Is deinstitutionalization working in our community?

This exploratory study examined the impact of deinstitutionalization on consumers admitted to a regional community care unit (CCU) between 1996 and 2007, and looked at lengths of stay and re-admissions to acute psychiatric care units and the impact this might have on quality of life. The results showed that the original and current residents of CCU have improved quality of life through friendships, a home-like environment, and reduced re-admissions to acute psychiatric care units; however, further improvements can be made with more emphasis on employment/vocational services and social inclusion. More concerning is those who are unable to access a CCU bed due to chronic CCU bed shortages. This group, referred to as the 'new chronic patients', tend to become victims of 'the revolving door phenomenon', homelessness, and substance abuse. The assertive community treatment model of care and community packages are recommended for people on waiting lists for CCU, or those who do not fit the CCU criteria, to try and reduce the level of disability that is likely to occur from frequent relapses.

Vulnerable populations and multicentred research.

There are many challenges facing researchers with projects requiring multicentred ethics approval. Achieving ethical approval at multiple sites, whether statewide or nationally, is a complex and time-consuming experience, compounded by the research process itself, as well as the recruitment of clinical sites and participants. Human ethics and research committees act as research gatekeepers and, as many research activities involve multiple applications and multiple approvals, can considerably delay the commencement of a project. A delay in ethics approval results in delays recruiting staff and participants, delays in the utilization of funding, and in delays regarding the progress and completion of projects. Such problems are additional problems for researchers of vulnerable populations, such as those in mental health or palliative care, where multicentred research is necessary to ensure the validity of the project itself. A current example of work that has required multicentred human ethics and research approval from around Australia is the establishment of the National Register of Antipsychotic Medication in Pregnancy. The guidelines for embarking on such a project with the requirement of multicentred ethical approval are described. Some of the issues, recommendations, and guidelines presented by the authors are taken from their experiences in establishing multicentred research projects.

Preliminary findings from the National Register of Antipsychotic Medication in Pregnancy.

OBJECTIVE: Following the presentation of a case study and an overview of current data highlighting the need for further research into the use of antipsychotic medication during pregnancy, the aim of the present paper was to outline the establishment of, and present preliminary data from, the National Register of Antipsychotic Medication in Pregnancy (NRAMP). METHOD: Australian women with a history of psychosis, including schizophrenia, bipolar affective disorder with psychosis, schizoaffective disorder and first-episode psychosis, who are pregnant, are currently being invited to participate. The confluence of speculated national pregnancy rates and epidemiological data regarding child-bearing-age women with psychosis suggested an enrollment target of 100 women over a 24 month period. Details of antipsychotic medication are recorded throughout the pregnancy and for 1 year postnatally. Interviews with the mother are conducted 6 weekly antenatally, and then at 6 and 12 weeks, and 6 and 12 months postnatally, to assess symptoms of psychosis and depression, and attitudes towards parenting. In addition, consultations are conducted with the women's health-care providers to collate information regarding pharmacology and related side-effects, obstetric outcomes, psychiatric diagnoses and symptoms during pregnancy and for 1 year after delivery, and the provision of details on the baby's health and well-being. RESULTS: NRAMP was launched in 2005. Ethics approvals have been gained at 14 sites nationally. Thirty women have consented, and 11 have completed. Data including demographics, health-care provision and medication for the first 30 participants are presented. CONCLUSIONS: The establishment of NRAMP is an important strategy in improving the management of serious mental illness such as schizophrenia and related disorders, in women who are pregnant. This project involves extensive collaboration between many different clinical groups and industry, and shall culminate in an important resource to improve the quality of life for both patients and future generations.

Managing psychosis in pregnancy.

OBJECTIVE: This article provides an introduction to the complex issues surrounding the management of women who have a history of psychosis and who become pregnant. Balancing the mental wellbeing of the woman and the safety and wellbeing of the baby is a complex task for both the expectant mother and the health professionals involved in her care. CLINICAL PICTURE: Within this article the complexity of the issues will be outlined as a case report of a woman with a history of psychotic related disorders, who was also pregnant. TREATMENT: The woman was being case managed by a Mental Health Service in Victoria, Australia, and was included on the National Register of Antipsychotic Medications in Pregnancy Register (NRAMP) recently established at the Alfred Psychiatry Research Centre (APRC). OUTCOME: The profile of women with a history of previous mental illness, and who are pregnant, often includes a poor psychosocial history and involvement with child protection agencies with regard to custody of the children. Well meant but poorly coordinated decisions by health professionals result in sub-optimal outcomes for both mother and infant. CONCLUSION: There is a need for the exploration of the management and experiences of women who have a history of psychosis and who are pregnant. This case example highlights the complexity of issues surrounding the management of this vulnerable group of women and their babies.