Strategies for the management of severe psychiatric illness in the community

Isaacs, A. D.; Bebbington, Paul

doi:10.3109/09540269109067522

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…Community-based services will have to provide comprehensive treatment schemes, including pharmacological, psychological and social management 23 . The usefulness of neuroleptic drugs in the treatment of schizophrenia is well documented 15 , but under normal treatment conditions results are as not as good as those observed in clinical trials 27 .…”

Section: Implications For a Community-based Mental Health Policymentioning

confidence: 99%

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The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

Menezes¹,

Mann²

1993

Rev. Saúde Pública

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A sample (n=124) of schizophrenic patients from a defined catchment area of the city os S.Paulo, Brazil, who had been consecutively admitted to hospital, was assessed for psychopathological status and social adjustment levels. Sociodemographic, socio-economic and occupational characteristics were recorded: almost 30% of the subjects had no occupation and received no social benefit, more than two-thirds had a monthly per capita income of US$ 100.00 or less. Sixty-five percent presented with Schneiderian firstrank symptoms. Nearly half the sample showed poor or very poor social adjustment in the month prior to admission. The most affected areas of social functioning were participation in the household activities, work and social withdrawal. The current mental health policy of promoting extra-mural care as an alternative to the previous hospital-based model will then mean the investment in a network of new community-based services, that give effective treatment and support to patients and their families. The need of further research into the current picture of mental disorders in the country is stressed.

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Section: Implications For a Community-based Mental Health Policymentioning

confidence: 99%

“…They should be provided by multidisciplinary teams, for patients' needs are of various orders 23 , occupational skill training, actual help in seeking jobs, and adequate housing provision being among the main issues for the proper maintenance of schizophrenic patients in the community 34 .…”

Section: Implications For a Community-based Mental Health Policymentioning

confidence: 99%

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

Menezes¹,

Mann²

1993

Rev. Saúde Pública

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“…However, models of the type of service to provide for this level of problems among its client group were well described from an empirical standpoint (Isaacs & Bebbington, 1991, Onyett, 1992. both as regards acute interventions and long-term continuing care.…”

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confidence: 99%

Care programming and service change in a psychiatric sector

1998

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The effects of service expansion and change (including joint working with social services) following the provision of a community mental health centre and the introduction of care management were examined by auditing service activity. Data were collected on service provision to 20 randomly selected patients who met the local criteria for care management, and also on the general level of service activity as judged by service contacts for all disciplines. Compared to the baseline period, face to face contact with caremanaged patients increased six-fold. There were more home contacts, a wider range of professional contacts occurred, and a greater variety of types of treatment provided.A substantial (though not statistically significant) reduction in day hospital attendance was seen over the period studied. The number of service contacts for non-care-managed patients also rose. The introduction of care management was simplified by changes in service organisation. Increased resources were needed to both implement care management and provide an adequate service to the remainder of patients. Both aspects of the service functioned efficiently in parallel.

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“…In developed countries, people with severe mental illnesses get a lot of social support from the government, such as housing and income benefits, sheltered work, and access to comprehensive psychiatric treatment, including home visits and medicines (Isaac and Bebbington 1991). Independence is seen as a target to be sought in rehabilitation programs (Wallace 1993).…”

Section: Prevalence Of Dual Diagnosismentioning

confidence: 99%

"Transtornos mentais graves na comunidade: um estudo em São Paulo"

Ratto¹

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To investigate the conditions of severe mental illnesses individuals by clinical characteristics, social adjustment, violent behavior, psychoactive substance use, and services use. The study had a cross-sectional design, followed by prospective cohort, with a one-year follow-up. Twenty mental health services (emergency, inpatient and outpatient services) were scrutinized to identify all patients aged 18 to 65 years old, with a clinical diagnosis of functional psychosis, who were resident in one of 7 administrative districts chosen for the study, and had had at least one contact with such services between 1 st September and 30 th November 1997. Assessments included psychiatric symptoms, social adjustment, violent behavior, patterns of alcohol, tobacco, drug use, and services use, using standardized instruments, at the baseline and 1 year after. Out of 620 patients identified, 404 were randomly selected to be interviewed. One hundred and ninety two patients (47.9%) were directly interviewed. The sample was then composed by 102 (52.3%) men, mean age was 41.5 years (s.d. = 11.4), predominantly single, not born in the city of Sao Paulo, with 8 years or less of formal education. The prevalence of substance abuse was 10,4% (95%CI: 6.5 to 15.6%), being 7,3% for alcohol abuse and 4,7% for drug abuse. The proportion of subjects showing any degree of impairment in social adjustment was very high, with almost 92% of the individuals with global scores of 1 to 5, but only 12.8% of the sample with scores 4 or 5. The most used health service was the psychiatry consultation. One hundred fifteen (59.9%; IC 95%: 52.6 to 66.9%) used tobacco in regular basis in the last year. Thirty-seven (19.4%, 95%CI 14-25.7%) subjects reported at least one episode of aggression in the 12 months prior to the interview, only 9 (4.7%) individuals reported more serious episodes of aggression, and just 2 (1%) episodes were considered severe. When analysing moderate and severe episodes together, male gender, being single and younger ages were characteristics associated to episodes of violent behaviour. At 1-year follow-up, 149 (77.6%) were reassessed. One hundred twenty (81.6%) had had no psychiatric admissions in the 1-year follow-up, 53.8% of the individuals who abused alcohol at index assessment had stopped using it, and 42.9% maintained the same pattern of index for abuse of illegal or nonprescribed substances. None individual started to smoke last year, and 9 (9.9%) stopped to smoke. Prevalence of substance abuse founded in Cohort study was still lower then the found in international studies, but tobacco use and nicotine addiction were similar to developed countries. The results point to the need of creation and implementation of a bigger and better mental health care system in the community, with a multidisciplinary approach.

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Strategies for the management of severe psychiatric illness in the community

Cited by 8 publications

References 16 publications

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

Care programming and service change in a psychiatric sector

"Transtornos mentais graves na comunidade: um estudo em São Paulo"

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