General Hospital Psychiatric Service Research Articles

Expanding the Mental Health Workforce in China: Narrowing the Mental Health Service Gap.

There is a significant gap between mental health service coverage and the need for these services in China. In particular, workforce shortages impair several aspects of China's national mental health service system, including access to timely diagnosis and treatment in rural areas, expansion of general hospital psychiatric consultation-liaison services, and leadership in establishing a collaborative stepped-care system. This column focuses on China's ongoing efforts to develop its mental health workforce to ensure a sustainable supply of psychiatrists and allied mental health professionals.

The clinical value of brain computerised tomography in a general hospital psychiatric service

BackgroundThe use of neuroimaging modalities in psychiatry has been evaluated in several studies. The vast majority seem to suggest that neuroimaging may be overutilised in psychiatry. There is a significant constraint on availability and cost related to neuroimaging of patients at general state medical facilities. The routine use of computerised tomography (CT) scanning is thus questioned.MethodsA retrospective analysis was undertaken of all psychiatric inpatients who had CT scans performed from 01 January 2011 to 31 December 2012. Demographic data, mental state examination, physical examination findings, substance use and diagnosis upon admission were recorded. The relationship between these variables and CT scan findings was analysed.ResultsA total of 897 admissions were retrospectively analysed. One hundred and three patients had documented CT scan imaging. In total, 17 of the 23 patients with abnormal findings on CT scan were found to be psychotic (74.0%). The remaining 26.0% included depression and dementia. There was no statistically significant difference between the normal and abnormal CT scan groups with regard to gender, age, family history, substance use and physical examination. The majority (65.2%) had cerebral atrophy and/or cerebral calcifications. A smaller group of other documented findings was noted.ConclusionsSelective indications and clinical markers may be utilised in order to justify brain imaging studies rather than performing them routinely. That being true, a multicentre study with a larger sample size is indicated to further improve the statistical significance and assist in formulating a more concrete guideline for neuroimaging of psychiatric patients.

Sentinel events and predictors of suicide among inpatients at psychiatric hospitals

BackgroundThe objective of this study was to assess sentinel event analysis and relative factors in different mental healthcare settings. In addition, the occurrence of sentinel events in different hospital settings was compared and potential risk factors contributing to sentinel events identified.MethodsA total of 75 consecutive adult subjects were enrolled from 2 psychiatric units, 1 within a general hospital and 1 at a psychiatric hospital in southern Taiwan. A retrospective chart review of the psychiatric inpatients was conducted for patients that met the criteria for a sentinel event between July 2004 and May 2011. A comparison of the hospital settings was made and differences between suicidal and non-suicidal sentinel events studied.ResultsPsychiatric patients that received general hospital psychiatric services (1) appeared to experience a sentinel event soon after admission, (2) the time between the sentinel event occurrence and patient death was shorter, (3) there was a higher probability of potential medical illness than among inpatients treated at a specialized psychiatric hospital, (4) the sentinel event subjects that committed suicide were younger, had a shorter hospital stay, shorter time to occurrence of the sentinel event followed by an unexpected death than the non-suicidal group, and (5) a younger age, higher education level, previous suicide attempt and family psychiatric history were important predictors of suicide among psychiatric inpatients.ConclusionsThe results of this study suggest that psychiatric inpatients treated at a general hospital require careful examination for potential physical illness and greater efforts to prevent suicide. A younger age, higher education level, history of a previous suicide attempt and family psychiatric history are additional risk factors for suicide among these patients.

P03-46 Aggressivity and atmosphere in a general hospital psychiatric emergency service

This research identifies possible indicators of risk of aggressivity in a general hospital psychiatric ward going beyond the analysis of the episode in itself. We suggest that behaviour can be strongly conditioned by the milieu (which is organised in a similar way to other hospital wards) especially since we have found that violence is not correlated with diagnosis. We have used the Overt Aggressivity Scale and our own Ward Atmosphere Evaluation Scale (currently under validation) in order to identify those features which increase or reduce the risk of violent episodes. Factorial analysis and the study of risk probability have enabled us to create a 12 point scale (from red alert to yellow calm) of the probability/possibility of violent episodes. the scale allows psychiatric staff to assess the risk of aggressivity and consequently to modify the management and organisation of the ward if necessary (including emotional and psychological attitudes of the staff).

