Long-term consequences of the reformation of psychiatric care: A 15-year follow-up study

Bülow, Per; Svensson, Tommy; Hansson, Jan-Håkan

doi:10.1080/08039480252803864

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…The mortality gap for death from unnatural causes between all eligible patients and the general population decreased apparently over the three periods of reform ( Table 5 ). Our results are supported by the findings of a previous study of specific populations that received mental health care during the reform of psychiatric services (Bulow, Svensson, & Hansson, 2002 ; Farragher, Carey, & Owens, 1996 ; Pirkola et al, 2007 ). However, some previous studies showed a persistent excessive mortality due to unnatural causes during the periods of deinstitutionalization (D'Avanzo et al, 2003 ; Rasanen et al, 2003 ).…”

Section: Discussionsupporting

confidence: 91%

Mortality among long-stay patients with schizophrenia during the setting-up of community facilities under the Yuli model

Cheng

Lin

Chang

et al. 2014

Health Psychology and Behavioral Medicine

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Objective: Over the past 15 years, Yuli Veterans Hospital (YVH) in Taiwan has developed the Yuli model to reform long-stay care for psychiatric patients. The development of the Yuli model could be divided into pre-early (1998–1999), early (2000–2006) and late (2007–2008) periods according to the setting-up of the community facilities. In the pre-early period, a vocational rehabilitation program was established for psychiatric patients in YVH. In the later periods, the independent living skills training and the program for social reintegration were instituted in the community facilities. This study aimed to evaluate mortality among the long-stay patients with schizophrenia during the three periods. Methods: In all, 2457 patients with schizophrenia who had been hospitalized for at least one year initially were retrospectively followed from 1 January 1998 to 31 December 2008. Compared with the general population in Taiwan, we calculated the age- and sex-specific standardized mortality ratios (SMRs) of those patients by cause of death during the three periods. Results: Most of the patients were male (81.3%). The mean ± SD age of the patients was 57.83 ± 16.95 years. The all-, natural- and unnatural-cause mortalities of the patients were nearly two times greater than those of the general population during the whole study period. Compared with those in the pre-early and early periods, all patients in the late period had the lowest mortality gaps. In the pre-early, early and late periods, the all-cause SMR were 5.40 (95% confidence interval (CI) = 4.27–6.81), 2.90 (95% CI = 2.20–3.79) and 1.17 (95% CI = 0.54–2.22), respectively, for the 50–69-year-old male patients. Nearly half of all the patients who participated the whole comprehensive rehabilitation program belonged to this sex and age group (N = 156, 46.6%). Conclusions: With the setting-up of community facilities for the comprehensive rehabilitation program, the mortality gaps among the 50–69-year-old male patients apparently decreased using the Yuli model.

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Section: Discussionsupporting

confidence: 91%

Mortality among long-stay patients with schizophrenia during the setting-up of community facilities under the Yuli model

Cheng

Lin

Chang

et al. 2014

Health Psychology and Behavioral Medicine

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“…How people with mental health problems experience life in the community has been studied from different perspectives, and investigated by quantitative as well as qualitative research methods. Some recurrent findings from quantitative studies reveal unmet needs for social contact, relationships and activities (Bulow, Svensson, and Hansson 2002;Hansson et al 2003;Jansson, Sonnander, and Wiesel 2003) and the importance of such factors for self-reported 'quality of life' (Borge et al 1999;Elstad 1999;Oliver, Huxley, and Bridges 1996). Qualitative studies have reported feelings of loneliness, shame and psychological pain, fear of neglect and exclusion, passivity and needs for support but not wanting to be subjected to control (Birkeland and Kristoffersen 2004;Erdner et al 2002;Granerud and Severinsson 2006;Green et al 2002).…”

Section: Previous Researchmentioning

confidence: 99%

Mental health centres as ‘meeting-places’ in the community: exploring experiences of being service users and participants

Elstad

Kristiansen

2009

Scandinavian Journal of Disability Research

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The purpose of this article is to present and discuss findings from a qualitative study within mental health centres called 'meeting-places' in the community. Ten service users were interviewed in order to explore and gain insight into what visiting the centres might mean in the daily life situations of people who experience mental health problems. The interviewees were recruited during fieldwork within these centres, aiming to facilitate the inclusion of service users who wished to share their experiences, but who might not otherwise come forward as research participants. Three main themes were identified in the data analysis: 'To belong and be recognized', 'Needs for support and challenges', and 'Participation and everyday life'. Flexible community mental health services can be helpful by offering support and challenges as well as possibilities for mutual relationships. However, the study also highlights a lack of opportunities for participation and recognition in the wider society.

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“…The number of psychiatric beds in Sweden has been reduced and lengths of stay have been shortened [13,14]. Psychiatric hospital beds have to be used as effective as possible in order to help patients in acute phases of mental illness being able to rely on outpatient services in the community.…”

Section: Discussionmentioning

confidence: 99%

Accumulated coercion and short-term outcome of inpatient psychiatric care

Kjellin

Wallsten

2010

BMC Psychiatry

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BackgroundThe knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric careMethods233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variablesResultsNumber of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scoresConclusionThe results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.

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Long-term consequences of the reformation of psychiatric care: A 15-year follow-up study

Cited by 8 publications

References 13 publications

Mortality among long-stay patients with schizophrenia during the setting-up of community facilities under the Yuli model

Mortality among long-stay patients with schizophrenia during the setting-up of community facilities under the Yuli model

Mental health centres as ‘meeting-places’ in the community: exploring experiences of being service users and participants

Accumulated coercion and short-term outcome of inpatient psychiatric care

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