PurposeThe aim of this study was to investigate the perceived level of internalized stigma among patients with severe mental illnesses and its relationship with demographic and clinical variables in Poland.Patients and methodsA study sample (n=114, mean age=42.46±14.1 years; 55% of females) consisting of patients with nonorganic psychotic disorders as well as unipolar and bipolar affective disorders was evaluated (58% of outpatients and 39% of inpatients). All patients filled in the Internalized Stigma of Mental Illness (ISMI) scale (maximum severity=4). The demographic and clinical data were collected.ResultsThe study population demonstrated a mild level of internalized stigma (2.23±0.5). The highest score was observed in the alienation domain (2.63±0.8) and reflected moderate severity. The lowest score was noted in the stereotype endorsement domain (2.08±0.6). Moreover, the highest degree of internalized stigma was present in participants with unipolar affective disorder and was of moderate severity (2.46±0.6), while the level was moderate in the alienation domain (2.85±0.8). The level of vocational training education was the only variable associated with higher internalized stigma (P=0.02). There were no associations between gender, employment, and marital status and internalized stigma. The duration of the disease was the only clinical factor showing a significant positive correlation with stigma internalization (r=0.23; P=0.01). The number of hospital admissions and suicide attempts was not significantly correlated with internalized stigma.ConclusionPeople with severe mental illnesses in Poland experience a mild level of self-reported internalized stigma. Internalized stigmatization was most strongly associated with alienation, which indicates the need for stigma assessment procedures followed by stigma intervention programs in daily clinical practice. This is in accordance with the trend of environmental “open door” psychiatry, which could be the first step to decrease the level of stigma and internalized stigma in psychiatric patients in Poland.
After twenty years of transformation of Finnish mental health care, in the late 80s and early 90s of the last century, incidence of schizophrenia in Western Lapland dropped from 35/100,000 to 7/100,000. This phenomenon is linked with Yrjo O. Alanen et al. who investigated schizophrenia treatment outcomes and psychosocial rehabilitation of people with schizophrenia. Investigators focused on an individually tailored psychotherapeutic recovery plan during patient's hospitalization, including care for patients' families. Within the "Finnish National Schizophrenia Project" the principles of the Need-Adapted Treatment were created and 50% of Finland's country gained access to mobile crisis intervention teams. Further studies were continued within "Acute PsychosisIntegrated Treatment Project" (1992-1993) which locally, in Western Lapland, proceeded into "Open Dialogue in Acute Psychosis Project" (ODAP) (1994-1997). In this approach, all important decisions regarding the patient, including hospitalization or pharmacotherapy, are discussed not only with the entire therapeutic team, but also with the patient and his family members. Two - and five-year follow-ups demonstrated high treatment efficacy as well as important cost reduction in mental health care spending. First two"Open Dialogue Method" training courses for representatives of the medical, psychological, nursing and social care have been completed in Poland in October 2014. Studies evaluating the therapeutic effectiveness of the described approach are being planned.
Purpose: The aim of this paper is to present current views on the meaning of trauma and its treatment by the use of Open Dialogue Approach (ODA). Authors broadly define trauma as mental crisis that urges an immediate and comprehensive care. Views: Open Dialogue Approach with its demand on development of professional mental health structures not only meet the requirements imposed on community mental health centre (CMHC) as a core of the National Mental Health Program, but it seems to be exceptionally useful in the context of therapeutic work with traumatized patients and with people in a mental crisis. One of the main aspect of currently carried out mental health reform is the liberalization of hospital beds for those who are in severe mental crisis, substantially the raise od hospital standard for patients admitted to psychiatric hospital and to offer an ambulatory, easily accessible (local) ways of dealing with mental health problems. Conclusions: At the core of the ODA lies a broad understanding of traumatic experience and broad perception of its symptomatic and processual consequences issuing mental crisis, which requires a fast, diverse and coordinated care. ODA may be defined as an integrative and community-oriented model of mental health service that follows constantly changing patients' needs. Available mental health structural frame-if well-coordinated-seems sufficient and could adequately respond to patient needs in the recovery process. Further prospective and methodologically well designed studies measuring method's treatment outcomes and cost-effectiveness should be conducted.
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