Preventing Suicidal Behaviour in a General Hospital Psychiatric Service: Priorities for Programming

General hospital psychiatric services are able to provide leadership and coordinate the development of suicide prevention programs for individuals serviced in general hospital settings. We completed this literature review to suggest priorities for programming. Our procedure was to update the review by Gunnell and Frankel that guided priorities for Health of the Nation, the national suicide prevention strategy in the UK. We completed a search, using the terms suicide prevention and control, of all English-language research and clinical trials conducted between January 1, 1994, and May 1, 2004. We identified 82 papers. Of these, 48 were excluded and the remaining 34 were grouped by secondary care setting categories. We found no articles on screening tools for predicting risk of suicide, 16 articles on interventions for individuals with suicidal behaviour, 14 articles on the treatment of major psychiatric disorders, 1 article and 1 published abstract on discharge from hospital, and 2 articles on reducing access to means. Based on a review of each category, we make several program and policy recommendations, including regularly updating clinical assessment skills, using guidelines for assessment of patients following a suicide attempt, assessing the risk of suicide 24 to 48 hours before discharge from hospital, and incorporating education about reducing access to means into routine psychiatric care.

Assessment and Aftercare for Deliberate Self-Harm Patients Provided by a General Hospital Psychiatric Service

We report on a sample of 135 deliberate self-harm (DSH) patients who were assessed by a general hospital DSH service, and on those who were offered aftercare by, or telephone open access to, the service. Patients' satisfaction with assessment and treatment, and their outcome were investigated at follow-up 12-20 months later. Four-fifths of patients reported the assessment following DSH to have been helpful and the assessor sympathetic. Thirty-three (24%) of the 135 patients assessed were offered treatment by the DSH service but 13 declined or failed to attend. Of the 20 who engaged in treatment, 17 (94%) were satisfied with their care. Open access to the DSH service by telephone was offered to 53 (39%) patients, nine (22%) of whom reported at follow-up that they had used this facility. A specialist DSH service can effectively assess and treat patients following DSH. It is important that the service is accessible and acceptable to patients.

Crisis—A Wide Range of Issues

EditorialCrisis—A Wide Range of IssuesJohn ConnollyJohn ConnollySearch for more papers by this authorPublished Online:January 01, 2003https://doi.org/10.1027//0227-5910.24.4.141PDFView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMore References Alte, da Veiga F, Braz, Saraiva CAge patterns of suicide: Identification and characterization of European clusters and trends.. Crisis, (2003). 24, 56–67 Link, Google ScholarBrophy, JSuicide outside of prison settings among males under investigation for sex offenses in Ireland during 1990 to 1999.. Crisis, (2003). 24, 155–159 Link, Google ScholarBrown, GS, Jones, ER, Betts, E, Wu, JImproving suicide risk assessment in a managed-care Environment.. Crisis, (2003). 24, 49–55 Link, Google ScholarChioqueta, AP, Stiles, TCSuicide risk in outpatients with specific mood and anxiety disorders.. Crisis, (2003). 24, 105–112 Link, Google ScholarDe Fauw, N, Andriessen, KNetworking to support suicide survivors.. Crisis, (2003). 24, 29–31 Link, Google ScholarHaw, C, Hawton, K, Whitehead, L, Houston, K, Townsend, EAssessment and aftercare for deliberate self-harm patients provided by a general hospital psychiatric service.. Crisis, (2003). 24, 145–150 Link, Google ScholarHoward, J, Lennings, CJ, Copeland, JSuicidal behavior in a young offender population.. Crisis, (2003). 24, 98–104 Link, Google ScholarLabelle, R, Lachance, LLocus of control and academic efficacy in the thoughts of life and death of young Quebec university students.. Crisis, (2003). 24, 68–72 Link, Google ScholarLeenaars, AACan a theory of suicide predict all “suicides” in the elderly?. Crisis, (2003). 24, 7–16 Link, Google ScholarLester, D, McIntosh, JLThe variation of the mean age of suicides in the United States.. Crisis, (2003). 24, 173–174 Link, Google ScholarManley, RS, Leichner,, PAnguish and despair in adolescents with eating disorders—Helping to manage suicidal ideation and impulses.. Crisis, (2003). 24, 32–48 Link, Google ScholarMcAuliffe, C, Corcoran, P, Keeley, HS, Perry, IJRisk of suicide ideation associated with problem-solving ability and attitudes toward suicidal behavior in university students.. Crisis, (2003). 24, 160–172 Link, Google ScholarNoor-Mahomed, SB, Schlebusch, L, Bosch, BASuicidal behavior in patients diagnosed with cancer of the cervix.. Crisis, (2003). 24, 168–172 Link, Google ScholarOsváth, P, Kelemen, G, Erdös, MB, Vörös, V, Fekete, SThe main factors of repetition: Review of some results of the Pecs Center in the WHO/EURO Multicentre Study on Suicidal Behavior.. Crisis, (2003). 24, 151–154 Link, Google ScholarOwens, C, Booth, N, Briscoe, M, Lawrence, C, Lloyd, KSuicide outside the care of mental health services: A case-controlled psychological autopsy study.. Crisis, (2003). 24, 113–121 Link, Google ScholarReith, DM, Whyte, I, Carter, G, McPherson, MAdolescent self-poisoning: A cohort study of subsequent suicide and premature deaths.. Crisis, (2003). 24, 79–84 Link, Google ScholarSarfati, Y, Bouchaud, B, Hardy-Baylé,, M-CCathartic effect of suicide attempts not limited to depression: A short-term prospective study after deliberate self-poisoning.. Crisis, (2003). 24, 73–78 Link, Google ScholarSattar, GThe death of offenders in England and Wales.. Crisis, (2003). 24, 17–23 Link, Google ScholarSchlebusch, L, Naseema, BM, Bosch, BASuicidal behavior in Black South Africans. Crisis, (2003). 24, 24–28 Link, Google ScholarSethi, S, Bhargava, SCChild and adolescent survivors of suicide.. Crisis, (2003). 24, 4–6 Link, Google ScholarSimkin, S, Hawton, K, Yip, PSF, Yam, CHKSeasonality in suicide: A study of farming suicides in England and Wales.. Crisis, (2003). 24, 93–97 Link, Google ScholarStanistreet, D, Jeffrey, VInjury and poisoning mortality among young men—Are there any common factors amenable to prevention?. Crisis, (2003). 24, 122–127 Link, Google ScholarFiguresReferencesRelatedDetails Volume 24Issue 4July 2003ISSN: 0227-5910eISSN: 2151-2396 Published online2003 InformationCrisis (2003), 24, pp. 141-144 https://doi.org/10.1027//0227-5910.24.4.141.© 2003Hogrefe & Huber PublishersPDF download

