Based on dual perspectives of management and ethics: exploring challenges and governance approaches for new media applications in psychiatric specialty hospitals

Numerous studies have evaluated the impacts of community housing models on outcomes of persons with severe mental illness. The authors conducted a meta-analysis of 44 unique housing alternatives described in 30 studies, which they categorized as residential care and treatment, residential continuum, permanent supported housing, and nonmodel housing. Outcomes examined included housing stability, symptoms, hospitalization, and satisfaction. Outcome scores were converted to effect size measures appropriate to the data. Effect sizes were combined to estimate random effects for housing models, which were then compared. All models achieved significantly greater housing stability than nonmodel housing. This effect was greatest for permanent supported housing (effect size=.63, p<.05). No differences between housing models were significant. For reduction of psychiatric symptoms, only residential care and treatment differed from nonmodel housing (effect size=.65, p<.05). For hospitalization reduction, both residential care and treatment and permanent supported housing differed from nonmodel housing (p<.05). Permanent supported housing achieved the highest effect size (.73) for satisfaction and differed from nonmodel housing and residential care and treatment (p<.001 and p<.05, respectively). The meta-analysis provides quantitative evidence that compared with nonmodel housing, housing models contribute to stable housing and other favorable outcomes. The findings also support the theory that different housing models achieve different outcomes for different subgroups. Data were not sufficient to fully answer questions designed to enable program planners and providers to better meet consumers' needs. It is important to answer these questions with research that uses common measures and adheres to scientific conventions.

Nurses’ information retrieval skills in psychiatric hospitals – Are the requirements for evidence-based practice fulfilled?

Issues in Medicaid Policy and System Transformation: Recommendations From the President's Commission

Recent changes, especially after the 90s in Albania, have marked an important turn in the whole health system and even more so in the field of mental health. With health services, policies and social services were implemented to people with mental health problems, and it in this form that there was a need to bridge these policies and services to beneficiaries, such as social workers in mental health. Now the social worker is one of the key persons in the multidisciplinary team whose purpose is to identify, diagnose, treat, plan and integrate these people into society. The study aims is to identify the support and role of social work in persons with mental health disorders at Psychiatric Hospital “Sadik Dinçi” Elbasan, Albania and in the supported housing in this city. Qualitative method was used for conducting the study, and semi-structured interview with a focus group of 4 social workers of this hospital, 2 social workers of Elbasan Community Mental Health Center and 4 day-care ergo therapists located within the premises of the hospital was used as measuring instruments to this hospital. Also, a survey was conducted with 15 patients of the hospital. According to the study, the role of the social worker is well positioned in the field of mental health, but at the same time the study highlights the need for modern European interventions and models for integrating these individuals away from the walls of psychiatric hospitals, models where these individuals are supported and integrated in society.

Coercive measures have been applied in mental health fields throughout history, denying people with mental illness the ability to decide, even though there is increasing evidence that these measures bring few benefits to these individuals. The objective of this study was to analyse the sociodemographic and clinical characteristics most likely associated with the use of mechanical restraints (MRs) in psychiatric hospital settings. This was a descriptive, comparative and analytical cross-sectional study in people with mental disorders who were hospitalized in two hospitals in the Autonomous Valencian Community (Spain). We included a total of 91 participants who completed the Scale to Assess Unawareness of Mental Disorder (SUMD), Positive and Negative Syndrome Scale (PANSS), Barrat's Impulsiveness Scale and the Hamilton Anxiety Scale. The results we collected indicated that the patients most likely to be mechanically restrained were younger people with less awareness of their symptoms and disease, previous admissions to a psychiatric hospital and cohabitation with parents and/or family. In addition, having been admitted involuntarily, previously having had MRs applied, presenting more positive psychotic symptoms and habitual caffeine consumption all predicted the use of MRs. The variables that were able to predict MR were involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Evaluation of the sociodemographic and clinical characteristics of patients can help health professionals, especially nurses, to recognize patients who are at risk of requiring MR. This allows mental health practitioners to take these factors into account during interventions or when implementing programmes designed to reduce the use of coercive measures in psychiatric hospital settings. What problem did the study address? Coercive measures have been applied in mental health fields throughout history, with no benefits to these patients. What were the main findings? There are studies that relate some variables to MR in psychiatric settings, but we have been able to find variables capable of predicting MR such as involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Where and on whom will the research have an impact? The findings of this study allow for the reduction of MRs in psychiatric units. The sociodemographic and clinical characteristics found to be related to MR will help professionals identify when a patient is admitted in order to use specific interventions aimed at preventing the use of MRs during admission. This is the first study to indicate a relationship between caffeine consumption and the use of MRs. Further studies will be necessary to verify if controlled caffeine supplementation during admission to psychiatric units could become an additional strategy contributing to preventing the application of MR specifically in individuals who habitually consume coffee or caffeine-containing beverages daily. We have adhered to relevant EQUATOR guidelines using the STROBE reporting method. No patient or public contribution.

