Users Of Psychiatric Services Research Articles

I do not expect much ikigai from work: A failed link between employment and well-being among adults with serious mental illness

BACKGROUND: Researchers argue that employment positively affects the well-being of people with serious mental illness. However, empirical studies have provided limited support for these hypotheses. OBJECTIVE: This study aimed to investigate perceptions of employment in relation to the meaning and purpose of life, an important aspect of well-being, among people with serious mental illness. METHOD: Qualitative research design was employed. Psychiatric service users with a history of employment (n = 21) were recruited from Japan. Photo-elicitation interviews were conducted, and the interview data were analyzed using thematic analysis. RESULTS: Employment was recognized as a source of life meaning and purpose when it reflected personal values such as mastery and contribution to society. Employment was not recognized as relevant to life’s meaning and purpose if it was regarded as an instrumental activity for making a living. Nevertheless, participants generally agreed that employment was indispensable because it was essential for fulfilling their basic needs and overcoming the stigma of mental illness. CONCLUSION: Our results demonstrate diverse attitudes toward employment among people with serious mental illness, which may explain why employment had only a small effect on well-being.

Prevalence and risk of sexual violence victimization among mental health service users: a systematic review and meta-analyses.

People with mental disorders are more likely to experience sexual violence than the general population, but little is known about the prevalence of sexual violence in people who use psychiatric services. This paper aims to estimate the prevalence and odds of sexual violence victimisation within mental health services by gender and mental health setting (i.e. inpatient, outpatient and mixed settings). This study is a systematic review and meta-analysis (PROSPERO registration number: CRD4201810019). Three databases (Medline, Embase, PsychINFO) were searched and citation tracking, and reference screening of included studies was conducted. Studies were included if the prevalence and/or risk of sexual violence in psychiatric service users were reported or calculable across the past year or adult lifetime. The methodological quality of included studies was assessed. A random effects meta-analyses was conducted to estimate odds ratios and pooled prevalence estimates of sexual violence in different mental health settings. Twenty-six studies were included encompassing 197,194 participants. The meta-analyses revealed high pooled prevalence estimates and increased odds of sexual violence victimisation in male and female psychiatric service users compared to non-psychiatric service users. Mental health practitioners should be trained to respond effectively to disclosures of sexual violence, particularly from these vulnerable groups. Future sexual violence interventions should consider mental health as a treatment outcome.

Experiences of Online Sexual Violence: Interviews With Swedish Teenage Girls in Psychiatric Care.

Research about online sexual violence (OSV) is needed to be able to better meet the needs of girls in psychiatric care. The objectives of this study are to explore experiences of online sexual violence among young female psychiatric service users. Interviews with nine girls with psychiatric care needs were analyzed with thematic analysis. The findings are summarized in four themes which contribute to the notion that online sexual violence is only one, albeit important, part of a more complex picture of violence among young girls in psychiatric care. The girls' narratives are shaped by, as well as reproducing gender norms.

A preliminary evaluation of Crisis Plus: a model for working with frequent users of psychiatric crisis and inpatient services

PurposeThere is a proportion of psychiatric service users whose needs are not met by existing models of care. This can lead to a reliance on acute and crisis services. These service users may be considered high intensity users (HIUs). The purpose of this research is to evaluate the Crisis Plus model, an intervention designed to better support HIUs in the community and reduce dependency on acute and crisis services.Design/methodology/approachForty-seven HIUs were involved in Crisis Plus. The core intervention of Crisis Plus was an Anticipatory Management Plan (AMP), produced in collaboration with service users, their families and their care coordinators. AMPs were shared with relevant services and attached to electronic patient notes to ensure a uniform, psychologically informed approach to care.FindingsHIU service use was compared pre and post-AMP. On average, number of inpatient admissions, number of days spent on the ward, accepted psychiatric liaison referrals and accepted home treatment team (HTT) referrals decreased significantly.Practical implicationsCrisis Plus has taken a collaborative, proactive approach to engage HIUs, their families and the services that care for them. Crisis interventions that emphasise collaborative working and service user agency are key.Originality/valueThe provision of dedicated psychological support to HIUs and their professional and personal network is crucial to reduce reliance on acute and crisis care. Crisis Plus is unique in that it instigates co-production and active consultation with HIUs and services to improve clinical outcomes, in addition to reducing NHS expenditure.

