Showing papers in "Psychiatric Services in 1977"
TL;DR: It is concluded that appropriate psychiatric consultation can enable the majority of patients with psychiatric problems to be maintained on the wards to which they were admitted, and that psychiatric liaison staff should be trained in a variety of consulting roles.
Abstract: The authors conducted a study of the rate of utilization of psychiatric consultation by various services at two general hospitals. The study found that the rehabilitation and plastic surgery services had the highest ratio of consultations to admissions. Depression was the most frequent reason cited in staff requests for psychiatric consultation. Male patients were overrepresented among the consultees in proportion to their number in the total general hospital census. The authors conclude that appropriate psychiatric consultation can enable the majority of patients with psychiatric problems to be maintained on the wards to which they were admitted, and that psychiatric liaison staff should be trained in a variety of consulting roles.
64 citations
TL;DR: In their study of the effects of posthospital treatment on psychiatric patients the authors found that those who entered aftercare were rehospitalized less often than those who did not and the rehospitalization rate was higher for schizophrenic patients than for patients in other diagnostic groups.
Abstract: In their study of the effects of posthospital treatment on psychiatric patients the authors found that those who entered aftercare were rehospitalized less often than those who did not. They found the rehospitalization rate was higher for schizophrenic patients than for patients in other diagnostic groups, and that schizophrenic patients who did not enter aftercare were rehospitalized at a higher rate than those who did. They found no difference between rehospitalization rates of patients who continued with their hospital therapist after discharge and those patients who worked with a new therapist.
43 citations
TL;DR: Rurality also has several advantages for the deinstitutionalization movement, including the existence of a strong sense of community, and the increased opportunity for the therapist to know personally the patient, his family, and his friends and thus to make more humane decisions concerning his treatment.
Abstract: While the deinstitutionalization movement in both urban and rural areas has been plagued by problems, the author feels that they are exaggerated in rural communities and are complicated by such factors as the essentially urban nature of the deinstitutionalization model, the unique demographic conditions of rural America, and the lack of anonymity in rural communities. However, rurality also has several advantages for the deinstitutionalization movement, including the existence of a strong sense of community, and the increased opportunity for the therapist to know personally the patient, his family, and his friends and thus to make more humane decisions concerning his treatment.
35 citations
TL;DR: A study of 224 involuntary patients admitted to, Harborview Medical Center in Seattle in 1974, the first year of the implementation of Washington States Involuntary Treatment Act, concur with others who believe involuntary treatment statues provide a means of dealing with the small group of psychiatric patients whose needs would otherwise go unattended.
Abstract: The authors describe a study of 224 Involuntary patients admitted to Harborview Medical Center in Seattle in 1974, the first year of the implementation of Washington State's Involuntary Treatment Act. The patients, 115 men and 109 women, had a total of 297 episodes of hospitalization, with an average length of stay of 12.7 days. Fifty-one per cent were discharged In less than ten days. The authors compare the findings with studies of similar patient groups in Sacramento, California, and New York City. They concur with others who believe involuntary treatment statutes provide a means of dealing with the small group of psychiatric patients whose needs would otherwise go unattended.
27 citations
TL;DR: Former VA inpatients who have similar diagnoses and respond satisfatorily to drug treatment join a Prolixin group, a lithium group, or an affective disorder group, and in monthly meetings patients learn about their illness, the importance of the taking medication as prescribed, and possible side-effects.
Abstract: In a study to evaluate the effectiveness of specific pharmacological treatment groups, former VA inpatients who have similar diagnoses and respond satisfatorily to drug treatment join a Prolixin group, a lithium group, or an affective disorder group. In monthly meetings patients learn about their illness, the importance of the taking medication as prescribed, and possible side-effects; they also receive psychological support. The 85 patients who joined the groups during the first 12 months attended 87.3 per cent of the sessions. Twenty per cent of them were rehospitalized, about half of them because they did not take medication as prescribed. The authors believe the groups are an economical and effective way to provide aftercare.
27 citations
22 citations
TL;DR: In general the aftercare services tended to be medically oriented, brief, and limited in number and were provided to a majority of the patients within their first month in the community.
Abstract: A cohort of 579 patients discharged from state mental hospitals in Kentucky during a one-year period was studied to determine the amount and nature of aftercare services provided to them. A total of 319 received some form of aftercare from community mental health centers during the two to three years after discharge. The majority received at least one service that could be classified as individual therapy or chemotherapy, about one-third received evaluation or rehabilitation services, and only a few had family interviews or group therapy. The majority of those receiving services had contact with psychiatrists, nurses, or other mental health professionals; less than half had contact with social workers or psychologists. In general the aftercare services tended to be medically oriented, brief, and limited in number. They were provided to a majority of the patients within their first month in the community.