Time for a global commission on mental health institutions

In 2023, 80 years have passed since the liberation of Stavropol from the Nazi invaders. The staff and patients of the psychiatric hospital were subjected to the horrors of the fascist regime. 660 patients and 30 employees of the Stavropol Psychiatric Hospital died in the gas chambers. The hospital honors the memory and does its best to preserve the story of people selflessly fulfilling their duty in difficult times for her and the whole country.The purpose of the study. In honor of the anniversary memorable date, the authors of the article want to tell about the history of the Stavropol Regional Psychiatric Hospital in chronological order from the day of its foundation to the present day.Materials and methods: a systematic analysis of scientific literature, archival data of the hospital was carried out, the A.J. Dorsht foundation, stored in the Museum of History of Stavropol State Medical University, was used.Results and discussion. The authors tell about the life of the hospital in different historical periods of our country. Special attention is paid to the period of the Great Patriotic War. It tells about the horrors that the hospital experienced during the German occupation, about the victims among patients and employees whose lives were claimed by the Great Patriotic War. The period of leadership of the outstanding chief physician, man and teacher, Adolf Yakovlevich Dorsht, is described with great respect and recognition.The article summarizes the history of the development of modern psychiatric services in the Stavropol Territory, the prevention of suicidal behavior among adolescents, the provision of psychiatric care to the population during a pandemic and a special military operation.Conclusion. Having survived many trials in its lifetime, at present the Stavropol Regional Psychiatric Hospital has been awarded numerous awards for asceticism in the field of mental health and is the largest in the North Caucasus.

The objectives of Psychiatric Reform were, on the one hand, psychiatric hospitals' shutting down and, on the other hand, the creation of Psychosocial Rehabilitation facilities, in order to provide appropriate care to individuals suffering from mental health problems in community. Therefore, mental health professionals' job satisfaction constitutes one of the fundamental factors leading either to success or failure of each reforming effort. The aim of this study was to investigate the level of professional satisfaction of nurses working in Psychosocial Rehabilitation facilities compared to other mental health professionals. Three hundred and sixty-seven mental health professionals, working in the field of psychosocial rehabilitation completed (a) a sociodemographic questionnaire, and (b) Spectοr's Job Satisfaction Survey (JSS). Moderate levels of total professional satisfaction were observed. Low satisfaction rates were recorded in "Pay," "Promotion," and "Fringe Benefits" subscale. High satisfaction rates were recorded in "Supervision," "Cooperation between colleagues," and "Nature of work," while moderate satisfaction rates were reported in "Contingent rewards," "Operating procedures," and "Communication" within facilities. It is noteworthy that nurses were statistically significant less satisfied with the "Contingent rewards" (p=0.028), the "Nature of work" (p=0.001), and the "Communication" (p=0.019), while they were statistically significant more satisfied with "Supervision" (p=0.007) compared to the other specialties of mental health professionals. The results can be used by those with administrative and scientific responsibilities in the field of mental health in order to recognize professionals' difficulties and solve their problems in psychosocial rehabilitation facilities. These interventions could improve their levels of job satisfaction, in order to achieve optimal therapeutic results for mentally ill and improve the quality of the services provided.

This study investigated the characteristics of mental healthcare in the cities situated at the Alto Uruguai from the perspective of the guidelines of the Brazilian Health System (SUS), and of the Psychiatric Reform. Based on a structured tool, we interviewed 31 subjects working in the public care network. The results point to centralized actions and ' medicalization' of symptoms in the clinical care model although all cities count on Family Health Programs; lack of integrated care in mental health; inexistence of a mental health service network in the cities except in the main city; transfer to psychiatric hospitals to solve acute and chronic cases; lack of follow-up after the patient is released from the psychiatric hospital characterizing the phenomenon of the revolving door; the inexistence of mental health programs in the Health Policies of the city; and the weak representation of these professionals in the Health Councils. We conclude that the transfer of the responsibility for mental healthcare to the local authorities in the northern region of Rio Grande do Sul is still incipient and that hospitalization in psychiatric hospitals continues the main intervention in the field of mental health.

