Reducing re-admissions at St. Ann’s psychiatric hospital

OBJECTIVE: This study addressed the psychoeducational approach to understand mental illness, illness self-management and social skills. It evaluated the effects of a structured-mannualized psychoeducation programme that taught inpatients about their illness and how to maintain remission after discharge and avoid re-admissions. DESIGN AND METHODS: A total of 505 inpatients admitted with mental disorders were randomly assigned to either an experimental group or control group. The psychoeducation programme consisted of six teaching modules distributed in 219 sessions of 45-minute-sessions in each of 5 wards, on a continuous, five-day-a-week schedule. The effects were measured reviewing the records of admissions and re-admissions after discharge. RESULTS: Results indicated that inpatients of the experimental group significantly improved their knowledge and performance of the skills taught in sessions, compared with the control group who did not participate in the educational group sessions. Re-admissions of participants of the experimental group were significantly less than the control group (2.1 percent versus 16.6 percent). CONCLUSIONS: Not only can patients learn relatively complex material during a typical inpatient stay despite the acuteness of their illness, but they can also meaningfully improve the continuity of their own care by participating in brief and highly structured teaching programmes in inpatient and outpatient settings.

Lunacy, time of the year and absconding from a psychiatric hospital

Personal characteristics of patients and environmental factors at psychiatric hospitals have been identified as predictors of absconding. In this chapter we seek to establish a relationship between time of the year and absconding. All characteristics of absconders were taken over a two-year period from hospital records (N=104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calender. Fridays was the most popular day of the week for absconding. Males were more likely to escape on the weekends while females tended to escape during the wet season. Christmas was the most popular holiday season for absconding. The largest percentage of absconding was at the full moon phase. It is recommended that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase.

Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission.

Background Many studies have found high levels of compulsory admission to psychiatric hospital in the UK among African–Caribbean and Black African patients with a psychotic illness. Aims To establish whether African–Caribbean and Black African ethnicity is associated with compulsory admission in an epidemiological sample of patients with a first episode of psychosis drawn from two UK centres. Method All patients with a firstepisode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas were included in the (ÆSOP)study. For this analysis we included all White British, other White, African–Caribbean and Black African patients from the ÆSOP sampling frame. Clinical, socio-demographic and pathways to care data were collected frompatients, relatives and case notes. Results African–Caribbean patients were significantly more likely to be compulsorily admitted than White British patients, as were Black African patients. African–Caribbean men were the most likely to be compulsorily admitted. Conclusions These findings suggest that factors are operating at or prior to first presentation to increase the risk of compulsory admission among African–Caribbean and Black African patients.

A comparative study of outcome of clients in a community residential facility and a mental hospital in Jamaica [abstract]

OBJECTIVE: To compare the clinical outcome of residents in a community-based residential facility and a similar cohort of patients with severe mental illness resident in a mental hospital in Jamaica. METHOD: In this case-control study, 40 patients with severe enduring mental illness resident in a community residential facility in St.Andrew, Jamaica, were compared with controls matched for age, gender and social class selected from the Bellevue Mental Hospital in Kingston, Jamaica. Demographic and clinical variables were collected using the PANSS interview schedule and the Krawiecka and Goldberg symptom severity schedule. The outcome variables studied were the WHO Quality of Life Assessment Scales parameters, the Cantril Self-Anchoring Ladder measuring levels of social isolation, and client's satisfaction Verona Satisfication Scale. Clients with a profile of severe enduring mental illness living in three privately run community residential facilities were interviewed and compared with a matched control cohort from the Bellevue Mental Hospital. RESULTS: The community group had fewer clinical symptoms and displayed a more favourable outcome variable profile. They had greater family and community contact, and decreased levels of social isolation. CONCLUSION: Community residential facilities offer substantially more robust clinical and social outcome for patients with severe enduring mental illness. (AU)

