Withdrawal from the homeless mentally ill.
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Attitude of Health Personnel↗
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Homelessness, the chronic mentally ill and community mental health centers.
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Chronic Disease↗
Day treatment as an aid to mainstreaming troubled children.
Problem children who are diverted from public school programming into a private psychoeducational day facility in a community mental health center are followed up in a 10-year study to determine the rate of return to regular classes. The evidence points to a successful reintegration into public schools for the great majority of students. A philosophy for mainstreaming which supports the need for proper preparation of children for public school reentry is basic to effective management.
Adolescent↗
Training residents for community psychiatric practice: guidelines for curriculum development.
There is a critical need to recruit and retain more psychiatrists with the required skills and interest to work with seriously mentally ill and/or socially disadvantaged patients within organized programs in community settings. More residency training programs having the capacity to prepare psychiatrists for community practice can help to meet this need. A consensus definition of the clinical, administrative, consultative and academic areas of contemporary community psychiatric practice developed by the American Association of Community Psychiatrists is used to determine the goals of the training curriculum described in this paper. A comprehensive list of knowledge, skill, and attitude objectives, as well as suggestions for structuring clinical training assignments are provided as guidelines for curriculum development.
Adult↗
Patients in the care of private psychiatric practitioners. Comparison with public hospital patients and the background districts' population.
In Western societies, the number of psychiatric hospital beds has decreased markedly in the past decades. The reduction in hospital beds has resulted in a relatively large number of mentally ill individuals residing in the community. They experience varying degrees of success. One form of treatment available to such patients is private psychiatric consultation. In Denmark and England (two countries with public supported health care systems) the number of psychiatrists in private practice (PPPs) has increased in recent years. These private practioners may offer a mode of treatment which may meet the needs of a subgroup of the psychiatric patients in the community. The fees of the PPPs are paid by the National Health Service. In this study we report on the characteristics of the patients attending the consultation of private psychiatrists and the treatment which they are offered. We compare the patients of the PPPs with 1. psychiatric patients residing in the same districts who are cared for by the public hospital system and 2. the background populations of these same districts. The results suggest that the patients in private psychiatric practice are distinct in a number of ways. Neurosis is the dominant diagnosis. Of the patients, 71% are women; the patients tend to be younger than the background districts population; after controlling for age, the marital status of the patients in PPPs' care does not differ significantly from that of the background population, and they are comparable to the background population in level of employment. These patients are more able to care for themselves than the psychiatric patients treated in the public hospital system. The results suggest that PPP is a means of caring for a subgroup of the psychiatric patients in urban settings.
Adult↗
A 3- to 6-year follow-up of former long-stay psychiatric patients in Northern Ireland.
Little is known about the first patients who left hospital before and during the official implementation of the hospital discharge policy in Northern Ireland. This study describes patterns of residential provision for former long-stay patients (approximately two-thirds of whom had an ICD-9 diagnosis of schizophrenia) discharged from the six major psychiatric hospitals in Northern Ireland between 1987 and 1990 (n = 321). It also employs several instruments within a retrospective survey design to examine outcomes for a 35% sample of people (112/321) discharged between 1997 and 1990 and followed up in 1993. Almost two-thirds (61%) had been discharged to independent living or low-staffed statutory settings. None of the group was homeless, one person was in prison and three people had committed suicide during the first 2 years after discharged. Almost one-third had to be re-admitted at some stage during the 6-year period and 13% had died. 'Moderate' to 'major problems' with most daily living skills were reported for less than 25% of people, while 15% or less had problem behaviour. Approximately 90% or more were satisfied with most aspects of their new homes and most also reported feeling happier (77%), healthier (63%) and more independent (78%) since discharge. However, social, recreational and occupational opportunities were limited. Purchasers, providers and practitioners need to review ways in which former long-stay patients might be empowered to live more meaningful and integrated lives in the community, particularly as the current government strategy for health and social well-being (1997-2002) in Northern Ireland points to the closure of existing psychiatric hospitals.
Activities of Daily Living↗
The run-down and closure of a psychiatric hospital. Effects on patients' behaviour.
The run-down and closure of psychiatric hospitals can be stressful for both staff and patients. Interviews with approximately 50% of over 100 long-stay psychiatric patients during an 18 month period preceeding a hospital closure show them to be generally ill-informed as to reasons for closure and future plans for their care. However, repeat measures of behavioural functioning (CAPE and REHAB) during this running-down period show no significant changes in patients' behaviour.
Activities of Daily Living↗
The closure of a long-stay psychiatric hospital: a longitudinal study of patients' behavior.
This paper summarises longitudinal data based on repeat assessments of the behavioural functioning of 90 long-stay psychiatric patients. Data were gathered over a period of 4-5 years that spanned a hospital closure and the resettlement of patients in various alternative settings. Time-series analyses of individual data sets showed that resettlement led to no significant behavioural change in the majority of patients. However, some significant behavioural improvements were evidenced for approximately 20% of the group, while behavioural deterioration occurred in approximately 12%. Supplementary findings showed that following resettlement the quality of care provided significantly improved in many respects. However, access to social, recreational or vocational activities was reduced. In addition, the level of physical health symptomatology was shown to increase for this group of patients.
Aged↗
Has the sectorization of psychiatric services in France really been effective?
