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PubMed1993

Homelessness and mental illness.

In Great Britain 1-2 million people may be homeless. Most homeless people are men, but about 10-25% are women, of whom about half are accompanied by children. Significant mental illness is present in 30-50% of the homeless: functional psychoses predominate; acute distress and personality dysfunction are also prevalent. Co-morbidity of mental illness and substance abuse occurs in 20%, and physical morbidity rates exceed those of domiciled populations. The homeless mentally ill also have many social needs. Pathways to homelessness are complex; deinstitutionalization may be only one possible cause of the increase in the number of homeless people. There is much recent research estimating the extent of mental illness and the characteristics of selected subgroups of accessible homeless people. The evaluation of potential service solutions has received less attention. This review outlines the research, highlights current views on the definition and classification of homeless populations, and offers some guidelines on avenues which need to be explored.

Cross-Cultural Comparison↗
PubMed2006

Computers, criminals, an eccentric billionaire, and APA: a brief autobiography.

In this invited autobiographical account, I sum up what life has been like for me personally and professionally. For most of the first 50 years of my life, I lived in Alabama. During my years at the University of Alabama, my professional activities included developing a computer-based system to interpret the MMPI (Hathaway & McKinley, 1943), managing a national and international continuing education program for psychologists, involvement in a class action suit that resulted in the deinstitutionalization of Alabama's mental hospitals, organizing a team of professionals to reclassify all of the inmates of Alabama's prison system, and conducting a psychological autopsy on Howard Hughes. I was the American Psychological Association (APA) president in 1988 and served from 1989 to 2003 as APA Chief Executive Officer. Since my time at APA, I have been engaged in work with international psychological organizations.

Computers↗
PubMed1980

Institutional vs. noninstitutional care for the elderly.

The question of institutionalization vs. home care of the aged in need of medical care has been debated extensively. The arguments for deinstitutionalization have stressed the issue of cost. Home care is felt to be more cost efficient than institutional care. In this paper, both sides of the issue are investigated in detail by drawing on published conference proceedings and empirical studies reported in the literature.

Aged↗
PubMed1984

Origins of the "Third psychiatric revolution": the Community Mental Health Centers Act of 1963.

In recent decades the community mental health movement has achieved a dramatic reduction in the census of state and county mental hospitals in the United States, and hundreds of federally-funded community mental health centers have been established nationwide. At the same time, national controversy has arisen in response to what in places has seemed the haphazard process of implementing "deinstitutionalization" and the fate of many chronically mentally ill persons who are without needed social services and psychological care. Despite the widespread attention that this contemporary program has received, theoretical analysis of the complex social, scientific, intellectual, and political origins of America's community mental health policy remains deficient. This article examines the background and development of the Community Mental Health Centers Act of 1963, tracing how an important shift in national policy toward the mentally ill grew out of changing perceptions--among policymakers, professional groups, and the general citizenry in the post-World War II era--of the nature of the problem of mental illness.

Community Mental Health Centers↗
PubMed1994

[Mental health services in Japan: development of community care for mentally ill patients and their families].

Psychiatric care in Japan has received criticisms not only within Japan but from other parts of the world. In contrast, the services for the mentally ill in England are considered to be superior, despite serious criticisms. Psychiatric services in Japan and England are compared using government statistics. In Japan, the number of inpatients per 100,000 population has increased from the 1950s, while that of England has decreased since 1954. Since 1972 the prevalence of inpatients has been higher in Japan than in England. The history of psychiatric services in England where, after World War II, deinstitutionalization has been occurring is briefly described. For developing community care of the mentally ill in Japan, alternatives to inpatient care are thought to be important. These include primary care, day care and residential service in the community. Studies on families of mentally ill patients are crucial in community care and, among them, Expressed Emotion (EE) study is promising. Twenty cohort studies on EE and schizophrenic relapse, most of which successfully replicated the relationship between EE of the family and the course of the disease, are reviewed. Finally, some important aspects of EE study in Japan are discussed.

