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Felton MC, Cashin CE, Brown TT. What does it take? California county funding requests for recovery-oriented full service partnerships under the Mental Health Services Act. Community Ment Health J 2010; 46:441-51. [PMID: 20440560 PMCID: PMC2929427 DOI: 10.1007/s10597-010-9304-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 04/08/2010] [Indexed: 11/25/2022]
Abstract
The need to move mental health systems toward more recovery-oriented treatment modes is well established. Progress has been made to define needed changes but evidence is lacking about the resources required to implement them. The Mental Health Services Act (MHSA) in California was designed to implement more recovery-oriented treatment modes. We use data from county funding requests and annual updates to examine how counties budgeted for recovery-oriented programs targeted to different age groups under MHSA. Findings indicate that initial per-client budgeting for Full Services Partnerships under MHSA was maintained in future cycles and counties budgeted less per client for children. With this analysis, we begin to benchmark resource allocation for programs that are intended to be recovery-oriented, which should be evaluated against appropriate outcome measures in the future to determine the degree of recovery-orientation.
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Affiliation(s)
- Mistique C Felton
- Nicholas C. Petris Center on Health Care Markets and Consumer Welfare at the University of California, 50 University Hall, MC7360, Berkeley, CA 94720, USA.
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52
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Mfoafo-M'Carthy M, Williams CC. Coercion and Community Treatment Orders (CTOs): One Step Forward, Two Steps Back? ACTA ACUST UNITED AC 2010. [DOI: 10.7870/cjcmh-2010-0006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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53
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Piat M, Sabetti J, Bloom D. The transformation of mental health services to a recovery-orientated system of care: Canadian decision maker perspectives. Int J Soc Psychiatry 2010; 56:168-77. [PMID: 20207679 PMCID: PMC4835229 DOI: 10.1177/0020764008100801] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recovery is emerging as a worldwide paradigm in mental health. There is increasing recognition that the transformation of mental health systems to a recovery perspective requires collaboration among all stakeholders. Research to date has focused on the perspectives of service users and providers. The role and influence of organizational decision makers in the transformation process has been less studied. MATERIALS This study reports findings from semi-structured interviews with decision makers on the implementation of recovery in Canada. DISCUSSION Decision makers view community-based services as most open to recovery-based approaches, and front-line providers as pivotal in implementing system change. Decision makers described their own role as limited to providing overall orientation and funding. CONCLUSIONS The shift to recovery must include active leadership from decision makers as a catalyst to change.
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Affiliation(s)
- Myra Piat
- Douglas Mental Health University Institute, McGill University, Montreal, Canada.
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54
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Abstract
OBJECTIVE This paper discusses choice in mental health supported housing, providing results from a longitudinal study of two models of supported housing (a higher support and a lower support model). METHODS The progress of 27 tenants at the two sites was tracked on measures of satisfaction with housing, social support satisfaction, mental health, physical health, and mastery over the course of one year. Measurements were taken at baseline, 6 months, and 12 months. RESULTS Although there were trends toward positive changes at both sites, with the Bonferroni adjustment, only positive within group changes in perceptions of physical health between baseline and 12 months at the higher support site endured. There were no significant differences in changes between the two sites. CONCLUSIONS We conclude that there appears to be some support for the positive effects of choice in mental health supported housing. Further research in this area will require flexible programming and funding that create opportunities for true partnerships with consumer-survivors.
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Shared decision making in public mental health care: perspectives from consumers living with severe mental illness. Psychiatr Rehabil J 2010; 34:29-36. [PMID: 20615842 DOI: 10.2975/34.1.2010.29.36] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Most theoretical and empirical work regarding decision making in mental health suggests that mental health consumers have better outcomes when their preferences are integrated into quality of life decisions. A wealth of research, however, indicates that providers have difficulty predicting what their clients' priorities are. This study investigates consumer decision-making preferences and understanding of construction of decisions in community mental health. METHODS People living with severe mental illness being treated in the public mental health care system (N=16) participated in qualitative interviews regarding case management decision making as a part of a larger study investigating a decision support system to facilitate shared decision making. Interviews were transcribed, coded, and cross-case thematic analyses were conducted. RESULTS Mental health consumers generally endorse a "shared" style of decision making. When asked what "shared" means, however, consumers describe a two-step process which first prioritizes autonomy, and if that is not possible, defers to case managers' judgment. Consumers also primarily focused on the relationship and affective components of decision making, rather than information-gathering or deliberating on options. Finally, when disagreements arose, consumers primarily indicated they handled them. CONCLUSIONS Mental health consumers may have a different view of decision making than the literature on shared decision making suggests. Mental health consumers may consciously decide to at least verbally defer to their case managers, and remain silent about their preferences or wishes.
