When a patient is in need of intensive psychiatric care, the first step is often hospitalization. However, psychiatric home treatment is proposed as an alternative. Model programs in Canada and the United Kingdom are publicly administered by community health agencies or teaching hospitals. Psychiatric Home Treatment provides a review of the literature on home care and describes working programs around the world. This timely volume reviews treatment plans for different disorders with case illustrations, explains the administration of a PHC program and offers guidelines to case workers. It will be of interest to mental health professionals and policy makers working on the issue of patient hospitalization.
When a patient is in need of intensive psychiatric care, the first step is often hospitalization. However, psychiatric home treatment is proposed as an alternative. Model programs in Canada and the United Kingdom are publicly administered by community health agencies or teaching hospitals. Psychiatric Home Treatment provides a review of the literature on home care and describes working programs around the world. This timely volume reviews treatment plans for different disorders with case illustrations, explains the administration of a PHC program and offers guidelines to case workers. It will be of interest to mental health professionals and policy makers working on the issue of patient hospitalization.
Subject terms:
home care, hospitals, medical treatment, mental health problems, acute psychiatric care, community mental health services;
The book asks, is madness best thought of as a medical condition? Psychiatrists and the drug industry maintain that psychoses are brain disorders amenable to treatment with drugs. There is no convincing evidence that the brain is disordered in psychosis, yet governments across the world are investing huge sums of money on mental health services that take for granted the idea that psychosis is an illness to be treated with medication. Although some people who use mental health services find medication helpful, many do not, and resist the idea that their experiences are symptoms of illnesses like schizophrenia. Consequently they are forced into having treatment against their wishes. The authors examine the conflicting ways in which politicians, academics, and mental health professionals appear to understand madness, and contrast this with voices and experiences that are usually excluded - those of the people who use mental health services. They then examine the power of psychiatry to shape how we understand ourselves and our emotions, before considering some of the basic limitations of psychiatry as science to make madness meaningful. In the final section of the book they draw on evidence from service users and survivors, the humanities and anthropology, to point out a new direction for mental health practice.
The book asks, is madness best thought of as a medical condition? Psychiatrists and the drug industry maintain that psychoses are brain disorders amenable to treatment with drugs. There is no convincing evidence that the brain is disordered in psychosis, yet governments across the world are investing huge sums of money on mental health services that take for granted the idea that psychosis is an illness to be treated with medication. Although some people who use mental health services find medication helpful, many do not, and resist the idea that their experiences are symptoms of illnesses like schizophrenia. Consequently they are forced into having treatment against their wishes. The authors examine the conflicting ways in which politicians, academics, and mental health professionals appear to understand madness, and contrast this with voices and experiences that are usually excluded - those of the people who use mental health services. They then examine the power of psychiatry to shape how we understand ourselves and our emotions, before considering some of the basic limitations of psychiatry as science to make madness meaningful. In the final section of the book they draw on evidence from service users and survivors, the humanities and anthropology, to point out a new direction for mental health practice.
Subject terms:
medical treatment, mental health problems, psychiatry, therapies, therapy and treatment, ethics;
The authors examined the effectiveness of compulsory community treatment for people with severe mental illness through a systematic review of all relevant randomised controlled clinical trials. Only two relevant trials were found and these provided little evidence of efficacy on any outcomes such as health service use, social functioning, mental state, quality of life or satisfaction with care. No data were available for cost and unclear presentation of data made it impossible to assess the effect on mental state and most aspects of satisfaction with care. In terms of numbers needed to treat, it would take 85 outpatient commitment orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest.
The authors examined the effectiveness of compulsory community treatment for people with severe mental illness through a systematic review of all relevant randomised controlled clinical trials. Only two relevant trials were found and these provided little evidence of efficacy on any outcomes such as health service use, social functioning, mental state, quality of life or satisfaction with care. No data were available for cost and unclear presentation of data made it impossible to assess the effect on mental state and most aspects of satisfaction with care. In terms of numbers needed to treat, it would take 85 outpatient commitment orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest.
