Traditional Psychiatric Services Research Articles

STAVOVI PREMA OSOBAMA S POTEŠKOĆAMA MENTALNOG ZDRAVLJA

ATTITUDES TOWARD PEOPLE WITH MENTAL HEALTH DIFFICULTIES The implementation of modern approaches that seek to deinstitutionalize traditional psychiatric services is hampered by unfavorable attitudes of the community towards people with mental disabilities. Stigma is one of the most important factors that delay seeking help and negatively affects the quality of life of people with mental health problems. The research was conducted to describe attitudes towards people with mental health problems and determine their relationship with socio-demographic variables, information, and personal experience with mental health problems. There were 108 participants aged 21 to 59 (71% female, 64.5% college and university degrees). The Community Attitudes toward Mental Illness scale (CAMI) (Taylor & Dear, 1981) and a survey questionnaire were used online. Participants have generally benevolent attitudes toward all dimensions of the scale. Higher self-assessment of knowledge about mental health problems leads to more favorable attitudes towards authoritarianism, and younger age to less social restraint. Participants with a high school diploma have more negative attitudes towards the dimensions of authoritarianism and benevolence than participants with a university degree. There are no significant differences in attitudes regarding the experience of seeking mental health support, but on the authoritarian dimension, there is a significant interaction effect of being informed and mental health support seeking. The results indicate the importance of further research into the relationship between attitudes and mental health support seeking and the level of being informed on mental health issues. Key words: mental health; mental health difficulties; attitudes; stigmatization

Outcomes of Assertive Community Treatment for Adolescents with Complex Mental Health Problems Who are Difficult to Engage

Assertive community treatment (ACT) is a well-established treatment for adults with mental illness and has an emerging evidence base for improving mental health outcomes for adolescents. Recent studies have utilized ACT with adolescents who are difficult to engage through traditional psychiatric services. The Assertive Mobile Youth Outreach Service (AMYOS) of Children’s Health Queensland in Australia provides ACT for families of adolescents with severe and persistent mental health problems, who have been unable to engage successfully through the standard mental health support services provided by community clinics. AMYOS clinicians work flexibly to engage adolescents in an individualized plan aimed at reducing risk of harm, supporting recovery, improving overall functioning, and engagement with education and vocational pathways. This study reports outcomes for adolescents involved in the first five years of the AMYOS program. Overall, there were significant improvements over time on questionnaires of global functioning, perceived suicidality, hostility and a wide range of mental health problems, as rated by clinicians and families. There were also significant reductions in average monthly duration and number of hospital admissions during AMYOS treatment compared with 12 months prior to referral. Increases in visits to Emergency Department during treatment did not translate into hospitalization, suggesting adolescents were better monitored when at-risk. There was also increased engagement in school and standard healthcare. This provides further evidence that provision of assertive community treatment is associated with improved mental health outcomes for at-risk adolescents. Future research could include comparison groups and investigate possible mechanisms for change.

Staff views on member participation in a mental health clubhouse.

The clubhouse model is a community psychiatric rehabilitation program aiming to provide a restorative environment for people with severe mental health problems. These clubhouses provide their members with opportunities for friendship, employment, and education, which help them on their paths towards mental health recovery. Towards that end, the model features clubhouse members and staff working side by side to execute clubhouse activities. That is, unlike most of the community mental health programs where staff provide services to their clients, clubhouse staff are required to partner with members in their work. The aim of this qualitative study was to understand how the clubhouse staff elicited member participation and facilitate recovery. The research was conducted between Year 2013 and Year 2014 at the world's first clubhouse: Fountain House in New York City. The first author conducted 262hr of active participant observation in 41 visits to Fountain House, and in-depth interviews with 38 staff members who had worked at Fountain House for at least 1month during the study period. The dimensional analysis procedure was used to analyse the observation notes and interview transcripts. Results showed that participation was a key to rebuilding members' self-confidence, which further encouraged members to seek more opportunities for self-enhancement and personal growth. Specific organisational policies, programming, practical considerations, and other strategies shaped a positive environment for members to exercise autonomy, experience self-efficacy, and model behaviours after others who have succeeded. Findings of this research support the egalitarian staff-member relationships and the maintenance of an open and transparent atmosphere of the clubhouse, as observational learning enables members to move forward with their journeys to recovery. Findings also may inform efforts to shift traditional psychiatric services towards recovery-oriented care.

