Dental care for children with mental retardation: thoughts about the Americans with Disabilities Act

The Americans with Disabilities Act bars discrimination in public accommodations, housing, employment and health care for people with disabilities. Efforts to "mainstream" (in housing and education) many of the individuals with mental retardation have altered the setting for dental services and place demands for services by dental practitioners in the community. These developments should be considered within the jurisdiction of this new legislation. Demographic characteristics and dental needs of children with mental retardation are reviewed to provide a background for this discussion.     

Normal housing with specialized supports: A psychiatric rehabilitation approach to living in the community.

Presents a conceptual and historical overview of residential services for Ss with psychiatric disability and challenges the appropriateness and effectiveness of the "continuum of services" model. The authors propose that the goal of residential services should be to assist all people with psychiatric disabilities to choose, obtain, and maintain normal housing and that rehabilitation technology is currently available to accomplish this goal. Data indicate that despite high costs, most state mental health systems are continuing to make large scale investments in facility-based residential programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discharge of psychiatric patients into the community: how many more must die?

Since the advent of community care, mental health services are increasingly coming under scrutiny, particularly the management of people with mental health problems in the community. Several murders committed by psychiatric patients in the community have fuelled public debate. This article reports on a study examining the recommendations of the Department of Health regarding the discharge of psychiatric patients from hospital to community care. It describes the background to events such as the Clunis report and guidance from the Department of Health on the management of mental health services. Semi-structured interviews, questionnaires and document analysis were used to ascertain the views of community psychiatric nurses and managers regarding the discharge of patients into the community. The findings identify areas of good practice and the need for nurses to improve their knowledge of the care-programming approach, risk assessment and inter-agency collaboration.     

Characteristics of the populations at the Robert Giffard Psychiatric Hospital Center: people with intellectual deficiencies and people with mental disorders

Within the context of the general reorganization of health care and social services in Québec, the present study aims at describing physical and mental characteristics of persons with mental health problems and who are mentally retarded still hospitalized in a psychiatric hospital. In the first study, 146 mentally retarded persons of which 74 formed the community group and 72 the institutionalized group. The results indicate that 84% of the mentally retarded persons still hospitalized manifested sufficiently important needs on the three measured variables (health, deficits and behaviors) to justify intensive care in a structured environment. The Behavior variable is more important in deciding the integration of these people in the community. As most of these persons have a higher level of disabilities and more behavior manifestations, the support required for these people in the community and persons delivering services will have to be more structured and intensive in nature. In the second study, 928 psychiatric patients still hospitalized were studied on the variables, age, sex, diagnostics and the global scores (physical and mental) of the level of care survey and functional autonomy. The results show that the proportion of women in the age group 35 and older were progressively increasing in relation to the men. The primary diagnostic reported more frequently was schizophrenia in 70% of cases. In the evaluation of physical care of the people still hospitalized, age becomes an important factor. Generally speaking, the population within the institution is aging and women are progressively growing in number. As these people expressed more physical ailments and a decline in basic autonomy, more structured and specialized care and support will be required to respond to their needs.     

Helping disabled people--the user's view

The main needs for most people with physical disabilities are housing and help with daily living. Thus, many of them will find the new emphasis on social aspects of community care particularly relevant. Peter Swain is a disabled man who leads a project in east Devon which ensures that disabled people have a voice in helping to shape the services they need. In this article he explains how the project, Living Options East Devon, works and how the new legislation for community care might affect disabled people.     

An integrative ideology to guide community-based multidisciplinary care of severely mentally ill patients

Most practitioners working in community support settings understand the need to provide a comprehensive array of well-coordinated services to individuals with severe mental disabilities. However, a lack of consensus about the conceptual basis of mental health care, especially between advocates of psychosocial rehabilitation and psychiatric practitioners who favor a more medically oriented approach, has hindered efforts to optimize the effectiveness of the multidisciplinary teams found in most community support programs. The authors articulate 18 basic assumptions that have been helpful in their clinical practice in building an integrative ideology among professionals with disparate training and orientations. The assumptions attempt to balance the reality of psychiatric disorders with a fundamental interest in maintaining the autonomy and dignity of people with severe mental disorders.     

