Suchergebnisse

AbstractWhile the state of the art in developing programs for severely mentally ill people with substance disorders is not well advanced, programs that show promise attend to a basic set of principles, providing or coordinating a core set of values.

AbstractThis chapter discusses a series of experimental tests of alternative approaches to treating the chronically and potentially chronically ill.

Psychisch Kranke haben es nach wie vor schwer. Ihr Image in der Öffentlichkeit ist geprägt von Vorstellungen, die eine Wiedereingliederung in alltägliche Lebenszusammenhänge erschweren. In den Medien wird das Bild des absonderlichen und gefährlichen Kranken gezeichnet. Im Meinungsbild der Bevölkerung drücken sich ebenfalls Bedrohtheitsgefühle aus, im Vergleich zur Medienberichterstattung ist jedoch eine tolerantere Haltung festzustellen. Der Beitrag berichtet über die Ergebnisse einer empirischen Studie über die Darstellung psychisch Kranker in den Medien sowie über Einstellungen in der Bevölkerung. Versucht man das Verhältnis zwischen psychisch Kranken und Gesunden zu verbessern, so ist zuallererst darauf hinzuwirken, daß mehr Kontakte zwischen diesen Personengruppen ermöglicht werden. Der Versuch, die Integration von Kranken allein über Einstellungsänderungen zu erreichen, kann aber nicht genügen. Notwendig sind auch Änderungen der strukturellen gesellschaftlichen Rahmenbedingungen. (pka)

While epidemiological research has offered much valuable information about substance use among homeless persons in general and homeless mentally ill persons in particular it has lacked information about the context in which substance use occurs, patterns of use, how use influences subsistence adaptation, and factors that mediate its effects. The Adaptation of the Homeless Mentally Ill (AHMI) research was able to address these gaps in our knowledge through long-term ethnographic field work with 50 homeless mentally ill individuals in the Skid Row area of Los Angeles. Most importantly, we found variation in the extent to which alcohol and drug use dominated the lives of sample members. Where some individuals organized their lives completely around the pursuit and use of drugs and alcohol, others were able to precariously balance their substance use with the tasks of meeting their basic needs. We then examine several of the possible factors that shape the relationship between substance use and subsistence adaptation, looking specifically at: (1) Skid Row; (2) psychopathology; (3) institutional affiliations; (4) values and beliefs, and; (5) the role of eventfulness. We conclude by summarizing our findings and their implications for social policy.

'Die Enthospitalisierung von psychisch kranken Langzeitpatienten kann von sehr verschiedenen Perspektiven aus betrachtet werden. Zum einen kann man sie deuten als die konsequente Anwendung anti-psychiatrischer und labeling-theoretischer Argumente. Zum anderen kann man sie betrachten als Teil der Strategie westlicher Wohlfahrsstaaten, ihre fiskalische Krise zu lösen - ohne Rücksicht auf die damit verknüpften Risiken für die Mehrheit der psychiatrischen Langzeitpatienten. In Deutschland entwickeln viele der für die Versorgung der psychisch Kranken zuständigen Stellen Überlegungen, die Zahl der Betten/Plätze für Langzeitpatienten drastisch zu reduzieren und möglichst viele Patienten aus den Kliniken und Heimen zu entlassen. Der folgende Aufsatz resultiert aus einer Untersuchung zur Evaluation der Enthospitalisierung psychisch kranker Langzeitpatienten in Eckardtsheim (Bielefeld). Wir stellen hier den theoretischen Bezugsrahmen dieser Untersuchung vor, aus der im nächsten Jahrgang empirische Ergebnisse berichtet werden.' (Autorenreferat)

Background: A great amount of research has been done in the area of gender and severe mental illness. However, there is an apparent lack of studies on gender differences concerning needs and care. Aim: To analyze differences in needs and care between men and women considered to be severely mentally ill (SMI) after the 1995 Swedish mental health care reform. Method: In one area of Sweden, surveys were made in 1995/96 and 2006 of persons considered to be SMI. These persons were interviewed and their needs assessed. In a cross-sectional study in 2006, the needs and care of men and women were compared. In a longitudinal study, men and women interviewed in both 1995/96 and 2006 were compared concerning the development of needs and care. Results: The structure of needs differed between men and women. Men had more needs concerning functional disability and those needs seemed possible to meet in the existing service structure. Women's needs concerning physical health, information about health and own security, seemed to be more difficult to meet. Only a few gender differences were found in satisfaction with services and service utilization. Conclusion: It seems urgent to have a gender perspective in a needs-led mental healthcare service.

Background: In a health-care service with the emphasis on improvement related to functioning and well-being, the communication process between patient and professionals is essential. There is a lack of research on this matter. Aim: The aim was to investigate, in a group of severely mentally ill persons, whether the use of a simple communication tool could influence the sense of empowerment, satisfaction with care, therapeutic alliance and unmet needs. Method: The study had a cluster randomized design. The intervention was a communication tool (2-COM) applied in two teams during one year. In a comparison group of two other teams, the treatment was as usual. At baseline, after six months, and after one year, assessments were made. Results: After one year the 2-COM groups seemed to have a larger reduction in unmet needs compared to the treatment-as-usual group. However, there were large problems with attrition in the study, and it was not possible to draw relevant conclusions. Conclusions: The methodological problems were substantial, and the study may be considered as a pilot study. In a main study the researchers ought to take control over the selection of patients on the basis of the experiences from this study.

AbstractAdministratively complex and politically sensitive issues can arise when mentally ill persons who are public program beneficiaries are enrolled in existing HMOs. The experiences of a demonstration program undertaken in Minnesota illustrate these issues.