Recovery and severe mental illness: The role of romantic relationships, intimacy, and sexuality.

The overall aim of this article is to examine the self-defined role of romantic relationships, intimacy and sexuality in recovery from severe mental illness. Semistructured interviews were conducted with 35 people with severe mental illness, accompanied by participant observation. Data were analyzed using thematic analysis. The vast majority of participants considered a supportive relationship that was emotionally or sexually intimate to be a key facilitator and indicator of recovery. However, only a small minority of participants were actually in such a relationship. Participants reported numerous barriers to forming and maintaining such relationships such as financial strain and enduring stigma against people with mental illness. Addressing relational and intimate needs have not been a focus of traditional psychiatric services. As such, some form of "supported dating" within the field of psychosocial rehabilitation may be an essential development to foster an oft-overlooked but important aspect of recovery. (PsycINFO Database Record

Mobile Psychiatry

In psychiatry, diagnosis and prognosis are essentially based on patient report and clinician observation (subjective parameters). Additionally, neither biomarkers nor physiological measures (objective parameters) highlighted in research studies are currently applied in everyday psychiatric practice. Annually, 38% of the European population fulfills diagnostic criteria for at least one mental disorder, corresponding to 164.8 million individuals. Mobile technologies are growing exponentially and their widespread use provides an unprecedented means of administering personalized interventions in real-world conditions. This presentation will review the state-of-art in mobile psychiatry, outlining relevant issues in this field as follows: 1) proactive mental health where psychiatric conditions could be detected and managed before any major complications develop the potential to provide more effective interventions, as well as how smart technologies could detect and support the needs of the psychiatric patient in independent living; 2) the opportunity of using mobile technologies to gather data from multiple sensors and modalities including divergent physiologic, behavioral, environmental, and self-reported factors that can be simultaneously linked to other indicators of social and environmental context; 3) the potential of personalized monitoring of psychiatric patients leading to better outcomes at a lower cost, toward changes in mental healthcare delivering systems; and 4) the emerging research problems of using mobile technologies in psychiatry, such as regulatory environment and security. Leveraging novel technologies to empower patients and extend the benefits of traditional psychiatric services may represent a new direction for translational psychiatry. Research is needed in furthering progress in this emergent field.

Improving access to mental health services via a clinic-wide mental health intervention in a Southeastern US infectious disease clinic

Stepleman, Hann, Santos, and House (2006) described a brief psychological consultation model, which aims to improve integration of mental health services into HIV primary care. This retrospective chart review sought to examine which patients in our adult Infectious Disease clinic were served by this model in a one-year period. Furthermore, we examined whether the patients who subsequently engage in mental health care differ demographically from the consult population. Results indicated that 26.1% (n=252) of the patients at our Infectious Disease clinic (n=963; 36% female, 75% racial minority) received a mental health consultation. We observed no statistically significant differences between the consult and clinic populations with respect to gender, age, or race. Moreover, 43.3% (n=109) of those patients served by the consult model received specialized psychiatric care. There were statistically significant racial differences between those patients who engaged specialty psychiatric care and those who did not after receiving a consultation (χ2(1)=16.65, p<0.001; 70% racial minority in consult vs. 47.7% racial minority in psychiatric care). While our in-clinic consultation service reached a representative population, we had less success recruiting this diverse patient population into traditional psychiatric care. Future efforts will need to examine how mental health consultation and traditional psychiatric services can best reduce barriers to engagement and retention in care.

Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking

Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking

Race-Ethnicity as a Predictor of Attitudes Toward Mental Health Treatment Seeking

Previous research on mental health disparities shows that persons from racial-ethnic minority groups have less access to mental health care, engage in less treatment, and receive poorer-quality treatment than non-Hispanic whites. Attitudes and beliefs about mental health treatment were examined to determine whether they contribute to these disparities. Data from the National Comorbidity Survey Replication (NCS-R) were analyzed to determine attitudes toward treatment-seeking behavior among people of non-Hispanic white, African-American, and Hispanic or Latino race-ethnicity. Additional sociodemographic variables were examined in relation to attitudes and beliefs toward treatment. African-American race-ethnicity was a significant independent predictor of greater reported willingness to seek treatment and lesser reported embarrassment if others found out about being in treatment. These findings persisted when analyses adjusted for socioeconomic variables. Hispanic or Latino race-ethnicity also was associated with an increased likelihood of willingness to seek professional help and lesser embarrassment if others found out, but these differences did not persist after adjustment for the effects of socioeconomic variables. Contrary to the initial hypothesis, African Americans and Hispanics or Latinos may have more positive attitudes toward mental health treatment seeking than non-Hispanic whites. To improve access to mental health services among racial-ethnic minority groups, it is crucial to better understand a broader array of individual-, provider-, and system-level factors that may create barriers to care.

