["VigilanSeu.r.se": A new profession?] / « VigilanSeu.r.se ¼ : un nouveau métier ?

In January 2015, in accordance with decades of scientific work based on maintaining contact, was born an innovative device for suicide prevention: VigilanS. To ensure this link, the choice was made to build a team with an equal number of nurses and psychologists, all located within the medical regulation. Nowadays, they are named "VigilanSeur": an original entity that highlights the emergence of this new profession, at the crossroads of several disciplines.

Reviewing the definition of crisis in dementia care.

BACKGROUND: Crisis is a term frequently used in dementia care lacking a standardized definition. This article systematically reviews existing definitions of crisis in dementia care literature to create a standardized definition that can be utilized for research, policy and clinical practice. METHODS: We systematically searched for articles containing definitions of crisis in the context of dementia care. We created an operational framework of crisis based on retrieved definitions. Recommendations to address crisis situations were reviewed and classified according to care settings. RESULTS: Abstracts and titles of 1,113 articles, screened from PubMed and EMBASE, were narrowed down to 27 articles. After review, crisis in dementia was defined as a process where a stressor causes an imbalance requiring an immediate decision to be made which leads to a desired outcome and therefore a resolution of the crisis. If the crisis is not resolved, the cycle continues. Recommendations for resolving crisis involving persons with dementia and their caregivers include awareness therapy after diagnosis and increased contact with general practitioners, case manager consultations, caregiver support and education. Furthermore, nursing home staff should be attuned to the environmental, physical and psychological needs of persons with dementia. CONCLUSIONS: This is the first article to review the definition of crisis in the context of dementia care. A review of the literature indicated that the definition of a crisis is idiosyncratic. Therefore, it is difficult to prevent or plan for all crises. We used an operational framework to compile types of crisis stressors and recommendations from the crisis literature based on three different perspectives; the person with the dementia, the caregiver and the healthcare providers.

The effect of stressor severity on outcome following group debriefing.

This analogue study reports data on the efficacy of group debriefing in the mitigation of distress for a stressful video, which had two levels of severity. It also provides a new procedure for use in experimental psychopathology studies. One hundred and nineteen participants were shown one of two stressful videos and, subsequently, 67 participants received group debriefing whilst 52 participants acted as a control. A statistical difference was found between the two groups for level of distress at follow-up, with those who had watched the more stressful video scoring higher on video distress and trauma-type symptomatology than those who watched the less stressful video. This was particularly the case for those who received debriefing -- adding further caution to the longer-term effects of systematised group interventions following harrowing events.

Ethical approach in contemporary psychiatry: a pragmatic approach in a psychiatry access center.

The field of mental health involves many ethical issues. As health care systems change to meet the demands of managed care it will be important to address these issues. At one academic center, a new service recently created to expand psychiatric care has been developed and implemented with ongoing attention to several common and important ethical concerns. A practical approach to the provision of mental health care services in light of issues such as confidentiality, informed consent, treatment refusal, commitment, and the suicidal patient is discussed.

Assessing therapeutic intervention used by NHS Direct nurse advisers.

The National Service Framework for Mental Health has identified NHS Direct as a "new point of access" to appropriate mental health services. Mental health calls account for approximately 4% of all calls received by NHS Direct but raise the greatest level of anxiety among advisers and take twice as long to deal with as other calls. In order to provide adequate advice, it is essential to ensure nurse advisers can deal with this type of call. As a first step in meeting these needs this short research article reports on the types of interventions deployed by 18 nurse advisers during role-plays with a mental health "client" expressing self-harm.

Does a brief suicide prevention gatekeeper training program enhance observed skills?

BACKGROUND: Suicide is a significant public health problem worldwide that requires evidence-based prevention efforts. One approach to prevention is gatekeeper training. Gatekeeper training programs for community members have demonstrated positive changes in knowledge and attitudes about suicide. Changes in gatekeeper skills have not been well established. AIMS: To assess and to predict the impact of a brief, gatekeeper training on community members' observed skills. METHODS: Participants in a community gatekeeper training were employees at US universities. 50 participants were randomly selected for skills assessment and videotaped interacting with a standardized actor prior to and following training. Tapes were reliably rated for general and suicide-specific skills. RESULTS: Gatekeeper skills increased from pre- to posttest: 10% of participants met criteria for acceptable gatekeeper skills before training, while 54% met criteria after training. Pretraining variables did not predict increased skills. LIMITATIONS: Results do not provide conclusions about the relationship between observed gatekeeper skills and actual use of those skills in the future. CONCLUSIONS: Gatekeeper training enhances suicide-specific skills for the majority of participants. Other strategies, such as behavioral rehearsal, may be necessary to enhance skills in the remaining participants.

Effectiveness of psychological debriefing.

OBJECTIVE: To identify literature concerning the effectiveness of psychological debriefing (PD) and analyse results according to different criteria of success and different uses of the intervention format. METHOD: Literature search was made in databases PubMed, PsycInfo and Psychlit. Twenty-five studies were selected for a thorough description. Forty-two studies provided additional information. RESULTS: Results indicate that, in general, debriefing does not prevent psychiatric disorders or mitigate the effects of traumatic stress, even though people generally find the intervention helpful in the process of recovering from traumatic stress. The intervention holds potential as a screening procedure, and there may be economic arguments for continued use. When used with adherence to traditional descriptions of treatment group, events, group format, leadership and time spent, a preventive effect emerges. No tendency according to timing was found. CONCLUSION: Current uses of PD are problematic. The concept needs to be redefined, and the scope of application must be revised. The objectives for use need to be clarified.

Emergency psychiatric intervention on the street.

The development of outreach approaches to engage and provide services to the homeless mentally ill must account for the heterogeneity of the population. The homeless mentally ill as a group are symbols of the failure of a comprehensive and integrated system of community-based care to develop in conjunction with the widespread proliferation of deinstitutionalization policies over the past several decades. Life in a community is far more complex and less easily controlled than life in an institution. People are free to reject the label of patient and refuse all mental health services. An engagement strategy must therefore be devised from the knowledge of specific aspects of a person's life in that community, so that outreach and networking efforts can be sensitive to the total context of the problems experienced by that patient. A multidisciplinary team approach is essential to the effort to engage and monitor those chronically mentally ill individuals who are at risk for psychiatric and/or medical decompensation. A variety of skills are needed, and team members must be flexible about their roles on the team. The clinician, while maintaining expert psychiatric, diagnostic, and treatment skills, must at the same time be able to adapt to people in their own environments, provide them with necessary social and medical services, and interface with other agencies working with these persons. The work is very labor intensive. It may involve two or more clinicians spending entire days with one patient. During a crisis state, these patients will require even more intensive attention from multiple team members to prevent decompensation and rehospitalization. In conclusion, there is no one intervention style in the work of psychiatric outreach. While the type of intervention offered follows from the mission of the outreach program, all outreach teams must be able to address the totality of needs of people who are fragile and at risk for psychiatric and medical decompensation. Case management services cannot be segregated easily from the task of crisis intervention in the work with the seriously mentally ill. The failure to establish an accessible network of community-based services for those chronically disaffiliated populations of mentally ill gives the outreach team the critical role of brokering any available services needed to support the individual in the community. The flexibility required of the outreach team derives both from the scarcity of community-based resources and the heterogeneity of the population of chronically ill adults who will most need these services.(ABSTRACT TRUNCATED AT 400 WORDS)