Mental Handicap Hospital Research Articles

Reduction in Antipsychotic Drug Dosage in Mentally Handicapped Patients

An investigation in a large mental handicap hospital revealed that 24% of the in-patients were receiving antipsychotic drugs. Chlorpromazine and thioridazine prescriptions accounted for 62% of the total while 10% of patients received depot preparations. Fifty-five per cent of the patients receiving these drugs had no established psychiatric diagnosis; most of these could be categorised as having a behaviour disorder. Patients aged 30-50 received higher doses, and female patients received a significantly higher mean dosage than male ones. In the patients receiving neuroleptic drugs who had also been taking them four years previously, there was a significant reduction in the dosage of the drugs received and the extent of polypharmacy of these agents. A mandatory requirement to review all prescriptions annually, implemented in 1984, may be a reason for this.

Facilities for mentally impaired patients: three years experience of a semi-secure unit

The Working Party on Security in NHS Hospitals (The Glancy Report, DHSS, 1974a) and the interim report of The Butler Committee (DHSS, 1974b) both recommended that secure provision should be made available for the treatment of mentally disordered patients who required greater security than could be provided in a standard hospital setting. They recommended that patients with mild or borderline mental handicap should be treated together with the mentally ill but that “severely subnormal patients” should be treated separately. Later the Royal College of Psychiatrists (1981) largely endorsed this advice proposing that: (a) individuals with borderline and mild mental handicap could be adequately treated in the secure units for mentally ill individuals(b) individuals with moderate mental handicap needed a special secure facility(c) individuals with severe mental handicap did not need high security, and should be managed in high-staffed wards in mental handicap hospitals.

Making a reality of joint planning

Summary The Care in the Community initiative has resulted in a renewed interest in collaboration between local and health authorities. The focus of such collaboration is commonly on the transfer of long‐stay patients from psychiatric and mental handicap hospitals that are due to close, though the extent of local authority involvement in closure programmes varies considerably. Joint planning typically involves a number of local authority departments: social services, housing, chief executives’ offices and legal services. It sometimes also involves education, recreation and leisure departments. Joint planning can be very time‐consuming and can call for considerable effort. It frequently gives rise to a good deal of conflict between the participating agencies. The pay‐offs, on the other hand, often appear to be small. Such plans as are finally implemented tend to be small‐scale: attempts at broader strategic planning almost invariably come to grief. The question then has to be asked, whether joint planning i...

News

Jersey nurse Kathy Harvey has launched a campaign on the island to collect warm clothing for children in Romania. She started the project after seeing television reports about conditions at a mental handicap hospital in the north of the country. See News item on page 7.

Behaviour disorders and other characteristics of the population of a mental handicap hospital

ABSTRACTThis paper presents information on the characteristics of 981 people living in a mental handicap hospital, including their sex, age, sensory and physical impairments, and level of behaviour disorder, and examines the inter‐relation of these features. The findings indicate that health and local authorities should take particular note of two features, age and behaviour disorders, when developing and implementing their resettlement policies for people with mental handicaps.

The quality of life of severely mentally handicapped patients in hospital

It is unclear how much the profound changes which have occurred in mental handicap hospitals in the last decade have improved the lot of the profoundly handicapped, since Baker & Urquhart (1987), in a national survey of Scottish Mental Handicap Hospitals, found that 45% of all hospital residents had no set occupation and that there was a relationship between occupation and ability level. Between 14% and 32% of all patients were without occupation and unable, or not allowed, to leave the ward without a member of staff.

Intrinsic interest of objects for elderly people in long‐stay mental handicap hospitals

When 97 elderly people with mental handicaps were observed on three long‐stay hospital wards, it was found that objects on the wards were used more if they were personal possessions, especially by the women. Manipulability of objects for women and sociability of objects for men also increased object interest. Most (60 per cent) of the 522 objects on the wards were never seen to be used.

Transition Shock and the Relocation of People from Mental Handicap Hospitals and Hostels

AbstractThe process of deinstitutionalisation has been gathering momentum in Britain and the United States since the mid‐1970s. A discussion of these trends provides the background to an examination of “transition shock” as it affects people relocated from mental handicap institutions. The paper explores the theoretical underpinnings of the concept of transition shock and links them to the findings of a follow‐up study of the behavioural consequences of relocation.

