Use of an Automated Information System in Rehabilitation of the Mentally Ill

This overview of the psychiatric hospital system in the Republic of Moldova is conducted by an international team of researchers from Moldova and the United States. The study is based on the interviews and observations made at the three main psychiatric hospitals and a large group home. The discussion is contextualized by a brief analysis of the Soviet system of care for the chronically mentally ill and its strong emphasis on psychiatric rehabilitation. The system of psychiatric care in Moldova at the present time is found to exist on deteriorating vestiges of the Soviet infrastructure and a waning rehabilitation philosophy. Moldovan academia is identified as the most promising source of new ideas and approaches to treatment of the chronically mentally ill. However, the lack of resources in this impoverished country continues to present a formidable obstacle to the meaningful reform.     

Changes in Object Relations in Long-Term Mentally Ill Patients Treated in a Psychiatric Day-Care Unit

Abstract

This naturalistic longitudinal study analyzed the reciprocal dependency of the helping alliance and symptom outcome over the course of mid- and long-term outpatient psychotherapy as practiced in routine care in Germany. Patient-rated helping alliance and symptom distress were assessed repeatedly over a 2-year period in a sample of 259 outpatients in psychodynamic, cognitive–behavioral, and psychoanalytic psychotherapy. Hierarchical linear models showed that initial symptom distress negatively predicted subsequent quality of the helping alliance but not vice versa. Only initial symptom distress affected symptom status at the last treatment session. These results raise doubts about the helping alliance being a strong predictor of outcome and indicate that other patient and therapist variables might be more important for treatment success.     

Mental Health and Community-Based Rehabilitation: A Qualitative Description of the Experiences and Perspectives of Service Users and Carers in Bangladesh

Since 2016, Promotion of Human Rights of Persons with Disabilities in Bangladesh (PHRPB) has been working to include people with psychosocial disabilities in their community-based inclusive development work, and to increase access to formal mental health care. Field visits were carried out to PHRPBD catchment areas in Dhaka and Chittagong for a case study on the integration of mental health into community-based rehabilitation (CBR). This paper synthesizes the results of twenty-five semi-structured interviews carried out as part of the case study. Participants included people with psychosocial disabilities, intellectual disabilities, epilepsy or other cognitive impairments and their carers as needed. Interviews were audio-recorded, transcribed and translated from Bangla to English, then hand-coded for content analysis. Results were organized into five overarching categories: (1) explanatory models, (2) help-seeking behaviors, (3) impact of services, (4) challenges and barriers to improving mental health, (5) recommendations of users and carers. Respondents either had no explanation for why service users had become unwell or attributed it to physically and/or emotionally traumatic events or supernatural causes. Before attending PHRPBD’s mental health services, most had visited formal or informal health care providers, often with disappointing results. Despite positive feedback on PHRPBD’s services, participants identified ongoing challenges. Stigma, discrimination and human rights abuses persist and are compounded by issues of gender inequality. Participants also identified barriers and made recommendations specific to the program itself, mainly regarding accessibility (e.g., cost, distance, frequency). This study adds to the limited body of qualitative research on mental health in Bangladesh, reinforcing previous findings on explanatory models and health-seeking behaviors while providing new insights into the impact of a CBR program in this context. Feedback of service users and carers suggests that CBR may indeed be a useful approach to increase access to services in Bangladesh for people with psychosocial or intellectual disabilities, epilepsy or other cognitive impairments. However, this program is not without its limitations, some of which are the product of broader issues within the mental health system and others of the social and cultural context. More research is needed to formally evaluate this and other CBR programs in the Global South.

     

Strategies for Maintaining Optimal Wellness in the Chronic Mentally Ill

TOPIC Ways the chronic mentally ill avoid loss of control and the importance of both the therapeutic environment and the nurse-patient relationship in helping them do this.
PURPOSE. To examine the strategies people with chronic mental illness use to prevent loss of control and maintain health, and ways nurses can help with this process.
SOURCE. Findings from a previously published study of seven chronically mentally ill clients in a rural day-treatment center.
CONCLUSIONS. Four properties related to the core variable of "preventing loss of control" are relationships, feelings, good attitude, and functional activity. These properties must be examined within the context of the therapeutic environment as well as the nurse-patient relationship.     

A survey of the California Alliance for the Mentally Ill

Family groups are becoming increasingly active in providing support to family members and in mental health advocacy. The authors report the results of a survey that assessed the concerns of members of the California Alliance for the Mentally Ill and the treatment history of disabled family members. The 199 respondents were typically the parents of a schizophrenic son between the ages of 24 and 34 whose illness was first noticed in the late teens and for whom assistance had been sought for at least a decade. The respondents indicated that medication, family support, socialization centers, community residential treatment, and locked facilities had most helped the family member to improve. The most important additional needs were housing, vocational, and social opportunities and research.     

Beardslee's Preventive Family Intervention for Children of Mentally Ill Parents: A Swedish National Survey

Beardslee's family intervention (FI) is a preventative method for children of depressed parents and included among evidence-based methods in the US. In Finland and Sweden the FI has been used in families with varying parental diagnoses, although research is lacking for other parental diagnoses than depression. The aim of this questionnaire study is to investigate the introduction and implementation of the FI in Sweden, its safety and its feasibility in clinical services. Professionals in adult psychiatry using FI recruited 103 families who had participated in FI during 2007, regardless of parents’ diagnosis. Children between the ages of eight and 18 years were included. Parents and children were generally satisfied with FI and predominantly reported a positive impact of FI. No differences in responses were found between diagnostic groups. The study lends support to the assumption that FI is safe and feasible for use in general psychiatric populations.     

