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1.
Public Health Rep ; 135(5): 599-610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645279

RESUMO

OBJECTIVE: We estimated the caseload of providers, practices, and clinics for psychosocial services (including psychotherapy) to Medicaid-insured children to improve the understanding of the current supply of such services and to inform opportunities to increase their accessibility. METHODS: We used 2012-2013 Medicaid claims data and data from the 2013 National Plan and Provider Enumeration System to identify and locate therapists, psychiatrists, and mental health centers along with primary, rehabilitative, and developmental care providers in the United States who provided psychosocial services to Medicaid-insured children. We estimated the per-provider, per-location, and state-level caseloads of providers offering these services to Medicaid-insured children in 34 states with sufficiently complete data to perform this analysis, by using the most recent year of Medicaid claims data available for each state. We measured caseload by calculating the number of psychosocial visits delivered by each provider in the selected year. We compared caseloads across states, urbanicity, provider specialty (eg, psychiatry, psychology, primary care), and practice setting (eg, mental health center, single practitioner). RESULTS: We identified 63 314 providers, practices, or centers in the Medicaid claims data that provided psychosocial services to Medicaid-insured children in either 2012 or 2013. The median provider-level per-year caseload was <25 children and <250 visits across all provider types. Providers with a mental health center-related taxonomy accounted for >40% of visits for >30% of patients. Fewer than 10% of providers and locations accounted for >50% of patients and visits. CONCLUSIONS: Psychosocial services are concentrated in a few locations, thereby reducing geographic accessibility of providers. Providers should be incentivized to offer care in more locations and to accept more Medicaid-insured patients.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Transtornos do Neurodesenvolvimento/terapia , Atenção Primária à Saúde/estatística & dados numéricos , Reabilitação Psiquiátrica/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Estados Unidos/epidemiologia
2.
Health Qual Life Outcomes ; 18(1): 164, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493419

RESUMO

BACKGROUND: Psychiatric disorders have a major individual and societal impact. Until now, the association between health-related quality of life and physical disorders has been far more investigated than the association with psychiatric disorders. Patient-reported outcome measures makes it possible to capture the patient perspective to improve treatments and evaluate treatment outcomes. The aim of this study is to measure health-related quality of life with the EQ-5D-Y-5L among patients in child and adolescent psychiatric inpatient care and to test the instrument's psychometric properties in terms of feasibility and construct validity. METHODS: Data were collected at the child and adolescent psychiatric inpatient facility in Region Stockholm. A questionnaire including the EQ-5D-Y-5L instrument, the Strengths and Difficulties Questionnaire with an impact supplement and a self-rated health question, was administered for self-completion using paper and pencil, with an interviewer present. The Chi-square test was used to investigate differences in proportion of reported problems in the EQ-5D-Y-5L dimensions and the Mann-Whitney U test was used for differences in mean EQ VAS scores. Feasibility was assessed by investigating proportion of missing and ambiguous answers and Spearman's and Pearson's correlation were used to examine construct validity. RESULTS: In total 52 adolescents participated in the study and the majority were girls. The most common diagnosis at admission was depressive episode/recurrent depressive disorder. All participants reported problems on at least one dimension. Most problems were reported in the dimension 'feeling worried, sad or unhappy', where 64% reported severe or extreme problems. Mean EQ VAS score was 29.2. Feasibility was supported and construct validity indicated as some of the hypothesised correlations between the EQ-5D-Y-5 L and the Strengths and Difficulties Questionnaire were found, however, for 'doing usual activities' and 'having pain or discomfort' the correlations were weaker than hypothesised. CONCLUSIONS: This is the first study where the newly developed EQ-5D-Y-5L instrument has been used in psychiatric inpatient care for youth. Participants reported problems in all severity levels in most of the EQ-5D-Y-5L dimensions; mean EQ VAS score was considerably low. Feasibility of the EQ-5D-Y-5L was supported, however other psychometric properties need to be further tested in a larger sample.


