Search results

1 – 10 of over 10000
To view the access options for this content please click here
Article
Publication date: 14 June 2021

John M. Majer, Ted J. Bobak and Leonard A. Jason

The purpose of this study is to examine the relationship between psychiatric severity and stress among persons utilizing medication assisted treatment (MAT), and there is…

Abstract

Purpose

The purpose of this study is to examine the relationship between psychiatric severity and stress among persons utilizing medication assisted treatment (MAT), and there is a need to identify resources that promote resilience against these risk factors. Although recovery homes might complement pharmacological interventions for persons using MAT, a lack of homophily (e.g. similar experiences) among residents could produce stress and increase psychiatric severity. The purpose of this paper is to examine stress and psychiatric severity in relation to recovery outcomes, and whether homophily moderated these relationships.

Design/methodology/approach

A cross-sectional analysis was conducted among recovery home residents who were recruited from the USA, including those using (n = 40) and not using (n = 132) MAT. Participants’ levels of psychiatric severity, stress, abstinence self-efficacy and quality of life were assessed in addition to whether residents using MAT were living with at least one other resident who used MAT. Moderated mediation analyses were conducted to examine whether homophily among residents using MAT would moderate the mediating effects of stress on the relationships between psychiatric severity and recovery outcomes (abstinence-self efficacy, quality of life).

Findings

Mediating effects were observed but they were significant only through homophily. Although stress increased the negative effects of psychiatric severity among residents using MAT, significantly lesser effects were observed among those living with residents using MAT.

Practical implications

Although psychiatric (problem) severity and stress threaten recovery for persons with substance use disorders, little is known how they impact recovery among those living in community-based settings such as recovery homes. In addition, there is a need to identify community resources that would complement MAT protocols, as patients who use MAT face unique stressors related to their sense of shared interests and experiences (i.e. homophily) when developing social bonds with others in recovery.

Social implications

This study suggests the social networks within recovery homes reduce the effects of psychiatric severity and stress, and that these effects are lessened for residents who use MAT when they live with others who also use MAT.

Originality/value

Little is known about recovery home residents who use MAT and have high psychiatric severity. Findings suggest homophily among persons using MAT living in recovery homes who have high psychiatric severity can promote resilience.

To view the access options for this content please click here
Article
Publication date: 29 March 2021

Pia Vedel Ankersen, Rikke Grynderup Steffensen, Emely Ek Blæhr and Kirsten Beedholm

Life expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are…

Abstract

Purpose

Life expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are significant causes, the Central Denmark Region set out to implement joint psychiatric and somatic emergency departments (EDs) to support integrated psychiatric/somatic care as an effort to prolong the lifetime of individuals with mental illness. Through the lens of Normalization Process Theory, the authors examine healthcare frontline staff’s perceptions of and work with the implementation of integrated psychiatric/somatic care in the first joint-specialty ED in Denmark.

Design/methodology/approach

A single-case mixed-methods study using Normalization Process Theory (NPT) as an analytic framework to evaluate implementation of psychiatric/somatic integrated care (IC) in a joint-specialty emergency department. Data were generated from observations, qualitative interviews and questionnaires distributed to the frontline staff.

Findings

Implementation was characterized by a diffuse normalization leading to an adaption of the IC in a fuzzy alignment with existing practice. Especially, confusion among the staff regarding how somatic examination in the ED would ensure prolonged lifetime for people with mental illness was a barrier to sense-making and development of coherence among the staff. The staff questioned the accuracy of IC in the ED even though they recognized the need for better somatic care for individuals with mental illness.

Practical implications

This study highlights that a focus on outcomes (prolonging lifetime for people with mental illness and reducing stigmatization) can be counterproductive. Replacing the outcome focus with an output focus, in terms of how to develop and implement psychiatric/somatic IC with the patient perspective at the center, would probably be more productive.

Originality/value

In 2020, the Danish Health Authorities published new whole-system recommendations for emergency medicine (EM) highlighting the need for intensifying integrated intra and interorganizational care including psychiatric/somatic IC (ref). Even though this study is not conclusive, it points to subjects that can help to identify resources needed to implement psychiatric/somatic IC and to pitfalls. The authors argue that the outcome focus, prolonging the lifetime for individuals with mental illness by identifying somatic illness, was counterproductive. In accordance with the recommendations of contemporary implementation studies, the authors recommend a shift in focus from outcome to output focus; how to develop and implement psychiatric/somatic IC.

