An Evaluation of Modified Intensive Care Management(M-ICM)&IPS(Individual Placement and Support) for Psychiatric Patients Readmitted within 3 months of Discharge

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The purpose of this study was to develop Modified Intensive Care Management(M-ICM,ICM is the same as Community Based Care Management)&IPS care model and to evaluate this care model for psychiatric patients who readmitted psychiatric patients within three month of discharge. This study was conducted with the cooperation of a psychiatric hospital in Kyushu at which M-ICM(CBCM)&IPS were provided to 70 schizophrenic patients from the time of their readmission to six months after discharge.The patients had been unstable both in their psychiatric symptoms and in self-care management. All were either readmitted within three months of their previous discharge or their hospitalization continued more than three months.Evaluations were made upon of readmission, discharge, three months and six months after discharge. Evaluations were based on indexes rating psychiatric symptoms, daily living skills, social functioning, family perceptions of the patient being a burden, Quality of Life (QOL) and wor … More k-rate.The patients were divided into two groups: 35 patients (Group A) were provided M-ICM&IPS and 35 patients (Group B) were provided only M-ICM. Many of the patients of both groups lived with their families, with parents playing the major role in terms of family support.Significant difference were recognized between two groups regarding the Brief Psychiatric Rating Scale (BPRS), the Life Skills Profile (LSP), QOL and work-rate. Furthermore Significant improvements were recognized regarding BPRS, GAF, LSP, FAS and work-rate at the times of admission, discharge, three month and six month after the discharge.Family perceptions of the patient being a burden also improved significantly, especially at times of discharge and three months after discharge in Group A. Group A received support interventions for both patients and their families. Through this it became clear that such interventions were needed, not just for control of symptoms, but for helping patients connect with the community based on an understanding of personality, psychological developmental issues, and desires concerning daily life. Furthermore patients in A-Group had high work-rate compared with that of B-Group. But many patients in A-Group was working at working house for psychiatric patients, not in the company.This study led us to the realization that optimum utilization of all the social resources available to the community-including resources for those with disabilities and difficulties and not necessarily tailored for patients with psychiatric disorders-promotes a patient's stable settlement in the community after discharge from the hospital.These results were discussed from a viewpoint acknowledging the significance of M-ICM(CBCM)&IPS, the necessity of finding and utilizing community resources, and the importance of transitional support from "Person-oriented" to "Place-oriented" so as to widen the patient's support base. Less