[Evaluation of the ICAR program--Internet communication and active rehabilitation for people with mental disorders]. / Ocena programu ICAR--"komunikacja w internecie i aktywna rehabilitacja dla psychicznie chorych".

UNLABELLED: Prevalence of Internet use indicates, that introducing internet to people with mental disorders might have a positive impact on their social integration. There are concerns about negative effects of dealing with virtual reality on the mental health of Internet users. AIM: Evaluation of the ICAR program--"Internet communication and active rehabilitation for people with mental disorders" concerning its utility in psychiatric rehabilitation. METHOD: 22 participants of the ICAR programme and 22 controls (people with mental disorders not participating in the programme) were investigated before and after the completion of the programme. There following were compared: their computer and Internet use skills, social functioning (Birchwood Scale), self-estimation of the mental health (Frankfurt Scale FBS), self-reported quality of life (WHO QOL BREV) and number of psychiatric hospitalisations during 11 months of the observation period. RESULTS: Among participants, their reported skills and motivation increased significantly following the programme. During 11 months of the observation there were less hospitalisations (1 fulltime and 1 daily) in the study group than in the control group (3 and 1). An increase of symptoms was observed in the Frankfurt Scale in 10 participants and 13 controls. The level of social functioning and severity of symptoms was not significantly different and did not change during observation. The self-reported quality of life increased in both groups during this period. CONCLUSIONS: ICAR training programme for the mentally ill, increases participants skills and motivation towards computer and Internet use, as well as their self-reported quality of life. The participation in the programme doesn't have any significant effect on the overall social functioning and number of psychiatric hospitalisations during the 11 months of observation. A positive effect of the ICAR programme on the quality of life, as well as some activating effect leading to exacerbation of the psychopatological symptoms--has an unspecific character and is therefore similar to the other community rehabilitation programmes. Wider spreading of computer training workshops similar to the ICAR programme might have a positive effect on social integration of people with mental disorders.

[Intentional self-poisonings among children and youth hospitalized in pediatric clinic]. / Celowe zatrucia u dzieci i mlodziezy w materiale kliniki ogólnopediatrycznej.

UNLABELLED: The aim of the study was to identify the most important factors that can favour suicide attempts among children and to establish the age of highest risk, and note the extent of the phenomenon on the base of admissions to hospital within five years. MATERIAL AND METHODS: The research covered 42 patients of Paediatric clinic at the age of 12-17 years. Clinical intervention and observation, psychological evaluation and psychiatric examination were carried out. RESULTS: Fifty percent of the patients came of an incomplete (single-parent) families. Thirty one percents of patients' families were affected by alcoholism, nearly half of poisoned children were 14-15 years of age. There was a significant prevalence of girls in the group (88%). Seventeen percents of them had a history of multiple suicidal attempts. Children hospitalized by reason of intentional self-poisoning constituted, according to a year of observation, 0.45-1.34% (mean 0,81%) of all patients of the Paediatric Clinic. CONCLUSIONS: Female sex and age of 15-16 years is a time of highest risk. Alcoholism is a frequent problem in families of children attempting suicide. Children with disturbed personality, behaviour and emotionality are particularly at risk of repeating an suicidal attempt and require longer psychological and psychiatrical care.

[Children from families with mental illness. Case study]. / Dzieci z rodzin dotknietych choroba psychiczna. Analiza sytuacji trzech rodzin.

The article reveals the influence of mental illness of one or both parents on the emotional and psychosocial development and possible adjustment disturbances of their children on the example of 3 patients. The patients (all females) were treated in the 4th Psychiatric Clinic of the Institute of Psychiatry and Neurology in Warsaw in the all-day clinic, and in the out-patient clinic with community mobile teams and specialised social help services. The analysis of the history of their mental illnesses was done and compared with the analysis of their family situation and accessible data about the emotional and psychosocial development of their children. Each of these patients was at some time a single parent due to different reasons. In each case the adjustment and emotional disturbances of patients' children occurred on a different level of their development (boy and girl of the primary school age, teenager and young adult). In all presented cases there is a need of help and support apart from the family, which indicates a need of early diagnosis of situations demanding proper systemic interventions.

Implementation of social services for the chronically mentally ill in a Polish mental health district: consequences for service use and costs.

BACKGROUND: In accordance with the mental health reform in Poland, from 1970 to 1980 the following mental health facilities were established within the general health system in the Warsaw District of Targowek: general hospital psychiatric ward, day hospital, outpatient clinic (OC), and community mobile team (CMT) with some procedures of assertive community treatment (ACT). In 1998 (according to the Mental Health Act of 1994), within the social welfare system, new community facilities were established in this district with psychosocial rehabilitation programs for the chronically mentally ill. These new social welfare facilities were a vocational rehabilitation center (VCR), community center of mutual help (CCOMH), and specialized social help services at client homes (SSHS). AIM OF THE STUDY: To determine the change of care delivered to chronic psychiatric patients in both the mental health and social welfare systems, and to compare the costs of care during two 2-year periods: before (Period A) and after (Period B) the 1998 implementation of the new social welfare facilities in the Warsaw District of Targowek. METHODS: The sample consisted of 73 chronic psychiatric patients, admitted since 1998 to the new social welfare facilities. The authors evaluated and calculated the costs of the patients' use of mental health facilities during the two years before their first admission to VCR, CCOMH or SSHS in 1998 (Period A: 1996-1998) and their use of mental health and social welfare facilities during the two years after their admission to VCR, CCOMH or SSHS in 1998 (Period B: 1998-2000). RESULTS: In this group of chronic patients, during Period B, the total duration of both full and partial hospitalizations decreased (-75.9% and -78.9% respectively), while the total number of outpatient mental health visits went up (+62.9%). In Period B the new social welfare facilities offered a substantial amount of day care and the global amount of supplied day care increased markedly. The total costs of the mental health system significantly decreased in Period B (-65.7%), but new costs emerged in the social welfare system. Taken together, the total costs of care provided by the two systems in Period B were higher than the costs incurred by the mental health system alone in Period A (+33.9 %), but the increase in the total amount of services delivered was also relevant (+98.3%). The "out of pocket" expenses incurred by patients increased in Period B (+13.9%). DISCUSSION: The activity of the new social welfare facilities (VRC, CCOMH, SSHS) seems to reduce both full time and partial hospitalizations. Despite the increasing costs of medication reimbursement, and the increased use of CMT and OC, the overall costs for the mental health system were substantially reduced. The decrease in day hospital use is probably due to the large amount of daily social support and home services offered in VRC, CCOMH and SSHS. The results emphasize the importance of evaluating the coordination of care for chronically mentally ill patients in the mental health and social welfare systems.

