Table 7 - uploaded by Ramon Z. Shaban
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1 -DSM-IV-TR Axis System and Related Classifications of Mental Illness
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This study was designed to examine the attitude of nonpsychiatric health professionals about mental illness in urban multispeciality tertiary care setting.
To assess attitude toward mental illness among urban nonpsychiatric health professionals.
A cross-sectional study design was used. A pretested, semistructured questionnaire was administered to 2...
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... 11,12,13 Deinstitutionalisation has led to an increase in the presentation of mental healthcare users (MHCUs) in the primary healthcare setting. 14,15 The MHCA provides guidance to different primary healthcare providers on the provision of mental healthcare, but fails to recognise prehospital emergency care providers' role in the provision of primary mental healthcare. 8,9,11 According to Chapter 5 (Section 40) of the MHCA, the well-being of an MHCU is the responsibility of the South African Police Services (SAPS) in the prehospital setting. ...
... Prehospital emergency care providers in this study showed overwhelmingly negative feelings when dispatched to a behavioural disturbance, which is not unique to the South African setting. 9,14,15,23,30,31 Participants experienced behavioural disturbances as emotionally and physically taxing but did not share the viewpoint, as described in the literature, that it was a waste of prehospital resources. 25,26 Interestingly, the unsympathetic feelings of prehospital emergency care providers towards MHCUs has been experienced by MHCUs and is described by Rees et al. 30 The results confirm that an MHCU can be perceived as a violent, overdosing or suicidal individual, who often refuses treatment and transportation. ...
... This finding substantiates Shaban's findings that prehospital emergency care providers find it difficult to make accurate management decisions during these situations. 14,15,24,33 One responsibility mentioned by participants, and not reported elsewhere, is reporting scene findings to the receiving facility to ensure that the MHCU receives appropriate care. ...
Background: Prehospital emergency care providers are frequently called to assist with the management of mental healthcare users (MHCUs). The Mental Health Care Act no. 17 of 2002 regulates mental healthcare in South Africa, but the act fails to consider the responsibilities of prehospital emergency care providers in the provision of mental healthcare. Rather South African Police Services were given authority over the well-being of a MHCU in the prehospital setting.
Aim: To investigate prehospital emergency care providers’ understanding of their responsibilities towards MHCUs and the community during the management of behavioural emergencies.
Setting: The research was carried out at prehospital emergency care providers from the three main levels of care, currently operational within the boundaries of Pretoria, South Africa.
Methods: A grounded theory qualitative study design was chosen using semi-structured focus groups for each level of prehospital emergency care – basic life support (BLS), intermediate life support (ILS) and advanced life support (ALS). Data from each focus group were collected through audio recordings and transcribed and analysed using a framework approach.
Results: A total of 19 prehospital emergency care providers participated; two focus group interviews were performed for each level of care. The BLS focus groups each consisted of two participants. The ILS focus groups consisted of three participants each, and the ALS focus groups consisted of six and three participants. Four key themes were identified: perceptions of behavioural emergencies, responsibilities, understanding of legislation and barriers experienced.
Conclusion: Participants placed high value on their moral and medical responsibilities towards MHCUs, which they described as ensuring the safety of themselves, MHCUs and the community; preventing further harm; and transporting MHCUs to an appropriate healthcare facility. There was a desire for revision of legislation, better education, skill development and awareness of mental healthcare in the prehospital emergency care setting.
... However, studies have reported that EMCPs encounter challenges when it comes to providing high-quality, safe and effective healthcare for the mentally ill [10,11]. It has been advocated that EMC personnel require mental health skills that will allow them recognise and manage mental illness in ways that will collaboratively add value to overall patient care [12]. At present, little is known about the knowledge of EMCPs in SA on pre-hospital management of psychiatric emergencies. ...
Introduction:
Studies have reported that emergency medical care practitioners (EMCPs) encounter challenges when attending to psychiatric emergencies. The EMC provider's ability to understand, assess and manage psychiatric emergencies has been reported to be poor due to limited knowledge and insufficient training. In South Africa (SA), little is known about the knowledge of EMCPs on pre-hospital management of psychiatric emergencies. The objective of this study was to assess the knowledge of EMCPs working in the Free State province on aspects of pre-hospital management of psychiatric emergencies.
Methods:
This descriptive study used a questionnaire survey to obtain data on the knowledge of EMCPs on aspects of pre-hospital management of psychiatric emergencies.
