Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-19T23:52:46.077Z Has data issue: false hasContentIssue false
  • English
  • Français

Innovations in Mental Health Care Delivery

Published online by Cambridge University Press:  02 January 2018

Isaac Marks
Isaac Marks*
Affiliation:
Institute of Psychiatry and Bethlem-Maudsley Hospital, London SE5 8AF
Get access Rights & Permissions [Opens in a new window]

Abstract

In serious mental illness (SMI) even good community care does not usually make a major impact on clinical or social function, but patients and relatives prefer community to hospital care, and it tends to be cheaper. Any gains are lost if the required community services are not resourced, coordinated, and maintained indefinitely. A few SMI patients continue to need asylum under one roof. CPNs see more anxiety/depression than SMI. Their patients come increasingly from GPs, and they tend to work in practices with less need. Their cost-effectiveness is uncertain, although nurse behaviour therapists are cost-effective in anxiety disorders in primary care. Such research is also needed into the work of other mental health professionals. Despite their effectiveness, there is a dearth of behaviour therapists among nurses and psychiatrists. Problem-orientated training is lacking for most professionals with most patients. Behavioural self-treatments have improved phobic disorders and non-severe depression in controlled studies. Gains were as great when self-treatment was guided by a computer or by a manual as by a clinician. Self-help can extend care delivery, with therapists acting as consultants. Computers can also aid clinical audit.

Type
Lecture
Information
The British Journal of Psychiatry , Volume 160 , Issue 5 , May 1992 , pp. 589 - 597
Copyright
Copyright © The Royal College of Psychiatrists, 1992 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alkubaisy, T., Marks, I. M., Logsdail, S., et al (1992) The role of exposure homework in phobia reduction. Behaviour Therapy (in press).Google Scholar
Cohen, L. J., Test, M. A. & Brown, R. L. (1990) Suicide and schizophrenia: data from a prospective community treatment study. American Journal of Psychiatry, 147, 602–607.Google ScholarPubMed
Ghosh, A. Marks, I. M. & Carr, A. (1988) Therapist contact and outcome of self-exposure treatment for phobias. British Journal of Psychiatry, 152, 234–238.Google Scholar
Hall, P. & Brockington, I. F. (1991) The Closure of Mental Hospitals. London: Gaskell.Google Scholar
Hoult, J. (1986) Community treatment of the acutely mentally ill. British Journal of Psychiatry, 149, 137–144.CrossRefGoogle ScholarPubMed
Jarman, B. (1984) Underprivileged areas. Validation and distribution of scores. British Medical Journal, 289, 1587–1592.Google Scholar
Johnstone, E., Owens, D., Gold, A., et al (1981) Institutionalisation and the defects of schizophrenia. British Journal of Psychiatry, 139, 195–203.Google Scholar
Lawrence, R. (1991) The impact of community care on the course of schizophrenia in Kidderminster. In The Closure of Mental Hospitals (eds Hall, P. & Brockington, I.), pp. 76–81. London: Gaskell.Google Scholar
Leff, J. (1991) Evaluation of the closure of mental hospitals. In The Closure of Mental Hospitals (eds Hall, P. & Brockington, I.), pp. 25–32. London: Gaskell.Google Scholar
Marks, I. M. (1978) Living with Fear. New York: McGraw-Hill.Google Scholar
Marks, I. M. (1986) Psychiatric Nurse Therapy in Primary Care, Research Monographs in Nursing Series. London: Royal College of Nursing Google Scholar
Marks, I. M. (1987) Fears, Phobias and Rituals. New York: Oxford University Press.Google Scholar
Marks, I. M., Lelliot, P., Basoglu, M., et al (1988) Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 152, 522–534.CrossRefGoogle ScholarPubMed
Marks, I. M. & Scott, R. (1990) (eds) Mental Health Care Delivery: Innovations, Impediments and Implementation. Cambridge: Cambridge University Press Google Scholar
Marks, I. M. & Swinson, R. (1990) Alprazolam and exposure for panic disorder with agoraphobia: summary of London/Toronto results. Journal of Psychiatric Research, 24 (suppl. 1), 100–101.CrossRefGoogle Scholar
McNamee, G., O'Sullivan, G., Lelliott, P., et al (1989) Telephone guided treatment for housebound agoraphobics with panic disorder: exposure vs relaxation. Behavior Therapy, 20, 491–497.CrossRefGoogle Scholar
Muijen, M. (1991) A controlled community care study in serious mental illness. PhD Dissertation, University of London.Google Scholar
O'Sullivan, G. & Marks, I. M. (1991) Long-term followup of phobics and obsessive compulsives. In Handbook of Anxiety, Vol. 4, (eds Noyes, R., Roth, M. & Burrows, G.), section 5, pp. 87–108. Amsterdam: Elsevier Google Scholar
Paykel, E. S. & Griffiths, J. H. (1983) Community Psychiatric Nursing for Neurotic Patients: the Springfield Controlled Trial, Research Monographs in Nursing Series. London: Royal College of Nursing Google Scholar
Robertson, J. A. (1991) A debate. In The Closure of Mental Hospitals (eds Hall, P. & Brockington, I.), pp. 131–132. London: Gaskell.Google Scholar
Sayce, L., Craig, T. K. J. & Boardman, A. P. (1991) The development of community mental health centres in the UK. Social Psychiatry and Psychiatric Epidemiology, 26, 14–20.CrossRefGoogle Scholar
Selmi, P. M., Klein, M. H., Greet, J. H., et al (1990) Computer-administered cognitive-behavioral therapy for depression. American Journal of Psychiatry, 147, 51–56.Google ScholarPubMed
Stein, L. & Test, L. U. (1980) Alternative to mental hospital treatment. Archives of General Psychiatry, 37, 392–397.Google Scholar
Team for the Assessment of Psychiatric Services (1990) Better Out Than In? London: North East Thames Regional Health Authority.Google Scholar
Telch, M., Agras, W. S. & Taylor, C. B. (1985) Imipramine and behavioural treatment for agoraphobia. Behaviour Research and Therapy, 23, 325–335.Google Scholar
Thornicroft, G. & Bebbington, P. (1989) Deinstitutionalisation – from hospital closure to service development. British Journal of Psychiatry, 155, 739–753.CrossRefGoogle ScholarPubMed
Thornicroft, G. & Breakey, W. (1991) The Costar Program. I: Improving patients' networks. British Journal of Psychiatry, 159, 245–249.Google Scholar
White, E. (1991) Community Psychiatric Nursing: A Research Project. London: Hyman.Google Scholar
Wing, J. (1991) Vision and reality. In The Closure of Mental Hospitals (eds Hall, P. & Brockington, I.), pp. 10–19. London: Gaskell.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.