Details

Journal of Integrated Care, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1476-9018

Keywords

To view the access options for this content please click here
Book part
Publication date: 5 February 2010

Stephanie Hartwell

Purpose – This chapter describes the problem of and approaches to ex-inmates with psychiatric disabilities exiting correctional custody. Although all ex-inmates must find…

Abstract

Purpose – This chapter describes the problem of and approaches to ex-inmates with psychiatric disabilities exiting correctional custody. Although all ex-inmates must find housing and employment, persons with psychiatric disabilities require linkages to various health-related services and supports. These linkages are necessary, but it is unknown whether they are sufficient because discharge planning services and transition programs for ex-inmates with psychiatric disabilities historically lack an evidence base.

Approach – After a decade, the first-generation re-entry programs for ex-inmates with psychiatric disabilities have yielded little in the way of empirical data, but they have provided models for program expansion and imperatives for second-generation program assessment. Related research findings for first- and second-generation programs are highlighted with an emphasis on a unique statewide program in Massachusetts.

Findings – A review of the first- and second-generation programs suggests that progress has been slow in identifying empirically supported best practices for this population. There is a growing evidence base that community reintegration outcomes for ex-inmates with psychiatric disabilities are the result of demographic and criminal history variations, yet implications of these variations needs further exploration in the realms of service access and receptivity as well as variations in postrelease adaptation.

Implications – More knowledge and innovative research is needed on the experience of ex-inmates with psychiatric disabilities and social integration. Resources for cost effectiveness studies as well as long-term follow-up qualitative studies are necessary.

Details

New Approaches to Social Problems Treatment
Type: Book
ISBN: 978-1-84950-737-0

To view the access options for this content please click here
Book part
Publication date: 17 October 2005

Jennifer Davis-Berman and Frances G. Pestello

This article presents a typology of the medicated self, as developed through in-depth interviews with twenty-two social work students and practitioners. Utilizing an…

Abstract

This article presents a typology of the medicated self, as developed through in-depth interviews with twenty-two social work students and practitioners. Utilizing an interactionist perspective, the experience of taking psychiatric medication is examined in both samples, using a comparative analysis. Emphasis is placed on the impact of taking psychiatric medication on the sense of self. The data suggest that the development of a medicated self is complex and varied, and includes a small number of those who feel that medication led to an improved self, and the majority who felt damaged by their experience with medication, and expressed varying degrees of ambivalence about its use. Despite this ambivalence, most of our respondents seemed to develop an altruistic, empathetic self geared toward helping others. This self emerged in spite of respondents saying that their self was damaged. Implications are presented, and conclusions and suggestions for further work on the impact of psychiatric medication use on the self are presented.

Details

Studies in Symbolic Interaction
Type: Book
ISBN: 978-0-7623-1186-6

Abstract

Details

Soldiers on International Missions
Type: Book
ISBN: 978-1-78973-032-6

To view the access options for this content please click here
Book part
Publication date: 4 July 2016

Adrianna Bagnall and Gil Eyal

We compare the deinstitutionalization of psychiatric patients and the developmentally disabled in the United States and demonstrate that there were two path-dependent…

Abstract

Purpose

We compare the deinstitutionalization of psychiatric patients and the developmentally disabled in the United States and demonstrate that there were two path-dependent processes with significant qualitative and quantitative differences, ultimately leading to better outcomes for developmentally disabled individuals.

Design

Using secondary literature, we construct a sustained comparison of the two processes in terms of outcomes, timing, tempo, extent, funding, demographic composition, and investment in community services. We then reconstruct the strategies of de-stigmatization and framings of moral worth deployed in the two cases, analyzing their effects on deinstitutionalization in terms of conceptions of risk, rights, and care.

