Susan stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.003.0002
- Subject:
- Psychology, Clinical Psychology
This chapter looks at how emergency services in general, and psychiatric emergency services specifically, operate within hospitals and mental health systems without ever being fully integrated into ...
More
This chapter looks at how emergency services in general, and psychiatric emergency services specifically, operate within hospitals and mental health systems without ever being fully integrated into either. It examines the pressures exerted on emergency departments (EDs) and the structural incentives under which they operate, many of which create unintentional barriers to optimal treatment of people in psychiatric crisis. Finally, the chapter provides a statistical snapshot of EDs and psychiatric emergency services today, and evaluates some of the most popular prevalent assumptions about the uses and abuses of EDs: that poor people use EDs for non-urgent medical needs; that most users of ED services are uninsured; and that EDs are a focal point of liability, especially in the case of suicidal patients. The research in the field, including the detailed statistical reports produced annually by the National Center for Health Statistics, shows that the first two assumptions are incorrect; surveys of case law show a more complex and ambiguous picture about ED liability issues.Less
This chapter looks at how emergency services in general, and psychiatric emergency services specifically, operate within hospitals and mental health systems without ever being fully integrated into either. It examines the pressures exerted on emergency departments (EDs) and the structural incentives under which they operate, many of which create unintentional barriers to optimal treatment of people in psychiatric crisis. Finally, the chapter provides a statistical snapshot of EDs and psychiatric emergency services today, and evaluates some of the most popular prevalent assumptions about the uses and abuses of EDs: that poor people use EDs for non-urgent medical needs; that most users of ED services are uninsured; and that EDs are a focal point of liability, especially in the case of suicidal patients. The research in the field, including the detailed statistical reports produced annually by the National Center for Health Statistics, shows that the first two assumptions are incorrect; surveys of case law show a more complex and ambiguous picture about ED liability issues.
Susan stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.003.0003
- Subject:
- Psychology, Clinical Psychology
This chapter summarizes the principal complaints that people with psychiatric disabilities voice about their treatment in emergency departments (EDs). These include use of force by security guards ...
More
This chapter summarizes the principal complaints that people with psychiatric disabilities voice about their treatment in emergency departments (EDs). These include use of force by security guards and/or emergency room professionals; discrimination against people with psychiatric disabilities by ignoring or minimizing their medical complaints; facing lack of respect and even hostility when seeking emergency care; and delays in emergency room treatment.Less
This chapter summarizes the principal complaints that people with psychiatric disabilities voice about their treatment in emergency departments (EDs). These include use of force by security guards and/or emergency room professionals; discrimination against people with psychiatric disabilities by ignoring or minimizing their medical complaints; facing lack of respect and even hostility when seeking emergency care; and delays in emergency room treatment.
Susan stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.003.0006
- Subject:
- Psychology, Clinical Psychology
This chapter looks broadly at two different kinds of solutions to the problems discussed in this book: the development of alternatives to the use of emergency departments (EDs) by people with ...
More
This chapter looks broadly at two different kinds of solutions to the problems discussed in this book: the development of alternatives to the use of emergency departments (EDs) by people with psychiatric disabilities, and the improvement and modification of current standards and practices used by general hospital EDs and psychiatric emergency services. The first part of the chapter describes a number of alternatives currently in use around the country, from mobile crisis units to family foster homes and crisis hostels, with practical emphasis on how they are funded, and research regarding their effectiveness. The second part of the chapter discusses proposed solutions to most of the problems discussed earlier in the book relating specifically to ED treatment of people with psychiatric disabilities. In addition, it delineates a number of very specific proposed standards and recommendations that, if adopted, would go a long way to improving the care received by people with psychiatric disabilities in ED settings.Less
This chapter looks broadly at two different kinds of solutions to the problems discussed in this book: the development of alternatives to the use of emergency departments (EDs) by people with psychiatric disabilities, and the improvement and modification of current standards and practices used by general hospital EDs and psychiatric emergency services. The first part of the chapter describes a number of alternatives currently in use around the country, from mobile crisis units to family foster homes and crisis hostels, with practical emphasis on how they are funded, and research regarding their effectiveness. The second part of the chapter discusses proposed solutions to most of the problems discussed earlier in the book relating specifically to ED treatment of people with psychiatric disabilities. In addition, it delineates a number of very specific proposed standards and recommendations that, if adopted, would go a long way to improving the care received by people with psychiatric disabilities in ED settings.
