The homeless mentally ill – an audit from an inner city hospital

AbstractObjective: To determine the proportion of those that are homeless attending the Mater Misericordiae Hospital's (MUH) psychiatric service, including those presenting to accident and emergency who were homeless, and to compare the homeless group with the non-homeless so as to obtain a profile of this group.Methods: All adults over 16, referred for psychiatric assessment, attending A&E were included, as were those attending outpatient clinics, liaison consultations and inpatients in the psychiatric unit, in the six-month period from January to June 2003. Excluded were those who were under 16, who refused to participate, who did not speak English, those with a diagnosis of personality disorder and organic brain damage. Questionnaires were completed by psychiatric registrars and a community psychiatric nurse, with an ICD-10 diagnosis recorded on each individual, in consultation with the treating consultant psychiatrist.Results: A total of 628 patients were seen in MUH during the study period, and 13.8% were homeless. Of the homeless, 56.3% were seen as emergency referrals in the A&E, 23% were inpatients (including the psychiatric unit and consultations in medical/surgical wards) and 20.7% were seen in the outpatient department. Of all the A&E referrals to psychiatry, 34.8% were homeless. The homeless presented most commonly in suicidal crisis (26.6%) compared with 12.5% in the non-homeless group. Substance-abuse disorders were the primary diagnosis in 42.3% of the homeless group, accounting for 14.2% in the housed sample. Outcome for both groups was similar, with slightly more homeless being referred for psychiatric admission (17.8%), as compared to 12.0% in the nonhomeless group.Conclusions: Mental illness and the need for psychiatric services remain a serious issue for a significant segment of the homeless population. The homeless are overrepresented in our accident and emergency department, with their psychological and medical needs not being met in primary care. An integrated multi-disciplinary treatment approach, including outreach work, that addresses their many needs, appears to hold the greatest promise of success in this population.

Download Full-text

Deployment, Supervision and Decision-Making of Residents in an Emergency Psychiatric Service

The Canadian Journal of Psychiatry ◽

10.1177/070674377902400302 ◽

1979 ◽

Vol 24 (3) ◽

pp. 207-211 ◽

Cited By ~ 6

Author(s):

A.J.R. Finlayson ◽

G. Bartolucci ◽

D.L. Streiner

Keyword(s):

Decision Making ◽

Psychiatric Service ◽

Inpatient Unit ◽

Psychiatric Admission ◽

Psychiatric Emergencies ◽

Psychiatric Residents ◽

Relationship Of ◽

The Relationship

A lessening of personal discomfort felt by residents on-call in the Emergency Psychiatric Service has resulted from changes in the frequency of being on-call, exclusion of beginning residents from duty and arranging for the presence of a faculty psychiatrist for one or two hours during each on-call period. Coincidental significant reductions in the number of cases admitted to hospital and reductions in the proportion of discrepancies between diagnoses made by the emergency resident and those made later by inpatient unit staff have been described. The relationship of the changes in resident experience to the reduction in admissions and decreased proportion of diagnostic discrepancy has been discussed using a model of the process of emergency psychiatric admission described earlier by Bartolucci et al. (1). Less isolation, anxiety and some increased experience on the part of the psychiatric residents on duty in the Emergency Psychiatric Service results in greater awareness and better appraisal of the nonmedical aspects of psychiatric emergencies.

Download Full-text

The Changes in The Utilization Rate of Traditional Chinese Medicine During the 2019 Coronavirus Pandemic

10.21203/rs.3.rs-77043/v1 ◽

2020 ◽

Author(s):