Increase in first admissions for schizophrenia and other major psychoses in Italy

Despite reports of falling first-admission rates for schizophrenia in some Western countries, methodological problems and bias preclude a definite conclusion about a genuine fall in the incidence of schizophrenia. This study set out to test the hypothesis that first admissions for schizophrenia in Italy have fallen in recent years. All admissions rated as ‘first contact’ in Italy from 1984 to 1994 for severe mental illnesses to general hospital psychiatric services, as reported in the Italian National Institute for Statistics Health-Care Yearbooks, were considered. Data were analyzed as rates per 100 000 in the general population, and changes over time in incidence of schizophrenia, paranoia, affective psychoses and drug-induced psychoses (diagnosed according to ICD 9) were recorded. Changes in rates over time, with rates as the dependent variable and years as the independent variable, were the main outcome measure. First-admission rates for schizophrenia and paranoia increased progressively from 1984 to 1994, as did those for affective psychoses, mania and, to a lesser extent, major depression. In the same period, all admissions (both total and rated as ‘first-contact’) for mental disorders increased. Although linear regression tests for admission rates in most, but not all, cases indicate a significant ascending linear trend, quadratic model results show a significantly better fit than does the simple linear regression model for the majority of data. The change described by the quadratic model suggests an increase in admission rates more marked in the second half than in the first half of the period of the study. First-admission rates for schizophrenia and, to a lesser extent, paranoia seemed to increase concurrent to a decrease in first-admission rates for ‘other’ non-organic psychoses. Contrary to reports from other Western countries, hospital incidence in Italy for schizophrenia is on the increase, as is that for other severe psychoses. This increase is likely to be a reflection of changes in mental health-care organisation, in treatment and diagnostic patterns, and in cultural attitudes towards mental illness. Radical changes in the true incidence of psychoses, in particular of mood disorders, as described elsewhere, cannot be ruled out as contributing factors. Data bias and limitations preclude a generalisation of results, however.

Using the Health of the Nation Outcome Scales in clinical practice

Aims and methodTo describe the implementation of a plan to use a validated outcome measure in the care and treatment of people with severe mental illness within a district general hospital psychiatric service. Multiple techniques were necessary to promote actual change of practice.ResultsA survey of practice found 77% of full Care Programme Approach patients to have recorded Health of the Nation Outcome Scales (HoNOS) scores in their care plans one year after the beginning of the implementation plan.Clinical implicationsIt is possible to incorporate the use of HoNOS in to everyday practice but it takes a lot of time, effort and resources. Mental health services may require a clearer indication from the NHS Executive regarding the use of such outcome scales before committing themselves.

