OBJECTIVEThis study investigated the contributions that persons with serious mental illness make to their families according to both clients and family respondents.METHODSThe sample consisted of 725 clients with serious mental illness and 725 family respondents living in rural counties or counties with small urban areas in Wisconsin. Clients were in contact with family respondents at least three times a year; 23.7 percent of them lived with the respondent. Clients returned a questionnaire, and family respondents completed a telephone interview; both rated the amount of help the client gave in eight areas such as household chores, shopping, and companionship.RESULTSOverall, the clients, especially those who lived with their families, provided substantial help. For the total sample, clients were most likely to contribute by providing companionship; family respondents reported that 59 percent of clients gave such help. For clients who lived with respondents, between 50 and 80 percent helped by doing household chores, shopping, listening to problems, providing companionship, and providing news about family and friends, according to family respondents.CONCLUSIONSMany persons with severe mental illness play positive roles in their families. Recognition of clients' contributions by providers, researchers, and clients and families themselves could help reduce stigma and expand community opportunities for persons with severe mental illness.
OBJECTIVE:The authors' aim was to test the relationship between receipt of desired community mental health services by homeless mentally ill forensic clients and whether the clients returned to jail within six months.METHODS:Mentally ill homeless clients leaving jail were randomly assigned to three service conditions: intensive case management provided by an assertive community treatment team, intensive case management provided by individual case managers, and referral to a community mental health center. Data on whether clients' service needs were met were analyzed using discriminant function and chi square analyses.RESULTS:Thirty-two percent of the 105 clients interviewed at six months were reincarcerated during the six-month study period. Jail recidivism was related to receipt of fewer services that clients reported they needed, specifically to receipt of fewer services for developing independent living skills. Service condition was not significantly related to return to jail.CONCLUSIONS:Case management, a flexible community-based service that does not lend itself to clearly prescribed procedures, may easily deteriorate into providing monitoring rather than rehabilitative services for forensic clients and thus may facilitate reincarceration.
Rochester mental health providers and planners are convinced that capitation is an effective financing mechanism that allows care to be tailored to the needs of the individual and that can drive development of needed services. Some of the problems encountered involved the stability of the financing mechanism, new assumption of costs not previously borne by mental health dollars, the appropriateness of stop-loss mechanisms, methods of incorporating Medicaid and Medicare funds, and definition of capitation rate groups as well as parameters for movement in and out of groups. Many of the contractual and administrative obstacles would be ameliorated if mechanisms were available at higher levels of government to allow for capitation financing and incorporation of other financing and reimbursement sources. The clinical benefits of capitation in Rochester were most demonstrable in the development of systems of care targeted to persons with serious and persistent mental illness and the transfer of care to the community for most of these persons. Whether capitation programs provide incentives for underserving enrollees was not really adequately tested in this demonstration project, as the capitation rates were generally adequate to support the needed care. The question has been asked whether we would implement another capitation program if given the opportunity. The answer is a resounding "You bet!"
OBJECTIVE:The treatment of suicidal patients contributes to escalating mental health expenditures. Fiscal realities necessitate that cost-containment measures be implemented wherever possible. The authors reviewed the literature to delineate factors that impede cost containment for the treatment of suicidal patients and to outline strategies for controlling costs while improving the quality of care.METHODS:Psychological Abstracts and MEDLINE databases were reviewed. Retrieval and analysis focused on literature published between 1982 and 1992.RESULTS AND CONCLUSIONS:Five factors unique to the treatment of suicidal patients that impede cost containment were identified: the lack of a specific and cost-effective screening method to determine true risk of suicide, the high number of parasuicidal and malingering patients, revolving-door admissions of involuntary patients who become noncompliant with treatment after discharge, the adverse clinical consequences of further increases in existing discriminatory mental health benefits, and the medicolegal liability incurred in treating suicidal patients. The low frequency of completed suicides in relation to attempts and reported ideation indicates that most inpatients labeled suicidal are hospitalized unnecessarily. Thus inpatient treatment should be reserved for patients who make attempts of high lethality and patients with suicidal ideation who are at high risk because of other factors. Ideally, suicidal patients should be committed not to an inpatient facility but to a treatment network in which they can move appropriately between inpatient, day hospital, and outpatient care.
The early argument for caring for the insane in general hospitals arose in the late 1800s in the context of criticisms of the asylum made by neurologists and some psychiatrists. The movement in support of general hospital psychiatry gained ground within psychiatry as the modernization of the general hospital made it a more attractive work site for physicians. By the second decade of this century, a newly independent discipline of hospital administration was providing an audience for psychiatrists who wanted to make the medical and financial case for the value of psychiatric care in the general hospital. Although in the 1930s only a fraction of general hospitals included a "department for mental patients," general hospital psychiatric treatment had ceased to be only a rhetorical or experimental concept and was fast becoming a practical program of treatment.
