Cooperatives as a social enterprise in Italy: a place for social integration and rehabilitation

This article analyses the history and development of an integrated cooperative established in 1981 in northern Italy. Integrated cooperatives, otherwise known as social enterprises, are among the most interesting activities developed in the area of social assistance and rehabiliation in recent years in Italy. In particular, they acquired relevance in the care of mentally disordered people by providing them with job opportunities, which is an important rehabilitative and integrative factor. The aim of social enterprises is two-fold. They have the economic goal of offering remunerative work just as any other commercial enterprise, as well as the social mandate of promoting the physical, social, and mental health of their members. A positive coexistence between market competition and rehabilitation is therefore constantly pursued. This research aimed at analysing the working and social experience of people employed by the cooperative during its 10-year life. The study was limited to those who had a social or health problem when entering the cooperative. The investigation was promoted by cooperative members, who felt the need to document their experience and to undertake initiatives towards evaluating the rehabilitative value of the social enterprise. The results show that cooperative members come from different marginalized areas of social and health distress, of which the two largest are social service users and psychiatric service users. There is a noticeable turn-over rate, which underlines one function of the cooperative as being a transitional working context from which users can gain access to other more rewarding job opportunities in the labour market.     

Utilizing social media to support community integration

With the rising use of social media, one unexplored area of research and practice is how social media can be used to support community integration among individuals with psychiatric disabilities. Young adults with psychiatric disabilities use social media at a rate similar to age matched peers and report a desire for more complete integration into the community. Utilizing a four-dimensional model of community integration (i.e., psychological, physical, social, and independence), this article presents how social media activities can support integration. Social media activities are broken down to demonstrate how individual platforms and functions may be used to support community integration. The authors draw from a diverse set of literature, including research regarding the psychological and social benefits of social media usage among young adults, social media usage among individuals with psychiatric disabilities, and the importance of community integration for individuals with psychiatric disabilities. This article provides theoretical evidence for the use of social media as a supportive component to be included with interventions aimed at increasing community integration. Future research should examine the impact of social media usage by individuals with psychiatric disabilities on domains of community integration as well as explore the impact of interventions utilizing social media to support community integration.     

Environmental control and social integration of a high-lesion tetraplegic patient: case report

In the rehabilitation of high lesion tetraplegic patients, we should always aim at re-integration into the family. For these patients electronic devices and some Aids for Daily Living (ADL) assistance are of the utmost importance.     

Recovery-oriented psychopharmacology: redefining the goals of antipsychotic treatment

The traditional goals of psychopharmacology stem from the medical model. Rehabilitation interventions attempt to improve aspects of functioning in patients with chronic illnesses that are not responsive to biological intervention. Recovery is a concept emanating from the consumer self-help movement. It describes a move away from the patient role defined by a diagnostic label toward community membership defined by relationships and responsibilities in the community. Comprehensive care for people with psychotic disorders can include attention to each realm. This article provides an overview of the 3 models of care and describes a role for the psychopharmacologist in each as well as his or her unique potential to incorporate all 3. We outline potential synergistic benefits of integrating recovery-, rehabilitation-, and medical-model thinking into the practice of psychopharmacology and explore implications for the goals and outcomes of treatment for people with psychotic disorders.     

Hyperreligiosity in temporal lobe epilepsy: redefining the relationship

Seventy-six subjects with the primary diagnosis of complex partial seizures with a unilateral temporal lobe focus were examined for the presence of hyperreligiosity. Fifty-one subjects had a left temporal lobe seizure focus and 25 had a right temporal lobe seizure focus. In addition to the temporal lobe epilepsy (TLE) groups, two reference groups were also examined. The first consisted of 31 subjects with primary generalized seizures. The second control group consisted of 27 subjects with documented pseudoseizures and no objective evidence of recurrent epileptic seizures. In all cases, the documentation of seizures or pseudoseizures as well as the localization of the seizure focus was accomplished through simultaneous videotaped recording of the 16-channel scalp EEG tracing and the concurrent overt behavior during the ictal phase. The results of this study fail to support the hypothesis that individuals with TLE are characteristically hyperreligious during the interictal state. There were no significant group differences between the left vs. the right TLE groups, nor were there any significant group differences between the two TLE groups vs. the two comparison groups.     

