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Chronic mental patients

Regional Convention of the World Psychiatric Society

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Congress on Preventive Psychiatry
Athens, 1999 Feb. 24-28

Co-operative management of chronic
mental patients to prevent re-hospitalization

The care and management of chronic patients present complex management problems for all of medecine. They incorporate the attention to medical management of the disease or disorder, the attention to support systems of living, movement within the community and relationships to the care-givers. However, the management of chronic mental patients is infinitely more complex. The treatment approaches, both psychotherapeutic as well as pharmacological, require a system of monitoring the symptoms, patient compliance and the daily adjustments to living within the community.
 
Frequently, relatives have died of having moved from the home areas leaving the system to provide surrogate attentive care-givers. The care of the chronic severely disordered individuals incorporates the protection by the courts adjudicating their rights and privileges under the law.
 
Programs for the chronically ill in the last decade have moved more and more into community-based organizations. However, the coordination and integration between the necessary elements have been fragmented and often absent. The premise of restructuring the system of care formerly centered in large state mental hospitals requires a more effective definition of the use of mental hospitals. Furthermore, economically driven decisions to limit and cost-manage admissions have often created a revolving door of ineffective treatment episodes.
 
In general, hospital episodes can be limited to:
 
1. imminently suicidal or homicidal patients, 2) patients requiring medication adjustments or requiring high doses of medication, 3. those requiring a highly structured environment for a period of time.
 
Other chronic patients should be attempted to be managed in the community, utilizing comprehensive resources to effect the maximal adjustment within the joint capacities of both the system and the patient.
 
The program is designed to respond to a particular group of patients who have been committed for care in state hospitals by the courts. In a program planned to use community commitment in place of hospital commitment, the program projected a working system alliance between the State Mental Health Program, the courts of jurisdiction, the agencies which deliver community mental health services and the social service system which arranges for housing, food and rehabilitative services. All the members of the alliance are committed to a training program for their staffs of the roles and services they are to provide. The entire system is connected through a common computer based system which monitors, audits, and evaluates the system. Patients may be admitted to a hospital for a brief period, to stabilize an acute exacerbation or to adjust the medication routine.
 
Components of a community-based chronic illness support system ->

H.M. Visotsky, Prof., MD
Department of Psychiatry
Northwestern University Medical School, Chicago

Main Menu

- Introduction
- First things first: Fight the stigma.
- Promotion of the psychosocial health of infants through primary health care.
- Teaching Bioethics in Medical School.
- Strategies for the prevention of suicide: emphasis on suicide attempters with concurrent psychiatric disorder.
- The ICD-10 training kit.
- Aniracetam treatment for lithium-produced cognitive deficits of bipolar patients.
- Brain plasticity and the course of mood disorders: Possible implications for secondary prevention.
- Inherited mental disorders can be prevented.
- Methodological issues in the study of Psychiatric Prevention.
- Co-operative management of chronic mental patients to prevent re-hospitalization.
- Components of a community-based chronic illness support system.
- Mobile units for rural areas in the service of psychiatric prevention.
- Prevention of personality disorders: realistic or utopic?.
- Prevention and treatment strategies should be multidimensional, continuous, multimodal and ecclectic.
- Early education intervention in schools and immediate environment.
- Before prevention.
- The relevance of comprehensive clinical diagnosis to prevention and health promotion.
- Preventive interventions for children of parents with a mental disorder: a multicomponent approach.
- Development and implementation of preventive measures for children with mentally ill parents.
- Nutrition and behavior changing concepts, changing concerns.
- The impact of perinatal care on the prevention of mental diseases.
- The WHO educational program on mental disorders in primary care.
- Biopsychosocial background and prevention of suicide.
- Current psychiatric prevention strategies in Japan.
- A case report regarding current psychiatric prevention strategies in Japan.

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