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PubMed1981

Measuring the relationship of public psychiatric admissions to rising unemployment.

The results of a correlational analysis of the relationship between monthly state unemployment statistics and admissions to eight Missouri Department of Mental Health facilities are presented. Over a period of 100 months, readmissions, rather than new admissions, showed the strongest positive relationship to unemployment. A second study-a retrospective analysis of admissions before and after a major increase in unemployment-supported the results of the correlational analysis. A third analysis of subset of the original sample, comprised of patients unemployed at the time of admission, suggests that public facilities are more accessible to the unemployed during times of economic adversity. The findings on the relationship of readmission rates to the state of the economy have important implications for policy on deinstitutionalization. The planning, development, and evaluation of community care programs should include consideration of employment data.

Deinstitutionalization↗
PubMed1981

Family participation in the community rehabilitation of schizophrenics.

Families of schizophrenic patients frequently are ill equipped to handle the primary caretaking responsibilities that have fallen to them due to deinstitutionalization. The authors describe a program begun at a medical center in Southern California in 1978 to assist schizophrenic patients living at home and their families. The program, which consists of family therapy sessions in the home, focuses on education about schizophrenia, development of communication skills, and acquisition of structured problem-solving and other behavioral strategies. Preliminary findings of a controlled study of program participants suggest that the family interventions are both cost-effective and highly successful in reducing the incidence of relapse and hospitalization.

Behavior Therapy↗
PubMed1982

Young adult chronic patients: an analytical review of the literature.

This article analyzes the periodical and "fugitive" literature concerned with an emerging psychiatric service entity, young adult chronic patients. The increasing prominence of a young adult patient population results from the confluence of two primary forces: deinstitutionalization policies and demographic factors. The author discusses the clinical diversity and program requirements of these patients. Young adult chronic patients are best served when their uniqueness as a patient population is acknowledged and heeded and when special services for them are integrated into the total system of care, the author concludes.

Adolescent↗
PubMed1982

Young adult chronic patients: the new drifters.

Young chronic patients are faced with the same concerns and life-cycle stresses as others in their age group. They strive for independence, satisfying relationships, a sense of identity, and a realistic vocational choice. Lacking the ability to withstand stress and intimacy, they struggle and often repeatedly fail. The result is anxiety, depression, psychotic episodes, and hospitalizations; gradually many begin to give up the struggle. Such concerns may become intensified during the reassessment of life that takes place at about age 30. Denial of illness, the rebelliousness of youth, and issues of control and violence compound the problems. Since deinstitutionalization, patients can no longer take asylum from stresses in a lifetime of hospitalization. Many patients drift from one city to another, or from one living situation to another. Some ways of approaching these problems, such as working with younger patients while they may still be motivated to make changes, helping them develop appropriate rationalizations, and supporting realistic goals, are discussed.

Achievement↗
PubMed1982

Mental illness and family burden: a public health perspective.

Family burden is the emotional and economic strain that family members experience when a relative is discharged from a mental hospital and returns home. Since World War II the length of hospital stays has declined steadily, and deinstitutionalization has promoted community care of the mentally ill. Studies suggest that more than 65 per cent of discharged mental patients return to their families. Family burden is a complex problem that seriously affects the treatment of chronic mental patients. The author discusses the scope of family burden and outlines some practical solutions.

Chronic Disease↗
PubMed1982

Community mental health centers: a look ahead.

Community mental health centers are subject to a number of pressures that will affect the way centers operate in the years ahead. These influences include a reduction in federal appropriations, the use of block grants to the states, the administration's efforts at deregulation, and the continuing impact of deinstitutionalization. Because of these pressures, changes can be expected in the staffing patterns, catchment-area philosophy, numbers of service mergers and consolidations, degree of competition with the private sector the role of the states, use of state hospitals, consumer and citizen involvement, and kind and degree of professional advocacy. The author cautions that these trends may lead to decisions harmful to patient care unless careful planning is carried out. Centers of the future may well have to serve fewer clients while maintaining a highly professional staff, a wide range of services, and an increased responsibility for caring for the chronic mentally ill.

Ambulatory Care↗
PubMed1983

Recent developments in the care, treatment, and rehabilitation of the chronic mentally ill in Britain.

Just as the deinstitutionalization movement has swept the United States in recent years, the effort to provide alternatives to public hospitals has been government policy in Britain for the past 20 years. While problems remain, Britain, which reduced its mental hospital census less than America, has had some success in finding proper community treatment and care for its former hospital patients, especially the chronically disabled. The author describes recent developments in the administration and organization of services for chronic patients and in clinical practice. The effects of new legislation and several government reports on community care are outlined, as are two new experiments in finding community housing for former hospital patients. Developments in biological psychiatry, use of depot neuroleptic therapy, electroconvulsive therapy, and industrial therapy are also briefly mentioned.

Chronic Disease↗
PubMed1983

What's new in aftercare? A review of recent literature.

With the deinstitutionalization movement has come the need to develop effective aftercare systems for chronic mental patients in the community. To assess the progress that has been made in aftercare, the authors conducted a review of the journal literature published since 1977. They summarize the major findings related to studies of aftercare in its various dimensions and conclude that, although numerous studies have reported more positive outcomes for patients involved in aftercare programs, none of the approaches used have been subjected to the kind of rigorous scientific investigation that would justify recommending their widespread application. They emphasize the need for further studies that attempt to define which type of treatment works for which type of patient.

Aftercare↗
PubMed1983

Street people and psychiatry: an introduction.

