The corrections department: the forgotten branch of the mental health system

The Hawaii Department of Corrections (DOC), like other corrections systems throughout the nation, struggles with problems arising from incarcerating mentally ill prisoners and detainees. The incarcerated population of mentally ill persons burgeoned as mental hospital inmates were "deinstitutionalized" during the 1960s and 1970s. However, correctional facilities, particularly jails, became alternative institutions for mentally ill persons when communities were unprepared to provide required services. Correctional facilities were equally unprepared to manage seriously disabled mentally ill (SDMI) inmates, but the facilities provided a dumping ground for a community's undesirables. Out of sight, out of mind!     

New develpments in civil commitment of the mentally ill. Impact for patient, family, and psychiatrist.

In deciding Addington vs Texas the US Supreme Court established "clear and convincing evidence" as the standard of proof necessary for civil commitment of the mentally ill rather than the criminal standard, "beyond a reasonable doubt." This decision has major implications for the mentally ill person, the family, and the psychiatrist. The mentally ill person is returned to the role of patient. The family is given aid in their dilemma of coping with their psychotic member. The psychiatrist is seen as helper rather than jailer.     

The effectiveness of routine screening questions in the detection of alcoholism

To assess the prevalence of alcoholism in an ambulatory medical clinic and to determine the effectiveness of screening questions for alcoholism, 232 new patients in a medical primary care unit were interviewed using a questionnaire that included the Michigan Alcoholism Screening Test (MAST). Based on MAST scores, 47 of 232 subjects were designated as alcoholics, yielding a prevalence of alcoholism of 20.3%. Sensitivities and specificities for alcohol-use questions were calculated using the MAST diagnosis of alcoholism. The questions "How much do you drink?" and "How often do you drink?" yielded low sensitivities of 34.0% and 46.8%, respectively. The question "Have you ever had a drinking problem?" considered alone had a high sensitivity of 70.2%; when combined with "When was your last drink?" this question had a sensitivity of 91.5%. We recommend the routine incorporation of these last two questions into the medical history in light of the high prevalence of alcoholism in this outpatient population.     

Smoking rates and attitudes to smoking among medical students: a 2009 survey at the Nagoya University School of Medicine

Since smoking is implicated in many diseases, medical professionals are expected to contribute to the reduction of smoking rates in their practice. Medical students are also expected to learn the importance of practical measures against smoking. This study surveyed the smoking rates and attitudes to smoking among medical students of the Nagoya University School of Medicine. Out of 612 students in their 1st to 6th year in 2009, 31 students answered "yes" to the question "Did you smoke one or more cigarettes this past month?" and eight students did not respond. The maximum smoking rate was 6.4% (39/612). The respective rates of students to accept smoking by doctors, co-medical personnel, patients in general, and terminally ill patients were 50.8% in males and 38.9% in females, 51.3% in males and 41.6% in females, 41.4% in males and 23.0% in females, 80.5% in males and 84.1% in females. This survey demonstrated that though smoking rates among medical students were relatively low, many accepted smoking, especially for terminally ill patients.     

An assessment of asthma needs in Hawaii

The Hawaii State Asthma Control Program, as a part of state planning, disseminated and collected an asthma needs questionnaire aimed at answering this question: "In your opinion, what asthma-related issues need to be better addressed in Hawaii?" The top five areas of need identified by asthma stakeholders were (1) education, (2) disease management, (3) prevention, (4) healthcare, and (5) support.     

Actions, causes, and psychiatry: a reply to Szasz

In a recent paper, it was argued forcefully by Thomas Szasz that it is crucial to the scientific credibility of psychiatry that it abandon talk of the behaviour of the mentally "ill" in terms of causes: such behaviour is not caused by their condition--it simply has reasons, which are discounted by the medical model. It is argued in this paper that Szasz's theory is incomplete for two reasons: first, in assuming that reasons are radically different from causes, it cannot account for the possibility that "sane" behaviour might be just as much caused as "insane"; and second, it tacitly assumes that the origin of behaviour always lies with the agent--a view that arguably is an accident of grammar. Hence while there is no mental illness, this is because there is nothing that could be ill--and this means that there is no such thing as mental "health" either.     

Stigmatisation of mental illness among employees of a Northern Nigerian University

Background:

Prejudices against people with mental illness are widespread in many societies leading to a number of detrimental consequences. In order to adequately develop programmes and services that will help protect the rights and privileges of people with mental illness, it is imperative to study the nature of stigma and factors associated with it. Our objective in this study was to observe the level of stigmatisation of the mentally ill among employees of a Nigerian University and the factors associated with it.

