Persisting gaps in M-OUD coverage at post-discharge recovery houses necessitate our continued advocacy.

Effective treatment of opioid use disorder (OUD) must target both the medical and psychosocial aspects of a patient's condition. This, in turn, requires a collaboration between medical providers and social supports. We would like to illustrate a key difficulty in this collaboration for some patients in our country: many post-discharge recovery houses continue to refuse to allow patients to remain on medication treatment for OUD (M-OUD). This barrier to M-OUD access in recovery houses is a significant obstacle to effective OUD treatment.

[Intersection of acute psychiatric wards and sheltered housing - parameters of patients with long inpatient episodes]. / Schnittstelle psychiatrische Akutstationen und betreute Wohneinrichtungen - Charakteristika von Patienten mit langen Klinikaufenthalten.

OBJECTIVE: This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room in a sheltered housing facility. METHODS: We investigated the longest inpatient treatment period of all patients aged between 18 and 65 years on an acute ward of the Psychiatric University Hospital Zurich (n = 3,928) using the basic documentation of the years 2006 to 2010. RESULTS: 20 % of all patients on acute wards had a stay of more than 60 days. Socio-demographic and clinical characteristics are similar to those of "heavy users" of mental health services. Social work is involved more frequently, and placement in sheltered housing facilities is intended in one third of those patients. CONCLUSIONS: A substantial part of the patients who stay at least once longer than two months on an acute ward are discharged to sheltered housing. Besides severity of illness it is likely that lack of availability of an adequate housing option contributes to length of stay. Intensified cooperation of the psychiatric clinic with sheltered housing facilities as well as alternative options for those in need of assisted housing and mental health care might help to reduce their extensive usage of inpatient treatment capacities. Interventions and services have to be adapted to local conditions.

La atención de la fractura de fémur en las unidades de convalecencia / No disponible

El desarrollo de las Unidades de Media Estancia (UME) o Convalecencia (UC), según las diferentes acepciones, ha permitido proseguir el proceso rehabilitador en los pacientes ancianos afectos de fractura del tercio proximal de fémur. Este hecho, contribuye a una reducción de la mortalidad innata del proceso, un mejor resultado de recuperación funcional así cómo a una disminución de las complicaciones propias, que un evento como la fractura de fémur, dada su magnitud, ocasiona al paciente anciano. Otro aspecto fundamental es el de la utilización de los recursos sociales y sanitarios, que se ven favorecidos y optimizados en su gestión gracias a la existencia de dichas unidades. La reducción de la estancia media en los hospitales de agudos y una menor tasa de institucionalización al final del alta médica, son claros ejemplos de la efectividad y la eficiencia de las unidades de convalecencia(AU)

The development of Geriatric Assesment Units or Geriatric Rehabilitation Units, according to different meanings, has allowed the rehabilitation process to be carried on in old patients affected in hip fracture. This fact, leads to a reduction of the death of the process, a better functional recuperation, and at the same time, decreasing of the common complications, which uses to affect the old patient, due to its magnitude. Another fundamental aspect is the use of sanitary and social sources, which are being optimized in their management due to the existence of some sectors. The reduction of average in hospitals and a lower tax in institutionalization at the end of medical discharge, are clear examples of the effectiveness and efficiency of the convalescence sectors(AU)

Juventude e consumo de drogas: oficinas de instrumentalização de trabalhadores de instituições sociais, na perspectiva da saúde coletiva / Young people and drug consumption: workshops to provide tools for workers in social institutions, from a collective health perspective / Juventud y consumo de drogas: talleres de instrumentalización de trabajadores de instituciones sociales en la perspectiva de la salud colectiva