Rapid detection and counting of viable bacteria in vegetables and environmental water using a photon-counting TV camera

A physical, cognitive, or mental disability presents significant challenges to an individual in gaining access to a coordinated program of preventive, primary, and secondary health care services. This article describes the health care needs of people with disabilities and discusses how the financial incentives in managed care may threaten access to the health care services they need to maintain their health and functional independence. We argue that despite the shortcomings of present models, managed care has the potential to improve the health care of people with disabilities. Moreover, as health plans become increasingly accountable to consumers (and begin to compete on the basis of quality), they will not be able to ignore the distinct health care needs of people with disabilities.     

Intensive care for people with serious mental illness

This article describes the development of a psychiatric 'intensive care' service for men and women with serious or enduring forms of psychotic disorder. The authors suggest that such a residential therapeutic service may be an essential part of the development of community care for the most vulnerable people served by mental health services.     

Employers' attitudes towards employment of people with mental illnesses in Mzuzu, Malawi

In Mzuzu as elsewhere, people with mental health problems have trouble finding and keeping jobs, and one aim of psychiatric rehabilitation is to assist them in this. This requires an understanding of the factors which lead to under-employment in this group, including the stigmatising attitudes of potential employers. Our survey explored this with hand delivered questionnaire administered to 58 of the main employers in Mzuzu, of whom 46 (79%) responded. Despite an often assumed negative attitude towards the mentally ill, we did not find high levels of stigmatisation or discrimination against this group. Fifty two per cent of respondents stated that they would consider offering work to recovered psychiatric patients and might even adapt working practices or provide extra training to accommodate them. As well as guiding our community education programmes on mental health the findings have implications for psychiatric rehabilitation services in the region, which as well as attending to daily living skills and rural crafts should be focused to maximise clients' employment opportunities on the open job market.     

The Disclosure Conundrum: How People With Psychiatric Disabilities Navigate Employment.

The vocational rehabilitation and mental health literatures usually urge people with psychiatric disabilities to disclose their disability at work. Reasons for preferring disclosure include the opportunity to invoke rights conferred by the Americans with Disabilities Act of 1990, the risk of losing federal disability benefits when earning a higher income, and the belief--held by many professionals--that people with psychiatric disabilities will experience permanently debilitating symptoms. However, a newer model of recovery from psychiatric disability challenges these assumptions. A qualitative study of people with psychiatric disabilities explored these issues. The participants were current or former recipients of social security benefits provided to persons with significant disabilities. Participants described complex situations around employment and disclosure, which were more difficult to resolve than disclosure advocates have recognized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CMHS data highlights on: availability of psychiatric beds, United States: selected years, 1970-1990

Despite the decrease from 474,190 to 250,541 between 1970 and 1990 in the overall number of non-Federal psychiatric beds (excluding "scatter" beds in non-Federal general hospitals), the trend was by no means constant over time. Between 1970 and 1982, a period of rapid deinstitutionalization of State mental hospitals, the number of beds in all organizations combined dropped precipitously from 474,190 to 222,666, led by State mental hospitals which decreased from 413,066 to 140,140 beds. This was the height of the community mental health center movement and the prevailing view of mental health administrators was that persons with mental illness could be cared for better in the community, rather than at State mental hospitals, far from their homes. Thus, some hospitals closed altogether, and many others closed wards and units as part of the downsizing process. Contrary to a decrease in the number of beds in State mental hospitals during the 1970-82 period, the number of beds in other organization types, in particular private psychiatric hospitals and separate psychiatric services of non-Federal general hospitals, remained relatively constant. The net result was a substantial decrease in the overall number of non-Federal psychiatric beds. In the 1982-90 period, a different phenomenon occurred. The number of beds in State mental hospitals was continuing to decline, but at a slower rate from 140,140 to 98,789, while the number of beds in other types of mental health organizations, particularly private psychiatric hospitals and separate psychiatric inpatient services of non-Federal general hospitals, expanded somewhat.(ABSTRACT TRUNCATED AT 250 WORDS)     

