Everything moves on: referral trends to a leavers' group in a high secure hospital and trial leave progress of group graduates.

BACKGROUND: Moving on from high secure psychiatric care can be a complex and potentially stressful experience, which may hinder progression. A leavers' group in a UK high secure hospital is offered to support patients with this transition. AIMS: The aims of this study are to investigate characteristics of patients referred for the leavers' group and compare outcomes for leavers' group graduates with those for patients who never attended a leavers' group for any reason. METHODS: A retrospective quasi-experimental design was applied to data extracted from various records sources - within and outside the high security hospital. RESULTS: About one-fifth of patients who left the hospital on trial leave during the study were referred to the leavers' group (N = 109). Referred patients were significantly more likely to have either been admitted from another high-security hospital or transferred from prison for treatment and have a diagnosis of paranoid schizophrenia. Patients not referred had a significantly higher rate of previously refusing to participate in groups. There was a tendency for rate of return from trial leave for group graduates to be lower than that of patients who did not attend the leavers' group, but this just failed to reach statistical significance (rate ratio [RR] = 1.04; CI 0.97-1.11). CONCLUSIONS: A leavers' group appeared to be a valued therapy option for people who had spent a long time in high secure psychiatric care, or those who continued to require hospital treatment beyond prison tariffs. There was a low return rate from trial leave, which made the evaluation of this outcome difficult. A detailed study into both the reasons for return from trial leave and successes would provide further information on ideal preparation for moving on. Copyright © 2016 John Wiley & Sons, Ltd.

Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis.

BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients. METHODS: QuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level. RESULTS: We found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled. CONCLUSIONS: This is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group.

La discapacidad intelectual y el ámbito penitenciario / Intelectural disability and the prison setting

Introducción: La prevalencia de discapacidad intelectual (DI) en el entorno penitenciario ha estado escasamente valorada. En España, a pesar de diversas aproximaciones o estimaciones no existen datos fiables respecto a las personas que sufren de DI. Objetivos: 1) Determinar la prevalencia de DI en una muestra de la población penitenciaria española, ubicada en módulos residenciales 2) Obtener datos sobre la prevalencia de DI en unidades y hospitales psiquiátricos penitenciarios. Métodos: 1) Se realizó una administración del TONI II en una submuestra (n: 398) de un estudio de prevalencia en cárceles españolas para identificar los internos con DI. 2) Se revisaron la memorias del Área Psiquiátrica Penitenciaria del Parc Sanitari Sant Joan de Deu para determinar los pacientes con diagnostico principal de DI. 3) Se revisaron datos de documentos de la Dirección General de Instituciones Penitenciarias para obtener la prevalencia de discapacidad intelectual en los Hospitales Psiquiátricos Penitenciarios. Resultados: Los datos del TONI II fueron que un 3,77% de la población estudiada presenta un Coeficiente Intelectual (CI) por debajo de 70, y un 7,54% presentaba una inteligencia límite. Siendo mayores cuando valoramos la hospitalización psiquiátrica. Conclusiones: Los datos de DI en población penitenciaria presentan unas tasas elevadas, especialmente aquellos que precisan una atención psiquiátrica especializada. Lo que pone de relieve que son necesarios recursos (penitenciarios y comunitarios) para una mayor atención de las personas con DI durante el recorrido en el ámbito penal (AU)

Introduction: The prevalence of intellectual disability (ID) in the prison setting has scarcely been studied. Although some approximations or estimates regarding people with intellectual disabilities have been performed in Spain, there is little in the way of reliable data. Objectives: 1) To determine the prevalence of ID in a sample population in the residential modules of a Spanish prison, 2) Obtain data on the prevalence of ID in prison psychiatric units and hospitals. Methods: 1) A TONI II test was performed on a sub-sample (n = 398) of a prevalence study in Spanish prisons33 to identify inmates with intellectual disabilities. 2) We reviewed the reports of the psychiatric department of Parc Sanitari Sant Joan de Deu to establish the diagnosis at discharge of patients with a primary diagnosis of intellectual disability 3) Data from the Directorate General of Prisons on the prevalence of ID in Prison Psychiatric Hospitals was reviewed. Results: The data obtained from the TONI II test found 3.77% of the study population has an IQ below 70, and 7.54% has a borderline IQ rate. Assessment of penitentiary psychiatric hospitalization data showed these figures to be higher. Conclusions: The data from a Spanish prison population showed that ID levels were higher than those in the community, especially amongst prisoners requiring specialized psychiatric care. What is also evident is that adequate resources are required in prisons and in the community to provide better care for people with intellectual disabilities who are in the pathway of the criminal justice system (AU)