Hepatitis B screening in a Northern Irish mental handicap institution: relevance to hepatitis B vaccination

The current DHSS guidelines on immunisation against hepatitis B in mental handicap hospitals recommend vaccination for personnel at risk directly involved in patient care (who may have direct contact with patients or their body fluids) and for new admissions into institutions where the incidence is known to be high. We report a serological survey of hepatitis B markers in over 99% of the residents of a large mental handicap hospital. Of 720 patients tested only one carried hepatitis surface antigen. This patient was anti-HBe positive. Only 4·5% of the residents carried any hepatitis marker. These results do not suggest the need for a local vaccination programme for patients or staff.

Prescribing practice in a mental handicap hospital: 2 — PSYCHOTROPIC MEDICATION FROM 1978–87

As described in a previous article (Lynch, 1989) prescription sheets and case notes of people resident in a mental handicap hospital on 31st March 1978 and 31st March 1987 were analysed to identify changes in prescribing patterns of psychotropic medication. The number of people on regular neuroleptics (major tranquillisers used in the treatment of psychoses) increased, but those on regular benzodiazepines (minor tranquillisers used to alleviate anxiety) did not change greatly over the period. The type of drug used in each class did alter. In the first class thioridazine and chlorpromazine were prescribed more often by 1987, and several newer benzodiazepines were prescribed, such as temazepam to replace flurazepam. The number of people on more than one drug did not alter greatly.

GROUPWORK ON “LIFE EVENTS AND SEXUALITY”

The twin concepts of normalisation (Wolfensberger, 1972) and care in the community (DHSS, 1981) have been the spurs to increased opportunities being given to people with mental handicaps to learn about sexuality. Too often these opportunities are provided as part of personal hygiene programmes or are based on child‐oriented materials. Little thought has yet been given to developing appropriate models of teaching which offer an all‐round approach, are geared to adults, take into account people's special learning difficulties, and put sexuality in the context of relationships, growing up, and other life events.This is the report of a multidisciplinary approach to help prepare some adults with mental handicaps, residing in a Chichester mental handicap hospital, for life in the community. Emphasis was placed on looking at sexuality and relationships in the context of life events.

Disorders of mental handicap institutions

In each of three mental handicap hospitals I have observed an institutional disorder. From consideration of these I have suggested a classification. I have analysed the aetiology and pathogenesis of some of these disorders and discuss the treatment and prognosis.

Recent experience in the control and management of tuberculosis in a mental handicap hospital

Sixteen cases of tuberculosis (14 in inmates, only one of whom was female) occurred in a mental handicap hospital of some 400 inmates during the period 1973-85. This represents an annual incidence of 269 per 100,000, substantially higher than that in the surrounding community. In 1980, 29% of inmates had Grade 3 or 4 positive Heaf tests. Widespread chemoprophylaxis was successfully undertaken in 1980/81, the only problem encountered being interaction of isoniazid with carbamazepine. One Down's syndrome patient had recurrent disease, and a second developed disease despite chemoprophylaxis. Immunological investigation of a small number of Down's syndrome patients with tuberculosis showed no consistent defect.

Risk management, public policy and informed consent: A case study

The present guidelines on the use of hepatitis B vaccine in mental handicap hospitals dictate the need for an a priori identification of occupational risk, but fail to clarify how this risk should be defined. The ethical requirement of a respect for autonomy however demands that in offering vaccine as a means of protection, the choice of options must be "informed'. The determinants of institutional transmission have not been clearly defined and it is therefore difficult to inform client groups as to the degree or nature of their occupational risk. It is questionable whether the literature can support the recommendations in their present form, and supposedly "cost-effective' solutions to the problem, pay scant regard to the fact that in risk management, the relative desirability of options is conditional on the alternatives considered, how they are framed, what evidence is consulted and how consequences are weighed. In informing the policy making process, it is imperative that the values of those whose voice is seldom heard, are considered.

