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PubMed1981

Community support systems: scaling community acceptance.

In recommendations for community support systems, there are expectations of public involvement in unprecedented proportions; yet evidence of fundamental shifts in attitudes and behaviors toward the mentally ill is lacking. Considerations of the complexity of public acceptance led to the development of a scale used to measure the extent of support for the chronically mentally ill among 574 randomly selected adults in Leon County, Florida. Comparison of the general population with residents in a neighborhood known to be opposed to community-based services served to establish the validity of the scale. The findings led to recommendations for future research in this area.

Adult↗
PubMed1986

Issues in the treatment of mentally retarded patients in the community mental health system.

Developmental disability, particularly mental retardation, both affects a person's cognitive functioning and places that person on an alternative track of development which, when combined with social, political and economic pressures, places the developmentally disabled person at increased risk for mental illness. The presenting symptoms of mental illness will be modified by the mentally retarded person's cognitive impairment, personality development, and massively different life experience, as will the nature of his interactions with helping agencies. Evaluation, diagnosis and treatment must evolve from an alliance with the mentally retarded persons, not with caretaking agencies, and must be modified to take into account the retarded person's powerlessness. The therapist must be prepared to act as both advocate and bridge-builder for the patient, with the patient's increasing participation. The therapist must be prepared to steer between the Scylla of ignorance about the diagnosis and treatment of mental illness in the mentally retarded and the Charybdis of financial disincentives for human service agencies to collaborate in their care. The advantages of inter-agency cooperation in the treatment of dually-diagnosed individuals is described and illustrated.

Adult↗
PubMed1993

Crisis stabilization services for children and adolescents: a brokerage model to reduce admissions to state psychiatric facilities.

There continues to be an increased interest in developing community-based services for children and adolescents as an alternative to inpatient care. However, there has been much more talk than action in creating such alternatives. This paper describes the success of a crisis stabilization program for children and adolescents in a community mental health center which historically over-utilized the State psychiatric facility for youth. The Crisis Stabilization Program consists of three components: (1) a two-person crisis team, (2) a four-person on-call team for after hours crises, and (3) funds which the crisis team utilized to broker for a wider array of community-based services.

Adolescent↗
PubMed1993

Psychiatric care of adults with developmental disabilities and mental illness in the community.

Large numbers of people with co-occurring developmental disorders and mental illnesses now live in the community. Though not specifically trained to care for this population, community psychiatrists already have the necessary basic concepts and skills from working with adults with persistent mental illnesses. There are, however, some population-specific aspects of information collection, clinical assessment, diagnosis, treatment planning and application of treatment. This paper presents a practical approach to the community mental health care of people with developmental disabilities and mental disorders.

Activities of Daily Living↗
PubMed1987

Retention of Hispanics in public sector mental health services.

Hispanic underutilization of mental health facilities extends to lowered retention rates among the chronically mentally ill. A theoretical model of retention was developed with four domains of variables: personal traits, accessibility of social support, treatment characteristics, and facility characteristics. Using data collected from CMHC clinical charts in 1983 and 1984, the model was tested using multiple regression and commonality analysis. The model was tenable (R = .59). However, the commonality analysis suggested that most of the unique variance was contributed by the treatment domain. The social support domain made negligible unique contribution. Implications of the model are discussed.

Affective Disorders, Psychotic↗
PubMed1986

Residential facilities for the mentally ill: needs assessment and community planning.

The planning and development of community-based facilities for the mentally ill have been hindered by many factors, one of which is the lack of an acceptable methodology for determining the housing needs of this population. This paper describes a consumer-oriented needs assessment strategy that provides a basis for planning residential facilities for the mentally ill. Survey results provided detailed descriptions of the population in need of residential programs, the types of facilities needed, the total volume of need for each, and the distribution of need. Implications for program planning are discussed as well as the advantages and disadvantages in utilizing this approach for establishing a basis for residential facilities planning for the mentally ill.

Adolescent↗
PubMed1986

The health of the chronically mentally ill: a review of the literature.

This paper reviews three areas of research on the health of the chronically mentally ill: epidemiological studies on this population, studies exploring the clinical interface of physical and psychiatric disorder, and studies illuminating barriers to adequate health care for this population. Its purpose is to increase our understanding of the unique health problems facing the chronically mentally ill so that appropriate interventions can be developed. The review suggests that greater attention to this area should result in improved physical health as well as improved psychiatric intervention. The implications for policy, practice, and research are discussed.

Chronic Disease↗
PubMed1985

Predictors of self-sufficiency for the mentally ill in long-term care.

