Running head: LITERATURE REVIEW
Literature Review
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留学生literature review代写 Glazer and Ereshefsky (2006) ascertain that over 50% of the beds are occupied by re hospitalization cases.
Introduction
Readmission rates of mental health patients have soared in the recent past. This trend is an inherent source of frustration to patients, families and the respective treatment teams. Indeed, the rapid deterioration of patients that culminates in readmission can be distressing to the patients as well as their supporters. The complex process of discharge and re hospitalization that happens within a very short period of time requires lengthy hours of multidisciplinary efforts and input that is always rendered redundant at the end of the process. In their nationwide study regarding the occupation of psychiatric wards,
Glazer and Ereshefsky (2006) ascertain that over 50% of the beds are occupied by re hospitalization cases. A notable pattern of patient illness in psychiatric wards is based along recurring of illnesses. Thus once the mental health patients leave the hospitals, the probability that they would return in future is seemingly high. 留学生literature review代写
The differences in the readmission of psychiatric patients are based on different factors of the institution milieu. The severity of the illness, indulgence in risky behaviors, substance use and abuse, fragmented care pathways and other modifiable factors have increasingly being associated with patient return in mental health institutions. Of great importance are the economic factors that have been identified as the main contributory factors to rapid readmissions. Generally, current statistics are a major cause of concern for most mental heath institutions. Efforts have been mounted through consistent research to identify intrinsic gaps that contribute to this scenario. This literature review underscores the previous findings in this regard.
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介绍 留学生literature review代写
最近，精神健康患者的再入院率飙升。这种趋势是患者、家属和各自治疗团队感到沮丧的内在原因。事实上，患者的快速恶化最终导致再次入院，这对患者及其支持者来说都是令人痛苦的。在很短的时间内发生的出院和再住院的复杂过程需要长时间的多学科努力和投入，但在过程结束时总是变得多余。在他们关于精神病房占用的全国性研究中，
Glazer 和 Ereshefsky (2006) 确定超过 50% 的床位被再住院病例占用。精神科病房中患者疾病的一个显着模式是基于疾病的复发。因此，一旦精神疾病患者离开医院，他们未来再次回来的可能性似乎很高。
精神病患者再入院率的差异基于机构环境的不同因素。疾病的严重程度、对危险行为的纵容、物质使用和滥用、支离破碎的护理途径和其他可改变的因素越来越多地与精神卫生机构的患者返回有关。经济因素非常重要，这些因素已被确定为导致快速再入院的主要因素。一般来说，当前的统计数据是大多数精神卫生机构关注的一个主要原因。已经通过一致的研究努力确定导致这种情况的内在差距。本文献综述强调了先前在这方面的发现。
Trends in Mental Health Policy
National statistics indicate that close to forty four million Americans suffer from mental health illness. In his study, Prince (2009) ascertained that the mental health department in America is presently experiencing a shortage in human resources. As a result, the quality of services being provided by the sector greatly compromises the recovery and holistic wellbeing of mental health patients.
Nationally, mental health has been identified as a neglected realm of the public health sector according to Delaney and Fogg (2007) who analyze the National health report based on the survey carried out in 2007. The information regarding the mental policy is also fragmented as exemplified by the World Heath Organization report of 2008. Essentially, it seeks to address the underlying goals of mental health but only mentions the reduction of suicide.
A report presented by Prince (2009) draws particular attention on the increasing rates of mortality for schizophrenia.
In addition, it cites vital surveys that highlight a significant 28% of the population believed to consult mental health services annually. Furthermore, he notes that social deprivation indicators like unemployment are elemental in psychiatric morbidity and highlights the urgent need for collaboration between different sectors. He concludes by stating that mental health services are critical for this segment of the national population whose incapacitation is likely to lead to increased poverty and marginalization. 留学生literature review代写
As highlighted above, mental health is relegated and is not identified as one of the public health priorities in America. Notably, psychiatric patients comprise of the poor in this nation. It is therefore imperative to enhance equitable distribution of mental health services in order to ensure that the psychiatric patients benefit from the same. Giffords (2006) has proposed the matrix model to be the most ideal approach to addressing the emergent concerns regarding healthcare. This presents various interventions with regard to mental health treatment, prevention, promotion and sustainable rehabilitation of the affected population. He argues that in order to attain optimal results, an all inclusive approach that incorporates both public and individual concerns needs to be adopted.
Burns and Fim (2002) affirm this contention by indicating that effective treatment of psychotic disorders requires input from all segments of the society.
In particular, they show that while pharmacological treatment controls severe symptoms, social interventions and psychological support are instrumental in enhancing the quality of life of the patients and preventing physical deterioration and malfunctioning. Further, a multivariate analysis revealed the inherent relationship between substance abuse and criminal victimization of the psychiatric patients. 留学生literature review代写
Burns and Fim (2002) also indicate that the sector has in the recent past received particular attention from consumer organizations. Fundamentally, these play a critical role in evaluating the performance of the sector. In particular, they publicize the extent of the department in addressing its goals of providing sufficient services to the mental health population, addressing stigmatization, providing integrated and comprehensive health services, reducing costs associated with mental health and increasing the workforce. A recent study indicates that the department has dismally failed in all these areas. By bringing these concerns to the fore, consumer organizations have played a critical role in encouraging formulation of sustainable policies by the federal government.
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心理健康政策的趋势 留学生literature review代写
国家统计数据表明，近四千四百万美国人患有精神疾病。在他的研究中，Prince (2009) 确定美国的精神卫生部门目前正面临人力资源短缺。因此，该部门提供的服务质量极大地损害了精神健康患者的康复和整体健康。
Delaney 和 Fogg (2007) 根据 2007 年进行的调查分析了国家健康报告，在全国范围内，精神卫生已被确定为公共卫生部门的一个被忽视的领域。 有关精神政策的信息也很分散，例如来自世界卫生组织 2008 年的报告。本质上，它寻求解决心理健康的基本目标，但只提到减少自杀。
王子 (2009) 提交的报告特别关注精神分裂症死亡率的上升。
此外，它还引用了重要调查，这些调查强调了据信每年有 28% 的人口咨询心理健康服务。此外，他指出失业等社会剥夺指标是精神病发病率的基本要素，并强调了不同部门之间合作的迫切需要。他最后指出，精神卫生服务对于这部分国民来说至关重要，因为他们的能力丧失可能会导致贫困和边缘化加剧。
如上所述，心理健康被降级，并没有被确定为美国的公共卫生优先事项之一。值得注意的是，精神病患者包括这个国家的穷人。因此，必须加强精神卫生服务的公平分配，以确保精神病患者从中受益。 Giffords (2006) 提出矩阵模型是解决有关医疗保健的紧急问题的最理想方法。这提出了有关受影响人口的心理健康治疗、预防、促进和可持续康复的各种干预措施。他认为，为了获得最佳结果，需要采用一种兼顾公众和个人关注的全包方法。
Burns and FIM (2002) 证实了这一论点，指出有效治疗精神障碍需要社会所有部门的投入。
特别是，他们表明，虽然药物治疗可以控制严重的症状，但社会干预和心理支持有助于提高患者的生活质量，防止身体恶化和功能障碍。此外，多变量分析揭示了药物滥用与精神病患者的犯罪受害之间的内在关系。
Burns 和 Fim (2002) 还指出，该行业最近受到了消费者组织的特别关注。从根本上说，这些在评估该行业的表现方面发挥着关键作用。特别是，他们宣传该部门在实现其为精神卫生人群提供足够服务、解决污名化、提供综合和全面的卫生服务、降低与精神卫生相关的成本和增加劳动力的目标方面的程度。最近的一项研究表明，该部门在所有这些领域都惨败。通过将这些问题放在首位，消费者组织在鼓励联邦政府制定可持续政策方面发挥了关键作用。
Implications of Deinstitutionalization
Various controversies have emerged over the process of deinstitutionalization that was carried out in the last quarter of the previous century. Shadish, Lurigio and Lewis (1995) decry this process and argue that mental health patients need long-term institutionalization in order to recover fully. He highlights the ineffectiveness of rehabilitation programs in dealing with violent behavior, impulsive suicide and substance abuse that is exhibited by the patients. However, Easterbrook, Berlin, Gopalan and Mathews (1991) point out that community programs have made it possible for the economically weak within the society to access these vital services. In response, Shadish et al (1995) ascertain that effective community care is more expensive than institutionalization. Further, he shows that long term rehabilitation that greatly benefits the patient is also an added expense.
Also, Gopalan and Mathews (1991) indicate that deinstitutionalization provides an ideal environment for the mental health patients to recover easily. In this regard, they argue that community based care provides a more humane environment that enables the mental health patients to access outpatient care. In addition, Geller (2000) posits that deinstitutionalization has been effective in shortening the period of time that the mental health patients stay in hospitals.
According to him, the hospital environment is restrictive and does not provide the patients with a chance to socialize with the entire public.
In other words, the environment provided therein is not viable and psychologically, this undermines the recovery process. However, Shadish et al (1995) contests this by indicating that this can only be achieved if the community based facilities are equipped with sufficient infrastructure including human resources. Notably, this has not been achieved in the US and as a result, mental patients continue to suffer. 留学生literature review代写
In his review, Dowdall (1999) describes deinstitutionalization a s an adjustment process that provides mental heath patients with a chance to recover without having to experience the effects of the life provided in institutions. This was based upon the realization that mental health patients that are institutionalized tend to become accustomed to the environment in the institutions and find it difficult to adjust to the conditions outside the institution. Dowdall (1999) asserts that deinstitutionalization allows that patients to be empowered and regain their freedom. This then enables them to assume responsibility for their action and therefore recover faster. Unlike in the mental institutions that have their distinct rules, the community environment allows the patients to adapt to the ‘normal’ environment and co-exist with the rest of the population with ease.
In his study, Scull (1991) argues that deinstitutionalization gives hope to the mental patients.
According to him, it provides a viable environment that enables the patients to be appreciated and be cared for by the entire community. This gives hope to the patients and hastens their recovery as they are perceived as normal individuals in a communal environment. Nonetheless, Shardish et al (1995) indicates that such an ideal scenario is yet to be achieved in the current US society as the patients face a high degree of stigmatization from the society. He further proposes that psycho education and other viable measures would be instrumental in altering the present demeaning perception that mental health is accorded by the public. According to him, only then would deinstitutionalization yield desirable outcomes.