The Subjective Experiences of Social Inclusion of People with Mental Disabilities: The Perspective of Psychiatric Rehabilitation Service Users

本研究從精神障礙者（以下簡稱精障者）的個人經驗與主體立場出發， 探討精障者個人日常生活遭遇的各項社會融合經驗，及其對於社區精神 復健服務的主觀評價，並藉此描述精障者的主體性如何受到精神復健機 構的形塑。透過深度訪談八位使用社區精神復健服務的精障者，本研究 歸納發現：（一）精障者對社會融合的想法乃是回歸社區自立生活，並 期待透過工作所得賺取獨立生活費用，精障者願意為生活增添其他可能 性而努力，也藉由信仰產生自然的人際交流；（二）精障者的主體性源 自於對生活步調的掌控、對生活安排的自主權，並獲得他人的尊重與平 等對待；反之，當精障者被迫接受機構的權威管理與過度生活規範，其主體性將受到傷害；（三）對精障者而言，機構安排豐富多元的日常活 動與工作訓練，以及提供社會融合的橋樑等，都是符合其需求的精神復 健服務，而長期留置復健機構從事一成不變且低薪的勞力工作，則是精 障者最期待有所改善的服務層面。基於上述研究發現，本研究最後提出 相關政策與服務建議。Research purpose Empirical studies on the social inclusion of people with mental disabilities in Taiwan are limited. This study aims to fill this gap. As social inclusion emphasizes the subjective feelings, willingness, and motivation levels of people with mental disabilities, this study explores the issue of social inclusion faced by people with mental disabilities from their individual perspectives and experiences. It also examines how psychiatric rehabilitation services shape the subjectivity of people with mental disabilities, reviewing the pros and cons of psychiatric rehabilitation services in fulfilling the needs of service users. There are three research questions to be answered in this study. First, what are the viewpoints and subjective experiences regarding social inclusion of people with mental disabilities? Second, how is the subjectivity of people with mental disabilities shaped by psychiatric rehabilitation services? Third, what services meet these needs, and what improvements in services need to be made for people with mental disabilities in psychiatric rehabilitation institutions? Method This study follows a qualitative research approach to delineate the social inclusion of people with mental disabilities in Taiwan. Since psychiatric rehabilitation institutions are set up to help people with mental disabilities recover, the research participants in this study were people with mental disabilities in these institutions. Considering the various degrees of autonomy and opportunities for social interaction among people with mental disabilities, the interviewees recruited in this study included residents of halfway houses, members of community rehabilitation centers, clubhouse members, and residents of community houses. Ethical approval was obtained before conducting the research interviews in 2022. Six participants recorded face-to-face semi-structured qualitative interviews and two participated in online interviews because of the pandemic breakout. In total, eight interviews were conducted. After transcribing the interview recordings, thematic analysis was used to analyze the interview transcripts, and thematic findings were derived in accordance with the repetitive analytical procedures of “whole-part-whole.”Results The findings are summarized as follows. People with mental disabilities think social inclusion is to live independently in the community. They hope to work and earn a living, and strive for other possibilities. They may also engage in interpersonal interactions through religious affiliations. In addition, rights of choice and autonomy, equal interaction and treatment, and respect for individual needs in psychiatric rehabilitation units are supportive factors of the subjectivity of people with mental disabilities. However, some adverse conditions such as class differences, inappropriate authoritarian management, and incomplete autonomy jeopardize the subjectivity of people with mental disabilities. Rehabilitation services that meet the needs of people with mental disabilities include various daily activities, multiple job training programs, and bridges for social inclusion. In contrast, rehabilitation services that need to be improved are mainly concerned with low wages, a limited variety of job opportunities, and reverse service effects. Conclusion Based on the research findings, some implications for government policy reform and service improvement in community mental health and social care are proposed. First, it emphasizes the subjectivity of people with mental disabilities. Training courses for rehabilitation institutions’ staff should emphasize the subjectivity of people with mental disabilities, help them achieve social inclusion and avoid the negative effects of institutionalization. Meanwhile, staff in rehabilitation institutions should return the choice and autonomy to people with mental disabilities and play the role of assistants with the belief that people with mental disabilities can be experts on their own lives. Second, they should provide employment opportunities for people with mental disabilities. Owing to the stigma of mental illness, poor educational backgrounds, aging problems, and other physical illnesses, people with mental disabilities are susceptible to social exclusion. Consequently, it is necessary to ensure that people with mental disabilities acquire various employment opportunities and job redesigning in response to functional impairment. To increase employment opportunities and income for people with mental disabilities, government sectors should work with rehabilitation institutions to expand employment resources, subsidize social enterprises, and establish shelter shops. Third, community support resources should be increased for individuals with mental disabilities. In the opinion of people with mental disabilities, financial problems are the most challenging for independent living. If government subsidies or residential services such as community houses are offered to people with mental disabilities to maintain a minimum quality of life, more people can return to community life. Additionally, people with mental disabilities require supportive community services to help them adjust to independent living and organize their daily lives. It is believed that by providing the abovementioned services, not only can the independent living and social inclusion advocated by the CRPD be fulfilled, but family caregivers’ stress and burden can also be reduced.