A growing interest of mental health professionals is the community adjustment of former mental hospital patients. Recognition of the influence of environmental factors on adjustment has led to attempts to determine the specific environmental factors that are influential. The present study of 87 former mental hospital patients in long-term care indicates that the type of management practices used, together with the facility director's attitudes toward social services are major predictors of clients self-sufficiency. Implications for administrators, staff and consultants to long-term care facilities are noted.

Activities of Daily Living↗
PubMed1989

Capitated payments for mental health care: the Rhode Island programs.

Capitation financing for the delivery of mental health care under public programs is receiving increasing attention from policymakers. Most initiatives in this respect are in the planning or early implementation stages. This paper describes five years of experience with capitated financing for mental health care in the state of Rhode Island. It discusses the motivation for the programs, their design, and the issues that have arisen with respect to their operation. The Rhode Island experience demonstrates that capitated financing for mental health care is feasible and that Community Mental Health Centers can operate effectively as providers of care under these arrangements. It also suggests that capitated programs can have unanticipated impacts on the operation of community-based mental health service delivery programs.

Capitation Fee↗
PubMed1989

Model services for treatment/management of the mentally retarded-mentally ill.

Mental illness affects nearly 25-30% of America's mentally retarded population. While a small number of these individuals will require institutional care, it is clearly possible to serve the majority in community-based residential settings. This paper will provide an overview of the various types of mental illness found in the mentally retarded population currently served by the Eastern Nebraska Community Office of Retardation (ENCOR), examine the treatment challenges which the provision of services to this special population have presented, and share recommendations as to how the ENCOR model can assist other communities in serving similar complex subpopulations in a developmental and cost-efficient manner.

Adult↗
PubMed1988

Are jails replacing the mental health system for the homeless mentally ill?

The author explores the process of how homeless mentally ill persons become involved with the criminal justice system. The unique demands of homelessness and chronic mental illness were specifically examined in this naturalistically based study. The author concludes that a combination of severe mental illness, a tendency to decompensate in a nonstructured environment, and an inability or unwillingness to follow through with aftercare contributed to involvement with the criminal justice system. Changes in the mental health system that would prevent the criminalization of the homeless mentally ill are suggested.

Adult↗
PubMed1993

Working with persons with serious mental illness: implication for social work recruitment and retention.

Educating and recruiting practitioners to work in community-based settings with persons with serious mental illness has become a national health person-power issue, particularly in underserved rural areas. This study was conceived in order to obtain a better basis for curriculum development and recruitment strategies. Graduate and undergraduate social work students, representing the greatest pool of mental health practitioners, were surveyed about their perceptions about working with persons with serious mental illness and about factors which are most important to their future job satisfaction. The findings indicate positive perceptions about work with the seriously mentally ill population by a significant number of students, and further reveal that students project job satisfaction factors related to intrinsic reward and ability to learn and grow in their work. The findings also reveal group differences related to educational level, previous work experience in mental health and expressed interest in working with persons with serious mental illness. Important implications for practitioner education, recruitment, administration and job development and ongoing in-service training are discussed.

Adult↗
PubMed1993

One community's response to the multi-system service needs of individuals with mental illness and developmental disabilities.

Individuals with mental illness and mental retardation often fall between system and agency service cracks. This paper describes some of the barriers individuals and communities confront in developing new or expanding existing services to meet the needs of this population. It then describes how one community initiated multi-system collaboration in its delivery of crisis intervention services, community mental health center services and specialized short-term residential living. By increasing the multi-system services available to individuals with dual diagnosis at the community level, fewer individuals encountered placement failure and re-institutionalization.

Community Mental Health Centers↗
PubMed1990

The homeless mentally ill and community-based care: changing a mindset.

The care of persons with severe, persistent and disabling mental illness has received increasing attention during the past ten years. This focus is due, to some extent, to the increased visibility of a subset of this population, the large number of individuals with psychiatric problems who have become homeless. These men and women, who are without homes or in temporary residences, present a sophisticated array of needs and a multiplicity of problems which have rendered most communities impotent to provide appropriate and adequate rehabilitative services. To date, there is no "perfect" community-based system of care for these men and women. What exists is a hodge-podge of shelter, outreach and drop-in center services. Most of these provide little more than a bed (or a chair) to sleep on, a hot meal and refuge from inclement weather. This article discusses some of the issues and assumptions that inhibit and foster the development and provision of a comprehensive system of community-based care for persons with serious and persistent mental disorders who have become homeless. A framework, useful in reconceptualizing the clients, the services and the interaction between them is presented.

Community Mental Health Services↗