Homelessness is not a new problem in the United States, but during the current recession we have witnessed an unprecedented increase in the number of people, many of them mentally ill, who live on the streets of American cities. The author traces the history of the homeless mentally ill in the United States; he then discusses the role of media coverage and reports in the scientific literature in alerting the public and the mental health field to the plight of the street people. The impact of deinstitutionalization and the work of advocacy organizations such as the National Coalition for the Homeless and the Philadelphia Committee for the Homeless are also discussed.

Adult↗
PubMed1984

Development of an emergency psychiatric treatment unit.

The increasing number of deinstitutionalized patients in crisis are placing new demands on general hospital emergency rooms. The authors discuss the approaches used in staffing and operating a psychiatric emergency service at a large general hospital in western Massachusetts. After studying the disposition of patients seen on the service, the authors determined that overnight hospitalization and crisis management could substantially reduce the need for longer hospital admissions. Subsequently a proposal was developed for a seven-bed emergency psychiatric treatment unit to provide brief, intensive psychiatric care for both voluntary and involuntary inpatients. The authors describe the staffing and layout of the unit, and the population to be served.

Crisis Intervention↗
PubMed1984

Psychiatric history as a barrier to residential care.

Bias against individuals with a history of psychiatric hospitalization can block their access to residential care homes and thus impede deinstitutionalization efforts. After surveying home operators in nine residential care programs in five states, the authors found that providers tend to accept a physically impaired client over one with behavioral problems or a history of psychiatric hospitalization. The authors also point out that actual admission practices may not reflect facility policies. For example, more than 30 percent of the operators said they admitted persons with behavioral problems or psychiatric histories, yet no such persons resided in their homes. The authors suggest strategies such as provider education and financial incentives to combat the operator's bias against former mental patients.

Aged↗
PubMed1984

Restrictiveness of care among the severely mentally disabled.

Restrictiveness of care was assessed among 286 severely mentally disabled individuals known to an urban community mental health center. By examining clinical records, the authors rated each subject for each month during a period of up to 85 months on four dimensions of restrictiveness: physical freedom, time constraints, legal status, and conservatorship. The maximum restrictiveness experienced by most of the subjects was high, reflecting periodic involuntary hospitalization. The average restrictiveness they experienced, however, was well below the level represented by state hospital care. Thus the authors suggest that the average restrictiveness experienced by this population has been reduced since the initiation of deinstitutionalization.

Commitment of Persons with Psychiatric Disorders↗
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

The nature of case manager support.

Case managers have been assigned a key role in community support systems (CSS) for deinstitutionalized chronic mental patients, yet little research has been published on how case managers actually work with clients. In separate intensive interviews the authors questioned 30 CSS clients and their 15 case managers about how the case managers helped or failed to help clients with their daily functioning. Results are discussed in terms of the case managers' general role, and their role in linking clients to activities, providing social support, and preventing rehospitalization. The findings suggest that the case managers, by focusing on management of reality rather than on symptomatology, foster their clients' community adjustment.

Community Mental Health Services↗
PubMed1985

Women's accounts of psychiatric illness and institutionalization.

Throughout the past century and a half, American women have written published accounts dealing with their mental illness and its treatment, yet this area of literature has been largely overlooked by those who study the relationship between gender and mental health. In their widely varying accounts--some autobiography, some thinly disguised fiction, and some poetry--women have provided valuable insights into the relationship between their mental illness and its treatment and their roles as wives, daughters, victims, and advocates. The accounts also reflect the impact of female-oriented psychiatric therapies, cultivation of stereotypical female behaviors, and deinstitutionalization policies on women psychiatric patients. The author illustrates these themes with passages from the approximately 175 accounts he has located to date.

Deinstitutionalization↗
PubMed1985

Beyond state hospital unitization: the development of an integrated mental health management system.

As commissioner of the Massachusetts Department of Mental Health, the senior author in 1975 initiated a reorganization of the department designed to provide greater continuity of care for deinstitutionalized patients by integrating management of hospital and community services at a local level. The new system continued the practice of dividing hospitals into units corresponding to geographical catchment areas (unitization), but it abolished the hospital superintendent's position and greatly broadened the role of the area directors of community services to include clinical administration of the hospital unit serving patients in catchment areas. The authors believe the new system played a role in reorienting the department's services toward community care of the seriously disabled patient and led to a more effective distribution of departmental resources.

Catchment Area, Health↗
PubMed1985

The mental health commissionership: major changes over a decade.

During the past decade major changes have occurred in the role of the state mental health program director. Those changes have made that position more complex, more administrative, and less medical. The author discusses four themes in particular: the growing belief in the desirability of employing professional managers, the increasing requirements for quantitative information, the loss of confidence in the overriding treatment ideology of deinstitutionalization, and managerial constraints imposed by consent decrees. Such changes make the role of the commissioner more important, yet more difficult.

Community Mental Health Services↗
PubMed1985

Documenting the relationship between homelessness and psychiatric hospitalization.

Homelessness among mental patients is frequently associated with deinstitutionalization. In a study to clarify the relationship between homelessness and psychiatric hospitalization, data from Illinois statistical reports and from admission reports of a state hospital that serves about 75 percent of the undomiciled mentally ill population in Chicago were analyzed. The rate of homelessness had increased substantially among psychiatric admissions over the last decade and was even higher among applicants for hospitalization. The homeless had lower admission rates than the domiciled, largely because of differing paths of referral. Nearly 20 percent of the homeless left the hospital against advice, and relatively few were referred to licensed long-term-care facilities. Until various systems develop adequate responses to the problem, both the numbers and the visibility of the homeless mentally ill are likely to increase.

Chicago↗