Susan stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.003.0005
- Subject:
- Psychology, Clinical Psychology
This chapter delineates federal and state legal and regulatory requirements governing the treatment of people with psychiatric disabilities, covering questions such as to whom the laws apply, what ...
More
This chapter delineates federal and state legal and regulatory requirements governing the treatment of people with psychiatric disabilities, covering questions such as to whom the laws apply, what standards they impose, and what questions arise uniquely in the context of emergency department (ED) treatment of people with psychiatric disabilities.Less
This chapter delineates federal and state legal and regulatory requirements governing the treatment of people with psychiatric disabilities, covering questions such as to whom the laws apply, what standards they impose, and what questions arise uniquely in the context of emergency department (ED) treatment of people with psychiatric disabilities.
Susan stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.003.0001
- Subject:
- Psychology, Clinical Psychology
This introductory chapter begins with a brief discussion of the common complaints that people with psychiatric disabilities have about their treatment when they are in crisis. It then outlines the ...
More
This introductory chapter begins with a brief discussion of the common complaints that people with psychiatric disabilities have about their treatment when they are in crisis. It then outlines the purpose of the book, which is to analyze the treatment of people with psychiatric disabilities in emergency department (ED) settings. An overview of the subsequent chapters is presented.Less
This introductory chapter begins with a brief discussion of the common complaints that people with psychiatric disabilities have about their treatment when they are in crisis. It then outlines the purpose of the book, which is to analyze the treatment of people with psychiatric disabilities in emergency department (ED) settings. An overview of the subsequent chapters is presented.
Susan Stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.001.0001
- Subject:
- Psychology, Clinical Psychology
Many hospital emergency departments are overcrowded and short-staffed, with a limited number of available hospital beds. It is increasingly hard for emergency departments and their staff to provide ...
More
Many hospital emergency departments are overcrowded and short-staffed, with a limited number of available hospital beds. It is increasingly hard for emergency departments and their staff to provide the necessary level of care for medical patients. Caring for people with psychiatric disabilities raises different issues and calls on different skills. In Emergency Department Treatment of the Psychiatric Patient, the author uses research, surveys, and statutory and litigation materials to examine problems with emergency department care for clients with psychiatric disorders. She relies on interviews with emergency department nurses, doctors and psychiatrists, as well as surveys of people with psychiatric disabilities in order to present the perspectives of both the individuals seeking treatment, and those providing it. This book explores the structural pressures on emergency departments and identifies the burdens and conflicts that undermine their efforts to provide compassionate care to people in psychiatric crisis. In addition to presenting a new analysis of the source of these problems, the author also suggests alternatives to emergency department treatment for people in psychiatric crisis. Moreover, she proposes standards for treatment of these individuals when they do inevitably end up in a hospital emergency department.Less
Many hospital emergency departments are overcrowded and short-staffed, with a limited number of available hospital beds. It is increasingly hard for emergency departments and their staff to provide the necessary level of care for medical patients. Caring for people with psychiatric disabilities raises different issues and calls on different skills. In Emergency Department Treatment of the Psychiatric Patient, the author uses research, surveys, and statutory and litigation materials to examine problems with emergency department care for clients with psychiatric disorders. She relies on interviews with emergency department nurses, doctors and psychiatrists, as well as surveys of people with psychiatric disabilities in order to present the perspectives of both the individuals seeking treatment, and those providing it. This book explores the structural pressures on emergency departments and identifies the burdens and conflicts that undermine their efforts to provide compassionate care to people in psychiatric crisis. In addition to presenting a new analysis of the source of these problems, the author also suggests alternatives to emergency department treatment for people in psychiatric crisis. Moreover, she proposes standards for treatment of these individuals when they do inevitably end up in a hospital emergency department.
Susan stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.003.0004
- Subject:
- Psychology, Clinical Psychology
This chapter considers the difficulties that administrators, physicians, nurses, psychiatrists, and other emergency department (ED) staff experience in the treatment of people with psychiatric ...