Treatment of acute schizophrenia in open general medical wards in Jamaica

OBJECTIVE: The study assessed the efficacy of treating acute psychotic illness in open medical wards of general hospitals. METHODS: The sample consisted of 120 patients with schizophrenia whose first contact with a psychiatric service in Jamaica was in 1992 and who were treated as inpatients during the acute phase of thier illness. Based on the geographic catchment area where they lived, patients were admitted to open medical wards in general hospitals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illness was assessed, and sociodemographic variables, pathways to care, and legal status were determined. At discharge and for the subsequent 12 months, patients' outcomes were assessed by blinded observers using variables that included relapse, length of stay, employment status after discharge, and clinical status. RESULTS: More that half (53 percent) of the patients were admitted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of symptoms, and s everity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychiatric units, and 17.3 days in the general hospital medical wards. Clinical outcome variables were significantly better for patients treated in the general hospital medical wards than for those treated in the mental hospital, as were outpatient compliance and gainful employment. CONCLUSIONS: While allowing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards results in outcome that is at least equivalent to, and for some patients, superior to the outcome of treatment in conventional psychiatric facilities.(Au)

Dual diagnosis among patients admitted to acute inpatient psychiatric treatment settings in two hospitals in Kingston, Jamaica, 1998-1999

A systematic sample of 174 psychiatric patients who were admitted to two urban acute inpatient psychiatric units between November 1998 and January 1999 was analyzed to determine the prevalence and characteristics of patients with dual diagnosis and to compare those patients with other patients without dual diagnosis. The diagnoses were ascertained with the Structured Clinical Interview for DSM-IV. 100 patients were from Bellevue Hospital and 74 from the University Hospital of the West Indies. The prevalence of dual diagnosis was 32 percent at Bellevue Hospital and 20 percent at University Hospital. Among those with dual diagnosis, schizophrenia and other psychoses (68 percent) was found to be the commonest axis I group disorder, followed by bipolar disorder (17 percent) and major depression (11 percent). Eight-nine percent of patients seen with dual diagnosis had cannabis related diagnosis. Dual diagnosis was more common among male patients (42/47, p<0.001) than among females. When compared to patients who did not have dual diagnosis, these men were found to be younger, in the age range 20-39 years (35/47). Such comparison, also showed that dually diagnosed patients were more likely to have had a previous or current criminal record with odds ratios of 3.67 and 7.44 respectively. The prevalence rates of dual diagnosis in this study are similar to those seen in other countries. Although there were some characterisitcs of the dually diagnosed patients which were similar to that found in studies done in various countries there were few differences. Although not a direct finding of this study, it has been established by previous studies that the fact of having dual diagnosis increases the likelihood of difficulties in diagnosis and treatment. This is further compounded by the absence in Jamaica of any programme to adequately treat these patients. To better inform such treatment planning, future research on dual diagnosis should utilize diverse clinical and functioning measures to make a more detailed needs assessment of these patients (AU)

Treatment of acute schizophrenia in open medical wards

The aim of this study was to compare the pathways to care and outcome of first contact patients with schizophrenia admitted to open medical wards with those treated in closed community psychiatric units and in acute wards of a custodial mental hospital. First contact with patients with schizophrenia who were identified in Jamaica in 1992 and admitted to the three different types of acute treatment facility across the island were followed in a blinded prospective study. Their pathways to care and standard clinical and sociological outcome parameters were identified and compared. 65 first contact patients were admitted to 3 acute wards of the Bellevue Mental Hospital, 20 patients to two closed psychiatric units in general hospitals, and 35 patients admitted to 8 general hospitals islandwide. The mean length of stay in the mental hospital wards was 88.3 days; in the psychiatric units was 29.9 days (p<0.01), and in the general hospitals was 14.1 days (p<0.0001). Clinical outcome variable were significantly better (p<0.03) for patients treated in open medical wards compared with those admitted to acute mental hospital wards. Fewer patients were admitted to open medical wards by the police (p<0.01), or by compulsory legal section (p<0.01). Compared with admissions to conventional psychiatric units, admissions to open medical wards had shorter lengths of stay (p<0.02), fewer admissions by compulsory detention (p<0.05) and had attained relative numerical but not statistical significance for most clinical outcome and pathway to care variables.(AU)