Violences sexuelles au sein des services de psychiatrie : la nécessaire prise de conscience derrière les tabous

Users of psychiatric services are a population that is particularly at risk of sexual violence. Although this violence mostly occurs outside of the care setting, it can sometimes occur during a psychiatric hospitalization. In this interview with Jean-Pierre Bouchard, Bettina Belet, Estelle Demeulemeester, Louise Ghestem, Fidji Dupont, Margot Trimbur, Marielle Wathelet, Fabien D’Hondt and Pierre Thomas, draw on their clinical experience and research to offer a summary of the issue. They discuss the consequences of this violence on the users, both victims and presumed perpetrators, as well as the experience of the caregivers who are confronted with these events. The interview also offers into how professionals should respond to this violence, and propose ways to improve current practices.

Use of digital technologies by users of psychiatric inpatient services in Berlin, Germany: a cross-sectional patient survey

Few studies and almost exclusively from the USA have recently investigated mobile phone and computer use among users of psychiatric services, which is of high relevance regarding the increasing development...

The structure of social support: a multilevel analysis of the personal networks of people with severe mental disorders

BackgroundFor psychiatric service users suffering from severe mental disorders, the social support provided by personal social networks is essential for living a meaningful life within the community. However, the importance of the support received depend on the relations between the providers of social support. Yet this hasn’t been addressed in the literature so far for people with severe mental disorders. This article seeks to investigate how characteristics of service users with severe mental disorders, their social contacts, and the pattern of relationships between those contacts influence the distribution and provision of social support to people with severe mental disorders.MethodsWe collected personal network data relating to 380 psychiatric service users from a random sample of health care providers in Belgium. We computed various measures of the structure of those networks and of the position of support persons within those networks. We conducted a multilevel analysis of the importance of the support provided by each support persons.ResultsThe results show that the more central a support person was in the network of a service user, the more important his or her support was considered to be by the service user. Also, the denser the network in which a support person was embedded, the less important was the support he or she offers, but only for hospitalised service users.ConclusionThese finding highlight the collective dimension of social support. We discuss the implications for the organisation of mental health care.

Satisfaction and associated factors among psychiatry service users at Amanuel mental specialized hospital. Addis Ababa, Ethiopia.

BackgroundPatient service satisfaction is the central point for the health system. Worldwide, around 450 million people suffer from mental and behavioral disorders. Clients who are dissatisfied with the service will miss appointments, abandon the treatment plan, and eventually relapse from the illness. Despite improved access to health services, the satisfaction from health institution services was decreasing from time to time and there is little information on health service consumer satisfaction.ObjectiveTo assess the satisfaction and associated factors among psychiatric service consumers at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, 2021/2022.Methods and materialsAn institutional-based cross-sectional study was conducted among 420 psychiatric service users from December 15 to January 16, 2021/2022. Systematic random sampling was used. A face-face interview technique and chart review were used to collect the data and a standard and validated tool called the mental health service satisfaction scale (MHSSS) was used to measure satisfaction. The collected data was entered into EPI info version 7 and exported to SPSS version 22 for analysis. The binary logistic regression model was used to analyze the data and bivariable and multivariable logistic regression analyses were conducted to identify associated factors with satisfaction. The level of significance was reported at P < 0.05.ResultsThe study showed that the magnitude of patient satisfaction was 63.3% [95% CI 58.3–67.9%). Sex (AOR = 1.7, 95% CI (1.072–2.88)], educational status (AOR 4.2, 95% CI 1.64–1.8), residency [AOR = 1.8, 95% CI (1.098–3.19)], distance from the hospital [AOR 0.56, (0.34–0.93)] were significantly associated with patient satisfaction at p < 0.05.ConclusionThe magnitude of patient satisfaction was high. The study showed that Sex, educational status, residence, and distance from the hospital were significantly associated with satisfaction. Prioritizing care for female patients and those coming from a distance is necessary. More ever, it is preferable to routinely and continually monitor healthcare facilities so that timely feedback can be given and problems that affect patient satisfaction can be resolved.

