Using personalized consumer charts in a partial hospitalization program.

One difficulty of moving the focus of care for the mentally ill from hospital to the community is that some patients with severe mental illness, who have been in hospital for a long time, are difficult to place in the community. The main problems that appear to be barriers to community-based care are aggressiveness and adverse sexual behaviour. New antipsychotics, such as risperidone, are likely to increase the proportion of patients who can be successfully placed in the community because the low liability for extrapyramidal symptoms will contribute to better compliance. A crucial aspect of the move to the community is the attitudes of neighbours. Studies show that the public is deterred from making contact with the mentally ill because they expect them to have inadequate communication skills. The public also expect bizarre behaviour and aggressiveness. However, the majority of those living near proposed new community homes would welcome the establishment of mental health facilities in their neighbourhood. A study of a public education campaign focussed on the neighbours of a sheltered home found that fear of the mentally ill was reduced and willingness to socialize with them was increased. This change in attitudes was reflected in increased social contact between patients and their neighbours. Therefore, attempts to open community homes for the mentally ill as unobtrusively as possible are likely to lead to more objections than if well constructed public education campaigns focussed on the neighbours are undertaken.

Community Mental Health Centers↗

PubMed1997

Predicting psychiatric emergency admissions and hospital outcome.

OBJECTIVES: A decision support tool for psychiatric hospital admissions was developed and validated to provide reliable, clinically relevant information to providers and case managers. METHODS: Using the Severity of Psychiatric Illness rating system, an empirical model of psychiatric emergency decision-making was constructed and validated on a spilt sample of 254 crisis cases. RESULTS: Three dimensions of the Severity of Psychiatric Illness system-Suicide Potential, Danger to Others, and Severity of Symptoms-were used to construct a model that successfully predicted 73% of decisions about level of care (inpatient or outpatient). Clear misses, patients with a 0.20 probability of being hospitalized who were admitted, and patients with an 0.80 probability or greater of being hospitalized who were not admitted were reviewed to allow for utilization review. This decision support tool then was validated by predicting hospital outcomes in two additional samples. First, a random sample of consecutive admissions to a not-for-profit psychiatric hospital were studied. Second, a panel of admissions from a large managed care firm were evaluated. CONCLUSIONS: Results demonstrate that the decision to hospitalize patients in psychiatric hospitals is rational and that models predicting admission also can predict in-hospital outcomes.

Community Mental Health Centers↗