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Fountain House: How A Community Can Engage Ralph Aquila, M.D. Sidney R. Baer Jr. Center New York, NY.

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Presentation on theme: "Fountain House: How A Community Can Engage Ralph Aquila, M.D. Sidney R. Baer Jr. Center New York, NY."— Presentation transcript:

1 Fountain House: How A Community Can Engage Ralph Aquila, M.D. Sidney R. Baer Jr. Center New York, NY

2 Schizophrenia: “The worst disease afflicting humanity” F Strikes 1% of world population or 50 million people F Most chronic, debilitating mental illness F Person becomes ill in late teens, early 20's - missed opportunities F Social toll includes emotional and financial costs to families F Persons suffer severe range of symptoms F Strikes 1% of world population or 50 million people F Most chronic, debilitating mental illness F Person becomes ill in late teens, early 20's - missed opportunities F Social toll includes emotional and financial costs to families F Persons suffer severe range of symptoms

3 The Burden of Schizophrenia on Individuals F All of us need to “fit in” with jobs, friends, family and social activities F The isolation, personal devastation and human suffering is enormous F Stigma F High rate of attempted / completed suicide F All of us need to “fit in” with jobs, friends, family and social activities F The isolation, personal devastation and human suffering is enormous F Stigma F High rate of attempted / completed suicide

4 The Burden of Schizophrenia on Families and Society $32 Billion F Direct medical costs: costs of providing care F Indirect costs: lost productivity on the part of patients and families F Other Costs: social welfare administration, crime and the criminal justice system, homelessness, premature mortality due to suicide $32 Billion F Direct medical costs: costs of providing care F Indirect costs: lost productivity on the part of patients and families F Other Costs: social welfare administration, crime and the criminal justice system, homelessness, premature mortality due to suicide

5 Schizophrenia: The Financial Burden F 2.5% of U.S. health care costs F 22% of mental illness costs F 1 in 3 psychiatric hospital beds F 25% of admissions to US hospitals F 40% of all long term care facilities Source: Rice and Miller 1996 F 2.5% of U.S. health care costs F 22% of mental illness costs F 1 in 3 psychiatric hospital beds F 25% of admissions to US hospitals F 40% of all long term care facilities Source: Rice and Miller 1996

6 Schizophrenia: Societal and Family Burden F Families provide most support - caring for loved ones impoverishes families F 33% of homeless (Carpenter & Buchanan 1994) F Tax payers pay 2/3 of direct costs for schizophrenia (Rice and Miller 1996) F Families provide most support - caring for loved ones impoverishes families F 33% of homeless (Carpenter & Buchanan 1994) F Tax payers pay 2/3 of direct costs for schizophrenia (Rice and Miller 1996)

7 Homelessness and Mental Illness F At any given time, 200,000 of 600,000 homeless in US are mentally ill 1 F There are remedies for homelessness in mentally ill populations 2 –74% to 93% one-year retention rates in supportive housing programs F –Homeless patients in NYC stayed 4.1 days or 36% longer per admission to general hospitals. The cost for psychiatric patients was $4,094. 1 US Dept HHS, 1992,; Culhane 1994 2 Center for Mental Health Services 1994 3 Salit et al 1998 F At any given time, 200,000 of 600,000 homeless in US are mentally ill 1 F There are remedies for homelessness in mentally ill populations 2 –74% to 93% one-year retention rates in supportive housing programs F –Homeless patients in NYC stayed 4.1 days or 36% longer per admission to general hospitals. The cost for psychiatric patients was $4,094. 1 US Dept HHS, 1992,; Culhane 1994 2 Center for Mental Health Services 1994 3 Salit et al 1998

8 Disproportionate Imprisonment of Mentally Ill Persons in US F 3 to 20% of persons in jails are mentally ill (Teplin 1990) F “...community correctional institutions, the jail and the police lock-up have become the nations new asylums” (Rock & Landsberg G 1998) F “Dubious award” for the largest “mental institution”: Rikers Island, NY vs. LA County jail F 3 to 20% of persons in jails are mentally ill (Teplin 1990) F “...community correctional institutions, the jail and the police lock-up have become the nations new asylums” (Rock & Landsberg G 1998) F “Dubious award” for the largest “mental institution”: Rikers Island, NY vs. LA County jail

