The first modern psychiatric day hospital founded over 40 years ago has gone through a number of re-organizations which reflect utilization patterns representative of day hospitals in general. The author traces chronologically the dynamic movement from self-contained settings emphasizing group integration to expanded structures providing individualized treatment approaches. The day hospital's unique location at the interface of the institution and the community has important implications for today's mental health policy.
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.
Analysis of the work of the ++somato-psychiatric departments entering a multiple-discipline hospital has shown that admission to these departments of patients with concomitant mental and somatic pathologies may be viewed as an episode for such patients. The latter ones cannot be regarded as a permanent group to be treated at the above departments. The duration of the stay at hospital is largely determined by the character of somatic pathology and, in a considerable number of cases, represents a stage in the psychiatric inpatient treatment. The data indicate that the present-day bed capacities in such departments (0.65 per 10 thousand adult and adolescent population) are insufficient. It is highly advisable that the number of such departments be increased.
A comparative evaluation of inpatient psychiatric care in Russia and some other countries is presented. A systematic analysis of the performance of psychiatric hospitals is conducted. The process of the deinstitutionalization in Russian psychiatry is highlighted. A range of problems hindering a reform of inpatient psychiatric service of the country is singled out.
Public Health Agency of Canada, Centre for Food-Borne, Environmental and Zoonotic Infectious Diseases, Environmental Issues Division, Canada; Faculty of Medicine, Department of Community Health and Epidemiology, Queen's University, Canada. Electronic address: firstname.lastname@example.org.
The purpose of this study was to assess the effects of extreme ambient temperature on hospital emergency room visits (ER) related to mental and behavioral illnesses in Toronto, Canada.
A time series study was conducted using health and climatic data from 2002 to 2010 in Toronto, Canada. Relative risks (RRs) for increases in emergency room (ER) visits were estimated for specific mental and behavioral diseases (MBD) after exposure to hot and cold temperatures while using the 50th percentile of the daily mean temperature as reference. Poisson regression models using a distributed lag non-linear model (DLNM) were used. We adjusted for the effects of seasonality, humidity, day-of-the-week and outdoor air pollutants.
We found a strong association between MBD ER visits and mean daily temperature at 28?C. The association was strongest within a period of 0-4 days for exposure to hot temperatures. A 29% (RR=1.29, 95% CI 1.09-1.53) increase in MBD ER vists was observed over a cumulative period of 7 days after exposure to high ambient temperature (99th percentile vs. 50th percentile). Similar associations were reported for schizophrenia, mood, and neurotic disorers. No significant associations with cold temperatures were reported.
The ecological nature and the fact that only one city was investigated.
Our findings suggest that extreme temperature poses a risk to the health and wellbeing for individuals with mental and behavior illnesses. Patient management and education may need to be improved as extreme temperatures may become more prevalent with climate change.
In Norway, general practitioners serve as gatekeepers for specialist psychiatric care. Out-of-hours primary healthcare (i.e. casualty clinics) is responsible for the major part of acute psychiatric referrals. There are concerns regarding regular general practitioners' (rGPs') role in emergency psychiatric care of their enlisted patients. Also, the quality of casualty clinics' care and their gatekeeper function are questioned.
To investigate differences between acute admissions to a psychiatric hospital from casualty clinics, rGPs, specialist psychiatric services and other specialist services regarding characteristics of patients and circumstances of the referrals.
A prospective observational study. In the period of 1 May 2005 to 30 April 2008, anonymous information was recorded for all consecutive admissions (n = 5317) to the psychiatric acute unit (PAU) at a psychiatric hospital serving 400,000 inhabitants. The recorded information was: referring agent, circumstances of the referral, patient characteristics, and assessments by the receiving psychiatric resident and the therapist in charge of treatment at the PAU.
There were only small differences between patients referred to PAU from casualty clinics, rGPs, specialist psychiatric services and other specialist services. The referrals from the different referring agents seemed equally well founded. However, the casualty clinics used more police assistance and coercion, and legal basis for admissions was more frequently converted than for other referring agents.
Casualty clinics seem to function adequately as gatekeepers. The high proportion of casualty clinic referrals with converted legal basis might indicate unnecessary use of coercion.
The objectives of this study were to explore age and gender differences in attitudes toward seeking professional psychological help, and to examine whether attitudes negatively influence intentions to seek help among older adults and men, whose mental health needs are underserved. To achieve these objectives 206 community-dwelling adults completed questionnaires measuring help-seeking attitudes, psychiatric symptomatology, prior help-seeking, and intentions to seek help. Older age and female gender were associated with more positive help-seeking attitudes in this sample, although age and gender interacted with marital status and education, and had varying influences on different attitude components. Age and gender also influenced intentions to seek professional psychological help. Women exhibited more favourable intentions to seek help from mental health professionals than men, likely due to their positive attitudes concerning psychological openness. Older adults exhibited more favourable intentions to seek help from primary care physicians than younger adults, a finding that was not explained by age differences in attitudes. Results from this study suggest that negative attitudes related to psychological openness might contribute to men's underutilization of mental health services. Help-seeking attitudes do not appear to be a barrier to seeking professional help among older adults, although their intentions to visit primary care physicians might be. These findings suggest the need for education to improve men's help-seeking attitudes and to enhance older adults' willingness to seek specialty mental health services.