Mental health in the Caribbean

Mental health is a term that is seldon used, but mental illness and mental disorder are expressions used by everyone. The phrase 'he/she is mental' is an indication that a person has a disturbed mind and may be in need or hospitalization, whether at a general hospital or a mental institution. There is no doubt that each country must deal with those psychotic individuals who have become a public nuisance, but we need to consider mental health and not just severe mental illness. Only a very small part of the general population suffers from psychotic illness but mental health issues cover a wide range of psychosocial factors and are of major importance in the development of any country. More emphasis must be put on developing community mental health programmes and less on institutional care. The areas of greatest concern to the public - drug abuse, childhood disorders and the increase in suicide - should be handled by specialist, who would then be responsible for building up appropriate services though use of the team approach (AU)

HIV infection in a psychiatric hospital - abstract

This study sought to identify the characteristics of HIV positive patients in a psychiatric hospital in Trinidad and Tobago. HIV testing is done on patients admitted to the hospital who were at potentially high risk for HIV infections as identified by their behavioural history and clinical examination. Of the patients tested, 6.9 percent were HIV positive. There were no significant gender differences between positive and negative patients but there was an association with age. The highest prevalence was in the 35-44 year age group (9.7 percent) and the 15-24 year age group (8.3 percent). This was statistically significant (p=0.01). East Indians were significantly less likely to be HIV positive (p=0.003) when compared to Africans and those of patients of mixed descent. The prevalence of HIV infection was highest among those patients with a diagnosis of cocaine abuse or dependence (12.4 percent) compared with schizophrenia (3.3 percent), depression (3.9 percent) and dementia (8.1 percent) (p<0.001). These findings illustrate that among psychiatric patients, HIV infection may be associated with cocaine abuse and is more likely to be seen in patients of African and mixed descent. (AU)

Analysis of inpatient admissions to the new acute psychiatry unit in Dominca - abstract

Admissions to the new acute psychiatry unit were studied by chart review over a one- year period to determine demographic and other factors contributing to the admission. A comparison of single admission and readmissions was done to detect factors that could contribute to relapse. The characteristics of first time admission were also determined from the chart review. 341 patients wre admitted in the study period. High unemployment, being single, of age group 30 - 40 years and coming from Roseau distirct were the prominent demographic features. Readmission were more likely to be young adults in the age group 20 - 30 years. The prevalence of substance abuse was high, 20 percent. Ward occupancy was high. The mean duration of stay was low. The presence of substance abuse among the young adult new patients suggests the need for implementing prevention and treatment projects. The high admission rate from Roseau, high unemployment and significant non-compliance with treatment reflect the need to implement preventative measures at the community level to prevent the rising trend of admissions. (AU)

A comparison of the sociodemographic and clinical characteristics of first admissions to the psychiatric hospital and the psychiatric unit of the General Hospital in Barbados, over the period 1st September, 1996 to 28th February 1997: a project report submitted in fulfillment of the requirement for the Doctor of Medicine degree in Psychiatry

A comparison of the sociodemographic and clinical characteristics of first admissions to the Psychiatric Unit of the General Hospital in Barbados, over the period 1st September, 1996 to 28th February, 1997 (AU)

The impact of the new Mental Health Act 1989 on admissions to the Psychiatric Hospital in Barbados

Although the new Mental Health Legislation appears to have facilitated hospital admission procedures, it has raised some serious concerns about the rights of patients under the Act. A retrospective case-note study using a questionnaire analysed 200 admissions under the old Mental Health Act and compared them with 200 admissions under the new Act. The results were interpreted along specific parameters of admission status, place from which the patient was brought to hospital, who accompanied the patient and others. The new admission status of Hospital order-emergency (HO-E) accounted for 20 percent of admissions. These HO-E patients appear to be those involuntary admissions that would have been admitted as temporary patients under the old Act. Admissions (56 percent) under the temporary involuntary status of the old Act were significantly reduced to (27 percent) under the new Act. The new Act made no mention of certification by Magistrates, however 5 percent of the 1993 admissions were admitted on certified status. In addition certified patients already in hospital are still detained on certified admission status and this is obviously an area that needs urgent attention. Further studies will be needed to fully evaluate the effects of the new Act. (AU)