Extended abstract:
Author
KISLEY S.; CAMPBELL L.A.; PRESTON N.; Title
Compulsory community and involuntary outpatient treatment for people with severe mental disorders: review Publisher
Cochrane Collaboration, 2005
Summary
The authors examined the effectiveness of compulsory community treatment for people with severe mental illness through a systematic review of all relevant randomised controlled clinical trials. Only two relevant trials were found and these provided little evidence of efficacy on any outcomes such as health service use, social functioning, mental state, quality of life or satisfaction with care. No data were available for cost and unclear presentation of data made it impossible to assess the effect on mental state and most aspects of satisfaction with care. In terms of numbers needed to treat, it would take 85 outpatient commitment orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. Context
There is controversy as to whether compulsory community treatment for people with severe mental illnesses reduces health service use, or improves clinical outcome and social functioning. Given the widespread use of such powers it is important to assess the effects of this type of legislation.
Contents
The report begins with an abstract summarising the background and objectives, describing the search strategy, selection criteria and data collection and analysis, and giving the main results and authors' conclusions. This is followed by a synopsis and description of the background, objectives, criteria for considering studies for the review, search strategy and methods. The studies are described and methodological quality discussed. This is followed by the results, discussion and authors conclusions, references, and tables of characteristics of included and excluded studies and additional tables and graphs.
Conclusion
Based on current evidence, community treatment orders may not be an effective alternative to standard care. It appears that compulsory community treatment results in no significant difference in service use, social functioning or quality of life compared with standard care. There is currently no evidence of cost effectiveness. People receiving compulsory community treatment were, however, less likely to be victims of violent or non-violent crime. It is, nevertheless, difficult to conceive of another group in society that would be subject to measures that curtail the freedom of 85 people to avoid one hospital admission or 238 to prevent one arrest. Further, good quality randomised controlled studies are urgently required to consolidate findings and establish whether it is the intensity of treatment in compulsory community treatment or its compulsory nature that affects outcome. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.
77 references
Subject terms:
involuntary clients, literature reviews, medical treatment, mental health problems, randomised controlled trials, community care, compulsory treatment;
British Journal of Psychiatry, 18(6), December 2005, pp.552-556.
Publisher:
Cambridge University Press
Most studies of mortality in psychiatric patients have investigated in-patients rather than those attending out-patient clinics or primary care, where most receive treatment. The aim was to evaluate the mortality risk in mental illness for patients in contact with psychiatric services or primary care (n=221 048) across Nova Scotia (population 936 025). A population-based record-linkage analysis was made of the period 1995-2000, using an inception cohort to calculate mortality rate ratios. The mortality rate was 1.74, with increased ratios for all major causes of death. Male mortality was almost double that of females after controlling for demographic factors, treatment setting and place of residence. Patients of lower income, in specialist psychiatric settings, and with dementia or psychoses were also at greater risk. However, in absolute numbers, 72% of deaths occurred in patients who had only seen their general practitioner. Mortality risk is increased in all psychiatric patients, not just those who have received in-patient treatment.
Most studies of mortality in psychiatric patients have investigated in-patients rather than those attending out-patient clinics or primary care, where most receive treatment. The aim was to evaluate the mortality risk in mental illness for patients in contact with psychiatric services or primary care (n=221 048) across Nova Scotia (population 936 025). A population-based record-linkage analysis was made of the period 1995-2000, using an inception cohort to calculate mortality rate ratios. The mortality rate was 1.74, with increased ratios for all major causes of death. Male mortality was almost double that of females after controlling for demographic factors, treatment setting and place of residence. Patients of lower income, in specialist psychiatric settings, and with dementia or psychoses were also at greater risk. However, in absolute numbers, 72% of deaths occurred in patients who had only seen their general practitioner. Mortality risk is increased in all psychiatric patients, not just those who have received in-patient treatment.
