Reduction Of Psychiatric Beds Research Articles

Community-Based Mental Health Services in Mexico.

This article describes the general characteristics of community-based mental healthcare in Mexico. Data from national surveys, special studies and statistics from the national information system during the period 2001-2017 are used. Available information on health systems, new regulations and the innovations implemented are reviewed, as well as research on psychosocial interventions conducted within the country. Data show a fragmented health system with services for workers and those without social security or private care. This is a treatment system essentially based on tertiary healthcare and not integrated into the general health system, with a significant treatment gap and delay in relation to the first treatment. At the same time, a slow but steady increase in the level of care provided at primary healthcare level and in specialized community services has been observed. This trend has been accompanied by an increase in the number of medical doctors, psychologists and, to a lesser extent, psychiatrists, incorporated into the primary healthcare services. At the same time, no new psychiatric hospitals have been built; there has been a proportional reduction in psychiatric beds but no increase in mental health services or beds allocated to first contact hospitals. Research initiatives have analysed the barriers to reform, and efficient interventions have been developed and tested for the community and for primary healthcare; special interventions are available for the most vulnerable but no formal efforts have been to facilitate their implementation. Evidence is available regarding the implementation of the transition from reliance on tertiary healthcare to reinforced primary care. At the same time, parity, financial protection, quality and continuity of care remain major challenges.

Is the Number of Mentally Disordered Offenders Appearing in Front of the Courts and in Prison Linked with the Rate of Civil Detentions and the Closure of Psychiatric Beds? Data from 1984-2016 in England

Background, The current Mental Health Act (MHA 1983) in England and Wales allows for two broad types of detentions in hospital: civil detentions under Part II; and forensic detentions under Part III. Concern has recently been expressed about the rising rate of detention. A strong association between the closure of mental illness beds and the rise in civil detentions has previously been reported. We will test whether there has been an association between the reduction of beds and the rate of forensic detentions, as well as the size of the prison population. We will explore any association between the rate of civil detentions and the rate of forensic detentions. Methods, Secondary analysis of routinely collected data with a time lagged analysis of time series of yearly rates of detention. Yearly rates of the prison population were also calculated. Forensic detentions were separated into prison transfers, court treatment orders, and court assessment orders. Findings, From 1984 until 2016 the rate of civil detention nearly tripled from 38.8 to 112.6 per 100,000 ( 191%) and the rate of prison transfers increased eightfold from 0.2 to 1.6 per 100,000 ( 710%). In contrast the rate of court treatment orders reduced by 39% from 2.3 to 1.4 per 100,000. There was an association between the reduction of psychiatric beds and the increase in prison transfers, and between the increase in civil detentions and the reduction in court orders. Interpretation, The closure of psychiatric beds, which has occurred at the same time as a substantial increase in the prison population, has been associated with a subsequent increase in the need for patients to be transferred from prison to hospital for treatment. The increase in civil detentions which has occurred over the thirty years of the study has been associated with a reduction in the rate of courts detaining people who have committed serious crimes to hospital. Funding Statement: none Declaration of Interests: no conflict of interests identified for any author Ethics Approval Statement: not applicable as this was a secondary analysis of routinely collected data.

Increase in US Suicide Rates and the Critical Decline in Psychiatric Beds

This Viewpoint discusses the apparent association between a reduction of psychiatric beds and increasing suicide rates in the United States, and proposes an expansion of inpatient psychiatric treatment facilities as a component of a national suicide prevention strategy.

Passageway: A Novel Approach to Success of Conditional Release - Principles and Constructs of the Model Residential Program for the Forensic Mentally III Patient.

With the advent of psychotropic medications and with the deinstitutionalization of psychiatry starting in 1968, patients were prematurely discharged from forensic state hospitals. Due to lack of resources, psychiatric forensic patients ended up in the correctional system or homeless with the reduction of psychiatric beds in forensic and civil state hospitals. Lacking proper training and medication management, the recidivism rate of this population was close to 10% for rearrest and about 35% for revocation of conditional release (CR; Manguno-Mire et al., ). A new treatment modality was created to successfully transition patients from the forensic state hospital system to the community. This article describes and analyzes the principles and constructs of Passageway, a model residential program for patients found not guilty by reason of insanity or those incompetent to proceed to CR. The CR allows for a program like Passageway to be successful in transitioning patients back into the community. This is accomplished with minimal government funding, and since 1982 has resulted in a 0% recidivism rate, for any known arrests or convictions and for recommittal of a felony, defined in the state of Florida as, "any criminal offense that is punishable under the laws of this state, or that would be punishable, if committed in this state, by death or imprisonment in a state penitentiary. " (Fla. Stat. § 775.08). Copyright © 2016 John Wiley & Sons, Ltd.

