Survival and its discontents: the case of British psychiatry

Sub-divisions of labour in health settings are common and medical dominance and encroachment from competitors are well known. This article considers this general picture but in specific relation to mental health work in Britain and its particular features of recent contestation. British psychiatric orthodoxy has faced challenges to its legitimacy for over a century. However, since the 1980s, in the wake of de-institutionalisation and a new shared service commitment to 'recovery', these challenges have taken new shape. They are explored by considering: the current ambit of mental health care; the sub-division of labour in specialist mental services; recent governmental expectations of the mental health workforce; and the contested legacy of theory and practice in mental health work. The conclusion is that the profession is not under immediate threat of collapse but that its fate may now rest on whether a biomedical or a biopsychosocial model of practice predominates in routine service delivery.     

Mental Health Service Use Types Among Asian Americans with a Psychiatric Disorder: Considerations of Culture and Need

Despite levels of need that are comparable with other groups, relatively few Asian Americans receive mental health care. While studies have described the tendency for Asian Americans to delay care until mental health symptoms are severe, relatively little research has examined how the severity of symptoms impact mental health service use. This study uses publicly available data from the National Latino and Asian American Study (NLAAS) and focuses solely on Asian American respondents with a psychiatric disorder (n?=?230). Unexpectedly, few Asian Americans with a psychiatric disorder received care in a medical setting. The perception of mental health needs increased the likelihood of using mental health specialist care. Social and systemic barriers together hinder mental health service use. Implications for addressing Asian American mental health service use within a changing health care environment are discussed.     

Perceived parental burden and service use for child and adolescent psychiatric disorders.

OBJECTIVES: Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. METHODS: A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. RESULTS: Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. CONCLUSIONS: Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.     

The relationship between type of mental health provider and met and unmet mental health needs in a nationally representative sample of HIV-positive patients

This study examined mental health service utilization among a nationally representative sample of adults with HIV and psychiatric disorders or perceived need for mental health services. Data are from the HIV Cost and Services Utilization Study (HCSUS) mental health survey (n = 1489) conducted in 1997–1998. Most (70%) needed mental healthcare. Of these, 30% received no mental health services in the previous 6 months, 16% received services from general medical providers (GMPs) only, and 54% used mental health specialists. Clients with perceived need for care were more likely to receive any mental health services and services from mental health specialists (versus GMPs) than clients having mental disorders without perceived need. More patients using specialists versus GMPs received psychotherapeutic medications and psychiatric hospitalizations, controlling for psychiatric symptom severity. The findings underscore that the differential mental health service provision between specialists and GMPs existing in the general population also is present among persons with HIV.     

The Changing Role of the Social Worker in the Mental Health System

ABSTRACT

The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons.

Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served.

Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.     

温州市综合医院精神卫生服务现状调查

目的：了解温州市综合医院精神卫生服务状况。方法：在温州市11所综合性医院进行问卷调查,内容包括医院规模及医疗服务总体资源,设置精神卫生服务机构及人员配置状况,精神卫生问题会诊情况,精神科联络情况及医院对临床医师进行精神卫生知识培训情况。结果：（1）11所综合医院中有5所设立了精神卫生科室,占45.5%;被调查的3所二甲医院均没有设立精神卫生科室。（2）设立精神卫生科室的5所综合性医院中,精神科会诊率平均为0.57%,在未开设精神卫生科室的医院中,精神科平均会诊率为0.13%,两者之间的差异非常显著。（3）11所医院都没有建立符合我国精神卫生特点的会诊—联络精神病学模式,都没有成立由精神科医师和临床医师共同参加的会诊联络小组。结论：温州市综合性医院精神卫生服务正处在起步阶段,已经开始重视精神卫生服务工作,但是资源配置、精神障碍的识别与处理、会诊联络精神病学工作及继续教育和培训等尚较粗略。     