O objeto deste estudo é a oficina de instrumentalização de trabalhadores de instituições sociais que trabalham com jovens, para compreender o consumo contemporâneo de drogas. Partiu-se do pressuposto de que a abordagem da temática na perspectiva da Saúde Coletiva, ou seja, a partir da compreensão estrutural da produção, distribuição e consumo contemporâneo de drogas, poderia aperfeiçoar o trabalho nessas instituições. O objetivo foi verificar a efetividade da oficina como instrumento do processo educativo. A metodologia consistiu na realização sistemática de oficinas com base no arcabouço teórico-metodológico da teoria histórico-crítica. A participação evoluiu qualitativamente, mostrando que os saberes identificados com os do senso comum inicialmente trazidos pelos trabalhadores evoluíram para uma compreensão das raízes do consumo prejudicial de drogas e para a superação de práticas reiterativas que retroalimentam mitos, preconceitos e estereótipos a respeito do usuário, bem como a respeito do poder e dos efeitos das drogas.

The objective of this study was, through workshops, to provide tools for workers in social institutions who work with young people, so that they could understand present-day drug consumption. It started from the presupposition that approaching this topic from a collective health perspective, i.e. from understanding the structure of the production, distribution and consumption of drugs today, the work of these institutions might be improved. The aim was to investigate the effectiveness of workshops as tools in the educational process. The methodology consisted of systematically conducting workshops within a theoretical-methodological framework of historical-critical theory. The workers' participation evolved qualitatively, thereby showing that the knowledge identified, along with the common sense initially brought in, evolved into comprehension of the roots of harmful drug consumption and into surmounting reiterative practices that fed back into myths, prejudice and stereotypes regarding users, as well as gaining respect for the power and effects of drugs.

El objeto de este estudio es el taller de instrumentalización de trabajadores de instituciones sociales que trabajan con jóvenes, para comprender el consumo contemporáneo de drogas. Se parte del presupuesto de que la aproximación de la temática en la perspectiva de la Salud Colectiva, o sea, a partir de la comprensión estructural de la producción, distribución y consumo contemporáneo de drogas, podría perfeccionar el trabajo en tales instituciones. El propósito ha sido verificar la efectividad del taller como instrumento del proceso educativo. La metodología consiste en la realización sistemática de talleres a partir de la estructura teórico-metodológica de la teoría histórico-crítica. La participación evolucionó cualitativamente, mostrando que los saberes identificados con los del sentido común inicialmente traidos por los trabajadores evolucionaron para una comprensión de las raíces del consumo perjudicial de drogas y para la superación de prácticas reiterativas que retro-alimentan mitos, preconceptos y estereotipos respecto al usuario, así como respecto al poder y a los efectos de las drogas.

HIV risk reduction and service delivery strategies in criminal justice settings.

Because of the HIV risk behaviors of substance abusers, particularly injection drug users and those who exchange sex for drugs, and the large numbers who are already infected with HIV or showing symptoms of AIDS, significant service delivery issues are associated with their criminal justice processing. Many strategies have been implemented in correctional settings in an effort to prevent and control the transmission of HIV. A number of these are for the purpose of lowering transmission risk in institutions, whereas others have been structured for the sake of offering prevention/intervention to inmates before they return to the free community. As such, prisons and jails represent opportune settings for HIV prevention and education. The most common HIV control/prevention/education strategies include mandatory testing of inmates for HIV, segregating infected inmates from the general prison population, establishing special health care units for HIV positive and AIDS symptomatic inmates, offering HIV prevention and risk reduction programs, and granting medical parole for the terminally ill. Because drug abuse treatment results in substantial declines in the use of heroin, cocaine, and other drugs, treatment per se can play a significant role in reducing the spread of HIV and AIDS among those coming to the attention of the criminal justice system. Most promising are continuous and integrated treatment services that are tied to the stages of correctional supervision: primary treatment while incarcerated; secondary treatment while on work release, halfway house or community supervision; and, tertiary treatment in ongoing aftercare.

Housing for people with mental illnesses: a comparison of models and an examination of the growth of alternative housing in Canada.

