[show abstract][hide abstract] ABSTRACT: Objective: This study presents the psychometric prop-erties of the Charleston Psychiatric Outpatient Satis-faction Scale—Hebrew Version adapted for use in Israel. Methods: Two sub-versions were constructed: one for adult clients—Mental Health Client Satisfac-tion Scale—Hebrew (MHCSS-H) and one for parents (or other caregivers) accompanying children with mental health problems—Mental Health Parent Sat-isfaction Scale—Hebrew (MHPSS-H). The scales were administered to representative samples of 453 adult outpatients with severe mental disorders and 255 parents, respectively. Results: Internal consistency was excellent for both scales (Cronbach's alpha coef-ficients 0.94 and 0.88, respectively). For both subvert-sions, there were moderate to strong correlations be-tween satisfaction with five service domains (Avail-ability/Accessibility, Quality of care, Explanation/ Participation, Staff's attitude, and Facilities condi-tions) and anchor items "Overall quality of the care provided" and "Would you recommend this clinic to a friend or relative should they need treatment?") scores. Clients with more time in treatment were more satisfied with all the service domains, except for the staff's attitude domain. Conclusions: The results suggest that both Hebrew subversions are appropri-ate for routine satisfaction surveys in mental health outpatient settings and for research purposes in Is-rael.
[show abstract][hide abstract] ABSTRACT: Aims: To compare the initial attitudes of nurses and other professional groups in a psychiatric hospital towards the legal representation (LR) of involuntary admitted psychiatric patients before District Psychi-atric Boards (DPB), and to assess how these attitudes changed after LR had become an everyday routine practice in the hospital. Background: LR of hospital-ized psychiatric patients before DPB has been intro-duced into mental health system worldwide, includ-ing Israel. Attitudes of psychiatric staff towards LR and their changes over time are a very important –though unstudied issue. Methods: Thirty seven psy-chiatric nurses employed in the Tirat Carmel Mental Health Center, Israel and 30 other mental health professionals (comparison group) completed the At-titudes to Legal Representation Questionnaire before LR has been instituted in the Center (November 1, 2006) and one year later. Baseline differences be-tween the groups were tested using one-way ANOVA, and pre-post differences in the attitude scores were tested by paired t-tests. Results: Baseline psychiatric nurses attitudes towards LR were significantly more negative than those of the comparison group [F 67,3 = 6.87, p < 0.0001], but they significantly improved over the study period (t 37 = 2.56, p = 0.015). Conclu-sion: Yearlong, routine exposure to the LR of invol-untarily admitted psychiatric patients may attenuate negative nurse beliefs and attitudes towards LR of such patients at DPB hearings. The more positive attitudes may enhance the nurses' ability to present information about patients without jeopardizing their human and civil rights, and help patients to attain a greater sense of control over their illness manage-ment and satisfaction with the services received.
[show abstract][hide abstract] ABSTRACT: The management of individuals with mental illnesses sometimes requires involuntary hospitalization. The Israel Mental Health Act requires that cases of involuntary psychiatric hospitalization (IPH) be periodically reviewed by the district psychiatric committee. The discussion in the committee often leads to debate regarding the need for an IPH potentially depriving the patient of his freedom. Little is known about the way in which the psychiatrists and attorneys on these committees arrive at their decisions. The present study was designed to examine the views of future doctors and attorneys concerning cases of possible IPH to determine whether their decisions would be influenced by their respective professional educational backgrounds.
After compiling demographic data, we asked 170 students from each of the two disciplines what their decision would be in two hypothetical cases that dealt with the question of a prolongation of a psychiatric hospitalization. Questionnaires examining social distance and possible stigmatizing views concerning psychiatric patients were also distributed and collected.
The response rates for the medical and law students were, respectively, 90% and 85%. We found no differences between the medical and law students regarding their views on prolongation of a psychiatric hospitalization. This was consistent regardless of whether the hospitalization was against the patient's will or according to his wish and against the treating physicians' advice. We also found that the medical and law students had similar general views regarding psychiatric patients, but that the latter evidenced greater social distance than the former.
Academic background and socialization were not found to influence the decisions of students regarding IPH. Educational programs and exposure to psychiatric patients during law studies are proposed to lessen psychiatric stigma and promote better understanding between members of the two disciplines.
International Journal of Law and Psychiatry 01/2011; 34(5):368-73. · 1.19 Impact Factor
[show abstract][hide abstract] ABSTRACT: To explore the proportion of defendants hospitalized by court observation order (COO) who were diagnosed as having a psychiatric disorder during: 1) the COO period, or 2) a 10-year follow-up period.
Data on all adult defendants, who underwent psychiatric hospitalization by COO between 1991 and 1995, were extracted from the National Psychiatric Case Registry of the Israel Ministry of Health, and rehospitalizations over the next ten years were identified. ANO VA and Wilcoxon signed-rank test were used for comparing the diagnosed and undiagnosed defendant cohorts.
