Biomedical subjects
Publications and source records attributed to N Kates.
To assess the preparation of residents in psychiatry for working with family physicians, a questionnaire was sent to the directors of Canada's 16 psychiatry residency programs. The results of the study are presented with recommendations for improving this aspect of training.
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For 25 years, the Hamilton-Wentworth region has had a well integrated network of psychiatric services. The initial impetus for its establishment came from the founders of the Department of Psychiatry at McMaster University in 1967. They envisaged a regional network of services that integrated the resources of a community-focused university department with those of local community agencies and other mental health care professionals. Over the years, the evolution of the network has been shaped by changes in the size and composition of the faculty, the emergence of additional clinical services and community programs, new directions in the field of psychiatry and changing economic forces and social values.
With a trend toward coordinated networks of mental health services, it is necessary to be able to assess their impact. This paper outlines an approach to network analysis, using a variety of methodologies to come up with a composite picture. Areas to examine include the network processes, such as its goals, functions, structures, outcomes, and the satisfaction of all involved.
This paper reviews the current state of Israel's mental health system during a period when it may be possible to bring about significant change. It analyses its strengths and weaknesses, including the heavy influence of the psychiatric hospital and the lack of necessary community programs. The author stresses the need for an integrated planning process, based upon a vision of what the mental health system should look like and who it should be serving, and discusses how this process could occur.
The majority of patients with emotional or psychiatric disorders are treated in the primary care setting without psychiatric input. Psychiatrists need to find ways of helping family physicians manage these patients without necessarily taking over their care. One way of achieving this is for a psychiatric consultant to visit the family physician's office on a regular basis to discuss the physician's problem cases. This paper describes such a pilot project, outlines the kinds of problems family physicians discussed and recommendations that were made, and discusses the benefits of this collaborative approach.
The house call is a valuable but underused component of community psychiatric care. A review of home visits conducted by the staff of a community mental health service over a 12 month period identified four situations in which a home visit is useful: getting reluctant patients to enter therapy, conducting a comprehensive assessment, strengthening a support network, and maintaining patients in the community when their condition has deteriorated. Making psychiatric house calls requires some additional skills on the part of therapists and offers residents valuable training experience.
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Explore the source record for details and available documents.
Data from the Ontario Child Health Study were used to examine the strength of association between child immigrant status and child psychiatric disorder, poor school performance, and use of mental health/social services. Bivariate results indicate that immigrant children are not at increased risk for psychiatric disorder or poor school performance and that they use mental health and social services significantly less often than do their nonimmigrant peers. Implications of the findings are explored.
Recent changes in Royal College training requirements have highlighted the need for residency programs to be able to offer challenging and worthwhile experiences to their trainees in caring for the chronically mentally ill. This training should bring them into contact with patients at each stage of their illness and recovery and expose them to the different settings in which treatment or management takes place. Postgraduate programs face many problems in organizing this teaching that arise from the nature and course of long-term psychiatric illnesses, the organization of residency training programs, attitudes and preconceptions of residents and teachers and competing time demands. The authors review these problems, identify specific goals for the training and suggest strategies for achieving these goals. Expectations of postgraduate programs, clinical placements, supervisors and residents themselves are outlined.
Family physicians spend up to 40% of their time dealing with emotional and psychiatric problems and may be the only caretaker for 60% of all episodes of psychiatric illness. One way of strengthening the role of the family physician in managing psychiatric problems in their practices is by involving them in an initial psychiatric assessment, which may entail the patient being seen in the primary care setting. This intervention, offered by a community mental health center (CMHC) in Ontario, Canada, was evaluated by examining all cases referred by family physicians over a 3-year period and comparing those seen in consultation in family physicians offices with those seen in consultation in the CMHC. While the office consultation appears to be a cost-effective intervention, the main factor that determined whether it took place appeared to be the attitude of the referring physician rather than the nature of presenting problem. Other benefits arising from such a liaison-consultation relationship are also discussed.
In an attempt to evaluate the current state of the training residents receive in psychiatric epidemiology in Psychiatry Residency programs, the Canadian Academy of Psychiatric Epidemiology sent a questionnaire to the 16 Canadian Residency Program Directors. Thirteen of the 16 directors (82%) responded. Program directors identified a number of the common components to the training, although there was wide variation in the time allocated and the availability of resources. The biggest single obstacle to the teaching was a perceived lack of interest on the part of the residents.
Despite its limited resources, Cuba has developed an integrated mental health system that emphasizes prevention and community care. It consists of three distinct organizations: the Committee for the Defense of the Revolution, one of many mass community organizations that strive to protect the revolution; the policlinics, which provide comprehensive health services to geographic areas containing 25,000 to 40,000 people; and the psychiatric hospitals. All three use treatment approaches that are based on a social systems model and that emphasize solving current problems and disturbances. Behavioral and milder psychiatric problems are treated by policlinic psychologists, in the community whenever feasible, and major psychiatric disorders are treated by psychiatrists at the hospitals. Services for children and adolescents, research, and staff training in Cuba are also discussed.
Family physicians may spend up to 50% of their time dealing with emotional problems but will refer less than 10% of these cases for psychiatric treatment. This paper describes an approach developed at McMaster University which emphasizes the importance of understanding the needs of family physicians and helping them make optimum use of available psychiatric services. Such an approach aims at increasing the comfort and expertise of family physicians in handling the problems they see on a regular basis, involving them actively in their patient's care after a referral, and offering relevant services that supplement those of the family physician, while monitoring and correcting problems that can arise when the two specialties work together. The implications that this has on the training of family medicine and psychiatry residents are discussed as well as ways in which continuing education can be provided for family physicians in community practice.
The authors describe a consultation-liaison relationship between a community psychiatry outpatient service and private community family practitioners, including some problems and solutions that have arisen as a result of this relationship. A medical student clerkship in this consultation-liaison setting is particularly useful in orienting students to community aspects of psychiatric care in primary care practice. Since 50% of medical students from McMaster University enter some form of primary care activity, this exposure and sensitization to community mental health activities is especially relevant.
Overcoming problems in communication between psychiatry and primary care requires new models of collaboration. Their success will depend upon the ability of participants to work productively with each other, which will require psychiatry residency programs to offer appropriate preparation for future graduates in working with primary care physicians. This article, based on the training at McMaster University in Hamilton, Ontario, describes a brief curriculum for training psychiatry residents to work effectively with primary care physicians that can be easily integrated with current training rotations and looks at adjustments academic departments need to make to support such programs.