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Psychiatrike = Psychiatriki Mar 2024The purpose of this study was to describe the demographic and clinical features of the inpatients currently residing at the Psychiatric Hospital of Leros. The present...
The purpose of this study was to describe the demographic and clinical features of the inpatients currently residing at the Psychiatric Hospital of Leros. The present systematic documentation and presentation aimed to demonstrate the standard of living and healthcare conditions provided today, after the implementation of the State's "Psychargos" program; this is the main Greek Psychiatric reform program, adhering to the principles of deinstitutionalization and community psychiatry, in accordance with the current international guidelines. In addition, we discussed the current relationship between the psychiatric departments of the hospital and the other departments and clinics in terms of providing healthcare services to chronic psychiatric inpatients in full compliance with the biopsychosocial model and its application to the unique case of Leros. The implemented patient profiles incorporated both subjective and objective factors, such as compliance with rules and treatment, self-injury, and harm to others. Furthermore, we quantified and categorized the level of care required for each patient in terms of personnel-reported activities. This parameter was assessed through the Greek version of Katz's Index of Independence in Activities of Daily Living. Simultaneously, the fundamental actions provided to inpatients by the social care and support services of the hospital were also depicted and categorized, in terms of connection to State social services, communication with the patient's families, and cooperation between the families and the hospital for the patient's healthcare needs. Furthermore, we analyzed and presented all statistically significant correlations found in our patients' characteristics. Briefly, the main results of our study show that the mean age of the 212 patients was 62.4 years old (with a standard deviation of ±13.6 years and the longest hospitalization of 62 consecutive years) including patients from the institution's asylum period. Since 1989, the year when the psychiatric reform began in our hospital, 87 new patients were admitted, 85.1% of whom were from the southern Aegean, thus following the principle of naiveness. Intellectual disabilities and psychotic spectrum disorders were the most common disorders among the total number of hospitalized patients, accounting for 40% in each category. Regarding the 87 patients hospitalized after 1989, psychotic spectrum disorders were diagnosed in the vast majority (58 patients, 66.7%) followed by organic mental disorders (10 patients, 11.5%). The rest were diagnosed with other disorders. Somatic comorbidity and the need for care and services, especially for patients with intellectual disabilities, demonstrate how the Institution now mainly offers psychogeriatric healthcare services. In conclusion, the purpose of this study was to highlight the Psychiatric Hospital of Leros as it stands today, in stark contrast to the long-established, stereotypical depiction of asylums in the scientific and public communities.
Topics: Humans; Middle Aged; Activities of Daily Living; Hospitals, Psychiatric; Intellectual Disability; Mental Disorders; Psychotic Disorders
PubMed: 37449849
DOI: 10.22365/jpsych.2023.017 -
Clinical Child and Family Psychology... Jun 2010With the increase in international adoptions during the last decade, many researchers have investigated the developmental outcomes of these adoptees, including their... (Review)
Review
With the increase in international adoptions during the last decade, many researchers have investigated the developmental outcomes of these adoptees, including their extreme behaviors. Collectively, these results have not always appeared consistent across studies, perhaps because studies have used children reared in institutions or not, the institutional environments vary in severity, children spend different lengths of time in the institution and are assessed at different ages, and studies use different outcome measures. In an attempt to discern more order in the literature, this review focuses on 18 studies, each of which used the Child Behavior Checklist, and their outcomes are viewed with respect to these parameters. Results suggest that the major factor contributing to extreme behaviors is age at adoption, with those adopted after 6/18 months having more behavior problems, especially Internalizing, Externalizing, and Attention problems. Generally, samples of post-institutional children have more problems than samples of mixed or non-institutional internationally adopted children, and some problems are more likely to be manifest in adolescence, suggesting the effects of deficient early experiences are not simply the persistence of learned behavior but more general dispositions that become more noticeable or severe during adolescence. Findings are discussed in terms of early deficient social-emotional caregiver-child interactions that characterize most institutional environments as a possible major cause of later difficulties in post-institutionalized children.
