Physicians are often unaware of mentally disabled outpatients' symptomatic behaviors that are relevant to their medication prescriptions. Such information is available to the clients' residential care providers . The present study trained clients' residential care providers in data collection and provided these data to physicians. It was predicted that these data would improve medication treatment for these clients and consequently lead to a decrease in client's symptomatic behaviors . The results did not confirm the predictions; the data provided to physicians on clients' between- visit behaviors had no measured effect on the physicians' treatment of these clients, although the physicians reported positive attitudes about the helpfulness and utility of ·the system .

The pattern of frequent discharges and readmissions which characterizes most psychiatric hospitalization in this country today was described, and it was argued that the costs of this “revolving door” outweigh such benefits as might be derived from it. An alternative stepwise progression model of aftercare was proposed. This model identified community tenure as the most appropriate goal for initial aftercare efforts. Attempts to identify correlates of the establishment of community tenure by mental hospital releasees were reviewed. It was found that the ex-patient's ability to remain in the community is not highly correlated with the extent to which he manifests deviant behavior. This finding was interpreted as an indication that environmental factors may play significant part in ex-patients’ avoidance of rehospitalization. Data were presented which indicated that a clear majority of mental hospital releasees take up residency immediately with family members. It was hypothesized, then, that measurable family variables are correlated with the ability of the ex-patient to achieve community tenure. An attempt was made to examine this hypothesis in the light of relevant research. Studies of the issue which contained substantive empirical support were categorized into four topic areas: family tolerance of the ex-patient's symptomatic behavior, kin role which the family affords to the ex-patient, familial expectations of the ex-patient's performance, and family attitudes and personality characteristics. After reviewing the studies of authors who attempted to assess the degree of correlation between the capacity of the ex-patient’s family to tolerate symptomatic behavior on the part of the ex-patient and the ex-patient’s ability to avoid rehospitalization, it was concluded that the linear correlation between the two variables which would be predicted logically may not exist. A review of studies of the relationship between the kin role which the ex-patient's family affords to him and the ex-patient's ability to achieve community tenure yielded a tentative conclusion that returning to the social biological role of “child” (son or daughter) as opposed to the kin role of spouse was positively correlated with remaining in the community. After examining studies which attempted to explore the relationship between familial expectations of instrumental performance on the part of the ex-patient and the ability of the ex-patient to avoid rehospitalization, it was concluded that little support was provided for the hypothesis that the two variables are related. A survey of attempts to identify family attitude and personality characteristic correlates of ex-patient achievement of community tenure resulted in arrival at the conclusion that such efforts, as a whole, have met with little success, although significant correlations between two general family attitudes toward mental illness and ex-patient avoidance of rehospitalization were found. Considering the findings which were reviewed as a whole, it was concluded that little support was provided for the hypothesis that measurable family variables are correlated with the ability of the ex-patient to achieve community tenure. The rather limited aftercare practice applications which could be drawn from the few correlations that have been discovered were described, and implications of the over-all finding for future research were discussed.

In recent years attention has been given to the problems of the chronically mentally ill in regard to the effects of deinstitutionalization and a need for community supports. In this study, 77 service providers to the chronically mentally ill of Multnomah County (Portland), Oregon were interviewed to assess the components of the existing community support system for this population, as well as to identify the strengths and weaknesses of the system. Ten chronically mentally ill clients were interviewed in a similar manner.

