Search

Objective Following a reorganization in the housing sector of mental health services in a region of Quebec, this descriptive study assessed the perceived integration of recovery principles according to service users (n=25), managers of residential facilities (n=19) and social and health care professionals (n=30). Method All participants completed the Recovery Self-Assessment. Service users also filled the Satisfaction with Life Domains Scale. Additional qualitative questions were asked in a written format. Results Most service users were satisfied overall with their current residence but noted that intervention options and addressing sexual needs could be improved. Clinicians perceived significantly less integration of the various dimensions of recovery than the two other groups (p < 0.001). All groups identified that persons with mental illness should be more involved in service planning in residences. Conclusion Integrating the perspectives of different key stakeholders highlighted the need to continue to work collaboratively to support a recovery process in housing facilities and involve more service users.

Objective: This paper aims to describe current approaches in Victoria to the development of perinatal and infant mental health services in regional areas., Method: The paper outlines the significance of perinatal mental disorder for maternal wellbeing and impact on infant development, and describes the model of care at the Agnes Unit., Results: The Agnes Unit has been established as a residential therapeutic unit offering short-term treatment that focusses on promoting parental mental health, parenting sensitivity and the parent-infant relationship., Conclusions: A coordinated and integrated approach with focus on early intervention is needed to deliver perinatal and infant mental health services. Services need to focus on the infant and parent-infant relationship in addition to parental mental health.

Brazilian public policy on drugs has been permeated by two diametrically opposing approaches: one focusing on prohibition and the other on non- prohibition. Similarly, there have been two opposing approaches to mental healthcare, one centered on hospitalization and the other psychosocial care and development. In the context of these different paradigms, this article presents an analysis of twenty-two documents sourced by the legislative rules over the last sixteen years. After the year 2000, a renewed focus by healthcare community on drugs was noticeable as was the immersion of a harm reducing approach. Following international trends, although there are still considerable divergencies between (a) psychosocial care and(b) residential care in the therapeutic communities there seems to be an alignment to anti- prohibition approaches.

Purpose: There are numerous barriers to improving healthcare delivery. This article summarizes contemporary theories and research evidence to focus on ways to motivate change within the hospital system to provide better health care., Conclusions: Understanding multidisciplinary team processes, recognizing hospitals as systems, and ascertaining the unit culture is a prerequisite for leaders and policy makers to improve mental health practices., Practice Implications: Finding ways to deliver better health care to people with a mental illness is a high priority, and nurses have a central role to play in this pursuit of excellence., (© 2010 Wiley Periodicals, Inc.)

It is only in the past few years that the mental health impact of disasters has gained attention in research and planning. This article provides a perspective of the experience of the H1N1 outbreak in New Zealand and the response by nurses in a community mental health residential facility. The key lessons learned were: planning and managing for infectious diseases should be part of disaster planning, know your clients and your community, share your knowledge, support the mental health of individuals throughout, and expect reactions as part of recovery. More research and publications are needed in this area for nurses to fully support consumers through pandemics in a more integrated manner.

Children in the child welfare system frequently experience trauma within the caregiving relationship. These traumatic experiences may be compounded by system trauma and place these children at high risk of emotional disorders and placement in out-of-home (OOH) mental health treatment programs. This article reviews the literature on trauma and children in the child welfare system and discusses a study of trauma-informed practices in OOH treatment programs and the curriculum Creating Trauma-Informed Care Environments, which resulted from study findings.

The ongoing development of generic intellectual disability services in Ireland, driven by a policy of inclusion and normalization, has posed significant challenges to the interdisciplinary team, with the creation of new frontline carer roles not linked to any particular profession. It is within this context that attention has been focused on the appropriateness of nursing to frontline caring in intellectual disability service provision. The separation of caring and nursing posts that is now evident within many residential services suggests that decisions have already been made regarding the appropriateness of nursing within particular settings. These decisions have, however, been made in the absence of any real attempt to delineate the contribution of nursing to frontline caring in Ireland. This study is the first of its type in Ireland and seeks to set out the unique interventional contribution of nursing and non-nurse caring within frontline intellectual disability services.

Aims: Characteristics of patients living in residential care facilities and the availability of mental hospital- and residential beds in Italy and The Netherlands were compared to assess whether differences in the process of deinstitutionalisation have influenced the composition of their residential patient populations., Methods: Data from the Dutch UTOPIA-study (UTilization & Outcome of Patients In the Association of Dutch residential care providers) and the Italian PROGRES-study were used., Results: Dutch residents were more likely to suffer from substance or alcohol abuse than Italian residents. The latter were more likely to suffer from schizophrenia or a related disorder, less likely to have experienced mental hospital admissions and showed an overall shorter duration of stay in residential care facilities. Contrary to our expectations Dutch residents, who still have good access to long stay beds in mental hospitals, are not less disabled than Italian residents. Finally, the number of beds in residential care facilities per 10,000 inhabitants in the Netherlands is twice (6) as high as in Italy (3)., Conclusions: The Italian and Dutch deinstitutionalisation processes have resulted in a different availability in the number of residential beds. However, it did not influence the overall level of functioning of both residential populations.