Materials and Methods:

The study was carried out at the Ahmadu Bello University Teaching Hospital and the Ahmadu Bello University main campus. Employing a two-staged random sampling technique, 15 departments were chosen from both institutions, after which 10 participants were further sampled from each department to obtain a total of 150 participants. All the participants were administered the socio-demographic questionnaire and Mental Illness Clinicians’ Attitude 4^th version (MICA 4).

Results:

The findings indicate that 53.4% of respondents’ classified as high stigmatisation while 46.6% was classified as low stigmatisation. Low scores on stigmatisation were observed among departments of psychiatry, nursing and ophthalmology, while high scores were observed among respondents from administration and engineering. Relationship between variables and predictors of stigmatisation were also established.

Conclusion:

There is a high tendency to stigmatise persons with mental illness except where there has been some contact with mental health practice or among the clinical departments in the hospital. We recommend community psychiatry care for the mentally ill and psycho-education for staff periodically to reduce this level of stigmatisation.     

Stigma of mental illness: A study in the Indian Armed Forces

Background

Stigma against mental illness exists across all countries. Stigma devalues the ill person and their relatives and denies them from attaining their rightful place in society. Stigma also prevents the ill person from seeking help. Stigma in the Armed Forces of UK and USA has been identified as a barrier to help seeking and a cause for concern as it could affect operational efficiency. However, studies conducted in the services of this country are lacking. Hence we decided to measure stigma perceived by patients and caregivers of the mentally ill and to assess stigma regarding the mentally ill patients and their caregivers, in the general population.

Methods

A cross sectional survey of patients (302), their caregivers (98), and members of the general population (102) who had no relatives suffering from mental illness was done. The patients were given the Stigma Scale developed by King et al. The caregivers (98) were given the devaluation of consumers scale and devaluation of consumer families scale developed by Struening et al.

Results

90% of patients admitted to experiencing stigma. 86% of patients had experienced discrimination. Females experienced more discrimination than males. Stigma perceived was irrespective to age, mental status, rank and education of the patient. Caregivers perceived stigma and felt blamed by the community. Members of the general population gave similar responses.

Conclusions

Study has brought out the high levels of stigma faced by the patients and their caregivers. High levels of stigma observed are a barrier to care.     

流浪精神病患者的护理要点

目的:探讨流浪精神病患者的护理技巧及要点,提高护理质量。方法:对21名流浪精神病患者的病情特点采取的护理措施进行总结,得出行之有效的护理措施。结果:通过对其提供相应的护理措施,流浪精神病患者症状明显好转。结论:根据流浪精神病患者不同阶段出现的护理问题及时采取相应的护理措施,有利于提高患者的依从性,促进疾病康复。     

46例有刑事责任能力的法医精神病学鉴定案例分析

目的:探讨鉴定为有刑事责任能力的精神障碍者与所患精神疾病间的相关性。方法:收集我院2006-2010年46例鉴定为完全或限定刑事责任能力的法医精神病学鉴定案例进行统计分析。结果:被鉴定为完全或限定刑事责任能力者文化素质普遍较低,年龄多为青壮年,其中无精神病与有精神障碍者分别占17.39%、82.61%。结论:在法医精神病学鉴定中应明确诊断,谨慎评定刑事责任能力,维护司法公平正义,保护当事人的合法权利。     

The homeless mentally ill. The perspective of the American Psychiatric Association

The homeless mentally ill have become one of the greatest problems of present-day society. The American Psychiatric Association's Task Force on the Homeless Mentally Ill concluded that this is not the result of deinstitutionalization per se but of the way it has been carried out; homelessness among the chronically and severely mentally ill is symptomatic of the grave problems facing them generally in this country. Thus, the problem will not be solved until the basic underlying problems are addressed and a comprehensive and integrated system of care for the chronically mentally ill is established. Specific recommendations of the Task Force include an ample range of graded, supervised community housing; comprehensive and accessible psychiatric care and rehabilitation; the availability of general medical assessment and care, crisis services, and a dependable source of income; a system of case management in which one mental health worker is responsible for each patient; changes in commitment laws to make them more responsive to clinical needs; coordination between the various community resources; and ongoing asylum and sanctuary for that small proportion who require it.     