Mental illness and social integration among suicide attempters in Copenhagen

In order to describe a population of suicide attempters in an affluent suburb of Copenhagen, 100 patients were interviewed, randomly chosen from a group of 246 patients referred to psychiatric consultation after a suicide attempt. The group consisted of 71 women and 29 men. Single status, abuse, and previous suicide attempts occurred frequently as did suicide among first-degree relatives. The most frequent reason for a suicide attempt was conflict with partners. In comparison with the normal population in the same catchment area, the patients were alone and felt lonely, but no difference was found in the group's relation to the labor market. After a four-year follow-up period, 9 persons had died by suicide. Borderline personality disorder and affective psychosis, no employment, 2 or more previous attempts, violent method and potential lethal attempt proved to be predictors of suicide later on. Alcohol and drug abuse, lack of social support and loneliness did not influence the risk.     

Time to reinvent the science of dementia: the need for care and social integration

Objectives: The increasing number of older adults with dementia is a large and growing public health problem. Alzheimer's disease, the prevailing form of dementia, is projected to quadruple worldwide. To date, the care and social integration of individuals with dementia is complicated by limited collaborations between biomedicine and other disciplines. The objective of this paper is therefore to reflect on the orientation of biomedicine with regard to the science of dementia, and to articulate a path for moving forward. Methods: The authors drew upon, and expanded, the insights of an interdisciplinary, international workshop entitled ‘Bioethics and the Science of Aging: The Case of Dementia’ held in October 2012 at the University of California in Berkeley.Results: The care of individuals with dementia compels solid interdisciplinary collaborations. There are several issues affecting the care of individuals with dementia: (1) an evolving definition of dementia; (2) the ambiguous benefits of the diagnosis of dementia; (3) ethical conflicts concerning consent processes and clinical trials; and (4) a limited understanding of the perspective of the person with dementia.Conclusion: We argue that it is time for a renewed dialogue between biomedicine and other disciplines -- particularly public health, the social sciences, the medical humanities and bioethics. This interdisciplinary dialogue would facilitate a process of self-reflection within biomedicine. This dialogue will also provide the foundation for equitable public health interventions and will further prioritize the values and preferences of individuals with dementia, as well as their care and social integration.     

Census tract predictors and the social integration of sheltered care residents

Summary It would appear that social-environmental circumstances surrounding the place of residence of patients discharged to sheltered care facilities are crucial to their adjustment to, and involvement in, community life. Census tract indicators of environmental circumstance were found to be strongly related to an individual's level of social integration. Mental health workers should carefully consider the immediate environmental situation in accepting a residence for the placement of discharged psychatric clients. Just as emphasis has been placed on the therapeutic milieu within the sheltered care facility, attention should be similarly directed to the attributes of the community immediately surrounding potential residential facilities.This study was supported in part by the Psychiatric Research Unit, Department of Public Health, Province of Saskatchewan, the California State Department of Health, and the National Institute of Mental Health, Grant No. MH25417-03     

A theory of social integration as quality of life

OBJECTIVE: Quality of life, once a priority in caring for people with severe mental illness, has since been eclipsed by other concerns. This article returns attention to quality of life by offering a theory of social integration (as quality of life) for persons disabled by severe mental illness. METHODS: Data collection for this qualitative study consisted of 78 individual, unstructured interviews with 56 adults who have been psychiatrically disabled. Field observations and interviews with staff and service users were carried out during eight ethnographic visits to service sites working to promote social integration. Data were analyzed with an inductive strategy based on grounded theory methodology and framed theoretically by the capabilities approach to human development. Goals were to identify personal capacities needed for integration, characterize occasions for capacity development in mental health care, and develop a working theory. RESULTS: Six personal capacities were identified: responsibility, accountability, imagination, empathy, judgment, and advocacy. Occasions were characterized in terms of their defining mechanisms: contradiction, reinterpretation, rehearsal, raising expectations, and confrontation. A working theory was constructed to characterize the process of capacity development for social integration through exposure to increasingly challenging occasions for growth in the context of mental health care. CONCLUSIONS: Capacities for social integration can be effectively developed as part of the everyday routines of mental health care. Eventually, the process shifts from development to the exercise of capacities and to participation as full citizens in the social world beyond treatment.     

