Direct Medical Cost of Treating Substance Use Disorders in Two Tertiary Hospitals in South-West, Nigeria: A Cross-Sectional Study

Introduction. Successful interventions for substance use disorders (SUDs), though obtainable, are not effectively utilized due to the high cost of treatment. The adoption of any given therapy is often impeded by insufficient evidence of the effectiveness of such treatment. Objective. This study aimed to assess the direct medical cost of treating SUD in two tertiary hospitals in South-West, Nigeria. Methods. A descriptive, cross-sectional survey of patients managed for SUD at the two psychiatric hospitals was carried out between January and June 2020. The inclusion criteria were patients with SUD above 18 years of age, registered and managed at the two hospitals. Data were collected from selected patients' case notes using a standardized data collection tool and analyzed using descriptive and inferential statistics. Results. The average costs of treatment for alcohol use disorder, drug use disorder, and drug and alcohol use disorder were ₦146,425.38 ± 57,388.84, ₦135,282.09 ± 53,190.39, and ₦143,877.33 ± 68,662.04, respectively. This translates to $384.82, $355.53, and $378.12, respectively. The highest contributors to SUD treatment cost are inpatient admissions and the cost of medicines; inpatient admissions include accommodation, feeding, and laundry. Conclusion. Considering that over 60% of the Nigerian population lives below the poverty line, the direct cost of SUD treatment is unaffordable to the patients and the health care system, which is grossly underfunded.

Understanding the Occupational Burnout Experience of Medical Specialists at the Time of Education and Career Launch: A Case Study of the Sechenov First Moscow State Medical University Students and Residents of the Alekseev Psychiatric Hospital N1

BACKGROUND: Occupational burnout in the most general terms is seen as a long-lasting stressful situation resulting from continuing occupational stress of moderate intensity. AIM: The objective of this article is to provide analysis of occupational burnout in psychiatrists and nurses of psychiatric hospitals, and the development of occupational burnout in students and residents. MATERIALS AND METHODS: The level of occupational burnout was determined using the “Attitude to work and occupational burnout” test, Seashore Group Cohesion Index, Stolin’s Self-Concept Questionnaire, and the Freiburg Multidimensional Personality Questionnaire (Freiburg Personality Inventory). The study proved the existence of patterns of occupational burnout in psychiatrists and nurses of psychiatric hospitals, as well as in students and residents. RESULTS: It has been revealed that the development of the burnout syndrome is influenced by personal qualities of psychiatrists and nurses (residents and students), and the managerial features of their activities, and that occupational burnout develops in psychiatrists and nurses over the course of their professional careers, but starts to emerge during their education. The score of the Integrative Burnout Index ranges from 48.99 in students of the [BLINDED] University to 23.52 in psychiatrists of the Alekseev Psychiatric Hospital N1. Occupational burnout syndrome is spread in medical students worldwide, with its level higher than in the overall population, in students of other specialties. CONCLUSIONS: Burnout at the stage of getting the education can hinder the professional development of students, expose patients to risk, and promote the development of various personality problems in future psychiatrists and nurses. The need of preventing professional burnout at the stage of obtaining a specialty has been substantiated.

Fractured minds to flourishing minds

<p>Youth suicide and self-harm are major public health concerns worldwide. The high rate of youth suicide and intentional self-harm in New Zealand, illustrates that there is a large amount of youth experiencing severe mental illness, as mental illness corresponds to suicidal/harmful behavior. Although more youth are seeking and receiving help, a large portion who are suffering are unwilling to engage in services, due to stigma surrounding mental health. Characteristics of the built environment can effect wellbeing and therefore architecture holds significant implications for the mental health of individuals. Inpatient environments are an effective intervention for the treatment of a range of severe mental illnesses, however there is a definitive lack of acute inpatient facilities for youth in New Zealand. A shift in the way mental healthcare services are provided has meant that large psychiatric hospitals have been closed or downsized and compulsory inpatient treatment has given way to voluntary engagement with community mental health services. This has not eliminated the need for inpatient care and there still remains a need for these highly specialized environments. These current specialized environments are generally not designed to benefit the mental health and wellbeing of patients, but are just regarded as settings in which recovery takes place. This thesis aims to explore how architecture can act therapeutically to support the wellbeing of individuals suffering mental illness. It looks at how architecture can retain the dignity of these patients, and challenge conventional norms of prior mental healthcare environments. This thesis aims to integrate Maori and Pacific models of health and wellbeing in order to allow improved care and treatment for Maori and Pacific groups. It responds to the lack and unsuccessful architectural responses for youth in New Zealand and in particular, the central region and aims to design a new mental health inpatient and outpatient facility specifically for youth suffering mental illness.</p>

