Suchergebnisse

Despite the progressive reduction over many years in patient populations of psychiatric hospitals in America and many European countries, there have been few attempts to evaluate this policy. The Team for the Assessment of Psychiatric Services (TAPS) was established to monitor and evaluate the closure of two large psychiatric hospitals in North London. A number of important problems have been identified in the course of the TAPS research programme. These include: the inertia of the planning process, the selection of the best patients first for discharge at the expense of the more disabled, the accumulation of new long-stay patients entering the admission wards of psychiatric hospitals, the policy of introducing patients into the community as unobtrusively as possible, and the difficulties of deinstitutionalis ing staff. Despite these problems, evidence is presented that discharge of long-stay patients into the community has been relatively successful.

People with serious mental illness no longer spend years of their lives in psychiatric institutions. In developed countries, there has been a major shift in the focus of care from hospitals into the community. However, whilst it means those with mental illness are not confined, it does not guarantee they will be fully integrated into their communities. The barriers to full citizenship are partly due to the disabilities produced by their illnesses and partly by stigmatising and discriminatory attitudes of the public. This book analyses the causes of these barriers and suggests ways of dismantling them. The book is constructed in two parts: the first relates to social inclusion and the second to occupational inclusion. Throughout, the text is annotated with quotes from consumers, to illustrate their experience of the issues discussed. The innovations outlined are described in sufficient detail for the reader to implement them in their own practice

AbstractA psychosocial program for the relatives of schizophrenic patients, in addition to regular medication, has contributed to keeping higher‐risk patients well and in the community.

Background: The need to achieve is common to all societies, and failure to do so may have a highly detrimental psychological impact. For those on the margins of mainstream society, especially migrants or descendants of migrants, the impact of failed or poor achievements may increase their vulnerability to mental illness. Aims: In a prospective study of schizophrenia in three ethnic groups (White, Indian and African-Caribbean) we studied the impact of goal striving and investigated whether the gap between the poor achievement and the high aspirations of members of some minority ethnic groups was potentially a factor contributing to the development of the illness. Methods: The patients and age- and sex-matched controls from their respective communities were asked to rate their perceived current levels of achievement and their past and future expectations in five domains - social standing, housing, education, employment and financial status on a 10-point scale. Results: The control subjects from the three ethnic groups scored similarly in most areas, supporting the validity of inter-ethnic comparisons. The gap between achievement and expectations did not appear to cause high disappointment levels in any group, and in fact only in the domain of housing did the African-Caribbean patients assess their current achievement as being significantly lower than that of their matched controls. Conclusions: Poor housing conditions may be one of the risk factors contributing to the high incidence of schizophrenia in African-Caribbeans.

Previous studies from the Indian subcontinent had suggested that the onset and outcome of schizophrenia is linked with social factors. We set out to study the inception rates and social factors in whites and Asians who were presenting for the first time ever to various catchment facilities in Ealing catchment area. A total of 62 cases (38 white and 24 Asians) were diagnosed as having schizophrenia. Using well established and previously validated standardised instruments we collected information on various social factors and inception rates of schizophrenia. The inception rates and social factors were largely similar in these two groups. By and large the social factors in the two groups were broadly similar except that Asians were significantly more likely to show increased religious activity compared with their white counterparts. Contrary to previous findings Asians were more likely to have had longer duration of symptoms prior to seeking help. These findings are discussed in relation to Asian support systems and suggestions made for future research.

Background: Previous epidemiological studies have shown a high incidence of schizophrenia in African-Caribbeans in the UK, but not in Asians. Aims: We investigated the hypothesis that cultural adherence might protect the Asians against the stress of living in a majority white culture. Methods: The Culture and Identity Schedule (CANDID) was given to patients with a diagnosis of schizophrenia making their first contact with psychiatric services, and to a matched group of controls randomly selected from the general population. Results: While the Asian patients displayed no drift away from the traditional values as espoused by their controls, the African-Caribbean patients were less traditional than their controls. Conclusions: The fact that a movement away from their traditional culture distinguishes African-Caribbean patients with a severe psychiatric illness, schizophrenia, from their mentally healthy controls strongly favours marginalization over biculturalism as an interpretation of this shift.

Background: Chronic pain is a sensory and emotional experience that causes significant disturbances to a patient's life as well as to their family. Whether the family environment is affected by chronic pain and, in turn, affects the patients' pain experience has yet to be investigated. The interaction between patients and spouses has been assessed using the expressed emotion (EE) construct, a tool previously described in the field of mental health. For schizophrenia and other psychiatric illnesses, a correlation exists between family EE and patients' outcomes. Aims: The main objective of this study was to observe the presence of EE among relatives of chronic spinal pain patients and to evaluate its correlation with their symptoms. Methods: A prospective observational study was conducted on 54 patients and their spouses currently seen at the Chronic Pain Unit of Hospital Clinic of Barcelona. The following variables were recorded: age, gender, pain score, quality of life and EE. Results: Data showed that a considerable proportion of spouses were rated as high EE. There was an association between EE and patients' quality of life, and the level of EE predicted some other variables of patients' quality of life. Conclusion: The EE level of spouses of chronic pain patients affects the patients' quality of life and thus the way that they experience their pain.

Background: There is concern about the level of satisfaction with mental healthcare among minority ethnic patients in the UK, particularly as black patients have more compulsory admissions to hospital. Aims: To determine and compare levels of satisfaction with mental healthcare between patients from different ethnic groups in a three-centre study of first-onset psychosis. Method: Data were collected from 216 patients with first-episode psychosis and 101 caregivers from South London, Nottingham and Bristol, using the Acute Services Study Questionnaire (Patient and Relative Version) and measures of sociodemographic variables and insight. Results: No differences were found between ethnic groups in most domains of satisfaction tested individually, including items relating to treatment by ward staff and number of domains rated as satisfactory. However, logistic regression modelling (adjusting for age, gender, social class, diagnostic category and compulsion) showed that black Caribbean patients did not believe that they were receiving the right treatment and were less satisfied with medication than white patients. Black African patients were less satisfied with non-pharmacological treatments than white patients. These findings were not explained by lack of insight or compulsory treatment. Conclusions: The study found that black patients were less satisfied with specific aspects of treatment, particularly medication, but were equally satisfied with nursing and social care. Understanding the reasons behind this may improve the acceptability of psychiatric care to black minority ethnic groups.