Psychopathology in Adults with Mental Retardation Before and After Deinstitutionalization

In a pilot study, the presence of psychopathology in 47 individuals with co-occurring mental retardation and psychiatric disturbance was examined before and after their move from the last remaining state institution for persons with mental retardation in Vermont. These persons, identified in previous literature as the least likely to succeed in community placements, experienced reduced psychopathological symptomatology and appeared to be served equally well in a variety of small-scale community residences irrespective of their care providers' prior experience. Individuals under 50 years of age showed significant psychiatric improvement while those older tended to remain unchanged. These preliminary findings appear to support the viability of a community-based service model using small residences for all persons with mental retardation regardless of their need for mental health care.     

Exploring Differences Between Community-Based Women and Men with a History of Mental Illness

Relatively little is understood concerning the role of gender in persons with a history of mental illness residing in the community. This paper aims to explore gender's effect using data from the Community Research University Alliance project entitled, Mental Health and Housing. The primary five-year longitudinal study examined housing situations for psychiatric consumer/survivors in a mid-size, central Canadian region in an effort to improve the number and quality of appropriate housing situations. Data from 887 subjects in the original research underwent secondary analysis with particular relevance to differences between gender and indicators of health status including psychiatric history, levels of functioning, personal strengths and resources, and illness severity. Results of the secondary analysis found male and female differences that corroborated previous research. More women are housed than men, more women with mental illness were coupled than men, men have fewer social supports, and men have more substance abuse issues than women. These findings suggest health services within the community must consider these sex differences if they wish to properly assist Canadian individuals diagnosed with mental illnesses.     

Nurse–client relationships: The experience of community psychiatric nurses

The aim of the present study was to construct an interpretation of the experience of the nurse–client relationship in the context of community psychiatric nursing. Hermeneutic phenomenology formed the framework of the study. Shared conversations were conducted with five experienced community psychiatric nurses and five clients. Themes of ‘Being there’, ‘Being concerned’, ‘Establishing trust’ and ‘Facilitating transition’ were identified from the nurses’ conversations. This thematic structure was used to illuminate the centrality of the nurse–client relationship, and to articulate the skills that are involved in establishing and maintaining the relationship with clients with mental illness.     

Development of an instrument to measure self-efficacy for social participation of people with mental illness

Promoting social participation is consistent with the principles of psychiatric rehabilitation of people with severe mental illness, but lack of self-efficacy in social participation is a major barrier to the community integration of these people. The purpose of this study was to develop an instrument in the form of a mental illness scale (self-efficacy for social participation [SESP]) to measure self-efficacy in social participation among Japanese people and to evaluate the scale's reliability and validity. Devised from a content analysis of interviews with 12 patients regarding their participation in socialization programs, the scale consisted of 37 items. The scale's validity and reliability were tested in a total of 340 community-dwelling individuals with severe mental illness. The final scale consisted of four dimensions with 27 items. Internal consistency of the overall SESP-27 was excellent (α = .96). The scale demonstrated adequate criterion and construct validity and was psychometrically sound. The scale may offer clinicians a tool for planning how to help individuals with mental illness boost their self-efficacy in social participation and community integration.     

Social competence and maladaptive behavior of people with dual diagnosis

This study describes the social competence and maladaptive behavior of mentally retarded individuals with psychiatric impairments and examines the validity of five major psychiatric diagnoses as applied to the mentally retarded population: schizophrenia, personality disorders, autism, adjustment disorders, and conduct disorders. The adaptive and maladaptive behavior of individuals with a dual diagnosis (N=3,975) have been compared with the behavior of control samples who were selected by a pair-wise matching procedure on age, sex, IQ, and type of residence (i.e., own home or independent living, community care facilities, and state institutions). Among the dual diagnosis population, schizophrenic adults and autistic children have shown disturbances in many areas of adaptive and maladaptive behavior in comparison to their nonpsychiatric counterparts. Conduct disturbances, personality disorders, and adjustment disorders have shown significantly higher maladaptive behavior than their non- psychiatric counterparts. The results indicate a strong need for refined diagnostic techniques for identifying personality disorders and adjustment disorders in the mentally retarded population.     

Undergraduate student nurses’ experience of mental health simulation pre‐clinical placement: A pre/post‐test survey

Undertaking a mental health clinical placement can be anxiety‐provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post‐test survey was administered to a cohort of N = 89 Australian pre‐registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre–post differences indicated that all three factors were significantly different between the initial and follow‐up responses, with follow‐up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre‐registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students’ nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.     

Dual Diagnosis: Examination of Service Use and Length of Stay During Psychiatric Hospitalization

Anecdotal reports suggest that persons with a dual diagnosis (mental retardation and psychiatric illness) admitted to acute psychiatric hospitals stay longer and require more services than individuals without mental retardation. To test these hypotheses, a questionnaire was completed for 64 people with dual diagnosis admitted to 10 psychiatric hospitals over 3 months. Multivariate analysis revealed that a diagnosis of mental retardation was not a predictor of length of stay. Use of 1-to-1 staffing was more likely, while arrangement of different community placement at discharge was less likely for persons with than without dual diagnosis. Additionally, age, diagnosis, symtomatology, living arrangement, insurance status, and service use distinguished the patient groups. Implications are discussed in the context of a need for further examination and training focused toward this population.     

