Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital

OBJECTIVE

The outbreak of severe acute respiratory syndrome (SARS) in 2003 resulted in 346 probable SARS cases and 37 deaths in Taiwan. This descriptive study, which was conducted from May to June 2003, intended to identify staff stress and coping strategies among a SARS team of nursing staff during the outbreak.

METHOD

Twenty-six female nurses of the SARS team completed a questionnaire about their experiences serving in the SARS team.

RESULTS

SARS had both positive and negative psychological impacts on the nurses. While worrying about infecting their families and colleagues, nurses were able to cope with the situation through various means. Additional findings include the need for more psychiatric staff to provide flexible and continuous service, the importance of meetings to improve teamwork and reduce conflict between doctors and nurses and the useful discovery that video cell phones provided needed reassurance from afar to the worried families of the nurses.

CONCLUSION

This study reinforces the importance and benefits of psychiatric services for SARS team members in reducing their secondary traumatization. It is hoped that the results will enhance our knowledge on the needs of frontline health care workers and support the planning of better psychiatric services in future epidemics.

Symptom, family, and service predictors of children's psychiatric rehospitalization within one year of discharge

OBJECTIVE

To investigate predictors of readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care hospitalization.

METHOD

One hundred nine children were followed for 1 year after discharge from inpatient care. Time to rehospitalization was the outcome of interest. Predictors of readmission, examined via the Cox proportional hazards model, were symptom and family factors assessed at admission, aspects of psychiatric treatment, and demographic variables.

RESULTS

The Kaplan-Meier rehospitalization risk within 1 year of discharge, taking into account known readmissions and censored observations, was 0.37. Most readmissions (81%) occurred within 90 days of discharge. Four variables contributed simultaneously to predicting readmission risk. More severe conduct problems, harsh parental discipline, and disengaged parent-child relations conferred a higher risk for rehospitalization; these risks were attenuated when parents disclosed higher stress in their parenting roles.

CONCLUSIONS

Findings showed that psychiatric rehospitalization of children is common, most likely in the trimester after discharge, and highly related to both child symptoms and family factors measurable at admission. Results suggest that efforts to improve postdischarge outcomes of children should target the initial period following inpatient care, address vigorously the complex treatment needs of those with severe conduct problems, and aim to improve parent-child relations.

Decentralisation of Mental Health Services under DMHP

The Bellary model of district mental health programme(DMHP) has been adopted by the government of India under the national mental health programme with the primary aim of making mental health care accessible to all by setting up psychiatric services in peripheral areas, training primary health care personnel and involving the community in promotion of mental health care. The DMHP was set up in Chandigarh in a 50 bedded Civil Hospital in a suburb of Chandigarh.This study aims to present the sociodemographic and clinical data of all cases seen in the first six months and discusses the need of decentralisation of mental health services. A total of 527 patients were seen in the first six months. 52% of the males presented with substance use disorders while a majority of the females (40%) presented with mood disorders. In patients with illness of duration more than one year, upto 51.9% had no past psychiatric treatment and 27.6% were on irregular treatment. Reasons for this are discussed. In conclusion, it was seen that decentralisation was a felt need of the community and required not only in rural but urban areas as well.

Referral gridlock: primary care physicians and mental health services

BACKGROUND

Patients' barriers to mental health services are well documented and include social stigma, lack of adequate insurance coverage, and underdiagnosis by primary care physicians. Little is known, however, about challenges primary care physicians face arranging mental health referrals and hospitalizations.

OBJECTIVE

To examine how practice setting and environment influence primary care physicians' ability to refer patients for medically necessary mental health services.

DESIGN

Cross-sectional analysis using nationally representative survey data from the 1998 to 1999 Community Tracking Study physician survey. The overall survey response rate was 61%.

PARTICIPANTS

A 1998 to 1999 telephone survey of 6586 primary care physicians.

MEASUREMENTS

Primary care physicians' report of whether they could obtain medically necessary referrals to high-quality mental health specialists or psychiatric admissions.

RESULTS

Overall, 54% of primary care physicians reported problems obtaining psychiatric hospital admissions, and 54% reported problems arranging outpatient mental health referrals. Primary care physicians practicing in staff and group model HMOs were much less apt to report difficulties than physicians in solo and small-group practices (P <.001). Reports of inadequate time with patients (P <.001) and smaller numbers of psychiatrists in a market area (P <.01) also were associated with problems obtaining mental health referrals. Pediatricians were more apt to report problems than general internists (P <.001).

CONCLUSIONS

Primary care physicians face greater hurdles obtaining mental health services than other medical services. Primary care is an important entry point for mental health services, yet inadequate referral systems between medical and mental health services may be hampering access.

Clinical profile of patients attending a prison psychiatric clinic

Psychiatric morbidity is higher in prison inmates as compared to that in general population but treatment facilities are often inadequate. The present work reports the profile of psychiatric patients seen in a jail hospital over a period of three months. The jail had about 9000 inmates. Psychiatric services consisted of weekly visit by a psychiatrist. Seventy two male inmates were seen during the period of study. Most of them (80%) were undertrials. Diagnosis included schizophrenia, depression, bipolar disorder, anxiety disorders, and malingering. Stress of imprisonment contributed to the illness only in a small percentage of patients. Among the admitted patients, jail environment interfered with improvement. Frequent relapses were noted among the improved schizophrenic patients when transferred back to the jail. The study emphasises the need for improving the conditions in jail and developing prison psychiatric units to be managed by psychiatrists.