天津市医疗机构精神卫生服务资源和利用状况调查

目的了解天津市医疗机构精神卫生服务资源和利用情况,为制定天津市精神卫生服务规划提供基础数据。方法使用《天津市医疗机构精神卫生服务状况调查问卷》调查并分析天津市18个区县365家医疗机构2006年精神卫生资源分布情况及精神卫生服务提供和利用情况。结果 2006年天津市有60家医疗机构提供精神卫生服务,共拥有精神科医生561人,精神科护士885人,精神科床位4281张,按人口密度计算分别为5.4/10万、8.5/10万、4.1张/万。全年总住院10449人次,门诊为434120人次。精神卫生资源相对集中于市内六区和其他六区,精神专科医院较综合医院的精神卫生资源更为丰富,三级医院所拥有的资源又明显多于一、二级医院。住院服务的利用主要在市内六区和精神专科医院,门诊服务利用主要在市内六区和非精神专科医院。结论天津市精神卫生资源处于国内较高水平,但是资源的分布和服务的利用极为不均衡,存在资源相对短缺和利用不足。     

The changing role of the social worker in the mental health system

The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons. Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served. Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.     

中国精神卫生资源状况分析

目的：掌握中国精神卫生资源分布和利用情况，为制定全国精神卫生防治体系建设与发展规划提供参考。方法：采用自编调查表对全国精神卫生机构进行调查，对其中机构、床位、人员数量等相关数据进行描述性分析。结果：截至2015年底，全国共有精神卫生机构2 936家，开放床位433 090张，卫生人员122 309人，其中执业（助理）医师30 122人，护士75 765人。385家设有老年病房，175家设有儿童病房；有528家精神专科医院设有康复科。结论：2010-2015年全国精神卫生专业机构数、床位数、医师数等大幅增长，但仍相对不足，且存在地域分布不均衡、亚专科发展滞后等问题。今后应进一步加强县级和中西部地区服务能力建设；大力支持亚专科发展，加强多学科专业队伍培养。     

深圳市宝安区社区全科医生精神卫生知识调查

目的调查深圳市宝安区社区全科医生对精神卫生知识的掌握情况。方法通过分层抽样,在宝安区的社区健康服务中心选取全科医生作为调查对象,以典型的焦虑症、抑郁症和精神分裂症个案作为案例描述,调查其对常见精神障碍的认识和相关知识的掌握情况。结果共回收有效问卷134份,深圳市宝安区社区全科医生对焦虑症、抑郁症、精神分裂症三种精神障碍的平均正确识别率为74.6%。对于非重性精神疾病中焦虑症和抑郁症,分别有85.1%和54.5%的全科医生建议咨询心理医生;而对于精神分裂症,79.1%全科医生建议看精神科医生。工作中遇到精神障碍患者,绝大多数(95.6%)会选择转诊转介专科机构,但其中只有71.4%人明确知道市级或区级精神卫生机构。结论有必要在社区全科医生中加大关于精神卫生知识的培训和宣传,提升其对常见精神障碍的识别、转诊、转介能力。     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

精神病专科医院经济运行调查和建议

精神卫生专业机构既是我国精神卫生服务体系的重要组成部分,也是精神卫生防治工作的主体。精神障碍发病率逐年增加,已经成为严重威胁我国居民健康的一类疾病。在新冠疫情防控期间,精神病专科医院在维持社会稳定方面起到的作用不可或缺。与综合医院和其他专科医院相比,精神病专科医院无论是在运营成本还是运营能力上都有所欠缺。研究揭示了精神病专科医院运行存在的一系列问题,建议社会和政府在要求精神病专科医院"公益"服务的同时,应切实了解精神病专科医院的运行现状并给予足够的支持。     

Eliminating The Wait For Mental Health Services

Timely access to mental health services is critical to successful treatment of adults with severe and persistent mental illness, and timeliness is a key quality indicator in calls for improvement to the health care system. Waiting weeks for a psychiatric appointment results in increased psychiatric hospitalizations, decompensation, and risk for suicide. However, many community mental health administrators assume that waiting lists for services are inevitable given the high demand for services. The present study evaluates the successful efforts of a large urban community mental health center to eliminate the wait for psychiatric services in an adult outpatient setting. Through systematic changes in the service delivery system, the wait time for a psychiatric appointment was reduced from 13 days to 0 days, and the no-show rate dropped from 52 to 18%. Furthermore, these changes were associated with reduced psychiatric hospitalizations and improved staff morale and teamwork. The change processes implemented can be successfully applied to other systems problems confronting mental health agencies.     