Findings

Deinstitutionalization began later for developmentally disabled individuals than for psychiatric patients, and was a more gradual, protracted process. It was not driven by fiscal conservatism, discharges, and the trans-institutionalization of the senile aged, as was deinstitutionalization for psychiatric patients, but primarily by the prevention of institutionalization of young children, and increased investment in infrastructure. Consequently, the deinstitutionalization of the developmentally disabled was far more thorough and successful. The process was shaped by the framing of the developmentally disabled as “forever children” by parents’ organizations that demanded a balance between autonomy, protection, and the provision of care. In contrast, the deinstitutionalization of psychiatric patients was shaped by their framing as autonomous citizens temporarily suffering from “mental health problems” that could be prevented, treated, and cured. This frame foregrounded the right to choose (and also refuse) treatment, while undervaluing the provision of care.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

Keywords

To view the access options for this content please click here
Article
Publication date: 11 May 2015

VIRGININIA DUBE-MAWEREWERE

– The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe.

Abstract

Purpose

The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe.

Design/methodology/approach

The study used the grounded theory approach utilising a mixed sequential dominant status design (QUAL/Quant). Pierre Bourdieu’s conceptual canon of field, habitus and capital was used as a theoretical point of departure by the research study. Confirmatory retrospective document review of 119 patients’ files was also done to substantiate the nurses’ experiences. Theoretical sampling of relatives was also done.

Findings

Findings and results revealed that nurses seemed to experience infrahumanisation, a subtler form of dehumanisation. The infrahumanisation was embodied in the unpleasant context in which nurses were expected to perform their mandate of championing rehabilitation of forensic psychiatric patients. The guards who represented the prison system seemed to possess all forms of capital in the prison system (where special institutions are housed): the prison cultural capital, social capital and economic capital. This capital seemed to represent symbolic power over the disillusioned and voiceless nurses. Guards attended to and discussed patients and relatives issues instead of nurses. This form of misrecognition of the nurses culminated in dominance and reproduction of the interests of the prison system which underlined the established order of realities in the rehabilitation of forensic psychiatric patients in special institutions at the time of the study. The nurses’ lived experience was confirmed by theoretically sampled by relatives of forensic psychiatric patients who also participated in the research study. Nurses’ powerlessness was also reflected in the patients’ files in which in which care was largely not documented.

Research limitations/implications

The study focused on the nurses experiences related to rehabilitation of male forensic psychiatric patients and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. For the little documentation that was done, there was also a tendency nurses to document negative rather than positive events and trends. The documents/files of patients had therefore a negative bias which was a major limitation to this study.

Practical implications

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting. Collaboration as academia, practice, professional organisations and regulatory bodies would foster a nurse led therapeutic jurisprudence in the future of rehabilitation of forensic psychiatric patients in Zimbabwe.

Social implications

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting.

Originality/value

This is the first description of the position of nurses’ seconded to special institutions in Zimbabwe and will go a long way in realigning conflictual policy documents guiding care of forensic psychiatric patients in special institutions.

Details

Journal of Forensic Practice, vol. 17 no. 2
Type: Research Article
ISSN: 2050-8794

Keywords

To view the access options for this content please click here
Article
Publication date: 20 September 2019

Enayatollah Homaie Rad, Leyla Amirbeik, Mohammad Hajizadeh, Shahrokh Yousefzadeh-Chabok, Zahra Mohtasham-Amiri, Satar Rezaei and Anita Reihanian

Mental health is an inevitable and vital dimension when it comes to providing a global definition for the appropriate health status. This highlights the importance of…

Abstract

Purpose

Mental health is an inevitable and vital dimension when it comes to providing a global definition for the appropriate health status. This highlights the importance of investigating factors influencing utilization and out-of-pocket payments (OOP) for mental health services. Thus, the purpose of this paper is to assess the determinants of the utilization and OOP for psychiatric healthcare in Iran.

Design/methodology/approach

A total of 39,864 households were included in this cross-sectional study. Data on the utilization and OOP for psychiatric healthcare as well as all their determinants (e.g. wealth index of households, geographical area, household size, etc.) were extracted from the Household Income and Expenditure Survey (HIES). The HIES was conducted by the Statistical Center of Iran in 2016. A zero-inflated Tobit model was used to identify the main factors affecting utilization and OOP for psychiatric healthcare utilization.

