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Biomedical subjects

H L Holley

Publications and source records attributed to H L Holley.

At least 19 recordsLinked to original sources
PubMed1998

Geography and mental health: a review.

In our current health care context, characterized by fiscal restraint and decentralization of accountability for health to regional authorities, geographic inequities in need, access to care, utilization, and health outcomes will come under increasing scrutiny. Knowledge gained from ecological studies about geographic disparities in mental health are likely to have important implications for policy, program planning, and resource allocations. In light of the growing relevance of the geography of mental health, this paper will review (1) selected contributions of geographic studies to the field of mental health, (2) common ecologic study approaches used in most geographic studies, (3) key conceptual and methodological challenges related to the application and interpretation of ecologic models in mental health, and (4) the wider potential of this technique for resource equity. Given the importance of geography for needs assessment and service planning, it is surprising that geographic study designs, which use ecological data, have not received greater attention as an important and viable method of assessing population mental health.

Diagnosis-Related Groups↗
PubMed1998

Suicide following an inpatient hospitalization for a suicide attempt: a Canadian follow-up study.

This study contributes a Canadian perspective to a growing body of international studies examining suicide among cohorts of suicide attempters, and a much more limited literature on the epidemiology of suicide in Canada. We evaluated the 13-year mortality experience of a regional cohort of 876 first-ever inpatient hospital admissions for a suicide attempt admitted between 1979 and 1981. Compared to the general population, study subjects were 4 times more likely to die of any cause, but 25 times more likely to commit suicide and 15 times more likely to die of accidental or adverse causes. Ten years after then first hospitalization for attempted suicide, 5.9% of study subjects had committed suicide. Baseline age appeared to be a risk factor for women, but not for men. Women under 60 years had the best 10-year survival (3.6% had committed suicide) and women over 60 years had the poorest (17.5%). A total of 8.7% of men under 60 years and 10% of those over 60 years committed suicide within 10 years. The remainder of the analysis focused on those under 60 years of age at the time of their index inpatient hospitalization. Three factors were prognostic for suicide: being male, which had a relative risk (RR) of 5.0, living in a lower income area (RR = 3.2), and having used a violent method during the index attempt (RR = 2.5). The periods of greatest risk for suicide were within the 1st and 4th years following first-ever inpatient hospitalization, with the 4th year representing the time of highest risk. The identification of time periods subsequent to first-ever hospitalization when patients are at greatest risk of suicide can be used to guide the timing and duration of clinical interventions and aftercare to ensure that patients are appropriately supported during periods of highest risk.

Adolescent↗
PubMed1998

Moving psychiatric patients from hospital to community: views of patients, providers, and families.

OBJECTIVE: Differences in the perspectives of severely and persistently ill patients, their family members, and clinical care providers on key aspects of community-based care were examined to help inform community service planning and development. METHODS: A sample of 183 patients being considered for relocation from psychiatric facilities in Alberta, Canada, to community-based care, were interviewed, as were their primary clinical care providers. Family members of 130 patients were also interviewed. RESULTS: Among the 130 patient-family pairs, 41 percent disagreed about the desirability of relocation, with fewer patients favoring relocation than families. Forty-nine percent of the pairs disagreed about the desired proximity to the family of the relocated patient, with the patient desiring closer proximity than the family member in about half of these cases. Fifty-three percent of the pairs disagreed about the amount of financial and emotional support that the family would provide after relocation. In half of these cases, patients believed the family would provide a higher level of support than the family indicated it could. Among the patients, 49 percent preferred independent living, whereas only 10 percent of family members and 17 percent of clinical care providers preferred it. Fifty-five percent of patients expressed a clear desire to work, whereas care providers believed that only 12 percent of patients were employable. CONCLUSIONS: Persistently mentally ill residents of psychiatric facilities express clear preferences about key aspects of community-based care when they are asked, and these preferences often reflect different views from those expressed by either family members or clinical care providers.

Aftercare↗
PubMed1997

Potential for community relocation among residents of Alberta's psychiatric facilities: a needs assessment.

OBJECTIVE: To identify the proportion of residents in Alberta's psychiatric hospitals who would be relocatable to community-based alternatives to care if appropriate programs were made available. METHODS: A Survey of a representative sample of residents in all psychiatric hospitals and care centres was undertaken, excluding patients in specialized programs for forensic psychiatry, brain injury, and substance abuse. RESULTS: Findings indicate that 11% of institutionalized patients could be considered good candidates for relocation to community-based alternative care. A further 35% were considered to have potential for relocation provided an intensive and complex array of services was first made available. CONCLUSION: Results support a phased-in approach to hospital downsizing and the need for considerable transitional funding. Because hospital downsizing is unlikely to save dollars, at least in the short term, reforms must remain guided by humanitarian motivations to improve quality of life for persons with severe and persistent mental illnesses.

