Mental health needs of the chronically mentally ill elderly.

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health assessment for older people

Marked arteriovenous malformation in the left parietooccipital area manifested only by symptoms of associative migraine involving changes of visual fields indicative of impaired functions of symmetrical compartments of the other brain hemisphere. Visual evoked potentials were changed in this patient because of dysfunction of both hemispheres and largely because of disorders in brain structures symmetrical to the site of arteriovenous malformation. This can be regarded as a manifestation of the so-called stealing phenomenon, when blood supply to one brain compartment is decreased because of excessive blood delivery to other regions of the brain. The results permit us to hypothesize regulation of blood supply to symmetrical compartments of brain hemispheres.     

U.S. mental health policy: Proactive evolution in the midst of health care reform.

Argues that it is vital that psychological and behavioral health care perspectives be explicitly recognized during the coming reform of the US health care system. Mental health policy should not be treated as a mere extension of physical health policy; to do so extends all the flaws of the physical health system into the psychological care arena, resulting in a mismatch with the actual health care needs of the nation. Furthermore, organized psychology must remind policymakers that psychologists provide health services in areas of health care beyond mental health. The challenge to psychology is to ensure the continuation of adequate and timely access to appropriate psychological and behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on Zimet's mental health care revolution.

Corrects the misstatement by C. N. Zimet (see record 1989-27152-001) by stating that the American Psychological Association (APA) Council of Representatives, at the initiation of the Committee for the Advancement of Professional Practice, unanimously adopted resolution IIE, "Resolution on Managed Health Care" (August 1988) making this resolution a policy of APA binding on all its members. The resolution, contrary to opposing managed care, outlined suggestions for practitioners dealing with managed care entities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing risk in a changing health care system

This article examines the information requirements and other strategies needed to manage business and financial risk in health care organizations. The business and financial risk of providers in the changing health care market is defined. The major factors that are increasing risk are outlined, and strategies for measuring and managing risk are discussed. The interaction of business and financial risk is described, and strategic goals that will minimize the effect of this interaction are presented.     

Preventive health care for mentally ill women

Utilization of preventive medical care was compared for two low-income groups--47 women with serious mental illness in an urban mental health center and 17 women patients at a primary care center. Appropriate preventive care was defined as at least one physical examination, a Pap test, and a breast examination in the past five years and a mammogram if the patient was over age 40. Receipt of preventive care by women in both settings was similar. Histories of physical and sexual abuse were prevalent in both groups, and a history of abuse was associated with less frequent receipt of preventive care. Results indicate that procedures to identify and provide services to women with abuse histories should be further developed.     

The chronically ill child in the school.

Focuses on the school attendance and performance problems encountered by chronically ill children (CIC), from the point of their re-entry after diagnosis or treatment. CIC exhibit school related problems, reflected in psychological well being, interaction with peers, academic performance, and higher absenteeism. Inability to attend school may lead to decreased self esteem and hopelessness about the future. Specific aspects of the illness or its treatment, the child's emotional response to the illness, prolonged absence, and learning problems may influence school functioning. Attitudes of parents, teachers, other school personnel and the health care team, and inability of the school to provide necessary daily health care services seriously affect successful school re-entry. School psychologists play an important role in maximizing CIC's success in school, as they prospectively monitor their educational functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religious coping and health status in medically ill hospitalized older adults

Associations between specific religious coping (RC) behaviors and health status in medically ill hospitalized older patients were examined and compared with associations between nonreligious coping (NRC) behaviors and health status. The sample consisted of 577 patients age 55 or over consecutively admitted to the general medical inpatient services of Duke University Medical Center (78%) or the Durham VA Medical Center (22%). Information was gathered on 21 types of RC, 11 types of NRC, and 3 global indicators of religious activity (GIRA). Health measures included multiple domains of physical health, depressive symptoms, quality of life, stress-related growth, cooperativeness, and spiritual growth. Demographic factors, education, and admitting hospital were control variables. "Negative" and "positive" types of religious coping were identified. Negative RC behaviors related to poorer physical health, worse quality of life, and greater depression were reappraisals of God as punishing, reappraisals involving demonic forces, pleading for direct intercession, and expression of spiritual discontent. Coping that was self-directed (excluding God's help) or involved expressions reflecting negative attitudes toward God, clergy, or church members were also related to greater depression and poorer quality of life. Positive RC behaviors related to better mental health were reappraisal of God as benevolent, collaboration with God, seeking a connection with God, seeking support from clergy/church members, and giving religious help to others. Of 21 RC behaviors, 16 were positively related to stress-related growth, 15 were related to greater cooperativeness, and 16 were related to greater spiritual growth. These relationships were both more frequent and stronger than those found for NRC behaviors. Certain types of RC are more strongly related to better health status than other RC types. Associations between RC behaviors and mental health status are at least as strong, if not stronger, than those observed with NRC behaviors.     

