A Discharge Group for Chronically Mentally Ill: Easing the way

Evaluation of Activities of Daily Living Ability and Awareness among Clients in a Forensic Psychiatry Evaluation Unit in Sweden

Introduction:

The aim of this exploratory study was to investigate activities of daily living (ADL) functioning for clients in a forensic psychiatry evaluation unit and also to investigate the relationship between ADL functioning and awareness of their ability to perform ADL.

Method:

The sample consisted of 35 participants at a forensic psychiatry evaluation unit in Sweden. ADL was investigated using the Assessment of Motor and Process Skills (AMPS) and awareness of ability was investigated using the Assessment of Awareness of Ability (A3).

Results:

The ADL mean motor ability for the participants was 1.68 logits and the process ability showed an ADL mean value of 0.83 logit. The mean value of awareness was 0.60 logit. A majority of the participants demonstrated ability measures below the cut-off criteria in the AMPS, which indicates that they might need support to function in the community. There was also a significant relationship between awareness of ability and ADL motor ability (rho = 0.49, p<0.01) and ADL process ability (rho = 0.77, p<0.01).

Conclusion:

Clients in forensic psychiatry demonstrate limited ability in ADL, associated with a limited awareness. Clients in forensic psychiatry may also need assistance to live in the community, which suggests that occupational therapy may be offered to these clients in order to prepare them to manage in the community.

Chronically mentally ill individuals re-entering the community after hospitalization

The purpose of this phenomenological study was to increase the understanding of the experiences of chronically mentally ill individuals who are re-entering the community after hospitalization. Ten individuals from an acute care psychiatric hospital who had had two or more admissions within a 12-month period were interviewed, shortly before discharge and subsequently between two and four times while in the community. Three interrelated themes emerged. First, at the time of discharge, the optimism of the participants about returning home was tempered by a realistic recognition of their problems. As time passed, their problems seemed to become their preoccupying focus and optimism faded. Second, for most of the participants, relationships with others, positive, negative or both, played an important role in their return to home and community. Third, participants who experienced more positive social relationships also described individual achievements and community involvement. The re-entry process was not a smooth transition for these individuals.

Scheduled Brief Admissions: Patient "Tuneups"

1. Incorporating brief, planned admissions into the treatment plan of chronically mentally disabled patients has demonstrated positive outcomes related to health care services, as well as to the patients' perceptions of their own health status. 2. A comparison of the "Tuneup" program before and since its inception showed that, while the number of patient hospitalizations increased, the patients' length of stay, amount of unplanned hospitalizations, and cost decreased significantly during this period. 3. The chronically mentally ill are a population at risk for a variety of hardships, including rehospitalization, social isolation, homelessness, and even death. Psychiatric nurses who understand the needs of these persons can serve as a vital force in mental health care reform.