The October 2002 issue of Archives of Psychiatric Nursing reported on the design of a prison-based mental health program implemented during the mid-1990s. The aim of this program was to reduce debilitating symptoms and promote coping skills, thereby enhancing both the functional status and the clinical management of mentally ill prisoners. This article presents a qualitative study of the same program conducted in 2001-2003 and describes critical issues facing mental health providers, correctional officers, and prisoners involved in this program today. Of key interest is how subsequent developments have eroded the original focus of the program.

The aim of this study was to predict retention in residential rehabilitation (RR) services for drug users, focusing on service provider factors. A national postal survey of RR services in England and Wales was carried out and information was obtained from 57 of 87 services identified (65.5%). Service managers were asked to complete a questionnaire asking about treatment philosophy, treatments provided, staff characteristics and staffing levels, as well as overall service size and funding. Services also provided information on the number of clients admitted and the number who had completed, dropped out and been asked to leave in the past year. Completion rates varied widely, from 3% to 92%, with an average of 48%. Higher completion rates were associated with lower counsellor caseloads, fewer beds, single rooms, shorter scheduled treatment durations, higher fees per client and provision of what could be termed a balanced treatment programme containing adequate amounts of individual counselling and programme-free time, and with only moderate demands for domestic duties. Programmes with more drug than alcohol users had lower completion rates, but the proportion of dual diagnosis or criminal justice referred clients did not appear to affect retention. Completion rates varied as a function of a number of service factors that are amenable to manipulation. To retain clients successfully, programmes should not be too large and should have adequate levels of therapeutic staff, a well-developed treatment schedule which is not too demanding for the client in terms of duties or overall time spent in structured activities, and which incorporates sufficient levels of individual counselling. [Meier PS, Best D. Programme factors that influence completion of residential treatment. Drug Alcohol Rev2006;25:349 - 355].

The aim of this study is to examine the mental health problems of older adults living in a residential home in a Greek rural area. A sample of 40 residents was compared with 40 matched controls attending a community open care centre for the elderly (OCCE). The following measures were used: Mini International Neuropsychiatric Interview (MINI), Geriatric Depression Screening Scale (GDSS), and the Mini Mental State Examination (MMSE). The group of the residents had a lower educational level and presented with a higher prevalence of depression and suicidality. Suicidal ideation was not significantly correlated to any of the examined independent social or psychological factors and was persistent during a period of two years follow-up. It is possible that, especially in rural areas, admission in the institution is per se a traumatic event precipitating suicidality. The issues of effective psychological care for older adults in residential care are discussed.

I examine the provision of mental health services to Medicaid recipients in New Mexico to illustrate how managed care accountability models subvert the allocation of responsibility for delivering, monitoring, and improving care for the poor. The downward transfer of responsibility is a phenomenon emergent in this hierarchically organized system. I offer three examples to clarify the implications of accountability discourse. First, I problematize the public-private "partnership" between the state and its managed care contractors to illuminate the complexities of exacting state oversight in a medically underserved, rural setting. Second, I discuss the strategic deployment of accountability discourse by members of this partnership to limit use of expensive services by Medicaid recipients. Third, I focus on transportation for Medicaid recipients to show how market triumphalism drives patient care decisions. Providers and patients with the least amount of formal authority and power are typically blamed for system deficiencies.

This paper describes methods being used to implement and assess the effects of a trauma-focused intervention in residential treatment programs for youths with emotional and behavioral problems, and histories of maltreatment and exposure to family or community violence. Preliminary baseline profiles of the therapeutic environments and youths are also presented. The intervention, referred to as the Sanctuary Model (Bloom, 1997), is based in social psychiatry, trauma theories, therapeutic community philosophy, and cognitive-behavioral approaches. Within the context of safe, supportive, stable, and socially responsible therapeutic communities, a trauma recovery treatment framework is used to teach youths effective adaptation and coping skills to replace nonadaptive cognitive, social, and behavioral strategies that may have emerged earlier as means of coping with traumatic life experiences.

This article describes the market for residential and day programs that provide education and treatment services on site for children with severe emotional disturbance (SED) in terms of the market's size, cost, and ownership mix. As policymakers encourage integration of services across sectors, this research fills a gap in the mental health services literature by providing a baseline of information on facilities from the education sector. Data are used from a national, stratified sample survey of separate day and residential schools for children with handicaps conducted by the Department of Education. There are 1,523 facilities providing educational and treatment services to 117,720 children with SED. Over half of the facilities are nonprofit, one-third are public, and less than one-tenth are for-profit. These programs represent a significant market of services for children with SED. Substantial differences in cost exist across ownership form that cannot be attributed to differences in size of facility or case mix of children enrolled.