Adolescent↗
PubMed1984

Undergraduate social work programs as health resources in rural areas: needs assessment as an example.

Undergraduate social work programs in rural areas can meet their students' learning needs and function as integral parts of the community health system, at the same time. Based on open systems and exchange theories, the author advocates enhanced resource sharing between undergraduate programs and community social and health agencies. Within the context of the need for increased experiential learning opportunities for students and for planning activities appropriate for student participation, a successful deinstitutionalization needs assessment project is described. As a generic model, the project has applicability to other health problem areas and settings.

Community Health Services↗
PubMedDate not supplied

Profile of psychiatric emergency patients.

From this mass of data, one can assemble a statistical composite profile of the psychiatric emergency patient. This patient is young, unmarried, female, living near the emergency department, poor, diagnosed as psychotic, exhibiting some acutely disruptive or life-threatening behavior, having a history of prior contact with the psychiatric system, arriving at night by herself, and at risk for medical illness or substance abuse. Such a composite profile is misleading, however, for it is unlikely that there is a homogeneous population seeking help in psychiatric emergency services. Rather it seems likely that the composite data conceals a number of demographic and clinical subgroups: the young unmarried borderline woman, the chronically psychotic deinstitutionalized single young male, the middle-aged alcoholic, and the other depressed and organically-impaired patient are examples of such subgroups. When these groups are lumped together in overall figures, salient features and differences are obscured. Studies of these subgroups are needed. Secondly, there is substantial variation between the different studies reported above. Thus, while this summary can give some general guidance for clinical and administrative planning, it is crucial for every psychiatric emergency service to monitor its own utilization statistics. Where the profile of emergency service users does not match that of the underlying census data or that of those persons most at risk for serious psychiatric illness, administrators must raise the question of over- or under-utilization. Finally, there is a need for further studies to build on this preliminary data. Such studies must use uniform diagnostic criteria such as DSM III, prospective blind design, and better coding of the data to facilitate retrieval and processing of relevant information.

Adult↗
PubMedDate not supplied

Coping with aging: international challenges.

This DataWatch discusses trends in functional health status among the elderly in several countries. Life expectancy at an advanced age has increased, and there is some evidence of lower prevalence of severe disability and a trend toward deinstitutionalization. These changes may result in fewer severely disabled persons, but the impact is less clear from the perspective of public finances, because of the increased need for formal home care and the relative subsidization of institutions. The implications for health care need further research but also may point to increased expenditures.

Aged↗
PubMed2005

Factors associated with low quality of life in schizophrenia.

Interest in quality of life in mental health care has been stimulated by the deinstitutionalization of psychiatric patients as well as a parallel interest in understanding the scope of their daily lives. This study aims to investigate the socio-demographic and clinical variables related to low quality of life, using a cross-sectional design to evaluate quality of life by means of the QLS-BR scale. We interviewed a sample of 123 outpatients from a reference mental health center in Divinópolis, Minas Gerais State, Brazil, clinically diagnosed with schizophrenia. Univariate and multivariate logistic regression analyses were carried out. The results showed that low quality of life is associated with one or more of the following: male gender, single marital status, low income plus low schooling, use of three or more prescribed psychoactive drugs, psychomotor agitation during the interview, and current follow-up care. The study identifies plausible indicators for the attention and care needed to improve psychiatric patient treatment.

Adolescent↗
PubMedDate not supplied

[Santa Tereza Windows: a study of the psycho-social rehabilitation process at the Psychiatric Hospital in Ribeirão Preto, São Paulo].

This is a case study of a psycho-social rehabilitation process taking place at Santa Tereza, a psychiatric hospital in Ribeirão Preto, whose objective is to understand possibilities and limitations implied in the rehabilitation process within Pensões Protegidas (Protected Homes) project. The basic strategies for the present study involved participative observation and interviews with individuals living in such homes as well as with the multi-professional staff working in the process. The results reveal a kind of orientation quite distant from the hospital-centered trend, since they reveal remarkable tendency towards deinstitutionalization. Finally, the author emphasizes the contribution of Pensões Protegidas Project at Santa Tereza for the better understanding of the so-called mentally ill.