Formación MIR en el Hospital Psiquiátrico Penitenciario de Fontcalent / Residency training in Fontcalent Prison Psychiatric Hospital

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Respuesta a la carta al director. Formación MIR en el Hospital Psiquiátrico Penitenciario de Fontcalent / Reply. Residency training in Fontcalent Prison Psychiatric Hospital

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Type of unit and population served matters when implementing a smoke-free policy in mental health settings: Perceptions of unit managers across England.

BACKGROUND: Globally, smoking remains a significant issue for mental health populations. Many mental health trusts in England are facing challenges of implementing the National Institute for Health and Care Excellence guidance according to which all mental health settings, no matter the type, should be entirely smoke-free and provide comprehensive smoking cessation support. AIM: The aim of this paper was to determine if unit type and unit manager smoking status influence mental health smoke-free policy implementation. METHOD: This paper reports on the secondary analysis of data from a cross-sectional survey of 147 mental health inpatient settings in England, in 2010. The original study's main aim was to understand unit managers' perceived reasons for success or failure of smoke-free policy. RESULTS: Unit managers (n = 131) held a positive stance towards supporting smoke-free policy and most perceived that the policy was successful. Non-smoker unit managers were more likely to adopt complete bans than smoker unit managers, whereas smoker unit managers were more likely than non-smoker unit managers to think that stopping smoking aggravated patients' mental illness. Smoking rates for staff and patients remain high, as perceived by unit managers, regardless of unit type. Proportion of units offering nicotine replacement therapy and peer support to patients was significantly higher in locked units compared to semi-locked or residential rehabilitation. Applied strategies significantly vary by type of unit, whereas unit managers' knowledge, attitude and practices vary by their smoking status. DISCUSSION: There are nuanced differences in how smoke-free policy is enacted which vary by unit type. These variations recognise the differing contexts of care provision in different types of units serving different patient groups. Addressing staff smoking rates, promoting consistency of staff response to patients' smoking and providing staff education and support continue to be key strategies to successful smoke-free policy. CONCLUSIONS: Our results demonstrate the importance of taking into account the type of unit and acuity of patients when enacting smoke-free policy and addressing staff smoking.

[Management documentation of therapeutic units on inpatient treatment for people with dementia--does it allow conclusion to be drawn them about inpatient services? An exploratory analysis]. / Leistungsdokumentation durch Therapieeinheiten bei stationär behandelten Menschen mit dementieller Erkrankung--erlauben sie Rückschlüsse auf das Leistungsgeschehen? Eine explorative Analyse.

