RESUMEN
OBJECTIVE AND METHOD: To consider the possibility that adverse aspects of psychiatric hospitalisation may precipitate suicide contributing significantly to the increased rate of suicide among inpatients, given little has been published about this. RESULTS AND CONCLUSIONS: It is likely that psychiatric hospitalisation itself contributes to some inpatient suicides. This has significant implications for the delivery of inpatient psychiatric care.
Asunto(s)
Hospitales Psiquiátricos , Pacientes Internos/psicología , Suicidio/psicología , Humanos , Factores de RiesgoRESUMEN
OBJECTIVE: This paper discusses an activity, hitherto inadequately identified, which is an increasingly important part of contemporary practice. CONCLUSION: Iatrogenesis presents today in new guises but can be satisfying and productive to address.
Asunto(s)
Errores Diagnósticos/tendencias , Trastornos Mentales/diagnóstico , Psiquiatría/tendencias , Australia , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/psicología , Humanos , Enfermedad Iatrogénica , Trastornos Mentales/psicología , Autoimagen , Aislamiento SocialRESUMEN
INTRODUCTION: Mental health is a national priority in Australia, and the need is greatest where access to specialist care is poorest, in the rural and remote regions of the nation. The Mental Health Emergency Care-Rural Access Project (MHEC) was developed to provide 24-hour access to mental health specialists in rural and remote New South Wales using video conferencing equipment. METHOD: An evaluation of the service activity of MHEC using a concurrent mixed methods approach. RESULTS: Use of the service increased from a low base to around 60 video assessments per month at the end of the study period. Use of video assessments was greatest in the remote zone (30.7 video assessments/10,000 population/year). The number of people referred to a mental health inpatient unit declined (50 fewer patients, representing a decrease from 73% to 52% of all admissions between 2008 and 2009). Both patients and providers found the service helpful. Most patients (81%) stated that they would recommend or use the service again. DISCUSSION: This service is well positioned to have an increasing effect on emergency nursing and patient outcomes, as well as potentially on transportations. Continued use of MHEC suggests that video conference technology is acceptable and offers responsive specialist emergency mental health care to rural and remote communities.
Asunto(s)
Servicios Comunitarios de Salud Mental/organización & administración , Enfermería de Urgencia/métodos , Trastornos Mentales/terapia , Servicios de Salud Rural/organización & administración , Telemedicina/organización & administración , Urgencias Médicas , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Trastornos Mentales/diagnóstico , Salud Mental , Nueva Gales del Sur , Innovación Organizacional , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Consulta Remota/organización & administraciónRESUMEN
OBJECTIVE: To consider whether the mentally disordered provisions of the NSW Mental Health Act 1990 can be ethically justified and whether any departure from the usual justification for compulsory care comes at a cost. CONCLUSIONS: The shaky ethical standing of these provisions has encouraged mental health services in NSW to play a role in controlling unacceptable behaviour, even in the absence of mental illness. This places the Act in an exceptional position in comparison to other Western Mental Health Acts. It is causing increasing strain on services as well as having unforseen consequences on those detained.