More
This chapter considers the difficulties that administrators, physicians, nurses, psychiatrists, and other emergency department (ED) staff experience in the treatment of people with psychiatric disabilities. These include accreditation and evaluation systems that create incentives that undermine appropriate psychiatric evaluation and treatment; the lack of standards in emergency room practice; financing emergency room care; and lack of continuity between emergency rooms and community care.Less
This chapter considers the difficulties that administrators, physicians, nurses, psychiatrists, and other emergency department (ED) staff experience in the treatment of people with psychiatric disabilities. These include accreditation and evaluation systems that create incentives that undermine appropriate psychiatric evaluation and treatment; the lack of standards in emergency room practice; financing emergency room care; and lack of continuity between emergency rooms and community care.
Larry Davidson, Janis Tondora, Martha Staeheli, Maria O’Connell, Jennifer Frey, and Matthew J. Chinman
- Published in print:
- 2005
- Published Online:
- April 2010
- ISBN:
- 9780195159226
- eISBN:
- 9780199893843
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195159226.003.0030
- Subject:
- Social Work, Health and Mental Health, Communities and Organizations
This chapter argues that continued use of inherited models of case management limits the progress that otherwise could be made in actualizing this shift from a deficit- and institution-based ...
More
This chapter argues that continued use of inherited models of case management limits the progress that otherwise could be made in actualizing this shift from a deficit- and institution-based framework to a recovery and community integration paradigm. This paradigm calls for new models of community-based practice that move beyond the management of cases and beyond merely semantic changes that introduce new terms for old practices. One such model that appears to be emerging in the field is that of tour guide, community guide, or, “recovery guide.” Prior to introducing this model, the chapter first reviews existing models of case management that have underlain the last 40 years of community-based practice. It then outlines the principles of care that ground a recovery-oriented alternative; describes the key components of the recovery guide model; and considers some of the broader implications of this model for community-based practice.Less
This chapter argues that continued use of inherited models of case management limits the progress that otherwise could be made in actualizing this shift from a deficit- and institution-based framework to a recovery and community integration paradigm. This paradigm calls for new models of community-based practice that move beyond the management of cases and beyond merely semantic changes that introduce new terms for old practices. One such model that appears to be emerging in the field is that of tour guide, community guide, or, “recovery guide.” Prior to introducing this model, the chapter first reviews existing models of case management that have underlain the last 40 years of community-based practice. It then outlines the principles of care that ground a recovery-oriented alternative; describes the key components of the recovery guide model; and considers some of the broader implications of this model for community-based practice.
Susan stefan
- Published in print:
- 2006
- Published Online:
- April 2010
- ISBN:
- 9780195189292
- eISBN:
- 9780199894017
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195189292.003.0007
- Subject:
- Psychology, Clinical Psychology
This chapter steps back and examines the factors that make the treatment of people with psychiatric disabilities different from medical patients in emergency department (ED) settings. In addition to ...
More
This chapter steps back and examines the factors that make the treatment of people with psychiatric disabilities different from medical patients in emergency department (ED) settings. In addition to the mandate to assess and involuntarily detain certain people with psychiatric disabilities — a mandate that does not extend to medical patients — another difference is the issue of the secondary utilizer of the ED. “Secondary utilizers” include the family members, police officer, or service provider who brings an individual to the ED — often against that individual's will — to solve a family problem or social conflict. Sometimes this happens at night, when regular treatment and service providers are not available. Sometimes the service providers seek a quick solution to a difficult problem by taking a client to the ED. In this way, the availability of EDs may contribute to inappropriate utilization individually and on a larger social level. Emergency departments provide cover for inadequate social service agencies suffering from budget cuts that make it difficult or impossible to provide the preventive and crisis stabilization services, medication, or sometimes just the reassurance and company that individuals in psychiatric crisis need. Thus, the larger solution to some ED problems must come from outside the hospital. At the same time, there is much that hospitals can do to improve their treatment of their patients with psychiatric disabilities without larger social change, and some hospitals are leading the way.Less
This chapter steps back and examines the factors that make the treatment of people with psychiatric disabilities different from medical patients in emergency department (ED) settings. In addition to the mandate to assess and involuntarily detain certain people with psychiatric disabilities — a mandate that does not extend to medical patients — another difference is the issue of the secondary utilizer of the ED. “Secondary utilizers” include the family members, police officer, or service provider who brings an individual to the ED — often against that individual's will — to solve a family problem or social conflict. Sometimes this happens at night, when regular treatment and service providers are not available. Sometimes the service providers seek a quick solution to a difficult problem by taking a client to the ED. In this way, the availability of EDs may contribute to inappropriate utilization individually and on a larger social level. Emergency departments provide cover for inadequate social service agencies suffering from budget cuts that make it difficult or impossible to provide the preventive and crisis stabilization services, medication, or sometimes just the reassurance and company that individuals in psychiatric crisis need. Thus, the larger solution to some ED problems must come from outside the hospital. At the same time, there is much that hospitals can do to improve their treatment of their patients with psychiatric disabilities without larger social change, and some hospitals are leading the way.
