The health care industry: a case study and future policy issues.
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This paper outlines a program for promoting mental health in the population by "giving away our skills" as mental health professionals. This kind of program can be started on a shoestring by a community mental health center, family service agency, or adult education program. It consists of teaching parent-child communication courses, with selected parents then becoming instructors to build a network of nonprofessional personpower. The paper explores strategies of setting up programs. It explores the shifting role of the professional toward a colleague relationship with nonprofessionals. Finally, it presents research on the program's effectiveness with parents and the impact on the lives and self-images of the nonprofessional instructors themselves.
Data are reported from an ongoing study comparing outcome in two groups of young, first-admission schizophrenics - one receiving "usual" treatment (including drugs) on the wards of a good community mental health center, the other being treated by a non-professional staff (usually without phenothiazines) in a small home-like facility in the community. Six-month and one-year outcome data show few differences in symptoms between the two groups, but three measures of psychosocial functioning significantly favor the experimental group.
The cost of schizophrenia has been estimated at $11.6 to $19.5 billion annually. About two-thirds of this cost is due to lack of productivity by schizophrenic patients and about one-fifth to treatment costs. The estimate might be considerably higher if better figures were available on the cost of maintaining patients in the community. In the absence of more effective treatment, the savings from the current trend toward shorter hospitalization cannot be expected to decrease-and may actually increase-the overall costs of schizophrenia to society. The authors make recommendations aimed at reducing the cost by helping schizophrenic patients to be more productive through a system of community alternative-care facilities, increased rehabilitation services, aftercare, and research.
A psychiatric center in Brooklyn provided a socialization program in a community residence for adults discharged from state hospitals and made a study of the program's outcome. Residents on two floors of the home, the experimental group, received an enriched treatment program; those on the other four floors, the control group, received a minimum of therapeutic intervention. A comparison of residents' ratings on assessment scales made early in the program and after seven months of operation showed that residents on all floors improved on measures of socialization, men improved more than women, and residents over 65 years of age improved the least. Residents in the experimental group did not improve much more than those in the control group. Costs for the experimental group, including room and board, were $16.59 a day per resident. Costs for the control group were $15.61 a day per resident.
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