Intended to stimulate much-needed public discussion, these remarkable contributions cover both general issues, such as Implementing practices in routine mental health settings, including strategies for disseminating evidence-based practices to staff members Ensuring that efforts to implement such practices are informed by the knowledge and experience of administrators, clinicians, patients, and advocates Integrating evidence-based practices with the recovery model and focusing on guidelines and algorithms for pharmacologic treatment of people with severe mental illness Identifying the policy implications of the movement, particularly in public-sector settings, and describing eight courses of action for addressing the gap between science and practice
and specific practices, such as Describing critical components of practices for which substantial evidence exists, such as supported employment, dual diagnosis services, and assertive community treatment Developing an evidence base for particular populations, such as children and adolescents and geriatric patients; and for clinical subgroups, such as patients with severe mental illness and posttraumatic stress disorder-and implementing a range of practices for each population
Debate in public forums is critical to explaining the benefits of evidence-based care and allaying the fears of patients, practitioners, administrators, policy makers, and vested interest groups that evidence-based care excludes them from the decision-making process. Patients need to know that their individual characteristics, preferences, and autonomy are highly valued and won't be discounted by rigid adherence to the particular treatments. Practitioners need to know about the credibility of the evidence base and about new techniques and responsibilities and to understand that their favorite practices won't necessarily be excluded during initial attempts to implement evidence-based practices. Administrators and policy makers need to know about financing, organizing, implementing, and sustaining new practices. Finally, vested interest groups need to know that the introduction of evidence-based practices doesn't mean that what they do now is ineffective.
This unique and densely informative volume will be welcomed by mental health care professionals and by lawmakers, planners, administrators, and others who are charged with the responsibility of providing effective care to vulnerable populations.
The findings of the American Psychiatric Association (APA) Task Force on ECT were published by the APA in 1990 as the first edition of The Practice of Electroconvulsive Therapy, inaugurating the development of ECT guidelines by groups both within the United States and internationally. Since then, advances in the use of this technically demanding treatment prompted the APA to mandate a second edition.
The updated format of this second edition presents background information followed by a summary of applicable recommendations for each chapter. This close integration of the recommendations with their justifications makes the material easy to read, understand, and use. To further enhance usability, recommendations critical to the safe, effective delivery of treatment are marked with the designation "should" to distinguish them from recommendations that are advisable but nonessential (with the designations "encouraged," "suggested," "considered").
The updated content of this second edition, which spans indication for use of ECT, patient evaluation, side effects, concurrent medications, consent procedures (with sample consent forms and patient information booklet), staffing, treatment administration, monitoring of outcome, management of patients following ECT, and documentation, as well as education, and clinical privileging.
This volume reflects not only the wide expertise of its contributors, but also involved solicitation of input from a variety of other sources, including applicable medical professional organizations, individual experts in relevant fields, regulatory bodies, and major lay mental health organizations. In addition, the bibliography of this second edition is based upon an exhaustive search of the clinical ECT literature over the past decade and contains more than four times the original number of citations.
Complemented by extensive annotations and useful appendixes, this remarkably comprehensive yet practical overview will prove an invaluable resource for practitioners and trainees in psychiatry and related disciplines.
The product of the American Psychiatric Association's (APA's) Council on Aging and its Committee on Long-Term Care and of the Elderly, the Manual of Nursing Home Practice for Psychiatrists stands out because it focuses on the "how" -- not the "why" -- of nursing home care. Of exceptional importance is its detailed discussion of the Minimum Data Set (MDS), a structured assessment required by both Medicare and Medicaid for all residents of skilled nursing facilities.
Divided into six sections, this "how to" volume contains practical information readers can use right away, from getting reimbursed by insurance companies to handling nursing facility politics: Clinical -- History; evaluation and management of psychiatric problems in long-term care patients; an overview of the MDS; sexuality within the nursing home care setting Regulatory -- Introduction to the Nursing Home Reform Act of 1987 (part of OBRA-87) and its implications for psychiatric care; details about the Resident Assessment Instrument (RAI), which includes the MDS, the Resident Assessment Protocols (RAPs), and Utilization Guides specified in the State Operations Manual (SOP) Financial -- Documentation, reimbursement, and coding; what to look for when contracting with nursing homes Legal and ethical -- The dehumanizing effect of diagnostic labels and the ethical issues inherent in regulating daily schedules (e.g., bed, meal, and bath times); nursing home placement; competence and decision-making ability; comfort care for end-stage dementia; coping with Alzheimer's disease; and the role of caregivers Summary and Future Perspectives -- A detailed vision about how psychiatrists can improve the diagnosis and treatment of nursing home patients Appendixes and bibliography -- Staffing recommendations and assessment instruments
Edited by a distinguished authority and former chair of the APA's Committee on Long-Term Care and Treatment of the Elderly, this comprehensive volume will appeal to a wide audience of professionals: from general psychiatrists, nurse practitioners, and clinical nurse specialists, to primary care physicians and residents.
