The effect of a mental hospital strike on general hospital psychiatric services

Abstract

SynopsisData collected from 6043 psychiatric in-patient records were analysed to assess the impact of a strike at a mental hospital on in-patient services in general hospital psychiatric units in St John's, Newfoundland, Canada. As a whole, during the strike general hospital units showed an increase in the number of involuntary admissions, the number of prior mental hospital admissions of patients, and indications of violent or suicidal behaviour; and a decrease in the occupational status of patients admitted and the prescription of minor tranquillizers. There was also evidence of considerable variation between general hospitals in the extent to which their admission pattern changed during the strike and the permanence of some of the strike effects. The data indicate that all patients showing violent or suicidal behaviour who would normally have been admitted to the mental hospital were treated in the general hospital units during the strike. On the other hand, a large number of patients diagnosed with schizophrenia, personality disorder or mental retardation, who normally would have been admitted to the mental hospital, apparently went without hospitalization during the strike. A substantial proportion of this latter group would usually have been admitted involuntarily.

The impact of strike action on patient morbidity: A systematic literature review

“…Four studies scored well, scoring six or above. 12 , 13 , 14 , 15 Several studies scored relatively low on this scale, with five papers scoring three or less. 16 , 17 , 18 , 19 , 20 The remainder of these studies fell somewhere between, scoring four or five.…”

“…In one of the earliest studies Norman and Malla 12 examined the impact of a strike on an in‐patient psychiatric hospital. This strike occurred in February 1977, involved ‘non professional’ workers and lasted 17 weeks.…”

“…That is, while some impacts were more clear cut, like Njuguna 24 above, this cannot be said of all studies. For example, while Norman and Malla 12 reported an increase in the rate of violent and involuntary psychiatric admissions during a strike (i.e., as a proportion of overall admissions), this appeared to have little to do with the strike itself; it may have been that voluntary or less acute patients put off seeking treatment which resulted in more acute patients making up a greater portion of overall patients during the strike. Finally, in saying this, we cannot completely rule out strike action having an impact on patient outcomes.…”

Organizational Behaviour Management in a Psychiatric Day Hospital

“…This interpretation is in keeping with related studies. In terms of the effects of non-attendance, Norman and Malla (1984) reported that a mental hospital strike led to more suicides and increased admission to a general hospital psychiatric unit. Pryce et al (1983) provided evidence suggesting that a non-directive programme of the kind the present unit used to offer maintained social adequacy and prevented relapse, but did not seem to be associated with clinical impovement.…”

Involuntary admissions in a Canadian province: The influence of geographic and population factors

“…Case records of all psychiatric admissions to the three general hospital units and the mental hospital in St. John's, over a three-year period (October 1975to October 1978, were examined as part of a larger study (Malla et al 1987;Malla and Norman 1983;Norman and Malla 1984). The admission status was recorded as voluntary or involuntary, as per the criteria described below.…”