9 9 Suicide Among Mentally Ill Inmates F Suicide by inmates with schizophrenia or manic-depressive illness is relatively common. F Data collected from New York State jails between 1977 and 1982 showed that half of all inmates who committed suicide had been previously hospitalized for treatment of a serious brain disorder. F For each successful suicide in jails, there are many others that are unsuccessful. F According to a chief psychiatrist in the Los Angeles County Jail, the ratio of failed suicide attempts to deaths by people with untreated brain disorders is about 20 to 1. Davida Adedjouma 2007

10 Schizophrenia is treatable F Outpatient treatment and rehabilitation programs for people with schizophrenia can reduce psychiatric re-hospitalization rates, improve quality of life, prevent homelessness and increase the likelihood of gainful employment (Hargreaves & Shumway, 1989) F Half of the people who receive treatment for schizophrenia either recover completely or are able to live independently with only modest psychosocial support (Biology of Mental Disorders, OTA, 1992) F Outpatient treatment and rehabilitation programs for people with schizophrenia can reduce psychiatric re-hospitalization rates, improve quality of life, prevent homelessness and increase the likelihood of gainful employment (Hargreaves & Shumway, 1989) F Half of the people who receive treatment for schizophrenia either recover completely or are able to live independently with only modest psychosocial support (Biology of Mental Disorders, OTA, 1992)

11 Progressive Stages of Illness in Untreated Schizophrenia

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16 Optimizing Outcomes: The Process of Recovery 1

17 Practice Guidelines? Acute Psychosis Long Term What are the outcomes? Practice Guidelines? Acute Psychosis Long Term What are the outcomes?

18 Clubhouse F Intentional community/relationships F Membership F Made to feel needed F Member needs to give back F Cost-effective F Generalist model F > 200 in USA

19 Clubhouse Continued F 350 members per day F Open 365 days per year F 1200 Active members F Work Ordered Day F Evening and Weekend Program

20 Aquila et al. Psychiatric Rehabilitation Journal Vol. 23, Num. 1 Rehabilitation/Recovery Alliance F Collaboration with patient & system, patient (person) becomes co-team leader F Treat symptoms with specific goals in mind F Focus on strengths & opportunities instead of only psychotic symptoms

21 Relapse: Psychosocial Relapse: Psychosocial F Lack of support Family &/or caregiver Stressful environment F Complex mental health system Only 50% of patients keep first outpatient appointment

22 The When of Rehabilitation F Geel 1300’s? F “Maintenance” before 1980 F Psychiatrists not included F 1990 ACT model incorporates employment F Consumers speak up F Clubhouse & psychiatry F Other models, The Village, Living Skills Modules …

23 Rehabilitation: a Treatment Necessity F Persons with serious mental illness can improve their lives F Every person has strenghts F Time is an ally F Employment and Education as a catalyst F Empowerment

24 A Few More Words about Rehabilitation F Non-traditional settings F Families as Advocates F “Workers” as Advocates F Patients/consumers as advocates

25 Adherence Tips for Psychoeducation Sessions F Ongoing contact with involved families is essential F Do not use “confidentiality” as an excuse to avoid making contact with the family F Listen carefully for concerns about any side effects

26 Adherence Tips for Psychoeducation Sessions (cont) F Family should avoid confrontation over medications F Find out if anyone is opposed to medication and try to get that person on board F Families can be part of the solution, not the problem

27 Per Diem Cost of NY/NY Housing & Alternatives The Campaign for New York, NY II: Background Report, February 1998. Per Diem Cost of NY/NY Housing & Alternatives

28 Dixon et al. Schizophrenia PORT. Schizophrenia Bulletin, 1998;24:1. Schizophrenia PORT: Recommendations & Implementation F Recommendation Families should be offered a psychosocial intervention that includes education, support problem-solving & crisis intervention F Implementation Of sample of 540 outpatients with families, 62.8% had not received ANY family contact or treatment in the last 6 months

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