Assuntos
Transtorno Depressivo Maior/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adolescente , Criança , Estudos Transversais , Estudos de Viabilidade , Feminino , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Psicometria/instrumentação
3.
Rev Lat Am Enfermagem ; 28: e3296, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32578752

RESUMO

OBJECTIVE: to assess risk related to drug use in men admitted to a psychiatric hospital and to identify associations with sociodemographic, socioeconomic variables, and risk conditions. METHOD: a cross-sectional study with the application of a screening test in 209 participants hospitalized for mental and behavioral disorders due to the use of psychoactive substances. Statistical analysis was performed using descriptive statistics and adjustment of a binary logistic regression model for moderate or high risk of drug use. The odds ratio measured the strength of association. RESULTS: high use in life was observed, with alcohol and tobacco experimentation in adolescence. A high prevalence of related risk was observed for alcohol, tobacco, smoked and inhaled cocaine, and marijuana. Moderate and elevated risks were found for tobacco (22.5% and 62.5%, respectively), alcohol (13.5% and 73%), marijuana (16% and 32.5%), smoked cocaine (3% and 41%) and inhaled cocaine (9% and 19.5%). CONCLUSION: the results showed high use in life, with an age of early experimentation. Tobacco and alcohol are the main drugs used by hospitalized men.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Hospitais Psiquiátricos/estatística & dados numéricos , Fumar/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fumar/epidemiologia , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
4.
Encephale ; 46(3): 193-201, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32370982

RESUMO

OBJECTIVE: The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS: The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS: We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Transtornos Mentais/terapia , Saúde Mental , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Idoso , Idoso de 80 Anos ou mais , Epidemias , França/epidemiologia , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/normas , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/prevenção & controle , Pandemias , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Quarentena/psicologia , Quarentena/estatística & dados numéricos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos
5.
Crim Behav Ment Health ; 30(1): 38-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32173951

RESUMO

BACKGROUND: In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings. AIMS: To describe and compare characteristics of long-stay patients in NHS and in PCS medium security hospital units. METHODS: Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total. RESULTS: 178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients. CONCLUSIONS: The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.


Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Inglaterra , Feminino , Humanos , Tempo de Internação , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Prisões , Instalações Privadas , Setor Privado , Logradouros Públicos , Setor Público , Medidas de Segurança , Fatores Socioeconômicos , Medicina Estatal/organização & administração
6.
J Nerv Ment Dis ; 208(1): 65-69, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31834191

RESUMO

The early prediction of patients at risk may facilitate the efficient use of interventions that have been demonstrated to reduce readmissions. The aim of the study was to analyze variables during first admissions associated with further high use of an inpatient hospitalization psychiatric unit in Málaga, Spain. The risk of having three or more psychiatric admissions was analyzed in a sample of 1535 first-time admissions with multivariate Cox regression. In the multivariate model, the variables associated with the risk of high use were age at admission (p < 0.001), length of stay (p < 0.001), place of residence (p < 0.001), and previous history with mental health services (p < 0.001). The results suggest that there are several easily accessible characteristics at first admission that are potentially useful in detecting patients at risk.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Espanha , Adulto Jovem
7.
Salud Publica Mex ; 62(1): 72-79, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-31869563

RESUMO

OBJECTIVE: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. MATERIALS AND METHODS: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychi- atric hospital. RESULTS: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (ß=1.062, p=.000), family income (ß=1.000, p=.000) and no laboral occupation (ß=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (ß=4.158, p=.000). CONCLUSIONS: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/epidemiologia , México/epidemiologia , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Fatores Socioeconômicos , Adulto Jovem
8.
Lancet Psychiatry ; 6(12): 1039-1053, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31777340

RESUMO

BACKGROUND: Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS: We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS: 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION: Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING: Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Tratamento Involuntário/estatística & dados numéricos , Narração , Transtornos Psicóticos/diagnóstico , Humanos , Internacionalidade , Fatores de Risco , Fatores Sexuais
9.
Ir J Psychol Med ; 36(4): 259-263, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31747990

