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PubMed1990

People against the mentally ill: community opposition to residential treatment facilities.

A community campaign against the establishment of psychiatric half-way house in Shatin District, Hong Kong was examined in terms of fear toward mental patients and problems in community relations. Failure of the Government to prepare for the community reintegration of mental patients pointed to lessons to be learned in Community Psychology. The apparent conflict between community empowerment and community care for the disabled was discussed. Suggestions for resolving the paradox included early community mental health education, involvement of community leaders in the planning, application of the knowledge and skills of Social Psychology in dealing with public panic, and cooperation with the mass media to reach the public.

Attitude to Health↗
PubMed1986

Community residential options for the chronically mentally ill.

We have discussed the problems of the new young chronic patients, deinstitutionalized old chronic patients now living in the community, and some of the groups of hard to place patients. We have talked about problems with community barriers, staff training, a spectrum of facilities, and we have looked at what new sorts of facilities may need to be developed. It seems clear that we have not yet developed a spectrum which can deal with all varieties of the chronically mentally ill. Pepper (1985) has suggested a different, more ideal spectrum of housing particularly suited to the young adult chronic patient. These include crisis residences, supervised 14-bed residences, growth house for 14 beds; support house for 14 beds; supervised apartments (satellite apartments), 14 beds; supportive apartments, 14 beds; (these have less intensive staffing than supervised ones); open community living; and residential congregate care for adults (RCCAs). These RCCAs are large facilities located either in old state hospitals or nursing homes which are primarily oriented towards the homeless mentally ill. According to Pepper, if a program can plan a spectrum of housing situations in the immediate catchment area, it can then actually meet the specific needs of each patient with a specific sort of residential facility. The challenge for community residences is certainly much greater than a decade ago and, with the homeless mentally ill population continuing to grow (Bachrach, 1985), one might be tempted to regard our present situation as one of crisis proportions. Clearly, there is little doubt that a need exists for a wide spectrum of living situations to be made available to the deinstitutionalized or never institutionalized young adult chronic patient. Yet very few incentives exist for those who would try to meet this challenge. To do this effectively will undoubtedly require the development of sizeable amounts of public funding through existing and new channels to provide support for a variety of new types of community living arrangements with varying degrees of structure and treatment. There is also a great need for continued educating of the community about the realities of treating chronic mental patients in tailored facilities who must be protected from harming themselves or others. Finally, we in the field need better continuing education for ourselves and for those staff working in the residential area. Most of us don't ever learn about how to operate outside of our offices.(ABSTRACT TRUNCATED AT 400 WORDS)

Chronic Disease↗
PubMed1987

Commitment of the mentally ill to outpatient treatment.

Outpatient commitment is examined in order to determine what types of civil commitment respondents are ordered to outpatient treatment. The sample consisted of 1226 adult civil commitment respondents having initial hearings in North Carolina. Respondents placed on outpatient commitment are compared with respondents who were released and respondents who were committed to the hospital. Respondents ordered to outpatient commitment are significantly more likely to be of the chronic, revolving door population of mental patients. Potential problems in evaluating the success of outpatient commitment are discussed.

Adult↗
PubMed1991

Attitudes of relatives of Afro-Caribbean patients: do they affect admission?

This pilot study explored suggestions made in the literature that high rates of Afro-Caribbean patients compulsorily admitted to hospital can be explained by the attitudes of relatives. In particular relatives who hold negative attitudes towards psychiatric services and adopt non-medical explanations for the onset of illness might delay in contacting hospital services. This could delay the process of admission and make a compulsory admission more likely. The attitudes and experiences of relatives of 15 patients admitted compulsorily and 10 admitted informally were compared. The relatives' attitudes did not differ between the two groups. There was also no difference in the severity of current symptoms or the relative's assessment of dangerousness. Neither group was characterised by the sorts of attitudes to illness that had been hypothesised. In fact the group were very similar to the relatives of white psychiatric patients. The data suggest that future research should concentrate on the interaction between families and the services. In particular attention needs to be paid to the possibility that compulsory admissions are occurring because relatives' need for help is not being met and because there is an over-expectation of dangerousness on the part of the services.

Adolescent↗
PubMed1987

Citizen participation in police crisis intervention activities.

