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Objective: Research and study the Lebanese employers’ attitudes, toward recruiting candidates with a mental illness and toward their employees who suffer chronic mental illnesses (A CMI) and the factors that may play a role in affecting it. Methods: A combined cross sectional and retrospective study. Interviews conducted with a mix of 63 human resource managers and high executive employees to assess the integration of people with A CMI at the workplace, and the attitudes toward them. Results: Primarily, the engagement of an occupational physician or a social worker in the process, was associated with a reduction in stigma surrounding the subject matter. Moreover, hiring a candidate with A CMI was perceived as a social image improvement of the hiring company. However, A CMI employees were perceived as having lower efficiency and self-esteem, as well as a greater vulnerability to dismissal. Conclusion: The presence and engagement of an occupational physician, and/or a social worker, has been found to be the main positive stigma modulator against mental illness, in a corporate setting.

Background: Patients with chronic mental illness are frequently hospitalized and discharged from psychiatry wards. This situation is referred to as the “revolving door phenomenon” (RDP). In addition to factors related to the patient and the disease, limited number of beds leading to shortened hospital stay are among the reasons associated with frequent hospitalization. This study aims to compare patients with RDP and patients with single hospitalization in terms of clinical, sociodemographic, and treatmentoriented characteristics in order to evaluate the risk factors causing frequent hospitalization. Subjects and methods: In this study, patients who were admitted and hospitalized between May 1, 2011 - May 1, 2016 were retrospectively evaluated from patient records. The RDP group consisted of 74 patients and the single-hospitalization group consisted of 59 patients who met inclusion criteria. Results: The RDP group had significantly higher rates of male gender, ECT history, past suicide attempts, multiple drug treatment, clozapine use, legal incidents, and noncompliance to follow up following discharge compared to the single hospitalization group (p

Background: Individuals with mental illness, as they are stigmatized by society, are also stigmatized themselves, and this process is internalized. This may adversely affect the recovery process. Aims: This study was conducted to investigate the relationship between internalized stigmatization and subjective recovery in patients with schizophrenic. Method: This research was performed for patients with schizophrenia at rehabilitation centers registered with the community mental health center. The survey was performed out with 94 patients in the recovery phase who met the inclusion criteria and who going to the center. Sociodemographic information form, internalized stigmatization scale and subjective recovery assessment scale were used in the collection of data. Results: In the study it was found that there is a relationship between internalized stigmatization and subjective recovery. Increased levels of internalized stigma patient outcome would decrease the level of recovery. Conclusion: It is recommended that nurses perform intervention programs to reduce internalized stigmatization in patients with schizophrenia.

NewAccess is a low-intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild-to-moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild-to-moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017-2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall 'reliable improvement' and 'recovery rates' were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a 'youth-friendly' service environment.

Severe mental illness (SMI) is associated with a reduced life expectancy of up to 20 years. One possible contributor to this fact is dysregulation of the hypothalamus-pituitary-adrenal (HPA)-axis. Looking at the morphology of effector organs, such as the adrenal glands themselves, could reveal insights into organ function and response to possible HPA-dysregulation. This forensic autopsy-based study investigated if there were any morphological changes in adrenal glands between decedents who had previously been submitted to a psychiatric hospital with a diagnosis of schizophrenia (

Background: Schizophrenia is a chronic mental illness that strongly affects not only the patients with schizophrenia, but also their families and close relatives. So far, family research on patients with schizophrenia has mainly focused on parents, but has neglected siblings. Aim: This study aims to evaluate the well-being of 103 siblings of patients with schizophrenia within the Lazarus and Folkman’s Transactional Coping and Stress Model. Materials: A Sociodemographic Information Form, Subjective Well-being Scale, Zarit Caregiver Burden Scale, Multidimensional Perceived Social Support Scale, Ways of Coping Scale and Shortened Perceived Parental Rearing Styles Form were administered to the siblings of patients with schizophrenia. Results: The results of this study revealed that well-being was associated with perceived mother overprotection, perceived social support, problem-focused coping and indirect coping. Social support moderated the relationship between burden and well-being as a buffering factor. Conclusion: Therefore, siblings of patients with schizophrenia should be given access to social support and their problem-focused coping strategies should be strengthened. Besides, parents should be supported to provide suitable care for the siblings of patients with schizophrenia.