Community psychiatry and deinstitutionalization in Jamaica

Between 1960 and 1990, the population of Jamaica's single mental hospital was reduced by 58 percent, from more than 3,000 to less than 1,300. Services were reoriented from mental-hospital-based custodial care to rehabilitative, community-based care with no appreciable increase in the mental health budget. Despite several changes in government over the past 30 years, continuity of public policy and fiscal support has allowed ongoing development of the island's community mental health services. The national community mental health service, which had a case-load of about 14,000 patients in 1990, relies on specially trained psychiatric nurse practitioners who provide crisis management, medication management, and supportive psychotheraphy; make home visits; and carry out treatment plans developed by the community psychiatrist. Community acceptance of mentally ill persons has been enhanced by public education programs and media coverage of advances in treatment (AU)

An analysis of re-admissions to the psychiatric hospital in Barbados - abstract

The purpose of this study was to ascertain the causes and the frequency for re-admission to the Psychiatric Hospital in Barbados, and to suggest remedial measures where possible. All re-admissions over the three-month period February - May 1991 were administered a structured questionaire by interview. Demographic data on admissions were obtained from published hospital statistics over the last 16 years. The results show that 74 per cent of the re-admissions were male which compares with 48 per cent of males in the general population of the country. Some of the factors associated with male re-admission, as compared with females, were an earlier age of onset of illness (males: 25.15 years; females 32.21 years), poor drug compliance (78 percent), a higher incidence of alcohol and other drug abuse (males: 89 percent; females: 13 percent) and a higher incidence of aggression and criminal behaviour (males: 50 percent; females: 7 percent). Most patients were from the urban parishes (60 percent), were unemployed (68 percent), and came from lower socio-economic backgrounds (88 percent). A finding of significance was that only 1 in every 35 patients registered with the outpatient services in the hospital. However, the district nursing service was not available in the urban areas from where 60 per cent of the patient came. It is concluded that the provision of adequate drug and alcohol rehabilitation facilities, and expansion of the Psychiatric District Nursing Services to urban areas, would reduce the number of patients readmitted to the psychiatric Hospital (AU)

Deinstitutionalization and community psychiatry in Jamaica - abstract

The process of deinstitutionalization in the 120-year-old, 3,000-bed Bellevue State Mental Hospital, Jamaica is described. The resident population fell by 58 percent from 3,094 in 1960, to 1,296 in 1990, a rate of 54 per 100,000, which compares with the rate of 110 per 100,000 in the USA in 1981, and 160 per 100,000 in England and Wales in 1977. The implementation of mental health legislation, training of psychiatric personnel, establishment of a rehabilitation programme and establishment of a community psychiatric service in the 30-year period required to bring about this change, are described. By 1990, the community service had a case load of 14,149 patients per year - a rate of 590 per 100,000, and the admission rate to Bellevue Hospital had fallen by 64 percent to 24 per 100,000. A vigorous `pick-up' programme was instituted by the community psychiatric service to keep the mentally ill homeless off the street. The results from this third world country are discussed in relation to deinstitutionalization programmes in other parts of the world (AU)

Patterns of first admissions in a psychiatric outpatient clinic in Trinidad - abstract

The aim of the study was to describe the pattern of first admissions to a psychiatric outpatient clinic in Trinidad. During 1990 a prospective study was done on 147 consecutive new cases that presented at the Tacarigua Health Centre. An incidence of 1.2/1000 was found with an average of 12 new patients/month. There were no differences in sex distribution. The average age of males was 35.6 years and 38.8 for females. Fifty-five point seven per cent of the sample were of African origin and 36.7 percent were of East Indian origin (p<0.005). Mood disorders were almost twice as common in females (37.0 percent) as in males (21.6 percent) p<0.01. Schizophrenia was almost twice as common in males as females (16.2 percent vs 8.2 percent, p<0.1). Psychoactive substances use disorders were four times more common in organic mental disorders in the men (12.2 percent). Major differences in demographic and diagnostic data in the two major ethnic groups suggest a need for culturally relevant programmes. Community clinics at the moment are underutilised and there is a need for the use of these clinics as a first illness contact station. The treatment of substance abusers is a burden to the psychiatric services and ought to be separated (AU)