Psychiatric services : a journal of the American Psychiatric Association
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Funding for mental health services has declined in recent years, posing the difficult challenge of setting program and individual client service priorities with reduced resources. The author reviews seven principles for resource allocation and their potential impact on people with severe and persistent mental illness. ⋯ Because none of these principles take precedence over the others, their joint application does not necessarily yield consistent program priorities. However, they provide a frame of reference for approaching the task of priority setting and for understanding why priorities may vary from different perspectives.
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To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored. ⋯ Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.
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The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. ⋯ The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended.