Background:Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities.Objectives:To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks.Methods:Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey asce...

https://journals.sagepub.com/doi/pdf/10.1177/070674370304800710

Toward benchmarks for tertiary care for adults with severe and persistent mental disorders.

Because of the significant comorbidity between mental and physical health conditions, it is imperative that access to high-quality primary physical health care be available for those with severe mental illnesses. Recognizing a gap in care, North York General Hospital (NYGH) developed and piloted a new service that built on the benefits of collaborative and shared care and the importance of co-location and service integration. In this reversed shared care clinic, access to primary physical health care was provided to patients of NYGH 's mental health department. Descriptive findings demonstrate the implementation of the service and patient demographics.

Reversed Shared Care in Mental Health: Bringing Primary Physical Health Care to Psychiatric Patients

Cet article presente les resultats d’une etude exploratoire portant sur les preferences residentielles de 315 personnes souffrant de troubles mentaux graves hebergees dans sept types d’hebergement a Montreal. Le portrait d’ensemble qui se degage de cette etude met en evidence que 22,0 % des usagers prefereraient habiter dans leur propre appartement, 16,0 % dans les HLM ou OSBL, 14,1 % dans les appartements supervises et 11,5 % dans les ressources de type familial. On note aussi que 31,7 % d’entre eux preferent le type de logement dans lequel ils habitaient au moment de l’etude. Notre reflexion sur les resultats de cette etude nous amene a conclure qu’une variete de types de ressources residentielles demeure necessaire pour rencontrer la diversite de besoins des usagers.

/pdf/les-preferences-residentielles-des-personnes-souffrant-de-397oop3vp9.pdf

Les préférences résidentielles des personnes souffrant de troubles mentaux graves : une étude descriptive

This study aimed to examine the specific characteristics of inpatients deemed by their psychiatrist to require ongoing care in a civil or forensic hospital setting compared to those who could benefit from care in a residential setting. The male participants (n = 178) involved in this study came from two such hospital settings. The results show that current hospitalization in a forensic psychiatric unit and aggressive behaviors act as obstacles to being redirected toward community-based treatment. There is a need to further assess interventions targeting aggressive behaviours so as to allow a greater number of patients to access community-based care.

Clinical Characteristics of Patients Deemed to Require Long-Term Hospitalization in a Civil or Forensic Psychiatric Setting

A small number of severely and persistently mentally ill in-patients awaiting residential or long-stay facilities represent an obstacle to the efficient utilization of acute care beds. These facilities are costly and currently reputed to be contrary to recovery principles. In 2013, all acute psychiatric care wards in Montreal identified 194 in-patients who could be discharged to residential or long-term nursing care facilities. Program clinical professionals of regional residential facilities sent adapted standardized questionnaires to ward staff. Evaluators also collected the residential preferences of both staff and patients, and then made their own assessments. The 194 in-patients were mostly middle-aged single men. Over 80% had a psychosis diagnosis and half had judicial constraints. The staff evaluated that 71.1% could be discharged from hospital within 24 h. Of these, 55% could be referred to group resources with continuous 24 h, 7 days a week staff presence, 32% could be transferred to apartments with 7-day continuous or non-continuous staff presence, 12% could be transferred to institutional care and only 2% could be moved to an apartment of their own. Evaluator and ward staff residential preferences were highly similar, but differed with patient preferences, half of whom prefer their own apartment. Discrepancy between staff evaluations and patient preferences were higher for longer stay patients with more severe symptoms and comorbidity of personality disorders.

Housing Orientations and Needs of Above-Average Length of Stay Hospitalized Psychiatric Patients.

Objectif: Comme la pression s'intensifie en vue de reduire le nombre de lits de soins actifs couteux, les gouvernements et la documentation proposent des ratios a la baisse, Est-ce raisonnable et juste pour les medecins responsables qui, a titre de principaux fournisseurs de soins, devront hospitaliser des patients et elaborer une planification des conges dans un milieu ou les lits sont reduits Methode : Les medecins traitants de 1) tous les patients hospitalises aux soins actifs un jour en particulier (n = 212) et de 2) toutes les nouvelles hospitalisations aux soins actifs sur une periode de 2 semaines (n = 125) ont rempli une version adaptee du questionnaire de Nottingham sur l'utilisation des lits de soins actifs (NABUS). Resultats : Concernant la journee en particulier, seulement 62 des 212 patients hospitalises etaient inaptes a l'hospitalisation aux soins de rechange ou actifs. Un ratio plancher de 18 lits de soins actifs par 100 000 habitants semble adequat pour l'aire de recrutement en question, pourvu que les solutions de rechange a l'hospitalisation soient pleinement et efficacement accessibles. Les solutions de rechange comportent essentiellement la gamme des milieux residentiels proteges suivants : les hopitaux de jour et les soins intensifs a domicile (de 2 a 6 heures par semaine). Le ratio des travailleurs de soins intensifs a domicile requis scrait de 25 par 100 000 habitants.

https://journals.sagepub.com/doi/pdf/10.1177/070674370204700108

Alternatives to acute hospital psychiatric care in east-end Montreal.

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Alternatives to acute hospital psychiatric care in east-end Montreal.