scholarly journals A psychiatrist with beds: evolution and evaluation of socio-therapy on an acute admission ward

1991 ◽  
Vol 15 (11) ◽  
pp. 684-686 ◽  
Author(s):  
John L. Cox
Keyword(s):  
Mental Illness ◽  
General Hospital ◽  
Clinical Experience ◽  
Mentally Ill ◽  
Community Psychiatry ◽  
Psychiatric Service ◽  
District General Hospital ◽  
Admission Ward ◽  
Current Thinking ◽  
Hospital Psychiatry

There is a serious flaw in much current thinking about the development of ‘community’ psychiatry because of the failure to consider the function of admission wards and to resource them adequately. Excessive emphasis is placed on the value of non-hospital psychiatry with an implication that psychiatrists can manage patients adequately without beds (see Dean & Gadd, 1990). Although I have not met a consultant who literally believes this to be true, the managerial consequences of this attitude leads to in-patient units being yet further under-resourced, and so becoming more disturbed and having lowered morale. Yet in Better Services for the Mentally Ill (HMSO, 1975) the District General Hospital In-patient Unit was regarded as a main component of a comprehensive psychiatric service. Clinical experience does suggest that without an effective admission ward the management of patients in the community, including those with intractable mental illness, is unsatisfactory and sometimes totally impossible.

scholarly journals Establishing a District Psychiatric Service without Psychiatric Trainees

1986 ◽  
Vol 10 (12) ◽  
pp. 338-340 ◽  
Author(s):  
D. G. Kingdon ◽  
T. K. Szulecka
Keyword(s):  
General Hospital ◽  
Social Services ◽  
Early Development ◽  
Royal College ◽  
Medical Staff ◽  
Psychiatric Service ◽  
District General Hospital ◽  
Short Report ◽  
House Of Commons ◽  
The Social

The Report of the Social Services Committee of the House of Commons in 1981 (the ‘Short Report’) recommended the establishment of consultant posts without the support of trainee medical staff as part of a strategy to correct the situation where too many doctors occupied training posts for the number of consultant posts available.1 The Royal College of Psychiatrists has endorsed this policy,2 and the withdrawal of approval for training from an increasing number of hospitals around the country is leading rapidly to a situation where a large number of them need to look at alternative arrangements for providing medical cover. We would like to report the establishment and early development of such an arrangement based in a district general hospital.

Psychiatric In-Patients and Out-Patients

1972 ◽  
Vol 120 (557) ◽  
pp. 474-475
Author(s):  
A. G. Mezey
Keyword(s):  
General Hospital ◽  
Hospital Admissions ◽  
Psychiatric Service ◽  
Admission Rate ◽  
District General Hospital ◽  
The Elderly ◽  
Referral Rate ◽  
Official Statistics ◽  
Cent Increase ◽  
Patient Referrals

The reply of Morgan and Compton in this issue of the Journal (pp. 433–6), is based on a misunderstanding of our results and of the problem investigated. This leads them into a refutation of ‘claims' never made and they buttress it with a statistical exercise of great naivety. Our findings were:(a) ‘… in certain important respects in-patients and out-patients are derived from different though overlapping populations.’ The most marked differences (dismissed by Morgan and Compton as 'slight’) were found among the elderly. ‘The admission rate for the over 65s of both sexes was 4 · 90 per 1,000. In contrast, increasing age was associated with a gradual fall of out-patient referral rate to 1 · 60 for the over 65s.’ We did not claim to have demonstrated the cause of these differences, but mentioned possible reasons for them.(b) In a district general hospital-centied psychiatric service we observed a 34 per cent increase of new out-patient referrals while hospital admissions remained static; this occurred over a period of three years, when nationally hospital admissions were still rising. We quoted in illustration some extreme figures from official statistics and the figures for the Sheffield and the Liverpool regions were extreme whether one refers to Tables 3, 11 or 13 (1). This prompted the hypothesis that an increase in new out-patient referrals can prevent admission or prove an alternative to it. No ‘claim’ was made, and we advisedly used the term 'suggestion’ to emphasize that these are ‘no more than tentative and incomplete incursions into this difficult and relatively unexplored field’ (2).

Psychiatric intensive care after two years

1989 ◽  
Vol 13 (8) ◽  
pp. 421-422 ◽  
Author(s):  
J. M. O'Dwyer ◽  
B. S. Mann
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Mentally Ill ◽  
Psychiatric Patients ◽  
District General Hospital ◽  
Descriptive Study ◽  
Psychiatric Unit ◽  
Health Authorities

The following is a descriptive study of Willoughby Ward, a psychiatric intensive care unit, opened in Parkside Hospital, Macclesfield, in July 1986. It provides a moderately secure facility for the treatment of psychiatric patients within both Crewe and Macclesfield Health Authorities. The unit has 15 beds, of which two are funded and used by Crewe area, where, unlike Macclesfield, the psychiatric unit is located in the district general hospital. Managed as a locked ward, the patients are admitted under the provisions of the Mental Health Act 1983. As well as being mentally ill as defined in the Act, the patients were disturbed to a degree as to be unmanageable in open conditions.