Housing trajectories and the risk of homelessness among new mental health service users: Protocol for the AMONT study.

High rates of mental illness among individuals experiencing homelessness, as well as documented contacts with psychiatric services prior to episodes of homelessness, indicate that early intervention could play a key role in homelessness prevention. Decision-makers and clinical teams need longitudinal data on housing trajectories following initial contact with psychiatric services, as well as on predictors of risk of housing instability and homelessness. This paper describes the AMONT study, a mixed-methods naturalistic longitudinal cohort study of individuals identified as new psychiatric service users in seven clinical sites across the province of Québec (Canada). The goal of AMONT is to examine the housing situations of individuals over 36 months after their initial contact with psychiatric services, and to identify environmental and individual correlates and predictors of housing outcomes. Participants complete a broad battery of instruments at baseline and follow-up assessments after 24 and 36 months. We explore housing stability following an initial episode of psychiatric service use from the perspective of service users, family members, and service providers, through qualitative interviews. The findings from the AMONT study will yield a better understanding of the residential pathways of individuals with mental illness, from their first contact with psychiatric services and for 3 years subsequently. This will inform service providers, decision-makers and managers on the specific housing concerns and issues that affect first-time mental health service users. This in turn can lead to the development and implementation of evidence-informed practices and policies that aim to prevent instability and homelessness.

Descriptive outcomes for a cohort of high-frequency psychiatric service users in the Western Cape, South Africa after 10 years

BackgroundAssertive community treatment (ACT) is an intervention implemented to manage the effects of deinstitutionalisation. South African studies have reported decreased admissions at 12 and 36 months when a modified ACT intervention is compared with standard care. However, costs associated with the intervention have raised the question of its feasibility in developing countries.AimThis study aimed to describe the long-term demographic and clinical outcomes of a group of psychiatric high-frequency users (HFUs) included in the first South African ACT study.SettingStikland Psychiatric Hospital, Cape Town, South Africa.MethodsData from 55 HFUs participating in the first South African ACT trial, including both the intervention and control groups, were retrospectively reviewed 10 years after the patients’ inclusion.ResultsOf the 55 HFUs initially included, nine remained in the formal ACT programme whilst 16 received standard care over the full 10 years. Five patients died and two were admitted to long-term wards. The mean number of admissions was 3.73 and the mean number of admission days was 261.11 over the 10 years. Twelve patients were never re-admitted; of these, nine came from the original study intervention group.ConclusionsThis was the first study looking at the long-term outcomes of a group of psychiatric HFUs in an under-resourced setting receiving either a modified ACT intervention or standard outpatient care. Reflecting broadly on the group, there were a larger number of patients in the original ACT group who had no re-admissions and a comparatively higher utilisation of available services during the 10-year follow-up period.

Suicidal Behavior in Emergency Child and Adolescent Psychiatric Service Users Before and During the 16 Months of the COVID-19 Pandemic.

BackgroundSlovenia is among the countries with the highest suicide rates in the world. The COVID-19 pandemic has had a significant impact on the mental health of children and adolescents. Our hypothesis is that the school closure during the pandemic with a gradual transfer to virtual schooling had an important impact on children's and adolescents' suicidal behavior. Therefore, we aimed to determine possible changes in the frequency of assessments as well as frequency and severity of suicidal behavior in the population of Slovene children and adolescents seeking emergency psychiatric help in correlation with the progression of the pandemic and online schooling.MethodsWe performed a retrospective observational analysis of medical records of all children and adolescents referred to the only 24-h emergency in- and outpatient child and adolescent psychiatry service in Slovenia from March 2019 through the end of July 2021. We extracted number of assessments, number of patients with suicidal ideation and with attempted suicide. A comparison between the same periods prior to the pandemic and during the pandemic was made. The months of school closure due to the COVID-19 restriction measures and the months without closures were also compared.ResultsDuring this period, 1966 children and adolescents were assessed. There was no statistically significant difference in the observed frequency of emergency visits when we compared all the months with to all the months without school closures, or when individual corresponding months with and without school closures were compared. However, there were statistically significantly more patients with suicidal ideation [t(16) = −2.739, p = 0.015; W = 25.0, p = 0.016] and patients who had attempted suicide [t(16)= −3.412, p= 0.004; W = 14.5, p =0.006] during the pandemic as individually compared to the corresponding pre-pandemic months.ConclusionsOur results show that the number of Slovene children and adolescents who required emergency psychiatric help with suicidality and attempted suicide increased during the COVID-19 pandemic. The increase was shown only after the first year of the pandemic. The observed increase did not appear to directly correspond to the school closures, but was more likely related to the duration of the pandemic.

