Delivery Of Psychiatric Services Research Articles

Training family practice residents in psychiatry: an ambulatory care training model.

To demonstrate the importance of providing psychiatric training to primary care practitioners in ambulatory care settings. Additionally, to describe the model used for this purpose in the Department of Psychiatry and Behavioral Sciences of the University of Texas Medical School at Houston in order to further stimulate educational opportunities on this topic. A review of the psychiatric curriculum offered to family practice residents during their PGY-2 year one-month rotation in psychiatry at the University of Texas Mental Sciences Institute is provided. Emphasis is given to key areas of the curriculum such as: knowledge, skills, and attitude development. Special focus on the clinical and educational experiences is also offered for the purpose of providing unique perspectives about the curriculum methodology. The careful assessment of the feedback obtained from the family practice residents who were exposed to this ambulatory training model demonstrates that this type of setting was satisfactory for the teaching of psychiatry to primary care residents. Primary care residents have always treated a large number of psychiatric patients. Given the current status of our health care system, primary care practitioners should have even a greater role in the future delivery of psychiatric services. In this article, we offer a model of training for primary care residents in psychiatry, which emphasize cost-effectiveness, high quality of care, and ambulatory care settings.

A model for clinical and educational psychiatric service delivery in remote communities.

A model of intermittent psychiatric service provision to rural and remote New South Wales communities by metropolitan psychiatrists and mental health professionals has been evaluated. The services provided included peer support to lone mental health and generic health workers, direct psychiatric care to clients in their own environment and skills development education sessions to general health staff and other professionals affiliated with health care (e.g. police and ambulance officers). There were 10 visits of teams made up of a psychiatrist and another mental health professional to six rural and remote locations. Outcomes of the services delivered were examined including clinical services and teaching skills training sessions. Indirect outcome measures included changes to Pharmaceutical Benefits Scheme prescription patterns in areas serviced and data regarding transfer of clients for psychiatric care in regional centres. Difficulties in evaluation are discussed. The feasibility of intermittent service provision was demonstrated. Education packages were well received and a positive change in workers' attitudes toward mental health practice was found. Intermittent psychiatric services in remote settings add value to health care delivery particularly when dovetailed with skills-based education sessions.

Academic psychiatry in the Deep South

SummaryTo highlight the problems in the delivery of psychiatric services in rural New Zealand. We describe the innovative collaboration between the University of Otago Medical School in Dunedin and the Southland Hospital in Invercargill.Clinical implicationsForging of academic links between the regional medical schools and rural hospitals is one way of delivering specialist psychiatric services in rural areas.

Outcome Measures of Psychiatric Service Delivery

The authors discuss the increasing importance of outcome measures as an indicator of quality of care in today's behavioral healthcare market. They discuss who best should evaluate quality, what variables should be measured as the best indicators, and the most appropriate time frame for measuring out

Behavioral Assessment, Analysis, and Support in a Psychiatric Partial Hospitalization Program for Adults with Developmental Disabilities

This article describes the objectives and operations of a behavioral psychology service within a partial hospitalization program for adults with psychiatric disorders and developmental disabilities. Partial hospitalization programs are an effective model of psychiatric service delivery but are not common for patients with mental retardation/mental illness. Phases of intake behavioral assessment, treatment planning and implementation, and discharge are described with an emphasis on functional assessment, data-based accountability, outcome measurement, and positively oriented behavioral support. The article concludes with a discussion of challenges which confront the design and application of behavior analysis procedures within the context of a psychiatric partial hospitalization program.

The dispensable psychiatrist

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.

User Involvement in Services--Incorporation or Challenge?

In recent years, users of social work, like those of psychiatry, have been increasingly drawn into the organization and delivery of social work and mental health services. This has been largely welcomed as a desirable development by planners, academics and practitioners in the field. In this article, we reappraise the broad issues raised by user involvement and consider the implications of this trend. Despite the attractiveness of the user perspective in the policy and delivery of social work and psychiatric services, we point to the dangers of incorporation and moderation of an oppositional position, from which, we argue, users can best challenge existing practices and connect with wider political struggles.

Developing clinical work processes in a state psychiatric hospital: a case study.

The Texas Department of Mental Health and Mental Retardation applied the continuous quality improvement (CQI) concept of work process to the delivery of clinical services in each of its eight state psychiatric hospitals. Two different clinical processes were involved: (1) individualized psychiatric treatment and (2) medical treatment. The processes were then benchmarked against national leaders in the delivery of public psychiatric hospital services. This case study demonstrates the applicability of the work process concept to a clinical environment where it can function as a management tool that can significantly improve the quality and efficiency of services provided to individual patients.