Joint Care Admissions to A Psychiatric Unit: A Prospective Analysis

Despite developments in general hospital liaison psychiatry over the past 20 years, joint care still remains underdeveloped in Europe. Psychiatry continues to move from the mental hospital to the general hospital unit without the parallel evolution of combined medical and psychiatric. An inpatient unit that provides both medical and psychiatric care may provide an essential integration of care that can benefit a select group of patients. The aims of this study were to prospectively evaluate the profile, treatment, and follow-up of patients admitted to the joint-care unit, and to examine the difficulties associated with the treatment of these patients on a joint unit. Eighty-nine patients were admitted to the joint care unit over a 6-month period. Their median length of stay was 2 days (range 1–52 days). Fifty-six (50%) were female. The majority (68) (76%) of the group were admitted following acts of deliberate self-harm. The overall predominant psychiatric diagnosis was depression (41) (46%). During admission, 23 (26%) patients were found to have behavioral and psychiatric problems that were difficult to manage on the ward. Eleven patients caused difficulties for staff relating to the management of their physical illness. Thirty-six (33%) patients were referred for further psychiatric inpatient care from the joint-care unit. The extra burden of these patients’ care was felt to fall on the staff working on the psychiatric unit. The joint care unit provided a combined psychiatric and medical service. It was used predominantly by patients following acts of deliberate self-harm. Joint care allowed a comprehensive assessment and initiation of treatment of this patient group as well as a learning experience for medical and nursing staff. The inclusion of such a unit is a worthwhile consideration in any general hospital psychiatric service, with advanced planning easing staff workload.

Deliberate self‐harm in alcohol and drug misusers: patient characteristics and patterns of clinical care

The aims of this study were to describe the characteristics of alcohol and drug misusers presenting to a general hospital following suicide attempts and to investigate the patterns of clinical care they received before and after the attempts. The Oxford Monitoring System for Attempted Suicide and patient case-notes were used to obtain information on alcohol and drug misusers assessed by the general hospital psychiatric services after deliberate self-harm in 1992. Of 724 patients, 200 (28%) were substance misusers (36% of males, 23% of females). Both alcoholics and drug misusers were more likely than other attempters to be male, have histories of personality disorder and criminal offences and to make repeat attempts, and the drug misusers were more likely to be living alone and unemployed. These are characteristics associated with particularly high risk of suicide. A large proportion of the substance misusers had received specific treatment for their misuse before their attempts and the majority were offered this afterwards. Over a quarter did not accept the care they were offered. The general hospital management of attempted suicide patients must include systematic assessment for evidence of alcohol and drug misuse and maintain close links with substance misuse services. Patients identified as having problems in the use of alcohol without having developed dependence and/or physical symptoms are a group that warrants specific attention. Audits should be conducted in general hospitals to ensure that sufficient attention is being paid to the detection and management of suicide attempters with substance misuse.

Health maintenance organization penetration and general hospital psychiatric services: Expenditure and utilization trends.

Expenditures for inpatient and outpatient psychiatric services provided through general hospitals and the utilization of those mental health and substance abuse services through general hospitals is examined for all states grouped by level of health maintenance organization (HMO) penetration. Between 1983 and 1990, outpatient use for general hospitals increased substantially for the highHMO group but decreased in the low-HMO group. During the same time period, per capita expenditures for inpatient and outpatient psychiatric services grew fastest in low-HMO areas. These findings suggest that HMOs restrain the growth of general hospital psychiatric expenditures and encourage the growth of outpatient alternatives to inpatient treatment. In increasing numbers, Americans are receiving mental health services through some form of managed mental health

Health maintenance organization penetration and general hospital psychiatric services: Expenditure and utilization trends.

Health maintenance organization penetration and general hospital psychiatric services: Expenditure and utilization trends.

Factors in the quality of patient evaluations in general hospital psychiatric emergency services.