Shun-Ku Lin ◽

Chien-Tung Wu ◽

Chia-Jen Liu ◽

Hui-Jer Chou ◽

Fu-Yang Ko ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Rural Areas ◽

Utilization Rate ◽

City Hospital ◽

Medical Needs ◽

Mobile Medicine ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Abstract Background: Large-scale epidemics have changed people’s medical behavior, and patients tend to delay non-urgent medical needs. However, the impact of the pandemic on the use of complementary and alternative medicine remains unknown. Methods: This retrospective study aimed to analyze the changes in the number of traditional Chinese medicine (TCM) patients and examine the epidemic prevention policy during the coronavirus disease 2019 (COVID-19) pandemic. We analyzed the number of TCM patients in Taipei City Hospital from January 2017 to May 2020. We tallied the numbers of patients in each month and compared them with those in the same months last year. We calculated the percentage difference in the number of patients to reveal the impact of the COVID-19 pandemic on TCM utilization. We used the Mann–Whitney U test to examine whether there was a significant difference in the number of patients during the COVID-19 pandemic. Results: We included a total of 41 months and 1,935,827 patients in this study. During the COVID-19 pandemic, the number of patients decreased significantly, except in February 2020. The numbers of patients during the COVID-19 pandemic had fallen by more than 15% compared with those in the same months last year. March and April had the greatest number of patient losses, with falls of 32.8% and 40%, respectively. TCM patients declined significantly during the COVID-19 pandemic, and mobile medicine provided to rural areas fell considerably. Among all the TCM specialties, pediatrics and traumatology, as well as infertility treatment, witnessed the most significant decline in the number of patients. However, the number of cancer patients has reportedly increased. Conclusions: The COVID-19 pandemic decreased the utilization rate of TCM, especially for mobile healthcare in rural areas. We suggest that the government pay attention to the medical disparity between urban and rural areas, which are affected by the pandemic, as well as allocate adequate resources in areas deprived of medical care.

Download Full-text

Audit of new long-stay patients in a district general hospital

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700016062 ◽

1994 ◽

Vol 11 (1) ◽

pp. 42-43 ◽

Cited By ~ 4

Author(s):

Mathew Kurian ◽

Shobha George ◽

Clive G Ballard ◽

Ramalingam NC Mohan ◽

Stuart Cumella

Keyword(s):

General Hospital ◽

Antisocial Behaviour ◽

District General Hospital ◽

Primary Diagnosis ◽

Psychiatric Ward ◽

Psychiatric Unit ◽

Prolonged Stay ◽

Diagnosis Of Dementia ◽

Rehabilitation Facilities ◽

Discharge From Hospital

AbstractObjective: To describe the characteristics of “new” long-stay patients in a district general hospital psychiatric unit. Method: A “new” long-stay patient was defined as a patient aged 18 or more who on the census date had been in a district general hospital psychiatric ward for longer than six months but less than six years. There was no upper age limit but patients with a primary diagnosis of dementia were excluded from the study. Information about each patient was obtained from medical and nursing cases notes. Patients were interviewed by one interviewer to determine their views on discharge from hospital. All the members of the multi-disciplinary team were interviewed by one interviewer to obtain their judgements about future accommodation needs of the patients. Results: “New” long-stay patients are typically single in their mid-forties with no supportive relatives. Most have a primary diagnosis of schizophrenia. They have a long psychiatric history and the majority had been in hospital between 6 months and three years. The principle reasons for prolonged stay were persistence of active psychotic symptomatology, schizophrenic defect state, poor social skills and antisocial behaviour. Conclusion: A group of “new” long-stay patients have accumulated in Wolverhampton district general hospital psychiatric unit, despite modern methods of treatment and the availability of a good range of rehabilitation facilities. They are a diverse group including patients with a severe schizophrenic disorders, affective disorders, personality disorders and organic disorders. Ideally, if these patients are to be placed in the community, rather than remaining as inpatients, then placement would need to be in specialised facilities like hospital hostels.

Download Full-text

Psychiatric Service for the Elderly: How Many Beds?

The British Journal of Psychiatry ◽

10.1192/bjp.129.5.418 ◽

1976 ◽

Vol 129 (5) ◽

pp. 418-423 ◽

Cited By ~ 17

Author(s):

D. J. Jolley ◽

Tom Arie

Keyword(s):

Cohort Study ◽

Psychiatric Service ◽

National Policy ◽

The Elderly ◽

Old People ◽

Psychiatric Unit ◽

Recommended Guidelines ◽

As If

SummaryReported here is a cohort study of five years' bed usage in the Goodmayes Psychiatric Unit for Old People. Patients first admitted in 1970 continued to use beds, by readmission or by continuing stay, over the next four years; subsequent cohorts of admissions made correspondingly extended use of beds. Bed-usage by men appears now to have stabilized, whilst for women it is still rising.Over the first six years the bed complement was reduced by 40%, despite an increase in referrals of over 40%; this is because the Unit's style of work prevented newly admitted patients from accumulating in beds made available by deaths. It looks as if in future not only will patients who die be replaced by new female admissions but more beds will be needed for these admissions. The present bed-usage is just within the Government's recommended guidelines, and the local issues are considered in the context of national policy.