Stigma of mental illness: A study in the Indian Armed Forces

Background

Stigma against mental illness exists across all countries. Stigma devalues the ill person and their relatives and denies them from attaining their rightful place in society. Stigma also prevents the ill person from seeking help. Stigma in the Armed Forces of UK and USA has been identified as a barrier to help seeking and a cause for concern as it could affect operational efficiency. However, studies conducted in the services of this country are lacking. Hence we decided to measure stigma perceived by patients and caregivers of the mentally ill and to assess stigma regarding the mentally ill patients and their caregivers, in the general population.

Methods

A cross sectional survey of patients (302), their caregivers (98), and members of the general population (102) who had no relatives suffering from mental illness was done. The patients were given the Stigma Scale developed by King et al. The caregivers (98) were given the devaluation of consumers scale and devaluation of consumer families scale developed by Struening et al.

Results

90% of patients admitted to experiencing stigma. 86% of patients had experienced discrimination. Females experienced more discrimination than males. Stigma perceived was irrespective to age, mental status, rank and education of the patient. Caregivers perceived stigma and felt blamed by the community. Members of the general population gave similar responses.

Conclusions

Study has brought out the high levels of stigma faced by the patients and their caregivers. High levels of stigma observed are a barrier to care.     

Self-reported adherence with medication and cardiovascular disease outcomes in the Second Australian National Blood Pressure Study (ANBP2)

OBJECTIVE: To investigate whether responses to a previously validated four-item medication adherence questionnaire were associated with adverse cardiovascular events. DESIGN: Survey conducted among a cohort of participants in the Second Australian National Blood Pressure Study. SETTING: Australian general practice. PARTICIPANTS: 4039 older people with hypertension. MAIN OUTCOME MEASURES: All major cardiovascular events or death; first specific cardiovascular event. RESULTS: Subjects who adhered to their medication regimen (compared with non-adherent subjects) were significantly less likely to experience a first cardiovascular event or a first non-fatal cardiovascular event (hazard ratio [HR] for both, 0.81; 95% CI, 0.67-0.98; P = 0.03); a fatal other cardiovascular event (HR, 0.68; 95% CI, 0.48-0.99; P = 0.04); or a first occurrence of heart failure (HR, 0.58; 95% CI, 0.37-0.90; P = 0.02). Those who answered yes to "Did you ever forget to take your medication?" were significantly more likely to experience a cardiovascular event or death (HR, 1.28; 95% CI, 1.04-1.57; P = 0.02); a first cardiovascular event or death (HR, 1.31; 95% CI, 1.07-1.60; P = 0.01); a first cardiovascular event (HR, 1.34; 95% CI, 1.09-1.65; P = 0.01); or a first non-fatal cardiovascular event (HR, 1.35; 95% CI, 1.09-1.66; P = 0.01). Those who answered yes to "Sometimes, if you felt worse when you took your medicine, did you stop taking it?" were significantly more likely to experience a first occurrence of heart failure (HR, 2.06; 95% CI, 1.16-3.64; P = 0.01). CONCLUSIONS: Subjects who adhered to their medication regimen were less likely to experience major cardiovascular events or death. The question relating to forgetting to take medication identified non-adherent subjects likely to experience a cardiovascular event or death. Clinicians could use this question to identify patients with hypertension who are likely to benefit from medication adherence strategies.     

What do final year medical students at the University of Papua New Guinea think of psychiatry?

This study was conducted in 2004 to determine whether there was any difference between final year medical students who had rotated in psychiatry and those who had not, in terms of their preference for psychiatry as a career and their attitudes towards mental illness. A self-rated questionnaire was given to all the final year medical students at the University of Papua New Guinea. The results showed that the medical students in general had a negative attitude towards psychiatry as a career option and, although they were accepting of the mentally ill in a professional setting as colleagues or patients, they had a negative attitude towards close social contact with them as neighbours or as in-laws. Several students believed mental illness could be caused by sorcery or by spending much time with the mentally ill. Most students believed mental illness could be treated by prayer, one in five believed in the effectiveness of traditional healers and one in five did not believe modern medicine could treat mental illness. Apart from a reduction in stigma and in prejudice against a mentally ill neighbour, there was no significant difference in attitude between students who had rotated in psychiatry and those who had not. There was no significant difference in attitude between male and female respondents. There were, however, significant differences in attitude between students who had a positive family history of mental illness and those who did not. It was concluded that psychiatry was an unpopular choice for specialization and that students' attitudes towards mental illness were influenced more by their cultural beliefs and their family history of mental illness than by their rotation in psychiatry. These external variables that are independent of their medical training need to be considered during undergraduate medical training in order to optimize the provision of health care to the mentally ill in Papua New Guinea.     

