Who uses bibliotherapy and why? A survey from an underserviced area.

OBJECTIVE: To assess which mental health therapists use bibliotherapy, their reasons for doing so, and rationale for recommending specific titles. To review the book selected most often in several categories, using prepublished criteria for reviewers of self-help books. METHOD: We sent a survey to all therapists in a Northern Ontario community requesting information on therapist demographics, the respondent's practice, the use of bibliotherapy, and details of the book most often prescribed in various categories. RESULTS: Of 112 surveys, 62 were returned, for a response rate of 55%. Sixty-eight percent of respondents indicated that they used bibliotherapy. The most common reason for recommending books was to encourage self-help. There was a significant relation between greater counselling experience and increased use of bibliotherapy. Three of the 5 books reviewed were based on empirical theory; only 1 met all the guidelines. CONCLUSION: Most therapists recommend books to their clients, but there is little empirical evidence of efficacy. Counsellors should review the books recommended and discuss them with the client. Client opinion should be solicited and effectiveness measured.

Criminal harassment by patients with mental disorders.

OBJECTIVE: To assess whether there is a subgroup of persons with mental disorders who engage in criminal harassment and to determine whether substance abuse is a cofactor in this behaviour. METHOD: A cross-sectional casenote study was used to examine incidents of harassment by patients prior to admission to acute and forensic wards (n = 106) at a provincial psychiatric hospital. RESULTS: Of 106 patients, 8 (7.5%) were found to have engaged in behaviour defined as criminal harassment prior to admission. Only 1 was charged under Section 264 of the Criminal Code. Alcohol was a cofactor in only 1 case. CONCLUSIONS: The number of persons with a mental disorder who engage in criminal harassment prior to admission is relatively small. The behaviour is not usually identified at any stage of the admission as criminal harassment. Although substance-abuse problems were prevalent, substance use was not a concomitant risk factor for behaviour defined as criminal harassment.

Who applies to regional review boards and what are the outcomes?

OBJECTIVE: To determine the outcomes for patients following applications to regional review boards at an Ontario provincial psychiatric hospital for 1992 through 1994. METHOD: A retrospective casenote study examined frequency of readmission, time to next admission, status upon readmission, and episodes of dangerous behaviour perpetrated in the community for patients applying to review boards. RESULTS: Over 3 years, 116 hearings took place to review various certificates. Only 57% of applications reached a hearing. Of those, 69% were confirmed and 31% rescinded. A small group of patients made multiple applications to the review board. Median time to next admission for patients who had certificates of involuntary admission rescinded by the review board was 14 days, compared with 53 days for those who remained in hospital until the time of planned discharge. CONCLUSION: Review boards consume considerable resources, serve only a small proportion of patients, and contribute to the "revolving door" phenomenon.