Reliability and Validity of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective in Its Turkish Translation.

Editors' Note: The Editors would like to address issues related to the acceptance of this manuscript. The original manuscript referenced the study tool as the Bipolar Prodrome Symptom Interview Scale-Prospective (BPSS-P). After the manuscript's initial acceptance, the authors requested a revision of the tool name to Bipolar Prodrome Symptom Interview Scale-Full Perspective (BPSS-FP). When this request was made, the original acceptance was rescinded, and the authors were asked to formally revise and resubmit the manuscript with an explanation for the change. This revision and subsequent review led to the final acceptance of the manuscript. The authors have assured us that the tool used in the manuscript was the BPSS-FP (version 5) as opposed to abbreviated forms of this tool that are also used in research (e.g., Bipolar Prodrome Symptom Scale-Abbreviated Screen for Patients (BPSS-AS-P). Background: No scale exists to assess patients at-risk for bipolar disorder (BD) in Turkey. We aimed to assess the psychometric properties of the Turkish version of the Bipolar Prodrome Symptom Interview and Scale-Full Prospective (BPSS-FP). Method: Psychiatric service users aged 11-18 years old were interviewed using the BPSS-FP translated into Turkish and the Kiddie Schedule for Affective Disorders and Schizophrenia. Youth with major depressive disorder (MDD, n = 63), bipolar-spectrum disorder (n = 47), and healthy controls (n = 122) were included. Cronbach's alpha was calculated to assess internal consistency. The Young Mania Rating Scale (YMRS) and Children's Depression Rating Scale-Revised (CDRS-R) were administered to test convergent/discriminant validity. Discriminant validity was further tested using one-way ANOVA and "receiver operating characteristic" (ROC) curves. Inter-rater reliability was tested using correlation coefficients. Findings: Across 232 youth, Cronbach's alpha values were 0.932 for the BPSS-FP total score, 0.878 for the Mania Symptom Index, 0.887 for the Depression Symptom Index, and 0.797 for the General Symptom Index. Correlation coefficients for inter-rater reliability were high for the Mania Symptom Index (r = 0.989), Depression Symptom Index (r = 0.973), and General Symptom Index (r = 0.981). There were high correlations between the BPSS-FP Mania Symptom Index subscore and YMRS (r = 0.732), and the BPSS-FP Depression Symptom Index subscore and CDRS-R (r = 0.754), whereas cross-polarity correlations were non-significant. ROC analysis cut-off value was ≥21 for the BPSS-FP Mania Symptom Index between patients with BD and MDD (specificity = 85.7%, sensitivity = 78.7%). Conclusion: The Turkish version of the BPSS-FP has good psychometric properties and can be used in research. Longitudinal studies are needed to confirm the predictive value of the BPSS-FP.

How Does It Feel to Have One's Psychiatric Diagnosis Altered? Exploring Lived Experiences of Diagnostic Shifts in Adult Mental Healthcare.

