Douglas House: seven years' experience of a community hostel ward

Article Abstract:

Douglas House, a hostel for psychiatric patients in England, was set up to offer longer-term care for patients of a university hospital that did not have long-term psychiatric beds. It has 10 beds and was designed to provide care and the training necessary for residents to eventually settle elsewhere. It is run by nurses and has medical and psychological support staff. Residents are trained to run the hostel independently. During its first seven years, Douglas House housed 24 patients. All were followed-up for purposes of this report. Upon admission to the program, demographic data, diagnosis, and duration of illness were recorded for each patient, and symptoms and behavior were assessed. There was documentation of length of stay at Douglas House, circumstance of readmission to the hospital, and psychiatric history subsequent to discharge. On average, the 24 patients spent nearly a third of their adult lives in a psychiatric hospital prior to admission to Douglas House. Chronic schizophrenia was the most common diagnosis (83 percent). Former residents can be divided into two groups, based on discharge. Nine were discharged to more independent living situations (the community discharge group) and six returned to more restrictive settings such as hospital wards (hospital discharge group). Nine patients remained in Douglas House, of whom five were expected to go into the community and four to remain there indefinitely. The community discharge group had illness characterized by good prognostic features, such as the absence of organic features in their illness, and a relatively short hospitalization history. A prior history of behavioral problems predicted behavioral disturbances while at Douglas House, sometimes contributing to the need for the patient to return to the hospital ward. Overall, Douglas House has successfully combined behavioral rehabilitation for chronically ill psychiatric patients with a more attractive and less restrictive environment than the hospital can offer. Autonomy is fostered for patients as well, and the nursing staff reports higher morale. (Consumer Summary produced by Reliance Medical Information, Inc.)

Disabled persons, Group homes for the handicapped, Group homes, Halfway houses

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Lithium maintenance: 2. Effects of personality and attitude on health information acquisition and compliance

Article Abstract:

There is little research on the use of health education programs for patients being maintained on lithium but there is evidence that behavioral programs encouraging compliance may be helpful. Regarding compliance with other drug programs, there is evidence that education programs may be helpful in the short-term, but not in the long-term. The importance of individual factors such as personality is well established with regard to the acquisition of information and such factors may be significant in the design of health education programs. Sixty patients participated in a study, half of whom were offered an educational program on the use of lithium. The program included audiovisual and written material and periodic testing of lithium knowledge and attitudes toward taking lithium, as well as checking compliance with significant others and by means of blood tests. All patients were tested with the Health Locus of Control to evaluate whether they were likely to attribute control over the outcomes of situations to themselves, to others or to chance. They were also given an inventory to detect obsessional behavior. It was found that during the six weeks after the education group received the program, they had a decrease in missed doses of lithium that was significant when compared with the control group, but both groups showed a reduction in missed dosages. Knowledge and attitudes regarding lithium also improved for the education group as compared with the control group, as they did for the control group after they received the educational program later in the study. This suggests that the educational program had an effect but it was not the only factor that improved compliance. Health locus of control did not appear to have an effect on knowledge acquisition but obsessional preoccupation with health did significantly interfere with knowledge acquisition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Usage, Patient compliance, Study and teaching, Patient education, Lithium, Lithium (Metal)

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