Economic Grand Rounds: A Self-Directed Care Model for Mental Health Recovery

Self-directed care programs give participants control over public funds to purchase services and supports for their own recovery. Data were examined for 106 individuals and showed that compared with the year before enrollment, in the year after enrollment, participants spent significantly less time in psychiatric inpatient and criminal justice settings and showed significantly better functioning. Of approximately $58,000 in direct expenditures by participants over 19 months of operation, 47% was spent on traditional psychiatric services, 13% on service substitutions for traditional care, 29% on tangible goods, 8% on uncovered medical care, and 3% on transportation. Early positive results of this pilot program support replication and evaluation elsewhere. (Psychiatric Services 59: 600–602, 2008)

Economic Grand Rounds: A Self-Directed Care Model for Mental Health Recovery

Self-directed care programs give participants control over public funds to purchase services and supports for their own recovery. Data were examined for 106 individuals and showed that compared with the year before enrollment, in the year after enrollment, participants spent significantly less time in psychiatric inpatient and criminal justice settings and showed significantly better functioning. Of approximately $58,000 in direct expenditures by participants over 19 months of operation, 47% was spent on traditional psychiatric services, 13% on service substitutions for traditional care, 29% on tangible goods, 8% on uncovered medical care, and 3% on transportation. Early positive results of this pilot program support replication and evaluation elsewhere.

Pattern of general practitioners' referrals to a rural community mental health centre: a 3-year analysis

Community mental health centres (CMHCs) represent a major trend towards developing locally based community psychiatric services. The Beaconfield Centre described here is an example of a rural project which aims to provide comprehensive and accessible psychiatric services to the population of the town of Grantham, in south Lincolnshire. The rate and pattern of referrals to the Beaconfield Centre over a period of 3 years are examined. It was found that the bulk of the general practitioners' (GPs) referrals were directed mainly to Community Psychiatric Nurses (CPNs), 49%, followed by the Consultant Psychiatrists, 42%. GPs considered the nature of the patient's problem to be responsible for nearly 20% of the total referrals. More work is required to test the appropriateness of these referrals and assess the degree of congruence between the GPs' and the mental health team's perception. The paper also highlights the need to assess regional variations in the function of these centres and their relationship to both primary health care and traditional psychiatric services. The future composition and the policy of referrals to the Community Mental Health Team (CMHT) need to be reviewed, particularly in relation to the growing number of fund holding general practices. The future role of all mental health professionals working in community settings urgently needs to be redefined with reference to the role of the CPNs vis a vis day care nurses.

The first 12 months of a perinatal outreach service

Aims and methodThis paper describes and evaluates a new community treatment service for women suffering from mental Illness during the perinatal period. Data about referrals, treatment methods and outcome were analysed for the first year of Its service.ResultsThe service was acceptable to patients and effective in improving the mental health and parenting skills of mothers but less successful in improving relationship problems.Clinical implicationsA specialised perinatal outreach service is likely to be more acceptable to new mothers than the traditional psychiatric service and may also be able to reduce the need for hospital admission and length of admission.

Prevalence of physical illness among psychiatric inpatients who die of natural causes.

The state psychiatric hospital is experiencing an increase in medically sick and aging patients who die of natural causes while hospitalized. This study explored the "medicalization" of the state hospital by examining the prevalence of medical illness and its relationship with psychiatric illness and age among state hospital psychiatric inpatients who died of natural causes--deaths that were not accidents, homicides, or suicides. A total of 179 inpatients who died of natural causes at Western State Hospital in Washington State between 1989 and 1994 were studied retrospectively through case file review. Their demographic and institutional characteristics and psychiatric diagnoses were compared with those of others treated at the hospital (N=9,258). The medical diagnoses of patients who died were analyzed by age and psychiatric condition. The patients who died were much older than the other patients treated during the study period. Two-thirds of those who died had organic mental disorders, mostly dementia, whereas only a fifth of the other patients had these disorders. The patients who died had a mean of eight physical illnesses, with a range from none to 21. Circulatory and respiratory conditions were most prevalent, affecting half to two-thirds of patients; these conditions had high rates of comorbidity with organic mental disorders. The characteristics of the state hospital population and the services provided are shifting in response to mental health reform and new policies on patient self-determination. Increased emphasis on medical care added to traditional psychiatric services will require increased financial and personnel resources.