18 citations
TL;DR: Despite the widespread availability of third-party insurance coverage, blacks use the private general hospital less ofter than whites and their patterns of use are substantially different.
Abstract: A study of 419 first admissions to a private general hospital psychiatric inpatient unit showed that only 8.8 per cent were blacks, while 23 per cent of the population in the community were blacks. When compared to white patients, blacks were much less likely to be referred for hospitalization by private sources, were substantially younger, and had shorter hospitalizations. The most common diagnosis for blacks was paranoid schizophrenia. The authors conclude that despite the widespread availability of third-party insurance coverage, blacks use the private general hospital less often than whites and their patterns of use are substantially different.
17 citations
TL;DR: A Chicana patient who believes in witchcraft and soul loss is used to illustrate the importance of understanding alternate theories of disease causation and how mental health centers can be made more relavant to Chicanos by providing such services as home visits and family therapy.
Abstract: The author uses the case study of a Chicana patient who believes in witchcraft and soul loss to Illustrate the importance of understanding alternate theories of disease causation. He describes the patient's unsuccessful attempts to find treatment appropriate for her culturally determined beliefs and feels her efforts were hampered because she was a member of a culture in transition. She was finally treated through home visits and medication. The author discusses factors related to the underuse of mental health services by Chicanos and the role of the indigenous therapist. He also suggests how mental health centers can be made more relevant to Chicanos by providing such services as home visits and family therapy.
17 citations
TL;DR: The authors propose two guidelines that must be considered simultaneously when deciding what special support system is most appropriate for a particular client, that the system be adequate to meet the client's unmet needs and not meet needs the client can meet hiself.
Abstract: Many chronically disabled patients need special support systems to help them meet material needs, personal-care needs, and psychosocial needs. The authors propose two guidelines that must be considered simultaneously when deciding what special support system is most appropriate for a particular client. The first is that the system be adequate to meet the client's unmet needs, and the second is that the system not meet needs the client can meet himself. The authors feel that one should look first to support systems other than special living arrangements, which can easily overprovide services to clients. If a special living arrangement is considered appropriate, the one selected should provide only for those needs the client cannot meet himself.
16 citations
TL;DR: The authors describe the postural abnormalities and sensory-integration deficits of process schizophrenics, or those who have had problems since childhood and who gradually slip into psychosis, and a treatment program designed to correct those deficits.
Abstract: The authors describe the postural abnormalities and sensory-integration deficits of process schizophrenics, or those who have had problems since childhood and who gradually slip into psychosis. A treatment program consisting of a variety of activities designed to correct those deficits was conducted for one year at the University of California, Irvine, Medical Center; it was coordinated by the occupational therapy department. At discharge the six participants had improved, and their gains were maintained at one-year follow-up. The authors believe similar programs would be useful in board-and-care homes and long-term-care facilities.
TL;DR: Changing perceptions of mental hospitals as resources for mental health care are discussed, trends that must be considered in developing a unified system of services are described, and recommendations about treatment plans, staffing, funding, organization and governance are made.
Abstract: The authors emphasize that the future of state mental hospitals should be considered only in the context of a unified system of care and treatment of the mentally ill. They discuss changing perceptions of mental hospitals as resources for mental health care, describe trends that must be considered in developing a unified system of services, and make recommendations about treatment plans, staffing, funding, organization and governance, and legal codes and standards of the components of a unified system.
TL;DR: Eighty therapists, the entire attending staff of a community mental health center, were interviewed to assess their perceptions of the center's interdisciplinary peer review system after it had been in operation for three and a half years.
Abstract: Eighty therapists, the entire attending staff of a community mental health center, were interviewed to assess their perceptions of the center's interdisciplinary peer review system after it had been in operation for three and a half years. While many expressed reservations about parts of the system, about two-thirds felt that the review committee generally maintained an appropriate balance between quality of care and allocation of funds. More than 90 per cent found peer review an educational experience, and more than half said they would now choose to present cases to the committee even if not required to do so. Fifteen per cent felt they had experienced bias because of the professional disciplines of the reviewers. After presenting additional findings, the authors tell why they believe this particular system has a high degree of acceptance.