A naturalistic experiment tested the proposition that police time could be saved in nondangerous crisis intervention calls through the use of citizen participants. Results showed that police officers who used citizen intervention spent less time per call than officers who did not. However, police time was not saved in family disturbance calls. Family disturbance control group calls were rated by police as having a higher degree of physical danger present than other calls.

Adult↗
PubMed1989

Impact of a television film on attitudes toward mental illness.

The possible impact of a prime time television film portraying a mentally ill killer was investigated. Groups of college students were shown the film with and without a film trailer reminding viewers that violence is not characteristic of mentally ill persons. A third group viewed a film not about mental illness. Postfilm responses to the Community Attitudes toward the Mentally Ill scale indicated that those who saw the target film expressed significantly less favorable attitudes toward mental illness and community care of mentally ill persons than did those who saw the control film, regardless of whether of not they received the trailer along with the target film. Results support concerns that media depictions add to mental illness stigma and also suggest that corrective information alone may be sufficient to counteract the stigmatizing impact of such audience-involving mass media portrayals.

Attitude↗
PubMedDate not supplied

Psychiatric commitment and involuntary hospitalization: an ethical perspective.

As a psychiatrist, I have focused in this paper on the medical model view of commitment. Directed against the medical model is the civil liberties position, mostly put forward by attorneys, which values autonomy over beneficence and sees psychiatric decision-making as biased, imprecise, and too paternalistic. Like the moral principles they champion, neither of these positions is "wrong." The tension between them is inevitable and sometimes beneficial. The conflict is inevitable because the proponents differ in their missions and how they think. Attorneys (and philosophers) think in terms of the general case, of classes of situations, whereas psychiatrists focus on individuals as unique. Chodoff has also pointed out that the medical model is a utilitarian one, i.e. the morality of an act is determined by, on balance, whether it increases the good for the individual or society. The civil liberties position, on the other hand, is a deontological one, i.e. the end does not justify the means; some moral principles must be considered even if they do not lead to maximally good outcomes. This conflict between positions can be ultimately beneficial, if we recognize that each is fighting for a good. As a society, we should expect psychiatrists and other mental health professionals to try their utmost to treat the mentally ill, and attorneys to protect their rights. When we view it as such a moral dilemma, "we are confronted not with melodrama, a contest of right against wrong, but rather with tragedy, a conflict of one right--to be at physical liberty--against another right--to be free dehumanizing disease."

Beneficence↗
PubMed1988

Parens patriae considerations in the commitment process.

Seventy-one commitment-seeking decisions made by 36 clinicians in a state-funded mental health center were studied to determine the extent to which clinicians attend to legally mandated "dangerousness" criteria in seeking commitment. A previous finding that clinicians rely largely on the dangerousness criteria was replicated. In addition, clinicians were found to be sensitive to clinical indicators of the patient's need for treatment, a question which is central to the parens patriae approach to involuntary hospitalization. Further, patients who were judged to be more seriously ill or more dangerous were more likely to retract their requests for discharge. This finding suggests that the patient's request for release and the psychiatrist's petition for commitment together constitute an interactive, transactional process in which the clinician's and the patient's views of the patient's need for hospitalization influence each other.

Commitment of Persons with Psychiatric Disorders↗
PubMed1993

A description of the forensic outpatient and the opinions of mental health professionals who work with these clients.

This paper presents a descriptive profile of clients placed on Conditional Release in New York State between September 1980 and September 1987 (N = 331). Data on the client's sociodemographic characteristics, prior mental health history, prior criminal justice history, and target offense are presented, as well as information on the conflicts faced by the primary therapists working with this population.

Adolescent↗
PubMed1993

The assessment of dangerousness and predictions of violence: recent research and future prospects.

Recent research on clinical and actuarial assessments of dangerousness leaves many important questions unanswered regarding the relative validity and utility of such assessments. Moreover, the focus that has existed on determining the false-positive and false-negative rates of predictions of violence may be fundamentally misplaced. Clinical evaluations of dangerousness should be viewed as assessments of risk rather than as predictions of violence; and future research should focus on understanding and evaluating how clinical assessments of dangerousness-regarding truly representative types of possibly dangerous patients--are (or should be) made. In the meantime, the research to date on clinical assessments of dangerousness cannot properly be taken to conflict with the Supreme Court's recent affirmations of the admissibility of such assessments in courtroom proceedings.

Actuarial Analysis↗