Background: One of the most important aspects of receiving medical care is access to that care. For people with mental illness who have greater healthcare needs and are at risk for poor health outcomes, reduced access to care constitutes a crisis. While the COVID-19 (coronavirus disease 2019) pandemic continues to affect the United States, specifying what it means to have access to mental healthcare is more critical than ever. Aims: The aims of this concept analysis are to review definitions and descriptions of access to mental healthcare in the literature and to synthesize the relevance of these findings to inform future research, theory development, policy, and practice. Methods: The concept of access to mental healthcare was analyzed using Rodgers’s evolutionary concept analysis method. CINAHL, PsycINFO, and MEDLINE were queried for peer-reviewed articles about access to mental healthcare published from January 2010 to April 2020 ( n = 72). Data were reviewed for concept antecedents, attributes, consequences, surrogate, and related terms. Results: Five models of access to mental healthcare were identified, with several antecedents and consequences: utilization, economic loss/gain, incarceration, and patient/provider satisfaction. Cross-sectional and predictive studies highlighted three interrelated attributes: clinical management, healthcare delivery, and connectedness. Conclusions: The concept of access to mental healthcare is often used stagnantly across disciplines to create health policies, yet the concept is transformative. Future research requires up-to-date operational definitions of access to mental healthcare to target interdisciplinary approaches.

Personal recovery is a process of developing new meaning and purpose in life beyond the catastrophic effects of mental illness. Benefit finding (BF) is conceptualized as finding positive changes or benefits through experiences in adversity. Sense of coherence (SOC) focuses on how people can stay healthy and maintain well-being, even in adversity. This study aimed to examine the relationships among the initial levels and longitudinal changes in personal recovery, BF, and SOC among people with chronic mental illness in Japan. In this longitudinal study, a two-wave self-report questionnaire survey was conducted for service users aged 20 or older with mental illness using convenience sampling method in 2014 and 2015. We applied the Latent Change Score approach. Model fit was evaluated according to the CFI and RMSEA. Among 373 eligible participants at baseline, valid responses in both T1 and T2 from 195 respondents were included in the study (valid response rate = 52.3%). Among them, 65.6% were male, with average age of 45.6. The model of the three constructs at the two time points had good to reasonable fit to the data. The initial levels and changes in personal recovery, BF, and SOC were significantly and positively related to each other.

International audience; Using French longitudinal register data, we compare the evolution of employment rates of persons with severe chronic mental illness, before and after the first medico-administrative recognition of the illness by the Statutory Health Insurance (SHI), with that of people without recognised mental illness. The study focuses on persons of working age having a work history before recognition. Our empirical approach relies on a double difference method with coarsened exact matching. Before illness recognition subjects had lower employment rates than those without mental illness but relatively high, reflecting their initial employment attachment. Results indicate that employment rates decrease sharply after recognition. A large employment rate gap between persons with and without severe mental illness develops during the four years following recognition. We examine whether the magnitude of the decrease is sensitive to the macroeconomic context. Findings show that the decline in employment rates was significantly more pronounced during the Great Recession compared with the pre-crisis period, amongst women. As a conclusion, this study points out that implementing coordinated early health and labour policies in the phase of the entry into the chronic-illness insurance scheme of the SHI might play a key role in preventing the detrimental effects of illness on economic and social conditions of persons with severe mental illnesses.

Bipolar disorder (BD) is a serious and chronic mental illness that may result in disability. We evaluated effect of the duration of untreated of bipolar (DUB) (manic episodes) on clinical outcomes, including episode severity, residual symptoms, duration of hospitalization, and suicide attempts, and on socioeconomic status of patients.A total of 216 participants who had bipolar I disorder (manic state) recruited from November 2017-December 2019 from an inpatient psychiatric unit. Patients divided into 2 groups based on DUB: Group A, with DUB4 months; and Group B, with DUB ≥4 months. All participants had evaluation for demographic and clinical features, Socioeconomic scale, Young mania rating scale (YMRS) at admission and discharge.Group A participants were more often male, urban residents, married, literate and educated, professionally employed. Group A had a younger age of onset, less duration of illness, less frequency of episode, less suicide attempts, less duration in hospital, high mean of socioeconomic, lower mean of YMRS at admission and discharge in compared to Group B.A longer DUB (manic episodes)was associated with negative clinical outcomes (more frequent episode, more symptoms severity, longer hospital admission, more suicide severity, more residual symptoms) and low socioeconomic state of patients with BDI (manic episodes).

The South African Mental Health Act of 2002 advocates the de-institutionalization of treatment of patients with mental disorders, so that the mental health care users or patients are treated in their communities. Although this approach is often used to discharge patients from hospital, no feasibility assessments are conducted to ascertain adequate care for these patients. The objective of the study was to explore the experiences of family members who provide home care for patients with serious mental disorders. A qualitative explorative design was used to interview 20 primary caregivers whose family members were readmitted to a public psychiatric hospital in Pretoria. Data were analysed using NVivo version 11. The findings are that caring for patients with serious mental illness at home is difficult, sometimes unbearable, because the families have to deal with violence perpetrated by the patients, safety concerns, financial difficulties and emotional turmoil, and wish that the patients would be kept in institutions. The absence of required skills and resources to care for the mentally ill at home exposes the patients and their families to emotional, financial and social difficulties, and results in unfavourable outcomes for both the patients and their families.