Cluster Analysis of Psychogeriatric Characteristics and Service Use Among Rural Elders

In developing models of psychiatric service delivery, nurses must be able to target groups on the basis of their health status and service needs. This investigation attempted to develop profiles of rural elderly, a significant risk population, by subjecting data on the psychogeriatric nursing status and health services utilization of 125 subjects to cluster-analytic methods. The cluster analysis yielded a three-cluster model: Cluster 1 (n = 39) predominantly comprised unmarried women in moderate health, but with a high degree of health service utilization; Cluster 2 (n = 53) had rural elders with moderate physical impairments, self-perceptions of poor health, and moderate health service utilization; and Cluster 3 (n = 33) comprised elders with severe cognitive and physical impairments and high health service utilization. Cluster 2 subjects were judged to be mild users of services because they were younger and married without a regular source of health care. Because subjects in Cluster I tended to be unmarried women who lived alone, with mild to moderate physical impairments and a regular source of health care, these subjects were assessed as moderate users of services. Cluster 3, which comprised the oldest and most impaired, both physically and cognitively, were judged to be intensive users of services.

Psychiatric Service Delivery in the Darwin Rural Region

During my elective year of training I worked in the Darwin region. As part of my work I provided psychiatric services to the isolated communities living in the Darwin rural region. A description and analysis of this work led me to develop a theoretical model of how psychiatric services could most appropriately and effectively be provided to such a unique region. This work formed the basis of my dissertation for the Section II examinations for FRANZCP.

Exploration of failure on the subspecialty examination for child and adolescent psychiatry

The purposes of this study were to compare first-time performance on the oral examination for certification in child and adolescent psychiatry with first-time performance on the written and oral examinations for certification in general psychiatry and to identify factors that contribute to failure on the child and adolescent psychiatry oral examination. To address the first question, two successive cohorts of first-time child and adolescent psychiatry candidates were identified, and chi-square analyses were used to explore the relationship between first-time performance on the different examinations. For the second question, a special checklist was developed and completed for all candidates who failed any section of the oral examination for child and adolescent psychiatry three successive times. There was no relationship between passing or failing the written and oral examinations for general psychiatry on the first attempt and passing or failing the child and adolescent psychiatry oral examination on the first attempt. The checklist results suggested that the failing candidates had difficulty in organizing and integrating case material. Other weaknesses were related to the specific sections of the oral examination. The results suggest that the knowledge and skills that are required to pass the child and adolescent psychiatry oral examination are different from those of the general psychiatry examination. The information about weaknesses should be of interest to general and child and adolescent psychiatric educators, candidates, and service delivery agencies.

Outcomes of psychiatric rehabilitation service delivery.

This chapter summarizes consumer outcomes following receipt of psychiatric rehabilitation services and reviews prior research studies in order to generate suggestions for improving the quality and consumer sensitivity of future outcomes research.

Policy Partners—Nursing and Psychiatry in the Capital: An Interview With Dr. Mary Jane England

In this era of change in psychiatric service delivery, we have been bombarded with the realities of man aged care. At the same time we are forging new rela tionships with payers, providers, and with each other. To most nurses, the term collaboration means work ing cooperatively with one's interdisciplinary team. Yet in this changing world where we are forced to ex pand our horizons at an increasingly faster rate, it is important to create dialogs with others who are influ ential in arenas other than those we live in day to day. Our guest is a well-known and highly respected child psychiatrist who rose to national prominence from her roots in Boston. She also has a very special orientation to nurses because her mother was a nurse graduate of the Eastern Maine Medical Center in Bangor, Maine, and practiced for many years at the Boston Lying-in Hospital, the Florence Crittenden- Hastings Home, and at the Phillips House of the Mas sachusetts General Hospital. At a time in psychiatry's evolution when so many are squabbling over turf is sues, Dr. Mary Jane England offers a fresh and non- discipline-specific view of the future of the delivery sys tem for psychiatric services and one where in the con tinuum of care nurses can best serve clients and their families. Dr. England is a child psychiatrist trained in adult psychiatry at Boston University Hospital and at Mount Zion in San Francisco. She also received training in child psychiatry at Boston City Hospital. After that she worked in the neighborhoods of Boston. In the mid- 1970s, she was appointed Associate Commissioner of the Department of Mental Health in Massachusetts. After 5 years, she was appointed Commissioner of So cial Services, a new state agency in Massachusetts for children and families. After 10 years in state govern ment, Dr. England joined the faculty at the Kennedy School of Government, Harvard University, where she was Associate Dean and Director of the Mid-Career Master in Public Administration Program. From academia she went to the Prudential Insurance Com pany of America as National Vice-President of Men tal Health and Substance Abuse, responsible for policy and program development for 25 million Americans. In 1990 she was recruited to serve as president of the Washington Business Group. The Washington Busi ness Group on Health is a national nonprofit health policy group whose membership includes the nation's largest employers, mostly from the private sector, such as International Business Machines, Chrysler, Ford Mo tor Company, Honeywell, and Pepsico. Some of the large public employers, such as the U.S. Postal Service and the California Public Employees Retirement Sys tem, are also members. Dr. England is the president of the American Psychiatric Association (APA), the third woman to hold the position.