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56
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Taylor TL, Killaspy H, Wright C, Turton P, White S, Kallert TW, Schuster M, Cervilla JA, Brangier P, Raboch J, Kališová L, Onchev G, Dimitrov H, Mezzina R, Wolf K, Wiersma D, Visser E, Kiejna A, Piotrowski P, Ploumpidis D, Gonidakis F, Caldas-de-Almeida J, Cardoso G, King MB. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems. BMC Psychiatry 2009; 9:55. [PMID: 19735562 PMCID: PMC2753585 DOI: 10.1186/1471-244x-9-55] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 09/07/2009] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. METHODS We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. RESULTS We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). CONCLUSION Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
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Affiliation(s)
- Tatiana L Taylor
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
| | - Helen Killaspy
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
| | - Christine Wright
- Division of Mental Health, St. George's University London, London, UK
| | - Penny Turton
- Division of Mental Health, St. George's University London, London, UK
| | - Sarah White
- Division of Mental Health, St. George's University London, London, UK
| | - Thomas W Kallert
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Mirjam Schuster
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | | | | | - Jiri Raboch
- Psychiatric Department of the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Kališová
- Psychiatric Department of the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Georgi Onchev
- Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria
| | - Hristo Dimitrov
- Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria
| | - Roberto Mezzina
- Dipartimento di Salute Mentale, University of Trieste, Trieste, Italy
| | - Kinou Wolf
- Dipartimento di Salute Mentale, University of Trieste, Trieste, Italy
| | - Durk Wiersma
- Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Ellen Visser
- Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - José Caldas-de-Almeida
- Department of Mental Health, Faculdade de Ciencias Medicas, New University of Lisbon, Lisbon, Portugal
| | - Graça Cardoso
- Department of Mental Health, Faculdade de Ciencias Medicas, New University of Lisbon, Lisbon, Portugal
| | - Michael B King
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
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57
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Psychometric properties of an assessment for mental health recovery programs. Community Ment Health J 2009; 45:246-50. [PMID: 19582574 PMCID: PMC2718196 DOI: 10.1007/s10597-009-9213-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 06/09/2009] [Indexed: 11/05/2022]
Abstract
The concept of recovery can be operationalized from either the point of view of the consumer, or from the perspective of the agency providing services. The Milestones of Recovery Scale (MORS) was created to capture aspects of recovery from the agency perspective. Evidence establishing the psychometric properties of the MORS was obtained in three efforts: Inter-rater reliability using staff at The Village, a multi-service organization serving the homeless mentally ill in Long Beach, California; inter-rater reliability was also obtained from Vinfen Corporation, a large provider of housing services to mentally ill persons in Boston, Massachusetts. A test-retest reliability study was conducted using staff rating of clients at The Village, and evidence for validity was obtained using the Level of Care Utilization System (LOCUS) as a validity measure. The intra-class correlation coefficient for the inter-rater reliability study was r = .85 (CI .81, .89) for The Village and r = .86 (CI .80, .90) for Vinfen Corporation; test-retest reliability was r = .85 (CI .81, .87); and validity coefficients for the LOCUS were at or above r = .49 for all subscales except one. There is sufficient evidence for the reliability and validity of the MORS.
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58
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Cleary A, Dowling M. Knowledge and attitudes of mental health professionals in Ireland to the concept of recovery in mental health: a questionnaire survey. J Psychiatr Ment Health Nurs 2009; 16:539-45. [PMID: 19594676 DOI: 10.1111/j.1365-2850.2009.01411.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recovery is the model of care presently advocated for mental health services internationally. The aim of this study was to examine the knowledge and attitudes of mental health professionals to the concept of recovery in mental health. A descriptive survey approach was adopted, and 153 health care professionals (nurses, doctors, social workers, occupational therapists and psychologists) completed an adapted version of the Recovery Knowledge Inventory. The respondents indicated their positive approach to the adoption of recovery as an approach to care in the delivery of mental health services. However, respondents were less comfortable in encouraging healthy risk taking with service users. This finding is important because therapeutic risk taking and hope are essential aspects in the creation of a care environment that promotes recovery. Respondents were also less familiar with the non-linearity of the recovery process and placed greater emphasis on symptom management and compliance with treatment. Multidisciplinary mental health care teams need to examine their attitudes and approach to a recovery model of care. The challenge for the present and into the future is to strive to equip professionals with the necessary skills in the form of information and training.