Fractured minds to flourishing minds

<p>Youth suicide and self-harm are major public health concerns worldwide. The high rate of youth suicide and intentional self-harm in New Zealand, illustrates that there is a large amount of youth experiencing severe mental illness, as mental illness corresponds to suicidal/harmful behavior. Although more youth are seeking and receiving help, a large portion who are suffering are unwilling to engage in services, due to stigma surrounding mental health. Characteristics of the built environment can effect wellbeing and therefore architecture holds significant implications for the mental health of individuals. Inpatient environments are an effective intervention for the treatment of a range of severe mental illnesses, however there is a definitive lack of acute inpatient facilities for youth in New Zealand. A shift in the way mental healthcare services are provided has meant that large psychiatric hospitals have been closed or downsized and compulsory inpatient treatment has given way to voluntary engagement with community mental health services. This has not eliminated the need for inpatient care and there still remains a need for these highly specialized environments. These current specialized environments are generally not designed to benefit the mental health and wellbeing of patients, but are just regarded as settings in which recovery takes place. This thesis aims to explore how architecture can act therapeutically to support the wellbeing of individuals suffering mental illness. It looks at how architecture can retain the dignity of these patients, and challenge conventional norms of prior mental healthcare environments. This thesis aims to integrate Maori and Pacific models of health and wellbeing in order to allow improved care and treatment for Maori and Pacific groups. It responds to the lack and unsuccessful architectural responses for youth in New Zealand and in particular, the central region and aims to design a new mental health inpatient and outpatient facility specifically for youth suffering mental illness.</p>

Memories of the Manicomio: Representations of Mental Illness and Psychiatric Institutions in Contemporary Italian Writing

<p>In the long-standing relationship between mental illness and literature in Italy, where historically literary and medical discourses on neurosis have been intertwined, the criticism of mental institutions has stood out as a literary trope only since the spread of radical psychiatry movements in the 1950s. From Le libere donne di Magliano (1953), by Tuscan psychiatrist and writer Mario Tobino, many writings produced around the years of the Basaglia reform and in the following decades have openly engaged with the dark present and past of psychiatric hospitals. However, while the shocking personal testimonies and photographic and audio-visual records of internment that supported and promoted the Basaglia reform are being reassessed today as tangible acts of memory, less attention has been given to the literary representations of asylums and their role as a medium of memory for a twenty-first-century readership. This has become clear in the years around the thirtieth anniversary of the Law 180/78, when the contemporary representations of the Italian teatro di narrazione significantly dealt with the theme of the internment, seeking to debunk the cultural myths surrounding psychiatric hospitals and their patients. This thesis seeks to address this gap by arguing that the literary discourse on mental hospitals in Italy has focused on the intricate relationship between cultural perceptions of mental disorders, personal experience of treatment and internment, and their legacy on the country’s collective memory. I structure my analysis within the intersection of two main theoretical frameworks: the first refers to the recent psychiatric and historical assessments of the Italian psychiatric confinement, and the second draws from theoretical conceptualisations of the relationship between literary genres and collective memory. To do this, I consider three literary genres that have played a significant role in this debate, each within their specific conventions: the memoir, the novel and narrative theatre. After introducing the discourse on the perception of mental confinement through a review of its representations in different media, I discuss the memoir in depth, focussing on Tobino’s three published diaries, Alda Merini’s L’altra verità. Diario di una diversa (1986) and Fabrizia Ramondino’s Passaggio a Trieste (2000). This is followed by a thorough analysis of the relationship between the novel and the psychiatric institution through the reading of Tobino’s Per le antiche scale. Una storia (1972), Italo Calvino’s La giornata d’uno scrutatore (1963) and Luca Masali’s La vergine delle ossa (2010). Finally, I discuss Ascanio Celestini’s La pecora nera. Elogio funebre del manicomio elettrico (2006), Renato Sarti’s Muri. Prima e dopo Basaglia (2008) and Marco Paolini’s Ausmerzen. Vite indegne di essere vissute (2012), in the context of narrative theatre. Through my analysis of these texts and theatrical performances, I show how the manicomio gradually acquires the status of lieu de mémoire in contemporary Italian writing. Depicting, criticising and remembering the asylum, contemporary literary writings have responded to its disappearance as a physical space by rethinking it as a metaphorical means of understanding the present. Progressively challenging a literary tradition which struggled to give voice to the experience of mental disorder, these depictions have recognized persistent forms of social exclusion in contemporary Italy and highlighted the pressing need for a new culture of representing internment.</p>