Psychosocial Treatments for Schizophrenia

Based upon educational and social learning principles, social skills training and family management modalities have been validated as effective in improving coping skills and symptomatic course and outcome of schizophrenia. Combined with judicious doses of antipsychotic medication, these modalities have been designed from the conceptualization of schizophrenia as a stress-related, biomedical disorder, with those afflicted having enduring vulnerability to the emergence or exacerbation of psychotic symptoms with associated social disability. Behaviorally oriented modalities require integration with a comprehensive psychiatric service delivery system to confer protection against relapse.

Guidelines for psychiatric services in prisons

Recent prevalence studies have found that 8–19% of prison inmates have significant psychiatric or functional disabilities. Efforts to establish adequate mental health systems in prisons within the USA were accelerated during the late 1970s as a result of successful class action lawsuits. These efforts have been assisted by the development of standards for correctional health care programmes by a variety of national organisations. This paper describes a framework for establishing an adequate mental health system within a prison. Basic principles for delivery of psychiatric services in prisons, administrative models for such services, guidelines for correctional based psychiatric treatment, and issues unique for correctional mental systems are reviewed.

Assessment for psychotherapy by interactive television suitable for transmission through telephone links

Despite the increased availability of psychotherapy within the NHS, inequalities remain (Holmes & Lindley, 1989). Traditionally, psychotherapy services have been provided from teaching centres in cities and patients have had to travel for treatment. This may account in part for the middle-class predominance in psychotherapy patients and Holmes (1991) has identified the need for psychotherapists to reach out and cater for the disadvantaged in large housing estates and rural areas. While services are changing to meet such needs (Pedder, 1989) there are powerful economic restrictions on service expansion. The potential for communications technology such as interactive television to aid the delivery of general psychiatric services has been reviewed by McLaren et al (1992) and similar arguments apply to the delivery of psychotherapy.

General hospitals and CMHCs: a commentary.

AbstractOur pluralistic service systems contain both advantages and disadvantages for the delivery of psychiatric services. Joint planning and true cooperative enterprise are essential for system success.

General Hospital Forensic Units: A New Approach To Forensic Psychiatry

Forensic Psychiatry has been criticized for losing pace with more general psychiatric trends toward community mental health. Traditionally, forensic programs have been located in the overly restrictive, anti-therapeutic environments of the jails, or have remained inaccessible in large, far away psychiatric hospitals. This article examines the general hospital forensic unit as a new approach to the delivery of forensic psychiatric services. The authors examine the viability of general hospitalforensic units in light of one such program-The Calgary General Hospital Forensic Unit, Calgary, Alberta. Service utilization patterns and logistical issues of security and patient's rights are discussed. General hospital forensic units are portrayed as firmly rooted in the Community Mental Health Philosophy and a viable alternative to traditionalforensic psychiatric delivery systems.

Emergency psychiatry in the general hospital setting.

AbstractEmergency psychiatric services in the general hospital setting play an increasingly critical role in the nation's psychiatric service systems. It is essential that general hospital emergency psychiatric services develop a spirit of accommodation to and common enterprise with other psychiatric service delivery facilities.

APA's Model Commitment Law and the Need for Better Mental Health Services

The author commends the American Psychiatric Association's model law on civil commitment model law on civil commitment as a practical document that is symbolic of psychiatry's concern about the quality of public mental health services. However, he believes that even the most progressive mental health laws have done little to ensure better or more responsive delivery of psychiatric services. Their effectiveness has been hampered by states' failure to provide funds for adequate services, lax interpretation and application of their provisions, and increasingly bureaucratic procedures resulting in impersonal treatment of patients. The author would strengthen the model law's section on patient advocacy, giving greater autonomy to advocates, and would extend legal authority for commitment to psychologists meeting specific qualifications.