Loss of Control and the Chronic Mentally Ill in a Rural Day-Treatment Center

problem . What do chronically mentally ill clients consider to be the core variable in maintaining health, and how do they go about doing this? methods . A grounded theory design with analysis of interviews of seven chronically mentally ill clients in a rural day-treatment center. findings . The core variable in maintaining health according to chronic mentally ill clients is preventing loss of control. A process was discovered that clients used to do this. conclusions . Chronic mentally ill clients prevent loss of control by using informal relationships to adapt behaviors, attitudes, and feelings within a supportive environment. If this fails, they turn to formal sources of control such as therapists, case workers, or other mental health providers.     

Capacity as a Determinant of Non-consensual Treatment of the Mentally Ill in Australia

Numerous authors have argued that a lack of capacity, not a likelihood of harm, should provide the legal basis for coercive treatment when a person suffers a mental illness. Recently, the governments of Victoria and the Australian Capital Territory have begun to investigate that avenue of law reform. In this context, this article surveys current Australian mental health legislation to determine to what extent, if any, a lack of capacity already forms a part of the legal basis of coercive treatment. Careful analysis of the statutes and relevant case law reveals that a lack of capacity plays almost no role as the basis for non-consensual treatment of people with mental illnesses in Australia. The article concludes by suggesting a mechanism by which capacity could be made the fulcrum of non-consensual treatment, using New South Wales as an example and adopting a minimalistic approach.     

A Model Program for the Treatment of Mentally Ill Offenders in the Community

There is a new and growing interest amongcommunity mental health providers and administrators inthe area of correctional psychiatry. From a column inPsychiatric Times to committees and task forces in APA and the American Academy of Psychiatry andthe Law, increased attention is being paid to the greatneed for the treatment of mentally ill offenders. Inthis article, we will introduce the reader to the magnitude of the correctional system and tothe prevalence of mental illness in the correctionalpopulation. We will then describe several model programsdesigned to work with mentally disordered offenders, and outline a novel collaborative approachbetween a CMHC and a Probation Office designed to helpmentally disordered offenders succeed in communitytreatment. Several barriers to treatment faced by this population will be identified, including doublestigma, lack of family/social support, comorbidity,adjustment problems, and boundary issues. Case vignettesdesigned to illustrate key points will beincluded.     

A Capitated Model for a Cross-Section of Severely Mentally Ill Clients: Hospitalization

Hospitalization outcomes are examined in a threeyear random assignment controlled study of two capitatedIntegrated Service Agencies (ISAs) in California. Studyparticipants were a cross-section of severely mentally ill clients. Using the flexibility ofcapitated funding, the urban ISA reduced inpatientlength of stay and days, but not admissions. Elements ofthe capitated ISA model worked together to produce clinically appropriate and less costly use ofinpatient services. At the rural ISA, admissions werereduced substantially during the first two years of thedemonstration but not costs.     

A Capitated Model for a Cross-Section of Severely Mentally Ill Clients: Employment Outcomes

Employment outcomes are examined in a three year controlled study of two Integrated Service Agencies (ISAs) for a cross-section of severely mentally ill clients. At each site significantly more ISA members than comparison clients obtained some paid employment. At the urban site the difference was dramatic: 73 vs 15 percent worked during the study period, and 29 percent of the ISA clients worked competitively. The significant but still limited ISA results argue for increased employment opportunities for all seriously mentally ill clients.     

A Psychoeducational Program for Caregivers of the Chronic Mentally Ill Residing in Community Residencies

The objective of this study was to develop apsychoeducational program for caregivers of thechronically mentally ill residing in communityresidencies. An evaluative component was added todetermine how well the program was received by caregivers andwhat impact the program had on the residents. A total of20 caregivers and 63 residents participated in theprogram. In general, the psychoeducational program was well received by the caregivers. Theyespecially liked the mental health component andopportunity to meet and interact with other caregivers.There was a significant drop in hospital admissionsfollowing the program. There was also improvement in anumber of quality of life activities such as trips tothe local coffee shop and mall.     

NPACT: Enhancing Programs of Assertive Community Treatment for the Seriously Mentally Ill

Morbidity and mortality due to physical illness is extremely high in the population of persons with serious mental illness. The purpose of this study was to examine the impact on psychiatric and physical outcomes through enhancing a standard Program of Assertive Community Treatment (PACT) with Advanced Practice Psychiatric Mental Health Nurses (APNs) and stabilized consumer peer providers (NPACT). In a two-group community comparison design, 38 participants receiving NPACT were compared to 21 participants receiving traditional PACT. Evaluations were conducted at baseline and 6 months. Significant improvements over time were demonstrated for both groups on all summary variables. Treatment effects for NPACT over PACT were demonstrated for psychiatric symptoms, community functioning, and consumer satisfaction. Conclusions: Enhancements for PACT using advanced practice nurses and consumer peer providers have the potential to address both health and mental health problems for the seriously mentally ill.     

Sociodemographic Characteristics of Severely Mentally Ill Clients in Rural and Urban Counties

Sociodemographic differences between rural and urban clients with severe mental illness (SMI) are explored using approaches which extend research in this area beyond limitations found in the few existing studies. Sixteen hundred adult clients from 18 Wisconsin counties are classified according to the degree of rurality of their counties of residence, using two definitions: a dichotomous metropolitan-non-metropolitan grouping and population density. There are significant differences between rural and urban clients for age, gender, and marital status, but not education or income. Young (18–35 years), unmarried males are more likely to live in more densely populated counties. Older (65 and older) women who are currently or previously married are more likely to live in less densely populated counties.     

Mentally Ill Populations in Jails and Prisons: A Misuse of Resources

Psychiatric Quarterly -