RIPPD
- Published in print:
- 2010
- Published Online:
- March 2012
- ISBN:
- 9780520252493
- eISBN:
- 9780520944565
- Item type:
- chapter
- Publisher:
- University of California Press
- DOI:
- 10.1525/california/9780520252493.003.0049
- Subject:
- Sociology, Gender and Sexuality
Rights for Imprisoned People with Psychiatric Disabilities (RIPPD) is a grassroots, direct-action organization united to demand justice and social change for prisoners with disabilities. It believes ...
More
Rights for Imprisoned People with Psychiatric Disabilities (RIPPD) is a grassroots, direct-action organization united to demand justice and social change for prisoners with disabilities. It believes in humane treatment for all regardless of race, class, or sexual identity. It wants to end the discrimination and dehumanization in the criminal justice system. It confronts all those who have the responsibility to make changes by strategizing, protesting, negotiating, collaborating with other groups, and by any creative means necessary. RIPPD's five main issues are: increasing the availability of alternatives to incarceration for people with mental illness in the criminal justice system; eliminating the use of solitary confinement for prisoners with psychiatric disabilities; improving mental health treatment inside jails and prisons; guaranteeing discharge planning for people with mental illness released from jails and prisons; ensuring more accountability and training for correction officers.Less
Rights for Imprisoned People with Psychiatric Disabilities (RIPPD) is a grassroots, direct-action organization united to demand justice and social change for prisoners with disabilities. It believes in humane treatment for all regardless of race, class, or sexual identity. It wants to end the discrimination and dehumanization in the criminal justice system. It confronts all those who have the responsibility to make changes by strategizing, protesting, negotiating, collaborating with other groups, and by any creative means necessary. RIPPD's five main issues are: increasing the availability of alternatives to incarceration for people with mental illness in the criminal justice system; eliminating the use of solitary confinement for prisoners with psychiatric disabilities; improving mental health treatment inside jails and prisons; guaranteeing discharge planning for people with mental illness released from jails and prisons; ensuring more accountability and training for correction officers.
Robert E. Drake, Gary R. Bond, and Deborah R. Becker
- Published in print:
- 2012
- Published Online:
- January 2013
- ISBN:
- 9780199734016
- eISBN:
- 9780199949755
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199734016.001.0001
- Subject:
- Social Work, Health and Mental Health
Employment is the highest priority for many people with severe mental illness and it is a central aspect of recovery. Over the past two decades, the Individual Placement and Support (IPS) model of ...
More
Employment is the highest priority for many people with severe mental illness and it is a central aspect of recovery. Over the past two decades, the Individual Placement and Support (IPS) model of supported employment has emerged as the prominent evidence-based approach to vocational rehabilitation. This book synthesizes the research and experience on IPS supported employment: historical context, core principles, effectiveness, long-term outcomes, non-vocational outcomes, cost-effectiveness, generalizability, fidelity, implementation, policy, and future research. This book relates to areas of work with populations with psychiatric disabilities and in community mental health and social service settings. In tracing the evolution of IPS, readers are equipped with an elegant example of the transition from needs assessment, to model development, to testing, and to dissemination.Less
Employment is the highest priority for many people with severe mental illness and it is a central aspect of recovery. Over the past two decades, the Individual Placement and Support (IPS) model of supported employment has emerged as the prominent evidence-based approach to vocational rehabilitation. This book synthesizes the research and experience on IPS supported employment: historical context, core principles, effectiveness, long-term outcomes, non-vocational outcomes, cost-effectiveness, generalizability, fidelity, implementation, policy, and future research. This book relates to areas of work with populations with psychiatric disabilities and in community mental health and social service settings. In tracing the evolution of IPS, readers are equipped with an elegant example of the transition from needs assessment, to model development, to testing, and to dissemination.