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Affiliation(s)
- A Cleary
- Mental Health, East Galway Mental Health Services, Loughrea Day Hospital, Barrick Street, Loughrea, Co Galway, Ireland
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59
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Huguelet P, Mohr S, Borras L. Recovery, Spirituality and Religiousness in Schizophrenia. ACTA ACUST UNITED AC 2009. [DOI: 10.3371/csrp.2.4.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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60
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Piat M, Sabetti J, Couture A, Sylvestre J, Provencher H, Botschner J, Stayner D. What does recovery mean for me? Perspectives of Canadian mental health consumers. Psychiatr Rehabil J 2009; 32:199-207. [PMID: 19136352 PMCID: PMC4828182 DOI: 10.2975/32.3.2009.199.207] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to explore the meaning of recovery from the perspectives of consumers receiving mental health services in Canada. METHODS Sixty semi-structured interviews were conducted with 54 mental health consumers in Montreal, Québec City and Waterloo-Guelph, Ontario. RESULTS Two contrasting meanings of recovery emerged. The first definition strongly attached recovery to illness while the second definition linked recovery to self-determination and taking responsibility for life. CONCLUSIONS The prominence of biomedical definitions of recovery suggests the need to find common ground between these two perspectives, if conceptualizations of recovery are to include the views of consumers who routinely experience the mental health system.
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Affiliation(s)
- Myra Piat
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
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61
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Cherry AL. Mixing Oil and Water: Integrating Mental Health and Addiction Services to Treat People with a Co-occurring Disorder. Int J Ment Health Addict 2008. [DOI: 10.1007/s11469-007-9074-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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63
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Trauer T, Tobias G, Slade M. Development and evaluation of a patient-rated version of the Camberwell Assessment of Need short appraisal schedule (CANSAS-P). Community Ment Health J 2008; 44:113-24. [PMID: 17701455 DOI: 10.1007/s10597-007-9101-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 07/06/2007] [Indexed: 11/25/2022]
Abstract
The comprehensive assessment of patients with severe mental health problems includes the evaluation of needs, as this informs service planning, and levels of unmet need have been found to be associated with lower subjective quality of life. The Camberwell Assessment of Need is the most widely used instrument for this purpose. We report the development and evaluation of a new, patient-rated, short form (CANSAS-P). The CANSAS-P exhibited comparable detection of needs with its predecessor, better identification of domains that are problematic for patients to respond to, good test-retest reliability, especially for unmet needs, and generally positive evaluations by patients. We recommend the CANSAS-P as the needs assessment measure of choice for completion by patients.
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Affiliation(s)
- Tom Trauer
- University of Melbourne and Monash University, Melbourne, Australia.
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64
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Choice of service provider: how consumer self-determination shaped a psychiatric rehabilitation program. Psychiatr Rehabil J 2008; 31:202-10. [PMID: 18194947 DOI: 10.2975/31.3.2008.202.210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To document the impact of consumer self-selection of service providers on their service receipt and attendance in a psychiatric rehabilitation program. METHODS Staff (8 FTE) in a new drop-in resource center tracked their service activities and contacts with consumers using daily service logs. Consumers (N = 46) checked their service needs at enrollment, and recorded their attendance on daily sign-in sheets. Regression analyses were conducted to examine correlations between these service measures and each consumer's count of key providers, with key provider defined as any staff worker with whom the consumer logged the equivalent of more than a full workday of contact (9+ hours) during a 6-month study period. RESULTS Service log findings suggest that key service providers were chosen by consumers through informal social interactions with staff. Members who had more key providers were more active in the program and more likely to have checked a need for psychiatric care at enrollment. In spite of member choice of provider, caseloads remained small and staff were able to dedicate their time to services related to their specialty training. CONCLUSIONS Facility-based programs can encourage consumer self-selection of service providers without overloading staff or restricting specialty services if they provide ample time for staff and consumers to get to know one another in informal social interactions.
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Abstract
Hurricanes Katrina and Rita alerted the world to North America's Gulf Coast's vulnerability to natural disasters. This vulnerability was most evident in poor, minority and elderly populations, and patients with chronic diseases requiring treatment such as dialysis. These hurricanes resulted in massive devastation of the healthcare infrastructure, including dialysis units, across the Gulf Coast region, and often resulted in temporary or permanent closure of dialysis units, predominantly in the New Orleans metropolitan area; however, Hurricane Rita primarily affected Lake Charles. Most notable was the population shift of dialysis patients in Louisiana due to hurricanes Katrina and Rita. Before the 2005 hurricane season, there were 2011 and 362 dialysis patients residing in the parishes (the Louisiana equivalent to counties) most affected by hurricanes Katrina and Rita, respectively. Each of these parishes had experienced increases in dialysis patient populations over the past 5 years. However, following the storms, there were 1014 and 316 dialysis patients residing in the affected parishes. Reasons for the population shifts were multifactorial in nature and included individual, provider, and healthcare system factors. As patients and physicians return to these affected areas, dialysis services will need to be reallocated based on new demographics and distribution of services in Louisiana communities. In planning for future dialysis services, adaptations will need to occur to prevent future interruption of services and loss of patient access to dialysis services.
