Long-term Psychiatric Patients Research Articles

Community Reintegration of Long-Term Psychiatric Patients Through a Creative Arts Rehabilitation Therapy Group

After years of inpatient treatment in a locked facility, psychiatric patients who are preparing to transition to lower-security residential settings often benefit from bridging that continuum of care with supervised community excursions. In this study, facilitators and patients collaborated to identify and engage in a variety of arts-related experiences and settings in nearby cities and nature areas as a medium through which to help reconnect patients in a state psychiatric hospital with their surrounding community. Preliminary findings from data gathered included increased positive affect and quality of life, decreased feelings of isolation and institutionalization, more positive regard for treatment, and maintained or improved pace of patient progress toward discharge and community reintegration. Supervised therapeutic exposure to arts in the community appears to be an indicated clinical option to help motivate and prepare select psychiatric inpatients for community reintegration. As this is an information-sharing article regarding research-informed practice rather than the result of a research project, formal research is recommended as a next step to establish external validity and further the field’s knowledge of this topic.

Length of Stay of Psychiatric Admissions: a Case-Control Study

To identify the exposure factors associated with the length of stay of psychiatric patients. A case-control study was performed at a psychiatric hospital in Brazil. The cases included all hospitalised patients with stays of over 60 continuous days over a 1-year period. The randomly chosen controls were matched by gender and age. Multivariate analyses using logistic regression were performed. A total of sixteen patients were selected. There were 72 cases (5.5% of all hospitalisations) and 144 controls; 63.9% were male, and the mean age was 44.4 years (± 11.9). The reasons for hospitalisation were risk to self and the inability to provide for self-care coupled with inadequate family/social support that were shown to be associated (p < 0.05) with length of stay of these psychiatric patients. Additional analytical studies to investigate the quality of life of long-term psychiatric hospitalisation patients are recommended.

The Mice Will Play: Theatre in a Psychiatric Clinic

At playing theatre in the clinic, a stigmatized group of long-term psychiatric patients can strengthen their self-respect. The playing space becomes a space of possibilities. Gradually, playing together becomes more and more of an experiment for an imagined departure from the clinic.

Animal-Assisted Therapy With Chronic Psychiatric Inpatients: Equine-Assisted Psychotherapy and Aggressive Behavior

Animal-assisted therapy (AAT), most frequently used with dogs, is being used increasingly as an adjunctive alternative treatment for psychiatric patients. AAT with larger animals, such as horses, may have unique benefits. In this randomized controlled study, equine and canine forms of AAT were compared with standard treatments for hospitalized psychiatric patients to determine AAT effects on violent behavior and related measures. The study included 90 patients with recent in-hospital violent behavior or highly regressed behavior. Hospitalization at the 500-bed state psychiatric hospital was two months or longer (mean 5.4 years). Participants were randomly selected to receive ten weekly group therapy sessions of standardized equine-assisted psychotherapy (EAP), canine-assisted psychotherapy (CAP), enhanced social skills psychotherapy, or regular hospital care. Participants' mean age was 44, 37% were female, 76% had diagnoses of schizophrenia or schizoaffective disorder, and 56% had been committed involuntarily for civil or forensic reasons. Violence-related incident reports filed by staff in the three months after study intake were compared with reports two months preintake. Interventions were well tolerated. Analyses revealed an intervention group effect (F=3.00, df=3 and 86, p=.035); post hoc tests showed specific benefits of EAP (p<.05). Similar AAT effects were found for the incidence of 1:1 clinical observation (F=2.70, df=3 and 86, p=.051); post hoc tests suggested benefits of CAP (p=.058) as well as EAP (p=.082). Covariance analyses indicated that staff can predict which patients are likely to benefit from EAP (p=.01). AAT, and perhaps EAP uniquely, may be an effective therapeutic modality for long-term psychiatric patients at risk of violence.