Elderly persons in old-age homes. A medical, psychiatric and social investigation

A survey of 100 consecutive admissions to homes for elderly Whites in Cape Town showed that an interplay of social, physical and psychiatric factors was responsible for most of the referrals, although psychiatric factors contributed to more than 50% of them. The largest proportion (37%) suffered from confusional states, 31% were diagnosed as having a senile organic condition and 25% showed moderate to severe depression. These old people were physically very frail; 53% had incapacitating muscular weakness or stiff and painful joints, 35% had a significant degree of deafness, 25% had a visual defect and 23% were incontinent. The findings indicate that old-age homes deal with a considerable amount of physical and mental ill health, and they are therefore an essential part of health services. The residents of old-age homes were much older than elderly people in the community, as well as being more socially isolated and very disadvantaged in terms of income and family and social support.     

The sexual health needs of people with learning disabilities

The sexual health of people with learning disabilities raises important management and practice issues for health services, and should be examined in the context of the current policy emphasis on advocacy, person-centred services and social inclusion (Department of Health, 2001). People with learning disabilities may have limited access to mainstream health services, and sexual health and genitourinary medicine (GUM) services are no exception (DoH, 2001; 1998). They are often excluded from society, either because they are 'segregated' within specialist support services in the community or because they live in isolation with carers, and health and social care models do not always join up locally to meet their needs.     

Accounting for case manager effects in the evaluation of mental health services.

Three methods of accounting for case manager effects in tests of the efficacy of mental health services are explored. These methods include (1) treating the case manager as a fixed factor, (2) treating the case manager as a random factor, and (3) examining service effects within the case manager. They are demonstrated with data from a nationally known case management program serving individuals with serious and persistent mental illness. Specifically, 3 conceptually distinct types of services provided or brokered by case managers are identified: habilitation-rehabilitation, community support, and traditional psychiatric services. The effectiveness of each in improving clients' adjustment is then examined with multiple regression adjustment strategies and each of the 3 methods to account for case manager effects. The results provide strong support for effects attributable to case managers and some support for the efficacy of habilitation-rehabilitation and community support services beyond the effects of traditional psychiatric services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pneumonitis after radiotherapy of bronchial carcinoma: incidence and influencing factors

The main purpose of the study was to describe the characteristics of homeless psychiatric patients, and to compare the treatment they are offered to that offered to domiciled patients by the psychiatric services. Another purpose was to analyse the prevalence of homelessness among psychiatric patients before and after the introduction of community mental health centres in Copenhagen. Cross-sectional studies were conducted in two intervention and two control districts before and after introduction of the new treatment modalities. In 1991, 80 of 1008 patients (8%) were homeless. Male sex, young age, living on general welfare, schizophrenia and alcohol or substance abuse were the factors that most markedly differentiated homeless from domiciled patients. Compared with the treatment of domiciled patients, the homeless were more likely to be offered no further treatment after consultation in a psychiatric emergency and, if admitted, they were more likely to be placed in locked wards, given compulsory medication, and medicated with depot neuroleptics. The homeless were also less likely to be offered psychotherapy and consultation with a social worker. Schizophrenia and alcohol or substance abuse characterised the majority of the patients discharged homeless. In the intervention districts, the number of homeless patients in contact with the psychiatric services was found to increase at the same rate as the number of all patients in contact with the psychiatric services. In the control districts, no changes in prevalence of homeless patients or other patients in contact with the psychiatric services occurred. It is concluded that homeless psychiatric patients comprise a difficult patient group, with problems of schizophrenia, substance abuse and lack of motivation for treatment. It is recommended that special efforts be made to create housing facilities that fit the needs of different types of homeless patients, and that the homeless mentally ill are assisted in obtaining and maintaining an acceptable housing situation.     