Activities of Daily Living↗
PubMed1995

The effects of changes in the law concerning mentally disordered offenders: the Alberta experience with Bill C-30.

OBJECTIVE: Until recently, the Criminal Code of Canada, enacted in 1892, stood stalwart to social, political and technological changes, particularly with respect to the regulations pertaining to the management of the mentally ill offender. This became more definitely so with the enactment of the Canadian Charter of Rights and Freedoms (1984) as many regulations in the Code about mentally ill offenders contravened the mandates contained in the Charter. The Supreme Court of Canada's decision on Regina v. Swain spurred the Federal Government to bring the regulations on the mentally ill offender into line with the Charter. The result was the enactment of Bill C-30 which was intended to dramatically change the way in which forensic psychiatry was practised in Canada. This paper presents the Alberta findings from a multi-site evaluation commissioned by the Federal Department of Justice to judge the effects of Bill C-30 on forensic health care practices. METHODS: Health records data were used to compare utilization patterns from the year prior to the enactment of Bill C-30 with the year following. In addition, qualitative data were obtained from key clinical and legal informants outlining implementation difficulties that they had experienced. RESULTS: Results support the judgement that Bill C-30 has not achieved its desired effects with respect to the length of the remand, and has resulted in an increased burden on hospitals and health care providers. In addition, an unanticipated finding was the increased use of the Mental Health Act which was considered to place forensic patients in a position of double jeopardy.

Adult↗
PubMed1994

An evaluation of legal outcome following pretrial forensic assessment.

This paper constitutes the first stage of data analysis in a larger controlled study designed to assess the effect of a forensic psychiatric assessment on legal disposition defined in three ways: 1. the number of days spent in custody prior to trial; 2. the number of sentenced days of incarceration; and 3. the conviction rate. A historical cohort design was used to follow two cohorts of individuals remanded, pretrial, to Southern Alberta Provincial Correctional Centres between 1988 and 1989. The study cohort consisted of all offenders detained who received a forensic psychiatric assessment. The comparison cohort consisted of a random sample of persons detained who did not undergo a forensic assessment. Because of small numbers, individuals below the age of 18 and women were excluded from study. This paper compares socio-legal characteristics of study and comparison subjects in order to better understand forensic psychiatric referral patterns and identify potentially confounding factors that would need to be controlled in subsequent analyses of legal outcomes. No differences were noted with respect to educational level but forensic subjects were found to be slightly older (average of 31 years compared to 29 years). Aboriginal peoples (Native Indian, Inuit and Metis) were three times more common among non-forensic offenders. Forensic patients were more likely to have had a prior forensic assessment but less likely to have a prior criminal detention. In addition, forensic patients were three times more likely to be charged with a crime against a person and counted more offenses in the target episode than comparison subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Antisocial burnout: an exploratory study.

The more flagrant aspects of Antisocial Personality Disorder (APD), particularly criminality, are thought to diminish or "burnout" after age 30. However, empirical evidence of burnout in clinically defined groups is lacking. This study explores burnout in a cohort of forensic psychiatric patients, aged 41 to 67, with clinically diagnosed DSM-III APD (N = 39). Conviction data revealed that criminality did appear to decline from age 27 onward, but not in a straightforward manner. Further, a significant portion of the cohort remained criminally active throughout most of their adult lives. Age did not appear to interact with crime class.

Adult↗
PubMed1989

A comparison of voluntary with remanded schizophrenics.

In this study two groups of schizophrenic patients are compared on a number of clinical and demographic variables. The first group consists of 52 consecutive admissions to a forensic assessment unit of patients with a diagnosis of schizophrenia. The second is a consecutive series of schizophrenic patients admitted to two open admission units. Significant differences were found between the two groups. Specifically the forensic patients were more often male, single and antisocial as assessed by previous convictions and more often transient or living semi-independently in sheltered accommodation. They were less compliant with treatment. The two groups did not differ with respect to clinical features such as duration of illness and number of hospitalizations. It is concluded that individual patient characteristics may contribute to an outcome of legal involvement among schizophrenics. The implications of this for service delivery and future research on criminalization are discussed.

Adult↗
PubMed1988

Criminalization of the mentally ill: Part I. Police perceptions.