BackgroundThough the socio-emotional significance of psychiatric diagnoses and the frequency of transitions between diagnostic classifications are widely acknowledged, minimal research reveals how “diagnostic shifts” are subjectively experienced by psychiatric service-users.AimThis study investigated how adult service-users make sense of diagnostic shifts and their impacts on one's life.MethodsTwenty-seven people with self-reported experiences of diagnostic shifts opted into this qualitative study. Virtual narrative interviews invited participants to share their “diagnosis stories.” Interview transcripts were analyzed using narrative thematic analysis to identify common and divergent experiences across participants.ResultsDiverse experiences of diagnostic shifts were related: diagnostic shifts could both promote and undermine clinical trust, therapeutic engagement and self-understanding. The analysis suggested that shared and divergent experiences could be attributed to two dimensions of narratives: participants' Interpretations of Diagnostic Shifts and Diagnosis-Specific Factors. Regarding the former, analysis produced a typology of three possible interpretations of diagnostic shifts, which were linked with consistently different antecedents, experiences and consequences. The latter dimension captured how experiences of diagnostic shifts also hinged on the unique meanings ascribed to the specific diagnoses gained and lost, particularly in relation to their perceived severity, stigma, personal associations, and related communities.ConclusionsFindings revealed how diagnostic shifts can be experienced as both traumatic and life-enhancing, depending on their social and subjective context. Understanding the range and predictors of variable experiences of diagnostic shifts is vital for sensitive clinical practice and communication.

Containment and therapeutic relationships in acute psychiatric care spaces: the symbolic dimensions of doors

BackgroundThere is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses’ experiences of open and locked working spaces.ResultsA sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be “invisible”. The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople’s crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users’ abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as ‘locked doors’ in the community (limited or no care continuity and stigma).ConclusionsThe impact of COVID-19 restrictions on people’s crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.

Frecuencia y determinantes de reingreso hospitalario en pacientes con trastorno mental grave

Introducción: Se estima que al menos el 50% de los pacientes que son usuarios habituales de los servicios de hospitalización psiquiátrica se han re-hospitalizado durante el primer año del alta hospitalaria. Para reducir el impacto derivado de la atención en eventos de salud, el SGGC de Colombia, recomienda a las instituciones de salud optimizar los recursos de atención, evaluar y mejorar la calidad de la atención en la población que requiera hospitalización.Objetivo: Identificar los determinantes relacionados con el reingreso hospitalario en pacientes con diagnóstico compatible con trastorno mental grave en una IPS especializada de Cali - Colombia 2017. Métodos: Se realizó un estudio de casos y controles en una IPS especializada en salud Mental de la ciudad de Cali, se incluyeron 105 casos y 315 controles. Para una muestra de 420 pacientes. se realizó un análisis bivariado y análisis multivariado. Resultados: El 14.2% de los pacientes presentaron al menos un reingreso. El trastorno afectivo bipolar se presentó con mayor frecuencia en los reingresos con un 41%, pero no presentó asociación estadísticamente significativa con un OR ajustado: 0.94 (IC 95%: 0.53–1.67). El modelo final arrojó significancia estadística en la adherencia al tratamiento como un factor protector para prevenir el reingreso hospitalario en pacientes con TMG, OR ajustado: 0.35 (IC 95%: 0.21–0.58).Conclusión: El total de pacientes, contribuyeron con 153 hospitalizaciones (20.7%). Por esta razon es importante hacer seguimiento al evento para estalbecer las causas de l reingreso y establecer las acciones para reducir la frecuencia.

Are acute psychiatric units providing adequate inpatient services for borderline personality disorder patients?

AimsTo assess the adherence to NICE guidelines CG78 (1.4) regarding the inpatient services provided for BPD patients at an acute psychiatric unit (The Oleaster).Borderline personality disorder (BPD) patients are frequent users of psychiatric inpatient services. However, evidence suggests that inpatient treatment is ineffective in the long-term recovery of such patients. The inpatient services at the Oleaster will be audited against NICE guidelines for BPD. We hope to improve the care of patients with BPD and ensure effective use of psychiatric resources.MethodRetrospective case notes review of 35 patients admitted into the Oleaster from 1/11/2018–31/10/2019. This was taken from an initial sample of 72. Patients were excluded if they were admitted for other concomitant mental or behavioural problems (except problem use of tobacco, drugs or alcohol).Result69% of patients were referred to other mental health services (e.g CRHT/HTT, other local alternatives, liaison team) prior to admission. There was no evidence of referrals in 31% of the sample population.The reasons for admission include significant risks to themselves/others (n = 14) and detention under MHA (n = 14). Reasons were not noted in 7 patients.Advance agreement on the length and purpose of admission took place in 19 and 27 patients respectively. Discussion of potential harms and benefits of admission only took place in 4 patients. Discussion was not applicable in 2 patients who lacked capacity.Of the patients admitted ≥2 times in the previous 6 months, only 38% had a CPA review arranged. It was not arranged in the remaining 62%.ConclusionThere is room for improvement in the appropriate admission and documentation of BPD patients. Referral prior to admission was well adhered but documentation was unclear. Implementing a set checklist before admission could be recommended. Active involvement of patients was inadequate. It is especially lacking in regard to informing patients of the potential harms of admission. This can be improved by educating patients and staff on this matter.CPA reviews were not arranged in a timely manner. Placing an alert on patients’ records when they are admitted again within the last 6 months would help to reduce this issue. Overall, greater effort is required to ensure patient's most current needs are met and that limited psychiatric resources are used effectively.

