Shirley A Smoyak

Discharge-ready patients who remain hospitalized: A re-emerging problem for mental health services

There is evidence that mentally ill patients nationwide are retained in state hospitals in spite of the fact that they are discharge-ready. New Jersey provided a unique opportunity to study this phenomenon, since it had been using specific procedures to identify discharge-ready patients in state hospitals. An analysis of New Jersey state hospital data found that about 45% of the state hospital patients were designated by either the legal or the clinical system, or both, as discharge-ready. Although a substantial number of these patients were, disabled, they were assessed as being able to manage in the community with appropriate support. Characteristics and service needs of these patients are described, and the differences between those designated as discharge-ready and those who were not are examined. Recommendations are made for future research addressing the legal, clinical and social processes that affect discharge readiness.

Telephone Therapy: Call for Help

1. Many disabled people are unable to take advantage of community resources because they cannot leave their homes, but the telephone can provide a link to psychotherapeutic services. 2. In both telephone and office therapy, the therapist orients members to the group, suggests an arena in which goals might be established, encourages verbalizations, sharing of concerns, strategies for solving problems, and assesses the psychodynamics of the therapeutic situation. 3. Psychotherapy via telephone can provide significant benefits to people who formerly were barred from services. Telephone therapy requires the therapists commitment to the challenge of mastering a new technique and to altering fee structures to allow those on fixed incomes to be served.

The history, economics, and financing of mental health care. Part 1: 17th to 19th centuries.

Families in colonial times cared for their mentally ill members at home, with little assistance from their communities. Community treatment is an old idea, not a new one. Early laws about containing the disturbances created by individuals with mental illness made no mention of clinical dimensions. The focus was strictly on the social and economic consequences of the mental disorders. Legislation about public mental hospitals in the mid-19th century was hardly enlightened. There were no particular plans, other than not to expend more dollars than actually necessary.

Use of Gaming Simulation by Health Care Professionals

Gaming-simulation is being developed for use in a variety of aspects of health care. A mental health diagnostic and therapeutic application is described for problems in parent-teenager relations; it features gaming, videotaping of interactions, and extensive discussion. Two applications which elucidate the nature of discord between couples and two applications for work-group problems are also described Gaming-simulation is used in basic and continuing education of health professionals for such issues as problems of dying patients and the aged, and prevention of coronary heart disease. Patients rights issues provide a potential focus for opening dialogues between patients and professionals about all facets of health and illness care.

Do You Know What You Are Drinking

Do you know what you are drinking? Do you know what your patients/clients are drinking? Can you distinguish among a drink, beverage, energizer, fortified beverage, sports drink, shot, or dietary supplement? If you drink coffee or tea, do you know how much caffeine is in each ounce? These questions came about when consumers of mental health services were assisting high energy drink (HED) researchers to design a revision of an existing HED survey. The original survey, designed for teenagers and college students, and modified for psychiatric nurses, was reported in the January issue of the Journal of Psychosocial Nursing and Mental Health Services (Smoyak, Nowik, & Lee, 2015). Consumers attending the Freehold Community Wellness Center, sponsored by Collaborative Support Programs of New Jersey (access http://www.cspnj.org), were approached. In this editorial, they will be referred to as consumers collaborating with Rutgers researchers (CCRC). The new project, with CCRC, was to create an instrument that would provide answers to questions about the knowledge, attitudes, and practices of individuals with mental illness about HED. Nothing in the literature exists about the use patterns of consumers of mental health services regarding HED and psychoactive agents. Use patterns, such as consuming HED before a psychiatric diagnosis or afterwards or instead of (i.e., in place of filling their prescription for psychoactive agents), have not been studied and reported.... Language: en

Young and Old Have New Issues With Being Transgender.

Both young people and old folks today are facing questions about being transgender that were never raised before. “What’s new” is that transgender is in public conversation as it has not been previously. In early textbooks used by faculty in nursing and other health sciences, the fact that gender is not a binary concept, but one distributed along a continuum, was noted. However, other than noting this fact, words to describe the various phenomena were absent. Today, books are being written, aimed at audiences as young as 8 years old. Older adults who are transgender are finding support in newly formed groups. What part did the Diagnostic and Statistical Manual of Mental Disorders (DSM 5th ed.; American Psychiatric Association [APA], 2013) play? A history refresher is in order. In 1973, the APA eliminated homosexuality from its list of disorders. In the new edition (i.e., DSM5), gender identity disorder was eliminated, and in its place is gender dysphoria. This new designation is not necessarily an improvement, because it still carries the connotation that someone is uncomfortable or distressed with the assigned biological gender. That is not essentially the case. Transgender individuals are not necessarily clinically depressed, nor are they troubled by other psychosocial symptoms. As Panas (2015) noted in her presentation at the World Congress for Psychiatric Nurses, in Banff, Canada, “I’m not sick! I’m transgender.” Her workshop explored the many challenges and barriers faced by individuals who are transgender as they attempt to navigate society. She compared the societal expectations for heterosexual individuals with those perceived as “others,” therefore strange and not normal. Her list of myths to be dispelled was received well by the audience.

The history, economics, and financing of mental health care. Part 3 : The present

1. Health care system changes, particularly the managed care plans, are altering mental health practices in significant ways. The autonomy and independent judgment of clinicians are being limited. 2. Market expansion created child and adolescent hospitals in the private sector. This market was very favorable to growth because of the great ambiguity in diagnosis and treatment, and the nonexistence of commitment laws for this population. 3. While insurance coverage for psychiatric diagnoses has expanded, more affluent people, with good employment possibilities, still have better insurance than poor individuals.

The HISTORY, ECONOMICS, and FINANCING of Mental Health Care

1. Health care system changes, particularly the managed care plans, are altering mental health practices in significant ways. The autonomy and independent judgment of clinicians are being limited. 2. Market expansion created child and adolescent hospitals in the private sector. This market was very favorable to growth because of the great ambiguity in diagnosis and treatment, and the nonexistence of commitment laws for this population. 3. While insurance coverage for psychiatric diagnoses has expanded, more affluent people, with good employment possibilities, still have better insurance than poor individuals.

We're Glad You Asked-

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Consumers of Mental Health Services: Their Knowledge, Attitudes, and Practices About High Energy Drinks and Drugs

To date, whether individuals with mental illness use high energy drinks (HED) to offset their symptoms, or whether their use began after diagnosis or psychoactive drugs were prescribed is unknown. Their degree of knowledge regarding their symptoms, diagnosis, or what strategies they have used to feel better is also undetermined. A search of the literature yielded no studies about these areas or domains. The current article provides background information on caffeine and HED, with or without alcohol, and the use patterns of consumers of mental health services, as well as their attitudes and knowledge. Participants in the Network for Psychiatric Nursing Researchers, who were consumers, influenced the current study group to expand their thinking about how to address the unknown areas. Their related work and publication are described. [Journal of Psychosocial Nursing and Mental Health Services, 55(4), 37-43.].