The Shape of things to come ... in UK ?? Short hospital stays failing schizophrenic patients Sonja Puzic, The Windsor Star Canada Published: Thursday, April 17, 2008 Canadian hospitals are recording high rates of readmissions for schizophrenia patients, suggesting that some of them are being released too quickly after the initial hospitalization. A report released Thursday by the Canadian Institute for Health Information (CIHI) found that nearly 40 per cent of schizophrenia patients discharged from a general hospital in Canada were readmitted for mental illness through emergency departments within a year. Between 2003 and 2005, one in eight schizophrenia patients -- or 12 per cent -- were readmitted to hospital within 30 days of their initial discharge. Sonja Grbevski, director of mental health services at Hotel-Dieu Grace Hospital, said it's safe to assume that the latest statistics are "a good reflection" of the problems faced by local schizophrenics and health-care providers. "Our individuals with schizophrenia are not much different than those any place else," she said, adding that the presence of other conditions, such as substance abuse, increase a schizophrenic's likelihood of being hospitalized again. . Schizophrenic patients are readmitted to hospital more frequently than those diagnosed with other mental disorders. The CIHI report found that schizophrenia patients with the longest initial hospital stays -- seven weeks or longer -- were less than half as likely to be readmitted within 30 days of discharge, compared to those whose hospital stays were one week or less. The chronic and debilitating nature of schizophrenia requires longer periods of stabilization than other mental health illnesses, the institute says. "We're kind of setting people up for failure," said Pamela Forsythe, the president of the Schizophrenia Society of Canada. "If we send people out before there's been a chance to arrange appropriate followup services or address issues around inadequate housing or access to appropriate supports and treatments ... the gains that may be starting to appear from the time in hospital are very quickly lost." it's "very taxing" on the health system to have schizophrenia patients readmitted frequently through already overburdened emergency departments. bed shortages at Hotel-Dieu and other local hospitals makes lengthy hospital stays an ongoing challenge. "We're an acute facility. We need to be able to intervene fast and discharge fast," . Adding to the problem are "tapped out" community resources, not enough family physicians and psychiatrists who can provide proper care and supervision for schizophrenics, especially those who stop taking their medication. "The problems become cyclical and they have to come back to the hospital for restabilization or medication adjustments," she said. the List of Inquiries after Homicides .... Inquiries by first letter of perpetrator The clinical staff never learnt from history - in most of the Reports of the Care and Treatment after Homicide there was information in the community, usually held by family, that was never sought , but if acted on would have seen care taken more seriously . The adjoining research work was done four years before the Care Programme Approach was given it's prominence as the basic process of care for mental illnesses. Clinicians and frontline professionals need to reflect on this research. The judgment, from a point in time interview, is often an inadequate assessment of what is going on. It needs to be assisted by the observation of those who spend a longer time with the patient, in ordinary surroundings.

10 20 British Journal of Psychiatry(1990),157-671 - 674 The Assessment of Psychiatric Disability in the Community A Comparison of Clinical, Staff, and Family Interviews C. R. BREWIN, F. VELTRO, J. K. WING, B. MAcCARTHY and T. S. BRUGHA .... "Assessments of some of the symptoms and behaviour problemsof long-term psychiatric patients living in the community were obtained independently from clinical interviewswith such patients, and from interviews with day staff, residential staff and families caring for them. In general, interviews with residential staff and family members revealed much higher levels of symptoms and behaviour problems than either of the other two interviews. " These findings have implications for research and clinical practice including the fact that adequate assessments should include the testimony of family or residential staff "

What can carers expect from the CPA? It is not about hiding behind confidentiality It is an important duty to recognise, inform and support carers

The CPA process should recognise the importance of carers as partners in care, in providing valued care and support

As the needs and views of carers may differ from service users, they should always be considered separately, including the impact of their caring role on their health and well-being

Carers have a right to their own assessment of needs, and a plan of support. Even where no care co-ordinator is involved, and/or there is no contact with secondary services, and/or the person they care for refuses services or support, the carer(s) have a right to an assessment of their needs by the local council.

> Carers should be kept up-to-date and involved in the care plan, although the service user needs to be agreeable to this

> Wherever possible, carers should be included in reviews > Carers can expect to have inform

ation and training to support them in their caring role > Carers can

expect their views to be kept confidential if they so wish

> Service user confidentiality may be overridden if the carer is deemed to be at risk

Young carers (e.g. children of service users) have recognised needs which should be responded to with great sensitivity, particularly to reduce their levels of anxiety and responsibility about what is going on

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