Showing papers in "Psychiatric Services in 1974"
TL;DR: The authors define a pseudotherapeutic community as a psychiatric unit that subscribes to a particular treatment philosophy, but covertly functions in ways contradictory to the expressed belief.
Abstract: If a psychiatric unit is to be effectively therapeutic, its staff must avoid the pitfalls that can turn it into a pseudotherapeutic community The authors define a pseudotherapeutic community as a psychiatric unit that subscribes to a particular treatment philosophy, but covertly functions in ways contradictory to the expressed belief They describe the major characteristics of such a unit and give examples showing how the antitherapeutic forces are activated and maintained
25Â citations
TL;DR: The author says programs designed to help alcoholics and their families should focus more attention on the needs of children, who frequently suffer serious emotional damage as a result of problems related to a parent's drinking.
Abstract: The author says programs designed to help alcoholics and their families should focus more attention on the needs of children, who frequently suffer serious emotional damage as a result of problems related to a parent's drinking. She reviews some of the effects observed among children of alcoholics.
20Â citations
TL;DR: The authors describe reality-orientation techniques and assess the results of the program based on a study of 125 men who participated in it and other rehabilitation activities between 1965 and 1970.
Abstract: As part of its rehabilitation program, the Veterans Administration Hospital in Tuscaloosa, Alabama, uses reality orientation with confused and disoriented patients. The authors describe reality-orientation techniques and assess the results of the program based on a study of 125 men who participated in it and other rehabilitation activities between 1965 and 1970. Overall, 32 percent of the men improved while 68 per cent remained the same; only one patient regressed.
18Â citations
TL;DR: The author was mental health commissioner in Alabama when the best known of the right-to-treatment cases, Wyatt v Stickney, was filed in 1970, and compares the Wyatt decision with the decision in Burnham v. Georgia, in which the court ruled that there is no constitutional right to treatment.
Abstract: The author was mental health commissioner in Alabama when the best known of the right-to-treatment cases, Wyatt v. Stickney, was filed in 1970. He describes the mental health department's response to the suit and discusses at length the staffing standards set by the court. He suggests not only that such standards are almost impossible to meet, but also that they are too restrictive to serve the best interests of the patients. He compares the Wyatt decision with the decision in Burnham v. Georgia, in which the court ruled that there is no constitutional right to treatment.
12Â citations
TL;DR: An outpatient clinic in a community setting is using medication groups to monitor and improve the effectiveness of psychotropic drugs administered to chronic patients with strong dependency needs.
Abstract: An outpatient clinic in a community setting is using medication groups to monitor and improve the effectiveness of psychotropic drugs administered to chronic patients with strong dependency needs. A third-year psychiatric resident leads the groups, assisted by a staff nurse. An intake team selects patients and sets up attendance schedules. During the meeting the resident checks with each patient about his medication and makes any adjustments necessary; the group members then discuss problems in daily living.
12Â citations
TL;DR: The authors conclude that the system of providing community-based care with state hospital backup is a significant bargain for state funding authorities.
Abstract: Noting that the high cost of inpatient programs in community mental health centers has long been used as an argument for terminating community inpatient programs, the authors report on a study comparing costs in Texas community mental health and mental retardation centers and in the state hospital system. The study reviewed characteristics and treatment costs of the 1347 persons treated in all Texas center inpatient programs in a three-month period and of the 169 patients who were subsequently treated in Texas state hospitals. The authors conclude that the system of providing community-based care with state hospital backup is a significant bargain for state funding authorities.
12Â citations
TL;DR: The University of Pennsylvania Hospital uses a day hospital program to treat obese patients that includes dissemination of information about obesity, actual preparation of meals, group behavior therapy sessions, and evening programs encouraging family involvement.
Abstract: The University of Pennsylvania Hospital uses a day hospital program to treat obese patients. The program includes dissemination of information about obesity, actual preparation of meals, group behavior therapy sessions, and evening programs encouraging family involvement. The average weight loss for 14 patients in the first two groups was 14 pounds at the end of ten weeks. Follow-up of 11 of them at six months showed they either continued to lose weight or maintained their weight loss.
10Â citations
9Â citations
TL;DR: In a study of the factors that contributed to the program's success, the authors examined the extent to which workers and program planners agreed about the duties and responsibilities of the workers, the degree of satisfaction the workers found in their role, and the benefits to clients and the center.
Abstract: In 1969 a community mental health center in Harlingen, Texas, began using indigenous mental health workers in a program considered highly successful by almost everyone involved. The role of the workers was only sketchily defined, allowing them considerable flexibility in developing their individual abilities and personal styles. In a study of the factors that contributed to the program's success, the authors examined the extent to which workers and program planners agreed about the duties and responsibilities of the workers, the degree of satisfaction the workers found in their role, and the benefits to clients and the center. Other critical factors were also identified.
9Â citations
8Â citations
TL;DR: The author says that right-to-treatment litigation is a potent new tool for attacking the system by which mentally impaired people are indefinitely confined to institutions against their will.