Results:
Only 159 of the initial 192 questionnaires distributed were returned, giving a response rate of 82.8%. The majority (87.4%) of the participants reported inadequate knowledge of pre-hospital management of psychiatric emergencies. More than a third of the participants reported that they are not knowledgeable on how to assess a psychiatric patient (P < 0.01), 64.2% and 73.6% (P < 0.001 in both cases) could not perform mental status examination and lack the knowledge of crisis intervention skills for managing a psychiatric emergencies. The majority (76.7%; P < 0.001) of the participants are not conversant with the Mental Health Care Act 2002 (Act no. 17 of 2002). Finally, participants (94.3% and 86.8%, respectively; P < 0.001) agree that teaching and prior exposure to a psychiatric facility, as in work integrated learning, will empower EMC graduates with skills required to effectively manage psychiatric emergencies.
Conclusion:
EMC practitioners are often the first healthcare professionals arriving at any scene of medical emergencies including psychiatric emergencies. To avoid malpractices, which could be detrimental to patient's health, it is of utmost importance that EMCPs are well trained and equipped to manage any form of medical emergency including those involving psychiatric patients.
... 3 Researchers thus recommend restructuring emergency mental health care systems 3 and further addressing mental health calls in the training of paramedics, an approach that the profession supports. [21][22][23] Last, the academic literature suggests that the increasing psychosocial component of calls requires moving beyond traditional, biomedically oriented training and assessments based largely on physical findings. 12 It also recommends that alternatively, paramedic services may consider including a social worker to address patients' psychosocial needs so as to allow paramedics to focus on their field of expertise, that is, emergency medical care. ...
Paramedics, health care workers who assess and manage health concerns in the prehospital setting, are increasingly providing psychosocial care in response to a rise in mental health call volume. Observers have construed this fact as “misuse” of paramedic services, and proposed as solutions better triaging of patients, better mental health training of paramedics, and a greater number of community mental health services. In this commentary, we argue that despite the ostensibly well-intentioned nature of these solutions, they shift attention and accountability away from relevant public policies, as well as from broader economic, social, and political determinants of mental health, while placing responsibility on those requiring services or, at best, on the health care system. We also argue that the perspective of paramedics, who are exposed to, and interact with, individuals in their everyday environments, has the potential to inform a better, structural and critical, understanding of the factors driving the rise in psychosocial crises in the first place. Finally, we suggest that a greater engagement with the political and social determinants of mental health would lead to preventing, rather than primarily reacting to, these crises after the fact.
... Here, the students came to understand dementia was a terminal condition that impacts on the person's cognition, communication, behaviour, emotions, function and physical abilities (43). Such improvements in understanding of dementia by students is vital given the forecast global increase in people with dementia (15) and the need for paramedics who are skilled in the assessment and management of people with cognitive and psychiatric deficits (44). ...
p> Introduction
This paper presents an evaluation of the pilot aged care clinical placement undertaken by undergraduate paramedic students in the university-based Wicking Dementia Research and Education Centre’s Teaching Aged Care Facilities Program . The objective is to examine the learning experiences of students taking part in the first paramedic student clinical placement in Tasmania to be situated in the residential aged care environment. The students’ interactions with residents with dementia and with older people requiring a palliative approach to care are discussed, as key strategies to enhance paramedic student learning.
Method
Twenty-one final year undergraduate paramedic students completed a 5-day (40 hour) clinical placement in September/October 2011, in two participating residential aged care facilities in Tasmania, Australia. Qualitative data were obtained from weekly feedback meetings with students, which were audio-recorded, transcribed, and subjected to content analysis. Quantitative data from pre and post-placement questionnaires were collected and descriptive analyses performed.
Results
The data showed that students enjoyed interaction with residents and that this built their communication skills, particularly with residents with dementia. Students also learnt about the importance of a palliative approach to care and improved their knowledge of dementia.
Conclusion
A supported placement program for paramedic students in residential aged care facilitates student learning in a number of areas, particularly around working with people with dementia, which is likely to enhance student readiness for the graduate paramedic role. </p
... This research is supported by others including a study in South Australia 9 that found there was an emphasis placed on the "load and go" philosophy with respect to mental health patients. As noted by Shaban, 18 Roberts 6 stated that she believed this was partly due to a lack of education. Given that South Australia has recently amended its Mental Health Act to include greater powers for paramedics similar to those provided in NSW, then it is reasonable to conclude that similar difficulties in implementation may be encountered. ...
Paramedics form part of the frontline response to mental health care in the community. Changes to mental health laws across the country have seen an increase in the role and responsibilities paramedics have in assessing, treating and managing mental health patients. The increasing complexity of the paramedic role associated with these changes requires a clear understanding of the legal, ethical and organisational requirements that accompany them. This paper will examine the relevant legislative principles and ethical dilemmas that are raised by these changes and will demonstrate the need for further research to assist in the development and implementation of strategies to assist paramedics in providing optimal patient care to a vulnerable section of the community.