TL;DR: The principles of treatment derived from the therapeutic community model--democratization and permissiveness--are generally incompatible with the effective treatment of manic patients, who can be a strong disruptive force on the patient and staff community.
Abstract: The authors observed the management of 35 manic patients admitted to a 32-bed general hospital unit that emphasized milieu treatment. They concluded that the principles of treatment derived from the therapeutic community model—democratization and permissiveness—are generally incompatible with the effective treatment of manic patients, who can be a strong disruptive force on the patient and staff community. The authors describe approaches to managing manic patients in four phases—preadmission evaluation, and the postadmission, middle, and termination phases of inpatient treatment. They stress that milieu modifications are necessary to meet individual treatment needs.
TL;DR: With the present emphasis on cost-effectiveness, it is important to consider the economic aspects of lithium treatment.
Abstract: UThere is flO longer any real doubt that lithium carhonate has a preventive effect on recurrent manicdepressive psychoses. There have been well-controlled double-blind studies confirming a prophylactic effeet.”2 A study that involved 18 hospitals and 205 patients showed that lithium was significantly more effective than a placebo in preventing relapses.3 After those reports, there has been a gradual increase in the number of patients on long-term lithium treatment. With the present emphasis on cost-effectiveness, it is important to consider the economic aspects of lithium treatment. A program for the treatment and prevention of recurrent affective disorders began in 1968 at St. Vincent’s Hospital and Medical Center of New York.4 In the past eight years, considerable experience has been accumulated with more than 100 patients. The patients are treated in a specialized lithium clinic in a teaching hospital setting. The staff include a senior psychiatrist, rotating psychiatric residents, a clinical sociologist, and a nurse. The patients are given extensive psychiatric,
TL;DR: The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious and abuses do exist, but they should be handled through writs of habeas corpus and malpractice suits.
Abstract: The actions of federal district courts and state legislatures in recent years have resulted in the growing application of procedures of the criminal justice system to the civil commitment process. Increasingly patients can be confined only if they are dangerous to others, and increasingly due-process procedures of the criminal law are required, to the detriment of the patient's treatment and his survival in the community. The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious. Abuses that do exist should be handled through writs of habeas corpus and malpractice suits, remedies much more available now than in the past. The principal abuse in commitment occurs not when patients are admitted, the author believes, but at discharge, when so many patients are turned out into communities that lack proper services for them.
TL;DR: Faced with day-to-day pressures for more service, professionals in a public emergency room are caught in a dilemma and must devise ways of discouraging new patients from entering the system while appearing totally dedicated to healing the sick.
Abstract: UA professional who refers a patient to a public hospital for a psychiatric admission is often chagrined to learnusually from the patient’s family-that the patient was not admitted, but sent home. The decision by the professionals in the emergency room to not admit the patient is often not wholly explainable on clinical grounds or by the lack of available hospital beds. Clearly another factor is at work. The last thing most public hospitals want is more patients. That is in striking contrast to the private hospital, which is interested in attracting more customers. The public hospital has little to gain by increasing its share of the market. A larger caseload rarely leads to a larger budget or to more income for the most productive members of the staff. More patients only mean more work. It follows that the staff are not too interested in satisfying the patients who do gain admission, since satisfied patients may encourage troubled neighbors to seek hospitalization. In fact, dissatisfied patients may justify a hospital’s request for a larger budget in order to improve its services. Faced with day-to-day pressures for more service, professionals in a public emergency room are caught in a dilemma. They must devise ways of discouraging new patients from entering the system while appearing totally dedicated to healing the sick. The exclusionary plot is successful if the denial of admission is presented as being in the best interests of the patient or patients at large. The following are some of the games played in a psychiatric emergency room. Obviously, similar ploys are used at the entry points of other components in mental health systems or in other public agencies.
TL;DR: The author reviews the history of the centers legislation and studies of center funding sources, describes barriers encountered by the centers in obtaining third-party reimbursements, discusses several trends that appear to reduce the likelihood of center self-sufficiency, and suggests some approaches to meeting the financial needs of the center.
Abstract: Federal funding of community mental health centers has been based on the "seed money" concept; the funds were to be gradually withdrawn as the centers became established and financially self-sufficient from other sources. The original legislation has been amended numerous times, extending and expanding the centers program and making it possible for some centers to receive federal funds over a period of 12 years. The author questions whether "seed money" is still a viable concept and whether self-sufficiency is a realistic or even a desirable goal for community mental health centers. He reviews the history of the centers legislation and studies of center funding sources, describes barriers encountered by the centers in obtaining third-party reimbursements, discusses several trends that appear to reduce the likelihood of center self-sufficiency, and suggests some approaches to meeting the financial needs of the centers.