Brazil↗
PubMed1978

Teaching retarded women a clothing selection skill using community norms.

Five institutionalized retarded women were taught a clothing selection skill to coincide with popular fashion. Normative data concerning popular styles of color-coordinated clothing were collected through observations of women's apparel in a local community. Using a puzzle simulation of a woman with alternative pieces of colored clothing, color coordination training was conducted using modelling, instructions, practice, praise, and feedback to teach popular selections of color combinations. A generalization training component with actual clothing was also included. Training was accompanied by large increases in percentage of popular color selections with the puzzle and actual clothing. The increases maintained over a seven- to 14-week followup period. Time efficiency measures supported the use of the simulation procedure as opposed to total reliance on actual clothing. The results underscore the utility of local norms in community preparation programs and the efficacy of instructional procedures for severely and profoundly retarded persons as part of their participation in the deinstitutionalization movement.

Adult↗
PubMed1986

Characteristics of sheltered homeless families.

To describe the characteristics of homeless families, we interviewed 80 homeless mothers and 151 children living in 14 family shelters in Massachusetts (two-thirds of the shelters in the state). Ninety-four per cent of the families were headed by women, 91 per cent were on AFDC (aid to families with dependent children), with twice as many as the state average having been on AFDC for at least two years; most had long histories of residential instability. Although 60 per cent had completed high school, only a third had worked for longer than one month. One-third of the mothers reported having been abused during their childhood, and two-thirds had experienced a major family disruption. At the time of the interview, almost two-thirds either lacked or had minimal supportive relationships and one-fourth of these named their child as the major support. Eighteen mothers were involved with the Department of Social Services because of probable child abuse or neglect. Seventy-one per cent of the mothers had personality disorders. In contrast to many adult homeless individuals, however, deinstitutionalized persons or those suffering from psychoses were not overrepresented. About 50 percent of the homeless children were found to have developmental lags, anxiety, depression, and learning difficulties, and about half required further psychiatric evaluation. Two-thirds described housing and social welfare agencies as not helpful. Given the many serious problems of the mothers and the difficulties already manifested by their children, comprehensive psychosocial and economic interventions must be made to interrupt a cycle of extreme instability and family breakdown.

Adolescent↗
PubMed1996

Predictors of mortality in children with severe mental retardation: the effect of placement.

OBJECTIVES: This study was undertaken to assess the predictors of mortality in severely disabled children with mental retardation, and to compare risk-adjusted mortality rates for those living in institutions with rates for those living in the community. METHODS: Statistical analysis was performed on a set of 24,469 person-years, derived from a population of all children with severe mental retardation and a fragile medical condition who are registered with the California Department of Developmental Services. Variables included age, several measures of mobility, the presence or absence of tube feeding, the level of retardation, and certain adaptive skills. RESULTS: Reduced mobility and the use of tube feeding were associated with a large increase in mortality risk. Own home residence and community care facilities have an estimated 25% higher risk-adjusted odds on mortality than institutions and health facilities. CONCLUSIONS: The differential mortality in the placements points to a possible effect of quality of care. One consequence of the current trend toward deinstitutionalization may be an increased mortality rate in children with severe developmental disability.

Adolescent↗
PubMed1993

Physical fitness and adults with mental retardation. An overview of current research and future directions.