PURPOSE To identify factors influencing the hopes of mental health nurses and to explore their experiences with a sense of hope. DESIGN AND METHODS A descriptive research survey was conducted with 113 nurses at three closed psychiatric wards in South Korea. FINDINGS Nurses' hope, interpersonal skill competence, and professional self-concept were all found to have statistically significant correlations (r = 0.60-0.73, p

Background: Schizophrenia is a chronic mental illness affecting the social and occupational lives of the sufferers and posing a considerable burden on the patients and their families. Furthermore, negative societal reactions and the internalization of these attitudes exacerbate the difficulties encountered. This study examines the perspectives of Turkish people with schizophrenia on how they view the impact of the illness on their lives, the societal reactions and attitudes to schizophrenia and whether they agree with these reactions. Methods: Twenty-three adult participants, all members of two schizophrenia associations in Ankara, capital of Turkey, were recruited. Semistructured interviews were used to find out their perspectives on how the illness affected their lives, how the society reacts to them and their views on these reactions. Interviews were recorded, transcribed and thematic analysis was used to capture the general and the subthemes. Results: The findings suggest that causal attributions for the illness, the impact of illness on various life domains, challenges of living with the illness and finally stigmatization are general categories that capture the perspectives of the participants. Conclusion: People diagnosed with schizophrenia experience the impacts and burdens of their illness in various domains of their lives and negative societal reactions heighten these burdens. It seems important to consider the challenges faced by people with schizophrenia in living with their illness and the impacts of negative societal behaviors and attitudes in offering psychosocial interventions programs for supporting this group. Furthermore, combating negative societal attitudes also seems to be necessary.

The purpose of the current descriptive qualitative study was to reveal experiences of family caregivers of individuals with chronic psychiatric illness. Family caregivers who provided care to 16 individuals with chronic mental illness were interviewed. Three themes emerged from the interviews: Illness Management , The Caregiver's World: Changes and Effects , and Coping From the Caregiver's Point of View . Understanding the experiences of family caregivers contributes to content development of family intervention programs. [ Journal of Psychosocial Nursing and Mental Health Services, 58 (3), 38–46.]

There is a relative paucity of literature in the field of spirituality among people who have a lived experience of severe mental illness from Australia. Sixteen individuals with a severe mental illness were interviewed on their experiences of spirituality. The three themes that emerged from the data were concepts of spirituality, benefits of intentional spiritual practices and perceived spiritual benefits of recreational pursuits and physical activity. This paper adds to the relatively sparse literature on spirituality among persons with a mental illness in Australia.

BACKGROUND: Further exploration of the practice roles of psychiatric mental health (PMH) advanced practice registered nurses (APRNs) is warranted. OBJECTIVE: In March of 2016, the American Psychiatric Nurses Association (APNA) conducted a national survey to gather data on the demographics, practice roles, and activities of certified PMH APRNs. DESIGN: The e-mail survey contained 46 questions consistent with minimum data set requirements of the Forum of State Nursing Workforce Centers. RESULTS: The data indicate that PMH APRNs are a clinically active workforce; the majority deliver a wide variety of mental health services including diagnosis and management of both acute and chronic mental illness, prescribing, and providing psychotherapy. CONCLUSION: PMH APRNs are delivering care to clients dealing with a range of serious mental illnesses across the life span in a variety of roles. It will be critical to monitor the activities and outcomes of this expanding behavioral health care workforce.

Objectives: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. Method: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. Results: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value Conclusion: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

OBJECTIVES The objective of this study was answer to the question: to what extent are the anger of the caregivers of patients diagnosed with schizophrenia and their perceived level of burden are related? METHOD The study is a descriptive and correlational study. The information form prepared by the researchers which questions the socio-demographic information of the individuals along with the “Caregiving Burden Inventory” which examines the burden of the caregiver as well as “Trait Anger and Anger Expression Style Scale (TAAES)” which determines the anger levels of the caregivers were used. RESULTS The caregiving burdens of the caregivers according to the score averages were determined as 11.88 ± 9.78 for time and dependency burden, 11.93 ± 8.46 for developmental burden, 8.47 ± 6.63 for physical burden, 5.61 ± 5.26 for social burden, 6.29 ± 5.25 for emotional burden and the total burden score was determined as 44.19 ± 26.75. According to the trait anger and anger expression style scale score averages; trait anger was determined as 15.12 ± 5.95, anger expression as 9.70 ± 3.43, anger-in as 15.22 ± 4.02, anger control as 28.05 ± 5.57 and anger total score average as 68.11 ± 9.97. CONCLUSION According to the results obtained from this study, caregivers of schizophrenia patients experience developmental, physical, social and emotional burdens in addition to trait anger. The caregivers of schizophrenia patients need knowledge and support in order to control the burden and the anger they experience during the caregiving process.