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Affiliation(s)
- Myra A Kleinpeter
- Department of Medicine/Nephrology and Hypertension, Tulane University Health Sciences Center, 1430 Tulane Avenue SL-45, New Orleans, LA 70112, USA.
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66
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Hackman A, Brown C, Yang Y, Goldberg R, Kreyenbuhl J, Lucksted A, Wohlheiter K, Dixon L. Consumer satisfaction with inpatient psychiatric treatment among persons with severe mental illness. Community Ment Health J 2007; 43:551-64. [PMID: 17641972 DOI: 10.1007/s10597-007-9098-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
Consumer satisfaction with inpatient care is an important component of quality of care and a recovery-oriented system of care. This study assessed association of patient, demographic and process of care variables with inpatient satisfaction focusing on modifiable service delivery factors. Participants were 136 people with psychotic or affective disorders recruited from VA inpatient units who were interviewed with an extensive assessment. Staff teaching efforts regarding medication, illness management, substance abuse, outpatient treatment and living skills were significantly associated with greater levels of satisfaction with care, controlling for demographic and clinical variables. This may reflect value consumers place on staff time, attention and communication. Teaching may enhance self-efficacy and hope thereby facilitating recovery.
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Affiliation(s)
- Ann Hackman
- Department of Psychiatry, University of Maryland, 630 W. Fayette Street, 4th floor, Baltimore, MD 21201, USA.
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67
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Prabhu R, Browne MO. A recovery-based outreach program in rural Victoria. Australas Psychiatry 2007; 15:120-4. [PMID: 17464654 DOI: 10.1080/10398560701196729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE A recovery-based outreach program for people with severe mental illness in regional Victoria is described. The paper covers a description of the program, the services provided and outcomes achieved. The program emphasized active collaboration between patients and clinicians as outlined in the collaborative recovery model and recognized that recovery from mental illness is an individual, personal process. CONCLUSIONS The program provided service to 108 people over 3 years and had a positive impact on clinicians, patients and carers. The benefits of recovery orientation, multidisciplinary teams, collaborative relationships and carer involvement are discussed. The paper highlights the need for a focus on recovery and comprehensive care for people with severe mental illness.
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Affiliation(s)
- Radha Prabhu
- Centre for Multi Disciplinary Studies, Monash University School of Rural Health, Traralgon, Vic, Australia.
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68
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Jacobson N. [Recovery in mental health policy and practice: an implementation primer]. SANTE MENTALE AU QUEBEC 2007; 32:245-264. [PMID: 18253671 DOI: 10.7202/016519ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
With the publication of Quebec's Plan d'Action en Santé Mentale 2005-2010 the province announced an intent to develop a recovery-oriented mental health system. This article provides planners in Quebec, and elsewhere, with an overview of issues pertinent to recovery implementation. It reviews examples of system-level guidelines, program models, practitioner competencies, and measurement tools designed to promote a recovery orientation and suggests how these tools might be used by those charged with implementing recovery in their own jurisdictions. Finally, it raises some of the hard questions about meaning and power that must be addressed during the implementation process.
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Affiliation(s)
- Nora Jacobson
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario
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Abstract
PURPOSE OF REVIEW To assess paradigms of psychiatry, assessing their strengths and limitations. RECENT FINDINGS The biopsychosocial model, and eclecticism in general, serves as the primary paradigm of mainstream contemporary psychiatry. In the past few decades, the biopsychosocial model served as a cease-fire between the biological and psychoanalytic extremism that characterized much of the 19th and 20th century history of psychiatry. Despite being broad and fostering an 'anything goes' mentality, it fails to provide much guidance as a model. In recent years, the biological school has gained prominence and now is under attack from many quarters. Critics tend toward dogmatism themselves, usually of postmodernist or libertarian varieties. Three alternate approaches include pragmatism, integrationism, and pluralism. Pluralism, as technically defined here based on the work of Karl Jaspers, rejects or accepts different methods but holds that some methods are better than others for specific circumstances or conditions. SUMMARY The compromise paradigm of biopsychosocial eclecticism has failed to sufficiently guide contemporary psychiatry. The concurrent revival of the biological model has led to postmodernist counter-reactions which, though valid in many specifics, promise to replace one ideological dogma with another. New paradigms are needed.
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Affiliation(s)
- Seyyed Nassir Ghaemi
- Department of Psychiatry and Public Health, Emory University, Atlanta, Georgia 30322, USA.
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