Public Mental Hospitals Research Articles

The clinical distinction between psychotic and neurotic depressions.

This paper describes an attempt to demonstrate by discriminant function analysis that psychotic and neurotic depressions are distinct conditions. The analysis was based on a comparison between 63 neurotic depressives and 115 psychotic depressives drawn from four series of consecutive admissions to public mental hospitals in London and New York. The clinical ratings were obtained by standardized interviewing techniques, and the choice of items for discriminant function analysis was based on prior chi-square comparisons between the two populations. In spite of these and other methodological refinements the distribution of the weighted scores of the 178 patients on the discriminant function was unimodal and did not differ significantly from a normal distribution. This finding reinforces the case for replacing the existing categorical classification of depressions by a dimensional classification.

Gordon Tullock Meets Phineas Gage: The Political Economy of Lobotomies in the United States

In the late 1940s, the United States experienced a “lobotomy boom” where the use of the lobotomy expanded exponentially. We engage in a comparative institutional analysis, following the framework developed by Tullock (2005), to explain why the lobotomy gained popularity and widespread use despite widespread scientific consensus it was ineffective. We argue that government provision and funding for public mental hospitals and asylums expanded and prolonged the use of the lobotomy. We support this claim by noting the lobotomy had virtually disappeared from private mental hospitals and asylums before the boom and was less used beforehand. This paper provides a more robust explanation for the lobotomy boom in the US and expands on the literate examining the relationship between state funding and scientific inquiry.

Sources of Social Support After Patient Assault as Related to Staff Well-Being.

Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.

Psychiatric Patient Length of Stay in the Emergency Department Following Closure of a Public Psychiatric Hospital

BackgroundPsychiatric patient boarding in the emergency department (ED) is a ubiquitous problem associated with increased morbidity and mortality. ObjectiveWe evaluate the effect of closing a public psychiatric facility in a major metropolitan area on the ED length of stay (LOS) of psychiatric patients. MethodsThis was a retrospective chart review at two metropolitan EDs of all patients assessed to require inpatient psychiatric hospitalization. The time of arrival, time of disposition, time of transfer, insurance status, and accepting facility type were collected prior to and following the closure of a local inpatient psychiatric facility. ResultsWe analyzed a total of 1107 patients requiring inpatient psychiatric hospitalization, with 671 patients who presented prior to the closure of the closest public psychiatric facility and 436 patients that presented following the facility closure. Following hospital closure, patients with private insurance (620 min before, 771 min after) and Medicare/Medicaid (642 min before, 718 min after) had statistically significantly longer ED LOS, as well as patients transferred to a private psychiatric hospital (664 min prior, 745 min after). However, overall ED length of stay following hospital closure for transfer of all psychiatric patients requiring inpatient hospitalization was not found to be statistically significant (1017 min prior, 967 min after). ConclusionThere was a statistically significant increase in ED LOS for patients with private insurance, Medicare/Medicaid, and for those patients transferred to a private psychiatric facility following closure of a public mental health hospital; however, overall, ED LOS was not increased for patients transferred to an inpatient psychiatric facility. This study highlights the significant impact that the closure of a single inpatient psychiatric facility can have on nearby EDs. We hope to bring attention to the need for increased psychiatric services during a time when there is a nationwide trend toward the reduction of available inpatient psychiatric beds.

Six years of national mental health seclusion data: the Australian experience.

Reducing or eliminating seclusion from mental health care settings has been a national priority for Australia since 2005. This paper describes Australia's national seclusion data collection, and summarises changes in seclusion rates in Australian public mental health services. Seclusion events per 1000 patient days were calculated from 2009-2010 to 2014-2015 utilising state and territory administrative data sources. Combined national data were used to calculate results for a number of service characteristics, such as target population and location of the service. The rate of seclusion events decreased by 43% over the 6 years. Child and adolescent services reported consistently higher rates of seclusion, but a shorter duration of seclusion episodes, compared with other service types. There is high variation in seclusion rates between individual services (range 0.0-53.0 seclusion events per 1000 bed days in 2014-2015). Seclusion event rates in Australia's specialised public acute mental health hospital services are declining. The use of existing administrative data was instrumental in establishing a national data source to facilitate the monitoring and reporting of progress of seclusion reduction strategies.

Mental Illness in America’s Jails Also Made Headlines 50 Years Ago

Mental Illness in America’s Jails Also Made Headlines 50 Years Ago

What interventions can improve the mental health nursing practice environment?

