Essay Sample on Clinical Study of Mental Ilnesses

Introduction

There are several cases of mental illnesses in correctional facilities such as jails and prisons as compared to hospitals. This has been raised owing to the uncontrolled measures to manage and minimize the rise and spread in the cases of mental issues in modern society. The increase in the number of people suffering from mental health in correctional facilities can be associated with the failure deinstitutionalization together with community health. Actually, correctional facilities have been considered the new asylums because several individuals who have become non-adherent with community mental health treatment, some who engage in substance abuse and are homeless find themselves into the criminal justice system.

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However, correctional facilities are suffering an acute shortage of adequate resources to facilitate the provision of mental health care (Fickenscher, Lapidus, Silk-Walker, & Becker, 2016). The shortage of resources also includes the insufficient number of health professionals who can help with the fastening the overall recovery process. Therefore, correctional healthcare nursing is faced with various daily challenges and that emphasizes the fact that correctional facilities are not adequately equipped to offer satisfactory mental health treatment. Therefore, as a result of lack of adequate resources, most of the inmates do not receive proper mental health treatment upon incarceration and end up suffering drug-induced psychosis or dual diagnosis "mental illness plus drug use".

One of the emerging issues in mental health nurse working in a custody setting such as jail with the intention to provide physical and psychological support is the increase in the number of inmates suffering from mental illness faced with the inadequacy of resources for mental healthcare treatment. The contemporary trends of mental illness in the criminal justice system range from arrest to conviction to incarceration (Simopoulos & Khin, 2014). There is a lot of uninterrupted or unclear circumstantial interpretation of the needs and the wants of the society to manage and organize the overall dangers of mental challenges in the correctional facilities. Some research studies have estimated the statistics of individuals who suffer mental health and the findings have proved that almost up to 20 percent of the total national convicts as well as 21 percent of those locked up in jails have a medical history of mental illness (Thornicroft, Deb & Henderson, 2016). However, up to one out of seventy percent of the total number of youths locked up by the juvenile justice system has some kind of mental illness however a total of 20 percent suffer from severe mental health illness (Haney, 2017).

Generally, the health conditions are likely to be damaging for those individuals who are taken into custody with a medical history of mental health illness. The increases in the number of individuals who suffer from mental health illnesses are as an impact of the closure of various state mental facilities in the communities and they ended up the prison. Healthcare patients in correctional facilities are not receiving adequate outpatient care because of lack of community-based health care services hence making the efficiency of deinstitutionalization a severe problem (Thornicroft, Deb & Henderson, 2016).

However, there is an effective approach to dealing with the increasing rates of mental illnesses in jails because establishing parallel psychiatric hospitals in prison has proved expensive in terms of management. Additionally, the operation of parallel psychiatric prison hospitals is a challenge because they also have limited capacity and are also associated with low release levels and often leave patients with severe and persistent stigma (Wion & Loeb, 2016). Therefore some of the ways of dealing with this emerging issue are to divert the individuals with disorders to divert towards the mental health system because prisons are meant for punishment and rather than treatment and care of individuals suffering mental health (Thornicroft, Deb & Henderson, 2016). The inmates should also be assessed for treatment and the referral of people with mental disorders which include substance abuse including the integral part of the general health services (Chodos et al., 2014). Finally, the mental healthcare plan for prisoners can be included in the federal mental health policies and plans so as to encompass the needs of the prison population.

Article Assessment

Did the trial address a clearly focused issue?

Yes, the trial addressed a clearly focused issue by recruiting only children who were less than 24 months of age with bronchiolitis attending the emergency department of John Hunter Hospital or the medical unit of John Hunter Children's Hospital in New South Wales. The trial was focused on specifically 202 children during July 16, 2012, to May 2015 in which 101 children were assigned to HFWHO and another set of 101 children was assigned to standard therapy. The trial was run in accordance with the international Human Rights and meeting the Children's protection criteria that met the fundamental children's rights.

Was the Assignment of Patients to Treatments Randomized?