Subject terms:
medical treatment, mental health problems, psychiatry, psychoses, risk, death, dementia;
Journal of Evidence-Based Social Work, 2(1/2), 2005, pp.113-135.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Serious mental illnesses (SMIs) commonly co-occur with substance-use disorders and, if undetected and untreated, adversely affect their clinical course. This paper describes the use and scoring of the K6 scale, a brief and valid screening tool for SMI, in a large general population sample derived from the 2001 National Household Survey on Drug Abuse (NHSDA). Analyses examine the demographic characteristics and patterns of substance use disorders among persons with and without a co-occurring SMI.
Serious mental illnesses (SMIs) commonly co-occur with substance-use disorders and, if undetected and untreated, adversely affect their clinical course. This paper describes the use and scoring of the K6 scale, a brief and valid screening tool for SMI, in a large general population sample derived from the 2001 National Household Survey on Drug Abuse (NHSDA). Analyses examine the demographic characteristics and patterns of substance use disorders among persons with and without a co-occurring SMI.
Subject terms:
medical treatment, mental health problems, social work, substance misuse, dual diagnosis, evidence-based practice;
British Journal of Psychiatry, 186(6), June 2005, pp.529-535.
Publisher:
Cambridge University Press
There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. The aim was to improve understanding of prior care-seeking and treatment of new patients seen at mental health services. Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as ‘gatekeeper’ in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.
There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. The aim was to improve understanding of prior care-seeking and treatment of new patients seen at mental health services. Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as ‘gatekeeper’ in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.
Subject terms:
medical treatment, medication, mental health problems, psychiatric care, primary care, doctors;
Content type:
research
Location(s):
Albania, Croatia, Macedonia, Romania, Serbia and Montenegro
The author explains why it is important for solicitors representing parents with mental health problems to have a basic knowledge of the terminology used by psychiatrists in the diagnosis and treatment of those suffering from a mental health problem. The article covers what is meant by psychotic illness and neurotic illness; the definition of mental disorder under section 1 of the Mental Health Act 1983; the main approaches to treating mental health problems; the concept of capacity, and representing parents in care proceedings.
The author explains why it is important for solicitors representing parents with mental health problems to have a basic knowledge of the terminology used by psychiatrists in the diagnosis and treatment of those suffering from a mental health problem. The article covers what is meant by psychotic illness and neurotic illness; the definition of mental disorder under section 1 of the Mental Health Act 1983; the main approaches to treating mental health problems; the concept of capacity, and representing parents in care proceedings.
Subject terms:
legal proceedings, medical treatment, mental health problems, parental role, parents, child protection, parental mental health;
Child Care in Practice, 11(1), January 2005, pp.7-22.
Publisher:
Taylor and Francis
This study examined the effectiveness of a cognitive-behavioural therapy programme for 13 children treated for severe emotional or behaviour disorders in a hospital setting. Data were obtained from multiple informants at pre-treatment, post-treatment, and three months follow-up. Results indicated statistically significant improvement in the children's global psychological functioning and reduction of maladaptive internalizing behaviours with maintenance at follow-up. The children reported statistically significant reduction in clinical maladjustment at discharge only. A positive trend toward healthier adaptive functioning was noted. Prognosis was poorer for children with comorbid diagnoses of internalizing and externalizing disorders. Clinical implications and directions for future research were discussed.
This study examined the effectiveness of a cognitive-behavioural therapy programme for 13 children treated for severe emotional or behaviour disorders in a hospital setting. Data were obtained from multiple informants at pre-treatment, post-treatment, and three months follow-up. Results indicated statistically significant improvement in the children's global psychological functioning and reduction of maladaptive internalizing behaviours with maintenance at follow-up. The children reported statistically significant reduction in clinical maladjustment at discharge only. A positive trend toward healthier adaptive functioning was noted. Prognosis was poorer for children with comorbid diagnoses of internalizing and externalizing disorders. Clinical implications and directions for future research were discussed.
Subject terms:
hospitals, medical treatment, mental health problems, behaviour modification, behaviour therapy, challenging behaviour, child care, children, cognitive behavioural therapy, emotionally disturbed children;