Study of recovery model implementation in psychiatric hospitals: Clients and multidisciplinary staff perspective

The recovery model guides mental health services. However, the delivery of recovery-oriented services in inpatient settings is still a challenge. Factors affecting recovery model implementation can be classified into three types: the hospital environment, the inpatient and the service provider. This study aims to quantitatively evaluate the impact of environment, inpatient and service provider factors on recovery model implementation in hospitals. Forty-five service providers and 42 inpatients from three types of wards (acute locked, acute open and daycare) of two hospitals participated in this cross-sectional study. We assessed inpatient cognition, functional capacity and illness severity. In addition, we retrieved information on service providers' professional status and evaluated the recovery model knowledge and attitudes. Implementation of the recovery model was measured using the Recovery Self-Assessment, both the inpatient and service provider versions. Differences were found between the three types of wards in recovery orientation as reported by service providers ( χ 2 2  = 15.3, P < 0.001), but not by inpatients ( χ 2 2  = 2.34, P > 0.05). Providers' internalized knowledge and attitudes toward recovery, inpatients' functional capacity and age of illness onset were associated with recovery implementation (0.31 < r < 0.48, P < 0.05). The findings confirm quantitatively the multilevel nature of factors that affect the implementation of the recovery model in psychiatric hospitals. The inpatients' perspective should be incorporated into the service development process. Based on the study results, the reduction in the restrictive features of the wards' environment is recommended. Promotion of the recovery model implementation in the hospital setting requires the expansion of staff's internal positive attitudes toward recovery.

First-episode psychosis in the ultra-Orthodox Jewish population

Few if any methodologically robust studies of first-episode psychosis have been carried out in the ultra-Orthodox Jewish population. The opening of an inpatient psychiatry department within an ultra-Orthodox neighborhood in Israel offered the unique opportunity to study the specifics of first -episode psychosis in this subpopulation. Medical records of 60 ultra-Orthodox male Jewish patients with first-episode psychosis were examined over the first 18 months of the new department's operation. Data regarding the patients' demographical status, anamnestic information, clinical presentation, and psychiatric care were analyzed. Participants were 18-30 years old; 15 (25%) were already engaged or married. Most patients (37, 61.7%) had not been employed in any formal activity prior to their hospitalization, with 21 patients (35%) studying in a Talmudical school. Religion-related delusions were noted in 20 patients (33.3%), and community/rabbi-related delusions in 18 patients (30%). Only three patients (5%) reported suicidal attempts. Duration of untreated psychosis (DUP) ranged between 1-48 months (mean 10.4, SD 9.5). In contrast to other first-episode psychosis studies, this study highlights specific features of first-episode psychosis in the ultra-Orthodox Jewish population, which is characterized by a high marriage rate, short DUP, low rates of substance use and suicidal attempts, expression of religious- and community-related themes in delusion content, and limited cooperation with health care providers. A better understanding of the cultural specifics of first-episode psychosis in this subpopulation may enable earlier treatment, improve prognosis, and facilitate compliance with medications and rehabilitation programs.

[TREATMENT ISSUES IN PSYCHIATRY IN THE MANAGEMENT OF THE HAREDI SUBPOPULATION]

In recent years, the importance of cultural sensitivity and the adaptation of mental health services to diverse populations has been growing. Simultaneously, awareness of psychiatric illnesses and treatment is increasing, even among the Haredi (ultra-orthodox) population in Israel, with specialized services developing. Many studies have emphasized the central role of religion and belief in the coping styles of those with mental illness and their healing processes. These characteristics are especially evident among the Haredi population, where religion is present in behavior, in thought, both within the individual and in the community, and throughout life. In the encounter between a religious Haredi patient and the professional, many issues arise regarding religion and the patient's socio-cultural affiliation. Being familiar with this world, including unique concepts and sensitivity to these issues, can promote treatment that is provided to ultra-orthodox individuals with mental-illness in a manner that is culturally sensitive. These issues include specific expressions and manifestations of psychiatric illness in the religious Haredi patient, and issues related to the specific Haredi community to which the patient belongs. Discussions in the literature and halakhic rulings are divided into issues concerning the patient, religious law observance by the patient with mental-illness, issues regarding treatment coercion, pregnancy, and issues relating to therapy, such as "privacy" and "life and death" dilemmas. Unique expressions of psychiatric disorders in the Haredi patient may be noted in eating disorders, psychosis and OCD, both in clinical terms and in prognosis and disease processes. Factors related to society and the ultra-orthodox community to which the psychiatric patient belongs include issues of stigma and secrecy that are maintained by the community in relation to mental illness; interference by non-professional individuals involved in treatment; as well as the distinctiveness of treatment and rehabilitation adapted to the Haredi population and finally cultural sensitivity to the needs of the religiously observant patient (such as avoiding desecration of Shabbat, rehabilitation in unique areas such as Torah study, etc.).