The nursing practice environment is an important factor for services to consider in the attraction and retention of a skilled workforce during future nursing shortages. Despite the significant number of international studies undertaken to understand the influence of the practice environment on nurse satisfaction and retention, few have been undertaken within the mental health setting. This paper reports on results from a survey conducted in a large Australian public mental health hospital to examine nurses' perceptions of their practice environment, and identifies interventions that could be implemented to improve the practice environment. The hospital is the only remaining, standalone public mental health hospital in Western Australia.

A Short Motivational Program Based on Temporary Smoking Abstinence: Towards Increased Self-Efficacy to Quit in Psychiatric Inpatients

Background: Specific approaches for smokers presenting with psychiatric disorders are scarce, even though the prevalence of smoking does not tend to decline in mental health settings, in contrast with general populations of most western countries. Methods: Inpatient smokers (n=69) in a public mental health hospital participated in a multicomponent motivational intervention based on a temporary 26 h abstinence period. Evaluations, performed 1 week pre-, during and 1 week post-intervention, included cigarette consumption, carbon monoxide level, stage of change, craving, as well as anxiety, depression, well-being and smoking cessation self-efficacy. Results: Carbon monoxide level significantly decreased during the intervention (median 16 to 6 ppm, p<0.001), with 76.8% of participants using nicotine replacement therapy. Craving decreased (MPSS 5 to 4, p=0.01), together with anxiety (STAI-State 47 to 38, p<0.001) and depression (BDI-21 18 to 13, p<0.001), whereas well-being increased (WHO-5 11 to 16, p<0.001). During the proposed 26 h abstinence period, 45.6% of participants successfully abstained from smoking, of which 58.1% subsequently attempted quitting. Ten participants (14.5% of 69) decided to stop smoking even though they had no intention to quit before the program. Self-efficacy for permanent cessation did not change, but self-efficacy for temporary abstinence increased (median 8 at pre- to 9 at post-evaluation, p=0.003). Conclusion: A short multicomponent motivational intervention based on temporary abstinence can be a positive experience for patients with severe psychiatric disorders, contribute to increase self-efficacy and trigger quit attempts. The present study suggests that integration of such a program in mental health care is feasible and wellaccepted.

DSMs and the Brazilian psychiatric reform.

DSMs and the Brazilian psychiatric reform.

Antipsychotic Polypharmacy Versus Monotherapy in Elderly with Chronic Schizophrenia: a Clinical Trial

Introduction Mental patients are at more risk of being under polypharmacy in compare to other medical disorders. Elderly patients are more at risk of using polypharmacy. Aims This research was designed to observe the benefits of replacing polypharmacy with a single medication in elderly patients with chronic schizophrenia. Objectives Antipsychotic polypharmacy in elderly results in higher rate of interactions, side effects and cost. Polypharmacy would escalate medical risks which ends to decrease patients' quality of life. Methods A survey was performed at the long stay public and academic Tehran Razi Mental Hospital. From the initial 157 conveniently access patients, 59 cases were selected based on inclusion and exclusion criteria. Before intervention, 7 patients did not participate in the study due to their newly occurred medical conditions. 52 cases entered and completed the 36 weeks of research time period. Systematically, the patients' multiple antipsychotics were switched to a single medication, Risperidone. Their clinical assessments applied weekly for 36 weeks. Evaluations achieved by using validated and reliable tools of Brief Psychotic Rating Scale (BPRS), Global Assessment of Functions (GAF) and Extra-Pyramidal Syndrome (EPS) tools. Results Wilcoxon signed ranks test and Friedman test revealed a significant difference in post intervention for positive, negative and general schizophrenic symptoms. Functional improvements and lower incidence of EPS, showed a significant difference statistically. Conclusions Risperidone may be safety used instead of other multiple antipsychotics in elderly patients with typical chronic schizophrenia. This replacement possibly will result in more clinical benefits, obvious cost reduction and less side effects.

Deinstitutionalization and the rise of violence.

The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.

Suicidal behavior during economic hard times.