The Chronically Mentally Ill in Community Facilities

1989 ◽  
Vol 154 (1) ◽  
pp. 77-82 ◽  
Author(s):  
C. J. Simpson ◽  
C. E. Hyde ◽  
E. B. Faragher
Keyword(s):  
Quality Of Life ◽  
General Hospital ◽  
Mentally Ill ◽  
District General Hospital ◽  
Group Homes ◽  
Chronically Mentally Ill ◽  
Community Facilities ◽  
Acute Wards

The quality of life of chronically mentally ill patients in acute wards in a district general hospital, a hostel ward and group homes was compared. Within the spectrum of care of these patients, the severity of psychopathology corresponded to their placement. Analysis, including adjustments for the influence of psychopathology, showed differences between the three types of facility. Although differences existed between all types of care, residents in group homes and the hostel ward shared more similarities in quality of life than those in the district general hospital. Problems of caring for the chronically mentally ill on acute wards are highlighted.

scholarly journals Universal SHO and SpR shift rotas adversely influence SHO operative experience

2006 ◽  
Vol 88 (7) ◽  
pp. 244-246 ◽  
Author(s):  
C Beaton ◽  
MR Stephens ◽  
AN Hopper ◽  
WG Lewis
Keyword(s):  
General Hospital ◽  
Shift Work ◽  
Clinical Experience ◽  
Surgical Training ◽  
General Surgery ◽  
District General Hospital ◽  
European Working ◽  
Training Post ◽  
Operative Experience ◽  
Working Time Directive

The European Working Time Directive (EWTD) will reduce the clinical experience obtained by surgeons prior to attaining consultant status from 21,000 surgical hours to 7,640 hours, 1 with shift work obligatory for compliance. We have shown previously that the operative experience of SHOs in general surgery is on the wane in our own hospital, varies with subspecialty interest 2 and has witnessed further erosion by the introduction of the EWTD. 3 The aim of this study was to assess the influence of an all tier shift rota on the emergency and elective operative experience of SHOs in a category 1 general surgical training post working in a large district general hospital serving a population of 600,000.

scholarly journals Rehabilitation in a district general hospital

1992 ◽  
Vol 16 (7) ◽  
pp. 431-432
Author(s):  
W. T. Astrid Maddocks ◽  
Peter D. Maddocks
Keyword(s):  
Mental Illness ◽  
General Hospital ◽  
Group Home ◽  
District General Hospital ◽  
Group Homes ◽  
Psychiatric Unit ◽  
Halfway Houses ◽  
Disabled Patients ◽  
Park Hospital

The Psychiatric Unit at Wexham Park Hospital has served a population of 230,000 with no entry to long-stay beds since 1972. There have been between 45 and 60 available beds for all types of mental illness except dementia. Various group homes and unstaffed halfway houses have been started, but the accumulation of more disabled patients showed the need for both a staffed group home, and rehabilitation to fit them for it. There was no separate ward or building in the hospital which could be used, and so rehabilitation had to be arranged on an acute ward. The staffed group home has a lower staff-patient ratio than a hospital hostel.

scholarly journals The effects of transcultural influences in community psychiatry as they affect the community nurse

Curationis ◽  
1980 ◽  
Vol 2 (4) ◽  
Author(s):  
E.D.D. Freed
Keyword(s):  
Mental Illness ◽  
Mentally Ill ◽  
Community Psychiatry ◽  
Cultural Psychiatry ◽  
Community Nurse ◽  
Cultural Aspects ◽  
After Care

Cultural psychiatry concerns itself with the cultural aspects of aetiology, frequency and nature of mental illness and the care and after-care of the mentally ill within the confines of a given cultural unit.

scholarly journals The dispensable psychiatrist

1997 ◽  
Vol 21 (9) ◽  
pp. 581-582
Author(s):  
John Kellett
Keyword(s):  
Mental Illness ◽  
Medical Students ◽  
Medical School ◽  
General Hospital ◽  
District General Hospital ◽  
Psychiatric Services ◽  
The Future ◽  
Stigma Of Mental Illness ◽  
Close Integration

Changes in the organisation and delivery of psychiatric services are likely to increase the stigma of mental illness, reduce the role of the psychiatrist, and inhibit recruitment of the best medical students. The value of close integration with the district general hospital and medical school is stressed. The future of psychiatry will be in doubt if this is ignored.

Underlying Patterns of Practice in a Regional Forensic Psychiatric Service

1993 ◽  
Vol 33 (1) ◽  
pp. 55-62 ◽  
Author(s):  
E F Mendelson
Keyword(s):  
Mental Illness ◽  
Personality Disorder ◽  
Sexual Risk ◽  
Mentally Ill ◽  
Psychiatric Service ◽  
Treatment Recommendation ◽  
Neurotic Disorder ◽  
Secure Care ◽  
Forensic Psychiatric ◽  
Patterns Of Practice

Using a sample of 306 consecutive referrals, the interactions were investigated between factors relating to patients, referral agencies, assessments and courts. Both the variations in referral rates of diagnoses and the psychiatric histories indicated that the service was being used largely for second opinions on the mentally ill, but for those with neurotic disorder or exacerbations of personality disorder it was more akin to a general psychiatric service. Those thought to pose a sexual risk to adults were particularly likely to have histories of violence, but the opposite was true for those considered a sexual risk to children. Reports initiated by the court are more likely to contain a treatment recommendation and are also more likely to be implemented than those in defence reports. Both the likelihood of a treatment recommendation and its acceptance by the court increased with the severity of diagnosis, with psychiatrist and court reaching full concordance in cases of mental illness. As many as 20 per cent of those seen in prison had mental illness and this was nearly seven times the out-patient rate. Forensic outpatient work was found to be independent of the provision of secure care. These and other findings are examined to help explore the nature of the service.

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