Recovery Services and Outcomes in a State Psychiatric Hospital.

Recovery has emerged as a focus of mental health rehabilitation in the past decade. Many have suggested that various domains of recovery-orientated services are integrated to an efficacious mental health care system. In this study we examined the association of domains of recovery-oriented services with recovery outcomes among inpatients in a state psychiatric hospital. A convenience sample of 36 hospital patients participated in a survey that included two standardized scales, with one measuring 6 domains of recovery-orientation of hospital-based services and one measuring 5 aspects of patients' recovery outcomes. We used regression analysis to estimate the association between recovery-oriented services and recovery outcomes adjusting for gender, race, and education. Nearly 90% of patients had lengths of stay of more than 3 months. On average, patients reported receiving moderate levels of recovery-oriented services. Nevertheless those who reported receiving higher levels of recovery-oriented services also reported better recovery outcomes. Specifically three domains of recovery-oriented services, i.e., life goal vs. symptom management, individual tailored, and diversity of treatment options, are associated with better overall recovery and 3 specific aspects of recovery, namely willingness to ask for help, goal and success orientation, and reliance on others. The data from a small sample of patients at a state psychiatric hospital suggest that self-reported recovery-oriented services received are associated with better recovery outcomes. Future larger studies are warranted to confirm the study findings, and to examine whether a contemporary recovery-focused care model can facilitate even greater recovery outcomes.

The First Step in Health Reform for Those With Serious Mental Illness: Integrating the Dis-Integrated Mental Health System.

Increasing attention is being directed toward meeting the psychiatric and medical needs of persons with persistent or recurrent mental illness through the integration of behavioral and medical healthcare. There are many models being considered or tested to achieve this objective. These models, however, generally ignore the challenge of integrating systems that are themselves dis-integrated. Also ignored is the fact that many persons with persistent or recurrent mental illness operate in the context of an array of entitlements; receive "services" from the criminal justice, as well as the health and behavioral health systems; and all these systems are both siloed and fail to meet the needs of this population. This article examines the current state of the cornucopia of services available to individuals with persistent or recurrent mental illness inclusive of federal statutes and policies to impact these services. Recommendations are made to move the dis-integrated system of mental health services toward an internally integrated system that would have the capacity to become integrated with a medical system of care and treatment to achieve a behavioral-medical integrated health delivery system.

Patient-centered, recovery-oriented psychiatric care and treatment are not always voluntary.

Explicitly coercive measures are sometimes necessary in the care and treatment of psychiatric patients. The author describes how use of such measures is not antithetical to patient-centered, recovery-oriented practice either in inpatient or outpatient settings. Citing a definition widely used by advocates to describe the overarching goal of recovery--"a full, meaningful, and self-determined life in the community … regardless of psychiatric status"--the author draws parallels between coercive measures taken by society to prevent and treat citizens' dangerous behaviors, such as speeding and public inebriation, and coercive interventions to address dangerous behaviors of psychiatric patients, such as harm to self or others. Society applies coercive interventions to address dangerous behaviors, not psychiatric status.

Interdisciplinary treatment planning in inpatient settings: from myth to model.

The staffs of many mental health facilities describe their treatment planning processes as interdisciplinary, but as most practicing clinicians know, this is more of a myth than reality. Individualized, person-focused treatment planning itself is not a simple endeavor. Effective treatment planning is further complicated by the fact that most discipline training programs teach neither treatment planning nor interdisciplinary methods to provide care and treatment. Psychiatric treatment teams are at a disadvantage from the start. Additionally, although facility and agency administrators expect treatment planning to occur, often the infrastructure to support the work is not there. This article describes a practical and effective treatment planning implementation model or framework developed by the authors, concentrating on three sub-sets of the treatment planning system: structure, content, and process.

The changing role of the state psychiatric hospital.

State hospitals were once the most prominent components of U.S. public mental health systems. But a major focus of mental health policy over the past fifty years has been to close these facilities. These efforts led to a 95 percent reduction in the country's state hospital population. However, more than 200 state hospitals remain open, serving a declining but challenging patient population. Using national and state-level data, this paper discusses the contemporary public mental hospital, the forces shaping its use, the challenges it faces, and its possible future role in the larger mental health system.

Integrating forensically and civilly committed adult inpatients in a treatment mall program at a state hospital.

OBJECTIVE: This brief report presents outcome data from a 350-bed state psychiatric hospital that integrated its adult forensically and civilly committed inpatient populations within one rehabilitative program. METHODS: Dorothea Dix Hospital, located in Raleigh, North Carolina, used the "treatment mall" model to offer all of its resources to all adult patients in a centralized setting. Program participation of 100 patients from two long-term civil units was compared with program participation of 94 patients from the hospital's medium- and maximum-security forensic units. RESULTS: The forensic patients were significantly less likely to refuse to join or to leave a group, and they were better engaged in their treatment. The use of restrictive interventions and the incidence of assault were minimal for both groups. CONCLUSIONS: The experience at Dorothea Dix Hospital suggests that integrating these populations in rehabilitative programming is not only fiscally responsible but also clinically promising, with no evidence of greater disruptiveness attributable to forensic patients.

Commentary: is CIT today's lobotomy?

Birthed in Memphis, Tennessee, in 1988, Crisis Intervention Teams (CITs) have had remarkable growth spurts with few, if any, developmental milestones to document their progress. Compton and colleagues investigated the evidence basis for CIT and found very little. They perhaps found even more than there actually is. There are contributions to CIT outcomes that are rooted in local variations in mental health services and regional culture. These are considered in this commentary, using Memphis as the example. None of us should be surprised that reform is evidence-absent. The mental illness delivery system and the criminal justice system have been instituting reform, and these reforms have had reverberating changes between the two systems, with little or no data to support the changes, for centuries. That there would be unexpected consequences should be obvious. But apparently not so evident that we don't continue to take one blind step after another. Is CIT on firm footing, or just another fool's journey?

A competency-based approach to managing violence with involuntary outpatient treatment.

Involuntary outpatient treatment is one of the most controversial areas in public psychiatry. There are cogent arguments and strong emotions both for and against the use of it. Yet there is violent behavior towards others by individuals with mental illness who reside in the community that is not managed well even when recognized as highly likely. For individuals already in the community mental health system, the ability to keep them in treatment, even against their will, is necessary in some instances to decrease the likelihood of them engaging in outwardly directed violent behavior.