RESUMO

BACKGROUND: Clozapine is an atypical antipsychotic agent used primarily in the management of treatment-resistant schizophrenia. Previous studies have demonstrated clozapine's superior efficacy over other antipsychotic medications in treating this population of patients. The aim of this study was to assess if the number of hospital admissions and days spent in hospital reduced with the initiation of clozapine, compared with when the same sample of patients were prescribed other antipsychotics prior to clozapine initiation. METHOD: A mirror-image study design was adopted. In this case the intervention under study was the initiation of clozapine. Information was collected retrospectively from the charts of patients attending the University Hospital Galway clozapine clinic. The number of admissions and number of hospital days were collected for each patient over the 3 years before and after clozapine initiation. Wilcoxon's signed-rank test was used to test for statistical significance. RESULTS: The total sample size comprised of 62 patients, of which the majority were male (74.2%) and had a diagnosis of schizophrenia (82.3%). The mean dose of clozapine was 417 mg, and mean age of the sample was 38 years. Mean number of hospital admissions reduced from 2.8 to 0.8 (p<0.0001) following initiation of clozapine. Mean number of days spent in hospital reduced from 116.4 to 17.1 (p<0.0001). CONCLUSION: After initiation of clozapine treatment, patients experience a substantial reduction in number of hospital admissions and number of days spent in hospital when compared with a similar period prior to clozapine initiation.


Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Substituição de Medicamentos/efeitos adversos , Hospitalização/estatística & dados numéricos , Adulto , Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Resistência a Medicamentos , Feminino , Hospitalização/tendências , Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Psiquiátricos/tendências , Humanos , Masculino , Estudos Retrospectivos , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Resultado do Tratamento
10.
Rev Bras Enferm ; 72(6): 1699-1706, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644763

RESUMO

OBJECTIVE: to evaluate the relation between sociodemographics factors, stress and burden of care of family caregivers of patients at a psychiatric hospital admission. METHOD: quantitative study, with a cross-sectional correlation design. A total of 112 family caregivers participated, older than 18, in a Brazilian psychiatric hospital. A sociodemographic questionnaire was used to collect data, the Zarit Burden Interview and LIPP Adult Stress Symptom Inventory. RESULTS: burden of care in family caregivers at a psychiatric hospital admission was significantly associated with stress (p=0.000). The psychological symptoms of stress predicted severe burden. Most caregivers presented a moderate or severe burden, with 52.7% in the resistance phase of stress; 66.1% presented psychological symptoms. CONCLUSION: results show the alarming situation of caregivers of patients from a psychiatric hospital, evidencing their own vulnerability to illness. Indeed, the during admission in a psychiatric hospital, not only patients need care, but also their caregivers.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Serviços de Saúde Mental/normas , Estresse Psicológico/etiologia , Adaptação Psicológica , Adulto , Idoso , Brasil , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Estresse Psicológico/psicologia , Inquéritos e Questionários
11.
BMC Health Serv Res ; 19(1): 691, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610790

RESUMO

BACKGROUND: The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a 'one-stop' mental health service hub. METHODS: We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale - Domains and Stages (RAS-DS) scores at intake and review (n = 108); (2) RAS-DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation. RESULTS: Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS-DS measurements, averaging 5 months apart. RAS-DS 'total recovery' scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS-DS domains ('Looking forward', p < 0.001; 'Mastering my illness', p < 0.001; and 'Connecting and belonging', p = 0.001). Corresponding improvements, except in 'Connecting and belonging', were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant. CONCLUSIONS: Despite the lack of a control group and small follow-up sample size, Floresco's integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Seguimentos , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Organizações , Avaliação de Programas e Projetos de Saúde , Queensland
12.
East Asian Arch Psychiatry ; 29(3): 87-90, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31566184

RESUMO

OBJECTIVE: This study aimed to determine the prevalence of violence and factors associated with aggressive or violent behaviour in Thai patients with schizophrenia. METHODS: This cross-sectional study was conducted in all patients with schizophrenia aged ≥18 years admitted to Suan Prung Psychiatric Hospital, Thailand, between January and November 2014. Baseline interviews were conducted by a psychiatrist and psychiatric nurses. Accessibility to weapons and toxic chemicals was evaluated. RESULTS: Of 230 patients with schizophrenia screened, 207 (162 men and 45 women) were included. Of them, only 16 (7.7%) patients had aggressive or violent behaviour, including verbal aggression (n = 7), physical aggression (n = 5), and aggression against property (n = 4). Nonetheless, only 2 (12.5%) of them had been charged by the police. The weapon score was higher in violent than non-violent patients (p < 0.05). Binary logistic regression analysis showed that the weapon score was the only significant predictor of violence. CONCLUSIONS: Patients with schizophrenia with greater access to weapons were more likely to have aggressive or violent behaviour. Routine screening for access to weapons in clinical settings and adequate treatment of psychotic symptoms may reduce the incidence of aggressive or violent behaviour and violent offences.