Only 17% of defendants hospitalized by COO received a psychiatric diagnosis (N=316), while the remaining referred defendants (N=1,532) were not diagnosed as suffering from any psychiatric disorder. Although 56% of the initially undiagnosed group (N=863) were rehospitalized and received a psychiatric diagnosis during the next ten years, 36% of the original cohort never received a diagnosis subsequent to hospitalization (N=556). Significant median differences in inpatient days associated with a follow-up diagnosis of psychotic disorder were found between the diagnosed and undiagnosed defendant cohorts (z=4.89, p less than .001).
The high rate of diagnosis of defendants who were undiagnosed at the index hospitalization suggests that the COO is ineffective and tends to discharge without diagnosis defendants who are later found to be psychotic. Therefore, an independent examination of the accuracy of the forensic psychiatric evaluation (FPE) process is called for, to determine whether actual disorders are being missed. There should be a professional and public debate on the unnecessary use of court-ordered hospitalizations and ways of their prevention.
The Israel journal of psychiatry and related sciences 01/2011; 48(3):201-6. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: In 2005 the Forensic Psychiatry Department of Mental Health Services at the Ministry of Health launched a pilot project: the Community Emergency Psychiatric Service (CEPS). The purpose was to offer community-based emergency response to acute psychiatric conditions during after-hours periods, including Saturdays and holidays. The project was implemented in the Tel Aviv, Central and Southern districts.
Advertisements were posted in mass circulating newspapers announcing the launching of the new program for the general public in the participating districts. The public was invited to call the hotline of the medical emergency service, Magen David Adom (MDA), in the event of psychiatric distress or emergency. MDA personnel were instructed to give the callers a telephone number of an on-call psychiatrist. The Ministry of Health engaged a pool of seven licensed psychiatrists to be available on-call one per shift. The psychiatrists offered crisis intervention over the phone or house visits when necessary.
Data were obtained from the Tel Aviv, Central and Southern Districts. The results show that there were 1,472 calls between May 2005 and June 2006. In 198 cases (13.5%) clients were referred for treatment and follow-up to local outpatient clinics, while in 116 of the cases (7.8%) a home visit by the on-call psychiatrist was carried out, resulting in 50 voluntary and 16 involuntary hospitalizations. An examination of records of calls received by the on-call psychiatrists (N=97) during August 2006 suggests that most callers fit the following profile: female, ranging in age 19-35, unmarried, with diagnosis of schizophrenia, with no previous psychiatric hospitalizations, and presenting no danger to herself or others.
A limited response team, comprised of one on-call psychiatrist per shift, can provide a viable service for psychiatric emergencies in a population center of approximately 2.7 million. The findings also suggest that such a service may increase the number of referrals to outpatient clinics in the community as well as the number of voluntary and involuntary hospitalizations after working hours. The potential contribution of such a project to improving accessibility to outpatient psychiatric care and to reinforcing continuity of care among in- and out-patient facilities needs further investigation as is the important question of cost-effectiveness.
The Israel journal of psychiatry and related sciences 01/2009; 46(3):207-12. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: The legal representation at District Psychiatric Boards hearings of psychiatric inpatients committed under a Compulsory Admission Order is a very important but insufficiently studied issue. This study aimed 1) to review the prac-tice of legal representation in the western world and Israel, and 2) to test the hypothesis that the legal representation of compulsorily committed psychiatric patients at their discharge hearings is associated with their subsequent readmission. A random sample of 153 compulsorily committed patients discharged in 2003 was drawn from Israel's National Psychiatric Case Register and their psychiatric readmission over the next two years was reviewed. The 109 patients who were dis-charged with legal representation (the index group) were compared with the 44 patients who were discharged without le-gal representation (the control group). Although the groups were comparable on all sociodemographic and background clinical characteristics the patients from the index group had significantly more readmissions and inpatient days over the follow-up period than the control group. The results suggest that the involvement of lawyers in the discharge process is associated with more readmissions and more inpatient time. The possible reasons for this and its implications are dis-cussed.
[show abstract][hide abstract] ABSTRACT: Outpatient commitment under court order is a controversial issue among mental health professionals in different countries. This kind of outpatient involuntary treatment is provided for mental patients suspected to have committed a crime endangering society while in a severe psychotic state. Despite their dangerousness, the Israeli Mental Health Law of 1991 provides outpatient commitment under court order as an alternative to inpatient commitment. This legal provision raises several concerns and important ethical questions. A major dilemma is the question of whether this legal tool is efficacious in stabilizing the mental condition of criminal mental patients in order to prevent the perpetuation of violent crimes in an open setting such as outpatient clinics. Other major concerns are: (a) who bears the responsibility for the implementation of the enforcement? (b) how the enforcement might be implemented? This paper discusses this complex issue and presents some possible solutions aimed at improving the practical use of this important component of the comprehensive modern system of care for mental patients.
[show abstract][hide abstract] ABSTRACT: Background
Though information about involuntary psychiatric hospitalizations (IPH) is crucial for the planning of Israel's National Mental Health Care Policy, very few studies have been carried out to date on this subject.
International Journal of Law and Psychiatry - INT J LAW PSYCHIATRY. 01/2007; 30(1):60-70.
