BACKGROUND: Due to long-term capacity problems in the psychiatric acute ward, we tried to canalise acute admissions due to life crises (and not serious mental disease) to a new short-term in-patient crisis unit. Our hypothesis was that the opening of this unit would lead to fewer admissions to the psychiatric acute ward and that this change would be reflected by an increase of patients with a more severe psychopathology. MATERIAL AND METHODS: The study had a quasi-experimental design. Two patient groups in a psychiatric acute ward (from separate catchment areas) were compared before (2.1.2003-1.6.2003) and after (2.1.2004-1.6.2004) establishment of a community based short-term inpatient crisis unit in one of the catchment areas. RESULTS: 234 patients were included in the study. Admissions to the psychiatric acute ward did not decline from any of the catchment areas from the first to the second time-period . The second time-period was associated with less psychopathology, but only for men in the area with a crisis unit. The reduction was largest for self-harm and suicidal behaviour (p = 0.02) and depression (p = 0.01). INTERPRETATION: None of our hypotheses were confirmed. Our main conclusion is that patient flow in acute mental health services involves a multitude of complex and unpredictable factors. The services continuously reorganise. Different ways of organising mental health services are rarely studied systematically, and such studies are difficult and resource demanding.
Many states have been interested in revising their systems of care for young people. The Alaska Youth Initiative (AYI) attempted to improve the system of care by providing community-based, individualized services to youths who would otherwise be institutionalized outside the state. Major policy changes included emphasis on local service provision, individualized services, unconditional care, and coordination of services. The AYI's performance on its original goals is mixed. Complications in implementation arose from lack of provider training, conflict over coordination at the state level, and difficulty in individualizing programs. Although significant successes have occurred, administrators could improve the implementation of similar types of programs by making specific plans to address concerns of various stakeholders, providing fiscal incentives for cooperation for state workers, and providing ongoing training in both clinical and administrative areas.
The development of coordinated systems for delivery of aftercare services to psychiatric patients has lagged far behind the theoretical emphasis on community maintenance. From a collaboration of 29 treatment and rehabilitation facilities, an independent agency was established to improve aftercare services in Metropolitan Toronto. Known as Community Resources Consultants, the agency was designed to facilitate and rationalize the use of existing services, to identify gaps in service, to initiate or cooperate in the development of new services, and to involve hospital and community service personnel in raising the level of expertise in the provision of aftercare. Formal and informal assessments indicate that CRC has had a positive effect on the provision of aftercare services and on professionals' level of awareness of aftercare priorities.
As many as 1,851 disease histories of patients belonging to the group of mental disorders of non-psychotic level (code MKB-9 300-317) were analyzed within the framework of the organizational experiment with a purpose of reorganizing the dispensary assistance. The data obtained indicate that the diagnosis and the treatment recommendations are not based enough in all the cases, with social restricting measures dominating over social and protective ones. For such a group of patients, the dispensary follow up is not justified. That is why the available dispensary services require changes in the principles and concrete patterns of their functioning.
The status of a fully indigenous mental health program serviced and controlled by the Tohono O'odham (Papago) Indian tribe is reviewed from the perspective of its 17-year history. The program functions in large measure in a crisis intervention model, with suicidal or acutely disturbed cases being most frequent. However, a whole range of disorders and ages are seen. Traditional Medicine Men and Women are often used as consultants, as are some professionals. In recent years child sex abuse and abuse of drugs among youth are prominent problems. The program experienced problems of obtaining services off reservations for patients in need, and in establishing credibility of the Indian Mental Health workers with the outside service providers.
This paper describes a shift in the focus of mental health services to remote Indian villages in Northwestern Ontario. Traditional indigenous counsellors are assuming control of this service, previously offered by non-Indian outsiders. The resources of the Federal Sioux Lookout Zone Hospital and psychiatrists from the University of Toronto are used in the ongoing training of the counsellors. Challenges encountered by outside non-Indian professionals providing relevant training and consultation to the area's natural helpers are described. This unique program has enjoyed enthusiastic acceptance by local people in helping positions.
1. This article describes a Swedish model of community support for patients with a long-term mental illness. 2. The result confirms that the staff-psychiatric practical nurses and aids are important in the care with support and coping as essential elements. 3. The staff members do require supervision from a nurse with knowledge about society and psychiatric care.