Nowadays, after reaching the numerous scientific conclusions in the field of mental health, it is evidently obvious that there is a direct link between the respect for rights of psychiatric patients and inpatient conditions on the one hand and patient treatment effectiveness, their deinstitutionalisation, and therefore, destigmatisation on the other. Nevertheless, in recent years, the reports delivered by the Ombudswoman and Disability Ombudswoman as well as numerous judgments of the European Court for Human Rights in cases of violation of rights of persons with mental difficulties are a clear warning about insufficient accommodation and treatment conditions in psychiatric institutions in the Republic of Croatia. Therefore, it proved justifiable to explore to what extent psychiatric patients exercise their rights as indoor patients and what are the conditions of their medical treatment. With this aim, the research was conducted at the Psychiatric Clinic „Vrapče“, Psychiatric Hospital Rab, Neuropsychiatric Hospital „Dr. Ivan Barbot“ Popovača and Psychiatric Hospital Ugljan, the only psychiatric hospitals in the Republic of Croatia with hospital wards designated for compulsory detention of mentally incapable defendants upon the decision of the criminal court. Two different questionnaires were disseminated, the Basic Questionnaire for Directors of Psychiatric Institutions and the anonymous questionnaire on the sample of 80 patients. The article presents the analysis of the results obtained from these two questionnaires.

Back to table of contents Previous article Next article Professional NewsFull AccessSmoking-Ban Benefits Don't Quell State Hospital Tobacco WarsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:17 Sep 2010https://doi.org/10.1176/pn.45.18.psychnews_45_18_018AbstractPeople with severe mental illness die decades sooner, on average, than those without such illnesses, and one of the reasons may be that many are heavy smokers.People with mental illness account for 44 percent of the tobacco market in the United States. Many are strongly addicted. About 68 percent of people with schizophrenia who smoke light up more than two packs a day.Yet it has not been easy to curb smoking in public psychiatric hospitals, according to researchers from the National Association of State Mental Health Program Directors Research Institute. They reported their findings in the September Psychiatric Services.Their survey of 70 psychiatric hospitals where smoking was permitted in 2006 found that only 28 had changed their policies to ban smoking entirely by 2008.Only four of the remaining 42 permitted smoking indoors, while the rest allowed patients or staff to puff away somewhere outdoors on hospital property.Smoking by people with mental illness has long been a contentious issue.“Silently and insidiously tobacco sales and tobacco smoking became an accepted way of life not only in our society, but also in our public mental health treatment facilities,” stated a 2006 position paper by the National Association of State Mental Health Program Directors (NASMHPD).Despite clear health benefits that derive from smoking bans, resistance to such bans at psychiatric facilities comes from both patients and staff members.Fear of adverse events is often listed as a reason not to ban smoking completely, said Vera Hollen, M.A., and colleagues in their Psychiatric Services report. Their survey found that staff members worried that without cigarettes patients would be more aggressive, and staff smokers would be unhappy. Survey respondents also said that smoking reinforced the therapeutic bond between patients and staff.“Smoke breaks became an ‘entitlement,’ deserved and protected, and are one of the only times [patients] can practice relating to each other and staff in a ‘normalized’ way,” said the 2006 NASMHPD statement.However, Hollen and colleagues found no increase in adverse events at psychiatric institutions that banned smoking.Of the 28 hospitals that changed their policies to become smoke free, tobacco-related health problems, seclusion and restraint, and use of coercion or threats all declined significantly, they said. Hospitals that did not adopt a smoke-free policy still saw fewer adverse events involving threats or coercion among patients and staff, according to Hollen.Some who object to tobacco bans at state psychiatric hospitals argue that smoking is an individual right. However, one major advocacy group suggested that there may be other points to consider before forbidding patients to smoke.“The real challenge, as it is elsewhere in the mental health field, is sustainability,” said Ron Honberg, J.D., director of policy and legal affairs for the National Alliance on Mental Illness (NAMI).NAMI's policy is to support and encourage smoke-free treatment facilities, he said. However, withdrawal from tobacco addiction is hard enough without attempting it during a psychiatric crisis.“When hospital stays were longer, you could work on broader health concerns with patients,” Honberg told Psychiatric News. “But if they are only in for several weeks and then leave, it is much harder to stay off tobacco afterward without some linkage in the community.”Also, the effects of forcing a patient to quit smoking on that patient's psychiatric condition are unknown, he said.Honberg also believes that tying a drop in adverse events to a smoking ban may be premature.“A reduction in adverse incidents can be due to a number of factors, like staffing levels or training or patient characteristics,” said Honberg, who found the new study's results “mildly encouraging.”All of the hospitals responding to the survey, regardless of whether they implemented smoking bans during the study period, offered nicotine-replacement therapy or smoking-cessation medications to help staff and patients quit smoking. The only statistically significant difference over the two years was that the institutions that went smoke-free more often offered pharmacotherapy to those who wanted to quit in 2008 than was the case in 2006.No such difference was observed in the number of hospitals offering nicotine-replacement therapy, possibly because an antismoking drug (bupropion) is available on hospital formularies, while nicotine-replacement therapies are often not.Smaller hospitals appeared to have had more success in changing policies, most likely because their size led to better communication among management, staff, and patients, suggested the authors.Communication may be the key to a successful transition to a smoke-free hospital, they concluded.“Hospitals must be proactive by involving advocates, families, and unions before, during, and after a smoking-policy change,” they said. “Any major policy change must also include a patient-education component.”“Effects of Adopting a Smoke-Free Policy in State Psychiatric Hospitals” is posted at <http://ps.psychiatryonline.org/cgi/content/full/61/9/899>. 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Aim: Changes in the mental health field have created new job expectations of occupational therapists (OTs). The present research investigated differences in general self-efficacy (GSE) and work-related self-efficacy (WRSE) between occupational therapists (OTs) working in psychiatric hospitals and OTs working in community-based mental health services. Method: Thirty-four OTs working in psychiatric hospitals and 30 OTs working in community-based settings (n = 60) completed the General Self Efficacy Scale (GSE) and the WRSE in Mental Health Occupational Therapy Scale (WSMOT). Results: The two groups showed no differences in total WRSE score. Both evinced high self-efficacy in direct intervention activities, and low self-efficacy in managing and counseling. Conclusion: Results enlighten an overall high WRSE, which indicates successful adaptation of OTs to changing roles and tasks in mental health, similar to studies in other countries. However, it reveals discrepancies between job demands and self-efficacy of OTs that should be addressed at educational and managerial levels.