Schizophrenia is a chronic mental illness which causes significant distress and dysfunction. Yoga has been found to be effective as an add-on therapy in schizophrenia. Modules of yoga used in previous studies were based on individual researcher's experience.This study aimed to develop and validate a specific generic yoga-based intervention module for patients with schizophrenia. The study was conducted at NIMHANS Integrated Centre for Yoga (NICY).A yoga module was designed based on traditional and contemporary yoga literature as well as published studies. The yoga module along with three case vignettes of adult patients with schizophrenia was sent to 10 yoga experts for their validation.Experts (n = 10) gave their opinion on the usefulness of a yoga module for patients with schizophrenia with some modifications. In total, 87% (13 of 15 items) of the items in the initial module were retained, with modification in the remainder as suggested by the experts.A specific yoga-based module for schizophrenia was designed and validated by experts. Further studies are needed to confirm efficacy and clinical utility of the module. Additional clinical validation is suggested.

Background: The global shift from institution-based to community-based care for chronic mental illness (CMI) care resulted in the de-institutionalization of clients with CMI. However, health systems which have been originally designed for acute hospital-based care do not seem to be appropriately transformed to manage CMI care at a community level. Aim: The aim of this study was to investigate how contextual factors influenced care coordination for chronic mental illness care within the eThekwini District. Methods: This study employed a qualitative multiple case study design with instrumental approach. Maximum variation sampling was used to select five Community Health Centres (CHC’s) and 48 health providers who worked with mentally ill clients in the sample CHC’s. Framework analysis was used to analyze the results. Results: Inequitably resourced catchment areas, unclear referral systems, high staff turnover, freezing of posts, chronic staff shortage and adverse working conditions contributed to care fragmentation, poor client care and client loss in the system. On the other hand, limited community support systems constituted barriers for client reintegration into society and relapses. Conclusion: The study concluded that the eThekwini District health facility settings were not adequately equipped to respond to care coordination demands for chronic mental illness care. Keywords: De-institutionalization, health facility settings, community support services, chronic mental Illness.

Schizophrenia is a serious chronic mental illness that results in marginalization and stigma for sufferers. It is the seventh leading cause for disability worldwide. The symptoms of the illness, including hallucinations, delusions, and extremely disordered thinking and behavior, may also introduce barriers to accessing treatment, education, housing, and employment. Little is known about end-of-life care for individuals with schizophrenia. To address this gap, a scoping review was conducted to enhance understanding of hospice and palliative care for patients with schizophrenia. From this scoping review, 342 unique titles and abstracts were identified through a search of 20 databases, including 11 social science databases, 6 medical databases, and 3 gray literature databases. A total of 32 articles met the inclusion criteria and the following 4 themes were identified: Stigma affecting quality of care and access to care; Issues related to consent and capacity for the patient’s end-of-life care decisions and to appoint substitute decision makers; Best practices for psychosocial interventions, pharmacology, family and health-care collaborations, goals of care, setting, and smoking; and Barriers to care, including setting, communication, provider education, and access to care. The review suggests the importance of mandatory interdisciplinary training practices and policy standards outlining cooperative communication across health-care providers. It highlights gaps in evidence-based research on psychosocial interventions and collaborative frameworks to enable the provision of quality end-of-life care for individuals with schizophrenia.

Glycine transporter-1 (GlyT1) inhibition has been extensively studied both in pharmaceutical companies and academic institutions primarily as a potential new approach to treat schizophrenia, a severe and chronic mental illness. More recently, preclinical results have suggested that this approach could also have therapeutic potential for CNS disorders beyond schizophrenia as well as for non-CNS indications. Over the past 17 years, Roche has been a key player in the GlyT1 field with the discovery and development of bitopertin, the most advanced GlyT1 inhibitor to date and the only one which completed Phase III clinical studies for schizophrenia. In this article, we relate the eventful journey of the discovery and development of bitopertin, from project initiation in 2001 to its evaluation today in patients suffering from beta-thalassemia, a monogenic hereditary haematological disorder.

Background: Bipolar disorder is a common, severe and chronic mental illness. Despite this, predictors of illness severity remain poorly understood. Impulsivity is reported to be associated with bipolar disorder and aggravating comorbidities. This study therefore sought to examine the predictive value of impulsivity for determining illness severity in euthymic bipolar disorder patients. Methods: Baseline trait impulsivity of 120 bipolar euthymic patients (81 bipolar disorder I [68%], 80 female [67%]) and 51 healthy controls was assessed using Barratt Impulsiveness Scale 11. The impact of impulsivity on illness severity (measured with morbidity index) was prospectively tested in 97 patients with sufficient follow-up data (average observation time: 54.4 weeks), using linear regression analysis. Results: Barratt Impulsiveness Scale 11 total (β = 0.01; p Limitations: The average year-long observation time might not be long enough to account for the chronic course of bipolar disorder. Conclusion: Trait impulsivity and particularly attentional impulsivity in euthymic bipolar patients can be strong predictors of illness severity in bipolar disorder. Future studies should explore impulsivity as a risk assessment for morbidity and as a therapeutic target in bipolar disorder patients.