The study examined the usefulness of a three-perspective model for determining the quality of evaluations in psychiatric emergency services. The model was used to evaluate the hypothesis that the provision of high-quality care in emergency services is primarily influenced by service objectives related to patients' clinical characteristics rather than by institutional constraints, such as workload or physical facilities, or by social biases, such as clinicians' attitudes toward patients or perceptions of community expectations. The evaluation of 683 persons assessed in nine California public facilities were independently observed. Multivariate techniques were used to test the relative importance of patients' clinical characteristics, possible sources of social bias among clinicians, and institutional constraints in influencing three quality-of-care dimensions: technical quality, the art of patient care, and optimum investment of time. The findings generally confirmed the hypothesis that patients' clinical characteristics have more influence on the quality of care provided than institutional constraints or social biases. However, one institutional constraint--increased workload demands--led to reduced technical quality and to less than optimal use of time. Further, social biases reflected in the clinician's like for and preconceptions about the patient also influenced the quality of their evaluations. The model is a useful tool for examining quality of care in the psychiatric emergency service. Increasing workload pressures negatively affect quality of care.

The quality of psychiatric emergency evaluations and patient outcomes in county hospitals.

Quality of care is widely assumed to be related to patient outcomes, but little is known about care in relation to outcomes in county general hospital psychiatric emergency services. It was hypothesized that conformity to professional standards (technical quality) and engagement of the patient (artful care) in psychiatric emergency services evaluations would contribute to improved patient functioning (Global Assessment Scale score) and appropriate disposition. A total of 583 cases in seven facilities were analyzed. Conformity to technical standards of care was associated with retention even after constraints, biases, and admission criteria had been taken into account. Conversely, artful care was associated with lower probability of retention and improved functioning.

A treatment system for combined psychiatric and addictive illness

Patients with combined general psychiatric and addictive disorders are a major public health problem in the US, and are being increasingly recognized as such world-wide. The authors describe a model treatment system for such patients in one municipal hospital in New York. It is composed of three complementary units: a locked ward, a halfway house and a day program. Treatment is based on a peer leadership approach coupled with professional treatment, and provides multiple levels of care to address the needs of respective patients. Of 464 admissions evaluated and treated, most were from disadvantaged minorities, homeless and abusers of cocaine. All were admitted with acute psychiatric or perinatal presentations, and carried Axis I diagnoses in addition to their substance abuse. Clinical experience over 6 years is reviewed, suggesting the feasibility of reorganizing general hospital psychiatric services to address the needs of the dually diagnosed.

Homeless mentally ill patients in the community: Results of a general hospital emergency room study

Previous inattention to the specific circumstances of homeless mentally ill individuals in general hospital settings is discussed. Homeless mentally ill individuals who presented for emergency psychiatric care in a public general hospital setting exhibited distinctive patterns of service utilization and showed evidence of being a uniquely disabled, rootless, and impoverished subgroup of mentally ill individuals. The characteristics of homeless users of general hospital psychiatric services may provide some important clues to system-wide deficits in community-based care for the members of this population.

Integration of general hospital psychiatric services with freestanding psychiatric hospitals.

General medical hospitals and freestanding psychiatric hospitals usually function independently. The authors review the relative strengths and weaknesses of the two settings and suggest a plan for a rational coordination of services. In an efficient integrated system, the general hospital would provide emergency psychiatric services and treat patients with combined medical and psychiatric conditions. The freestanding facility would offer inpatient and outpatient services, as well as partial hospitalization and transitional living arrangements, to psychiatric patients without medical complications. All facilities would share professional staff and data processing capabilities and would have common policies and procedures, reducing the cost of treatment and facilitating patient transfers.

Effects of a smoking ban on a general hospital psychiatric service.

After a private general hospital announced plans to ban smoking inside the hospital, the authors initiated a study on the psychiatric units to identify anticipated and actual patient-related problems associated with the ban and to assess staff and patient attitudes toward the ban. Data were obtained through pre- and post-ban surveys of medical and nursing staff and predischarge interviews with patients. The findings showed that staff anticipated more smoking-related problems than actually occurred and that patients who smoked were able to reduce their tobacco use during their hospital stay. No evidence was found to suggest that hospitalized psychiatric patients are less capable of cutting down on smoking than the general population.

Day treatment of alcoholism: an outcome study.

Thirty-seven (27 male and 10 female) alcoholics, treated in a brief day program, were assessed on a number of alcohol related and psychosocial variables 15 months following the initial treatment. Thirty percent (30%) remained totally abstinent, another 30% reduced their drinking to less than 10%, and 35% showed a moderate reduction of 10 to 50% in their pre-treatment drinking. Significant reduction was reported by these patients in their utilization of health services for purposes of detoxification, psychiatric treatment, visits to the family physician, and emergency department. Improvement was also reported on employment status, legal problems, general emotional state and some symptoms suggestive of depression. These findings are discussed in the light of the viability of cost effective day treatment programs for alcoholism within the context of general hospital psychiatric services.