Psychiatric services : a journal of the American Psychiatric Association
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There is an increasing focus on physician wellness as an indicator of health system quality, and terms related to wellness, such as "burnout" and "resilience," have blossomed in the international discourse. An emphasis on the current concept of resilience shifts the responsibility for systemic problems to the individual. Examining the history of the term "resilience" reveals its origins in ecological studies and its subsequent mobilization by economic theorists and politics. Understanding this historical context when considering wellness initiatives may help providers recognize which interventions and changes to individual behaviors or systems might be useful; it also encourages providers to focus on political action (local and national) to facilitate change.
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The study examined the availability and characteristics of assertive community treatment (ACT) programs across mental health treatment facilities in the United States. ⋯ Substantial differences existed in availability of ACT and ACT-like programs among states, with evidence of a large unmet need overall, even when a very broad and inclusive definition of ACT was used. Few ACT programs offered all core services. Legislative, administrative, and funding differences may explain some of the variability.
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Many states have adopted risk-based, preemptive gun removal laws to reduce gun violence. In this column, the authors describe the general structure of these laws, consider arguments for and against them, and briefly review the evidence regarding their impact. As psychiatrists in a state that recently implemented such a law, the authors consider the possible impact of the law on their practice and the well-being of their patients and the public, including the possibility that they and other Oregon psychiatrists could be held liable for failing to address the topic of gun seizure with a patient's family.
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Observational Study
Comparing Preventable Hospitalizations Among Veterans With and Without Mental Illnesses Before and After Implementation of PACT.
The authors examined whether the rate of preventable hospitalizations among veterans with mental illness changed after implementation of the Department of Veterans Affairs (VA) primary care medical home-Patient Aligned Care Teams (PACT). ⋯ In this retrospective, observational study examining large systemwide changes in clinical practice, mental illness was more likely to be diagnosed after PACT implementation, compared with before, and results suggested a benefit of PACT implementation among older veterans in terms of a reduction in ACSC-related hospitalizations.