Bipolar disorder is a complex and chronic mental illness. Individuals with this disorder usually have medical comorbidities needing management in primary care. This article focuses on bipolar disorder identification and medication management concerns for primary care nurse practitioners.

The Netherlands was one of the first countries in the world to establish a legal framework for physician-assisted dying (PAD). In this article, we provide an overview of the public, political, legal, and medical debates on physician-assisted dying in the Netherlands, focusing on the role of psychiatry and mental illness. The number of individuals with chronic mental illness requesting PAD has been relatively small (although the number can be expected to increase because of the activities of various civic organizations advocating the right to die) and Dutch psychiatrists have been extremely reluctant to respond to such requests. Nevertheless, mental conditions have been central to the public debate on PAD by helping to define the nature and limits of current legislation and professional practice. Although a few Dutch psychiatrists have campaigned to increase the involvement of psychiatrists and many support PAD in principle, the majority has been hesitant to engage in PAD despite increasing public pressure.

BACKGROUND: “Systems of care” are strengths-based approaches to treating adolescents and others with disruptive disorders. However, little is known about why some adolescents improve and others do not. OBJECTIVE: To examine changes in personal strengths and family functioning as predictors of behavioral and social functioning among adolescents with disruptive disorders who participated in a system of care program. DESIGN: Secondary analyses of data from 114 adolescents (12-17 years of age) with disruptive disorders and their caregivers who participated in the Dawn Project Evaluation Study. Caregivers completed in-depth interviews conducted by trained data collectors using standardized questionnaires. Baseline and 12- month data are reported here. RESULTS: Improvement in personal strengths was a significant predictor of improvement in adolescent behavioral and social functioning, controlling for demographics ( p < .001). CONCLUSION: In adolescents with disruptive disorders, psychiatric nurses should focus on enhancing adolescents’ personal strengths to improve behavioral and social functioning.

Many children with ADHD remain symptomatic in (young) adulthood. It is important to understand what characterizes this persistent ADHD group. Since ADHD has been associated with neurocognitive dysfunctioning on a variety of neurocognitive domains, and many of these domains are influenced by the same risk genes that influence ADHD, neurocognitive functions are a potential predictor for ADHD persistence. We carried out a systematic literature review on the predictive value of neurocognitive functioning for future ADHD. Based on eighteen studies there was no evidence that either automatically controlled (requiring little mental effort; lower level), or more consciously controlled (requiring high levels of mental effort; higher level) neurocognitive functions differentiated ADHD persistence from remittance. In general, both persisters and remitters showed weaker performance than typically developing controls, although the effect was smaller for remitters. Neurocognitive functions measured in childhood predicted ADHD a few years later, regardless of the type of neurocognitive function. Our findings do not support the model of Halperin and Schulz (2006), which suggests a maturation of more consciously controlled neurocognitive functions in ADHD remitters. (C) 2013 Elsevier Ltd. All rights reserved

For people with chronic mental illness, their support system (including direct support staff at group homes) play a key role in ameliorating exacerbations leading to crisis care. However, little information exists on curriculum or training programs focused on reducing exacerbations while promoting compassionate care. We developed, implemented and evaluated such a program that featured role-playing and animated videos supplemented with limited didactics. During development phase, direct support staff reviewed videos and rated them as depicting realistic situations with high acceptability. During implementation, the 6-week course (at least one staff from six different group homes not involved in the development phase) using a 3-month pre-post design found reductions in total number of incident reports and pre-specified outcomes of recipient right complaints, emergency calls, and psychiatric hospitalizations. The program demonstrated acceptability, improved care and better outcomes on some but not all outcomes. Improved training of direct support staff is possible and has positive outcomes.

We thank the commentators very much for their reaction to our article.1 We appreciate the theoretical issues they raised concerning the approaches to competence, as well as their discussion of the cases we have presented. In some cases of mental illness, for example, in severe dementia or paranoid delusions, the line between competence and incompetence is not very difficult to draw. However, in clinical practice healthcare professionals may encounter cases where the line becomes less clear, and the criteria commonly used do not seem to cover the specific problems the patients encounter when deciding about their treatment. This appears to be particularly true for cases of chronic mental illness. Previously, Tan et al pointed at the limits of the cognitive model in patients with anorexia nervosa.2 In our study, we looked deeper into decision-making in obsessive-compulsive disorder (OCD) patients, in order to articulate the challenges, they face when deciding about treatment options. We suggest that in such cases neither the cognitive nor the emotions or values approach enable us to really grasp how competence may be challenged—and supported—in these patients. We propose a practical wisdom approach to competence as an alternative. In what follows, we respond to Crisp and Sullivan-Bissett's thoughtful comments in some detail. Crisp3 defends a cognitive approach, emphasising that competence requires the ability to reason. In his interpretation of the case of Mary, he argues that her expression that she was ‘fed up’ with treatment can be …

