Comprehensive Psychiatric Service Research Articles

Day care and a hostel – a cost effective approach

In order to plan a comprehensive psychiatric service for County Clare, it was necessary to divide the county into four sectors, North, East, South and West. The area I am discussing is the West Sector, which covers 800 square kilometres and has a population of 20, 000. Kilrush town is the capital of the West Sector situated 50 kilometres from the main hospital in Ennis. Psychiatric morbidity was noted to be high in this rural area. Prior to opening a Day Hospital in Kilrush (May 1986) we were using 15 beds in the acute unit. Now we are using, on average, five beds at any given time.

Comprehensive psychiatric emergency services

Comprehensive psychiatric emergency services

Effects of a psychiatrists' strike on emergency psychiatric referral and admissions

This is a report on the effects of a psychiatrists' strike in Israel on emergency psychiatric referrals and admissions from two catchment areas. One had comprehensive psychiatric services, the other did not. Three periods were compared - before, during and after the strike. During the strike period, overall referrals to the emergency room decreased by 3.9%. A significant 15.8% decrease in referrals was registered in the comprehensive psychiatric service area, and an 11.4% increase in referrals in the other catchment area. Although no increase was seen in total emergency admissions during the strike, involuntary admissions increased by 21.6%, within the catchment area which did not have a comprehensive service, whereas within the area with the comprehensive service there was a significant decrease of 33% in involuntary admissions. The impact of these services on emergency referrals and admissions, especially during the strike, is discussed.

A haven for the severely disabled within the context of a comprehensive psychiatric community service.

The priorities accorded severely disabled or disturbed long-stay patients in Regional and District planning strategies vary enormously. A scheme to cater for the needs of this group is described. The scheme includes: non-stigmatising housing; a domestic regime, daytime occupation and leisure activities offering forms of enabling and caring that foster the highest possible levels of functioning; a secure home; private and peaceful outdoor space; and graduated steps towards independence that allow for the possibility of relapse. The central concept is the establishment of a Community for people with severe difficulties in making social contacts. The importance of integrating the scheme into a comprehensive District psychiatric service is emphasised.

Should physician training centers offer formal psychiatric assistance to house officers? A report on the major findings of a prototype program.

The literature suggests that the emotional needs of interns, residents, and fellows have received inadequate attention. Comprehensive psychiatric services are provided by a model program at UCLA. During the 1981-1983 academic years, 89 house officers were seen. Between 16% and 19% of certain groups sought help each year; depression was the most frequent diagnosis (63%, N = 56), followed by anxiety disorders (24%, N = 21). Over two-thirds of the evaluated residents entered free or low-fee treatment, and these therapies were generally considered quite beneficial. This report reemphasizes the desirability of providing carefully structured, confidential psychiatric assistance to house staff and documents medical trainees' acceptance and use of such programs.

Closure of Large Mental Hospitals--Practicable or Desirable?

The move towards community care essentially aims at the provision of a comprehensive psychiatric service in each Dis trict with facilities for the chronically disabled based outside the hospital for the greater part. Parallel with this move runs the aim to close all large mental hospitals. The present debate centres around the extent to which we can move towards a system of comprehensive District psychiatric services alone at this stage in time and the question of whether it is desirable to abandon totally the large psychiatric hospital style of care. The brief of this paper is to summarize the reasons for concern about a wholesale move towards District-based services from the large mental hospital from the psychiatrists' view-point.

Closure of Large Mental Hospitals—Practicable or Desirable?

The move towards community care essentially aims at the provision of a comprehensive psychiatric service in each District with facilities for the chronically disabled based outside the hospital for the greater part. Parallel with this move runs the aim to close all large mental hospitals. The present debate centres around the extent to which we can move towards a system of comprehensive District psychiatric services alone at this stage in time and the question of whether it is desirable to abandon totally the large psychiatric hospital style of care. The brief of this paper is to summarize the reasons for concern about a wholesale move towards District-based services from the large mental hospital from the psychiatrists' view-point. Unfortunately, much of the debate is based on speculation because of the experimental nature of this move and the fact that objective research is lacking on any changes already made in this country.

A comprehensive psychiatric service

A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service, and an outpatient service. The number of chronic patients has not decreased, due to an influx of unruly senile patients. The close proximity of the service to the community has increased the pressure with regard to the care of such patients. Other services, such as outpatient treatment of alcoholics and neurotics, have suffered, due to the increased workload caused by these senile patients.

A process recording for evaluating group psychotherapy training methods

This paper discusses an exploratory investigation concerned with the long range questions: How does group psychotherapy help patients? and How can psychiatry residency programs best train residents to treat patients in therapeutic groups? Group psychotherapy has come to be accepted in its own right as a decisive contribution to the study of and relief of emotional disorders. As a component of comprehensive psychiatric services it is indispensable. However, while its clinical value has been demonstrated, its scientific validity has not. A Group Process Inventory has been developed by the author and has been utilized for the past two years by psychiatric residents in recording the process of their therapeutic groups in a teaching hospital mental hygiene clinic. The preliminary use of this recording as a clinical-teaching instrument has proven effective. This inventory is being revised to serve as a research instrument.

A hospital‐based psychiatric unit for mentally handicapped adults

SUMMARYThe organisation and functioning of a psychiatric unit for mentally handicapped adults established within a mental handicap hospital is described. Admissions over a five year period are analysed. Requirements for a comprehensive psychiatric service for mentally handicapped adults and youths are discussed.