A retrospective study examining the adverse effect of childhood abuse among adult psychiatric service users in Britain.

The long-term effects of childhood abuse have been well studied though the effects of abuse of specific types in adult psychiatric service users are less known. This study aimed to assess the association between childhood abuse and the development of harmful social and behavioural outcomes among adult psychiatric service users. Adult psychiatric service users were accessed from secondary mental health services in South London. A retrospective analysis was conducted of a randomly selected sample of 342 mental health records. Chi-square tests and logistic regression models were used to examine associations between childhood abuse - sexual abuse, physical abuse and psychological/emotional abuse - and health and behavioural outcomes. This study identified that 109 (31.8%) psychiatric service users had some history of childhood abuse and more often presented with high-risk or severe behaviours. Sexual abuse in childhood was linked with social isolation related to loss of friends (odds ratio (OR)=2.68, P<0.01), risky behaviours such as binge drinking (OR=2.15, P<0.05) and self-harming (OR=2.86, P<0.01), while childhood physical abuse was associated with drug abuse in adulthood (OR=1.88, P<0.05). Revictimization (adult domestic violence) also impacted on service users' quality of life in terms of loss of housing (OR=2.21, P<0.05) and loss of friends/family contact (OR=2.73, P<0.01). These findings suggest childhood abuse may play an important role in shaping risk and vulnerability for mental health problems across a lifespan. In acute mental health services, the incorporation of a trauma-informed nursing care model is necessary to generate a shift in culture in the delivery of care.

"Time is a Great Teacher, but Unfortunately It Kills All Its Pupils": Insights from Psychiatric Service User Engagement.

:In this Foundations article, the authors reflect on the meaning of time through their past work creating novel roles for psychiatric service users to be involved in the education of health professions trainees and faculty. Inspired by music composer Hector Berlioz, the authors explore and critique the ableist, chrononormative temporalities of academia, and medical education. The authors introduce the conception of crip time from critical disability studies and use it to reflect on their experiences of the different temporalities that people bring to service user engagement and other collaborative projects. “Crip time” can help challenge notions of pace and productivity to create a more inclusive space for teachers and learners in health professions education.

Stakeholder perspective on barrier to the implementation of Advance Care Planning in a traditionally paternalistic healthcare system.

BackgroundAdvance psychiatric agreements could guide medical teams in providing care consistent with the incapacitated service user’s wishes. However, these types of agreements are rarely completed in Asian settings. What challenges can a traditionally paternalistic healthcare system expect to encounter when attempting to implement psychiatric advance directives?MethodsWe answered this research question by exploring the cultural, administrative and logistical challenges that might impede the implementation of the system supporting the service. We interviewed key stakeholders, 28 service users and 22 service providers, to seek their views and interests in the implementation of directives. We structured our analyses along a literature-review-based framework designed to guide further implementation studies, proposed by Nicaise and colleagues (2013). Accordingly, we divided our inductively generated themes into four longitudinal categories: pre-development stage, development stage, implementation stage, post-implementation stage.ResultsOverall, the findings indicated that many service users and service providers are interested in advance care planning. They believed that foreseeable challenges could be overcome with appropriate measures. However, the multiple challenges of implementation led some service providers to be ambivalent about their implementation and led service users to dismiss them. Specifically, factors related to the local culture in Singapore necessitated adjustments to the content and structure of the directives. These include language barriers in a multicultural society, conflicting wishes in a collectivist society, taboos for speaking about undesirable outcomes in a traditionalist society, and time limitations in a fast-paced society.ConclusionWhile culture-specific changes may be required to enable service users in a small Asian country to employ existing advance psychiatric agreement approaches, service providers and service users see their benefits. However, service providers must be mindful not to assume that service users are willing to defer every decision to their physician.