Robert E. Drake, Gary R. Bond, and Deborah R. Becker
- Published in print:
- 2012
- Published Online:
- January 2013
- ISBN:
- 9780199734016
- eISBN:
- 9780199949755
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199734016.003.0036
- Subject:
- Social Work, Health and Mental Health
Two major barriers prevent people with psychiatric disabilities from becoming employed: disincentives within the health care and social insurance systems; and lack of access to Individual Placement ...
More
Two major barriers prevent people with psychiatric disabilities from becoming employed: disincentives within the health care and social insurance systems; and lack of access to Individual Placement and Support (IPS). Overcoming these barriers will require major policy changes. This chapter suggests several principles for policy makers. First, for long-term illnesses, consider a life span perspective, including primary, secondary, and tertiary prevention to minimize disability. Second, unlink health insurance and disability status. Third, make certain that disability regulations reinforce recovery rather than continued disability. Fourth, fund evidence-based recovery services rather than ineffective segregated services. Fifth, reduce societal stigma by increasing incentives for schools to educate people with disabilities and for employers to hire them.Less
Two major barriers prevent people with psychiatric disabilities from becoming employed: disincentives within the health care and social insurance systems; and lack of access to Individual Placement and Support (IPS). Overcoming these barriers will require major policy changes. This chapter suggests several principles for policy makers. First, for long-term illnesses, consider a life span perspective, including primary, secondary, and tertiary prevention to minimize disability. Second, unlink health insurance and disability status. Third, make certain that disability regulations reinforce recovery rather than continued disability. Fourth, fund evidence-based recovery services rather than ineffective segregated services. Fifth, reduce societal stigma by increasing incentives for schools to educate people with disabilities and for employers to hire them.
Tina Minkowitz
- Published in print:
- 2015
- Published Online:
- January 2016
- ISBN:
- 9781447314578
- eISBN:
- 9781447314608
- Item type:
- chapter
- Publisher:
- Policy Press
- DOI:
- 10.1332/policypress/9781447314578.003.0013
- Subject:
- Sociology, Politics, Social Movements and Social Change
This chapter is a transcript of an interview with Tina Minkowitz, who represented the World Network of Users and Survivors of Psychiatry in the drafting and negotiation of the Convention on the ...
More
This chapter is a transcript of an interview with Tina Minkowitz, who represented the World Network of Users and Survivors of Psychiatry in the drafting and negotiation of the Convention on the Rights of Persons with Disabilities. The chapter explains why members of the mental health user/survivor movement claimed the Convention on the Rights of Persons with Disabilities as a necessary vehicle for advocating for their human rights. The terms ‘psychosocial (or psychiatric) disability’ and the reason for its adoption in the US context, is discussed. The chapter responds in detail to the concern that abolishing specific mental health legislation might lead to the criminalisation and/or neglect of people with mental health problems, arguing that criminal behaviour needs to be dealt with under criminal law and advocates for the transformation of the criminal justice system.Less
This chapter is a transcript of an interview with Tina Minkowitz, who represented the World Network of Users and Survivors of Psychiatry in the drafting and negotiation of the Convention on the Rights of Persons with Disabilities. The chapter explains why members of the mental health user/survivor movement claimed the Convention on the Rights of Persons with Disabilities as a necessary vehicle for advocating for their human rights. The terms ‘psychosocial (or psychiatric) disability’ and the reason for its adoption in the US context, is discussed. The chapter responds in detail to the concern that abolishing specific mental health legislation might lead to the criminalisation and/or neglect of people with mental health problems, arguing that criminal behaviour needs to be dealt with under criminal law and advocates for the transformation of the criminal justice system.
