Nine Recommendations to Increase Continuity of Mental Health Care ForSchizophrenia Patients

Continuity of therapy is a vital component of quality care for people with serious mental illnesses and must be given more attention by consumers themselves, family members, advocates, providers, administrators, and researchers alike. At the moment, there is an important opportunity to develop a national consensus statement on the principles and practice standards that should form the basis of a continuum of therapy designed to provide realistic assurance that consumers can access vital medications when and where they are needed. Important strides have been made in identifying the specific factors which promote continuity of therapy - it is time to seize this important opportunity as yet another stepping stone to achieving the transformation of America's mental health care system for the benefit of consumers and their families, our communities, and our Nation. A roundtable of mental health experts has developed a set of nine recommendations for enhancing continuity of medication therapy for persons with schizophrenia or serious mental illness, including schizophrenia. They are as follows:
Mental Healthcare Recommendation #1 -
Encourage collaborations between hospitals and community-based organizations. Use fiscal incentives to foster collaborations including the standardization of information and shared electronic health records.
Mental Healthcare Recommendation #2 -
Use a quality improvement approach to enhance continuity of therapy by benchmarking at the organizational level performance and outcomes standards regarding continuity of care.
Mental Healthcare Recommendation #3 -
Ensure all consumers have a level of care management for the transition from inpatient to community. Care management services should be reimbursable by all payers and the disincentives to providing it should be removed.
Mental Healthcare Recommendation #4 -
Hospitals and community providers should focus on the "Pull Model" of transition from inpatient to outpatient care. The Pull Model focuses on involving community-based providers in the transition planning process from the beginning. Provider organizations should focus on staff competency in engagement and strategies and motivational interviewing.
Mental Healthcare Recommendation #5 -
Accreditation standards should be aligned to address and improve continuity of therapy in treating serious mental illness. This may include developing standards to ensure evidence of an active process of care management and transition between levels of care, a quality review of the success of transition plans, and measuring engagement.
Mental Healthcare Recommendation #6 -
Consumers and their families should be educated about the benefits of maintaining their personal health care history. Ensuring that consumers have detailed information about their illnesses and treatment history will help ensure that providers have access to the information they need to provide appropriate care in a timely manner. The options here range from simple paper and pencil logs and medication histories to electronic records on memory sticks.
Mental Healthcare Recommendation #7 -
Consumer-driven recovery planning should include and the appropriate and necessary use of hospitalization. More thoughtful use of inpatient services could lead to a reduction in emergency room use and ultimately to a decrease in the number of hospitalizations.
Mental Healthcare Recommendation #8 -
Parties who collect data about mental health services and performance should share it with appropriate stakeholders in usable and timely ways. Many payers and public entities collect both population and individual specific information about mental health consumers and services. Population-based data should be shared with all stakeholders, including families and consumers to aid in enhancing the system of care.
Mental Healthcare Recommendation #9 -
There should be meaningful involvement of consumers and their advocates in all levels of system delivery and evaluation. Global involvement of consumers and their advocates in the care delivery process is essential. Examples include using peer specialists as part of a treatment team, active involvement in policy and planning, as well as involvement in developing and implementing performance measurement and evaluation.
Applying these Mental Healthcare Recommendations -
While we have learned that maintaining continuity of therapy has a positive impact on consumer outcomes, the barriers and other impediments to ensuring this continuum of care have been long entrenched in mental health and related care systems. An unacceptably high number of people with serious psychiatric issues - including schizophrenia, depression and bipolar disorder - are "falling between the cracks" in the transition between acute inpatient settings and the community causing harm and disruption in their own lives and those of their families and often bringing their recovery process to a halt.
A continuity of therapy initiative is likely to decrease inappropriate use of emergency room services by consumers with schizophrenia or other serious mental illnesses by assuring consistency in the disease management approach used by all community provider organizations. Both of these likely outcomes of continuity of therapy provide cost reductions for the hospital and cost offset for the investments in continuity of therapy initiative and related therapies.
In addition, the continuity of therapy initiative provides the community hospital with another very tangible benefit. The continuity of therapy initiative provides the relationships, process, and infrastructure for an overall discharge planning functionality for all consumers with mental illnesses. This discharge planning functionality is a new, and critical, element in modern behavioral health standards that began in 2007.

WHAT MAKES AN IDEAL KITCHEN

It is a mistake to suppose that any room, however small and unpleasantly situated, is "good enough" for a kitchen. This is the room where housekeepers pass a great portion of their time, and it should be one of the brightest and most convenient rooms in the house; for upon the results of no other department depend so greatly the health and comfort of the family as upon those involved in this 'household workshop'.

Every kitchen should have windows on two sides of the room, and the sun should have free entrance through them; the windows should open from the top to allow a complete change of air, for light and fresh air are among the chief essentials to success in all departments of the household. Good drainage should also be provided, and the ventilation of the kitchen ought to be even more carefully attended to than that of a sleeping room. The ventilation of the kitchen should be so ample as to thoroughly remove all gases and odors, which, together with steam from boiling and other cooking processes, generally invade and render to some degree unhealthful every other portion of the house.

There should be ample space for tables, chairs, range, sink, and cupboards, yet the room should not be so large as to necessitate too many steps. Undoubtedly much of the distaste for, and neglect of, "housework," so often deplored, arises from unpleasant surroundings. If the kitchen be light, airy, and tidy, and the utensils bright and clean, the work of compounding those articles of food which grace the table and satisfy the appetite will be a pleasant task.