Inpatient treatment of major depression in Austria between 1989 and 2009: Impact of downsizing of psychiatric hospitals on admissions, suicide rates and outpatient psychiatric services

During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates. Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants. While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers. Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert. Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates.

Mortality among patients with schizophrenia and reduced psychiatric hospital care

There are suggestions that mortality, especially that due to suicide, increases among schizophrenia patients during a period of declining psychiatric beds. We investigated the mortality of schizophrenia patients in the general population of Finland during the reduction of psychiatric beds during 1980-1996. Patients hospitalized for schizophrenia before 31 December 1996, and alive on 1 January 1980 (n = 58761) were identified via the National Hospital Discharge Register. General population data came from the National Population Register, and mortality data from the National Causes of Death Register. We calculated relative risks (RR) for total mortality, mortality due to natural causes (cancer, ischaemic heart disease, respiratory disease), unnatural causes (accident, homicide, suicide), and suicide. Patients with schizophrenia had an increased mortality both from natural causes (RR 2.59, 95% CI 2.55-2.63) and from suicide (RR 9.9, 95% CI 9.43-10.30). The RR for both natural and unnatural deaths was highest among patients with < 5 years since onset of schizophrenia. Among them all-cause mortality rose in the 1990s, but decreased among patients with > 10 years from onset. Otherwise no major changes or linear trends were found in mortality during deinstitutionalization. Reduction of psychiatric beds did not generally increase the mortality of patients with schizophrenia. However, patients in their early years of illness experienced increased mortality after the steepest bed reduction. Improved recognition and treatment of somatic illness would benefit patients with schizophrenia.

Are sociodemographic factors and year of delivery associated with hospital admission for postpartum psychosis? A study of 500 000 first‐time mothers

To examine the association between first hospital admissions due to postpartum psychosis and the explanatory variables age, educational level, marital status and year of delivery. All Swedish first-time mothers (n = 502,767) were included during a 12-year period and followed for first hospital admissions due to postpartum psychosis. Cox regression was used to estimate hazard ratios, adjusted for the explanatory variables. Older age and being a single mother implied an increased risk of first hospital admissions due to postpartum psychosis among first-time mothers. Educational level was not associated with first hospital admissions due to postpartum psychosis. During the 1990s, when a reduction in psychiatric beds occurred, first hospital admissions due to postpartum psychosis decreased significantly. Certain sociodemographic factors are associated with first hospital admissions due to postpartum psychosis. Untreated postpartum psychosis due to fewer psychiatric beds could have hazardous effects on mothers and their children.

Psychosocial wellbeing and psychiatric care in the European Communities: analysis of macro indicators

This paper reports the findings of an analytical comparison of several macro indicators collected routinely from institutional sources in Europe. We carried out a review of macro indicators capable of providing a synthetic description of mental health status and the availability of psychiatric care in European countries. These were collected routinely from sources such as WHO, OECD, EUROSTAT, and IMS. The evaluation of temporal trends in each nation permits subsequent comparisons between countries. In all European countries, a decreased trend of suicides was observed in the period 1980-2000, with the exception of Ireland and (partially) of Spain. In Ireland, the increased trend was particularly strong, with a high risk in young and adult males. Portugal and Greece had respectively the highest and the lowest rates of undetermined causes of death. Most countries that were high consumers of alcohol in the initial period of observation had a rate above the national mean until 1980, after which consumption decreased. Most nations that were low consumers in 1960 had rates below the mean until 1980,when the rates progressively increased. However, a general decrease of alcohol-related deaths was apparent in all countries. Mortality associated with mental disorder increased, most clearly during the mid 1980s. The number of psychiatrists per 100,000 inhabitants ranged from 3.6 in Spain to 17.5 in Finland; of child psychiatrists, from 0.9 in Germany to 5.1 in Portugal. Psychiatric beds ranged from 0.4 per 1,000 inhabitants in Italy and Spain to 1.3 in Ireland. Nine countries showed a trend towards a reduction in psychiatric beds, whilst in a further five countries no change was observed. Rates of long-stay patients varied from 9.5 in the UK to 84 in Belgium, with a generally decreasing trend. The use of outpatient facilities differed markedly between countries, although there was a general increase over time. Official data were scarce in relation to the sale of psychotropic drugs. IMS data indicated increasing consumption in all European countries for antidepressant and antipsychotic medication. The official data resources available for European countries seem to indicate some discrepancies, probably relating to methods of recording. Better co-ordination in the collection of data about mental health status in the European Union and an improvement of the quality in available services is needed.

