scholarly journals Absconding from a psychiatric hospital in Johannesburg, South Africa: Are we seeing a decrease since the implementation of the Mental Healthcare Act?

2019 ◽  
Vol 25 ◽  
Author(s):  
Feroza Arbee ◽  
Ugasvaree Subramaney
Keyword(s):  
Risk Assessment ◽  
Substance Use ◽  
Psychiatric Hospital ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Mental Healthcare ◽  
Psychiatric Services ◽  
Economic Implications ◽  
Impact Risk ◽  
General Populations

Background: Absconding from psychiatric facilities, the aetiology and impact of which have major socio-economic implications, has a multifactorial aetiological basis. Absconding patients are at higher risk of self-harm, violence, non-adherence, relapses, substance use and negative media attention. Most health professionals associate absconding with the escape of potentially dangerous psychiatric patients. Absconding causes fear and uncertainty, and portrays psychiatric services negatively. Identification of potential absconders would assist with risk assessment and prevention.Aim: The aim of this study was to formulate an absconding rate as well as a descriptive profile of absconders since the inception of democracy and deinstitutionalisation.Setting: The study was conducted at Sterkfontein Hospital, a specialised psychiatric hospital outside Johannesburg.Methods: A retrospective record review of absconders from Sterkfontein Hospital in Johannesburg over 1 year was conducted.Results: The absconding rate was 7.83%. The characteristics of the typical absconder included single, unemployed male, early 30s, known to psychiatric services, diagnosed with schizophrenia and co-morbid substance use. An absconder is more likely to be a forensic patient not returning from official leave of absence.Conclusion: The absconding rate has decreased to less than half that of a previous study, and is within international norms. While the descriptive profile is of limited value, it does appear that psychiatric patients are being treated in a less restrictive manner resulting in fewer absconders and a change in the method of absconding. The implications for clinical practice are firstly that a clearer definition of the term absconding is needed as this will impact risk assessment and management. It is recommended that future studies separate forensic and general populations. Lastly, the formulation and use of a risk assessment tool may be of value.

scholarly journals Decision-making capacity for treatment in psychiatric and medical in-patients: Cross-sectional, comparative study

2013 ◽  
Vol 203 (6) ◽  
pp. 461-467 ◽  
Author(s):  
Gareth S. Owen ◽  
George Szmukler ◽  
Genevra Richardson ◽  
Anthony S. David ◽  
Vanessa Raymont ◽  
...  
Keyword(s):  
Decision Making ◽  
Psychiatric Hospital ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Secondary Analysis ◽  
Medical Setting ◽  
Cross Sectional ◽  
Psychiatric Setting ◽  
Decision Making Capacity ◽  
Tool Treatment

BackgroundIs the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients?AimsTo compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice.MethodA secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool – Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability.ResultsMost people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P=0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P=0.02).ConclusionsAmong those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting.

scholarly journals Venous thromboembolism risk in psychiatric in-patients: a multicentre cross-sectional study

2019 ◽  
Vol 43 (6) ◽  
pp. 255-259
Author(s):  
Natalie Ellis ◽  
Carla-Marie Grubb ◽  
Sophie Mustoe ◽  
Eleanor Watkins ◽  
David Codling ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
The Uk

Aims and methodWe assessed venous thromboembolism (VTE) risk, barriers to prescribing VTE prophylaxis and completion of VTE risk assessment in psychiatric in-patients. This was a cross-sectional study conducted across three centres. We used the UK Department of Health VTE risk assessment tool which had been adapted for psychiatric patients.ResultsOf the 470 patients assessed, 144 (30.6%) were at increased risk of VTE. Patients on old age wards were more likely to be at increased risk than those on general adult wards (odds ratio = 2.26, 95% CI 1.51–3.37). Of those at higher risk of VTE, auditors recorded concerns about prescribing prophylaxis in 70 patients (14.9%). Only 20 (4.3%) patients had a completed risk assessment.Clinical implicationsMental health in-patients are likely to be at increased risk of VTE. VTE risk assessment is not currently embedded in psychiatric in-patient care. There is a need for guidance specific to this population.

scholarly journals Predictive Validity of the HKT-R Risk Assessment Tool: Two and 5-Year Violent Recidivism in a Nationwide Sample of Dutch Forensic Psychiatric Patients