[show abstract][hide abstract] ABSTRACT: To examine the characteristics of patients whose first admission to Israel's psychiatric units was involuntary, and to identify a specific profile of the patients at increased risk for future readmissions. Our hypothesis was that when the first admission of a patient was involuntary, the number and duration of future hospitalizations would be greater.
We used information extracted from the National Psychiatric Case Registry on all patients admitted for the first time during 1991 (N=2150) and on their follow-up over the next ten years. Chi-square statistics were used to test for significance differences in demographic and clinic variables between patients hospitalized voluntarily and those hospitalized involuntarily. Multiple regression analysis was performed to identify a specific profile of risk of recidivism during a ten-year period (1991-2000).
Compared with patients admitted voluntarily, those who were admitted involuntarily had a significantly greater number and duration of rehospitalizations. They were more likely be diagnosed as suffering from schizophrenia while the voluntarily admitted patients were more likely be diagnosed as having an affective disorder. Risk factors for the number of readmissions included: young age, legal status (involuntary) of the first admission, as well as period of residence in the country. Risk factors affecting the duration of readmissions were single/widowed status, native born and a suicide attempt in the two months prior to the first admission.
Two distinct profiles for the number ofreadmissions and inpatient days were identified. A diagnosis of schizophrenia and selected demographic variables were better at predicting risk of recidivism than the involuntary legal status of the first admission.
The Israel journal of psychiatry and related sciences 02/2006; 43(1):57-64. · 1.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: Despite the growing awareness of mental patients of their rights, the number of complaints is still under-represented for different reasons including the patients' fear that they will be 'punished' because of their complaints or their lack of knowledge concerning the correct procedure and the appropriate address for issuing their complaint. This article presents the summary of one year's work (year 2001), on the complaints and letters we received at the Forensic Psychiatry Unit, Mental Health Services, Ministry of Health, from the general public, mental health patients, their families or Advocacy Agencies concerning mental patients' rights. We analyzed the complaints according to the topic, the process and the results of our interventions. The data collected on the complaints show that most of the complainants were the patients themselves, especially males and adults. Most of the complaints dealt with the patients' dissatisfaction with the type of treatment received, in that it did not match their expectations. Fifty percent of the complaints involved treatment received at psychiatric hospitals and 34% of the complaints were related to out-patient treatment. Sixty-five percent of complainants wrote a single complaint during the year 2001. Our intervention and reply to the complainants was completed within a month in 66% of the cases. We conclude suggesting different ways to improve this important service.
[show abstract][hide abstract] ABSTRACT: Risk or dangerousness is a problem which, of its very nature, must occupy the minds of all mental health and law enforcement professionals. Papers and research studies without number have attempted to define its extent and constituent elements and plumb the secrets of its assessment. Defining the tools and skills needed to analyze and predict dangerousness is a key contribution to helping psychiatrists and lawyers take their critical decisions on compulsory hospitalization, issuing or refusing a gun or driving license, etc. Members of other professions too have not only to decide whether or not to curtail an individual's civil rights but to be able to put forward rational and coherent grounds for their decision. And yet time after time mistaken decisions are made, frequently causing the subject of the decision unnecessary suffering and sometimes leading to a tragic outcome. The difficulty of risk assessment is its complexity, the result of a multitude of contributing and interacting variables. The 'dangerous person' does not have a single profile: there is no individual who under certain circumstances cannot become dangerous. That being so, the focus of our study must not be the factors capable of making a person violent but correctly managing the circumstances and situations in which violence can occur. For the purposes of this paper we concern ourselves only with the physical aspects of dangerousness. Although the risk we analyze here is bound up with an act of violence, we must keep in mind that dangerousness and violence are two separate concepts. After reviewing existing theory and current knowledge on risk assessment and prediction, we shall describe how the Israeli judicial and legislative systems deal with risk and attempt the task of forecasting the use of violence in a divided society in the throes of modernization. To close we propose an explorative study, designed to develop a short- and medium-range risk assessment instrument.
[show abstract][hide abstract] ABSTRACT: Though information about involuntary psychiatric hospitalizations (IPH) is crucial for the planning of Israel's National Mental Health Care Policy, very few studies have been carried out to date on this subject.
To identify trends in first IPH to all inpatient psychiatric settings in Israel.
The sample included all admissions of adults (18 years and older) over the ten-year period, 1991-2000, according to the registration of such admissions in the National Psychiatric Case Registry.
A 2.4-fold increase was found in first IPH over the decade studied. The typical profile of the involuntarily admitted patient was that of a native-born Jewish male, aged 18-24 or 65 and older, single, with less than 8 years of education, and with a diagnosis of schizophrenia or delusional psychosis.
These findings suggest the need for improving the interfaces between hospital and community services, and for preparing specific guidelines to extend the use of involuntary ambulatory treatment orders. Further study is needed to explore the respective roles of involuntary inpatient and outpatient treatment.
International Journal of Law and Psychiatry 30(1):60-70. · 1.19 Impact Factor