Delay in discharge of psychiatric patients frequently is attributed to the lack of available community resources, or to the unwillingness of the patient or his family to accept discharge or transfer to another facility. The role of the psychiatric system itself rarely is mentioned as a factor. A study of 138 psychiatric patients in a Canadian community hospital in 1978 showed that 35 per cent were judged to be delayed in their discharge. By far the greatest source of delay was the administration of the various psychiatric services within the system. Delayed patients were found to be statistically similar to nondelayed patients, except for the delayed patients tendency to be poorer and to be overrepresented on two of the six wards studied. The cost implications of the delays in discharge are discussed, as are suggestions for solving the problems within the administrative framework.
The authors analyze activities of the daytime gerontopsychiatric hospital as a new organizational form within the structure of the district psychoneurological dispensary. During 12 months, 70 patients were treated at the hospital. The demographic, nosological and syndromological characteristics of the patients are provided. A range of the clinical indications were determined for referral to the specialized semi-hospital with regard to the mental status, somatic pathology and social status of the patients.
The high readmission rates of discharged psychiatric patients have forced mental health professionals to play closer attention to aftercare planning. A program was developed at a psychiatric hospital in Ontario in 1977 to deal with "problem patients"--those who were deemed difficult to place in the community by the referral person or department. The program was characterized by shared institutional-community staffing, systematic aftercare assessment and planning, a crisis intervention approach to discharge, the use of a transitional staff member with patients, and the development of close relationships with community agencies. Study data show that the program was effective in limiting the number of readmissions during its first two years to 20 per cent.
An assessment of risk management systems for patients on Warrants of the Lieutenant Governor in the provincial psychiatric hospitals was conducted. The assessment revealed that, to date, with some exceptions, the system has coped reasonably well. However, with a present count of over 400, and the ever increasing number of patients on warrants, there is a pressing need to improve the overall coordination of the system. The numbers, types and location of beds required to serve the system must be reviewed. Staff needs and training must be addressed. Increased numbers of coordinated research studies and improved information systems are required. System-wide policies and procedures for releasing information to policy, employers and home operators are necessary. As well, there must be a consistent approach in dealing with potential abuse of alcohol and non-prescribed drugs. Systems for authorizing and documenting patient privileges can be improved in some hospitals. A set of guidelines for interpreting terms and conditions of warrants is necessary. Lastly, information for staff treating patients on warrants should be developed and distributed.
The development of mental health care services in rural areas has been a constant challenge in most countries of significant geographical size. By use of a case study from Canada, the development of a relationship between rural and urban mental health services was described. Issues including referral patterns, service accessibility, professional recruitment and the development of service in rural regions were studied. It is advanced that mental health administrators, policy-makers, clinical service coordinators and educators will find that this approach to the development of mental health services in rural areas has some utility in Canada and in other countries.
The main aim of the study was to describe whether staff training and lectures on milieu therapy to nursing staff can change the treatment environment, as perceived by the patients, in a desirable direction. The study was approved by the Regional Ethics Committee for Medical Research.
To measure the patients' perceptions of the treatment environment we used the Ward Atmosphere Scale (WAS). The ward atmosphere was evaluated three times during a 12-month period. Additionally, the patients completed five questions concerning satisfaction with the treatment environment. Between the first and the second ward evaluation the nursing staff was given 3 weeks of lectures on different aspects of milieu therapy. The nursing staff completed the WAS and three satisfaction items.
The study revealed a change in desired direction after education in five of the six key subscales of the WAS (Involvement, Support, Practical orientation, Angry and aggressive behaviour and Order and organization). Staff control was the only subscale with no changes. The patients also reported an increase in satisfaction. The study revealed no major changes in the staff scores. The present study included only a small number of patients and examined the changes in only one psychiatric department; hence it could be argued that the results cannot be generalized to equivalent populations within the forensic services.
The study indicated that it is possible to improve the ward atmosphere in a desirable direction by a 3-week training programme for nursing staff about important aspects of milieu therapy.