Topics: Adolescent; Adoption; Age Factors; Attention; Child; Child Behavior Disorders; Child, Institutionalized; Deinstitutionalization; Humans; Internal-External Control; Internationality; Risk Factors; Social Adjustment
PubMed: 20514520
DOI: 10.1007/s10567-010-0068-x -
Inquiry : a Journal of Medical Care... 2023This study objective to verify the existence of gaps in the dynamics and performance of fulfillment of the deinstitutionalization of psychiatric care in the Czech...
This study objective to verify the existence of gaps in the dynamics and performance of fulfillment of the deinstitutionalization of psychiatric care in the Czech Republic (CZ) and the Slovak Republic (SR) in the period between 2010 and 2020. The introduction of this the study is a search for expert knowledge in the field of deinstitutionalization of psychiatric care. The study uses the method of multi-criteria comparison of TOPSIS variants and a cluster analysis. The results 22 variants range from (ci 0.6716-0.2571) and confirm that there are large differences between CZ and SR in performance gaps (fulfillment) of deinstitutionalization goals. The SR variants are clearly better than the CZ variants, although during the years studied, the CZ variants are improving, and the size of the gap compared to the SR variants is decreasing. In the first year of the evaluated period (2010), the performance gap was 56% and in the last year (2020), the performance gap was only 31%. The conclusion of the study confirms that the measures associated with the deinstitutionalization of psychiatric care are linked to the time they were introduced and the overall implementation period of the reform.
Topics: Humans; Deinstitutionalization; Mental Disorders
PubMed: 37211825
DOI: 10.1177/00469580231170727 -
Neuropsychopharmacologia Hungarica : a... Dec 2011Referring to the scientific literature the authors analyze the correlation between criminal offense and psychiatric disorders. Frequency of violent behaviour in... (Review)
Review
Referring to the scientific literature the authors analyze the correlation between criminal offense and psychiatric disorders. Frequency of violent behaviour in schizophrenia together with the risk factors are reviewed. The issue of violent offense is separately discussed. Impact of deinstitutionalization on offense is also analyzed. Results regarding the genetic correlations are also reviewed. Finally the question of re-offending is discussed. In summary the importance of this issue in stigmatization and in the development of the mental health care system is highlighted.
Topics: Crime; Deinstitutionalization; Humans; Mental Disorders; Risk Factors; Schizophrenia; Schizophrenic Psychology; Social Behavior Disorders; Violence
PubMed: 22184195
DOI: No ID Found -
Ciencia & Saude Coletiva Jan 2019The Open Dialogue Method was developed in Finland in order to deal with severe psychotic crises using dialogue and social network inclusion. By means of a review of the... (Review)
Review
METHOD
The Open Dialogue Method was developed in Finland in order to deal with severe psychotic crises using dialogue and social network inclusion. By means of a review of the literature on the Open Dialogue Method, this article sought to identify the principles and contributions for deinstitutionalization.The PubMed (365), PsycInfo (134), Lilacs (no articles found) databases and 2 books were consulted. Thirty-four publications that fulfilled the requirements of this review were selected. The search was conducted in October 2015. The key words used were: open dialogue, crisis, first psychotic episode, schizophrenia, family therapy, need-adapted approach.
RESULTS
There were 3 reviews, 5 theoretical studies, 21 qualitative studies and 5 quantitative studies. Two of them were written in Italian, one in French and thirty-one in English. The authors were from Norway, the United States, Finland, Australia, the United Kingdom, Belgium, Canada and Poland. The publications were grouped for purposes of analysis into the following categories: Open Dialogue concepts and principles; Open Dialogue contributions; Challenges for Open Dialogue implementation in other countries, realities and contexts.
Topics: Acute Disease; Crisis Intervention; Family Therapy; Finland; Humans; Mental Health; Psychotic Disorders; Severity of Illness Index; Social Support
PubMed: 30698256
DOI: 10.1590/1413-81232018241.32232016 -
AIMS Public Health 2021Individuals with intellectual disabilities (ID) are an expanding population that confronts multiple disadvantages from social and environmental determinants of health....
Individuals with intellectual disabilities (ID) are an expanding population that confronts multiple disadvantages from social and environmental determinants of health. Deinstitutionalization and community integration have improved the lives of individuals with ID in many ways. However, deinstitutionalization may increase their access to alcohol and drugs and the potential for developing Substance Abuse Disorders (SUD). It is estimated that 7-8 million people in the United States with an intellectual disability (ID) suffer disproportionately from substance use problems [1]. There is a lack of empirical evidence to inform prevention and treatment efforts in this population and more research needs to be done in order to address these issues.
