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Biomedical subjects

H R Lamb

Publications and source records attributed to H R Lamb.

At least 55 records · Page 3Linked to original sources
PubMed1988

One-to-one relationships with the long-term mentally ill: issues in training professionals.

In training mental health professionals to work with long-term mentally ill persons, the importance of the one-to-one relationship needs to be emphasized. As advocated here, this should be a reality-based, problem solving approach. No part of this work is more important than giving these persons a sense of mastery over their internal drives, their symptoms, and the demands of their environment. Trainees need to be taught that it is important to be active in these one-to-one relationships; this includes giving advice. Insight, as defined in this article, is not to be neglected as a goal for the long-term mentally ill.

Aftercare↗
PubMed1988

Court-mandated community outpatient treatment for persons found not guilty by reason of insanity: a five-year follow-up.

The authors conducted a 5-year follow-up study of 79 persons found not guilty by reason of insanity who were referred to and accepted for court-mandated community outpatient treatment. This was a severely mentally ill and violent group with extensive experience in both the criminal justice and mental health systems. This program was not without risks despite a readiness to revoke the patients' conditional release status when indicated; during the 5-year follow-up period, 25 (32%) were rearrested (18 [72%] for crimes of violence), 37 (47%) were hospitalized, and 38 (48%) had their conditional releases revoked. The authors believe that members of this population need social controls and long-term treatment when they are in the community.

Adult↗
PubMed1988

Court-mandated outpatient treatment for insanity acquittees: clinical philosophy and implementation.

Court-mandated outpatient treatment for offenders found not guilty by reason of insanity is an alternative form of treatment in which insanity acquittees may be released into the community after serving part of their commitment in a forensic hospital. Working with this difficult population requires a close liaison with the criminal justice system and a clearly articulated treatment philosophy. Essential elements include an emphasis on structure and supervision, recognition of the importance of neuroleptic medication, a reality-based approach to therapy and a focus on the problems of everyday living, and incorporation of the principles of case management. Treatment staff must be comfortable with giving support, enforcing limits, and recommending revocation of the patient's community status when necessary. Case illustrations of successful and unsuccessful community treatment for insanity acquittees are included.

Adult↗
PubMed1988

Deinstitutionalization at the crossroads.

Much has gone wrong with deinstitutionalization. To get back on course, the author says, we should acknowledge that while deinstitutionalization was a positive step, it has gone too far--that some of the long-term mentally ill now in the community need highly structured residential care. The long-term mentally ill should be made the highest priority in public mental health, and a comprehensive system of care that recognizes their heterogeneity needs to be established. Vigorous rehabilitation efforts aimed at helping them attain higher levels of functioning should be continued, but mental health professionals should also give high priority to those who function less well and recognize the gratification that can be derived from working with them. The more favorable long-term outcome of schizophrenia should not be confused with the lesser improvements that can be made over the short or intermediate term. Professionals need to come to grips with the bureaucracy, politics, and inefficiency of our largest cities and should also actively advocate for involuntary treatment when it is clinically indicated.

Chronic Disease↗
PubMed1987

Incompetency to stand trial. Appropriateness and outcome.

Of 85 persons (38% of those found incompetent to stand trial in Los Angeles County in 1983), 92% were currently charged with felonies and 62% with crimes of violence. Eighty-seven percent had a history of serious physical violence against persons and 68% had prior felony arrests. This study indicated that in this jurisdiction, incompetency to stand trial is not being used to divert mentally ill persons, charged with minor offenses, into intermediate or long-term psychiatric hospitalization to circumvent obstacles such as restrictive commitment laws and rapid hospital discharge policies. The lack of adequate postrelease planning and follow-up for most of these chronically and severely mentally ill offenders was clear. Neither the criminal justice nor the mental health system is inclined to take responsibility for their care. Mandatory community treatment on release is recommended.

Adolescent↗
PubMed1987

Expressed emotion in families: a critical review.

Research on expressed emotion in the families of schizophrenic patients has seemed to offer a new perspective on environmental factors that cause relapse in schizophrenia. A review of the literature, however, reveals that while expressed emotion may predict relapse, there is no evidence that it causes relapse. Nor does the evidence support the continued linkage of the three components of expressed emotion--criticism, hostility, and emotional overinvolvement--in a single global variable. The authors also question the clinical significance of expressed emotion ratings and believe that treatment strategies based on them tend to blame relatives for the patient's continuing difficulties. They suggest that clinicians assess family responses in the context of the patient's behavior and life situation before helping families develop more effectual coping strategies.

Attitude of Health Personnel↗
PubMed1986

The homeless mentally ill. The perspective of the American Psychiatric Association.

