Pastoral care in psychiatric crisis

Pastoral Psychology -     

Improving clinical outcomes in REBT/CBT: The therapeutic uses of tape-recording

This paper outlines the numerous ways in which clinical outcomes in REBT/CBT can be enhanced and therapeutic impasses overcome through the regular and creative use of audiotherapy as a treatment adjunct. In particular therapy dosage intensity can be enhanced significantly and homework compliance improved. Audiotherapy also has a key role to play with clients who are isolated or are unsupported in their living environments. Such clients can be encouraged to use audio-taping as therapist-assisted interventions, so increasing the likelihood of their initiating therapeutic tasks such as graded activity assignments and disputing cognitive distortions and dysfunctional beliefs in vivo. The paper finally recommends that audio-taping of therapy sessions has sufficient major benefits to suggest its routine incorporation into therapeutic practice.     

Requirement for and position of partial clinical treatment in the system of psychiatric care

Reference is made to the level of development of psychiatry in the USSR and the general principles of psychiatric care accepted in the country. Part of the development in the GDR is then described, followed by an argument in favour of day and night care for patients. This is an area where much remains to be done. This partial clinical treatment is to fill the gap between inpatient and outpatient facilities and should be available in the residential area of the patient.     

Families and therapists achieve clinical outcomes,systems of care mediate the process

Conclusion The values articulated in the system of care philosophy (Stroul & Friedman, 1994) have been necessary elements of local, state, and national efforts to reform mental health care for children. The importance of the values of family collaboration, cultural competence, interagency coordination, individualized care, and use of the least restrictive treatment setting articulated by the system of care philosophy has been affirmed by practitioners, policy makers, and mental health services researchers. Such values, however, are likely not sufficient to achieve clinical outcome. Clinical outcomes are more likely to be achieved by family members and therapists when clinical practices are changed to reflect the demanding and comprehensive work of changing child and family social ecologies.     

The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities

Introduction

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service.

Results

These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes.

Conclusion

Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

     

Pastoral care of the discharged psychiatric patient

Pastoral Psychology -     

Changes in general hospital psychiatric care, 1980-1985

More than 60% of all inpatient psychiatric episodes occur in general hospitals. The need for psychologists' involvement in this important area is discussed. Changes in general hospital inpatient care from 1980 to 1985 are described. These include important and controversial changes in public policy, most notably Medicare's prospective payment system. Substantial changes in the de facto system occurred in patterns of diagnosis, sites of care, and the role of third-party payers. Implications for public policy and future investigations are drawn.     

Youth suicides unknown to psychiatric care providers.

Less than 50% of young suicides have consulted psychiatric care providers. Thus the population not found within the psychiatric care sector is described in this paper. Fifty-eight consecutive suicides among adolescents and young adults, studied by psychological autopsies, were classified according to presence or absence of previous psychiatric care. Fifteen of the sixteen subjects without previous care were males, six of these were diagnosed as having an adjustment disorder related to a recent event. Unemployment was less common (p < 0.01), the suicidal processes were shorter (p < 0.001), and previous parasuicide was less frequent (p < 0.001) among nonpatients. Evaluation in accordance with DSM-III-R criteria showed fewer substance abuse disorders (p < 0.01). Open suicidal communication prior to the suicide was less frequent but active methods were used by this population as often as by subjects known to care providers.     

Community care for the kibbutz chronic psychiatric patient

After over 15 years' experience with a very structured community care program for kibbutz chronic psychiatric patients, the author is convinced that these severely disturbed patients show improved psychosocial adjustment and a highly significant reduction in recidivism and rehospitalization as compared to their records before the institution of the community treatment program.1981, Fall     

Community care for the kibbutz chronic psychiatric patient

After over 15 years' experience with a very structured community care program for kibbutz chronic psychiatric patients, the author is convinced that these severely disturbed patients show improved psychosocial adjustment and a highly significant reduction in recidivism and rehospitalization as compared to their records before the institution of the community treatment program.     

Health-protective effects of attachment among African American girls in psychiatric care

African American girls in psychiatric care are at increased risk for HIV and sexually transmitted infection (STI) through sexual risk taking. Adolescent sexual behavior often reflects peer norms and behavior. Secure attachment patterns with mothers and peers might lessen the effects of negative peer influences and reduce sexual risk taking among African American girls. This study examined the relationships among mother-daughter and peer attachment, peer norms, and sexual-risk behaviors in African American girls seeking outpatient psychiatric care. A group of 12-16-year-old African American girls (N = 262; M age = 14.45 years) reported on their attachment to their mothers and peers, peer risk-taking and dating behaviors, peer pressure, and sexual-risk behaviors (e.g., number of partners, high-risk partners, and condom use). Structural equation modeling examined whether peer attachment and peer norms mediated the relationship between mother attachment and sexual risk. Findings supported peer norms, but not peer attachment, as a mediator of mother attachment and girls' sexual-risk behaviors. Findings revealed important family and peer factors for African American girls in psychiatric care. HIV prevention programs may be strengthened by improving mother-daughter relationships, addressing the importance of peer relationships, and emphasizing how secure mother-daughter relationships can temper the impact of peer norms.     

Behavioral knowledge among direct care staff in an inpatient psychiatric setting

Despite demonstrations of the utility and cost effectiveness of behavioral programming, such techniques are not commonly employed in psychiatric inpatient settings. Several explanations for this have been proposed, including inadequate levels of training and competence in behavioral programming among prevalent treatment staff. This study employed a multiple choice inventory to assess behavioral knowledge among subjects representing several direct care disciplines commonly found in inpatient psychiatric settings. The results support assertions of relatively low levels of behavioral knowledge among disciplines that are most prevalent in such settings. The implications of these results for initiatives to enhance behavioral knowledge and skills are discussed.