Professional recommendations: disclosing facts and values

It is not unusual for patients and their families, when confronted with difficult medical choices, to ask their physicians for advice. This paper outlines the shades of meaning of two questions frequently put to physicians: "What should I do?" and "What would you do?" It is argued that these are not questions about objective matters of fact. Hence, any response to such questions requires an understanding, appreciation, and disclosure of the personal context and values that inform the recommendation. A framework for considering and articulating a response to these questions is suggested, using as a heuristic the phrasing "If I were you.../If it were me..." Journal of Medical Ethics Key Words: Professional-patient relations ? informed consent ? truth disclosure ? ethics, medical     

The moral status of the embryo post-Dolly

Cameron and Williamson have provided a provocative and timely review of the ethical questions prompted by the birth of Dolly. The question Cameron and Williamson seek to address is "In the world of Dolly, when does a human embryo acquire respect?". Their initial discussion sets the scene by providing a valuable overview of attitudes towards the embryo, summarising various religious, scientific, and philosophical viewpoints. They then ask, "What has Dolly changed?" and identify five changes, the first being that fertilisation is no longer required to create an embryo. Following this analysis they then ask when an embryo created other than by fertilisation begins to acquire respect. This paper explores the ethical and legal issues highlighted by Cameron and Williamson's paper.     

Adaptation of children to a chronically ill or mentally handicapped sibling.

The presence of a chronically ill or mentally handicapped child in a family can be a stress for the child's siblings, who often are ill informed about the nature and prognosis of the illness, may be uncertain what is expected of them in the caregiving role, may feel their own identities threatened, and may experience ostracism by their friends and misunderstanding at school. Although individual reactions vary widely, feelings of anger, guilt, resentment and shame are commonly reported. Excessive responsibility and concern about one's identity may add to these feelings and culminate in psychologic problems in the sibling. The physician caring for the family must be alert for symptoms of emotional disturbance or social maladjustment among the siblings of chronically ill or mentally handicapped children and should be prepared to counsel the family or refer them to a counsellor experienced in this area. In general, the first step is to be sure that the sibling is fully informed about the condition and to encourage frank discussion between the parents and the handicapped child's siblings.     

The torturer's horse

Noncoverage of the costs of care for the uninsured poor and their resultant lack of access to health care affect every American through the spread of disease, risk of dangerous behavior by the untreated mentally ill, and the slowing of American productivity and competitiveness. Insured, middle-class Americans must recognize that the low-income uninsured are not someone else's problem, and that the "us and them" attitude underlying medical indigence will ultimately present an enormous cost that we all pay -- both in the last-minute care provided in costly hospital settings and in the effects of our cruelty toward the most fragile members of our society.     

精神障碍犯罪嫌疑人刑事责任能力评定结果分析

目的 探讨影响精神障碍犯罪嫌疑人刑事责任能力评定的相关因素.方法 通过回顾性病例对照研究,采用简明精神症状评定量表(BPRS)和精神障碍犯罪嫌疑人刑事责任能力量表,对147例精神障碍犯罪嫌疑人进行评定,并分为无刑事责任能力组(91例)和有刑事责任能力组(56例).结果 无刑事责任能力组BPRS的总分和思维障碍、激活性、敌对猜疑等因子分分别为(45.23±7.88)分、(17.23±4.49)分、(4.80±2.04)分、(8.18±3.21)分,高于有刑事责任能力组的(31.16±9.32)分、(8.18±5.19)分、(3.89±1.67)分、(5.36±3.23)分,差异均有统计学意义(P＜0.05).逐步判别分析显示,既往精神病史(X2)、鉴定诊断(X3)、BPRS中的思维障碍(X6)、激活性(X7)、及精神病人刑事责任能力量表中分别反映作案时情况的因子2(X10)、对作案后对后果认识的因子3(X11)、作案后对自我保护能力因子4(X12)、疾病严重程度因子5(X13)等8个变量是精神障碍犯罪嫌疑人刑事责任能力评定量表的主要影响因子.结论 精神障碍种类、精神症状及其严重程度、作案时的诱因、作案后对其后果认识、作案后的自我保护能力等因素是精神障碍犯罪嫌疑人刑事责任能力的主要影响因素.