Quality of life of mental health consumers in Hong Kong: Analysis of service perceptions

Objectives Successful psychiatric rehabilitation entails fostering overall quality of life of individuals recovering from severe mental illnesses. Understanding how service-related perceptions may be related to quality of life can be useful in improving the effectiveness of community-based care. This study investigated the quality of life of mental health consumers using a service-oriented paradigm. Methods 162 mental health consumers from community-based psychiatric rehabilitation centers were interviewed. Analyses were conducted to investigate the relationships between service perceptions (perceived treatment coercion, rehabilitation needs, and continuity of care) and quality of life. Results Physical health quality was negatively related to rehabilitation needs. Mental health quality was negatively related to both rehabilitation needs and poorer continuity of service. Life satisfaction was negatively related to poorer continuity of service and higher perceived treatment coercion. Conclusions This study highlighted the significance of service perceptions in the well-being of individuals with severe mental illness.     

Using health production functions to evaluate treatment effectiveness: an application to a community mental health service

The randomized controlled trial (RCT) is the recommended means of evaluating health care effectiveness and cost-effectiveness. Whilst representing a 'gold-standard' in health services research, RCT evidence on the clinical and economic desirability of services and treatments is often absent. Where RCT evidence is lacking, or where it is infeasible to implement randomized controlled comparisons, longitudinal observational and naturalistic data sources when analysed appropriately can yield useful insights regarding the clinical effectiveness and economic efficiency of treatments. In this paper we demonstrate the utility of applying panel estimation methods to data from an Italian psychiatric case register as a means of modelling the mental health outcomes of patients referred to a community-based mental health service. Emphasis is placed on quantifying the clinical effectiveness of consultations with different mental health professionals (including in-patient days) and whether service outcomes are affected by psychiatric diagnosis. The impact of service consultations and their interaction with different types of psychiatric diagnosis on a measure of patient mental health are found to be statistically significant, although the size of these effects are not substantial from a clinical perspective.     

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan

Objectives The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. Methods A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Results Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of “restriction”. Conclusions Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.     

Challenges to implementing and sustaining comprehensive mental health service programs

The President's New Freedom Commission recently concluded that the nation's mental health service delivery system is ill equipped to meet the complex needs of persons with mental illness. A major contributor to this service quality crisis has been the longstanding divergence of research efforts and clinical programs. In this article, the authors begin by describing the unique needs of persons with serious and persisting psychiatric disorders and the evolution of the mental health service system that has attempted to meet these needs. They then discuss recent efforts to upgrade services by emphasizing the use of evidence-based practices (EBPs) and the research underlying their development. Next, they describe the difficulties of using traditional research methods to develop and test interventions for persons receiving services at public mental health agencies. Finally, they outline the challenges confronted when trying to disseminate these EBPs to the wider clinical community.     

上海市社区医护人员精神卫生知识的现状及影响因素*

目的了解上海市社区医护人员的精神卫生知识现状及其影响因素,为今后针对性开展培训、提高社区心理卫生服务能力提供依据。方法依托上海市心理卫生服务体系建设三年行动计划项目,选取上海市3家试点社区卫生服务中心的医护人员进行调查,采用"非精神科临床医师心理卫生知识调查问卷"对医护人员进行调查。结果 (1)本次调查总体平均分50.0分,各维度得分均低于60.0%满分;(2)职业类别、参与精防工作和参加过培训是影响精神卫生及各维度知识得分的主要因素;(3)家庭医生的精神卫生知识得分较高57.4分,相比公共卫生人员高12.3分,家庭医生各维度的知识得分均较高,其次是中医/理疗/康复人员;(4)参加精防工作人员的精神卫生知识得分比没有参与的高14.6分,其各维度的知识得分均较高;(5)参加过培训在个别维度的得分较高。结论社区医护人员的精神卫生知识水平总体偏低,对抑郁、焦虑等心理疾病的认识有待提高;培训与实践相结合,是提高社区医护人员精神卫生知识水平的有效途径。     

昆明市精神障碍患病率与卫生资源利用研究

目的：掌握昆明市精神障碍患病率和精神卫生资源投入及利用现状。方法：抽样调查全市精神疾病患病率及诊治情况,同时普查全市精神卫生资源现状。结果：精神和行为障碍的30天患病率为4．53％,12个月患病率为6．41％,终生患病率为15．19％,重性精神病30天患病率为1．02％,推算全市现重性精神病人51000人。全市共拥有精神科正规病床1920张,即每万病人拥有床位数为152张,精神科病床年平均使用率为92．6％。结论：昆明市精神卫生资源投入不足。