A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services

Aims and method This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. Results Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. Clinical implications New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.

"Why I Stay in Community Psychiatric Rehabilitation" -A Semi-Structured Survey in Schizophrenic Patients

Aims: Although community psychiatric rehabilitation plays an important role in returning schizophrenic patients to the society, Many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study aimed is to explore the underlying causes of this trend and identify possible solutions.Methods: A total of 28 schizophrenic patients were enrolled in this study. We used semi-structured telephone interviews to obtain patients’ perceptions on the effectiveness and attraction of community mental rehabilitation, as well as the difficulties of social inclusion, then applied the grounded theory to analyze the responses. Investigation of interviews include effect of community rehabilitation, attractiveness, and difficulties in social communication.Results: Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society.Conclusions: Schizophrenic patients with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.

Eventful past, stagnant present, and hopeful future: A time order analysis of experiences of homeless women with chronic mental illness residing in shelter care homes

Background: In developing countries like India, many women with mental illness are residing in shelter care homes (SCHs) without their wish. SCHs are residential facilities provided to the socially and economically backward women for free of cost. These facilities are funded by government or voluntary organizations. Aim: To understand the living experiences of homeless women with chronic mental illness (HWCMI) admitted in SCHs. Method: This article highlights learning from a qualitative study, 17 HWCMI participated in the research. Along with their past experiences, present life, and expectations in the future, other socio-demographic details also recorded. Qualitative data were analyzed using thematic analysis approach with the Atlas ti-8 software. Findings: Three main themes were emerged from the analysis such as ‘Eventful past’, ‘Stagnant present’, and ‘Hopeful future’. The theme ‘Eventful past’ shows clear pathways to homelessness. ‘Stagnant present’ reflects upon trapped present life and their concerns and care-related aspects. The final theme, ‘hopeful future’, depicts strong hope in future and readiness for changing their living situations. The findings are discussed in the background of current trends in psychiatric rehabilitation and what is lacking in the Indian context. Conclusion: This study attempts to unveil the gender-specific and person-centric explanations of experiences associated with the combination of homelessness and mental illness.

The Effectiveness of a Community Psychiatric Rehabilitation Program Led by Laypeople in China: A Randomized Controlled Pilot Study

Background: Community psychiatric rehabilitation has proven effective in supporting individuals and their families in recovering from mental illness. The delivery of evidence-based community rehabilitation services, however, requires health care workers to possess a set of specially trained knowledge and skills. Most developing countries, including China, do not have specially trained mental health personnel. The purpose of this study was to test the feasibility and efficacy of a community psychiatric rehabilitation program delivered by laypeople.Method: We conducted a randomized controlled study. Patients at two sites in Chengdu, China, were randomly assigned to either the laypeople-delivered (LPD) community psychiatric rehabilitation group (N = 49) or the drop-in center control group (N = 45). The outcomes were changes in symptoms, social functioning, and family functioning over 6 months, as measured by the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance Scale (PSP), the Family Burden Scale of Disease (FBS), and the Family APGAR index.Results: The number of sessions received over the 12-week period of treatment ranged from 20 to 100%, with a mean completion rate of 77.32% for all 12 sessions. Statistically significant interactions between group and time were found for the total PANSS [F(2, 94) = 12.51, p < 0.001] and both the Negative PANSS [F(2, 94) = 5.89, p < 0.01] and Positive PANSS [F(2, 94) = 6.65, p < 0.01] as well as the PSP [F(2, 94) = 3.34, p < 0.05], FBS [F(2, 94) = 5.10, p < 0.01], and Family APGAR index [F(2, 94) = 4.58, p < 0.01]. The results showed that the experimental group outperformed their counterparts in symptom management, personal social functioning, family care burden, and coherence.Conclusion: These results support the feasibility and efficacy of having laypeople deliver psychiatric rehabilitation services. A discussion and limitations of the study have been included.

Easier Said Than Done: The Challenge to Teach “Personal Recovery” to Mental Health Professionals Through a Short, Targeted and Structured Training Programme

This study assesses the effectiveness of our short Personal Recovery Training Program (PRTP) for mental health professionals. Fifty-two healthcare professionals from Italian mental health services and forty students in psychiatric rehabilitation completed the Recovery Knowledge Inventory (RKI) pre- and post-training, divided into two groups: the PRTP (N = 45) and the Family Psychoeducational Training Program (FPTP; N = 47). Participants’ understanding of personal recovery improved more significantly for those in the PRTP than for those in the FPTP group in two domains, “Roles and responsibilities” and “Non-linearity of the recovery process”; the FPTP group showed a significant improvement in the “Role of self-definition and peers in recovery” domain. Two consumers were involved in the PRTP and represented a resource to help participants understand the personal recovery process. Our findings indicate that a brief PRTP supported by consumers can improve staff and students' recovery orientation. The translation of the training into clinical practice remains unevaluated.

Predictors of laxative use in inpatients with schizophrenia on clozapine

Objectives: Constipation, a clinical manifestation of gastrointestinal hypomotility, is a common and potentially serious complication of clozapine therapy, requiring laxatives for its prevention and treatment. We explored the predictive factors of the increased laxative use in inpatients receiving a long-term clozapine therapy. Methods: In the cross-sectional study of 93 patients in a psychiatric rehabilitation hospital, we examined a four-week prevalence of laxative use and a range of demographic and clinical factors associated with the number of prescribed laxatives. Results: Seventy-four percent of inpatients with schizophrenia were prescribed laxatives, and they were statistically significant older and taking higher daily doses of clozapine. In generalized Poisson regression analysis, the clozapine dose, age, and comorbid diabetes mellitus and hypothyroidism were independently associated with the number of concurrently used laxatives. No association was found between the laxatives and gender, duration of clozapine treatment, and the number of other medications with a potential to cause constipation. Conclusion: The clozapine dose, age, diabetes mellitus, and hypothyroidism were shown to be the independent predictors of the increased laxative use among inpatients on clozapine and might be associated with the increased risk of clozapine-induced constipation and gastrointestinal hypomotility.

The benefit of an ambulant psychiatric rehabilitation program in Vienna, Austria: an uncontrolled repeated measures study

We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program’s effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program’s cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.