BACKGROUND: Against the background of the continuously growing incidence rates of gerontopsychiatric disorders, their economic dimen-sions, and the effects on persons affected as well as their social environments, the present study focuses on an analysis of the services provided in acute psychiatric care settings for patients with dementia. RESULTS are based on secondary data. AIM OF THE STUDY: We aim to compare therapeutic service units of different clusters of occupational groups (physicians/psychologists, nurses/special therapists) for the ICD-10 diagnostic groups F00-F03 and G30 in the years 2010 (starting with July) and 2011. Main research question is how many patients are mappable with 'therapeutic units' (Therapieeinheiten, TE) of the operation and procedures catalogue (OPS). METHODS: The present study is based on an analysis of the §21 KHEntgG data record of 35 acute psychiatric facilities. Data collection took place within the project "Versorgungsindikatoren für die Psychiatrie und Psychosomatik (VIPP)", "Supply indicators for psychiatric and psychosomatic settings". The data record implies statewide data of specialised hospitals, university hospitals and departments of psychiatry of the Federal Republic of Germany. RESULTS: In total, 5 111 cases were included in the analysis. Nurses and special therapists carried out significantly more therapeutic units in the main diagnoses groups (F01, F03 and G30) and the care groups (regular vs. intensive) than physicians and psychologists (p<0.05). It was not possible to map all patients with the use of therapeutic units (G30 78.8%, F01 83.4%, F03 81.2%). Mapping of patients was significantly higher in the intensive care compared to regular care in both occupational clusters (p<0.05). CONCLUSIONS: We demonstrated that the "therapeutic units" of the OPS codes are now used in the routine data (§21 KHEntgG), and that they are able to portray relevant aspects of non-medication therapeutic service. The present study provides a preliminary/exploratory overview on the services provided, mapped by therapeutic units. Future research should focus on the overlap between the category "therapeutic" units and the services actually provided.

Implementation of a smoke-free policy in a high secure mental health inpatient facility: staff survey to describe experience and attitudes.

BACKGROUND: In 2008, a new forensic hospital was opened as a totally smoke-free facility. This study describes the attitudes and experience of mental health professionals working in the high secure mental health facility three years after it was opened. It is part of a larger evaluation describing the experience of current and discharged hospital patients. METHODS: Quantitative data was collected using a survey of hospital staff (N = 111) with a 50% response rate. The survey collected demographic and smoking data to describe staff responses to statements relating to hospital smoking policy, patient care and staff support. RESULTS: Among staff surveyed, 13% were current smokers and 41% were ex-smokers (10% quit after commencing employment in the smoke-free hospital). Most (88%) preferred to work in a smoke-free environment, although this was significantly lower in smokers compared to non-smokers (39% vs. 95%). While most staff felt that the smoke-free environment had a positive impact on the health of patients (86%) and on themselves (79%), smokers were significantly less likely to agree. Just over half (57%) of staff surveyed agreed that patient care was easier in a totally smoke-free environment, although less smokers agreed compared to non-smokers. Staff who smoked were also significantly less likely to indicate they had sufficient support working in a smoke-free environment, compared to non-smokers (15% vs. 38%). CONCLUSIONS: The staff surveyed supported the smoke-free workplace policy; most agreed that patient care was easier and that the policy did not lead to an increase in patient aggression. Implementation of a total smoking ban can result in positive health outcomes for patients and staff, and may influence some staff to quit. Staff who smoke have a less positive experience of the policy and require additional support.

Análisis de la demanda de interconsultas psiquiátricas en los hospitales generales de Pamplona / Analysis of the psychiatric consultation-liason in general

En este trabajo realizamos un estudio prospectivo de cuatro meses de duración sobre la psiquiatría de enlace en los dos Hospitales Públicos de Pamplona, Hospital Virgen del Camino y Hospital de Navarra, en el cual describimos y reflexionamos sobre la situación actual de la psiquiatría de interconsulta en Navarra. Asimismo, comparamos nuestros resultados con los obtenidos en un estudio realizado a mediados de los años 90 en el Hospital Provincial de Navarra, reseñando las semejanzas y las diferencias que se desprenden de ambos estudios e intentando analizar las posibles causas que pudieran conducir a las mismas

In this work we make a four months prospective study about the consultation-liaison service in the General Hospitals of Pamplona, Hospital Virgen del Camino and Hospital de Navarra, where we describe and reflect on the present situation of the Liaison Psychiatry of Navarra. Also, we compare our results with a study made in the middle of the nineties in the Provincial Hospital of Navarra, describing the similarities and the differences that exist between both studies and trying to analyze its possible causes

Defining the needs of patients with intellectual disabilities in the high security psychiatric hospitals in England.