Download Full-text

Identifying Homeless Population Needs in the Emergency Department Using Community-Based Participatory Research

10.1101/2020.05.23.20104463 ◽

2020 ◽

Author(s):

Andrew Franco, MD ◽

Jonathan Meldrum, MBBS ◽

Christine Ngaruiya, MD, MSc

Keyword(s):

Health Care ◽

Emergency Department ◽

Participatory Research ◽

Discharge Planning ◽

Underserved Populations ◽

Community Based Participatory Research ◽

Homeless Population ◽

Provider Attitudes ◽

Community Based ◽

Medical Needs

Background: Annually 1.5 million Americans face housing insecurity, and compared to their domiciled counterparts are three times more likely to utilize the Emergency Department (ED). Community Based Participatory Research (CBPR) methods have been employed in underserved populations, but use in the ED has been limited. We employed CBPR with a primary goal of improved linkage to care, reduced ED recidivism, and improved homeless health care. Methods: A needs analysis was performed using semi-structured individual interviews with participants experiencing homelessness as well as with stakeholders. Results were analyzed using principles of grounded theory. At the end of the interviews, respondents were invited to join the CBPR team. At CBPR team meetings, results from interviews were expounded upon and discussions on intervention development were conducted. Results: Twenty-five stakeholders were interviewed including people experiencing housing insecurity, ED staff, inpatient staff, and community shelters and services. Three themes emerged from the interviews. First, the homeless population lack access to basic needs, thus management of medical needs must be managed alongside social ones. Second, specific challenges to address homeless needs in the ED include episodic care, inability to recognize housing insecurity, timely involvement of ancillary staff, and provider attitudes towards homeless patients affecting quality of care. Lastly, improved discharge planning and communication with outside resources is essential to improving homeless health and decreasing ED overutilization. A limitation of results is bias towards social networks influencing included stakeholders. Conclusion: CBPR is a promising approach to address gaps in homeless health care as it provides a comprehensive view incorporating various critical perspectives. Key ED-based interventions addressing recidivism include improved identification of housing insecurity, reinforced relationships between ED and community resources, and better discharge planning.

Download Full-text

Psychiatric Service in 1967 at the Royal Infirmary of Edinburgh

Scottish Medical Journal ◽

10.1177/003693306801301105 ◽

1968 ◽

Vol 13 (11) ◽

pp. 388-393 ◽

Cited By ~ 1

Author(s):

R. C. B. Aitken ◽

G. M. Carstairs

Keyword(s):

Emergency Department ◽

Teaching Hospital ◽

Psychiatric Service ◽

Royal Infirmary ◽

Epidemiological Features ◽

Accident And Emergency ◽

Large Teaching Hospital ◽

Treatment Centre ◽

Accident And Emergency Department ◽

General Wards

The psychiatric service provided at a large teaching hospital is reviewed. Epidemiological features are reported on the patients seen from 4 sources: poisoning treatment centre; general wards; psychiatric out-patient clinic; and accident and emergency department. Substantial increase in the referral rates from the first two sources is noted. Distributions of the diagnoses are given, with details of the further management offered.

Download Full-text

The relationship between menstruation and psychiatric admissions

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700002974 ◽

1997 ◽

Vol 14 (2) ◽

pp. 46-48 ◽

Cited By ~ 2

Author(s):

Jane O'Dwyer ◽

Trevor Friedman ◽

Elizabeth Clifford

Keyword(s):

Risk Factor ◽

Premenstrual Syndrome ◽

Inclusion Criteria ◽

Psychiatric Unit ◽

Psychiatric Admission ◽

Menstrual Function ◽

Psychiatric Admissions ◽

Time Of Admission ◽

The Relationship

AbstractObjective: To determine whether the previously reported relationship between menstruation and emergency psychiatric admissions still pertains.Method: All females admitted on an emergency basis to a general psychiatric unit of a DGH, were interviewed and data regarding menstrual function was collected on those fitting the inclusion criteria who consented to inclusion in the study.Results: Ninety three people were included in the study, of whom significantly more were admitted in the late luteal and menstrual phases of the cycle. Symptoms suggestive of premenstrual syndrome were significantly commoner in those admitted in the late luteal and menstrual phases.Conclusions: The findings suggest that the premenstrual syndrome is either a risk factor for psychiatric admission or is important in determining the time of admission. Adequate detection and treatment of premenstrual syndrome, could in theory, reduce some psychiatric admissions. The methodology and limitations of the study are discussed.