VIDEO ASSISTED LEARNING for adults with mental handicaps

This article reviews the way that video equipment was used to help train four adults living in a mental handicap hospital who had been chosen as potential candidates for a group home.It describes the idea of video as a teaching aid, the training areas, and how video recordings were used to assist the learning process. It offers further ideas for the use of video in the group home, discusses the use of video as an analytic tool, and concludes by summarising the advantages of video as a teaching aid.

Prescribing practice in a mental handicap hospital: 1—ANTICONVULSANTS FROM 1978–87

This is the first of two articles which consider the use of medication in a mental handicap hospital over a ten‐year period. The present article reviews the use of medication to control epilepsy. The second will look at the use of psychotropic medication, that is, medication intended to alter mood, conciousness, or awareness.Prescription sheets and case notes of people resident in the hospital on 31st March 1978 and 31st March 1987 were studied to see trends in anticonvulsant usage during that period. There was a decline in the use of phenobarbitone and primidone, and an increase in the use of carbamazepine. The number of people on more than one drug did not alter greatly, but fewer were on more than two drugs by 1987. These results, and the continuing problem of people being prescribed more than one anticonvulsant at a time, are discussed.

Evolution of the Motor Pattern from Birth to Puberty in Genetic Microcephaly

This is a case review of a girl now living in a long-stay mental handicap hospital. As well as describing the evolution of her motor pattern, it gives a brief description of her general development and other aspects of genetic microcephaly which have had a direct bearing on her physiotherapeutic management. It shows the necessity of ensuring that facilities for regular monitoring and intensive and consistent treatment at the appropriate time are available. Section 2 describes the physiotherapy methods and management carried out in conjunction with the multidisciplinary team. This is a case review of a girl now living in a long-stay mental handicap hospital. As well as describing the evolution of her motor pattern, it gives a brief description of her general development and other aspects of genetic microcephaly which have had a direct bearing on her physiotherapeutic management. It shows the necessity of ensuring that facilities for regular monitoring and intensive and consistent treatment at the appropriate time are available. Section 2 describes the physiotherapy methods and management carried out in conjunction with the multidisciplinary team. Biography: Since qualifying from the Queen Elizabeth School of Physiotherapy, Birmingham in 1962, Mrs Rennie's places of work have included Charing Cross Hospital; Oslo Observation Home and Outpatient Clinic for Mentally Handicapped Children, Norway; The Bath and Wessex Orthopaedic Hospital; and Gogarburn Hospital, Edinburgh, initially as solecharge physiotherapist. After a break in service Mrs Rennie worked part-time at Westerlea School for Cerebral Palsied Children in Edinburgh and is currently working part-time at Gogarburn Hospital.

Groups in a mental handicap hospital

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Forms of ignorance and their role in the joint planning process

AbstractThe Care in the Community initiative has given a new lease of life to joint planning between health and local authorities. The planned closures of psychiatric and mental handicap hospitals offer a new opportunity for these agencies to collaborate in the planning of alternative provision.All too often, though, considerable ignorance impedes their joint efforts. This ignorance relates to the scope of the exercize, the precise nature of the required services, and agencies’ knowledge of their different organizational systems, political ideologies and professional cultures. Such ignorance is built into the system, and it can serve agencies’ political purposes and offer them a means of attaining desired goals.The sociological literature offers a number of insights into relations between organizations. The concept of ignorance, however, has received little attention, yet it is one of the most striking aspects of joint planning.

Voting rights of people living in mental handicap hospitals

Journal of the British Institute of Mental Handicap (APEX)Volume 17, Issue 1 p. 39-39 Free Access Voting rights of people living in mental handicap hospitals PAM HYETT, PAM HYETT PAM HYETT, Deputy Director of Nursing and Hospital Services, Lea Hospital, Stourbridge Road, Bromsgrove, Worcs. B61 OAX.Search for more papers by this author PAM HYETT, PAM HYETT PAM HYETT, Deputy Director of Nursing and Hospital Services, Lea Hospital, Stourbridge Road, Bromsgrove, Worcs. B61 OAX.Search for more papers by this author First published: March 1989 https://doi.org/10.1111/j.1468-3156.1989.tb00511.x AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume17, Issue1March 1989Pages 39-39 RelatedInformation