Nonetheless, Shardish et al (1995) indicates that deinstitutionalization has resulted in incidences of homelessness. This is due to the fact that it results in to premature discharge of the mental health patients from the hospitals. However, the community based mental health institutions lack the vital infrastructure and resources to provide quality services to the discharged patients. In the long run, the patients lack vital care and fall victims of homelessness. 留学生literature review代写
Burns and Fim (2002) pertaining to USA health services reviewed the transfer of mental health patients for hospitals to community care programs.
Findings indicated that community based models were more effective in shortening the duration of the patients in hospitals, reducing incidences of readmission, and enhancing community integration. However, a parallel review undertaken by Foster (2002) indicated an increase in mortality rates, homelessness and frequent readmissions for patients whose conditions were severe. In order to counter the later scenario, Foster (2002) proposed that there is need to ensure that the community programs and given sufficient resources and are well planned for. In particular, he cites that that planning of community programs need to be attuned to the specific needs of the psychiatric patients.
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去机构化的影响 留学生literature review代写
在上个世纪的最后 25 年实施的去机构化过程中出现了各种争议。 Shadish、Lurigio 和 Lewis (1995) 谴责这一过程，并认为精神健康患者需要长期收容机构才能完全康复。他强调了康复计划在处理患者表现出的暴力行为、冲动自杀和药物滥用方面的无效性。然而，Easterbrook、Berlin、Gopalan 和 Mathews (1991) 指出，社区计划使社会中的经济弱势群体有可能获得这些重要的服务。作为回应，Shadish 等人 (1995) 确定有效的社区护理比机构化更昂贵。此外，他还表明，对患者大有裨益的长期康复也是一项额外费用。
此外，Gopalan 和 Mathews (1991) 指出，去机构化为精神健康患者提供了一个轻松康复的理想环境。在这方面，他们认为基于社区的护理提供了一个更加人性化的环境，使精神健康患者能够获得门诊护理。此外，Geller (2000) 认为去机构化在缩短精神健康患者住院时间方面是有效的。
根据他的说法，医院环境是受限制的，不为患者提供与整个公众交往的机会。
换句话说，其中提供的环境在心理上是不可行的，这会破坏恢复过程。然而，Shadish 等人（1995 年）对此提出异议，指出只有基于社区的设施配备有足够的基础设施（包括人力资源）才能实现这一点。值得注意的是，这在美国尚未实现，因此，精神病患者继续受苦。
在他的评论中，Dowdall (1999) 将去机构化描述为一种调整过程，它为精神健康患者提供了康复的机会，而不必经历机构提供的生活的影响。这是基于这样的认识，即被收容的精神健康患者往往会习惯收容所内的环境，并发现难以适应收容所外的条件。 Dowdall (1999) 断言，去机构化允许患者获得授权并重新获得自由。这使他们能够为自己的行为承担责任，从而更快地恢复。与有明确规则的精神病院不同，社区环境允许患者适应“正常”环境并轻松与其他人群共存。
在他的研究中，SCULL (1991) 认为去制度化给精神病患者带来希望。
据他介绍，它提供了一个可行的环境，使患者能够得到整个社区的赞赏和照顾。这给患者带来了希望并加速了他们的康复，因为他们在公共环境中被视为正常人。尽管如此，Shardish 等 (1995) 指出，由于患者面临来自社会的高度污名化，因此在当前的美国社会中还没有实现这种理想情况。他进一步建议，心理教育和其他可行的措施将有助于改变目前公众给予心理健康的贬低看法。他认为，只有这样，去机构化才会产生理想的结果。
尽管如此，Shardish 等人 (1995) 指出，去机构化导致了无家可归的发生。这是因为它导致精神健康患者过早出院。然而，社区精神卫生机构缺乏为出院患者提供优质服务的重要基础设施和资源。从长远来看，患者缺乏重要的护理并沦为无家可归的受害者。
Burns 和 Fim（2002 年）关于美国卫生服务部门审查了将精神病患者从医院转移到社区护理项目的情况。
结果表明，基于社区的模式在缩短患者住院时间、降低再入院率和加强社区融合方面更有效。然而，Foster (2002) 进行的一项平行审查表明，病情严重的患者的死亡率、无家可归和频繁再入院的情况有所增加。为了应对后一种情况，Foster (2002) 提出需要确保社区计划并给予足够的资源并进行周密的计划。他特别指出，社区项目的规划需要适应精神病患者的具体需求。
Modifiable Risk Factors for Rapid Readmission in Mental Health Hospitals
Frequent Hospitalization
In their research, Weiden and Glazer (1997) found out that a history of consistent hospitalization in mental health hospitals is a predictor of rapid readmissions. According to this study, patients that had a pattern of seeking inpatient treatment tended to repeat the treatment-seeking behavior.
In this regard, Carmel (2002) affirms that psychiatric patients that are accustomed to the mental health institutions or felt comfortable and relieved during their previous admissions often prefer readmissions as a viable mode of adjustment to their painful experiences during a relapse. He refers to this tendency as ‘hospitalphilia’. This is characterized by a short interval between admissions that lasts for a relatively shorter duration and often ends against the medical advice. Such patients according to him prefer short and frequent admissions to extended periods of admission. 留学生literature review代写
Although previous studies indicated that such admissions are influenced by violence, this study found out that the admissions are self initiated and the characteristic aggression does not influence re hospitalization. Notably, the patients did not exhibit any form of violence after admission, perhaps a strategy aimed at restraining the hospital staff from interfering with the self initiated admission schedule.
The limitation of this study was that it reviewed only documented and published information about the patients.
At this point, it should be acknowledged that unpublished studies are likely to contain more factual information that would conflict with these findings. However, the study was very comprehensive and various documentaries from a diverse cultural background were reviewed. Therefore, it can be applicable to other countries outside USA.
In a bit to explain the relationship between system variables and rapid re hospitalizations, Carmel (2002) found out that the attitude that the mental health workers accorded patients also influenced rapid readmissions. The study employed a sample of sixty one mental patients with ‘revolving door’ syndrome in a psychiatric unit in North Carolina. 留学生literature review代写
The results indicated that patients that were perceived ‘regulars’ by the nurses were in some instances overlooked when admitted or handled superficially.
As a result, the emergent issues in their medical status were not handled effectively because particular attention was given to major symptoms. Lack of timely interventions regarding emergent infections of these patients influenced their rapid readmission. In order to address this, the study recommended a change in the attitude towards frequently admitted mental health patents by the mental health providers.
Notably this study was restricted to one facility and one state. In this regard, it should be appreciated that the professional experiences of mental health individuals vary across the nation. These variations are influenced by the different economic resources that the states have. In addition, Huff (2000) notes that state policies also influence the quality of mental services offered in different states. It can therefore be argued that the findings do not have a nationwide application. However, the implications of these findings to policy formulators are desirable.
译文：
精神卫生医院快速再入院的可改变风险因素 留学生literature review代写
频繁住院
在他们的研究中，Weiden 和 Glazer (1997) 发现精神卫生医院持续住院的历史是快速再入院的预测因素。根据这项研究，有寻求住院治疗模式的患者倾向于重复寻求治疗的行为。
在这方面，Carmel (2002) 肯定，习惯于精神卫生机构或在之前入院时感到舒适和放松的精神病患者通常更喜欢再入院，作为一种可行的方式来调整他们在复发期间的痛苦经历。他将这种趋势称为“嗜好医院”。其特点是入院间隔时间较短，持续时间相对较短，并且常常违背医疗建议而结束。根据他的说法，这些患者更喜欢短期和频繁的入院，而不是延长入院时间。
虽然之前的研究表明此类入院受暴力影响，但本研究发现入院是自发的，特征性的攻击行为不影响再次住院。值得注意的是，患者入院后没有表现出任何形式的暴力，这可能是一种旨在限制医院工作人员干扰自行安排入院时间表的策略。
本研究的局限性在于它仅审查了有关患者的记录和公开信息。
在这一点上，应该承认未发表的研究可能包含更多与这些发现相冲突的事实信息。然而，这项研究非常全面，审查了来自不同文化背景的各种纪录片。因此，它可以适用于美国以外的其他国家。
为了解释系统变量与快速再住院之间的关系，Carmel（2002）发现精神卫生工作者对患者的态度也影响了快速再入院。该研究在北卡罗来纳州的一家精神病院使用了 61 名患有“旋转门”综合症的精神病患者作为样本。
结果表明，被护士视为“常客”的患者在某些情况下在入院或表面处理时会被忽视。
结果，他们的医疗状况的紧急问题没有得到有效处理，因为对主要症状给予了特别关注。对这些患者的紧急感染缺乏及时干预影响了他们的快速再入院。为了解决这个问题，该研究建议改变精神卫生提供者对经常承认的精神卫生专利的态度。
值得注意的是，这项研究仅限于一个设施和一个州。在这方面，应该理解的是，全国各地的心理健康人员的专业经验各不相同。这些变化受到各州拥有的不同经济资源的影响。此外，Huff (2000) 指出，州政策也会影响不同州提供的精神服务质量。因此，可以说这些发现在全国范围内没有应用。然而，这些发现对政策制定者的影响是可取的。
Non Compliance to Treatment and Medical Appointments
In his study, Green (1998) analyzed the causes and patterns of acute admissions in a psychiatric unit in New York for patients with ‘revolving door’ syndrome. He employed 63 inpatients that were suffering from schizophrenia. This study was aimed at making efforts to improve treatment options and enhance sustainability upon discharge from the hospital. The leading cause was identified to be lack of compliance to medication.
Lack of response to the treatment was cited as the second most common cause of acute readmissions in the institution. The treatment that was currently available for use at the time of study was oral conventional antipsychotic, atypical antipsychotic and depot conventional antipsychotic. The decision to employ either atypical or depot treatment was based on the identification of whether the relapse was caused by non response or non compliance. This study recommended that medication for such patients need to be determined during acute admission.
Notably, the study relied solely on the data collected from in patient.
In his review Easterbrook et al (1991) argues that inpatients tend to have different characteristics from outpatients. In particular, he ascertains that the attention and management that the two groups of patients are accorded differs significantly. This has various implications on the policies undertaken at various stages. At this juncture, it can be argued that the data employed for this study was not presentation of the psychiatric population. However, it can be contended that the first hand information got from the study is very instrumental in making viable decisions regarding treatment of inpatients suffering from mental disorders. 留学生literature review代写
A previous study undertaken by Weiden and Glazer (1997) that employed a pharmaco-economic decision analysis model evaluated the implications of changing treatment from traditional oral neuroleptics to modern atypical oral treatments and depot neuroleptics for ‘revolving door’ patients. The study employed one hundred and fifty patients that were randomly picked from various psychiatric state institutions across US.
The rationale for this was to capture the inherent economic disparities and analyze how the same contributed to rapid readmission of mental health patients.