This compelling monograph combines -- for the first time -- the reports from two American Psychiatric Association task forces on quality in psychiatric care (March 1999, which focused on adults, and October 2001, which focused on children and adolescents), offering a clinical framework for quality measurement that provides sample indicators of quality for health plans, facilities, and systems of care.
Using similar formats and definitions, each task force considered a matrix of priority areas of care, including specific patient populations (e.g., elderly, seriously and persistently mentally ill, developmentally disabled people) and diagnostic categories (e.g., depressive disorder, schizophrenia, substance use disorders). Each then examined important aspects of patient care and constructed a quality framework that included dimensions of access, quality (appropriateness of care), perception of care (satisfaction), outcome, and -- for the children's report -- prevention.
Each task force also considered relevant methodological issues: cultural, linguistic, and ethnic differences; data collection and tracking; confidentiality of data; risk adjustment; use of rating scales and standardized instruments; and designation of standards.
Sample recommended goals include For adults: patients with serious and persistent mental illness should have access to newer generations of antipsychotic medications as these become available; patients should achieve a significant reduction in symptom. For children and adolescents: the mental health status of children and adolescents should be assessed annually; children with severe or persistent mental illness whose care involves multiple child-serving systems, caregivers, and service providers should have their care coordinated
Sample indicators include For adults: utilization of new antipsychotics for patients with the diagnosis of schizophrenia; reduction in frequency of panic attacks in patients with the diagnosis of panic disorder For children and adolescents: high levels of satisfaction of adolescents using mental health services or substance abuse services; reduction in a family's stress level and impact of illness
As the initial step in what must be an evolving effort by clinicians to define, measure, report, and improve the care that patients and their families receive, this monograph is essential reading for those who provide and receive care, accredit and regulate care, and purchase and administer clinical services.
Purchasers of mental health care want clear, reliable, meaningful, and comparable information on what care is provided and with what results. APA convened these two task forces to lend its professional expertise to that issue, to advise on how to develop clinically based, patient focused quality indicators that use existing and ongoing research and clinical consensus in selecting potential indicators.
A shortage of ethics instruction from medical school through residency has left many psychiatrists facing the increasingly complex field of ethics without a clear guide to ethical decision making and conduct until now.
Informed by some of the formal proceedings of the APA Ethics Committee, Ethics Primer of the American Psychiatric Association presents today's ethical dilemmas in eleven informative chapters -- brought to life by the clinical vignettes based on actual cases seen by this primer's distinguished contributors. Boundary violations between the doctor -- patient relationship and any other relationship (e.g., social, sexual/romantic, business) Issues such as informed consent, psychopharmacology, hospitalization, and psychotherapy with children, adolescents, and families Issues such as confidentiality, competence and consent, quality of life, abuse and neglect, and use of restraints with geriatric populations Involuntary hospitalization rife with conflict and controversy where many ethical principles clash (e.g., beneficence, autonomy, informed consent) Reconciling ethical conduct (as delineated in guidelines of the AMA, APA, and Sabin) with managed care's cost containment and rationing of medical services Confidentiality, how this fundamental ethics principle can clash with the business ethics of managed care and insurance companies Gifts from patients and industry when and why they are or are not acceptable The often uncomfortable duty to report colleagues who engage in fraud or deception, from speaking privately with a colleague to referring a concern to a departmental committee, supervisor, or local APA ethics committee (and applicable legal mandates) Emergency care ethics how to ensure proper treatment for psychiatric patients who come to the emergency room with physical illnesses forensic psychiatry, including codes of ethics, boundary issues, and management of allegations of ethical misconduct When consultations and second opinions are needed
Including an appendix with selected material from The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry, this clinical guide and reference is sure to stimulate the discussion so integral to maintaining the dynamic tradition of ethics. As such, it is essential reading for every psychiatrist -- whether in training or in established clinical practice -- who aspires to a richer appreciation for the wisdom and subtleties of the guidelines and principles of medical ethics.