients with a Chronic Disease (PPCZ) were used. Data from 1788 chronically medical ill patients (nine disease categories) concerning their mental and physical health have been used in a cross-sectional, multivariate analysis. Somatic disease, generic disease characteristics and physical quality of life were assessed by medical doctors. Mental distress and social/ relationship problems were assessed by questionnaire (respectively, GHQ-12 and Biopro). Members of the panel had more mental distress than a random community sample. However, there were no differences between specific somatic diseases. Relationship, job-related and financial problems increased the probability of mental disorder considerably. Relationship problems may be considered a generic characteristic of chronically ill patients, causing an increased risk of mental disorder. Poor physical health condition contributed to a higher probability of mental disorder as well. General practitioners, home care providers and medical specialists should be aware that people with chronic diseases are in general more at risk of mental disorder. For many chronically ill people, this risk is further exacerbated by social/relationship problems, and a poor level of perceived health.     

Food skills assessment tools for people with a mental illness

The present review defines food skills assessment tools and explores reasons for assessing food skills. The purpose of the present review was to consider tools appropriate for assessing food skills in people with a mental illness. Six assessment tools met the selection criteria: (i) the Rabideau Kitchen Evaluation, Revised; (ii) the Moss Kitchen Assessment; (iii) the Kitchen Task Assessment; (iv) the Functional Needs Assessment Program for Chronic Psychiatric Patients (Nutritional Management Program); (v) the Routine Task Inventory; and (vi) Assessment of Motor and Process Skills, 2nd edition. Each assessment tool was reviewed for criteria including strengths and weaknesses, the original target population, psychometric properties, scoring system and training requirements for the interviewer. The review concluded that food skills in people with a mental illness can be measured in many different ways; therefore, the precise reason for making the assessment should be established prior to selection of the assessment tool to ensure the most suitable method of assessment is chosen.     

Mandated treatment in the community for people with mental disorders

Commitment to community-based mental health treatment bears limited resemblance to commitment to treatment in a closed institution. It can be better understood in the context of a broad movement to apply leverage to induce treatment engagement, a movement that includes use of the social welfare and justice systems and psychiatric advance directives. Understanding "mandated community treatment" in all of its forms can be advanced by viewing it within the framework of health care quality as recently outlined by the Institute of Medicine, particularly along the dimension of patient-centeredness.     

Obesity among people with and without mental retardation across adulthood

OBJECTIVE: This study was designed to explore obesity during adulthood and the likelihood of moving out of obesity among 1809 adults without disability and 680 adults with mental retardation who received care at the same primary care practices during the period of 1990 to 2003. Research Method and Procedures: A retrospective observational design using medical records first identified patients with mental retardation (MR) and age-matched controls without disabilities. Data on BMI collected during each primary care visit allowed exploration of obesity at three levels. Moving out of obesity was defined as having a BMI <25 kg/m(2). We also abstracted data on age, sex, race, and other medical conditions. RESULTS: For adults 20 to 29 years of age, 33.1% of patients without disability and 21% of patients with MR had a BMI >30 kg/m(2). Between the ages of 50 and 59 years, 40.5% of the patients without disability and 35.2% of the patients with MR had a BMI >30 kg/m(2). Patients with mild MR had similar prevalence rates of obesity and patients with severe MR had significantly lower prevalence of obesity compared with the patients without disability through 50 years of age. Throughout the period from 20 to 60 years of age, between 15% and 40% of individuals with and without MR, who were previously obese, were not currently obese. DISCUSSION: Throughout the adult years, an increasing proportion of individuals with and without MR are obese. However, obesity is not a chronic state; many people transition back to a normal body weight.