The homeless mentally ill have become one of the greatest problems of present-day society. The American Psychiatric Association's Task Force on the Homeless Mentally Ill concluded that this is not the result of deinstitutionalization per se but of the way it has been carried out; homelessness among the chronically and severely mentally ill is symptomatic of the grave problems facing them generally in this country. Thus, the problem will not be solved until the basic underlying problems are addressed and a comprehensive and integrated system of care for the chronically mentally ill is established. Specific recommendations of the Task Force include an ample range of graded, supervised community housing; comprehensive and accessible psychiatric care and rehabilitation; the availability of general medical assessment and care, crisis services, and a dependable source of income; a system of case management in which one mental health worker is responsible for each patient; changes in commitment laws to make them more responsive to clinical needs; coordination between the various community resources; and ongoing asylum and sanctuary for that small proportion who require it.

Chronic Disease↗
PubMed1986

Some reflections on treating schizophrenics.

Until recently, most mental health professionals and society generally have been reluctant to provide the community care and treatment needed by schizophrenics. To understand this, some of the recurrent and underlying issues that often impede treatment are briefly discussed: our expectations of schizophrenics and of ourselves; how to derive gratification from working with schizophrenics; dealing with issues of dependency and independence; providing asylum; taking into account the needs of families; and the barriers to setting limits and involuntary treatment. If mental health professionals pursue goals and use techniques that are not consistent with clinical reality, the recently revived interest in the chronically mentally ill will be lost out of frustration, staff burnout, and the disappointed hopes of administrators and the general public.

Attitude of Health Personnel↗
PubMed1986

Families of schizophrenics: a movement in jeopardy.

The family self-help movement in schizophrenia is in danger of losing its effectiveness, the authors believe. Many in the movement seem overly concerned with being accepted by professionals and others, which means that they become less single-minded in their advocacy for their relatives and for their own needs. Family groups are having difficulty maintaining their separate and unique identity and are including others who tend to undermine their efforts. The family movement in schizophrenia would do well to follow the example of the parents of the developmentally disabled in their unswerving devotion to their cause, which appears to be the key to their success in achieving greatly increased services and funding.

Chronic Disease↗
PubMed1986

Needed changes in law and procedure for the chronically mentally ill.

Three areas of legal change have had major effects on the chronic mentally ill: substantive and procedural alterations in civil commitment laws, the limited implementation of a constitutionally based right to treatment, and the partial recognition of a right to refuse treatment. After discussing these changes, the authors make recommendations they believe would be beneficial. Revised civil commitment laws should allow greater access to both emergency and ongoing involuntary treatment, including reintroduction of a need-for-treatment standard and use of informal rules of evidence. The right to treatment should be implemented beginning with established constitutional minimums of providing reasonable care and safety, reasonably nonrestrictive confinement, and treatment to prevent clinical deterioration. Legislation should permit medication of involuntarily committed patients without their consent.

Chronic Disease↗
PubMed1984

Psychiatric needs in local jails: emergency issues.

There is an urgent need for psychiatric services for mentally ill inmates in local jails. The authors recommend that a psychiatric team be established inside the jail to provide short-term crisis evaluation, disposition, and treatment; that special training be provided for jail booking personnel in the recognition of psychiatric problems during the initial jail screening and classification process; that special modules be developed for mentally ill inmates; and that inmates in need of hospitalization have easy access to hospital beds. They describe a psychiatric ward actually located within a county jail to treat mentally ill inmates who are considered security risks.

Adult↗
PubMed1984

The need for continuing asylum and sanctuary.

Deinstitutionalization of the chronically mentally ill does not mean they no longer need social support, protection, and relief from the pressures of life--in other words, asylum and sanctuary. The authors address the questions of why asylum should be provided, for what patients, the relationship between asylum and rehabilitation, and the implications for mental health professionals. They point out that while many chronic patients eventually attain high levels of social and vocational functioning, many cannot meet simple demands of living, even with long-term rehabilitative help. Many consciously limit their exposure to stimuli and pressure not from laziness but from a well-founded fear of failure. Professionals must realize that whatever degree of rehabilitation is possible for each patient cannot take place unless support and protection--whether from family, treatment program, board-and-care home, or public hospital--are provided at the same time.

Activities of Daily Living↗
PubMed1984

Deinstitutionalization and the homeless mentally ill.

Although homelessness among the chronically mentally ill is closely linked with deinstitutionalization, it is not the result of deinstitutionalization per se but of the way deinstitutionalization has been carried out. The lack of planning for structured living arrangements and for adequate treatment and rehabilitative services in the community has led to many unforeseen consequences such as homelessness, the tendency for many chronic patients to become drifters, and the shunting of many of the mentally ill into the criminal justice system. It has become clear after two decades of deinstitutionalization that what is needed is a vast expansion of community housing and other services and a whole revamping of the mental health system to meet the needs of the chronically mentally ill for support and stability. In addition, mental health professionals must accept the full extent of the dependency needs of many chronic patients.

Adolescent↗