1. Knocking on Heavens Door
ERFCON 2017
9th International Conference of the Faculty of
Education and Rehabilitation Sciences
University of Zagreb
17 – 19 May 2017, Zagreb
Knocking on Heavens Door
Mirta Vranko, Dolores Novak, Jelena Sušac
University Psychiatric Hospital Vrapče
INTRODUCTION
REVOLVING DOOR SYNDROME
In mental health, revolving door syndrome describes a subpopulation of chronically mentally ill patients frequently readmitted to psychiatric units. Clients get better for a while, and then end up relapsing Literature review indicates that patients at higher risk for revolving-door phenomenon are more likely to be younger, single males, with a diagnosis of a psychotic illness and high number of previous admissions. It most often applies to those with serious disorders, such as schizophrenia, but anyone with a mental health condition could potentially be at risk.
Patients with poor support networks, lower levels of education and challenging social environments are likely to remain well for shorter periods. Non-adherence to prescribed medications contributes significantly to relapse rates. The most consistently identified predictor is the number of previous hospitalizations.
Paper discusses the revolving door syndrome in psychiatric patient, the phenomenon of returning to the hospital during disease relapse, and a continuum of participation in the use of different systems of Social. The work is theoretically based on the concept of developmental psychopathology, following the patient from the stage of a child at risk, through adolescent with behavioral problems, to adult with schizophrenia.
The patient (34) to be shown is divorced, living with mother, father-in-law and brother-in-law. He is retired house painter and has no children. Through his growing up, was (and still is) user of different systems; starting from pre-school through educational, social welfare system, family legal protection, the health and retirement systems. The patient comes for the 10th time on treatment in the University Psychiatric hospital Vrapče, or is in regular outpatient treatment. He also has parents who are diagnosed with some kind of mental health illness.
Child „at risk”
„Mom’s crazy... and Pop’s also. There’s no chance in hell I cound end up being normal.”
Primary school
„I was in in some kind of group for savage kids. They knew someting was off with me...”
Institution for Education of Children and Juveniles Dugave
„They observed me for couple of weeks for some reason. But it was cool there. Because there was many kids like me. And yeah, because I didn’t have to spent time with my stupid and abusive stepfather...”
Secondary school
„I feel strange. Nobody gets me. They look at me like I’m some kind of freak. I don’t understand...”
Children and Adolescent Psychiatric Hospital Zagreb
„I hear some voices when I’m alone. I also ocassionaly hear music. It makes me feel bad. Like I did something wrong. I don’t know who they belong to. Often they judge me and comment me. What’s wrong with me?”
Social Welfare System
„Finally someone reacted. I coudn’t stand it anymore. Eventhough it was supervision, she made things right for a little while and they finally saw me...”
Ministry of the Interior
„I didn’t do anything but the cops wanted my statement as a whitness at my neighbours favour. I never liked cops...”
Mental Health System
„I am useless... Nobody needs me... Everybody hates me... I am dead...”
Retirement System
„They retired me because I’m crazy. And uncapable for work.”
Family Legal Protection
„Marriage was biggest mistake of my life. It lasted like 2 seconds and I’ve ruined my life with that decision. She was much crazier than me and she didn’t want to let me go. Oh, and I failed again.”
CONCLUSION
This paper argues the phenomenom of the revolving door
syndrome through case study. We present schizophrenic
patient in stable remission whose risk factors were analyzed.
Often we whitness the fragmentation and network poverty of
the various stakeholders of the system, whose participants
are also mentally ill persons. The above mentioned implies
further their stigmatization. Early detection of risk factors
in people at risk for the development of mental illness
could be prevented from different kind of disorders,
but also revolving door effect within a single system
of social life.
Risk factors
Parental mental illness
Drugs
Young age
Adverse experience in childhood
Low social economic status
Social incompetence