OBJECTIVE:In a previous study of outpatients with chronic mental illness who were treated with neuroleptic medication, the authors found a higher incidence of tardive dyskinesia among blacks than among whites. In this study the authors examined psychosocial, clinical, treatment, and medical correlates of race that might explain this finding.METHODS:Extensive baseline data were obtained for 398 outpatients at risk for tardive dyskinesia. Pearson and Mantel-Haenszel chi square analyses were used to determine significant associations between a large number of variables and race.RESULTS AND DISCUSSION:Compared with whites, nonwhites were more likely to be younger, less skilled, and unmarried; to report contacts with relatives outside the home; to have a diagnosis of schizophrenia; and to receive higher doses of neuroleptic drugs primarily through depot medications. Nonwhites were less likely to receive nonneuroleptic psychotropics, to wear dentures, and to report social contact with fathers. None of these racial differences explained more than a trivial portion of the association between race and the incidence of tardive dyskinesia.CONCLUSIONS:These results suggest the need for studies of differences in diagnostic and prescribing practices for black and white patients and of differences in the action and side effects of neuroleptics.
Back to table of contents Previous article Next article ArticleNo AccessAn Inpatient Team's Response to Alleged Sexual Misconduct by an Outpatient PsychotherapistKenneth P. Pages, Peter E. Maxim, and Heidi WaschKenneth P. PagesSearch for more papers by this author, Peter E. MaximSearch for more papers by this author, and Heidi WaschSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.45.12.1231AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "An Inpatient Team's Response to Alleged Sexual Misconduct by an Outpatient Psychotherapist." Psychiatric Services, 45(12), pp. 1231–1232 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Register for access Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 45Issue 12 December 1994Pages 1231-1232 Metrics PDF download History Published online 1 April 2006 Published in print 1 December 1994
Back to table of contents Previous article Next article ArticleNo AccessRisperidone's CostRobert EilersRobert EilersSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.45.9.937AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Risperidone's Cost." Psychiatric Services, 45(9), pp. 937–938 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byCost-benefits of risperidone1 April 2006 | Psychiatric Services, Vol. 47, No. 3Mobile crisis services1 April 2006 | Psychiatric Services, Vol. 47, No. 3 Volume 45Issue 9 September 1994Pages 937-938 Metrics PDF download History Published online 1 April 2006 Published in print 1 September 1994
OBJECTIVE The study sought to determine the proportion of patients treated in a jail psychiatric service who were jailed again within a year of release and to identify the factors that most effectively predicted jail recidivism in this population. METHODS Clinical records for a random sample of 231 persons who received treatment at a jail psychiatric service were reviewed. Logistic regression analysis of 160 cases not transferred from jail to the state prison was used to identify factors, including demographic and clinical variables and prior jail detention, that predicted reincarceration within a year of release from jail. RESULTS Younger age, a history of substance abuse, and prior jail detention were strong predictors of jail reincarceration. CONCLUSIONS Return to jail is more likely for a subgroup of jail detainees for whom appropriate, effective treatment is less available in the community. Further research is needed to investigate the relationship between the course of substance abuse and jail reincarceration among younger psychiatric patients. Innovative treatments might be used to engage patients while in jail and follow them into the community after release.
Public mental health administrators are increasingly being held accountable for outcomes in mental health systems characterized by longstanding, complex, and seemingly intractable problems. To meet demands for accountability and to satisfy accreditation requirements, the principles and techniques of quality improvement are especially useful. The author draws on his experience as a surveyor for the joint Commission on Accreditation of Healthcare Organizations to show the potential applicability of quality improvement in public mental health systems. He presents illustrations of quality improvement principles in the areas of patient advocacy, monitoring hospital admissions, and monitoring use of restraints.
Occupational therapy practitioners intervene in a wide variety of settings with people who abuse substances. Recognition of the effect that the substance abuse has had on the occupational functioning of the individual and the family is a unique dimension that the occupational therapist brings to the interdisciplinary approach. By facilitating the skills, daily routines, and occupational roles that the individual values and helping integrate them into the individual's view of self, the occupational therapist can enhance the life-style and support the abstinence of the newly recovering substance abuser.
Soranusś writings survive only in fragments, and we know virtually nothing about the details of his life and death. Yet his legacy of acute clinical observation, and his emphasis on the importance of diagnosis and the need to adapt treatment to the circumstances of each patient, as well as his compassion and common sense, shine through the remaining documents. Soranusś contribution to the science and art of psychiatry should not be forgotten.