Memories of the Manicomio: Representations of Mental Illness and Psychiatric Institutions in Contemporary Italian Writing

<p>In the long-standing relationship between mental illness and literature in Italy, where historically literary and medical discourses on neurosis have been intertwined, the criticism of mental institutions has stood out as a literary trope only since the spread of radical psychiatry movements in the 1950s. From Le libere donne di Magliano (1953), by Tuscan psychiatrist and writer Mario Tobino, many writings produced around the years of the Basaglia reform and in the following decades have openly engaged with the dark present and past of psychiatric hospitals. However, while the shocking personal testimonies and photographic and audio-visual records of internment that supported and promoted the Basaglia reform are being reassessed today as tangible acts of memory, less attention has been given to the literary representations of asylums and their role as a medium of memory for a twenty-first-century readership. This has become clear in the years around the thirtieth anniversary of the Law 180/78, when the contemporary representations of the Italian teatro di narrazione significantly dealt with the theme of the internment, seeking to debunk the cultural myths surrounding psychiatric hospitals and their patients. This thesis seeks to address this gap by arguing that the literary discourse on mental hospitals in Italy has focused on the intricate relationship between cultural perceptions of mental disorders, personal experience of treatment and internment, and their legacy on the country’s collective memory. I structure my analysis within the intersection of two main theoretical frameworks: the first refers to the recent psychiatric and historical assessments of the Italian psychiatric confinement, and the second draws from theoretical conceptualisations of the relationship between literary genres and collective memory. To do this, I consider three literary genres that have played a significant role in this debate, each within their specific conventions: the memoir, the novel and narrative theatre. After introducing the discourse on the perception of mental confinement through a review of its representations in different media, I discuss the memoir in depth, focussing on Tobino’s three published diaries, Alda Merini’s L’altra verità. Diario di una diversa (1986) and Fabrizia Ramondino’s Passaggio a Trieste (2000). This is followed by a thorough analysis of the relationship between the novel and the psychiatric institution through the reading of Tobino’s Per le antiche scale. Una storia (1972), Italo Calvino’s La giornata d’uno scrutatore (1963) and Luca Masali’s La vergine delle ossa (2010). Finally, I discuss Ascanio Celestini’s La pecora nera. Elogio funebre del manicomio elettrico (2006), Renato Sarti’s Muri. Prima e dopo Basaglia (2008) and Marco Paolini’s Ausmerzen. Vite indegne di essere vissute (2012), in the context of narrative theatre. Through my analysis of these texts and theatrical performances, I show how the manicomio gradually acquires the status of lieu de mémoire in contemporary Italian writing. Depicting, criticising and remembering the asylum, contemporary literary writings have responded to its disappearance as a physical space by rethinking it as a metaphorical means of understanding the present. Progressively challenging a literary tradition which struggled to give voice to the experience of mental disorder, these depictions have recognized persistent forms of social exclusion in contemporary Italy and highlighted the pressing need for a new culture of representing internment.</p>

Nachsorge unter erschwerten Vorzeichen – Erfahrungen forensischer Nachsorgeambulanzen mit Sexualstraftätern, die nach der Novelle der Verhältnismäßigkeitsregelung entlassen wurden

A major amendment of the German Criminal Code concerning treatment in forensic psychiatric hospitals (Secs. 63, 67 StGB) became effective in August 2016 and has led to an increasing number of discharges of sex offenders. In addition to inpatient treatment practice, this also poses great challenges for forensic aftercare. After a brief overview of the amendment, this article examines how it affects the release practice and legal probation. Based on the analysis of the post-inpatient development of ten sex offenders from North Rhine-Westphalia who were released for disproportionate reasons, the far-reaching consequences of the amendment forensic aftercare have to deal with are illustrated. Finally, attention is drawn to the great need for action and alternative solutions to reduce the length of stay and strengthens the patients fundamental right to freedom are proposed.