Abstract: The author says that right-to-treatment litigation is a potent new tool for attacking the system by which mentally impaired people are indefinitely confined to institutions against their will. He discusses the objectives of cases such as Wyatt v. Stickney and the impact of the decision and its implementation.
TL;DR: Study of 217 recommendations to 80 families indicated three variables that were significantly correlated with compliance: agreement with the diagnosis, postdischarge contact with the ward, and preadmission stresses of caring for the child.
Abstract: Parental compliance with postdischarge recommendations was accepted as the criterion for successful intervention in a study conducted on a short-term inpatient ward for retarded children. Parents' attitudes toward the diagnosis and hospitalization and the extent to which they had followed the recommendations were assessed in telephone interviews at least three months after the child war discharged. Study of 217 recommendations to 80 families indicated three variables that were significantly correlated with compliance: agreement with the diagnosis, postdischarge contact with the ward, and preadmission stresses of caring for the child. The authors discuss the findings and their implications.
TL;DR: A significant outcome of the program was the clergyman's awareness of mental health services in the community and his increased ability to recognize parishioners who needed those services.
Abstract: A mental health center initiated a six-month pilot program to teach counseling skills and techniques to clergymen. Two groups of eight students each met once a week. The clergymen developed skills in working with the terminally ill and the aged and in counseling individuals with marital problems. A significant outcome of the program was the clergyman's awareness of mental health services in the community and his increased ability to recognize parishioners who needed those services.
TL;DR: Comparison with control groups has shown that at the end of the four months the self-concept of the delinquents improves, as does the behavior of the patients they visit.
Abstract: Juvenile delinquents from an Illinois correctional facility for boys visit patients in a state mental hospital in a program to improve the delinquents' self-concept by enabling them to help others. For about four months the delinquents go to the hospital every other day to work with the patients in a variety of individual and group activities. Comparison with control groups has shown that at the end of the four months the self-concept of the delinquents improves, as does the behavior of the patients they visit.
TL;DR: A hospital-based training program for paraprofessional mental health workers focuses on maximizing their human-relations skills and providing continuous care to the patients from admission through discharge and readjustment to the community.
Abstract: A hospital-based training program for paraprofessional mental health workers focuses on maximizing their human-relations skills and providing continuous care to the patients from admission through discharge and readjustment to the community. In coordinated clinical, academic, and community experiences the trainee learns to act as a patient advocate, long-term therapist, and treatment integrator. The training curriculum includes the theory and application of group process and systems change as well as work in nonconventional community service agencies.
TL;DR: A description of the various political power plays that go on as a patient moves toward admission shows the vicissitudes of a system impinging on a patient needing help, and the problems thus presented to the personnel within the system.
Abstract: How a cry for help, such as a request for admission to a hospital, is answered depends as much on the hospital's political environment as on the patient's presenting problem. The political environment here refers to the hospital complex within which competing interest groups or individuals vie for power or control. A description of the various political power plays that go on as a patient moves toward admission shows the vicissitudes of a system impinging on a patient needing help, and the problems thus presented to the personnel within the system. The situation described is a composite based on the author's training and work experiences in various medical settings.
TL;DR: A brief history of patients' struggle for rights beginning with suits brought by individual patients who were criminally committed and culminating in a class-action suit on behalf of those who were involuntarily civilly committed.
Abstract: The author gives a brief history of patients' struggle for rights beginning with suits brought by individual patients who were criminally committed and culminating in a class-action suit on behalf of those who were involuntarily civilly committed. As an example of how class-action cases develop, he describes his experience as a defendant in a suit in Massachusetts that charged him and several of his associates with mistreatment of retarded individuals in a state school.
TL;DR: The authors believe the problem-oriented record is clearly superior to the narrative chart on a unit where treatment is provided by multi-disciplinary teams.
Abstract: The authors describe the introduction and use of the problem-oriented record on a short-term psychiatric inpatient unit where treatment is provided primarily by nurses and psychiatric aides. The introduction of the new system required careful planning, staff seminars, and individual supervision. Its use has permitted informational deficiencies to be more quickly identified and corrected, treatment planning to be more effective, staff skills to be improved, and the quality of patient care to be assessed. The authors believe the problem-oriented record is clearly superior to the narrative chart on a unit where treatment is provided by multi-disciplinary teams.
TL;DR: The author describes a private residential-care program he founded in New York City in 1966 that includes the 196-bed Boerum Hill Home for Adults, which is certified by the state as a proprietary home and a community residence.
Abstract: The author emphasizes the need for a wide variety of community living arrangements for former mental patients, and describes a private residential-care program he founded in New York City in 1966. The program includes the 196-bed Boerum Hill Home for Adults, which is certified by the state as a proprietary home and a community residence, and the Brooklyn Vocational Rehabilitation Institute, which conducts vocational training programs for former patients in clerical, food service, and home management areas. It also operates a 64-bed satellite-housing and apartment-living program. The problems and advantages of operating a proprietary home are discussed, as well as some of the broader issues involved in community care of former patients.