Download Full-text

The dynamics of patient visits to traditional Chinese medicine during the 2019 coronavirus pandemic

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-021-03245-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shun-Ku Lin ◽

Chien-Tung Wu ◽

Hui-Jer Chou ◽

Chia-Jen Liu ◽

Fu-Yang Ko ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Rural Areas ◽

City Hospital ◽

Medical Needs ◽

Mobile Medicine ◽

Percentage Difference ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Abstract Background Large-scale epidemics have changed people’s medical behavior, and patients tend to delay non-urgent medical needs. However, the impact of the pandemic on the use of complementary and alternative medicine remains unknown. Methods This retrospective study aimed to analyze the changes in the number of traditional Chinese medicine (TCM) patients and examine the epidemic prevention policy during the coronavirus disease 2019 (COVID-19) pandemic. We analyzed the number of TCM patients in Taipei City Hospital from January 2017 to May 2020. We tallied the numbers of patients in each month and compared them with those in the same months last year. We calculated the percentage difference in the number of patients to reveal the impact of the COVID-19 pandemic on TCM utilization. We used the Mann–Whitney U test to examine whether there was a significant difference in the number of patients during the COVID-19 pandemic. Results We included a total of 1,935,827 TCM visits of patients from January 2017 to May 2020 in this study. During the COVID-19 pandemic, the number of patients decreased significantly, except in February 2020. The number of patients during the COVID-19 pandemic had fallen by more than 15% compared with those in the same months last year. March and April had the greatest number of patient losses, with falls of 32.8 and 40% respectively. TCM patients declined significantly during the COVID-19 pandemic, and mobile medicine provided to rural areas fell considerably. Among all the TCM specialties, pediatrics and traumatology, as well as infertility treatment, witnessed the most significant decline in the number of patients. However, the number of cancer patients has reportedly increased. Conclusions The COVID-19 pandemic decreased the utilization rate of TCM, especially for mobile healthcare in rural areas. We suggest that the government pay attention to the medical disparity between urban and rural areas, which are affected by the pandemic, as well as allocate adequate resources in areas deprived of medical care.

Download Full-text

Five-Year Trend in Issuing Disability Certificates from a General Hospital Psychiatric Unit in South India

Indian Journal of Psychological Medicine ◽

10.1177/0253717620947163 ◽

2020 ◽

Vol 42 (5) ◽

pp. 451-455

Author(s):

Padmavathi Nagarajan ◽

Balaji Bharadwaj ◽

Shivanand Kattimani

Keyword(s):

Mental Illness ◽

Mental Health Professionals ◽

Developmental Disorder ◽

Disability Evaluation ◽

Tertiary Care ◽

Primary Diagnosis ◽

Mental Disability ◽

Clinical Psychologist ◽

Psychiatric Unit ◽

The Public

Background: Mental disability is a common condition but is considered as an invisible disability. The disability certificate in psychiatry remains underexplored. Some reasons are issues of confidentiality, stigma, lack of awareness in the public, and the hesitancy in the mental health professionals. We aim to provide a brief profile of patients with mental illness issued disability certificates from a psychiatric unit over a five-year period (2013–2017). Methods: Our retrospective study is based on the data available from the copies of the issued disability certificates from a psychiatric unit that functions in a multispecialty tertiary care teaching government hospital in Southern India. Patients undergoing treatment in psychiatry apply for a disability certificate to the medical superintendent of the hospital. Each applicant undergoes a detailed workup to ascertain the diagnosis, and the mental disability is assessed using Indian Disability Evaluation and Assessment Scale (IDEAS). Those with intellectual developmental disorder (IDD) are assessed by a clinical psychologist for quantifying intelligence quotient, based on which the disability certificate is issued. Data were extracted and analyzed using SPSS. Descriptive statistics were used. Results: Over five years, 258 disability certificates were issued. A total of 218 were for mental illness and 40 were for IDD. Schizophrenia was the commonest primary diagnosis. There was no gender predominance, nor the influence of gender on different domains of IDEAS except on work domain dysfunction due to mental illness. The validity period was not mentioned in 81% of the issued certificates for mental illness. Conclusions: This descriptive study found a lower number of certificates issued from the psychiatric unit. Schizophrenia remains the main psychiatric diagnosis for which a disability certificate was issued. We did not assess the utilization pattern of the issued certificates.

Download Full-text

Drug-Related Admissions to a Veterans' Administration Psychiatric Unit

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808401800117 ◽

1984 ◽

Vol 18 (1) ◽

pp. 74-76 ◽

Cited By ~ 8

Author(s):

Ronald B. Salem ◽

Terence M. Keane ◽

James G. Williams

Keyword(s):