Doctors, unsurprisingly, get sick. The UK General Medical Council says, “If you have a health condition or have a problem with alcohol or drugs that may put patients at risk, you need to let us know so that we can ensure that patients are protected.”1 One doctor told me that she’d told the GMC that she thought she could put patients at risk if she had a relapse of her chronic mental illness. This led to a fitness to practise process, even though she’d taken independent advice, spent time off work as advised, …

In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the will. I will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions ('depressive habituality'). These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her 'depressive disabilities' (i.e., her levelled amount of daily activities, her social retreat in certain periods). Lastly, I will compare this manner of life-conduct with the constellation of includence (Inkludenz), as described by Tellenbach, and discuss the limitations of this study.

Terminally ill individuals with serious and persistent mental illness (SPMI) are currently underserved by palliative care. However, palliative care nurses can expect to see more patients with SPMI because an estimated 6% of the adult population has chronic mental illness, and mortality and morbidity rates are higher in this group. Reasons for these increased rates are discussed. Literature regarding the provision of palliative care to those with SPMI is sparse, but what literature there is does offer suggestions for improvements in clinical practice. These suggestions for improvement are explored, and conclusions are drawn about the need for future research.

Seeking to align psychiatric practice with general medicine following the inauguration of the National Health Service, psychiatric hospitals in post-war Britain deployed new treatments designed to induce somatic change, such as ECT, leucotomy and sedatives. Advocates of these treatments, often grouped together under the term ‘physical therapies’, expressed relief that the social problems encountered by patients could now be interpreted as symptomatic of underlying biological malfunction rather than as a cause of disorder that required treatment. Drawing on the British Journal of Psychiatric Social Work, this article analyses the critique articulated by psychiatric social workers based within hospitals who sought to facilitate the social reintegration of patients following treatment. It explores the development of ‘psychiatric social treatment’, an approach devised by psychiatric social workers to meet the needs of people with enduring mental health problems in hospital and community settings that sought to alleviate distress and improve social functioning by changing an individual’s social environment and interpersonal relationships. ‘Physical’ and ‘social’ models of psychiatric treatment, this article argues, contested not only the aetiology of mental illness but also the nature of care, treatment and cure.

This review begins with an outline of outcome measurement in the country where it has been most thoroughly implemented, namely Australia. There follows a consideration of what constitutes an outcome in mental illness generally, and chronic mental illness in particular. Some instruments, such as the Health of the Nation Outcome Scales (HoNOS), focus primarily on illness severity, and examples of their use in the area of chronic mental illness are presented. Other instruments, such as the Life Skills Profile (LSP), assess personal functioning or disability, and that literature is reviewed. One major area of attention in the chronically mentally ill is quality of life. Another fruitful approach to assessing outcome is to look at needs, especially unmet needs, for which the leading instrument is the Camberwell Assessment of Need; relevant findings are reviewed. The most recent area of interest is recovery. While several scales have been developed, there are as yet relatively few reports of their application with patients with chronic mental illness. The concluding section considers the benefits and weaknesses of using the same standard instruments with all consumers within a service, and shows the utility of outcome results in groups and individuals with generally small overall changes.

Nurses have a long history of caring for clients with chronic mental illness. A primary treatment modality used with these clients is supportive psychotherapy. Often this approach is not well understood, even by those who purport to practice it. While supportive therapy tends not to enjoy the prestige associated with other forms of individual psychotherapy, the author contends that supportive psychotherapy can be an interesting and challenging treatment modality for working with clients with chronic mental illness.

The concept of competence is central to healthcare because informed consent can only be obtained from a competent patient. The standard approach to competence focuses on cognitive abilities. Several authors have challenged this approach by emphasising the role of emotions and values. Combining cognition, emotion and values, we suggest an approach which is based on the notion of practical wisdom. This focuses on knowledge and on determining what is important in a specific situation and finding a balance between various values, which are enacted in an individual's personal life. Our approach is illustrated by two cases of patients with obsessive-compulsive disorder.