Forecasting the number of inpatients with schizophrenia.

There has been much discussion in Japan regarding the reduction of psychiatric beds. For effective healthcare planning, reliable forecasting is important. The purpose of this study was to predict the number of future schizophrenic inpatients using quantitative methodology. Data was obtained from a survey of schizophrenic inpatients conducted annually at the end of March by the Niigata Prefecture from 1974 to 2003. The numbers of schizophrenic inpatients in different age groups over a long period of time were used in a precise time-series analysis to establish trends. Then these past trends were used to forecast inpatient numbers for future years. The pattern of ascents and declines of each inpatient group stratified by age appeared to be duplicated by the next older age group 10 years later. The numbers of inpatients with schizophrenia in 2013 and 2023 are projected to be 78.5% and 56.7% of the number of patients in 2003, respectively. By 2033, the number is forecast to decline to 41.0% of the number in 2003. This study forecasts that inpatients with schizophrenia will decrease substantially over the next several decades. Policy should be designed to reflect this trend.

Admission of the homeless mentally ill in the UK

The reduction in psychiatric beds over the past few decades has coincided with burgeoning homelessness in the UK. What effect has this had on the provision of in-patient care to this neglected section of the population? Admissions of people of ‘no fixed abode’ in Birmingham were compared for the years 1961–1964 and 1995–1996. Both the number of admissions and duration of in-patient episodes had decreased and many patients continued to receive no aftercare. Solutions to the problem of homelessness among the severely mentally ill must address failings in hospital as well as community services.

Reduction in psychiatric beds diminishes the advantages of community care

Reduction in psychiatric beds diminishes the advantages of community care

Mental Health Policy in Northern Ireland

AbstractMental health policy in Northern Ireland has moved through a number of phases during the past seventy years. This article examines some of the developments during each of these phases in the context of political factors which had an effect on policy formation and implementation. The services which existed in 1921 were deeply rooted in the lunacy legislation and provision of nineteenth century Ireland. The political uncertainty and financial stringency, which characterized the following two decades, resulted in a situation of almost complete stagnation in those services. The contribution of Northern Ireland during the Second World War guaranteed a financial commitment by Britain to the building of a comprehensive health service in the post‐war era. The expansion in mental health services was unprecedented. The relative stability of this era was shattered by the political “troubles” of the 1970s and the imposition of “direct rule” from Westminster. Though advantageous to health service development at first, this has now led to tighter central controls and the further loss of local autonomy. In policies dictated from Westminster, Area Boards moved towards a reduction in psychiatric beds to 1,500—the level of provision in 1870. History tells us that the needs of mentally ill people have not had a significant impact on services in the past. Will the future be any different?

Psychiatry in Denmark in the 1990s

In Denmark an extreme reduction in the number of psychiatric beds has taken place over the last 15 years - from 2.4/1000 inhabitants in 1976 to 0.9/1000 inhabitants in 1991. With a substantial delay, community psychiatric services have been organized in the country. Concomitantly, the social services are working hard to take over the responsibility of treating psychiatric patients. In spite of severe opposition from the Danish Society of Psychiatry they have succeeded in several regions in Denmark. However, the Danish Parliament has now recommended a stop in the further reduction of psychiatric beds, and The National Board of Health has stated in their status on psychiatry and plans for the future that psychiatry still has its place among the medical specialities.