The deinstitutionalization movement of the past 25 years has focused on the placement of people with mental retardation into community-based settings. There is a need for exercise- and health-related professionals to demonstrate a thorough understanding of the term mental retardation and all of the intellectual and behavioural ramifications that coexist with this condition before addressing the 'how to' of fitness evaluation. Therefore, the article outlines the range of intellectual and behavioural characteristics of this population, based on the level of retardation. Many researchers investigating body composition have reported that a disproportionate number of adults with mental retardation carry a percentage of body fat that would be considered unhealthy (e.g. it increases the risk of early onset of such diseases as hypertension and adult onset diabetes mellitus). Living arrangements (i.e. institution vs smaller residences) play a role in the prevalence of obesity. Many attempts of researchers to control weight in adults with mental retardation through caloric restriction, exercise, and a combination of diet and exercise, have had a varied outcome. Cardiovascular capacity is considered by most exercise physiologists as the major physiological indicator for overall fitness. The majority of researchers who have evaluated the cardiovascular fitness levels of adults with mental retardation have reported fitness levels representative of a very sedentary population. Therefore, one would expect a keen sense of urgency among researchers to develop training regimens targeted specifically for people with mental retardation. Many have been developed, but to date only 2 cardiovascular training regimens have been reported that specifically describe the necessary components of an exercise programme (i.e. frequency, duration, intensity) that would allow for reproducibility--a stationary bicycle routine using the Schwinn 'Air-Dyne' ergometer and a run/walk programme. Of these, only the programme using the Schwinn 'Air-Dyne' ergometer reported significant improvements in cardiopulmonary fitness. Researchers have demonstrated that: (1) body strength is valuable for recreation activities and activities of daily living; (2) competence in upper body muscular skills is a prerequisite for many available vocational opportunities; and (3) positive correlations have been established between muscular strength and industrial work performance in people with mental retardation. Therefore, there is a need for appropriate evaluation procedures for determining the muscular strength and endurance of people with mental retardation. The future directions for researchers and professionals concerned with the fitness status of people with mental retardation includes answering question such as: What will be the effect of obesity on general health status?(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Substance use and abuse among mentally retarded persons: a comparison of patients and a survey population.

Substance abuse among mentally retarded persons, first described 55 years ago, has received little or no attention by specialists in mental retardation. With deinstitutionalization, this problem has reappeared, often followed by victimization (i.e., assault, rape, robbery). In this study the demographic characteristics, family and childhood history, substance use patterns, and substance-related problems of 40 mild mentally retarded persons are compared with those of 40 mild mentally retarded persons without substance abuse. Similarities with substance abusers who are not mentally retarded are noted. Recommendations for alleviating this serious problem among mentally retarded persons are made.

Adult↗
PubMed1990

Reorganization of community psychiatric services by professional nurses.

This article describes the reorganization of one part of an individual, home visiting service for mentally dysfunctional women into a group intervention. Deinstitutionalization has been followed by escalating health care costs, cost containment, and restructuring of services, affecting the already constrained resources for community psychiatric services. Faced with these challenges, a nursing staff, under the administration of a clinical specialist psychiatric nurse, began reorganization of a home visiting service with one trial group. The model group used the prior success reports of groups that were adapted prospectively with a focus on immediate needs and led by nurses for women. The aims were to enhance social supports of the clients while reducing their relapse rates and to reduce the personnel time and cost. Evaluation found that these objectives were met. Thus, the involvement of nurses in the assessment, planning, implementation, and evaluation of its services demonstrates success in the redesign and reorganization of community psychiatric services.

Adult↗
PubMed1998

Virtual reality: consumer perspectives.

This commentary extends the discussion of the applications of virtual reality to persons with disabilities by focusing on: (a) the use of virtual reality for stimulating residential features for persons being deinstitutionalized into four-person community residences; and (b) the involvement of consumers in key decisions regarding their residence and personal assistive technologies.

Adult↗
PubMed1983

Administrative use of systems analysis to troubleshoot a problematic work situation.

The deinstitutionalized mentally ill continue to seek housing. The present private nursing home industry has sought to fill this population's needs by expanding their business endeavors to low cost residential facilities. The industry, of course, must seek a profit. These investors, however, lack a thorough understanding of the exact housing needs of the people from whom they seek their profits. Failure to establish a residence with a health stabilizing program sufficiently strong to mitigate the residents' health deficits produces a loss that is both financial and human. Many residential administrators are faced with trying to understand and remedy the situation in which they find themselves. The following case study illustrates this point and offers some administrative tools for assessing and communicating to investors the adjustments necessary in order to promote a profit from providing a residence for health impaired populations.

Administrative Personnel↗