BACKGROUND: Previous studies have suggested that a substantial proportion of the patients with intellectual disabilities (ID) in the high security psychiatric hospitals (HSPHs) should be transferred to more appropriate services to cater for their specific needs in the longer term. METHOD: The individual and placement needs of high secure psychiatric patients detained under the legal category of mental impairment or severe mental impairment were assessed in a cross-sectional survey. RESULTS: Patients had a large number of needs (on average 10.8), about a third of which were rated as unmet and therefore represented significant continuing problems. Approximately one-third of the sample could be moved out of HSPHs if appropriate alternatives were available. Factors associated with the continued need for high security included higher treatment and security needs, younger age, recent violent conduct and their index offence profile. CONCLUSIONS: High security services are still required for a number of patients with ID. New and existing services need to be configured to meet specific profiles of need and provide long-term rehabilitation and specialist care. DECLARATION OF INTEREST: This was part of a larger project funded by grants from the High Security Psychiatric Services Commissioning Board and Department of Health.

Profiling hospitals for length of stay for treatment of psychiatric disorders.

Managed behavioral health care organizations (MBHOs) often profile hospitals on length of stay (LOS) and other performance measures. However, previous research has suggested that most of the variation in utilization for general medical conditions is attributable to case-mix indicators and random sources rather than individual providers. Hospital discharge data are used to estimate hierarchical linear models, where hospitals and physicians within hospitals are treated as a random effect. The goal was to determine the intraclass correlation coefficient (ICC) for psychiatric LOS for hospitals and for physicians before and after making case-mix adjustments. After controlling for case-mix, the hospital ICCs for depression, schizophrenia, and bipolar disorder show that 32%, 36%, and 11% of the variation in LOS, respectively, can be attributed to hospitals, while 7%, 5%, and 6% of the variation in LOS, respectively, can be attributed to physicians or provider practice. Unlike health services for other conditions, the variation in LOS for inpatient psychiatric treatment of depression and schizophrenia is quite dependent upon hospitals.

[The origin of mental hospital in Japan and its typological classification].

Before the beginning of the Modernization in 1868, there were no psychiatric hospitals in the sense of Modern-Western in Japan. Instead of them, as far as I ascertained, altogether 30 asylums are existed in the whole country. They are mainly buddhistic temples and shrines, where psychotic patients and their families are treated by monks in various way. The ways of treatment are quite different, so that the typological classification of asylums is possible according to this point: 1. treatment by waterfall or water, 2. treatment with old Chinese herbal medicine, 3. treatment with collaborative conjuration associated musical instrument (drum). From the historical standpoint of view the Type 1 has oldest tradition. In the late of 11th century a daughter of the emperor was psychotic and sent into the temple Iwakura-Daiunji in northern suburb in Kyoto-City. She was treated successfully with holly waterfall and water and after this legend many psychotic patients gathered there. From the end of 14th century the Temple Juninji near the City of Okazaki began treatment with Chinese herb for the psychotics. Compared to Daiunji which belongs to Mikkyo-sect in the national Buddhism Juninji belongs to Jodoshin-sect in the frame of the reformed Buddhism. Altogether 4 temples of Type 2 are belonging to this new sect without exception and after the Modernization (Meiji-Restoration in 1868) became psychiatric hospitals. The all temples belonging to Type 3 are Nichiren-sect also in the reformed Buddhism and began the conjuration-treatment after 17th. century. The typology of asylums before the Modernization brings us necessary to the question on the origin of the ways and methods in psychiatric treatments in the history.

A comparison of the performance of for-profit and nonprofit U.S. psychiatric inpatient care providers since 1980.

OBJECTIVE: The authors synthesized evidence from a systematic review of the literature reporting substantiated performance differences between private for-profit and private nonprofit psychiatric inpatient care providers in the United States since 1980. They also compared reported differences in performance between nonprofit and for-profit inpatient psychiatric care providers with reported differences between nonprofit and for-profit providers of other types of health care. METHODS: Studies were located by means of computerized bibliographic searches and follow-up searches of studies cited in the articles located in the computerized search. The analysis included peer-reviewed studies that compared the performance of for-profit and nonprofit health service providers, including inpatient psychiatric services, in the areas of access, quality, cost-efficiency, and amount of charity care on the basis of quantitative data collected after 1980. The studies were classified in one of three categories according to the study conclusion: for-profit superiority, nonprofit superiority, or no difference or mixed results. RESULTS: Almost all studies (with one exception) found that the nonprofit psychiatric providers performed as well as or better than their for-profit counterparts. The proportion of studies reporting performance superiority of nonprofit versus for-profit psychiatric inpatient providers was greater than the proportion of studies reporting the same conclusion for providers of all other types of health care taken together. CONCLUSIONS: On the basis of data collected since 1980, nonprofit psychiatric inpatient care providers in the United States had superior performance on access, quality, cost-efficiency, and amount of charity care, compared with for-profit providers. Caution is warranted in pursuing public policies that permit or encourage the replacement of nonprofit psychiatric inpatient care providers with for-profit providers of these services.

