Determining suitability of placement for long-stay psychiatric inpatients.

Fifty-three long-stay patients on the back wards of a large psychiatric hospital in London were assessed to determine their suitability for other placements after the hospital was closed. The general and deviant behavior subscales of the REHAB Scale were used in the assessment. A wide range of scores indicated that these patients varied greatly in basic living skills. Associations were investigated between patients' scores and somatic problems, fluctuations in mental state, and adverse reactions to change, which affect patients' ability to live in the community. Of 14 patients whose scores indicated a potential for discharge, two had significant deviant behaviors, seven had fluctuating mental states, and two were known to react adversely to change. Although the REHAB Scale is useful, results show that placement decisions should not be based on scores alone. Flexible services that take into account fluctuations in patients' functioning are required.     

A comparative study of long-stay psychiatric patients discharged to boarding houses and satellite houses.

A comparative psychosocial study of two groups of long-stay psychiatric patients discharged from Callan Park Hospital to boarding houses and satellite houses in the Callan Park Hospital region is reported. It was concluded that the social and vocational functioning of both groups was at a low level but that satellite house residents had more spare money and described a less institutionalized and a more homely environment in satellite houses.     

Effect of psychopharmacotherapy on suicide risk in discharged psychiatric inpatients.

We investigated 64 former psychiatric inpatients who had committed suicide within 1 year after their discharge and compared them with a carefully matched control group of patients who did not commit suicide. One third of the patients in both groups were no longer in treatment at the time of the suicide or, for controls, at the corresponding point in time. At that time, a significantly higher proportion of controls had been receiving psychopharmacotherapy and a significantly higher proportion of them were on lithium.     

Meeting community service needs of discharged psychiatric patients

There is a growing recognition that the chronically mentally ill are a heterogeneous population with a multiplicity and diversity of needs. But inadequate information concerning the extent of the population service needs and the degree to which aftercare services meets these needs has contributed to the minimization of the problem. This article reports on the extent to which aftercare services meets the needs of discharged patients.Most discharged patients had a need for basic maintenance aftercare services such as individual counseling, chemotherapy, and financial assistance. However, there was also a high need for more rehabilitative services such as socialization services, social and vocational rehabilitation, and supportive residential services. Although almost half had their basic service needs met by aftercare services, few had their rehabilitative ones met.This study was funded by Grant 81–326 from the Office of Program Evaluation and Research, Ohio Department of Mental health.The authors wish to acknowledge Anne Mason, Paula Fishbein and Barry Gordon, Ph.D. for all their assistance.     

Personality disorders and unmet needs among psychiatric inpatients

OBJECTIVE: This study sought to examine the association between unmet need and personality disorders in a sample of psychiatric inpatients. The authors tested the hypothesis that the presence of a personality disorder would be independently associated with a significantly greater number of unmet needs. METHODS: A total of 153 psychiatric inpatients from four acute hospital wards serving an inner-city borough in London, United Kingdom, received standardized assessments of need and personality disorder by use of the Camberwell Assessment of Need Short Assessment Schedule and Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: Fifty-four percent of the sample had a personality disorder. The presence of a personality disorder was associated with greater unmet need. In multiple regression analyses, after adjustment was made for the effects of all covariates, severity of personality disorder was significantly associated with unmet need. Personality disorder was significantly associated with greater need in eight of 22 domains of need: self-care, psychotic symptoms, psychological distress, risk to self, risk to others, alcohol use, sexual expression, and budgeting. CONCLUSIONS: Personality disorder was found to be independently associated with a greater level of unmet need among psychiatric inpatients. The study highlights for the first time the importance of a comprehensive assessment of need for patients with personality disorders.     

精神科自动出院患者前瞻性调查分析

目的:探讨影响精神科住院患者自动出院的原因和有关因素.方法:对843例住院患者进行问卷调查,分析患者自动出院的原因及其影响因素.结果:自动出院者239例,Logistic回归分析显示:病区模式、性别、年龄、家属文化程度、费用负担、求医途径及患者家庭收入是患者自动出院的影响因素.经济困难是导致自动出院的最主要原因.结论:加强精神疾病知识的宣传教育,减轻疾病负担,是降低精神疾病未治率和提高治疗有效率的积极措施.     

Inpatient bed needs for psychiatric care

Along with other types of hospital inpatient care, acute psychiatric units are subject to state certificate-of-need review under Public Law 93-641. A study of 15 hospitals in Virginia suggests that prevailing techniques for determining inpatient bed needs are not appropriate for psychiatric beds, if indeed they are for other types of care. An alternative technique is offered, not as a substitute for judgment in such matters, but as assistance to it.Dr. MacStravic is an Associate Professor and Associate Director, Graduate Program in Health Services Administration and Planning, University of Washington, Seattle.     

Effects of patient and health-system characteristics on community tenure of discharged psychiatric inpatients

OBJECTIVE: The purpose of this study was to identify the differential effect of patient and health-system characteristics on length of stay in the community among recidivist psychiatric patients. METHODS: Data on demographic and clinical characteristics and mental health service utilization were collected for patients with at least one previous psychiatric hospitalization (N=1,972) who visited a psychiatric emergency department at a university hospital in Leuven, Belgium, between March 2000 and March 2002. Logistic regression analysis was used to compare the characteristics of patients with a short (less than two months), intermediate (two to 12 months), or long (12 months or longer) stay in the community between their last hospital discharge and referral to the psychiatric emergency department. RESULTS: One in three patients visited the psychiatric emergency department within 30 days of discharge from a psychiatric hospitalization, and 43 percent of the patients visited within 60 days of discharge. Patients with a short community stay were more likely to be unemployed and to have had a discharge against medical advice, a short previous hospitalization, no aftercare plan, and a history of two or more previous hospitalizations. Longer community stays were predicted by the presence of a personality disorder. CONCLUSIONS: For patients with a history of psychiatric hospitalization, early psychiatric recidivism may be more highly influenced by health-system characteristics than by the presence of severe mental illness.     