TL;DR: Members of group psychotherapy for elderly outpatients of a municipal hospital in an industrial community of Baltimore became involved in volunteer or part-time work, renewed contact with family and friends, and were better able to deal with life's stresses.
Abstract: Two case studies illustrate the positive effects of group psychotherapy for elderly outpatients of a municipal hospital in an industrial community of Baltimore. Most of the outpatients were depressed about physical, mental, or social losses. A total of five brief therapy groups were established. Each group had a maximum of 12 members and met in the hospital for an hour and a half once a week for 12 consecutive weeks. Members could continue in subsequent 12-week sessions if they desired. As a result of their participation in groups, many members became Involved in volunteer or part-time work, renewed contact with family and friends, and were better able to deal with life's stresses.
TL;DR: A social worker helps meet the social and emotional needs of cancer patients undergoing radiation therapy at the University of Utah Medical Center and the needs of their families.
Abstract: A social worker helps meet the social and emotional needs of cancer patients undergoing radiation therapy at the University of Utah Medical Center and the needs of their families. He makes personal contact with the patient and family on their first visit to the radiation division, answers questions, provides information on community services, and generally lets the patient and family know that they can call on him any time during the treatment process. He also follows up patients who are still seriously ill after treatment, and tries to maintain periodic contact with families of patients who have died.
TL;DR: It is suggested that treatment is somewhat effective even for the readdicted patient and that readmission to drug treatment is evidence of continued gradual treatment progress rather than of failure.
Abstract: A comparison was made of the drug-involvement levels and sociocriminal histories at the time of first admission and at readmission of 94 male drug addicts who had initially undergone detoxification and 24 others who had undergone detoxification plus rehabilitation. Results showed only minimal change in the amount and number of drugs used at each admission. However, the period of drug use before seeking help was shorter, there were fewer criminal charges, and more patients were employed at the time of readmission in both groups, especially the rehabilitation group. The authors suggest that treatment is somewhat effective even for the readdicted patient and that readmission to drug treatment is evidence of continued gradual treatment progress rather than of failure.
TL;DR: The authors describe a short-term inpatient program for adolescents that uses a variety of group sessions to help them deal with their immediate problems and, when necessary, prepare them for outpatient treatment.
Abstract: The authors describe a short-term inpatient program for adolescents that uses a variety of group sessions to help them deal with their immediate problems and, when necessary, prepare them for outpatient treatment. No attempt at complete ego reconstruction is made. The program includes family therapy and sessions on practical living skills, such as job hunting, productive use of leisure time, transportation, food planning, and renting and leasing. Assertiveness techniques are taught in small groups, and their use is encouraged on the unit, where staff attempt to create an acceptable social environment and provide a model for group decision-making.
TL;DR: An evaluation of the children's program at Marshall I. Pickens Hospital in Greenville, South Carolina, based on the Re-ED model, accepts only boys of normal intelligence between the ages of six and 12; most are referred because of disruptive behavior in the classroom and at home and low academic achievement.
Abstract: In 1974 the authors undertook an evaluation of the children's program at Marshall I. Pickens Hospital in Greenville, South Carolina. The program, based on the Re-ED model, accepts only boys of normal intelligence between the ages of six and 12; most are referred because of disruptive behavior in the classroom and at home and low academic achievement. To evaluate the program, questionnaires were mailed to the families of all children who had been discharged from the program six months or longer a total of 123. Sixty-three of the 101 parents responding said the program had provided very much help for their child. At follow-up 89 children were enrolled in some kind of school program, and one had graduated from high school. However, 66 parents reported their child continued to have academic problems. The authors compare the findings with follow-up studies of three other Re-ED programs and discuss possible modifications that might make such programs more effective for children who fail to adjust.
TL;DR: The author discusses how local zoning codes are often used to hinder development of community residences, and he describes some of the court cases growing out of the disputes.
Abstract: With the trend toward deinstitutionalization have come attempts to establish group homes and halfway houses for former patients in the community. The mental health and social service professionals called upon to establish the homes are faced with the difficult and unfamiliar task of interpreting complicated and frequently outdated local zoning codes. The author discusses how the codes are often used to hinder development of community residences, and he describes some of the court cases growing out of the disputes. He also examines legislation recently passed in some areas of the country to permit the development of group homes, and he discusses the need for state legislation to help ensure the right of the mentally disabled to live in residential communities.