Viewing chronic mental illness: a conceptual framework

The relationship between community psychiatric nurses and clients with severe and persistent mental illness: the client's experience

The aim of this phenomenological study was to construct an interpretation of the experience of nurse-patient relationships, in the context of community psychiatric nursing. The purpose of this paper is to focus on the experience of the relationship from the perspective of the clients. Themes of 'having someone looking out for me', 'working in collaboration', and 'being understood and gaining understanding' were identified. This thematic structure was used to understand the meaning of the relationship for the clients. Implications for practice, education, clinical supervision and mental health services are discussed.

Nurse--client relationships: the experience of community psychiatric nurses

The aim of the present study was to construct an interpretation of the experience of the nurse--client relationship in the context of community psychiatric nursing. Hermeneutic phenomenology formed the framework of the study. Shared conversations were conducted with five experienced community psychiatric nurses and five clients. Themes of 'Being there', 'Being concerned', 'Establishing trust' and 'Facilitating transition' were identified from the nurses' conversations. This thematic structure was used to illuminate the centrality of the nurse--client relationship, and to articulate the skills that are involved in establishing and maintaining the relationship with clients with mental illness.

Correlates of functioning in a population with dual diagnoses: an examination of diagnosis and problem history

This study examines the relationship between diagnosis and life functioning using the Addiction Severity Index (ASI) with 467 hospitalized individuals with mental illness and substance abuse problems. Persons diagnosed with schizophrenia were the best functioning group across most of the ASI domains except employment and psychiatric functioning. More robust relationships were found between problem history (i.e., prior symptomatology or treatment) and current functioning. Respondents with histories of drug treatment, prior experience of anxiety and depression, self-injurious behavior, or violence control problems experienced more severe medical, drug, alcohol, psychiatric, legal, and family/social problems at the time of hospitalization. Violence control problems were related to drug use and criminal involvement, whereas self-injurious behavior was more often related to alcohol use and psychiatric distress. These findings suggest that problem history may be a stronger predictor of treatment need at the time of hospital entry than are more commonly used indexes, such as diagnosis.

Psychosocial rehabilitation and psychiatry: what are the boundaries?

OBJECTIVES

1. To examine the conceptual underpinnings of psychosocial rehabilitation and underscore its essential relationship to the practice of psychiatry. 2. To explore and dispel some misunderstandings and myths that practitioners in each field sometimes carry about the other.

METHOD

Literature review and observation.

RESULTS

Psychiatry and psychosocial rehabilitation's shared emphasis on the biopsychosocial nature of mental illness forms a compelling basis for cooperative enterprise.

CONCLUSIONS

Mentally ill persons are best served when the disciplines of psychiatry and psychosocial rehabilitation come together in a common cause.

Health care of the chronically mentally ill: the culture broker model

The chronically mentally ill tend to receive inadequate medical care for nonpsychiatric illnesses and to have poor health care status. Their medical problems lead to excessive morbidity and mortality and adversely affect their adjustment to psychiatric illness. The authors argue that many of the barriers to medical care for these patients can be overcome by using case managers as "culture brokers"-persons who provide bridges between the worlds of the chronically mentally ill and medical providers. This paper presents the culture broker model and its roots in anthropology, and illustrates its application to the medical care of the chronically mentally ill with case examples.

Problem analysis: an instrument in the rehabilitation of chronic psychiatric patients in the community

In the light of governmental policy in European countries to enhance and reinforce community psychiatric services, the need to introduce a more systematic approach in the treatment of chronic psychiatric patients by the community psychiatric services is currently being stressed. In this paper the problem analysis (P.A.) is described. It is a practical, treatment-oriented instrument which methodically compiles information on chronic patients and their systems. The systematic acquisition and examination of such information provide clues to a rational rehabilitation plan, one that can be carried out by a multidisciplinary community psychiatric service. Such an approach has the added advantage of making education and research in the field feasible.

The stalemate position

The psychosurgical operation of stereotactic subcaudate tractotomy can be a highly effective treatment for chronic and intractable affective disorders. We have lately given increasing attention to cases where the depressed mood appears to lift although there is little improvement in social function. In these cases there has been a failure of rehabilitation and the complexities of this process post-operatively are discussed. In addition, relatives report in some 10% of cases "personality changes" after the operation which are not perceived in this way by an independent medical assessor and these observations seem to depend upon relatives mis-interpreting the resumption of pre-morbid personality function after long illnesses as undesirable side-effects. Case histories illustrating the problems are described. Treatment and rehabilitation strategies are outlined.