Assuntos
Agressão/psicologia , Psicologia do Esquizofrênico , Violência/psicologia , Violência/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Hospitalização , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Prevalência , Tailândia/epidemiologia , Armas/estatística & dados numéricos
13.
BMC Psychiatry ; 19(1): 270, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481048

RESUMO

BACKGROUND: The treatment of homeless dual-diagnosis patients (i.e., those with severe mental illness and substance-use disorder) is difficult and often fails. For patients in the Netherlands who had not responded to earlier voluntary and compulsory treatment, a new treatment facility - Sustainable Residence (SuRe) - was developed to offer long-term compulsory in-patient treatment. AIM OF THE STUDY: To study patterns of changes in clinical and functional outcomes during treatment at SuRe and how these relate to eventual treatment outcome. METHODS: On the basis of the intensity of care needed after four years, three groups of patients were distinguished (total n = 165): those discharged to a less restrictive and less supportive setting (n = 70, 42%), those still hospitalized at SuRe at the end of the four-year study period (n = 69, 42%) and those referred to a more appropriate setting (n = 26, 16%). Random coefficient analysis was used to examine differences between groups regarding changes in clinical and functional outcomes during treatment. During treatment, outcomes were monitored using Routine Outcome Assessment. RESULTS: All three groups made small but significant improvements on global psychosocial functioning, distress and therapeutic alliance (effect sizes (ES) 0.11 to 0.16 per year). Patients who were discharged to a less restrictive setting showed small to moderate improvement in risk to self and others, psychiatric symptoms, and skills for daily living (ES 0.19-0.33 per year and 0.42-0.73 for their mean 2.2-year treatment period). Patients remaining at SuRe showed a small increase in risk to self (ES 0.20 per year; 0.80 for their treatment period of four years or more). Oppositional behaviour was consistently greater in referred patients than in the other groups (ES 0.74-0.75). CONCLUSION: Long-term compulsory treatment appeared to have helped improve clinical and functional outcomes in a substantial proportion (42%) of previously severely dysfunctional, treatment-resistant dual-diagnosis patients, who could then be discharged to a less restrictive and less supportive environment. However, risk-to-self increased in a similar proportion. A smaller number of patients (16%) showed marked oppositional behaviour and needed a higher level of care and protection in another facility.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Diagnóstico Duplo (Psiquiatria) , Feminino , Hospitalização , Humanos , Masculino , Países Baixos , Avaliação de Resultados em Cuidados de Saúde , Resultado do Tratamento
14.
Psychiatr Pol ; 53(3): 673-689, 2019 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-31522205

RESUMO

OBJECTIVES: A growing number of patients whose length-of-stay in forensic services is aboveaverage length are identifiable in several European countries. Forensic services are situated within a particular sociocultural setting. Accordingly, this trend to increased admission length cannot be solely attributed to patient characteristics. This is the first known study exploring the influence of external factors on length-of-stay in forensic services. METHODS: Representatives from 16 European countries, members of the international COST project, focused on forensic psychiatric service, analyzed their respective forensic services using a structured tool. Responses were combined and analyzed using thematic analysis. RESULTS: Four themes described the factors influencing length-of-stay: care and treatment pathways; resources; legal and systemic impact; and sharing expertise. CONCLUSIONS: Findings suggest multidisciplinary consideration of the whole care pathway is required to address increased length-of-stay. Further research is required to support development of evidence-based standards applicable across Europe, and improve outcomes for patients at risk of increased length-of-stay in forensic services.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transtornos Mentais/terapia , Adulto , Europa (Continente) , Feminino , Psiquiatria Legal , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , Alta do Paciente/estatística & dados numéricos , Fatores de Risco , Violência/estatística & dados numéricos
17.
Res Nurs Health ; 42(5): 410-415, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31429481