The decrease over the past three decades in institutional care for people with mental illness has not been matched by the adequate development of specialized housing in the community. Broadly speaking, two major models of housing have emerged in the past 30 years: custodial and alternative. Large custodial settings, including boarding houses, nursing homes and special care homes, are typically not associated with residents' satisfaction or a positive outcome. Alternative housing refers to a range of models, including halfway houses, group homes, co-ops and supported housing. It is associated with better residents' outcomes. This paper briefly compares the two models and examines key issues in alternative housing and its development in Canada.

Supportive housing: a consumer evaluation study.

The current debate about how to provide housing for persons with persistent psychiatric disabilities should be informed by empirical information from a variety of sources. Data from a study of 17 residents discharged from Regeneration House Inc., illustrates the value of consumer perceptions in the evaluation of supportive housing. Extensive exploration of the positive and negative aspects of living in a group home from the perspective of experienced residents provides useful input for programme planning. The implications of the findings for the individual programme and the wider field are discussed.

A ten-year perspective on three models of sheltered care.

Data from three surveys of California sheltered care residents and facilities were used to determine which of three models best describes the use of sheltered care by residents and the provision of services to residents between 1973 and 1983. The continuum-of-care model emphasizes a person's movement along a treatment continuum to greater independence. In the residual model, the focus is on providing habitation for a chronic population from the era before deinstitutionalization. The developmental model emphasizes providing long-term care to persons who seek supported living arrangements at a particular point in their life cycle. Results indicated that the developmental model best describes the way residents used sheltered care, while service provision was based on the continuum-of-care model. In light of these findings, it should be determined whether service provision reflects the actual needs of this population.

Special treatment facilities for alcoholics in Japan.

No comprehensive study on special treatment facilities for alcoholics in Japan has been reported. We conducted a questionnaire survey of alcoholism treatment wards, alcoholism treatment rooms, special outpatient clinics for alcoholics and halfway houses for alcoholics. The survey covered nearly all of such facilities in Japan. The results of the survey revealed the following characteristics: (1) The number of such facilities has increased rapidly in recent years; (2) the facilities are concentrated in cities; (3) the great majority of the facilities are privately operated; (4) many of the facilities are associated with psychiatric departments; and (5) there are very few facilities exclusively for female alcoholics. The most fundamental and important point is that the number of special treatment facilities for alcoholics is insufficient to meet current needs. These facilities have not diversified sufficiently to address adequately the changing needs of Japanese alcoholics.

Replacing the mental hospital. Community provision for a district's chronically psychiatrically disabled in domestic environments?

Eighteen long-stay patients from an old county asylum moved into hospital hostels. After 12-24 months, there were significant reductions in overall symptoms, as rated by the CPRS and the Krawiecka scale, as well as in deviant but not general behaviour, rated by the REHAB scale. Six later moved to live in supported accommodation. All relatives and patients who expressed an opinion to an independent assessor were satisfied with their present accommodation or wished to move to more independent living.

Families caring for a young adult with mental retardation: service needs and urgency of community living requests.

Service needs of families caring for 571 individuals with mental retardation (ages 20 to 24) during the transition into adulthood was described, with an emphasis on the urgency of requests for community state-supported living services. Results of a multiple regression analysis suggested that requests for community living were related more to family stressors than to characteristics of the young adult or participation in regular daytime activities. Most families also requested daytime services and at least one type of social support. The services most requested were those representing normalizing activities, and the major reasons for seeking them involved promoting the young adults' independence.

Overview of a research programme designed to address key issues in the planning and delivery of services for people with mental handicap.

This paper describes the programme of mental handicap research funded by the UK Department of Health, which addresses issues of policy, planning and service delivery of key interest to all involved professionals. The author is manager of the research programme and the research discussed covers the provision of good community residential care, hospital contraction, costs, other services in the community, supporting children with mental handicaps at home with their families, and the special needs of certain groups.

Mental hospital depopulation in Canada: patient perspectives.