Most research on suicide is quantitative, and qualitative research is needed to reveal how individuals subjectively experience and account for suicidal behaviors. The aim of this study is to learn about the circumstances, motivations and consequences of suicidal behavior among individuals hospitalized for attempted suicide and suicidal ideation during the global economic recession. In-depth semi-structured interviews were conducted with in-patients hospitalized for suicidal behavior in a state-subsidized public mental hospital and analyzed with framework analysis. Interpersonal conflict in the context of severe economic hardship and inadequate mental health care preceded suicidal behavior, rescue and a subsequent respite from desperate situations. Attempted suicide led to increased attention and concern from loved ones and immediate access to mental health care. Government-subsidized funding for outpatient mental health care should be sustained or increased during economic recessions to protect the most vulnerable from suicidal behavior when it is the only viable path toward immediate psychiatric treatment.

Reducing seclusion and restraint use in inpatient settings: a phenomenological study of state psychiatric hospital leader and staff experiences.

The current study explored and described the experiences of individuals who either directed or participated in successfully reducing the use of restraint and seclusion (R/S) in two inpatient public mental health hospitals. A phenomenological methodology was used to capture the lived experiences of 21 study participants, including senior leaders, middle managers, and direct care staff, who were interviewed as key informants. Thirty-two themes were extracted and subsequently synthesized into five "meaning themes." The five meaning themes yielded six significant findings: (a) critical roles of leadership and staff in successful R/S reduction projects; (b) ability of leaders and staff to change their beliefs and behaviors; (c) ability of leaders and staff to build a shared vision that was critical to the reduction of R/S use in in-patient settings; (d) identification and resolution of key challenges staff and leaders experienced in reduction efforts; (e) use of a solid performance improvement lens to direct changes in practices; and (f) important lessons learned.

Psychiatrists and patients suffering from depressive disorders and schizophrenia in one organization basing on the hospitals in Lodz region

Abstract Collaboration between doctors and patient is a perfect example of a specific kind of collaboration in the organization. Difficulties with establish proper relations between psychiatrists and patients with depressive disorders and schizophrenia is the subject of the paper. The thesis of the work assumes that psychiatrists and patients belong to the totally different “worlds” what is the cause of inability to create proper mutual collaboration between them. In 2009 a questionnaire survey was conducted at public mental hospitals of the Lodz region. Both doctors and patients notice a number of communication barriers and factors hampering the mutual cooperation, at the same time demonstrating the will to agree and cooperate. The proper contact and collaboration affect mental disposition and motivation for the process of recovery from the illness. Conclusion: To a large extent not only a course of the treatment, but also a correct social functioning of both groups of the patients depends on the quality of the interrelation between them and psychiatrists. It appears, however, that the hierarchy of obstacles of successful therapy is completely different among the doctors and patients

Change, Challenge and Opportunity: Psychiatry in Age of Reform and Enlightenment

Change, Challenge and Opportunity: Psychiatry in Age of Reform and Enlightenment

Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital

ObjectivesTo investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals.MethodsWe performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania). We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit.ResultsThe development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital.ConclusionsRevenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental) hospitals.

Mistakes to avoid in the implementation of community mental health care.

In this issue of the journal, we publish the first WPA guidance produced as part of the WPA Action Plan 2008-2011 1, 2, dealing with steps, obstacles and mistakes to avoid in the implementation of community mental health care. Two further documents are almost ready and will soon appear in the journal: the WPA guidance on how to combat stigmatization of psychiatry and psychiatrists, and the WPA guidance on mental health and mental health care in migrants. The guidance we present in this issue can be regarded as a “second-generation” document in the area of community mental health care, because it takes advantage of the experience of the countries in which the development of community care has been most active, to point out not only what should to be done to implement the process, but also the errors which should not be repeated. In this latter respect, the document contains several important statements, which I will now list and discuss briefly.

