Public Mental Health Hospital Research Articles

Chronic Obesity in Deinstitutionalized Mentally Ill Adults Receiving Rehabilitative Services in Rhode Island

There is little published literature regarding the nutritional status of the mentally ill, except for limited data on the institutionalized mentally ill. The rate of deinstitutionalization in Rhode Island is over 98%, the highest in the nation. For every 100 Rhode Island residents in public mental health hospitals in 1955, fewer than 2 are there today. A pilot study was conducted to determine the nutrititional status of a population of mentally ill adults in Rhode Island residing in both community based group homes and independent settings receiving rehabilitative services. Fifteen males and 15 females (n = 30) were included in the study. Ages ranged from 35 to 73 years (mean = 50 years). Body mass index (BMI) ranged from 15 to 41kg/m2 (mean=31kg/m2). The prevalence of obesity was determined to be §7% which is more than double that of the general population. Review of past medical history revealed that the obesity was chronic as the obesity and the trend for increasing weight was documented for a minimum of two years. The severity of obesity was found to be variable from 33% with mild obesity, BMI = 27–29kg/m2; 43% with moderate obesity, BMI = 30–39kg/m2; to 13% with severe obesity, BMI ≥ 40kg/m2. Activity was sedentary to mildly active without evidence of physical limitation. Medication review revealed extensive polypharmacy with nutritional implications for altered appetite (n=28), weight (n=28), gastrointestinal function (n=30), and dental health (n=30). Poor motivational and cognitive functioning in this population present a challenge for obesity management, however close association between the members and case workers present a unique opportunity for dietitians to increase fitness and nutrition knowledge to accomplish a modest weight reduction.

The Fall and Rise of TQM at a Public Mental Health Hospital

Public mental health care is undergoing a period of fundamental change as it attempts to adapt to an environment characterized by increasing fiscal constraints, the need to demonstrate effectiveness of services, and consumer empowerment. Total quality management (TQM) provides a framework that enables mental health care to meet these demands. The author provides his perspective on a public, multipurpose psychiatric hospital's (Georgia Regional Hospital at Augusta) experience in making the transition from quality assurance to TQM. Successful implementation of TQM rests on clinical staff's viewing TQM as a useful mechanism for achieving agreed-on patient/customer goals. Staff cannot simply do what they have been doing, but now do it better; there needs to be an understanding of what "better" means. TQM'S INTRODUCTION AND REINTRODUCTION: When first introduced in 1992, TQM was viewed by staff as the latest variant of quality assurance--and was therefore unsuccessful. When reintroduced in 1993, TQM contributed to the development of a psychosocial rehabilitation program. The staff's active involvement in establishing patient-specific goals was critical to the program's success. The hospital's Performance Improvement Committee has spearheaded the monitoring of treatment programs and the development of critical paths. In developing critical paths, the treatment team sets goals for patients' improvement both within the hospital and postdischarge and for treatment processes. The keys to a successful TQM program are effective leadership, a clear organizational mission, customer-oriented performance goals, staff empowerment, and the application of the scientific method to the workings of the organization.

Linkages Between Community Mental Health Centers and Public Mental Hospitals

Directors of community mental health centers and superintendents of public mental health hospitals in one state were surveyed to gather data on interagency linkages. Implementation of affiliation agreements, exchange of staff training, and exchange of patient information were investigated. Affiliation agreements tended to be implemented with little difficulty and there was more interagency cooperation than that reported in earlier research. However, exchange of training and staff were still areas of minimal interaction. Geographic proximity was found to have a positive influence and competition a negative influence on cooperation. Further attempts at interagency linkages in the interest of continuity of patient care are recommended.