This paper describes the implementation of the French sectorization policy during the last 20 years, and how effectively it has delivered care to patients suffering from severe mental health disorders. This change in policy has resulted in a dramatic and progressive decline in full-time hospitalization and an increase in outpatient care, without, however, any marked increase in the readmissions rate. The resources and services provided by a representative section are described, followed by an account of a plan for closing psychiatric beds in a specific area of the centre of France. The full implementation of the policy has some distance to go, but the graded way in which it was carried out seems generally to have protected patients from adverse consequences. However, there has been little formal evaluation, and more is required before the policy can be deemed to have been successful.
Adolescent↗
Ethics and involuntary treatment.
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Altruism↗
Helping some state hospital mental patients make small but necessary changes: transference openings from countertransference traps.
Severely, chronically mentally ill, poor prognosis, long-term patients in state mental hospitals do succeed in moving out of hospitals into community residences. They succeed by virtue of small but critical behavior changes. For some, these changes in behavior follow a treatment strategy that recognizes and corrects treatment impasses that have developed and been maintained by fixed countertransference positions on the part of hospital staff. In the two case examples presented, the historical information necessary to unravel the transference paradigm was part of routine hospital records, corrective action did not entail any major staff interventions, improved behavior led directly to movement out of the hospital, and community adjustment was successful. Improved mental and behavioral functioning was sustained at a year and a half follow-up.
Adult↗
Social networks and psychiatric clients: the personal and environmental context.
The study examines the extent to which characteristics of psychiatric clients (interpersonal problem-solving) and their families (family climate and family social resources) are associated with dimensions of clients' social networks (size and support). Respondents were 35 clients recruited from outpatient psychiatric clinics and the family members with whom they resided. The results revealed that individual and environmental variables were significant correlates of social network dimensions. For example, client problem-solving was positively related to the number of intimates cited by the client, while level of independence was positively related to the degree of support clients reported receiving from their peers. Level of client psychopathology partially moderated the effects of some of the predictor variables. The results highlight the need to examine the individual and environmental processes that shape and are shaped by social network patterns.
Adaptation, Psychological↗
The community competence scale: preliminary reliability and validity.
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Adult↗
Effects of community placement on chronic mental patients.
Patients judged ready for release from a state mental hospital were interviewed to determine their levels of depression and psychosocial functioning. This interview was repeated for 31 of the patients 8 weeks after their release and simultaneously repeated for 31 similar patients who remained in the hospital. In comparison with the matched controls, released patients became less depressed, less socially isolated, and less irritable. No differential improvement was found in their self-image. These findings, controlled for certain potential biases in a quasi-experimental design, identify some specific benefits of community placement for chronic mental patients.
Adult↗
Self-labeling by educably mentally retarded high school students in their mainstream and special education classes.
Educably mentally retarded (EMR) students and nonhandicapped students from their mainstream classes completed semantic differential ratings of a stereotypic popular teen-ager, juvenile delinquent, and special education student. Subjects also rated their global self-concepts and situation-specific self-concepts within the mainstream and the special class settings. Ratings were done at the beginning (Time 1) and the end (Time 2) of a semester. Results showed that mainstream classes did not "de-label" EMR students. Within the mainstream class, the number of EMR students who saw themselves as similar to a special education student significantly increased over time. Moreover, at Time 2, EMR students were more likely to think of themselves as similar to a special education student in their mainstream class than in their special education class. However, EMR subjects' global self-concepts did not change. Implications for mainstreaming are discussed.
Adolescent↗
The relationship between long-term psychiatric clients' psychological well-being and their perceptions of housing and social support.
This research tested hypotheses derived from motivation-hygiene theory that housing and social support would be differentially related to long-term psychiatric clients' Positive Affect and Negative Affect. The participants were 89 people between the ages of 18 and 65, who had been hospitalized for psychiatric problems at least twice and who had been diagnosed as schizophrenic, chronic depressive, or manic-depressive. Results indicated that the number of Housing Concerns was positively correlated with Negative Affect but not Positive Affect. Support Satisfaction was negatively correlated with Negative Affect, and Frequency of Support was positively correlated with Positive Affect. Interactions between the housing variable and Network Size were found for both Positive Affect and Negative Affect, thus supporting the stress-buffering hypothesis. The findings provided mixed support for motivation-hygiene theory.
Adult↗
Community integration of the mentally ill in residential facilities.
Much of the empirical research on the social adjustment of the mentally ill has focused on client variables. More recently, recognition of environmental factors as influences on behavior has led to attempts to determine environmental factors that may play a role in former mental patients' community integration. The secondary data analysis of 87 former state hospital patients in residential facilities suggests that while client characteristics are important in explaining community integration, facility, and community characteristics, particularly the level of skills training offered in the facility, size of city, and level of depersonalization of residents, have a significant impact. Results indicating the major importance of informal interactions between staff and clients are discussed, with implications for facility staff noted.
Activities of Daily Living↗
Empowering people with physical disabilities through advocacy skills training.
Members of an advocacy organization for people with physical disabilities were trained to identify and report issues at group meetings. In addition, two consecutive chairpersons were trained to conduct action-oriented meetings. Measures of group members' activities outside meetings and related outcomes on identified issues were also collected. Results indicated increases in the number of disability-related issues reported by trained members and consistent improvements in chairperson performance following training. Retrospective interviews and permanent records showed that advocacy activities, as well as the outcomes of members' actions, increased after training. These findings and their implications for the empowerment of people with disabilities are discussed.
Adult↗