Learning from Ward Number Six

The physician Anton Chekov (1860–1904) developed a passion for writing at an early age. Acutely aware of the social and health inequalities, his stories centre upon clinical encounters with poor and marginalised sectors of a society in turmoil. In Ward Number Six (1892), the setting is a destitute provincial hospital, the demise of which has gone unnoticed by the central authorities. The unwelcoming and rusting premises exude a ‘doomed air’. The story centres upon Andrej Ragin, the chief doctor, and his relationship with Ivan Gromov, a longterm psychiatric patient. Ragin is initially outraged by the filthy conditions and seeks to bring about change. However, the relentless flow of illness and death take their toll, and Ragin’s determination gives way to disillusionment and despair. A fatalistic attitude — ‘expel physical and moral filth from one place and it will only crop up elsewhere’ — eases his conscience and justifies his waning engagement with patients and dissipating sense of professional and moral duty. Ragin spends more and more of his time debating the purpose of life and death with Gromov. Ragin has lived a protected and comfortable life and believes that suffering and hardship are bestowed upon individuals at random and that these individuals must learn to ignore their effects. His philosophical stance is countered by

Social Interactions Observed by Playing Board Games with Long-Term Psychiatric Patients : Fieldwork Conducted in a Closed Ward for Female Patients

Social Interactions Observed by Playing Board Games with Long-Term Psychiatric Patients : Fieldwork Conducted in a Closed Ward for Female Patients

The prevalence of metabolic syndrome and its associated factors in long-term patients in a specialist psychiatric hospital in South Africa

The aims of this study were to determine the prevalence of metabolic disorders in long-term psychiatric patients, and the relationship between known risk factors and these metabolic disorders. All psychiatric in-patients ≥18 years, who had been admitted ≥six months were invited to participate. Eighty-four patients participated. They were interviewed, examined, measured and blood tests conducted to determine several demographic and clinical variables including age, gender, weight, blood pressure and fasting blood glucose. The prevalence of the metabolic disorders were: metabolic syndrome 32%, hypertension 32%, diabetes mellitus 8%, cholesterol dyslipidaemia 32%, triglyceride dyslipidaemia 29%, low density lipoprotein (LDL) dyslipidaemia 50%, overweight 37%, and obesity 24%. Black African and female patients were more likely to have metabolic syndrome. Female patients were more likely to have cholesterol dyslipidaemia and obesity. Hypertension was associated with age. Ninety-six percent of patients with dyslipidaemia were newly diagnosed during the study. Three out of the seven previously diagnosed diabetic patients had raised fasting blood glucose levels. The prevalence of metabolic syndrome falls towards the lower limits of the expected prevalence rate. Race and gender showed a moderate statistical association with metabolic syndrome. There is a lack of screening for dyslipidaemia in this setting. Diabetic patients should be referred to specialist diabetic clinics for better monitoring and control.

Are long-term psychiatric patients causing more crisis consultations outside office hours in mental health care?

As well as an improvement in community services, the de-institutionalization of patients receiving long-term psychiatric care can lead to marginally staffed mental health services, more homelessness, rising admission rates and more people in prison cells. It is assumed that an imbalance between community and hospital care for chronic patients puts pressure on crisis services. In this study, the central question is whether patients receiving long-term psychiatric care in Amsterdam do indeed put pressure on the city's emergency mental health services. We compare the pressure exerted by this group with the pressure resulting from the use of these services by all registered patients. Data were taken from the client registration systems of three mental health organizations in Amsterdam in the period from 2000 to 2004. Inclusion criteria for long-term psychiatric patients were age above 19 years and uninterrupted receipt of mental health care for a minimum of two successive years. Annually, 6%-8% of all non-long-term patients experienced a crisis outside office hours in the period under investigation; this was 4%-6% for long-term patients. The non-long-term patients accounted for 83% of crisis contacts outside office hours over the entire study period, with long-term patients accounting for 17%. The assumption that crises are more prevalent in long-term patients in the community seems to be an example of stigmatization rather than an observation based on fact.

