Showing papers in "Psychiatric Services in 1969"

Reinforcement therapy with chronic patients.

Abstract: M chronic, long-term mental patients have been relatively unaffected by such treatment concepts as milieu therapy and the therapeutic community. Such patients have few verbal or social skills, and verbally oriented approaches are ill-suited to their needs. Often they are put in locked wards, away from the mainstream of treatment, and are tacitly abandoned by staff and ignored by other patients. Our hospital had no real program for the 30 patients on the locked side of our 136-bed ward for men, and we on the nursing staff were asked to develop one. We had had considerable success in the open ward with a progress-level system, in which each patient passes through graded steps of responsibility and privileges on his way through the program and out of the hospital.l But we did not know what to do for the patients in the locked area. First we

Psychiatry in a changing society

Abstract: T ALK OF CHANGE is always timely, because as a science, psychiatry must change continuously and does-and we are aware of the changes. At times it seems to be changing too rapidly; we wonder if we can keep up. We see changes in the modalities of treatment-psychological, social, chemical, and physi. cal. Each has its successes, each has its failures; we seek the best combinations. Perhaps the greatest current change may be our restatement of diagnoses. That is very popular in some quarters, but you all know how I feel about psychiatric name-calling-that psychiatric diagnosis should not mean attaching to the patient a label, one of many collected by a committee and put in a book and forced on residents who are told they must find a number and a label to fit every patient they are treating, or else report to the record clerk in the morning. It seems to me wrong, and I must therefore speak out, for us to brand for life with a pejorative, eternally damning label people who come to us innocently and wistfully asking for help. I must confess that I urge a little enlightened civil disobedience in that matter to all the residents I teach. I still think it is more useful to stress the degree of disorganization that exists within the organism in relation to the particular environment to which it is trying to adapt. We should note the fluctuations and

The organizational structure of the therapeutic team.

Abstract: H OW A ThERAPEUTIC TEAM interacts when a crisis arises about one of its patients is an indication of the team’s organizational structure. There are several types of structure, running the gamut from rigidly hierarchical to loosely democratic. On our 26-bed service for adolescents, we have attempted to develop a team structure that is somewhere between those two extremes. The interaction concerning a 17-year-old girl named Mary illustrates our team philosophy. 1ary had been psychotic and withdrawn since puberty. After a year on our service, she was beginfling to emerge from her autism and was having great difficulty managing her aggressive impulses, which took the form of attempted physical assault. Most of her aggression was directed at her therapist, but one morning in sewing class she slapped her roommate, Carol, apparently for refusing to give her cigarettes. Carol, who was 16 and had been in the hospital a month, also had poor impulse control, but she did not retaliate. The homemaking teacher took Mary back to her room; when her therapist interviewed her 20 minutes later, she was agitated and tearful, and she projected the entire blame onto

Retarded women teach self-help skills.

Abstract: D URING the last decade, Idaho State School and Hospital, like other institutions for the mentally retarded, started trying to offer training and habilitation instead of only custodial care to its patients. However, the number of attendants available to work intensively with patients had not increased enough to enable us to give training to all who needed it. The shortage was particularly acute in the buildings for severely and profoundly retarded patients; they needed intensive training in self-help skills, especially dressing themselves, feeding themselves, and going to the toilet. The attendants had to spend so much time doing those very things for the patients that they had no time left to train them. We considered and discarded several possible solutions. We could not afford to hire enough fulltime employees, and part-time volunteers could not offer regular enough training to be helpful. We also discarded the idea of trying mass or group conditioning. What we needed seemed unattainable-a daily intensive training program involving teacher and pupil in a one-to-one relationship over an extended period of time. Then it occurred to us that moderately or mildly retarded patients who already possessed self-help skills might be able to train the more retarded. We therefore set up a pilot program to test the feasibility of the idea. We moved ten profoundly retarded women, whom we called little sisters, from their building into one that housed moderately and mildly retarded women. There each little sister was taken in charge by one of the less retarded women, who was called her big sister. At the same time, ten big sisters were moved to the building from which the profoundly retarded patients had come. There each was assigned a little sister to train. The big sisters were from 22 to 53 years old, with an average age of 36. Their IQ scores, as measured by various standardized tests, ranged from