Integration of general hospital psychiatric services with freestanding psychiatric hospitals

General medical hospitals and freestanding psychiatric hospitals usually function independently. The authors review the relative strengths and weaknesses of the two settings and suggest a plan for a rational coordination of services. In an efficient integrated system, the general hospital would provide emergency psychiatric services and treat patients with combined medical and psychiatric conditions. The freestanding facility would offer inpatient and outpatient services, as well as partial hospitalization and transitional living arrangements, to psychiatric patients without medical complications. All facilities would share professional staff and data processing capabilities and would have common policies and procedures, reducing the cost of treatment and facilitating patient transfers.     

Meeting training needs of foreign psychiatric residents in state hospitals.

Foreign medical graduates entering psychiatric residency programs in the United States must cope with cultural, language, educational, and status barriers during their crucial first year of training. The authors point out the shortcomings of American residency programs for foreign trainees and describe how a program was developed to meet their special needs. It includes a more authoritarian form of instruction patterned after the educational structure the students were used to in their native countries and courses in American culture, English language, and problem-solving techniques.     

Oral health of psychiatric inpatients: a survey of central Taiwan hospitals

Objective

The objective was to investigate the status of oral health and its determinants in a group of psychiatric inpatients in central Taiwan.

Method

A cross-sectional study of the oral health of psychiatric inpatients (n=200) in three hospitals in central Taiwan was carried out during a half-year period. Demographic data and data on oral health habits, dental visit frequency, treatment fear and dental health knowledge were collected. Oral health was determined by the Decayed/Missing/Filled Teeth (DMFT) index, Community Periodontal Index (CPI), Plaque Index and Gingival Index.

Results

In terms of prevalence of caries, the mean DMFT score for all patients was 14.9±8.8 (S.D.), which was significantly worse than that in the general population. The CPI showed that only 10% of patients were periodontally healthy, 9.5% had bleeding, 31% had calculus and 49.5% had periodontal pockets. Increasing age, treatment anxiety, neglect of tooth-brushing and chronic ward inpatients were predictive factors for poor periodontal health. The self-awareness of poor oral health was inadequate and the treatment needs were huge in psychiatric inpatients.

Conclusion

The oral health of psychiatric inpatients was poor compared with the general population and was generally ignored by the patients themselves. The phenomenon is universal, occurring in both Western and Eastern countries.     

Awareness of treatment needs and length of stay amongst psychiatric inpatients

IntroductionInpatient psychiatric units experience significant pressure from third party payers to keep length of stay (LOS) to a minimum despite having to treat more severely ill patients. However, there is a paucity of empiric data for guiding treatment decisions that maximize therapeutic outcome while minimizing LOS. We therefore endeavored to begin utilizing a newly created psychometric instrument that assesses patient psychological factors, which we propose will allow for LOS prediction and individualization of therapeutic outcome.Materials and methodsThe Goals Questionnaire (GQ), created to determine awareness of treatment needs, was administered to newly admitted patients. Linear regression analyses were conducted to ascertain the relationship between the GQ score and LOS, as well as the effects of confounding factors.ResultsA significant and inverse relationship was found between the GQ score and LOS (β = −4.4; p = 0.007) that was dependent upon (i.e., had a significant interaction with) age and substance use disorders. There was minimal confounding from common administrative, legal, and clinical factors.ConclusionsThe GQ may have utility for inpatient treatment teams, providing information that can be used to maximize and individualize therapeutic outcome while minimizing LOS.     

Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: a qualitative study

Background

While the mental health situation for most people in low and middle-income countries is unsatisfactory, there is a renewed commitment to focus attention on the mental health of populations and on the scaling up of mental health services that have the capacity to respond to mental health service needs. There is general agreement that scaling up activities must be evidence-based and that the effectiveness of such activities must be evaluated. If these requirements are to be realised it will be essential to strengthen capacity in countries to conduct rigorous monitoring and evaluation of system development projects and to demonstrate sustained benefit to populations.

The Observatory

The International Observatory on Mental Health Systems (IOMHS) will build capacity to measure and to track mental health system performance in participating countries at national and sub-national (provincial and district) levels. The work of IOMHS will depend on the establishment of robust partnerships among the key stakeholder groups. The Observatory will build the capability of partner organisations and networks to provide evidence-based advice to policy makers, service planners and implementers, and will monitor the progress of mental health service scaling up activities.

Summary

The International Observatory on Mental Health Systems will be a mental health research and development network that will monitor and evaluate mental health system performance in low and middle-income countries.     

Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: a qualitative study

Background  

Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatric hospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway) and the differences in the treatment of depressive episodes.     

Burnout and the work environment of nurses in psychiatric long-stay care settings

The aim of this study was to investigate the relationship between burnout and a number of workrelated factors among nurses working in psychiatric long-stay care settings. Another aim was to investigate the differences between these associations at individual and at group level. Differences were found in the correlations, as well as in the regression analyses, at individual and group level. The correlations between burnout and the independent variables were more often significant at individual level and the explained variances of the regression analyses were much higher at ward than at individual level. Results showed that work environments associated with low levels of burnout were those in which workers had good support and feedback, job clarity, autonomy and low levels of complexity in their work, who had managers with a social leadership style and who had realistic expectations about their patients' potential for rehabilitation. Furthermore, it was found that it was not the individual work experience of the nurse that was important in determining burnout, but the mean work experience of the nursing staff.