This descriptive and comparative study employed a Q-sort process to describe common factors of therapy in two group therapies for inpatients with chronic mental illness. While pharmacological treatments for chronic mental illness are prominent, there is growing evidence that cognitive therapy is also efficacious. Groups examined were part of a larger study comparing the added benefits of cognitive versus supportive group therapy to the treatment milieu. In general, items described the therapist's attitudes and behaviors, the participants' attitudes and behaviors, or the group interactions. Results present items that were most and least characteristic of each therapy and items that discriminate between the two modalities. Therapists in both groups demonstrated good therapy skills. However, the cognitive group was described as being more motivated and active than the supportive group, indicating that the groups differed in terms of common as well as specific factors of treatment.

In the current age of genomic health care, family history is an essential tool for health assessment, especially for those with chronic mental illness. Three methods of family history assessment (genograms, ecomaps, and pedigree analysis) are described and illustrated. Examples from the family history literature demonstrate each method's usefulness. These approaches improve both consumers' and psychiatric nurses' abilities to comprehend overall health status as well as risks at the individual, family, and community levels.

Job initiation rates are steadily improving for people with severe and persistent mental illnesses. Yet, job retention rates, especially for those individuals who historically have had difficulty maintaining employment, continue to concern vocational rehabilitation professionals. In this paper, the author develops and refines her ideas that were presented in a previous research paper titled "Differences in Job Retention in a Supported Employment Program, Chinook Clubhouse." A more complete model, "The PASS to Success," is suggested by incorporating existing research with the author's revised work. Components of the model (Placement, Attitude, Support, Skills), can be used to predict vocational success and promote job retention.

Chronic mental illness results in the patient becoming adhered to a DSM-IV diagnostic label. Over time, this diagnosis can expand and become a "mask" that invisibly covers over the true person of the patient. Most commonly, two things then occur. First, the outside world forgets that the patient is a person and family, friends, staff, and doctors begin to treat the patient according to the superficial aspects of what the mask of the diagnosis connotes, rather than connecting with the person struggling with the illness. Second and, perhaps, more insidious, is that the patient, who has been vulnerable and shattered by his or her experience and battle with the illness, adopts the mask as a kind of invisible protective shield. The task of making contact with the patient behind the mask of the diagnosis is therefore a formidable one for psychoanalysts and therapists and staff who work with seriously ill patients. Treatment must focus on the dual process of interfering with the patient's use of the diagnostic mask while, at the same time, making safe contact with the person of the patient behind the mask. A focus on affect can help achieve these dual goals. By utilizing Semrad's (Semrad and van Buskirk, 1969) method of noticing and asking about "feelings" as conveyed by hallucinations, delusions, or bodily sensations, a reliable relationship can evolve and the clinician can come to have an important "selfobject" (Kohut, 1971) meaning for the patient. By attuning to the patient's "vitality" affects (Stern, 1985), great stability and a new sense of "aliveness" is made possible to help the patient emerge from the deadening effects of the illness and the mask of the diagnosis.

In the context of a larger investigation of follow-up of a specific group of mentally disordered individuals, the study described here examined the characteristics of all 55 people conditionally discharged for the first time from a medium secure unit in the West Midlands over a 13-year period. A retrospective case note analysis was undertaken. The findings illustrate that these patients are a distinct group. They were mainly single men who had committed a grave offence. The majority had an extensive criminological history with early onset of offending and chronic mental illness. Fifty per cent of those with a criminal record had received at least one custodial sentence prior to the index offence. Co-morbid substance misuse was common, as was a history of self-harm. There were high levels of previous contact with psychiatric services and compulsory in-patient treatment. Most were detained under the Mental Health Act category of mental illness. A quarter had been transferred from a special hospital prior to conditional discharge into the community. The characteristics of this sample demonstrate clearly the need for the provision of long-term medium secure facilities and allied services.

Sertraline (Zoloft trade mark, Pfizer) is a selective serotonin re-uptake inhibitor (SSRI) with proven efficacy in the treatment of post-traumatic stress disorder (PTSD). PTSD is a serious, complex and often chronic mental illness that may follow exposure to a traumatic event. The high prevalence of traumatic events and PTSD in the general population and the resulting distress and dysfunction present a need for the systematic study of the efficacy and effectiveness of treatments for PTSD. Sertraline offers advantages over the older antidepressants, including demonstrated efficacy in PTSD, improved tolerability and low risk of lethality in overdose. Sertraline's efficacy, favourable tolerability profile and relatively weak effect on the cytochrome P450 system are factors that contribute to make it a first-line agent of choice in the treatment of PTSD.

In recent years, a deinstitutionalization movement has been occurring in Canadian psychiatric institutions. Occupational therapists, experts in evaluating occupational performance, are key contributors to the selection of appropriate community housing environments. This study describes the global functioning, performance in activities of daily living, social behavior, cognitive status, and quality of life of 33 older adults with a severe and chronic mental illness, who were transferred from a psychiatric hospital to community facilities between 1995 and 1998. Evaluations were repeated five times, twice before discharge and three times after the transfer. Participants demonstrated stability in their global, social and ADL functioning over time. In general, participants required occasional intervention for management of social behaviors, moderate assistance in activities of daily living, and were highly satisfied with their community accommodation. The transfer to community settings did not lead to a significant deterioration in the participants' levels of global functioning and quality of life.