RESUMO

The purpose of this study was to examine national trends and variation in nurse staffing on inpatient psychiatric units in US general hospitals from 2005-2017. The National Database of Nursing Quality Indicators® provided data on nurse staffing from 1,143 psychiatric units in 610 US hospitals. A weighted linear mixed model was fitted for each of two staffing measures: Registered nurse (RN) hours per patient day (HPPD) and non-RN HPPD. Monthly staffing levels were modeled as a function of study year, unit type, and hospital bed size, teaching status, government ownership, for-profit status, metropolitan location, and US census division. Very gradual upward trends in staffing were observed. Compared with adult units, child/adolescent units had lower RN staffing and higher non-RN staffing. Levels of both types of staffing were lower in for-profit facilities. The Pacific census division had higher RN staffing than every other census division by an estimated margin of 0.52-1.54 HPPD, and census divisions with the lowest levels of RN staffing had the highest levels of non-RN staffing. Despite concerns expressed over the past 15 years about patient violence, staffing levels, and use of seclusion and restraint on psychiatric units, average staffing levels have apparently increased only modestly since 2005, and increases in RN staffing on psychiatric units have not kept pace with increases in general care units. Marked regional differences in staffing merit further investigation.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Psiquiátricos/tendências , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Recursos Humanos de Enfermagem no Hospital/tendências , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/tendências , Adulto , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Estados Unidos
18.
Rev Bras Enferm ; 72(4): 834-840, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432935

RESUMO

OBJECTIVE: To characterize the presence of psychosocial risks related to the work of the nurse in a psychiatric hospital and the strategies for managing these risks. METHODS: Qualitative, in which 25 nurses from a psychiatric hospital participated using semi-structured interviews from November 2014 to January 2015. Data analysis was performed using the thematic method. RESULTS: The results showed psychosocial risks related to the work of psychiatric nurses, such as: insufficient academic training; lack of preparation and maintenance of equipment; poor relationship with colleagues; shortage of human resources and lack of capacity building; conflict between the demands of the home and work, as well as strategies for managing psychosocial risks such as family, cinema, music, reading, among others. FINAL CONSIDERATIONS: This study should provoke the reflection of managers and future nurses regarding the working conditions in a psychiatric hospital and possible psychosocial risks to which they are exposed.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Enfermagem Psiquiátrica/métodos , Estresse Psicológico/complicações , Adulto , Atitude do Pessoal de Saúde , Brasil , Feminino , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermagem Psiquiátrica/tendências , Pesquisa Qualitativa , Estresse Psicológico/psicologia
19.
Rev Peru Med Exp Salud Publica ; 36(2): 326-333, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31460648

RESUMO

This paper analyzes the implementation, initial results, and sustainability of innovations in the provision, financing, and management of mental health services in Peru, carried out during 2013-2018. By applying new financing mechanisms and public management strategies, 104 Community Mental Health Centers and eight Protected Homes were implemented, which prove to be more efficient than psychiatric hospitals. The set of 29 centers created between 2015 and 2017 produced in 2018 an equivalent number in consultations (244,000 vs. 246,000) and patients attended (46,000 vs. 48,000) than the set of three psychiatric hospitals, but with 11% of financing and 43% of psychiatrists. The way mental health care is being provided is changing in Peru by involving citizens and communities in ongoing care and creating better conditions for the exercise of mental health rights. Community mental health reform has gained broad support from political, international, and academic sectors, and from the media. We conclude that the reform of community-based mental health services in Peru is viable and sustainable. It is in a position to scale up the entire health sector throughout the country, subject to the commitment of the authorities, the progressive increase in public financing, and national and international collaborative strategies.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Reforma dos Serviços de Saúde , Hospitais Psiquiátricos/organização & administração , Serviços de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental/economia , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Eficiência Organizacional , Financiamento da Assistência à Saúde , Hospitais Psiquiátricos/economia , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Transtornos Mentais/terapia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Peru
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