This paper reviews briefly the history of mental health depopulation in Canada over the past 30 years. The term "deinstitutionalization" is often used but is unsatisfactory. Using an exploratory, qualitative, methodological approach, data were collected on the problems encountered by a disproportionate, stratified random sample of 139 formerly institutionalized patients living in various geographical locales in Eastern Canada. Adopting a symbolic interactionist theoretical approach, this study, in an effort to fill a neglect in the literature, attempted to discover what the everyday world(s) of Canadian ex-mental patients was really like. Problems encountered related to stigma, poor housing, lack of back living skills, poverty, unemployment and aftercare. Quotations from patients are provided to illustrate such themes. The findings are discussed.

Clinical judgement on alternative care for longstay patients in Dutch mental hospitals.

How many longstay patients could be equally served by less sheltered facilities, and what are the main reasons for staff members to judge patients suitable for such alternative care? These were two questions in a Dutch study (1984-1985) of five mental hospitals. The attending psychiatrists in these hospitals and members of the nursing staff, were asked to give an independent judgement for each of a random sample of 381 longstay patients. Thirty percent of the longstay patients were judged eligible for alternative care. They were generally younger, less frequently diagnosed as schizophrenic, better integrated both inside and outside the mental hospital, more likely to be resident of wards with high turnover rates, were less aggressive, had better social skills, and had shorter periods of inpatient stay. Compared with the rest of the patients no statistically significant differences were found with regard to suicidal behaviour, organic brain syndrome and formal admission status.

[Complementing and replacing the clinic sensibly--on the management, effectiveness and indications for a complementary psychiatric residence. Results of a 1-year prospective evaluation study]. / Die Klinik sinnvoll ergänzen und ersetzen--zur Versorgung, Effektivität und Indikation des komplementären psychiatrischen Wohnbereichs. Ergebnisse einer einjährigen prospektiven Evaluationsstudie.

The complementary psychiatric (home) area is a relatively new branch of institutional psychiatry, the therapeutic evaluation and integration of which into everyday psychiatric thinking and acting has not yet become a reality. The evaluative study presented here covered 53 inmates and concerned their everyday life, the success of the treatment, predictors and perspectives. A gradual change in the means and aims of psychiatric rehabilitation seems to be materializing: the (re-)integration of the subject into his family of origin or into the psychosocial network will probably become more important than just reinstating the patient into his original place and kind of work. For the future it appears desirable that the inmates and the equipment are financially secured, that the entire setup is integrated into the system of psychiatric institutions, and that the method can be applied to further groups of patients.

Model services for treatment/management of the mentally retarded-mentally ill.

Mental illness affects nearly 25-30% of America's mentally retarded population. While a small number of these individuals will require institutional care, it is clearly possible to serve the majority in community-based residential settings. This paper will provide an overview of the various types of mental illness found in the mentally retarded population currently served by the Eastern Nebraska Community Office of Retardation (ENCOR), examine the treatment challenges which the provision of services to this special population have presented, and share recommendations as to how the ENCOR model can assist other communities in serving similar complex subpopulations in a developmental and cost-efficient manner.

Movement of developmentally disabled individuals among out-of-home residential facilities.

This paper reported on the movement of a large (N = 2271) probability sample of the nation's residents of public (PRF) and community (CRF) residential facilities for developmentally disabled children and adults. Estimates placed the national population at 217,410 in all facilities--73,709 in CRFs and 143,701 in PRFs--in the fall of 1978, when the sample was selected, although extrapolation from subsequent surveys suggest that the CRF numbers should be about 100,000. In the winter of 1979 direct care staff and administrators completed detailed information about each resident sampled, about themselves, and about their facilities. In 1980 they were asked if their residents had moved exactly one year later. Most residents (91%) had not moved; 1.3% had died; and about 8.5% had moved. Most moves featured greater integration into the community. Multivariate analyses indicated very little difference between moved and unmoved residents. Among moved subjects, three dimensions accounted for 62% of the common variance in placement status: (a) ability, (b) age, and (c) autonomy.

Living arrangement options for young people preparing for independent living.

Innovative living arrangement options are being developed around the country to provide both preparation and practical experience in independent living for older youths unable to return home. This article describes in detail the full continuum of existing options and their general characteristics.