The social integration of psychiatric patients in nursing homes

The authors explored self-reports of the social integration of 163 chronically ill psychiatric patients who were admitted to 12 nursing homes over a 1-year period. Results suggest that nursing home care for psychiatric patients is custodial and institutional in character and that the social integration of such patients is generally low. Nursing home patients had lower scores than outpatients but not inpatients on a measure of social participation; they were similar to both these groups on measures of spending and employment. Levels of social integration changed little over 1 year, either for better or for worse.     

Social role valorization insights into the social integration conundrum

More and more persons with mental retardation and psychiatric disabilities are present in mainstream society, yet have little interaction and few relationships outside their own peer groups of devalued persons. Social integration remains a desirable yet elusive goal for most human service organizations, and there continues to be a certain amount of confusion about what constitutes social integration. Recent reviews in North America and Europe testify to the difficulty of achieving social integration, particularly for people with mental retardation and psychiatric disabilities. Social role valorization, with its use of the social role concept, provides useful insights and tools for analyzing the social integration conundrum. A social role conceptualization of social integration is proposed and an illustrative example is provided.     

Treatment guidelines for Alzheimer's disease: redefining perceptions in primary care

Background: Current treatment guidelines for Alzheimer's disease (AD) do not reflect more recently collected data on therapeutic outcomes other than cognitive function and memory, and this has led to a limited understanding of the value of drug therapy in AD.Objectives: To evaluate the need to revise treatment guidelines for AD, to review data that have become available since the publication of current guidelines, and to communicate how existing guidelines and relevant new data can be valuable to the primary care provider who assesses and treats patients with AD.Data Sources: A MEDLINE search was conducted to identify existing treatment guidelines using the MeSH headings Alzheimer disease-drug therapy AND practice guidelines. The alternative terms treatment guidelines, practice parameter, and practice recommendation were also searched in conjunction with the MeSH term Alzheimer disease-drug therapy. Additionally, MEDLINE was searched using the term dementia and publication type "practice guideline." All searches were limited to articles published within the last 10 years, in English. A total of 116 articles were identified by these searches. Additional publications were identified by manually searching the reference lists of these articles and of published clinical trials of AD therapies.Study Selection and Data Extraction: Current AD treatment guidelines and clinical trial results for AD treatment options were extracted, reviewed, and summarized to meet the objectives of this article.Data Synthesis: Current guidelines support the use of cholinesterase inhibitors in patients with mild to moderate AD. More recent clinical research indicates that cholinesterase inhibitor treatment provides effectiveness across a wide range of dementia severity and multiple symptom domains. These medications also significantly decrease caregiver burden and may lower the risk for nursing home placement.Conclusions: The expanding literature on AD medications suggests that treatment guidelines need to be reexamined. Recent data emphasize preservation of abilities and delay of adverse outcomes in AD patients rather than short-term improvements in cognitive test scores. Treatment appears to provide the greatest benefit when it is initiated early in the course of the disease and maintained over the long term. Revised treatment guidelines should address newer medications and more recent outcomes considerations, as well as provide guidance on how long to continue and when to discontinue pharmacotherapy for AD.     

Quality of life and social integration of severely mentally ill patients: a longitudinal study.

The quality of life concept serves to measure functional changes and program outcome. Patients with schizophrenia have an improved prognosis. Is quality of life improving over time, and if so, over what period? These questions were addressed in a longitudinal study where subjective quality of life (SQOL) was rated by severely mentally ill patients living in the community and using support services located in an outlying area of Quebec. The Satisfaction for Life Domains Scale (SLDS) (Baker and Intagliata 1982) measuring SQOL as a whole and in specific domains (for example, housing, finances, social relationships) was repeated over a period of 7 y. Results show that SQOL ratings received the same scores after 7 y. Functional status was decreased, while social integration improved and more services were used. The results could be due to sample characteristics or to the ambiguity of the SQOL construct. In our opinion, extensive community-based support services may have played a key role in the maintenance of patient''s quality of life.