Shifting of treatment was perceived as a viable means of management of schizophrenic out patients. This study found out that patients with limited resources were more likely to be rapidly readmitted than their counterparts. This was attributed to the low quality of previous medication that such patients were previously accorded. It was further compounded by lack of quality after care services at the community level. The study affirmed that these conditions worsened the symptoms after discharge and prompted rapid readmission.
In his study that sought to determine the relation between non compliance to outpatient admissions and rapid re hospitalization in psychiatric wards, Geller (2000) found out that patients who did not comply with outpatient appointments after being discharged from the hospitals were three times more likely to be readmitted. He employed a sample of 241 revolving door patients in three south eastern states. 留学生literature review代写
Findings indicated that out of the entire sample, almost sixty percent did not comply with the outpatient appointments regardless of the fact that they had been scheduled accordingly by respective institutions.
These segment of the sample experienced more rapid readmission rates than their counterparts. The study recommended that patients utilizing outpatient services need to comply with the medical instructions in order to avoid rapid readmission. According to this study, lack of compliance complicated the recovery process and made it difficult for the health providers to monitor the status of the illness and intervene accordingly. The limitation of this study was that it was restricted to female patients only.
Notably, non compliance to medical appointments has been associated with non compliance to treatment. In his research regarding the relationship between non compliance and rapid readmission, Bech (2005) found out that psychiatric patients who personally discontinued their medication found it difficult to disclose this to the medical providers. As such, they preferred to discontinue with the appointments altogether. 留学生literature review代写
Conversely, the psychiatric patients that missed important appointments tended to make misinformed decisions regarding their after care.This led to complications that ultimately culminated in rapid readmission. Further, Bech (2005) shows that non compliance to appointments and treatment undermines the quality of services that the patients are given by the medical staff. In particular, this tendency compromises communication between the patients and health providers, decreases the degree of health provider empathy and increases the level of provider frustration. In order to avoid this, Bech (2005) proposed that the patients should be given sufficient information regarding medical schedules.
译文：
不遵守治疗和医疗预约 留学生literature review代写
在他的研究中，Green (1998) 分析了纽约精神病院“旋转门”综合征患者急性入院的原因和模式。他雇佣了 63 名患有精神分裂症的住院病人。本研究旨在努力改进治疗方案并提高出院后的可持续性。确定的主要原因是对药物缺乏依从性。
对治疗缺乏反应被认为是该机构急性再入院的第二大常见原因。目前在研究时可用的治疗是口服常规抗精神病药、非典型抗精神病药和长效常规抗精神病药。使用非典型治疗或长效治疗的决定是基于确定复发是由无反应还是不依从引起的。该研究建议需要在急性入院期间确定此类患者的药物治疗。
值得注意的是，该研究完全依赖于从患者身上收集的数据。
Easterbrook et al (1991) 在他的评论中认为，住院病人往往与门诊病人有不同的特征。特别是，他确定这两组患者所得到的关注和管理存在显着差异。这对不同阶段采取的政策有不同的影响。在这一点上，可以说本研究使用的数据并不是精神病人群的表现。然而，可以说，从研究中获得的第一手信息对于对患有精神障碍的住院患者的治疗做出可行的决定非常有帮助。
Weiden 和 Glazer (1997) 之前进行的一项研究采用了药物经济决策分析模型，评估了将治疗从传统口服抗精神病药转变为现代非典型口服治疗和对“旋转门”患者的长效抗精神病药的影响。该研究雇用了 150 名患者，这些患者是从美国各地的精神病学机构中随机挑选的。
这样做的理由是捕捉固有的经济差异并分析这些差异如何促进精神健康患者的快速再入院。
转移治疗被认为是管理精神分裂症患者的可行方法。这项研究发现，资源有限的患者比同行更有可能迅速重新入院。这归因于先前给予此类患者的先前药物质量低。社区层面缺乏优质的售后服务使情况进一步复杂化。该研究证实，这些情况使出院后的症状恶化，并促使患者迅速再次入院。
Geller (2000) 在他的研究中试图确定不依从门诊入院与精神科病房快速重新住院之间的关系，发现出院后不遵守门诊预约的患者的可能性要高出三倍被重新接纳。他在东南部三个州使用了 241 名旋转门患者作为样本。
调查结果表明，在整个样本中，近 60% 的人不遵守门诊预约，而不管他们已由各自机构做出相应安排。
样本中的这些部分经历了比同行更快的再入院率。该研究建议使用门诊服务的患者需要遵守医疗指示，以避免迅速再次入院。根据这项研究，缺乏依从性会使康复过程复杂化，并使医疗保健提供者难以监测疾病状态并进行相应干预。这项研究的局限性在于它仅限于女性患者。
值得注意的是，不遵守医疗预约与不遵守治疗有关。 Bech (2005) 在他关于不依从性和快速再入院之间关系的研究中发现，亲自停药的精神病患者发现很难向医疗提供者披露这一点。因此，他们宁愿完全停止任命。
相反，错过重要预约的精神病患者往往会做出关于他们的后续护理的错误决定。这导致并发症，最终迅速再次入院。 此外，Bech (2005) 表明，不遵守预约和治疗会破坏医务人员为患者提供的服务质量。 特别是，这种趋势会损害患者和医疗服务提供者之间的沟通，降低医疗服务提供者的同理心，并增加提供者的挫败感。 为了避免这种情况，Bech (2005) 建议应向患者提供有关医疗时间表的足够信息。
Severity of Illness
In his consultative review, Blader (2004) explored factors that determined rapid readmission in psychiatric institutions for adolescents and reported that severe early diagnosis especially that of affective psychoses and schizophrenia contributed significantly to rapid relapse that characterizes the ‘revolving door’ syndrome. Despite the fact that this study entirely focused on adolescents, it can be argued that this applies to children as well as adults. Also, the deductions can be ascertained to have been based on credible data due to the fact that the study was conducted within a period of ten years. Conventional studies have cited severity of the illness to be a contributory factor to frequent readmission. These are represented by Lyons, Uziel-Miller and Reyes (2000) that employed psychometric screening procedures in identifying psychiatric patients that were at a high risk of rapid readmission.
In this, they ascertained that factors relating to frequent readmission in hospitals had been studied intensely in the recent past in a bit to curb the expenses involved as well as improve the outcomes of the disease.
In this respect, they referred to the recent dramatic increases in readmissions in mental hospitals that involved ‘revolving door’ patients. Notably, this led to an increase in deinstitutionalization. Their study employed 130 patients and lasted for a period of three months. They concluded that identification of the patients that were at a higher risk of readmission would be useful. In particular, it would give mental health personnel a chance to plan for their management in a timely manner and make viable interventions accordingly. Such measures according to them would include discharging patients to community based institutions. 留学生literature review代写
The limitation of this study was that it was undertaken within a very short period of time. Considering the fact that it was using observation as an important tool of collecting data, this study should have taken more time in order to come up with viable conclusions. In this respect, Boardman, Hodgson, Lewis and Allen (1997) point out that severity of illness in mental patients is contributed to by various factors that are both environmental and economic in nature. It is therefore imperative to take sufficient time to identify deserving patients and take intervention measures accordingly. Nevertheless, the study was credible as it utilized factual first hand information from the mental health practitioners.
译文：
疾病的严重程度
在他的咨询评论中，Blader (2004) 探讨了决定青少年在精神病院快速再入院的因素，并报告说严重的早期诊断，尤其是情感性精神病和精神分裂症的早期诊断，对快速复发的“旋转门”综合征特征有显着贡献。尽管这项研究完全专注于青少年，但可以说这适用于儿童和成人。此外，由于该研究是在十年内进行的，因此可以确定扣除额是基于可靠的数据。传统研究指出，疾病的严重程度是频繁再入院的一个促成因素。 Lyons、Uziel-Miller 和 Reyes（2000）代表了这些，他们采用心理测量筛查程序来识别处于快速再入院高风险的精神病患者。
对此，他们指出，为了控制费用，改善病情，近来对医院频繁再入院的相关因素进行了深入研究。
在这方面，他们提到最近精神病院重新入院的人数急剧增加，涉及“旋转门”患者。值得注意的是，这导致了去机构化的增加。他们的研究雇用了 130 名患者，持续了三个月。他们得出的结论是，识别出再入院风险较高的患者将是有用的。特别是，这将使精神卫生人员有机会及时规划他们的管理并相应地进行可行的干预。根据他们的此类措施将包括将患者转移到社区机构。
这项研究的局限性在于它是在很短的时间内进行的。考虑到它使用观察作为收集数据的重要工具这一事实，这项研究应该花更多的时间才能得出可行的结论。在这方面，Boardman、Hodgson、Lewis 和 Allen (1997) 指出，精神病患者的疾病严重程度是由环境和经济方面的各种因素造成的。因此，当务之急是花足够的时间来识别值得患者并采取相应的干预措施。尽管如此，该研究还是可信的，因为它利用了来自心理健康从业者的真实第一手信息。
Substance Abuse
In his study in mental hospitals in the State of Mississippi Prince (2009) found out that coupled with treatment non compliance, substance abuse contributed significantly to rapid re hospitalization for ‘revolving door’ patients. His study was based on a sample of seventy patients that were randomly picked from a psychiatric institution.
He concluded that sustainable intervention measures such as patient education could be instrumental in reducing such incidences. Like wise, Haywood, Kravitz, Grossman and Lewis (2008) carried out a comparative evaluation of mental health inpatients without and with co morbid substance-related complications. They found out that instances of readmissions were more rapid for the psychiatric patients with co morbid substance-related complications. However, they indicated that this was only for a short period of time.
Further, Gastal, Andreoli and Quintama (2000) carried out a four year prospective review after relapse in schizophrenia for one hundred patients.
Their findings indicated that non compliant patients that had been previously diagnosed of substance assumed a significant 64% of the institutional rapid readmissions.
They also found out that the duration before re hospitalization was relatively shorter for non compliant patients that had dual diagnosis for substance use and abuse than for non compliant patients that had not been previously diagnosed for substance abuse. Further, they indicated that patients that were medication compliant had a relatively longer period before readmission than their counterparts that had been diagnosed of substance abuse. Basing on this analysis, they concluded that sustainable treatment programs in this respect need to address substance abuse and non compliance in order to attain optimal results. 留学生literature review代写
A relative research was carried out by Levine (1998) who sought to identify factors that contributed to substance use and abuse by schizophrenic patients and the relationship of the same with rapid readmissions. This study was motivated by the recognition that substance abuse was one of the reasons behind rapid re hospitalization of mental health patients in the state of Arizona.