On Professional Prejudice

Journal Article On Professional Prejudice Get access Gene N. Berg, Gene N. Berg State Department of Mental HealthHighland, California Search for other works by this author on: Oxford Academic PubMed Google Scholar Julian C. Hall Julian C. Hall Division of Comprehensive Psychiatric Services Malcolm Bliss Mental Health CenterSt. Louis, Missouri Search for other works by this author on: Oxford Academic PubMed Google Scholar Social Work, Volume 27, Issue 4, July 1982, Pages 381–382, https://doi.org/10.1093/sw/27.4.381-b Published: 01 July 1982

The Medical Contribution to the Management of Mental Illness Services

Health Advisory Service visits to services for the mentally ill in recent months keep throwing up a persistent theme: the apparent failure of the medical staff to provide the impetus that is necessary to develop and manage an effective comprehensive psychiatric service based upon the needs of patients rather than on professional or sectional interests.

Experience in a District General-Hospital Comprehensive Psychiatric Unit

It has been the policy of the British Department of Health since the mid-1960s to close the large mental hospitals in this country and replace them with comprehensive psychiatric services, based in district general hospitals. The most recent details of this policy have been documented in the publication Better services for the mentally ill (Department of Health and Social Security, 1975). The decision to adopt this policy has been based on a number of factors: 1. There is an obvious desire to dispense with the large, impersonal institution, frequently housing more than a thousand patients and often situated some distance from the community it serves. Instead there is to be a centrally situated service, convenient for, and identified with, the people using it. 2. Including psychiatric patients in a general hospital reduces the stigma that has for years been attached to the treatment of mental disorder. This results in better community relationships and greater public interest in such matters. 3. The therapeutic results claimed by existing psychiatric departments in general hospitals have seemed impressive. 4. The desire of psychiatrists to be identified with mainstream medicine has caused the staff of such departments to have close working relationships with their medical colleagues in other specialties and has promoted common interests. This has, in turn, led to a reidentification of psychiatric illness as an integral part of general medicine and has assisted in the management of cases that cross the boundaries of different specialties. There has also

Psychiatric service planning: Beds in perspective

The origins and validity of the British national planning “norm” for psychiatric beds are discussed. Evidence of present and future use of psychiatric beds is drawn from a number of studies relating to the remnant of earlier long-stay cohorts, the current accumulation of new long-stay patients, and the present use of beds for short and medium stays. The use of “beds” in the context of a comprehensive psychiatric service and the dangers of planning beds in isolation are discussed. Suggestions are made for an alternative approach to “norms” and psychiatric service planning.

Incidence of referred mental illness in Chichester and Salisbury.

The annual rates of referral to two differently organized comprehensive psychiatric services in separate but demographically similar areas are presented for various demographic social and clinical categories. In Part 1 the rates are examined for similarities both between the two areas and with findings from other studies in order to obtain pointers to factors affecting the inception of psychiatric disorders. In Part 2 an attempt is made to evaluate an aspect of the community service. Differences between the rates in the two areas are discussed with a view to identifying those variables that selectively affect referral to a community service.

Elements of a comprehensive psychiatric service.

Elements of a comprehensive psychiatric service.

Elements of a comprehensive psychiatric service.

Elements of a comprehensive psychiatric service.

From practice to theory. Community mental-health services and the nature of psychoses.

Abstract Experiments with comprehensive (community) psychiatric services have resulted in a striking reduction in chronic cases of what may be termed social-breakdown syndrome (S.B.S.). This practical experience can be referred back to theory, to throw new light on the textbook description of psychoses and on standard psychiatric training programmes. The pathogenesis of S.B.S. can be thought of in seven stages— from the time when an individual's ability comes to be at odds with what society expects of him, via a vague diagnostic label resulting in exclusion from society into mental hospital, and ending in expedient compliance with hospital conditions. Preventive measures along this pathway can best be achieved by a team, responsible for the continuing care of the patient.

Psychiatric Emergencies in an Urban Borough

An analysis is presented of all emergency calls made in one year, "out of hours," to local authority mental health social workers as part of a comprehensive psychiatric service in an urban community. Of 212 calls received, more related to men than women, and in both sexes the peak age group was 40 to 49 years; 72% of referrals were in the psychosis or personality disorder diagnostic groups. A minority of cases referred had symptoms of only recent onset, and 70% of all calls related to patients previously known to the local services.

Community psychiatry.

Much confusion has resulted in recent years from the use of the word “community” to mean merely “outside hospital”. Community psychiatry is not just extramural work or a means of avoiding hospitalization. A community mental health service is a comprehensive psychiatric service of care and treatment for a defined population, including full hospital facilities (Freeman, 1963). The hospital is in fact part of the community, and provides one of its services. The size of population base that can most efficiently support a comprehensive service is probably between 150,000 and 200,000 in urban areas, judging by experience in Lancashire (Smith, 1965). This is large enough to contain all the basic services that are needed, and small enough to allow all key professional workers to remain in constant face-to-face contact. Within its defined area, the service must have continuous and final responsibility, whatever the clinical state of individual patients. It must offer a continuous spectrum of integrated services, from full-time, permanent care in an institution on the one hand, to occasional support for a patient or family at home on the other. Since the demand for services is potentially infinite, an essentially ideological choice must be made in assessing priorities for the resources that exist. I believe that if we try to act primarily on the basis of human needs within the total community, the first call on these resources must be for the three great problems of schizophrenia, subnormality and old age. Concentration on psychotherapy would make it more likely that these greater social needs remained unmet, and it may well be that any large-scale treatment of neurosis or personality problems would have to be outside psychiatric—or even medical—channels (Ryle, 1967).