OBJECTIVE:Untreated major mood disorders during pregnancy pose significant risks. The author reviews case reports of the use of electroconvulsive therapy (ECT) during pregnancy to clarify potential risks and modifications of ECT techniques that make the procedure safer for pregnant women. METHODS:A total of 300 case reports of ECT during pregnancy drawn from the literature from 1942 through 1991 were reviewed. RESULTS:Twenty-eight of the 300 cases reported complications associated with ECT during pregnancy, including transient, benign fetal arrhythmias; mild vaginal bleeding; abdominal pain; and self-limited uterine contractions. Without proper preparation, there was also increased likelihood of aspiration, aortocaval compression, and respiratory alkalosis. CONCLUSIONS:Electroconvulsive therapy is a relatively safe and effective treatment during pregnancy if steps are taken to decrease potential risks. Preparation for ECT during pregnancy should include a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended. Informed consent for ECT should include the patient's capacity to understand and rationally evaluate risks and benefits to herself and the fetus.
This paper describes the rationale, development, and implementation of a countywide scattered-site crisis bed program for seriously emotional disturbed youngsters. The program was developed by an interagency coalition consisting of representatives of the county's mental health, social service, and juvenile justice systems and was implemented with no new funding using available beds in facilities administered by the participating agencies. Referrals are screened by an interagency crisis consultation team responsible for the program's operation. A computerized registry significantly reduces the amount of time needed to make placements and helps agencies meet the goal of placing youngsters on the day of referral. Evaluation of the first 100 placements indicated that the program is a cost-effective alternative to more restrictive, longer-term placements and has resulted in positive clinical outcomes.
Back to table of contents Previous article Next article ArticleNo AccessA Quality Improvement Program in a State Hospital During a Period of DownsizingLee D. Hanes, Judith M. Butz, and Joette H. LeonardLee D. Hanes, Judith M. Butz, and Joette H. LeonardPublished Online:1 Apr 2006https://doi.org/10.1176/ps.45.9.929AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "A Quality Improvement Program in a State Hospital During a Period of Downsizing." Psychiatric Services, 45(9), pp. 929–930 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Register for access Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 45Issue 9 September 1994Pages 929-930 Metrics PDF download History Published online 1 April 2006 Published in print 1 September 1994
Back to table of contents Previous article Next article ArticleNo AccessResidential Planning: Concepts and ThemesLeona L. BachrachLeona L. BachrachPublished Online:1 Apr 2006https://doi.org/10.1176/ps.45.3.202AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Residential Planning: Concepts and Themes." Psychiatric Services, 45(3), pp. 202–203 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byThe Carter Commission's Contributions to Mental Health Service PlanningLeona L. Bachrach1 April 2006 | Psychiatric Services, Vol. 45, No. 6The Past and Future of Psychiatric Emergency Services in the U.SJames Randolph Hillard1 April 2006 | Psychiatric Services, Vol. 45, No. 6 Volume 45Issue 3 March 1994Pages 202-203 Metrics PDF download History Published online 1 April 2006 Published in print 1 March 1994
Back to table of contents Previous article Next article ArticleNo AccessSelf-Injurious Behavior in a State Psychiatric HospitalCalliope G. Callias, and Mary D. CarpenterCalliope G. CalliasSearch for more papers by this author, and Mary D. CarpenterSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.45.2.170AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byDialectical Behavior Therapy for Patients With Borderline Personality DisorderJournal of Psychosocial Nursing and Mental Health Services, Vol. 39, No. 10 Volume 45Issue 2 February 1994Pages 170-172 Metrics PDF download History Published online 1 April 2006 Published in print 1 February 1994
Back to table of contents Previous article Next article ArticleNo AccessMental Health Research Connection 1992: Matching Ideas With ResourcesGail W. Stuart, John A. Morris, and Tracy HutchesonGail W. Stuart, John A. Morris, and Tracy HutchesonPublished Online:1 Apr 2006https://doi.org/10.1176/ps.45.3.278AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Register for access Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 45Issue 3 March 1994Pages 278-280 Metrics PDF download History Published online 1 April 2006 Published in print 1 March 1994
The creation of an effective coalition of mental health organizations was integral to the mental health community's early success in furthering coverage for mental health services in national health care reform. A unified coalition was able to establish political credibility and clarify substantive choices while the Task Force on National Health Care Reform was formulating the Clinton Administration's proposal, leading to initial indications that parity for mental health benefits and flexible coverage of a wide range of services would be included. As concerns about the cost of the benefit package increased, the Administration stepped back from including comprehensive coverage, and some organizations in the coalition became divided over specific provisions. However, as of June 1994, the mental health community's consistent consensus about the need for comprehensive coverage and parity enabled the field to gain inclusion for mental health services and, in fact, wider coverage in some of the proposals emerging from Congressional subcommittees.