The findings indicated that the relatives, family and community members of the patients contributed to their substance abuse by selling alcohol and drugs to them.
In addition, this study revealed that use of alcohol and drugs by the patients was aimed at containing severe side effects that are related to the use of anti-psychotic drugs, avoiding drowsiness and suppressing hunger as a result of shortage of food. However, this led to severe side effects and undermined the effectiveness of the medication. As such, affected patients were readmitted in hospitals within a very short period f time. 留学生literature review代写
The key areas of intervention in this regard were identified as enhancing psycho education amongst patients and the community at large, raising community awareness with regard to substance use and abuse, strengthening the abilities of law enforcers and care takers to curb substance use and abuse and initiating community based campaigns that target the protection and care of the mental health patients. The limitation of this study was that the data that was used was derived from clinical records. However, the implications can be applied to a large geographical area.
译文：
药物滥用 留学生literature review代写
他在密西西比王子州精神病院的研究（2009 年）发现，与治疗不依从性相结合，药物滥用显着导致“旋转门”患者的快速重新住院。他的研究基于从精神病院随机抽取的 70 名患者的样本。
他的结论是，诸如患者教育之类的可持续干预措施可能有助于减少此类事件的发生。同样，Haywood、Kravitz、Grossman 和 Lewis（2008 年）对没有和有共病物质相关并发症的精神健康住院患者进行了比较评估。他们发现，患有物质相关并发症的精神病患者再入院的速度更快。然而，他们表示这只是很短的一段时间。
此外，GASTAL、ANDREOLI 和 QUINTAMA (2000) 对一百名患者在精神分裂症复发后进行了为期四年的前瞻性审查。
他们的研究结果表明，先前被诊断出患有物质的不依从患者占机构快速再入院的 64%。
他们还发现，对于药物滥用和滥用双重诊断的不依从患者，重新住院前的持续时间比以前没有被诊断为药物滥用的不依从患者要短。此外，他们指出，与被诊断出滥用药物的患者相比，依从药物治疗的患者在再入院前的时间相对较长。基于这一分析，他们得出结论，在这方面的可持续治疗计划需要解决药物滥用和违规问题，以达到最佳效果。
Levine (1998) 进行了一项相关研究，他试图确定导致精神分裂症患者使用和滥用药物的因素以及这些因素与快速再入院的关系。这项研究的动机是认识到药物滥用是亚利桑那州精神健康患者迅速重新住院的原因之一。
调查结果表明，患者的亲属、家人和社区成员通过向他们出售酒精和药物而助长了他们的药物滥用。
此外，这项研究还表明，患者饮酒和吸毒的目的是控制与使用抗精神病药物有关的严重副作用，避免因食物短缺而导致的困倦和饥饿。然而，这导致了严重的副作用并削弱了药物的有效性。因此，受影响的患者在很短的时间内重新入院。
这方面的关键干预领域被确定为加强对患者和整个社区的心理教育，提高社区对药物使用和滥用的认识，加强执法人员和护理人员遏制药物使用和滥用的能力，并启动以保护和护理精神健康患者为目标的社区运动。这项研究的局限性在于所使用的数据来自临床记录。但是，其含义可以应用于较大的地理区域。
Violence
Violence and criminal behavior have also been implicated for contributing significantly to rapid readmission. A study conducted in North Carolina by Appleby, Desai and Luchins (2001) using a sample of 330 involuntary out patients suffering from psychotic and major mood disorders analyzed the specific characteristics and environments of violent mental patients. They found out that violent behavior was exhibited by half of the sample and contributed significantly to rapid readmission. The main limitation of this study was that the data employed was derived from a single facility.
Further, a study conducted by Casper and Regan (1996) in Canada indicated that violence was one of the main reasons that contributed to frequent and rapid readmissions. This viewpoint was brought forth by the care giving relatives who ascertained that severe relapse of mental health disorder in psychiatric patients culminated in a situation where the safety of the relatives was jeopardized, their property destroyed and in severe instances, their lives threatened as a result of violence.
A study conducted by Gastal et al (2000) in Mexico indicated that such a situation became even more disheartening in cases where the law enforcement agencies failed to respond in a timely manner.
Further, the fact that the patients were unlikely to be held criminally responsible for their activities made the relatives to request for rapid readmissions. In his study regarding the relationship between violence, substance abuse, criminal victimization and rapid readmission, Boardman et al (1997) found out multiple actors that discouraged the care giving relatives from taking up criminal proceedings in such instances. 留学生literature review代写
To begin with, it was indicated that relatives feared that their patient was likely to lead a devastating life in prison while s/he is awaiting trial. Further, the fact that the patient was likely to receive long term hospitalization in instances where s/he was found mentally unfit to stand trial made the relatives reluctant to pursue criminal proceedings. Finally, Burns and Fim (2002) found out that the police were always reluctant to press criminal charges in such instances and therefore the efforts could be fruitless.
In his study undertaken in New York about the reasons for frequent readmissions, Gifford (2006) found out that five of the 60 patients with ‘revolving door’ syndrome had spend close to five months in the institution because of violence. Haywood et al (2008) explains this by indicating that the care giving relatives often take hasty measures in incidences where the patient has previously portrayed violent behavior. In particular, they arrange for readmission as soon as the patient goes in to a relapse.
In order to address this Casper and Regan (1996) suggest that the public and especially the relative care givers need to liaise with community mental health providers.
This would ensure that they are well acquainted with vital information regarding violence and mental health. In particular, they would be informed of timely and effective measures to manage such relapse and avoid readmission. In addition, they note that the criminal justice system also needs to be well informed about the implications of violence in this regard. Policy changes with respect to long term stay in mental institutions are likely to have a positive impact on the perception of the public about violence and mental health. 留学生literature review代写
This study was limited by the involuntary nature of the respondents. In this regard, Gifford (2006) indicates that seeking the consent of the patient is important as it ensures that the information is given out of free will. Notably, this enhances the credibility of such information. With regard to the above study, it can be argued that the data collected was subjective in nature. Nevertheless, the fact that a significant number of respondents were employed implies that such mishaps were screened accordingly.
译文：
暴力 留学生literature review代写
暴力和犯罪行为也被认为是导致快速重新入院的重要原因。 Appleby、Desai 和 Luchins（2001 年）在北卡罗来纳州进行的一项研究使用了 330 名患有精神病和严重情绪障碍的非自愿患者作为样本，分析了暴力精神病患者的具体特征和环境。他们发现一半的样本表现出暴力行为，并显着促进了快速再入院。这项研究的主要限制是所使用的数据来自单一设施。
此外，加拿大 Casper 和 Regan (1996) 进行的一项研究表明，暴力是导致频繁和快速再入院的主要原因之一。这种观点是由照顾精神病患者的亲属提出的，他们确定精神病患者的精神健康障碍严重复发，最终导致亲属的安全受到威胁，他们的财产被摧毁，在严重的情况下，他们的生命受到威胁。暴力。
Gastal 等人 (2000) 在墨西哥进行的一项研究表明，如果执法机构未能及时做出反应，这种情况会变得更加令人沮丧。
此外，患者不太可能对其活动承担刑事责任这一事实使亲属要求迅速重新入院。在他关于暴力、药物滥用、犯罪受害和快速重新入院之间关系的研究中，Boardman 等人 (1997) 发现了多种行为者在这种情况下不鼓励照顾亲属进行刑事诉讼。
首先，有人表示，亲属担心他们的病人在等待审判期间可能会在监狱中过上毁灭性的生活。此外，患者在被发现精神上不适合接受审判的情况下可能需要长期住院治疗，这一事实使亲属不愿提起刑事诉讼。最后，Burns 和 Fim (2002) 发现，在这种情况下，警方总是不愿意提出刑事指控，因此这种努力可能是徒劳的。
Gifford (2006) 在纽约进行的关于频繁再入院原因的研究中发现，60 名“旋转门”综合征患者中有 5 名因暴力而在该机构待了近五个月。 Haywood 等人 (2008) 解释了这一点，指出在患者之前描绘过暴力行为的情况下，提供护理的亲属通常会采取仓促的措施。特别是，一旦患者复发，他们就会安排再次入院。
为了解决这个问题，Casper 和 Regan (1996) 建议公众，尤其是相关护理人员需要与社区心理健康提供者保持联系。
这将确保他们熟悉有关暴力和心理健康的重要信息。特别是，他们将被告知及时有效的措施来管理此类复发并避免再次入院。此外，他们指出，刑事司法系统也需要充分了解暴力在这方面的影响。关于长期留在精神病院的政策变化可能会对公众对暴力和心理健康的看法产生积极影响。
这项研究受到受访者的非自愿性质的限制。在这方面，Gifford (2006) 指出寻求患者的同意很重要，因为它确保信息是出于自愿提供的。值得注意的是，这增强了此类信息的可信度。关于上述研究，可以说收集的数据本质上是主观的。然而，大量受访者受雇这一事实意味着此类事故已得到相应筛选。
Implications of High Risk Behavior
Rapid readmission in mental health hospitals is also occasioned by manifestation of high risk behavior. This is all inclusive and it includes drug use and abuse and inappropriate sexual behavior that expose individuals to infections such as HIV. This then makes the mental health patients susceptible to readmissions. In his study in New York, Casper and Donaldson (2000) ascertained that high risk behavior has far reaching implications on the mental health patients with the profound being probability of frequent readmission in mental hospitals. The limitations of this study were that it was not gender representative as the researcher placed undue emphasis on the female segment of the society. Nevertheless Gifford (2006) indicates that the implications are transgender and therefore are applicable to all segments of the society.
With regard to vulnerability and susceptibility, Green (1998) points out that the vulnerable segment of the society is usually comprised of the elderly, women and persons that are intellectually and physically fragile. It is posited that they are frequently admitted because they are considered to be at risk and therefore require a considerable degree of protection from the society that they belong to. According to Carmel (2002), their vulnerability loading undermines their ability to protect themselves against societal ills and violence. Thus in most cases, they are victimized and suffer dire consequences.
Suicide attempts as a result of high risk behavior have also been identified as a major contributory factor to rapid readmissions in mental hospitals.
In this regard, Fontanella, Bridge and Campo (2009) indicate that suicidal thoughts stem from the understanding and experience of the grave implications that are associated with high risk behaviors. In particular they ascertain that use and abuse of drugs causes suicidal thoughts in mental heath patients. In their survey in thirty three mental institutions across US, Fontanella et al (2009) found out that fifty two percent of the mental health patients were readmitted rapidly because of suicidal attempts. While some were associated with economic vulnerability, a significant 63% were attributed to risky behavior after discharge from hospital. 留学生literature review代写
These presumptions were also affirmed by Geller (2000) who undertook a similar study in UK.