Learning from the world of mental health care: nursing students' narratives

This narrative study describes the substance of nursing students' learning in the area of mental health and their responses to the challenges of working in the psychiatric field. The data consisted of 39 critical incidents written by 20 Finnish second-year nursing students during their 5-week mental health placement. The narrative analysis method was used in the data analysis and the configuration of three consistent learning storylines: self-awareness and self-esteem, the nurse-patient relationship and mental health care methods. The three storylines characterized the essence of the students' learning and their responses to the challenges of the psychiatric field during the placement. The students were actively exposed to complicated care situations and patient encounters in which they had to face their own emotions and test coping skills. It seems that the critical incident technique stimulated students' narrative skills and possibly sensitized them for listening at the stories of their future patients.     

Reshaping students' attitudes toward individuals with mental illness through a clinical nursing clerkship

The purpose of this study was to evaluate the degree to which a psychiatric clinical clerkship alters nursing students' attitudes toward individuals with mental illness. The goal of the 4-week clerkship is to provide students with the knowledge, skills, and professional attitudes that will enable them to care for individuals with mental illness in different health care settings. A pencil-and-paper questionnaire was administered to 126 third-year students before and after the clerkship. Students were presented with four hypothetical patients with schizophrenia and were asked to what extent the patient was responsible for his condition, the emotions students felt, and whether students were willing to care for the patient or to segregate him in the hospital. After the clinical clerkship, students became more compassionate and less frightened by psychiatric patients, were more willing to care for individuals with mental illness, and expressed less need to segregate them from the community. In addition, in accord with professional attitudes, students became aware of their own attitudes (the responsibility attributed to patients) and their emotional responses, but these were no longer associated with reluctance to provide care.     

Reintegrating the mentally ill in the community

Substantial reductions in the in-patient census of state hospitals throughout the United States have led to the concentration of large numbers of formerly mentally ill individuals in sheltered living arrangements in local communities. These efforts represent a major change in providing care for the long-term chronic patient. How is the life of this individual affected by community placement? A survey was completed of 499 residents in 234 facilities representing all formerly hospitalized non-retarded mental patients between 18 and 65 years old in California's sheltered care facilities. Results indicate that the social functioning of individuals in the external community is enhanced primarily by the characteristics of the community in which they are placed. In contrast, the social functioning of individuals within the immediate environment of their sheltered living arrangements is most affected by the character of the placement itself. The particular characteristics of communities and facilities found to be most important in addition to the characteristics of the residents which impact on social integration are discussed in the study.     

A Descriptive Study of Pica Behavior in Persons with Mental Retardation

Individual variables of 45 persons residing in an institutional setting who displayed pica behavior were studied. Included in the analysis were the demographics of the sample, the types of materials being ingested, the sample's psychiatric diagnoses, and social skills deficits in persons with pica. Pica was prevalent in all age ranges of lower functioning clients with mental retardation. Furthermore, subjects in the study engaged in pica for predominantly nonsocial reasons (automatic reinforcement). Persons who displayed the mental disorders of pica, autism, and stereotypic movement disorder were more likely to exhibit pica. Implications of these results are discussed.     

Impact of theory and clinical placement on undergraduate students' mental health nursing knowledge, skills, and attitudes

Mental health issues are common and contemporary nursing students need to be well prepared to meet the mental health care needs of Australians. This study explored the influence of the mental health component of a Bachelor of Nursing course on second-year undergraduate nursing students' self-reported knowledge, skills, and attitudes in relation to mental health nursing. The study used a quasiexperimental research design involving questionnaires and individual interviews to determine nursing students' self-reported knowledge, skills, attitudes. Questionnaires were administered prior to undertaking the mental health theory, repeated prior to undertaking a clinical placement in either a community or inpatient mental health setting, and again after the clinical placement. The findings of the study indicated that a positive clinical placement had the greatest influence on nursing students' self-reported knowledge, skills, and attitudes and interest in nursing people experiencing mental health problems; however, the quantity of theoretical education also emerged as an influencing variable.     

The effect of a plant cultivating program conducted at a community mental health center on the functional remission of individuals with schizophrenia: A randomized controlled study

PurposeThis study was conducted to determine the effect of a plant cultivating program carried out in a community mental health center (CMHC) on the functional remission levels of individuals with schizophrenia.Materials and methodsThe study was carried out as experimental research in pretest-posttest with control group design. Eighty individuals being followed up and treated at two CMHCs were randomly assigned to an intervention and a control group. The plant cultivating program, containing a theoretical and a practical sequence, was conducted for six weeks in the intervention group. The effectiveness of the program was assessed with the Functional Remission of General Schizophrenia (FROGS) scale.ResultsThe individuals participating in the program registered a significant increase in their FROGS scale overall scores as compared to the control group following the program. After the program, the intervention group's social, health, daily skills and professional functioning posttest scores were significantly higher than those of the control group.ConclusionThe plant cultivating program applied to individuals with schizophrenia at the CMHCs positively resulted in an improvement in their functional remission. The nurse-led plant cultivating program conducted at the CMHCs was observed to be an effective and applicable program that would improve the social, health, daily skills and professional functioning of individuals with schizophrenia.     