2017 ◽  
Vol 62 (8) ◽  
pp. 2259-2270 ◽  
Author(s):  
Stefan Bogaerts ◽  
Marinus Spreen ◽  
Paul ter Horst ◽  
Coby Gerlsma
Keyword(s):  
Risk Assessment ◽  
Predictive Validity ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Area Under The Curve ◽  
Assessment Instrument ◽  
Risk Judgment ◽  
Risk Assessment Instrument ◽  
Forensic Psychiatric Patients ◽  
Forensic Psychiatric

This study has examined the predictive validity of the Historical Clinical Future [ Historisch Klinisch Toekomst] Revised risk assessment scheme in a cohort of 347 forensic psychiatric patients, which were discharged between 2004 and 2008 from any of 12 highly secure forensic centers in the Netherlands. Predictive validity was measured 2 and 5 years after release. Official reconviction data obtained from the Dutch Ministry of Security and Justice were used as outcome measures. Violent reoffending within 2 and 5 years after discharge was assessed. With regard to violent reoffending, results indicated that the predictive validity of the Historical domain was modest for 2 (area under the curve [AUC] = .75) and 5 (AUC = .74) years. The predictive validity of the Clinical domain was marginal for 2 (admission: AUC = .62; discharge: AUC = .63) and 5 (admission: AUC = .69; discharge: AUC = .62) years after release. The predictive validity of the Future domain was modest (AUC = .71) for 2 years and low for 5 (AUC = .58) years. The total score of the instrument was modest for 2 years (AUC = .78) and marginal for 5 (AUC = .68) years. Finally, the Final Risk Judgment was modest for 2 years (AUC = .78) and marginal for 5 (AUC = .63) years time at risk. It is concluded that this risk assessment instrument appears to be a satisfactory instrument for risk assessment.

Assessing the risk of venous thromboembolism in psychiatric in-patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S686-S686
Author(s):  
N. Ellis ◽  
M. Quraishy ◽  
C.M. Grubb ◽  
S. Fitch ◽  
J. Harrison
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Health Board ◽  
Compression Stockings ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Competing Interest ◽  
The Uk

IntroductionVenous thromboembolism (VTE) is a potentially fatal condition. Hospital-associated VTE leads to more than 25,000 deaths per year in the UK. Therefore identification of at-risk patients is crucial. Psychiatric in-patients have unique factors which may affect their risk of VTE (antipsychotic prescription, restraint) however there are currently no UK guidelines which specifically address VTE risk in this population.ObjectivesWe assessed VTE risk among psychiatric inpatients in Cardiff and Vale university health board, Wales, UK, and whether proformas currently provided for VTE risk assessment were being completed.MethodsAll acute adult in-patient and old age psychiatric wards were assessed by a team of medical students and a junior doctor over three days. We used the UK department of health VTE risk assessment tool which was adapted to include factors specific for psychiatric patients. We also assessed if there were concerns about prescribing VTE prophylaxis (compression stockings or anticoagulants), because of a history of self-harm or ligature use.ResultsOf the 145 patients included, 0% had a completed VTE risk assessment form. We found 38.6% to be at an increased risk of VTE and there were concerns about prescribing VTE prophylaxis in 31% of patients.ConclusionsOur findings suggest that VTE risk assessment is not being carried out on psychiatric wards. Staff education is needed to improve awareness of VTE. Specific guidance for this population is needed due to the presence of unique risk factors in psychiatric in-patients and concerns regarding VTE prophylaxis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Challenging healthcare discrimination

2010 ◽  
Vol 16 (1) ◽  
pp. 60-62 ◽  
Author(s):  
Peter Byrne
Keyword(s):  
Healthcare Professionals ◽  
Mental Health Problems ◽  
Psychiatric Patients ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
Government Funding ◽  
Psychiatric Services ◽  
Stigma By Association ◽  
Value Judgements ◽  
Education And Society

SummaryStigma-discrimination against people with mental health problems is more prevalent and damaging than the weaker ‘stigma by association’ experienced by mental healthcare professionals. Not only are patients reluctant to seek psychiatric help, but they are shunned by society and discriminated against by general healthcare services when they do. Other clinicians see psychiatric services as a last resort and government funding of these services is disproportionately low. Psychiatrists must engage in anti-stigma activities. I suggest ways in which, both in the clinical arena and in the wider context of education and society, psychiatrists can challenge clinicians' and the public's value judgements of psychiatric patients.

Sign in / Sign up

Export Citation Format

Share Document