TL;DR: The author suggests that menial health facilities unable to afford long-term programs of organization development, such as those used by industry, can benefit by brief OD consultation directed at small units or specific problems.
Abstract: The author suggests that menial health facilities unable to afford long-term programs of organization development, such as those used by industry, can benefit by brief OD consultation directed at s...
TL;DR: Having a high degree of resentment about peer review was significantly correlated with seeing a low need for it and with 17 other items on the questionnaire.
Abstract: At Duke University's department of psychiatry, staff members' attitudes about peer review were measured through a 36-item questionnaire. Two-thirds of the respondents felt that peer review was needed, and 51 per cent believed it should not be limited to the work of physicians. Senior staff psychiatrists were considered most qualified to be on the panel, followed by third-year psychiatric residents and senior staff psychologists. Among all respondents, having a high degree of resentment about peer review was significantly correlated with seeing a low need for it and with 17 other items on the questionnaire.
TL;DR: North Dakota State Hospital has adopted a problem-oriented approach to record-keeping, and in one regional treatment unit is experimenting with applying the system to utilization review and continuing education.
Abstract: North Dakota State Hospital has adopted a problem-oriented approach to record-keeping, and in one regional treatment unit is experimenting with applying the system to utilization review and continuing education. An interdisciplinary audit committee uses a chart-review checklist to ensure reliable auditing of the records. Deficiencies in patient management revealed in the auditing provide a basis for constructing relevant continuing-education programs for professional staff.
TL;DR: There are fewer hopeless cases than generally believed, particularly by adherents of the disease model, in a unit that began to actively treat supposedly hopeless chronic schizophrenic men in 1970.
Abstract: In 1970 a 160-bed unit previously oriented toward custodial care began to actively treat supposedly hopeless chronic schizophrenic men, with the goal of increasing their release rate from the hospital. The unit conceptualized schizophrenia as a social-breakdown syndrome, and the treatment approach focused on increased social interaction and group activities. Patients were viewed as responsible individuals rather than custodial cases, and staff served as role models and teachers rather than authority figures. The unit achieved a release rate of 21 per cent, almost three times that expected for chronic schizophrenics. The authors conclude that there are fewer hopeless cases than generally believed, particularly by adherents of the disease model.
TL;DR: It is found that internal motivation rarely leads to successful treatment of drug addicts unless it is supplemented by external pressures from families and the courts, and that addicts screened for motivation had no better outcomes than those admitted without screening.
Abstract: Drug addicts who seek treatment may speak poignantly of the physical and emotional exhaustion resulting from the pressures caused by their addiction. The authors have termed these pressures the "fatigue factor." Although such internal motivation has been highly valued by psychotherapists, the authors have found that it rarely leads to successful treatment of drug addicts unless it is supplemented by external pressures from families and the courts. They base their conclusions on a two-year experience in a drug treatment program in which addicts screened for motivation had no better outcomes than those admitted without screening.
TL;DR: The author's approach has been to see the partners individually and together for a total of three sessions a week over a limited period of time to allow each partner to gain an understanding of his own dynamics and help emphasize each individual's responsibility for the success or failure of the relationship.
Abstract: A large percentage of the author's caseload at a rural mental health center in New Hampshire is made up of couples seeking help with marital problems. The author's approach has been to see the part...
TL;DR: The author suggests that family therapy is one of the most important channels of primary care in preventive psychiatry and promises new and more effective forms of mental health services for people who previously could not afford them.
Abstract: The author suggests that family therapy is one of the most important channels of primary care in preventive psychiatry. In recent years its growth has been impressive, reaching into every area of clinical practice. Although problems exist in the field (they include theoretical inconsistency, lack of attention to ethnic and subcultural differences in families, and economic issues), the author believes family therapy promises new and more effective forms of mental health services for people who previously could not afford them.
TL;DR: The author describes the goals of the Missouri automated Standard System of Psychiatry, the clinical instruments that have been incorporated into the system, and how the accumulated data can be used to plan for patient care and to facilitate delivery of useful and effective services.
Abstract: The author believes a computerized data system can be a valuable tool in establishing some of the basic knowledge now lacking about diagnosis and treatment of the mentally ill. He describes the goals of the Missouri automated Standard System of Psychiatry, the clinical instruments that have been incorporated into the system, and how the accumulated data can be used to plan for patient care and to facilitate delivery of useful and effective services.
TL;DR: A model for measuring organizational climate after the introduction of a geographical unit system brought a major change in the hospital's structiue is developed.
Abstract: Understanding the impact of change on an organization requires measuring various aspects of the organizational climate or environment. In a study at a psychiwric hospital in Maine, the authors developed a model for measuring organizational climate after the introduction of a geographical unit system brought a major change in the hospital's structiue. Through questionnaires and interviews, they examined staff attitudes toward nine factors that are generally accepted as determinants. of organizational climate. Areas studied included gaps in role perception between workers and supervisors, relationships among members and leaders of ward teams, motivational factors, and staff perceptions of the impact of change.