The next wave of change for psychology and mental health in the health care revolution.

Recent national changes in the de facto system of health and mental health care are described. Although the percentage of people without health insurance (always or sometimes) has not decreased, the organization of insured care has changed dramatically. Of the insured population, 75% are under some form of managed care. For 88% of the managed care population, mental health care has not been integrated with health care: the so-called carve-out. The author argues that system integration (carve-ins), for a variety of reasons, will begin soon and will occur very rapidly. A tilt toward carve-ins will have substantial impact on psychologists' training, service delivery, and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caring for older people. Community services: health

Many frail or disabled elderly people are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for older people in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental, and dietetic services. In many areas, services are evolving to meet needs and some examples of innovative practice are included.     

Acute health care and Australia's ethnic people

At some stage, people of non-English speaking background (NESB) living in Australia will require acute health care. This in itself is not particularly remarkable or problematic; however, as the mainstream services available to the community are essentially monocultural (i.e. reflect the domination of Anglo-Australian cultural values), it is questionable as to whether the unique needs of Australia's culturally diverse people are being met. The discussion will focus on some of the problems encountered by people of NESB and/or culturally different backgrounds in acute health care services. Nursing as a profession defends rigorously the notions of holistic and morally accountable nursing practice. For my part, it is difficult to accept that unacceptable nursing attitudes and practices toward patients of culturally different backgrounds have been tolerated by the nursing profession--not least, in its failure to correct them, and by virtue of its silence which has, until recently, tacitly validated them. While it might be said that the case studies presented here are few and limited, I am sad to say that there are many other similar examples (see Johnstone & Kanitsaki 1991a, Kanitsaki 1989a, 1983, Parsons 1990). Certainly these cases 'speak for themselves' in depicting a range of unacceptable nursing behaviours.     

Can home care services achieve cost savings in long-term care for older people?

OBJECTIVE: To determine whether efficient allocation of home care services can produce net long-term care cost savings. METHODS: Hazard function analysis and nonlinear mathematical programming. RESULTS: Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. DISCUSSION: Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.     

The mental health care revolution: Will psychology survive?

Managed mental health care, which encompasses a wide variety of approaches, is a response to precipitous increases in health care expenditures, particularly as they relate to mental health care. The shift from what seemed certain to become a national health insurance program only 15 years ago to the profit-driven corporate health care industry of today is truly revolutionary. These profound changes are beginning to have a major impact on the independent practices of psychologists. In this article, psychologist practitioners are exhorted to recognize this new development in the marketplace. Data are cited that show the rapid shift from free choice care to various forms of managed care, and practitioners are urged to participate in shaping the changes that are now in process in order to develop a humane and effective system of mental health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of carers in evaluating mental health services for older people

OBJECTIVES: To examine, using the published literature and local service experience, the contributions that carers can make to the development and evaluation of specialist mental health services for the elderly. METHODS: MEDLINE search for relevant papers about carers and the elderly, especially with mental disorders; review of recent experience of service planning, implementation and evaluation in the Cambridge area. RESULTS: Increased emphasis on the role of carers in recent literature, extending into acknowledgement of the carer perspective in official publications; few papers on the role of carers specifically in evaluating services, with only one study looking solely at an old age psychiatry service. CONCLUSIONS: There is considerable scope for involving carers in the development and evaluation of services, though there are also some potential concerns, not least that carers and users may have different perspectives. These issues are discussed, along with possible future developments, such as the need for a standardized assessment of carer satisfaction.