Mapping Men's Mental Health

The central theme of this paper is that men are at one and the same time both damaged and damage-doing. The process of being damaged through the agency of masculinity predisposes men to exploit, dominate and abuse-not only as boys, as partners and fathers, but as priests, teachers, therapists, lawyers, nurses, psychologists and psychiatrists. Mental health services need to see both aspects of this male equation: a focus on male abuse alone leads to punishment, containment and, very likely, the continuation of abuse; a focus on male damagedness alone preserves the ideology of male unaccountability. However, evidence reviewed here suggests that most traditional psychiatric services fail to acknowledge the impact of inequalities on men's mental health as comprehensively as they fail to acknowledge the impact of these inequalities on the mental health of women. This is a significant problem, and we suggest ways that a gendered analysis of masculinity can be used to help address this deficit. This analysis is used to develop a map of men's mental health that not only accommodates traditional categories of mental health difficulty, but other important consequences of the close association between masculinity and sexuality inequality, especially the use of violence and the capacity to do harm. This analytical framework also invites consideration of the invisibility of male distress, the disallowing and desensitizing of 'vulnerability', and their submersion in a kind of psychology of entitlement. Finally, we consider the implications of this mapping exercise for mental health services and for working with men.

Making community based comprehensive mental health services work

There hat boon until recently a dearth of descriptions of locally targeted community mental health services. Such a service, developed by changing a traditional psychiatric service in an inner setting, is described. The service addresses the needs of those with predominantly severe/enduring mental health problems, by increasingly using research based treatments in an ordinary district setting.

Accounting for case manager effects in the evaluation of mental health services.

Three methods of accounting for case manager effects in tests of the efficacy of mental health services are explored. These methods include (a) treating the case manager as a fixed factor, (b) treating the case manager as a random factor, and (c) examining service effects within the case manager. They are demonstrated with data from a nationally known case management program serving individuals with serious and persistent mental illness. Specifically, 3 conceptually distinct types of services provided or brokered by case managers are identified: habilitation-rehabilitation, community support, and traditional psychiatric services. The effectiveness of each in improving clients' adjustment is then examined with multiple regression adjustment strategies and each of the 3 methods to account for case manager effects. The results provide strong support for effects attributable to case managers and some support for the efficacy of habilitation-rehabilitation and community support services beyond the effects of traditional psychiatric services.

Do GPs want community mental health facilities?

Much of a typical general practitioner's time is spent dealing with people who present with “psychological” problems. Of those people who are detected as suffering from a mental health problem, most are then dealt with by the GP without recourse to specialist services. There is a wide variation in referral rate, and a recent review (Wilkinson, 1989) suggests that GPs are most likely to refer a patient to a psychiatrist when he/she has failed to respond to previous GP treatment, an opinion about diagnosis is sought, or there is some specific request either by the patient or another person involved. One of the reasons why GPs are disinclined to refer is their perception of stigma associated with attending a psychiatric clinic, although they do not appear to be unduly perturbed by aspects of the referral process itself, such as a waiting list. Overall, it appears that around 95% of patients in general practice presenting with mental distress arenotreferred to a psychiatrist. As well as being concerned about the stigma associated with traditional psychiatric services, we hypothesise that another concern of GPs may be a lack of liaison and consultation between primary and secondary care services.

Community treatment teams in New Zealand – are they suitable for Britain?

The run-down of the psychiatric institutions has led to innovative and novel methods of treatment of the mentally ill in the community. In New Zealand, as in other countries, deinstitutionalisation of the more traditional psychiatric services is proceeding rapidly and the statutory and non-statutory community services are straining under the burden. Amid the turmoil of change and the crying out for alternative provisions, a pilot scheme was proposed to serve the mentally ill in the population of West Auckland. In early 1988 the Extended Hours Team (EHT) was born. It is based on the model used in North Sydney, Australia (Hoult, 1986) and Madison, Wisconsin (Stein &amp; Test, 1980). At the time of conception of the EHT, cost cutting was the rule which led to a difficult gestation but a surprisingly easy delivery and subsequent development over the first year.