Quality of life and unmet need in people with psychosis in the London Borough of Haringey, UK.

Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users' evaluation of need and by care workers. Design. Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing. Setting. London Borough of Haringey. Outcome Measures. 110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information. Results. People in “low-support” and “high-support” housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents' and care-workers' assessments of need differed considerably. Conclusions. Although patients' housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of “recovery” is to advance.

Better off in the community? A 5-year follow up study of long-term psychiatric patients discharged into the community

The quality of life of long-term psychiatric inpatients relocated to the community was investigated in this study. The aim was to investigate what changes, if any occurred, on standardised quality of life related instruments between discharge from hospital and at 1 year after discharge into the community. We were also interested to see if these changes continued 5 years after discharge into the community. 87 long-stay psychiatric patients were enrolled in the study. Each patient was assessed on four standardised assessment instruments designed to assess their attitudes towards community living and level of functioning in the community. Patients reported being satisfied in their new community environment. They showed improvements in their level of self-care and social functioning after 1 year in the community. These improvements were not maintained in their fifth year in the community. In addition, there were no improvements in patient's domestic skills, community skills or activity and social relations levels. Weekly occupation levels increased after 5 years in the community and their level of interests in things increased over the first year but not after 5 years in the community. This study adds to the previous work carried out on patients discharged from large psychiatric hospitals into the community. Patients expressed a desire to continue to live in the community and while they showed improvements in self care and social functioning in the first year following discharge, these improvements were not sustained after 5 years in the community. Further training is needed for staff in the community residences so that patients can achieve their maximum potential.

Clinical characteristics in long-term care psychiatric patients: A descriptive study

Objective: The purpose of this study was to describe the clinical characteristics and related comorbid conditions of psychiatric patients admitted to residential facilities (RFs) and their impact on the levels of functioning of such patients. Methods: We assessed 426 patients admitted to residential facilities, by using SCID-I, SCID-II, BPRS, GAF and DAS. Results: The most common diagnostic category was schizophrenia/psychotic disorders (41.8%), followed by affective disorders (35.4%), personality disorders (14.1%), and other disorders (8.7%). In addition 33.3% had a psychiatric comorbidity, and 62.6% had a medical comorbidity. Low levels of functioning were significantly correlated with both medical and psychiatric comorbid conditions. Conclusions: Comorbidity is common in patients requiring long-term residential care. Thus improved detection and treatment of these conditions in people with severe mental illnesses will have significant benefits for their psychosocial functioning and overall quality of life.

Psychiatry, Testimony, and Shoah: Reconstructing the Narratives of the Muted

SUMMARY A 1999 examination of approximately 5,000 long-term psychiatric patients in Israel identified 725 as Holocaust (Shoah) survivors. Review of these cases has shown that these patients had not been treated as a unique group, and that their trauma-related illnesses had been neglected in their decades-long treatment. We discovered that many of these patients had never openly shared their severe persecution history. We postulated that many of them could have avoided lengthy if not lifelong psychiatric hospitalization had they been able to openly share that history. Instead, those gruesome and traumatic experiences remained encapsulated, split off, causing the survivor to lead a double life. These patients may physically inhabit the world as psychogeriatric patients, though emotionally they may remain in adolescence or childhood due to early traumatic experiences. Some 26 patients at two institutions gave consent to be interviewed by a professional team and have their testimonies recorded on videotape. The aim of this study was to investigate the role of video testimony as a potential useful psychotherapeutic clinical intervention. By videotaping testimonies of these patients' experiences before, during, and after World War II, we had created highly condensed texts that could be interpreted on a multiplicity of levels going far beyond the mere narrative content of clinical medical history. Joint observation, reiteration, and discussion of these testimonies with staff members and the patients themselves has been not only an interesting experience, but also one of therapeutic value yet to be fully appreciated.