Supported Employment: a Route to Social Networks

Background Evidence suggests that social networks mediate social functioning, self‐esteem, mental health and quality of life. This paper presents findings concerning changes in the social lives, skills, behaviour and life experiences of a group of people with intellectual disabilities (n = 18), who gained support from an employment agency to find paid work. Method The composition and quality of individuals’ social networks were mapped using a Social Network Guide. Changes in skills, behaviour and life experiences were assessed using standardized measures. Results The social network size of participants increased over time, with most social contacts being drawn from community contexts. This linked to improvements in life experiences, particularly in relation to leisure activities. Some improvements in adaptive behaviour were also found over time but no significant relationship between social network size and changes in adaptive behaviour were evident. Conclusions Whilst work will not guarantee social relationships, it can help maintain network size and provides a good opportunity for people with intellectual disabilities to meet others who are not associated with intellectual disability services.     

Survey of nursing and medical profile prior to deinstitutionalization of a population with profound mental retardation

During the planning stages of deinstitutionalization, the importance of nursing services must be recognized and given priority consideration in the community placement of persons with serious developmental disabilities. The objective of this study was to survey the medical and nursing profile of a group of nonambulatory, institutionalized individuals with profound mental retardation in anticipation of their nursing and medical needs in the community. Data were collected from the Individual Habilitation Plans of 55 individuals who had resided in a residential facility for individuals with mental retardation and were scheduled for community placement Serious medical problems in decreasing frequency were constipation (96%), seizure disorder (70%), poor dental hygiene (67%), cerebral palsy (62%), scoliosis (61%), contractions (41%), aspiration (44%), skin lesions (40%), and dysphagia (22%). Considering the complexity of health issues encountered in this population, adequate nursing and medical planning are critical to the wellness and successful community placement of a population with special needs.     

The Characteristics of Consumers Receiving Case Management in the Community: A Review of Literature

Mental health nurses increasingly provide care for consumers in the community who once would have received treatment in psychiatric inpatient units. The purpose of this review is to determine the characteristics of these consumers. We searched electronic databases and obtained information on some of the characteristics of community mental health consumers. For some nurses, over half of their caseloads are consumers with schizophrenia. Up to about one-third of consumers may be involuntary, but this proportion varies considerably. Impairments of health and social functioning appear common among consumers of community mental health services. This study identifies the need for greater interrogation of national databases to enhance understanding of community caseloads.     

Schizophrenia: management and care in the community

The move to community care has resulted in many more individuals with severe mental health needs relying on community services. Community facilities did not receive the proceeds from hospital closures and this had led to inadequate provision and facilities for individuals with severe mental health needs. There also appears to have been a lack of effective interventions and skills for dealing with this specific client group. The National Framework Strategy (Department of Health, 1999) for mental health outlines ways to modernize mental health services and aims to ensure that they will be more accessible, more effective and coordinated across health and social care. Over the past decade, there has been a great deal of research examining the effectiveness of psychosocial and family interventions for individuals with psychosis. This article discusses how such interventions could address some of the shortcomings of community care for the severely mentally ill.     

Undergraduate nursing students’ stigma and recovery attitudes during mental health clinical placement: A pre/post‐test survey study

Undergraduate nursing students have been reported to hold negative and stigmatizing attitudes towards mental health consumers and to be under‐prepared for mental health clinical placement. This study aimed to investigate undergraduate nurses’ stigma and recovery attitudes to mental illness, and describe their understandings of personal recovery on entry and exit to traditional mental health clinical placement. A pre/post‐test survey was administered to N = 249 nursing students in Australia. Demographic data, attitudes towards mental health nursing and clinical placement, the Opening Minds Scale for Healthcare Providers (OMS‐HC), Recovery Attitudes Questionnaire (RAQ‐7), and an open‐ended question on understandings of personal recovery from mental illness were collected on entry (T1) and exit (T2) to placement. At T1, students reported moderate stigma and positive attitudes towards recovery (OMS‐HC mean = 34.6; RAQ‐7 mean = 4.0). At T2, there was a reduction in stigma (social distance P = 0.02, d = 0.26) and improvement in recovery attitudes (P < 0.01, d = 0.40). Attitudes towards mental health nursing and placement also improved (P < 0.01). Having a family member with mental illness predicted improvements in stigma and recovery attitudes. On entry to placement, most students described accurate understandings of personal recovery, which were maintained during placement. The findings indicate that mental health clinical placements are effective in improving students’ mental health stigma and recovery attitudes and provide a prime opportunity to attract students into the field. Co‐produced or consumer‐led education provided by peer workers during clinical placements may improve students’ stigmatizing attitudes and stimulate their interest to work in the field.