Judge Rejects State's Plan to Improve Mental Hospitals

Back to table of contents Previous article Next article Legal NewsFull AccessJudge Rejects State's Plan to Improve Mental HospitalsRich DalyRich DalySearch for more papers by this authorPublished Online:4 Dec 2009https://doi.org/10.1176/pn.44.23.psychnews_44_23_028AbstractGeorgia continues to face the threat that it could lose control of its public mental hospitals to the federal government after a judge rejected a reform plan by the state.On September 30 U.S. District Judge Charles Pannell rejected Georgia's settlement agreement that aims to fix the state's ailing mental health network over five years. The court had initially accepted the settlement agreement in January as part of an effort to address problems identified by the U.S. Department of Justice and patient advocacy groups. But the judge rejected the settlement agreement after the Justice Department raised fresh allegations of neglect, abuse, and substandard medical care in the state psychiatric system.“The judge recognized that these problems are endemic,” said Ron Honberg, J.D., legal director of the National Alliance on Mental Illness, in an interview with Psychiatric News.In an October court filing in response to the judge's decision, state officials wrote that the state has made improvements and that it is in “significant compliance” with the January settlement.The voluntary settlement agreement stems from a Justice Department lawsuit (also filed last January) over allegations that the state was failing to prevent needless suffering and death at Georgia's state psychiatric hospitals.Advocates and now the Justice Department objected to the settlement agreement because it lacked details and timelines, as well as ways to improve Georgia's community-based mental health services. Under-funded community psychiatric programs result in unnecessarily lengthy stays as well as frequent rehospitalization in state psychiatric hospitals, said the critics.“For many, the only barrier to discharge is that they have nowhere to go,” said Alison Barkoff, a senior staff attorney at the Bazelon Center for Mental Health Law and an attorney in the case, in an interview with Psychiatric News.The lack of community-based treatment has led psychiatric hospitals to discharge patients directly to jails, homeless shelters, or motels instead of community treatment programs.The state will now have until January to continue its reform efforts before it must again report to the judge on its progress. If the judge is not satisfied, he could order vast, costly changes to the state's mental health network, and Georgia could lose control of its psychiatric hospitals.Patient Advocates ConcernedThe judge's September decision came after also hearing from a group of patient advocates, including the Carter Center, which criticized the state's mental health reform plans as lacking specific details to improve the system.“The agreement [reached in January] amounts to little more than a promise by Georgia to do better,” wrote advocates in a letter to the judge.The advocates' concerns were echoed by the Justice Department, which alleged both “significant risks of harm” to patients in a state psychiatric hospital and failure to ensure that patients “are adequately evaluated for placement in the most integrated setting.” Such evaluations are required by the Supreme Court's 1999 Olmstead decision—also focused on the Georgia state psychiatric system—which requires states to develop appropriate community-based services for people with disabilities who are institutionalized but are capable of living independently with support services.“Regularly, the hospitalized individual is kept in the hospital unnecessarily and/or discharged to a personal care home without necessary services and supports,” wrote Susan Jamieson, director of the Mental Health and Disability Rights Unit at the Atlanta Legal Aid Society, to the court.William McDonald, M.D., president-elect of the Georgia Psychiatric Physicians Association and an advisor to the state on implementing the reforms, told Psychiatric News that the state has made progress in making reforms that were not fully under way until July. In that short time, he said, Georgia has taken “real strides” in improving both psychiatric hospitals and community-based care.Among the improvements are additions to available community-based supportive housing and an agreement by the Medical College of Georgia to assume leadership of one state psychiatric hospital, McDonald said.Barkoff challenged that assessment and noted that her clients have reported no improvements in community-based mental health services around the state.Funding NeededMcDonald maintained that the state will provide enough changes to address issues raised by the lawsuit and settlement; however, the degree of success could depend on legislators' willingness to provide additional funding increases soon.“Like a lot of states, with mental health [funding], you have to fight for it,” McDonald said. Mental health care “is not always first in line.”Barkoff countered that many improvements could come with little or no additional funding. “What we're talking about is downsizing the hospitals and allocating that money to the community setting,” Barkoff said.The court also is considering holding a “status conference” that could be used to expand the settlement agreement to explicitly order improvements to the Georgia community-based treatment system.The settlement agreement reached in January is posted at <www.bazelon.org/pdf/Georgia_settlement.pdf>. ISSUES NewArchived

The Changing Role Of The State Psychiatric Hospital

State hospitals were once the most prominent components of U.S. public mental health systems. But a major focus of mental health policy over the past fifty years has been to close these facilities. These efforts led to a 95 percent reduction in the country's state hospital population. However, more than 200 state hospitals remain open, serving a declining but challenging patient population. Using national and state-level data, this paper discusses the contemporary public mental hospital, the forces shaping its use, the challenges it faces, and its possible future role in the larger mental health system.

A Proposed Instrument for the Assessment of Job Satisfaction in Greek Mental NHS Hospitals

Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically significant lower scores in comparison to the rest of the employees. Strong Pearson correlations were detected between GSI and "working conditions", "interpersonal relations", "organization", "salary" and "supervision" factors. The retention factors presented stronger impact on GSI in comparison to the motivation ones. The results of the study indicate that the proposed instrument presents satisfactory validity and reliability for the assessment of job satisfaction in Greek mental NHS hospitals.