Changing the inpatient setting for long-term psychiatric patients

Beds in Israel's private psychiatric hospitals, where the standard of care is markedly lower than in state-run facilities, are being closed down. Their patients - many hospitalized for years - are being re-assessed and those still needing inpatient care transferred to state hospitals. The aim is to give a better quality of life, conduct a thorough psychiatric reappraisal and offer the latest therapeutic options.The merged Be'er Ya'akov-Ness Ziona- Israel Prisons Service Mental Health Center set up a multidisciplinary team to conduct a coordinated process of reappraisal, preparation, reorganization and admission for these patients and their families. We found in the patients complex self-management problems, a high level of dependency, severe neglect, a range of tendencies to violence, and mistrust of the staff. The family members revealed high levels of anxiety and fear. Given this situation, a nursing staffer was appointed to liaise with the families, be freely available for consultation and act as patient advocate.In this presentation we describe the core principles for this multidisciplinary reassessment and re-placement process, which began by assessing the patients in their setting of origin. We report on the planning of new interventions incorporating the latest therapeutic advances, exceptional incidents, changing the profile of the psychogeriatric ward, etc. We offer the conclusions and recommendations drawn from this change process, undergone equally by patients, family members and staff, and report on its results, which for many of the patients led to a more open care-setting in the community and for some a return home.

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

Reductions in Postdischarge Suicide After Deinstitutionalization and Decentralization: A Nationwide Register Study in Finland

Effects of a Tobacco Ban on Long-term Psychiatric Patients

A total ban on all tobacco products was implemented in a diverse psychiatric institution. A post hoc evaluation examined the effect of the ban on long-term patients by comparing their characteristics the year before the ban to the year after. Several variables measuring physical health, psychiatric symptomatology, feelings of well-being, and interpersonal conflict were coded with very high reliability from health records. For the majority of patients who were in the maximum security forensic division, the tobacco ban was associated with almost no detectable ill effects with some clear benefits. Among the remainder of the long-term patients, the ban might have been associated with a temporary increase in physical aggression towards staff members. It was concluded that successful implementation, and the avoidance of ill effects, depended entirely on the success staff members had in actually preventing patient access to tobacco.

Psychiatry, Testimony, and Shoah

Summary A1999 examination of approximately 5000 long-term psychiatric patients in Israel identified 725 as Holocaust (Shoah) survivors. Review of these cases has shown that these patients had not been treated as a unique group, and that their trauma-related illnesses had been neglected in their decades long treatment. We discovered that many of these patients had never openly shared their severe persecution history. We postulated that many of them could have avoided lengthy if not life-long psychiatric hospitalization had they been able to openly share that history. Instead, those gruesome and traumatic experiences remained encapsulated, split-off, causing the survivor to lead a double-life. These patients may physically inhabit the world as psychogeriatric patients, though emotionally they may remain in adolescence or childhood due to early traumatic experiences. Some twenty-six patients at two institutions gave consent to be interviewed by a professional team and have their testimonies recorded on videotape. The aim of this study was to investigate the role of video testimony as a potential useful psychotherapeutic clinical intervention. By videotaping testimonies of these patients' experiences before, during, and after World War II, we had created highly condensed texts that could be interpreted on a multiplicity of levels going far beyond the mere narrative content of clinical medical history. Joint observation, reiteration, and discussion of these testimonies with staff members and the patients themselves has been not only an interesting experience, but also one of therapeutic value yet to be fully appreciated.

Community integration of elderly mentally ill persons in psychiatric hospitals and two types of residences.