The purpose of this survey was to obtain information from hospital emergency room staff on each mental health admission during the period of December 15, 1977 to January 15, 1978. Mental health admissions were broadly defined to include those people who were experiencing an observable mental health difficulty, but who may have initially presented primary medical problems. At the request of Multnomah County Mental Health Division's Management Team, and with the approval of the Emergency Department Nurses Association (EDNA), questionnaires were distributed among 16 general hospitals in the Portland, Oregon, Tri-County area. These hospitals are located in Multnomah, Clackamas, and Washington Counties. This survey represents the first attempt (1) to obtain information on an area-wide basis, on emergency room (ER) treatment of mental health admissions; and (2) to ascertain the availability and use of community mental health resources. The collection of such information is important to planning for comprehensive mental health services and in improving the existing service delivery system.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Assertive Community Treatment (ACT) is a widely implemented evidence-based practice for consumers with severe mental illness. However, fidelity to the model is variable and program drift, in which programs decrease in fidelity over time, can occur. Given substantial variability in fidelity and program drift in evidence-based practices, a study to examine how to re-implement ACT to high fidelity on established teams was warranted. The present study examined three teams providing moderate fidelity services prior to a state-wide policy change to the definition of ACT. Two of the teams attempted to implement ACT in accordance with state standards, while the third team served as a quasi-control for factors related to other state policy changes, such as a change to the funding mechanism. The implementation effort was examined using qualitative and quantitative measures over a 14-month period at a large, psychosocial rehabilitation center. Themes that were common across all three teams included the perceived negative impact of fee-for-service, ambiguity of stipulations and lack of guidance from the Department of Mental Health (DMH), difficulties with the managed care organization, importance of leadership within the agency, and familiarity with the services. Perceived barriers specific to the implementation of ACT standards included DMH stipulations, staff turnover, lack of resources, and implementation overload, i.e., too many changes at once. One team also had the significant barrier of a misalignment of requirements between two funding sources. Staff attitudes represented both a facilitator and a barrier to ACT implementation, while management being supportive of ACT was viewed as a major facilitator. One of the two teams seeking ACT status was rated at high fidelity within 6 months and maintained high fidelity throughout the study. The other team seeking ACT status never achieved high fidelity and decertified from ACT status after 6 months. The agency’s focus on productivity standards during the implementation effort hampered fidelity on the two teams seeking ACT status and greatly contributed to burnout on all three teams. The team achieving ACT status overcame the barriers in the short-term; however, DMH requirements may have threatened the long-term sustainability of ACT at the agency.

published_or_final_version / Social Work / Master / Master of Social Work

The current study investigated the relationship between social support and quality of life (QoL) as well as social support and community functioning among persons with severe and persistent mental illness (SPMI). Empirical data from Phase II of the Continuity of Mental Health Services (COMHS) Study of Alberta (Adair, Wild, Joyce, McDougall, Gordon, et al., 2003) were used to comprehensively examine these variables among a broad-based sample of 301 people with SPMI receiving a mix of inpatient, outpatient, and community services. Multiple measures administered in Phase II of the COMHS research program provided comprehensive data on QoL (i.e., disease-specific and generic QoL), functioning (i.e., community ability), and objective (OSS) and subjective (SSS) measures of social support. Higher ratings of both OSS and SSS were associated with better QoL and functioning at outcome. Participant ratings of objective dimensions of their own social support were shown to be most important in determining life quality and functioning at outcome. Of the two SSS variables, the one most predictive of life quality was the participants’ sense of the provision and receipt of social support. Clinician-rated OSS was a significant predictor of QoL only for participants who rated social support availability as poor. The results of this study may inform policy development, planning, and resource allocation for community treatment programs in Alberta and elsewhere, as there is widespread support both provincially and nationally for increasing community support services and decreasing the number and length of inpatient admissions (Kirby & Keon, 2006). A better understanding of the relative impact of social support variables is essential for further development of effective psychosocial rehabilitation programming. / xvii, 217 leaves ; 29 cm.

The global change in the provision of mental health care services from long-term institutionalization to community-based care brought changes in the care giving responsibilities. This approach shifted the responsibility for the care of individuals with serious mental illness from psychiatric hospitals where health professionals were the primary care-givers, to community health care services where the family members are now the primary care-givers and the major sources of psychosocial support for the individuals with serious mental illness (Chamber, et al., 2001; Seloilwe, 2006). The aim of this study was therefore to explore the care giving burden as perceived by family members of individuals with serious mental illness and the association between their coping strategies and the perceived burden. Methodology: An exploratory-descriptive, non- experimental quantitative study was adopted to describe and explore perceptions of care giving burden by family members, and the association between the perceived burden and the family coping strategies. The Zarit Burden Interview (ZBI) was used to collect data on perceived family burden and the Carers Assessment of Management Index (CAMI) to collect data on coping strategies. The questionnaire was self- administered to 120 family members of the individuals with serious mental illness who accompanied their relatives at the clinic and who met the sample inclusion criteria. Findings: The findings revealed that family members in the uThukela District were experiencing great burden while caring for their relative with serious mental illness. The most influencing factors were the worsened condition of a relative with unmanageable behaviour, poverty, lack of resources including knowledge, rehabilitation centres. Over dependency of a relative with serious mental illness on family members was one of the greatest worries of the participants. The situation negatively affects on the social lives of the family members and on their well being. In terms of coping strategies, family members were found to be using both problem-focused and emotional-focused strategies to balance their coping abilities. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2010.

No abstract available. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.