PubMed: 34395697
DOI: 10.3934/publichealth.2021037 -
Social Work Nov 1979After one hundred years the family is once again being asked to assume its major function as care-giver for the long-term mentally ill. Is the family able to support... (Review)
Review
After one hundred years the family is once again being asked to assume its major function as care-giver for the long-term mentally ill. Is the family able to support chronic mental patients? Is it willing to assume responsibility for these patients? This article addresses these questions, as well as others, and discusses the implications of family policy for community care.
Topics: Aftercare; Community Mental Health Services; Deinstitutionalization; Family; Health Policy; Humans; Mental Disorders; United States
PubMed: 10313883
DOI: 10.1093/sw/24.6.521 -
Medical Care Sep 2011
Topics: Deinstitutionalization; Female; Health Care Costs; Humans; Male; Medicaid; Nursing Homes; Patient Discharge
PubMed: 21862904
DOI: 10.1097/MLR.0b013e31822ebefc -
The Milbank Quarterly Dec 2019Policy Points Widespread diffusion of policy innovation is the exception rather than the rule, depending as it does on the convergence of a variety of intellectual,...
UNLABELLED
Policy Points Widespread diffusion of policy innovation is the exception rather than the rule, depending as it does on the convergence of a variety of intellectual, political, economic, and organizational forces. The history of Assertive Community Treatment (ACT) provides a compelling case study of this process while also showing how conditions may shift over time, altering the scenarios for continued program expansion. Diffusion of a program like ACT challenges government to play a nuanced role in which public endorsement and resources are used to strengthen a worthwhile service, but without suppressing flexibility and ongoing experimentation as core program values. Acceptance as a proven form of "evidence-based practice" is a critical element in the validation of ACT and other community mental health interventions that combine clinical and social features in novel ways. However, the use of conventional evidence-based research as a singular gold standard of program value narrows the range of stakeholder input, as well as the evaluation methodologies and forms of data deemed worthy of attention.
CONTEXT
Originating at the county level in Wisconsin in the early 1970s, Assertive Community Treatment is one of the most influential mental health programs ever developed. The subject of hundreds of research studies and recipient of enthusiastic backing from private advocacy organizations and government agencies, the program has spread widely across the United States and internationally as a package of resources and management techniques for supporting individuals with severe and chronic mental illness in the community. Today, however, ACT is associated with a rising tide of criticism challenging the program's practices and philosophy while alternative service models are advancing.
METHODS
To trace the history of the Assertive Community Treatment movement, a diffusion-of-innovation framework was applied based on relevant concepts from public policy analysis, organizational behavior, implementation science, and other fields. In-depth review of the literature on ACT design, management, and performance also provided insight into the program's creation and subsequent evolution across different settings.
FINDINGS
A number of factors have functioned to fuel and to constrain ACT diffusion. The former category includes policy learning through research; the role of policy entrepreneurs; ACT's acceptance as a normative standard; and a thriving international epistemic community. The latter category includes cost concerns, fidelity demands, shifting norms, research contradictions and gaps, and a multifactorial context affecting program adoption. Currently, the program stands at a crossroads, strained by the principle of adherence to a long-standing operational framework, on the one hand, and calls to adjust to an environment of changing demands and opportunities, on the other.
CONCLUSIONS
For nearly 50 years, Assertive Community Treatment has been a mainstay of community mental health programming in the United States and other parts of the world. This presence will continue, but not in any static sense. A growing number of hybrid and competing versions of the program are likely to develop to serve specialized clientele groups and to respond to consumer demands and the recovery paradigm in behavioral health care.
PubMed: 31680353
DOI: 10.1111/1468-0009.12429 -
Lancet (London, England) Jul 2015It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed... (Review)
Review
It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.
Topics: Brain; Child; Child Development; Child Welfare; Child, Institutionalized; Deinstitutionalization; Developmental Disabilities; Humans; Institutionalization; Orphanages; Social Support
PubMed: 25638660
DOI: 10.1016/S0140-6736(14)61131-4