People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care.The review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and supportive care needs for people with dementia. These articles included consensus statements, models of care; studies of why models of care, for example Advanced Care Planning were not being implemented; and carer reports of care in the last year of life.Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.

Sztmmary.-34 volunteers diagnosed as chronically mentally ill were administered a questionnaire to evaluate what factors were important in preventing rehospitalization. The volunteers were divided into cwo groups based on their relapse history. Analysis showed the nonrelapse group were more JikeJy to attribute factors such as in-home therapy, taking medication, and having fun with friends than did the group who had experienced at least one relapse in the past 24 months. More than two decades have passed since the development and implementation of Community Support Programs designed for individuals with chronic mental Illness. Trained mental health technicians who offer therapy and support directly in the clients' home provide the services. The primary focus in Community Support Programs is assisting those with chronic mental illness to develop and maintain skds and attitudes consistent with successful independent living (Turner, 1977). Outcome research using a variety of parameters to measure success has been uniformly positive (Husted, Wentler, Allen, & Longhenry, 2000). Few studies are available which focus on the environmental or interpersonal factors associated with Community Support Program's long-term effectiveness. The community (environment) is of particular interest since the therapy is delivered in each individual's home rather than in an office or outpatient chic. The literature review was focused on studies of why these in-home approaches worked so well, i.e., which environmental and interpersonal factors appeared most facditative of clients' success. In organizing the literature review, we choose to separate reported studies into those focusing on interpersonal, diagnostic, or family factors, and those whose primary focus seemed more environmental. Vaughan, Doyle, McConaghy, Blaszc~nski, Fox, and Tarrier (1992) repor~ed a significant relationship between the number of critical comments expressed by relatives living with he schizophrenic individual returning

Community-based services are being developed as mental health services. The purpose of this study was to examine the effect between home care and half-way house services on patients with schizophrenia. The design was quasi- expsriroental and used repeated measurements. There were 60 subjects, 37 receiving home care and 23 receiving half-way house care which were affiliated with one general hospital in the south of Taiwan. Of the 60 chronic schizophrenic patients, there were 34 males and 26 females with an average age of 34 years. The Quality of Life Scale was applied to measure each patient four times, at an interval of two months. These follow-up data were analyzed by Generalized Estimating Equation-I (GEE-I) because repeated observations on an individual may be correlated. The result showed that the total QOL in patients receiving home care programs was significantly higher than those receiving half-way house service. The total scores of QOL in patients under half-way house and home care services did not show secular change. The patients under home care program showed a somewhat improvement for a short period of time. However, as time went on, the patients showed no obvious improvement in their life quality. The dimensions of indepen dence and social activity in QOL also showed significantly different between these two groups. The results may provide guides on designing programs and activities for the chronic mental patients. However, the best decision to apply which program for patients need continouous and comprehensive assessment.

Objective: To examine hospital outcome measures for individuals with chronic and severe mental illnesses before and after their registration in an assertive community treatment (ACT) program in Edmonton, Alberta. Methods: Data were collected from Alberta Health on individuals who were registered in ACT from April 1993 to April 1995. For each individual, hospital outcome measures were calculated for the 365 days prior to and 365 days after registration for ACT (thus covering April 1, 1992-March 31,1996). Results: Data were collected from 295 individuals. Compared with 1 year prior to beginning ACT, there was a 34% reduction in hospital separations for patients with psychiatric diagnoses. The average length of stay (LOS) for each separated patient decreased by 56%, and the hospitalization days for each patient separated also decreased by 39%. The number of emergency visits for psychiatric reasons was reduced by 32%, and the number of clients visiting emergency departments for psychiatric reasons declined by 30%. Conclusions: In the 1-year period after registration in an ACT program, hospital outcome measures were improved in this cohort of 295 individuals with severe and chronic mental illnesses.

Mental health services are rapidly shifting from acute-based care to community-based care. More adults over the age of 65 years are being treated in the home or community for chronic mental illness. As care moves to the community, funding and regulatory sources are demanding a greater focus on measuring quality of care by assessing and evaluating outcomes. This article outlines the selection of outcome assessment instruments used in geropsychiatric home care.

The aim of the phenomenological study described in this article was to depict the lived world of caring for a family member with chronic mental illness. Through two individual in-depth interviews, 14 participants were asked to describe their experience of caring for a son, daughter, or parent affected by chronic mental illness. The main themes emerging from the study related to temporality, the need to "live each day as it comes" without being able to make long-term plans, and to relationality, the need to "look at the world through the other's window," always aware of how the world responds, not only to oneself but also to the person with mental illness.