His findings indicated that while a great percentage of the population believed that suicidal attempts by mental health patients were associated with their vulnerable status and the stigmatization from the society, some of them (54%) were caused by the implications of high risk behavior. In particular, he indicated that the implications of the female patients being sexually and/or physically assaulted because of their unstable mental status made them feel dejected and resort to suicide. In addition, this study affirmed that use and abuse of drugs was responsible for triggering suicidal thoughts in mental health patients and therefore prompting readmissions.
In order to counter this, Geller (2000) asserted that the stakeholders in community mental health need to complement their efforts towards enhancing care and protection of the mental health patients in the community. To achieve this, he indicated that the community needs to be educated about mental health. In addition patients need to spend sufficient time in institutions so that they can be informed about their vulnerability and how to manage the same. This according to Geller (2000) can only be attained if patients recover well before being discharged to mental health institutions. Notably, complete recovery also enables them to understand their status and avoid resistance.
译文：
高风险行为的影响 留学生literature review代写
精神卫生医院的快速再入院也是由高危行为的表现引起的。这包罗万象，包括药物使用和滥用以及使个人暴露于艾滋病毒等感染的不当性行为。这使得精神健康患者容易重新入院。在他在纽约的研究中，Casper 和 Donaldson (2000) 确定高风险行为对精神健康患者具有深远的影响，因为他们很可能在精神病院频繁再入院。这项研究的局限性在于它不具有性别代表性，因为研究人员过分强调社会中的女性部分。尽管如此，Gifford (2006) 指出其影响是跨性别的，因此适用于社会的所有阶层。
关于脆弱性和易感性，Green (1998) 指出，社会的弱势群体通常由老年人、妇女和智力和身体脆弱的人组成。据推测，他们经常被接纳是因为他们被认为处于危险之中，因此需要他们所属社会的相当程度的保护。根据 Carmel (2002) 的说法，他们的脆弱性削弱了他们保护自己免受社会弊病和暴力侵害的能力。因此，在大多数情况下，他们成为受害者并遭受可怕的后果。
由高风险行为导致的自杀企图也被确定为精神病院快速再入院的主要因素。
在这方面，Fontanella、Bridge 和 Campo (2009) 指出，自杀念头源于对与高风险行为相关的严重影响的理解和体验。他们特别确定使用和滥用药物会导致精神病患者产生自杀念头。 Fontanella 等人（2009 年）在他们对美国 33 家精神病院的调查中发现，52% 的精神病患者因企图自杀而迅速重新入院。虽然有些与经济脆弱性有关，但有 63% 的原因是出院后的危险行为。
这些假设也得到了 Geller (2000) 的肯定，他在英国进行了类似的研究。
他的研究结果表明，虽然很大一部分人认为精神健康患者的自杀未遂与他们的弱势地位和社会污名有关，但其中一些 (54%) 是由高危行为的影响造成的。他特别指出，女性患者因精神状态不稳定而受到性和/或身体攻击的影响使她们感到沮丧并求助于自杀。此外，该研究证实，药物的使用和滥用是引发精神健康患者自杀念头并因此导致再次入院的原因。
为了解决这个问题，Geller (2000) 断言社区精神卫生的利益相关者需要补充他们的努力，以加强对社区精神卫生患者的护理和保护。为了实现这一目标，他表示需要对社区进行心理健康教育。此外，患者需要在机构中花费足够的时间，以便他们能够了解自己的脆弱性以及如何管理这些脆弱性。根据 Geller (2000) 的说法，只有在患者出院到精神卫生机构之前恢复良好，才能实现这一点。值得注意的是，完全康复还使他们能够了解自己的状态并避免抵抗。
Social Deprivation
Numerous studies of whom Hawthorne, Green and Lohr (1999) are represented ascertain that social indicators of deprivation contribute to an increase in readmission in mental institutions. They demonstrate that composite measures of social deprivation such as unemployment rates, Jarman Underprivileged Area Score and various other complex statistical models have successfully and accurately been employed in the past to determine the rate of readmission in psychiatric hospitals.
Of great importance is the fact that this study ascertains that social deprivation influences re hospitalization in psychiatric institutions. This contention is also affirmed by Roy (1996) who asserts that particular indicators such as lack of a car as well as unemployment are predictive of readmission. Further, social derivation also contributes to relative disorders such as personality disorders, psychotic disorders and substance use and abuse. Notably, these compromise treatment and compliance to medication. 留学生literature review代写
In this regard, Roy (1996) indicates that lack of sufficient economic resources makes individuals susceptible to mental illness.
However, mental illness also contributes to economic deprivation. This according to him is well exemplified by schizophrenia patients that have been proved to be liable to ‘downward social rift’ phenomenon. This twin relationship makes it difficult to identify specific causal factors that are responsible for increased readmissions.
He employed a sample size of sixty psychiatric patients that were drawn from three different mental institutions.His findings indicated that almost half of the patients were unemployed. Of the thirty two male patients, twenty six were not married. In addition, the study found out that eighteen of the patients were homeless and did not leave any address for follow up. However, this study failed to provide a clear differentiation between first admissions and readmissions. 留学生literature review代写
Further, Walling and Bishop (1996) attribute rapid readmissions to multiple intricate and augmenting factors.They used clinical information and records to ascertain that the nature of diagnosis, occupational status, previous episodes, multiple agency use and the number of previous re hospitalizations can be used to analyze the frequency of readmissions. In order to attain optimal results, they asserted that they need to be prioritized in order of relevance to a patient and then employed in monitoring patients accordingly.
译文：
社会剥夺 留学生literature review代写
以 Hawthorne、Green 和 Lohr（1999 年）为代表的众多研究确定，社会剥夺的指标导致精神病院再入院率增加。他们证明，社会剥夺的综合衡量标准，例如失业率、贾曼贫困地区得分和各种其他复杂的统计模型，过去已成功且准确地用于确定精神病院的再入院率。
非常重要的是，这项研究确定了社会剥夺会影响精神病院的再住院。 Roy (1996) 也证实了这一论点，他断言诸如缺乏汽车和失业等特定指标可以预测再入院。此外，社会推导也会导致相关障碍，例如人格障碍、精神障碍以及物质使用和滥用。值得注意的是，这些损害了治疗和对药物的依从性。
在这方面，Roy (1996) 指出缺乏足够的经济资源使个人容易患上精神疾病。
然而，精神疾病也会导致经济剥夺。据他说，这很好地体现在精神分裂症患者身上，这些患者已被证明容易出现“向下的社会裂痕”现象。这种双重关系使得很难确定导致再入院率增加的具体因果因素。
他从三个不同的精神病院抽取了 60 名精神病患者作为样本。他的研究结果表明，几乎一半的患者都失业了。三十二名男性患者中，二十六名未婚。此外，研究发现，有 18 名患者无家可归，没有留下任何地址进行后续跟踪。然而，这项研究未能明确区分首次入院和再入院。
此外，Walling 和 Bishop (1996) 将快速再入院归因于多个复杂和增强的因素。他们使用临床信息和记录来确定诊断的性质、职业状态、以前的发作、多机构使用和以前的再住院次数可以是用于分析再入院的频率。为了获得最佳结果，他们断言需要按照与患者相关的顺序对它们进行优先排序，然后相应地用于监测患者。
Care Pathways
In their review, Mahendran, Mythily and Chong (2005) ascertained that the rapid readmission of patients in psychiatric hospitals in the state of Georgia was attributed to poor coordination of vital services with regard to referral pathways between secondary specialists and primary healthcare. This study employed a sample population of three psychiatric institutions and was carried out over a period of two years. The results ascertained that in order to enhance quality services, the referral system between specialists and health care provides needs to be clarified. In particular, the study recommended that there is an urgent need to increase the specific referral systems to facilitate and increase the accessibility of psychiatric patients to an integrated and comprehensive system as well as to community- based healthcare provision. 留学生literature review代写
This study was limited by it’s over reliance on informal reports provided by the patients and their relatives. Thus the accuracy of its conclusions can not be accredited. However, the fact that it employed more than one mental institution during its study shows that it captured the diversity required. In this regard, it is worth acknowledging that the contextual conditions of various mental institutions differ. As such, the quality of the services provided by such institutions also differs considerably. Notably, the study captured these differences and therefore, it can be ascertained that the conclusions are representative of the mental health institutions in Gorgia.
In his review, Kastrup (1997) contends that the mental health care givers as well as their clients are in most instances confused with regard to the correct and effective healthcare path way.
In his partially qualitative review undertaken in rural Virginia, he indicated that most patients and care givers fail to understand the best approaches that can be used to treat the mental health disorder effectively. This according to this study is attributed to various factors that range from complexity of the disease to the equally complex mental health system in the country. The limitation of this study was that it employed a rural population. Thus its findings can not be applied in the urban context that comprises a host of mental health patients.
Further, a study conducted by Goodpastor and Hare (2002) in New York ascertains that the multicultural and relatively complex emergent economic factors make it difficult for the mental health care givers to figure out the specific cause of the disease and take timely and effective intervention measures. They employed a sample of fifty mental health patients that were drawn from a diverse background with respect to social, racial, cultural and economic wellbeing. 留学生literature review代写
Apart from the economic and environmental factors, this study found out that cultural indifference and in particular language highly compromised the quality of mental heath services. In this regard, they showed that differences in language made it difficult for minority patients to follow the Doctors instructions and prescriptions accordingly. Thus they failed to adhere to the medication instructions which led to rapid readmission. This was further compounded by the complex nature of the mental health system in the country. To counter this they suggest that there is need to ensure that the health care pathways are well defined.
