scholarly journals Service innovations: Sherbrook partial hospitalisation unit

2001 ◽  
Vol 25 (2) ◽  
pp. 56-58 ◽  
Author(s):  
M. L. Wesson ◽  
P. Walmsley
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Care ◽  
Patient Admission ◽  
First Year ◽  
Clinical Implications ◽  
Short Stay ◽  
Short Term ◽  
Extended Day ◽  
Innovative System

Aims and MethodNationally, a variety of community care projects are being developed to replace institution-based care. We describe an innovative system of providing mental health care in Southport, combining an extended day service with short-term hospital admission – the partial hospitalisation philosophy.ResultsDuring the first year of operation 438 assessments took place with 27% of patients being admitted to a crisis bed and a further 25% supported via attendance at the unit.Twelve per cent needed in-patient admission and 10% were deemed not to require any involvement of the mental health service.Clinical ImplicationsThe use of short-stay admission coupled with extended day care and crisis line support can provide a viable alternative to admission to the acute ward.

scholarly journals Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel Sayko Adams ◽  
Esther L. Meerwijk ◽  
Mary Jo Larson ◽  
Alex H. S. Harris
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Chronic Pain ◽  
Veterans Health Administration ◽  
First Year ◽  
Veterans Health ◽  
Health Administration ◽  
Military Health System ◽  
Military Health ◽  
The Military

Abstract Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

Community Care in Camberwell

1984 ◽  
Vol 145 (2) ◽  
pp. 178-186 ◽  
Author(s):  
Elizabeth Sturt
Keyword(s):  
Patient Care ◽  
Residential Care ◽  
Day Care ◽  
Community Care ◽  
Important Determinant ◽  
First Year ◽  
Short Term ◽  
Term Care ◽  
Residential Services ◽  
History Of

SummaryA census was taken of all patients in psychiatric hostels and homes, psychiatric day care, and short-term in-patient care who also had at least one year's history of contact with services. During the following two years, 61% of the patients stayed continuously in day or residential care, while 17% were discharged from care within the first year and made no further use of day or residential services. Two main patterns of contact were evident–repeated short-term in-patient care or longer-term care in services outside hospital. Their most important determinant was whether a viable marriage still existed for the patient.

Doctors' Holding Power in Practice: Section 5(2) of the Mental Health Act 1983

1995 ◽  
Vol 35 (3) ◽  
pp. 231-236 ◽  
Author(s):  
A D Hall ◽  
B K Puri ◽  
T Stewart ◽  
P S Grahame
Keyword(s):  
Mental Health ◽  
Psychotic Disorder ◽  
Psychiatric Service ◽  
Patient Admission ◽  
Case Note ◽  
Short Term ◽  
Affective Psychosis ◽  
Mental Health Act ◽  
Holding Power ◽  
Large Catchment

Section 5(2) of the Mental Health Act 1983 (England and Wales) is a commonly used short term power of detention often implemented by junior medical staff, which has no statutory right of appeal. There is little published analysis of its use in clinical practice. A detailed case note study of its use in a psychiatric service with a large catchment area is presented. Fifty-seven per cent of the patients detained under s.5(2) were female. Affective psychosis was over-represented in detained females, while schizophrenia and paranoid states were over-represented in males. Eight per cent of s.5(2) detentions were initiated via the nurses' holding power, s.5(4). None of these patients were subsequently regraded to s.2 or 3, which may be accounted for by the finding that personality disorder and alcohol dependence were more commonly diagnosed in this subgroup. Of s.5(2) detainees, none of those with a non-psychotic disorder were regraded to s.2 or 3. Three patients had not accepted in-patient admission prior to implementation of s.5(2). Moreover, 38 per cent of all s.5(2) detentions took place within 24 hours of admission. Patients with a psychotic disorder were more likely to be detained within 24 hours of admission. Doubts regarding the validity of consent to voluntary admission in these patients are raised.