Findings

The average of utilization and OOP for psychiatric services was found to be 14.67 times per 1,000 households and $7.783 per month for service users, respectively. There were significant positive relationships between income and utilization (p=0.0002) and OOP (p<0.0001) for psychiatric services. Significant negative associations were found between the number of illiterate people in the household and OOP (coefficient=−1.56) and utilization (coefficient=−0.2002) for psychiatric services. Utilization and OOP for psychiatric services were statistically significantly higher among households with higher wealth status.

Originality/value

Despite the higher rate of mental disorders, the utilization of psychiatric services in Iran is very low. Due to financial barriers and insufficient insurance coverage, high socioeconomic status (SES) households utilize more psychiatric services than low-SES households. Thus, the integration of mental health services in public health programs is required to improve the utilization of psychiatric services in Iran.

Details

Journal of Public Mental Health, vol. 19 no. 2
Type: Research Article
ISSN: 1746-5729

Keywords

To view the access options for this content please click here
Article
Publication date: 7 November 2016

Thokozani Bvumbwe

The purpose of this paper is to explore newly graduated nurses’ experiences of their preparation for psychiatric nursing practice in Malawi. Knowledge of how basic or…

Abstract

Purpose

The purpose of this paper is to explore newly graduated nurses’ experiences of their preparation for psychiatric nursing practice in Malawi. Knowledge of how basic or undergraduate nursing training programs prepare nurses for mental health services will inform educators to maximize the teaching and learning processes. Students are a key stakeholder in professional training hence an understanding of their experiences of training programs is critical.

Design/methodology/approach

A qualitative exploratory study was undertaken. In total, 16 newly graduated nurses with six months work experience at three psychiatric hospitals in Malawi were purposively sampled and recruited into the study. One to one interviews which lasted almost 45 minutes were conducted. Data were analyzed using content analysis.

Findings

Findings show that training programs fall short in preparing students for psychiatric nursing practice. Participants reported little attention to the specialty as compared to other specialties by educators. Inadequate academic support during practice sessions was highlighted by the majority of participants.

Research limitations/implications

The study needed to compare the findings with experiences of students who have been allocated to other nursing specialties.

Originality/value

Psychiatric nursing specialty remains the least preferred career choice for many nursing students. However, preservice nursing education programs are expected to socialize, motivate and prepare students for psychiatric practice as well. It is therefore critical to understand gaps that exist in student preparation for psychiatric nursing services in order to improve mental health training.

Details

The Journal of Mental Health Training, Education and Practice, vol. 11 no. 5
Type: Research Article
ISSN: 1755-6228

Keywords

To view the access options for this content please click here
Article
Publication date: 2 September 2014

Wouter Stassen, Petra Habets, Astrid Mertens, Jan De laender and Inge Jeandarme

In Belgium approximately a quarter of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. This situation has yielded the Belgian…

Abstract

Purpose

In Belgium approximately a quarter of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. This situation has yielded the Belgian government several convictions from the Human Rights Court in Strasbourg. In an attempt to facilitate admissions from penitentiary to psychiatric hospital, the Forensic Department of the psychiatric hospital in Rekem (OPZC Rekem), has piloted the InReach project. The paper aims to discuss these issues.

Design/methodology/approach

The objective of this project is to engage a psychiatric nurse on the ward in pretherapeutic and motivational activities on a regular basis in the penitentiary for vulnerable groups of forensic psychiatric patients, forming a bridge between penitentiary and hospital. The InReach project even considers patients who have no desire to leave the penitentiary (e.g. due to their psychiatric profile). A motivational approach is used to support these patients in making the transition from penitentiary to hospital.

Findings

The current article describes the focus of the InReach project (procedures and InReach candidate profiles) together with the first impressions of the progress that has been made by the InReach project. In addition two case studies of InReach patients are presented. The InReach project is clearly needed in Belgium and because of its success it has been extended to another penitentiary. It is probable the two other medium-security wards will also be included in the project in the near future.

Originality/value

The Belgian government has received several convictions from the Human Rights Court in Strasbourg because a substantial number of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. The InReach project presented in this paper is clearly needed in Belgium and was implemented to initiate and facilitate the transition from penitentiaries to treatment facilities. The need for this type of project is reflected in the number of forensic psychiatric patients that reside within a penitentiary and that are not able or willing to make the transition to a treatment facility because of their psychiatric profile.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 35 no. 3
Type: Research Article
ISSN: 0964-1866

Keywords

1 – 10 of over 10000