译文：
护理途径 留学生literature review代写
Mahendran、Mythily 和 Chong（2005 年）在他们的评论中确定，佐治亚州精神病院患者的快速再入院归因于重要服务在二级专科医生和初级医疗保健之间的转诊途径方面协调不善。这项研究使用了三个精神病院的样本人群，并进行了两年的时间。结果表明，为了提高服务质量，需要明确专家和医疗保健提供者之间的转诊制度。特别是，该研究建议迫切需要增加特定的转诊系统，以促进和增加精神病患者对综合和综合系统以及基于社区的医疗保健提供的可及性。
这项研究因过度依赖患者及其亲属提供的非正式报告而受到限制。因此其结论的准确性无法得到认可。然而，它在研究期间雇用了不止一家精神病院这一事实表明它抓住了所需的多样性。在这方面，值得承认的是，各种精神病院的背景条件不同。因此，这些机构提供的服务质量也有很大差异。值得注意的是，该研究捕捉到了这些差异，因此可以确定结论代表了高尔吉亚的精神卫生机构。
在他的评论中，Kastrup (1997) 认为精神卫生保健提供者及其客户在大多数情况下都对正确有效的医疗保健途径感到困惑。
在他在弗吉尼亚州农村进行的部分定性审查中，他指出大多数患者和护理人员未能理解可用于有效治疗精神健康障碍的最佳方法。根据这项研究，这归因于各种因素，从疾病的复杂性到该国同样复杂的心理健康系统。这项研究的局限性在于它雇用了农村人口。因此，它的发现不能应用于包含大量心理健康患者的城市环境。
此外，纽约 Goodpastor 和 Hare (2002) 进行的一项研究确定，多元文化和相对复杂的新兴经济因素使精神卫生保健提供者难以弄清楚疾病的具体原因并及时采取有效的干预措施。 .他们使用了 50 名心理健康患者作为样本，这些患者来自社会、种族、文化和经济福祉的不同背景。
除了经济和环境因素外，本研究还发现文化差异，尤其是语言差异极大地影响了心理健康服务的质量。在这方面，他们表明语言的差异使得少数民族患者难以相应地遵循医生的指示和处方。因此，他们未能遵守导致迅速再入院的药物说明。该国精神卫生系统的复杂性进一步加剧了这种情况。为了解决这个问题，他们建议需要确保明确定义医疗保健途径。
Lack of insight, knowledge and Acceptance of the Psychiatric Condition
Prince (2009) indicates that insight, knowledge and acceptance of the mental situation of the patient need to occur at a macro level. In particular, the patient, household and general neighborhood should understand and appreciate the situation. In their study that sought to underscore the implications of stigmatization to mental patients in Illinois and the relationship of the same with rapid readmission, Mueller, Carlos and Wulf (2005) found out that stigmatization contributed significantly to denial of the mental illness by the patient and resistance to medication. This was further compounded by the adverse effects of mental illness to the wellbeing of the patients. In this respect, it is indicated that the judgment of such patients is often impaired and this makes it difficult for them to understand and accept their status. This undermines the treatment and rehabilitation efforts. 留学生literature review代写
Further, Mueller et al (2005) noted that stigmatization was more pronounced amongst the members of the public than amongst patients. This according to him made it difficult for the patients to cope with ease after being discharged from mental hospitals. Of great importance to this study is the indication that stigmatization contributes to social seclusion and compromises the process of recovery.
In a follow up study by Dalrymple and Fata (2003) in New York concerning the effectiveness of community based care, findings showed that most mental health patients cease taking their medication once they leave the hospital.
Basically, they believe that they have recovered fully and the illness is unlikely to recur. This then culminates in noncompliance to medication and frequent readmission. This study was qualitative in nature and it employed ten ‘revolving door’ patients in the psychiatric unit. The nurse of this institution contended that the period of hospitalization is short as the patient leaves as soon as s/he starts stabilizing.
At this point, the patient may not have recovered enough to participate actively in the treatment plan and s/he may be unreceptive of any knowledge or insight. Also, the relatively short period of hospitalization does not provide sufficient time to explain to the patients the implications and management of the mental illness. The limitation of this stud was that it focused on one mental facility.
译文：
缺乏对精神疾病的洞察力、知识和接受度 留学生literature review代写
Prince (2009) 指出，对患者心理状况的洞察力、知识和接受需要在宏观层面上发生。尤其是患者、家庭和一般社区应该了解和欣赏这种情况。在他们试图强调污名化对伊利诺伊州精神病患者的影响的研究中，Mueller、Carlos 和 Wulf（2005 年）发现污名化对患者否认精神疾病有显着影响，并且对药物的抵抗力。精神疾病对患者健康的不利影响进一步加剧了这种情况。在这方面，表明此类患者的判断力往往受到损害，这使他们难以理解和接受自己的现状。这破坏了治疗和康复工作。
此外，Mueller 等人 (2005) 指出，与患者相比，公众成员中的污名化更为明显。据他说，这让精神病院的病人在出院后难以轻松应对。对这项研究非常重要的是，表明污名化会导致社会隔离并损害康复过程。
DALRYMPLE 和 FATA (2003) 在纽约进行的一项关于社区护理有效性的后续研究显示，大多数精神健康患者在离开医院后就停止服药。
基本上，他们认为自己已经完全康复，疾病不太可能复发。这最终导致不依从药物治疗和频繁再入院。这项研究本质上是定性的，它在精神病院雇用了 10 名“旋转门”患者。该院护士称住院时间短，病情稳定后即出院。
此时，患者可能尚未恢复到足以积极参与治疗计划的程度，并且他/她可能无法接受任何知识或见解。此外，相对较短的住院时间并没有提供足够的时间向患者解释精神疾病的影响和治疗。这个螺柱的局限性在于它专注于一种心理设施。
Psychiatric Disorders
In their study about the predictors of readmission amongst children and youths, Lyons, Uziel-Miller and Reyes (2000) cited psychiatric disorders to be one of the strongest predictors of rapid readmission in mental health hospitals. He observed that children that are frequently readmitted suffer from depressive disorders. Notably, these findings complemented Blader’s observations that indicated the youth with depressive disorders were more likely to be rapidly readmitted in mental hospitals than their counterparts (Blader, 2004).
In addition, the study found out that mental health youths who exhibited oppositional deviant behavior were frequently admitted.
This study was compromised by different factors. To begin with, it entirely focused on a Caucasian sample. Then, it also relied on informal information from the relatives of the children. Accuracy of such information was not assured. However, it presented useful insights regarding the contribution of psychiatric disorders to frequent re hospitalization. It recommended that in order to yield optimal results, mental treatment in children and adolescents needs to treat the related behavioral disorders too. 留学生literature review代写
Another study conducted by Anderson and Estle (1999) regarding factors influencing rapid readmission in psychiatric hospitals amongst the elderly indicated that secondary medical conditions have limited influence on re hospitalization. It employed a sample population of one hundred and fifty elderly patients that had been identified to have ‘revolving door’ syndrome. In particular, the study analyzed the influence of cardiac diseases and diabetes on rapid re hospitalization. This study had a limitation of primarily depending on clinical records for data. Thus the credibility was undermined by its employment of secondary, rather than primary data. However, the fact that the data captured differences in racial and economic status of the patients enhanced its applicability to a diverse population.
译文：
精神疾病
Lyons、Uziel-Miller 和 Reyes (2000) 在他们关于儿童和青少年再入院预测因素的研究中指出，精神疾病是精神卫生医院快速再入院的最强预测因素之一。他观察到经常被重新接纳的儿童患有抑郁症。值得注意的是，这些发现补充了 Blader 的观察结果，即患有抑郁症的年轻人比他们的同行更有可能迅速重新入院（Blader，2004）。
此外，研究发现，表现出反常行为的心理健康青年经常被承认。
这项研究受到了不同因素的影响。首先，它完全专注于白人样本。然后，它还依赖于孩子们亲属的非正式信息。无法保证此类信息的准确性。然而，它提供了关于精神疾病对频繁再住院的贡献的有用见解。它建议，为了取得最佳效果，儿童和青少年的心理治疗也需要治疗相关的行为障碍。
Anderson 和 Estle (1999) 进行的另一项关于影响老年人在精神病院快速再入院的因素的研究表明，二级医疗条件对再入院的影响有限。它使用了 150 名已被确定患有“旋转门”综合症的老年患者作为样本人群。该研究特别分析了心脏病和糖尿病对快速再住院的影响。这项研究有一个局限性，主要取决于数据的临床记录。因此，可信度因使用次要数据而不是主要数据而受到损害。然而，数据捕捉到患者种族和经济状况的差异这一事实增强了其对不同人群的适用性。
Challenges Facing Community Based Institutions
The ineffectiveness of community healthcare has been blamed by Foster (2002) for the increasing incidences of rapid readmissions. Usually, patients that do not find sustainable care in the community institutions tend to deteriorate with time. He shows that in order to provide sustainable services to the affected population, community mental health institutions need to be expanded. It is because the number of mental health patients being discharged from the hospitals has increased in the recent past. At this juncture, it is worth noting that deinstitutionalization sought to transfer the resources from a central point to community services. As such, they need to be utilized accordingly.
In his study that sought to determine the quality of resources in mental health institutions, Foster (2002), noted that insufficient bed capacity contributed to frequent re hospitalization of mental health patients. This study found out that this situation led to early discharge of mental patients before they attained stability. This was influenced by the increased number of mental health patients.
In addition, he found out that lack of vital resources in community health institutions contributed to a large turnover in the same.
This study ascertained that the quality of the infrastructure that is found in secondary healthcare institutions is far much better than that employed at primary level. It recommended that in order to enhance service delivery, there is need to provide sufficient resources in mental health institutions. The main limitation of this study was that it was conducted in a single state. Nationwide application was therefore undermined in this respect. 留学生literature review代写
Lack of sufficient staff was also identified to be a contributory factor to frequent and rapid readmission. In this regard, Foster (2002) found out that limited hospital staff does not allow that patients to undergo effective treatment. In Particular, he noted that the level of counseling, community support to the families and relatives and quality of psycho education was very low. In this respect, Carmel (2002) indicates that according counseling and psycho education sufficient time was instrumental in avoiding readmissions. In order to counter this situation and provide quality mental services to the population, Foster (2002) suggested that there is need for the government to reconsider distribution of resources and ensure that all mental services are equipped with sufficient resources.
译文：
社区机构面临的挑战
Foster (2002) 将快速再入院率的增加归咎于社区医疗保健的无效性。通常，在社区机构中找不到可持续护理的患者往往会随着时间的推移而恶化。他表示，为了向受影响人群提供可持续的服务，需要扩大社区精神卫生机构。这是因为最近从医院出院的精神健康患者的数量有所增加。此时，值得注意的是，去机构化试图将资源从一个中心点转移到社区服务。因此，它们需要相应地加以利用。
在他试图确定精神卫生机构资源质量的研究中，福斯特（2002 年）指出，床位容量不足导致精神卫生患者频繁再住院。本研究发现，这种情况导致精神病人未达到稳定就提前出院。这受到精神健康患者数量增加的影响。
此外，他还发现社区卫生机构缺乏重要资源也导致了巨大的营业额。
本研究确定，二级医疗机构的基础设施质量远好于初级医疗机构。它建议，为了加强服务提供，需要在精神卫生机构中提供足够的资源。这项研究的主要局限性在于它是在单一状态下进行的。因此在这方面破坏了全国范围的应用。
缺乏足够的工作人员也被认为是频繁和快速重新入院的一个促成因素。在这方面，Foster (2002) 发现有限的医院工作人员不允许患者接受有效的治疗。他特别指出，辅导水平、社区对家庭和亲属的支持以及心理教育的质量都非常低。在这方面，Carmel (2002) 指出，根据咨询和心理教育，充足的时间有助于避免再次入院。为了应对这种情况，为民众提供优质的精神服务，Foster (2002) 建议政府需要重新考虑资源分配，确保所有精神服务都配备足够的资源。
Diathesis-stress Model
This denotes that every individual has a certain level of vulnerability and susceptibility (diathesis) that makes the same liable to developing a mental disorder (Scher, Rick & Zindel, 2005). Nevertheless, this model presumes that persons have their own individual points at which they develop the disorder. This is entirely influenced by the interaction between the level of stress being experienced by the individual and the degree of the risk factors.