Un modelo grupal para el abordaje de los pacientes con trastornos de la conducta alimentaria atendidos en un servicio público de salud mental extrahospitalario de osakidetza/servicio vasco de salud / A group model for approaching patients with eating disorders attended in an outpatient public mental health department in Osakidetza/Basque Department of Health (Spain)

Objetivo: El tratamiento de los trastornos de la conducta alimentaria debe de ser jerárquico, escalonado, multifacético e integrador y controlar la situación clínica a nivel médico, psiquiátrico y grupal. Nuestro objetivo es poner a prueba un modelo de abordaje grupal (incluido en un programa específico de tratamiento de los trastornos de la conducta alimentaria y coordinado dentro de un plan global e individualizado de tratamiento) para aplicar específicamente en estos trastornos. Pacientes y método: Se presenta un modelo de grupo psicoterapéutico de un año de duración y realizado con mujeres adolescentes afectadas (n = 8; edad media, 16 años; tiempo medio de evolución, 2 años; un 63 por ciento con tratamientos previos fallidos). Se evalúa a través de CGI, EEAG, etapa de cambio, SCL 90, EAT, EDI II y otras características clínicas de la enfermedad. Para la evaluación se realiza un diseño factorial mixto 2 * 2. Resultados: El clima grupal permite la verbalización de los conflictos y el crecimiento personal, con mayor conciencia introspectiva y menor impulsividad. Asimismo, disminuyen la obsesión por la delgadez, la insatisfacción corporal, los sentimientos de ineficacia e inseguridad social y el miedo a la madurez. En el grupo control se objetiva una mayor tasa de abandonos, una mayor tasa de riesgos asociados de tipo orgánico-psicosomático y una evolución comparativa más deficitaria. Conclusiones: El grupo dota a los pacientes de estrategias adecuadas de afrontamiento y adaptativas para el cambio, aumenta la autonomía y el crecimiento personal, evita la cronificación, disminuye la sintomatología y aumenta la concienciación-motivación para el tratamiento. La intervención y evaluación grupal nos permiten optimizar los tratamientos, adecuándolos a la población objetivo (AU)

Plan moderno de asistencia a los alienados (1926)

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Plan moderno de asistencia a los alienados (1926)

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Creación de un Cuerpo de Alienistas (1926)

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Measuring the technical efficiency of psychiatric hospitals.

The purpose of this study was to assess the efficiency of psychiatric hospitals. Data Envelopment Analysis was used to examine the technical efficiency for sample of the 85 profit and not-for-profit psychiatric hospitals. Results suggests reduction of excessive resource use by all inefficient facilities would result, on average, in a $7.2 million dollar savings in operational expenses, a total of 1715 FTEs in labor reductions, and a reduction of 1129 beds.

Psychiatric hospital care and changes in insurance coverage strategies: a national study.

The 1975, 1980, and 1986 sample surveys from the National Institute of Mental Health were used to predict the type of inpatient psychiatric facility where people were admitted. Predictors used were demographics (age, gender, race, marital status, and education), psychiatric diagnosis, and insurance status (primary payment source). A discriminant analysis revealed that insurance status was the most important discriminator in predicting hospital type. State hospitals were more likely to care for patients with little or no resources, whereas private hospitals cared for patients with some form of insurance. The authors discuss the implications of insurance status and access to psychiatric treatment.