luh

• Treatment Settings


  • Inpatient Hospital Treatment
  • Partial Hospitalization Programs
  • Residential Setting
• Inpatient Hospital Treatment


  • Advantage: Everything needed for treatment is readily available
  • Disadvantage: Expensive, mostly short-term intervention, once symptoms subside patients are discharged
• Inpatient Hospital Treatment


  1. Rapid assessment

  2. Stabilization of symptoms

  3. Discharge planning
• Inpatient Hospital Treatment - Short-stay clients


  Clients who require brief stay
• Inpatient Hospital Treatment - Long-stay clients


  Clients with severe, persistent mental illness requiring acute care services, including those who were hospitalized before deinstitutionalization and remain hospitalized despite efforts at community placement, and those who have been hospitalized consistently for long periods despite efforts to minimize their hospital stays
• Case management


  Case managers work with clients on a broad range of issues, from accessing needed medical and psychiatric services to carrying out tasks of daily living such as using public transportation, managing money, and buying groceries
• Partial Hospitalization Programs (PHP)


  Designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions
• Partial Hospitalization Programs


  • Day treatment programs
• Goals of Partial Hospitalization Programs


  • Eight broad categories of goals (see Box 4.1)
• Day-Treatment program


  • Hospital Admissions would be for certain treatments only e.g. ECT (6-12 Hours). After the procedure the patients would be discharged
• Residential Settings


  • Group homes
  • Supervised apartments
  • Board and care homes
  • Assisted living
  • Adult foster care
  • Respite/crisis housing, short-term temporary shelter
  • Transitional housing
• Group homes


  House six to 10 residents, who take turns cooking meals and sharing household chores under the supervision of one or two staff persons
• Board and care homes


  Provide a room, bathroom, laundry facilities, and one common meal each day
• Respite/crisis housing, short-term temporary shelter


  Intended for patients who have no available caregivers for a short period of time. When patients have caregivers available, they are discharged
• Transitional housing


  Intended for the homeless, or at risk for homelessness so they can be ready for independent living, to live in the outside world, outside the institution (hospitals). Patients here are usually stable with treatments available in the community
• Board and care homes are not an example of a partial hospitalization program
• Psychiatric rehabilitation


  Services designed to promote the recovery process for clients with mental illness
• Recovery


  Goes beyond symptom control and medication management, includes personal growth, reintegration into the community, empowerment, increased independence, and improved quality of life, higher level goals and expectations for later stages of recovery, and has improved outcome by providing community support services
• Goals of Psychiatric Rehabilitation


  • Recovery from mental illness
  • Personal growth
  • Quality of life
  • Community reintegration
  • Empowerment
  • Increased independence
  • Decreased hospital admissions
  • Improved social functioning
  • Improved vocational functioning
  • Continuous treatment
  • Increased involvement in treatment decisions
  • Improved physical health
  • Recovered sense of self
• Characteristics of Later Recovery


  • Accepting illness
  • Managing symptoms effectively
  • Being actively engaged in the community
  • Having meaningful social contact
  • Coping with family relationships
  • Valuing self and others
• One of the challenges of moving toward a recovery model of care is creating and managing the change this requires, both for individual staff and throughout the organization
• Community support programs and services provide psychiatric rehabilitation to varying degrees, often depending on the resources and the funding available
• Psychiatric rehabilitation has improved client outcomes by providing community support services to decrease hospital readmission rates and increase community integration
• Managed care has reduced the "medically necessary" services that are funded, which has led to barriers to community integration that are not funded
• Peer counselors or consumer providers


  Programs employing peers found improvement in client functioning satisfaction with programming, self-confidence, and hope for recovery
• Clubhouse model


  Based on the belief that people with mental illness can lead fulfilling lives and contribute meaningfully to their communities with the right support and opportunities
• Clubhouse model


  • Four guaranteed rights of members: A place to come to, Meaningful work, Meaningful relationships, A place to return to (lifetime membership)
• Clubhouse model


  Provides members with many opportunities, including daytime work activities, evening/weekend/holiday leisure activities, transitional and independent employment support and efforts, and housing options
• Rehabilitation alliance


  The network of relationships that must develop over time to support people with psychiatric disabilities, including the client, family, friends, clinicians, and even landlords, employers, and neighbors
• Assertive Community Treatment (ACT)


  One of the most effective approaches to psychiatric rehabilitation and recovery
• Assertive Community Treatment (ACT)


  Problem-solving orientation, direct provision of service rather than referral to other programs or agencies, intense services with three or more face-to-face contacts with clients tailored to meet their needs, and no time constraints
• Mendota State Hospital


  They believed that skills training, support, and teaching should be done in the community where it was needed rather than in the hospital
• Madison model


  First known as the Madison model, then "training in community living," and finally, ACT, or the program for assertive treatment
• The mobile outreach and continuous treatment programs of today all have their roots in the Madison model
• ACT (Assertive Community Treatment) program


  • Problem-solving orientation (no problem is too small); staff members attend to specific life issues, no matter how mundane
  • Direct provision of service rather than referral to other programs or agencies, and they implement the services in the clients' homes or communities, not in offices
  • Intense services; three or more face-to-face contacts with clients are tailored to meet clients' needs
  • No time constraints; the team approach allows all staff to be equally familiar with all clients, so clients do not have to wait for an assigned person
  • ACT programs also make a long-term commitment to clients, providing services for as long as the need persists
• Transition from ACT services


  Strategies include building skills and planning for increased independence, relationships with new providers, coordination and integration of new services into daily routine, and celebrating transition as a success, not a loss
• Rural ACT programs have resulted in fewer hospital admissions, greater housing stability, improved quality of life, and improved psychiatric symptoms, even with certain modifications of traditional ACT programs
• In New York, ACT services have been modified to include services designed to prevent arrest and incarceration of adults with severe mental illness who have been involved in the criminal justice system
• Components of an ACT program


  • Having a multidisciplinary team that includes a psychiatrist, psychiatric–mental health nurse, vocational rehabilitation specialist, and social worker for each 100 clients (low staff-to-client ratio)
  • Identifying a fixed point of responsibility for clients with a primary provider of services
  • Ameliorating or eliminating the debilitating symptoms of mental illness
  • Improving client functioning in adult social and employment roles and activities
  • Decreasing the family's burden of care by providing opportunities for clients to learn skills in real-life situations
  • Implementing an individualized, ongoing treatment program defined by clients' needs
  • Involving all needed support systems for holistic treatment of clients
  • Promoting mental health through the use of a vast array of resources and treatment modalities
  • Emphasizing and promoting client independence
  • Using daily team meetings to discuss strategies to improve the care of clients
  • Providing services 24 hours a day that would include respite care to deflect unnecessary hospitalization and crisis intervention to prevent destabilization with unnecessary emergency department visits
  • Measuring client outcomes on various aspects
• Telepsychiatry, telepsychology, telemental health, e-mental health


  Mental health services delivered via Information and Communication Technology (ICT)