Deinstitutionalization policy in the Netherlands has given rise to two new living arrangements for elderly long-term psychiatric patients. Both involve accommodation in mainstream residential homes for elderly persons, either concentrated in a specialized care unit or dispersed throughout the facility. The authors studied the effectiveness of these two housing models for the community integration of such residents compared with accommodation in a psychiatric hospital. Three subsamples were selected: 49 residents in six units of concentrated housing, 47 residents in 12 units of dispersed housing, and 78 patients in 24 psychiatric hospital units, for a total sample of 174 participants. These samples were compared in a quasi-experimental, posttest-only design that used four measures of community integration: amount of perceived influence over one's daily life, involvement in social activities, social network size, and frequency of visits received from members of the network. To adjust for differences in the populations, the hospital patients were matched to the residential home residents, and confounding factors were controlled for. Residential homes afforded more privacy, were closer to public services, and had a more diversified population than psychiatric hospitals. Participants in dispersed housing experienced more personal influence over their lives than did hospital patients. Concentrated-housing participants were less enterprising and had smaller social networks. The three groups did not differ in the frequency of visits received from network members. Community-integrated facilities do not necessarily imply community-integrated residents. Only dispersed-housing residences were an improvement over hospitals, and then solely in terms of residents' influence over their own daily lives. The advantage of the dispersed-housing model is that it resembles independent living while its institutional nature offers structure and protection.

Hospital-acquired infections in Norwegian long-term-care institutions. A three-year survey of hospital-acquired infections and antibiotic treatment in nursing/residential homes,including 4500 residents in Oslo

Point prevalence studies of hospital-acquired infections among the elderly in 65–70 long-term care facilities (LTCF) were carried out once a year over a three-year period in Oslo city, Norway. They showed an overall rate of 6.5% of hospital-acquired infections among 13 762 residents. The infection rate was approximately the same as in hospitals and twice as high as among hospitalized long-term psychiatric patients. Residents who had received surgical treatment within the previous three months had a high rate of postoperative infections, especially wound infections (14.8%). During the study period, the LTCFs were found to be understaffed and overcrowded. They had few private rooms, a lack of bathrooms and toilets, no isolation facilities and deficient ventilation systems. The economic consequences of hospital-acquired infections in these LTCFs were extra costs in medical and nursing care and antibacterial treatment of 157 500 Nkr/day (22500 USD). There would be a substantial cost-benefit in effective preventive measures against hospital-acquired infections in long-term care institutions.

Utility and stability of the basic personality inventory in psychiatric patients with longstanding psychotic disorders in a new psychiatric rehabilitation program over a two-year period.

34 long-term psychiatric patients with psychotic-type diagnoses, participating in a Psychiatric Rehabilitation program, completed the Basic Personality Inventory 5 times at 6-mo. intervals. In comparison with normative data, participants had statistically significant (p < .01) higher means at Time 1, indicating greater reported psychopathology on all scales except Interpersonal Problems. Program participants also showed greater impairment than a heterogeneous group of 112 psychiatric patients, with statistically higher means on the scales of Denial, Persecutory Ideas, Thinking Disorder, and Self-depreciation. No statistically significant differences were found for sex, time, or their interaction. Correlations indicated high stability in the scale scores over time. Considerable stability in test scores over time does not indicate lack of program success but reflects stability maintenance goals and processes in patients with longstanding psychotic disorders.

Defining effective community support for long-term psychiatric patients according to behavioural principles

Objective: The purpose of this article is to define the characteristics of effective support in community mental health settings for patients with serious and persistent mental illness.Method: A broad literature providing empirical evidence on competent caregiver behaviours and styles is selectively reviewed. Relevant findings from family caregiver research and studies of social environments that enhance skill development in people with intellectual disabilities are incorporated, within a cognitive-behavioural framework.Results: Six important domains are identified which represent positive caregiver styles: acceptance, creating a positive atmosphere, expectations of change, responsiveness, normalisation and educativeness.Conclusion: The characteristics hypothesised to be critical for caregivers and support workers are defined in a general way that can allow for individualisation according to the goals of the programs and the cultural priorities of staff and patients. Further empirical validation of these characteristics would enable community mental health services to provide more specialised clinical treatments.