In their review of related theories, Scott and Anne (1991) cite the model to be instrumental in determining the persons that are likely to develop disorders because it solely addresses the interaction between situational stressors and pre morbid risk factors. The risk factors that have been widely studied entail mental illness or family history of drug use and abuse, personal psychological factors like impulsivity or hostility, environmental characteristics like low socioeconomic status and biological factors. Stress in this regard refers to experiences and events that trigger psychological distress (Scher et al., 2005). It has negative implications on the vital body mechanisms that enhance the cognitive, physical and emotional stability of an individual. 留学生literature review代写
As indicated earlier, this model implies that if a person is highly susceptible, a relatively low degree of stress is required for the person to fall ill and vice versa.
It shows that determination of a person’s stress and vulnerability is fundamental in ascertaining the probability of the person falling ill or the illness reoccurring. Thus the model is imperative for preventing the occurrence of illness. It is because timely intervention measures that target individuals that have the highest risk of developing negative health implications can be undertaken accordingly. A classic example in this regard would include psychological interventions that are taken to ensure that an individual at risk responds to stressful situations with ease.
The model is perceived important in explaining the occurrences of mental and behavioral disorders.
In this respect, Scott and Anne (1991) indicate that previously, it has been employed in underscoring the relationship between environmental and hereditary factors that contribute to mental illnesses such as schizophrenia. Further, it has been beneficial in stimulating relevant research in mental health. In particular, it is indicated that it has enhanced research and treatment of mental disorders. Most importantly, it has been employed in mitigating stress and therefore preventing the pronunciation of diathesis through development of viable protective factors. The most common protective factors that have been put forth by Scott and Anne (1991) include skill building, rigorous psychopharmacology and development of effective support systems for the affected individuals. 留学生literature review代写
The model has also been beneficial to the care takers and families of mental health patients. In this respect, Scott and Anne (1991) indicate that it enables the close associates of these individuals to determine periods when the patients are vulnerable, examine the stressors leading to such experiences and employ protective factors in helping the person cope with the experience effectively. Utilization of this profile has enhanced humane, efficient and effective treatment interventions.
译文：
素质-压力模型 留学生literature review代写
这表示每个人都有一定程度的脆弱性和易感性（素质），这使得他们容易患上精神障碍（Scher、Rick & Zindel，2005）。然而，这个模型假设人们有自己的个体点，在这些点上他们会患上这种疾病。这完全受个人所经历的压力水平与风险因素程度之间的相互作用的影响。
在他们对相关理论的回顾中，Scott 和 Anne (1991) 引用该模型有助于确定可能患上疾病的人，因为它仅解决了情境压力源和病前风险因素之间的相互作用。被广泛研究的风险因素包括精神疾病或吸毒家族史、冲动或敌意等个人心理因素、社会经济地位低等环境特征和生物因素。在这方面的压力是指引发心理困扰的经历和事件（Scher 等，2005）。它对增强个体认知、身体和情绪稳定性的重要身体机制有负面影响。
如前所述，该模型意味着如果一个人高度易感，则该人需要相对较低的压力才能生病，反之亦然。
它表明，确定一个人的压力和脆弱性对于确定该人生病或疾病复发的可能性至关重要。因此，该模型对于预防疾病的发生是必不可少的。这是因为可以相应地采取针对具有产生负面健康影响的最高风险的个人的及时干预措施。这方面的一个经典例子包括采取心理干预措施，以确保处于危险中的个人能够轻松应对压力情况。
该模型被认为在解释精神和行为障碍的发生方面很重要。
在这方面，Scott 和 Anne (1991) 指出，以前，它被用于强调导致精神分裂症等精神疾病的环境因素与遗传因素之间的关系。此外，它有利于促进心理健康的相关研究。尤其是在精神障碍方面的研究和治疗得到加强。最重要的是，它已被用于减轻压力，从而通过发展可行的保护因素来防止素质的发音。 Scott 和 Anne (1991) 提出的最常见的保护因素包括技能培养、严格的精神药理学以及为受影响个体开发有效的支持系统。
该模式也对精神健康患者的照顾者和家属有所帮助。在这方面，Scott 和 Anne (1991) 指出，它使这些人的亲密伙伴能够确定患者易受伤害的时期，检查导致此类经历的压力源，并采用保护性因素帮助患者有效应对这些经历。使用此配置文件增强了人性化、高效和有效的治疗干预。
Current Thinking on Modifiable Risk Factors
From the preceding analysis, it is certain that modifiable risk factors inhibit treatment and prevention of mental health illnesses. In deed, the implication of these factors to effective prevention, intervention and treatment of mental illness can not be overlooked. While Carmel (2002) points out that frequent readmission are effective in enhancing the treatment and ultimate recovery of mental heath patients, it is worth acknowledging that modifiable risk factors compromise the overall quality of mental health service.
In their review, Stanley, Kutcher and Magdalena (2005) indicate that not only do these factors undermine recovery, but they also lead to waste of resources that could have otherwise been employed for other purposes. This is even more important at this time when there is increased pressure on the mental health resources. For instance, it can not be disputed that preventing readmission of one patient in this respect would enable ‘new’ patients to access the same. This according to Stanley et al (2005) is vital in enhancing early interventions and ensuring that appropriate measures are undertaken to prevent severity of the disease. 留学生literature review代写
Further, Delaney and Fogg (2007), cite that addressing modifiable risk factors would be instrumental in reducing the risk of the persons suffering from mental health illness.
This presumption is deduced from the Diathesis-stress model conception. Notably, modifiable risk factors are ‘stressors’. As such, they increase the vulnerability of persons at risk. Considering that this school of thought believes that biological factors can not be detrimental and are relatively manageable without the stress, it therefore follows that elimination of such stress would reduce the vulnerability of individuals of suffering from mental illness.
Further, Fontanella et al (2009) indicates that modifiable risk factors can not be effectively addressed without the intervention measures from the mental health providers. Generally, mental health practitioners are very resourceful and their knowledge is very instrumental in providing the right direction for the any action. In this regard, Foster (2002) argues that the information provided by these personnel is based upon factual analysis of the mental health status of the patients. As such, he recommends that they should not be eliminated from the cycle at all costs. 留学生literature review代写
At this point in time, it should be acknowledged that the efforts of every stakeholder are imperative in addressing the modifiable risk factors. Major stakeholders in this respect entail the patients, mental health providers and the government (Nelson, Maruish & Axler, 2000). Patients are charged with the responsibility of abstaining from activities that are likely to have adverse implications on their health and cooperating with the mental health providers by following medical instructions accordingly.
The mental health providers on the other hand provide technical support to the patients.
In particular, they are responsible for providing vital information regarding the management of the disease to the patients. This is achieved through clear instructions and effective counseling. Further, they provide timely preventive and curative interventions to the patients. Of great importance is their role of making follow up to ensure strict adherence to medical instructions by the patients.
Finally, the government and relevant policy makers are expected to avail vital resources to the mental health department. These range from sufficient infrastructure in both primary and secondary mental health institutions to adequate human resource and facilities. In addition, Roy (1996) indicates that there is need to ensure that the mental health facilities are distributed equally across the nation. This would enable all segments of the population to have access to these vital services. Notably, failure of each one of the stakeholders to play his or her role is likely to compromise the quality of services and compromise the effort towards addressing modifiable risk factors. 留学生literature review代写
In his viewpoint, Geller (2000) notes that the scientific effectiveness of the interventions that seek to address the modifiable risk factors is yet to be established.
In this respect, he indicates that a great percentage of the research undertaken has been compounded by complexities that are related to the short duration of analysis, non randomization of interventions, use of inadequate sample sizes and employment of surrogate outcome measures. Thus to ascertain the effectiveness of the intervention measures, there is need to undertake consistent and credible research in this regard.
Furthermore, Kastrup (1997) shows that the ineffectiveness of the intervention measures is exemplified through the increase in the mental health patients in the recent past. This trend has continued irrespective of the fact that the intervention measures have been implemented in the past. To counter this, Geller (2000) recommends that prevention strategies need to be delivered based on available evidence of their effectiveness Otherwise, parents, educators, health providers and politicians are likely to continue investing in these programs that are either ineffective or harmful to the general public.