The Structure and Philosophy of Georgia's Halfway Houses

Abstract: I N NOVEMBER 1964 the Georgia Division of Voca.I_ tional Rehabilitation opened the state’s first rehabilitation residence for furloughed mental patients. That first house was for women, and in April 1965 one was opened for men. Both houses are in Atlanta, and each accommodates 15 clients, in addition to a man and wife who serve as houseparents. The houses were supported in part by a research and demonstration grant from tile Social and Rehabilitation Service. A rehabilitation residence, sometimes called a halfway house, is a transitional vocational rehabilitation facility for patients WIlo would find it stressful to readjust to employment and community without tile protection the residence offers. Indeed many could not be released unless such a facility existed. Like most transitional residences, ours keeps clients between two and nine months. Most of the clients who come to the Atlanta houses have spent an average of three years in a hospital. Seventy-four per cent had been diagnosed as having chronic psychotic disorders, with schizophrenia the predominant category. Most of the residents have multiple handicaps to overcome: they have suffered an extended period of illness that followed a cycle of severe stress-

An attitude therapy program in a teaching hospital.

Abstract: T lIE INCREASING DEMAND for psychiatric services that has been stimulated by recent federal legislation has highlighted gross inadequacies in our methods of evaluating and treating patientsespecially those from lower socioeconomic levels, who comprise the majority of tile population of most public mental hospitals. Psychological and sociological descriptions of such patients force one to condude either that they are untreatable or that we Iliust devise new treatment methods for them. Such patients are said to have low iQs and little education aii(l tO seek relief from their symptoms iather thaim personal insight. Their expectations

Satellite Halfway Houses in Vermont

Abstract: T N VERMONT we have several types of halfway I facilities that offer a variety of programs and settings for former mental hospital patients, to meet their changing needs. They include foster homes, private halfway houses, boarding homes, and a community hotel. The facilities constitute an informal satellite system radiating from the state’s first halfway house, Spring Lake Ranch, established in 1932 in Cuttingsville, a rural community ten miles from Rutland.’ All the satellite facilities are within 50 miles of the ranch, and the ranch staff supervise the residents of all the facilities; they remain on the rolls of the ranch until they are living on their own. From 1958 to 1966, when I joined the board of trustees, I served as psychiatric consultant to the ranch and its satellite programs, a task that has now been taken over by others. We speak of all the residents as guests, rather than patients, because our facilities are not medical. Most of the guests have been sent to us from well-known private institutions, either because they were considered therapeutic failures or because they have no family to which they can return. Some come from the vocational rehabilitation division and others from Vermont State Hospital, which considers the ranch and its satellites an integral part of its rehabilitation program. The ranch is a nonprofit organization, supported by guests’ payments of $650 a month. We also offer scholarships for some who cannot afford the full fees. Guests at the satellite facilities pay their

Manpower and Training in Community Mental Health Centers

Abstract: T HE COMMUNITY MENTAL HEALTh CENTERS PROGRAM, established under Public Law 88-164 and its amendments, P.L 89-105 and P.L. 90-31, has significantly changed the projected patterns of using mental health manpower. The changes raise many questions. Of perhaps greatest interest is what manpower is being used in community mental health centers, and what the projected future use will be. Those issues are related to the centers’ future effect

Mutual benefits of a foster grandparent program in a hospital for the retarded.

Abstract: KAREN M. GREEN, R.N. Area Administrator Glenwood (Iowa) State Hospital-School M ANY PEOPLE over 60 years of age in southwest Iowa who previously felt lonely, forgotten, and unwanted have re-entered the mainstream of society through our foster grandparent program. It has given purpose to their lives, put money in their pockets, and provided retarded children with the love they need. Mrs. Story’s experience is typical. In January 1967, at 76, she believed her future held only arthritic pains and a meager existence on Old-Age Assistance. She had little to talk about with her husband, an invalid who depended on her physically and financially. In ‘sfarch she read an advertisement in the local paper about the foster grandparent program at our institution. She was skeptical, but willing to try anything that might make her days more interesting. She joined the program, and after two weeks of inservice training she was a certified foster grandparent. When she met tile two children assigned to her, she found they could neither walk nor talk, nor were they toilet-trained. She began to spend two hours a day with each of them five days a week. She fed them, played with them, pampered them, and loved them. The children learned to recognize her voice and the touch of her hand and showed definite signs of improvement. Mrs. Story looked forward to each day, knowing that the children needed her. The money she earned, at $1.40 an hour, helped stretch her budget. She felt better physically, and her marriage was happier-sile had something to talk about with her husband.