Coercion in Community Mental Health Care

2016 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mentally Ill ◽  
Community Care ◽  
Current Knowledge ◽  
Community Services ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Improved Outcome

The use of coercion is one of the defining issues of mental health care and has been intensely controversial since the very earliest attempts to contain and treat the mentally ill. The balance between respecting autonomy and ensuring that those who most need treatment and support are provided with it has never been finer, with the ‘move into the community’ in many high-income countries over the last 50 years and the development of community services. The vast majority of patients worldwide now receive mental health care outside hospital, and this trend is increasing. New models of community care, such as assertive community treatment (ACT), have evolved as a result and there are widespread provisions for compulsory treatment in the community in the form of community treatment orders. These legal mechanisms now exist in over 75 jurisdictions worldwide. Many people using community services feel coerced, but at the same time intensive forms of treatment such as ACT, which arguably add pressure to patients to engage in treatment, have been associated with improved outcome. This volume draws together current knowledge about coercive practices worldwide, both those founded in law and those ‘informal’ processes whose coerciveness remains contested. It does so from a variety of perspectives, drawing on diverse disciplines such as history, law, sociology, anthropology, and medicine and for is explored

Attitudes toward Psychology, Psychiatry and Mental Illness in the Central Eastern Cape of South Africa

1996 ◽  
Vol 26 (4) ◽  
pp. 221-225 ◽  
Author(s):  
Christopher R. Stones
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Service Providers ◽  
Psychiatric Treatment ◽  
First Year ◽  
Eastern Cape ◽  
Medical Practitioners ◽  
General Medical Practitioners

A survey of attitudes held by a large sample of university students as well as by smaller samples of psychologists, general medical practitioners, members of the public, psychiatric hospital staff and patients in the central eastern Cape toward mental illness and mental health-care service providers was conducted during the early part of 1994. It was found that marked differences existed between the different samples and that the extent of a person's knowledge about mental illness, as well as the degree of contact with mental-health professionals and their services, were important influences on the attitudes of respondents. In particular, third-year psychology students tended to be more negatively disposed to psychiatric treatment than those students in their first year of study. Conversely, the attitudes of final-year students toward the discipline of psychology were more positive than those held by students in their first year of studying psychology. Within both the student and the patient samples, only a small minority indicated that they would first seek help from general medical practitioners if they were ever to contemplate taking their own lives or if they were seriously mentally ill. Psychiatric patients and service providers indicated their confidence in psychiatric treatment and the psychiatrist was considered to be the most appropriate professional to deal with mental illness. Members of the general public were found to be more optimistic than psychologists about the efficacy of psychological and psychiatric treatment, but less so than general medical practitioners. Although mental health-care professionals were viewed in a favourable light, most respondents indicated that they would nevertheless prefer to approach a friend in times of psychological distress.

scholarly journals Residential care homes for the mentally ill

2001 ◽  
Vol 25 (2) ◽  
pp. 58-61 ◽  
Author(s):  
C. Kinane ◽  
K. Gupta
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mentally Ill ◽  
Catchment Area ◽  
Care Homes ◽  
Rehabilitation Services ◽  
Clinical Implications ◽  
Care Provision ◽  
Total Cost ◽  
Cost Implications

Aims and MethodThis study describes residents in seven care homes, reviews their usage of mental health services and evaluates cost implications of psychiatric health care provision.ResultsThe patients are predominantly male with multiple diagnoses who are receiving psychiatric health care, but in general lack structured rehabilitation services. Forty-seven per cent of the residents moved into the trust catchment area in order to occupy the placement.The cost associated with the provision of differing models of out-patients care varies considerably.Clinical ImplicationsThese vulnerable residents are costing the mental health service relatively little, although the total cost to society is higher.This study points to the necessity of multiagency planning for 'new long-stay' patients.

scholarly journals Understanding ‘significant impaired decision-making ability’ with regard to treatment for mental disorder: an empirical analysis

2010 ◽  
Vol 34 (6) ◽  
pp. 239-242 ◽  
Author(s):  
Evonne Shek ◽  
Donald Lyons ◽  
Mark Taylor
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Cognitive Function ◽  
Mental Disorder ◽  
Psychotic Symptoms ◽  
Clinical Implications ◽  
Definition Of

Aims and MethodTo capture psychiatrists' reasons for ‘significant impaired decision-making ability’ (SIDMA) as there is no definition of SIDMA in the Mental Health (Care and Treatment) (Scotland) Act 2003. One hundred consecutive mental health reports from January to February 2008 were examined using a questionnaire.ResultsMore than half the mental health reports noted lack of insight as the main cause of SIDMA. Other reasons for SIDMA included limited cognitive function and presence of psychotic symptoms.Clinical implicationsFive reasons for SIDMA were identified: lack of insight, cognitive impairment, presence of psychosis, severe depressive symptoms and learning disability. We recommend psychiatrists working in Scotland give full descriptions of SIDMA, indicating how this has an impact on the patient's ability to make decisions.

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