With high rates of psychiatric and substance use problems, homeless women need a wide variety of services. This study, focusing on homeless women with and without symptoms of mental illness, examined the association of predisposing, enabling, and need factors (based on Aday-Andersen's health services utilization model) with use of behavioral, medical, and human services. Data from 738 homeless women from the National Survey of Homeless Assistance Providers and Clients were analyzed. Homeless women with symptoms of mental illness showed higher rates of service use in behavioral, medical, and human domains, a finding that indicates that there are stronger service linkages for this group than for women without symptoms of mental illness. Predictors associated with service use differed by psychiatric symptoms among homeless women: predisposing and enabling factors influenced service use among homeless women without symptoms of mental illness, whereas need factors influenced service use among women with symptoms of mental illness. Mental illness symptoms may be a trigger for receiving an array of services for homeless women once they gain entrance into a service system. There was a negative association between symptoms of mental illness and use of behavioral health services among homeless mothers, which may be the result of the fear of child welfare service intervention and loss of child custody. This service distribution inequity among homeless women using mental health services deserves attention by policy makers, researchers, and providers.

The Methodological Guide to the Discipline Romanian as a foreign language for medical students Didactic assistance for optimizing doctor-patient communication is structured in 3 chapters: the first chapter includes conceptual milestones of competency-based education, data on the concept of competences and their role in modern education; the second chapter analyzes the concept of interpersonal communication versus linguistic competence including general considerations on the communication competence between linguistic knowledge and performance as an integral part of the competence formation process of doctor-patient interpersonal communication looked through the prism of medical terminology knowledge; the third chapter highlights pragmatic hypostases of formation/development of doctor-patient communication competence focused on Romanian medical language, as well, are presented practical reasonings for optimizing doctor-patient communication competence focused on specialized language and methodological recommendations for formation/development of doctor-patient communication competence within the Discipline Romanian as a foreign language for medical students. To attain the established objectives, the formation/development of doctor-patient interpersonal communication competence within the Discipline Romanian as a foreign language for medical students, we focused on the innovative teaching and creative learning of some curricular content and on contextualized use of a number of communication methods and techniques based on the development of critical and creative thinking such as: Ciorchinele; Mosaic; SINELG; Glottodrama, Cinquain, Project, etc. According to therapeutic and ethical perspectives, the modern doctor should be able to create and maintain correct relationship with patients, their relatives, as well as in relationship with colleagues and society, etc. The modern doctor is able to effectively use communication techniques, request and provide information, correctly apply active listening, explanation, silence, paraphrasing, empathy, acceptance, etc. Physicians should receive adequate training that meets the patients’ current needs and is based on their holistic approach.

BackgroundCommon mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1) to evaluate GPs' opinions on their day-to-day practice with Patients with Mental Health Problems (PMHP) and on relationships with Mental Health Professionals (MHPro); 2) to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration.MethodsAll GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro.ResultsA majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians.Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro.Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP.ConclusionGPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.