The assignment of patients for trial was randomized evident in the trial between July 16, 2012, and May 1, 2015. A total of 202 children were randomly assigned differently to HFWHO with a total of 101 children and alternatively Standard Therapy with also 101 children. Random treatment is best in ascertaining the quality of healthcare as well as establishing the correct procedure for statistically correct data interpretation.

Were the Patients who entered the Trial Properly Accounted for at its Conclusion?

The proper accountancy of the patients can be determined in the sense that the median time for the trial was 24 hours for the randomized group of standard therapy and a total of 20 hours for the patients who were randomized for HFWHO because of the differences in survival distributions. The conclusion took care of every subject that was involved in the total study.

Were the Patients, Health Workers and Study Personnel 'blind' to Treatment?

The patients were 'blind' to treatment because the trial only incorporated children below the age of 24 months who had been admitted to the ward and had any diagnosis of bronchiolitis and were assessed of being moderate severity using the NSW Health clinical practice guideline as well as necessary supplemental oxygen. Most of the patients were not well educated and alerted on the extents and the fact that they were participating in the study.Were the Groups Similar at the Start of the Trial?

Yes, the groups used for the trial were similar from the beginning of the trial to the end because the patients were only randomized into two categories; either standard therapy or HFWHO.

Aside from the Experimental Intervention were the Groups Treated Equally?

The random groups were also treated equally for instance in the provision of oxygen 100% through infant nasal cannulae at either low-flow or Optiflow. The weaning of oxygen was enabled for three hours on maximum treatment using a novel dose-finding procedure that involved the track-and-trigger standard pediatric observation charts established by the NSW Ministry of Health Clinical Excellence Commission in 2011.

How large was the Treatment Effect?

The weaning of oxygen was determined and measured as the primary outcome for both clinicians and the caregivers who were invested in seeing their children recover and quickly discharged. The secondary safety outcomes of the trial were the duration from randomization to the failure of the treatment, the probability of treatment failure or the probability of severe events together with the transfer to ICU. In the initial outcome, the protocol stated that death, transfer to another health facility or withdrawal from the study by complying the caregivers would result in the patients being censored at the time of the event. The secondary outcome results include severe conditions, subsequent medical care, parental concern with oxygen therapy, as well as a parental rating of the comfort of their children regarding their ability to feed and sleep.

How Precise was the Estimate of the Treatment Effect?

The confidence limit of the trial was set at a rapid response for ICU evaluation within ten minutes to diminish the dangers of performance bias in the view of the inability to conceal the allocated therapy. The precise estimate of the treatment effect was therefore set at 10 minutes of assessment of the rapid response of ICU. The treatment failures were also established as essential abnormal observations that fell within the red zone on an age-appropriate SPOC for heart rate which was dependent on the age as well as the respiratory rate. The red zone observations demanded an authorized frequent check within a timeframe of ten minutes by the ICU department.

Can the Results be Applied to the Local Population, or in your context?

Generally, the results of the trial are applicable to the general public in my opinion because the criteria used in the random selection of the patients covered by the trial can still be used to effectively administer equal therapy to other patients suffering from bronchiolitis. The patients who will receive the treatment are not very different from others because the trial was designed for children below the age of 24 months and are diagnosed with bronchiolitis.

Were all Clinically Important Outcomes Considered?

The most significant clinical outcomes were regarded in the trial which includes the outcomes for both the clinicians and the parents or caregivers of the patients. However, complete outcome information was not made available until the final analysis of the trial results. The initial and the secondary safety outcomes were analyzed by an approach of a-priori interim analysis that was conducted towards the end of the winter period with 93 out of the 202 patients in the trial.

Are the Benefits worth the Harms and Costs?

Generally, the benefits of the trial are worth than the cost and harms because this it is an exploration to open up opportunities to help understand high-flow warm dehumidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis. Even though the costs of the trial might have been very high, so does the number of children who may need intensive care as a result of HFWHO which can be accomplished by the study.

Discussion

Rigor is well elaborated in the trial presented in the article because the trial can be reflected upon and used as a point of reference because the details of the study are sufficiently comprehensive. The study is very precise in terms of the methods used especially the design of the study...