2008 Mental Health: Adult Licensed Residential Settings

2008 ◽  
Stanovnistvo ◽  
2014 ◽  
Vol 52 (2) ◽  
pp. 91-111
Author(s):  
Milan Markovic

The 2011 Census in the Republic of Serbia introduced, for the first time questions about difficulties in functioning, following the Recommendations from the Washington Group on Disability Statistics. Since there are no stable and continuous sources on the position of persons with disabilities in Serbia, the Census results may be used as a relevant source on disability measurement. Of course, due to the main goal of census disability measurement, and that is a general identification of disability in population, these results should be employed with certain reservations and carefully, especially because of some methodological specification in approaching disability. The main use of census data on disability should be found in evaluating the "equality of opportunity" in relevant areas, such as economic activity (labour and employment), education, living sources, etc. and this is to be achieved mainly through comparison between the values in the general population and population with disabilities. Having done that, we were able to conclude on visible inequality of opportunities between the general and population with disabilities. These discrapancies are indeed evident first in the area of education-especially in accessing elementary education, where the percentage of persons with disabilities that never attended school is extremely high (12.2% v. 2.68% in general population). The unfavourable status of persons with disabilities in the context of education continues in almost all levels of education. An even more obvious inequality of opportunity is present in the area of economic activity, where the prevalence of inactive persons with disability is very high - almost 90%. Having gone through all the age categories, what becomes abvious is a significantly lower activity among all age groups in comparison to the same groups in general population. However, the main goal of this article was to detect the discrapancies existing between the position of persons with disabilities that live in the community and those living in institutional settings - institutions for collective housing. In both areas of education and economic activity, the results tell us very much about a much more problematic status of those living in residential settings. Overall, the access to education is much lower with residents, making an even more negative picture about this smaller group of persons with disabilities in Serbia. In the area of economic activity, the percentage of economically active persons with disabilities in residential settings does not climb to one percent (0.30% excluding the homes for adults and the elderly), which is indeed a worrying situation. Having in mind well known facts on the effects of institutionalization of persons with disabilities in terms of almost all their rights and freedoms, the results that we have encountered are to confirm a negative status of those living in residential settings. Experiences of discrimination, marginalization, segregation and exclusion are evident in the census results. Even if one tries to focus only on analyzing the equality of opportunity in the given context, in comparison with the general population, or even only with the contingent of persons with disabilities out of the residential settings, those living in institutions in Serbia are seriously suffering from lack of access to education, training, labour market and other important areas of life and social functioning. In addition, a potentially relevant insight has been made into the correlation of the type of problem and the status within economic activity and education of persons with disabilities in Serbia. The results confirm that those persons identified through census questions that aim at detecting problems of mental health (intellectual and psycho-social disability) are in the least favourable position in both of the observed areas. Such conclusions should also be connected to a specifically problematic social inclusion and acceptance of those with mental health problems and the extremely high burden of social stigma towards them, combined with the long-going practice of exclusion and discrimination (legal capacity, education, employability, etc.).


BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Natalie B. Riblet ◽  
Daniel J. Gottlieb ◽  
Bradley V. Watts ◽  
Maxwell Levis ◽  
Brian Shiner

Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.


2021 ◽  
Vol 17 (1) ◽  
pp. 51-60
Author(s):  
Khalifa Elzubeir ◽  
Stephen Dye

Background: Little is known regarding capacity to agree to admission of informal patients later detained under Section 5(2) of the UK Mental Health Act.<br/> Aim: To evaluate how frequently such capacity is assessed and to discover associations related to length of time from admission until imposition of Section 5(2).<br/> Method: Patients detained under Section 5(2) on acute inpatient general adult and old age psychiatric wards in one UK location between June 2016 and March 2018 were identified. Their admission records were scrutinized.<br/> Results: Capacity was assessed in 97 of 124 patients. Fewer assessments were performed immediately prior to admission, especially upon patients admitted from residential settings. On admission, medical staff assessed for capacity less than non-medics, but found an individual lacked capacity more frequently. Time until detention was less upon a first admission, in absence of pre-admission capacity assessment, when medical staff assessed, or when any inpatient clinician detected incapacity.<br/> Conclusion: Routine capacity assessment immediately prior to and at psychiatric admission should be formalized and offers potential to reduce use of Section 5(2), unlawful detention and negative sequalae.


2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.


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