Hawaii's public mental health system.

The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors

Differences in Daily Hassle Patterns Among California's Seriously Mentally Ill Sheltered Care Residents.

The present study investigated the daily hassles of a severely mentally ill population in sheltered care facilities in California. The results show that financial problems, loneliness, boredom, crime, accomplishments, verbal and written expression, and health were their most frequent concerns, reflecting the life-style of a low income, socially isolated, population whose disability renders an active, upwardly mobile life difficult. Age, gender, racial, and residential status differences in the most frequent and most severe hassles were found with age differences being the most pronounced. Younger individuals reported more hassles than elderly individuals, the nature of their concerns focus more on social acceptance, while physical health issues were of greater importance for elders. Racial differences were second in prominence, with discrimination issues being high in the minds of minority members of the population. Sheltered care residents were less stressed by problems with crime and declining physical abilities and more stressed by problems with exploitation and confrontation than were community dwellers

Daily Hassles and Health Among Persons with Severe Mental Disabilities.

The present study investigated the impact of daily stress or hassles on the physical and psychological health of persons with severe mental disabilities. The results suggest that the most frequently reported hassles were financial concerns, loneliness, boredom, crime, concerns about accomplishments, problems with verbal and written expression, and declining health. High levels of stress were related to both increased somatic and psychiatric symptomology, indicating that the association found between hassles and adaptational outcomes in general population samples can be generalized to those with psychiatric disabilities. Implications of the results include a continued emphasis on rehabilitation programs focusing on strategies that help these individuals cope with the stresses of their daily lives

Daily hassles and health among persons with severe mental disabilities.

The present study investigated the impact of daily stress or hassles on the physical and psychological health of persons with severe mental disabilities. The results suggest that the most frequently reported hassles were financial concerns, loneliness, boredom, crime, concerns about accomplishments, problems with verbal and written expression, and declining health. High levels of stress were related to both increased somatic and psychiatric symptomology, indicating that the association found between hassles and adaptational outcomes in general population samples can be generalized to those with psychiatric disabilities. Implications of the results include a continued emphasis on rehabilitation programs focusing on strategies that help these individuals cope with the stresses of their daily lives

Daily Hassles and Health Among Persons with Severe Mental Disabilities.

The present study investigated the impact of daily stress or hassles on the physical and psychological health of persons with severe mental disabilities. The results suggest that the most frequently reported hassles were financial concerns, loneliness, boredom, crime, concerns about accomplishments, problems with verbal and written expression, and declining health. High levels of stress were related to both increased somatic and psychiatric symptomology, indicating that the association found between hassles and adaptational outcomes in general population samples can be generalized to those with psychiatric disabilities. Implications of the results include a continued emphasis on rehabilitation programs focusing on strategies that help these individuals cope with the stresses of their daily lives

Health and a residential care population

This article describes the health status of 234 severely mentally ill (SMI) persons residing in California's supervised residential care facilities in 1973. Relocated in 1983, 63.2% reported their health as good to excellent. Over the follow-up period 80.8% maintained their SSI benefits, insuring them of health insurance coverage. Surprisingly the follow-up sample, believed to be at high risk of increased physical morbidity, compared quite favorably to low income subsamples of the National Health Interview Survey (NHIS). The SMI reported better health, access to and utilization of health services. Differences were particularly striking in the poor health category with NHIS respondents reporting poor health 3.5 times more frequently than SMI sample numbers. These results offer some support for the contribution of health insurance benefits and supervised residential settings to positive health outcomes of this vulnerable population.severely mentally ill health care residential care supported housing

The Role of Centralized Reading of Endoscopy in a Randomized Controlled Trial of Mesalamine for Ulcerative Colitis

Interobserver differences in endoscopic assessments contribute to variations in rates of response to placebo in ulcerative colitis (UC) trials. We investigated whether centralized review of images could reduce these variations. We performed a 10-week, randomized, double-blind, placebo-controlled study of 281 patients with mildly to moderately active UC, defined by an Ulcerative Colitis Disease Activity Index (UCDAI) sigmoidoscopy score ≥2, that evaluated the efficacy of delayed-release mesalamine (Asacol 800-mg tablet) 4.8 g/day. Endoscopic images were reviewed by a single expert central reader. The primary outcome was clinical remission (UCDAI, stool frequency and bleeding scores of 0, and no fecal urgency) at week 6. The primary outcome was achieved by 30.0% of patients treated with mesalamine and 20.6% of those given placebo, a difference of 9.4% (95% confidence interval [CI], -0.7% to 19.4%; P = .069). Significant differences in results from secondary analyses indicated the efficacy of mesalamine. Thirty-one percent of participants, all of whom had a UCDAI sigmoidoscopy score ≥2 as read by the site investigator, were considered ineligible by the central reader. After exclusion of these patients, the remission rates were 29.0% and 13.8% in the mesalamine and placebo groups, respectively (difference of 15%; 95% CI, 3.5%-26.0%; P = .011). Although mesalamine 4.8 g/day was not statistically different from placebo for induction of remission in patients with mildly to moderately active UC, based on an intent-to-treat analysis, the totality of the data supports a benefit of treatment. Central review of endoscopic images is critical to the conduct of induction studies in UC; ClinicalTrials.gov Number, NCT0105934