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PubMed1986

The need for asylum for the chronically mentally ill.

Our society highly values autonomy, independence, and freedom. In our model programs for the chronically mentally ill (CMI), we aim for these values and, in the process, may be doing a disservice to those people who cannot attain them. This article proposes that even the best in community care is not enough protection for many CMI. We need to do a better job of discriminating between who can and who cannot benefit from model community programs. We also need to develop a whole continuum of care that accepts the dependency of CMI people, and their various levels of functioning, as well as the progress, deterioration, and inevitable fluctuations that occur. Emphasis is placed on the need for sanctuary and asylum for many that only permanent housing of some kind can provide.

Adult↗
PubMed1988

REHAB: a new assessment instrument for chronic psychiatric patients.

The renewed interest in the care and treatment of chronic psychiatric patients has led to an awareness of the need for improved assessment methods for this group. This article describes the development of REHAB, a behavior rating scale for use with people with chronic psychiatric disability, which has been carefully designed with respect to content, format, and ease of use. The article also draws together the various factor-analytic, reliability, validity, and sensitivity-to-change studies that provide the basic psychometric evidence for the scale's value. REHAB is presented as an integrated package of materials with special attention paid to training of raters and simplicity of interpretation. It has been used for a variety of different assessment purposes, in both research and clinical settings.

Deinstitutionalization↗
PubMed1981

Nursing homes and chronic mental patients: a second opinion.

Through a critical review of Shadish and Bootzin's (1981) work in "Nursing Homes and Chronic Mental Patients," the author defines the larger context in which this national problem occurs, presents important distinctions among various subgroups of nursing home residents, and summarizes some of the most glaring historical inadequacies of using institutions as the core of a mental health system. Through this approach, the presentation raises serious questions about Shadish and Bootzin's proposal to use nursing homes as a foundation on which to reconstruct an improved community services system for chronically mentally ill persons.

Aged↗
PubMed1981

Long-term community care: mental health policy in the face of reality.

Nursing homes play an important role in the care of chronic mental patients, and they could be used as one base on which to build a better system of care. Carling, in his article "Nursing Homes and Chronic Mental Patients: A Second Opinion," appears to question aspects of this contention. His efforts in this regard are interesting but unconvincing, though his thoughtful comments usefully elaborate the problems inherent in trying to incorporate nursing homes into the mainstream of mental health care. He more successfully uses his article to describe the National Plan for the Chronically Mentally Ill, a recent policy proposal of great merit that may some day significantly benefit metal patients. Meanwhile, mental health policy must face the reality that nursing homes are providing useful services to many chronic mental patients who have been inadequately served by current community care programs. This is not likely to change in the foreseeable future. Policy advocates need to attend to practical alternatives, not just to idealized possibilities.

Chronic Disease↗
PubMed1982

What are the needs of chronic mental patients?

A former long-term resident of a state psychiatric hospital describes the obstacles to successful re-entry into the community. Among the problems facing chronic mental patients in the community are housing, loneliness, absence of choice, lack of meaningful activity, and unrealistic expectations of others. Fountain House, a clubhouse model program, run by its members and staff, provides the emotional and practical support necessary for patients to become a contributing part of the general community.

Adult↗
PubMed1982

How families evaluate mental health professionals, resources, and effects of illness.

Evaluations by families (of chronically mentally ill individuals) of mental health professionals and resources were solicited through a mail survey. The respondents, largely better educated, white, and female, indicated a generally high level of dissatisfaction. Emotional support, information, and aftercare resources were identified as particular areas of concern. The survey findings present a challenge to mental health professionals to reconsider the effects of chronic mental illness on the family and the needs of the non-ill family members.

Adult↗
PubMed1982

Developing an enforceable "right to treatment" theory for the chronically mentally disabled in the community.

Historical developments, mental health approaches, and applicable legal authorities are examined in arguing a legal basis for pursuing greater treatment benefits for chronically mentally disabled persons in the community. Mental health lawyers have traditionally been concerned with patients' right to treatment while in the hospital. Lawyers are called on to examine the plight of (and to extend advocacy for) the chronically mentally disabled in the community.

Chronic Disease↗
PubMed1982

A dialogue among patients, families, and professionals. Overview and reflections.

What seems to be a general dissatisfaction with the mental health system is discussed in the context of the inevitable problems created by chronic mental illness. Patients, families, and professionals can, instead of blaming each other for such problems, acknowledge the common difficulties and begin to seek new strategies. Each of us has unique strengths to share, but to do so requires moving beyond traditional roles.

Chronic Disease↗
PubMed1982

Improving the quality of community care for the chronically mentally disabled: the role of case management.

This article draws upon an extensive case management literature in order to integrate a number of key concepts and findings that must be considered by those responsible for the planning, administration, and provision of effective community care to the chronically mentally disabled. A discussion of the reasons for the current popularity of the case management concept within human services is followed by a detailed presentation of the objectives, ideology, functions, and structural elements that characterize case management systems. A series of practical problems and issues that must be addressed to effectively implement a case management system are then identified and analyzed. Finally, a set of recommendations for those developing case management systems is offered, and a number of important unanswered research questions about the delivery and impact of case management services are identified.

Community Mental Health Services↗
PubMed1994

Psychiatry, German society, and the Nazi "euthanasia" programme.

The paper begins by establishing the position of psychiatry after the First World War, concentrating upon the interplay between economy measures and limited reform during the Weimar Republic. Each therapeutic advance involved the definition of irremediable subgroups within the already socially marginalized psychiatric constituency. Nazi policy towards psychiatric patients during the 1930s involved further economy measures, and the introduction of negative eugenic strategies, were similar in kind if not degree, to those pursued in some other countries at that time. The decision to kill the mentally ill and physically disabled was taken by Hitler in order to clear the decks for war, and was justified with the aid of crude utilitarian arguments, as well as what limited evidence there was regarding popular attitudes on these issues. Many health professionals and psychiatrists accommodated themselves to policies which a few years later became one of the components of the 'Final Solution of the Jewish Question', i.e. Hitler's vengeance against the Jewish people in circumstances of war he had envisaged much earlier.

Adult↗
PubMedDate not supplied

The new generation of chronic psychiatric patients.

A study of 100 clients admitted to the partial care program of a community mental health center found the majority to be young, single, well-educated adults with chronic psychiatric disorders. These clients are frequently hospitalized in other than state or county hospitals. This article supports the hypothesis that a new generation of chronic psychiatric patients exists.

Adolescent↗
PubMed2006

Leaving care: retrospective reports by alumni of Israeli group homes.

This study examines the retrospective reports of alumni of Israeli group homes on their experiences of leaving care, taking into account possible gender differences as well as associations with their experiences while in care. The reports of 94 alumni (38 men and 56 women) interviewed by phone revealed major difficulties associated with the transition from the group home. About half perceived their transition from care as "quite hard" or "very hard". A fifth reported having no one to talk to during the first period of leaving care. Generally, the transition was more difficult for girls than boys. The longer the alumni (especially boys) stayed in care, the more difficult they found the transition to independent living. Better relationships between the child and the group-home parents while in care were associated with a more difficult transition to independent living. This study highlights the need for longer and more extensive preparation for leaving out-of-home care.

Adolescent↗