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1.
OBJECTIVE: To reduce the use of restraint and seclusion with children and adolescents in psychiatric inpatient units by promoting a preventive, strength-based model of care. METHOD: The State Mental Health Authority used data analysis, quality improvement strategies, regulatory oversight, and technical assistance to develop and implement system change over a 22-month period. No changes in regulation or policy were undertaken. RESULTS: Comparative data collected before and after the interventions demonstrated substantial reductions in the use of restraint and seclusion. Child units (age 5-12) decreased from 84.03 to 22.78 episodes per 1,000 patient days (72.9%), adolescent units from 72.22 to 37.99 episodes (47.4%), and mixed child/adolescent units from 73.37 to 30.08 episodes (59%). CONCLUSIONS: The use of restraint and seclusion in child and adolescent inpatient settings can be reduced through a systems approach, which may have applicability to other settings and systems.  相似文献   

2.
Compulsory admission is not just restricted to younger psychiatric patients. However, despite the differences in clinical presentation between younger and older adults, there has been very little research comparing different age groups. In this study, elderly and younger adult patients who had compulsory psychiatric admissions were compared according to a number of social and clinical variables. Elderly patients were less likely to have police involvement in an admission but more likely to be referred by their own GP and to live alone. The particular needs of the elderly could be reflected by better guidelines on the use of the Mental Health Act.  相似文献   

3.
The focus of this article is on families with both parental mental health issues and child protection concerns, a common clinical situation. Ethical dilemmas can arise from conflicting laws in a particular jurisdiction. This is evident in the State of South Australia, Australia. The issue is highlighted by examining the Mental Health Act 1993 (SA), the Children's Protection Act 1993 (SA) and Mental Health Act 2009 (SA). In developing a family approach where a parent has a mental illness and where statutory child protection concerns exist, both the Mental Health Act and the Children's Protection Act are needed to inform the clinical decision making for family members. Clinical, ethical, and legal issues are discussed. Two ethical models: Relational Ethics and Co-operation Despite Disagreement put forward the need for services to develop meaningful dialogue and collaborative practice. Professional codes of ethics need to address these complex, pluralistic ethical issues.  相似文献   

4.
The National Institute of Mental Health established a special subgroup of its National Advisory Mental Health Council to review major research findings on child and adolescent psychiatric disorders over the past decade and to recommend research priorities for the next decade. This Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment published its report, titled Blueprint for Change: Research on Child and Adolescent Mental Health, in August 2001, and several new research announcements reflecting these new directions have been issued since that time. This article summarizes the rationale for and background to the report, its major conclusions, and the reasons why interdisciplinary and translational approaches to research questions in child and adolescent mental health will help to maximize scientific advances.  相似文献   

5.
Background:  There is a need for more accurate information regarding the staffing of Child and Adolescent Psychiatric inpatient units. This is both to facilitate clinical governance and to allow planning and focused further development of these services.
Method:  Postal surveys were sent to all units in England and Wales.
Results:  Seventy-three percent ( n  = 1060) of the 1460 staff employed by the units were nurses; 43% of nurses were unqualified. On average there was one consultant psychiatrist for every 25 patients. Only 12% of nurses working on a 'census' day held a specialist qualification in nursing children. The use of agency and bank staff was higher in independent sector units than in NHS units (37% vs 10% of all nurses who worked a shift on the census day).
Conclusions:  Some child and adolescent inpatient units are not staffed by a multi-disciplinary team. There is evidence of problems of recruitment and retention of nurses.  相似文献   

6.
The Mental Health Act 2007 (UK) (MHA 2007) received Royal Assent in July 2007 and has now reached the statute books after 8 years of controversy and debate. The MHA 2007 makes amendments to several pieces of existing legislation, but the main changes it makes are to the Mental Health Act 1983 (MHA 1983) and the introduction of “Deprivation of liberty safeguards” into the Mental Capacity Act 2005 (UK). Much of the concern about more patients being subject to detention is a perception of the new legislation, tempered by the antecedents to the MHA 2007 (which included an expert report, a Green paper, a White Paper and two draft Bills’) as well as Government propaganda. The purpose of the present article was to highlight how the Government's approach and propaganda has fuelled these concerns, to scrutinize the amendments contained in the MHA 2007, and to consider whether these may result in more patients being subject to compulsion.  相似文献   

7.
Abstract The 1986 General Health Act and the so-called 'psychiatric reform' were key issues in the development of the mental healthcare system (MHCS) in Spain. The World Health Organization Declaration and Action Plan on Mental Health in 2005 gave it a revitalizing impetus and resulted in the first National Health System (NHS) Mental Health Strategy in 2006. A literature search was performed using MEDLINE, Spanish journals, reference lists, national databases, and European and Spanish official documents to describe the current state of the MHCS in Spain. The main results were: (1) existence of great variability among the autonomous communities with respect to mental health resources and provision of care; (2) lack of national epidemiological information on mental disorders with the exception of substance use disorders and suicide, which comprise powerful longitudinal national data, (3) training in psychiatry is well established, although there is no specialism of child and adolescent psychiatry, and (4) a dramatic increase in scientific productivity in the last decade among research groups, in part due to the creation of the Spanish Mental Health Network, the Centro de Investigación Biomédica en Red en el área de Salud Mental (CIBERSAM). Quantifiable and reliable indicators are needed to provide efficient monitoring and analysis of epidemiological events and subsequently to understand the status of the Spanish MHCS.  相似文献   

8.
Background:  Most previous studies of service use in relation to mental health have examined services in the USA. We wanted to provide up-to-date findings from a general population sample of British schoolchildren.
Method:  A total of 2461 children aged 5–15 from the 1999 British Child and Adolescent Mental Health Survey were followed up for 3 years. We examine the relationship between a wide variety of potential predictors gathered in 1999 and the use of services over the following 3 years.
Results:  Contact with most services was predicted by three factors: the impact of psychopathology; contact with teachers or primary health care; and parents' and teachers' perceptions that the child had significant difficulties. Other predictors were specific to each service.
Conclusions:  Education of parents, teachers and other important adults might increase the proportion of children with impairing psychiatric disorders reaching services.  相似文献   

9.
Background:  The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team.
Method:  Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP.
Results:  The median DUP across the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route ( p  < .001), and age of onset, with earlier age of onset associated with shorter DUP ( p  = .015).
Conclusion:  These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services.  相似文献   

10.
Background: This article describes an action research project aimed at examining the accessibility of a child and adolescent mental health service to its ethnic minority populations.
Method: A Child and Adolescent Mental Health Service was involved in a process of inquiry, deciding first to compare rate of referral and treatment outcomes for the four largest ethnic groups amongst the client population. Following discussion of findings throughout the service, groups of Bangladeshi service users and professionals were interviewed about low rates of referral amongst this community.
Results: By highlighting the different referral rates and profiles of different ethnic groups, the study elicited an increasingly shared commitment across the service to addressing issues of accessibility to ethnic minority communities.
Conclusions: The study is presented as one possible model of response to the challenge to all public services made by Macpherson (1999), to examine the 'appropriateness' of the service offered to different ethnic populations.  相似文献   

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