It is desirable, from a sanitary standpoint, that the kitchen floor be made impervious to moisture; hence, concrete or tile floors are better than wooden floors. Cleanliness is the great desideratum, and this can be best attained by having all woodwork in and about the kitchen coated with polish; substances which cause stain and grease spots, do not penetrate the wood when polished, and can be easily removed with a damp cloth.

The elements of beauty should not be lacking in the kitchen. Pictures and fancy articles are inappropriate; but a few pots of easily cultivated flowers on the window ledge or arranged upon brackets about the window in winter, and a window box arranged as a jardiniere, with vines and blooming plants in summer, will greatly brighten the room, and thus serve to lighten the task of those whose daily labor confines them to the precincts of the kitchen.

The kitchen furniture.
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The furniture for a kitchen should not be cumbersome, and should be so made and dressed as to be easily cleaned. There should be plenty of cupboards, and each for the sake of order, should be devoted to a special purpose. Cupboards with sliding doors are much superior to closets. They should be placed upon casters so as to be easily moved, as they, are thus not only more convenient, but admit of more thorough cleanliness.

Cupboards used for the storage of food should be well ventilated; otherwise, they furnish choice conditions for the development of mold and germs. Movable cupboards may be ventilated by means of openings in the top, and doors covered with very fine wire gauze which will admit the air but keep out flies and dust.

For ordinary kitchen uses, small tables of suitable height on easy-rolling casters, and with zinc tops, are the most convenient and most easily kept clean. It is quite as well that they be made without drawers, which are too apt to become receptacles for a heterogeneous mass of rubbish. If desirable to have some handy place for keeping articles which are frequently required for use, an arrangement similar to that represented in the accompanying cut may be made at very small expense. It may be also an advantage to arrange small shelves about and above the range, on which may be kept various articles necessary for cooking purposes.

One of the most indispensable articles of furnishing for a well-appointed kitchen, is a sink; however, a sink must be properly constructed and well cared for, or it is likely to become a source of great danger to the health of the inmates of the household.  The sink should if possible stand out from the wall, so as to allow free access to all sides of it for the sake of cleanliness. The pipes and fixtures should be selected and placed by a competent plumber.

Great pains should be taken to keep the pipes clean and well disinfected. Refuse of all kinds should be kept out. Thoughtless housekeepers and careless domestics often allow greasy water and bits of table waste to find their way into the pipes. Drain pipes usually have a bend, or trap, through which water containing no sediment flows freely; but the melted grease which often passes into the pipes mixed with hot water, becomes cooled and solid as it descends, adhering to the pipes, and gradually accumulating until the drain is blocked, or the water passes through very slowly. A grease-lined pipe is a hotbed for disease germs.

MACARONI RECIPES

Home-made macaroni.
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To four cupfuls of flour, add one egg well beaten, and enough water to make a dough that can be rolled. Roll thin on a breadboard and cut into strips. Dry in the sun. The best arrangement for this purpose is a wooden frame to which a square of cheese-cloth has been tightly tacked, upon which the macaroni may be laid in such a way as not to touch, and afterwards covered with a cheese-cloth to keep off the dust during the drying.

Boiled macaroni.
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Put a larg cup of macaroni into boiling water and cook until tender. When done, drained thoroughly, then add a pint of milk, part cream if it can be afforded, a little salt and one well-beaten egg; stir over the fire until it thickens, and serve hot.

Macaroni with cream sauce.
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Cook the macaroni as directed in the proceeding, and serve with a cream sauce prepared by heating a scant pint of rich milk to boiling, in a double boiler. When boiling, add a heaping tablespoonful of flour, rubbed smoothed in a little milk and one fourth teaspoonful of salt. If desired, the sauce may be flavored by steeping in the milk before thickening for ten or fifteen minutes, a slice of onion or a few bits of celery, and then removing with a fork.

Macaroni with tomato sauce.
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Drop a cup of macaroni into boiling milk and water, equal parts. Let it boil for an hour, or until perfectly tender. In the meantime prepare the sauce by rubbing a pint of stewed or canned tomatoes through a colander to remove all seeds and fragments. Heat to boiling, thicken with a little flour; a tablespoonful to the pint will be about the requisite proportion. Add salt and if desired, a half cup of very thin sweet cream. Dish the macaroni into individual dishes, and serve with a small quantity of the sauce poured over each dish.

Macaroni baked with granola.
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Cook a large cup of macaroni until tender in boiling milk and water. When done, drain and put a layer of the macaroni in the bottom of a pudding dish, and sprinkle over it a scant teaspoonful of granola. Add a second and third layer and sprinkle each with granola; then turn over the whole a custard sauce prepared by mixing together a pint of milk, the well beaten yolks of two eggs or one whole egg, and one-fourth of a teaspoonful of salt. Care should be taken to arrange the macaroni in layers loosely, so that the sauce will readily permeate the whole. Bake for a few minutes only, until the custard has well set, and serve.

Eggs and macaroni.
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Cook a cup of macaroni in boiling water. While the macaroni is cooking, boil the yolks of four eggs until mealy. The whole egg may be used if caught so the yolks are mealy in the whites simply jellied, not hardened. When the macaroni is done, drain and put a layer of it arranged loosely in the bottom of a pudding dish. Slice the cooked egg yolks and spread a layer of them over the macaroni. Fill the dish with alternate layers of macaroni and egg, taking care to have the top layer of macaroni. Pour over the whole a cream sauce prepared as follows: Heat one and three fourths cup of rich milk to boiling, add one fourth teaspoonful of salt and one heaping spoonful of flour rubbed smooth in a little cold milk. Cook until thickened, then turn over the macaroni. Sprinkle the top with grated bread crumbs, and brown in a hot oven for eight or ten minutes. Serve hot.