[The influence of community support services on the costs of treatment of chronically mentally ill patients]. / Znaczenie srodowiskowych placówek wsparcia spolecznego dla kosztów leczenia osób przewlekle chorych psychicznie.

AIM: To determine changes in costs of treatment for chronically mentally ill patients after their admittance to new social help units; Vocational Rehabilitation Center, Community Center of Mutual Help and Specialised Social Help Services at Client's Home. METHOD: In the group of 73 chronically mentally ill persons, for two years before and after their admission to social help units, the global amount of care (months x persons) and all the costs (PLN) in both social help and mental health systems were compared. RESULTS: For two years after the admission to the mentioned services all the costs in mental health system were significantly decreasing (71.9%), but new costs in social welfare system emerged. The overall costs of care were higher than before, but the elevation (35.4%) of all the costs was not so high as the increase (99,3%) of the care. The structure of care was improved (more day-, and less stationary care). The "out of the pocket" expenses for patients increased. CONCLUSIONS: The implementation of social help services for chronic mentally ill patients is reducing the amount of stationary and day treatment, but increasing active community treatment. Money in the health system is saved, but all the expenses on community care are increased. Coordination of care and finances between the mental health and social welfare is needed. Common financing for both systems is questionable because of impending over medicalisation. The allocation of money saved to early rehabilitation in schizophrenia would be profitable in the future.

[Specifics of working with chronic mentally ill patients in Specialised Social Help Services--experiences in training and supervision meetings]. / Specyfika pracy z przewlekle chorym psychicznie w ramach psychiatrycznych specjalistycznych uslug opiekunczych--doswiadczenia ze spotkan superwizyjnych.

Information was presented on the development and efficiency of The Specialised Psychiatric Social Help Services for the mentally ill in Poland. It took into consideration the specifics of this work and formal requirements for special training of the staff. The experiences of the 3.5 years of work of the specialised services in the Warszawa Targówek district (October 1997 - June 2001) were discussed. Organisational solutions and basic data about clients and staff and establishments and experiences coming from training and supervision meetings were discussed. Problems and difficulties most often experienced by the staff workers at their work with chronic mentally ill patients were described. Consideration was put from one side on the big rotation of the staff and from the other on the need of the extension of the theoretical and practical knowledge as well as of supervision and support was often mentioned in the questionnaire. A need of elaborating the programme of training and professional courses for workers of the specialised psychiatric social help services was also pointed out.

[The importance of community services for rehabilitation and social support to decrease psychiatric hospitalization]. / Znaczenie srodowiskowych placówek rehabilitacji i oparcia spolecznego dla ograniczenia hospitalizacji psychiatrycznych.

GOAL: The evaluation of community services for social support concerning minimalization of psychiatric hospitalizations. METHOD: Mean duration, global time and the number of stays in hospital ward, day treatment ward and "home hospitalisation"; in two year periods before and after their admission to an Occupational Therapy Workshop (O.T.W.), a Community Home Of Mutual Help (C.H.O.M.H.) or to Community Specialised Social Help Services (C.S.S.H.S.) at home were compared in the group of 73 chronic patients. RESULTS: In two years after the admission to the social support units, the number of all the hospitalizations was decreased (twice or three times). A mean duration of stay in the hospital ward and in the day treatment ward shortened (from 101 days to 48.4 days, from 108 days to 73.3 days), and "home hospitalisation" prolonged (from 112 days to 190 days). The global time of stay in the hospital and in the day ward became significantly shorter (by 12.2% and 5.1%), but "home hospitalisation" did not change significantly. The most effective was the care of specialised services at home connected with the participation at the same time in one of the day units O.T.W. or the C.H.O.M.H. (16 persons). The minimalization of the number (3x) and the time of staying in the day treatment ward referred to the participants of the O.T.W. or the C.H.O.M.H. (by 7.2%, 7.9%), but not of the C.S.S.H.S. at home. CONCLUSIONS: Introducing of O.T.W., C.H.O.M.H. and C.S.S.H.S. resulted in a significant reduction of hospital stays. The best results come from the combination of the care given by the daily units (O.T.W. or C.H.O.M.H.) with specialised services at home. The care supplied at the O.T.W. or the C.H.O.M.H. reduced the number and time of staying in the day treatment ward.