The necessary components of a comprehensive service of local non-institutional forms of care for the seriously mentally ill have been researched separately in pilot trials, but not within integrated programmes for defined populations. Reported outcomes are at least as favourable as for traditional long-term hospital care, but alternative provisions are no less costly. A case manager system may allow co-ordinated formal and informal services to meet the individual needs of chronically ill patients. Poorly integrated programmes will expose discharged patients to disadvantages.

Deinstitutionalisation--from hospital closure to service development.

Background Reports.- Studies on the Cost-Effectiveness of Managing Chronic Psychotic Patients. Report on a WHO Planning Meeting at Mannheim, 2-4 May, 1983.- Summary Report of the WHO Meeting 'Cost-Effectiveness of Managing Chronic Psychotic Patients', Munich, 16-18 December, 1985.- National Approaches.- Management of the Cost-Effectiveness of Managing Chronic Psychotic Persons in Ireland.- Social and Economic Policies in the Mental Health Sector in Greece.- Financing of Care for the Chronically Mentally Ill in the USA: A Patchwork of Policies.- Managing Chronic Psychotic Patients: A Clinical and a Political Point of View.- Regional Approaches.- Economic Analysis of Different Patterns of Psychiatric Treatment and Management of Chronic Psychotic Patients in the Basque Country.- Cost-Effectiveness of Health-Care Delivery to Chronic Psychotic Patients in Southern Alberta, Canada.- Schizophrenia: Results of a Cohort Study with Respect to Cost-Accounting Problems of Patterns of Mental Health Care in Relation to Course of Illness.- Cost-Effectiveness of Managing Chronic Psychotic Patients: Italian Experience Under the New Psychiatric Law.- Institutional Approaches.- The Application of Modified Cost-Benefit Analysis in the Evaluation of a Hostel Ward for Chronic Psychotic Patients.- The Cost of Long-Term Psychoses in a Scottish Psychiatric Hospital.- Management of Schizophrenia: Cost-Benefits, Time-Budget, Better Treatment? Which Time Frame Are We in?.- Methodological Approaches.- Methodological Problems of Comparing the Cost-Effectiveness of Different Mental Health Institutions.- Time-Budget Analysis for Chronic Patients. Towards a Cost-Effectiveness - Oriented Indicator System for Comparing Inpatient and Outpatient Psychiatric Care.

Costs and effects of managing chronic psychotic patients

Mental health consumer participation: a technical action research project

Background: Since the closure of the mental hospitals, there has been an acknowledged failure to provide secure, long-term residential care for patients at the most severe end of the psychiatric spectrum.Aims: This paper describes an unusual care setting that caters for this most vulnerable population and aims to situate this within a broad historical and political context.Methods: An ethnographic study was conducted using participant observation and semi-structured interviews.Results: The paper argues that the current failure in the provision of asylum results from a false dichotomy between asylum and “a normal life” that can be traced to the work of Goffman and other twentieth-century critics of the mental hospital. It shows that these two are not necessarily irreconcilable: that it is possible to be fully committed to the principles of integration and normalization, whilst also creating a safe, highly supportive and bounded environment.Conclusions: The time is ripe for a rethinking of the concept of as...

The glass-walled asylum: A description of a lay residential community for the severely mentally ill

Law and the behavioral sciences are often at odds with one another. The recent case of Cark v. Arizona is just the latest in a long history of skepticism that courts have openly displayed towards disciplines that offer explanations for social behavior. The disparities between how law and the behavioral sciences understand complicated questions of intentionality, free will, and causation are fundamentally rooted in their different epistemologies. But these theoretical foundations are not formed in isolation. As much as science presents itself as objective and untouched by the influence of politics, it does operate within a political world that shapes and defines its identity and ambitions. This article traces the development of modern psychiatry and demonstrates how its internal politics have resulted in the current state where law and psychiatry - as Clark painfully shows - are further apart than ever.

The Myth of Mental Disorder: Transsubstantive Behavior and Taxometric Psychiatry

The author explores the initial intent of the asylum, a reform designed to ensure humane care of the mentally ill, drawing especially on Samuel Tuke's account of the York Retreat. He presents key concepts ofthe asylum related to codes of conduct, management ofrestraint, and social amenities f rom the perspective of Tuke and other reformers, and challenges some interpretations oftbe early asylums made by Michel Foucault.

Aaron Rosenblatt

Papers

Concepts of the asylum in the care of the mentally ill.