This paper reports the findings from Phase I of an ongoing prospective, longitudinal study of mentally ill offenders. The study documents the nature, extent and location of mentally ill offenders in the criminal justice system in Southern Alberta, evaluates mechanisms which are used to identify mentally ill offenders in need of treatment, identifies existing psychiatric services available within the criminal justice system and documents their psychiatric service utilization patterns. A study cohort of 611 was identified at their time of arrest and followed through the justice process from initial detention until final release. Part I on this study focuses on the period of arrest. More specifically, police perceptions of disturbed behaviour are examined. The prevalence of police-identified offenders is reported and police judgments regarding possible causes of disturbed behaviour (that is, mental illness, drugs, alcohol) and recommendations for psychiatric treatment are examined. Discrepancies between official recommendations made by police to a bail magistrate (and recorded on the arrest report) and unofficial recommendations collected as part of the study are explained in terms of differing decision-making models; clinical versus legal. Finally, the importance of police perceptions concerning the presence of mental illness as opposed to substance abuse are identified as important factors which influence the decision to recommend psychiatric examinations.

Adult↗
PubMed1988

Criminalization of the mentally ill: Part II. Initial detention.

In 1939 Penrose explained the correlation between crime and mental illness in terms of an administrative rather than an etiological link. Penrose's theory encompasses the idea that social standards for defining aberrant behaviour change as do the administrative facilities designed to control such behaviour. Social groups cope with individuals who display undesirable behaviour in one of two ways. They define the behaviour as incompetent and invoke the mental health system or they define the behaviour as criminal and employ the jail. Penrose documented an inverse relationship between these facilities whereby the population of mental hospitals increases as the population of jails decreases, and vice versa, depending on the prevailing laws, funding or stage of development of either system. The actual size of the population requiring institutional care, however, remains stable forcing individuals to transmigrate from one system to the other in order to obtain institutional support. Over the past two decades, increasing numbers of mentally ill have found their way into jails, however, little systematic evidence has been produced to document the process followed by these individuals as they move through the justice-correctional system, or how their psychiatric needs are met. The authors have conducted a prospective longitudinal investigation to document the transmigration of mental patients through the criminal justice system and have followed a cohort of individuals arrested in the City of Calgary during the month of October, 1984. Arresting officers were asked to complete a special study form to identify individuals who, in their perception, displayed mentally disordered behaviour during the arrest.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Development of a suicide screening instrument for use in a remand centre setting.

In penal settings it is important to be able to quickly discriminate which kinds of self-destructive behaviours carry a larger suicide potential and which inmates present a greater suicide risk. This paper is a preliminary report of the first phase of a suicide research project conducted at the Calgary Remand Centre, Calgary, Alberta which has entailed the development of a tool for screening potentially suicidal inmates. The Suicide Checklist was designed for use by the nursing staff of the Centre to provide a screening process which would be: (a) reliable; (b) valid (within the broad constraints and difficulties inherent in any attempt to predict dangerousness to self); (c) standardized; (d) quick and feasible to implement; and (e) a combination of clinical and past history variables. This paper identifies some of the issues which have surrounded the development of this tool and presents findings from an initial reliability study.

Humans↗
PubMed1987

Pre-trial assessment of schizophrenics on remand.

This paper examines the clinical and legal outcomes of a consecutive series of 52 schizophrenic patients remanded to a Forensic Assessment Unit. Typically patients were isolated single males who were unemployed, living on Social Security and had a history of multiple psychiatric hospitalizations. Less than half had previous convictions and about one-third had previous incarcerations. Nearly all were acutely ill on admission and received antipsychotic medication. Seventy-one percent were returned to court fit to stand trial and the remainder were diverted from the criminal justice system. None were found unfit to stand trial. This was achieved by discussions between crown and defence lawyer and psychiatrist near the end of the remand period. Court reports did not make recommendations about legal disposition but did outline the treatment available whatever the legal outcome. It is concluded that these people were treated in legally and medically appropriate ways.

Adolescent↗
PubMed1987

Sexual quality-of-life of patients with arthritis compared to arthritis-free controls.

The influence of arthritis upon sexual satisfaction and activity and patient receptivity to sexual rehabilitation was investigated by interviewing 169 patients with arthritis and 130 controls. Patients differed from controls in their greater loss of sexual satisfaction over time, but they were comparably satisfied with their current sexual adjustment. They reported similar reductions in frequency of intercourse over time. Joint symptoms and fatigue disturbed the sexual adjustment of patients more than controls, but damaged body image, worry about partner interest, loss of libido and loss of lubrication did not. There was receptivity to a program of sexual rehabilitation among patients and controls that was not dependent upon sexual dissatisfaction.

Adolescent↗