Transcultural therapy. 2: Mental health and learning disabilities

The first article in this two-part series (Vol 7(15): 901-6) examined the issues surrounding healthcare provision in the context of the UK as a multicultural society in relation to mental health and learning disabilities. This second article considers the development of psychotherapy, theory and skills of working in terms of its impact and influence upon the education and practice of community mental health nurses and community nurses in learning disability within the UK. The major schools of influence in psychology will be examined in relation to their limitations for practice with clients from various cultures. In addition, three multicultural models of counselling which address cultural diversity will be appraised. Finally, the need for educational systems and service providers to foster and develop positive cultural attitudes among nurse practitioners will be emphasized. Both individual practitioners and employment organizations will need to be much more responsive and committed to developing multicultural services as we approach the millennium.     

Social work with transport disabled persons: a wayfinding perspective in health care

Transport disabled persons confront extensive architectural and psychosocial barriers during their travel to community based health care services by mass transit. The current health care reform movement affords social work an opportunity to consolidate its expertise with this population. The Certificate of Need program is a method with which social work can provide service to people with transportation disabilities. Social work can also continue its use of the Americans with Disabilities Act and the Urban Mass Transportation Act to assist people with transport disabilities to access community based health care services.     

The costs of schizophrenia

Schizophrenia is regarded as the most expensive mental illness because of its specific symptoms and characteristics (e.g. early onset, often chronic course, high rates of readmission to hospital treatment, high rate of disabilities and extensive rehabilitative interventions), which prove to be extremely costly. Despite this, studies on the financial aspects of schizophrenia or the provision of care for schizophrenic patients has become an issue of psychiatric research only since the beginning of the reform of mental healthcare. Early cost studies had been conducted in the United States (US) during the fifties. Since then, they have grown in number not only in the US and in Great Britain, but also on the Continent of Europe. On an international level, comprehensive literature concerning methodology has attempted to establish cost studies as an integral part of mental health services research. Germany, however, is far behind international developments. Although the fundamental lack of empirical data on costs both in psychiatry as a whole and in schizophrenia had already been ascertained in a large national survey called "Psychiatrie-Enquête" in the mid-seventies, little has changed since then. One reason for these possibly great methodological problems is associated with the assessment of cost data in fragmented community mental health care networks, which in Germany include the additional obstacle--unlike abroad--of non-availability of access to data from case registers. Psychiatric case registers are not permitted in Germany because of very strict data protection laws. Despite the problems in methodology, there is an urgent need in Germany to remedy the lack of cost data for schizophrenic-patient care. The pressure of curbing costs in health care will probably force the German mental health care services to provide detailed cost data with regular reports in the future.     

Dexamethasone concentration in vitreous and serum after oral administration

OBJECTIVE: To assess the outcomes of changes in mental health policy introduced in Italy in 1978. METHODS: Data on psychiatric services, before and after the policy change, are presented. Effects of change are evaluated through indicators related to four issues: transfer of care, criminalisation of the mentally ill, suicides, and homelessness. RESULTS: Admissions of new patients to mental hospitals have been stopped and the size of the mental hospital population is now very low (26 per 100,000 population). Psychiatric care has been shifted to community services including general hospital psychiatric units. There has been an overall reduction of psychiatric hospitalisation. However, the provision of residential facilities is inadequate and community services are unevenly distributed across the country. Few negative effects of changing patterns of care have been reported, although the low quality of data limits the validity of such a conclusion. Outcome of care in areas where the full range of community services is available has been rated as satisfactory. CONCLUSIONS: Although care of the mentally ill has been shifted to community services, we lack hard data on the social and clinical outcome of community care at the nation-wide level. Long-term monitoring and evaluation of community services is a high priority in Italy.     

Sexual health for people with learning disabilities

This article is based on work into the sexual health needs of people with learning disabilities, carried out by a working group of the RCN Family Planning Forum. Literature searches were conducted, and local initiatives, specialist services and information sources for training and education for clients and staff were identified. The authors' aim in this article is to increase awareness among those involved in the care of people with learning disabilities and those providing family planning and sexual health services, so that these services are appropriate, accessible and sensitive to the needs of this vulnerable client group.