Causes and Classification of Mental Illness

While the classification of psychiatric disorders has been critiqued for failing to adequately account for culture, the inclusion of the Cultural Formulation Interview (CFI) in the DSM-5 has been viewed as a promising development for the inclusion of cultural factors in diagnosis and treatment of mental illness. In this study, we assess the appropriateness, acceptability, and clinical utility of the CFI among outpatients in a Mexican psychiatric hospital. Our assessment included observations of psychiatric residents’ application of the CFI with 19 patients during routine outpatient visits, along with pre- and post-CFI interviews to determine providers’ and patients’ views of the CFI. The CFI was generally well received by providers and patients, viewed as a way of building trust and increasing providers’ understanding of contextual factors influencing mental illness, such as social support. However, the CFI questions specifically related to “culture” were of limited effect and both patients and providers did not view them as useful. We discuss implications for the clinical assessment of cultural factors influencing mental health and illness and for the incorporation of the CFI in Mexican clinical settings.

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Trends in special (high-security) hospitals

The British Journal of Psychiatry ◽

10.1192/bjp.176.3.260 ◽

2000 ◽

Vol 176 (3) ◽

pp. 260-265 ◽

Cited By ~ 38

Author(s):

Martin Butwell ◽

Elizabeth Jamieson ◽

Morven Leese ◽

Pamela Taylor

Keyword(s):

Mental Illness ◽

Service Use ◽

Learning Difficulties ◽

Annual Number ◽

Hospital Discharges ◽

Mental Impairment ◽

Admission Source ◽

New Treatments ◽

Special Hospital

BackgroundIt has been argued that many patients in special hospital beds do not need to be there. In the 1990s there were initiatives to discharge women and people with learning difficulties.AimsTo test for trends in special hospital discharges and to examine annual resident cohorts.MethodThis study was from case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by region; admission episodes; legal category of detention; admission source and type of offence.ResultsThe median annual number of residents was 1859 (range 1697–1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded.ConclusionsService planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings, have gone against this trend.

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