译文：
当前对可改变风险因素的思考 留学生literature review代写
从前面的分析来看，可以肯定的是，可改变的风险因素会抑制心理健康疾病的治疗和预防。事实上，这些因素对有效预防、干预和治疗精神疾病的影响不容忽视。虽然 Carmel (2002) 指出频繁的再入院对于加强精神健康患者的治疗和最终康复是有效的，但值得承认的是，可改变的风险因素会影响精神健康服务的整体质量。
在他们的评论中，Stanley、Kutcher 和 Magdalena (2005) 指出，这些因素不仅会破坏恢复，而且还会导致本可以用于其他目的的资源的浪费。在精神卫生资源面临越来越大的压力时，这一点更为重要。例如，无可争辩的是，在这方面阻止一名患者再次入院将使“新”患者能够获得同样的治疗。根据 Stanley 等人 (2005) 的说法，这对于加强早期干预和确保采取适当措施来预防疾病的严重程度至关重要。
此外，DELANEY 和 FOGG (2007) 指出，解决可改变的风险因素将有助于降低患有精神健康疾病的人的风险。
这一假设是从素质-压力模型概念推导出来的。值得注意的是，可改变的风险因素是“压力源”。因此，它们增加了处于危险中的人的脆弱性。考虑到这一学派认为生物因素不会是有害的，并且在没有压力的情况下是相对可控的，因此消除这种压力会降低患有精神疾病的个体的脆弱性。
此外，Fontanella 等人（2009 年）指出，如果没有心理健康提供者的干预措施，就无法有效解决可改变的风险因素。一般来说，心理健康从业者非常足智多谋，他们的知识非常有助于为任何行动提供正确的方向。在这方面，Foster (2002) 认为这些人员提供的信息是基于对患者心理健康状况的事实分析。因此，他建议不应不惜一切代价将它们从循环中消除。
此时，应该承认每个利益相关者的努力对于解决可修改的风险因素都是必不可少的。这方面的主要利益相关者包括患者、心理健康提供者和政府（Nelson、Maruish 和 Axler，2000）。患者有责任避免可能对其健康产生不利影响的活动，并按照相应的医疗指示与心理健康提供者合作。
另一方面，心理健康提供者为患者提供技术支持。
特别是，他们负责向患者提供有关疾病管理的重要信息。这是通过明确的指示和有效的咨询来实现的。此外，他们为患者提供及时的预防和治疗干预。非常重要的是他们的作用是跟进以确保严格遵守患者的医疗指示。
最后，政府和相关政策制定者有望为精神卫生部门提供重要资源。这些范围从初级和二级精神卫生机构的充足基础设施到充足的人力资源和设施。此外，Roy (1996) 指出需要确保精神卫生设施在全国平均分布。这将使所有人口群体都能获得这些重要服务。值得注意的是，每个利益相关者未能发挥其作用可能会损害服务质量并损害解决可修改风险因素的努力。
在他看来，Geller (2000) 指出，寻求解决可改变风险因素的干预措施的科学有效性尚未确定。
在这方面，他指出，由于分析持续时间短、干预措施的非随机化、使用的样本量不足和采用替代结果措施等复杂性，所进行的研究的很大一部分变得更加复杂。因此，为了确定干预措施的有效性，需要在这方面进行一致和可信的研究。
此外，Kastrup (1997) 表明，干预措施的无效性体现在最近精神健康患者的增加。 无论干预措施过去是否已实施，这一趋势仍在继续。 为了解决这个问题，Geller (2000) 建议需要根据现有的有效性证据来实施预防策略，否则，父母、教育工作者、卫生服务提供者和政治家可能会继续投资于这些对一般人无效或有害的计划上市。
Conclusion
From the review, it is certain that the US mental health department has continuously failed to cater for the emergent needs of the mental health patients. This has been ascertained by the present trends that indicate that the sector is accorded minimal attention. Conventionally, deinstitutionalization was aimed at providing the mental health patients with a viable environment for recovery. Notably, this has not been achieved because of lack of sufficient resources and social stigmatization. Of great reference are the modifiable risk factors that undermine the effectiveness of the entire system.
At this juncture, it is important to acknowledge that modifiable risk factors remain a major setback in enhancing the provision of mental health to the US population.
Severity of the illness, a history of hospitalization, substance use and abuse, fragmented pathways and lack of sufficient resources amongst others have been cited to undermine the quality of mental heath services in various ways. This is further compounded by the existence of a fragmented institutional framework and policies that are sectoral in nature. In addition, the complex nature of the mental health system makes it difficult for the minority patients to access quality care. Essentially, modifiable risk factors are a source of stress that increases the vulnerability of the population to mental illness. As such, sustainable measures need to ensure that preventive and effective intervention measures are used to prevent the occurrence of the mental illnesses. 留学生literature review代写
In this regard, consistent, comprehensive and credible research needs to be undertaken. This is because of the fact that previous researches have had numerous inadequacies. This explains why previous intervention measures have been fruitless. Seemingly, the problem is not insurmountable. The challenge to attaining a sustainable solution is in mobilizing and marshalling the necessary will, political or otherwise to address the issues accordingly. As the current thinking about the modifiable risk factors ascertains, this can be achieved through partnerships and relevant collaborations between major stakeholders in the mental health sector. Efforts by individual stakeholders need to complement each other in order to come up with viable and lasting solutions to addressing modifiable risk actors and enhancing the quality of life of mental health patients.
译文:
结论 留学生literature review代写
综上所述，可以肯定的是，美国精神卫生部门一直未能满足精神卫生患者的紧急需求。目前的趋势表明该部门很少受到关注，这一点已经得到证实。传统上，去机构化旨在为精神健康患者提供一个可行的康复环境。值得注意的是，由于缺乏足够的资源和社会污名，这尚未实现。具有重要参考意义的是破坏整个系统有效性的可修改风险因素。
在这个时刻，重要的是要承认可改变的风险因素仍然是提高美国民众心理健康水平的主要障碍。
疾病的严重程度、住院史、药物使用和滥用史、支离破碎的途径和缺乏足够的资源等都被认为以各种方式破坏了精神健康服务的质量。分散的体制框架和部门性政策的存在进一步加剧了这种情况。此外，心理健康系统的复杂性使得少数患者难以获得优质护理。从本质上讲，可改变的风险因素是压力的来源，增加了人群对精神疾病的脆弱性。因此，可持续的措施需要确保采取预防和有效的干预措施来防止精神疾病的发生。
在这方面，需要进行一致、全面和可信的研究。这是因为之前的研究存在许多不足之处。这就解释了为什么之前的干预措施没有结果。看来，这个问题并非不可逾越。实现可持续解决方案的挑战在于动员和组织必要的意愿，无论是政治上的还是其他方面的，以相应地解决这些问题。正如当前对可改变风险因素的思考所确定的那样，这可以通过精神卫生部门主要利益相关者之间的伙伴关系和相关合作来实现。各个利益相关者的努力需要相互补充，以提出可行和持久的解决方案，以应对可改变的风险因素并提高精神健康患者的生活质量。
References
Anderson, R. & Estle, G. (1999). Understanding Mental Health among the Elderly. Hospital and Community Psychiatry, 30, 330-46.
Appleby, L., Desai, P. & Luchins, D. (2001). Causes of Frequent Readmission of Psychiatric Patients in Mental Institutions. American Journal of Psychiatry, 149, 70-79.
Bech, M. (2005). Relationship between Non attendance and Rapid Readmission. Health Policy, 73, 180-91.
Blader, J. (2004). Causes of Re hospitalization of Mental health Children. Journal of American Academy of Child and Adolescent Psychiatry, 43(4), 441-52.
Boardman, P., Hodgson, R., Lewis, M. & Allen, K. (1997). Social Indicators of Frequent Re hospitalization. British Journal of Psychiatry, 170, 455-68.
Burns, T. & Fim, N. (2002). Community Mental Health. Oxford: University Press.
Carmel, H. (2002). Readmission vs Recividivism. American Journal of Psychiatry, 1950-9.
Casper, E. & Regan, J. (1996). Predictors of Readmission. Canadian Journal of Psychiatry, 38, 656-62. 留学生literature review代写
Dalrymple, A. & Fata, M. (2003). Addressing Rapid Readmissions. Canadian Journal of Psychiatry, 37, 56-64.
Delaney, K. & Foggy, L. (2007). Determinants of Re Hospitalization amongst Children and Youths. Psychiatry Services, 56 (1), 185-93.
Dowdall, G. (1999). Implications of Deinstitutionalization on Mental Health. USA: Kluwer.
Easterbrook, D., Berlin, J., Gopalan, R. & Mathews, D. (1991). Controversies in Clinical Research. Lancet, 336, 865-73.
Fontanella, A, Bridge, A. & Campo, V. (2009). Suicide and early Readmission. American Journal of Psychiatry, 43(11), 1930-49.
Foster, E. (2002). Aftercare Services and Psychiatric Readmissions. Health Services Research, 33, 710-40.
Gastal, F., Andeoli, S. & Quintana, M. (2000). Predicting Re hospitalization. Revista de Saude Publica, 33: 280-9.
Geller, J. (2000). Psychiatry in UK. Psychiatric Services, 50, 40-67.
Gifford, S. (2006).Addressing Qualitative Research. Health Promotion. Journal of Australia, 6, 59-70.
Glazer, M. & Ereshefsky, L. (2006). Frequent Admissions in Psychiatry. Journal of Clinical Psychiatry, 57 (7), 335-49.
Goodpastor, W. & Hare, B. (2002). Understanding Multiple Admissions in Mental Institutions. Psychiatric Services, 19, 216-25.
Green, H. (1998). Frequent Readmission and Non Compliance. Hospital and Community Psychiatry, 39, 960-6.
Hawthorne, W., Green, E. & Lohr, J. (1999). Outcomes of Residential Treatment. Psychiatric Services, 50, 400-8.
Haywood, D., Kravitz, H., Grossman, L. & Lewis, T. (2008). Predicting Re hospitalization. American Journal of Psychiatry, 50 (6), 857-61.
Huff, D. (2000) Quality Service and Re hospitalization. Evaluating Health Professionals, 21, 440-60.
Kastrup, M. (1997). Understanding ‘Revolving Door’ Patients. Health Services Research, 76, 80-9. 留学生literature review代写
Levine, S. (1998). Experiences of Schizophrenic Patients in Communities. Psychiatry in Practice, 1, 38-43.
Lyons, J., Uziel-Miller, N., & Reyes, F. (2000). Understanding Frequent Readmission of Adolescents. Journal of the American Academy of Child and Adolescents, 43, 335-66.
Mahendran, R., Mythily, C. & Chong, S. (2005). Factors Underlying Re hospitalization. Canadian Journal of Psychiatry, 37, 286-99.
Mueller, B., Carlos, N. & Wulf, G. (2005). Psychiatry Social Stigma. Social Science and Medicine, 62, 38-41.
Nelson, E., Maruish, M. & Axler, J. (2000). Causes of Frequent Readmissions. Psychiatric Services, 50, 850-6.
Prince, J. (2009). Substance abuse and Frequent Readmissions. American Journal of Public Health, 99-170.
Roy, P. (1996). Ethnic Minorities. International Journal of Social Psychiatry, 30, 100-20.
Scher, D., Rick, E., & Zindel, V. (2005). Evaluating the Diathesis-Stress Model. Clinical Psychological Review, 24: 488-512.
Scott, M. & Anne, D. (1991). Diathesis- Stress Theories. Psychological Bulletin, 110(2), 406-24. 留学生literature review代写
Scull, A. (1991). Social Order vs Mental Order. California: University Press.
Shadish, W, Lurigio, A. & Lewis, A. (19995). Deinstitutionalization: Implications on Future Mental Health. Journal of Social Issues, 44, 1-17.
Starnley, P., Kutcher, M. & Magdalena, S. (2005). Preventing Modifiable Risk Factors. Journal of Canadian Medical Association, 178 (2), 280-8.
Walling, P. & Bishop, S. (1996). Addressing Rapid Readmissions. Journal of Nervous and Mental Disease, 180, 510-17.
Weiden, S & Glazer, W. (1997). Evaluating ‘Revolving Door’ Schizophrenic Patients. Psychiatry Quarterly, 68, 376-93.
